Incidence of Postoperative Cognitive Dysfunction Following Inhalational Vs. Total Intravenous General Anesthesia: A Systematic Review and Meta-Analysis.

Postoperative cognitive dysfunction (POCD) has been increasingly recognized as a contributor to postoperative complications. A consensus-working group recommended that POCD should be distinguished between delayed cognitive recovery, i.e., evaluations up to 30 days postoperative, and neurocognitive disorder, i.e., assessments performed between 30 days and 12 months after surgery. Additionally, the choice of the anesthetic, either inhalational or total intravenous anesthesia (TIVA) and its effect on the incidence of POCD, has become a focus of research. Our primary objective was to search the literature and conduct a meta-analysis to verify whether the choice of general anesthesia may impact the incidence of POCD in the first 30 days postoperatively. As a secondary objective, a systematic review of the literature was conducted to estimate the effects of the anesthetic on POCD between 30 days and 12 months postoperative. For the primary objective, an initial review of 1,913 articles yielded 12 studies with a total of 3,639 individuals. For the secondary objective, five studies with a total of 751 patients were selected. In the first 30 days postoperative, the odds-ratio for POCD in TIVA group was 0.60 (95% CI = 0.40 - 0.91; p = 0.02), compared to the inhalational group. TIVA was associated with a lower incidence of POCD in the first 30 days postoperatively. Regarding the secondary objective, due to the small number of selected articles and its high heterogeneity, a metanalysis was not conducted. Giving the heterogeneity of criteria for POCD, future prospective studies with more robust designs should be performed to fully address this question.

Strategic Robustness in Bi-level System-of-systems Design

Robust designs protect system utility in the presence of uncertainty in technical and operational outcomes. Systems-of-systems, which lack centralized managerial control, are vulnerable to strategic uncertainty from coordination failures between partially or completely independent system actors. This work assesses the suitability of a game-theoretic equilibrium selection criterion to measure system robustness to strategic uncertainty and investigates the effect of strategically robust designs on collaborative behavior. The work models interactions between agents in a thematic representation of a mobile computing technology transition using an evolutionary game theory framework. Strategic robustness and collaborative solutions are assessed over a range of conditions by varying agent payoffs. Models are constructed on small world, preferential attachment, and random graph topologies and executed in batch simulations. Results demonstrate that systems designed to reduce the impacts of coordination failure stemming from strategic uncertainty also increase the stability of the collaborative strategy by increasing the probability of collaboration by partners; a form of robustness by environment shaping that has not been previously investigated in design literature. The work also demonstrates that strategy selection follows the risk dominance equilibrium selection criterion and that changes in robustness to coordination failure can be measured with this criterion.

Optimization of Design Margins Allocation When Making Use of Additive Remanufacturing

Coping with changing requirements by means of introducing design margins may result in overdesign. In this paper, we present a design optimization method for minimizing overdesign by exploiting additive remanufacturing. Our problem formulation makes use of recently defined constituents of design margins: buffer and excess. The proposed method can be used to obtain a set of design decisions for different changing requirement scenarios. We demonstrate it using a turbine rear structure design problem where changes in the temperature loads are met by depositing different types of stiffeners on the outer casing. The results of the case study are visualized in a tradespace, which allows for comparison between sets of optimal, flexible, and robust designs. Results show that the optimized set of design decisions balances flexibility and robustness in a cost-effective manner.

Local structure of DNA toroids reveals curvature-dependent intermolecular forces

In viruses and cells, DNA is closely packed and tightly curved thanks to polyvalent cations inducing an effective attraction between its negatively charged filaments. Our understanding of this effective attraction remains very incomplete, partly because experimental data is limited to bulk measurements on large samples of mostly uncurved DNA helices. Here we use cryo electron microscopy to shed light on the interaction between highly curved helices. We find that the spacing between DNA helices in spermine-induced DNA toroidal condensates depends on their location within the torus, consistent with a mathematical model based on the competition between electrostatic interactions and the bending rigidity of DNA. We use our model to infer the characteristics of the interaction potential, and find that its equilibrium spacing strongly depends on the curvature of the filaments. In addition, the interaction is much softer than previously reported in bulk samples using different salt conditions. Beyond viruses and cells, our characterization of the interactions governing DNA-based dense structures could help develop robust designs in DNA nanotechnologies.

A Quasi-Experimental Study on the Effectiveness of Dutch Cell Dogs in Incarcerated Youth

This study examined the effectiveness of Dutch Cell Dogs (DCD), a prison-based dog training program that aims to improve socioemotional functioning of incarcerated youth by giving them the opportunity to train a shelter dog. Primary (aggression and institutional infractions) and secondary (wellbeing and therapeutic functioning) outcomes were assessed for the intervention ( n = 61) and comparison group ( n = 77) before the start of DCD, after 4 weeks, and after 8 weeks at posttest. Overall, DCD participation was not effective. Compared to the comparison group, institutional infractions decreased in DCD participants with an immigrant background and increased in DCD participants with a native Dutch background. In addition, DCD participation reduced the quality of the therapeutic alliance for younger participants and those in secure residential facilities. The current study demonstrated heterogeneity in DTP responsiveness. Future research with robust designs and sufficiently large samples is needed to further identify who benefits from DTPs.