Increasing data (INAA) on Ecuadorian obsidian artifacts: preliminary provenance and a clue for pre-Columbian eastward trade.

In this work we carried out INAA major (Na, K, Ca and Fe %) and trace (ppm) elements (plus Mn by FAAS analysis) of 15 obsidian samples (waste flakes) coming from an unknown archaeological site (14C-AMS age of 1425 AD) located on the south-eastern flank of the back-arc Sumaco volcano, in the Sub-Andean Ecuador (to the east of the Cordillera Real) and from two already known pre-Columbian archaeological localities: La Florida (Quito) and Milan (Cayambe). Literature compositional data of the Ecuadorian obsidian outcrops (Bigazzi et al., 1992, Asaro et al., 1994, Bellot-Gurlet et al., 1999, 2008) provide some constraints on the provenance of the analyzed waste flakes, even though different methods of analyses make comparisons a difficult task. Concerning the obsidian artifacts of La Florida and Milan, they come from the well known Sierra de Guamanì obsidian sources (Cordillera Real). By contrast, the obsidian fragments of the Sumaco settlement show Mn-rich, U- Th-poor compositions and relatively high Nb/Zr ratios, these characters being compatible with obsidian erratic pebbles recently discovered by Bellot-Gurlet et al. (2008) in some river banks of the Amazonian foothills draining the easternmost flanks of the Antisana volcano in the Cordillera Real as well. In this way, the obsidian artifacts found at the Sumaco site reinforce the opinion of Bellot-Gurlet et al. (2008) that Ecuadorian source inventory is not yet exhaustive. These preliminary inferences of provenance for the Sumaco obsidian findings would however need to be furtherly tested with the same analytical methods on both artifacts and sources. The Antisana volcano, located 30 km to WNW of the Amazonian foothills, seems to be the best candidate to find out additional primary outcrops of obsidian sources. Obsidian ancient trade was well established in Ecuador among the Andean people of the Cordillera Real and between them and people of the Pacific coast, whereas an eastward trade toward the rainforest people was never documented. In this framework, the archaeometric study of the obsidian samples of the 1425 AD site of Sumaco, located well eastward of the Cordillera Real, is of paramount importance in tracing the ancient routes of the obsidian trade toward the Amazonian region. It can not be also excluded that sub-Andean and Amazonian people direcly took advantage from obsidian secondary sources (i.e. within the river banks of the Amazonian foothills) rather than procurements from primary outcrops in the Cordillera Real

Die Behandlungspraxis bei Patienten mit isolierter stumpfer Milzverletzung: Eine Befragung der Schweizer Traumatologen

Zusammenfassung: Hintergrund: Das nicht-operative Management (NOM) des stumpfen Milztraumas hat sich in den vergangenen Jahren als Therapiekonzept etabliert. Es bestehen jedoch zahlreiche Kontroversen bezüglich der Überwachung und Nachsorge dieser Patienten. Ziel dieser Studie war es, mittels einer Umfrage bei Mitgliedern der Schweizerischen Gesellschaft für Allgemeine und Unfallchirurgie (SGAUC) die aktuelle Praxis bezüglich NOM beim isolierten Milztrauma zu erfassen und mögliche Diskrepanzen zur aktuellen Literatur zu eruieren. Studiendesign und Untersuchungsmethode: Sämtliche praktizierende Mitglieder der SGAUC wurden mittels schriftlichem Umfragebogen adressiert. Dieser enthielt Fragen zu Person und Klinik des Chirurgen, Fragen zu Diagnostik und Management während der Hospitalisation sowie zu radiologischen Verlaufskontrollen und zur stufenweisen Wiederaufnahme von Alltagsaktivitäten. Ergebnisse: An der Umfrage nahmen 52 von 165 (31,5%) praktizierenden Mitgliedern der SGAUC teil. Diese deckten 62,8% aller Schweizer Traumazentren ab. Vierzehn Befragte (26,9%) verfügen an ihrer Klinik über ein Protokoll zur Behandlung des Milztraumas. Als initiale Bildgebung beim hämodynamisch stabilen Patienten mit stumpfem Abdomaninaltrauma gaben 82,7% der Befragten die Sonographie an. Bei sonographischem Verdacht auf Milztrauma verzichteten allerdings 19,2% der Befragten auf eine weitergehende Diagnostik. Die Hälfte der Chirurgen gab außerdem an, bei sichtbarem Kontrastmittelextravasat aus der Milz keine weiteren therapeutischen Maßnahmen einzuleiten. 86,5% der Befragten würden Patienten mit niedriggradigem Milztrauma für durchschnittlich 1,6 (0-4Tage) in einem kontinuierlich-monitorisierten Bett überwachen. Keine Unterschiede wurden hinsichtlich der Aktivitätsrestriktion zwischen mittel- und hochgradigen Milztraumata gemacht. Schlussfolgerung: Aufgrund eines Mangels an evidenzbasierten Richtlinien zum NOM des Milztraumas gibt es eine beträchtliche Variabilität in der klinischen Praxis selbst unter erfahrenen Chirurgen. Die größten Diskrepanzen zu den Empfehlungen in der aktuellen Literatur waren zum einen der Verzicht auf eine Computertomographie bei Verdacht auf Milztrauma, zum anderen das konservative Vorgehen trotz nachgewiesenem Kontrastmittelaustrit

Nurturing the young shoots of talent: Using action research for exploration and theory building

This is an Author's Accepted Manuscript of an article published in European Early Childhood Education Research Journal, 19(4), 433-450, 2011, copyright Taylor & Francis, available online at: http://www.tandfonline.com/10.1080/1350293X.2011.623515.This paper reports the outcomes of a set of action research projects carried out by teacher researchers in 14 local education authorities in England, working collaboratively with university tutors, over a period of three years. The common aim of all the projects was to explore practical ways of nurturing the gifts and talents of children aged four–seven years. The project was funded by the Department of Education and Skills in England as part of the government's gifted and talented programme. The project teachers felt that their understanding of issues relating to nurturing the gifts and talents of younger children was enhanced through their engagement in the project. It was possible to map the findings of the projects to the English government's National Quality Standards for gifted and talented education which include: (1) identification; (2) effective provision in the classroom; (3) enabling curriculum entitlement and choice; (4) assessment for learning; (5) engaging with community, families and beyond. The findings are also analysed within the framework of good practice in educating children in the first years of schooling. Participating practitioners felt that action research offered them a suitable methodology to explore the complexity of the topic of giftedness through cycles of planning, action and reflection and personal theory building

The Impact of the Introduction of Total Mesorectal Excision on Local Recurrence Rate and Survival in Rectal Cancer: Long-Term Results

Purpose: To investigate the influence of the introduction of total mesorectal excision (TME) on local recurrence rate and survival in patients with rectal cancer. Methods: A total of 171 consecutive patients underwent anterior or abdominoperineal resection for primary rectal cancer. When the TME technique was introduced, the clinical setting, including the surgeons, remained the same. Group 1 (1993-95, n=53) underwent conventional surgery and group 2 (1995-2001, n=118) underwent TME. All patients were followed for 7years or until death. Results: Between the two groups, no statistically significant differences were present with regards to patient-, treatment-, or tumor-related characteristics apart from the time point of radiotherapy. The total local recurrence rates were 11 of 53 (20.8%) in group 1 and 7 of 118 (5.9%) in group 2, and the rates of isolated local recurrences were 6 of 53 (11.3%) in group 1 and 2 of 118 (1.7%) in group 2. Both differences were highly statistically significant. The disease-free survival in groups 1 and 2 was 60.4 and 65.3% at 5years, and 58.5 and 65.3% at 7years, respectively. Excluding patients with synchronous or metachronous distant metastasis from the analysis, both the disease-free survival and the cancer-specific survival were statistically significantly better in group 2 than in group 1. No statistically significant difference between the two groups was detected regarding the overall survival. Conclusions: The introduction of TME led to an impressive reduction of the local recurrence rate. Survival is mainly determined by the occurrence of distant metastasis, but TME seems to improve survival in patients without systemic diseas

Imaging-Guided Percutaneous Puncture and Embolization of Visceral Pseudoaneurysms: Feasibility and Outcomes

Visceral artery pseudoaneurysms (VAPAs) are the most frequently diagnosed pseudoa-neurysms (PSAs). PSAs can be asymptomatic or symptomatic. The aim of our study was to evaluate the safety and effectiveness of percutaneous embolization of VAPAs performed on patients with an unfeasible trans-arterial approach. Fifteen patients with fifteen visceral PSAs, with a median dimension of 21 mm (IQR 20–24 mm), were retrospectively analyzed. No patients were suitable for trans-arterial catheterization and therefore a percutaneous approach was chosen. During percutaneous treatments, two embolic agents were used, either N-butyl cyanoacrylate (NBCA) (Glubran II, GEM Milan, Italy) mixed with Lipiodol (Lipiodol, Guerbet, France) or thrombin. The outcomes of this study were technical success, primary clinical success, and secondary clinical success. In our population the 15 PSA were located as follows: 2 in the left gastric artery, 1 in the right gastric artery, 3 in the right hepatic artery, 2 in a jejunal artery, 1 in left colic artery branch, 1 in a right colic artery branch, 1 in the gastroepiploic artery, 1 in the dorsal pancreatic artery, 1 in an ileocolic artery branch, 1 in an iliac artery branch, and 1 in a sigmoid artery branch. 80% of PSAs (12/15) were treated with a NBCA:lipiodol mixture and 20% of PSAs (3/15) were treated with thrombin. Technical, primary, and secondary clinical successes were obtained in 100% of the cases. No harmful or life-threatening complications were observed. Minor complications were registered in 26.6% (4/15) of the patients. Percutaneous embolization of visceral PSA is a safe and effective treatment and should be considered as an option when the endovascular approach is unsuccessful or unfeasible

Surveillance for Hepatocellular Carcinoma Also Improves Survival of Incidentally Detected Intrahepatic Cholangiocarcinoma Arisen in Liver Cirrhosis

Background: Due to its poor survival, intrahepatic cholangiocarcinoma (ICC) is held to be a much more aggressive cancer than hepatocellular carcinoma (HCC). In most published series, patients were diagnosed when symptomatic. However, ICC is now increasingly being discovered during the surveillance for HCC in cirrhosis. Whether this earlier detection of ICC is associated with an equally dismal prognosis or not is unknown. Methods: This is amulticenter retrospective study of consecutive ICC patients. Patients were stratified into subgroups according to the absence/presence of cirrhosis. A propensity score matching was performed to reduce the potential biases. Cirrhotic patients were further stratified according to their surveillance status. The lead-time bias and its potential effects were also estimated. Results: We gathered 184 patients. Eighty-five patients (46.2%) were cirrhotic. Liver cirrhosis was not related to a worse overall survival (33.0 vs. 32.0 months, p = 0.800) even after the propensity score analysis (43.0 in vs. 44.0 months in 54 pairs of patients, p = 0.878). Among the cirrhotic population, 47 (55.3%) patients had received a diagnosis of ICC during a surveillance programme. The 2 subgroups differed in maximum tumour dimensions (30 vs. 48 mm in surveyed and non-surveyed patients, respectively). Surveyed patients were more likely to receive surgical treatments (59.8 vs. 28.9%, p = 0.003). Overall survival was higher in surveyed patients (51.0 vs. 21.0 months, p 0.001). These benefits were confirmed after correcting for the lead-time bias. Conclusions: Cirrhotic patients have different clinical presentation and outcomes of ICC according to their surveillance status. In our series, ICC in cirrhosis was not associated with worse OS. Cirrhosis itself should not discourage either surgical or non-surgical treatments

Life cycle inventory data for the Italian agri-food sector: background, sources and methodological aspects

AbstractPurposeFor the development of any life cycle assessment study, the practitioner frequently integrates primary data collected on-field, with background data taken from various life cycle inventory databases which are part of most commercial LCA software packages. However, such data is often not generally applicable to all product systems since, especially concerning the agri-food sector, available datasets may not be fully representative of the site specificity of the food product under examination. In this context, the present work investigates the background, sources and methodological aspects that characterise the most known commercial databases containing agri-food data, with a focus on four agri-food supply chains (olive oil, wine, wheat products and citrus fruit), which represent an important asset for the Italian food sector.MethodsSpecifically, the paper entails a review of currently available LCI databases and their datasets with a twofold scope: firstly, to understand how agri-food data is modelled in these databases for a coherent and consistent representation of regional scenarios and to verify whether they are also suitable for the Italian context and, secondly, to identify and analyse useful and relevant methodological approaches implemented in the existing LCI databases when regional data are modelled.ResultsBased on the aforementioned review, it is possible to highlight some problems which may arise when developing an LCI pertaining to the four Italian agri-food supply chains, namely:1. The need for specific inventory datasets to tackle the specificities of agri-food product systems.2. The lack of datasets, within the existing DBs, related to the Italian context and to the abovementioned supply chains. In fact, at present, in the currently available LCI DBs, there are very few (or in some cases none) datasets related to Italian wine, olive oil, wheat-based products and citrus fruit. The few available datasets often contain some data related to the Italian context but also approximate data with that of product systems representing other countries.Furthermore, the present study allowed to identify and discuss the main aspects to be used as starting elements for modelling regional data to be included in a future Italian LCI database of the abovementioned four supply chains.ConclusionsThe results of the present study represent a starting point for the collection of data and its organisation, in order to develop an Italian LCI agri-food database with datasets which are representative of the regional specificities of four agri-food supply chains which play an important role in the Italian economy