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Introduction Single-fraction intraoperative radiation therapy (IORT) has emerged as a therapeutic option in patients undergoing breast conserving therapy (BCT) for early stage breast cancer, often eliminating the need for postoperative external beam radiation therapy. However, if a positive margin is encountered after BCT, the patient will ultimately require external beam radiation therapy. The purpose of this study was to identify preoperative factors from patient demographics, preoperative workup, or biopsy results that may be predictive of postoperative margin status. Materials and Methods A retrospective chart review was performed on 396 patients who underwent BCT with IORT. Logistic regression models were utilized for statistical analysis. Results The majority of studied variables were similar; however, differences were noted for high-grade tumors, in situ status, and progesterone receptor-negative (PR−) tumors. Grade 3 tumors were significantly associated with positive margin status when compared with Grade 1 (odds ratio, 2.30; P = .036). PR− status tumors were found to be approximately 2 times more likely to have a positive margin (P = .028). Patients with in situ (stage 0) status tumors were 1.986 times more likely to have positive margins when compared with those with an invasive tumor (P = .030). Conclusions Higher grade PR− tumors are at increased risk of having a positive margin, which should be taken into consideration when considering treatment with IORT.

The purpose of this study was to investigate our institution's experience with pediatric firearm events. We sought to determine the relationship between a community's level of socioeconomic distress and the incidence of youth gun violence.We performed a retrospective review of children18 years involved in firearm events. Using visual cluster analysis, we portrayed all firearm events and violent firearm events (assaults + homicides). Distressed community indices (DCIs) were obtained from an interface that uses US Census Bureau data. Incident rate ratios (IRRs) were calculated for firearm circumstances (i.e. assault, homicide, suicide) using a DCI. Significant IRRs were analyzed to discern which DCI metrics contributed most to gun violence.There were 114 children involved in firearm events; 66 were county residents. The DCI of injury location significantly predicted total firearm events (IRR 1.02, 95% CI 1.01-1.03), assaults (IRR 1.02, 95% CI 1.01-1.05), and violent firearm events (IRR 1.03, 95% CI 1.01-1.05). The proportion of adults without a high school diploma, poverty rate, median income ratio, and housing vacancy rate were highly predictive of gun violence (VIP1).Community distress significantly predicts pediatric firearm violence. Local interventions should target neighborhoods with high levels of distress to prevent further youth gun violence.Retrospective study, IV.

Gastric banding for surgical treatment of morbid obesity has a complication rate of 20 to 50 per cent. Complications include band erosion, band slippage, and failed weight loss. One salvage procedure used is the laparoscopic sleeve gastrectomy. We aimed to compare our results between single-stage and two-stage conversation of gastric band with sleeve gastrectomy. We performed a retrospective review of 27 gastric band patients converted to sleeve gastrectomy. Hospital length of stay, surgical complications, and weight loss were compared. Twelve patients had a two-stage conversion and 15 patients had a single-stage conversion. There were no surgical complications in either group. There was a significant reduction in BMI after conversion, starting at one month and continuing forward to 12 months. The average BMI reduction over the two-year follow-up period was 8.19. There was no significant difference in length of hospital stay between the groups. Single-stage conversion of gastric band to sleeve gastrectomy does not lead to increased hospital length of stay or surgical morbidity. In the presence of gastric band slip or erosion, a two-stage approach is preferable. Conversion resulted in statistically significant weight loss in all patients.

Introduction Golf cart trauma in southeast Georgia represents a significant source of morbidity in the pediatric population. We believe these events are related to the introduction of new state legislation that allows local authorities to govern golf cart operation. Methods We performed a retrospective review from 2010 to 2016 of children involved in golf cart traumas (n = 46). We recorded age, gender, Glasgow Coma Scale score (GCS), Injury Severity Score (ISS), location of event, and patient position during event. Outcomes included injury type and length of stay (LOS). Results The most common position in a golf cart was a passenger (52.2%). Events varied regionally and correlated with stringency of local legislation. Skull fractures afflicted 48% (n = 22) of children and traumatic brain injuries (TBIs) were noted in 35% (n = 17) of patients. TBIs (LOS = 4.6 days, p = 0.006) and abdominal injuries (LOS = 8.5 days, p = 0.017) lengthened mean hospital stay. Increasing ISS was associated with an increased probability of sustaining a TBI (OR 1.295, p = 0.004). Younger children were more likely to sustain a skull fracture (OR 1.170, p = 0.034) while older children incurred more orthopedic injuries (OR 1.217, p = 0.045). Conclusion Skull fractures and TBIs are common following pediatric golf cart trauma. Georgia's varying municipality legislation likely contributes to the growing frequency of this trend. Level of Evidence Retrospective study, IV.

Venous thromboembolisms (VTEs) occur more frequently in patients with traumatic brain injuries (TBIs) and spinal cord injuries, yet the use of chemoprophylaxis is controversial. The purpose of this study was to investigate the relationship between the timing of chemical VTE prophylaxis initiation and the development of VTE events in these patients.Prospective data were collected and retrospectively reviewed on 1425 patients sustaining TBIs or spinal injuries from 2010 to 2014. Patients were reviewed with respect to age, gender, injury severity score, Glasgow coma score, and mechanism of injury as well as timing of initiation of chemical VTE prophylaxis and presence or absence of VTE.Patients who developed a VTE had a significantly longer time to initiation of chemical VTE prophylaxis (6.7 ± 4.9 d versus 4.7 ± 4.9 d, P 0.001) compared with those that did not develop a VTE. Also, for each 1 d increase in time to prophylaxis initiation, the odds of developing a VTE increased significantly (odds ratio = 1.055, P0.001). The combination subarachnoid hemorrhage/subdural hemorrhage group was started on VTE prophylaxis significantly later (8.3 ± 6.1 d versus 6.7 ± 3.9 d, P 0.01) than the overall TBI group and had a higher incidence of VTE (14.4 versus 10.4%, P = NS). In contrast, patients sustaining isolated spinal injuries received chemical VTE prophylaxis significantly earlier (3.4 ± 4.2 d versus 6.7 ± 3.9 d, P 0.001) and had a significant decrease in their VTE rate (4.4 versus 10.4%, P 0.0001) compared with the overall TBI group.Patients with VTEs had a significant delay in time to initiation of chemoprophylaxis compared with patients without VTEs. Patients sustaining a TBI had a 2-fold delay in initiation of chemoprophylaxis and an associated 2-fold increase in VTE events compared with patients who sustained spinal injuries. Of those patients who developed a TBI, patients who sustained a combination subarachnoid hemorrhage and/or subdural hemorrhage had a significant delay in initiation of chemoprophylaxis with a higher rate of VTE events.

When clinical examination is not reliable for brain death (BD) diagnosis, the preferred confirmatory test at our institution is nuclear medicine perfusion test (NMPT). Computed tomographic angiography (CTA) has been described as an alternative for BD confirmation. This study was designed to quantitatively analyze CTA, assess its accuracy compared with NMPT, and define set parameters for BD confirmation.This is a prospective clinical study, from 2007 to 2014, evaluating a consecutive series of clinically BD patients (n = 60) and randomly selected control group with normal CTA findings (n = 20). NMPT, used as the reference standard, was performed on all study patients followed immediately by CTA. Assessment of NMPT and quantitative CTA Hounsfield units of the horizontal segment of middle cerebral artery (M1), precommunicating segment of anterior cerebral artery (A1), and basilar artery (BA) was performed.In the study cohort, 88% demonstrated absence of cerebral blood flow (CBF) on NMPT; however, only 50% demonstrated absence on CTA. Together, 50% had no CBF on NMPT and CTA (Group 1), 38% had no CBF on NMPT but persistent CBF on CTA (Group 2), 12% had persistent CBF on both NMPT and CTA (Group 3). Analysis of variance demonstrated that all groups varied significantly for M1, A1, and BA (p0.001). We were able to establish criteria that differentiate persistent CBF on CTA as either preserved cerebral perfusion or stasis filling.We propose that a CTA Hounsfield units less than 80 in M1, A1, and BA is concordant with no CBF on NMPT, therefore indicative of a lack of physiologic cerebral perfusion, and thus allows the confirmation of BD with 97% sensitivity and 100% specificity.Diagnostic study, level II.

The article summarizes the results of the researches that have been conducted for the PIXE analyses of different north Australian pigments. The procedure, findings and the benefits of the analysis are all reported.

The methodological problems that arise in ex-post evaluation of agricultural projects are identified. The issues are illustrated by evaluation experience of a groundwater irrigation project in Jordan. The paper considers the implications of this analysis and experience for project appraisal. And in the light of this, the authors are critical of sophisticated appraisal methods, for several reasons, and urge a more simple approach to planning. Resume L'EVALUATION RETROACTIVE DES PROJETS AGRICOLES — SON IMPLICATION POUR LA PLANIFICATION Cet article cerne les problemes methodologiques qui surviennent dans l'evaluation retroactive des projets agricoles. Les questions qui se posent sont illustrees par l'experience faite dans l'evaluation d'un programme d'irrigation en Jordanie. L'article examine ensuite les implications de cette analyse et experience pour l'appreciation des projets et, a la lumiere de ce qui precede, les auteurs critiquent, pour plusieurs raisons, l'emploi des methodes d'appreciation trop elaborees et recommandent instamment l'adoption de theories beaucoup plus simples pour apprehender les problemes de la planification. Zusammenfassung EX-POST EVALUIERUNG LANDWIRTSCHAFTLICHER PROJEKTE - IHRE AUSWIRKUNG AUF DIE PLANUNG Die methodologischen Probleme, die sich aus der Evaluierung land-wirtschaftlicher Projekte ergeben, werden bestimmt. Die Folgerungen werden anhand einer Evaluierungserfahrung, gewonnen an einem Grundwasser Bewasserungsprojektes im Jordan, illustriert. Der Artikel betrachtet die Implikationen dieser Analyse und Erfahrung fur die Projektbewertung. Und in diesem Licht aussern sich die Autoren aus mehreren Grunden kritisch zu hochentwickelten Bewertungsmethoden und sie drangen auf einen einfacheren Zugang zur Planung.

For two hectic months in 1972 an I.L.O./U.N.D.P. mission gathered in Nairobi to deliberate on the employment problems facing Kenya. The report which was published before the end of the year received a good deal of publicity,1 much of it complimentary, and served as a blue print for subsequent I.L.O. employment missions to other developing countries.2 Six years later it seems opportune to review briefly those of its recommendations which were specifically aimed at the agricultural sector, and to assess the extent to which they have influenced the policies of the Government.

There were remarkable and sustained increases in agricultural and food production in the developing countries over the last three decades. But the fruits of this progress were not shared by all, and many remain in poverty. Some believe this due to the unequal distribution of benefits and accordingly claim that an agricultural strategy which focuses on reducing disparities of income, assets and access is the most important objective for agricultural development. This approach is justified by claims of wide and increasing disparities of income in the agricultural sectors of LDCs. This paper looks at the evidence for such claims and finds that they cannot be supported by hard evidence. Indeed, the few valid studies of agricultural income distribution show modest disparities. Accordingly, redistribution strategies, especially those aimed at uni-modal farm sectors, are rejected as unnecessary, undesirable and unachievable (without destroying the main spring of agricultural progress). On the contrary, it is urged that growth in productivity, output and incomes should be the dominant development objective to encourage, as many examples show, the enterprise, ability and energy of small farmers and their families. Such a strategy produces a degree of unequal distribution of benefits which reflects the distribution of personal qualities and endowments and acts as an incentive to their exercise. To keep disparities within bounds, agricultural policies relating to pricing, extension, credit, research and so on should aim at widening the number of small farmer beneficiaries of agricultural development.

There is a compulsive urge to seek generalised explanations of small farmer response and allocation behaviour. Such an achievement would certainly improve the formulation of effective policies and prediction of their effects. But, against a background of diverse technical, economic and socio-political endowments and constraints, together with varying and sometimes conflicting economic and socio-economic objectives, it seems reasonable to question whether it is possible to generalise about small farmer behaviour and decision-making. Early attempts to do this centred on the response of smallholders to price and other economic incentives. They were a reaction to the early theory of sociological dualism which regarded the smallholder sector as a backward, static area of activity, likely to remain so because of farmer inertia and unresponsiveness to economic advantage. The smallholder was satisfied with his lot and policies which aimed to increase his income were doomed to failure. Validation of the theory depended upon acceptance of the target income hypothesis and the associated notion of a backward-bending supply curve of labour.

Development of the methodology and practice of farming systems research (FSR) stems largely from the pioneering work of research workers at the Guatemalan Institute of Agricultural Science and Technology (ICTA), and certain of the International Agricultural Research Centres (IARCs), notably the International Maize and Wheat Improvement Centre (CIMMYT) in Mexico and the International Rice Research Institute (IRRI) in the Philippines. They have played a major role in the field application of FSR, including the Eastern Africa Programme of CIMMYT under the directorship of M. P. Collinson. From his considerable African experience, he independently evolved a farming systems approach to small farm management research. A similar approach was also used by D. W. Norman at Ahmadu Bello University in Nigeria. These three sources are naturally strong protagonists of FSR and they are in fairly close agreement on its methodology and procedures. However, they do place different emphases on the various aspects of procedure.

The uncertainty and marked seasonality of most tropical climates makes the use of hand labour for farm operations especially constraining. The hand labour economies of peasant agriculture are generally faced by ‘acute labour bottlenecks’ when the labour demands of seed-bed preparations, planting, weeding and often harvesting, can exceed the labour availability of the farm family. The need to ‘break these labour bottlenecks’ has encouraged the substitution of hand labour by animal and mechanical power to facilitate and speed up the performance of vital farm tasks. In many parts of the developing world, the use of mechanical farm power in smallholder agriculture has taken the form of the four-wheel tractor, being primarily used for cultivation and preparation of seed-beds. Although the decision to mechanise some farm operations can be taken on several grounds — economic, social, technical and political — the decision of the individual small farmer will generally be based on an economic criterion. In this case, a decision to mechanise will imply that the financial benefits of mechanisation will exceed the costs arising from it.

It is necessary to distinguish between farm management and farm management research. Farm management is what farmers do, but farm management research is what agricultural economists do. The definition and the aims of FMR have varied in time and space. The development and early practice of FMR was strongly anchored to the theory of the firm and profit maximising assumptions.

Although this quotation has an archaic ring, it nevertheless reminds us that the notion of ‘poverty’ being synonymous with ‘underdevelopment’ is not of recent origin. The alleviation of poverty has long been considered an essential goal of the development process and, in the decades since World War II, objectives have been postulated and strategies formulated which, it was hoped, would achieve this elusive goal.

It is a central theme of this book that an essential ingredient of sustained development and progress in peasant agriculture is its operation within a free enterprise economy — certainly as far as production and, in most cases, marketing of agricultural products is concerned.1 The main role of governments should be to provide conditions which are conducive to increasing agricultural productivity. Government should intrude, by appropriate policies and actions, to prevent undesirable distortions arising, for example, from employment-destroying technologies; an inequitable flow of the fruits of development to a limited group of beneficiaries; the monopsonistic domination of input delivery systems (of credit, fertiliser, extension advice, etc.) by a politically or economically dominant group; the appearance of external diseconomies, such as a changing farm structure which diminishes the size or threatens the smallholder sector, or the creation of landlessness on a significant scale, by reducing the access of small farmers to land; or other situations which have a seriously deleterious social, economic or environmental impact.

The advocacy of changing development objectives has been accompanied, not only by the advocacy of different development strategies, but also by a decline in the quality of discussion on development issues. To a large extent this is because measurable parameters have been substituted by unmeasurable and unmeasured parameters.

The systematic monitoring of agricultural projects is the newest component of the project planning cycle. In recent years a growing volume of literature on the subject has come into existence, much of it from the international agencies. There is overlapping and divergence of viewpoint in these discussions, but a fairly clear picture has emerged from them of the role, form and function of project monitoring, the design and operation of monitoring systems, their essential ingredients and the problems which arise from their usage. These issues have been discussed in theoretical and practical terms, in the literature. But this discussion will focus on the more practical aspects of monitoring activities as they relate to agricultural development projects.

Equality is an elusive notion about which reasonable men can disagree. This disagreement can stem from different ethical beliefs, the imprecise use of language or a failure to allow evidence to modify belief. In order to separate out areas of possible agreement and disagreement it is helpful, as Lord Robbins has suggested, to distinguish between the three main aspects of equality.1 These are equality before the law, equality of opportunity and equality of income and wealth. The first is probably the only aspect of equality about which there is wide agreement on its desirability as a precisely defined social objective — that is, exactly the same treatment for all, for rich or poor, for exalted or lowly.