Search

There has been an increase in the utilization of robotic surgery in addition to traditional open or laparoscopic approaches. Aim of this study is to compare the short-term outcomes for open, laparoscopic, and robotic surgery for rectal and sigmoid cancer. One hundred and forty-seven patients (open n = 48, laparoscopic n = 49, robotic n = 50) undergoing curative resections by two surgeons between 2013 and 2020 were included. Data analyzed included patient demographics, tumor characteristics, length of stay, post-operative outcomes, and pathologic surrogates of oncologic results, including total mesorectal excision (TME) quality, circumferential resection margin (CRM) involvement and lymph node (LN) yield. Median age of population was 68 years (IQR 59–73), majority (68%) were males. Median distance from anal verge in the robotic surgery group was 8 cm, compared to 15 and 14.5 cm in the open and laparoscopic groups, respectively, p = 0.029, (laparoscopic vs robotic, p = 0.005 and open vs robotic, p = 0.027). Proportion of patients who received neoadjuvant radiotherapy in robotic surgery group was higher, p = 0.04. In sub-group of tumors between 3 and 7 cm from anal verge more patients in the robotic surgery group had sphincter preservation, p = 0.006. Length of stay, maximum C-reactive protein, and white blood cell rise favored minimally invasive approaches compared to open surgery. There were no differences in post-operative complications, lymph node yield or CRM positivity rate between the three groups. Robotic surgery approach is safe and allows sphincter preservation without compromising TME quality in rectal cancer surgery.

Janos Kornai developed soft budget constraint logic to explain the socialist world’s dysfunctional economies. We extend his logic to explain dysfunctional land reform in the developing world. International development organizations such as the World Bank provide support for land privatization to developing-country governments, softening their budget constraints. Softer budget constraints encourage developing-country governments to pursue land privatization even when its social value is negative. Kenya’s land reform program illustrates the soft budget constraint syndrome.

Background and Hypothesis: Unicompartmental Knee Arthroplasty (UKA) is a technically demanding procedure vulnerable to errors in component positioning. Recent studies suggest robotic-assistance improves precision of implant placement, minimizes outliers, and improves survivorship. However, we have previously demonstrated an experienced surgeon can match robotic accuracy. This study evaluated revision rates and functional outcomes of radiographic outliers in manual UKA. Experimental Design or Project Methods: A retrospective review of 222 consecutive fixed-bearing medial UKAs was conducted. Implant positioning and alignment were assessed radiographically measuring tibial coronal (TCA), femoral coronal (FCA), tibial sagittal (TSA) and femoral sagittal (FSA) angles as well as implant overhang. UCLA Activity Level and all-cause survivorship were evaluated. Student’s t-test, Chi square, and Kaplan Meier curves were used in analyses with alpha ≤ .05 designating statistical significance. Results: Using previously published alignment goals, our manual UKAs achieved the following targets: 92% for TCA, 100% for FCA, 88% for TSA, and 100% for FSA. For implant overhang, 100% met medial, anterior, and posterior targets. Our manual UKAs achieved desired alignment and overhang goals more frequently than previously published manual success. Survivorship free from aseptic revision in this study was 96% at 8.5 years. Additionally, there was no difference in UCLA Activity Level improvement comparing outliers and non-outliers (p³0.159). Conclusion and Potential Impact: Manual UKAs performed by an experienced surgeon showed improved success in achieving alignment and implant overhang goals compared to published manual UKA data and similar success compared to published robotic-assisted UKA data. We found no differences in revision rates or functional outcomes between outliers and non-outliers using previously published targets. For robotic assistance to be cost effective, it must demonstrate improved outcomes or survivorship when compared to manual UKAs. Our results contradict recently published claims that manual alignment outliers and failure rates fail to meet expectations for UKA.

There has been an increase in the utilization of robotic surgery in addition to traditional open or laparoscopic approaches. Aim of this study is to compare the short-term outcomes for open, laparoscopic, and robotic surgery for rectal and sigmoid cancer. One hundred and forty-seven patients (open n = 48, laparoscopic n = 49, robotic n = 50) undergoing curative resections by two surgeons between 2013 and 2020 were included. Data analyzed included patient demographics, tumor characteristics, length of stay, post-operative outcomes, and pathologic surrogates of oncologic results, including total mesorectal excision (TME) quality, circumferential resection margin (CRM) involvement and lymph node (LN) yield. Median age of population was 68 years (IQR 59-73), majority (68%) were males. Median distance from anal verge in the robotic surgery group was 8 cm, compared to 15 and 14.5 cm in the open and laparoscopic groups, respectively, p = 0.029, (laparoscopic vs robotic, p = 0.005 and open vs robotic, p = 0.027). Proportion of patients who received neoadjuvant radiotherapy in robotic surgery group was higher, p = 0.04. In sub-group of tumors between 3 and 7 cm from anal verge more patients in the robotic surgery group had sphincter preservation, p = 0.006. Length of stay, maximum C-reactive protein, and white blood cell rise favored minimally invasive approaches compared to open surgery. There were no differences in post-operative complications, lymph node yield or CRM positivity rate between the three groups. Robotic surgery approach is safe and allows sphincter preservation without compromising TME quality in rectal cancer surgery.

Property rights are the rules governing ownership in society. This Element offers an analytical framework to understand the origins and consequences of property rights. It conceptualizes of the political economy of property rights as a concern with the follow questions: What explains the origins of economic and legal property rights? What are the consequences of different property rights institutions for wealth creation, conservation, and political order? Why do property institutions change? Why do legal reforms relating to property rights such as land redistribution and legal titling improve livelihoods in some contexts but not others? In analyzing property rights, the authors emphasize the complementarity of insights from a diversity of disciplinary perspectives, including Austrian economics, public choice, and institutional economics, including the Bloomington School of institutional analysis and political economy.

The literature on wealth destruction as a response to conflict largely focuses on the problem of external threats. Yet unresolved internal conflict can also pose a problem for a functioning social order. We provide a theory of wealth destruction as a mechanism to mitigate internal conflict, illustrated through the phenomenon of grave goods. Where inheritance laws are ambiguous and negotiation is costly, deliberately destroying wealth can prevent internal conflict over the redistribution of assets following a death. Rather than engage in costly infighting over ownership claims, the codependent parties agree to mutual destruction through a shared cultural practice of burying items with their dead. We test our theory using evidence from grave goods as practiced by saga era Vikings.

Having empirically identified institutions as critical determinants of socioeconomic outcomes, social scientists are starting to turn their attention to empirically identifying sources of institutional change. Rational choice scholars offer two theories of such change: conflict theory and cooperation theory. We highlight crucial but easily overlooked methodological issues involved in attempting to evaluate these theories empirically. To do so, we critically examine Coleman and Mwangi’s study of property evolution among Maasai pastoralists in Kajiado, Kenya. Lessons from our examination, we hope, will help this burgeoning area of research proceed productively.

According to conventional wisdom, privatizing the commons will create wealth. Yet in cases found throughout the developing world, privatizing the commons has destroyed wealth. To explain this phenomenon, we develop a theory of wealth-destroying private property rights. Privatization’s effect on social wealth depends on whether privatizing an asset confers net gains or imposes net losses on society. The decision to privatize, however, depends on whether privatizing an asset confers net gains or imposes net losses on property decision makers. When decision makers are residual claimants, these effects move in tandem; privatization occurs only if it creates social wealth. When decision makers are not residual claimants, these effects may diverge; privatization occurs if it benefits decision makers personally even if privatization destroys social wealth. We apply our theory to understand wealth-destroying land privatization in Kajiado, Kenya.

Appendiceal diverticulitis is a rare diagnosis and culprit for acute appendicitis. The majority of these cases are diagnosed post-operatively on histopathology. In the following case it was grossly identifiable intraoperatively. Our treatment was appendicectomy. The purpose of this article was to provide pictorial evidence of this exceedingly rare intra-operative finding.

Tracking individual marine predators can provide vital information to aid the identification of important activity (foraging, commuting, rafting, resting, etc.) hotspots and therefore also to delineate priority sites for conservation. However, in certain locations (e.g. Antarctica) many marine mammal or seabird colonies remain untracked due to logistical constraints, and the colonies that are studied may not be the most important in terms of conservation priorities. Using data for one of the most abundant seabirds in the Antarctic as a case study (the Chinstrap Penguin Pygoscelis antarcticus), we tested the use of correlative habitat models (used to predict distribution around untracked colonies) to overcome this limitation, and to enable the identification of important areas at-sea for colonies where tracking data are not available. First, marine Important Bird and Biodiversity Areas (IBA) were identified using a standardised, published approach using empirical data from birds tracked from colonies located in the South Orkney Islands. Subsequently, novel approaches using predicted distributions of Chinstrap Penguins derived from correlative habitat models were applied to identify important marine areas, and the results compared with the IBAs. Data were collected from four colonies over 4 years and during different stages of the breeding season. Results showed a high degree of overlap between the areas identified as important by observed data (IBAs) and by predicted distributions, revealing that habitat preference models can be used to identify marine IBAs for these penguins. We provide a new method for designating a network of marine IBAs for penguins in Antarctic waters, based on outputs from correlative habitat models when tracking data are not available. This can contribute to an evidence-based and precautionary approach to aid the management framework for Antarctic fisheries and for the protection of birds.

Aim:\ud To provide a method of analysing penguin tracking data to identify priority at-sea areas for seabird conservation (marine IBAs), based on pre-existing approaches for flying seabirds but revised according to the specific ecology of Pygoscelis penguin species.\ud Location:\ud Waters around the Antarctic Peninsula, South Shetland and South Orkney Archipelagos (FAO Subareas 48.1 and 48.2)\ud Methods:\ud We made key improvements to the pre-existing protocol for identifying marine IBAs that include refining the track interpolation method, and revision of parameters for the kernel analysis (smoothing factor and utilization distribution) using sensitivity tests. We applied the revised method to 24 datasets of tracking data on penguins (three species, seven colonies and three different breeding stages – incubation, brood and crèche).\ud Results:\ud We identified 5 new marine IBAs for seabirds in the study area, estimated to hold ca. 600,000 adult penguins.\ud Main conclusions:\ud The results demonstrate the efficacy of a new method for the designation of a network of marine IBAs in Antarctic waters for penguins based on tracking data, which can contribute to an evidence-based, precautionary, management framework for krill fisheries.

Clearance of native vegetation in the Mount Lofty Ranges 1945-68

The Workers' Compensation Board of British Columbia in Canada is the provincial agency mandated to investigate workplace injuries and fatalities. In 2012, the Fatal and Serious Injuries Investigation section of this organization initiated the integration of forensic nursing expertise into the investigation of workplace incidents. The goals were to improve investigative outcomes and aid in prevention initiatives by achieving a more accurate understanding of incident causation through the application of forensic nursing science. An unexpected outcome of the use of forensic nursing expertise was providing closure for families through a deeper understanding of their loved one's tragic workplace incident.

Self-governance of common pool resources is presumed to work well in small, homogeneous communities where interaction is repeated, agents have low discount rates, and information about past performance is available. It is presumed to work poorly elsewhere. This paper provides a case study of online communities who use peer-to-peer networks to illegally share copyrighted material — 'Pirates' — to investigate the robustness of self-governance institutions in less favorable conditions. Early models of peer-to-peer networks predicted complete collapse due to issues of free-riding. When these networks are used to illegally share copyrighted material, the increased risk of legal punishment leads to a further disincentive to contribute. Despite the increased incentive to free-ride, online pirate communities have developed a robust set of institutional mechanisms designed to mitigate the effects of free-riding in the network. My study highlights the diversity, and commonality, of institutional arrangements developed by self-governing communities to solve collective action problems under unfavorable conditions.

The forensic evaluation of trauma in occupational injuries and fatalities can provide the benefit of a more thorough analysis of incident causation. Forensic nursing science applied during workplace investigations can assist investigators to determine otherwise unknown crucial aspects of the incident circumstances that are important to event reconstruction, the enforcement of occupational health and safety requirements, and the direction of workplace prevention initiatives. Currently, a medical and forensic medical knowledge gap exists in the subject-matter expertise associated with occupational accident investigations. This gap can be bridged with the integration of forensic nursing in the investigation of workplace fatalities and serious injuries.

The Pyramid Trough (Lat 78°S) has recently gained protection under the Antarctic Treaty system, owing to its wetland values. Here, we describe the microbial diversity of this system, with emphasis on cyanobacteria, and evaluate environment-biota relationships. Geochemistry separates ponds along hydrological gradients receiving recent inflows of dilute meltwater, from a second group that is rarely inundated and where chemistry is dominated by evaporation. Cyanobacteria-based microbial mats dominated the biota throughout. Mats were characterized by light-microscopy, pigment analysis, automated ribosomal intergenic spacer analysis and 16S rRNA gene clone libraries. A total of 17 morphotypes and 21 ribotypes were identified, mostly Oscillatoriales and several taxa that are usually rare in continental Antarctica, including Chroococcales and scytomin-rich Calothrix/Dichothrix, were abundant. There was a general decline in cyanobacterial diversity with increasing conductivity, but weak support for either differences in community composition between the two groups of ponds or sorting of taxa along the hydrological gradients with the pond groups. This implies a broad environmental tolerance and a prevalence of neutral assembly mechanisms in cyanobacterial communities of Antarctic wetland ecosystems.

While there are several best practice standards available for minimizing the energy requirement for compressed air use in an industrial context, moving to best practice often requires investment and operational change. In production facilities, there is often a reluctance to commit to this type of change without a clear view of the benefit. Furthermore, there is very little detailed information available in the open literature that allows even a qualitative assessment of priorities. In order to address this shortcoming, a practical approach is proposed to provide detailed compressed air consumption information throughout an industrial site. The energy of the compressed air is evaluated at each key element of the system and the typical end-use application profile assessed. Simple models of the consumption rates are used to relate duty cycle and device count with actual total consumption. This approach is complemented with a novel method of assessing the leak rate from the entire system, based on the pressure decay time. The method, referred to as the ‘end use catalogue’ has been demonstrated at a manufacturing site with a wide range of compressed air applications. The model has been used to identify the most significant energy-intensive compressed air applications and possible strategies to reduce the energy requirement. In the particular site used as a demonstration, it was found that open blowing operations (e.g. fluidizing) are the largest consumers of compressed air which are amenable to intervention. System leakage accounts for almost 21 per cent of the compressed air generated, representing an energy input of 432 kWh per day. It is concluded that this approach can help to identify priorities for optimizing compressed air use at an industrial site without compromising the production yield.

The discovery of an abundant monospecific population of Roundstonia globulifera (Brady) 1868 from an early Flandrian (9000–8500 B.P.) Dublin Bay mud horizon at - 18 m Ordnance Datum has resulted in an ontogenetic analysis of the ostracod. Data on size, shape and morphological development through eight growth-stages are presented. It occurs with a monospecific population of the foraminifer Elphidium clavatum subclavatum Gudina, the ecology of which is known. From this, and sedimentological data, it is inferred that the assemblages lived in shallow, muddy estuarine channels. Information from other parts of the Irish Sea provides evidence of the course of the Flandrian transgression. It is proposed that early in Boreal times, water masses invading from the north and south, were separated by a barrier south of Dublin until 8500 B.P.

We present a systematic microscopic approach to diffusion and diffusion-limited processes in Ni3Al. These processes have been identified as controlling the deformation of the material under specific circumstances. The embedded atom method calculations are done using kinetic Monte Carlo combined with the Dimer method of finding saddlepoints. We compute the tracer diffusivities as functions of composition and temperature. The comparison with available experiments is good. We find that at temperatures below about 1000 K, the diffusivity is a sharp function of composition, showing a pronounced dip on the Ni-rich side at 76 at.% Ni. This agrees well with experiment, except that the experiments show this structure setting in a temperatures below about 1300 K. We show that the structure arises from the composition dependence of both the vacancy formation energy and pre-exponential of the diffusivity. We also compute the mobility of an anti-phase boundary perpendicular to its plane, and conclude that vacancy-assistance is very plausible. We conclude that the kMC + Dimer method works well for these problems above 700 K but less effectively below, owing to the presence of short-range, low-energy hops that tend to localize the vacancy and lower the efficiency of the calculation. � 2005 Elsevier B.V. All rights reserved.

The article presents the study "Optimising Storage and Access in UK Research Libraries" by John Fielden, Colin Harris, Helen Hayes and Allan Schofield. It evaluates the present shortage of research library storage, the options for the most efficient and cost-effective nationwide solution and to make recommendations. The growth of print collections is constant despite the growing number of electronic journals. Research libraries are surveyed, with a response rate of 88 percent. More information could be found in the article.

Introduces NoWAL (Northwest Academic Libraries), a consortium in the north west of England. Describes NoWAL's staff training and development programme which includes a general programme, the CILIP Certificate in Library and Information Practice, the CALIM Standard Professional Training programme and a pilot project for senior management. Additionally, NoWAL members engage in exchanging experience, job shadowing and visits. Also recounts how NoWAL secured a contract with OCLC's netlibrary that has led to the acquisition of a collection of up to 12,000 priced and 3,800 free titles - the biggest e-book deal in Europe.

1. This report was commissioned by CURL (the Consortium of University Research Libraries) with the support of the British Library Cooperation and Partnership Programme in order to recommend the best UK wide monograph interlending infrastructure and associated business model for the higher education research community for the next ten years. The report does not consider the interlending needs of other sectors (for example, public libraries), but its recommendations are unlikely to have adverse implications for them. 2. The report estimates that for 2001-2002 the overall total of interlending requests initiated by the UK higher education sector was approximately 325,000. Of these some 90% (295,000) were estimated to have been successfully completed, of which approximately 79% were supplied by the British Library Document Supply Centre (BLDSC), which holds the most dominant position in the UK monograph interlending system. In addition to the BLDSC there are a number of other providers to whom higher education libraries typically turn if the BLDSC cannot supply an item, but the overall volume of such loans is low. 3. The current monograph interlending system based on the BLDSC has several important strengths: first and most importantly, it works, and has done so successfully for many years. The system is well understood by researchers, is valued by them, and as our own data demonstrates has the support of all CURL libraries. The overall performance of the BLDSC is high in terms of speed of delivery and other operational benchmarks, and also represents good value for money for the sector as a whole. Studies undertaken for the Research Support Libraries Group (RSLG) estimated the savings achieved through all forms of central document supply to be between £45 and £50 million. In relation to individual loan charges an email survey of CURL libraries suggested that although those responding welcomed the cheaper options provided by some other providers, the charges of the BLDSC were accepted as being at least satisfactory. 4. The current system has no major weaknesses, however significant concerns exist about whether it can be sustained in the future without change. The current interlending system is likely to come under increasing strain because of: declining investment in loan stock unless more collaborative approaches to acquisition take place; an increase in the diversity of lending provision as libraries struggle to meet the needs of their own researchers in the context of a declining central fill rate; and specific difficulties concerning the loan of items from special collections. These concerns are part of the broader issue of the future of library resources which is addressed in the RSLG report. 5. If such developments were allowed to occur, they would lead to the loss of many of the advantages of centralisation that now exist, and involve interlending librarians spending much more time trying to source material. Rather we see the opposite as desirable: obtaining maximum benefit through a suitably run single source of supply, with as much requesting and distribution as possible done electronically. The RSLG has made it clear that a gradual deterioration in resource availability for research use should not be accepted, and our conclusion is that the same principle should apply to document supply and loans. 6. The report considers nine wide-ranging options for revising the current interlending system, and seeks to build upon existing strengths. Each option is tested against six key criteria: ○ It should enable the current fill rate in higher education libraries of approximately 90% to be maintained, and if possible improved. ○ It should operate to performance standards not lower than those currently achieved by the BLDSC. ○ It should maximise value for money in relation to collection development, procurement, and in other related areas.