Background We describe a novel laparoscopic “clam shell” partial fundoplication, incorporating a modified Toupet with an anterior fundic flap for the management of medically recalcitrant ...gastroesophageal reflux disease. We hypothesize that this clam-shell–like mechanism allows a dynamic rather than rigid circumferential antireflux barrier allowing effective reflux control (compared with partial fundoplication) with reduced occurrence of postoperative dysphagia, gas bloating and vagal nerve injury (compared with Nissen fundoplication). Methods Between November 2002 and May 2006, 140 patients (82 female; mean age, 53 years) underwent this laparoscopic clam shell fundoplication procedure for medically recalcitrant gastroesophageal reflux disease (n = 94) or large paraesophageal hernias (n = 46). Preoperative invasive studies (endoscopy, manometry, pH monitoring) and noninvasive studies (barium swallow and radionuclide gastroesophageal motility) revealed esophageal dysmotility in 26 patients. Routine barium swallow and radionuclide studies were performed 6 months postoperatively and then at yearly intervals. Results There was no mortality or conversions to open procedures. Mean operative time was 45 minutes; median hospital stay was 1 day (range, 1 to 4). Overall control of reflux symptoms was seen in 95% of patients. Postoperative gas bloating and significant dysphagia occurred in only 11% and 6% of patients, respectively. Three patients (2%) experienced postoperative complications (pneumonia, 2; pleural effusion requiring drainage, 1). Postoperative studies demonstrated reflux in 8 patients (5%) and the presence of small hiatal hernias in 5 patients (4%) during a mean follow-up 19 months (range, 7 to 42). Twenty five patients (17%) underwent postoperative esophageal dilation (median dilations, 1; range, 1 to 3) for dysphagia (11 of these patients had preoperative esophageal dysmotility). Five patients underwent repeat fundoplication (recurrent reflux, 2; gas bloating, 1; dysphagia, 2). Conclusions Clam shell near-circumferential fundoplication may be considered as an attractive alternative antireflux approach to Nissen fundoplication, particularly among patients at risk for postoperative dysphagia or gas bloating.
This study examined the effectiveness of an emotions education program (SELF-AWARE) for preservice teachers on their emotional awareness and their emotion-related social behaviors when interacting ...with children at the Auburn University Early Learning Center (AUELC) as observed by Head Teachers. It was hypothesized that preservice teachers that received SELF-AWARE would have an increase in emotional awareness in comparison to a control group of students, and an increase in their emotion-related social behaviors in comparison to nonparticipating AUELC preservice. Regression analyses were conducted to examine how posttest scores of emotional awareness and emotion-related behaviors differed from pretest scores of those variables. Anxiety, attachment, and training dosage were included as control variables, along the interaction of condition and time. The regressions indicated an increase in emotional awareness and emotion-related behaviors irrespective of the condition. An interesting finding existed; reported insecure attachment was related to participants reporting a greater ability to describe their emotional experiences at posttest.
This research evaluated the role of the rural pastor in making mental health referrals. A questionnaire was mailed to pastors in several rural California counties in order to assess the referral ...patterns of pastors to mental health professionals. The questionnaire consisted of demographic information and Likert-style questions inquiring about pastoral interaction, willingness to refer, and referral history with mental health professionals. It was expected that many variables including levels of education, counseling experience, exposure to mental health, specific denominations, and belief systems would affect the referral pattern to mental health professionals. It was also expected that all rural pastors would be more likely to refer to a religious versus a nonreligious mental health professional. Results of the findings were significant at .01–.05 levels. These rural pastors were significantly more willing to refer to a mental health professional with a similar belief system. Correlational results showed that several variables seemed to increase the likelihood to refer to an atheist, agnostic, non-Christian, Christian, or similar-believing mental health professional. The results suggest that while the mental health professionals' belief system seems to be the most significant factor in a pastor's decision to refer, other variables may increase the pastor's willingness to consider a referral to those who have a dissimilar belief system and whom he or she does not know. Rural pastors appear to have some distrust of the mental health profession, but many of them are willing to refer if they do not feel capable in addressing the laymen's concerns. Therefore, for the rural mental health professional with a same or similar belief system as the pastor, building a relationship with the pastor would be an efficient means of initiating a referral source. The results indicate that the rural pastor is more likely to refer to a mental health professional with a dissimilar belief system if the pastor has had prior exposure to a mental health professional; mental health education; or experience in psychology, counseling, or mental health.
Self-medication provides a compelling explanation of motive for a woman to overuse and become dependent on alcohol and drugs, especially given intense stress symptoms that are characteristically ...manifested in response to chronic and traumatic victimization, such as childhood abuse and/or spousal battering. This study sampled 78 battered women, using validated pen and paper instruments to measure the variables of substance abuse, severity of battering, childhood physical and sexual abuse, and Posttraumatic Stress Disorder (PTSD). Significant correlations were found between severity of battering and victim alcohol abuse and between childhood sexual abuse and victim alcohol abuse, supporting a self-medication model. Multiple regressions yielded childhood sexual abuse as the strongest predictor of victim alcohol abuse, when parental substance abuse was statistically controlled.
Subleasing Rules for the Road Clark, Alicia B
National Real Estate Investor,
01/2010, Letnik:
52, Številka:
1
Magazine Article, Trade Publication Article
When Associates Commercial Corp. needed more office space and wanted to move, it hoped the process would be easy. There was a tenant in the same building who wanted to sublease its space. All that ...Associates Commercial needed was permission from the landlord. It wasn't so simple. The landlord, Bayou Management, refused to give consent. Associates Commercial paid 13 months rent and an early lease termination fee. The landlord then leased the space to the company that Associates Commercial had initially proposed, charging the new tenant a higher rent. Associates Commercial sued, and the landlord had to refund the rent and termination fee. This landmark case from the early 1980s shows the importance of spelling out sublease terms in the original lease to avoid the courtroom.
Sustainability Science: Toward a Synthesis Clark, William C; Harley, Alicia G
Annual review of environment and resources,
10/2020, Letnik:
45, Številka:
1
Journal Article
Recenzirano
Odprti dostop
This review synthesizes diverse approaches that researchers have brought to bear on the challenge of sustainable development. We construct an integrated framework highlighting the union set of ...elements and relationships that those approaches have shown to be useful in explaining nature-society interactions in multiple contexts. Compelling evidence has accumulated that those interactions should be viewed as a globally interconnected, complex adaptive system in which heterogeneity, nonlinearity, and innovation play formative roles. The long-term evolution of that system cannot be predicted but can be understood and partially guided through dynamic interventions. Research has identified six capacities necessary to support such interventions in guiding development pathways toward sustainability. These are capacities to (
a
) measure sustainable development, (
b
) promote equity, (
c
) adapt to shocks and surprises, (
d
) transform the system into more sustainable development pathways, (
e
) link knowledge with action, and (
f
) devise governance arrangements that allow people to work together in exercising the other capacities.
The History of Zarzuela Alicia García Clark
The Hispanic outlook in higher education,
10/2006, Letnik:
17, Številka:
2
Magazine Article
It started during the 1630s, when King Phillip IV developed a taste for music and theater and had presentations at his hunting lodge near Madrid, known as La Zarzuela because of the brambles (zarzas) ...that surround it. From the very beginning, some of the performances at La Zarzuela mixed singing and dialogues, while others were composed to imitate Italian operas. To stage such operas for the king meant robbing the Teatro del Buen Retiro in Madrid of almost all its singers and musicians. They then produced lighter pieces that soon came to be known as "fiestas de la zarzuela." By the end of the century, they were called simply "zarzuelas." The Género Chico developed after the revolution of 1868. Composers drew such popular music as the "schottische" and the "mazurca" that the Madriléños had come to consider as part of their folklore. It was so successful and the demand so great that, in the 1890s, 1,500 examples were produced. Some of those works remain popular till today: Breton's La Verbena de la Paloma, Chapi's and Balverde's La Gran Via, Gerónimo Jiménez's Las Bodas de Luis Alonso, Callero's Gigantes y Cabezudos, to name a few.
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