Outcomes after endovascular mechanical thrombectomy in occluded vascular access used for dialysis purposes

PURPOSE: Endovascular mechanical thrombectomy using the AngioJet™ system can be considered to reestablish patency in occluded vascular access. The aim of this study was to review our results for endovascular mechanical thrombectomy using the AngioJet™ system in patients with arteriovenous fistulae (AVF) and arteriovenous grafts (AVG). METHODS: Data collected in a database of patients requiring hemodialysis for renal failure were analyzed. Patients who underwent endovascular mechanical thrombectomy procedures with the AngioJet™ system for occlusion of vascular access were included. Clinical and technical success rates and patency rates were calculated. Multivariate analysis was used to identify factors of influence. RESULTS: A total of 92 AngioJet™ procedures in 60 patients with thrombosed vascular access were reviewed during a mean follow-up period of 21.5 months in patients with an AVF and 11.9 months in patients with an AVG. Technical and clinical success was achieved in 92.6% of AVF cases and 92.0 and 90.8% of AVG cases with an AVG, respectively. Significantly higher primary and primary-assisted patency rates were observed in the AVF group. Multivariate regression analysis indicated that left-sided vascular access and female sex were independent predictors for failure regarding primary patency in AVG patients. Immunosuppressive drugs and older age were negative predictors for secondary patency in AVG patients. CONCLUSIONS: The AngioJet™ system can be deemed an effective technique to reestablish patency in occluded vascular access with minimal use of central venous catheters for dialysis. Good technical and clinical success rates were achieved with acceptable patency rates, especially in AVF patients

Only Moderate Intra- and Inter-observer Agreement between Radiologists and Surgeons when Grading Blunt Paediatric Hepatic Injury on CT Scan

Introduction: The American Pediatric Surgical Association developed guidelines for the management of haemodynamically stable children with hepatic or splenic injury, based on grade of injury on CF scan. This study investigated the intra- and inter-observer agreement of radiologists, paediatric surgeons, trauma surgeons and hepatobiliary surgeons when scoring liver injury based on CT scan findings. Patients and Methods: CT scans of patients with blunt abdominal trauma were independently assessed twice by a fellow and a consultant radiologist, paediatric surgeon, trauma surgeon and one consultant hepatobiliary surgeon. Reviewers were unaware of the clinical course. All scans were multislice CTs with a slice thickness of 3 mm, and both the arterial and venous phase were assessed. Injury was scored using the American Association for the Surgery of Trauma (AAST) liver injury scale. Intra-observer agreement was tested using Cohen's kappa coefficient. Inter-observer agreement was tested using Cohen's kappa for the second reading of individual observers and Spearman's rank correlation for the mean of both readings from each observer. Results: CT scans of 27 patients (11 girls and 16 boys, median age 11.7 +/- 5.2 years) were reviewed. Mean AAST grade of liver injury was 3.3 +/- 1.1 for radiologists, 2.9 +/- 1.0 for paediatric surgeons, 3.0 +/- 0.9 for trauma surgeons and 3.2 +/- 0.8 for the hepatobiliary surgeon (p=0.30) Intra-observer agreement was moderate, with kappa below 0.7 for all observers except for one of the radiologists. Inter-observer correlation using Cohen's kappa coefficient was also moderate, with kappa below 0.5. In contrast, inter-observer correlation using Spearman's test was good, suggesting that there is agreement on the general severity of injury but not on the exact grading of injury using the AAST scoring system. Conclusion: Intra-observer agreement is only moderate when assessing liver injury using the AAST grading system. Only the most experienced radiologist demonstrated good intra-observer agreement which might indicate the necessity of the presence of a senior trauma radiologist at all times. However, this is not possible in most centres. Although there was agreement concerning the general severity of injury, inter-observer agreement is also moderate. These data cast doubt on the use of the AAST liver injury score alone as a decision-making tool when assessing haemodynamically stable children with blunt hepatic injury

Introduction:How European Players Captured the Computer and Created Scenes

Playfulness was at the heart of how European players appropriated microcomputers in the last quarter of the twentieth century. Although gaming has been important for computer development, that is not the subject of Hacking Europe. Our book’s main focus is the playfulness of hacker culture. The essays argue that no matter how detailed or unfinished the design projecting the use of computers, users playfully assigned their own meanings to the machines in unexpected ways. Chopping games in Warsaw, hacking software in Athens, creating chaos in Hamburg, producing demos in Turku, or partying with computing in Zagreb and Amsterdam—wherever computers came with specific meanings that designers had attached to them—local communities throughout Europe found them technically fascinating, culturally inspiring, and politically motivating machines. They began tinkering with the new technology with boundless enthusiasm and helped revolutionize the use and meaning of computers by incorporating them into people’s daily lives. As tinkerers, hackers appropriated the machine and created a new culture around it. Perhaps best known and most visible were the hacker cultures that toyed with the meaning of ownership in the domain of information technology. In several parts of Europe, hackers created a counterculture akin to the squatter movement that challenged individual ownership, demanded equal access, and celebrated shared use of the new technological potential. The German Chaos Computer Club best embodied the European version of the political fusion of the counterculture movement and the love of technology. Linguistically, in Dutch, the slang word kraken, the term used for both hacking and squatting, pointedly expressed such creative fusion that is the subject of this book

Imagining the thinking machine: Technological myths and the rise of artificial intelligence

This paper was accepted for publication in the journal Convergence and the definitive published version is available at https://doi.org/10.1177/1354856517715164.This article discusses the role of technological myths in the development of Artificial Intelligence (AI) technologies from 1950s to the early 1970s. It shows how the rise of AI was accompanied by the construction of a powerful cultural myth: the creation of a thinking machine, which would be able to perfectly simulate the cognitive faculties of the human mind. Based on a content analysis of articles on Artificial Intelligence published in two magazines, the Scientific American and the New Scientist, which were aimed at a broad readership of scientists, engineers, and technologists, three dominant patterns in the construction of the AI myth are identified: (1) the recurrence of analogies and discursive shifts, by which ideas and concepts from other fields were employed to describe the functioning of AI technologies; (2) a rhetorical use of the future, imagining that present shortcomings and limitations will shortly be overcome; (3) the relevance of controversies around the claims of AI, which we argue should be considered as an integral part of the discourse surrounding the AI myth