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The transition to democracy in Chile, which took place under the rules established in the authoritarian constitution, led political parties and voters to align along an authoritarian/democratic divide. In the campaign for the constitutional plebiscite in 2022, some of those in favor of a new constitution linked their position to democratic values and labeled those opposed to the new draft as lacking democratic values. Many of those opposed to the new constitution purposely distanced themselves from the authoritarian legacy. We rely on a pre-electoral poll to explore democratic values in the vote choice in the plebiscite. When factoring for economic perceptions, ideological identification, and sociodemographic traits, while holding authoritarian values was positively associated with voting Reject, expressing democratic values had a weak association with voting Approve. The authoritarian/democratic divide in the party system in the early 1990s was not a relevant determinant of vote choice in the 2022 plebiscite.
This is a case of a 6-week-old male with D-TGA and multiple large ventricular septal defects who presented with oxygen desaturations into the 60s. He had initially undergone palliative pulmonary artery banding at a different institution, for concern that patch closure of his large ventricular septal defect would compromise ventricular function. We decided to undergo 3D printing and 4D modelling of his heart to delineate his ventricular septal defect anatomy in preparation for their closure and arterial switch operation. A 4D CTA showed a large perimembranous outlet ventricular septal defect and a very large “swiss cheese” muscular defect. We then segmented the heart and produced 3D models of the diastolic and systolic phases and printed 1- and 1.5x-sized 3D heart models. The 3D and 4D models were used to evaluate all ventricular septal defects from both sides of the ventricular septum to plan their closure. The systolic phase of the CTA demonstrated near obliteration of the apical muscular ventricular septal defects. The patient underwent complete surgical repair at 4 months. The posterior septal, apical, and large anterior muscular ventricular septal defects were closed by bovine pericardium. However, the large perimembranous and inlet ventricular septal defects were closed with a single patch, sparing the intervening muscle band that was thought to contain the conduction system. From the models, the most distal apical ventricular septal defects were shown to close with ventricular contraction during systole. Therefore, apical exclusion of the RV was not required. Thus, this additional information enabled an optimal surgical approach to efficiently close ventricular septal defects in need of closure without futile attempts at closing remote ventricular septal defects.
This paper considers the propagation, arrest and recession of a planar hydraulic fracture in a porous elastic medium whose footprint is constrained to a growing or shrinking rectangular region with a constant height. Hydraulic fractures with large aspect ratio rectangular footprints are frequently referred to as PKN fractures in recognition of the original researchers (Perkins & Kern 1961 J. Petrol. Tech.13, 937–949) and (Nordgren 1972 J. Petrol Technol.1972, 306–314) who first analyzed models of such fracture geometries. We investigate the one-dimensional non-local PKN approximation to a fully planar rectangular hydraulic fracture model in a three-dimensional elastic medium. By analysing the tip behaviour of the non-local PKN model, a transformation procedure is established to render the asymptotic equations for the dynamics of the steady semi-infinite PKN and plane strain models formally identical, which implies that all the existing multiscale plane strain asymptotes can be converted directly to the PKN case by making use of this transformation. Using this transformation, it is shown that the appropriate PKN asymptotes for the average aperture $\bar {w}$ with distance $\hat {x}$ to the fracture front are $\bar {w}\sim \hat {x}^{1/2},\ \hat {x}^{5/8}\ {\textrm{and}}\, \ \hat {x}^{2/3}$ in the toughness, leak-off and viscous modes of propagation, respectively; as well as the linear elastic fracture mechanics tip asymptote $\bar {w}\sim \hat {x}^{1/2}$ for arrest, which transitions to the linear asymptote tip $\bar {w}\sim \hat {x}$ for a fracture driven to recede due to fluid leak-off. Both the arrest and recession tip asymptotes share the intermediate leak-off asymptote $\bar {w}\sim \hat {x}^{3/4}$. A scaling analysis yields the arrest time, length and aperture as functions of a dimensionless injection-cessation time $\omega$. An asymptotic analysis of the non-local PKN model is used to establish the fundamental decoupling between dynamics and kinematics, which leads to the emergence of a similarity solution – termed the sunset solution – close to the time of collapse of the fracture. The multiscale PKN numerical solutions agree well with those for a fully planar multiscale rectangular hydraulic fracture model in a three-dimensional elastic medium. The scaling laws and the emergence of the sunset solution are confirmed by the PKN numerical model. The sunset solution also emerges in the fully planar numerical model and persists beyond the collapse time of the PKN model, by which time its footprints have separated from the upper and lower constraining sedimentary layer boundaries and have assumed self-similar elliptic shapes that shrink as they approach collapse.
Females may adjust how many eggs they lay over the course of their lifetime (i.e., their egg-laying pattern) to bias their investment into either current or future reproduction. Using mate availability cues to bias reproductive investment could ensure that females obtain the benefits of multiple mating when future mate availability is high or low. We studied whether perceived mate availability influenced egg-laying patterns in Teleogryllus oceanicus Le Guillou (Orthoptera: Gryllidae), the Pacific field cricket, and whether variation in those patterns affected females’ future egg-laying or total reproductive output. On hearing the male calling song to simulate high mate availability, females did not alter their egg-laying patterns relative to females that did not hear the song. The lack of influence of perceived mate availability on egg-laying patterns is noteworthy because this treatment affects many other aspects of this species’ reproductive investment. Neither investing highly in current versus future egg-laying nor having a highly variable egg-laying pattern appeared to be costly in this species. Despite consistent conditions and sufficient resources for females during the experiment, our fine-scale study of egg-laying patterns highlights the variability that exists in these patterns, and we speculate on some factors that may drive this variation.
In the rapidly rotating limit, we derive a balanced set of reduced equations governing the strongly nonlinear development of the convective wall-mode instability in the interior of a general container. The model illustrates that wall-mode convection is a multiscale phenomenon where the dynamics of the bulk interior diagnostically determine the small-scale dynamics within Stewartson boundary layers at the sidewalls. The sidewall boundary layers feedback on the interior via a nonlinear lateral heat-flux boundary condition, providing a closed system. Outside the asymptotically thin boundary layer, the convective modes connect to a dynamical interior that maintains scales set by the domain geometry. In many ways, the final system of equations resembles boundary-forced planetary geostrophic baroclinic dynamics coupled with barotropic quasi-geostrophic vorticity. The reduced system contains the results from previous linear instability theory but captured in an elementary fashion, providing a new avenue for investigating wall-mode convection in the strongly nonlinear regime. We also derive the dominant Ekman-flux correction to the onset Rayleigh number for large Taylor number, ${\textit {Ra}} \approx 31.8 \,{\textit{Ta}}^{1/2} - 4.43 \,{\textit{Ta}}^{5/12} + {\mathcal{O}}({\textit{Ta}}^{1/3})$ for no-slip boundaries. However, we find that the linear onset in a finite cylinder differs noticeably compared with a Cartesian channel. We demonstrate some of the reduced model’s nonlinear dynamics with numerical simulations in a cylindrical container.
Psychiatric advance directives (PADs) are documents enabling individuals with mental health conditions to specify their treatment preferences for future mental health crises. Despite the benefits of PADs, their implementation has progressed slowly. Concerns about PADs among professionals seem to be part of the explanation. A commonly reported concern is that service users will use PADs to document extensive treatment refusals. Research has not yet explored professionals’ views on ethical conflicts arising from such refusals.
Objectives:
The objective of this study was to explore professionals’ perspectives on ethical conflicts arising from treatment refusals in legally binding PADs.
Methods:
We carried out semi-structured interviews with 14 mental health professionals working in Germany with professional experience with PADs. We prompted discussions using a case report of an ethical conflict arising from a treatment refusal documented in a PAD. We analyzed the data thematically.
Results:
Professionals described the case as extreme yet not unfamiliar. While many felt obligated to respect the PAD, they also felt inclined to override it to promote service user well-being, restore service user autonomy, and protect others. Those inclined to override the PAD focused on scrutinizing its validity and applicability, raising doubts about information disclosure, voluntariness, decision-making capacity, and PAD irrevocability. Professionals believed ethics consultation would help address the ethical conflict.
Conclusions:
Legally binding PADs can create ethical conflicts when they include treatment refusals. While the best policy response remains unclear, professionals can help prevent such conflicts by supporting service users in drafting PADs.
Civic engagement benefits both participants and society, but what motivates young adults to decide to become civically engaged? A cost-benefit analysis concludes that resumé-building is a major motivator for young adult civic engagement participation because it has more visible short-term impacts compared to social or community motivators. Using a preregistered survey experiment and follow-up focus groups fielded to college students, I demonstrate that respondents exposed to a treatment describing the social benefits of civic engagement are significantly more willing to increase their civic engagement. Counter to expectations, career benefits are—at best—a secondary motivating factor. These results suggest that civic engagement does not appear to be inherently beneficial to young adults. Non-profit organizations and educators should consider ways to draw attention to the social benefits of civic engagement as a method of attracting additional program interest.
This study employs a direct numerical simulation method to investigate the wake pattern evolutions of flows past an insulated spheroid and provides expressions of force and torque coefficients influenced by a streamwise magnetic field in an incompressible, conducting, viscous fluid. A total of 1150 cases are examined covering a parameter range of Reynolds number $50 \leqslant \textit{Re} \leqslant 250$, aspect ratio $1.5 \leqslant \beta \leqslant 6$, inclination angle $0^\circ \leqslant \theta \leqslant 90^\circ$, and interaction parameter $0 \leqslant N \leqslant 10$, where $\beta$ and $N$, respectively, reflect the anisotropy of the spheroid and the strength of magnetic field. Nine wake patterns are classified based on wake structure features and summarised in three maps of regimes according to the inclination angle. The transition mechanisms among these wake patterns are also investigated under the influence of a streamwise magnetic field. Furthermore, expressions for drag, lift and torque coefficients are derived with the help of three fundamental physical criteria. Results indicate that the force and torque expressions give a good prediction within the present parameter space $\{\textit{Re}, \beta , \theta , N\}$.
The global diffusion of state power has led to a decline in global governance; that is, in the attempt to build authoritative rules and institutions that represent the common goals of the international community. The rise of China and other powers has increased the heterogeneity of the international system, and the erstwhile hegemon has turned against the international order. The major powers today have vastly different domestic characteristics and pursue strongly divergent interests. This has gridlocked and marginalized multilateral organizations such as the United Nations and World Trade Organization and seen a worrying disregard for international law. In response, the institutional ecosystem of global governance is adapting by lowering its scope, weakening its commitments, and splintering into partly competing institutional orders. Adaptation and decline are not mutually exclusive: Today, we can witness the adaptation of global governance to its own decline. Theoretically, this points to the enduring relevance of hegemonic stability theory for global governance. The result is a reduced normative ambition for global governance, signaling a retreat from the grand internationalist vision of organized cooperation among all the members of the international community.
Successful implementation of patient engagement (PE) and mHealth could reduce inappropriate catheter use and Catheter-associated urinary tract infections (CAUTIs). Insight into patient acceptance, impact on PE and quality of care, potential barriers and facilitators to the implementation of an mHealth intervention could improve the impact of both current and future infection prevention programs.
Methods:
Implementation of the smartphone app “Participatient” was evaluated in four Dutch hospitals. Patient questionnaires assessed the acceptability of the app and its impact. Healthcare professionals (HCPs) were interviewed to evaluate the implementation process.
Results:
Acceptability constructs were evaluated positively. PE and quality of care were rated high before and after implementation. All 22 HCPs perceived barriers, eg incomplete training for HCPs and unclear communication on roles; and lack of promotion by ward professionals. The principal facilitator was the HCPs’ positive attitude toward PE.
Conclusions:
App users perceived the Participatient app as acceptable, which fulfills a precondition for implementation. The implementation strategy evaluated in the present study was designed to fulfill all the conditions considered crucial for implementation. Nevertheless, the level of adoption remained low, and HCPs still imputed their failure to promote the use of the app to insufficiencies in training and communication and to a misfit between the app and their existing workflow. These findings underscore the need to verify whether there may be additional, less evident barriers to the adoption of mHealth tools that support PE in general, and more specifically, to the adoption of Participatient to engage patients in preventing CAUTIs.
A patient with Kabuki syndrome and a parachute mitral valve was referred for mitral stenosis. Echocardiography indicated right ventricular dilatation and a suspected vertical ascending vein. Cardiac CT confirmed dual drainage of the left upper pulmonary vein and hemiazygos vein continuity. Despite echocardiographic limitations, surgery was performed. This rare case is reported due to its unique anatomical variation.
We prove that every $\Sigma ^0_2$ Gale-Stewart game can be won via a winning strategy $\tau $ which is $\Delta _1$-definable over $L_{\delta }$, the $\delta $th stage of Gödel’s constructible universe, where $\delta = \delta _{\sigma ^1_1}$, strengthening a theorem of Solovay from the 1970s. Moreover, the bound is sharp in the sense that there is a $\Sigma ^0_2$ game with no strategy $\tau $ which is witnessed to be winning by an element of $L_{\delta }$.
Although workplace mental health screening is often implemented to aid early identification of mental health symptoms and facilitate access to treatment, supporting evidence is limited.
Aims
We aimed to evaluate the effect of independently conducted, confidential, online mental health screening, paired with automated tailored feedback recommending referral services, on help-seeking and psychological distress.
Method
We conducted a cluster-randomised controlled trial with firefighters from an Australian fire and rescue service. Randomisation occurred by station (N = 264). Firefighters at stations allocated to the intervention group received tailored information detailing suitable mental health services based on their Kessler-6 psychological distress score (K6). The control group received generic feedback on services irrespective of K6 score. The primary outcome was help-seeking at 3-months post-intervention for those with at least moderate levels of psychological distress at baseline (K6 ≥14). The study was registered with Australian New Zealand Clinical Trials Registry (no. ANZCTR 12621001457831).
Results
Of the 459 firefighters screened, 141 (30.72%) scored ≥14 on K6. Among this subgroup at 3 months, no differences were observed in rates of overall help-seeking between the intervention and control groups (P = 0.31). In contrast, levels of psychological distress remained high in the intervention group but declined in the control group (t[111] = 2.29, 95% CI: 0.24, 3.23, P = 0.024). The difference in psychological distress associated with workplace mental health screening equated to an effect size of −0.42 (95% CI: −0.04, −0.79).
Conclusions
Our findings suggest that independent, confidential online mental health screening, paired with tailored online feedback and information on available treatment, does not significantly increase help-seeking and may sustain psychological distress over time compared with receiving generic information. As such, it should not be implemented to promote help-seeking and reduce levels of psychological distress. These findings are relevant for workplaces, mental health researchers and practitioners alike, highlighting the potential risk and potential harm of mental health screening conducted in this way on individuals.
Between the fifth and first century BC, calendars that compiled astronomical and meteorological information, known as parapēgmata, came to be used throughout the Greek-speaking world. In the course of the Hellenistic period, numerous such almanacs attributed to scientific authorities who operated in different regions were circulating, some of which emphasized distinct atmospheric phenomena. By ca. 100 BC at the latest, individuals and communities began combining astrometeorological parapēgmata to produce their own, including inscribed public versions. I argue that politically active citizens and doctors would have benefited from the use of these calendars within the context of the Hellenistic polis because weather was believed to have a direct impact on the collective food supply and health of communities and such documents were perceived as an invaluable tool for anticipating important atmospheric changes, determining when meteorological thresholds were crossed and building consensus for communal action taken in response.