Anesthesia Preoperative Clinic Referral for Elevated Hba1c Reduces Complication Rate in Diabetic Patients Undergoing Total Joint Arthroplasty

Background: Diabetes mellitus (DM) is risk factor for complications after orthopedic surgery. Objectives: We tested the hypothesis that anesthesia preoperative clinic (APC) referral for elevated glycosylated hemoglobin (HbA1c) reduces complication rate after total joint arthroplasty (TJA). Patients and Methods: Patients (n = 203) with and without DM were chosen from 1,237 patients undergoing TJA during 2006 - 12. Patients evaluated in the APC had surgery in 2006 - 8 regardless of HbA1c (uncontrolled). Those evaluated between in subsequent two-year intervals were referred to primary care for HbA1c ≥ 10% and ≥ 8%, respectively, to improve DM control before surgery. Complications and mortality were quantified postoperatively and at three, six, and twelve months. Length of stay (LOS) and patients requiring a prolonged LOS (\u3e 5 days) were recorded. Results: Patients (197 men, 6 women) underwent 71, 131, and 1 total hip, knee, and shoulder replacements, respectively. Patients undergoing TJA with uncontrolled HbA1c and those with HbA1c \u3c 10%, but not those with HbA1c \u3c 8%, had a higher incidence of coronary disease and hypercholesterolemia than patients without DM. An increase in complication rate was observed in DM patients with uncontrolled HbA1c versus patients without DM (P \u3c 0.001); the complication rate progressively decreased with tighter HbA1c control. More DM patients with preoperative HbA1c that was uncontrolled or ≥ 10% required prolonged LOS versus those without DM (P \u3c 0.001 and P = 0.0404, respectively). Conclusions: APC referral for elevated HbA1c reduces complication rate and the incidence of prolonged hospitalization during the first year after surgery in diabetics undergoing TJA

Model-Free Detection of Cyberattacks on Voltage Control in Distribution Grids

Incorporating information and communication technology in the operation of the electricity grid is undoubtedly contributing to a more cost-efficient, controllable, and flexible power grid. Although this technology is promoting flexibility and convenience, its integration with the electricity grid is rendering this critical infrastructure inherently vulnerable to cyberattacks that have potential to cause large-scale and far-reaching damage. In light of the growing need for a resilient smart grid, developing suitable security mechanisms has become a pressing matter. In this work, we investigate the effectiveness of a model-free state-of-the-art attack-detection method recently proposed by the cybersecurity community in detecting common types of cyberattacks on voltage control in distribution grids. Experimental results show that, by monitoring raw controller and smart-meter data in real time, it is possible to detect denial of service, replay, and integrity attacks, thus contributing to a resilient and more secure grid

Employers' and Employees' Understanding of Occupational Health and Safety Risks in Small Businesses: A Case Study

Many small businesses have hazardous work environments and exposures to significant occupational health and safety risks. Differences in understanding of risks by employers and employees are one of the factors leading to the hazardous work environment and risk exposures in small businesses. Employees generally describe “the tools of the trade” as the sources of risks of accidents and injuries, whereas employers generally identify “bad employees” or “bad luck” as the cause of accidents. It seems that employer and employees having the same or a shared understanding of occupational health and safety problems, their causal relations and the course of action is essential to remedy the work environment problems in the workplace. This paper describes a study that explores owner/managers’ and employees’ understandings of occupational health and safety risks in small business workplaces within the framework of the Local Theory of Work Environment. A case study of an independently operated restaurant and café in New Zealand employing 6­19 employees was undertaken.. Data was collected using participant­as­observer ethnographic observation of the workplace followed by semi structured interviews of the owner, a manager and more than fifty per cent of employees employed in the business. Preliminary findings based on interview data are reported in this paper. The results suggest that the owner/manager and employees mainly consider physical safety problems experienced by employees or food safety problems affecting the customers as the key work environment problems. The owner/manager and employees generally link common sense and breach of norms with the causal relation behind these problems. Social exchange and external certification, among others, are found to be prominent reasons for bringing to attention the perceived problems in the wider work environment context. Implicit individual element of action and explicit organizational element of action are recognised as the two courses of action remedying the occupational health and safety problems. Further studies can be directed at finding how a shared understanding of the OHS risks occurs and what influences this process

Effects of stratosphere-troposphere chemistry coupling on tropospheric ozone

A new, computationally efficient coupled stratosphere-troposphere chemistry-climate model (S/T-CCM) has been developed based on three well-documented components: a 64-level general circulation model from the UK Met Office Unified Model, the tropospheric chemistry transport model (STOCHEM), and the UMSLIMCAT stratospheric chemistry module. This newly developed S/T-CCM has been evaluated with various observations, and it shows good performance in simulating important chemical species and their interdependence in both the troposphere and stratosphere. The modeled total column ozone agrees well with Total Ozone Mapping Spectrometer observations. Modeled ozone profiles in the upper troposphere and lower stratosphere are significantly improved compared to runs with the stratospheric chemistry and tropospheric chemistry models alone, and they are in good agreement with Michelson Interferometer for Passive Atmospheric Sounding satellite ozone profiles. The observed CO tape recorder is also successfully captured by the new CCM, and ozone-CO correlations are in accordance with Atmospheric Chemistry Experiment observations. However, because of limitations in vertical resolution, intrusion of CO-rich air in the stratosphere from the mesosphere could not be simulated in the current version of S/T-CCM. Additionally, the simulated stratosphere-to-troposphere ozone flux, which controls upper tropospheric OH and O3 concentrations, is found to be more realistic in the new coupled model compared to STOCHEM. © 2010 by the American Geophysical Union

Aesthetics and literature : a problematic relation?

The paper argues that there is a proper place for literature within aesthetics but that care must be taken in identifying just what the relation is. In characterising aesthetic pleasure associated with literature it is all too easy to fall into reductive accounts, for example, of literature as merely "fine writing". Belleslettrist or formalistic accounts of literature are rejected, as are two other kinds of reduction, to pure meaning properties and to a kind of narrative realism. The idea is developed that literature-both poetry and prose fiction-invites its own distinctive kind of aesthetic appreciation which far from being at odds with critical practice, in fact chimes well with it