Beyond Goldwater-Nichols

This report culminated almost two years of effort at CSIS, which began by developing an approach for both revisiting the Goldwater-Nichols Department of Defense Reorganization Act of 1986 and for addressing issues that were beyond the scope of that landmark legislation

The Technology Effect: How Perceptions of Technology Drive Excessive Optimism

Purpose: We propose that constant exposure to advances in technology has resulted in an implicit association between technology and success that has conditioned decision makers to be overly optimistic about the potential for technology to drive successful outcomes. Three studies examine this phenomenon and explore the boundaries of this “technology effect.” Design/Methodology/Approach: In Study 1, participants (N = 147) made simulated investment decisions where the information about technology was systematically varied. In Study 2 (N = 143), participants made decisions in a resource dilemma where technology was implicated in determining the amount of a resource available for harvest. Study 3 (N = 53 and N = 60) used two implicit association tests to examine the assumption that people associate technology with success. Findings: Results supported our assumption about an implicit association between technology and success, as well as a “technology effect” bias in decision making. Signals of high performance trigger the effect, and the effect is more likely when the technology invoked is unfamiliar. Implications: Excessive optimism that technology will result in success can have negative consequences. Individual investment decisions, organizational decisions to invest in R&D, and societal decisions to explore energy and climate change solutions might all be impacted by biased beliefs about the promise of technology. Originality/Value: We are the first to systematically examine the optimistic bias in the technology effect, its scope, and boundaries. This research raises decision makers’ awareness and initiates research examining how the abstract notion of technology can influence perceptions of technological advances

Selective Use of Pericardial Window and Drainage as Sole Treatment for Hemopericardium from Penetrating Chest Trauma

Background Penetrating cardiac injuries (PCIs) are highly lethal, and a sternotomy is considered mandatory for suspected PCI. Recent literature suggests pericardial window (PCW) may be sufficient for superficial cardiac injuries to drain hemopericardium and assess for continued bleeding and instability. This study objective is to review patients with PCI managed with sternotomy and PCW and compare outcomes. Methods All patients with penetrating chest trauma from 2000 to 2016 requiring PCW or sternotomy were reviewed. Data were collected for patients who had PCW for hemopericardium managed with only pericardial drain, or underwent sternotomy for cardiac injuries grade 1–3 according to the American Association for the Surgery of Trauma (AAST) Cardiac Organ Injury Scale (OIS). The PCW+drain group was compared with the Sternotomy group using Fisher’s exact and Wilcoxon rank-sum test with P\u3c0.05 considered statistically significant. Results Sternotomy was performed in 57 patients for suspected PCI, including 7 with AAST OIS grade 1–3 injuries (Sternotomy group). Four patients had pericardial injuries, three had partial thickness cardiac injuries, two of which were suture-repaired. Average blood drained was 285mL (100–500 mL). PCW was performed in 37 patients, and 21 had hemopericardium; 16 patients proceeded to sternotomy and 5 were treated with pericardial drainage (PCW+drain group). All PCW+drain patients had suction evacuation of hemopericardium, pericardial lavage, and verified bleeding cessation, followed by pericardial drain placement and admission to intensive care unit (ICU). Average blood drained was 240mL (40–600 mL), and pericardial drains were removed on postoperative day 3.6 (2–5). There was no significant difference in demographics, injury mechanism, Revised Trauma Score exploratory laparotomies, hospital or ICU length of stay, or ventilator days. No in-hospital mortality occurred in either group. Conclusions Hemodynamically stable patients with penetrating chest trauma and hemopericardium may be safely managed with PCW, lavage and drainage with documented cessation of bleeding, and postoperative ICU monitoring. Level of evidence Therapeutic study, level IV

Usability and feasibility of consumer-facing technology to reduce unsafe medication use by older adults

Background Mobile health technology can improve medication safety for older adults, for instance, by educating patients about the risks associated with anticholinergic medication use. Objective This study's objective was to test the usability and feasibility of Brain Buddy, a consumer-facing mobile health technology designed to inform and empower older adults to consider the risks and benefits of anticholinergics. Methods Twenty-three primary care patients aged ≥60 years and using anticholinergic medications participated in summative, task-based usability testing of Brain Buddy. Self-report usability was assessed by the System Usability Scale and performance-based usability data were collected for each task through observation. A subset of 17 participants contributed data on feasibility, assessed by self-reported attitudes (feeling informed) and behaviors (speaking to a physician), with confirmation following a physician visit. Results Overall usability was acceptable or better, with 100% of participants completing each Brain Buddy task and a mean System Usability Scale score of 78.8, corresponding to “Good” to “Excellent” usability. Observed usability issues included higher rates of errors, hesitations, and need for assistance on three tasks, particularly those requiring data entry. Among participants contributing to feasibility data, 100% felt better informed after using Brain Buddy and 94% planned to speak to their physician about their anticholinergic related risk. On follow-up, 82% reported having spoken to their physician, a rate independently confirmed by physicians. Conclusion Consumer-facing technology can be a low-cost, scalable intervention to improve older adults’ medication safety, by informing and empowering patients. User-centered design and evaluation with demographically heterogeneous clinical samples uncovers correctable usability issues and confirms the value of interventions targeting consumers as agents in shared decision making and behavior change

Prograde and retrograde growth of monazite in migmatites: An example from the Nagercoil Block, southern India

Data from a migmatised metapelite raft enclosed within charnockite provide quantitative constraints on the pressure–temperature–time (P–T–t) evolution of the Nagercoil Block at the southernmost tip of peninsular India. An inferred peak metamorphic assemblage of garnet, K-feldspar, sillimanite, plagioclase, magnetite, ilmenite, spinel and melt is consistent with peak metamorphic pressures of 6–8 kbar and temperatures in excess of 900 °C. Subsequent growth of cordierite and biotite record high-temperature retrograde decompression to around 5 kbar and 800 °C. SHRIMP U–Pb dating of magmatic zircon cores suggests that the sedimentary protoliths were in part derived from felsic igneous rocks with Palaeoproterozoic crystallisation ages. New growth of metamorphic zircon on the rims of detrital grains constrains the onset of melt crystallisation, and the minimum age of the metamorphic peak, to around 560 Ma. The data suggest two stages of monazite growth. The first generation of REE-enriched monazite grew during partial melting along the prograde path at around 570 Ma via the incongruent breakdown of apatite. Relatively REE-depleted rims, which have a pronounced negative europium anomaly, grew during melt crystallisation along the retrograde path at around 535 Ma. Our data show the rocks remained at suprasolidus temperatures for at least 35 million years and probably much longer, supporting a long-lived high-grade metamorphic history. The metamorphic conditions, timing and duration of the implied clockwise P–T–t path are similar to that previously established for other regions in peninsular India during the Ediacaran to Cambrian assembly of that part of the Gondwanan supercontinent

Primary adenoid cystic carcinoma of the breast: case report and review of the literature

Adenoid cystic carcinoma (ACC) of the breast is a rare neoplasm accounting for 0.1% of all breast carcinomas, and presenting most commonly as a painful breast mass. In contrast to the aggressive nature of ACC at other sites, ACC of the breast has a favorable prognosis, lymph node involvement or distant metastases seldom occur. Treatment is basically of simple mastectomy. Chemotherapy, radiation and hormonal treatment have been infrequently used and evaluated. We report a case of ACC of the breast managed with mastectomy and review the literature

Increased white matter fibre dispersion and lower IQ scores in adults born preterm

Preterm birth has been associated with altered microstructural properties of the white matter and lower cognitive ability in childhood and adulthood. Due to methodological limitations of the diffusion tensor model, it is not clear whether alterations in myelination or variation in fibre orientation are driving these differences. Novel models applied to multi-shell diffusion imaging have been used to disentangle these effects, but to date this has not been used to study the preterm brain in adulthood. This study investigated whether novel advanced diffusion MRI metrics such as microscopic anisotropy and orientation dispersion are altered in adults born preterm, and whether this was associated with cognitive performance. Seventy-two preterm born participants (37 weeks gestational age) controls (34 males, mean age 30.9 ± 4.0 years) were recruited from the general population. Tensor FA was calculated with FSL, while microscopic FA and orientation dispersion entropy (ODE) were estimated using the Spherical Mean Technique (SMT). Estimated Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) were obtained from the WASI-II (abbreviated) IQ test. Voxel-wise comparisons using FSL's tract-based spatial statistics were performed to test between-group differences in diffusion MRI metrics as well as within-group associations of diffusion MRI metrics and IQ outcomes. The preterm group had significantly lower FSIQ, VCI and PRI scores. Preterm subjects demonstrated widespread decreases in ODE reflecting increased fibre dispersion, but no differences in microscopic FA. Tensor FA was increased in a small area in the anterior corona radiata. Lower FA values in the preterm population were associated with lower FSIQ and PRI scores. An increase in fibre dispersion in white matter and lower IQ scores after preterm birth exist in adulthood. Advanced diffusion MRI metrics such as the orientation dispersion entropy can be used to monitor white matter alterations across the lifespan in preterm born individuals. Although not significantly different between preterm and term groups, tensor FA values in the preterm group were associated with cognitive outcome