We report a case of hypoplastic left heart syndrome and with subsequent aortopathy and then found to have hereditary haemorrhagic telangiectasia/juvenile polyposis syndrome due to a germline SMAD4 pathologic variant. The patient’s staged palliation was complicated by the development of neoaortic aneurysms, arteriovenous malformations, and gastrointestinal bleeding thought to be secondary to Fontan circulation, but workup revealed a SMAD4 variant consistent with hereditary haemorrhagic telangiectasia/juvenile polyposis syndrome. This case underscores the importance of genetic modifiers in CHD, especially those with Fontan physiology.

What impact do local candidates have on elections in single member district plurality electoral systems? We provide new evidence using data from a large election study carried out during the 2015 Canadian federal election. We improve on the measurement of local candidate effects by asking over 20,000 survey respondents to rate the candidates in their constituency directly. We present three estimates. We find that when all voters are considered together, local candidate evaluations are decisive for approximately 4 per cent of voters. Second, these evaluations are decisive for the outcome of 10 per cent of constituency contests. Third, when models are estimated for each constituency, we find significant evaluation effects for 14 per cent of candidates.

High-fidelity simulation (HFS) is a relatively new teaching modality, which is gaining widespread acceptance in medical education. To date, dozens of studies have proven the usefulness of HFS in improving student, resident, and attending physician performance, with similar results in the allied health fields. Although many studies have analyzed the utility of simulation, few have investigated why it works. A recent study illustrated that permissive failure, leading to simulated mortality, is one HFS method that can improve long-term performance. Critics maintain, however, that the use of simulated death is troubling and excessive. Given the controversy regarding simulated death, we consider the data about the educational value and the emotional harms associated with them, expecting that evidence could be useful in resolving the question. The goal of this narrative review is to explore the argument against simulated mortality and provide educators with an imperative as to why it can be safely utilized.

The rate of methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing in neonatal intensive care units. We determined the economic impact of isolating and cohorting MRSA-colonized neonates on total hospital cost at a 49-bed, level III-IV neonatal intensive care unit.

This paper describes a method for finding the least fixed points of higher-order functions over finite domains using symbolic manipulation. Fixed point finding is an essential component in the calculation of abstract semantics of functional programs, providing the foundation for program analyses based on abstract interpretation. Previous methods for fixed point finding have primarily used semantic approaches, which often must traverse large portions of the semantic domain even for simple programs. This paper provides the theoretical framework for a syntax-based analysis that is potentially very fast. The proposed syntactic method is based on an augmented simply typed lambda calculus where the symbolic representation of each function produced in the fixed point iteration is transformed to a syntactic normal form. Normal forms resulting from successive iterations are then compared syntactically to determine their ordering in the semantic domain, and to decide whether a fixed point has been reached. We show the method to be sound, complete and compositional. Examples are presented to show how this method can be used to perform strictness analysis for higher-order functions over non-flat domains. Our method is compositional in the sense that the strictness property of an expression can be easily calculated from those of its sub-expressions. This is contrary to most strictness analysers, where the strictness property of an expression has to be computed anew whenever one of its subexpressions changes. We also compare our approach with recent developments in strictness analysis.

Psychiatry is one of six major subjects examined in Finals, the others being medicine, surgery, obstetrics and gynaecology, paediatrics and community medicine. One of the main aims of our teaching is to help students to appreciate the importance of psychological factors in the diagnosis and treatment of all illness, and to realise that attention to a patient's psychological adjustment may be important even where physical illness is paramount.