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Background: Congenital cardiac care involves multiple stakeholders including patients and their families, surgeons, cardiologists, anaesthetists, the wider multidisciplinary team, healthcare providers, and manufacturers, all of whom are involved in the decision-making process to some degree. Game theory utilises human behaviour to address the dynamics involved in a decision and what the best payoff is depending on the decision of other players. Aim: By presenting these interactions as a strategic game, this paper aims to provide a descriptive analysis on the utility and effectiveness of game theory in optimising decision-making in congenital cardiac care. Methodology: The comprehensive literature was searched to identify papers on game theory, and its application within surgery. Results: The analysis demonstrated that by utilising game theories, decision-making can be more aligned with patient-centric approaches, potentially improving clinical outcomes. Conclusion: Game theory is a useful tool for improving decision-making and may pave the way for more efficient and improved patient-centric approaches.
We use Stein’s method to obtain distributional approximations of subgraph counts in the uniform attachment model or random directed acyclic graph; we provide also estimates of rates of convergence. In particular, we give uni- and multi-variate Poisson approximations to the counts of cycles and normal approximations to the counts of unicyclic subgraphs; we also give a partial result for the counts of trees. We further find a class of multicyclic graphs whose subgraph counts are a.s. bounded as $n\to \infty$.
The Energy Charter Treaty (ECT) is one of the best-known and most controversial of the international investment treaties. The energy transition necessary to achieve the Paris Agreement climate target will require large and sustained flows of investment capital. Scholars, environmentalists, industry representatives, and governmental officials have intensively debated the modernization of the ECT. The main point of contention is whether the ECT can facilitate the energy transition or whether it entrenches fossil lock-in in unsustainable and unjust ways. This article proposes a comprehensive and integrated approach to the ECT, guided by the theoretical matrix of Earth system law scholarship. Our analysis reveals that the ECT cannot address contemporary socio-ecological challenges, but rather it remains a sectoral piece of a supranational economic constitution far removed from the most pressing exigencies of the Anthropocene.
Harbour seals were extensively hunted in Denmark, but have only been driven to local extinction in one larger area, the South Funen Archipelago and Little Belt, where the species has been absent throughout the 20th century. Despite high growth rates of the Danish harbour seal populations after protection from hunting in 1976, seals have only been observed sporadically in the South Funen Archipelago and Little Belt until recent years, where recolonisation now causes conflicts with fisheries. Here, we review historical sources documenting the local extinction of harbour seals in the area during the 19th century and report the results of aerial surveys of haul-out sites during moulting seasons of 2021–2023 and pupping seasons of 2022 and 2023. Historical sources reveal that seal hunting was a common practice in southern Denmark, but catches dwindled to rarities during the 19th century. During recent surveys, seals were detected at six of the identified potential haul-out sites. Around Aarø Island, an average of 141 (range: 92–186) harbour seals were recorded over four moulting season surveys, constituting the majority (90%) of the total counts of the surveyed area. During the pupping seasons, a total of five pups was encountered at two different haulouts. As none of the haulouts are protected during the pupping and breeding seasons, protective measures may support this recolonisation of the historic harbour seal breeding range.
This study investigates the impact of warfare on nuptial patterns, focusing on the trends and characteristics of age differences within marriage. Specifically, it explores the socio-demographic outcomes of the Imjin War (1592–1598) and post-war reconstruction in Korea, using the earliest extant Chosŏn household registers, compiled between 1606 and 1630. Individual-level microdata were derived involving 2,336 married couples based on 11,749 entries in these registers, covering four administrative districts located in the southeastern region of the Korean peninsula severely devastated by the war. Factors such as status, property, warfare, social practices, and legal regulations influenced spousal age differences. First, social rank and family wealth played pivotal roles, with age gaps widening as a husband's socio-economic status increased. Second, females born after 1580, whose first marriages were affected by the Imjin War and post-war circumstances, experienced an average marital age gap of about ten years. Third, this effect was further complicated by the imposition of socio-legal rules on remarriage; that is, the yangban entailed a pronounced age difference owing to the Neo-Confucian norm of chaste widowhood. This study enriches the understanding of historical marriage customs in Korea and offers insights for studies on age disparity in marriage.
The injection of ${\rm CO}_2$ into depleted reservoirs carries the potential for significant Joule–Thomson cooling, when dense, supercritical ${\rm CO}_2$ is injected into a strongly under-pressured reservoir. The resulting low temperatures around the wellbore risk causing thermal fracturing of the well/near-well region or causing freezing of pore waters or formation of gas hydrates which would reduce injectivity and jeopardise well and reservoir integrity. These risks are particularly acute during injection start-up when ${\rm CO}_2$ is in the gas stability field. In this paper we present a model of non-isothermal single-phase flow in the near-wellbore region. We show that during radial injection, with fixed mass injection rate, transient Joule–Thomson cooling can be described by similarity solutions at early times. The positions of the ${\rm CO}_2$ and thermal fronts are described by self-similar scaling relations. We show that, in contrast to steady-state flow, transient flow causes slight heating of ${\rm CO}_2$ and reservoir gas either side of the thermal front, as pressure diffuses into the reservoir. The scaling analysis here identifies the parametric dependence of Joule–Thomson cooling. We present a sensitivity analysis which demonstrates that the primary controls on the degree of cooling are reservoir permeability, reservoir thickness, injection rate and Joule–Thomson coefficient. The analysis presented provides a computationally efficient approach for assessing the degree of Joule–Thomson cooling expected during injection start-up, providing a complement to complex, fully resolved numerical simulations.
The articulations of science and politics in the Cold War in the United States are well studied in histories of American political culture. However, these histories are often given focus and coherence via concepts and understandings taken from political realism and sociological institutionalism, thereby underestimating the transformations in the very idea of political reality that helped form the Cold War era in the United States. This paper launches an investigation of the relationship between speculative fiction and scientific and political discourse during that era to explore how the political culture of the United States came to be structured not only by a certain imagination but also by a particular set of fantasies. Building on the history of war-gaming at the RAND Corporation, the author conducts a close reading of a RAND Corporation report turned popular science publication. This suggests that, during the Cold War, a new standpoint from which to view the political world – the view from outer space – began to organize how the American political project for the globe represented its own modernity to itself. This view, drawn from science fiction but made real in its ethos and its political consequences, projected an understanding of “mankind” as but an infant in the early stages of what would become its interstellar destiny. A baleful consequence of this view was its tendency to free political actors and intellectuals from the urgent problem, identified acutely by Hannah Arendt in her essay “Man’s Conquest of Space,” of creating a world in common on earth.
Ecological momentary assessment (EMA) involves repeated collection of real-time self-report data, often multiple times per day, nearly always delivered electronically by smartphone. While EMA has shown promise for researching internal states, behaviors, and experiences in multiple populations, concerns remain regarding its feasibility in samples with cognitive impairments, like those associated with chronic moderate-to-severe traumatic brain injury (TBI).
Methods:
This study examines adherence to a 7-week high-frequency (5x daily) EMA protocol in individuals with moderate-to-severe TBI, considering changes in response rate over time, as well as individual participant characteristics (memory function, education, injury severity, and age).
Results:
In the sample of 39 participants, the average overall response rate was 65% (range: 5%–100%). Linear mixed-effects modeling revealed a small but statistically significant linear decay in response rate over 7 weeks of participation. Individual trajectories were variable, as evidenced by the significant effect of random slope. A better response rate was positively associated with greater educational attainment and better episodic memory function (statistical trend), whereas the effects of age and injury severity were not significant.
Conclusions:
These findings shed light on the potential of EMA in TBI studies but underscore the need for tailored strategies to address individual barriers to adherence.
Let $\eta $ be [-11pc] [-7pc]a closed real 1-form on a closed Riemannian n-manifold $(M,g)$. Let $d_z$, $\delta _z$ and $\Delta _z$ be the induced Witten’s type perturbations of the de Rham derivative and coderivative and the Laplacian, parametrized by $z=\mu +i\nu \in \mathbb C$ ($\mu ,\nu \in \mathbb {R}$, $i=\sqrt {-1}$). Let $\zeta (s,z)$ be the zeta function of $s\in \mathbb {C}$, defined as the meromorphic extension of the function $\zeta (s,z)=\operatorname {Str}({\eta \wedge }\,\delta _z\Delta _z^{-s})$ for $\Re s\gg 0$. We prove that $\zeta (s,z)$ is smooth at $s=1$ and establish a formula for $\zeta (1,z)$ in terms of the associated heat semigroup. For a class of Morse forms, $\zeta (1,z)$ converges to some $\mathbf {z}\in \mathbb {R}$ as $\mu \to +\infty $, uniformly on $\nu $. We describe $\mathbf {z}$ in terms of the instantons of an auxiliary Smale gradient-like vector field X and the Mathai–Quillen current on $TM$ defined by g. Any real 1-cohomology class has a representative $\eta $ satisfying the hypothesis. If n is even, we can prescribe any real value for $\mathbf {z}$ by perturbing g, $\eta $ and X and achieve the same limit as $\mu \to -\infty $. This is used to define and describe certain tempered distributions induced by g and $\eta $. These distributions appear in another publication as contributions from the preserved leaves in a trace formula for simple foliated flows, giving a solution to a problem stated by C. Deninger.
This paper discusses the complexities of teaching Hebrew to Israel's largest minority group, the Arabs, who must be fluent in the language if they are to succeed. While policy-making institutions in Israel today are aware of the importance of Hebrew for Arab students, the teaching of Hebrew faces serious challenges involving the status of Hebrew in Arab society, the inner-Arab state of diglossia, and the training and placement of Arab teachers of Hebrew. The distribution of the Arab population (in mixed Jewish–Arab towns, and in Arab towns and villages), as well as differing levels of exposure to Hebrew, also pose considerable challenges. The paper combines a historical-theoretical with a philosophical-theoretical approach. It analyzes findings of previous studies that examined Hebrew writings of Arabs studying to be teachers of Hebrew, and policy documents dealing with teacher training and placement in the schools. Our study found a profound gap between Arab Hebrew teachers' academic-pedagogical training and its implementation. Our main recommendations for reducing the gap are: (1) the curriculum should take Israeli Arabs' sociolinguistic situation into account; (2) the teacher placement system needs an overhaul; and (3) the teaching of Hebrew should begin in third grade.
When young patients with an oval fossa defect present early with symptoms of heart failure and pulmonary hypertension, surgical treatment is recommended in small bodyweight rather than transcatheter closure.
Methods:
Outcomes of device closure in consecutive symptomatic children weighing under 10 kg were compared with young children aged below 4 years but weighing above 10 kg. Transthoracic echocardiography under conscious sedation guided the procedure in all without need for balloon sizing, transesophageal echocardiogram, and intubation anaesthesia. Symptoms, anthropometry, shunt ratio, pulmonary pressures, defect and device size, percentage oversizing, device/body weight ratio, complications, and post-procedural growth spurt were compared.
Results:
Ninety-six patients weighing under 10 kg were compared with 160 patients weighing above 10 kg. In total, 83.3% of patients in the study group and 25% of controls were severely malnourished. The median indexed defect size was 35.2 mm/sq.m and 27.4 mm/sq.m, and the device was oversized by 8.7% and 14.2% in the study group and controls, respectively. The device/body weight ratio was 1.93 in study group and 1.4 in controls. Procedure was successful in all except one patient weighing under 10 kg who had a device embolisation. Both groups showed significant growth spurts and proportion, with severe malnutrition reduced to 42% and 11% in the two groups.
Conclusions:
Device closure was feasible and safe in patients under 10 kg. Transthoracic echocardiographic imaging on conscious sedation provided adequate guidance. Symptoms and growth significantly improved after intervention. Despite a larger defect size, smaller patients had comparable outcomes. In symptomatic children under 10 kg needing early closure, transcatheter intervention should not be deferred.
Soft robotics is rapidly advancing, particularly in medical device applications. A particular miniaturized manipulator design that offers high dexterity, multiple degrees-of-freedom, and better lateral force rendering than competing designs, has great potential for minimally invasive surgery. However, it faces challenges such as the tendency to suddenly and unpredictably deviate in bending plane orientation at higher pressures. In this work, we identified the cause of this deviation as the buckling of the partition wall and proposed design alternatives along with their manufacturing process to address the problem without compromising the original design features. In both simulation and experiment, the novel design managed to achieve a better bending performance in terms of stiffness and reduced deviation of the bending plane. We also developed an artificial neural network-based inverse kinematics model to further improve the performance of the prototype during vectorization. This approach yielded mean absolute errors in orientation of the bending plane below $5^{\circ }$.
The Ediacaran Subcommission of the International Commission on Stratigraphy is diligently working toward the goal of subdividing the Ediacaran Period into precise and useful chronostratigraphic units. As emphasized by Xiao and colleagues in 2016, one of the most effective tools in this endeavor will be the use of index fossils. Our special issue serves as a presentation of ongoing research efforts aimed at advancing this task and contains explorations into taxonomy, taphonomy, and the diversity of life during the Ediacaran Period.
Identify risk factors for central line-associated bloodstream infections (CLABSI) in pediatric intensive care settings in an era with high focus on prevention measures.
Design:
Matched, case–control study.
Setting:
Quaternary children’s hospital.
Patients:
Cases had a CLABSI during an intensive care unit (ICU) stay between January 1, 2015 and December 31, 2020. Controls were matched 4:1 by ICU and admission date and did not develop a CLABSI.
Methods:
Multivariable, mixed-effects logistic regression.
Results:
129 cases were matched to 516 controls. Central venous catheter (CVC) maintenance bundle compliance was >70%. Independent CLABSI risk factors included administration of continuous non-opioid sedative (adjusted odds ratio (aOR) 2.96, 95% CI [1.16, 7.52], P = 0.023), number of days with one or more CVC in place (aOR 1.42 per 10 days [1.16, 1.74], P = 0.001), and the combination of a chronic CVC with administration of parenteral nutrition (aOR 4.82 [1.38, 16.9], P = 0.014). Variables independently associated with lower odds of CLABSI included CVC location in an upper extremity (aOR 0.16 [0.05, 0.55], P = 0.004); non-tunneled CVC (aOR 0.17 [0.04, 0.63], P = 0.008); presence of an endotracheal tube (aOR 0.21 [0.08, 0.6], P = 0.004), Foley catheter (aOR 0.3 [0.13, 0.68], P = 0.004); transport to radiology (aOR 0.31 [0.1, 0.94], P = 0.039); continuous neuromuscular blockade (aOR 0.29 [0.1, 0.86], P = 0.025); and administration of histamine H2 blocking medications (aOR 0.17 [0.06, 0.48], P = 0.001).
Conclusions:
Pediatric intensive care patients with chronic CVCs receiving parenteral nutrition, those on non-opioid sedative infusions, and those with more central line days are at increased risk for CLABSI despite current prevention measures.
We show that if one of various cycle types occurs in the permutation action of a finite group on the cosets of a given subgroup, then every almost conjugate subgroup is conjugate. As a number theoretic application, corresponding decomposition types of primes effect that a number field is determined by the Dedekind zeta function. As a geometric application, coverings of Riemannian manifolds with certain geodesic lifting behaviours must be isometric.
Poursuite de l’invasion de l’Ukraine, guerre dans la bande de Gaza, crise alimentaire, transition énergétique sans précédent, rééquilibrage géostratégique, montée du populisme, ingérence de toute sorte, explosion du recours à l’intelligence artificielle, inflation à maîtriser, voilà autant de traits caractérisant l’année 2023 et ayant eu le potentiel de redéfinir les relations commerciales mondiales. Dans ce contexte, mu par une nouvelle diplomatie pragmatique,1 le Canada tente d’innover tout en renouant avec son rôle d’antan: préserver ses partenaires usuels tout en développant de nouvelles relations d’opportunité (au risque parfois de piler sur ses valeurs), réinvestir les enceintes internationales avec le dessein de les moderniser, diversifier ses relations en déployant des forces diplomatiques dans de nouveaux territoires et réaffirmer sa souveraineté face à toute sorte de menaces que ce soit en Arctique ou dans le cadre électoral canadien. Ce contexte a nécessairement eu des impacts sur les choix que fait le Canada en matière commerciale.
There has long been debate about the capacity of the US Supreme Court to achieve “progressive” social change. Recent decisions of the court also point to a new worry for American progressives: the court may not only have a limited capacity to drive such change. In some cases, it may actively stand in the way of such change or help reverse it. This invites us to rethink when, or under what conditions, courts are likely to be effective in driving change—whether in a positive, dynamic, or else more obstructionist or regressive direction.