531 research outputs found
Author Correction: Loss of Phd2 cooperates with BRAFV600E to drive melanomagenesis
No full textThe original version of this Article contained an error in the spelling of the author Brett L. Ecker, which was incorrectly given as Brett Ecker. This has now been corrected in both the PDF and HTML versions of the Article.published_or_final_versio
Response to: Managing the High-risk Pancreatic Anastomosis
No full textThis a response to Pedrazzoli et al on our paper "Characterization and Optimal Management of High-risk Pancreatic Anastomoses During Pancreatoduodenectomy
Impact of Operative Time on Outcomes after Pancreatic Resection: A Risk-Adjusted Analysis Using the American College of Surgeons NSQIP Database
No full textBACKGROUND: Longer operative time (OT) has been associated with negative outcomes in various surgical procedures, but its role in pancreatic resection, a complex, high-acuity endeavor, is not yet well defined. The aim of this study was to analyze the relationship between OT and pancreatectomy outcomes in a risk-adjusted fashion. STUDY DESIGN: This retrospective cohort study analyzed patients undergoing pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between 2014 and 2015 using the procedure-targeted pancreatectomy database of the American College of Surgeons NSQIP. Univariable analyses and multiple backward stepwise conditional logistic regression models were used to assess the impact of OT on postoperative occurrences. RESULTS: Among 10,157 patients, 6,844 PDs and 3,313 DPs were performed. Median operative time was 358 minutes (interquartile range 282 to 444 minutes) for PD and 213 minutes (interquartile range 157 to 285 minutes) for DP. Male sex, younger age, obesity, neoadjuvant treatment, minimally invasive approaches, and vascular/concurrent organ resections were associated with longer OT for both procedures. Morbidity increased in a stepwise manner with increasing OT. After risk adjustment, increasing OT was negatively associated with overall morbidity, major complications, pancreatectomy-specific complications, infectious complications, and prolonged hospital stay. These associations were independent from patients' preoperative characteristics, operative approach, vascular or concurrent organ resection, and postoperative diagnosis. These findings held true for both PD and DP. Conversely, the association between OT and mortality was mainly driven by the excessive operative durations for PDs, and was not significant for DPs. CONCLUSIONS: Longer OT is independently associated with worse perioperative outcomes after pancreatic resection, and should be considered a relevant parameter in risk-adjustment processes for outcomes evaluation. These findings suggest possible areas of quality improvement through individual and system-level initiatives
Response to: "Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation"
No full textThis is a response to Yang et al on our work entitled ‘Risk-adjusted Outcomes of Clinically RelevantPancreatic Fistula Following Pancreatoduo-denectomy: A Model for Performance Evaluation", mainly centered on the debate whether octreotide is beneficial in preventing pancreatic fistul
Taking Theory to Practice: Quality Improvement for Pancreaticoduodenectomy and Development and Integration of the Fistula Risk Score
No full textImprovements in surgical outcomes are predicated on recognizing effective practices with subsequent adaptation. It is unknown whether risk assessment for pancreatic fistula (clinically relevant postoperative pancreatic fistula [CR-POPF]) after pancreaticoduodenectomy (PD) translates to improved patient outcomes at the practice level
Boys of England and Edwin J. Brett, 1866-99
No full textBoys of England was a Victorian boys' periodical. It was published weekly by Edwin J. Brett from 1866 to 1899, initially from the Fleet Street offices of the Newsagents'
Publishing Company, and later from Brett's own `Boys of England Office'. It was the first periodical of its kind, and achieved a large sale amongst eager youngsters.
The purpose of this thesis is to provide a general history of BOE and Brett, neither of which has yet been attempted. More specifically, the thesis is intended to address
misconceptions regarding Brett and his work. Historians of boys' periodical literature have tended to portray Brett's papers as largely supportive of middle class hegemony. They
argue that they failed to connect with the lives of their upper working and lower middle class readers. However, this thesis contends that in actual fact BOE engaged closely with
the lives of its readership, comprised mainly of boys from the `respectable' working classes. Therefore, BOE should rightly be considered an important, indigenous component
of working class society and culture in mid to late Victorian Britain.
To provide as comprehensive an analysis as possible, the thesis is divided into three sections: `Paper and Proprietor'; `Content'; `Response'. These sections are divided into further chapters, each exploring a salient facet of BOE and Brett. Some of these engage with, and challenge, the existing historiography of boys' periodical literature. Others introduce historiographies previously remote from the study of boys' papers, widening the
remit of this relatively self-contained field. Some examine entirely unstudied, or largely understudied, subject matter.
Ultimately, this thesis is intended to make a valuable contribution not only to the historiography of boys' papers specifically, and children's literature in general, but also to the wider historiographies of Victorian social and cultural history and the Victorian working class
Pancreatic fistula risk for pancreatoduodenectomy: an international survey of surgeon perception
No full textIntroduction Clinically relevant postoperative pancreatic fistula (CR-POPF) is a morbid complication following pancreatoduodenectomy (PD). It is unclear how pancreatic surgeons perceive risk for this complication, and the implications thereof. Methods A web-based survey was distributed to members of 22 international GI surgical societies. CR-POPF risk factors were categorized as follows: (i) patient factors, (ii) pancreatic gland characteristics, (iii) intraoperative variables, (iv) perioperative mitigation techniques, or (v) institutional features. Results Surveys were completed by 897 surgeons worldwide. The most commonly cited contributors to CR-POPF risk were gland characteristics (90.7%), while patient and intraoperative factors were selected 71.2 and 69.3% of the time, respectively. Conversely, institutional features (31.7%) and perioperative mitigation techniques (21.3%) were rarely recognized. Eighty percent of surgeons use drain amylase concentration to guide drain removal decision-making; however, only 45.2% of surgeon remove drains early based upon drain amylase values. When evaluating clinical scenarios, surgeons were able to identify both negligible and high risk scenarios but struggled to differentiate between low and moderate CR-POPF risk. Conclusion This international study analyzed how surgeons discern CR-POPF risk for PD. There was considerable variability in surgeons’ perceptions of risk, which may have an adverse effect on the clinical use of risk adjustment measures
On Determinatives and the Category-Function Distinction: A Reply to Brett Reynolds
No full textThis article examines the arguments made in the article “Determiners, Feline Marsupials, and the Category-Function Distinction: A Critique of ELT Gram- mars” by Brett Reynolds recently published in the TESL Canada Journal (2013). In our response, we demonstrate that the author’s arguments are problematic on both theoretical and empirical grounds. In particular, we show that, by the author’s own metrics, (a) the items in the so-called my set (i.e,. my, your, his/ her, etc.) should be determinatives rather than pronouns, and (b) even items that the author argues to be determinatives (i.e., all, many, few, little, etc.) cannot be classified as such if we apply the tests suggested by the author. We conclude our critical response by discussing some of the pedagogical implications of the author’s article.Cet article porte sur les arguments présentés dans l’article “Determiners, Feline Marsupials, and the Category-Function Distinction: A Critique of ELT Gram- mars” écrit par Brett Reynolds et récemment publié dans la Revue TESL du Ca- nada (2013). En réponse à cet article, nous démontrons que les arguments de l’auteur sont problématiques sur les plans tant théorique qu’empirique. Plus pré- cisément, nous expliquons, en nous basant sur les paramètres mêmes de l’auteur, que (a) les items de l’ensemble qu’il nomme ‘my set’ (c.-à-d., ma, ta, sa, etc.) devraient être considérés des déterminants plutôt que des pronoms et que (b) même des items que l’auteur décrit comme étant des déterminants (c.-à-d., tout, plusieurs, peu, etc.) ne peuvent être classés ainsi si l’on se base sur les tests qu’il propose. Nous concluons notre critique en discutant certaines incidences pédago- giques découlant de l’article de l’auteur
Trends in practice patterns and outcomes: A decade of sarcoma care in the United States
No full textBACKGROUND: Soft tissue sarcomas (STS) represent a rare and heterogeneous group of tumors. We sought to characterize national trends in referral patterns, treatment strategies, and overall survival (OS) over the course of a decade. METHODS: Adult patients with extra-abdominal STS were identified using the National Cancer Database and categorized by diagnosis year (2005-2009 and 2010-2014). High-volume hospitals (HVH) were defined as those >90th percentile in volume of STS patients treated, and others were defined as low-volume hospitals (LVH). Standard statistical methods were used to compare treatment strategies and OS by diagnosis period. RESULTS: Of 55,212 patients, 25,469 (46.1%) were diagnosed in 2005-2009 and 29,743 (53.9%) in 2010-2014. Despite increased utilization of neoadjuvant radiation therapy (26.6% vs. 34.8%, P < 0.001), the rate of R0 resections did not change (75.0% vs. 74.8%, P = 0.067). Furthermore, at a national level, OS did not improve over time (HR 0.99, 95% CI 0.96-1.01). When outcomes were stratified by volume, treatment at HVH compared to LVH was associated with improved rates of R0 resection (OR 1.27, 95% CI 1.20-1.35) and OS (HR 0.92, 95% CI 0.89-0.95). Moreover, there was a modest improvement in OS at HVH (HR 0.95, 95% CI 0.91-1.00), but not at LVH (HR 1.01, 95% CI 0.97-1.04). However, referral to HVH did not change over time (40.7% vs. 40.7%, P = 0.91). CONCLUSION: OS for STS did not change at a national level over the course of a decade, although it improved at HVH. Further outcome improvements will likely require more effective systemic therapies
Identification of Patients for Adjuvant Therapy After Resection of Carcinoma of the Extrahepatic Bile Ducts: A Propensity Score-Matched Analysis
No full textBACKGROUND: Resectability rates for extrahepatic cholangiocarcinoma have increased over time, but long-term survival after resection alone with curative intent remains poor. Recent series suggest improved survival with adjuvant therapy. Patient subsets benefiting most from adjuvant therapy have not been clearly defined. METHODS: Patients with extrahepatic cholangiocarcinoma who underwent resection with curative intent and received adjuvant therapy (chemotherapy ± radiotherapy) or surgery alone (SA) were identified in the U.S. National Cancer Data Base (2004-2014). Cox regression identified covariates associated with overall survival (OS). Adjuvant therapy and SA cohorts were matched (1:1) by propensity scores based on the survival hazard in Cox modeling. Overall survival was compared by Kaplan-Meier estimates. RESULTS: Of 4872 patients, adjuvant chemotherapy was used frequently for 2416 (49.6%), often in conjunction with radiotherapy (RT) (n = 1555, 64.4%). Adjuvant chemotherapy with or without RT was used increasingly for cases with higher T classification [reference: T1-2; T3: 1.36; 95% confidence interval (CI), 1.19-1.55; T4: 1.77; 95% CI 1.38-2.26], nodal positivity [odds ratio (OR), 1.26; 95% CI 1.01-1.56], lymphovascular invasion (OR 1.21; 95% CI 1.01-1.46), or margin-positive resection (OR 1.85; 95% CI 1.61-2.12), and was associated with significant improvements in OS for each high-risk subset in the propensity score-matched cohort. Adjuvant therapy was associated with improved median OS for hilar tumors (40.0 vs 30.6 months; p = 0.025) but not distal tumors (33.0 vs 30.3 months; p = 0.123). Chemoradiotherapy was associated with superior outcomes compared with chemotherapy alone in the subset of margin-positive resection [hazard ratio (HR), 0.63; 95% CI 0.42-0.94]. CONCLUSIONS: Adjuvant multimodality therapy is associated with improved survival for patients with resected extrahepatic cholangiocarcinoma and high-risk features
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