As mariculture—the cultivation of aquatic organisms in marine environment—intensifies to meet the demands of sustainable blue growth and national policies, novel ethical challenges will arise. In the ...context of ethics, primary concerns over aquaculture and mariculture tend to stay within differing value-based perspectives focused on benefits to human and non-human subjects, specifically animal welfare and animal rights. Nonetheless, the burgeoning field of feminist blue humanities provides ethical considerations that extend beyond animal subjects (including humans), often because of its concerns with new materialist, posthumanist, and other relations-based theories. This article examines feminist blue humanities and the contributions it may bring to understanding contemporary and future ethical challenges posed by mariculture and its intensification, especially the cultivation of low-trophic organisms. By offering an overview of feminist blue humanities, this article explores some of its particularities by drawing out three major ethical concerns facing contemporary mariculture, specifically material reconfigurations, radical alteration of the lives of low-trophic species through industrialization and increases in maricultural waste products.
Background
The presence of valvular heart disease (VHD) may affect the risk of stroke and mortality in patients with atrial fibrillation (AF). Community‐based estimates of prevalence and outcomes of ...specific forms of VHD in patients with AF are lacking.
Methods and Results
We examined the prevalence of VHD, anticoagulation use, mortality, stroke/transient ischemic attack, and bleeding among a community cohort of patients with AF. Significant VHD was defined as follows: (1) moderate/severe mitral stenosis or mechanical valve; (2) bioprosthetic valve, surgical repair, or balloon valvuloplasty; and (3) moderate/severe aortic regurgitation or stenosis, mitral regurgitation, or tricuspid regurgitation. Proportional hazards models were performed to test the association between VHD groups and outcomes. Among 9748 patients with AF, 2705 (27.7%) had significant VHD. Anticoagulation use was highest among patients with mitral stenosis/mechanical valve (91.8%). Compared with individuals with no significant VHD, individuals with aortic regurgitation/aortic stenosis, mitral regurgitation, or tricuspid regurgitation (hazard ratio, 1.23; 95% confidence interval, 1.07–1.42) had the highest risk of death. There were no differences in stroke or transient ischemic attack and major bleeding among individuals with and without significant VHD. Patients with AF and aortic stenosis had the highest risk of death (hazard ratio, 1.32; 95% confidence interval, 1.08–1.62).
Conclusions
Significant VHD is common among patients with AF in community practice. In a community cohort of patients with AF and CHA2DS2‐VASc score ≥2, most were anticoagulated. Individuals with AF and moderate‐to‐severe biological VHD have more comorbidities and a higher mortality risk; however, stroke and major bleeding are similar among those with and without significant VHD.
Objective: Past research has revealed that posttraumatic stress disorder (PTSD) is characterized by disturbances in emotional reactivity, including anger reactions. In turn, posttraumatic stress ...symptoms (PTSS) and anger reactions have been shown to be independently associated with posttraumatic growth (PTG). As such, anger reactions may serve as a pathway of influence through which PTSS lead to PTG in trauma-exposed adults. Method: The current study examined cross-sectional relationships among PTSS, anger reactions, and PTG in 318 participants who were exposed to the violent political protests in Ferguson, Missouri after the officer-involved shooting of Michael Brown. Specifically, anger reactions were examined as a pathway of influence through which PTSS contribute to PTG. Results: PTSS positively predicted anger reactions and PTG. Further anger reactions were associated with PTG. Anger reactions were found to partially account for the relationship between PTSS and PTG; thus, PTSS affect PTG, in part, through anger reactions to traumatic events. Conclusion: These results indicate a more direct role of anger reactions in facilitating growth after the associated distress of community violence. On the basis of these findings, anger may be useful in galvanizing individuals to make positive change after traumatic events.
Objective To provide data on management and outcomes of patients with acute retrograde aortic dissection (AD) originating from a tear in the descending aorta with extension into the aortic arch or ...ascending aorta. Methods All patients enrolled in the International Registry of Acute Aortic Dissection from 1996 through 2015 were reviewed. Retrograde AD was defined by primary tear in the descending aorta with proximal extension into the arch or ascending aorta. Primary end-points were in-hospital management strategy and mortality. Results We identified 101 retrograde AD patients (67 men; 63.2±14.0 years). During index hospitalization, medical (MED), open surgical (SURG) and endovascular (ENDO) therapies were undertaken in 44, 33, and 22 patients, respectively. The SURG group presented with larger ascending aorta ( P =.04) and more frequent ascending aortic involvement (81.8% 27/33 vs. 22.7% 15/66, P <.001) compared with the MED and ENDO groups. Early mortality was 9.1% 4/44, 18.2% 6/33, and 13.6% 3/22, for the MED, SURG and ENDO groups ( P =.51). A favorable early mortality was observed in patients with retrograde extension limited to the arch (8.6% 5/58) versus into the ascending aorta (18.6% 8/43, P =.14). Early mortality of patients with retrograde AD with primary tear in the descending aorta (12.9% 13/101) was significantly lower than those with classic type A AD presenting with primary tear in the ascending aorta (20.0% 195/977, P =.001). Conclusions A subset of patients with acute retrograde AD originating from primary tear in the descending aorta might be managed less invasively with acceptable early results, particularly among those with proximal extension limited to the arch.
Objective This study examines the association of hospital coronary artery bypass procedural volume with mortality, morbidity, evidence-based care processes, and Society of Thoracic Surgeons composite ...score. Methods The study population consisted of 144,526 patients from 733 hospitals that submitted data to the Society of Thoracic Surgeons Adult Cardiac Database in 2007. End points included use of National Quality Forum–endorsed process measures (internal thoracic artery graft; preoperative β-blockade; and discharge β-blockade, antiplatelet agents, and lipid drugs), operative mortality (in-hospital or 30-day), major morbidity (stroke, renal failure, reoperation, sternal infection, and prolonged ventilation), and Society of Thoracic Surgeons composite score. Procedural volume was analyzed as a continuous variable and by volume strata (<100, 100–149, 150–199, 200–299, 300–449, and ≥450). Analyses were performed with logistic and multivariate hierarchical regression modeling. Results Unadjusted mortality decreased across volume categories from 2.6% (<100 cases) to 1.7% (>450 cases, P < .0001), and these differences persisted after risk factor adjustment (odds ratio for lowest- vs highest-volume group, 1.49). Care processes and morbidity end points were not associated with hospital procedural volume except for a trend ( P = .0237) toward greater internal thoracic artery use in high-volume hospitals. The average composite score for the lowest volume (<100 cases) group was significantly lower than that of the 2 highest-volume groups, but only 1% of composite score variation was explained by volume. Conclusion A volume–performance association exists for coronary artery bypass grafting but is weaker than that of other major complex procedures. There is considerable outcomes variability not explained by hospital volume, and low volume does not preclude excellent performance. Except for internal thoracic artery use, care processes and morbidity rates were not associated with volume.
We present the outcome of a mission concept study that designed a small atmospheric entry probe and examined the feasibility and benefit of a future multi-probe mission to Uranus. We call our design ...the Small Next-generation Atmospheric Probe (SNAP). The primary scientific objective of a multi-probe mission is to reveal spatial variability of atmospheric conditions. This article first highlights that not all measurements must be repeated by multiple probes; some quantities, notably the noble gas abundances and elemental isotopic ratios, are not expected to be variable, and thus need to be performed only by a single large Primary Probe. Our study demonstrates that, by focusing its measurements on spatially variable quantities including atmospheric vapor concentrations, thermal stratification and wind speed, a viable atmospheric probe design is realized with an entry system with 50-cm heatshield diameter and 30-kg atmospheric entry mass.
As a case study, we present a detailed analysis of adding SNAP to a notional Uranus Orbiter with Probe mission, which launches in 2031 and arrives at Uranus in 2043, designed by the NASA-funded Science Definition Team study in 2017. We demonstrate that, with minimal changes to the notional carrier mission, a large Primary Probe and SNAP can be delivered to the winter and summer hemispheres to examine seasonal atmospheric variabilities, and transmit data to the Orbiter, which in turn relays the data to Earth. The additional maneuvers needed to deliver SNAP totals a Delta-V of 84 m/s, and consumes 43 kg of propellant. The addition of SNAP is expected to cost $79.5 million in FY2018 dollars; thus, our study demonstrates that a multi-probe mission can be implemented with a 4% cost increase relative to the $2.0 billion cost estimate of the notional mission designed by NASA’s Ice Giant Flagship Science Definition Team study reported in 2017.
The SNAP design incorporates several technologies that are currently under development at various Technology Readiness Levels (TRL) between TRL = 4 and TRL = 6. In particular, our study recommends targeted technology development in Thermal Protection System materials, advanced batteries, and miniaturized instruments to enable and enhance future small atmospheric probes like SNAP.
Abstract Objective Although hemodynamic monitoring is often performed after coronary artery bypass grafting (CABG), the role of monitoring postoperative central venous pressure (CVP) measurement as a ...predictor of clinical outcomes is unknown. As such, this study tests the hypothesis that postoperative CVP is predictive of operative mortality or renal failure. Methods This is an observational cohort study of detailed clinical data from 2390 randomly selected patients undergoing high-risk CABG or CABG/valve at 55 hospitals participating in the Society of Thoracic Surgeons' National Cardiac Surgery Database 2004-2005. Eligible patients underwent elective/urgent CABG with an ejection fraction less than 40% or elective/urgent CABG at 65 years or older with diabetes or a glomerular filtration rate less than 60 mL/min per 1.73 m2 . The exposure of interest is CVP monitoring in the intensive care unit after adult cardiac surgery. The primary outcome measure was correlation between postoperative CVP and inhospital/30-day mortality and renal failure, assessed as a continuous variable, both unadjusted and after adjusting for important clinical factors using logistic regression modeling. Results Mean age was 72 years, 54% of patients had diabetes mellitus, 49% were urgent procedures, and mean cardiopulmonary bypass time was 105 minutes. Patients' CVP 6 hours postoperation was strongly associated with inhospital and 30-day mortality: odds ratio (OR) of 1.5 (95% confidence interval CI, 1.23-1.87) for every 5-mm Hg increase in CVP; P < .0001. This association remained significant after risk adjustment: adjusted OR of 1.44 (95% CI, 1.10-1.89); P < .01. A model adjusting for cardiac index also revealed increased incidence of mortality or renal failure: adjusted OR of 1.5 (95% CI, 1.28-1.86) for every 5-mm Hg increase in CVP; P < .0001. Conclusions Patients' CVP at 6 hours after CABG surgery was highly predictive of operative mortality or renal failure, independent of cardiac index and other important clinical variables. Future studies will need to assess whether interventions guided by postoperative CVP can improve patient outcomes.
Desulfovibrio vulgaris Hildenborough is a model organism for studying the energy metabolism of sulfate-reducing bacteria (SRB) and for understanding the economic impacts of SRB, including ...biocorrosion of metal infrastructure and bioremediation of toxic metal ions. The 3,570,858 base pair (bp) genome sequence reveals a network of novel c-type cytochromes, connecting multiple periplasmic hydrogenases and formate dehydrogenases, as a key feature of its energy metabolism. The relative arrangement of genes encoding enzymes for energy transduction, together with inferred cellular location of the enzymes, provides a basis for proposing an expansion to the 'hydrogen-cycling' model for increasing energy efficiency in this bacterium. Plasmid-encoded functions include modification of cell surface components, nitrogen fixation and a type-III protein secretion system. This genome sequence represents a substantial step toward the elucidation of pathways for reduction (and bioremediation) of pollutants such as uranium and chromium and offers a new starting point for defining this organism's complex anaerobic respiration.
Background Black and Hispanic populations are at increased risk for developing heart failure (HF) at a younger age and experience differential morbidity and possibly differential mortality compared ...with whites. Yet, there have been insufficient data characterizing the clinical presentation, quality of care, and outcomes of patients hospitalized with HF as a function of race/ethnicity. Methods We analyzed 78,801 patients from 257 hospitals voluntarily participating in the American Heart Association's Get With The Guidelines–HF Program from January 2005 thru December 2008. There were 56,266 (71.4%) white, 17,775 (22.6%) black, and 4,760 (6.0%) Hispanic patients. In patients hospitalized with HF, we sought to assess clinical characteristics, adherence to core and other guideline-based HF care measures, and in-hospital mortality as a function of race and ethnicity. Results Relative to white patients, Hispanic and black patients were significantly younger (median age 78.0, 63.0, 64.0 years, respectively), had lower left ventricular ejection fractions, and had more diabetes mellitus and hypertension. With few exceptions, the provision of guideline-based care was comparable for black, Hispanic, and white patients. Black and Hispanic patients had lower in-hospital mortality than white patients: black/white odds ratio 0.69, 95% CI 0.62-0.78, P < .001 and Hispanic/white odds ratio 0.81, 95% CI 0.67-0.98, P = .03. Conclusions Hispanic and black patients hospitalized with HF have more cardiovascular risk factors than white patients; however; they have similar or better in-hospital mortality rates. Within the context of a national HF quality improvement program, HF care was equitable and improved in all racial/ethnic groups over time.
Background Edifoligide, an E2F transcription factor decoy, does not prevent vein graft failure or adverse clinical outcomes at 1 year in patients undergoing coronary artery bypass grafting (CABG). We ...compared the 5-year clinical outcomes of patients in PREVENT IV treated with edifoligide and placebo to identify predictors of long-term clinical outcomes. Methods A total of 3,014 patients undergoing CABG with at least 2 planned vein grafts were enrolled. Kaplan-Meier curves were generated to compare the long-term effects of edifoligide and placebo. A Cox proportional hazards model was constructed to identify factors associated with 5-year post-CABG outcomes. The main outcome measures were death, myocardial infarction (MI), repeat revascularization, and rehospitalization through 5 years. Results Five-year follow-up was complete in 2,865 patients (95.1%). At 5 years, patients randomized to edifoligide and placebo had similar rates of death (11.7% and 10.7%, respectively), MI (2.3% and 3.2%), revascularization (14.1% and 13.9%), and rehospitalization (61.6% and 62.5%). The composite outcome of death, MI, or revascularization occurred at similar frequency in patients assigned to edifoligide and placebo (26.3% and 25.5%, respectively; hazard ratio 1.03 95% CI 0.89-1.18, P = .721). Factors associated with death, MI, or revascularization at 5 years included peripheral and/or cerebrovascular disease, time on cardiopulmonary bypass, lung disease, diabetes mellitus, and congestive heart failure. Conclusions Up to a quarter of patients undergoing CABG will have a major cardiac event or repeat revascularization procedure within 5 years of surgery. Edifoligide does not affect outcomes after CABG; however, common identifiable baseline and procedural risk factors are associated with long-term outcomes after CABG.
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