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In line with recent studies revealing the role of neoliberalism in Dutch post-war history, this article highlights the influence of neoliberal ideas during the first half of the 1970s. In addition to a clear orientation towards supply-side economic policies and a firm tradition of fixed budgetary rules, the author emphasises the importance of Dutch monetarism in guiding Central Bank policies and prioritising monetary objectives such as price stability, fixed exchange rates and balance of payment equilibrium over Keynesian policy goals. A short-lived Keynesian intermezzo of countercyclical demand-management commenced in March 1974, after which rules-based, stability- and supply-side economic, financial and monetary policies started to regain the upper hand in 1976.
On August 1, 2022, the Grand Chamber of the Court of Justice of the European Union (Court of Justice) published its judgment on the joined cases of Sea Watch eV against the Italian Ministero delle Infrastrutture e dei Transporti, the Capitaneria (Harbor Master's Office) di Porto di Palermo, and the Capitaneria di Porto di Porto Empedocle. The Court of Justice's judgment clarifies EU law regarding the additional inspection and detention of a private humanitarian assistance ship. A port state must make a reasonable and justified decision to conduct additional inspections or to detain a ship. The port state must base its decision on serious indications of dangerous operation. However, interpreting the EU law alongside the United Nations Convention on the Law of the Sea (UNCLOS) and the International Convention for Safety of Life at Sea (SOLAS), the Court of Justice held that a port state cannot justify such additional inspections solely based on an excess of passengers beyond a ship's classification or certifications when that ship is rendering assistance to rescued individuals.
To conduct feasibility and cost analysis of portable MRI implementation in a remote setting where MRI access is otherwise unavailable.
Methods:
Portable MRI (ultra-low field, 0.064T) was installed in Weeneebayko General Hospital, Moose Factory, Ontario. Adult patients, presenting with any indication for neuroimaging, were eligible for study inclusion. Scanning period was from November 14, 2021, to September 6, 2022. Images were sent via a secure PACS network for Neuroradiologist interpretation, available 24/7. Clinical indications, image quality, and report turnaround time were recorded. A cost analysis was conducted from a healthcare system’s perspective in 2022 Canadian dollars, comparing cost of portable MRI implementation to transporting patients to a center with fixed MRI.
Results:
Portable MRI was successfully implemented in a remote Canadian location. Twenty-five patients received a portable MRI scan. All studies were of diagnostic quality. No clinically significant pathologies were identified on any of the studies. However, based on clinical presentation and limitations of portable MRI resolution, it is estimated that 11 (44%) of patients would require transfer to a center with fixed MRI for further imaging workup. Cost savings were $854,841 based on 50 patients receiving portable MRI over 1 year. Five-year budget impact analysis showed nearly $8 million dollars saved.
Conclusions:
Portable MRI implementation in a remote setting is feasible, with significant cost savings compared to fixed MRI. This study may serve as a model to democratize MRI access, offer timely care and improved triaging in remote areas where conventional MRI is unavailable.
Inspired by a twist map theorem of Mather. we study recurrent invariant sets that are ordered like rigid rotation under the action of the lift of a bimodal circle map g to the k-fold cover. For each irrational in the rotation set’s interior, the collection of the k-fold ordered semi-Denjoy minimal sets with that rotation number contains a $(k-1)$-dimensional ball with the weak topology on their unique invariant measures. We also describe completely their periodic orbit analogs for rational rotation numbers. The main tool used is a generalization of a construction of Hedlund and Morse that generates symbolic analogs of these k-fold well-ordered invariant sets.
The National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC) lacks a rigorous enrollment audit process, unlike other collaborative networks. Most centers require individual families to consent to participate. It is unknown whether there is variation across centers or biases in enrollment.
Methods:
We used the Pediatric Cardiac Critical Care Consortium (PC4) registry to assess enrollment rates in NPC-QIC for those centers participating in both registries using indirect identifiers (date of birth, date of admission, gender, and center) to match patient records. All infants born 1/1/2018–12/31/2020 and admitted 30 days of life were eligible. In PC4, all infants with a fundamental diagnosis of hypoplastic left heart or variant or who underwent a surgical or hybrid Norwood or variant were eligible. Standard descriptive statistics were used to describe the cohort and center match rates were plotted on a funnel chart.
Results:
Of 898 eligible NPC-QIC patients, 841 were linked to 1,114 eligible PC4 patients (match rate 75.5%) in 32 centers. Match rates were lower in patients of Hispanic/Latino ethnicity (66.1%, p = 0.005), and those with any specified chromosomal abnormality (57.4%, p = 0.002), noncardiac abnormality (67.8%, p = 0.005), or any specified syndrome (66.5%, p = 0.001). Match rates were lower for patients who transferred to another hospital or died prior to discharge. Match rates varied from 0 to 100% across centers.
Conclusions:
It is feasible to match patients between the NPC-QIC and PC4 registries. Variation in match rates suggests opportunities for improvement in NPC-QIC patient enrollment.
Resilience promotes positive adaptation to challenges and may facilitate recovery for adolescents experiencing psychopathology. This work examined concordance across the experience, expression, and physiological response to stress as a protective factor that may predict longitudinal patterns of psychopathology and well-being that mark resilience. Adolescents aged 14–17 at recruitment (oversampled for histories of non-suicidal self-injury; NSSI) were part of a three-wave (T1, T2, T3) longitudinal study. Multi-trajectory modeling produced four distinct profiles of stress experience, expression, and physiology at T1 (High-High-High, Low-Low-Low, High-Low-Moderate, and High-High-Low, respectively). Linear mixed-effect regressions modeled whether the profiles predicted depressive symptoms, suicide ideation, NSSI engagement, positive affect, satisfaction with life, and self-worth over time. Broadly, concordant stress response profiles (Low-Low-Low, High-High-High) were associated with resilient-like patterns of psychopathology and well-being over time. Adolescents with a concordant High-High-High stress response profile showed a trend of greater reduction in depressive symptoms (B = 0.71, p = 0.052), as well as increased global self-worth (B = –0.88, p = 0.055), from T2 to T3 compared to the discordant High-High-Low profile. Concordance across multi-level stress responses may be protective and promote future resilience, whereas blunted physiological responses in the presence of high perceived and expressed stress may indicate poorer outcomes over time.
Darwin's Doubt (DD) – a thesis according to which the probability of the human cognitive mechanism's reliability given non-guided evolution is low – is central to Plantinga's Evolutionary Argument Against Naturalism and his suggestion that the adoption of guided evolution thesis is preferable from a theory choice point of view. In this article I'll argue that there are three fundamental failures in Plantinga's argument. First, I argue that Plantinga's argument for DD is question-begging. Second, I point out that this very same argument is not in accordance with the way the evolutionary scientists usually reason. And finally I argue that the replacement of non-guided by guided evolution violates some reasonable belief-revision procedures in the history of science.
Type A3 truncus arteriosus describes pulmonary atresia with non-confluent mediastinal pulmonary arteries in which one pulmonary artery arises from a patent ductus arteriosus and the contralateral pulmonary artery from the aorta resulting in ductal dependent pulmonary blood flow. We describe a premature neonate with caudal regression syndrome and type A3 truncus arteriosus who was palliated with a ductal stent allowing completion of a prolonged neonatal ICU hospitalisation for multiple comorbidities.
This article examines Sikh conceptualizations about death and immortality, focusing on several thematic lines of inquiry drawn from the utterances of the Sikh Gurus (gurbāṇī): (i) ordinary or empirical death; (ii) deathless states; (iii) after death? (iv) this life; (v) personhood and the (non-)existence of God. These themes address philosophical issues related to concerns about fear of death, belief in an afterlife, as well as its implications for the nature of self and the concept of God in Sikhism. At the same time, however, the article complicates our understanding of these topics by resituating them within discussions of time and time-consciousness, thereby highlighting the need for a form of logic more conducive to the understanding of death and immortality in Sikh thought.
This study investigated the association between early extubation (EE) and the degree of postoperative intensive care unit (ICU) support after the Fontan procedure, specifically evaluating the volume of postoperative intravenous fluid (IVF) and vasoactive-inotropic score (VIS).
Methods:
Retrospective analysis of patients who underwent Fontan palliation from 2008 to 2018 at a single center was completed. Patients were initially divided into pre-institutional initiative towards EE (control) and post-initiative (modern) cohorts. Differences between the cohorts were assessed using t-test, Wilcoxon, or chi-Square. Following stratification by early or late extubation, four groups were compared via ANOVA or Kruskal-Wallis Test.
Results:
There was a significant difference in the rate of EE between the control and modern cohorts (mean 42.6 versus 75.7%, p = 0.01). The modern cohort demonstrated lower median VIS (5 versus 8, p = 0.002), but higher total mean IVF (101±42 versus 82 ±27 cc/kg, p < 0.001) versus control cohort. Late extubated (LE) patients in the modern cohort had the highest VIS and IVF requirements. This group received 67% more IVF (140 ± 53 versus 84 ± 26 cc/kg, p < 0.001) and had a higher median VIS at 24 hours (10 (IQR, 5–10) versus 4 (IQR, 2–7), p < 0.001) versus all other groups. In comparison, all EE patients had a 5-point lower median VIS when compared to LE patients (3 versus 8, p= 0.001).
Conclusions:
EE following the Fontan procedure is associated with reduced post-operative VIS. LE patients in the modern cohort received more IVF, potentially identifying a high-risk subgroup of Fontan patients deserving of further investigation.
The Stop the Bleed course aims to improve bystander hemorrhage control skills and may be improved with point-of-care aids. We sought to create and examine a variety of cognitive aids to identify an optimal method to augment bystander hemorrhage control skills in an emergency scenario.
Methods:
Randomized trial of 346 college students. Effects of a visual or visual-audio aid on hemorrhage control skills were assessed through randomization into groups with and without prior training or familiarization with aids compared with controls. Tourniquet placement, wound packing skills, and participant comfortability were assessed during a simulated active shooter scenario.
Results:
A total of 325 (94%) participants were included in the final analyses. Participants who had attended training (odds ratio [OR], 12.67; P = 9.3 × 10−11), were provided a visual-audio aid (OR, 1.96; P = 0.04), and were primed on their aid (OR, 2.23; P = 0.01) were superior in tourniquet placement with less errors (P < 0.05). Using an aid did not improve wound packing scores compared with bleeding control training alone (P > 0.05). Aid use improved comfortability and likelihood to intervene emergency hemorrhage scenarios (P < 0.05).
Conclusions:
Using cognitive aids can improve bystander hemorrhage control skills with the strongest effects if they were previously trained and used an aid which combined visual and audio feedback that they were previously introduced to during the course training.
The propagation of a finite blister of fluid beneath an elastic sheet is controlled by the local dynamics at the peeling periphery of the current. Previous works have described constant volume elastic blisters by considering the peeling due to curvature at these edges. Here, we show that an along-slope component of gravity fundamentally changes the dynamics by removing the role of curvature at the trailing, upslope edge. The local dynamics of this trailing edge is instead controlled by shear stress in the sheet, as in the elastic Landau–Levich problem, and thereby allows for a receding edge, in contrast to propagation by peeling for which only an advancing contact line is possible. Using an asymptotic analysis, we show that this receding edge condition allows for a new, nearly translating regime in which the body of the blister moves at an approximately constant speed, leaving behind a thin layer of fluid. This prediction is verified by detailed numerical modelling of the two-dimensional downslope spreading. We conclude by discussing the applicability of these results in the rapid spreading of subglacial meltwater.
Enteral feeding prior to cardiac surgery has benefits in pre-operative and post-operative patient statuses. In 2020, to increase pre-operative feeding for single-ventricle patients prior to stage 1 palliation, an enteral feeding algorithm was created. The aim of this study is to monitor the impact of our practice change with the primary outcome of necrotising enterocolitis incidence from birth to 2 weeks following surgical intervention.
Methods:
This is a single-site, retrospective cohort study including patients from 1 March, 2018 to 1 July, 2022. Variables assessed include demographics, age at cardiac surgery, primary cardiac diagnosis, necrotising enterocolitis pre-operative and 2 weeks post-operative cardiac surgery, feeding route, feeding type, volume of trophic enteral feeds, and near-infrared spectroscopy.
Results:
Following implementation of a pre-operative enteral feeding algorithm, the rate of neonates fed prior to surgery increased (39.5–75%, p = .001). The feedings included a mean volume of 28.24 ± 11.16 ml/kg/day, 83% fed breastmilk only, 44.4% tube fed, and 55.5% of infants had all oral feedings. Comparing enterally fed neonates and those not enterally fed, the necrotising enterocolitis incidence from birth to 2 weeks post-op was not significantly increased (p = 0.926).
Conclusion:
As a result of implementing our feeding algorithm, the frequency of infants fed prior to stage I Norwood or Hybrid surgeries increased to 75%, and there was no significant change in the incidence of necrotising enterocolitis. This study confirmed that pre-operative enteral feeds are safe and are not associated with increased incidence of necrotising enterocolitis.
Logical frameworks that are sensitive to features of sentences’ subject-matter—like Berto’s topic-sensitive intentional modals (TSIMs)—demand a maximally faithful model of the topics of sentences. This is an especially difficult task in the case in which topics are assigned to intensional formulae. In two previous papers, a framework was developed whose model of intensional subject-matter could accommodate a wider range of intuitions about particular intensional conditionals. Although resolving a number of counterintuitive features, the work made an implicit assumption that the subject-matter of an intensional conditional is a function of the subject-matters of its subformulae. This assumption—which I will call a principle of topic sufficiency—runs counter to some natural intuitions concerning topic. In this paper, we will investigate topic sufficiency and offer a semantic account that is state-sensitive, providing an implementation through the introduction of topic-sensitive logics related to William Parry’s prototypical $\mathsf {PAI}$.
I argue that Grim's diagonalization argument against the possibility of omniscience is not sound by arguing that the properties of being a proposition or a truth are not legitimate sortal properties. Thus, the fact that there can be no set corresponding to the extension of these properties does not imply that there is no completed totality of the things possessing it. First, I demonstrate that a correspondence theory of truth implies that propositions are non-linguistic representations of a type that resist determinate and uniform individuation into units and allow for arbitrary division into parts that are also propositions. The property is, therefore, an abstract mass property with no determinate cardinality of individuals that possess it. I then sketch a new theory of omniscience with this as its basis.
We first introduce the concept of weak random periodic solutions of random dynamical systems. Then, we discuss the existence of such periodic solutions. Further, we introduce the definition of weak random periodic measures and study their relationship with weak random periodic solutions. In particular, we establish the existence of invariant measures of random dynamical systems by virtue of their weak random periodic solutions. We use concrete examples to illustrate the weak random periodic phenomena of dynamical systems induced by random and stochastic differential equations.