Search

To investigate the impact of national income level and sex on mortality trends from aortic aneurysm and dissection in addition to all aortic disease as a whole.

The notion of “vulnerability” occupies a central role in academic literature, policymaking, humanitarian debates, and everyday discourses on migration and asylum. Its popularity has led some academics and practitioners to use “vulnerability” as a self-explanatory condition or phenomenon. However, a common and systematic understanding of the concept is still missing, and the moral and political meaning often ascribed to this notion may have (un)intended detrimental consequences for those migrants deemed vulnerable. Thus, this paper sets out to critically unpack and highlight the complexities hidden behind this notion in order to provide a conceptual analysis of vulnerability in the context of migration. We do so by (1) providing an overview of definitions of vulnerability across different fields of research, (2) identifying common conceptualizations or types of vulnerability and discussing their implications, and (3) highlighting possible negative societal and psychological consequences of its implementation in the context of migration. Finally, we propose (4) a new conceptual model for understanding vulnerability in the context of migration, showing how this notion can become a useful analytical tool in migration research.

Aortic regurgitation (AR) has a prevalence of 2.2% in elderly people. Transthoracic echocardiography (TTE) is usually performed to evaluate AR. Importantly, TTE is often impaired by adverse sonographic conditions and may lead to underestimation of AR severity. Therefore, transesophageal echocardiography is essential. Untreated AR is associated with high mortality. Aortic valve replacement improves survival but was limited to patients deemed operable. Recently the JenaValve has been proven to be safe and effective, thus enabling interventional treatment of older and multimorbid patients.

Flotation control and supervision allow flotation circuits to maintain target concentrate grades and plant recoveries. The decision-making required for effective supervision of flotation control systems (e.g., selection of targets, setpoints, and setpoint limits) is enhanced by up-to-date information on total and component mass flows throughout the circuit. Limited instrumentation in flotation circuits typically yields a partial, noisy, and infrequently updated view of flotation conditions. Data reconciliation approaches have traditionally been used in conjunction with conservation balances to provide more consistent estimates of mass flows, although unmeasured and unobservable variables are either not fully characterized or at all. In this work, a probabilistic approach to mass balance estimation is presented, which can generalize different use cases (full redundancy, full observability, and partial observability with additional process assumptions) – using maximum a posteriori and marginal density estimation methods. This probabilistic approach is demonstrated on two case studies (a simple illustration and the Brunswick Mining flotation circuit).

Zusammenfassung: Das thorakale Aortenaneurysma ist eine lebensbedrohliche Erkrankung, die durch strukturelle Veränderungen der Aorta zu Ruptur oder Dissektion führen kann. Während die genaue Ätiologie noch unklar ist, werden die verlängerte Lebenserwartung sowie die arterielle Hypertonie und eine positive Familienanamnese hinsichtlich Gefäßaneurysmen, aber auch Atherosklerose, Rauchen und chronisch obstruktive Lungenerkrankung als Risikofaktoren diskutiert. Eine Diagnose gelingt heute oft im symptomfreien Stadium. Das Risiko einer Ruptur bei einem Diameter deutlich >5,5 cm variiert zwischen 46–74% mit einer 2-Jahres-Mortalitätsrate von etwa 70%. Die 5-Jahres-Überlebensrate bei konservativer Behandlung soll bei 13–34% liegen, gegenüber 70–79% bei optimaler prophylaktischer chirurgischer Sanierung. Grundsätzlich stehen medikamentöse, operative und perkutan-interventionelle therapeutische Strategien zur Verfügung.

ObjectiveAortic dissection and aortic aneurysm rupture are aortic emergencies and their clinical outcomes have improved over the past two decades; however, whether this has translated into lower mortality across countries remains an open question. The purpose of this study was to compare mortality trends from aortic dissection and rupture between the UK, Japan, the USA and Canada.MethodsWe analysed the WHO mortality database to determine trends in mortality from aortic dissection and rupture in four countries from 2000 to 2019. Age-standardised mortality rates per 100 000 persons were calculated, and annual percentage change was estimated using joinpoint regression.ResultsAge-standardised mortality rates per 100 000 persons from aortic dissection and rupture in 2019 were 1.04 and 1.80 in the UK, 2.66 and 1.16 in Japan, 0.76 and 0.52 in the USA, and 0.67 and 0.81 in Canada, respectively. There was significantly decreasing trends in age-standardised mortality from aortic rupture in all four countries and decreasing trends in age-standardised mortality from aortic dissection in the UK over the study period. There was significantly increasing trends in mortality from aortic dissection in Japan over the study period. Joinpoint regression identified significant changes in the aortic dissection trends from decreasing to increasing in the USA from 2010 and Canada from 2012. In sensitivity analyses stratified by sex, similar trends were observed.ConclusionsTrends in mortality from aortic rupture are decreasing; however, mortality from aortic dissection is increasing in Japan, the USA and Canada. Further study to explain these trends is warranted.

In recent years, the social sciences and humanities have been increasingly interested in diversity and everyday life. Rather than focusing on the negative aspects of diversity, such as the lack of social cohesion, interethnic conflict and segregation, they have gradually turned to studying concrete examples of intercultural communal life. This new perspective is reflected in expressions like ‘prosaic multiculture’ or ‘everyday cosmopolitanism’ and, most importantly, in the notion of ‘conviviality’. The article explores diversity and ways of living together in Luxembourg. Referring to examples from various research projects, it offers an exploratory journey into understanding how difference is being constructed, experienced and negotiated in everyday encounters. Luxembourg shows historical and sociocultural particularities that make it an interesting case for comparison. These particularities can be summarised in a series of seeming opposites. Luxembourg is very small but superdiverse. It is highly urbanised but shows persistent rural social structures. It has no colonial past but is nevertheless part of considerable global historical entanglements. It combines a high degree of traditionalism with equally remarkable cosmopolitan traits. The article concentrates on two dimensions that can be characterised as visible versus invisible moments of diversity: the importance of multilingualism and the impact of non-European immigration on national multiculture. By distinguishing the visible and the invisible and thus linking research on conviviality to explorations of the relation between perception and social recognition, we hope to contribute to the debate on conviviality and especially to the question of how it relates to power inequalities and conflict.

Acute type B aortic dissection (TBAD) is a rare disease that is likely under-diagnosed in the UK. As a progressive, dynamic clinical entity, many patients initially diagnosed with uncomplicated TBAD deteriorate, developing end-organ malperfusion and aortic rupture (complicated TBAD). An evaluation of the binary approach to the diagnosis and categorisation of TBAD is needed.

Background: Patient Controlled Analgesia is a popular technique used to manage postoperative pain. The suitability of Patient Controlled Analgesia in older patients after surgical procedures and its effect on postoperative outcomes are not clear.Method: The records of 305 older patients undergoing orthopaedic surgeries in a single tertiary centre were reviewed. Postoperative outcomes were compared between those given Patient Controlled Analgesia and those who were not, using multinomial logistic regression adjusted by propensity scores.Results: Physical function on day 3 after surgery is worse, and risk of requiring personal assistance is higher if the patient had Patient Controlled Analgesia (p = 0.01). Length of stay in patients using patient-controlled analgesia was longer than patients not using patient-controlled analgesia (p = 0.002), and patients given Patient Controlled Analgesia had higher odds of needing support on discharge (p = 0.01). Surprisingly, pain control is poor in the Patient Controlled Analgesia group (p = 0.009).Conclusion: In this review, Patient Controlled Analgesia use was common (40% of our sample), and postoperative outcomes such as physical function on day 3, length of stay and discharge destination were unfavourable in patients who had Patient Controlled Analgesia.

The expansion in the repertoire of genes linked to thoracic aortic aneurysms (TAA) has revolutionised our understanding of the disease process. The clinical benefits of such progress are numerous, particularly helping our understanding of non-syndromic hereditary causes of TAA (HTAAD) and further refinement in the subclassification of disease. Furthermore, the understanding of aortic biomechanics and mechanical homeostasis has been significantly informed by the discovery of deleterious mutations and their effect on aortic phenotype. The drawbacks in genetic testing in TAA lie with the inability to translate genotype to accurate prognostication in the risk of thoracic aortic dissection (TAD), which is a life-threatening condition. Under current guidelines, there are no metrics by which those at risk for dissection with normal aortic diameters may undergo preventive surgery. Future research lies with more advanced genetic diagnosis of HTAAD and investigation of the diverse pathways involved in its pathophysiology, which will i) serve to improve our understanding of the underlying mechanisms, ii) improve guidelines for treatment and iii) prevent complications for HTAAD and sporadic aortopathies.

IMPORTANCE: Early data revealed a mortality rate of 1% to 2% per hour for type A acute aortic dissection (TAAAD) during the initial 48 hours. Despite advances in diagnostic testing and treatment, this mortality rate continues to be cited because of a lack of contemporary data characterizing early mortality and the effect of timely surgery. OBJECTIVE: To examine early mortality rates for patients with TAAAD in the contemporary era. DESIGN, SETTING, AND PARTICIPANTS: This cohort study examined data for patients with TAAAD in the International Registry of Acute Aortic Dissection between 1996 and 2018. Patients were grouped according to the mode of their intended treatment, surgical or medical. EXPOSURE: Surgical treatment. MAIN OUTCOMES AND MEASURES: Mortality was assessed in the initial 48 hours after hospital arrival using Kaplan-Meier curves. In-hospital complications were also evaluated. RESULTS: A total of 5611 patients with TAAAD were identified based on intended treatment: 5131 (91.4%) in the surgical group (3442 [67.1%] male; mean [SD] age, 60.4 [14.1] years) and 480 (8.6%) in the medical group (480 [52.5%] male; mean [SD] age, 70.9 [14.7] years). Reasons for medical management included advanced age (n = 141), comorbidities (n = 281), and patient preference (n = 81). Over the first 48 hours, the mortality for all patients in the study was 5.8%. Among patients who were medically managed, mortality was 0.5% per hour (23.7% at 48 hours). For those whose intended treatment was surgical, 48-hour mortality was 4.4%. In the surgical group, 51 patients (1%) died before the operation. CONCLUSIONS AND RELEVANCE: In this study, the overall mortality rate for TAAAD was 5.8% at 48 hours. For patients in the medical group, TAAAD had a mortality rate of 0.5% per hour (23.7% at 48 hours). However, among those in the surgical group, 48-hour mortality decreased to 4.4%.

The concept of acute aortic syndrome (AAS) facilitates the early identification of patients with chest pain caused by an aortic condition, and expedites risk stratification and definitive treatment. Important differential diagnoses are acute coronary syndrome, pulmonary embolism and chest pain from trauma. Individuals with AAS should be evaluated using a combination of blood tests, electrocardiography and imaging, such as computed tomography CT or echocardiography initially, and magnetic resonance imaging at a later stage. Classic aortic dissection is the most common form of AAS. Risk factors include congenital factors such as hereditary connective tissue disorders, bicuspid aortic valve with aortopathy and, most importantly, acquired conditions such as untreated hypertension. Patients with evidence of rupture of one aortic layer, malperfusion syndrome or end-organ ischaemia require urgent intervention; in cases of proximal dissection including the arch this is typically open surgery, and in distal or type B dissection it is usually endovascular stent-graft placement with ancillary procedures. The optimal management of patients with AAS is challenging and requires a multidisciplinary team approach. Further studies are required to fully characterize conditions within the AAS spectrum and to offer an individualized, patient-centred treatment.

Pulp-phase dynamics strongly impact flotation performance, yet flotation control and monitoring are usually limited to surface level froth characteristics. An online pulp-phase sensor promises a better understanding of flotation process dynamics and performance. This utility needs to be demonstrated through field trials with structured experimental design and testing under representative conditions. A three-factor Box-Behnken design was implemented to test airflow, pulp level, and frother reagent addition on pulp-phase measurements. The correlation of online pulp-phase measurements to offline pulp sensor measurements is analysed and discussed.

BackgroundMethylphenidate is mainly used for the treatment of attention-deficit/hyperactive-disorder (ADHD). Its effect of increased attentiveness leads to the potential of off-label use by students for academic enhancement—previously demonstrated in undergraduate students. No publication exists on postgraduate student use of methylphenidate.ObjectivesTo provide a summary of the self-reported prevalence and correlates of methylphenidate use in Masters of Medicine (MMed) students registered at the Faculty of Medical and Health Sciences of a South African university.MethodsA cross-sectional study was conducted. Data were collected via a self-administered anonymous online questionnaire distributed by email to 505 registered MMed students.ResultsOf the 253 responses (response rate 50.1%) received 71 (28.1%) have used methylphenidate. Only 2.4% have been diagnosed with ADHD. The majority (73.2%) obtained it without a formal medical consultation. Self-prescription (26.8%) and prescription by a colleague without consultation (23.9%) contributed significantly. Academic performance enhancement was the primary motivation for use in 71.8% and 42.3% of users started using methylphenidate while registered as an MMed student. There was no statistically significant difference in terms of gender (p=0.151), age (p=0.288) or year of study (p=0.149).ConclusionsOff-label use of methylphenidate is prevalent in MMed students registered at this South African university. The prevalence is significantly higher than in undergraduate medical students. The non-conventional means of access is of great concern. Efforts should be made to discourage self-prescription, educate students on the dangers of methylphenidate use, promote better access regulation and enhance psychological support.

The interaction between COVID-19, non-communicable diseases, and chronic infectious diseases such as HIV and tuberculosis is unclear, particularly in low-income and middle-income countries in Africa. South Africa has a national HIV prevalence of 19% among people aged 15–49 years and a tuberculosis prevalence of 0·7% in people of all ages. Using a nationally representative hospital surveillance system in South Africa, we aimed to investigate the factors associated with in-hospital mortality among patients with COVID-19.

Purpose: To evaluate the safety and feasibility of the in situ needle fenestration (ISNF) technique for reconstruction of the left subclavian artery (LSA) during thoracic endovascular aortic repair (TEVAR) of complicated aortic arch pathologies.Materials and Methods: A retrospective review was conducted from January 2014 to December 2019 of 50 patients (mean age 60.2±11.1; 45 men) who underwent ISNF to revascularize the LSA during TEVAR. Twenty-one of the patients also required revascularization of the left common carotid artery (LCCA; n=19) and innominate artery (IA; n=2) using physician-modified in vitro fenestration. Overall, 73 supra-aortic branches were targeted for revascularization.Results: ISNF was successful in 48 patients (96%); one LSA could not be stented and a tortuous LSA prevented the needle from fenestrating the graft. No perioperative major adverse event occurred. There were no type I and 4 type III endoleaks (8%), 3 of which occurred among the first 20 cases. Types II and IV endoleaks were found in 3 (6%) and 6 (12%) cases, respectively; all disappeared during a median follow-up of 15 months (range 3–66). One death (2%) occurred within 12 months due to cerebral hemorrhage. Two patients (4%) required open reinterventions at 6 and 62 months.Conclusion: ISNF for revascularization of the LSA during TEVAR seems to be feasible with acceptable midterm outcomes. The learning curve and evolving patient selection criteria affected technical success, complications, and the need for reinterventions. Long-term durability requires further evaluation.

ABSTRACTFollowing the terrorist attacks in Paris (November 2015) and Brussels (March 2016), several EU Member States have decided to re-establish border controls or to build walls inside the Schengen Area. Although these decisions are temporary and legally framed by the Schengen code, their extent disrupts the free movement within the Schengen Area, in particular in border areas. While lawyers and economists have analyzed the impacts of this situation, the spatial perspective has remained rather neglected. This exploratory contribution aims to address this gap in the literature by outlining the spatial significance of reintroduced controls for border areas inside the Schengen Area. This contribution firstly undertakes a literature review of the different conceptual tools at hand. These are then compared with a set of exploratory empirical materials. The article focuses more precisely on the Greater Region where France and Germany have reintroduced border controls, thus disrupting in particular daily cross-border flows with Luxembourg and Belgium. The analysis demonstrates that the border acts as a filter, disrupting cross-border flows and cooperation. Also, it sheds some light on the important role played by the ideational perception of the border for practitioners and decision-makers. This contribution concludes by suggesting several paths for a future research agenda.

Acute aortic syndrome and in particular aortic dissection (AAD) persists as a cause of significant morbidity and mortality despite improvements in surgical management. This clinical review aims to explore the risks of misdiagnosis, outcomes associated with misdiagnosis and evaluate current diagnostic methods for reducing its incidence.Due to the nature of the pathology, misdiagnosing the condition and delaying management can dramatically worsen patient outcomes. Several diagnostic challenges exist, including low prevalence, rapidly propagating pathology, non-discrete symptomatology, non-specific signs, analogy with other acute conditions and lack of management infrastructure. A similarity to acute coronary syndromes is a specific concern and risks patient maltreatment. AAD with malperfusion syndromes are both a cause of misdiagnosis and marker of disease complication, requiring specifically tailored management plans from the emergency setting.Despite improvements in diagnostic measures, including imaging modalities and biomarkers, misdiagnosis of AAD remains commonplace and current guidelines are relatively limited in preventing its occurrence. This paper recommends the early use of AAD risk scoring, focused echocardiography and most importantly, fast-tracking patients to cross-sectional imaging where the suspicion of AAD is high. This has the potential to improve the diagnostic process for AAD and limit the risk of misdiagnosis. However, our understanding remains limited by the lack of large patient datasets and an adequately audited processes of emergency department practice.

This special issue of Comparative Migration Studieson the occasion of the IMISCOE 2021 Conference with the theme “Crossing borders, connecting cultures” features five invited contributions by several conference speakers as well as an article by the host university.

The Turkish economy has been growing fast and Turkish organisations increasingly rival their Western competitors in terms of innovativeness. While strategy scholars primarily focus on internal capabilities such as learning orientation, network scholars typically consider external network ties as determinants of organisational success. Building on both research streams, our study develops and empirically tests an integrative framework that incorporates the specific cultural context of Turkey. Based on empirical data from 178 organisations, we demonstrate that in Turkey organisational innovativeness results from learning orientation mediating the effect of network ties on innovativeness. Thus, our study links external and internal explanations of what drives innovativeness and suggests that organisations in Turkey need to develop a network-enabled orientation towards learning. We make important recommendations for managers of Turkish organisations and those wishing to enter the Turkish market.

Even though intra-European youth mobility is valued as a boost for personal and professional development, few opt for it. While obstacles preventing young people to become mobile have been discussed broadly, less attention has been paid to the obstacles for the youth who are already on the move. We offer this rare perspective in regard to intra-European mobility. We focus on youth in four types: pupil mobility, vocational (education and training) mobility, higher education student (degree and credit) mobility and employment mobility, in six countries: Germany, Hungary, Luxembourg, Norway, Romania and Spain. Our analysis, based on qualitative (140 interviews) and quantitative (N=1.682) data, reveals that the perceived obstacles vary between the mobility types, with the greatest divergence between the educational and work-related mobilities. Obstacles such as lack of financial resources and guidance, the perceived incompatibility of institutional regulations within Europe, are shared by all mobile youth.

European youth mobility seems to be fostering Europe’s unequal pace of integration, which sees certain countries benefit at the expense of others (Ohmacht et al., 2009; van Mol & Timmerman, 2014). Using a comparative approach, the paper aims to relate a macro-level country-typology focussing on human capital with individual mobility-motivations on the micro-level. Our methodological approach is based on a secondary macro-data analysis and analyses of mobility-motivations of young people (micro-data) deriving from qualitative (N=152) and quantitative data (N=5,499) collected in six European countries. In order to examine correspondence between macro-conditions and micro-aspects, we relate information on mobility-motivations to the country-typology by allocating mobile youth to the respective types of their home country. The results show that the country-types compose different opportunity structures, which are reflected in individual motivations. Accordingly, different country-types can be seen as an example of the heterogeneity and inequality of European social and territorial mobility frames.

Where does youth mobility stand in the complex picture of diverse types of inequalities that affect youth and the content of their mobilities? In the light of this question, with this special issue, we look at the hindering and fostering factors in the mobility of young people, and examine different facets of mobility (social networks, transnational activities, agency, gender, household decisions) in different types of mobility (considering mobility for volunteering, vocational education and training, higher education including both credit and degree mobility, and employment). The analysis presented in the papers of this special issue will enable the identification of inequalities accompanying youth mobility at different levels. The articles in this issue reveal that when it comes to possibilities for becoming mobile, many other types of inequalities apart from the solely economic ones must be considered (Oxfam, 2016, p. 7; Hargittai and Hinnant 2008), including legal, political, social, moral inequalities (White, 2007) together with gender inequality. This special issue on “Inequalities and Youth Mobilities in Europe from Comparative Perspectives” serves the purpose of revealing how diverse types of inequalities can exist within seemingly equal societies.

ObjectiveLower systemic arterial compliance (SAC) is associated with increased cardiovascular morbidity and mortality in hypertension, but this has not been assessed in a prospective study in aortic valve stenosis (AS).MethodsData from 1641 patients (38% women) with initially asymptomatic mild-moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study was used. Median follow-up was 4.3 years. SAC was assessed from Doppler stroke volume index to central pulse pressure ratio and considered low if ≤0.64 mL/m², corresponding to the lower tertile in the population. The association of SAC with outcome was assessed in Cox regression analysis and reported as HR and 95% CI.ResultsLow SAC at baseline was characterised by older age, female sex, hypertension, obesity, presence of a small aortic root, lower mean aortic gradient and more severe AS by effective aortic valve area (all p<0.01). In Cox regression analysis adjusting for factors, low SAC was associated with higher HRs for cardiovascular death (HR 2.13(95% CI 1.34 to 3.40) and all-cause mortality (HR 1.71(95% CI 1.23 to 2.38)), both p=0.001). The results did not change when systolic or diastolic blood pressure, other measures of AS severity or presence of discordantly graded AS were included in subsequent models. Presence of low SAC did not improve mortality prediction in reclassification analysis.ConclusionsIn patients with AS without diabetes and known cardiovascular disease, but a high prevalence of hypertension, low SAC was associated with higher cardiovascular and all-cause mortality independent of well-known prognosticators.Trial registration numberNCT00092677; Post-results.

Infection is a serious complication of left ventricular assist device (LVAD) therapy. However, an optimal antimicrobial surgical infection prophylaxis (SIP) regimen for LVAD implantation is not well established. We retrospectively reviewed all adults who underwent continuous-flow LVAD implantation from February 2007 to March 2015 at Mayo Clinic Rochester. Left ventricular assist device infection (LVADI) was defined using criteria published by the International Society for Heart and Lung Transplant. Patients excluded from the analysis included those who did not have HeartMate II or HeartWare device, patients with incomplete documentation of SIP, and those with an actively treated infection at the time of LVAD implantation. We compared risk of LVAD-specific and LVAD-related infections and all-cause mortality between SIP regimens at postoperative day 90 and 1 year using Kaplan–Meier time-to-event analyses. During study period, 239 adults underwent continuous-flow LVAD implantation at our institution where 199 patients received single-drug and 40 received multidrug SIP regimen. Median patient age was 62 years. Left ventricular assist device infection occurred in three patients (1.5%) in the single-drug group versustwo patients (5.0%) in the multidrug group at 90 days (p= 0.4). There was no difference in infection-free (p= 0.4) and overall survival (p= 0.9) between two groups at 1 year. In conclusion, there was no clear benefit of using multidrug regimen as it did not impact infection-free survival or all-cause mortality compared with single-drug regimen. Prospective clinical trials are needed to further define the optimal SIP regimen for LVAD implantation.

Background:Sarcopenia, the loss of muscle mass and strength, is associated with adverse health outcomes. Calf circumference (CC) has been proposed as a surrogate measure of muscle mass in the elderly; however, ethnic/sex specific cut-off values remain to be established.Objective:A study was undertaken to investigate the relationship between CC and appendicular skeletal muscle mass (ASM), and the ASM index (ASMI), as well as to determine whether CC could be used to diagnose sarcopenia.Methods:This was a cross-sectional study of 247 older black women living from Tlokwe, South Africa. ASM was measured using dual-energy X-ray absorptiometry, and the ASMI was calculated. Receiver operator characteristics curves and maximum Youden index were applied to identify a CC cut-off point for sarcopenia according to low gait speed (< 0.8 m/s), low hand-grip strength (< 16 kg) and low ASMI using a South African cut-off point for sarcopenia (ASMI < 4.94 kg/m2).Results:A strong positive correlation between CC and ASMI (r = 0.84, p < 0.001) was observed. The CC to predict low hand-grip strength was 34.3 cm and 37.8 cm for low gait speed. A CC of 29.9 cm was indicative of sarcopenia. The area under the curve for all outcomes was > 0.60.Conclusion:A CC of 30 cm is proposed as a simple and inexpensive way to predict, screen or diagnose sarcopenia in black women in low-resource health settings. An accessible, inexpensive screening or diagnostic tool could facilitate timely interventions and prevention.

Carbon dioxide (CO2) emissions and the resultant negative effects thereof on the environment due to climate change remain a global challenge. In South Africa, passenger vehicles contribute significantly to the amount of CO2that is emitted into the atmosphere. In an effort to address this challenge, South Africa introduced a CO2emissions tax from 1 September 2010. The aim of this tax is to make the vehicles on South Africa’s roads more environmentally friendly by influencing consumer behaviour at the point of a new car purchase. This paper considers the effect of this tax by way of a survey that targeted consumers who have bought a new passenger vehicle since the implementation of the tax. The paper aimed to measure consumers’ awareness of and insight into this CO2emissions tax, as well as to determine whether the CO2emissions tax influenced their purchasing decision. The results of this survey indicate that most consumers are not aware of the CO2emissions tax. There is thus evidence to substantiate that the CO2emissions tax has not achieved its purpose of making South Africa’s fleet of motor vehicles more environmentally friendly by changing consumers’ behaviour through influencing the purchase decision relating to new car sales.

Acute aortic syndrome includes a wide spectrum of aortic conditions such as classic acute aortic dissection, intramural haematoma, symptomatic penetrating aortic ulcers and traumatic aortic lesions. These result primarily from disruption of the inner wall layer, and involve thinning of the aortic wall, increased wall stress, progressive dilatation, evolution of intramural haemorrhage and possibly dissection and rupture. Chronic hypertension and connective tissue disorders are often implicated. Echocardiography, contrast-enhanced computed tomography and dynamic magnetic resonance imaging are used to establish the diagnosis. Aortic dissection is primarily classified according to anatomical characteristics: presence or absence of ascending aortic involvement is distinguished for prognostic and therapeutic reasons. In general, open surgery is indicated for dissection involving the ascending aorta, whereas medical management and/or endovascular stent-graft implantation is considered where the ascending aorta is spared. Pathology involving the aortic arch can be treated using a hybrid approach combining debranching with stent-graft implantation or branched or fenestrated stent-grafts. Stent-graft-induced remodelling seems to have long-term benefits in both complicated and uncomplicated distal dissection. In addition, long-term medical therapy to control hypertension and surveillance are paramount in all patients who have survived aortic dissection to reduce late complications, including recurrent dissection, aneurysm formation and rupture.

We use X-ray-induced photochemistry, which is well known to cause changes in a number of systems, to reduce Hg(II) to Hg(0) in frozen aqueous solution with added glycerol maintained at 10 K. X-ray absorption spectroscopy was used to monitor the extent of the reaction and to characterize the species. An analysis of the extended X-ray absorption fine structure (EXAFS) of the photochemical product indicated a nearly monatomic Hg(0) species bound only by long, weak bonds to oxygens at ∼3.5 Å. The results of the EXAFS analysis agree quantitatively with the results of density functional theory calculations using the meta-GGA approximation with the M11-L functional. This is the first structural characterization of nearly monatomic Hg(0) bound by hard ligands similar to those expected in aqueous environmental systems. We conclude that Hg(0) is expected to exist in solution as a nearly monatomic entity.

Supplemental Digital Content is available in the text.Acute aortic dissection (AAD) is a life-threatening condition associated with high morbidity and mortality rates, and it remains a challenge to diagnose and treat. The International Registry of Acute Aortic Dissection was established in 1996 with the mission to raise awareness of this condition and provide insights to guide diagnosis and treatment. Since then, >7300 cases have been included from >51 sites in 12 countries. Although presenting symptoms and physical findings have not changed significantly over this period, the use of computed tomography in the diagnosis has increased, and more patients are managed with interventional procedures: surgery in type A AAD and endovascular therapy in type B AAD; with these changes in care, there has been a significant decrease in overall in-hospital mortality in type A AAD but not in type B AAD. Herein, we summarized the key lessons learned from this international registry of patients with AAD over the past 20 years.

In patients with bicuspid aortic valve (BAV), complications including progressive aortic stenosis and aortic dilatation develop over time. The morphology of cusp fusion is one of the determinants of the type and severity of these complications. We present the association of morphology of cusp fusion in BAV patients with distinctive genetic syndromes.

Spiral concentrators are robust gravity separation devices that allow for concentration of slurry streams. Optimal splitter position (which determines recovery and grade) is dependent on the interface positions of the concentrate, middlings and/or tailings in the trough. Various image processing techniques have been proposed to automatically detect interface positions, which could be useful for spiral concentrator monitoring and control. Two methods are compared in this work: the first is the previously-described genetic algorithm optimization of the parameters of a traditional edge detection algorithm. The second uses logistic regression, a well-known statistical classifier. The performance of the two methods was compared on two data sets, for ilmenite and chromite concentration. The logistic regression method was shown to outperform the genetic algorithm approach, in terms of computational cost of training and successful interface detections on test data, for both the relatively easy ilmenite concentrate interface, and the more challenging chromite concentrate interface.

Purpose:To present a novel endovascular management option that avoids open surgery in selected patients with subacute type A aortic dissection (DeBakey II). Case Report:A 75-year-old woman with previous infrarenal abdominal aortic aneurysm repaired in 2006 and multiple comorbidities (EURO score II 20.5%) was admitted with chest pain; computed tomography angiography (CTA) showed a new dissection in the ascending aorta just above the right coronary ostium. As the patient was considered unfit to undergo surgery, an endovascular solution was suggested after multidisciplinary team discussion. With a single entry identified, coils were deployed in the false lumen followed by a patent foramen ovale (PFO) occluder placed across the entry tear to seal the cavity. Intraprocedural digital subtraction angiography and transesophageal echocardiography, as well as CTA 3 days postprocedure, confirmed an entirely thrombosed false lumen. The 6-month follow-up CTA demonstrated the PFO occluder firmly in place, shrinkage of the false lumen, and remodeling of the ascending aorta. Conclusion:Interventional management of the false lumen in proximal (type A) dissection is feasible and sustainable. The use of coils and closure devices may present a new, efficient, minimalistic strategy to avoid open surgery in selected cases.

Current guidelines recommend potent platelet inhibition with prasugrel or ticagrelor for 12 months after an acute coronary syndrome managed with percutaneous coronary intervention (PCI). However, the greatest anti-ischaemic benefit of potent antiplatelet drugs over the less potent clopidogrel occurs early, while most excess bleeding events arise during chronic treatment. Hence, a stage-adapted treatment with potent platelet inhibition in the acute phase and de-escalation to clopidogrel in the maintenance phase could be an alternative approach. We aimed to investigate the safety and efficacy of early de-escalation of antiplatelet treatment from prasugrel to clopidogrel guided by platelet function testing (PFT).

A controlled three‐dimesional ground penetrating radar monitoring study over simulated clandestine graves was conducted near Pretoria, South Africa, in which the detectability of graves as a function of post‐burial interval was assessed, as this is of particular interest to local forensic investigators. It was demonstrated that the site‐specific environmental parameter (a clay‐rich loamy soil with poor drainage) and heavy seasonal rainfall (as confirmed by ground‐penetrating‐radar‐derived soil moisture estimates) drastically compromised the long‐term grave detectability, especially when adopting a three‐dimensional depth slice analysis approach. It is also seen that the disturbed burial zone is the major contributor to the total grave anomaly rather than the buried body due to the combination of environmental parameters and the absence of buried artefacts. This paper also advocates the combined use of different data representations (two‐dimensional and three‐dimensional) to increase the likelihood of detecting subtle grave anomalies.

Copper is an essential nutrient required for many biological processes involved in primary metabolism, but free copper is toxic due to its ability to catalyze formation of free radicals. To prevent toxic effects, in the cell copper is bound to proteins and low molecular weight compounds, such as glutathione, at all times. The widely used chemotherapy agent cisplatin is known to bind to copper-transporting proteins, including copper chaperone Atox1. Cisplatin interactions with Atox1 and other copper transporters are linked to cancer resistance to platinum-based chemotherapy. Here we analyze the binding of copper and cisplatin to Atox1 in the presence of glutathione under redox conditions that mimic intracellular environment. We show that copper(I) and glutathione form large polymers with a molecular mass of approximately 8 kDa, which can transfer copper to Atox1. Cisplatin also can form polymers with glutathione, albeit at a slower rate. Analysis of simultaneous binding of copper and cisplatin to Atox1 under physiological conditions shows that both metals are bound to the protein through copper-sulfur-platinum bridges.

Bicuspid aortic valve (BAV) occurs both as an isolated cardiac lesion and in association with congenital heart defects (CHD). Their aim was to identify the incidence and morphology of BAV in patients with coexisting CHD and compare their disease progression to patients with isolated BAV. The Mayo Clinic echocardiography database was retrospectively analyzed to identify pediatric and young adult patients (≤22 years) who were diagnosed with BAV from 1990 to 2015. The morphology of BAV was determined from the echocardiographic studies before any intervention. Overall, 1010 patients with BAV were identified, 619 (61%) with isolated BAV and 391 (39%) with BAV and coexisting CHD. The incidence of BAV was highest in patients with coarctation of the aorta (36%) and interrupted aortic arch (36%). In comparison to patients with isolated BAV, patients with BAV and left‐sided obstructive lesions more frequently had right‐left cusp fusion (P= .0001). BAV in patients with right‐sided obstructive lesions was rare, but they more frequently had right‐noncoronary or left‐noncoronary cusp fusion (P= .01). No significant progression of aortic stenosis or regurgitation was observed in patients with BAV and coexisting CHD; however in patients with isolated BAV the severity of aortic regurgitation increased with age. In patients with isolated BAV, the ascending aorta diameter (z‐score) increased with age, peaked around 8–9 years of age, and was larger in comparison to patients with BAV and coexisting CHD. The sinus of Valsalva diameter (z‐score) in patients with BAV and ventricular septal defect was larger than isolated BAV patients after 18 years (P< .04). The morphology of BAV, the pattern and progression of aortic dilatation, and the severity of aortic valve disease vary in pediatric and young adult patients with BAV and coexisting CHD. However, there was no significant BAV disease progression when associated with these CHD.

Im Zuge des Managements von Großschutzgebieten spielen die Fragen der Akzeptanz des Schutzgebietes an sich und der Umgang mit Konflikten, die aus dem Schutzgebietsregime heraus resultieren können, eine wichtige Rolle. Der Beitrag untersucht zunächst die unterschiedliche Rolle der Akzeptanzforschung von Großschutzgebieten im deutsch- und englischsprachigen Raum. Anhand der verschiedenen Aufgaben und Handlungsfelder von Nationalparken und Biosphärenreservaten wird dann die Vielfalt möglicher Konfliktpotenziale aufgezeigt, die am Beispiel von vier Fallstudien näher beschrieben werden. Eine Medienanalyse und vertiefende Experteninterviews dienen als Grundlage für die detaillierte Untersuchung der vier Fallstudien: der Nationalpark Berchtesgaden mit einem latenten Konfliktpotenzial bei unvorhergesehenen Naturereignissen wie Borkenkäferbefall sowie die potenzielle Nationalparkregion Senne-Teutoburger Wald-Eggegebirge mit ihrem hohen Anteil an Privatwaldbesitzern und der Problematik der Zonierung, das Biosphärenreservat Bliesgau, die vor allem bereits in ihrer Entstehungsphase Konfliktpotenziale der Landnutzung sowie sich überschneidender Kompetenzbereiche aufzeigte sowie das Biosphärenreservat Pfälzerwald mit der neuen Konfliktlage der möglichen Ausweisung von Windenergieanlagen. Der Beitrag schließt mit Handlungsempfehlungen für die Raum- und Umweltplanung, den Akzeptanzbegriff insgesamt als Bestandteil eines aktiven Umfeldmanagements zu betrachten und adaptive Ansätze besser in das Schutzgebietsmanagement zu integrieren.

Landnutzungssysteme und die Vielfalt der Biodiversität lassen sich in Deutschland anhand des Netzes von Großschutzgebieten untersuchen. Im vorliegenden Schwerpunktheft stehen Natur- und Nationalparke sowie Biosphärenreservate im Fokus, die sich in unterschiedlicher Weise mit Flächenkonkurrenzen und Akzeptanzproblemen auseinandersetzen müssen. Der Arbeitskreis „Biodiversität und nachhaltige Landnutzung in Großschutzgebieten“ der Akademie für Raumforschung und Landesplanung (ARL) hat sich mit dieser Thematik befasst. Der vorliegende Beitrag zeigt dabei die Forschungsfragen auf, die in den nachfolgenden Beiträgen dieses Heftes debattiert werden. Dazu gehört, welchen Einfluss unterschiedliche Landnutzungssysteme auf die Beschaffenheit von Ökosystemleistungen haben, wie die Großschutzgebietstypen hinsichtlich ihres jeweiligen Beitrages zu Erhalt und Entwicklung von Biodiversität zu bewerten sind, welche Rolle speziell dem Wald und dessen Bewirtschaftung im Hinblick auf Biodiversität und nachhaltige Landnutzung zukommt und welche Konfliktmuster durch Raumnutzungskonkurrenzen bestehen. Untersucht werden auch konkrete Governance-Ansätze in Großschutzgebieten vor dem Hintergrund von Flächenkonkurrenzen und es wird der Frage nachgegangen, wie in Großschutzgebieten gewonnene Erfahrungen auf die Gesamtfläche übertragen werden können. Darüber hinaus liefert dieser Beitrag die grundlegenden Definitionen zum Thema des Heftes. Schließlich werden aus unterschiedlicher fachlicher Perspektive Forderungen an politische und planerische Akteure gestellt, die eine nachhaltige Entwicklung von Großschutzgebieten in Deutschland unterstützen sollen. Eine stringente Stärkung des Stellenwertes von Großschutzgebieten auf Bundesebene mit entsprechenden administrativen Strukturen steht hier ebenso im Fokus wie die Forderung nach einer stärkeren Qualitätssicherung und -entwicklung der Großschutzgebiete. Auch das Spannungsfeld zwischen der Notwendigkeit des stärkeren Prozessschutzes und der Intensivierung der Landwirtschaft im Zuge der Gemeinsamen Agrarpolitik der EU wird in den Forderungen aufgegriffen.