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Interprofessional teams in the pediatric cardiac ICU consolidate their management plans in pre-family meeting huddles, a process that affects the course of family meetings but often lacks optimal communication and teamwork.
Methods:
Cardiac ICU clinicians participated in an interprofessional intervention to improve how they prepared for and conducted family meetings. We conducted a pretest–posttest study with clinicians participating in huddles before family meetings. We assessed feasibility of clinician enrollment, assessed clinician perception of acceptability of the intervention via questionnaire and semi-structured interviews, and impact on team performance using a validated tool. Wilcoxon rank sum test assessed intervention impact on team performance at meeting level comparing pre- and post-intervention data.
Results:
Totally, 24 clinicians enrolled in the intervention (92% retention) with 100% completion of training. All participants recommend cardiac ICU Teams and Loved ones Communicating to others and 96% believe it improved their participation in family meetings. We exceeded an acceptable level of protocol fidelity (>75%). Team performance was significantly (p < 0.001) higher in post-intervention huddles (n = 30) than in pre-intervention (n = 28) in all domains. Median comparisons: Team structure [2 vs. 5], Leadership [3 vs. 5], Situation Monitoring [3 vs. 5], Mutual Support [ 3 vs. 5], and Communication [3 vs. 5].
Conclusion:
Implementing an interprofessional team intervention to improve team performance in pre-family meeting huddles is feasible, acceptable, and improves team function. Future research should further assess impact on clinicians, patients, and families.
Relatively, recent work by Jeganathan (2008, Cowles Foundation Discussion Paper 1649) and Wang (2014, Econometric Theory, 30(3), 509–535) on generalized martingale central limit theorems (MCLTs) implicitly introduces a new class of instrument arrays that yield (mixed) Gaussian limit theory irrespective of the persistence level in the data. Motivated by these developments, we propose a new semiparametric method for estimation and inference in nonlinear predictive regressions with persistent predictors. The proposed method that we term chronologically trimmed least squares (CTLS) is comparable to the IVX method of Phillips and Magdalinos (2009, Econometric inference in the vicinity of unity. Mimeo, Singapore Management University) and yields conventional inference in regressions where the nature and extent of persistence in the data are uncertain. In terms of model generality, our contribution to the existing literature is twofold. First, our covariate model space allows for both nearly integrated (NI) and fractional processes (stationary and nonstationary) as a special case, while the vast majority of articles in this area only consider NI arrays. Second, we allow for nonlinear regression functions. The CTLS estimator is obtained by applying certain chronological trimming to the OLS instruments using appropriate kernel functions of time trend variables. In particular, the instruments under consideration are a generalized (averaged) version of those widely used for time-varying parameter (TVP) models. For the purposes of our analysis, we develop a novel asymptotic theory for sample averages of various processes weighted by such kernel functionals which is of independent interest and highly relevant to the TVP literature. Leveraging our nonlinear framework, we also provide an investigation on the effects of misbalancing on the predictability hypothesis. A new methodology is proposed to mitigate misbalancing effects. These methods are used for exploring the predictability of SP500 returns.
The passage into law of the Economic Crime and Corporate Transparency Act 2023 (ECCTA 2023) marks the first time that Parliament has made significant changes to the common law principles of corporate criminal liability. First, for fault-based crimes, the ECCTA 2023 extends the common law practice of identifying a company with the criminal acts of its directors. By virtue of section 196 of the Act, a company may now also be identified with fault-based criminal acts engaged in by its ‘senior managers’ below directorial level. Secondly, the ECCTA 2023 creates a new corporate offence of failing to prevent fraud, although this may be committed only by so-called ‘large organisations’. I argue that the first of these reforms was not properly thought through, and that it should in any event have been made largely redundant by giving wider scope to the second of these reforms. An opportunity was missed in the ECCTA 2023 to make a failure-to-prevent serious crime a more generally applicable principle of corporate criminal liability.
For fixed $0<r<1$, let $A_r=\{z \in \mathbb {C} : r<|z|<1\}$ be the annulus with boundary $\partial \overline {A}_r=\mathbb {T} \cup r\mathbb {T}$, where $\mathbb T$ is the unit circle in the complex plane $\mathbb C$. An operator having $\overline {A}_r$ as a spectral set is called an $A_r$-contraction. Also, a normal operator with its spectrum lying in the boundary $\partial \overline {A}_r$ is called an $A_r$-unitary. The $C_{1,r}$class was introduced by Bello and Yakubovich in the following way:
McCullough and Pascoe defined the quantum annulus$\mathbb Q \mathbb A_r$ by
$$\begin{align*}\mathbb Q\mathbb A_r = \{T \,:\, T \text{ is invertible and } \, \|rT\|, \|rT^{-1}\| \leq 1 \}. \end{align*}$$
If $\mathcal A_r$ denotes the set of all $A_r$-contractions, then $\mathcal A_r \subsetneq C_{1,r} \subsetneq \mathbb Q \mathbb A_r$. We first find a model for an operator in $C_{1,r}$ and also characterize the operators in $C_{1,r}$ in several different ways. We prove that the classes $C_{1,r}$ and $\mathbb Q\mathbb A_r$ are equivalent. Then, via this equivalence, we obtain analogous model and characterizations for an operator in $\mathbb Q \mathbb A_r$.
Patent ductal arteriosus stenting is an alternative procedure in patients with pulmonary-ductal-dependent circulation. Stent embolization is one of the major acute complications of ductal stenting procedure. We describe the case of a stent embolization into the abdominal aorta during the deployment of ductal stent in a premature low-weight infant (1.850 kg), affected by critical pulmonary stenosis and duct-dependent pulmonary circulation. The stent was successfully retrieved through a 4F Flexor catheter without vascular complication by using a new approach.
This article focuses on the problem of the categorization of the adverb sans doute as an epistemico-modal marker or an evidential marker. Starting from a critical appraisal of an analysis proposed by Bourmayan et Ashino, in which sans doute is considered fundamentally epistemico-modal, three hypotheses are presented, which depart from theirs. First, sans doute has as its main lexical element an inferential evidential value: it signals that the content qualified by the adverb is the result of a defeasible type of inference from clues/premises. Second, due to the defeasibility of the inference, the statement containing the adverb takes on, invariably, a pragmatic value of non-certainty, not lexically coded, however. Sans doute is thus not an epistemico-modal marker by itself in contemporary French. Third, the adverb combines these values with an epistemic value of what we call “posture of certainty”. Different from epistemic modality, which refers to an evaluation in terms of certainty, and/or to the epistemic cognitive state linked to that, posture of certainty refers to what can be called the tone or epistemic behavior of confidence the speaker shows. Sans doute therefore indicates without contradiction, a defeasible and, thus, uncertain hypothesis, presented with a tone of full confidence.
How do sociolegal scholars who liken monetary sanctions to “bleeding a turnip” or “drawing blood from stones” reconcile these idioms with the fact that fines and fees constitute a growth industry? We take up this puzzle by turning our attention to perhaps the most relatable experience with monetary sanctions among the population: parking tickets. Much of the available law and society literature on fines and fees documents how these sanctions disproportionately impact communities subjugated by race and class. Because parking tickets are adjudicated within a legal domain so fundamentally different from fines and fees that dominate the academic focus, we ask whether these insights extend outside criminal counts to municipal ones. Using Chicago as a case study, our inquiry measures the structural determinants of 11.3 million tickets issued between 2013 and 2017. We use a series of count models to predict the incidence rates of tickets at the tract level as well as how many were subject to reprimands for nonpayment. What we find are disparate patterns of racialization in terms of who is targeted by these sanctions versus who is devastated by them. We synthesize key ideas from empirical critical race theory and developing work on predation theory to make sense of these findings.
The article analyses how Russian state-controlled media adapt narratives across their language versions to speak to specific national audiences. These media support the Kremlin by echoing its strategic narratives in the international arena. Our article stems from the assumption that the media tailor the narratives and do not deliver homogenous news. Texts published since the initial days of the Russian invasion of Ukraine were analyzed from Sputnik Czech Republic, Germany, and Sputnik World, known to spread the Russian regime’s propaganda. The central question was how the Russian regime depicted and explained the invasion of Ukraine in 2022 in the chosen languages. Qualitative coding based on a predefined codebook, modified with codes inductively acquired during the analysis, was used to deeply understand strategic narratives and identify key differences among the Russian regime’s influence campaigns in various national contexts. Some narratives were found to differ based on the national contexts, strengthening the initial assumption. However, analyzed texts also consistently depict Russia as a victim and the West as a threat across the language versions.
Toxocara canis is a widespread parasite of canids with a wide range of paratenic hosts, but also one of the overlooked agents causing nervous system infections of humans. Previous experimental infections of mice demonstrated the impact of high infection doses of larvae on neurobehavioral disorders and pathological changes. In contrast to previous studies, we aimed to investigate the long-term (up to 100 weeks) impact of low- to high-dose infection in mice. We focused on their physical condition, motor skills, and the accompanying pathologies in the brain. Three groups of BALB/c mice were infected with 10, 100, and 1000 T. canis larvae/mouse and specific anti-T. canis excretory-secretory antigens immunoglobulin G antibody response, general condition, and motor skills were tested in defined intervals within 100 weeks after infection. The number of larvae in selected organs was assessed and the pathological changes in the brain were studied histologically. As a result, subtle to severe impairments in general condition and motor skills were detected, with generally earlier onsets occurring the higher the infection dose was. The specific immunoglobulin G antibody levels corresponding to the infection dose were detected in all infected groups. Necrosis, cellular infiltrations, and foamy cells developed in moderate- and high-infection dose mice, in contrast with hemorrhages detected in all groups. This study demonstrated the long-term negative impact of T. canis infection on the paratenic host, particularly at moderate and high infectious doses. Although pathological changes in the brain were observed even in low-infection dose mice, their physical and motor condition was comparable to the control group.
A modeling method of multi-objective optimization design for parallel mechanisms (PMs) is proposed, whose implementation is illustrated with 2RPU-RPS mechanism as an example. The orientation of biased output axis on moving platform is depicted by spherical attitude angles, and its kinematic model is deduced through vector method. With screw theory as mathematic tool, a comprehensive evaluation method of kinematic performance for PM is established. On this basis, the expensive constrained multi-objective optimization model of dimensional parameters for the discussed mechanism is constructed. The NSDE-II algorithm, formed by replacing the genetic algorithm operators in non-dominated sorting genetic algorithm II (NSGA-II) with DE operators, is utilized to solve this multi-objective optimization problem, thus obtaining multiple Pareto optimal solutions with engineering application significance, which proves the feasibility and effectiveness of the proposed modeling method and algorithm. Moreover, the normalization coverage space and the minimum adjacent vector angle are proposed to evaluate the computational performance of NSDE-II. Finally, the potential engineering application value for the optimized 2RPU-RPS PM is presented.
In October 2022, the Church of England commissioned a study of the likely impacts of allowing the blessing or marriage of same-sex couples in church. This paper reports on a survey of key informers (bishops or chief executive officers) in dioceses in the seven provinces of the Anglican Communion that had at that time allowed either same-sex blessings (SSB) or same-sex marriages (SSM). Of 183 provinces or dioceses contacted, 62 (31%) replied to an online survey of which 74% had decided to allow SSB and 55% to allow SSM. While all provinces reported some losses of clergy or congregations, these were not as great as some had expected. Smaller provinces that had made spaces and time for those of differing opinions to meet together tended to report more positive outcomes than those where processes were dominated by synodical debates.
Quantitative analysis using two scales of internal (church-facing) and external (society-facing) impact showed that dioceses that allowed SSM rather than just SSB reported more positive external impact. Those that had allowed SSM reported better internal and external impact compared with those who allowed only SSB or neither. Open answers offered critical reflections highlighting important lessons learnt in the process of making decisions.
Let $E/\mathbb {Q}$ be an elliptic curve and let p be a prime of good supersingular reduction. Attached to E are pairs of Iwasawa invariants $\mu _p^\pm $ and $\lambda _p^\pm $ which encode arithmetic properties of E along the cyclotomic $\mathbb {Z}_p$-extension of $\mathbb {Q}$. A well-known conjecture of B. Perrin-Riou and R. Pollack asserts that $\mu _p^\pm =0$. We provide support for this conjecture by proving that for any $\ell \geq 0$, we have $\mu _p^\pm \leq 1$ for all but finitely many primes p with $\lambda _p^\pm =\ell $. Assuming a recent conjecture of D. Kundu and A. Ray, our result implies that $\mu _p^\pm \leq 1$ holds on a density 1 set of good supersingular primes for E.
This paper initiates the explicit study of face numbers of matroid polytopes and their computation. We prove that, for the large class of split matroid polytopes, their face numbers depend solely on the number of cyclic flats of each rank and size, together with information on the modular pairs of cyclic flats. We provide a formula which allows us to calculate $f$-vectors without the need of taking convex hulls or computing face lattices. We discuss the particular cases of sparse paving matroids and rank two matroids, which are of independent interest due to their appearances in other combinatorial and geometric settings.
Pulmonary valve replacement in small children is rarely needed; when performed, it is usually done surgically. Herein, we describe a hybrid technique for pulmonary valve replacement through a small subxiphoid incision in a Toddler without utilising the cardiopulmonary bypass machine. The procedural technique is thoroughly explained. Collaboration between paediatric cardiology and cardiovascular surgery teams achieved optimal outcome with minimised invasiveness.
We report an uncommon case of tetralogy of Fallot with absent pulmonary valve and extreme right pulmonary artery dilatation in patient with 22q11.2 deletion syndrome.