Towards a cooperative urbanism? An alternative conceptualization of urban development for Johannesburg's mining belt.

This paper explores the multidimensional aspects of inequality that shape urban areas and imagines an alternative future for one such space in Johannesburg, South Africa. It builds on literature from urban studies and planning theory to explore planning practices that politicize inequality, valorize difference and promote the shared management of collective resources. Then, drawing on a decade of qualitative research, the paper imagines how cooperative urbanism could be applied in the factious context of Johannesburg, describing the potential for developing the former mining belt of the Witwatersrand as a series of multi-scalar interventions, networking sites of cooperative action to incrementally address the entrenched inequality of the region. Thus, the paper brings together interdisciplinary conversations on theory with empirical research, discussing concrete ways to continue shifting urban planning and development towards increased environmental and social justice.

Perioperative Family Updates Reduce Anxiety and Improve Satisfaction: A Randomized Controlled Trial.

PURPOSE: This study aimed to determine if standardized updates at specific perioperative events affect anxiety and satisfaction of the family members and if the length of surgical procedure affects the satisfaction with updates. METHODS: This study was a randomized control trial. In the control group, surgeons communicated with the family only once near the completion of the procedure. In the intervention group, families received electronic updates at 3 significant perioperative events during the procedure. A postoperative survey rating family member satisfaction and anxiety levels, using a Likert scale of 0-5, was administered. RESULTS: Mean level of overall satisfaction did not differ between groups (intervention: 4.68 ± 0.69 [95% CI: 4.50, 4.87]; control: 4.61 ± 0.78 [95% CI: 4.40, 4.82]; P=0.69). Mean anxiety levels were lower in the intervention group (2.48 ± 1.43 [2.10, 2.86]) than in the control group (3.12 ± 1.32 [2.77, 3.47]; P=0.01). Mean satisfaction with perioperative updates was higher in the intervention (4.48 ± 0.83 [4.26, 4.70]) versus control group (3.16 ± 1.89 [2.67, 3.65]; P=0.0001). For all subjects, there was positive correlation between procedure time and anxiety (Spearman's rho: 0.34; P=0.0002) and negative correlation between procedure time and overall satisfaction (Spearman's rho: -0.23; P=0.01). CONCLUSIONS: Anxiety and satisfaction with perioperative updates were significantly improved by additional perioperative updates. These findings indicate that updating families during significant standardized strategic perioperative events can reduce the anxiety of loved ones and are preferred by most families.

A community hospital's experience with robotic thoracic surgery.

INTRODUCTION: The emergence of minimally invasive thoracic surgery has positively impacted postoperative recovery. Robotic-assisted thoracoscopic surgery (RATS) has been shown to have equivalent short- and long-term outcomes as compared with video-assisted thoracoscopic surgery (VATS). The introduction of RATS offers a three-dimensional high-definition image, improved ergonomics, and wristed movement. The purpose of this paper was to define the learning curve of RATS. METHODS: This study is a retrospective review of a single surgeon's RATS experience in a community hospital. All patients who underwent RATS between December 2011 and April 2014 were included. The cohort was divided into 2 groups: "early" and "late." These groups were created based on the date before or after February 2013, respectively. Data is presented as means and percentages. Significance was defined as a P value < 0.05. All categorical variables were evaluated with Fisher's exact t test and all continuous variables were compared via a paired t test. RESULTS: Seventy-nine patients were identified with a mean age of 59. There were 39 patients in the early group and 40 in the late. Rates of conversion to open thoracotomy (13% vs 10%, P = 0.74) and operative time (180 vs 204 min, P = 0.34) did not demonstrate any statistical significance between the two cohorts. Postoperative morbidity (21% vs 28%, P = 0.60) and mortality (3% vs 0%, P = 1.00) were equivalent between both groups. There was a higher percentage of lobectomies performed during the late group (38% vs 65%, P = 0.02). Furthermore, these lobectomies were performed at a faster rate in the late group. CONCLUSION: Based on our experience, the complexity of the operations that can be performed robotically increased with the number of operations performed without an impact on postoperative morbidity and mortality.

Effect of Pregnancy Interval on Second Pregnancy Blood Pressure Following Prior Preeclampsia.

OBJECTIVE: Preeclampsia generally occurs in first pregnancies and tends not to recur when the interpregnancy interval (IPI) is short. We hypothesized that, in women experiencing preeclampsia in their first pregnancy, the difference in mean arterial pressure (MAP) across pregnancy between their index and subsequent pregnancy would be inversely associated with the length of time between pregnancies and that the interval between pregnancies will be directly associated with the likelihood of preeclampsia recurrence. METHODS: This was a retrospective chart review evaluating 171 women diagnosed with preeclampsia during their first pregnancy who had a subsequent pregnancy at our institution. Blood pressures were collected from each pregnancy, marking the recurrence of hypertensive disorders, including preeclampsia. Antepartum MAP was compared between pregnancies, examining differences as a function of IPI. RESULTS: There was a significant association of IPI with the reduction in MAP between pregnancies across trimesters ( P = .04), but this reduction became smaller over time. The MAP during the third trimester decreased significantly between pregnancies across all patient groups (IPI <24 months: -5.7 mm Hg, P < .0001; IPI 24-48 months: -4.5 mm Hg, P < .0001; IPI >48 months -3.4 mm Hg, P = .03). The recurrence rate of preeclampsia did not vary significantly with IPI ( P = .21). CONCLUSION: The IPI influences the MAP of the second pregnancy in women with prior preeclampsia. Shorter IPI is associated with a greater reduction in MAP when compared to the longer IPI. Although there was a trend toward higher preeclampsia recurrence with longer IPI, this trend did not reach statistical significance.