Management and Outcome of Prosthetic Patch Infection after Carotid Endarterectomy: A Single-centre Series and Systematic Review of the Literature

AbstractObjectivesOutcomes following prosthetic patch infection after carotid endarterectomy (CEA).MethodsRetrospective audit and systematic review.Results22 patients were treated between January 1992 and April 2012, 5 having undergone their original CEA at another institution. The commonest infecting organism was Staphylococcus. One patient was treated by antibiotic irrigation, one was stented, while 20 underwent debridement and patch excision plus; carotid ligation (n = 3), vein patching (n = 3) or vein bypass (n = 14). There was one peri-operative stroke, but no peri-operative deaths. There were no reinfections at a median follow-up of 54 months.A systematic review identified 123 patients with prosthetic patch infection in the world literature. Thirty-six (29%) presented <2 months, 78 (63%) presented >6 months after the original CEA. Seventy-nine of/87 patients (91%) with a positive culture yielded Staphylococci or Streptococci. Seventy-four patients were treated by patch excision and autologous reconstruction. Four (5%) developed reinfection <30 days, but later reinfections have been reported. Seven of nine patients (78%) undergoing prosthetic reconstruction either died or suffered reinfection. Five patients were treated with a covered stent, none developing reinfection (median followup 12 months).ConclusionPatch infection following CEA is rare. Few have undergone stenting and long term data are awaited. For now, patch excision and autologous reconstruction remains the ‘gold standard’

Deep Brain Stimulation of the Subthalamic Nucleus Induces Impulsive Responses to Bursts of Sensory Evidence

Decisions are made through the integration of external and internal inputs until a threshold is reached, triggering a response. The subthalamic nucleus (STN) has been implicated in adjusting the decision bound to prevent impulsivity during difficult decisions. We combine model-based and model-free approaches to test the theory that the STN raises the decision bound, a process impaired by deep brain stimulation (DBS). Eight male and female human subjects receiving treatment for Parkinson's disease with bilateral DBS of the STN performed an auditory two-alternative forced choice task. By ending trials unpredictably, we collected reaction time (RT) trials in which subjects reached their decision bound and non-RT trials in which subjects were forced to make a decision with less evidence. A decreased decision bound would cause worse performance on RT trials, and we found this to be the case on left-sided RT trials. Drift diffusion modeling showed a negative drift rate. This implies that in the absence of new evidence, the amount of evidence accumulated tends to drift toward zero. If evidence is accumulated at a constant rate this results in the evidence accumulated reaching an asymptote, the distance of which from the bound was decreased by DBS (p = 0.0079, random shuffle test), preventing subjects from controlling impulsivity. Subjects were more impulsive to bursts of stimuli associated with conflict (p &lt; 0.001, cluster mass test). In addition, DBS lowered the decision bound specifically after error trials, decreasing the probability of switching to a non-RT trial after an error compared to correct response (28% vs. 38%, p = 0.005, Fisher exact test). The STN appears to function in decision-making by modulating the decision bound and drift rate to allow the suppression of impulsive responses

Isotopic Dependence of the Casimir Force

We calculate the dependence of the Casimir force on the isotopic composition of the interacting objects. This dependence arises from the subtle influence of the nuclear masses on the electronic properties of the bodies. We discuss the relevance of these results to current experiments utilizing the iso-electronic effect to search at very short separations for new weak forces suggested by various unification theories.Comment: 12 pages, Revtex (to appear in Physical Review Letters

A generation apart? Youth and political participation in Britain

Conventional wisdom holds that young people in Britain are alienated from politics, with some claiming that this reflects a wider crisis of legitimacy that should be met by initiatives to increase citizenship. This article addresses these areas, presenting both panel survey and focus group data from first-time voters. It concludes that, contrary to the findings from many predominantly quantitative studies of political participation, young people are interested in political matters, and do support the democratic process. However they feel a sense of anti-climax having voted for the first time, and are critical of those who have been elected to positions of political power. If they are a generation apart, this is less to do with apathy, and more to do with their engaged scepticism about ‘formal’ politics in Britain

HIV Services Utilization in Los Angeles County, California

Recipients of HIV/AIDS prevention services in Los Angeles County California were surveyed in 2004 by 220 HIV prevention service provider staff from 51 agencies funded by the Office of AIDS Programs and Policy. This resulted in 2,102 usable surveys for cluster analysis purposes. This Countywide Risk Assessment Survey assessed demographics, sexual history, substance use, perceptions regarding HIV/AIDS, and use of 18 different services at both the agency administering the survey and at other agencies. The 36 types of service use data were subjected to a cluster analysis that found five clusters. These service pattern clusters differed from each other on proportion HIV positive, HIV testing history, history of abuse, education, type of residence, type of funding, intervention type, and ethnicity. The analysis also suggests that domestic violence services availability and utilization should be examined more thoroughly in the future for HIV infected/affected populations

Engaging communities to improve mental health in African and African Caribbean groups: a qualitative study evaluating the role of community well-being champions.

Over the last decade, Britain has undergone reforms to promote engagement in local structures of governance. These reforms have encouraged the promotion of active citizenship and have been central to the government's public service modernisation agenda. This article presents the findings from a study evaluating a pilot outreach intervention which adopted a community engagement model to address the mental health needs of African and African Caribbean groups, which entailed a partnership between faith-based organisations, local public services and community organisations to co-produce the pilot project. Lay people were trained to raise awareness about mental health among these communities in South London. Between 2012 and 2013, a qualitative participatory approach was used to evaluate the pilot project, which enabled a researcher to take part in the engagement phase of the pilot project, and the project co-ordinators to be involved in the research process. Semi-structured, one-to-one interviews were carried out with 13 community and well-being champions (CWBCs) recruited from African and African Caribbean communities (seven male and six female). This study examines the impact of the relationship between the intervention and community through the participants' engagement in the pilot outreach project and the action undertaken as champions. We found that although CWBCs used circles of influence to share ideas about mental health and well-being and to encourage change, they encountered resistance on the part of the people they engaged with, which resulted from a lack of knowledge about mental health, taboos and ascribed stigma. We argue that CWBCs acted as healthy examples to communicate mental health knowledge to those approached, but that they needed to be equipped with bespoke communication skills to be able to talk about such sensitive issues as mental health

Am empirical comparison of the performance of classical power indices

Power indices are general measures of the relative voting power of individual members of a voting body. They are useful in helping understand and design voting bodies particularly those which employ weighted voting, in which different members having different numbers of votes. It is well known that in such bodies a member's voting power, in the sense of their capacity to affect the outcomes of votes called, rarely corresponds to the actual number of votes allocated to him. Many voting bodies for which this is an important consideration exist: examples include international organisations (notably the World Bank, the IMF, the European Union), the US presidential Electoral College and corporations in which votes are proportionate to stockholdings. Two classical power indices dominate the literature: the Shapley-Shubik index and the Banzhaf index (also known by other names). Both are based on the idea that a member's power depends on the relative number of times they can change a coalition from losing to winning by joining it and adding their vote. They may be defined in probabilistic terms as the probability of being able to swing the result of a vote, where all possible outcomes are taken as equiprobable. The indices differ however in the way they count voting coalitions. In probabilistic terms they use different coalition models and therefore differ in precisely what is meant by equiprobable outcomes. The indices have been used in a number of empirical applications but their relative performance has remained an open question for many years, a factor, which has hindered the wider acceptance of the approach. Where both the indices have been used for the same case, they have often given different results, sometimes substantially so, and theoretical studies of their properties have not been conclusive. There is therefore a need for comparative testing of their relative performance in practical contexts. Very little work of this type has been done however for a number of reasons: lack of independent indicators of power in actual voting bodies with which to compare them, difficulties in obtaining consistent data on a voting body over time with sufficient variation in the disposition of votes among members of actual legislatures and the lack of independent criteria against which the results of the indices may be judged. It has also been hampered to some extent by lack of easily available algorithms for computing the indices in large games. This paper assesses the indices against a set of reasonable criteria in terms of shareholder voting power and the control of the corporation in a large cross section of British companies. Each company is a separate voting body and there is much variation in the distribution of voting shares among them. Moreover reasonable criteria exist against which to judge the indices. New algorithms for the Shapley-Shubik and Banzhaf indices are applied to detailed data on beneficial ownership of 444 large UK companies without majority control. Because some of the data is missing, both finite and oceanic games of shareholder voting are studied to overcome this problem. The results, judged against these criteria, are unfavorable to the Shapley-Shubik index and suggest that the Banzhaf index much better reflects the variations in the power of shareholders between companies as the weights of shareholder blocks vary