People are less myopic about future than past collective outcomes.

Myopia involves giving disproportionate weight to outcomes that occur close to the present. Myopia in people's evaluations of political outcomes and proposals threatens effective policymaking. It can lead to inefficient spending just before elections, cause inaction on important future policy challenges, and create incentives for government interventions aimed at boosting short-term performance at the expense of long-term welfare. But, are people generally myopic? Existing evidence comes mostly from studies that disregard either the future or collective outcomes. Political science characterizes people as myopic based on how they retrospectively evaluate collective outcomes, such as the state of the economy. Behavioral economics and psychology find that people make myopic choices involving future individual outcomes, such as money or personal health. To characterize myopia more generally, we offer two innovations: First, we adapt measurement approaches from behavioral economics and psychology to precisely gauge myopia over politically relevant collective outcomes. Second, we estimate myopia using the same approach for collective political outcomes in both past and future. We conduct two surveys on three different samples (including a large probability-based sample) asking respondents to evaluate national conditions randomly described as past or future while holding constant the domain, information about conditions, and the elicitation method. Results show that prospective evaluations are significantly less myopic than retrospective evaluations. People are often not myopic at all when looking to the future. This surprising pattern calls for more research to probe its robustness and spell out how low prospective myopia might lead to forward-looking policy.

Adaptation to compound climate risks: A systematic global stocktake.

This article provides a stocktake of the adaptation literature between 2013 and 2019 to better understand how adaptation responses affect risk under the particularly challenging conditions of compound climate events. Across 39 countries, 45 response types to compound hazards display anticipatory (9%), reactive (33%), and maladaptive (41%) characteristics, as well as hard (18%) and soft (68%) limits to adaptation. Low income, food insecurity, and access to institutional resources and finance are the most prominent of 23 vulnerabilities observed to negatively affect responses. Risk for food security, health, livelihoods, and economic outputs are commonly associated risks driving responses. Narrow geographical and sectoral foci of the literature highlight important conceptual, sectoral, and geographic areas for future research to better understand the way responses shape risk. When responses are integrated within climate risk assessment and management, there is greater potential to advance the urgency of response and safeguards for the most vulnerable.

Is a Rational Politics of Disaster Possible? Making Useful Decisions for Others in an Experimental Disaster Game.

Disaster responses are political. But can citizens make useful disaster decisions? Potential obstacles are that such decisions are complex, involve public goods, and often affect other people. Theories of political decision-making disagree on whether these problems can be overcome. We used experimental economic games that simulate disaster to test whether people are willing and able to prevent disasters for others. Groups of players face a complex task in which options that might help vary in their riskiness. Importantly, although all options are reasonable, which option is most useful depends on the experimental condition. We find that players will pay to help, can identify which option is most useful across experimental conditions, and will pay to learn how best to help. Thus, players were able to make useful and costly decisions to prevent others from experiencing disaster. This suggests that, in at least some situations, citizens may be able to make good disaster decisions. Supplementary Information: The online version contains supplementary material available at 10.1007/s11109-021-09700-2.

Augmented-reality telementoring for leg fasciotomy: a proof-of-concept study.

BACKGROUND: Prolonged field care is required when casualty evacuation to a surgical facility is delayed by distance, weather or tactical constraints. This situation can occur in both civilian and military environments. In these circumstances, there are no established treatment options for extremity compartment syndrome. Telementoring by a surgeon may enable the local clinician to perform a fasciotomy to decompress the affected compartments. METHODS: Six military clinicians were asked to perform a two-incision leg fasciotomy in synthetic models under the guidance of an orthopaedic surgeon located 380 km away. Communication occurred through commercially available software and smartglasses, which also allowed the surgeon to send augmented-reality graphics to the operators. Two blinded surgeons evaluated the specimens according to objective criteria. Control specimens were added to ensure the integrity of the evaluation process. RESULTS: The six study participants were military physician assistants who had extensive clinical experience but had never performed a fasciotomy. The average duration of the procedure was 53 min. All six procedures were completed without major errors: release of all four compartments was achieved through full-length incisions in the skin and fascia. The only surgical complication was a laceration of the saphenous vein. All three control specimens were correctly assessed by the evaluators. None of the participants experienced adverse effects from wearing the smartglasses. Four dropped calls occurred, but the connection was re-established in all cases. CONCLUSION: All six surgical procedures were completed successfully. We attribute the dropped calls to a mismatch between the size of the graphic files and the available bandwidth. A better technical understanding of the software by the mentoring surgeon would have avoided this problem. Important considerations for future research and practice include protocols for dropped communications, surgical skills training for the operators and communication training for the surgeons.

Preferences for Prevention: People Assume Expensive Problems Have Expensive Solutions.

People support inefficient spending on preventing disasters, and these preferences are translated into inefficient policies as elected officials try to appeal to their constituents. Here, we find preferences for prevention spending are biased by the "cost conflation" mechanism, where people assume expensive problems have expensive solutions. In this article, we present a formal model of collective action, and illustrate how cost conflation causes people to deviate from the equilibria. We test for these hypothesized deviations using an incentivized experiment. The experimental subjects engage in cost conflation-they believe the costs of disaster prevention are positively related to the costs of disaster damages, even when explicitly told otherwise. As a result, they fail to prevent smaller disasters and pay too much to prevent large disasters when cheap solutions exist. Furthermore, we provide evidence that overemphasizing disaster damages undermines successful disaster prevention because people view these disasters as too big to solve.

Silk-elastinlike copolymers enhance bioaccumulation of semisynthetic glycosaminoglycan ethers for prevention of radiation induced proctitis.

Radiation-induced proctitis (RIP) is a debilitating adverse event that occurs commonly during lower abdominal radiotherapy. The lack of prophylactic treatment strategies leads to diminished patient quality of life, disruption of radiotherapy schedules, and limitation of radiotherapy efficacy due to dose-limiting toxicities. Semisynthetic glycosaminoglycan ethers (SAGE) demonstrate protective effects from RIP. However, low residence time in the rectal tissue limits their utility. We investigated controlled delivery of GM-0111, a SAGE analogue with demonstrated efficacy against RIP, using a series of temperature-responsive polymers to compare how distinct phase change behaviors, mechanical properties and release kinetics influence rectal bioaccumulation. Poly(lactic acid)-co-(glycolic acid)-block-poly(ethylene glycol)-block-poly(lactic acid)-co-(glycolic acid) copolymers underwent macroscopic phase separation, expelling >50% of drug during gelation. Poloxamer compositions released GM-0111 cargo within 1 h, while silk-elastinlike copolymers (SELPs) enabled controlled release over a period of 12 h. Bioaccumulation was evaluated using fluorescence imaging and confocal microscopy. SELP-415K, a SELP analogue with 4 silk units, 15 elastin units, and one elastin unit with lysine residues in the monomer repeats, resulted in the highest rectal bioaccumulation. SELP-415K GM-0111 compositions were then used to provide localized protection from radiation induced tissue damage in a murine model of RIP. Rectal delivery of SAGE using SELP-415K significantly reduced behavioral pain responses, and reduced animal mass loss compared to irradiated controls or treatment with traditional delivery approaches. Histological scoring showed RIP injury was ameliorated for animals treated with GM-0111 delivered by SELP-415K. The enhanced bioaccumulation provided by thermoresponsive SELPs via a liquid to semisolid transition improved rectal delivery of GM-0111 to mice and radioprotection in a RIP model.

Two-wave panel survey dataset on who feels affected by Hurricane Florence.

Feeling affected by climate change related natural disasters is an important predictor of engaging in climate change mitigation behavior. We therefore collected data to identify who felt affected by Hurricane Florence, which made landfall in the United States on September 14th, 2018. In the months before Hurricane Florence, we collected survey responses from a nationally representative sample of United States citizens. We measured their attitudes towards climate change, emotional predispositions, and demographic information. Then, in the days after the hurricane, we re-contacted respondents to identify whether or not they felt personally affected by Hurricane Florence. These data can be used first to identify variables associated with climate change attitudes, and second to identify the traits that predispose individuals to feel affected by climate change related disasters.

[Bilateral adrenal hemorrhage under apixaban in primary antiphospholipid syndrome]. / Nécrose hémorragique bilatérale des surrénales sous apixaban : penser au syndrome des antiphospholipides ?

INTRODUCTION: Adrenal hemorrhage is a classical but rare complication of antiphospholipid syndrome, revealing diagnosis in one third of the cases. Anti-vitamin K therapy is the standard treatment but direct oral anticoagulants are discussed as an alternative. In the latest recommendations, it is advised not to use direct oral anticoagulants in the setting of antiphospholipid syndrome. CASE REPORT: We present a case of bilateral adrenal hemorrhage revealing primary antiphospholipid syndrome with triple positive antibody profile, in a 47-year-old man treated by apixaban for previous venous thromboembolism. CONCLUSION: To our knowledge, it is the first case of adrenal hemorrhage occurring during apixaban treatment in a patient with antiphospholipid syndrome. This case illustrates the inefficacy of direct oral anticoagulants to prevent thrombotic events in antiphospholipid syndrome, in accordance with the latest recommendations.

The political complexity of attack and defense.

De Dreu and Gross's distinction between attack and defense is complicated in real-world conflicts because competing leaders construe their position as one of defense, and power imbalances place status quo challengers in a defensive position. Their account of defense as vigilant avoidance is incomplete because it avoids a reference to anger which transforms anxious avoidance into collective and unified action.

Short-Term Outcomes of Colorectal Resection for Cancer in Elderly in the Era of Enhanced Recovery.

BACKGROUND AND AIMS: Early rehabilitation protocols should be assessed in elderly. We aimed to study the outcomes of colorectal surgery and the observance of the modalities of an early rehabilitation protocol in patients over 80 years. MATERIAL AND METHODS: All consecutive patients who underwent surgery for colorectal cancer in our center over a 19-month period were included. All of these patients were managed using the same early rehabilitation protocol. Patients older than 80 were compared to younger patients. RESULTS: A total of 173 patients were included and 36 were ≥80 years (20.8%). Patients aged ≥80 years had a significantly higher ASA score and were operated on in emergency. In the peroperative period, patients aged ≥80 years were more likely to undergo laparotomy than patients <80 years in univariate analysis (p = 0.048), but in multivariate analysis, the choice for a laparoscopy was influenced by ASA score ≤2 (odds ratio = 3.55, 95% confidence interval = 1.67-7.58) and emergency surgery (odds ratio = 0.18, 95% confidence interval = 0.06-0.50). In the postoperative period, peristalsis stimulation and vascular catheter ablation were significantly better followed in Group 1 (p = 0.012 and 0.031). However, in multivariate analysis, age was not significantly associated with these parameters. Peristalsis stimulation was influenced by ASA score ≥2 (odds ratio = 4.27, 95% confidence interval = 1.18-15.37) and vascular catheter ablation was also influenced by ASA score ≤2 (odds ratio = 2.63, 95% confidence interval = 1.33-5.21). Emergency surgery had a strong trend to influence these parameters (p = 0.08). CONCLUSION: Although age or comorbidities may affect observance for certain modalities such as chewing gum use and vascular catheter ablation, an early rehabilitation protocol can be used after colorectal cancer surgery in patients ≥80 years old, where it would improve functional results and postoperative outcomes.

Beyond market behavior: Evolved cognition and folk political economic beliefs.

Boyer & Petersen (B&P) lay out a compelling theory for folk-economic beliefs, focusing on beliefs about markets. However, societies also allocate resources through mechanisms involving power and group decision-making (e.g., voting), through the political economy. We encourage future work to keep folk political economic beliefs in mind, and sketch an example involving pollution and climate change mitigation policy.

Bioaerosols in the Barcelona subway system.

Subway systems worldwide transport more than 100 million people daily; therefore, air quality on station platforms and inside trains is an important urban air pollution issue. We examined the microbiological composition and abundance in space and time of bioaerosols collected in the Barcelona subway system during a cold period. Quantitative PCR was used to quantify total bacteria, Aspergillus fumigatus, influenza A and B, and rhinoviruses. Multitag 454 pyrosequencing of the 16S rRNA gene was used to assess bacterial community composition and biodiversity. The results showed low bioaerosol concentrations regarding the targeted microorganisms, although the bacterial bioburden was rather high (104 bacteria/m3 ). Airborne bacterial communities presented a high degree of overlap among the different subway environments sampled (inside trains, platforms, and lobbies) and were dominated by a few widespread taxa, with Methylobacterium being the most abundant genus. Human-related microbiota in sequence dataset and ascribed to potentially pathogenic bacteria were found in low proportion (maximum values below 2% of sequence readings) and evenly detected. Hence, no important biological exposure marker was detected in any of the sampled environments. Overall, we found that commuters are not the main source of bioaerosols in the Barcelona subway system.

Does enhanced recovery reduce postoperative ileus after colorectal surgery?

INTRODUCTION: While enhanced recovery after surgery (ERAS) has been proven to improve results in colorectal operations with regard to morbidity and duration of hospital stay, its impact on recovery of bowel motility is poorly documented. The aims of this study were to assess the impact of ERAS on bowel motility recovery, and to assess the consequences of the definition of postoperative ileus on its reported incidence in the literature. MATERIAL AND METHODS: This is a single-center prospective observational study of consecutive patients who underwent colorectal resection with anastomosis over a period of 17 months. Global resumption of intestinal transit (GROT) was defined as passage of stool combined with alimentary tolerance of solid food. RESULTS: One hundred and thirty-one patients were included. A median of 14 items (range: 13-16) was complied out of 19 observable items in the protocol. Median time to passage of flatus (MTPF) was 2 days and the GROT was 3 days. The time interval to MTPF as well as to GROT decreased as adherence to the ERAS protocol increased (respectively P<0.001, r2=0.11 and P=0.04, r2=0.06). The incidence of postoperative "ileus" varied from 1.5% to 61.8% depending on the interval chosen to define ileus (cut-off from 1 to 7 days). Adherence to≥85% of the items in the ERAS protocol protected patients from "prolonged ileus", i.e., lasting≥4 days (OR=0.35; 95% CI=0.15 to 0.83). CONCLUSION: The implementation of and compliance with an ERAS protocol allowed a reduction in the time to GROT. There is a need for a consensual definition of postoperative ileus.

ROS-generating NADPH oxidase NOX4 is a critical mediator in oncogenic H-Ras-induced DNA damage and subsequent senescence.

Activated Ras oncogene induces DNA-damage response by triggering reactive oxygen species (ROS) production and this is critical for oncogene-induced senescence. Until now, little connections between oncogene expression, ROS-generating NADPH oxidases and DNA-damage response have emerged from different studies. Here we report that H-RasV12 positively regulates the NADPH oxidase system NOX4-p22(phox) that produces H(2)O(2). Knocking down the NADPH oxidase with small interference RNA decreases H-RasV12-induced DNA-damage response detected by γ-H2A.X foci analysis. Using HyPer, a specific probe for H(2)O(2), we detected an increase in H(2)O(2) in the nucleus correlated with NOX4-p22(phox) perinuclear localization. DNA damage response can be caused not only by H-RasV12-driven accumulation of ROS but also by a replicative stress due to a sustained oncogenic signal. Interestingly, NOX4 downregulation by siRNA abrogated H-RasV12 regulation of CDC6 expression, an essential regulator of DNA replication. Moreover, senescence markers, such as senescence-associated heterochromatin foci, PML bodies, HP1ß foci and p21 expression, induced under H-RasV12 activation were decreased with NOX4 inactivation. Taken together, our data indicate that NADPH oxidase NOX4 is a critical mediator in oncogenic H-RasV12-induced DNA-damage response and subsequent senescence.

Do histological, immunohistochemical, and metabolic (radioiodine and fluorodeoxyglucose uptakes) patterns of metastatic thyroid cancer correlate with patient outcome?

The aim of this study is to search for relationships between histology, radioiodine ((131)I) uptake, fluorodeoxyglucose (FDG) uptake, and disease outcome in patients with metastatic thyroid cancer. Eighty patients with metastatic thyroid cancer (34 males, 46 females, mean age at the time of the diagnosis of metastases: 55 years) were retrospectively studied. All patients were treated with radioactive iodine and evaluated by FDG-positron emission tomography (PET). Primary tumor tissue sample was available in all cases. Forty-five patients (56%) had a papillary, 12 (15%) a follicular, and 23 (29%) a poorly differentiated thyroid cancer. Cellular atypias, necrosis, mitoses, thyroid capsule infiltration, and vascular invasion were frequently detected (70, 44, 52, 60, and 71% respectively). Metastases disclosed FDG uptake in 58 patients (72%) and (131)I uptake in 37 patients (45%). FDG uptake was the only significant prognostic factor for survival (P=0.02). The maximum standardized uptake value and the number of FDG avid lesions were also related to prognosis (P=0.03 and 0.009). Age at the time of the diagnosis of metastases (P=0.001) and the presence of necrosis (P=0.002) were independent predictive factors of FDG uptake. Radioiodine uptake was prognostic for stable disease (P=0.001) and necrosis for progressive disease at 1 year (P=0.001). Histological subtype was not correlated with in vivo tumor metabolism and prognosis. In conclusion, FDG uptake in metastatic thyroid cancer is highly prognostic for survival. Histological subtype alone does not correlate with (131)I/FDG uptake pattern and patient outcome. Well-differentiated thyroid cancer presenting histological features such as necrosis and FDG uptake on PET scan should be considered aggressive differentiated cancers.

Revisional bariatric surgery.

BACKGROUND: Revisional surgery is required in a significant number of patients because of failure to lose weight, loss of quality of life, weight regain, or complications of the previous procedure. It has traditionally been associated with higher complication rates, and there appears to be no standardized surgical approach to revisional surgery. The aim of the study was to review the revisional procedures performed at St George Private Hospital and analyze the outcomes of the different types of revisional surgery. METHODS: We performed a retrospective review of 75 patients who underwent revisional surgery between December 2003 and October 2007. Demographic, anthropometric, perioperative, and clinical follow-up data were collected, and statistical analyses were performed using SPSS version 14.0. RESULTS: Sixty-six of the 75 patients were female. The mean age at the time of revision was 46.32 (22-68) years. Mean initial weight was 119.08 kg, and body mass index (BMI) was 43.42 kg/m(2). The lowest BMI and excess weight loss (EWL) recorded after primary surgery was 36.9% and 53.5%, respectively. At the time of revision, the mean EWL was 24.79. The EWL at 3 months and 6 months were 41.7% and 47.8%, respectively. Revision was performed laparoscopically in 51 patients and via laparotomy in 24 patients. There was no mortality in the cohort, but there were 17.3% minor and 4.0% major perioperative morbidities. CONCLUSION: Our study suggests that revision can be performed safely. Weight loss is satisfactory, and complications of the previous operations were all reversed. Furthermore, revisions may be done laparoscopically, including those who had previous open procedures.

Role of sugars in regulating transfer cell development in cotyledons of developing Vicia faba seeds.

Transfer cell formation in cotyledons of developing faba bean (Vicia faba L.) seeds coincides with an abrupt change in seed apoplasm composition from one dominated by hexoses to one in which sucrose is the principal sugar. On the basis of these observations, we tested the hypothesis that sugars induce and/or sustain transfer cell development. To avoid confounding effects of in planta developmental programs, we exploited the finding that adaxial epidermal cells of cotyledons, which do not become transfer cells in planta, can be induced to form functional transfer cells when cotyledons are cultured on an agar medium. Growth rates of cotyledons cultured on hexose or sucrose media were used to inform choice of sugar concentrations. The same proportion of adaxial epidermal cells of excised cotyledons were induced to form wall ingrowths independent of sugar species and concentration supplied. In all cases, induction of wall ingrowths coincided with a marked increase in the intracellular sucrose-to-hexose ratio. In contrast, further progression of wall ingrowth deposition was correlated positively with intracellular sucrose concentrations that varied depending upon external sugar species and supply. Sucrose symporter induction and subsequent maintenance behaved identically to wall ingrowth formation in response to an external supply of hexoses or sucrose. However, in contrast to wall ingrowth formation, induction of sucrose symporter activity was delayed. We discuss the possibility of intracellular sugars functioning both as signals and substrates that induce and control subsequent development of transfer cells.

Progressive symptoms and signs following institution of highly active antiretroviral therapy and subsequent antituberculosis therapy: immune reconstitution syndrome or infection?

A 36 year old man presented with weight loss, cough, fever, and exertional dyspnoea shortly after a diagnosis of HIV infection. Symptoms and initial radiological abnormalities worsened after highly active antiretroviral therapy was started. An eventual diagnosis was established but multiple problems occurred throughout the treatment period. Differentiation between immune reconstitution inflammatory syndrome and an infective cause was problematic.

Total dorsal pancreatectomy for intraductal papillary mucinous neoplasm in a patient with pancreas divisum.

We report a case of intraductal papillary mucinous neoplasm confined to the dorsal (Santorini) pancreatic duct. A 51-year-old woman presented with a cystic lesion in the head of her pancreas and pancreas divisum. A biopsy taken during cyst-enteric drainage revealed dysplastic epithelium so the patient was scheduled for resection. At operation, excision of the entire dorsal pancreas was performed with preservation of the unaffected ventral pancreas and the spleen and its vessels. Over 6 years later she remains well with stable weight and a good quality of life. This case illustrates the benefits of anatomical preservation in pancreatic resection, and was performed some years prior to the only other reported similar case.

Hepatic portal vein gas as a complication of cryotherapy.

BACKGROUND: Hepatic portal vein gas (HPVG) is a radiological finding normally associated with life-threatening conditions such as mesenteric ischaemia and necrotising enterocolitis in infants. Its presence has previously been associated with a high mortality rate. As a result of more sensitive imaging modalities the spectrum of conditions for which portal vein gas is detected has broadened. We present a patient who developed HPVG as a complication of cryotherapy. The association between portal vein gas and cryotherapy has not previously been described in well over one thousand patients with hepatic cryotherapy reported in the literature.