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Pulmonary artery capacitance is a relatively novel measurement associated with adverse outcomes in pulmonary arterial hypertension. We sought to determine if preoperative indexed pulmonary artery capacitance was related to outcomes in paediatric heart transplant recipients, describe the changes in indexed pulmonary artery capacitance after transplantation, and compare its discriminatory ability to predict outcomes as compared to conventional predictors.
Methods:
This was a retrospective study of paediatric patients who underwent heart transplant at our centre from July 2014 to May 2022. Variables from preoperative and postoperative clinical, catheterisation, and echo evaluations were recorded. The primary composite outcome measure included postoperative mortality, postoperative length of stay in the top quartile, and/or evidence of end organ dysfunction.
Results:
Of the 23 patients included in the analysis, 11 met the composite outcome. There was no statistical difference between indexed pulmonary artery capacitance values in patients who met the composite outcome [1.8 ml/mmHg/m2 (interquartile 0.8, 2.4)] and those who did not [1.4 (interquartile 0.9, 1.7)], p = 0.17. There were no significant signs of post-operative right heart failure in either group. There was no significant difference between pre-transplant and post-transplant indexed pulmonary artery capacitance or indexed pulmonary vascular resistance.
Conclusions:
Preoperative pulmonary artery capacitance was not associated with our composite outcome in paediatric heart transplant recipients. It did not appear to be additive to pulmonary vascular resistance in paediatric heart transplant patients. Pulmonary vascular disease did not appear to drive outcomes in this group.
Scholars disagree as to whether Americans’ attitudes toward local issues are structured ideologically and whether these are related to national policy ideology. We use two surveys of American adults to assess whether and to what extent Americans' local policy attitudes exhibit a similar structure as do national policy attitudes. We find that items asking about local policy are just as likely to reflect a latent dimension of policy preferences as those asking about national policy. Additionally, when local and national items are scaled separately, those scales are highly correlated. Our findings indicate that attitudes toward many local issues are aligned with national ideology. A smaller subset of attitudes about local issues appears distinctively local and possibly structured by non-ideological cleavages.
Agri-environmental schemes (AES) are used to enhance pollinator diversity on agricultural farms within the UK. Though the impacts of these schemes on archetypal pollinator species such as the bumblebee (Bombus) and honeybee (Apis) are well-studied, the effects on non-target bee species like solitary bees, in the same environment, are generally lacking. One goal of AES is to alter floral provision and taxonomic composition of plant communities to provide better forage for pollinators, however, this may potentially impact other ecological communities such as fungal diversity associated with plant-bee communities. Fungi are integral in these bee communities as they can impact bee species both beneficially and detrimentally. We test the hypothesis that alteration of the environment through provision of novel plant communities has non-target effects on the fungi associated with solitary bee communities. We analyse fungal diversity and ecological networks formed between fungi and solitary bees present on 15 agricultural farms in the UK using samples from brood cells. The farms were allocated to two categories, low and high management, which differ in the number of agri-environmental measures implemented. Using internal transcribed spacer metabarcoding, we identified 456 fungal taxa that interact with solitary bees. Of these, 202 (approximately 44%) could be assigned to functional groups, the majority being pathotrophic and saprotrophic species. A large proportion was Ascosphaeraceae, a family of bee-specialist fungi. We considered the connectance, nestedness, modularity, nestedness overlap and decreasing fill, linkage density and fungal generality of the farms' bee–fungi ecological networks. We found no difference in the structure of bee–fungi ecological networks between low and high management farms, suggesting floral provision by AES has no significant impact on interactions between these two taxonomic groups. However, bee emergence was lower on the low management farms compared to high management, suggesting some limited non-target effects of AES. This study characterizes the fungal community associated with solitary bees and provides evidence that floral provision through AES does not impact fungal interactions.
To evaluate the change in vancomycin days of therapy (DOT) and vancomycin-associated acute kidney injury (AKI) after an antimicrobial stewardship program (ASP) intervention to decrease vancomycin use in stable patients after hematopoietic stem cell transplantation (HSCT).
Design:
Retrospective cohort study and quasi-experimental interrupted time series analysis. Change in unit-level vancomycin DOT per 1,000 inpatient days after the intervention was assessed using segmented Poisson regression. Subject-specific risk of vancomycin-associated AKI was evaluated using a random intercept logistic regression model with mediation analysis.
Setting:
HSCT unit at a single quaternary-care pediatric hospital.
Participants:
Inpatients aged 3 months and older who underwent HSCT between January 1, 2015, and March 31, 2019 (27 months before and after the intervention) who received any dose of vancomycin.
Intervention:
An ASP intervention in April 2017 creating a new practice guideline to decrease prolonged (>72 hours) vancomycin courses for stable HSCT patients with febrile neutropenia.
Results:
Overall, 439 vancomycin exposures (234 before the intervention and 205 after the intervention) occurring across 300 transplants and 259 subjects were included. The mean vancomycin DOT was 307 per 1,000 inpatient days (95% confidence interval [CI], 272–342) and decreased after the intervention to 207 per 1,000 inpatient days (95% CI, 173–240). In multivariable analyses, the odds of AKI in the postintervention period were 37% lower than in the preintervention period (adjusted OR, 0.63; 95% CI, 0.42–0.95; P = .0268); 56% of the excess risk was mediated by vancomycin DOT.
Conclusions:
An ASP intervention successfully decreased vancomycin use after HSCT and resulted in a decrease in AKI. Reducing empiric antibiotic exposure for stable patients after HSCT can improve clinical outcomes.
We argue that falling farm product prices, incomes, and spending may explain 10–30 percent of the 1930 U.S. output decline. Crop prices collapsed, reducing farmers’ incomes. And across U.S. states and Ohio counties, auto sales fell most in crop-growing areas. The large spending response may be explained by farmers’ indebtedness. Reasonable assumptions about the marginal propensity to spend of farmers relative to nonfarmers and the pass-through of farm prices to retail prices imply that the collapse of farm product prices in 1930 was a powerful propagation mechanism worsening the Depression.
Are local politics usually characterized by disagreement or consensus? While scholars of politics in major cities such as New York, Atlanta, and Los Angeles have long emphasized the centrality of racial and class cleavages in elections and governing, the conventional wisdom is that local politics outside such urban behemoths – that is, in the thousands of smaller cities and towns where nearly 3 in 4 Americans live – are relatively staid. According to this view, local politics are distinctive from national or state politics because they typically revolve around relatively low-stakes issues and rely on elected officials who are characterized more by managerial acumen than ideological fervor. These characteristics, the argument goes, make local politics relatively placid in comparison with the pitched battles that frequently roil national politics.
On August 9, 2014, Michael Brown, an unarmed eighteen-year-old African American man, was fatally shot by Darren Wilson, a white police officer, following a violent altercation on the streets of Ferguson, Missouri. With many of the crucial facts surrounding Brown’s death under dispute – in particular, whether Wilson’s stop of Brown was justified, whether Wilson or Brown initiated the confrontation, whether Brown surrendered or resisted arrest – many residents in the majority African American community took to the streets to protest what they viewed as an emblematic instance of police brutality, as well as general indifference among community leaders toward the concerns of black and brown residents. In response, Ferguson police – and eventually the Missouri National Guard – mustered an intimidating show of force in an effort to contain the protests. The presence of large numbers of heavily armed police and guardsmen exacerbated an already tense situation, leading to charged and sometimes violent encounters between protestors and law enforcement officials. Wilson’s killing of Brown, the heated and sometimes violent protests, and the extraordinary heavy-handedness of the police response made the events in Ferguson national news, riveting public attention and forcing conversations about police brutality and the over-policing of communities of color.
For many Americans of color, the promise of local democracy seems unfulfilled. On average, African Americans and Latinos are underrepresented descriptively on municipal councils, ideologically distant from local elected officials, and poorly represented in the overall ideological orientation of local government policy. At the same time, however, the picture is not uniformly bleak: There are perceptible differences in how well or how poorly different local governments perform in substantively representing the preferences of African American and Latino constituents.
In the previous chapter, we examined patterns in descriptive representation, ideological congruence representation, and policy responsiveness across economic groups in communities throughout the United States, revealing the substantial underrepresentation of citizens with low wealth at the municipal level. Importantly, however, Chapter 7 focused largely, though not exclusively, on general patterns of (inequality in) representation. This emphasis, while vital, has the effect of minimizing the nontrivial number of instances in which less affluent residents receive considerable representation at the local level.
An impressive body of research has expanded our understanding of how American democracy works, as well as when and why it fails to do so. Important studies have focused on inequalities in representation based on race, generally finding that nonwhites receive less representation from government than do white constituents. Meanwhile, a growing body of research examining the relationship between income and representation suggests that “the wealthiest Americans exert more political influence than their less fortunate fellow citizens do.”
A rural, working-class community of about 12,000 residents (38 percent of whom are African American), Brookhaven, Mississippi, is located in Lincoln County, approximately 60 miles south of Jackson, the state’s capital. Traditionally, Brookhaven has been dominated by timber and cotton concerns, and these industries still play a major role in the community, along with light industry and warehousing and distribution services. In tacit acknowledgment of the economic and social challenges the town has faced in an era of globalization and rising economic inequality, a local history describes the town as “a charismatic survivor” that persisted in the face of “vicissitudes similar to those which resulted in the diminishment or disappearance of [other] formerly flourishing Lincoln County villages and towns.”
Houston, Texas is a city of roughly 2.3 million people, located in the southeastern portion of the state, near Galveston Bay and the Gulf of Mexico. It has a dynamic economy, with two dozen Fortune 500 companies, the nation’s second-most-active port, and significant energy, technology, aerospace, medical, and manufacturing sectors. Although the city has a white-plurality population (37.3 percent of residents identify as white), it is very racially diverse, with 36.5 percent of residents identifying as Hispanic/Latino; 16.6 percent identifying as African American; 7.5 percent identifying as Asian; and 2 percent identifying as “Other.” Compared with many cities of similar size, Houston boasts an attractive combination of abundant jobs, affordable housing, and exciting cultural amenities.
In 2017, researchers at Portland State University reached an eye-popping conclusion about the state of participation in local politics in the United States. Examining more than 23 million voting records, as well as information about community populations from the US Census, they estimated rates of voter turnout in the nation’s fifty largest cities. Their findings were staggering – and depressing. Across the fifty communities, the median turnout rate in municipal elections was only 20 percent of the eligible electorate, and in Las Vegas, Ft. Worth, and Dallas, turnout was in the single digits. “low voter turnout is a problem in cities across the country,” the study leaders concluded. “Too few people choose our local leaders.”