631 research outputs found
A sociological history of Christian worship
No full textIn this book the 2000-year history of Christian worship is viewed from a sociological perspective. Martin Stringer develops the idea of discourse as a way of understanding the place of Christian worship within its many and diverse social contexts. Beginning with the Biblical material the author provides a broad survey of changes over 2000 years of the Christian church, together with a series of case studies that highlight particular elements of the worship, or specific theoretical applications. Stringer does not simply examine the mainstream traditions of Christian worship in Europe and Byzantium, but also gives space to lesser-known traditions in Armenia, India, Ethiopia and elsewhere. Offering a contribution to the ongoing debate that breaks away from a purely textual or theological study of Christian worship, this book provides a greater understanding of the place of worship in its social and cultural context.--From publisher description
A sociological history of Christian worship
No full textIn this book the 2000 year history of Christian worship is viewed from a sociological perspective. Martin Stringer develops the idea of discourse as a way of understanding the place of Christian worship within its many and diverse social contexts. Beginning with the Biblical material the author provides a broad survey of changes over 2000 years of the Christian church, together with a series of case studies that highlight particular elements of the worship, or specific theoretical applications. Stringer does not simply examine the mainstream traditions of Christian worship in Europe and Byzantium, but also gives space to lesser-known traditions in Armenia, India, Ethiopia and elsewhere. Offering a contribution to the ongoing debate that breaks away from a purely textual or theological study of Christian worship, this book provides a greater understanding of the place of worship in its social and cultural context
A Sociological History of Christian Worship
No full textIn this book the 2000 year history of Christian worship is viewed from a sociological perspective. Martin Stringer develops the idea of discourse as a way of understanding the place of Christian worship within its many and diverse social contexts. Beginning with the Biblical material the author provides a broad survey of changes over 2000 years of the Christian church, together with a series of case studies that highlight particular elements of the worship, or specific theoretical applications. Stringer does not simply examine the mainstream traditions of Christian worship in Europe and Byzantium, but also gives space to lesser-known traditions in Armenia, India, Ethiopia and elsewhere. Offering a contribution to the ongoing debate that breaks away from a purely textual or theological study of Christian worship, this book provides a greater understanding of the place of worship in its social and cultural context.</jats:p
A Strain-Based Health Indicator for the SHM of Skin-to-Stringer Disbond Growth of Composite Stiffened Panels in Fatigue
No full textReal-time Structural Health Monitoring (SHM) of aeronautical structural components is a technology persistently investigated the last years by researchers and engineers to potentially reduce the cost and/or implementation of scheduled maintenance tasks. To this end, various types of sensors have been proposed to serve this role, e.g. piezoelectric, acoustic emission, and strain sensors. In the present paper, a strain-based SHM methodology is proposed for skin/stringer disbond propagation health monitoring. Fiber-optic strain sensors with engraved Bragg gratings are utilized in order to evaluate the propagation of artificially-induced disbonds at single-stringered composite panels. The specimens are subjected to a block loading compression-compression fatigue spectrum. Longitudinal static strains are periodically acquired during quasi-static loadings every 500 cycles. A Health Indicator (HI), based on strains received from the stringer’s feet, is proposed and utilized to monitor the disbond growth. The evolution of this indicator is experimentally monitored throughout the lifespan of the specimens. The present paper verifies and consolidates via actual fatigue experiments the potential of the proposed static-strain based HI developed from numerical data in our previous work.Green Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Structural Integrity & Composite
Orientation dependence of THz scattering from cylindrical strands
No full text© Copyright 2009 IEEE – All Rights ReservedScattering of terahertz radiation from cylindrical strands is explored as a means of studying the effects of hair on the results of bio-tissue analysis. Strands of fiberglass are aligned either parallel or perpendicular to the polarization vector of the incoming terahertz beam. Spectroscopic results reveal that the material's intrinsic THz transmission properties are highly dependent on fiber orientation. ©IEEE.Gretel M. Png, Mark R. Stringer, Brian W.-H. Ng, Derek Abbott and Robert E. Mileshttp://ieeexplore.ieee.org/xpls/abs_all.jsp?arnumber=466551
The Human Ileocaecal Junction: An Anatomical Study using Classical and Modern Techniques
No full textIntroduction
As a major site of regulation of the physiological unidirectional flow of gastrointestinal content, the human ileocaecal junction (ICJ) is an important structure for the health of the individual. Although historically it has been considered as a valve, other evidence points to its action as a sphincter. Within the literature, debate continues over the anatomy and action(s) of the ICJ, which prompted further investigation of the anatomy of this discrete region using a combination of established and modern techniques. This is not only important in advancing our understanding of this region but also may assist investigators attempting to devise structures that mimic the actions of the ICJ in patients with distressing symptoms following its surgical removal. The aim of this investigation was to test several hypotheses concerned with the concept that the ICJ is an anatomically specialised region in terms of its musculature, vasculature, nerve supply and distribution of interstitial cells of Cajal (ICCs).
Methods and Materials
A total of 27 ileocaecal specimens were obtained for this study (20 cadaver and seven surgical, 12 male, mean age 78 years, age range 49-94 years). Of these, 10 cadaver and five surgical samples were prepared and processed for histology. Surgical samples were also investigated using immunohistochemistry to identify the following antigens: S100 (neural marker), PGP 9.5 (neural marker) and CD117 (a marker for interstitial cells of Cajal). ImageJ was used for quantitative muscle and vascular analyses within histology sections, and for analysis of S100 immunolabelled sections. Observations within the ileal papilla were compared to the adjacent caecum and terminal ileum. Statistical analyses were undertaken using Student’s t-tests, Technical Error of Measurement (TEM) and Intra-class Correlation Coefficient (ICC). Resin injected vascular corrosion casts were produced from two fresh cadaver ICJ specimens. Seven cadaver and one surgical specimen were used to produce ultrathin (1mm) E12 plastinated slices of the junction for qualitative observations and three-dimensional reconstruction. The poor quality of one cadaver and one surgical specimen precluded further analysis.
Results
The muscularis externa was thickest at the base of the ileal papilla (4.18 ± 0.4mm), with a gradual increase in thickness in the distal 13mm of the terminal ileum and a gradual tapering towards the tip of the ileal papilla. No secondary muscle thickening was located within the ileal papilla. There was no evidence of increased submucosal vascularity in the ileal papilla compared to the adjacent ileum (p = 0.35) or caecum/colon (p = 0.16) but the inferior lip was more vascular than the superior lip (p = <0.01). The density of S100 immunolabelling was less in the caecum and ileal papilla compared to the terminal one centimetre of ileum (p = <0.01). PGP 9.5 and CD117 positively labelled neuronal and interstitial cells of Cajal within the myenteric plexus, but there was no obvious difference in their density within the ileal papilla compared to the adjacent terminal ileum and caecum. The ICJ was well demonstrated by ultrathin E12 slice plastination enabling the construction of a three-dimensional model of the musculature of the region. The two resin vascular corrosion casts supported the histological observation that the ileal papilla itself was not more vascular than the adjacent terminal ileum but appeared more vascular than the adjacent caecum.
Conclusion
In this novel quantitative study of the musculature of the human ICJ, there was evidence of a discrete thickening of the muscularis externa at the base of the papilla consistent with the concept of an anatomical sphincter. There was no anatomical evidence to support a secondary sphincter within the ileal papilla. Neither was there evidence of an increase in vascularity in the ileal papilla or greater density of innervation, contradicting previous suggestions within the literature. These anatomical investigations of the musculature, vascularity, innervation, and distribution of interstitial cells of Cajal within the human ileocaecal junction do not suggest that it is a highly specialised region compared to the adjacent terminal ileum and caecum but are consistent with a sphincteric function. The term ileocaecal valve is misleading and should be replaced by ileocaecal junction
The Human Ileocaecal Junction: An Anatomical Study using Classical and Modern Techniques
Get PDFIntroduction
As a major site of regulation of the physiological unidirectional flow of gastrointestinal content, the human ileocaecal junction (ICJ) is an important structure for the health of the individual. Although historically it has been considered as a valve, other evidence points to its action as a sphincter. Within the literature, debate continues over the anatomy and action(s) of the ICJ, which prompted further investigation of the anatomy of this discrete region using a combination of established and modern techniques. This is not only important in advancing our understanding of this region but also may assist investigators attempting to devise structures that mimic the actions of the ICJ in patients with distressing symptoms following its surgical removal. The aim of this investigation was to test several hypotheses concerned with the concept that the ICJ is an anatomically specialised region in terms of its musculature, vasculature, nerve supply and distribution of interstitial cells of Cajal (ICCs).
Methods and Materials
A total of 27 ileocaecal specimens were obtained for this study (20 cadaver and seven surgical, 12 male, mean age 78 years, age range 49-94 years). Of these, 10 cadaver and five surgical samples were prepared and processed for histology. Surgical samples were also investigated using immunohistochemistry to identify the following antigens: S100 (neural marker), PGP 9.5 (neural marker) and CD117 (a marker for interstitial cells of Cajal). ImageJ was used for quantitative muscle and vascular analyses within histology sections, and for analysis of S100 immunolabelled sections. Observations within the ileal papilla were compared to the adjacent caecum and terminal ileum. Statistical analyses were undertaken using Student’s t-tests, Technical Error of Measurement (TEM) and Intra-class Correlation Coefficient (ICC). Resin injected vascular corrosion casts were produced from two fresh cadaver ICJ specimens. Seven cadaver and one surgical specimen were used to produce ultrathin (1mm) E12 plastinated slices of the junction for qualitative observations and three-dimensional reconstruction. The poor quality of one cadaver and one surgical specimen precluded further analysis.
Results
The muscularis externa was thickest at the base of the ileal papilla (4.18 ± 0.4mm), with a gradual increase in thickness in the distal 13mm of the terminal ileum and a gradual tapering towards the tip of the ileal papilla. No secondary muscle thickening was located within the ileal papilla. There was no evidence of increased submucosal vascularity in the ileal papilla compared to the adjacent ileum (p = 0.35) or caecum/colon (p = 0.16) but the inferior lip was more vascular than the superior lip (p = <0.01). The density of S100 immunolabelling was less in the caecum and ileal papilla compared to the terminal one centimetre of ileum (p = <0.01). PGP 9.5 and CD117 positively labelled neuronal and interstitial cells of Cajal within the myenteric plexus, but there was no obvious difference in their density within the ileal papilla compared to the adjacent terminal ileum and caecum. The ICJ was well demonstrated by ultrathin E12 slice plastination enabling the construction of a three-dimensional model of the musculature of the region. The two resin vascular corrosion casts supported the histological observation that the ileal papilla itself was not more vascular than the adjacent terminal ileum but appeared more vascular than the adjacent caecum.
Conclusion
In this novel quantitative study of the musculature of the human ICJ, there was evidence of a discrete thickening of the muscularis externa at the base of the papilla consistent with the concept of an anatomical sphincter. There was no anatomical evidence to support a secondary sphincter within the ileal papilla. Neither was there evidence of an increase in vascularity in the ileal papilla or greater density of innervation, contradicting previous suggestions within the literature. These anatomical investigations of the musculature, vascularity, innervation, and distribution of interstitial cells of Cajal within the human ileocaecal junction do not suggest that it is a highly specialised region compared to the adjacent terminal ileum and caecum but are consistent with a sphincteric function. The term ileocaecal valve is misleading and should be replaced by ileocaecal junction
An evidence-based reappraisal of human surface anatomy
No full textSurface anatomy is routinely taught to medical and anatomy students and is a core component of human anatomy in clinical practice. Accurate surface anatomy and awareness of variations are both essential for safe clinical practice. Our knowledge of surface anatomy is largely derived from cadaver studies and radiographic investigations in living subjects. Numerous inconsistencies in clinically important surface markings exist between and within anatomical reference texts. Moreover, only a few texts comment on anatomical variation and the effects of respiration, posture, ethnicity and body build on surface anatomy. The aim of this thesis is to reassess the accuracy of common and clinically important surface landmarks in vivo using modern imaging techniques including ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI).
All three imaging modalities were selected to investigate different aspect of surface anatomy. Firstly, ultrasound was used to record the calibre and course of the accessory nerve in the posterior triangle of the neck in 50 healthy volunteers (mean age 37 years, range 18-62 years, 56% female). Secondly, 52 CT scans of the neck (mean age 63 years, range 30-94 years; 40% female), 153 thoracic CT scans (mean age 63 years, range 19-89 years, 53% female), 108 abdominal CT scans (mean age 60 years, range 18-97 years; 59% female) and 52 thoracoabdominal CT scans (mean age 61 years, range 26-86 years, 56% female) from supine adults at end tidal respiration were analysed to determine the surface anatomy of the neck (e.g. bony and cartilaginous structures), thorax (e.g. central veins and heart), abdomen (e.g. transpyloric plane and kidneys) and pelvis (e.g. plane of the pubic crest). Patients with distorting space-occupying lesions, scoliosis, abnormal kyphosis and lordosis, obvious visceromegaly, and a previous history of major injury were excluded. Thirdly, 45 cranial MRI scans (mean age 56 years, range 24-84 years; 56% female) were analysed to determine the surface anatomy of the central sulcus of the brain.
Some traditional surface landmarks were found to be accurate and reliable (e.g. the hard palate, cardiac apex, formation of the brachiocephalic veins, transpyloric plane). In contrast, some others were inaccurate and unreliable when compared with in vivo findings: the surface markings of the spinal accessory nerve in the posterior triangle of the neck were very variable with the nerve exiting the posterior border of sternocleidomastoid at a mean of 6.7 (4.0-9.4) cm below the mastoid process and penetrating the anterior border of trapezius 5.4 (2.1-9.2) cm above the clavicle; the central sulcus of the brain was located a mean of 2 ± 0.9 (0.3-4) cm behind the midpoint between the nasion and inion; the spleen was most frequently located between the 10th and 12th ribs (48%) with its long axis in line with the 11th rib (55%); the 11th rib was a posterior relation of the left kidney in only 28% of scans; and the level at which the inferior vena cava and oesophagus traversed the diaphragm was T11.
Whilst the surface anatomy of some structures is consistent with standard descriptions, that of other structures is inaccurate and must be revised in the light of results using modern imaging techniques in living subjects. An evidence-based framework is essential if surface anatomy is to be fit for purpose. The effects of gender, age, posture, respiration, build and ethnicity also deserve greater emphasis
Iatrogenic Upper Limb Nerve Injuries
Get PDFBackground: Complications due to errors made by health practitioners are a major cause of concern and a source of distress, disability, and death in patients. In addition, they are associated with litigation and impose a major financial burden on healthcare budgets. Peripheral nerve injuries are among the most frequent iatrogenic complications. Recently, numerous studies have explored specific iatrogenic nerve injuries and possible ways of improving patient safety and preventing error. However, there are few data on the spectrum and relative frequency of iatrogenic nerve injuries and no national studies have been undertaken.
Aim: To describe the current spectrum of iatrogenic upper limb nerve injuries in New Zealand, focusing particularly on injuries that have an anatomical and possibly preventable component.
Methods: Three studies were undertaken. (1) A systematic review of English biomedical literature in the last ten years relating to major iatrogenic upper limb nerve injuries. The context, mechanism and frequency of nerve injuries were recorded. (2) A retrospective analysis of the Accident Compensation Corporation‟s (ACC) accepted claims database from the first six months of 2009, focusing on iatrogenic nerve injuries. (3) An educational poster targeted at operating staff using international recommendations was produced in consultation with local practising anaesthesiologists.
Results: The systematic literature review revealed iatrogenic upper limb nerve injuries are relatively common and can affect patients in any surgical specialty. The spectrum of injuries has changed in parallel with technological advances in surgery and medicine. Analysis of the ACC‟s database revealed 151 successful treatment injury claims that could be classified as iatrogenic nerve injury during the study period. The majority of claimants were female (54.9%) and the elderly was over-represented with the median age being 51.5yrs, (range 0-83yrs). The five most frequent iatrogenic injuries were to the median nerve, sciatic nerve, common fibular nerve, radial nerve and ulnar nerve. An educational poster demonstrating the dos and don‟ts of upper limb positioning under general anaesthesia was successfully produced.
Conclusion: This study has described for the first time the contemporary spectrum of iatrogenic nerve injuries in New Zealand as reported to the ACC. Appreciation and raising awareness of the risks associated with medical procedures is an essential first step in developing and implementing strategies to reduce iatrogenic injuries and improve patient safety. This study provides invaluable data by highlighting the procedures that need most attention. Future application of these results will hopefully benefit everyone involved in the New Zealand healthcare system
Anatomical aspects of iatrogenic nerve injury
No full textIatrogenic nerve injury causes distress and disability, often leading to litigation. To date, the scale and profile of these injuries can only be estimated from published case reports or series, and medico-legal claims analyses. Some iatrogenic nerve injuries may be avoidable, but without understanding their spectrum and circumstances, the development or wider implementation of preventive strategies is limited.
A systematic review was undertaken to analyse recently published literature on iatrogenic nerve injury, selecting one major upper and lower limb nerve as examples. The databases MEDLINE, PubMed, Cochrane Library, and Google Scholar were searched for relevant reports published between January 2000 and October 2012, focusing on injury context, mechanism, and frequency. Case reports and series of specific nerve injuries accounted for most publications. Most injuries occurred in the context of surgery.
An observational study was undertaken to determine the contemporary spectrum of iatrogenic nerve injury in New Zealand, by analysing treatment injury claims accepted by the Accident Compensation Corporation (ACC) during 2009. The hypothesis was that this spectrum of nerve injury is different to that reported in the recent literature. Of 5,227 treatment injury claims examined, 313 were for iatrogenic nerve injury. Two-thirds occurred in surgical patients. Leading causes of injury were patient malpositioning under general anaesthesia and venepuncture, most often affecting the ulnar and median nerves, respectively. Both leading contexts were underreported in the literature. On the basis of these findings two further studies were performed.
The first investigated ulnar nerve blood supply in relation to upper limb positioning in supine adults. Colour Doppler ultrasound was used to assess the effect of elbow flexion (~120°) and shoulder hyperabduction (120°) on arterial resistance in two arteries supplying the ulnar nerve at the elbow, in 38 healthy adults. Both positions affected arterial resistance, but resistance in the posterior ulnar recurrent artery was significantly increased with elbow flexion. These findings provide novel insights into the potential mechanisms of ulnar nerve ischaemia secondary to upper limb positioning.
There were 26 claims for venepuncture-related nerve injury in the ACC analysis, mainly for median nerve damage, prompting the question whether phlebotomists have an adequate knowledge of anatomy. A questionnaire was sent to 49 registered phlebotomists in seven community laboratories in New Zealand, to survey their knowledge, education and experience of venepuncture-related nerve injury. Thirty-seven (76%) returned questionnaires, 29 of whom reported some education about nerve injury. Symptoms of injury were well described but knowledge of nerve anatomy in the cubital fossa was limited; only 25% of respondents recognised the median nerve as being at risk from venepuncture. Phlebotomists may benefit from further information about peripheral nerve injury, especially in relation to avoiding median nerve injury.
Iatrogenic nerve injury occurs in a wide range of contexts, and affects a variety of nerves. Some may be unavoidable, but many cases might be preventable by a better knowledge of relevant anatomy and a greater awareness of the contexts in which specific nerves are vulnerable. Educating healthcare professionals on this subject may help to reduce the frequency of this distressing iatrogenic complication
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