To review the published diagnostic accuracy figures for the performance of colposcopy and to assess how the various forms of bias might explain the very wide range of reported values and the impact ...they have on quality assurance of cervical screening.
Publications were only selected where they contained sufficient raw data to enable diagnostic accuracy statistics to be calculated for the detection of cervical intraepithelial neoplasia grade 2+ (CIN2+), as determined by punch biopsy. In addition, both the colposcopic impression at the time of examination and the disease threshold used to determine the need for biopsy must have been reported.
Large differences in diagnostic accuracy figures were found when the output of colposcopy was defined either, on the basis that the colposcopist thought there was CIN2+ present or, that the colposcopist considered there to be some disease present and so took a biopsy to confirm this. Weighted mean sensitivity was 68.5% (95% CI 59.9–77.1) for the first method but 95.7% (95% CI 93.4–98.0) for the second method. Weighted mean specificity was 75.9% (95% CI 69.3–82.5) for the first method but 34.2% (95% CI 27.0–41.4) for the second method. Weighted mean PPV was 68.9% (95% CI 64.2–73.6) for the first method but 54.3% (95% CI 46.5–62.1) for the second method.
The main reason for the wide range of published diagnostic accuracy figures, arises from the use of two different methods of assessing the output of colposcopy. Colposcopic Impression is appropriate when assessing the performance of a colposcopist at the time of examination, but the taking of a biopsy to confirm that Disease is Present should be used when assessing patient management. Accurate assessment of both outcomes is fundamental to any quality assurance programme.
Purpose
This paper analyses public sector accounting and organisation reforms, focusing on the departments in charge of defence, military procurement and war between 1850 and 2000 in Britain. Over ...this period, three parliamentary acts, resulting from a power struggle between the Treasury and Parliament, produced the shift between two institutional logics: probity (spending properly) and performance (spending well). The purpose of this paper is to describe how the acts produced a shift between two institutional logics.
Design/methodology/approach
The authors adopt Quattrone’s (2015) procedural notion of institutional logics and the consequent concept of “unfolding rationality”. Using documents from the National Archives, the authors analyse three reforms: The Exchequer and Audit Departments Act 1866 (towards probity), The Exchequer and Audit Departments Act 1921 (towards performance) and the National Audit Office Act of 1983 (towards performance and probity).
Findings
For a long time, the actors narrated in this story argued and acted as if probity and performance were incompatible. The two are now treated as compatible and equally important. Before that, the “incompatibility” was a rhetorical, or “procedural”, device. The authors argue that a procedural rather than substantive notion of institutional logics is more suitable to explain the trajectory that was the result of constant negotiation among actors.
Practical implications
The study might contribute to the understanding of the increase in national defence-spending at continental level and the call for a common European Union (EU) military procurement strategy that followed the invasion of Ukraine. The war could produce changes in what is a traditional tension between two logics: sovereignty or efficiency.
Originality/value
The originality of this paper stands in highlighting the link between the institutional logic of public-administration accounting and military history. This link emerges also thanks to a very long time-horizon. Additionally, from a theoretical viewpoint, the authors have put Quattrone’s approach to the test in a context very different from the original one (the Jesuit order).
The U.S. electric-power infrastructure urgently needs renovation. Recent major power outages in California, New York, Texas, and Florida have highlighted U.S. electric-power unreliability. The media ...have discussed the U.S. aging power infrastructure and the Public Utilities Commission has demanded a comprehensive review of the causes of recent power outages. This paper explores geographic information systems (GIS) and a spatially enhanced predictive power-outage model to address: How may spatial analytics enhance our understanding of power outages? To answer this research question, we developed a spatial analysis framework that utilities can use to investigate power-failure events and their causes. Analysis revealed areas of statistically significant power outages due to multiple causes. This study’s GIS model can help to advance smart-grid reliability by, for example, elucidating power-failure root causes, defining a data-responsive blackout solution, or implementing a continuous monitoring and management solution. We unveil a novel use of spatial analytics to enhance power-outage understanding. Future work may involve connecting to virtually any type of streaming-data feed and transforming GIS applications into frontline decision applications, showing power-outage incidents as they occur. GIS can be a major resource for electronic-inspection systems to lower the duration of customer outages, improve crew response time, as well as reduce labor and overtime costs.
Background
Energy informatics (EI) is the area of research that addresses the application of technology to resolve complex problems in the energy domain. Goebel et al. (BISE 6:25–31, 2014) provided ...an EI research framework to encompass all aspects of EI research. Due to rapid EI improvements, many current research areas have not been incorporated into this framework. Specifically, this research posits that grid reliability is an underrepresented research area and should be incorporated into the framework. The rapidly changing nature of energy generation, and new developments in the electric-power network, are driving the need for grid reliability research. The goal of this paper is to extend the EI research framework offered by the Goebel et al. through a systematic review of current literature.
Methods
This literature review includes current publications (2015–2017) in power utility and technical reference libraries together with the earlier foundational EI papers.
Results
The systematic literature review is based on a broad automated search of appropriate digital sources (IEEE Xplore and the Web of Science) using relevant search terms. The paper also details the components of grid reliability research as well as their accompanying use cases.
Conclusion
The expanded EI research framework presented in this literature review should help researchers identify areas for future research endeavors. In the extended EI research framework, service reliability is now included as a third research component adding to the existing energy efficiency and renewable-energy supply components.
The United States (U.S.) electric infrastructure urgently needs renovation, as highlighted by recent major outages in California, New York, Texas, and Florida. The media has discussed the aging power ...infrastructure, and the Public Utilities Commission called for a comprehensive review of the causes of recent power outages. Without optimization algorithms to account for the many operating parameters and outage scenarios, planning engineers may inadvertently choose non-optimal locations for new components such as automated distribution switches, thereby impacting circuit reliability. This study aims to address this problem by answering the research question: “How may location analytics should be used to enhance the reliability of the smart grid?” To address this problem, Insights for ArcGIS was used to build worksheets using a geographic information systems (GIS)-based approach to resolve the challenges faced by utilities to reduce power outage frequency. Three case studies demonstrate various risk scenarios wherein a utility can prepare for the unexpected. An artefact in Insights for ArcGIS was created using a design science research methodology. This research proposes a solution to facilitate storm/disaster planning and vegetation management, identify optimal grid locations needing inspection or work, and detect regions where new distribution switches may provide benefits, considering the many operating parameters and outage scenarios. The artefact demonstrates that GIS can play an integral role in resolving this problem.
"'Taiwan Expendable?' Reconsidered" Paul Hilton, Brian
The Journal of American-East Asian relations,
01/2018, Letnik:
25, Številka:
3
Journal Article
Recenzirano
In 2005, noted historian Nancy Bernkopf Tucker advanced the thesis that President Richard M. Nixon and National Security Advisor Henry Kissinger viewed Taiwan as an expendable asset in their rush to ...promote Sino-American normalization, resulting in the administration conceding more than necessary in disregard for Taiwan's future or status. This article examines documents declassified since Tucker's study to argue that this interpretation is no longer tenable. Nixon and Kissinger applied to their Taiwan policy a set of principles remarkably consistent with their broader views on foreign policy, namely an emphasis on peoples directly involved in conflicts undertaking gradual, peaceful changes, while maintaining in the interim some form of security arrangement to maintain peace. Moreover, both Nixon and Kissinger understood the myriad benefits of the u.s. relationship with the Republic of China in advancing American interests and maintaining credibility in a volatile world, and, in fact, did consider the future status of Taiwan and its government. This culminated in the Kissinger-Zhou Enlai discussions in 1971 where the former deftly defended, to the extent possible, a principled commitment to Taiwan. Ultimately, the administration's insistence on establishing rapprochement with Beijing did not mean that Washington simply would cave to every Chinese demand. Taiwan was not expendable.
Use of chlorhexidine in clinical settings has led to concerns that repeated exposure of bacteria to sub-lethal doses of chlorhexidine might result in chlorhexidine resistance and cross resistance ...with other cationic antimicrobials including colistin, endogenous antimicrobial peptides (AMPs) and their mimics, ceragenins. We have previously shown that colistin-resistant Gram-negative bacteria remain susceptible to AMPs and ceragenins. Here, we investigated the potential for cross resistance between chlorhexidine, colistin, AMPs and ceragenins by serial exposure of standard strains of Gram-negative bacteria to chlorhexidine to generate resistant populations of organisms. Furthermore, we performed a proteomics study on the chlorhexidine-resistant strains and compared them to the wild-type strains to find the pathways by which bacteria develop resistance to chlorhexidine. Serial exposure of Gram-negative bacteria to chlorhexidine resulted in four- to eight-fold increases in minimum inhibitory concentrations (MICs). Chlorhexidine-resistant organisms showed decreased susceptibility to colistin (8- to 32-fold increases in MICs) despite not being exposed to colistin. In contrast, chlorhexidine-resistant organisms had the same MICs as the original strains when tested with representative AMPs (LL-37 and magainin I) and ceragenins (CSA-44 and CSA-131). These results imply that there may be a connection between the emergence of highly colistin-resistant Gram-negative pathogens and the prevalence of chlorhexidine usage. Yet, use of chlorhexidine may not impact innate immune defenses (e.g., AMPs) and their mimics (e.g., ceragenins). Here, we also show that chlorhexidine resistance is associated with upregulation of proteins involved in the assembly of LPS for outer membrane biogenesis and virulence factors in
. Additionally, resistance to chlorhexidine resulted in elevated expression levels of proteins associated with chaperones, efflux pumps, flagella and cell metabolism. This study provides a comprehensive overview of the evolutionary proteomic changes in
following exposure to chlorhexidine and colistin. These results have important clinical implications considering the continuous application of chlorhexidine in hospitals that could influence the emergence of colistin-resistant strains.
Ceragenins were designed as non-peptide mimics of endogenous antimicrobial peptides, and they display broad-spectrum antibacterial and antifungal activities, including the ability to eradicate ...established biofilms. These features of ceragenins make them attractive potential therapeutics for persistent infections in the lung, including those associated with cystic fibrosis. A characteristic of an optimal therapeutic for use in the lungs and trachea is the exertion of potent antimicrobial activities without damaging the cilia that play a critical role in these tissues. In previous work, potent antimicrobial activities of ceragenin CSA-131 have been reported; however, we found in
studies that this ceragenin, at concentrations necessary to eradicate established biofilms, also causes loss of cilia function. By formulating CSA-131 in poloxamer micelles, cilia damage was eliminated and antimicrobial activity was unaffected. The ability of CSA-131, formulated with a poloxamer, to reduce the populations of fungal pathogens in tracheal and lung tissue was also observed in
studies. These findings suggest that CSA-131, formulated in micelles, may act as a potential therapeutic for polymicrobial and biofilm-related infections in the lung and trachea.
In an effort to reforest school sites with limited resources, communities and non-profits have implemented projects on Los Angeles Unified School District (LAUSD) school sites, often without thought ...for the best location, long-term maintenance, or appropriateness of the tree type. Although studies exist related to sun safety policies in schools, there has been little emphasis on the environmental public health benefits of trees in public schools. The LAUSD School Shade Tree Canopy Study was a response to this issue in which data was analyzed (a total of 33,729 trees in the LAUSD were mapped) regarding tree canopy coverage, pervious/impervious areas, and buildings for 509 elementary schools to assess urban forestry management issues and environmental injustices within communities of the district. The results of these analyses indicate that there is a wide range of school site size, tree canopy coverage as a percentage of school site size, tree canopy coverage as a percentage of play area, and percentage of unpaved surface play areas (e.g., (~20%) of the schools have both (0.0%) tree canopy coverage play areas and 100% paved surfaces). This finding alone has implications in how the LAUSD may implement sun safe polices which would aid in preventing skin cancer and other adverse health outcomes for students within the school district.
An environmental impact assessment (EIA) is a decision-making process that evaluates the possible significant effects that a proposed project may exert on the environment. The EIA scoping and ...reviewing stages often involve public participation. Although its importance has long been recognized, public participation in the EIA process is often regarded as ineffective, due to time, budget, resource, technical and procedural constraints, as well as the complexity of environmental information. Geographic Information System (GIS) and Volunteer Geographic Information (VGI) have the potential to contribute to data collection, sharing and presentation, utilize local user-generated content to benefit decision-making and increase public outreach. This research integrated GIS, VGI, social media tools, data mining and mobile technology to design a spatially intelligent framework that presented and shared EIA information effectively to the public. A spatially intelligent public participative system (SIPPS) was also developed as a proof-of-concept of the framework. The research selected the Tehachapi Renewable Transmission Project (TRTP) as the pilot study area. Survey questionnaires were designed to collect feedback and conduct evaluation. Results show that SIPPS was able to improve the effectiveness of public participation, promote environmental awareness and achieve good system usability.
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