Habitus and climate change: Exploring support and resistance to sustainable welfare and social-ecological transformations in Sweden.

We explore peoples' dispositions and practices with regard to social-ecological transformations based on a sustainable welfare policy strategy in Sweden. We draw on Bourdieu's concept of habitus to highlight the relations between social positions, dispositions, and position-takings. Using data from an own survey, we identify habitus types and place these in the space of social positions. We apply principal component analysis to a large set of questions about social, ecological, and climate change related topics and identify eight underlying eco-social dispositions. These are used for cluster analyses that find typical constellations of eco-social dispositions within the Swedish population: variants of eco-social habitus. We find seven habitus types and describe their social characteristics, political preferences, and practices. Finally, the seven habitus are plotted onto the map of social positions, the Bourdieusian social space, highlighting their relations-proximities, tensions, and contestations-to each other. We find evidence that political struggles around social-ecological transformations reproduce existing social structures but are also connected to new "eco-social" divisions that appear between groups in similar positions. In the conclusion we discuss the implications for social-ecological transformations based on sustainable welfare.

Factors associated with the development of chronic pain after surgery for breast cancer: a prospective cohort from a tertiary center in the United States.

Chronic pain has been shown to affect up to 60% of patients undergoing surgery for breast cancer. Besides younger age, other risk factors for the development of chronic pain have not been consistent in previous studies. The objective of the current investigation was to detect the prevalence and risk factors for the development of chronic pain after breast cancer surgery by examining a patient population from a tertiary cancer center in the United States. The study was a prospective observational cohort study. Subjects were evaluated at least 6 months after the surgical procedure. Subjects responded to the modified short form Brief pain inventory and the short form McGill pain questionnaire to identify and characterize pain. Demographic, surgery, cancer treatment, and perioperative characteristics were recorded. Propensity matching regression analysis were used to examine risk factors associated with the development of chronic pain. 300 patients were included in the study. 110 reported the presence of chronic pain. Subjects with chronic pain reported median (interquartile range [IQR]) rating of worst pain in the last 24 hours of 4 (2-5) and a median (IQR) rating on average pain in the last 24 hours of 3 (1-4) on a 0-10 numeric rating scale. Independent risk factors associated with the development of chronic pain were age, OR (95% CI) of 0.95 (0.93-0.98) and axillary lymph node dissection, 7.7 (4.3-13.9) but not radiation therapy, 1.05(0.56-1.95). After propensity matching for confounding covariates, radiation was still not associated with the development of chronic pain. Chronic pain after mastectomy continues to have a high prevalence in breast cancer patients. Younger age and axillary lymph node dissection but not radiation therapy are risk factors for the development of chronic pain. Preventive strategies to minimize the development of chronic pain are highly desirable.

Perioperative systemic magnesium to minimize postoperative pain: a meta-analysis of randomized controlled trials.

BACKGROUND: Systemic magnesium has been used to minimize postoperative pain with conflicting results by clinical studies. It remains unknown whether the administration of perioperative systemic magnesium can minimize postoperative pain. The objective of the current investigation was to evaluate the effect of systemic magnesium on postoperative pain outcomes. METHODS: A wide search was performed to identify randomized controlled trials that evaluated the effects of systemic magnesium on postoperative pain outcomes in surgical procedures performed under general anesthesia. Meta-analysis was performed using a random-effect model. Publication bias was evaluated by examining the presence of asymmetric funnel plots using Egger regression. RESULTS: Twenty randomized clinical trials with 1,257 subjects were included. The weighted mean difference (99% CI) of the combined effects favored magnesium over control for pain at rest (≤4 h, -0.74 [-1.08 to -0.48]; 24 h, -0.36 [-0.63 to -0.09]) and with movement at 24 h, -0.73 (-1.37 to -0.1). Opioid consumption was largely decreased in the systemic magnesium group compared with control, weighted mean difference (99% CI) of -10.52 (-13.50 to -7.54) mg morphine IV equivalents. Publication bias was not present in any of the analysis. Significant heterogeneity was present in some analysis, but it could be partially explained by the sole intraoperative administration of magnesium compared with the intraoperative and postoperative administration. None of the studies reported clinical toxicity related to toxic serum levels of magnesium. CONCLUSION: Systemic administration of perioperative magnesium reduces postoperative pain and opioid consumption. Magnesium administration should be considered as a strategy to mitigate postoperative pain in surgical patients.

Characterization and control of the microbial community affiliated with copper or aluminum heat exchangers of HVAC systems.

Microbial growth in heating ventilation and air-conditioning (HVAC) systems with the subsequent contamination of indoor air is of increasing concern. Microbes and the subsequent biofilms grow easily within heat exchangers. A comparative study where heat exchangers fabricated from antimicrobial copper were evaluated for their ability to limit microbial growth was conducted using a full-scale HVAC system under conditions of normal flow rates using single-pass outside air. Resident bacterial and fungal populations were quantitatively assessed by removing triplicate sets of coupons from each exchanger commencing the fourth week after their installation for the next 30 weeks. The intrinsic biofilm associated with each coupon was extracted and characterized using selective and differential media. The predominant organisms isolated from aluminum exchangers were species of Methylobacterium of which at least three colony morphologies and 11 distinct PFGE patterns we found; of the few bacteria isolated from the copper exchangers, the majority were species of Bacillus. The concentrations and type of bacteria recovered from the control, aluminum, exchangers were found to be dependent on the type of plating media used and were 11,411-47,257 CFU cm(-2) per coupon surface. The concentration of fungi was found to average 378 CFU cm(-2). Significantly lower concentrations of bacteria, 3 CFU cm(-2), and fungi, 1 CFU cm(-2), were recovered from copper exchangers regardless of the plating media used. Commonly used aluminum heat exchangers developed stable, mixed, bacterial/fungal biofilms in excess of 47,000 organisms per cm(2) within 4 weeks of operation, whereas the antimicrobial properties of metallic copper were able to limit the microbial load affiliated with the copper heat exchangers to levels 99.97 % lower during the same time period.

Deriving realistic source boundary conditions for a CFD simulation of concentrations in workroom air.

Computational fluid dynamics (CFD) is used increasingly to simulate the distribution of airborne contaminants in enclosed spaces for exposure assessment and control, but the importance of realistic boundary conditions is often not fully appreciated. In a workroom for manufacturing capacitors, full-shift samples for isoamyl acetate (IAA) were collected for 3 days at 16 locations, and velocities were measured at supply grills and at various points near the source. Then, velocity and concentration fields were simulated by 3-dimensional steady-state CFD using 295K tetrahedral cells, the k-ε turbulence model, standard wall function, and convergence criteria of 10(-6) for all scalars. Here, we demonstrate the need to represent boundary conditions accurately, especially emission characteristics at the contaminant source, and to obtain good agreement between observations and CFD results. Emission rates for each day were determined from six concentrations measured in the near field and one upwind using an IAA mass balance. The emission was initially represented as undiluted IAA vapor, but the concentrations estimated using CFD differed greatly from the measured concentrations. A second set of simulations was performed using the same IAA emission rates but a more realistic representation of the source. This yielded good agreement with measured values. Paying particular attention to the region with highest worker exposure potential-within 1.3 m of the source center-the air speed and IAA concentrations estimated by CFD were not significantly different from the measured values (P = 0.92 and P = 0.67, respectively). Thus, careful consideration of source boundary conditions greatly improved agreement with the measured values.

Favourably regulating two-phase flow regime of flow boiling HFE-7100 in microchannels using silicon nanowires.

High performance miniaturized electronic devices require enhanced, compact and reliable thermal management system. As an efficient compact space cooling technique, flow boiling in microchannels has recently gained wide acceptance. However, weak buoyancy effects and microgravity in avionics and numerous space systems operations hinder the performance of flow boiling microchannel thermal management system due to poor bubble departure capacity and unfavorable development of flow regimes. Here we report the flow boiling silicon nanowires (SiNWs) microchannels which can favorably regulate two-phase flow regimes by enhancing explosive boiling, minimizing bubble departure diameter, and smoothing flow regime transition. Extensive experimental investigations along with high speed visualizations are performed. The experiments are performed with the dielectric fluid HFE-7100 in a forced convection loop for wide range of heat and mass fluxes. High speed flow visualizations have been employed at up to 70 k frames per second (fps) to understand the boiling mechanism in terms of bubble dynamics, flow patterns, and flow regime developments for SiNWs microchannels. These studies show that SiNWs reduce intermittent flow regimes (slug/churn), improve rewetting and maintain thin liquid film at wall. Therefore, flow boiling in SiNW microchannels is promising to thermal management owing to its high heat transfer rate with low pressure drop and negligible microgravity sensitivity.

Use of the Lean Manufacturing Principles to Improve Total Parenteral Nutrition Logistics and Clinical Outcomes in the Neonatal Patient Population.

Total parenteral nutrition (TPN) is one of the most frequently used pharmaceuticals administered to patients in our Neonatal Intensive Care Unit (NICU). Initially, the total interdepartmental processing time (ordering, manufacturing, and delivery between NICU and Pharmacy) averaged 15.2 hours. Inefficiencies in this process only allowed TPN to infuse 8.8 hours on average before labs were collected the next morning. Given the short administration-to-laboratory collection time, we hypothesized that laboratory samples would not adequately reflect the effect of the current TPN infusion. Furthermore, clinicians would be making decisions based on suboptimal data and ultimately nourish this patient population inadequately. METHODS: The project team and the frontline staff created an efficient process for the manufacture and delivery of TPN. They removed waste in the process associated with manufacturing TPN and created capacity for change upstream (ordering process) and downstream (TPN infusion process) of the internal pharmacy process. The use of selection criteria and new standard operating procedures allowed for controlled PDSA testing of changes on a subset of patients. After we attained proven, sustainable results, we scaled the improvement efforts to the entire NICU patient population. RESULTS: After 4 cycles of change, patients now receive TPN on average 14.2 hours before new labs are collected. The interventions over the continuum of this project yielded statistically significant results, increased infusion times to our patients by 61.4% (P < 0.001), improved glucose homeostasis, and decreased average length of stay. CONCLUSIONS: In conclusion, creating process capacity from incremental changes and iterative PDSA cycles has yielded sustained results.

Massive fetal cervical teratoma managed with the ex utero intrapartum treatment (EXIT) procedure.

Teratomas are rare congenital tumors typically comprising all 3 germ cell layers. Cervical teratomas arise in the neck and represent a minority of all teratomas. These are associated with high morbidity and mortality because of their propensity to cause airway obstruction. Demonstration on prenatal magnetic resonance imaging is uncommon, especially for a tumor of this size. Fetuses diagnosed with large neck masses are managed through cesarean section with the ex utero intrapartum treatment procedure to secure the airway, such as in our case of a large cervical teratoma in the female fetus of a 30-year-old mother who went into preterm labor.

Assessing the Accuracy of Foveal Avascular Zone Measurements Using Optical Coherence Tomography Angiography: Segmentation and Scaling.

PURPOSE: The foveal avascular zone (FAZ) is altered in numerous diseases. We assessed factors (axial length, segmentation method, age, sex) impacting FAZ measurements from optical coherence tomography (OCT) angiography images. METHODS: We recruited 116 Caucasian subjects without ocular disease, and acquired two 3 × 3 mm AngioVue scans per each right eye (232 total scans). In images of the superficial plexus, the FAZ was segmented using the AngioVue semiautomatic nonflow measurement tool and ImageJ manual segmentation. In images from the full retinal thickness, the FAZ was segmented using the AngioAnalytics automatic FAZ tool. Repeatability, reliability, and reproducibility were calculated for FAZ measurements (acircularity, area). RESULTS: FAZ area (mean ± SD) for manual segmentation was 0.240 ± 0.0965 mm2, greater than both semiautomatic (0.216 ± 0.0873 mm2) and automatic (0.218 ± 0.0869 mm2) segmentation (P < 0.05). Not correcting for axial length introduced errors up to 25% in FAZ area. Manual area segmentation had better repeatability (0.020 mm2) than semiautomatic (0.043 mm2) or automatic (0.056 mm2). FAZ acircularity had better repeatability with automatic than manual segmentation (0.086 vs. 0.114). Reliability of all area measurements was excellent (intraclass correlation coefficient [ICC] = 0.994 manual, 0.969 semiautomatic, 0.948 automatic). Reliability of acircularity measurements was 0.879 for manual and 0.606 for automatic. CONCLUSION: We identified numerous factors affecting FAZ measurements. These errors confound comparisons across studies and studies examining factors that may correlate with FAZ measures. TRANSLATIONAL RELEVANCE: Using FAZ measurements as biomarkers for disease progression requires assessing and controlling for different sources of error. Not correcting for ocular magnification can result in significant inaccuracy in FAZ measurements, while choice of segmentation method affects both repeatability and accuracy.

Accessory thyroid nodule in sub-mandibular region.

A case of an accessory thyroid nodule with a diagnosis of focal lymphocytic thyroiditis, in 23 years old lady, on histopathological examination, is presented. Patient had a single swelling in the left submandibular region without any abnormality. Postoperative thyroid scan showed thyroid gland in its normal anatomical location with suppressed activity and thyroid profile revealed subclinical hypothyroidism.

Indices of hemodynamic and respiratory functions in premature infants at risk for the development of cerebral white matter injury.

OBJECTIVE: To examine potential differences in clinical risk factors, including indices of hemodynamic and respiratory functions, of premature infants developing periventricular hemorrhagic infarction (PHI) or periventricular leukomalacia (PVL). STUDY DESIGN: Indices of hemodynamic stability and respiratory function were measured prospectively during the first week of life in a cohort of 100 premature infants with respiratory distress. Maternal history was retrospectively reviewed. These data were correlated with cranial ultrasonography using one-way ANOVA, Bonferroni multiple comparisons, and Wilcoxon rank sum tests. Longitudinal analysis was performed using Generalized Estimating Equations. RESULTS: Fifty-two infants with normal cranial ultrasound studies were compared to 12 with PHI and 9 with PVL. Infants developing PHI had significantly lower birth weights, lower Apgar scores, were more often male and multiple gestations, and required more vasopressor support than infants with normal ultrasound studies. Infants with PHI had significantly worse indices of respiratory function than either normal infants or those with PVL. PVL was significantly associated with maternal chorioamnionitis, whereas PHI was not. CONCLUSION: These data suggest that there are important differences in the pathogenesis of PHI and PVL. A clear understanding of these differences is required before future preventive strategies can be formulated.

Spontaneous feeding tube knotting over a vesical calculus.

A case of spontaneous feeding tube knotting over a vesical calculus, in a 3 years child, is presented which had evaded clinical diagnosis and was discovered at open cystolithotomy. A vesical calculus with a firm simple knot of feeding tube over it and stuck at internal urethral meatus was found. Feeding tube was cut and cystolithotomy performed. Postoperative follow-up was without complication.

Severe cystic periventricular leukomalacia in a premature infant with capnocytophaga sepsis.

Capnocytophaga is an opportunistic gram-negative anaerobic bacillus found in the oropharyngeal cavity of mammals and is associated with periodontal disease in humans. Sepsis, osteomyelitis, lung abscess, endocarditis, and meningitis have been reported in humans following animal bites. Perinatal infection with Capnocytophaga is infrequent and is generally considered to have a low risk of morbidity to the mother and fetus. We report a case of neonatal Capnocytophaga sepsis associated with the development of severe cystic periventricular leukomalacia.

A functional ectopic vaginal anus: a rare clinical entity.

A case of functional ectopic vaginal anus is presented in a 20 years old girl. Patient complained of passage of stool through her vagina. She was continent and had no complaint of constipation. Her examination revealed imperforated anus with functional ectopic vaginal anus. Her surgery was performed in two stages. In first stage, anoplasty was performed at midpoint between the vulval and anal opening. The posterior vaginal wall was repaired in two layers and protective loop colostomy was made. In the second stage, after a period of 3 months loop colostomy was closed. Patient's recovery was smooth, she is not constipated and continent with Wexner score of 3. She was advised pelvic floor rehabilitation exercises.She improved within a month with Wexner score of zero.

Wireless Body Area Network (WBAN) design techniques and performance evaluation.

In recent years interest in the application of Wireless Body Area Network (WBAN) for patient monitoring applications has grown significantly. A WBAN can be used to develop patient monitoring systems which offer flexibility to medical staff and mobility to patients. Patients monitoring could involve a range of activities including data collection from various body sensors for storage and diagnosis, transmitting data to remote medical databases, and controlling medical appliances, etc. Also, WBANs could operate in an interconnected mode to enable remote patient monitoring using telehealth/e-health applications. A WBAN can also be used to monitor athletes' performance and assist them in training activities. For such applications it is very important that a WBAN collects and transmits data reliably, and in a timely manner to a monitoring entity. In order to address these issues, this paper presents WBAN design techniques for medical applications. We examine the WBAN design issues with particular emphasis on the design of MAC protocols and power consumption profiles of WBAN. Some simulation results are presented to further illustrate the performances of various WBAN design techniques.

Low temperature conversion of plastic waste into light hydrocarbons.

Advance recycling through pyrolytic technology has the potential of being applied to the management of plastic waste (PW). For this purpose 1 l volume, energy efficient batch reactor was manufactured locally and tested for pyrolysis of waste plastic. The feedstock for reactor was 50 g waste polyethylene. The average yield of the pyrolytic oil, wax, pyrogas and char from pyrolysis of PW were 48.6, 40.7, 10.1 and 0.6%, respectively, at 275 degrees C with non-catalytic process. Using catalyst the average yields of pyrolytic oil, pyrogas, wax and residue (char) of 50 g of PW was 47.98, 35.43, 16.09 and 0.50%, respectively, at operating temperature of 250 degrees C. The designed reactor could work at low temperature in the absence of a catalyst to obtain similar products as for a catalytic process.

Performance evaluation of a Wireless Body Area sensor network for remote patient monitoring.

In recent years, interests in the application of Wireless Body Area Network (WBAN) have grown considerably. A WBAN can be used to develop a patient monitoring system which offers flexibility and mobility to patients. Use of a WBAN will also allow the flexibility of setting up a remote monitoring system via either the internet or an intranet. For such medical systems it is very important that a WBAN can collect and transmit data reliably, and in a timely manner to the monitoring entity. In this paper we examine the performance of an IEEE802.15.4/Zigbee MAC based WBAN operating in different patient monitoring environment. We study the performance of a remote patient monitoring system using an OPNET based simulation model.

Monitoring of physiological parameters from multiple patients using wireless sensor network.

This paper presents a wireless sensor network system that has the capability to monitor physiological parameters from multiple patient bodies. The system uses the Medical Implant Communication Service band between the sensor nodes and a remote central control unit (CCU) that behaves as a base station. The CCU communicates with another network standard (the internet or a mobile network) for a long distance data transfer. The proposed system offers mobility to patients and flexibility to medical staff to obtain patient's physiological data on demand basis via Internet. A prototype sensor network including hardware, firmware and software designs has been implemented and tested. The developed system has been optimized for power consumption by having the nodes sleep when there is no communication via a bidirectional communication.