Obsolete Techniques Research Articles

Advances in Head-and-Neck Interventional Radiotherapy (Brachytherapy)

Interventional radiotherapy, also known as brachytherapy, is the use of sealed radioactive sources that directly deliver radiation to the tumor or tumor bed. Its unique dose distribution profile allows for high conformality, making it a very useful modality in the treatment of cancers in the head and neck, where different organs and substructures that serve various but related functions are situated close to each other. In recent years, we have seen several important technological breakthroughs in the field, especially regarding its application in head and neck cancers. These include advances in treatment delivery, dosimetry planning , image guidance , and catheter positioning techniques . These innovations, which often require interdisciplinary interventions, have resulted in enhanced treatment accuracy, and therefore, major clinical advantages in terms of increased local control and decreased toxicity, as well as economic benefits. In order to highlight the differences from old brachytherapy techniques, a more appropriate terminology should perhaps be adopted, to signify these advancements that resulted in new opportunities, approaches and better outcomes – interventional radiotherapy (IRT). Such a change in terminology will not only allow recognition of these advances, but also a meaningful distinction from obsolete techniques and suboptimal outcomes that are associated with traditional brachytherapy. This is very important in increasing awareness among professionals outside the field of radiation oncology. We briefly review these recent advances, the current indications, and future directions for IRT in head-and-neck cancers. Keywords : interventional radiotherapy, brachytherapy, head-and-neck cancers, image-guidance

Displacement

The concept of displacement and its consequences are permanently present in my practice, either in the narratives explored in light of the personal stories that have a wider psychological impact, or in the archaeological approach to tame raw, organic materials through the reconstitution of technological, 19th-century procedures considered obsolete and commercial. The approach to paper based on multiple experiments led to reconstructing feasible alternatives to the traditional techniques of obtaining images, including photographic and non-photographic processes. Revision of gillotage, reconstruction of lithographic drawing, painting and printing tools and working in situ directed the research into more immediate work with raw materials like resins, plasters, organic glues, and pigments. Preliminary tests of image development with dichromate dusting methods established satisfactory surfaces for traditional photo-enamel. In my PhD proposal, displacement meets with the obsolete techniques and the fusion of printmaking, photography, and glass as a haptic medium that corresponds to my heuristic approach.

From Theory to Practice: Teaching English to Generation Z

Language education evolves and is shaped by the needs of the generations as well as the contemporary realities of the world. Today, humanity faces with rapid developments and innovations in technology and science. These realities shape the society and each community in the world. In this regard, the term Generation Z (Gen Z) has emerged. Gen Z has its own dynamics and realities which, in turn, entails new issues in learning and teaching. It is not possible to implement classical and obsolete techniques and ways while teaching English to Gen Z. Current paper is an attempt to investigate the theoretical and practical issues of teaching English to Gen Z. The paper has a secondary focus on educating Gen Z towards future regarding global competences.

Mechatronic design of a modular artificial honeycomb for the automatic extraction of honey from Apis Melliferas bees in Huancayo, Peru

This research develops the mechatronic design of an artificial honeycomb for Apis Melliferas bees, which allows the automatic extraction of honey in the farms of the province of Huancayo, Peru, since Junin produces 208.26 tons of honey annually with traditional and obsolete techniques. This design was executed under the German VDI 2221 standard and contemplates the mechanical, electronic and control system, which are dimensioned according to the theories and laws of: distortion energy, polynomial 3 4 5, involute curve gears, Kirchhoff, Ohm, on-off control, among others. It was possible to design, in Inventor, the honeycomb structure whose cells have a 19° slope for the honey gravity flow, a gear-rack-gear system for the transmission of torque from the servomotor to the cam shaft to move the grid, which opens the flow duct; also, it was possible to design, in Proteus, the electronic system made up by the Arduino UNO, a servomotor of 2. 5 Kg-cm servomotor with rotation restricted to 110° and the 15mm force sensor; finally, the actuator control and the monitoring of the weight according to the on-off logic were programmed in Arduino IDE. According to the simulations performed, the design is technologically feasible.

787 The Hidden and The Lost: A Case of a Rare Complication from A Long-Lost Surgical Technique

Abstract Background Various operative techniques have been developed for liver transplant since the 1960's. Waddell-Calne technique for biliary reconstruction in orthotopic liver transplant (OLT) was one of the rare and now relatively obsolete techniques. The aim of our presentation is to describe a long-term complication of this lost technique and how it posed multiple diagnosis and management challenges after 35 years post-liver transplant. Case presentation Our case is on a 50-year-old lady with a history of OLT for end-stage liver failure secondary to type-1 autoimmune hepatitis. Peri and postoperative period were completely unremarkable. 35 years later, she presented with symptoms of recurrent cholangitis. Magnetic resonance cholangio-pancreaticography demonstrated biliary tree dilatation with choledocholithiasis and possible cholecystitis. Removal of the distal stones together with pig-tail stent insertion was achieved via endoscopic retrograde cholangio-pancreaticography, however, her biliary colic persisted. The background of OLT and grossly distorted anatomy on imaging posed a challenge for further surgery. Extensive tracing of the history back from 1985 and multicentre multidisciplinary discussion revealed that the Waddell-Calne technique was carried out for her OLT where a gallbladder conduit was used for the hepaticojejunal-anastomosis. Finally, excision of the gallbladder conduit and hepaticojejunostomy with long Roux-en-Y was able to perform successfully. Conclusions Waddle-Calne technique is rarely seen globally nowadays but should be considered as a possible cause of recurrent cholangitis in patients with a history of OLT a long time ago. We demonstrated that the knowledge of such a rare procedure, together with the multidisciplinary approach could enormously benefit the management of the case.

Reconstructing CNC platform for EDM machines towards smart manufacturing

CNC (computer numerical control) systems play an ultimately important role for controlling EDM (electrical discharge machining) machine tools and their machining processes. Till now, existing CNC systems do not offer sufficient openness that supports researchers and engineers to expend its capabilities and functionalities in response to the increasing demands of smart manufacturing; on the other hand, transforming an EDM machine made by small and medium-sized machine tool builders, into a smart manufacturing system has never been an easy job. To address the issues and overcome the difficulties which block the way towards smart manufacturing, this paper proposes an open architecture CNC platform for EDM machine tools. This platform utilizes the state-of-the-art technologies in implementation of the hardware and software without compromising with the constraints of obsolete techniques. For demonstrating the unique capabilities, the generalized unit arc length increment (GUALI) interpolation method and the Digitizer/Player system architecture are adopted. To exhibit the feasibilities of the newly developed platform, three kinds of EDM machine tools are applied associated with advanced functionalities such as machining process adaptive control, applications of machine learning, 6-axis EDM of shrouded turbine blisks etc. In addition, a small-scale smart manufacturing unit for drilling film cooling holes of turbine blades is built up into real production by applying the new CNC system and related software applications. From the practitioner’s viewpoint, openness and standardization are the keys that enable the people from academia and industry bringing in their domain knowledge to enrich the smart manufacturing ecosystem.

Nagelchirurgie bei Kindern

Although interventions on the skin of children and adolescents often heal better than in adults, inappropriate interventions on nails can lead to avoidable trauma and irreparable damage to fingers and toes. When are interventions on nails indicated in children? What age-related characteristics are important? With reference to the literature and experience from own clinical cases, the most commonly occurring constellations in children are discussed and approaches to protective treatment are demonstrated. Ingrown toenails are one of the most common reasons for presentation due to nail problems in childhood. Conservative measures or protective interventions on the nail matrix avoid unnecessary trauma caused by currently obsolete techniques. Additional nail problems in children which could be treated operatively included nail pigmentation, exostosis and onychodystrophy. A thorough evaluation of the indications and cautious implementation allows a targeted nail surgery or its avoidance even in childhood.

Repeated innovation in great apes

Innovation has been defined as a solution to a novel problem or a novel solution to an old problem. The second part of this definition requires the inhibition of previously learnt solution strategies before a novel solution can be found. Therefore, inventing novel solutions for an old problem is considered to be particularly difficult. We investigated the ability of great apes to produce multiple new solutions to a task after each of those solutions became obsolete. We presented all four nonhuman great ape species with a task consisting of extracting a food reward from a puzzle box. Initially, the task could be solved in three different ways that varied in difficulty. After subjects discovered the first solution, we allowed them to use it for some trials and then it became obsolete. If the apes could overcome their initial response and find the next solution, we again allowed them to use it for some time and once again it became obsolete. The final step consisted of finding the third solution to secure the food reward. We found that all species except orang-utans, Pongo abelii , were able to solve all versions of the problem. Furthermore, they overcame the obsolete techniques quickly and efficiently, indicating high degrees of behavioural flexibility and inhibitory control. In contrast to previous research on social learning, our results suggest that great apes are not conservative and adjust their behaviour flexibly when the physical constraints of a task change. ► Great apes adjust their behaviour flexibly to match the task demands. ► Orang-utans exhibit less cognitive flexibility than the other great apes. ► Great apes are not conservative and rapidly abandon old strategies that no longer work. ► Prior problem experience does not hinder the solving of a new problem.

Impact of Rural Tourism Operated by Retiree Farmers on Multifunctionality: Evidence from Chiba, Japan

This paper examines the roles and significance of rural tourism activity undertaken by those farmers who have retired from non-farming jobs from a multifunctional perspective in Chiba, Japan. The results revealed that rural tourism activities by retirees could realize efficient and sustainable resource utilization of the farm and therefore enhance multifunctionality of agriculture. The main findings were the following. (1) The farming style of the study farm is small production of multiple products all year round, which increases opportunities for farming and farm-life experiences by local school children and urban visitors, although this type of farming was not respected from a productivity-oriented farming perspective. (2) Providing farming experience services makes it possible to utilize unused resources, including obsolete farming techniques, in the farmyard. (3) All of these activities promote multifunctionality not only in terms of environmental functions such as land preservation, landscape formation and biodiversity, but also cultural and social functions such as recreational and educational functions. These results indicate that multifunctionality is not in parallel with the low productivity of retiree farmers and that rural tourism will be an effective and recommended activity for those farm-oriented people who have retired from non-farming occupations.

Changes in Patterns of Care for Limited-Stage Small-Cell Lung Cancer: Results of the 99-01 Patterns of Care Study—A Nationwide Survey in Japan

This study was undertaken to analyze the practice process of thoracic radiotherapy (TRT) and evaluate changes in patterns of care for patients with limited-stage small-cell lung cancer (LS-SCLC) in Japan. The Patterns of Care Study (PCS) conducted the second nationwide survey of care process for patients with LS-SCLC treated by using TRT between 1999 and 2001. The PCS collected data for 139 patients with LS-SCLC (man-woman ratio, 5:1; median age, 69 years; age > 70 years, 43%; Karnofsky Performance Status > 70, 73%; and Stage III, 88%). Median total dose was 50 Gy. Twice-daily TRT was used in 44% of patients. Median field size was 12 x 14 cm. The most commonly used photon energy was 10 MV (77%), whereas obsolete techniques using (60)Co or X-ray energy less than 6 MV comprised 12%. Three-dimensional conformal therapy was used with 12% of patients. Computed tomography simulation was performed in 40% of cases. Only 12 patients (8.6%) received prophylactic cranial irradiation (PCI). Concurrent chemotherapy and TRT (CCRT) was used for 94 patients (68%). Only 6 patients (4.4%) entered clinical trials. Compared with the previous PCS 95-97, significant increases in the use of CCRT (34-68%; p < 0.0001), twice-daily TRT (15-44%; p < 0.0001), and PCI (1.7-8.6%; p =0.0045) were observed, although the absolute number of patients receiving PCI was still extremely low. Evidence-based CCRT and twice-daily TRT has penetrated into clinical practice. However, PCI is not yet widely accepted in Japan.

Which Breast Cancer Patients Should Really Worry About Radiation-Induced Heart Disease—And How Much?

The most difficult portion of my discussion with breast cancer patients about the potential adverse effects of radiation therapy (RT) is estimating their long-term chance of developing radiationinduced heart disease (RIHD). Very large studies combining tumor registry data with pre-existing regional or national hospital discharge diagnosis and death records and the Oxford metaanalyses of randomized trials found increased risks of coronary heart disease (CHD) for irradiated patients compared with nonirradiated ones, or for patients treated to the left breast or chest wall compared to those treated to the right side. However, most patients in these studies were treated with obsolete techniques that exposed much larger volumes of the heart to radiation than is done today, often with daily doses (fraction sizes) of 2.5 Gy or higher. Patients whose treatment was administered after 1975 to 1980 followed for median times of approximately 9 to 10 years had little or no increased risk of RIHD in these and additional registry and large clinical series (700 to 3,000 patients). For example, Giordano et al found that the 15-year risk of cardiac mortality for 8,652 patients treated from 1973 to 1979 was substantially higher when left-sided irradiation was administered than when right-sided irradiation was used (13.1% v 10.2%; P .02). This absolute 15-year rate decreased substantially for 6,495 patients treated from 1980 to 1984 (9.4% v 8.7%, respectively; P not significant), and there was further greater reduction for 12,136 patients treated from 1985 to 1989 (5.8% and 5.2%, respectively). Certainly, more patients in recent times have been treated to the intact breast without nodal irradiation, which eliminates cardiac irradiation entirely in most patients and, for those still exposed, reduces the irradiated volume. Improvements in treatment of CHD also no doubt played a major role in these absolute reductions in both laterality groups, a matter I will return to later. These data have shortcomings. Coding of whether patients actually received RT or had a cardiac event may be inaccurate, particularly in registry studies or when death certificates are the main source of information. For example, Vallis et al found that 16% of myocardial infarctions coded in Ontario (Canada) hospital registries were not verifiable according to standard criteria when individual medical records were reviewed. Further, RIHD can take at least 15 to 20 years to develop, and few of these more recently treated patients have been followed that long. Nonetheless, I am reasonably certain that patients treated today on average will have a very low risk of RIHD. My problem comes when trying to move beyond the average. For any one patient, the risk of RIHD seems likely to be a function of three variables: the cardiac “dose-volume histogram,” the use of potentially cardiotoxic systemic therapy, and the presence and treatment of independent risk factors for CHD (such as hypertension, diabetes, cholesterol and lipid disorders, and smoking). Unfortunately, I do not have an equation at hand with which to make this calculation reliably. Only very recently has the widespread availability of computed tomography (CT) -based treatment planning made it possible to measure accurately how much of the heart is included in or near the RT fields for individual patients. Prosnitz and Marks recently reviewed studies of radionuclide cardiac imaging which correlate (imperfectly) the development of perfusion abnormalities with increasing irradiated cardiac volume. However, it is simply too early to know whether this is a reliable surrogate marker for the long-term risk of RIHD. (Indeed, some of these defects disappear with time.) It is also not certain that this is the optimal parameter. Perhaps the critical target is really the coronary arteries, as suggested by a study of Hodgkin’s disease patients treated at Stanford University (Stanford, CA) in which increased left ventricular blocking by itself did not reduce the risk of myocardial infarction. Tracing the coronary arteries requires administering intravenous contrast, something not usually done in day-to-day clinical RT planning or in these perfusion imaging correlation studies. There is surprisingly little shortor long-term data on cardiac toxicity rates for patients treated with both anthracyclines and RT. Perhaps the most important information so far comes from Bonneterre et al, who studied cardiac function in surviving node-positive patients included in the French Adjuvant Study Group Trial 05, conducted from 1990 to 1993. Patients received six cycles of fluorouracil, cyclophosphamide, and epirubicin, the latter administered at either 50 or 100 mg/m/cycle (FEC50 or FEC100). Almost all patients had RT that included the internal mammary nodes (IMNs). With a median follow-up time of 102 months, the risk of left ventricular dysfunction in patients with right-sided cancers receiving FEC50 was 7% (two of 30), compared with none of 34 patients irradiated to the left side. For patients receiving JOURNAL OF CLINICAL ONCOLOGY E D I T O R I A L VOLUME 24 NUMBER 25 SEPTEMBER 1 2006

Rational Use of Thyroid Function Tests

In this era of cost containment, it is necessary to efficiently select the most important laboratory investigations for diagnostic and management purposes. with patient benefit as the ultimate objective. Thyroid function tests collectively represent a very costly item for laboratory services and have tended to be unselectively overutilized virtually until the present. Tests available for thyroid function testing include both in vitro and in vivo tests. Virtually all physicians are familiar with the free thyroxine (fT4) or its equivalents (fT4E). total and free triiodothyronine (TT3 and fT3). and sensitive thyrotrophin (TSH) assays, to which may be added plasma thyroglobulin (Tg), and thyroid autoantibodies (TAb) (including thyroid stimulating antibody [TSAb]). In vitro tests include thyroidal uptakes and scans, as well as other imaging techniques (e.g., ultrasound). Other less commonly used or obsolete techniques are not discussed. For screening or case finding where there is little probability that the patient(s) has thyroid dysfunction, a sensitive TSH assay is all that is initially required. If, however, the TSH result is elevated, a fT4E and TAb should then be performed. If the TSH is subnormal, then a fT4E. TT3. and (if still necessary) TSH response to TRH would determine if that patient was truly hyperthyroid (in elderly patients, a low TSH is often not associated with hyperthyroidism). Conversely, not all patients with elevated fT4 are truly hyperthyroid. Uptakes and scans are primarily of importance in the comt diagnosis of unusual cases of hyperthyroidism and for nodular disease. When patients already diagnosed are being followed, proper selection of testing is again important, sometimes emphasizing one test over others (e.g., TT3); for example, in patients with Graves' Disease on anti-thyroid drugs, the fT4E and TSH values may not reflect the true status of the patient. On the one hand, the TSH may remain low for months after the patient has become euthyroid, and on the other hand, the fT4E may drop even below normal, whereas the T3 remains elevated (and the patient still hyperthyroid). The many other vagaries of these tests are also mentioned.

Burns of the female genitalia and perineum

Burns of the female genitalia and perineum mostly occur in connection with more extensive thermal injuries to the trunk and lower extremities. Isolated burns to the vulva are very unusual because this area is anatomically well-protected. A few reports in the literature describe injuries due to bizarre accidents and now obsolete techniques. The management of these injuries, possible complications, prognosis and long-term results are discussed following a case report of a 28-year-old woman who sustained extensive deep dermal burns to her external and internal genitalia in a suicide attempt involving a firework.

The place of radiotherapy in Stage I and IIA Hodgkin's disease (or radiotherapy revisited)

For the majority of patients presenting with early Hodgkin's disease, the chance of death due to their disease is related to prognostic factors, e.g. age, systemic symptoms, ESR bulk, number of sites of disease, histology, haemoglobin, lymphocyte count etc. More than 50% of those with Stage I and IIA disease fall into an intermediate prognostic category where a variety of initial treatment strategies—chemotherapy alone (CT), radiotherapy alone (RT) or a combination of chemotherapy and radiotherapy (combined modality therapy CMT) result in comparable survival rates. There is therefore increasing emphasis on incidence of relapse and treatment related morbidities rather than on survival alone when evaluating the role of different treatment for Hodgkin's disease. Radiotherapy has an essential part to play in any initial strategy aiming to keep relapse rate low, as chemotherapy alone has been demonstrated to be less effective in treating macroscopic disease. Late side-effects associated with radiation are largely associated with obsolete techniques involving very wide fields, high doses and large fraction size delivered to anterior structures within the thorax. The risk of second solid tumour appears related to the volume of radiation fields and the risk of cardiac damage is probably related to both total dose and dose per fraction delivered. There is still uncertainty as to the potential late toxicity of modern techniques, particularly in combination with chemotherapy. Increasingly numbers of patients are likely to be treated with initial CMT rather than RT alone to reduce relapse rates. The risk of leukaemia associated with CMT to patients with curable Hodgkin's disease appears to have been overestimated. There are some patients who may choose to take the risk of a salvagable relapse to avoid initial systemic therapy.

Interpreting the Heritage of Wales

Abstract It is believed by many that ethnological studies, and the presentation and interpretation of those studies in museums and other institutions, should be concerned almost entirely with the unchanging ways of inward-looking, mainly rural communities. To many, the raw materials of folk life study are the obsolete techniques, the primitive artefacts and the redundant buildings of a people tied to the land and who never wandered far from their native areas. Many ethnologists have been overwhelmingly concerned with recording the minutiae of forgotten beliefs, redundant customs and obsolete techniques, and recording those members of society who really do not belong to the last quarter of the twentieth century.

Productivity and Price Trends in Construction Since 1947

EITTLE is known about the real output, productivity, and price trends in the construction Nevertheless, there exists an undercurrent of feeling that the performance of this giant industry has lagged considerably behind the American economy as a whole. Economists have tended to shy away from this area of research because the available statistics have been viewed as inappropriate or unreliable. Consequently, the field has been pre-empted, more or less, by the popular press which has propagated a most distinct notion. The industry, in the words of one writer, is noted for its incredible inefficiency (particularly home building). As an explanation of . why new homes cost too much, he stated that . home builders are forced to use wasteful and obsolete techniques and materials, do little or no research [and] are hobbled by a maze of outdated building codes.' To the extent that such an opinion is held within the economics profession it usually can be traced to the Department of Commerce's construction composite cost index.2 Since World War II the composite has risen faster than most other well known price indexes and the implication has been drawn that much of the rise has been due to inefficiency. However, the composite is essentially a simple inputcost index 3 and no inference about productivity can be logically deduced from it. To the knowledge of this writer, only a few economists have published any research on real output, productivity, or prices in construction. Most of these have been interested in construction only incidentally, as one sector to be integrated into the whole. Their estimates relating to construction can be summarized as follows: Schultze found that construction prices rose 53.7 per cent over the decade beginning in 1947.4 For the same period, the composite rose 47.5 per cent. Alterman and Jacobs estimated that the average annual change in real product between 1947 and 1955 was 5.6 per cent and 2.5 per cent came from an increase in real product per man-hour.5 This figure is surprisingly large when contrasted with the popular view. Yet it appears from their work that construction productivity lagged considerably behind the average for the economy and even behind total services. Kendrick deflated value added by an output deflator closely akin to the composite to yield an index of real output and estimated that real output per man-hour rose at an average rate of 3.9 per cent between 1948 and 1953,6 but productivity had not advanced between 1909 and 1948. Haber and Levinson, writing in the early fifties, thought that productivity had been increasing by about 1.5 per cent per year in residential construction and two per cent in industrial and commercial building.7 They attributed this low rate to the . economic characteristics of the industry. The most recent estimate is that of Domar, et al.8

The Cabinet Minister and Administration Winston S. Churchill at the Admiralty, 1911-15

The history of the British Admiralty, like that of the War Office, furnishes an exceptionally good opportunity for reviewing the relationship which exists between a Cabinet Minister and his subordinates. This relationship, of course, presents in all departments essentially the same general features, namely, the control of a specialized group of officials by one who, though ignorant in a technical sense, nevertheless possesses unusual competence in his own field of administration and politics. But in the fighting services parts of this picture are etched with deeper and darker lines. In the first place, there is obviously a greater disparity of talent between Minister and official than occurs in most departments, and the experts seem as a rule less able, or willing, to appreciate the political implications of the demands they are constantly making. The relationship is thus apt to be more difficult and occasionally more exacerbating; but it creates by that very fact a greater need for providing the department with a sympathetic spokesman and advocate in the Cabinet, while insisting at the same time on the absolute supremacy of the political power. In the second place, the pervasive influences of bureaucracy and departmentalism, on which the Minister must wage relentless war, occur in the fighting services in an acute and aggravated form. Officials in other departments may hold narrow and circumscribed views, but their counterparts at the War Office and the Admiralty will frequently add to those a complacent and unimaginative professionalism of their own; the fondness of a civil servant for unnecessary formalism may have a military or naval parallel in ponderous methods and obsolete techniques; bureaucratic prejudice may become red-tabbed or gold-braided intolerance; an esprit de corps may be transmuted into an un-discriminating loyalty to the ship, to the battalion, or to the service.