Late reoperation in vascular surgery

Objectives:Assessment of late reoperation (after 30 days) following vascular surgery.Design:Analysis of a prospectively collected database of consecutive patients undergoing vascular surgery.Setting:A single teaching unit's experience between 1986–1993.Materials:Patients undergoing 2501 primary arterial reconstructions.Chief outcome measures:Reoperation after 30 days.Main results:One hundred and fifty eight patients (6%) underwent further operations, at more than 1 month after the primary procedure. Primary procedures at highest risk for reoperations were axillobifemoral bypasses and femorodistal bypasses with respective late reoperation rates of 20% and 16%. The majority of patients required late reoperation because of graft occlusion or stenosis. Overall, of the 158 late reoperations performed, 114 were related to the same arterial segment with the same presenting symptoms as the primary operation, and 44 for a different indication. A second or subsequent reoperation was required in 54 patients and the overall operative mortality was 11%.Conclusion:Patients undergoing certain vascular procedures, should be informed of the high risk of a subsequent procedure when consent is obtained

Linkage analysis in a large kindred with autosomal dominant transmission of polyglandular autoimmune disease type II (Schmidt syndrome)

Schmidt syndrome (PGA syndrome type II) is a rare condition characterized by polyglandular failure. It is an autosomal dominant trait with variable expressivity that was inherited over four generations in an Indiana kindred. Association of HLA-B8 has been reported with Schmidt syndrome. Our proband is a 12-year-old boy with Addison disease, insulin dependent diabetes mellitus (IDDM), and vitiligo. Two of his eight sibs had either IDDM (sister) or vitiligo and hyperthyroidism (brother). His mother had hypothyroidism. Seven members of earlier generations apparently were also affected. We obtained peripheral blood for HLA and genetic analysis from 21 relatives in a family with 8 Schmidt syndrome individuals in three generations. HLA studies on 15 affected and unaffected relatives showed only 2 of 7 persons with B8-containing haplotypes. Therefore, no association exists between the B8-containing haplotype and the syndrome. We identified informative marker loci. No evidence for linkage of the Schmidt locus to any of the 14 markers was found and close linkage to esterase D and adenylate kinase and possibly properdin factor B was excluded

Two distinct lithium diffusive species for polymer gel electrolytes containing LiBF₄, propylene carbonate (PC) and PVDF

Polymer gel electrolytes have been prepared using lithium tetrafluoroborate (LiBF₄), propylene carbonate (PC) and polyvinylidene fluoride (PVDF) at 20% and 30% concentration by mass. Self diffusion coefficients have been measured using pulse field gradient nuclear magnetic resonance (PFG-NMR) for the cation and anion using ⁷Li and ¹⁹F resonant frequencies respectively. It was found that lithium ion diffusion was slow compared to the much larger fluorine anion likely resulting from a large solvation shell of the lithium. Lithium ion diffusion measurements exhibited two distinct diffusive species, whereas the fluorine ions exhibited only a single diffusive species

Compulsory licensing and access to drugs

Compulsory licensing allows the use of a patented invention without the owner's consent, with the aim of improving access to essential drugs. The pharmaceutical sector argues that, if broadly used, it can be detrimental to innovation. We model the interaction between a company in the North that holds the patent for a certain drug and a government in the South that needs to purchase it. We show that both access to drugs and pharmaceutical innovation depend largely on the Southern country's ability to manufacture a generic version. If the manufacturing cost is too high, compulsory licensing is not exercised. As the cost decreases, it becomes a credible threat forcing prices down, but reducing both access and innovation. When the cost is low enough, the South produces its own generic version and access reaches its highest value, despite a reduction in innovation. The global welfare analysis shows that the overall impact of compulsory licensing can be positive, even when accounting for its impact on innovation. We also consider the interaction between compulsory licensing and the strength of intellectual property rights, which can have global repercussions in other markets beyond the South

Human Resource Flexibility as a Mediating Variable Between High Performance Work Systems and Performance

Much of the human resource management literature has demonstrated the impact of high performance work systems (HPWS) on organizational performance. A new generation of studies is emerging in this literature that recommends the inclusion of mediating variables between HPWS and organizational performance. The increasing rate of dynamism in competitive environments suggests that measures of employee adaptability should be included as a mechanism that may explain the relevance of HPWS to firm competitiveness. On a sample of 226 Spanish firms, the study’s results confirm that HPWS influences performance through its impact on the firm’s human resource (HR) flexibility

Computed Tomography Angiography for Detection of Pulmonary Embolism in Western Australia Shows Increasing Use with Decreasing Diagnostic Yield

(1) Background: Pulmonary embolism (PE) can be fatal. Computed tomography pulmonary angiography (CTPA) can accurately diagnose PE, but it should be used only when reasonable pre-test probability exists. Overtesting with CTPA exposes patients to excess ionizing radiation and contrast media, while PE overdiagnosis leads to the treatment of small emboli unlikely to cause harm. This study assessed trends in CTPA use and diagnostic yield. We also assessed trends in PE hospitalizations and mortality to indicate PE severity. (2) Methods: Analysis of Western Australian linked administrative data for 2003–2015 including hospitalizations, emergency department (ED) attendances, and CTPA performed at hospitals. Age-sex standardized trends were calculated for CTPA use, PE hospitalizations, and mortality (as a proxy for severity). Logistic regression assessed diagnostic yield of CTPA following unplanned ED presentations. (3) Results: CTPA use increased from 3.3 per 10,000 person-years in 2003 (95% CI 3.0–3.6) to 17.1 per 10,000 person-years (16.5–17.7) in 2015. Diagnostic yield of CTPA increased from 12.7% in 2003 to 17.4% in 2005, declining to 12.2% in 2015 (p = 0.049). PE hospitalizations increased from 3.8 per 10,000 (3.5–4.1) in 2003 to 5.2 per 10,000 (4.8–5.5) in 2015. Mortality remained constant at 0.50 per 10,000 (0.39–0.62) in 2003 and 0.42 per 10,000 (0.32–0.51) in 2015. (4) Conclusions: CTPA increased from 2003 to 2015, while diagnostic yield decreased, potentially indicating overtesting. PE mortality remained constant despite increasing hospitalizations, likely indicating a higher proportion of less severe cases. As treatment can be harmful, this could represent overdiagnosis

Effects of silver sulfide nanomaterials on mycorrhizal colonization of tomato plants and soil microbial communities in biosolid-amended soil

We investigated effects of Ag2S engineered nanomaterials (ENMs), polyvinylpyrrolidone (PVP) coated Ag ENMs (PVP-Ag), and Ag+ on arbuscular mycorrhizal fungi (AMF), their colonization of tomato (Solanum lycopersicum), and overall microbial community structure in biosolids-amended soil. Concentration-dependent uptake was measured in all treatments. Plants exposed to 100 mg kg−1 PVP-Ag ENMs and 100 mg kg−1 Ag+ exhibited reduced biomass and greatly reduced mycorrhizal colonization. Bacteria, actinomycetes and fungi were inhibited by all treatment classes, with the largest reductions measured in 100 mg kg−1 PVP-Ag ENMs and 100 mg kg−1 Ag+. Overall, Ag2S ENMs were less toxic to plants, less disruptive to plant-mycorrhizal symbiosis, and less inhibitory to the soil microbial community than PVP-Ag ENMs or Ag+. However, significant effects were observed at 1 mg kg−1 Ag2S ENMs, suggesting that the potential exists for microbial communities and the ecosystem services they provide to be disrupted by environmentally relevant concentrations of Ag2S ENMs.Jonathan D. Judy, Jason K. Kirby, Courtney Creamer, Mike J. McLaughlin, Cathy Fiebiger, Claire Wright, Timothy R. Cavagnaro, Paul M. Bertsc

Chaos in a double driven dissipative nonlinear oscillator

We propose an anharmonic oscillator driven by two periodic forces of different frequencies as a new time-dependent model for investigating quantum dissipative chaos. Our analysis is done in the frame of statistical ensemble of quantum trajectories in quantum state diffusion approach. Quantum dynamical manifestation of chaotic behavior, including the emergence of chaos, properties of strange attractors, and quantum entanglement are studied by numerical simulation of ensemble averaged Wigner function and von Neumann entropy.Comment: 9 pages, 18 figure