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111.
Joseph R. Habib Benedict Kinny-Köster Floortje van Oosten Ammar A. Javed John L. Cameron Kelly J. Lafaro Richard A. Burkhart William R. Burns Jin He Elizabeth D. Thompson Elliot K. Fishman Christopher L. Wolfgang 《Surgery》2021,169(5):1026-1031
Most patients diagnosed with pancreatic cancer are classified as nonoperative candidates based on the contemporary guidelines of resectability. The advent of more potent control of systemic disease using neoadjuvant chemotherapy has enabled more aggressive operative interventions. In our multidisciplinary practice, patients with Stage III, locally advanced pancreatic cancer and superior mesenteric artery (SMA) encasement are now carefully triaged with high quality, preoperative imaging to determine if they can be considered candidates for operative resection with periadventitial dissection of the SMA. Patients displaying a “halo sign,” where the encased SMA remains fully patent and free from arterial invasion, are now candidates for SMA periadventitial dissection. This procedure involves the surgical stripping of the infiltrated neurolymphatic tissue off the SMA leaving behind a bare “skeletonized artery.” Alternatively, the “string sign” involving the SMA confers a more likely case of arterial invasion, where a complete oncologic resection cannot be achieved successfully. This method of patient selection in case of SMA involvement abandons the traditional metrics of circumferential degrees of the arterial encasement to guide surgical decisions. Our institutional approach has allowed us to meaningfully expand our operative methods of resection with the potential for improved longitudinal outcomes to pancreatic cancer patients who were deprived historically from the more effective and possibly curative treatment. 相似文献
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Ruth Naughton-Doe MSc PhD Ailsa Cameron MSc John Carpenter B.Sc. Cert. App. Soc. Studies C.Q.S.W. C.Psychol. AFBPsS DSc 《Health & social care in the community》2021,29(5):1285-1295
This paper explores the potential contribution of timebanking, an innovative volunteering scheme, to the co-production of preventive social care with adults in England. Interest in volunteering in social care has increased as one proposed solution to the international crisis of a rising demand for services in juxtaposition with decreased resources. Volunteering has been particularly promoted in preventive services that prevent or delay care needs arising. Despite sustained interest in volunteering and co-production in social care, little is known about how theory translates into practice. Reporting implementation data from a Realistic Evaluation of six case studies in England, this paper explores one volunteering scheme, timebanking. The research explores how timebanks were working, what contribution they can make to adult social care, and whether they are an example of co-production. Data collected included interviews, focus groups or open question responses on surveys from 84 timebank members, and semi-structured interviews with 13 timebank staff. Each timebank was visited at least twice, and all timebank activity was analysed for a period of 12 months. Data were triangulated to improve reliability. The research found that in practice, timebanks were not working as described in theory, there were small numbers of person-to-person exchanges and some timebanks had abandoned this exchange model. Timebanks faced significant implementation challenges including managing risk and safeguarding and the associated bureaucracy, a paternalistic professional culture and the complexity of the timebank mechanism which required adequate resources. Lessons for timebanks are identified, as well as transferable lessons about co-production and volunteering in social care if such schemes are to be successful in the future. 相似文献
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Established lines of SV40-transformed human amnion cells 总被引:3,自引:0,他引:3
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O G Cameron J G Modell R D Hichwa B W Agranoff R A Koeppe 《Journal of cerebral blood flow and metabolism》1990,10(1):38-42
Eight healthy right-handed young men were subjected to local CBF measurement by [15O]water and positron emission tomography during partial sensory deprivation and during sensory-cognitive activation; physiological, hormonal, and subjective stress measurements were also performed. Results indicated that (a) "whole-brain" CBF increased during activation; (b) the greatest increase in CBF was in the primary visual cortex; (c) differences between hemispheres were not observed, but CBF was greater anteriorly than posteriorly in the deprivation condition only; (d) within-subject variability of CBF was not influenced by the sensory-cognitive condition; and (e) the procedure was not stressful. 相似文献
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New community-based preventive initiatives are required if a reduction in deliberate self-poisoning is to be achieved. Local epidemiological data can be used in a health education approach, directed at professionals who have the most contact with potential cases of deliberate self-poisoning and also to those people falling within identified high-risk groups. Such initiatives require defined outcome measures and a number are proposed. The implications for data collection on deliberate self-poisoning are discussed. 相似文献