The recent 'trade war' between Australia and China has understandably sparked fear amongst Australian policymakers, voters and businesses. China's alleged economic coercion towards Australia has the ...strange property that Chinese leaders are not making any clear explicit demands of Australia. Moreover, this behaviour follows a pattern in recent Chinese dealings with other Asia-Pacific states. Why would a state initiate economic coercion without making clear demands? In this paper, I offer an explanation, building on the logic of audience costs in wars of attrition. I suggest that China's strategy of economic coercion without explicit demands serves a key strategic purpose. Omitting specific demands makes the outcome of any given dispute less clear and hence makes it easier for either side to claim victory. This negates a key advantage which democratic states have in bargaining with autocratic adversaries-the fact that their audience costs for backing down are usually higher, which makes them less likely to initiate but more likely to win international disputes. Implicit economic coercion should therefore be a strategy which is primarily targeted at China's democratic trading partners. I examine the record of Chinese uses of economic coercion in the past and find that this pattern finds much support.
State-level child access prevention (CAP) laws impose criminal liability on adults who negligently allow children access to firearms. The CAP laws can be further divided into strong CAP laws which ...impose criminal liability for negligently stored firearms and weak CAP laws that prohibit adults from intentionally, knowingly, and/or recklessly providing firearms to a minor. We hypothesized that strong CAP laws would be associated with a greater reduction in pediatric firearm injuries than weak CAP laws.
We constructed a cross-sectional national study using the Healthcare Cost and Utilization Project-Kids Inpatient Database from 2006 and 2009 using weighted counts of firearm-related admissions among children younger than 18 years. Poisson regression was used to estimate the association of CAP laws with pediatric firearm injuries.
After adjusting for race, sex, age, and socioeconomic income quartile, strong CAP laws were associated with a significant reduction in all (incidence rate ratio, 0.70; 95% confidence interval, 0.52-0.93), self-inflicted (incidence rate ratio, 0.46; 95% confidence interval, 0.26-0.79), and unintentional (incidence rate ratio, 0.56; 95% confidence interval, 0.43-0.74) pediatric firearm injuries. Weak CAP laws, which only impose liability for reckless endangerment, were associated with an increased risk of all pediatric firearm injuries.
The association of CAP laws on hospitalizations for pediatric firearm injuries differed greatly depending on whether a state had adopted a strong CAP law or a weak CAP law. Implementation of strong CAP laws by each state, which require safe storage of firearms, has the potential to significantly reduce pediatric firearm injuries.
Prognostic and epidemiology study, level III.
In recent years, far-right organisations have formed in response to what they believe to be the threat from the rise of Islam in Australia. Parallel movements have spawned an extensive literature ...internationally. In this study I investigate this movement in Australia using automated text analysis of all public posts from two of the most popular Australian anti-Islam groups on social media. This approach complements traditional polling methods by offering access to large samples of the spontaneously generated opinions, allowing subjects to speak in their own words. My analysis finds evidence that concerns about terrorism and the perceived political threat from Islam are paramount in these groups' discussion of Muslims. I conclude by discussing the implications for counter-messaging strategies.
INTRODUCTION:Thoracoabdominal aortic aneurysm (TAAA) remains a challenging problem. We sought to examine our experience with thoracic and thoracoabdominal aortic repairs over a 24-year period.
...METHODS:Patient information was collected in a prospective database and analyzed retrospectively. Univariate and multivariable analysis was performed.
RESULTS:Between January 1991 and December 2014, we repaired 1896 descending thoracic (DTAA) or TAAA in 1795 patients. Mean age was 64.2 ± 13.8, and 702 (37%) were women. Of 1896 operations, 646 (34.1%) were DTAA, 316 (16.7%) TAAA extent I, 310 (16.4%) TAAA extent II, 187 (9.9%) TAAA extent III, 348 (18.4%) TAAA extent IV, and 112 (5.9%) TAAA extent V. Adjunct cerebrospinal fluid drainage (CSFD) + distal aortic perfusion (DAP) was used in 78.4%. Mean preoperative glomerular filtration rate (GFR) was 75.1 ± 14.9 mL/min/1.73 m. Renal dysfunction occurred in 461 (24.3%). Immediate neurodeficit (IND) occurred in 79 (4.2%) and delayed in 104 (5.5%). Of these, 47/104 (45%) recovered by discharge. Postoperative stroke was 95/1896 (5%). Early mortality was 302/1896 (15.9%). Mortality with GFR >95.3 was 28/457 (6.1%), and 131/432 (30.3%) was with GFR < 48.3 (P < 0.0001). Predictors of early mortality were age (P < 0.02), GFR (P < 0.0001), TAAA2 or 3 (P = 0.001), coronary artery disease (P = 0.001), and emergency (P < 0.0001).
CONCLUSIONS:Open DTAA and TAAA repair can be performed with acceptable early and late outcomes. This study provides important early- and long-term data on open repair, allowing for better risk stratification of patients with DTAA and TAAA. It is the high-risk subgroup that can now be targeted for endovascular techniques.
Summary
Polyhydroxyalkanoates (PHAs) are biopolymers with desirable material properties similar to petrochemically derived plastics. PHAs are naturally produced by a wide range of microorganisms as a ...carbon storage mechanism and can accumulate to significantly high levels. PHAs are an environmentally friendly alternative to their petroleum counterparts because they can be easily degraded, potentially reducing the burden on municipal waste systems. Nevertheless, widespread use of PHAs is not currently realistic due to a variety of factors. One of the major constraints of large‐scale PHA production is the cost of carbon substrate for PHA‐producing microbes. The cost of production could potentially be reduced with the use of waste carbon from food‐related processes. Food wastage is a global issue and therefore harbours immense potential to create valuable bioproducts. This article's main focus is to examine the state of the art of converting food‐derived waste into carbon substrates for microbial metabolism and subsequent conversion into PHAs.
Food wastage is a global issue and therefore harbors immense potential to create valuable bioproducts. This article's main focus is to examine the state of the art of converting food‐derived waste into carbon substrates for microbial metabolism and subsequent conversion into PHAs.
Urban areas now house more than half the world's population, and are estimated to contribute over 70% of global energy‐related CO2emissions. Many cities have emission reduction policies in place, but ...lack objective, observation‐based methods for verifying their outcomes. Here we demonstrate the potential of satellite‐borne instruments to provide accurate global monitoring of megacity CO2 emissions using GOSAT observations of column averaged CO2 dry air mole fraction (XCO2) collected over Los Angeles and Mumbai. By differencing observations over the megacity with those in nearby background, we observe robust, statistically significant XCO2 enhancements of 3.2 ± 1.5 ppm for Los Angeles and 2.4 ± 1.2 ppm for Mumbai, and find these enhancements can be exploited to track anthropogenic emission trends over time. We estimate that XCO2 changes as small as 0.7 ppm in Los Angeles, corresponding to a 22% change in emissions, could be detected with GOSAT at the 95% confidence level.
Key Points
Existing satellite observations can detect megacity CO2 enhancements
These observations can be used to track anthropogenic emissions trends in time
Objectives Endovascular treatment of traumatic aortic injury (TAI) is an alternative to open repair (OR) in patients with blunt trauma. We report our initial experience after integration of ...endovascular repair using thoracic devices. Methods A retrospective review of a prospectively collected institutional trauma registry was performed. Between September 2005 and November 2008, 71 patients with TAI presented to our institution. Based on imaging, TAIs were classified into grade 1-4 in severity. These included: grade 1, intimal tear; grade 2, intramural hematoma; grade 3, aortic pseudoaneurysm; and grade 4, free rupture. Initial management included resuscitation, blood pressure control, and treatment of associated injuries. After stabilization, all patients were considered for thoracic endovascular aortic repair (TEVAR) using a thoracic device. If contraindicated, candidates underwent OR. Outcome measures were mortality, stroke, paraplegia, intensive care unit (ICU), and hospital stay. Results The mean age was 39.8 years, with 50 males. The mean injury severity score (ISS) was 42.6. Nineteen (27%) patients with a mean ISS of 60 died shortly after arrival prior to any vascular intervention. Ten (14%) patients with grade 1 injuries were managed medically. The remaining 42 (59%) patients with grade 2 and 3 injuries underwent repair. Median interval between admission and repair was 4.3 days (range, 0-109 days). Fifteen (21%) patients with a mean ISS of 34.4 underwent OR with no mortality, stroke, or paraplegia. Twenty-seven (38%) patients with a mean ISS of 36.7 underwent TEVAR with no mortality or paraplegia. One TEVAR patient suffered a perioperative stroke. Twenty-two patients had a TAG (W.L. Gore & Associates, Flagstaff, Ariz) device. Four patients had a Talent Thoracic (Medtronic Vascular, Santa Rosa, Calif), and 1 patient had an Excluder (W.L. Gore) device. The left subclavian artery was covered in 13 (48%) patients. Patients who underwent TEVAR were older than those who had OR (47.8 vs 31.1 years, P < .006). The aortic diameter proximal to the injury was larger in the TEVAR group (24.4 vs 19.6 mm, P < .0001). There was no difference in the mean ICU or hospital length of stay between the two groups. Mortality correlated with the ISS score ( P < .0001). Median follow-up time was 19.4 months (range, 0-27). Only 56% of the TEVAR patients were fully compliant with their surveillance imaging protocol. Conclusion In this initial experience, the results of TEVAR did not differ from OR. Long-term follow-up is required to determine the effectiveness of this treatment strategy. Adherence to follow-up imaging protocols is challenging in this patient population. Next generation devices will make TEVAR applicable to a wider range of patients.
Adnexal torsion: review of the literature Sasaki, Kirsten J; Miller, Charles E
Journal of minimally invasive gynecology,
03/2014, Volume:
21, Issue:
2
Journal Article
Peer reviewed
Adnexal torsion is one of a few gynecologic surgical emergencies. Misdiagnosis or delay in treatment can have permanent sequelae including loss of an ovary with effect on future fertility, ...peritonitis, and even death. A PubMed search was performed between 1985 and 2012 for reviews, comparative studies, and case reports to provide a review of the epidemiology, risk factors, clinical presentation, common laboratory and imaging findings, and treatments of adnexal torsion. Common symptoms of torsion include pain, nausea, and vomiting, with associated abdominal or pelvic tenderness, and may differ in premenarchal and pregnant patients. Laboratory and imaging findings including ultrasound with Doppler analysis, computed tomography, and magnetic resonance imaging can assist in making the diagnosis but should not trump clinical judgment; normal Doppler flow can be observed in up to 60% of adnexal torsion cases. Treatment depends on the individual patient but commonly includes detorsion, even if the adnexae initially seem necrotic, with removal of any associated cysts or salpingo-oophorectomy, because recurrence rates are higher with detorsion alone or detorsion with only cyst aspiration.
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