Reoperations after operation on the thoracic aorta: etiology, surgical techniques, and prevention

Recurrent aortic aneurysms, persistent or new dissection, new onset of valvular and coronary artery disease, graft infection, and prosthetic endocarditis are not rare after thoracic aortic operations; they can be difficult to diagnose and represent a formidable surgical challenge. Between 1977 and 1991, 876 operations were performed on the thoracic aorta in our institution: 340 in dissections, 299 in true aneurysms, 150 for aortic remodeling and external wall support during aortic valve replacement, and 87 for miscellaneous causes. During the same period, there were 193 additional reoperations. Vascular reoperations on abdominal aorta and peripheral arteries accounted for 73 cases and are not further discussed in this study. The reasons for reoperation (n = 130) in 120 patients were: failure of biologic valves (n = 23); aneurysm recurrence in a proximal or distal aortic segment (n = 21); pseudoaneurysm formation at suture lines (n = 13); new dissection or dilatation involving ascending aorta (n = 11), aortic arch (n = 13), and descending aorta (n = 10); aneurysm after aortic remodeling (n = 13); new onset of valvular disease (n = 5); and new onset of coronary disease (n = 5). Infected aortic graft and prosthetic endocarditis accounted for 10 reoperations, and a planned two-staged procedure was performed in 6 patients. Omitting the failed biologic valves, reoperations were performed on the aortic segment previously operated on in 69.3% of the cases and on other thoracic segments in 30.7%. Overall hospital mortality rate after reoperation was 5.8%. A significant decrease in operative mortality was observed in the most recent period (3.0% between 1989 and 1991). Reoperations are technically demanding, and some of them are preventable; therefore (1) graft inclusion technique should be abandoned in ascending aortic operation due to formation of false aneurysms; (2) in patients with Marfan syndrome, complete repair of the diseased aorta should be attempted during the initial operation; (3) aortic arch dissection should be repaired definitively during the first operation in low-risk patients; (4) biological valves should be avoided in aneurysm operations; and (5) homograft replacement is the treatment of choice in prosthetic endocarditis or in infected composite graft after an aortic valve or ascending aortic operation.     

Monies,economies and democracy: cultivating ambivalence in the co-design of digital currencies

ABSTRACT

Systematised collaborative design of complementary currencies is still a largely unexplored area that offers underutilised opportunities for supporting a fair and sustainable sharing economy. Future currency design necessitates attention to the systemic factors and the social particularities in which new monetary alternatives, i.e. ‘monies’, and the technological solutions that serve these alternatives, are created. This paper argues for a socially and contextually sensitive design of complementary currency innovation. It considers the technological conditions and the tendencies to exploitation from contemporary capitalism. Based on the literature review, we propose collaborative design of complementary currencies with particularist and inclusive approaches. New directions for open-ended economic innovation are explored in finding opportunities in the future-oriented Transition Design, supported by an empathic and ambivalent design mindset.     

A novel sediment gas sampler and a subsurface gas collector used for measurement of the ebullition of methane and carbon dioxide from a eutrophied lake

A novel sediment bubble gas sampler and a subsurface bubble gas collector were designed to measure the ebullition of gases from profundal sediments of aquatic ecosystems. The sediment gas sampler was constructed to collect bubble gas samples directly from the uppermost sediment layers for gas composition analysis. The floating subsurface gas collector, designed to trap the bubbles released naturally from sediments, permitted the measurement of both the volume and the composition of the bubble gas. Due to its low cost, light weight and rapid sampling capability, the gas collector is ideal for studies requiring many replicate collectors. These devices were used for measurement of the ebullition of methane (CH4) and carbon dioxide (CO2) during an open water period from hypereutrophic Lake Postilampi, situated within the midboreal zone in Finland. The bubble gas obtained from the sediment with the sediment gas sampler had higher concentrations of CH4 and CO2 than the bubbles trapped in the gas collectors. This indicated that the bubble gas composition changed, either naturally during the migration of the bubbles from the sediment through the water column to the gas collectors, and/or during their storage in the collectors prior to sampling. The mean CH4 ebullition from Lake Postilampi was estimated to be in the range from 36 to 46 mg m(-2 d(-1), based on the bubble gas CH4 concentrations measured from the gas collectors and sediment, respectively. The bubbles contained only 0.02-0.57% of CO2 and thus, the ebullition had no significance in the release of CO2 from the lake.     

Oxidative capacity and hemolytic activity of settled dust from moisture‐damaged schools

Exposure to moisture‐damaged indoor environments is associated with adverse respiratory health effects, but responsible factors remain unidentified. In order to explore possible mechanisms behind these effects, the oxidative capacity and hemolytic activity of settled dust samples (n = 25) collected from moisture‐damaged and non‐damaged schools in Spain, the Netherlands, and Finland were evaluated and matched against the microbial content of the sample. Oxidative capacity was determined with plasmid scission assay and hemolytic activity by assessing the damage to isolated human red blood cells. The microbial content of the samples was measured with quantitative PCR assays for selected microbial groups and by analyzing the cell wall markers ergosterol, muramic acid, endotoxins, and glucans. The moisture observations in the schools were associated with some of the microbial components in the dust, and microbial determinants grouped together increased the oxidative capacity. Oxidative capacity was also affected by particle concentration and country of origin. Two out of 14 studied dust samples from moisture‐damaged schools demonstrated some hemolytic activity. The results indicate that the microbial component connected with moisture damage is associated with increased oxidative stress and that hemolysis should be studied further as one possible mechanism contributing to the adverse health effects of moisture‐damaged buildings.     

The effect of ozonization on furniture dust: Microbial content and immunotoxicity in vitro

Moisture and mold problems in buildings contaminate also the furniture and other movable property. If cleaning of the contaminated furniture is neglected, it may continue to cause problems to the occupants even after the moisture-damage repairs. The aim of this study was to determine the effectiveness of high-efficiency ozone treatment in cleaning of the furniture from moisture-damaged buildings. In addition, the effectiveness of two cleaning methods was compared. Samples were vacuumed from the padded areas before and after the treatment. The microbial flora and concentrations in the dust sample were determined by quantitative cultivation and QPCR-methods. The immunotoxic potential of the dust samples was analyzed by measuring effects on cell viability and production of inflammatory mediators in vitro. Concentrations of viable microbes decreased significantly in most of the samples after cleaning. Cleaning with combined steam wash and ozonisation was more effective method than ozonising alone, but the difference was not statistically significant. Detection of fungal species with PCR showed a slight but nonsignificant decrease in concentrations after the cleaning. The immunotoxic potential of the collected dust decreased significantly in most of the samples. However, in a small subgroup of samples, increased concentrations of microbes and immunotoxicological activity were detected. This study shows that a transportable cleaning unit with high-efficiency ozonising is in most cases effective in decreasing the concentrations of viable microbes and immunotoxicological activity of the furniture dust. However, the method does not destroy or remove all fungal material present in the dust, as detected with QPCR analysis, and in some cases the cleaning procedure may increase the microbial concentrations and immunotoxicity of the dust.     

A new method for evaluating the subjective image quality of photographs: dynamic reference

The Dynamic Reference (DR) method has been developed for subjective image quality experiments in which original or undistorted images are unavailable. The DR method creates reference image series from test images. Reference images are presented to observers as a slide show prior to evaluating their quality. As the observers view the set of reference images, they determine the overall variation in quality within the set of test images. This study compared the performance of the DR method to that of the standardized absolute category rating (ACR) and paired comparison (PC) methods. We measured the performance of each method in terms of time effort and discriminability. The results showed that the DR method is faster than the PC method and more accurate than the ACR method. The DR method is especially suitable for experiments that require highly accurate results in a short time.     

Schooling space: where South Africans learnt to position themselves within the hierarchy of apartheid society

In setting out to understand how South African school space was harnessed to the political project of apartheid, the author explores memory accounts from several adults who attended school during the apartheid era. Her analysis of their reminiscences found that non-pedagogic areas of the school and public domain beyond school premises were places where learners encountered their Other. Those sites provided the conditions for poignant awakenings to racialised identifications within discriminatory hierarchies. The article ends with the author reflecting on the effectiveness of spatially segregated schooling, when she works towards understanding her informants' uncritical tributes to the educational and moral value of their apartheid-era schooling.