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The Pediatric Acute Care Cardiology Collaborative (PAC3) previously showed decreased postoperative chest tube duration and length of stay in children undergoing 9 Society of Thoracic Surgeons benchmark operations. Here we report how these gains were sustained over time and spread to 8 additional centers within the PAC3 network.
Methods:
Patient data were prospectively collected across baseline and intervention phases at the original 9 centres (Pioneer) and 8 new centres (Spread). The Pioneer baseline phase was 6/2017–6/2018 and Spread was 5/2019–9/2019. The Pioneer intervention phase was 7/2018–7/2021 and Spread 10/2019–7/2021. The primary outcome measure was postoperative chest tube duration in hours, with the aim of 20% overall reduction. Balancing measures included chest tube reinsertion and readmission for pleural effusion. Statistical process control methods and traditional statistics were used to analyse outcomes over time.
Results:
Among 5,042 patients at 17 centres, demographics were comparable. The Pioneer cohort (n = 3,383) sustained a 22.6% reduction in mean chest tube duration (from 91.9 hours to 70.5 hours), while the Spread cohort (n = 1,659) showed a 9.7% reduction (from 73.1 hours to 66.0 hours) in the first 13 months following intervention. Across both cohorts, rates of reinsertion (2.0% versus 2.1%, p = 0.869) and readmission for effusion did not change (0.3% versus 0.5%, p = 0.285).
Conclusions:
This multicenter prospective quality improvement study demonstrated sustained reduction in chest tube duration at 9 centres while successfully spreading improvement to 8 additional centres. This project serves as a model for post-operative multicentre quality improvement across a large cohort of congenital cardiac surgery patients.
Müller Ice Cap sits on Umingmat Nunaat (Axel Heiberg Island), Nunavut, Canada, ~ 80°N. Its high latitude and elevation suggest it experiences relatively little melt and preserves an undisturbed paleoclimate record. Here, we present a suite of field measurements, complemented by remote sensing, that constrain the ice thickness, accumulation rate, temperature, ice-flow velocity, and surface-elevation change of Müller Ice Cap. These measurements show that some areas near the top of the ice cap are more than 600 m thick, have nearly stable surface elevation, and flow slowly, making them good candidates for an ice core. The current mean annual surface temperature is −19.6 °C, which combined with modeling of the temperature profile indicates that the ice is frozen to the bed. Modeling of the depth-age scale indicates that Pleistocene ice is likely to exist with measurable resolution (300–1000 yr m−1) 20–90 m from the bed, assuming that Müller Ice Cap survived the Holocene Climatic Optimum with substantial ice thickness (~400 m or more). These conditions suggest that an undisturbed Holocene climate record could likely be recovered from Müller Ice Cap. We suggest 91.795°W, 79.874°N as the most promising drill site.
Upernavik Isstrøm, the largest contributor to sea-level rise in northwest Greenland, has experienced complex and contrasting ice-flow-speed changes across its five outlets over the last two decades. In this study, we present a detailed remote-sensing analysis of the ice dynamics at Upernavik's outlets from 2000 to 2021 to evaluate the details of these changes. Previous research suggested that the presence or absence of floating ice tongues strongly influences Upernavik's ice dynamics. We use several lines of evidence to document the presence of floating ice tongues, and find that, while several outlets experienced ice-tongue formation and/or loss during the study period, these changes do not explain observed fluctuations in ice-flow velocity. Further exploration of ice-dynamic forcings using a flowline model suggests that changes in basal slipperiness near the terminus have a strong impact on upstream ice dynamics and can explain the velocity variations. Our results suggest that speed fluctuations at Upernavik's outlets may be seasonally and interannually controlled by bed conditions near the terminus, and highlight the need for further research on the influence of basal conditions on complex tidewater glacier dynamics.
Ice-crystal fabric can induce mechanical anisotropy that significantly affects flow, but ice-flow models generally do not include fabric development or its effect upon flow. Here, we incorporate a new spectral expansion of fabric, and more complete description of its evolution, into the ice-flow model Elmer/Ice. This approach allows us to model the effect of both lattice rotation and migration recrystallization on large-scale ice flow. The fabric evolution is coupled to flow using an unapproximated non-linear orthotropic rheology that better describes deformation when the stress and fabric states are misaligned. These improvements are most relevant for simulating dynamically interesting areas, where recrystallization can be important, tuning data are scarce and rapid flow can lead to misalignment between stress and fabric. We validate the model by comparing simulated fabric to ice-core and phase-sensitive radar measurements on a transect across Dome C, East Antarctica. With appropriately tuned rates for recrystallization, the model is able to reproduce observations of fabric. However, these tuned rates differ from those previously derived from laboratory experiments, suggesting a need to better understand how recrystallization acts differently in the laboratory compared to natural settings.
Online treatments are increasing in number and are currently available for a wide range of clinical problems. To date little is known about the role of treatment expectations and other placebo-like mechanisms in online settings compared to traditional face-to-face treatment. To address this knowledge gap, we analyzed individual participant data from randomized clinical trials that compared online and face-to-face psychological interventions.
Methods
MEDLINE (Ovid) and PsycINFO (Ovid) were last searched on 2 February 2021. Randomized clinical trials of therapist guided online v. face-to-face psychological interventions for psychiatric or somatic conditions using a randomized controlled design were included. Titles, abstracts, and full texts of studies were independently screened by multiple observers. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Authors of the matching trials were contacted for individual participant data. Ratings from the Credibility and Expectancy Questionnaire and the primary outcome measure from each trial were used to estimate the association between expectation ratings and treatment outcomes in online v. face-to-face interventions, using a mixed-effects model.
Results
Of 7045 screened studies, 62 full-text articles were retrieved whereof six studies fulfilled the criteria and provided individual participant data (n = 491). Overall, CEQ ratings predicted clinical outcomes (β = 0.27) at end of treatment with no moderating effect of treatment modality (online v. face-to-face).
Conclusions
Online treatment appears to be equally susceptible to expectancy effects as face-to-face therapy. This furthers our understanding of the importance of placebo-like factors in online treatment and may aid the improvement of healthcare in online settings.
This book offers an empirically-based view on Europeans’ interconnections in everyday life. It looks at the ways in which EU residents have been getting closer across national frontiers. The book considers how people reconcile their increasing cross-border interconnections and a politically separating Europe of nation states and national interests.
We explore the prevalence of delinquency and incarceration from a global, contextual perspective and review risk factors identified in the literature, as well as prevention efforts from a public health approach. As the correlation between disadvantage and delinquency is well-established, we propose that formulating this issue as one of public health provides the opportunity for both systemic and individual intervention. The relationship between disadvantage, delinquency, and adult imprisonment will be shown to be a global trend. As a public health issue, the opportunity for both systemic change and earlier individual prevention strategies arises. The absence of these community-based diversionary approaches places pressure on correctional facilities to provide these default community services. Given this, the worldwide trend for recidivism is the outcome of a predictable cyclical failure to meet this community public health need. As such, communities must recognize that current prison service designs fulfill this public health function. Their function is to separate offenders from the community, but remain connected to the community. The tragedy of the incarcerated individuals' experience is shown with a US case example demonstrating the manifestation of this complexity within an overburdened system. Implications for interdisciplinary efforts between public health and community psychology are discussed.
Following the landmark essay of T. H. Marshall, Citizenship and the Social Class (1949), it has conventionally been assumed that the introduction and expansion of social rights in Europe happened as the final stage of a long process of democratization that included the granting of first civil and then political rights. We present a radically different perspective on the relationship between the extension of suffrage (under meaningful competition for government power) and social rights, that is state-financed entitlements that make citizens’ livelihood independent from the labor market in the instance of events such as unemployment or sickness. First, some countries institutionalized a state-financed poor relief system much before mass democratization. In these countries, the primary effect of suffrage extension was to reduce public social spending, not expand it. Second, the way this retrenchment occurred was partly by creating a negative link between social rights, on the one hand, and civil and political rights, on the other. We test our argument with case studies of nineteenth- to early-twentieth-century England, Denmark, Norway, and Prussia, all of which are paradigmatic cases that represent the variation in welfare state types.
Bulk directional enhancement factors are determined for axisymmetric (girdle and single-maximum) orientation fabrics using a transversely isotropic grain rheology with an orientation-dependent non-linear grain fluidity. Compared to grain fluidities that are simplified as orientation independent, we find that bulk strain-rate enhancements for intermediate-to-strong axisymmetric fabrics can be up to a factor of ten larger, assuming stress homogenization over the polycrystal scale. Our work thus extends previous results based on simple basal slip (Schmid) grain rheologies to the transversely isotropic rheology, which has implications for large-scale anisotropic ice-flow modelling that relies on a transversely isotropic grain rheology. In order to derive bulk enhancement factors for arbitrary evolving fabrics, we expand the c-axis distribution in terms of a spherical harmonic series, which allows the rheology-required structure tensors through order eight to easily be calculated and provides an alternative to current structure-tensor-based modelling.
We prove a generalisation of the Brill-Noether theorem for the variety of special divisors$W^r_d(C)$ on a general curve C of prescribed gonality. Our main theorem gives a closed formula for the dimension of$W^r_d(C)$. We build on previous work of Pflueger, who used an analysis of the tropical divisor theory of special chains of cycles to give upper bounds on the dimensions of Brill-Noether varieties on such curves. We prove his conjecture, that this upper bound is achieved for a general curve. Our methods introduce logarithmic stable maps as a systematic tool in Brill-Noether theory. A precise relation between the divisor theory on chains of cycles and the corresponding tropical maps theory is exploited to prove new regeneration theorems for linear series with negative Brill-Noether number. The strategy involves blending an analysis of obstruction theories for logarithmic stable maps with the geometry of Berkovich curves. To show the utility of these methods, we provide a short new derivation of lifting for special divisors on a chain of cycles with generic edge lengths, proved using different techniques by Cartwright, Jensen, and Payne. A crucial technical result is a new realisability theorem for tropical stable maps in obstructed geometries, generalising a well-known theorem of Speyer on genus$1$ curves to arbitrary genus.
There are increasing efforts aiming to utilise endophytes as biological control agents (BCAs) to improve crop production. However, reliability remains a major practical constraint for the development of novel BCAs. Many organisms are adapted to their specific habitat; it is optimistic to expect that a new organism added can find a niche or even out-compete those adapted and already present. Our approach for isolating novel BCAs for specific plant diseases is therefore to look in healthy plants in a habitat where disease is a problem, since we predict that it is more likely to find competitive strains among those present and adapted. In vitro inhibitory activities often do not correlate with in planta efficacy, especially since endophytes rely on intimate plant contact. They can, however, be useful to indicate modes of action. We therefore screen for in planta biological activity as early as possible in the process in order to minimise the risk of discarding valuable strains. Finally, some fungi are endophytic in one situation and pathogenic in another (the mutualism–parasitism continuum). This depends on their biology, environmental conditions, the formulation of inoculum, the health, developmental stage and cultivar of the host plant, and the structure of the plant microbiome.
In this chapter, we will take another look at the data our study provides on what might be conceived as ‘everyday transnationalism’ among ordinary European populations. European integration has provided for an extraordinary range of rights enabling European citizens to benefit from participation in a wide and open European space, whether for economic and business reasons, leisure, tourism and consumption, or in terms of wider knowledge and interest in countries around the region. Transnationalism has become a commonplace possibility of everyday life for ordinary citizens across the continent.
In academic analyses of Europe, however, it has become routine to argue that European integration most benefits elites and upper classes – the people most likely to have international connections – while being of much less benefit to lower classes (Fligstein 2008). This may fuel a certain resentment towards those seen to be better able to take up the opportunities of a more mobile world (Kuhn 2015). In turn, this is linked to the widespread mistrust and (sometimes) hostility among ordinary citizens to the European project in political and identification terms (de Vries 2018). Sociologists (Beckfield 2006), meanwhile, have presented evidence that European integration is causing more inequality in the context of global economic change.
So how has the possibility of mobility been understood and experienced by ordinary Europeans? Freedom of movement, after all, is routinely cited by the EU itself as its most popular achievement (Recchi 2015). Previous chapters have provided a quantitative overview of the cross-border mobility practices of residents living in the six EUCROSS countries. Chapter Two in particular showed significant variation between countries in terms of average levels of mobility, as well as its fundamental social stratification. Including intra-EU migrants and residents of a new member state (Romania) introduces further varieties into the aggregate mix, as well as a certain degree of noise, given the quite different migration and mobility scenarios faced by Turkish or Romanian citizens. Our goal in this chapter is disaggregation, and a focus on understanding qualitatively the positional variation of Europeans in a mobile Europe. For all its complexity in measuring mobilities, the aggregate survey can only tell us so much about how Europeans experience travel, long-distance contacts, experiences and ideas of other places, and so on.
An insect trap constructed using three-dimensional (3D) printing technology was tested in potato (Solanum tuberosum Linnaeus; Solanaceae) fields to determine whether it could substitute for the standard yellow sticky card used to monitor Bactericera cockerelli (Šulc) (Hemiptera: Psylloidea: Triozidae). Sticky cards have shortcomings that prompted search for a replacement: cards are messy, require weekly replacement, are expensive to purchase, and accumulate large numbers of nontarget insects. Bactericera cockerelli on sticky cards also deteriorate enough that specimens cannot be tested reliably for the presence of vectored plant pathogens. A prototype trap constructed using 3D printing technology for monitoring Diaphorina citri Kuwayama (Hemiptera: Psylloidea: Liviidae) was tested for monitoring B. cockerelli. The trap was designed to attract B. cockerelli visually to the trap and then funnel specimens into preservative-filled vials at the trap bottom. Prototype traps were paired against yellow sticky cards at multiple fields to compare the captures of B. cockerelli between cards and traps. The prototype trap was competitive with sticky cards early in the growing season when B. cockerelli numbers were low. We estimated that two or three prototype traps would collect as many B. cockerelli as one sticky card under these conditions. Efficacy of the prototype declined as B. cockerelli numbers increased seasonally. The prototype trap accumulated nontarget taxa that are common on sticky cards (especially Thysanoptera and Diptera), and was also found to capture taxa of possible interest in integrated pest management research, including predatory insects, parasitic Hymenoptera, and winged Aphididae (Hemiptera), suggesting that the traps could be useful outside of the purpose targeted here. We believe that 3D printing technology has substantial promise for developing monitoring tools that exploit behavioural traits of the targeted insect. Ongoing work includes the use of this technology to modify the prototype, with a focus on making it more effective at capturing psyllids and less susceptible to capture of nontarget species.