Early reoperation for acute dysphagia following laparoscopic fundoplication

Background: A small number of patients develop acute severe dysphagia for which reoperation is necessary within 10 days of laparoscopic fundoplication. The aim of this study was to identify clinical variables that might predict the likelihood of this condition occurring, such that it could be avoided in the future. Methods: This was a prospective cohort study from three tertiary referral centres, using reoperation for acute dysphagia as the main outcome variable. Gastrointestinal symptom rating scale, and psychological well-being index questionnaires were undertaken before laparoscopic fundoplication, and dysphagia scores were determined before operation and 1 year later. Standard preoperative assessment included gastroscopy, oesophageal manometry and pH studies. Results: Twelve (1.9 per cent) of the 617 patients suffered acute dysphagia, which was predicted by older age and female sex, and resulted in a longer duration of hospital stay. This condition was not predicted by any other demographic, clinical, investigative or operative variables. Conclusions: The study did not identify useful criteria by which severe acute dysphagia could be anticipated and thereby avoided following laparoscopic fundoplication.

Porphyrins as early biomarkers for arsenic exposure in animals and humans

We studied the effect of arsenic exposure on the haem biosynthetic pathway in the rat and humans. Significant increases in protoporphyrin IX, coproporphyrin III, coproporphyrin I were observed in the blood, liver and kidney, and in the urine of rats after a single dose of arsenic. The level of increase was dependent on the arsenic species present. Most of porphyrin concentrations in the tissues increased within 24 hr and urinary excretion elevated within 48 hr. In the human study, we collected urine samples from 113 people who live in Xing Ren of Guizhou Province, a coal-borne arsenicosis endemic area in southwest of PR China and from 30 people who live in Xing Yi (about 80 km southwest of Xing Ren) where arsenicosis is not prevalent. We analyzed the urinary porphyrins using HPLC. Results indicate that all urinary porphyrins were higher in the arsenic exposed group than those in the control group. Women, children and older age people spend much of their time indoors, they had greater increases of urinary arsenic and porphyrins. They were the higher risk groups among the study subjects. A positive correlation between the urinary arsenic levels and porphyrin concentrations demonstrated the effect of arsenic on haem biosynthesis. Significant alteration in the porphyrin excretion profiles of the younger age (

Input-driven Language Learning

Input-driven models provide an explicit and readily testable account of language learning. Although we share Ellis's view that the statistical structure of the linguistic environment is a crucial and, until recently, relatively neglected variable in language learning, we also recognize that the approach makes three assumptions about cognition and language learning that are not universally shared. The three assumptions concern (a) the language learner as an intuitive statistician, (b) the constraints on what constitute relevant surface cues, and (c) the redescription problem faced by any system that seeks to derive abstract grammatical relations from the frequency of co-occurring surface forms and functions. These are significant assumptions that must be established if input-driven models are to gain wider acceptance. We comment on these issues and briefly describe a distributed, instance-based approach that retains the key features of the input-driven account advocated by Ellis but that also addresses shortcomings of the current approaches.

Extending Learning Opportunities through a virtual faculty

This paper presents the notion of a virtual faculty as a viable alternative to extending and maintaining learner opportunities for students in regional universities or at universities where specialisations in which they are interested may not be offered. Staff from a number of Australian Universities participated in a CUTSD project to explore the viability of establishing a virtual faculty using videoconferencing as the medium of delivery. The success of this project was the result of close collaboration at a number of levels within the participating institutions and a willingness to explore effective approaches to teaching and learning for a videoconference environment.

Preparing students for the virtual organisation: an evaluation of learning with virtual learning technologies

The paper explores the development of learning behaviours in a virtual management course and the factors that impacted on this development. Data suggest that most teams experienced three kinds of learning behaviours – social, operational and content learning. We propose that the need for technical expertise and team participation will vary during these different stages of learning. Addressing the characteristics of these stages, we comment on the development of a ‘completion phase’ of team development. We argue that the extent to which teams demonstrate different learning stages has a significant impact on the development of on-line learning behaviours. Discussing these results, we suggest why different teams develop distinct learning behaviours, with accordant emphasis on teaching as a moderating and co ordinating role, despite current virtual team pedagogical expectations.

Exploring the role of market learning capability in competitive strategy

It has been argued that a firm's capacity to learn from its market is a source of both innovation and competitive advantage. However, past research has failed to conceptualize market-focused learning activity as a capability having the potential to contribute to competitive advantage. Prior innovation research has been biased toward technological innovation. However, there is evidence to suggest that both technological and non-technological innovations contribute to competitive advantage reflecting the need for a broader conceptualization of the innovation construct. Past research has also overlooked the critical role of entrepreneurship in the capability building process. Competitive advantage has been predominantly measured in terms of financial indicators of performance. In general, the literature reflects the need for comprehensive measures of organizational innovation and competitive advantage. This paper examines the role of market-focused learning capability in organizational innovation-based competitive strategy. The paper contributes to the strategic marketing theory by developing and refining measures of entrepreneurship, market-focused learning capability, organizational innovation and sustained competitive advantage, testing relationships among these constructs.

Prognostic use of growth characteristics of early gastric cancer and expression patterns of apoptotic, cell proliferation, and cell adhesion proteins

Background and Objectives: Selection of suitable treatment for early gastric cancers, such as endoscopic mucosal resection or the major surgical option of resection of the cancer together with a radical lymph node dissection, may be assisted by comparing the growth characteristics of the cancer with selected molecular characteristics. The results could be used to predict those cases that have a higher risk of developing secondary metastases. Methods: A total of 1,196 Japanese patients with early gastric cancers (648 mucosal cancers and 548 submucosal) were included in the selection of two groups: a metastatic group made up 57 cancers with lymph node metastasis (9 mucosal, 48 submucosal), and a nonmetastatic group of 61 cases (6 mucosal, 55 submucosal) without lymph node metastasis. Growth characteristics of the cancers (superficially spreading, penetrating or invasive, lymph node metastasis) were compared with immunohistochemical expression of single-stranded DNA (ssDNA) protein (apoptosis indicator), bcl-2 and p53 (apoptosis-associated), Ki-67 (cell proliferation), and E-cadherin (cell adhesion) proteins. Results: The lesions in the nonmetastatic group had higher levels of apoptosis and lower expression of bcl-2 than in the metastatic group, indicating an inhibitory role for apoptosis in malignant progression. Apoptosis was also higher in the superficial compared with the invasive lesions of both groups. The lesions in the metastatic group had higher p53 expression than that of the nonmetastatic group, whereas apoptosis in the metastatic group was lower than in the nonmetastatic group. An unproved explanation for this finding may be that, although increased, p53 was mutated and ineffective in promoting apoptotic control of metastatic progression. E-cadherin was decreased in the invasive lesions of both groups, indicating a greater ability of these cells to lose adhesion, to invade the submucosa, and to metastasize. Cell proliferation was highest in the superficial lesions of both metastatic and nonmetastatic groups. Conclusions: Early gastric cancers with low levels of apoptosis, increased bcl-2, and high levels of p53 expression are more likely to invade and metastasize. (C) 2003 Wiley-Liss, Inc.