Windward Woes: The Misalignment of Economic Incentives and Renewable Energy Development Goals

Energy tax credits have always been a significant driver of renewable energy development, but the recent Inflation Reduction Act in response to new national development goals represents the most significant change in several decades. The Inflation Reduction Act is certainly a step in the right direction, but there are numerous factors that limit the impact on future developments that should be remedied to allow for the nation’s best chance to reach 2030 renewable energy goals

The potential role of kelp forests on iodine speciation in coastal seawater

Funding: FCK would like to thank the TOTAL Foundation (Paris) and the MASTS pooling initiative (The Marine Alliance for Science and Technology for Scotland) for their support. MASTS is funded by the Scottish Funding Council (grant reference HR09011) and contributing institutions. JG acknowledges support from an SDSU Research Foundation Summer Undergraduate Research Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer reviewedPublisher PD

Beneficial effects of childhood selective dorsal rhizotomy in adulthood

Background: Selective dorsal rhizotomy (SDR) has been used to treat children with spastic cerebral palsy (CP) for over three decades. However, little is known about the outcomes of childhood SDR in adults.  Objectives: 1) To study the effects of childhood SDR on the quality of life and ambulatory function in adult life. 2) To determine late side effects of SDR in adults.   Methods: Adults (> 17.9 years) who underwent SDR in childhood (2 - 17.9 years) between 1987 and 2013 were surveyed in 2015. Patients completed a survey, including questions on demographic information, quality of life, health, surgical outcomes, motor function, manual ability, pain, braces/orthotics, post-SDR treatment, living situation, education level, work status, and side effects of SDR.  Results: In our study population of 294 patients (18.0 - 37.4 years), patients received SDR during the ages of 2.0 - 17.9 years and were followed up 2.2 to 28.3 years after surgery. Eighty-four percent had spastic diplegia, 12% had spastic quadriplegia, and 4% had spastic triplegia. The majority (88%) of patients reported improved post-SDR quality of life and 1% considered the surgery detrimental. Most (83%) would recommend the procedure to others and 3% would not. However, patients who would not recommend SDR to others ambulated with a walker or were not ambulatory at all prior to SDR. The majority (83%) of patients improved (30%) or remained stable (53%) in ambulation. Twenty-nine percent of patients reported pain, mostly in the back and lower limbs, with a mean pain level of 4.4 ± 2.4 on the Numeric Pain Rating Scale (NPRS). Decreased sensation in small areas of the lower limbs was reported by 8% of patients, though this did not affect daily life. Scoliosis was diagnosed in 28%, with 40% of these patients pursuing treatment. Whether scoliosis was related to SDR is not clear, though scoliosis is known to occur in patients with CP and also in the general population. Only 4% of patients underwent spinal fusion.  Orthopedic surgeries were pursued by 59% of patients. The most common orthopedic surgeries were hamstring lengthenings (31%), Achilles tendon lengthenings (18%), adductor lengthenings (16%), and derotational osteotomies (16%). Twenty-four percent of all patients later underwent hip surgery and 8% had surgeries on their knees.  Conclusion: Results of this study indicate that the beneficial effects of childhood SDR extend to adulthood quality of life and ambulatory function without late side effects of surgery

Late erosion of a prophylactic Celect IVC filter into the aorta, right renal artery, and duodenal wall

We present the case of a patient with retrievable inferior vena cava (IVC) filter-related pseudoaneurysms of the infrarenal aorta and right renal artery, with associated erosion into the duodenal wall. The patient was seen 10 months following multiorgan trauma and placement of a prophylactic retrievable IVC filter (R-IVCF). Management required autogenous aortic reconstruction, caval repair, and subsequent right nephrectomy. This case demonstrates that R-IVCFs may be associated with significant risks, which is concerning, as a majority of prophylactic R-IVCFs placed after multisystem trauma are not removed

Responding to crisis through strategic knowledge management

Purpose - Many managers would like to take a strategic approach to preparing the organisation to avoid impending crisis but instead find themselves fire-fighting to mitigate its impact. This paper seeks to examine an organisation which made major strategic changes in order to respond to the full effect of a crisis which would be realised over a two to three year period. At the root of these changes was a strategic approach to managing knowledge. The paper's purpose is to reflect on managers' views of the impact this strategy had on preparing for the crisis and explore what happened in the organisation during and after the crisis. Design/methodology/approach - The paper examines a case-study of a financial services organisation which faced the crisis of its impending dissolution. The paper draws upon observations of change management workshops, as well as interviews with organisational members of a change management task force. Findings - The response to the crisis was to recognise the importance of the people and their knowledge to the organisation, and to build a strategy which improved business processes and communication flow across the divisions, as well as managing the departure of knowledge workers from an organisation in the process of being dissolved. Practical implications - The paper demonstrates the importance of building a knowledge management strategy during times of crisis, and draws out important lessons for organisations facing organisational change. Originality/value - The paper represents a unique opportunity to learn from an organisation adopting a strategic approach to managing its knowledge during a time of crisis. © Emerald Group Publishing Limited

Influence of computed tomography angiography reconstruction software on anatomic measurements and endograft component selection for endovascular abdominal aortic aneurysm repair

ObjectiveThree-dimensional (3D) centerline reconstruction of computed tomography angiography (CTA) images permits detailed anatomic characterization of abdominal aortic aneurysms and facilitates planning of endovascular repair. Although several programs for 3D CTA reconstruction and measurement are available, direct comparisons have not been published, and reliability between software platforms has not been characterized. We evaluated agreement between anatomic measurements obtained from 3D CTA reconstructions using three commercially available software programs and characterized concordance between the programs for endograft component selection.MethodsImages from 92 CTA studies performed before abdominal aortic aneurysm repair were reconstructed and measured using three different software programs: independent reconstruction with proprietary software (Preview; M2S Inc, Lebanon, NH), surgeon-based reconstruction with proprietary software (AquariusNet Thin Client; TeraRecon Inc, San Mateo, Calif), and surgeon-based reconstruction with open-source software (Osirix MD; Pixmeo, Geneva, Switzerland). Agreement between outer wall diameter and length measurements obtained from centerline reconstructions created with each program was evaluated using scatter plots, intraclass correlation coefficients, and Bland-Altman plots. Concordance between aortic and iliac endograft component diameters selected from measurements with each program based on published instructions for use was examined using weighted κ statistics.ResultsDiameter measurements were generally similar between programs. Mean diameters at all locations were within ≤1 mm of one another, and mean length measurements were within ≤10 mm of one another for all pairwise comparisons. Intraclass correlations coefficients between programs for diameter measurements were comparable between programs (≥0.82 for all diameter comparisons and ≥0.88 for all length comparisons) and indicated good correlation. Pair-wise comparisons indicated similar rates of identical and adjacent size endograft component selection without an obvious trend toward superior agreement for any two programs. Rates of identical proximal endograft diameter selection ranged from 46% to 59%, whereas 89% to 100% of proximal endograft diameters selected between programs were within one adjacent (smaller or larger) size of each other. For iliac endograft selection, rates of identical component diameter selection between programs ranged from 36% to 69%, and 58% to 99% of selected iliac endograft diameters were within one adjacent size.ConclusionsOuter wall diameter and centerline length measurements obtained from 3D CTA reconstructions demonstrated good correlation between imaging analysis software programs, and graft diameter selections based on these measurements were reasonably similar. Comparable 3D CTA reconstruction measurements can be generated from independent and surgeon-based approaches using proprietary and open-source software, and the selection of a method to interpret images for endograft planning can be individualized according to operator experience and available resources while retaining sufficient accuracy

Outcomes of acute intraoperative surgical conversion during endovascular aortic aneurysm repair

PurposeOutcomes and predictors of acute surgical conversion during endovascular aortic aneurysm repair (EVAR) were examined using the American College of Surgeons-National Safety and Quality Improvement Project (ACS-NSQIP) Database (2005 to 2008).MethodsAcute intraoperative surgical conversions occurring during elective EVAR were identified using Current Procedural Terminology codes. Nonemergent EVAR and primary open surgical repairs of infrarenal aneurysms were examined for comparison. Perioperative morbidity was categorized as wound, pulmonary, venous thromboembolic, genitourinary, cardiovascular, operative, and septic. Mortality, overall morbidity, and length of stay (LOS) were examined.ResultsWe identified 72 acute conversions, 2414 open repairs, and 6332 EVAR without acute conversion. Demographics and comorbidities were generally similar among operative groups. Mean operative time was 274 minutes for acute conversion vs 226 minutes for primary open repair and 162 minutes for EVAR (conversion vs EVAR and open repair vs EVAR P < .0001 for each; conversion vs open repair P = .0014; analysis on rank operative time). Blood transfusion was required in 69% of acute conversions (mean volume, 6.0 units) vs 73% of open repairs (mean volume, 3.3 units) and 12% of EVARs (mean volume, 2.6 units; P < .0001 for each pair-wise comparison; analysis on rank number of units among those transfused). Major morbidity was 28% for acute conversions, 28% for open repairs, and 12% for EVARs. Mortality was 4.2% for acute conversions, 3.2% for open repairs, and 1.3% for EVARs. Median (quartile 1, quartile 3) LOS was 7 (5, 9) days for acute conversion and open repair, and 2 (1, 3) days for EVAR. Morbidity and mortality were significantly higher for acute conversion and open repair vs EVAR. The OR (95% confidence interval) for morbidity was 2.9 (1.7-4.8) after conversion and 2.8 (2.5-3.2) after open repair (P < .0001 for both) and for mortality was 3.4 (1.0-10.9; P = .0437) for conversion and 2.5 (1.9-3.5; P < .0001) for open repair. Morbidity and mortality were similar between acute conversion and open repair. A similar pattern among repair groups was demonstrated for LOS, with similar LOS for acute conversions and open repair, which were significantly longer than those observed for EVAR. No significant demographic or medical risk factor predictors of acute conversion during EVAR were identified.ConclusionAcute surgical conversion was a rare complication affecting 1.1% of EVAR cases, with no broadly identifiable at-risk population. When conversion did occur, morbidity and mortality rates paralleled those observed for elective open repair