Second Primary Tumors in Patients with Head and Neck Cancer

This is a review on second primary tumors in patients with head and neck cancer. These patients have a high risk of developing other cancers simultaneously or subsequently. The incidence of multiple primary tumors in this population can be as high as 27%. Recurrences are the most common cause of treatment failure within the first 2 years of follow-up. After the third year the diagnosis of a second primary tumor becomes the most important cause of morbimortality in head and neck cancer patients, especially in those treated for cancers early diagnosed. Most second primary tumors occur in the upper aerodigestive tract (40%-59%), lung (31%-37.5%), and esophagus (9%-44%). Patients who develop second primary tumor have a significant reduction of survival expectancy.

The 'triple contrast' method in experimental wound ballistics and backspatter analysis.

In practical forensic casework, backspatter recovered from shooters' hands can be an indicator of self-inflicted gunshot wounds to the head. In such cases, backspatter retrieved from inside the barrel indicates that the weapon found at the death scene was involved in causing the injury to the head. However, systematic research on the aspects conditioning presence, amount and specific patterns of backspatter is lacking so far. Herein, a new concept of backspatter investigation is presented, comprising staining technique, weapon and target medium: the 'triple contrast method' was developed, tested and is introduced for experimental backspatter analysis. First, mixtures of various proportions of acrylic paint for optical detection, barium sulphate for radiocontrast imaging in computed tomography and fresh human blood for PCR-based DNA profiling were generated (triple mixture) and tested for DNA quantification and short tandem repeat (STR) typing success. All tested mixtures yielded sufficient DNA that produced full STR profiles suitable for forensic identification. Then, for backspatter analysis, sealed foil bags containing the triple mixture were attached to plastic bottles filled with 10 % ballistic gelatine and covered by a 2-3-mm layer of silicone. To simulate backspatter, close contact shots were fired at these models. Endoscopy of the barrel inside revealed coloured backspatter containing typable DNA and radiographic imaging showed a contrasted bullet path in the gelatine. Cross sections of the gelatine core exhibited cracks and fissures stained by the acrylic paint facilitating wound ballistic analysis.

An institutional understanding of triple bottom line evaluations and the use of social and environmental metrics

Measuring social and environmental metrics of property is necessary for meaningful triple bottom line (TBL) assessments. This paper demonstrates how relevant indicators derived from environmental rating systems provide for reasonably straightforward collations of performance scores that support adjustments based on a sliding scale. It also highlights the absence of a corresponding consensus of important social metrics representing the third leg of the TBL tripod. Assessing TBL may be unavoidably imprecise, but if valuers and managers continue to ignore TBL concerns, their assessments may soon be less relevant given the emerging institutional milieu informing and reflecting business practices and society expectations.

Challenging endoscopy reprocessing guidelines: a prospective study investigating the safe shelf life of flexible endoscopes in a tertiary gastroenterology unit.

Professional prac− tice guidelines for endoscope reprocessing re− commend reprocessing endoscopes between each case and proper storage following repro− cessing after the last case of the list. There is lim− ited empirical evidence to support the efficacy of endoscope reprocessing prior to use in the first case of the day; however, internationally, many guidelines continue to recommend this practice. The aim of this study is to estimate a safe shelf life for flexible endoscopes in a high−turnover gastroenterology unit. Materials and methods: In a prospective obser− vational study, all flexible endoscopes in active service during the 3−week study period were mi− crobiologically sampled prior to reprocessing be− fore the first case of the day (n = 200). The main outcome variables were culture status, organism cultured, and shelf life. Results: Among the total number of useable samples (n = 194), the overall contamination rate was 15.5 %, with a pathogenic contamination rate of 0.5 %. Mean time between last case one day and reprocessing before the first case on the next day (that is, shelf life) was 37.62 h (SD 36.47). Median shelf life was 18.8 h (range 5.27± 165.35 h). The most frequently identified organ− ism was coagulase−negative Staphylococcus, an environmental nonpathogenic organism. Conclusions: When processed according to es− tablished guidelines, flexible endoscopes remain free from pathogenic organisms between last case and next day first case use. Significant re− ductions in the expenditure of time and resources on reprocessing endoscopes have the potential to reduce the restraints experienced by high−turnover endoscopy units and improve ser− vice delivery.

The importance of a triple bottom line approach for safeguarding urban water quality

Water environments are greatly valued in urban areas as ecological and aesthetic assets. However, it is the water environment that is most adversely affected by urbanisation. Urban land use coupled with anthropogenic activities alters the stream flow regime and degrade water quality with urban stormwater being a significant source of pollutants. Unfortunately, urban water pollution is difficult to evaluate in terms of conventional monetary measures. True costs extend beyond immediate human or the physical boundaries of the urban area and affect the function of surrounding ecosystems. Current approaches for handling stormwater pollution and water quality issues in urban landscapes are limited as these are primarily focused on ‘end-of-pipe’ solutions. The approaches are commonly based either on, insufficient design knowledge, faulty value judgements or inadequate consideration of full life cycle costs. It is in this context that the adoption of a triple bottom line approach is advocated to safeguard urban water quality. The problem of degradation of urban water environments can only be remedied through innovative planning, water sensitive engineering design and the foresight to implement sustainable practices. Sustainable urban landscapes must be designed to match the triple bottom line needs of the community, starting with ecosystem services first such as the water cycle, then addressing the social and immediate ecosystem health needs, and finally the economic performance of the catchment. This calls for a cultural change towards urban water resources rather than the current piecemeal and single issue focus approach. This paper discusses the challenges in safeguarding urban water environments and the limitations of current approaches. It then explores the opportunities offered by integrating innovative planning practices with water engineering concepts into a single cohesive framework to protect valuable urban ecosystem assets. Finally, a series of recommendations are proposed for protecting urban water resources within the context of a triple bottom line approach.

Industrial design in endoscopy : the development of a tissue and organ extractor

Throughout history, developments in medicine have aimed to improve patient quality of life, and reduce the trauma associated with surgical treatment. Surgical access to internal organs and bodily structures has been traditionally via large incisions. Endoscopic surgery presents a technique for surgical access via small (1 Omm) incisions by utilising a scope and camera for visualisation of the operative site. Endoscopy presents enormous benefits for patients in terms of lower post operative discomfort, and reduced recovery and hospitalisation time. Since the first gall bladder extraction operation was performed in France in 1987, endoscopic surgery has been embraced by the international medical community. With the adoption of the new technique, new problems never previously encountered in open surgery, were revealed. One such problem is that the removal of large tissue specimens and organs is restricted by the small incision size. Instruments have been developed to address this problem however none of the devices provide a totally satisfactory solution. They have a number of critical weaknesses: -The size of the access incision has to be enlarged, thereby compromising the entire endoscopic approach to surgery. - The physical quality of the specimen extracted is very poor and is not suitable to conduct the necessary post operative pathological examinations. -The safety of both the patient and the physician is jeopardised. The problem of tissue and organ extraction at endoscopy is investigated and addressed. In addition to background information covering endoscopic surgery, this thesis describes the entire approach to the design problem, and the steps taken before arriving at the final solution. This thesis contributes to the body of knowledge associated with the development of endoscopic surgical instruments. A new product capable of extracting large tissue specimens and organs in endoscopy is the final outcome of the research.

Three carrier ambiguity resolution : distance-independent performance demonstrated using semi-generated triple frequency GPS signals

In spite of significant research in the development of efficient algorithms for three carrier ambiguity resolution, full performance potential of the additional frequency signals cannot be demonstrated effectively without actual triple frequency data. In addition, all the proposed algorithms showed their difficulties in reliable resolution of the medium-lane and narrow-lane ambiguities in different long-range scenarios. In this contribution, we will investigate the effects of various distance-dependent biases, identifying the tropospheric delay to be the key limitation for long-range three carrier ambiguity resolution. In order to achieve reliable ambiguity resolution in regional networks with the inter-station distances of hundreds of kilometers, a new geometry-free and ionosphere-free model is proposed to fix the integer ambiguities of the medium-lane or narrow-lane observables over just several minutes without distance constraint. Finally, the semi-simulation method is introduced to generate the third frequency signals from dual-frequency GPS data and experimentally demonstrate the research findings of this paper.