The Evolution of American Microtargeting: An Examination of Trends in Political Messaging

The usage of targeted messaging by political campaigns has seen a drastic evolution over the past half-century. Through advancement in campaign technology, and an increasingly large amount of personal information up for sale, campaigns have continually narrowed their scope from targeting large demographic groups to targeting each voter individually through a process called microtargeting. This presentation examines both the history of microtargeting in American politics, and the potential effects of its utilization

The Evolution of American Microtargeting: An Examination of Modern Electoral Messaging

The original intent of this work was slightly different than what follows. In an effort to provide information on the current state of micro targeting, 1 had planned to research the campaign tactics of the 2012 Obama and Romney presidential campaigns in Ohio. This goal quickly became unattainable due to time restrictions and a lack of available interviewees. Several requests for interviews went unanswered, and state political parties were not able to provide adequate information on the efforts of the campaigns. Through searching the Internet for information on campaign officials responsible for the Ohio presence of the Romney and Obama campaigns, I found that many of them have now gone into the private sector, working for firms which specialize in targeted messaging for non-profits or other entities. Their transition into the private sector demonstrates the increasing economic and political values of targeting based upon personal information, and could provide one explanation for their hesitance to provide an interview. Additionally, Eitan Hersh, a researcher whom I was able to reach via email and whose work I have utilized, informed me that little scholarly work has been done demonstrating the evolution of political targeting from its infancy to modern state, stating that 2012 data was going to be especially scarce I. Hersh himself was actually involved in a study paid for by the Obama for America campaign in an attempt to better understand the intricacies of their strategy and how it worked. The fact that the campaign itself felt the need to pay for this study perhaps demonstrates the relatively new strategies and teclmology at hand. This newness has caused me to change my focus to what microtargeting is, what led to its usage, and important factors impacting its future implementation

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Redefining β-blocker response in heart failure patients with sinus rhythm and atrial fibrillation: a machine learning cluster analysis

Background: Mortality remains unacceptably high in patients with heart failure and reduced left ventricular ejection fraction (LVEF) despite advances in therapeutics. We hypothesised that a novel artificial intelligence approach could better assess multiple and higher-dimension interactions of comorbidities, and define clusters of β-blocker efficacy in patients with sinus rhythm and atrial fibrillation. Methods: Neural network-based variational autoencoders and hierarchical clustering were applied to pooled individual patient data from nine double-blind, randomised, placebo-controlled trials of β blockers. All-cause mortality during median 1·3 years of follow-up was assessed by intention to treat, stratified by electrocardiographic heart rhythm. The number of clusters and dimensions was determined objectively, with results validated using a leave-one-trial-out approach. This study was prospectively registered with ClinicalTrials.gov (NCT00832442) and the PROSPERO database of systematic reviews (CRD42014010012). Findings: 15 659 patients with heart failure and LVEF of less than 50% were included, with median age 65 years (IQR 56–72) and LVEF 27% (IQR 21–33). 3708 (24%) patients were women. In sinus rhythm (n=12 822), most clusters demonstrated a consistent overall mortality benefit from β blockers, with odds ratios (ORs) ranging from 0·54 to 0·74. One cluster in sinus rhythm of older patients with less severe symptoms showed no significant efficacy (OR 0·86, 95% CI 0·67–1·10; p=0·22). In atrial fibrillation (n=2837), four of five clusters were consistent with the overall neutral effect of β blockers versus placebo (OR 0·92, 0·77–1·10; p=0·37). One cluster of younger atrial fibrillation patients at lower mortality risk but similar LVEF to average had a statistically significant reduction in mortality with β blockers (OR 0·57, 0·35–0·93; p=0·023). The robustness and consistency of clustering was confirmed for all models (p<0·0001 vs random), and cluster membership was externally validated across the nine independent trials. Interpretation: An artificial intelligence-based clustering approach was able to distinguish prognostic response from β blockers in patients with heart failure and reduced LVEF. This included patients in sinus rhythm with suboptimal efficacy, as well as a cluster of patients with atrial fibrillation where β blockers did reduce mortality

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

NÄYTTÖÖN PERUSTUVA HOITOTYÖ EKG-REKISTERÖINNISSÄ

TIIVISTELMÄ Opinnäytetyössämme käsittelemme laadukkaan elektrokardiografian rekisteröintiä. Tutkimuksen tarkoituksena oli kuvailla hoitajien toimintaa EKG-rekisteröintitilanteissa terveyskeskuksen päivystyksessä, yhteispäivystyksessä sekä sairaalan laboratoriossa. Opinnäytetyömme tavoitteena oli selvittää, miten hoitajat toteuttavat EKGrekisteröinnin eri osa-alueet. Tavoitteena oli selvittää myös, miten hoitajat arvioivat EKG-tulosteen laatua. Tutkimuksen toteutimme havainnoimalla eri työyksiköissä EKGrekisteröintiä. Havainnoinnissa käytimme strukturoitua havainnointilomaketta sekä kenttäpäiväkirjaa. Havainnointiin osallistui yhteensä 6 henkilöä, jotka olivat sekä sairaanhoitajia, että laboratoriohoitajia sekä yksi lähihoitajaopiskelija. Tutkimustuloksista kävi ilmi, että koulutuspohjalla on merkitystä siihen, miten rekisteröijä rekisteröi EKG:n. Laboratoriohoitajilla oli enemmän tietoa EKGrekisteröinnistä kuin sairaanhoitajilla. Lähihoitajaopiskelijan EKG-rekisteröintitaito oli samankaltainen kuin sairaanhoitajien. Rekisteröijät tietävät EKG-rekisteröinnin pääpiirteet ja niiden toteuttamisen. Rekisteröijien toiminta käytännössä osoittaa kuitenkin, että perehdytystä tai lisäkoulutusta olisi hyvä olla saatavilla. Tutkimustuloksista nousee esille sekä heikkouksia että vahvuuksia osaamisessa ja erilaisten asioiden huomioonottamisessa sekä tekemisessä. Taitoa rekisteröijillä on selvästi, mutta tutkittavan henkilön tilan kriittisyys tai rekisteröijän epätietoisuus EKGrekisteröintiin kuuluvista asioista vähentää EKG-tulosteen laadukkuutta.ABSTRACT In our thesis we deal with high-quality electrocardiogram registration in a real nursing situations. The purpose of this study is to describe how the nurses behave in ECG monitoring situations at the health centre emergency department, the hospital emergency department and in the laboratory. Our study objective was to determine how nurses carry out the different parts of the ECG registration. The aim was also to explore how nurses assess the quality of the ECG printout. We carried out the study by observing the ECG registration in different work units. We carried out the observation by using a structured observation form and the a field diary. The observation was attended by six people who were registered nurses, laboratory technicians and one student of practical nursing. The research results showed that education background matters when the registrant registered the ECG. The laboratory techinicians had more knowledge about the ECG than the registered nurses. The student of practical nursing had the similar skills of ECG registration as the registered nurses. The registrants can use the ECG equipment and they know the main points of ECG registration. It would be good to have induction training or additional training available. The results of the study show that the registrants have strenghts and weaknesses in their skills of ECG registration and how they take into account various things and how they work. The registrants have a clear knowledge of registration in practice but the ECG printout quality may suffer when the patient's condition is acute or when the registrant is unaware of the matters concerning ECG registration

Constraints on solar wind density and velocity based on coronal tomography and Parker Solar Probe measurements

Previous work has established an empirical relationship between densities gained from coronal rotational tomography near the ecliptic plane with solar wind outflow speeds at heliocentric distance r₀ = 8R⊙. This work aims to include solar wind acceleration, and thus velocity profiles out to 1 au. Inner boundary velocities are given as a function of normalized tomographic densities, ρN, as V₀ = (75 * ᵉ⁻[⁵.²⁺ρᴺ] + 108), and typically range from 100 to 180 km s−1. The subsequent acceleration is defined as V(r) = V₀(1+αIP[1-e⁽⁻[ʳ⁻ʳ⁰]/ʳᴴ⁾]), with αIP ranging between 1.75 and 2.7, and rH between 50 and 35 R⊙ dependent on V0. These acceleration profiles approximate the distribution of in situ measurements by Parker Solar Probe (PSP) and other measurements at 1 au. Between 2018 November and 2021 September these constraints are applied using the HUXt model and give good agreement with in situ observations at PSP, with a ∼6% improvement compared with using a simpler constant acceleration model previously considered. Given the known tomographical densities at 8 R⊙, we extrapolate density to 1 au using the model velocities and assuming mass flux conservation. Extrapolated densities agree well with OMNI measurements. Thus coronagraph-based estimates of densities define the ambient solar wind outflow speed, acceleration, and density from 8 R⊙ to at least 1 au. This sets a constraint on more advanced models, and a framework for forecasting that provides a valid alternative to the use of velocities derived from magnetic field extrapolations

Insights into the epidemiology of cardiopulmonary resuscitation-induced consciousness in out-of-hospital cardiac arrest

Objectives To describe the characteristics and outcomes of cardiopulmonary resuscitation (CPR)-induced consciousness patients from a large database of out-of-hospital cardiac arrest (OHCA). Methods Included were adult patients, attended between January 2007 and December 2018 by the Queensland Ambulance Service, where resuscitation was attempted by paramedics. Manual review of records was undertaken to identify CPR-induced consciousness cases. Patients exhibiting purposeful limb/body movement during CPR, with or without displaying other signs, were considered to be CPR-induced consciousness. Characteristics and outcomes of CPR-induced consciousness patients were compared to those without CPR-induced consciousness. Results A total of 23 011 OHCA patients were included; of these, 52 (0.23%) were CPR-induced consciousness. This translates into an incidence rate of 2.3 cases per 1000 adult resuscitation attempts over 12 years. Combativeness/agitation was the most common sign of CPR-induced consciousness, described in 34.6% (18/52) of patients. CPR-induced consciousness patients had numerically higher rates of return of spontaneous circulation on hospital arrival (51.9% vs 28.6%), discharge survival (46.2% vs 15.1%) and 30-day survival (46.2% vs 14.7%), than those without CPR-induced consciousness; however, CPR-induced consciousness was not found to be an independent predictor of survival. Higher proportions of CPR-induced consciousness patients had arrest witnessed by paramedics, occurring in public places, of cardiac aetiology and initial shockable rhythm, than patients without CPR-induced consciousness. Conclusions CPR-induced consciousness in OHCA appears to be associated with higher survival rates. Standardised guidelines on recognition and management of CPR-induced consciousness remain to be established