INTRODUCTION

Restenosis is usually defined as a re-narrowing of the arterial lumen occurring after a vascular intervention intended to treat ischemic lesions. This loss of lumen area results from the injury caused by all forms of vascular intervention, including direct repair (patch angioplasty, endarterectomy) and intraluminal approaches (balloon angioplasty, atherectomy, stent angioplasty). While there are clear differences between arteries and veins (review in), this review will also include discussion of stenosis after vein bypass grafting or creation of arteriovenous fistula dialysis access because stenosis in these cases also results from injury.

Lumen enlargement after angioplasty or stenting is the result of a combination of plaque reduction (compression and embolization), plaque redistribution within or outside the lesion area, and vessel expansion (see review). Failure occurs at early times because of technical problems and thrombosis (e.g. small diameter vein graft, limited out-flow, or hypercoagulability) and later times (1-18 months) primarily because of injury-induced scarring. At much later times (> 18 months), failure primarily results from the ongoing atherosclerotic process. Although restenosis occurs within the con- text of atherosclerosis, the clinical features and genetic control of atherosclerosis and restenosis are different. Atherosclerosis develops slowly over decades, while restenosis occurs within months to years.

The costs of restenosis are considerable, since greater than 20% of all interventions fail because of restenosis. In the U.S. alone, it is estimated that as many as 200,000 cases of drug eluting stent (DES) restenosis occur every year (see review).

‘The Last Enemy transports us to a Britain of the not-too-distant future, where personal information has become the weapon of a surveillance state against its own citizens, and where a super-database called ‘TIA–Total Information Awareness’ appears to fuse state of the art technology with a rather draconian reinterpretation of the art of the State.’

‘The Last Enemy is an emotional odyssey about a man in search of the truth of what happened to his brother, and to his society. It's a cautionary tale about technology, with identity cards, biometric tests and armed police becoming an everyday presence in our lives.’

Introduction

The Last Enemy aired in Australia in 2009. In 2008, it caused a sensation in England when the British Broadcasting Corporation first screened it. The series depicts Britain transformed into a security state by a major terrorist attack. Identity cards are strictly required and citizens are watched, so the government can catch the terrorists before they strike again.

The tag line from The Last Enemy is ‘tomorrow is nearer than you think’ and the series presents a plausible future where a person's ability to function as an autonomous individual is dictated by the personal information which is collected and stored by the government in its identity database. The collection and use of that information was initially justified on the basis of law enforcement and public security, but the Total Information Awareness database (‘TIA’) is now used as a means of control. In effect, the shield has become the sword.

The first City of Adelaide Plan recognised ‘a need to protect, reinforce and enhance many … subtle qualities of townscape throughout the City’. The Plan described ‘Desired future character’ statements for each precinct of the city, but those statements did not afford adequate protection to townscapes. Such protection could only come from statutory recognition of a concept of heritage beyond the criteria for listing on the Registers of State and City of Adelaide Heritage Items. ACC's townscape initiative aimed to conserve groups of buildings that contributed to the traditional character of the city and reflected past periods and change. They might be mansions or modest villas or rows of workers' cottages, shops or warehouses, corner pubs or minor churches constructed of stone and brick in Victorian and Edwardian styles common to Adelaide and North Adelaide. Owners of designated townscape properties would be required to retain only those portions of their buildings viewable from the street, whereas owners of heritage-listed buildings were required to maintain the whole of their buildings.

INTRODUCTION

Over the last decade aortic aneurysm has gained increased focus for a number of reasons. Firstly, the widespread use of imaging and screening in some countries has resulted in greater detection of the condition. Secondly since the condition is much more common in the elderly the number of patients with the problem is projected to increase progressively with the rising average age of the population. Surgical and endovascular treatments have not been shown to reduce mortality for patients with small abdominal aortic aneurysms (AAAs) and thus other therapies are required to deal effectively with the large group of patients being identified with small AAAs. There is also a need to provide better prognostic information for patients with AAA by risk stratification in terms of the likelihood of complications, including AAA progression to a stage where surgery is required and also other cardiovascular complications. As a result of these current management deficiencies, there has been an explosion in studies directed at improved understanding of AAA pathogenesis. These studies have mainly consisted of investigations in animal models or assessments of human DNA, tissue or blood samples. Mice models have been particularly popular due to the ability to perform elegant interventions and assess their influence on AAA. Data from such studies has thus had a major impact on pathogenesis theories and treatment targets. However, animal models have limitations and cannot be expected to be completely comparable to human disease.

In the movie The Net Angela Bennett, played by the actress Sandra Bullock, goes to the American Consulate to apply for a temporary visa in order to return to the United States, after her purse containing her passport is stolen while she is on vacation in Mexico. In the Consulate office she is approached by a consular officer holding an application form:

Officer: ‘Ruth Marx? Ruth Marx? Excuse me, are you Ruth Marx?’ Angela: ‘No.’

Officer: ‘You are not the woman who was here about a temporary visa?’

Angela: ‘No, I am here about a temporary visa but …’

Officer: ‘Is your social security number 915301717?’

Angela: ‘Yes.’

Officer: ‘Do you live at 407 Finley Avenue, Venice, California?’

Angela: ‘Yes.’

Officer: ‘Well then, according to the California Department of Motor Vehicles you are Ruth Marx.

Introduction

In this chapter, I examine the legal function and nature of the new concept of identity in a transactional context. This chapter builds on the functional analysis in chapter 2 and considers the legal role played by transaction identity, as a prelude to examining the inherent vulnerabilities of the scheme (chapter 4), the individual rights arising as a consequence of the emergent concept of identity (chapter 5), and the misuse of an individual's transaction identity information by another person (chapter 6).

This chapter focuses on the functions of transaction identity at the time of a transaction.

This study, which originated as a PhD thesis, examines heritage issues and conflict in Adelaide from enactment of the first South Australian Heritage Act in 1978 to it successor in 1993, and also extends certain issues from that period into the twenty-first century. State legislation introduced by the Labor government of Premier Mike Rann (2002 – present) has affected the built environment significantly since I drafted this book. The Rann government has given the built heritage a low priority in it strategic plan compared to population growth, while Adelaide City Council (ACC has become more balanced in the past decade, although the council too has focussed on increasing Adelaide's population. The result has been more high-rise buildings a the expense of heritage conservation and historic precincts.

The building boom of the 1980s and early 1990s was characterised mainly by speculation in office development, as described in this book. From the late 1990s residential development, particularly high-rise apartments and hotels, has been another major growth sector of the building industry in Adelaide, largely the result of government policies, while office development has continued. Both the state and city governments planned for residential growth aimed at halting urban sprawl, with its demands on infrastructure development, by creating higher density living in the metropolitan areas. The 2004 state Government Strategic Plan, introduced before the impacts of the global financial crisis were felt, projected an unrealistic state population growth to 2 million by 2010.

THE PATHOPHYSIOLOGY OF GRAFT HEALING

The mechanisms of graft healing are of central importance in understanding the successes and failures of current bypass grafts. The tissue response to implantation of a prosthetic graft is complex with many variable factors involved such as the material used, its construction, its porosity, and its length. Further important factors relate to the interaction between the graft and the host artery at the anastomotic areas. Until recently graft design focused on simple conduits for blood flow which were strong (resistant to pressure), biologically inert (resistant to biodegradation) and non-leaking. Each of the major causes of graft failure, luminal thrombogenicity, compliance mismatch and anastomotic intimal hyperplasia, have the potential to be modulated if their aetiology could be better understood. A further stimulus to study of this area is the still unresolved puzzle of man's inability to endothelialise a prosthetic graft beyond the immediate 2 cm or so from the anastomosis.

The peri-anastomotic area

Intimal or neointimal hyperplasia is a characteristic healing reaction to vascular injury. In prosthetic grafting the injury typically involves the direct trauma of implantation, and subsequent exposure of the anastomotic areas to haemodynamic stress (compliance mismatch, turbulent flow and altered shear stress). This results in injury which is transmural with endothelial removal, variable disruption of the internal elastic lamina and medial smooth muscle cells (SMC).

The three phases of intimal hyperplasia will develop quite rapidly with the first being proliferation of medial smooth muscle cells as soon as 24 hours after injury and lasting up to 4 weeks.