DAVID BUNTING | Eastern Washington University, Cheney, Washington, 99004 (original) (raw)

Papers by DAVID BUNTING

Journal of Economic Issues, Dec 1, 1982

In 1905, Wall Street Journal editor Sereno S. Pratt examined the control of large American corpor... more In 1905, Wall Street Journal editor Sereno S. Pratt examined the control of large American corporations and found that, despite its republican form, "in practical operation, . . . the stock company is subject to autocratic or oligarchical control. The stockholders do not vote-they send proxies that are held by the powers that be.... It is not difficult for a small group of financiers to dominate properties worth billions of dollars, belonging to thousands of investors, who have really no voice in their management" [Pratt 1905, pp. 6704-5]. Twenty-five years later, A. A. Berle, Jr. and G. C. Means made a similar argument, but suggested that power "ultimately (lay) in the hands of management itself, a management capable of perpetuating its own position" [Berle and Means 1932, p. 124]. While both Pratt and Berle-Means believed that the inability of owners to effectively exercise ownership rights led to their usurpation by other, better organized forces, they disagreed as to who actually seized control. Berle and Means assumed that managers took control from shareholders. On the other hand, Pratt concluded that shareholders had long lost out to

Business History Review, 1971

GRADUATE STUDENT IN ECONOMICS FLORIDA STATE UNIVERSITY Interlocking Directorates in Large America... more GRADUATE STUDENT IN ECONOMICS FLORIDA STATE UNIVERSITY Interlocking Directorates in Large American Corporations, 1896-1964' (An examination of interlocking directorates in major American businesses since 1896 indicates that the incidence of interlocking has declined considerably in this century. Industrial America experienced two vast and fundamental changes between 1896 and 1905. First, large corporations, stigmatized as "trusts," became the predominant business form. The 100 largest corporations not only increased their average size four times during this ten-year period, but in addition, gained control of 40 per cent of the nation's industrial capital.' Most of these organizations were new; many were less than ten years old. Second, certain fundamental property rights disintegrated. Corporate shareholders found it nearly impossible to exercise the ownership rights of their stock. More than one stockholder, when questioning some corporate proposal, was told simply to "vote for it first and discuss it afterwards." 2 These circumstancesnew, huge, apparently uncontrollable organizationsnaturally created concern. Depending upon the enumerator, 300 to 700 corporations were created, promoted, and Business History Review, Vol. XLV, No. 3 (Autumn, 1971). Copyright a The President and Fellows of Harvard College. *Research for this paper was conducted at the University of Oregon; computer time was provided by the Department of Economics there. Responsibilities were divided as follows: Bunting sought data on industrial, railroad, banking, and investment organizations; Barbour collected information on utilities. Jerry Paul Simpson and Professor Robert E. Smith offered many comments. An earlier version of this paper was presented at the 1970 Western Economic Association meetings. Carol Choat typed the manuscript. 1 David Bunting, "The Rise of Large American Corporations: 1896-1905," (Ph.D. dissertation, University of Oregon, in preparation), Chapter II. SAlexander D. Noyes, Forty Years of American Finance (New York, 1909), 344. floated after 1896.8 Many of these quickly disappeared into new promotions; some were frauds; most enjoyed indifferent success; a few returned handsome dividends.4 Nearly all were promoted as devices to gain large dividends through the elimination of competition, the consolidation of inefficient organizations, and the exercise of large-scale economies." Yet these supposed benefits failed to convince many citizens. Instead, these promotions appeared to be merely financial machinations to replace local enterprises with national consolidations. Many corporate promoters were unscrupulous megalomaniacs, bent on creating financial empires. Since social and legal constraints were lacking, megalomania prevailed and "empires" were created. These in turn attracted other similarly inclined individuals who attempted to construct their own giant enterprises or capture those already in existence. Titanic financial battles ensued. Well known examples include the Harriman-Hill fight over the Chicago, Burlington & Quincy, the Standard Oil-Lawson-Heinze dispute in copper, and Morgan's termination of C. W. Morse's chain banking activities. Out of this chaos arose "communities of interest" wherein various properties were shared. Thus, Hill and Harriman compromised with Northern Securities, the Pennsylvania Railroad purchased stock in competing lines, Standard Oil interests collaborated with the National City Bank, and J. P. Morgan constructed voting trusts. Because this activity was limited to a few principals, the public, lacking power, was excluded. Control of much of American finance and industry passed into the hands of a few individuals. Over the years, the magnitude of this control has been studied and restudied with the common conclusion that financial oligarchies controlled the economy then and still exercise that control today. In 1905, Seno Pratt, an editor of the Wall Street Journal, identified "the seventy-six men who make up the 'Business Senate' of the United Stateswhat they controltheir cliques and parties."6 Pratt further stated, "In practical operation. .. the stock company 8 Seven hundred ninety-three trusts (453 industrial and 340 local or "natural") are listed in the

The Journal of Physiology, 2000

Community & Junior College Libraries, Jun 8, 1985

Page 1. The Classroom . . . and the Library . . . That Cover Seven Counties Katherine A. Wacker J... more Page 1. The Classroom . . . and the Library . . . That Cover Seven Counties Katherine A. Wacker Judith D. Dennis-Burns David R. Bunting ABSTRACT. This article describes an instructional telecommuni-cations system in use ...

Surgical laparoscopy, endoscopy & percutaneous techniques, Oct 1, 2012

A prevascular femoral hernia is a rare type of femoral hernia in which the neck lies anterior to ... more A prevascular femoral hernia is a rare type of femoral hernia in which the neck lies anterior to the femoral vessels. Obturator hernias are unusual herniations through the obturator foramen. There are no reports in the literature of coexisting prevascular and obturator hernias. Although obturator hernias have been treated successfully by laparoscopic techniques, there are no published reports of prevascular hernias treated in this way. We report the first case in the literature of a patient with a prevascular femoral hernia treated successfully by laparoscopic preperitoneal mesh repair in a rare case associated with ipsilateral obturator and classic femoral hernias. Prevascular femoral hernias are rare, potentially difficult to treat and are ideally suited to investigation and repair by laparoscopic means.

Journal of Surgical Research, Feb 1, 2007

International Journal of Surgery, Nov 1, 2015

Common day case laparoscopic procedures are usually safe, with low rates of bleeding complication... more Common day case laparoscopic procedures are usually safe, with low rates of bleeding complications. At our trust most patients undergo preoperative group and save (G&S) for these procedures, at a cost of £18.39 per sample excluding laboratory staffing costs. Our aim was to assess if routine G&S is indicated. Methods: Retrospective review of all patients undergoing laparoscopic cholecystectomy (LC), laparoscopic inguinal hernia repair (LIH) and diagnostic laparoscopy (DL) April 2012eMarch 2014. Patients identified using hospital coding records. Transfusion department records were reviewed to see which patients had undergone pre-operative G&S or cross-match, and perioperative transfusion. Results: 532 procedures in 2 years, 0 patients transfused for bleeding complications. 1 patient transfused to optimise pre-existing anaemia.

International Journal of Surgery, Nov 1, 2016

Results: Analysis included 906 complete responses from training-grade surgeons (34.8% female) fro... more Results: Analysis included 906 complete responses from training-grade surgeons (34.8% female) from all UK recognised specialties and all grades of training. More than two-thirds (68.5%) believed that overstatement or misrepresentation of case involvement occurs. A fifth (20.8%) reported witnessing trainees logging cases they had not actually participated in and almost a third (32.7%) had witnessed overstatement, yet few (7.6%) had raised it with a supervisor. Most (75.1%) respondents had few or no eLogbook entries validated. More than a quarter of respondents felt pressure to overstate their involvement in (28.8%) and number of (28.5%) cases. Almost a quarter (22.8%) felt the required case number for completion of training was not achievable. Female trainees were less likely to feel well supervised (p¼0.022) and to perceive targets for completion of training were achievable (p¼0.005). Thematic analysis identified four key themes to explain logbook misuse: High numerical requirements; technical eLogbook issues; training deficiencies and probity. Conclusions: Inaccurate operative recording was widely reported, primarily in response to perceived pressure to achieve targets for career progression. This represents a significant probity issue. Operative logbooks may not be as clear cut as they appear.

This review aims to summarise the published literature on extranodal natural killer/T-cell lympho... more This review aims to summarise the published literature on extranodal natural killer/T-cell lymphoma using a case report as a working example. Extranodal natural killer/T-cell lymphomas are rare, particularly in western countries and usually associated with Epstein-Barr infection. They most commonly affect the upper aerodigestive tract but can present at distant sites as primary lesions or as disseminated disease. The diagnosis of extranodal natural killer/T-cell lymphoma is often made at an advanced stage and prognosis is generally poor. A case of disseminated, upper aerodigestive tract extranodal natural killer/T-cell lymphoma affecting the colon initially treated by laparoscopic right hemicolectomy is presented. Follow up at one year following surgery demonstrated no residual disease. Surgery is rarely indicated in the management of extranodal natural killer/T-cell lymphoma but in selected cases it may offer potentially curative treatment in combination with chemotherapy and radiotherapy.

International Journal of Surgery, Apr 1, 2018

Aims: Vitamin D receptor (VDR) expression has been associated with survival in several cancer sit... more Aims: Vitamin D receptor (VDR) expression has been associated with survival in several cancer sites. This study aims to evaluate the association between VDR expression and prognosis in oesophageal adenocarcinoma patients. Results: During a median of 2.5 (maximum 9) years of follow-up, 75 patients died. In analysis adjusted for confounders, higher VDR expression was associated with an improved overall survival (HR 0.49 95% CI 0.25-0.96) and disease-specific survival (HR 0.50 95% CI 0.26-0.99), when comparing the highest with the lowest tertile of expression. These associations were strongest in sensitivity analysis restricted to junctional tumours. Conclusions: This study is the first to demonstrate that patients with higher VDR expression in oesophageal adenocarcinoma have a more favourable prognosis. Further work is needed to validate these findings, and to define the role of VDR in the aetiology, progression and management of oesophageal adenocarcinoma. Methods: Oesophageal adenocarcinoma specimens and clinical data were collected from 130 patients treated with neo-adjuvant chemotherapy prior to surgical resection at the Northern Ireland Cancer Centre between 2004 and 2012. Tissue microarrays were created and immunohistochemical staining for VDR was performed on triplicate tumour cores from each resection specimen. Cox proportional hazards models were applied to evaluate associations between VDR, according to tertiles of expression, and survival outcomes.

International Journal of Surgery, Nov 1, 2016

Changes in the delivery of the healthcare structure have led to the expansion of the non-medical ... more Changes in the delivery of the healthcare structure have led to the expansion of the non-medical workforce (NMW). The non-medical practitioner in surgery (a healthcare professional without a medical degree who undertakes specialist training) is a valuable addition to a surgical firm. However, there are a number of challenges regarding the successful widespread implementation of this role. This paper outlines a number of these concerns, and makes recommendations to aid the realisation of the nonmedical practitioner as a normal part of the surgical team. In summary, the Association of Surgeons in Training welcomes the development of the non-medical workforce as part of the surgical team in order to promote enhanced patient care and improved surgical training opportunities. However, establishing a workforce of independent/semi-independent practitioners who compete for the same training opportunities as surgeons in training may threaten the UK surgical training system, and therefore the care of our future patients.

This copy of the thesis has been supplied on the condition that anyone who consults it is underst... more This copy of the thesis has been supplied on the condition that anyone who consults it is understood to recognise that its copyright rests with its author and that no quotation from the thesis and no information derived from it may be published without the author's prior consent.

material is granted provided that the copies are not made or distributed for direct commercial ad... more material is granted provided that the copies are not made or distributed for direct commercial advantage, the ACM copyright notice and the title of the publication and its date appear, and notice is given that copying is by permission of the Association for Computing Machinery. TO copy otherwise, or to republish, requires a fee and/or specific permission.

World Journal of Surgery, Dec 2, 2014

Positron emission tomography-computed tomography (PET-CT) scanning is used routinely in the stagi... more Positron emission tomography-computed tomography (PET-CT) scanning is used routinely in the staging of oesophageal cancer to identify occult metastases not apparent on CT and changes the management in typically 3-18 % patients. The authors aim to re-evaluate its role in the management of oesophageal cancer, investigating whether it is possible to identify a group of patients that will not benefit and can safely be spared from this investigation. Consecutive patients with oesophageal cancer undergoing PET-CT staging between 2010 and 2013 were identified from a specialist modern multidisciplinary team database. Without knowledge of the PET-CT result, patients were stratified into low-risk or high-risk groups according to the likelihood of identifying metastatic disease on PET-CT based on specified criteria routinely available from endoscopy and CT reports. Clinical outcomes in the two groups were investigated. In 383 undergoing PET-CT, metastatic disease was identified in 52 (13.6 %) patients. Eighty-three patients were stratified as low risk and 300 as high risk. None of the low-risk patients went on to have metastatic disease identified on PET-CT. Of the high-risk patients, 17 % had metastatic disease identified on PET-CT. In one of the largest studies to date investigating the influence of staging PET-CT on management of patients with oesophageal cancer, the authors report a classification based on endoscopy/CT criteria is able to accurately stratify patients according to the risk of having metastatic disease. This could be used to avoid unnecessary PET-CT 22 % of patients, saving cost, inconvenience and reducing potential delay to definitive treatment in this group.

Journal of Laparoendoscopic & Advanced Surgical Techniques, Oct 1, 2015

Pancreatic fistula (PF) is a common postoperative complication following distal pancreatectomy. T... more Pancreatic fistula (PF) is a common postoperative complication following distal pancreatectomy. The prolonged prefiring compression (PFC) technique to reduce PF has been described by Nakamura and colleagues in Japan. The present study assessed if this technique can be applied to the United Kingdom patient population in a tertiary referral center and replicate the low incidence of PF after the laparoscopic approach to distal pancreatectomy (Lap-DP). This is a retrospective study of all patients who underwent Lap-DP using the modified PFC technique by the senior author between June 2011 and July 2014. The modified PFC technique involved compression of the pancreatic parenchyma with an endo-stapler for a 3-minute period prior to firing and further 1-minute compression after firing prior to removal of the stapler, which is a small variant to the original technique of maintaining a 2-minute compression post firing. Twenty patients (15 females; median age, 66 [range, 25-77] years) underwent Lap-DP using the PFC technique during the study period. Six patients had splenic-preserving Lap-DP. Median operating time was 240 minutes (range, 150-420 minutes) with a median length of hospital stay of 6 days (range, 3-22 days). Six patients (30%) developed Type A (biochemically noted as high drain fluid amylase) PF, and none of the patients had Type B/C PF. In the splenic preservation group, 1 patient had complete splenic infarction requiring laparoscopic splenectomy on Day 3, and 1 patient had partial infarction requiring prolonged hospital stay for pain relief. One patient required prolonged respiratory support due to severe preexisting lung disease. Overall mortality was zero. Our data confirm that the PFC technique is safe, feasible, and effective in reducing clinically significant PF post-Lap-DP in the United Kingdom patient population.

JSLS, 2010

Background:Port-site hernia is a rare but potentially serious complication of laparoscopic cholec... more Background:Port-site hernia is a rare but potentially serious complication of laparoscopic cholecystectomy. This study aimed to review the current literature, assess the incidence and causes of port-site hernias, and identify methods to reduce the risk.Methods:A systematic search of the literature published in English from 1995 to 2010 was conducted using PubMed to identify all reports of port-site, trocar-site, or incisional hernia following laparoscopic cholecystectomy. Studies in over 100 patients were identified before the application of defined exclusion criteria. The incidence of port-site hernia was calculated and compared with historical data. Predisposing factors were reviewed.Results:Seven studies met the search criteria, with 99 port-site hernias in 5984 patients. The overall incidence of port-site hernia was 1.7% (range, 0.3% to 5.4). The most important factors were older age, higher body mass index, preexisting hernia, trocar design, trocar diameter, increased duration of surgery, and extension of the port site for gallbladder extraction.Conclusion:The incidence of port-site hernia is low but likely to be underestimated and has not declined over time. Awareness of the predisposing factors and modification of techniques may help to reduce the risk.

Community College Journal of Research and Practice, Feb 1, 2006

Journal of Economic Issues, Dec 1, 1982

In 1905, Wall Street Journal editor Sereno S. Pratt examined the control of large American corpor... more In 1905, Wall Street Journal editor Sereno S. Pratt examined the control of large American corporations and found that, despite its republican form, "in practical operation, . . . the stock company is subject to autocratic or oligarchical control. The stockholders do not vote-they send proxies that are held by the powers that be.... It is not difficult for a small group of financiers to dominate properties worth billions of dollars, belonging to thousands of investors, who have really no voice in their management" [Pratt 1905, pp. 6704-5]. Twenty-five years later, A. A. Berle, Jr. and G. C. Means made a similar argument, but suggested that power "ultimately (lay) in the hands of management itself, a management capable of perpetuating its own position" [Berle and Means 1932, p. 124]. While both Pratt and Berle-Means believed that the inability of owners to effectively exercise ownership rights led to their usurpation by other, better organized forces, they disagreed as to who actually seized control. Berle and Means assumed that managers took control from shareholders. On the other hand, Pratt concluded that shareholders had long lost out to

Business History Review, 1971

GRADUATE STUDENT IN ECONOMICS FLORIDA STATE UNIVERSITY Interlocking Directorates in Large America... more GRADUATE STUDENT IN ECONOMICS FLORIDA STATE UNIVERSITY Interlocking Directorates in Large American Corporations, 1896-1964' (An examination of interlocking directorates in major American businesses since 1896 indicates that the incidence of interlocking has declined considerably in this century. Industrial America experienced two vast and fundamental changes between 1896 and 1905. First, large corporations, stigmatized as "trusts," became the predominant business form. The 100 largest corporations not only increased their average size four times during this ten-year period, but in addition, gained control of 40 per cent of the nation's industrial capital.' Most of these organizations were new; many were less than ten years old. Second, certain fundamental property rights disintegrated. Corporate shareholders found it nearly impossible to exercise the ownership rights of their stock. More than one stockholder, when questioning some corporate proposal, was told simply to "vote for it first and discuss it afterwards." 2 These circumstancesnew, huge, apparently uncontrollable organizationsnaturally created concern. Depending upon the enumerator, 300 to 700 corporations were created, promoted, and Business History Review, Vol. XLV, No. 3 (Autumn, 1971). Copyright a The President and Fellows of Harvard College. *Research for this paper was conducted at the University of Oregon; computer time was provided by the Department of Economics there. Responsibilities were divided as follows: Bunting sought data on industrial, railroad, banking, and investment organizations; Barbour collected information on utilities. Jerry Paul Simpson and Professor Robert E. Smith offered many comments. An earlier version of this paper was presented at the 1970 Western Economic Association meetings. Carol Choat typed the manuscript. 1 David Bunting, "The Rise of Large American Corporations: 1896-1905," (Ph.D. dissertation, University of Oregon, in preparation), Chapter II. SAlexander D. Noyes, Forty Years of American Finance (New York, 1909), 344. floated after 1896.8 Many of these quickly disappeared into new promotions; some were frauds; most enjoyed indifferent success; a few returned handsome dividends.4 Nearly all were promoted as devices to gain large dividends through the elimination of competition, the consolidation of inefficient organizations, and the exercise of large-scale economies." Yet these supposed benefits failed to convince many citizens. Instead, these promotions appeared to be merely financial machinations to replace local enterprises with national consolidations. Many corporate promoters were unscrupulous megalomaniacs, bent on creating financial empires. Since social and legal constraints were lacking, megalomania prevailed and "empires" were created. These in turn attracted other similarly inclined individuals who attempted to construct their own giant enterprises or capture those already in existence. Titanic financial battles ensued. Well known examples include the Harriman-Hill fight over the Chicago, Burlington & Quincy, the Standard Oil-Lawson-Heinze dispute in copper, and Morgan's termination of C. W. Morse's chain banking activities. Out of this chaos arose "communities of interest" wherein various properties were shared. Thus, Hill and Harriman compromised with Northern Securities, the Pennsylvania Railroad purchased stock in competing lines, Standard Oil interests collaborated with the National City Bank, and J. P. Morgan constructed voting trusts. Because this activity was limited to a few principals, the public, lacking power, was excluded. Control of much of American finance and industry passed into the hands of a few individuals. Over the years, the magnitude of this control has been studied and restudied with the common conclusion that financial oligarchies controlled the economy then and still exercise that control today. In 1905, Seno Pratt, an editor of the Wall Street Journal, identified "the seventy-six men who make up the 'Business Senate' of the United Stateswhat they controltheir cliques and parties."6 Pratt further stated, "In practical operation. .. the stock company 8 Seven hundred ninety-three trusts (453 industrial and 340 local or "natural") are listed in the

The Journal of Physiology, 2000

Community & Junior College Libraries, Jun 8, 1985

Page 1. The Classroom . . . and the Library . . . That Cover Seven Counties Katherine A. Wacker J... more Page 1. The Classroom . . . and the Library . . . That Cover Seven Counties Katherine A. Wacker Judith D. Dennis-Burns David R. Bunting ABSTRACT. This article describes an instructional telecommuni-cations system in use ...

Surgical laparoscopy, endoscopy & percutaneous techniques, Oct 1, 2012

A prevascular femoral hernia is a rare type of femoral hernia in which the neck lies anterior to ... more A prevascular femoral hernia is a rare type of femoral hernia in which the neck lies anterior to the femoral vessels. Obturator hernias are unusual herniations through the obturator foramen. There are no reports in the literature of coexisting prevascular and obturator hernias. Although obturator hernias have been treated successfully by laparoscopic techniques, there are no published reports of prevascular hernias treated in this way. We report the first case in the literature of a patient with a prevascular femoral hernia treated successfully by laparoscopic preperitoneal mesh repair in a rare case associated with ipsilateral obturator and classic femoral hernias. Prevascular femoral hernias are rare, potentially difficult to treat and are ideally suited to investigation and repair by laparoscopic means.

Journal of Surgical Research, Feb 1, 2007

International Journal of Surgery, Nov 1, 2015

Common day case laparoscopic procedures are usually safe, with low rates of bleeding complication... more Common day case laparoscopic procedures are usually safe, with low rates of bleeding complications. At our trust most patients undergo preoperative group and save (G&S) for these procedures, at a cost of £18.39 per sample excluding laboratory staffing costs. Our aim was to assess if routine G&S is indicated. Methods: Retrospective review of all patients undergoing laparoscopic cholecystectomy (LC), laparoscopic inguinal hernia repair (LIH) and diagnostic laparoscopy (DL) April 2012eMarch 2014. Patients identified using hospital coding records. Transfusion department records were reviewed to see which patients had undergone pre-operative G&S or cross-match, and perioperative transfusion. Results: 532 procedures in 2 years, 0 patients transfused for bleeding complications. 1 patient transfused to optimise pre-existing anaemia.

International Journal of Surgery, Nov 1, 2016

Results: Analysis included 906 complete responses from training-grade surgeons (34.8% female) fro... more Results: Analysis included 906 complete responses from training-grade surgeons (34.8% female) from all UK recognised specialties and all grades of training. More than two-thirds (68.5%) believed that overstatement or misrepresentation of case involvement occurs. A fifth (20.8%) reported witnessing trainees logging cases they had not actually participated in and almost a third (32.7%) had witnessed overstatement, yet few (7.6%) had raised it with a supervisor. Most (75.1%) respondents had few or no eLogbook entries validated. More than a quarter of respondents felt pressure to overstate their involvement in (28.8%) and number of (28.5%) cases. Almost a quarter (22.8%) felt the required case number for completion of training was not achievable. Female trainees were less likely to feel well supervised (p¼0.022) and to perceive targets for completion of training were achievable (p¼0.005). Thematic analysis identified four key themes to explain logbook misuse: High numerical requirements; technical eLogbook issues; training deficiencies and probity. Conclusions: Inaccurate operative recording was widely reported, primarily in response to perceived pressure to achieve targets for career progression. This represents a significant probity issue. Operative logbooks may not be as clear cut as they appear.

This review aims to summarise the published literature on extranodal natural killer/T-cell lympho... more This review aims to summarise the published literature on extranodal natural killer/T-cell lymphoma using a case report as a working example. Extranodal natural killer/T-cell lymphomas are rare, particularly in western countries and usually associated with Epstein-Barr infection. They most commonly affect the upper aerodigestive tract but can present at distant sites as primary lesions or as disseminated disease. The diagnosis of extranodal natural killer/T-cell lymphoma is often made at an advanced stage and prognosis is generally poor. A case of disseminated, upper aerodigestive tract extranodal natural killer/T-cell lymphoma affecting the colon initially treated by laparoscopic right hemicolectomy is presented. Follow up at one year following surgery demonstrated no residual disease. Surgery is rarely indicated in the management of extranodal natural killer/T-cell lymphoma but in selected cases it may offer potentially curative treatment in combination with chemotherapy and radiotherapy.

International Journal of Surgery, Apr 1, 2018

Aims: Vitamin D receptor (VDR) expression has been associated with survival in several cancer sit... more Aims: Vitamin D receptor (VDR) expression has been associated with survival in several cancer sites. This study aims to evaluate the association between VDR expression and prognosis in oesophageal adenocarcinoma patients. Results: During a median of 2.5 (maximum 9) years of follow-up, 75 patients died. In analysis adjusted for confounders, higher VDR expression was associated with an improved overall survival (HR 0.49 95% CI 0.25-0.96) and disease-specific survival (HR 0.50 95% CI 0.26-0.99), when comparing the highest with the lowest tertile of expression. These associations were strongest in sensitivity analysis restricted to junctional tumours. Conclusions: This study is the first to demonstrate that patients with higher VDR expression in oesophageal adenocarcinoma have a more favourable prognosis. Further work is needed to validate these findings, and to define the role of VDR in the aetiology, progression and management of oesophageal adenocarcinoma. Methods: Oesophageal adenocarcinoma specimens and clinical data were collected from 130 patients treated with neo-adjuvant chemotherapy prior to surgical resection at the Northern Ireland Cancer Centre between 2004 and 2012. Tissue microarrays were created and immunohistochemical staining for VDR was performed on triplicate tumour cores from each resection specimen. Cox proportional hazards models were applied to evaluate associations between VDR, according to tertiles of expression, and survival outcomes.

International Journal of Surgery, Nov 1, 2016

Changes in the delivery of the healthcare structure have led to the expansion of the non-medical ... more Changes in the delivery of the healthcare structure have led to the expansion of the non-medical workforce (NMW). The non-medical practitioner in surgery (a healthcare professional without a medical degree who undertakes specialist training) is a valuable addition to a surgical firm. However, there are a number of challenges regarding the successful widespread implementation of this role. This paper outlines a number of these concerns, and makes recommendations to aid the realisation of the nonmedical practitioner as a normal part of the surgical team. In summary, the Association of Surgeons in Training welcomes the development of the non-medical workforce as part of the surgical team in order to promote enhanced patient care and improved surgical training opportunities. However, establishing a workforce of independent/semi-independent practitioners who compete for the same training opportunities as surgeons in training may threaten the UK surgical training system, and therefore the care of our future patients.

This copy of the thesis has been supplied on the condition that anyone who consults it is underst... more This copy of the thesis has been supplied on the condition that anyone who consults it is understood to recognise that its copyright rests with its author and that no quotation from the thesis and no information derived from it may be published without the author's prior consent.

material is granted provided that the copies are not made or distributed for direct commercial ad... more material is granted provided that the copies are not made or distributed for direct commercial advantage, the ACM copyright notice and the title of the publication and its date appear, and notice is given that copying is by permission of the Association for Computing Machinery. TO copy otherwise, or to republish, requires a fee and/or specific permission.

World Journal of Surgery, Dec 2, 2014

Positron emission tomography-computed tomography (PET-CT) scanning is used routinely in the stagi... more Positron emission tomography-computed tomography (PET-CT) scanning is used routinely in the staging of oesophageal cancer to identify occult metastases not apparent on CT and changes the management in typically 3-18 % patients. The authors aim to re-evaluate its role in the management of oesophageal cancer, investigating whether it is possible to identify a group of patients that will not benefit and can safely be spared from this investigation. Consecutive patients with oesophageal cancer undergoing PET-CT staging between 2010 and 2013 were identified from a specialist modern multidisciplinary team database. Without knowledge of the PET-CT result, patients were stratified into low-risk or high-risk groups according to the likelihood of identifying metastatic disease on PET-CT based on specified criteria routinely available from endoscopy and CT reports. Clinical outcomes in the two groups were investigated. In 383 undergoing PET-CT, metastatic disease was identified in 52 (13.6 %) patients. Eighty-three patients were stratified as low risk and 300 as high risk. None of the low-risk patients went on to have metastatic disease identified on PET-CT. Of the high-risk patients, 17 % had metastatic disease identified on PET-CT. In one of the largest studies to date investigating the influence of staging PET-CT on management of patients with oesophageal cancer, the authors report a classification based on endoscopy/CT criteria is able to accurately stratify patients according to the risk of having metastatic disease. This could be used to avoid unnecessary PET-CT 22 % of patients, saving cost, inconvenience and reducing potential delay to definitive treatment in this group.

Journal of Laparoendoscopic & Advanced Surgical Techniques, Oct 1, 2015

Pancreatic fistula (PF) is a common postoperative complication following distal pancreatectomy. T... more Pancreatic fistula (PF) is a common postoperative complication following distal pancreatectomy. The prolonged prefiring compression (PFC) technique to reduce PF has been described by Nakamura and colleagues in Japan. The present study assessed if this technique can be applied to the United Kingdom patient population in a tertiary referral center and replicate the low incidence of PF after the laparoscopic approach to distal pancreatectomy (Lap-DP). This is a retrospective study of all patients who underwent Lap-DP using the modified PFC technique by the senior author between June 2011 and July 2014. The modified PFC technique involved compression of the pancreatic parenchyma with an endo-stapler for a 3-minute period prior to firing and further 1-minute compression after firing prior to removal of the stapler, which is a small variant to the original technique of maintaining a 2-minute compression post firing. Twenty patients (15 females; median age, 66 [range, 25-77] years) underwent Lap-DP using the PFC technique during the study period. Six patients had splenic-preserving Lap-DP. Median operating time was 240 minutes (range, 150-420 minutes) with a median length of hospital stay of 6 days (range, 3-22 days). Six patients (30%) developed Type A (biochemically noted as high drain fluid amylase) PF, and none of the patients had Type B/C PF. In the splenic preservation group, 1 patient had complete splenic infarction requiring laparoscopic splenectomy on Day 3, and 1 patient had partial infarction requiring prolonged hospital stay for pain relief. One patient required prolonged respiratory support due to severe preexisting lung disease. Overall mortality was zero. Our data confirm that the PFC technique is safe, feasible, and effective in reducing clinically significant PF post-Lap-DP in the United Kingdom patient population.

JSLS, 2010

Background:Port-site hernia is a rare but potentially serious complication of laparoscopic cholec... more Background:Port-site hernia is a rare but potentially serious complication of laparoscopic cholecystectomy. This study aimed to review the current literature, assess the incidence and causes of port-site hernias, and identify methods to reduce the risk.Methods:A systematic search of the literature published in English from 1995 to 2010 was conducted using PubMed to identify all reports of port-site, trocar-site, or incisional hernia following laparoscopic cholecystectomy. Studies in over 100 patients were identified before the application of defined exclusion criteria. The incidence of port-site hernia was calculated and compared with historical data. Predisposing factors were reviewed.Results:Seven studies met the search criteria, with 99 port-site hernias in 5984 patients. The overall incidence of port-site hernia was 1.7% (range, 0.3% to 5.4). The most important factors were older age, higher body mass index, preexisting hernia, trocar design, trocar diameter, increased duration of surgery, and extension of the port site for gallbladder extraction.Conclusion:The incidence of port-site hernia is low but likely to be underestimated and has not declined over time. Awareness of the predisposing factors and modification of techniques may help to reduce the risk.

Community College Journal of Research and Practice, Feb 1, 2006