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A pathological communication between the trachea and oesophagus – a tracheoesophageal fistula – may be congenital or acquired, benign or malignant, necessitating a multidisciplinary approach. Conservative attempts at closure of this abnormal connection are ineffective; the interposition of healthy vascular tissue offers the least chance of recurrence.
Methods
Outcomes of an islanded fasciocutaneous internal mammary artery perforator flap applied for tracheoesophageal fistula management were assessed in four radiated patients with laryngeal carcinoma using retrospective records.
Results
Four male patients, with an average age of 60.75 years, underwent tracheoesophageal fistula closure between September 2017 and February 2021. A left-sided second internal mammary artery perforator flap was used in all cases, with an average dimension of 10.5 × 4.5 cm. There were no complications of tracheoesophageal leak, flap issues or donor site morbidity on follow up.
Conclusion
Recent advances in angiosomal territory mapping and microvascular dissection techniques, combined with an understanding of tracheoesophageal fistula pathology, have changed management perspectives in these difficult-to-treat patients.
The objective of this research was to assess the adoption of circular agricultural practices as a tool to improve the recovery use efficiency of phosphorus (P) applied to tropical soils. Two Brazilian farms (1 and 2) that are under long-term no-till and cropped year-round with cover and/or cash crops were used in this study. Soybean, maize and common bean were grown during the summer season (October–February), followed by wheat, common bean and maize during the winter season (February–August). Brachiaria ruziziensis was intercropped with off-season maize. Farm 1 also grew sweet potatoes in rotation with grains. In the integrated crop–livestock system, the leftovers from the silos and crop residues were used to feed beef cattle, while the residues not used in the confinement were turned into compost and applied in the production fields. During the last 3 years, 80 (farm 1) and 71 (farm 2) kg/ha/year of P-fertilizer was applied to meet the demand of the different crops and 56% (farm 1) and 58% (farm 2) of P-fertilizer was exported through the crops and livestock. P-recovery represented more than 50% on both farms. Around 60% of the P consumed by animals was excreted in the form of faeces and urine and the animal manure was used to produce organic compost. Therefore, most of the P consumed by the livestock was returned back to the field to serve as organic fertilizer. This study showed that circular agricultural practices can enhance P-recovery.
Japan is often said to have one of the lowest rape rates in the world, and Japanese police claim to solve 97 percent of rape cases. But in reality, only 5–10 percent of rape victims report it to police, and police record half or less of reported cases while prosecutors charge about one-third of recorded cases. The result of this process of caseload attrition is that for every 1,000 rapes in Japan, only 10–20 result in a criminal conviction – and fewer than half of convicted rapists are incarcerated. Similar patterns characterize Japan's criminal justice response to other sex crimes. This article shows that impunity for sex offenders is extremely common in Japan, and it argues that patriarchal social and legal norms help explain this pattern.
Most states acknowledge the significance of Indigenous rights to rectify past injustices. Yet, on the domestic level, the realization of these rights depends on national policies. For democratic societies, questions about public opinion toward Indigenous policies are thus of great interest but remain largely unstudied. To what extent does the ethnic majority support policies conducive to Indigenous rights realization? And how different are the Indigenous population’s policy preferences? I use original experimental data from a vignette study to investigate these questions in the case of the Sámi people in Norway and Sweden. I hypothesize that groups’ attitudes are shaped by policies’ potential to alter the social status hierarchy between the majority and Indigenous populations. The results provide a nuanced picture. The ethnic majority shows significantly less support for policies facilitating Sámi linguistic, self-governance, and territorial rights. While the Sámi have, in general, more positive attitudes toward such policies, their support seems to be less pronounced than the majority’s resistance. Moreover, as attitudes are surprisingly similar when compared between Norway and Sweden, a country’s existing policy context does not appear to be crucial in the formation of these preferences.
My response to Gabriele Gava’s Kant’s Critique of Pure Reason and the Method of Metaphysics (2023) focuses on Kant’s conception of the role of critique in the Critique of Pure Reason. On my account, Gava’s emphasis on the constructive elements of the Critique downplays the critique of former metaphysics elaborated in all three parts of the Transcendental Doctrine of Elements. After some comments on Kant’s conception of the Critique as a doctrine of method, I support this view by discussing the relation between transcendental philosophy and transcendental critique, Kant’s analysis of the faculties, and his transcendental deduction of space.