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25 - Developing the Vision for EBM Governance in the Wider Caribbean
- Edited by Lucia Fanning, Robin Mahon, Patrick McConney, L. Verhart
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- Book:
- Towards Marine Ecosystem-Based Management in the Wider Caribbean
- Published by:
- Amsterdam University Press
- Published online:
- 22 January 2021
- Print publication:
- 15 July 2012, pp 355-366
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Summary
Introduction
Countries of the Wider Caribbean have committed to principled ocean governance through several multilateral environmental and fisheries agreements at both the regional (e.g., the Cartagena Convention SPAW Protocol) and international level (e.g., the Convention on Biological Diversity, the United Nations Fish Stocks Agreement, the FAO Code of Conduct for Responsible Fishing). They have also committed to the 2002 World Summit on Sustainable Development (WSSD) targets for fisheries and biodiversity conservation. However, the ongoing challenge is to put in place the measures required to give effect to these principles at the local, national and regional levels (Fanning et al. 2009). While not minimising the important role of science in an ecosystem approach to managing the living marine resources of the Wider Caribbean Region, the chapters in this book serve to highlight the importance that regional experts have placed on the role of governance to address the problems in the region.
This synthesis chapter presents the outputs of a discussion specifically relating to the role of governance in achieving and implementing a shared vision for ecosystem-based management (EBM) in the Wider Caribbean, using the process described in Chapter 1. In terms of structure, the chapter first describes a vision for governance and reports on the priorities assigned to the identified vision elements. It then discusses how the vision might be achieved by taking into account assisting factors (those that facilitate achievement) and resisting factors (those that inhibit achievement). The chapter concludes with guidance on the strategic direction needed to implement the vision, identifying specific actions to be undertaken for each of the vision elements.
The Vision
The occupational breakdown of members of the Governance Working Group reflected the diversity of affiliations present at the EBM Symposium and included governmental, intergovernmental, academic, non-governmental and private sector (fishers and fishing industry and consulting) representatives. With guidance provided by the facilitator, this diverse grouping of participants was asked to first address the question: “What do you see in place in 10 years’ time when EBM/EAF has become a reality in the Caribbean?”. This diversity provided for a fruitful and comprehensive visioning process, the results of which are summarised in Table 25.1, in terms of the key vision elements and their subcomponents, and in Figure 25.1, which illustrates the level of priority assigned to each of the vision elements.
14 - The pelvis
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- By S. J. Vinnicombe, The Royal Hospitals of St Bartholomew, the London and the London Chest, London, J. E. Husband
- Edited by Paul Butler, The Royal London Hospital, Adam W. M. Mitchell, Charing Cross Hospital, London, Harold Ellis, University of London
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- Book:
- Applied Radiological Anatomy
- Published online:
- 05 February 2015
- Print publication:
- 14 October 1999, pp 279-300
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Summary
Imaging methods
Conventional radiography, ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) are all capable of providing detailed anatomical information.
The gross bony anatomy of the pelvis, as well as the detailed trabecular pattern of bone, are best demonstrated on conventional radiographs, which have higher spatial resolution than CT or MRI. However, CT with reconstruction of the data using a bone algorithm provides superior information regarding spatial relationships, for example, in the demonstration of bone fragments in pelvic fractures. Although MRI is not capable of demonstrating cortical or trabecular bone, the technique provides unique information regarding bone marrow components such as fat, haemopoietic tissue and bone marrow pathology.
The soft tissues of the pelvis are demonstrated using ultrasound, CT and MRI, which all provide complementary information. Ultrasound and MRI have the advantage of not utilizing ionizing radiation. Transabdominal ultrasound is useful as a basic screen, but requires a full bladder to act as an acoustic window and to displace gas-filled loops of bowel out of the pelvis, whereas endovaginal and transrectal ultrasound, though invasive, can provide exquisite detail of the internal anatomy of the male prostate and seminal vesicles and the female genital tract without the necessity of a full bladder. MRI provides similar detail, either by use of dedicated surface phased array coils or endocavitary coils. However, the hysterosalpingogram (HSG) still has an important role in the evaluation of the uterine cavity and Fallopian tubes.
Although ultrasound (with colour flow and pulsed wave Doppler techniques), MRI and contrast-enhanced CT (particularly helical CT), are able to visualize much of the pelvic vasculature, pelvic arteriography remains the gold standard investigation, particularly for delineating the internal iliac arterial tree.
The treatment of node negative squamous cell carcinoma of the postcricoid region
- A. S. Jones, R. D. McRae, D. E. Phillips, J. Hamilton, J. K. Field, D. Husband
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- Journal:
- The Journal of Laryngology & Otology / Volume 109 / Issue 2 / February 1995
- Published online by Cambridge University Press:
- 29 June 2007, pp. 114-119
- Print publication:
- February 1995
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This study includes 155 patients with T1–4N0 carcinoma of the postcricoid region seen between 1963 and 1993. Sixty-seven were treated by primary surgery, 50 by primary irradiation therapy, 36 were unsuitable for curative treatment and two patients were lost to follow-up. Reasons for deciding against curative therapy were: advanced age, poor general condition and advanced disease at the primary site. This study included only those patients who had no neck node metastases at presentation.
Patients receiving surgery tended to be in better general physical condition and tended to have more advanced disease than those treated by irradiation in this series. The tumour-specific five-year survival rate for those treated by surgery was 43 per cent (95 per cent confidence interval (CI) 23–60 per cent). For those patients treated by irradiation the five-year survival rate was 48 per cent (95 per cent CI 27–66 per cent) and for those receiving no treatment the median survival rate was three months (95 per cent CI two-six months). The observed survival for the surgery group was only 18 per cent and for the radiotherapy group 25 per cent at five years.
Multiple logistic regression showed no significant difference in proportions of host and tumour factors between the group receiving radiotherapy and the group receiving surgery. Recurrence at the primary site and the appearance of neck node metastases were not predicted by any host or tumour factor.
Twenty-one patients out of 67 receiving primary surgery had recurrence at the primary site compared with 26 patients out of 50 receiving primary irradiation. Neck node metastases occurred in 16 out of 67 patients receiving surgery and in eight out of 50 receiving radiotherapy. The difference was statistically significant for recurrence at the primary site (X21 = 4.261; p = 0.039) but not significant for neck node metastases (X 21= 0.661;p = 0.416). The data were further analysed using Cox's proportional hazards model for survival and no host or tumour factors were found to be predictive of eventual outcome apart from poorly differentiated histology. This adversely affected survival (X21 = 6.4444; p = 0.011). If patients not treated were included in the model, treatment became a significant factor in improving the survival (X21 = 4.4197; p = 0.034).
Radiotherapy appears to be at least as good as surgery for treating patients with an early carcinoma of the postcricoid region. We would recommend radiotherapy is used in patients with no detectable neck node metastases and in tumours <5 cm long. The complication rate from radiotherapy was reduced when compared with that of surgery.
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