Endoscopic mucosal resection in the esophagus with a new rigide device : an animal study

Résumé: Introduction : L'utilisation de méthodes endoscopiques peu invasives est en constante augmentation pour le traitement des lésions tumorales précoces de l'oesophage. Le but du traitement comprend l'éradication complète de tous les foyers de dysplasie ou de carcinome in situ, notamment dans les métaplasies intestinales de l'oesophage de Barrett, qui peuvent dégénérer en adénocarcinome. Plusieurs techniques d'ablation de la muqueuse oesophagienne (laser, argon plasma, electrocoagulation, photothérapie dynamique, résection endoscopique) ont été utilisées jusqu'à présent, mais aucune n'a vraiment donné entière satisfaction. Les techniques actuelles de résections endoscopiques par fibroscopie sont entre autres limitées par le grand nombre de séances nécessaires à l'éradication complète de la lésion et par la petite taille des fragments de muqueuse obtenus, ce qui rend l'analyse histologique difficile. Dans notre étude animale, nous avons évalué la faisabilité, l'efficacité et la sécurité d'une méthode de résection endoscopique à l'aide d'un nouvel oesophagoscope rigide. Matériel et méthode : Le résectoscope est formé d'un oesophagoscope rigide avec une fenêtre distale transparente à travers laquelle la muqueuse et une partie de la sous-muqueuse sont aspirées et ensuite réséquées avec une anse thermique. Les diverses fenêtres utilisées ont une taille comprise entre 2.2 et 4.4 cm. Le mouton a été choisi en raison de la ressemblance de son oesophage avec celui de l'humain en ce qui concerne l'épaisseur de son oesophage et sa structure histologique. Nous avons effectué 55 résections hémi-circonférentielles sur 21 animaux et 11 résections circonférentielles sur 11 autres. La Mitomycine-C, une substance qui inhibe la prolifération fibroblastique, a été utilisée dans 8 résections circonférentielles à différents intervalles de temps afin d'empêcher la survenue de sténoses oesophagiennes. Résultats : Toutes les résections hémi-circonférentielles ont permis d'obtenir des fragments compacts de tissu avec des bords nets, ce qui permet une excellente étude histologique. La surface du tissu prélevé était en corrélation avec la taille de la fenêtre du resectoscope. Nous avons ainsi pu obtenir des fragments avec des dimensions comprises entre 6 et 12 cm2. Pour les résections circonférentielles, les tissus étaient obtenus en 2 parties, en inversant de 180° la position de l'appareil. La profondeur de la résection a été optimale dans 58 cas sur 65 avec une découpe précise au niveau de la sous-muqueuse sans lésion de la couche musculaire sous- jacente. Il n'y a pas eu de complications après les résections hémi-circonférentielles. Les complications engendrées par les résections circonférentielles (sténose, perforation) n'ont plus été rencontrées après application locale de Mitomycine-C administrée à des intervalles de temps bien précis. Conclusion : Notre méthode de résection endoscopique de la muqueuse oesophagienne offre une nouvelle approche très prometteuse par rapport aux options déjà disponibles. Elle apparaît supérieure en ce qui concerne la taille de tissu prélevé, la précision et régularité de la profondeur de résection, ainsi que la facilité et sûreté du diagnostic histologique et des marges de sécurité. Les résections hémi-circonférentielles se sont révélées sûres chez le modèle animal. Cette nouvelle technique mérite de plus amples investigations pour les résections circonférentielles avant son utilisation chez l'humain. Abstract: Background and Study Aims: We undertook this retrospective study to evaluate the frequency and prognosis of endoscopic treatment of laterally spreading tumors (LSTs) in the rectum. The recurrence rate for lesions of the lower rectum was compared with that of the upper rectum. Patients and Methods: During the period from July 1989 to June 2002, a total of 1237 rectal tumors were detected. LSTs accounted for 6.9% (85/1237) of all rectal tumors. A total of 224 tumors of the lower rectum were detected among the 1237 rectal tumors. LSTs accounted for 16.1 % (36/224) of all the lower rectal tumors. From 85 LST lesions, 67 were evaluated for their prognosis after endoscopic mucosal resection (EMR). Patients whose LSTs had been resected were followed up by endoscopy at the following frequencies: once 15 (22.4%); twice (more than 1 year), 20 (29.9%); three times (more than 3 years), 21(31.3%); and four times or more (more than 5 years), 11 (16.4%). Results: A total of 67 patients with endoscopically treated LSTs were followed up by endoscopy. We observed recurrences in two lesions of the upper rectum (2/38, 5.3%) and five lesions of the lower rectum (5/29, 17.2%) (P = 0.2364); all seven lesions were resected piecemeal. LSTs whose horizontal margin reached the pectinate line frequently recurred in the lower rectum, at a rate of 80% (4/5). However, all patients were completely cured by additional endoscopic resections, the greatest number of treatments being four. Conclusion: For early detection of recurrence and successful endoscopic cure, further colonoscopic examination within a few months after the first treatment is necessary.

Endoscopic and surgical treatment of vesico-ureteral reflux in children. Comparative long-term follow-up.

PRINCIPLES: This retrospective study analyzes the long-term results of endoscopic and surgical treatment of vesico-ureteral reflux in children. METHODS: A cohort of 130 patients, 67 girls and 63 boys with a mean age of 30 months were treated either by endoscopic subureteral collagen injection (SCIN) in 92 and by Cohen reimplantation surgery in 123 refluxing ureteral units. Mean follow-up was 4.2 years varying from 1 to 8.7 years. Reflux recurrence, urinary tract infection (UTI) and renal function were evaluated. RESULTS: After SCIN reflux was absent in 64% at 6 months. 20% of the initially 92 refluxing ureters were injected twice. After one or two injections reflux was absent in 71%. In 21% recurrent reflux was of grade I or II, not requiring further treatment. UTI was observed in 27%. After Cohen ureteral reimplantation reflux was absent in 96% at 6 months. UTI was observed in 23%. Renal function at diagnosis and follow-up was compared in children with bilateral grade III reflux only. In patients treated with SCIN it was normal in 77% preoperatively and in 90% at follow-up. In patients treated by open surgery it was normal in 47% preoperatively and in 76% at follow-up. CONCLUSION: For high-grade vesico-ureteral reflux re-implantation surgery remains the gold standard. SCIN is indicated for low and medium grade reflux. Recurrent bacteriuria was observed more often after SCIN and pyelonephritis more often after open surgery. The renal function seems to be preserved with both techniques.

Capacity and transformational development within the 2005 Canada Summer Games host society

Although capacity has been used in recent federal government accords and policies related to the voluntary and amateur sport sectors, there is little consensus over the meaning of the term. Consequently, the purpose of this qualitative case study was to explore the concept of organizational capacity within a temporary voluntary sport organization. Specifically, the nature of organizational capacity was examined within the case of the Volunteers Division of the 2005 Canada Summer Games (CSG) Host Society. Data were collected from executive planning and middle management CSG volunteers through the use of a variety of methods: verbal journals, interviews, observations, documents and a focus group. Findings indicated several challenges associated with the volunteer management model utilized by the host society, varying levels of importance among six elements of capacity, and key aspects of the relationship between organizational capacity and transformational development. Implications focused upon the importance of highlighting individuals rather than the organizational as a whole in order to build capacity, and utilizing a brain or hybrid brain-machine organizational form to enhance capacity. Recommendations are provided for both the Canada Games Council and Canada Games host societies.

Study of heat capacity measurement methods for small samples

Methods of measuring specific heats of small samples were studied. Three automated methods were explored, two of which have shown promising results. The adiabatic continuous heating method, has provided smooth well behaved data but further work is presently underway to improve on the results obtained so far . The decay method has been success fully implemented demonstrating reasonable agreement with accepted data for a copper test sample.

Human skeletal muscle pyruvate dehydrogenase phosphatase activity and expression : the effect of aerobic capacity

Activation of pyruvate dehydrogenase (PDH), which converts pyruvate into acetyl-CoA, is accomplished by a pair of specific phosphatases (PDP 1 & 2). A cross-sectional study investigating the effect of aerobic capacity on PDP activity and expression found that: 1) PDP activity and PDP! protein expression were positively correlated with most aerobic capacity measures in males (n=lS), but not females (n=12); 2) only males showed a positive correlation between PDP activity and PDPl protein expression (r=0.47; p=O.05), indicating that the increase in PDP activity in males is largely explained by increased PDPl protein expression, but that females rely on another level for PDP activity regulation; and 3) PDP} and Ela protein expression increase in unison when expressed relative to the E2 core. These data suggest that with increased aerobic capacity there is an increased capacity for carbohydrate oxidation through PDH, via El a, and an increased ability to activate PDH, via PDP, when exercising maximally.

The Development of a Survey to Assess the Type of Capacity within Nonprofit Sport Organizations

The topic of organizational capacity and organizational capacity-building has gained importance among Canadian nonprofit sport organizations. This is illustrated by practitioners calling for increased attention to the capacity-building matters of nonprofit organizations, and two critical Canadian federal government documents outlining strategic direction for the nonprofit sport sector. Consequently, the purpose of this quantitative research study was to develop a valid and reliable survey to categorize nonprofit sport organizations into capacity types identified by Stevens (Stevens, 2006). This quantitative research study offers a preliminary development towards achieving a reliable and valid tool for assessing types of nonprofit sport organizational capacity. This research provides interesting insight into what capacity means by organizing the all-encompassing literature into an easy to understand framework. In addition, it sets the stage for future researchers to build upon this survey development process to achieve a reliable and valid capacity measuring tool.

The role of leaders in building organizational learning capacity

In a world in which social, economic, and environmental circumstances are continuously evolving and increasingly complex, leaders face the challenging prospect of navigating their organizations through unpredictable operating conditions. Finding a way to tap into the learning capacity of the people who comprise their organizations may be the answer to adapt and to survive. This qualitative research study explored the role of leaders in building this organizational learning capacity. The literature identified three domains of personal, interpersonal, and organizational capacity for learning in an organizational setting. Interviews with three senior leaders who had successfully built learning capacity in their respective organizations revealed four elements of leader commitment: (a) to the process of building learning capacity, (b) to organizational objectives and results, (c) to personal actions and behaviours, and (d) to the people of the organization. Each of the four elements of leader commitment spans the three domains of learning capacity that can guide leaders as they build organizational learning capacity.

Organizational capacity and knowledge transfer : a qualitative case study of the 2007 Canada Winter Games host society

Understanding and managing the knowledge transfer process in sport organizations is an essential component to enhance organizational capacity. Very little research on either capacity or knowledge transfer within a sport organization exists. Consequently, the purpos e of this qualitative case study was to, examine the transfer of knowledge process within a major games host society. Specifically, two research goals guided the study: 1) To develop a model to explain a knowledge t r ans f e r process in a non-profit ma jor games hos t organization and 2) To examine the relevance of the model to a Canada Games Hos t Society. Data we r e collected from interviews with middle and senior level volunteers as well as senior s t a f f members (n= 27), document s and observations. The findings indicated three barriers to knowledge transfer: structural, systemic, and cultural. As a result of the findings a revised model for knowledge transfer wa s proposed that included modifications related to the direction of knowledge flow, timing of the knowledge transfer process, and group inter-relations. Implications identified the importance of intuition managers, time and organizational levels for successful knowledge transfer. Recommendations for future host societies and the Canada Games Council are presented.

Report of Loss in Capacity Due to Ice at Rankine Station - April 1934 through April 1937

A report compiled by Canadian Niagara Power Company describes the loss in capacity due to ice. The chart reveals the kilowatts lost and the duration of the outage and the "min. forebay elevation during ice loss period".

Assessing the adaptive capacity of the Ontario wine industry to climate change: A case study

The global wine industry is experiencing the impacts of climate change. Canada’s major wine sector, the Ontario Wine Industry (OWI) is no exception to this trend. Warmer winter and summer temperatures are affecting wine production. The industry needs to adapt to these challenges, but their capacity for this is unclear. To date, only a limited number of studies exist regarding the adaptive capacity of the wine industry to climate change. Accordingly, this study developed an adaptive capacity assessment framework for the wine industry. The OWI became the case study for the implementation of the assessment framework. Data was obtained by means of a questionnaire sent to grape growers, winemakers and supporting institutions in Ontario. The results indicated the OWI has adaptive capacity capabilities in financial, institutional, political, technological, perceptions, knowledge, diversity and social capital resources areas. Based on the OWI case study, this framework provides an effective means of assessing regional wine industries’ capacity to adapt to climate change.

A research capacity strengthening project for infectious diseases in Honduras: experience and lessons learned

Background: In Honduras, research capacity strengthening (RCS) has not received sufficient attention, but an increase in research competencies would enable local scientists to advance knowledge and contribute to national priorities, including the Millennium Development Goals (MDGs). Objective: This project aimed at strengthening research capacity in infectious diseases in Honduras, focusing on the School of Microbiology of the National Autonomous University of Honduras (UNAH). The primary objective was the creation of a research-based graduate program for the continued training of researchers. Parallel objectives included institutional strengthening and the facilitation of partnerships and networks. Methods: Based on a multi-stakeholder consultation, an RCS workplan was designed and undertaken from 2007 to 2012. Due to unexpected adverse circumstances, the first 2 years were heavily dedicated to implementing the project's flagship, an MSc program in infectious and zoonotic diseases (MEIZ). In addition, infrastructure improvements and demand-driven continuing education opportunities were facilitated; biosafety and research ethics knowledge and practices were enhanced, and networks fostering collaborative work were created or expanded. Results: The project coincided with the peak of UNAH's radical administrative reform and an unprecedented constitutional crisis. Challenges notwithstanding, in September 2009, MEIZ admitted the first cohort of students, all of whom undertook MDG-related projects graduating successfully by 2012. Importantly, MEIZ has been helpful in expanding the School of Microbiology's traditional etiology-based, disciplinary model to infectious disease teaching and research. By fulfilling its objectives, the project contributed to a stronger research culture upholding safety and ethical values at the university. Conclusions: The resources and strategic vision afforded by the project enhanced UNAH's overall research capacity and its potential contribution to the MDGs. Furthermore, increased research activity and the ensuing improvement in performance indicators at the prime Honduran research institution invoke the need for a national research system in Honduras.

Conceptualizing Institutional Capacity Building Through a Learning Process Set in Motion by a Foundation

Employing critical pedagogy and transformative theory as a theoretical framework, I examined a learning process associated with building capacity in community-based organizations (CBOs) through an investigation of the Institutional Capacity Building Program (ICBP) initiated by a Foundation. The study sought to: (a) examine the importance of institutional capacity building for individual and community development; (b) investigate elements of a process associated with a program and characteristics of a learning process for building capacity in CBOs; and (c) analyze the Foundation’s approach to synthesizing, systematizing, and sharing learning. The study used a narrative research design that included 3 one-on-one, hour-long interviews with 2 women having unique vantage points in ICBP: one is a program facilitator working at the Foundation and the other runs a CBO supported by the Foundation. The interviews’ semistructured questions allowed interviewees to share stories regarding their experience with the learning process of ICB and enabled themes to emerge from their day-to-day experience. Through the analysis of this learning process for institutional capacity building, a few lessons can be drawn from the experience of the Foundation.

Capacity to Attend to the Needs of Persons with Dual Diagnoses in the Criminal Justice System: Views of Mental Health and Criminal Justice Professionals

Currently, individuals with intellectual disabilities are overrepresented within the Criminal Justice System (Griffiths, Taillon-Wasmond & Smith, 2002). A primary problem within the Criminal Justice System is the lack of distinction between mental illness and intellectual disabilities within the Criminal Code. Due to this lack of distinction and the overall lack of identification procedures in the Criminal Justice System, individuals with disabilities will often not receive proper accommodations to enable them to play an equitable role in the justice system. There is increasing evidence that persons with intellectual disabilities are more likely than others to have their rights violated, not use court supports and accommodations as much as they should, and be subject to miscarriages of justice (Marinos, 2010). In this study, interviews were conducted with mental health (n=8) and criminal justice professionals (n=8) about how individuals with dual diagnosis are received in the Criminal Justice System. It was found that criminal justice professionals lack significant knowledge about dual diagnosis, including effective identification and therefore appropriate supports and accommodations. Justice professionals in particular were relatively ill-prepared in dealing effectively with this population. One finding to highlight is that there is misunderstanding between mental health professionals and justice professionals about who ought to take responsibility and accountability for this population.

Exploring Capacity Building of Ontario Dental Hygiene Educators During National Curriculum Reform

In times of educational change, educators are given the task of implementing new initiatives that meet the needs of a changing environment; yet, they are often dismissed from developmental phases of the reform. This top-down structure deters educators’ personal capacity building as their knowledge, values, assumptions, and beliefs are not acknowledged or explicitly developed as part of the initiative. This study explored Ontario dental hygiene educators’ perspectives of how they may build personal capacity during an externally mandated national curriculum reform, the Entry-to-Practice Competencies and Standards for Canadian Dental Hygienists (National Competencies). Narratives were collected from 5 dental hygiene educators of diverse educational training and teaching organizations. Three themes emerged that included perceptions of structural influence, perceptions of learning access, and perceptions of identity. Each theme was linked to tasks that were required to build personal capacity for sustainable school change. The theoretical framework and the required tasks demonstrated the interconnectedness between educators, leaders, and the organization for building educators’ personal capacity.