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BackgroundThe role of routine lymphadenectomy in the surgical treatment of pancreatic neuroendocrine tumors (pNET) remains poorly defined. The objective of the current study was to investigate trends in the number of lymph nodes (LN) evaluated for pNET treatment at a nationwide level.MethodsPatients undergoing surgery for pNET between 2000 and 2016 were identified in the U.S. Neuroendocrine Tumor Study Group (US-NETSG) database as well as the Surveillance, Epidemiology, and End Results (SEER) database. The number of LNs examined was evaluated over time.ResultsThe median number of evaluated LNs increased roughly fourfold over the study period (US-NETSG, 2000: 3 LNs vs. 2016: 13 LNs; SEER, 2000: 3 LNs vs. 2016: 11 LNs, both p < 0.001). While no difference in 5-year OS and RFS was noted among patients who had 1–3 lymph node metastases (LNM) vs. ≥ 4 LNM between 2000–2007 (OS 73.5% vs. 69.9%, p = 0.12; RFS: 64.9% vs. 40.1%, p = 0.39), patients who underwent resection and LN evaluation during the period 2008–2016 had an incrementally worse survival if the patient had node negative disease, 1–3 LNM and ≥ 4 LNM (OS 86.8% vs. 82.7% vs. 74.9%, p < 0.001; RFS: 86.3% vs. 64.7% vs. 50.4%, p < 0.001). On multivariable analysis, a more recent year of diagnosis, pancreatic head tumor location, and tumor size > 2 cm were associated with 12 or more LNs evaluated in both US-NETSG and SEER databases.ConclusionThe number of LNs examined nearly quadrupled over the last decade. The increased number of LNs examined suggested a growing adoption of the AJCC staging manual recommendations regarding LN evaluation in the treatment of pNET.

In 1986, Kowol and Mitsch studied properties of the so-called ‘natural partial order’≤ on T(X), the total transformation semigroup defined on a set X. In particular, they determined when two total transformations are related under this order, and they described the minimal and maximal elements of (T(X), ≤). In this paper, we extend that work to the semigroup P(X) of all partial transformations of X, compare ≤ with another ‘natural’ partial order on P(X), characterise the meet and join of these two orders, and determine the minimal and maximal elements of P(X) with respect to each order.

This article addresses workplace culture in academic libraries as an aspect of organizational success in achieving on-the-job diversity. It introduces a conceptual framework in the form of selected indicators as measurements of cultural integration in the workplace. Characteristics of organizational cultural health are also identified in order to direct an organization toward greater inclusiveness. The emphasis is on academic libraries, but the concept and content are applicable to information centers and libraries of all types.

In this paper we describe R -unipotent semigroups being regular extensions of a left regular band by an R -unipotent semigroup T as certain subsemigroups of a wreath product of a left regular band by T. We obtain Szendrei’s result that each E-unitary R -unipotent semigroup is embeddable into a semidirect product of a left regular band by a group. Further, specialising the first author’s notion of λ -semidirect product of a semigroup by a locally R -unipotent semigroup, we provide an answer to an open question raised by the authors in [Extensions and covers for semigroups whose idempotents form a left regular band, Semigroup Forum 81 (2010), 51-70].

The focus of this dissertation is examining the impact of Imago Relationship Therapy (IRT), more specifically the “Getting the Love You Want” workshop (GTLYW), on five Black/African American couples’ attachment, interactions, marital satisfaction and communication. This study examines Black couples’ lived experiences through a modified version of a quantitative measure, called the Patient Attachment Client System (PACS), the Marital Satisfaction Questionnaire-Revised (MSQ-R), semi-structured questionnaires to measure qualitative data as well as direct observation of participants’ interactions. PACS analyzes how patients’ in-session discourse enables them to share present experiences and link these processes with their attachment structure. In this view, attachment was assessed by delineating distinctive acts regarding how participants communicated their internal moment-to-moment experiences. Qualitative findings reveal a majority of study participants reported an improvement in their overall ability to communicate with their partner, an increase in their ability to communicate about race and racial distress, and an increase in their understanding and ability to deal with conflict and frustrations as a result of participating in the GTLYW workshop. Qualitative findings also showed that the structure of the Imago couples dialogue itself provided the conditions necessary for secure attachment, as measured utilizing PACS discursive markers, to occur between partners who are attachment figures to each other. Quantitative results in this study revealed that frequency of participants’ secure attachment discursive markers (PACS) increased over the length of the GTLYW workshop, and that the secure attachment discursive markers were highest in the racial distress dialogue. While participation in the GTLYW increased Black couples’ perception of their own marital satisfaction, it provided less strong support for an increase in their perception of their partner’s marital satisfaction. The underestimation of the partner’s view of marital satisfaction might be due to the differences in a subjective post-analysis self/other measure and an in-the-moment dialogic combined view measure. Educational workshops such as GTLYW may be a valuable prevention tool for couples and an efficient adjunct to therapy for clinicians who are trying to help couples struggling to remain in their marital relationship. Implications of the aforementioned findings, study limitations, recommendations and future directions are also discussed. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu).

In 1987, Sullivan characterised the elements of the semigroup NI(X) generated by the nilpotents in I(X), the symmetric inverse semigroup on an infinite set X; and, in the same year, Gomes and Howie did the same for finite X. In 1999, Marques-Smith and Sullivan determined all the ideals of NI(X) for arbitrary X. In this paper, we use that work to describe all the congruences on NI(X).

Purpose This study aimed to identify optimal management decisions for surgeons preforming pancreatic head resection on patients with altered anatomy due to a previous Roux-en-Y gastric bypass (RYGB). Methods A multi-national (4), multi-center (28) collaborative of 55 pancreatic surgeons who have performed pancreatoduodenectomy or total pancreatectomy following RYGB for obesity (2005–2018) was created. Demographics, operative details, and perioperative outcomes from this cohort were analyzed and compared in a propensity-score matched analysis with a multi-center cohort of 5533 pancreatoduodenectomies without prior RYGB. Results Ninety-six patients with a previous RYGB undergoing pancreatic head resection were assembled. Pathologic indications between the RYGB and normal anatomy cohorts did not differ. Propensity score matching of RYGB vs. patients with unaltered anatomy demonstrated no differences in major postoperative outcomes. In total 20 distinct reconstructions were employed (of 37 potential options); the three most frequent reconstructions accounted for 52.1%, and none demonstrated superior outcomes. There were no differences in outcomes observed between original biliopancreatic limb use (66.7%) and those where a secondary Roux limb was created for biliopancreatic reconstruction. Remnant stomachs were removed in 54.7% of cases, with no outcome differences between resected and retained stomachs. Venting gastrostomy tubes were used in 36.2% of retained stomachs without obvious outcome benefits. Jejunostomy tubes were used infrequently (11.7%). Conclusions Pancreatic head resection after RYGB is an infrequently encountered, unique and challenging scenario for any given surgeon. These patients do not appear to suffer higher morbidity than those with unaltered anatomy. Various technical reconstructive options do not appear to confer distinct benefits.

In Billhardt et al. (Semigroup Forum 79:101–118, 2009) the authors introduced the notion of an associate inverse subsemigroup of a regular semigroup, extending the concept of an associate subgroup of a regular semigroup, first presented in Blyth et al. (Glasg. Math. J. 36:163–171, 1994). The semigroups of these two classes admit axiomatic characterisations in terms of unary operations and can, therefore, be considered as unary semigroups. In this paper we introduce the notion of unary semigroup with associate inverse subsemigroup [with associate subgroup] and show that the classes of such unary semigroups form varieties.