Open radical cystectomy: still the gold standard for muscle invasive bladder cancer

INTRODUCTION Muscle invasive bladder cancer is an unforgiving disease, and if untreated, it leads to death within 2 years of the diagnosis in >85 % of the patients. Long-term oncologic efficacy remains the ultimate standard that all procedures have to be measured by. In the past decades, open radical cystectomy (RC), extended pelvic lymph node dissection (PLND), and urinary diversion have been established as the gold standard. In the last few years, however, growing attention has been set on robotic-assisted radical cystectomy (RARC). RESULTS Even in the very long term, open RC has good oncological results and if an ileal neobladder is performed excellent functional results. Follow-up of patients after open RC exceeds more than a decade which is unsurpassed by any other technique. Its outcomes have been proven to be durable and cost-effective. Least perioperative complications as well as best oncological and functional results can be achieved if open RC and urinary diversion were performed in a high-volume hospital by high-volume surgeons and an experienced team. CONCLUSIONS Despite upcoming new technologies such as RARC, open RC following extended (PLND) remains the gold standard treatment for high-grade muscle invasive bladder cancer.

Standard cystectomy fits all: truth or myth?

Radical cystectomy (RC) with pelvic lymph node dissection (PLND) followed by urinary diversion is the treatment of choice for muscle-invasive bladder cancer (BC) and non-invasive BC refractory to transurethral resection of the bladder (TUR-B) and/or intravesical instillation therapies. Since the morbidity and possible mortality of this surgery are relevant, care must be taken in the preoperative selection of patients for the various organ-sparing procedures (e.g., bladder-sparing, nerve sparing, seminal vesicle sparing) and various types of urinary diversion. The patient’s performance status and comorbidities, along with individual tumor characteristics, determine possible surgical steps during RC. This individualized approach to RC in each patient can maximize oncological safety and minimize avoidable side effects, rendering ‘standard’ cystectomy a surgery of the past.

Endoscopic Biopsy for Intra- and Paraventricular Tumors: Rates of Complications, Mortality, and Tumor Cell Dissemination

Background and Study Aim Intra- and paraventricular tumors are frequently associated with cerebrospinal fluid (CSF) pathway obstruction. Thus the aim of an endoscopic approach is to restore patency of the CSF pathways and to obtain a tumor biopsy. Because endoscopic tumor biopsy may increase tumor cell dissemination, this study sought to evaluate this risk. Patients, Materials, and Methods Forty-four patients who underwent endoscopic biopsies for ventricular or paraventricular tumors between 1993 and 2011 were included in the study. Charts and images were reviewed retrospectively to evaluate rates of adverse events, mortality, and tumor cell dissemination. Adverse events, mortality, and tumor cell dissemination were evaluated. Results Postoperative clinical condition improved in 63.0% of patients, remained stable in 30.4%, and worsened in 6.6%. One patient (2.2%) had a postoperative thalamic stroke leading to hemiparesis and hemineglect. No procedure-related deaths occurred. Postoperative tumor cell dissemination was observed in 14.3% of patients available for follow-up. Conclusions For patients presenting with occlusive hydrocephalus due to tumors in or adjacent to the ventricular system, endoscopic CSF diversion is the procedure of first choice. Tumor biopsy in the current study did not affect safety or efficacy.

Field-Based Evaluations of Horizontal Flat-Plate Fish Screens

Diversions from streams are often screened to prevent the loss of or injury to fish. Hydraulic criteria meant to protect fish that encounter screens have been developed, but primarily for screens that are vertical to the water flow rather than horizontal. For this reason, we measured selected hydraulic variables and released wild rainbow trout Oncorhynchus mykiss over two types of horizontal flat-plate fish screens in the field. Our goal was to assess the efficacy of these screens under a variety of conditions in the field and provide information that could be used to develop criteria for safe fish passage. We evaluated three different inverted-weir screens over a range of strewn (0.24-1.77 m(3)/s) and diversion flows (0.10-0.31 m(3)/s). Approach velocities (AVs) ranged from 3 to 8 cm/s and sweeping velocities (SVs) from 69 to 143 cm/s. We also evaluated a simple backwatered screen over stream flows of 0.23-0.79 m(3)/s and diversion flows of 0.08-0.32 m(3)/s. The mean SVs for this screen ranged from 15 to 66 cm/s and the mean AVs from 1 to 5 cm/s. The survival rates of fish held for 24 h after passage over these screens exceeded 98%. Overall, the number of fish-screen contacts was low and the injuries related to passage were infrequent and consisted primarily of minor fin injuries. Our results indicate that screens of this type have great potential as safe and effective fish screens for small diversions. Care must be taken, however, to avoid operating conditions that produce shallow or no water over the screen surface, situations of high AVs and low SVs at backwatered screens, and situations producing a localized high AV with spiraling flow.

Corporate Tax Avoidance and High Powered Incentives

This paper analyzes the links between corporate tax avoidance, the growth of highpowered incentives for managers, and the structure of corporate governance. We develop and test a simple model that highlights the role of complementarities between tax sheltering and managerial diversion in determining how high-powered incentives influence tax sheltering decisions. The model generates the testable hypothesis that firm governance characteristics determine how incentive compensation changes sheltering decisions. In order to test the model, we construct an empirical measure of corporate tax avoidance - the component of the book-tax gap not attributable to accounting accruals - and investigate the link between this measure of tax avoidance and incentive compensation. We find that, for the full sample of firms, increases in incentive compensation tend to reduce the level of tax sheltering, suggesting a complementary relationship between diversion and sheltering. As predicted by the model, the relationship between incentive compensation and tax sheltering is a function of a firm.s corporate governance. Our results may help explain the growing cross-sectional variation among firms in their levels of tax avoidance, the .undersheltering puzzle,. and why large book-tax gaps are associated with subsequent negative abnormal returns.

An analysis of the RightCare policy at Ben Taub General Hospital, Houston, Texas

Introduction. This study is a two-part evaluation of the RightCare policy, a policy implemented to reduce crowding at the Emergency Center (EC) at Ben Taub General Hospital in Houston, Harris County, Texas. This research includes an evaluation of the policy's impact on specific hospital measures, along with a description of the policy's demise from the point of view of hospital staff. Objective. The purpose of this study is two-fold: (1) To determine whether RightCare policy affected the level of crowding in the Emergency Center and (2) to identify the conditions that may have led to the policy's demise. Methods. For the policy impact portion of this research, hospital measures were collected from existing databases. Analysis included a pre-post comparative design in which the 12 months preceding the policy's implementation were compared with the 12 months following the policy's implementation. For the policy perception portion, employees were surveyed using an on-line questionnaire. Results. The results of the study are mixed. Some measures improved, including time spent on ambulance diversion and the proportion of those who left without being seen, while others did not, such as return visits and total length of stay. Employees generally supported the policy, but expressed concerns over insufficient training and funding. Conclusion. The RightCare policy was a good initial attempt to improve crowded conditions in the EC. The study showed that a clearer policy design, improved training, adequate staffing levels, and better communication would improve operational outcomes in the future.^

Salinidad del agua freática en el área regadía del río Mendoza

La provincia de Mendoza tiene la mayor superficie regada de Argentina y cuenta con una vasta infraestructura de riego y drenaje en los cinco ríos aprovechados. Los suelos son de origen aluvial, con perfiles que alternan capas de distintas texturas, observándose la presencia de estratos muy finos -casi impermeables- que impiden el libre drenaje del agua de riego. Esta situación dinámica es más evidente a medida que el río disminuye su pendiente coincidiendo con los sectores bajos de la cuenca. La acumulación de agua produce el ascenso de los niveles freáticos hasta aproximarse a la superficie del suelo, incrementando la salinización del mismo. El área de riego del río Mendoza, con valores de salinidad media del agua en su derivación hacia la red de riego menor de 1 dS.m-1, es una de las más intensamente explotadas del país y presenta dos sectores con problemas de freática cercana a superficie. Los mismos corresponden a una zona central llamada Área de Surgencia AS y a otra llamada Área Lavalle AL. En AS hay una red de 98 pozos de observación (freatímetros) para conocer las profundidades, direcciones de flujos y calidad del agua freática. El AL tiene una red de 100 freatímetros distribuidos en tres subáreas correspondientes a tres colectores de drenajes: Tres de Mayo-Jocolí TMJ, Villa Lavalle VL y Costa de Araujo-Gustavo André CG. El presente trabajo muestra los resultados de la evaluación de la salinidad del agua freática expresada como salinidad total a 25 °C (CE) para las dos áreas de estudio. Las muestras han sido extraídas en 2002 y 2004. Los resultados indican que en los dos momentos de muestreo la mediana es menor que la media correspondiente, lo que evidencia asimetría positiva en las distribuciones. Las medianas obtenidas fueron: 6180 μS cm-1 (2002) y 6195 μS cm-1 (2004). Además se observan cambios en las distribuciones entre los momentos de muestreo y entre las áreas: en 2004 aparecen valores extremos superiores mucho mayores que en 2002, y el área VL acusa frecuencias relativas más uniformes y los mayores incrementos de CE. Se distingue también que en los dos momentos de muestreo el área AS posee los valores de posición de CE más bajos, aunque también es la zona con mayor cantidad de outliers; las áreas TMJ, CG y AS no han sufrido cambios importantes en los valores de CE en dos años, pero sí se advierte un sensible aumento de la CE en VL. Con la base de datos depurados se realizaron isolíneas para diferentes intervalos de la variable analizada (CE) que muestran espacialmente los sectores afectados con los distintos intervalos de salinidad freática.

Calidad del agua en el área regadía del Río Mendoza (Argentina)

El río Mendoza conforma el oasis norte que es el más importante de la provincia. El crecimiento urbano ha avanzado sobre áreas originalmente agrícolas, rodeando la red de canales y desagües, que también recibe los desagües pluviales urbanos, producto de tormentas convectivas. La actividad antropogénica utiliza el recurso para bebida, saneamiento, riego, recreación, etc., y vuelca sus excedentes a la red, contaminándola. Para conocer la calidad del agua de esta cuenca se seleccionaron, estratégicamente, 15 sitios de muestreo: 3 a lo largo del río y a partir del dique derivador Cipolletti (R_I a R_III), 5 en la red de canales (C_I a C_V) y 7 ubicados en los colectores de drenaje (D_I a D_VII). Se realizaron los siguientes análisis físico-químicos y microbiológicos; en el río y en la red de canales: conductividad eléctrica, temperatura, pH, aniones y cationes (cálculo de RAS), oxígeno disuelto (OD), sólidos sedimentables, demanda química de oxígeno (DQO), bacterias aerobias mesófilas (BAM), coliformes totales y fecales y metales pesados. En la red de drenaje sólo se realizaron los cuatro primeros. Los resultados de los análisis, se incorporaron a una base de datos y se sometieron a un análisis estadístico descriptivo e inferencial. Este último consistió en la aplicación de diversas pruebas en busca de posibles diferencias entre los sitios de muestreo, para cada variable respuesta, a un α = 0.05. Se realizó el análisis de la varianza de efectos fijos y de efectos aleatorios y se probaron los supuestos de homocedasticidad y de normalidad de los errores. En el caso de violación de los supuestos, se utilizó la prueba de Kruskal- Wallis. Se compararon los siguientes sitios de muestreo entre sí: ríos, R_I-canales y drenajes. Se concluyó que hay un aumento significativo de la salinidad y la sodicidad en R_II, que los cambios de calidad ocurridos entre R_II y R_III podrían deberse al aporte de otras aguas. Con respecto a la comparación de los parámetros entre la cabeza del sistema (R_I) y la red de canales se puede decir que los aportes realizados por los escurrimientos urbanos ubicados hacia el oeste del canal Cacique Guaymallén, sumados a los vuelcos de Campo Espejo (detectados en C_II), incrementan significativamente la salinidad (+55 %) y sodicidad del agua (+95 %) respecto del punto R_I, aunque el valor de sodicidad sigue siendo bajo. También se han encontrado incrementos de salinidad (+80 %), de DQO (+1159 %) y BAM (+2873 %) con lógica disminución de OD (-58 %) en el punto C_V (canal Auxiliar Tulumaya) respecto del punto R_I, ocasionados por aportes urbanos (Gran Mendoza) sumados a la carga contaminante del canal Pescara. Los metales pesados no presentan grandes diferencias entre sitios de muestreo.

Calidad del agua en el área regadía del río Mendoza : temperatura, pH, iones solubles y sólidos

El río Mendoza riega el oasis Norte en el que se encuentra asentada la población del Gran Mendoza. El crecimiento urbano avanzó sobre áreas originalmente agrícolas, rodeándolas y atravesándolas con una intrincada red de canales y desagües de riego y colectores de desagües urbano-pluviales. Para conocer la evolución de la calidad del agua de esta cuenca se seleccionaron, estratégicamente, diversos sitios de muestreo: tres puntos (RI a RIII) a lo largo del río a partir del derivador (dique Cipolletti), cinco en la red de canales (CI a CV) y siete ubicados en los colectores de drenaje (DI a DVII). En ellos se realizó el análisis de las variables temperatura, pH, iones solubles y sólidos (en suspensión, sedimentables 10 minutos, totales, fijos y volátiles). En la red de drenaje sólo se analizaron los tres primeros parámetros. La metodología estadística incluyó el análisis descriptivo, inferencial y espacial de cada variable. Los resultados indican que en el río no hay diferencias entre los puntos de muestreo en lo que respecta a pH y sólidos totales volátiles. En cambio, sí se encuentran diferencias en todas las demás variables, y en general entre RIII y RII respecto de RI. En canales y RI no hay diferencias entre los puntos de muestreo en carbonatos y sólidos totales volátiles y sí en todas las demás variables analizadas.

Algunas conclusiones acerca de la diversión de jóvenes y adolescentes en la provincia de Mendoza

La temática que se aborda en el presente artículo se refiere a algunas conclusiones que surgen del trabajo de investigación «La diversión nocturna de jóvenes y adolescentes». Pretende aportar algunos elementos para conocer a los/las adolescentes y jóvenes, sus percepciones y significaciones, particularmente respecto de las actividades de diversión como forma de expresión particular. Interesa que se tengan en cuenta sus resultados como contribuciones para el diseño, implementación y reformulación de actuales o futuras políticas públicas. Las expresiones de los/las adolescentes y jóvenes permiten descubrir nuevos posicionamientos y legitimar su voz procurando instalar sus intereses en la agenda del Estado, como aporte a la construcción de la ciudadanía.

Stable isotopes, sedimentology and geochemical analyses of Middle Eocene to early Miocene sediments of ODP Site 177-1090

During Leg 177 of the Ocean Drilling Program (ODP), a well-preserved middle Eocene to lower Miocene sediment record was recovered at Site 1090 on the Agulhas Ridge in the Atlantic sector of the Southern Ocean. This new sediment record shows evidence of a hitherto unknown late Eocene opal pulse. Lithological variations, compositional data, mass-accumulation rates of biogenic and lithogenic sediment constituents, grain-size distributions, geochemistry, and clay mineralogy are used to gain insights into mid-Cenozoic environmental changes and to explore the circumstances of the late Eocene opal pulse in terms of reorganizations in ocean circulation. The base of the section is composed of middle Eocene nannofossil oozes mixed with red clays enriched in authigenic clinoptilolite and smectite, deposited at low sedimentation rates (LE 2 cm/ka). It indicates reduced terrigenous sediment input and moderate biological productivity during this preglacial warm climatic stage. The basal strata are overlain by an extended succession (100 m, 4 cm/ka) of biosiliceous oozes and muds, comprising the upper middle Eocene, the entire late Eocene, and the lowermost early Oligocene. The opal pulse occurred between 37.5 and 33.5 Ma and documents the development of upwelling cells along topographic highs, and the utilization of a marine nutrient- and silica reservoir established during the pre-late Eocene through enhanced submarine hydrothermal activity and the introduction of terrigenous solutions from chemical weathering on adjacent continents. This palaeoceanographic overturn probably was initiated through the onset of increased meridional ocean circulation, caused by the diversion of the Indian equatorial current to the south. The opal pulse was accompanied by increased influxes of terrigenous detritus from southern African sources (illite), mediated by enhanced ocean particle advection in response to modified ocean circulation. The opal pulse ended because of frontal shifts to the south around the Eocene/Oligocene boundary, possibly in response to the opening of the Drake Passage and the incipient establishment of the Antarctic Circumpolar Current. Condensed sediments and a hiatus within the early Oligocene part of the section possibly point to an invigoration of the deep-reaching Antarctic Circumpolar Current. The mid-Oligocene to lower Miocene section on long time scale exhibits less pronounced lithological variations than the older section and points to relatively stable palaeoceanographic conditions after the dramatic changes in the late Eocene to early Oligocene.

East Asia's Economic Development cum Trade "Divergence"

This paper addresses some salient features of how some of "successful" East Asian economies have been faring in terms of enhancing their export competitiveness. That export becomes more divergent in terms of its unit price as more technology-enhancing economic activity is undertaken within an economy, is the primary message that this study conveys. This is indeed what Schumpeter had addressed in conjunction with his "creative destruction" thesis. From this perspective, East Asia's export-led industrialization has been attained through a particular policy focus upon high "trade divergence" sectors underpinned by a generally high level of manufacturing flexibility. The experience of Malaysia's development serves as the strong case in point. As an East Asia-wide FTA is expected to facilitate "divergent" export-led industrialization through enhanced knowledge interaction, this dynamic or "divergent" impact that knowledge creation could exert should come to the fore of relevant policy arguments, together with static consideration of trade creation and diversion. A formal statistical test of the "divergence hypothesis" above is called for with a view to building upon this preliminary study.

Calculation Methodology and Fabrication Procedures for Particle Accelerator Strip-Line Kickers: Application to the CTF3 Combiner Ring Extraction Kicker and TL2 Tail Clippers

A particle accelerator is any device that, using electromagnetic fields, is able to communicate energy to charged particles (typically electrons or ionized atoms), accelerating and/or energizing them up to the required level for its purpose. The applications of particle accelerators are countless, beginning in a common TV CRT, passing through medical X-ray devices, and ending in large ion colliders utilized to find the smallest details of the matter. Among the other engineering applications, the ion implantation devices to obtain better semiconductors and materials of amazing properties are included. Materials supporting irradiation for future nuclear fusion plants are also benefited from particle accelerators. There are many devices in a particle accelerator required for its correct operation. The most important are the particle sources, the guiding, focalizing and correcting magnets, the radiofrequency accelerating cavities, the fast deflection devices, the beam diagnostic mechanisms and the particle detectors. Most of the fast particle deflection devices have been built historically by using copper coils and ferrite cores which could effectuate a relatively fast magnetic deflection, but needed large voltages and currents to counteract the high coil inductance in a response in the microseconds range. Various beam stability considerations and the new range of energies and sizes of present time accelerators and their rings require new devices featuring an improved wakefield behaviour and faster response (in the nanoseconds range). This can only be achieved by an electromagnetic deflection device based on a transmission line. The electromagnetic deflection device (strip-line kicker) produces a transverse displacement on the particle beam travelling close to the speed of light, in order to extract the particles to another experiment or to inject them into a different accelerator. The deflection is carried out by the means of two short, opposite phase pulses. The diversion of the particles is exerted by the integrated Lorentz force of the electromagnetic field travelling along the kicker. This Thesis deals with a detailed calculation, manufacturing and test methodology for strip-line kicker devices. The methodology is then applied to two real cases which are fully designed, built, tested and finally installed in the CTF3 accelerator facility at CERN (Geneva). Analytical and numerical calculations, both in 2D and 3D, are detailed starting from the basic specifications in order to obtain a conceptual design. Time domain and frequency domain calculations are developed in the process using different FDM and FEM codes. The following concepts among others are analyzed: scattering parameters, resonating high order modes, the wakefields, etc. Several contributions are presented in the calculation process dealing specifically with strip-line kicker devices fed by electromagnetic pulses. Materials and components typically used for the fabrication of these devices are analyzed in the manufacturing section. Mechanical supports and connexions of electrodes are also detailed, presenting some interesting contributions on these concepts. The electromagnetic and vacuum tests are then analyzed. These tests are required to ensure that the manufactured devices fulfil the specifications. Finally, and only from the analytical point of view, the strip-line kickers are studied together with a pulsed power supply based on solid state power switches (MOSFETs). The solid state technology applied to pulsed power supplies is introduced and several circuit topologies are modelled and simulated to obtain fast and good flat-top pulses.

Análisis empírico del tráfico en las autopistas de peaje radiales 3 y 5 de Madrid

El propósito de la presente investigación es determinar si, a través del estudio y análisis de los estudios de tráfico en autopistas de peaje, se pueden determinar las razones de los incumplimientos en las previsiones de estos estudios. La metodología se basa en un análisis empírico ex- post facto de los estudios de tráfico contenidos en los anteproyectos de las autopistas Radial 3 y Radial 5 y los datos realmente verificados. Tras una introducción para presentar las principales características de las autopistas de peaje, se realiza una revisión de la bibliografía sobre el cumplimiento de las previsiones de tráfico. Lo anterior permite establecer una serie de aspectos que pueden contribuir a estos incumplimientos, así como una serie de medidas encontradas para mejorar las futuras previsiones. Ya en el núcleo fundamental de la investigación, esta se centra en el análisis del cumplimiento de las previsiones de tráfico contenidas en los anteproyectos de la Radial 3 y Radial 5. Se realiza un análisis crítico de la metodología adoptada, así como de las variables e hipótesis realizadas. Tras este primer análisis, se profundiza en la fase de asignación de los estudios. Siempre con base a los tráficos reales y para el año 2006, se cuantifica el efecto en los incumplimientos, por un lado de las variables utilizadas, y por otro, del propio método ó curva de asignación. Finalmente, y con base en los hallazgos anteriores, se determinan una serie de limitaciones en el método de asignación de tráficos entre recorridos alternativos para el caso de entornos urbanos usado. El planteamiento con base a las teorías del agente racional y maximización de la utilidad esperada es criticado desde la perspectiva de la teoría de decisión bajo condiciones de riesgo planteada por Kahneman y Tversky. Para superar las limitaciones anteriores, se propone una nueva curva de asignación semi empírica que relaciona la proporción del tráfico que circula por la autopista de peaje con la velocidad media en la autovía libre alternativa. ABSTRACT The aim of this research is to confirm whether the forensic analysis of the traffic forecast studies for tolled highways may bring to light the reasons behind the lack of accuracy. The methodology used on this research is empirical and is based on the ex –post facto analysis of the real traffic numbers compared to the forecasted for the tolled highways Radial 3 and Radial 5. Firstly the main features of tolled highways are presented as an introductory chapter. Secondly a broad bibliographic search is presented, this is done from a global perspective and from the Spanish perspective too. From this review, a list of the main causes behind the systematic inaccuracy together with measures to improve future traffic forecast exercises are shown. In what we could consider as the core of the research, it focuses on the ratios of actual / forecast traffic for the tolled highways Radial 3 y Radial 5 in Madrid outskirts. From a critical perspective, the methodology and inputs used in the traffic studies are analysed. In a further step, the trip assignment stage is scrutinised to quantify the influence of the inputs and the assignment model itself in the accuracy of the traffic studies. This exercise is bases on the year 2006. Finally, the assignment model used is criticised for its application in tolled urban highways. The assumptions behind the model, rational agent and expected utility maximization theories, are questioned under the theories presented by Kahneman and Tversky (Prospect Theory). To overcome these assignment model limitations, the author presents a semi empiric new diversion curve. This curve links the traffic proportion using the tolled highway and the average speed in the toll free alternative highway.

Energy requirements in pressure irrigation systems

Modernization of irrigation schemes, generally understood as transformation of surface irrigation systems into pressure –sprinkler and trickle- irrigation systems, aims at, among others, improving irrigation efficiency and reduction of operation and maintenance efforts made by the irrigators. However, pressure irrigation systems, in contrast, carry a serious energy cost. Energy requirements depend on decisions taken on management strategies during the operation phase, which are conditioned by previous decisions taken on the design project of the different elements which compose the irrigation system. Most of the countries where irrigation activity is significant bear in mind that modernization irrigation must play a key role in the agricultural infrastructure policies. The objective of this study is to characterize and estimate the mean and variation of the energy consumed by common types of irrigation systems and their management possibilities. The work includes all processes involved from the diversion of water into irrigation specific infrastructure to water discharge by the emitters installed on the crop fields. Simulation taking into account all elements comprising the irrigation system has been used to estimate the energy requirements of typical irrigation systems of several crop production systems. It has been applied to extensive and intensive crop systems, such us extensive winter crops, summer crops and olive trees, fruit trees and vineyards and intensive horticulture in greenhouses. The simulation of various types of irrigation systems and management strategies, in the framework imposed by particular cropping systems, would help to develop criteria for improving the energy balance in relation to the irrigation water supply productivity.