Valproate Protein Binding Is Highly Variable in ICU Patients and Not Predicted by Total Serum Concentrations: A Case Series and Literature Review

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136503/1/phar1912-sup-0001-SupInfo.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136503/2/phar1912_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136503/3/phar1912.pd

Two sword lengths apart: Credible commitment problems and physical violence in democratic national legislatures

Ideally, national legislatures in democracies should be venues for peacefully resolving conflicts between opposing groups. However, they can become places of physical violence. Such violence can be an indication that countries’ legislative institutions are functioning far from the democratic ideal of being venues for peaceful conflict reconciliation. In some cases, such as Ukraine prior to the 2014 outbreak of armed conflict in the country’s east and south, violence can indicate and possibly fuel deeper political divisions. In this first global study of legislative violence, I show that brawls are more likely when legislators find it difficult to credibly commit to follow peaceful bargains. Credible commitment problems are more acute in countries with new democracies and disproportionate electoral outcomes – that is, when electoral votes for parties do not closely correspond to the legislative seats they are given. I find robust support for this argument by first examining a case study of legislative violence in the antebellum United States Senate. Pro- and anti-slavery senators became increasingly unable to maintain credible commitments in the lead-up to the 1856 caning of Senator Charles Sumner as the allocation of seats in the legislative body became more disproportional. Second, I find further support for my argument in a new global dataset of contemporary instances of violence in national legislatures. In addition, I find strong evidence that violence is more likely in legislatures with small minority governments. Despite reasonable expectations, civil wars are not associated with more legislative violence

The association of partial pressures of oxygen and carbon dioxide with neurological outcome after out-of-hospital cardiac arrest: an explorative International Cardiac Arrest Registry 2.0 study

Background Exposure to extreme arterial partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) following the return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA) is common and may affect neurological outcome but results of previous studies are conflicting. Methods Exploratory study of the International Cardiac Arrest Registry (INTCAR) 2.0 database, including 2162 OHCA patients with ROSC in 22 intensive care units in North America and Europe. We tested the hypothesis that exposure to extreme PaO2 or PaCO2 values within 24 h after OHCA is associated with poor neurological outcome at discharge. Our primary analyses investigated the association between extreme PaO2 and PaCO2 values, defined as hyperoxemia (PaO2 > 40 kPa), hypoxemia (PaO2  6.7 kPa) and hypocapnemia (PaCO2  40 kPa with PaCO2  6.7 kPa and neurological outcome. To define a cut point for the onset of poor neurological outcome, we tested a model with increasing and decreasing PaO2 levels and decreasing PaCO2 levels. Cerebral Performance Category (CPC), dichotomized to good (CPC 1–2) and poor (CPC 3–5) was used as outcome measure. Results Of 2135 patients eligible for analysis, 700 were exposed to hyperoxemia or hypoxemia and 1128 to hypercapnemia or hypocapnemia. Our primary analyses did not reveal significant associations between exposure to extreme PaO2 or PaCO2 values and neurological outcome (P = 0.13–0.49). Our secondary analyses showed no significant associations between combinations of PaO2 and PaCO2 and neurological outcome (P = 0.11–0.86). There was no PaO2 or PaCO2 level significantly associated with poor neurological outcome. All analyses were adjusted for relevant co-variates. Conclusions Exposure to extreme PaO2 or PaCO2 values in the first 24 h after OHCA was common, but not independently associated with neurological outcome at discharge.publishedVersio

Risk Stratification Among Survivors of Cardiac Arrest Considered for Coronary Angiography.

BACKGROUND: The American College of Cardiology Interventional Council published consensus-based recommendations to help identify resuscitated cardiac arrest patients with unfavorable clinical features in whom invasive procedures are unlikely to improve survival. OBJECTIVES: This study sought to identify how many unfavorable features are required before prognosis is significantly worsened and which features are most impactful in predicting prognosis. METHODS: Using the INTCAR (International Cardiac Arrest Registry), the impact of each proposed unfavorable feature on survival to hospital discharge was individually analyzed. Logistic regression was performed to assess the association of such unfavorable features with poor outcomes. RESULTS: Seven unfavorable features (of 10 total) were captured in 2,508 patients successfully resuscitated after cardiac arrest (ongoing cardiopulmonary resuscitation and noncardiac etiology were exclusion criteria in our registry). Chronic kidney disease was used in lieu of end-stage renal disease. In total, 39% survived to hospital discharge. The odds ratio (OR) of survival to hospital discharge for each unfavorable feature was as follows: age \u3e85 years OR: 0.30 (95% CI: 0.15 to 0.61), time-to-ROSC \u3e30 min OR: 0.30 (95% CI: 0.23 to 0.39), nonshockable rhythm OR: 0.39 (95% CI: 0.29 to 0.54), no bystander cardiopulmonary resuscitation OR: 0.49 (95% CI: 0.38 to 0.64), lactate \u3e7 mmol/l OR: 0.50 (95% CI: 0.40 to 0.63), unwitnessed arrest OR: 0.58 (95% CI: 0.44 to 0.78), pH85 years, time-to-ROSC \u3e30 min, and non-ventricular tachycardia/ventricular fibrillation) together or ≥6 unfavorable features predicted a ≤10% chance of survival to discharge. CONCLUSIONS: Patients successfully resuscitated from cardiac arrest with 6 or more unfavorable features have a poor long-term prognosis. Delaying or even forgoing invasive procedures in such patients is reasonable

Explaining Institutional Change: Why Elected Politicians Implement Direct Democracy

In existing models of direct democratic institutions, the median voter benefits, but representative politicians are harmed since their policy choices can be overridden. This is a puzzle, since representative politicians were instrumental in creating these institutions. I build a model of direct democracy that explains why a representative might benefit from tying his or her own hands in this way. The key features are (1) that voters are uncertain about their representative's preferences; (2) that direct and representative elections are complementary ways for voters to control outcomes. The model shows that some politicians benefit from the introduction of direct democracy, since they are more likely to survive representative elections: direct democracy credibly prevents politicians from realising extreme outcomes. Historical evidence from the introduction of the initiative, referendum and recall in America broadly supports the theory, which also explains two empirical results that have puzzled scholars: legislators are trusted less, but reelected more, in US states with direct democracy. I conclude by discussing the potential for incomplete information and signaling models to improve our understanding of institutional change more generally

Post tracheostomy and post intubation tracheal stenosis: Report of 31 cases and review of the literature

<p>Abstract</p> <p>Background</p> <p>Severe post tracheostomy (PT) and post intubation (PI) tracheal stenosis is an uncommon clinical entity that often requires interventional bronchoscopy before surgery is considered. We present our experience with severe PI and PT stenosis in regards to patient characteristics, possible risk factors, and therapy.</p> <p>Methods</p> <p>We conducted a retrospective chart review of 31 patients with PI and PT stenosis treated at Lahey Clinic over the past 8 years. Demographic characteristics, body mass index, co-morbidities, stenosis type and site, procedures performed and local treatments applied were recorded.</p> <p>Results</p> <p>The most common profile of a patient with tracheal stenosis in our series was a female (75%), obese (66%) patient with a history of diabetes mellitus (35.4%), hypertension (51.6%), and cardiovascular disease (45.1%), who was a current smoker (38.7%). Eleven patients (PI group) had only oro-tracheal intubation (5.2 days of intubation) and developed web-like stenosis at the cuff site. Twenty patients (PT group) had undergone tracheostomy (54.5 days of intubation) and in 17 (85%) of them the stenosis appeared around the tracheal stoma. There was an average of 2.4 procedures performed per patient. Rigid bronchoscopy with Nd:YAG laser and dilatation (mechanical or balloon) were the preferred methods used. Only 1(3.2%) patient was sent to surgery for re-stenosis after multiple interventional bronchoscopy treatments.</p> <p>Conclusion</p> <p>We have identified putative risk factors for the development of PI and PT stenosis. Differences in lesions characteristics and stenosis site were noted in our two patient groups. All patients underwent interventional bronchoscopy procedures as the first-line, and frequently the only treatment approach.</p

Erwartungsbildung über den Wahlausgang und ihr Einfluss auf die Wahlentscheidung

Erwartungen über den Wahlausgang haben einen festen Platz sowohl in Rational-Choice-Theorien des Wählerverhaltens als auch in stärker sozialpsychologisch orientierten Ansätzen. Die Bildung von Erwartungen und ihr Einfluss auf die Wahlentscheidung ist dabei jedoch ein noch relativ unerforschtes Gebiet. In diesem Beitrag werden anhand von Wahlstudien für Belgien, Österreich und Deutschland verschiedene Fragen der Erwartungsbildung und ihrer Auswirkungen untersucht. Zunächst wird die Qualität der Gesamterwartungen analysiert und verschiedene Faktoren identifiziert, die einen systematischen Einfluss auf die Erwartungsbildung haben. Im zweiten Schritt wenden wir uns den Einzelerwartungen über verschiedene Parteien und Koalitionen zu und finden eine moderate Verzerrung zugunsten der präferierten Parteien und Koalitionen. Dabei kann gezeigt werden, dass der Effekt des Wunschdenkens mit dem politischen Wissen und dem Bildungsgrad abnimmt. Schließlich werden in einem letzten Schritt zwei unterschiedliche Logiken für die Auswirkungen von Erwartungen getestet, das rationale Kalkül des koalitionsstrategischen Wählens zur Vermeidung der Stimmenvergeudung sowie der sozialpsychologisch begründete Bandwagon-Effekt. Das Ausmaß an politischem Wissen scheint dabei eine zentrale vermittelnde Variable zwischen den beiden Logiken zu sein

POLICY PREFERENCE FORMATION IN LEGISLATIVE POLITICS:STRUCTURES, ACTORS, AND FOCAL POINTS

This dissertation introduces and tests a model of policy preference formation in legislative politics. Emphasizing a dynamic relationship between structure, agent, and decision-making process, it ties the question of policy choice to the dimensionality of the normative political space and the strategic actions of parliamentary agenda-setters. The model proposes that structural factors, such as ideology, shape policy preferences to the extent that legislative specialists successfully link them to specific policy proposals through the provision of informational focal points. These focal points shift attention toward particular aspects of a legislative proposal, thus shaping the dominant interpretation of its content and consequences and, in turn, individual-level policy preferences. The propositions of the focal point model are tested empirically with data from the European Parliament (EP), using both qualitative (interview data, content analyses of parliamentary debates) and quantitative methods (multinomial logit regression analyses of roll-call votes). The findings have implications for our understanding of politics and law-making in the European Union and for the study of legislative decision-making more generally

A new path to first light for the Magdalena Ridge Observatory Interferometer

The Magdalena Ridge Observatory Interferometer (MROI) was the most ambitious infrared interferometric facility conceived of in 2003 when funding began. Today, despite having suffered some financial short-falls, it is still one of the most ambitious interferometric imaging facilities ever designed. With an innovative approach to attaining the original goal of fringe tracking to H = 14$^{th}$ magnitude via completely redesigned mobile telescopes, and a unique approach to the beam train and delay lines, the MROI will be able to image faint and complex objects with milliarcsecond resolutions for a fraction of the cost of giant telescopes or space-based facilities. The design goals of MROI have been optimized for studying stellar astrophysical processes such as mass loss and mass transfer, the formation and evolution of YSOs and their disks, and the environs of nearby AGN. The global needs for Space Situational Awareness (SSA) have moved to the forefront in many communities as Space becomes a more integral part of a national security portfolio. These needs drive imaging capabilities ultimately to a few tens of centimeter resolution at geosynchronous orbits. Any array capable of producing images on faint and complex geosynchronous objects in just a few hours will be outstanding not only as an astrophysical tool, but also for these types of SSA missions. With the recent infusion of new funding from the Air Force Research Lab (AFRL) in Albuquerque, NM, MROI will be able to attain first light, first fringes, and demonstrate bootstrapping with three telescopes by 2020. MROI’s current status along with a sketch of our activities over the coming 5 years will be presented, as well as clear opportunities to collaborate on various aspects of the facility as it comes online. Further funding is actively being sought to accelerate the capability of the array for interferometric imaging on a short time-scale so as to achieve the original goals of this ambitious facility.AFRL (Cooperative Agreement FA9453-15-2-0086 titled “Amplitude Interferometer Research for Geosynchronous Earth Orbit (GEO) Space Situational Awareness (SSA)”), Congressional Delegation of the State of New Mexico, Science and Technology Facilities CouncilThis is the author accepted manuscript. The final version is available from SPIE via http://dx.doi.org/10.1117/12.223391