For decades, conservationists have remained steadfastly committed to protected areas (PAs) as the best means to conserve biodiversity. Using Collaborative Event Ethnography of the 10 th meeting of ...the Conference of the Parties to the Convention on Biological Diversity (CBD/CoP), we examine how the PA concept remains hegemonic in conservation policy. We argue that, as a broadening base of actors frame their political objectives through PAs in order to further their agendas, they come together in a discourse coalition. In this coalition, actors do not necessarily have common interests or understandings; rather, it is through dynamic struggles over the meaning of the PA concept and the continual process of reshaping it that actors reproduce its hegemony. In this process, the CBD/CoP disciplines and aligns disparate actors who might otherwise associate with distinct discourse coalitions. As the concept accommodates a wider range of values, PAs are increasingly being asked to do more than conserve biodiversity. They must also sequester carbon, protect ecosystem services, and even promote human rights. These transformations reflect not only changes in how PAs are defined and framed, but also in the realignment of relationships of authority and power in conservation governance in ways that may marginalise traditional conservation actors.
Robotic cholecystectomy is being increasingly used for patients with acute gallbladder disease who present to the emergency department, but clinical evidence is limited. We aimed to compare the ...outcomes of emergent laparoscopic and robotic cholecystectomies in a large real-world database.
Patients who received emergent laparoscopic or robotic cholecystectomies from 2020 to 2022 were identified from the Intuitive Custom Hospital Analytics database, based on deidentified extraction of electronic health record data from US hospitals. Conversion to open or subtotal cholecystectomy and complications were defined using ICD10 and/or CPT codes. Multivariate logistic regression with inverse probability treatment weighting (IPTW) was performed to compare clinical outcomes of laparoscopic versus robotic approach after balancing covariates. Cost analysis was performed with activity-based costing and adjustment for inflation.
Of 26,786 laparoscopic and 3,151 robotic emergent cholecystectomy patients being included, 64% were female, 60% were ≥45 years, and 24% were obese. Approximately 5.5% patients presented with pancreatitis, and 4% each presenting with sepsis and biliary obstruction. After IPTW, distributions of all baseline covariates were balanced. Robotic cholecystectomy decreased odds of conversion to open (odds ratio, 0.68; 95% confidence interval, 0.49-0.93; p = 0.035), but increased odds of subtotal cholecystectomy (odds ratio, 1.64; 95% confidence interval, 1.03-2.60; p = 0.037). Surgical site infection, readmission, length of stay, hospital acquired conditions, bile duct injury or leak, and hospital mortality were similar in both groups. There was no significant difference in hospital cost.
Robotic cholecystectomy has reduced odds of conversion to open and comparable complications, but increased odds of subtotal cholecystectomy compared with laparoscopic cholecystectomy for acute gallbladder diseases. Further work is required to assess the long-term implications of these differences.
Therapeutic/Care Management; Level IV.
Abstract
A 61-year-old man with a past medical history significant for heavy alcohol consumption and an extensive smoking history presented with a left neck mass which was diagnosed as a pT3N2bM0 ...squamous cell carcinoma (SCC) of the submandibular gland. The patient was later found to have recurrence with mediastinal metastasis despite adjuvant chemoradiation. He subsequently developed abdominal distention with computed tomography revealing an ascending colon mass and findings concerning for perforation. The patient underwent an exploratory laparotomy with right hemicolectomy. Surgical pathology was consistent with metastatic SCC.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
For decades, conservationists have remained steadfastly committed to protected areas (PAs) as the best means to conserve biodiversity. Using Collaborative Event Ethnography of the 10thmeeting of the ...Conference of the Parties to the Convention on Biological Diversity (CBD/CoP), we examine how the PA concept remains hegemonic in conservation policy. We argue that, as a broadening base of actors frame their political objectives through PAs in order to further their agendas, they come together in a discourse coalition. In this coalition, actors do not necessarily have common interests or understandings; rather, it is through dynamic struggles over the meaning of the PA concept and the continual process of reshaping it that actors reproduce its hegemony. In this process, the CBD/CoP disciplines and aligns disparate actors who might otherwise associate with distinct discourse coalitions. As the concept accommodates a wider range of values, PAs are increasingly being asked to do more than conserve biodiversity. They must also sequester carbon, protect ecosystem services, and even promote human rights. These transformations reflect not only changes in how PAs are defined and framed, but also in the realignment of relationships of authority and power in conservation governance in ways that may marginalise traditional conservation actors.
Single center data demonstrates that regional analgesia (RA) techniques are associated with reduced risk of delirium in older patients with multiple rib fractures. We hypothesized that a similar ...effect between RA and delirium would be identified in a larger cohort of patients from multiple Level I trauma centers.
Retrospective data from seven Level-I trauma centers were collected for ICU patients ≥65 years old with ≥3 rib fractures from 1/2012-12/2016. Those with a head and/or spine injury AIS ≥ 3, or a history of dementia were excluded. Delirium was defined as one positive Confusion Assessment Method for the ICU (CAM-ICU) score in the first 7 days of ICU care. Poisson regression with robust standard errors was used to determine the association of RA (thoracic epidural or paravertebral catheter) with delirium incidence.
Data of 574 patients were analyzed with the median age=75 years IQR=69-83, ISS=14 IQR=11-18, and ICU length of stay (LOS)=3 days IQR=2-6. 38.9% of patients were women, 15.3% were non-white, and 31.4% required a chest tube. RA was used in 19.3% patients. Patient characteristics did not differ by RA use, however, patients with RA had more severe chest injury (chest AIS, flail segment, hemopneumothorax, thoracostomy tube). In univariate analysis, there was no difference in the likelihood of delirium between the RA and no RA groups (18.9% vs. 23.8% p=0.28). After adjusting for age, sex, ISS, max chest AIS, thoracostomy tube, ICU LOS, and trauma center, RA was associated with reduced risk of delirium (IRR 0.65; 95% CI: 0.44, 0.94), but not with in-hospital mortality (IRR 0.42; 95% CI: 0.14, 1.26) or respiratory complications (IRR 0.70; 95% CI: 0.42, 1.16).
In this multicenter cohort of injured older adults with multiple rib fractures, regional analgesia use was associated with a 35% lower risk of delirium. Further studies are needed to standardize protocols for optimal pain management and prevention of delirium in older adults with severe thoracic injury.
Level III (therapeutic).
Discourse used in the field of conservation, be it of animals, land masses or marine zones, matters in that discourse and practice are mutually constitutive and discourse will therefore ultimately ...influence how conservation is practiced. Conservation discourses have shifted over time depending on the broader political economic climate. At present, neoliberal conservation discourse is gaining traction amongst terrestrial conservationists and has both proponents and detractors; however, it is less clear whether marine conservationists have similarly adopted the discourse of property rights, markets and incentives. Marine conservation is a newer pursuit, and has tended to follow in the path of its terrestrial counterpart. It is therefore of consequence whether and how the neoliberal discourse is beginning to impact marine conservation. While some academic literature has focused on neoliberal discourse in marine environments, to date it has been narrow in scope, mostly focusing on the privatization of fisheries and the role of neoliberalism in the privatization of marine protected areas (MPAs). However, the versatility of neoliberal approaches to conservation suggests that the impact may be much more widespread than this. With the potential to align itself with previously dominant discourses such as fortress conservation and community-based conservation, neoliberal conservation stands to gain traction. This thesis addresses the lack of attention given to neoliberal conservation in marine environments by conducting a collaborative event ethnography (CEE) of the Tenth Conference of the Parties to the Convention on Biological Diversity (CBD-COP10). The CBD-COP10 is a forum where a diverse array of actors from the public, private and civil society sectors come together to discuss the future of the field of conservation. It is here that ideas about conservation are both conceptualized and contested, and those that become dominant discourses can ultimately influence how conservation is undertaken in practice. The research finds that as with terrestrial conservation, a wide range of marine actors are indeed invoking neoliberal conservation discourse. At the CBD-COP10, neoliberal discourse and its related practices were rarely challenged and often lauded, from NGO and government partnerships with the private sector, to economic valuation, to the drive towards a ‘green economy’. By revealing this usage, this thesis contributes to scholarship by addressing the lack of attention to the impact of neoliberal conservation discourses in the marine realm. It also shows that the study of discourse can be a useful mode of understanding how marine conservation is conceptualized. It helps to illuminate the power channels through which discourse travels and how a particular discourse can become dominant, which is important to understand because dominant discourses can ultimately impact how conservation is practiced.
SSHRC; Research supported by the US National Science Foundation (award nos. 1027194 and 1027201)
X-ray transmission imaging has been used in a variety of applications for high-resolution measurements based on shape and density. Similarly, X-ray diffraction (XRD) imaging has been used widely for ...molecular structure-based identification of materials. Combining these X-ray methods has the potential to provide high-resolution material identification, exceeding the capabilities of either modality alone. However, XRD imaging methods have been limited in application by their long measurement times and poor spatial resolution, which has generally precluded combined, rapid measurements of X-ray transmission and diffraction. In this work, we present a novel X-ray fan beam coded aperture transmission and diffraction imaging system, developed using commercially available components, for rapid and accurate non-destructive imaging of industrial and biomedical specimens. The imaging system uses a 160 kV Bremsstrahlung X-ray source while achieving a spatial resolution of ≈ 1 × 1 mm
and a spectral accuracy of > 95% with only 15 s exposures per 150 mm fan beam slice. Applications of this technology are reported in geological imaging, pharmaceutical inspection, and medical diagnosis. The performance of the imaging system indicates improved material differentiation relative to transmission imaging alone at scan times suitable for a variety of industrial and biomedical applications.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
The cytoplasmic lipid droplet (CLD) protein perilipin-2 (Plin2) is expressed in multiple nonadipose tissues, where it is thought to play a role in regulating their lipid storage properties. However, ...the extent to which Plin2 functions in nutrient utilization and metabolism, or how it influences the consequences of over-feeding, remains unclear. In this study, we demonstrate that the absence of Plin2 prevents high-fat diet(HFD)-induced obesity in male and female mice. This response is associated with increased formation of subcutaneous beige adipocyte cells with uncoupling protein 1 expression, and amelioration of inflammatory foci formation in white adipose tissue and steatosis in the liver. Experiments demonstrate that Plin2 loss results in reduced energy intake and increased physical activity in response to HFD feeding. Our study provides the first evidence that Plin2 contributes to HFD-induced obesity by modulating food intake, and that its absence prevents obesity-associated adipose tissue inflammatory foci and liver steatosis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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