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Over-exposure of the hand-arm system to intense vibration and force over time may cause degeneration of the vascular, neurological, and musculoskeletal systems in the fingers. A novel animal model using rat tails has been developed to understand the health effects on human fingers exposed to vibration and force when operating powered hand tools or workpieces. The biodynamic responses, such as vibration stress, strain, and power absorption density, of the rat tails can be used to help evaluate the health effects related to vibration and force and to establish a dose-effect relationship. While the biodynamic responses of cadaver rat tails have been investigated, the objective of the current study was to determine whether the biodynamic responses of living rat tails are different from those of cadaver rat tails, and whether the biodynamic responses of both living and cadaver tails change with exposure duration. To make direct comparisons, the responses of both cadaver and living rat tails were examined on four different testing stations. The transfer function of each tail under a given contact force (2 N) was measured at each frequency in the one-third octave bands from 20 to 1000 Hz, and used to calculate the mechanical system parameters of the tails. The transfer functions were also measured at different exposure durations to determine the time dependency of the response. Differences were observed in the vibration biodynamic responses between living and cadaver tails, but the general trends were similar. The biodynamic responses of both cadaver and living rat tails varied with exposure duration.

The central concern of this paper is guided by two brief citations, one from Jacques Derrida and the other from Walter Benjamin. In ways that are both direct and indirect, these philosophers reference architecture, love and ruin. The paper’s aim is to suggest that architectures of love, whatever they may be, are obliged to address our encounters with violence, justice and politics, especially in relation to crises we could gather under the notions of precarity and ruin, what Derrida at one time called the bio-deconstruction of lifedeath, and Benjamin the politics of nihilism. The paper’s introductory paragraphs aim at offering an orientation for asking something fundamental in the approaches taken by Derrida and Benjamin.

Thermal spray coating involves spraying a product (oftentimes metal) that is melted by extremely high temperatures and then applied under pressure onto a surface. Large amounts of a complex metal aerosol (e.g., Fe, Cr, Ni, Zn) are formed during the process, presenting a potentially serious risk to the operator. Information about the health effects associated with exposure to these aerosols is lacking. Even less is known about the chemical and physical properties of these aerosols. The goal was to develop and test an automated thermal spray coating aerosol generator and inhalation exposure system that would simulate workplace exposures. An electric arc wire-thermal spray coating aerosol generator and exposure system was designed and separated into two areas: (1) an enclosed room where the spray coating occurs; (2) an exposure chamber with different measurement devices and controllers. The physicochemical properties of aerosols generated during electric arc wire-thermal spray coating using five different consumable wires were examined. The metal composition of each was determined by inductively coupled plasma-atomic emission spectroscopy (ICP-AES), including two stainless-steel wires [PMET720 (82 % Fe, 13 % Cr); PMET731(66 % Fe, 26 % Cr)], two Ni-based wires [PMET876 (55 % Ni, 17 % Cr); PMET885 (97 % Ni)], and one Zn-based wire [PMET540 (99 % Zn)]. The particles generated regardless of composition were poorly soluble, complex metal oxides and mostly arranged as chain-like agglomerates and similar in size distribution as determined by micro-orifice uniform deposit impactor (MOUDI) and electrical low-pressure impactor (ELPI). To allow for continuous, sequential spray coating during a 4-hr exposure period, a motor rotated the metal pipe to be coated in a circular and up-and-down direction. In a pilot animal study, male Sprague-Dawley rats were exposed to aerosols (25 mg/m3 × 4 h/d × 9 d) generated from electric arc wire- thermal spray coating using the stainless-steel PMET720 consumable wire. The targeted exposure chamber concentration was achieved and maintained during a 4-hr period. At 1 d after exposure, lung injury and inflammation were significantly elevated in the group exposed to the thermal spray coating aerosol compared to the air control group. The system was designed and constructed for future animal exposure studies to generate continuous metal spray coating aerosols at a targeted concentration for extended periods of time without interruption.

IntroductionFrailty is associated with adverse postoperative health outcomes, including increased mortality, longer length of stay, higher rehospitalization, and other complications. There are many frailty assessment tools are to assess the level of frailty in vascular surgery patients. The aim of this study was to perform a systematic review and meta-analysis to assess the association between the frailty levels described by different frailty scores and adverse postoperative health outcomes among hospitalized vascular surgery patients and patients undergoing amputation.MethodsStudies utilizing frailty scores and similar frailty assessment tools to describe frailty and investigate the association between frailty and health outcomes were searched. The primary outcomes of this study were in-hospital mortality, postdischarge mortality, length of hospital stay, rehospitalization, and discharge location. Additional outcomes included postoperative myocardial infarction, postoperative renal failure, cerebrovascular accident and stroke, comorbidities, and estimated glomerular filtration rate (eGFR) levels. Joanna Briggs Institute (JBI) Critical Appraisal Tools were used for quality assessment.ResultsIn total, 24 studies with 1,886,611 participants were included in the final analysis. The overall results found that higher in-hospital mortality and postdischarge mortality were significantly associated with frailty. Frailty was also found to be significantly associated with a longer length of hospital stay, higher rehospitalization, and higher likelihood of non-home discharge. In addition, the results also showed that frailty was significantly associated with all kinds of comorbidities investigated, except chronic kidney disease. However, lower eGFR levels were significantly associated with frailty.ConclusionAmong patients who underwent all types of vascular surgery and those who underwent amputations, assessment of frailty was significantly associated with adverse postoperative outcomes and multiple comorbidities.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=336374, identifier CRD42022336374.

Abstract Background Mental ill-health in health professionals, including doctors, is a global and growing concern. The existing literature on interventions that offer support, advice and/or treatment to sick doctors has not yet been synthesised in a way that considers the complexity and heterogeneity of the interventions, and the many dimensions of the problem. We (1) reviewed interventions to tackle doctors’ and medical students’ mental ill-health and its impacts on the clinical workforce and patient care—drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives—and (2) produced recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts. Methods Realist literature review consistent with the RAMESES quality and reporting standards. Sources for inclusion were identified through bibliographic database searches supplemented by purposive searches—resulting also from engagement with stakeholders. Data were extracted from included articles and subjected to realist analysis to identify (i) mechanisms causing mental ill-health in doctors and medical students and relevant contexts or circumstances when these mechanisms were likely to be ‘triggered’ and (ii) ‘guiding principles’ and features underpinning the interventions and recommendations discussed mostly in policy document, reviews and commentaries. Results One hundred seventy-nine records were included. Most were from the USA (45%) and were published since 2009 (74%). The analysis showed that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote wellbeing. Interventions creating a people-focussed working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors and medical students needed to have confidence in an intervention for the intervention to be effective. Conclusions Successful interventions to tackle doctors’ and students’ mental ill-health are likely to be multidimensional and multilevel and involve multiple stakeholders. Evaluating and improving existing interventions is likely to be more effective than developing new ones. Our evidence synthesis provides a basis on which to do this. Study registration PROSPERO CRD42017069870. Research project webpage http://sites.exeter.ac.uk/cup/

Background: The growing incidence of mental ill-health in health professionals, including doctors, is a global concern. Although a large body of literature exists on interventions that offer support, advice and/or treatment to sick doctors, it has not yet been synthesised in a way that takes account of the complexity and heterogeneity of the interventions, and the many dimensions (e.g. individual, organisational, sociocultural) of the problem. Objectives: Our aim was to improve understanding of how, why and in what contexts mental health services and support interventions can be designed to minimise the incidence of doctors’ mental ill-health. The objectives were to review interventions to tackle doctors’ mental ill-health and its impact on the clinical workforce and patient care, drawing on diverse literature sources and engaging iteratively with diverse stakeholder perspectives to produce actionable theory; and recommendations that support the tailoring, implementation, monitoring and evaluation of contextually sensitive strategies to tackle mental ill-health and its impacts. Design: Realist literature review consistent with the Realist And Meta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards. Data sources: Bibliographic database searches were developed and conducted using MEDLINE (1946 to November week 4 2017), MEDLINE In-Process and Other Non-indexed Citations (1946 to 6 December 2017) and PsycINFO (1806 to November week 2 2017) (all via Ovid) and Applied Social Sciences Index and Abstracts (1987 to 6 December 2017) (via ProQuest) on 6 December 2017. Further UK-based studies were identified by forwards and author citation searches, manual backwards citation searching and hand-searching relevant journal websites. Review methods: We included all studies that focused on mental ill-health; all study designs; all health-care settings; all studies that included medical doctors/medical students; descriptions of interventions or resources that focus on improving mental ill-health and minimising its impacts; all mental health outcome measures, including absenteeism (doctors taking short-/long-term sick leave); presenteeism (doctors working despite being unwell); and workforce retention (doctors leaving the profession temporarily/permanently). Data were extracted from included articles and the data set was subjected to realist analysis to identify context–mechanism–outcome configurations. Results: A total of 179 out of 3069 records were included. Most were from the USA (45%) and had been published since 2009 (74%). More included articles focused on structural-level interventions (33%) than individual-level interventions (21%), but most articles (46%) considered both levels. Most interventions focused on prevention, rather than treatment/screening, and most studies referred to doctors/physicians in general, rather than to specific specialties or career stages. Nineteen per cent of the included sources provided cost information and none reported a health economic analysis. The 19 context–mechanism–outcome configurations demonstrated that doctors were more likely to experience mental ill-health when they felt isolated or unable to do their job, and when they feared repercussions of help-seeking. Healthy staff were necessary for excellent patient care. Interventions emphasising relationships and belonging were more likely to promote well-being. Interventions creating a people-focused working culture, balancing positive/negative performance and acknowledging positive/negative aspects of a medical career helped doctors to thrive. The way that interventions were implemented seemed critically important. Doctors needed to have confidence in an intervention for the intervention to be effective. Limitations: Variable quality of included literature; limited UK-based studies. Future work: Use this evidence synthesis to refine, implement and evaluate interventions. Study registration: This study is registered as PROSPERO CRD42017069870. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 19. See the NIHR Journals Library website for further project information.

Resistance spot welding is a common process to join metals in the automotive industry. Adhesives are often used as sealers to seams of metals that are joined. Anti-spatter compounds sometimes are sprayed onto metals to be welded to improve the weldability. Spot welding produces complex aerosols composed of metal and volatile compounds (VOCs) which can cause lung disease in workers. Male Sprague-Dawley rats (n = 12/treatment group) were exposed by inhalation to 25 mg/m3 of aerosol for 4 h/day × 8 days during spot welding of galvanized zinc (Zn)-coated steel in the presence or absence of a glue or anti-spatter spray. Controls were exposed to filtered air. Particle size distribution and chemical composition of the generated aerosol were determined. At 1 and 7 days after exposure, bronchoalveolar lavage (BAL) was performed to assess lung toxicity. The generated particles mostly were in the submicron size range with a significant number of nanometer-sized particles formed. The primary metals present in the fumes were Fe (72.5%) and Zn (26.3%). The addition of the anti-spatter spray and glue did affect particle size distribution when spot welding galvanized steel, whereas they had no effect on metal composition. Multiple VOCs (e.g., methyl methacrylate, acetaldehyde, ethanol, acetone, benzene, xylene) were identified when spot welding using either the glue or the anti-spatter spray that were not present when welding alone. Markers of lung injury (BAL lactate dehydrogenase) and inflammation (total BAL cells/neutrophils and cytokines/chemokines) were significantly elevated compared to controls 1 day after exposure to the spot welding fumes. The elevated pulmonary response was transient as lung toxicity mostly returned to control values by 7 days. The VOCs or the concentrations that they were generated during the animal exposures had no measurable effect on the pulmonary responses. Inhalation of galvanized spot welding fumes caused acute lung toxicity most likely due to the short-term exposure of particles that contain Zn. Keywords: Resistance spot welding, Aerosol generation, Inhalation, Zinc, Methyl methacrylate

High air temperature and high humidity, combined with low wind speeds, are common trends in the tropical urban climates, which collectively govern heat-induced health risks and outdoor thermal comfort under the given hygrothermal conditions. The impact of different urban land-uses on air temperatures is well-documented by many studies focusing on the urban heat island phenomenon; however, an integrated study of air temperature and humidity, i.e., the human-perceived temperatures, in different land-use areas is essential to understand the impact of hot and humid tropical urban climates on the thermal comfort of urban dwellers for an appraisal of potential health risks and the associated building energy use potential. In this study, we show through near-surface monitoring how these factors vary in distinct land-use areas of Kuala Lumpur city, characterized by different morphological features (high-rise vs. low-rise; compact vs. open), level of anthropogenic heating and evapotranspiration (built-up vs. green areas), and building materials (concrete buildings vs. traditional Malay homes in timber) based on the calculated heat index (HI), apparent temperature (TApp) and equivalent temperature (TE) values in wet and dry seasons. The results show that the felt-like temperatures are almost always higher than the air temperatures in all land-use areas, and this difference is highest in daytime temperatures in green areas during the dry season, by up to about 8 °C (HI)/5 °C (TApp). The TE values are also up to 9% higher in these areas than in built-up areas. We conclude that tackling urban heat island without compromising thermal comfort levels, hence encouraging energy use reduction in buildings to cope with outdoor conditions requires a careful management of humidity levels, as well as a careful selection of building morphology and materials.

The global financial crash of 2008 had many precipitating causes and has had massive repercussions over the past seven years on global economic activity as well as on how urban infrastructure, housing and services are financed and delivered. The crash was precipitated by the massive escalation in global derivatives trading, especially that related to low income housing mortgages. It was also precipitated by a failure of predictive measures, probability models and the calculability of market forecasts that have been the foundation to economic planning since the emergence of political economy at the end of the eighteenth century. This paper aims to do two things in relation to this recent episode in economic history. The first is to undertake a genealogy of the emergence of political economy and a State’s reliance on probability and statistics for its governance. This is primarily analysed through the writings of Michel Foucault on space, power and the aleatory. The second is to introduce the thinking of the economics philosopher, Elie Ayache, who wrote a book after the crash on the end of probability. The paper’s overall aim is to bring the work of Foucault and Ayache together in drawing out a radical thinking with respect to the urban of the relation between space, power, contingency, and writing.

All industries are based upon a core of knowledge. Economic evolution is the growth of this knowledge as an experimental and path-dependent process involving markets, firms, finance, entrepreneurship, and often substantial uncertainty. In the set of industries associated with information technology, the core of knowledge is programmable digital computation (PDC). In this paper, we outline the origins and development of PDC, and in particular the path from the mainframe industry to the PC. We tell this story in order to highlight a number of salient features about the relationship between competition and evolution. First, the predominant form of competition was not focused about competitive pricing in existing markets, but rather for the creation of new markets and therefore monopoly positions. Second, as the IBM story demonstrates, this involved leveraging competencies between markets, often deliberately destroying a market in order to create a new one. Third, as the hacker tradition illustrates, much of the entrepreneurial development of the industry came from the users, due to their close conception of the technological possibilities and opportunities. Fourth, we highlight the overarching importance of the setting of standards (by fiat, by self-organization, or by monopoly) and the role this has in reducing uncertainty. We offer some policy and management lessons based upon this analysis.

To reduce inaccuracies in the measurement of air pollutants by portable monitors it is necessary to establish quantitative calibration relationships against their respective reference analyser. This is usually done under controlled laboratory conditions or one-off static co-location alongside a reference analyser in the field, neither of which may adequately represent the extended use of portable monitors in exposure assessment research. To address this, we investigated ways of establishing and evaluating portable monitor calibration relationships from repeated intermittent deployment cycles over an extended period involving stationary deployment at a reference site, mobile monitoring, and completely switched off. We evaluated four types of portable monitors: Aeroqual Ltd. (Auckland, New Zealand) S500 O3 metal oxide and S500 NO2 electrochemical; RTI (Berkeley, CA, USA) MicroPEM PM2.5; and, AethLabs (San Francisco, CA, USA) AE51 black carbon (BC). Innovations in our study included: (i) comparison of calibrations derived from the individual co-locations of a portable monitor against its reference analyser or from all the co-location periods combined into a single dataset; and, (ii) evaluation of calibrated monitor estimates during transient measurements with the portable monitor close to its reference analyser at separate times from the stationary co-location calibration periods. Within the ~7 month duration of the study, ‘combined’ calibration relationships for O3, PM2.5, and BC monitors from all co-locations agreed more closely on average with reference measurements than ‘individual’ calibration relationships from co-location deployment nearest in time to transient deployment periods. ‘Individual’ calibrations relationships were sometimes substantially unrepresentative of the ‘combined’ relationships. Reduced quantitative consistency in field calibration relationships for the PM2.5 monitors may have resulted from generally low PM2.5 concentrations that were encountered in this study. Aeroqual NO2 monitors were sensitive to both NO2 and O3 and unresolved biases. Overall, however, we observed that with the ‘combined’ approach, ‘indicative’ measurement accuracy (±30% for O3, and ±50% for BC and PM2.5) for 1 h time averaging could be maintained over the 7-month period for the monitors evaluated here.

Introduction Oil spill cleanup workers come into contact with numerous potentially hazardous chemicals derived from the oil spills, as well as chemicals applied for mitigation of the spill, including oil dispersants. In response to the Deepwater Horizon Macondo well oil spill in the Gulf of Mexico in 2010, a record volume of the oil dispersant, COREXIT EC9500A, was delivered via aerial applications, raising concern regarding potential health effects that may result from pulmonary exposure to the dispersant. Methods The current study examined the effects on pulmonary functions, cardiovascular functions, and systemic immune responses in rats to acute repeated inhalation exposure of COREXIT EC9500A at 25 mg/m 3 , five hours per day, over nine work days, or filtered air (control). At one and seven days following the last exposure, a battery of parameters was measured to evaluate lung function, injury, and inflammation; cardiovascular function; peripheral vascular responses; and systemic immune responses. Results No significant alterations in airway reactivity were observed at one or seven days after exposure either in baseline values or following metha-choline (MCh) inhalation challenge. Although there was a trend for an increase in lung neutrophils and phagocyte oxidant production at one-day post exposure, there were no significant differences in parameters of lung inflammation. In addition, increased blood monocytes and neutrophils, and decreased lymphocyte numbers at one-day post exposure also did not differ significantly from air controls, and no alterations in splenocyte populations, or serum or spleen immunoglobulin M (IgM) to antigen were observed. There were no significant differences in peripheral vascular responsiveness to vasoconstrictor and vasodilator agonists or in blood pressure (BP) responses to these agents; however, the baseline heart rate (HR) and HR responses to isoproterenol (ISO) were significantly elevated at one-day post exposure, with resolution by day 7. Conclusions In summary, acute repeated exposure to COREXIT EC9500A did not alter pulmonary function, lung injury/inflammation, systemic immune responses, or vascular tone, but did cause transient chronotropic effects on cardiac function.

Objectives: To explore patients’ views on the EuroQol-5D and Coronary Revascularisation Outcome Questionnaire, tools currently used for collecting patient-reported outcome measures in the English National Health Service. The key questions were as follows: (1) whether patients consider them sensitive enough to detect change in their health after cardiovascular disease interventions and (2) whether they consider the health-related quality-of-life questions as meaningful. Methods: Data were collected on patients’ views using focus groups. We held four focus groups selecting participants on the basis of their baseline and follow-up EuroQol-5D scores. Data were analysed using framework analysis and grounded theory. Results: Focus group participants confirmed that they had derived substantial health benefits from their cardiac interventions despite the lack of measurable effects on the EuroQol-5D scores. Participants felt that the EuroQol-5D questionnaire was limited because of the following reasons: Their health fluctuates from day to day. They had difficulty assessing their general health status on the visual analogue scale. They felt that the Coronary Revascularisation Outcome Questionnaire was limited because of the following reasons: They did not understand the clinical terms used. The impact of tiredness on their quality of life was not captured. They were unable to distinguish between the effects of their heart condition and other health issues. Additionally, neither questionnaire considers the adjustments people have made to their domestic arrangements to improve their health-related quality of life. Conclusion: This study provides evidence that the two questionnaires do not capture some aspects of health that patients consider important. Furthermore, the presence of co-morbidities masks the symptoms relating to the heart disease and the effect of their cardiac interventions. Future work on patient-reported outcome measures should consider developing new questionnaires that address these major concerns.

Acute coronary syndrome is a common cause of presentation to hospital. ST segment elevation on an electrocardiogram (ECG) is likely to be cardiac in origin, but in low-risk patients other causes must be ruled out. We describe a case of a man with hypercalcaemia, no evidence of cardiac disease, and ECG changes mimicking acute myocardial infarction. These ECG changes resolved after treatment of the hypercalcaemia.

Symposium in Honour of Joseph Rykwert Saturday 15 November 2008 Call for Papers On Adam’s House in the Pacific If, in this part of the world, the context is defined as paradisiacal, what is the need for architecture? Is it enough that building in such circumstances be as little mediated, as natural, as possible? How does architecture become dependent on this natural context? What is this Pacific which is invoked in the guise of a scene or site to safeguard a paradise and to define a natural architecture? Idyllic, remote and untouched parts, where architecture is barely needed, seem to summon up notions of original dwelling from the very surroundings in forests, glades, clearings, mountains, beaches, lakes and deserts. They summon up the primitive in the form of sheds, cabins and even villas and tourist resorts which assemble sources for the uncorrupted hut. Why does the private or single family house gain importance within such a primal setting? Does the proliferation of books on the house signify that this is the sole local discourse? How does this demand for native traits measure against the original dwellings, such as whare and fale? Where do they fit? How do they fit? What has been the role of the discourse of appropriation? The primitive hut seems to provide the basis of a natural perception, uncluttered by cultural baggage where only innate ideas and external necessities prevail in the pursuit of ever purer tectonics and returns to origins. As Joseph Rykwert argued over thirty years ago in On Adam’s House in Paradise: The Idea of the Primitive Hut in Architectural History (1972), the primitive hut provides an image of perpetual reconstruction, a paradigm of building and renewal by return to origins. But perhaps this primitive hut could also be encountered as an exorbitant cultural accumulation of concerns with natural origins, derivative of a Rousseau-inspired Eurocentrism, an overly-cluttered baggage of cultural assumptions and idealisms. Since the publication of Adam’s House, discourses of architecture have engaged in a panoply of critical concerns that question the search for origins and the existence of simple natures. Would Adam’s house, for example, survive the tremors of Grammatology? Could a radical understanding of communitarian ethics be derived from the Hut’s primitive and essential nature? In what ways are these themes still alive and relevant today? What modes of renewal, return, persistence, continuity exist in today’s architecture here? What further contribution could be made to the theme of Adam’s House? The symposium will take place on Saturday 15 November from 10am-6pm at the School of Architecture & Planning, The University of Auckland. While participants will deliver only 20 minute papers in the first instance, it is intended that the result will be an edited book published by Interstices. Please send 300 word abstracts by Friday September 12 to Ross Jenner: r.jenner@auckland.ac.nz And Mark Jackson: mark.jackson@aut.ac.nz Abstracts will be peer reviewed. Further details to be advised.

Background: Venous grafts commonly develop myointimal hyperplasia, which can lead to stenoses and, ultimately, with expression of adhesion molecules, lumenal occlusion. The aim of the present study was to investigate whether wall shear stress measured post-operatively would predict subsequent myointimal hypertrophy in lower limb venous bypass grafts. Methods: Magnetic resonance imaging and ultrasound were performed in a cohort of patients following lower limb venous bypass graft surgery for peripheral arterial disease at baseline (1–2 weeks) and at follow-up (9–12 months). Wall shear stress was determined at baseline using computational fluid dynamics techniques and intima-media thickness along the length of the graft was measured by ultrasound at baseline and follow up. Results: Complete follow-up was possible in eight patients, in whom low wall shear stress at baseline predicted high intima-media thickness. The relationship between wall shear stress (WSS) and intima-media thickness (IMT) was curvilinear with IMT increasing sharply at lower levels of WSS (IMT >1.0 mm at

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