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Advances in artificial intelligence (AI) have great potential to help address societal challenges that are both collective in nature and present at national or transnational scale. Pressing challenges in healthcare, finance, infrastructure and sustainability, for instance, might all be productively addressed by leveraging and amplifying AI for national-scale collective intelligence. The development and deployment of this kind of AI faces distinctive challenges, both technical and socio-technical. Here, a research strategy for mobilising inter-disciplinary research to address these challenges is detailed and some of the key issues that must be faced are outlined.
In recent issues of the Journal of the Society for Cardiovascular Angiography and Interventions and the Journal of the American College of Cardiology: Cardiovascular Interventions, Holzer and colleagues presented an Expert Consensus Document titled: “PICS / AEPC / APPCS / CSANZ / SCAI / SOLACI: Expert consensus statement on cardiac catheterization for pediatric patients and adults with congenital heart disease.” This Expert Consensus Document is a massively important contribution to the community of paediatric and congenital cardiac care. This document was developed as an Expert Consensus Document by the Pediatric and Congenital Interventional Cardiovascular Society, the Association for European Paediatric and Congenital Cardiology, the Asia-Pacific Pediatric Cardiac Society, the Cardiac Society of Australia and New Zealand, the Society for Cardiovascular Angiography and Interventions, and the Latin American Society of Interventional Cardiology, as well as the Congenital Cardiac Anesthesia Society and the American Association of Physicists in Medicine.
As perfectly stated in the Preamble of this Expert Consensus Document, “This expert consensus document is intended to inform practitioners, payors, hospital administrators and other parties as to the opinion of the aforementioned societies about best practices for cardiac catheterisation and transcatheter management of paediatric and adult patients with congenital heart disease, with added accommodations for resource-limited environments.” And, the fact that the authorship of this Expert Consensus Document includes global representation is notable, commendable, and important.
This Expert Consensus Document has the potential to fill an important gap for this patient population. National guideline documents for specific aspects of interventions in patients with paediatric heart disease, including training guidelines, do exist. However, this current Expert Consensus Document authored by Holzer and colleagues provides truly globally applicable standards on cardiac catheterisation for both paediatric patients and adults with congenital heart disease (CHD).
Our current Editorial provides different regional perspectives from senior physicians dedicated to paediatric and congenital cardiac care who are practicing in Europe, the Asia-Pacific region, Latin America, Australia/New Zealand, and North America. Establishing worldwide standards for cardiac catheterisation laboratories for children and adults with CHD is a significant stride towards improving the quality and consistency of care. These standards should not only reflect the current state of medical knowledge but should also be adaptable to future advancements, ultimately fostering better outcomes and enhancing the lives of individuals affected by CHD worldwide.
Ensuring that these standards are accessible and adaptable across different healthcare settings globally is a critical step. Given the variability in resources and infrastructure globally, the need exists for flexibility and tailoring to implement recommendations.
The potential impact of the Expert Consensus Document and its recommendations is likely significant, but heterogeneity of healthcare systems will pose continuing challenges on healthcare professionals. Indeed, this heterogeneity of healthcare systems will challenge healthcare professionals to finally close the gap between acceptable and ideal in the catheterisation of patients with paediatric and/or congenital heart disease.
Land divisions are ubiquitous features of the British countryside. Field boundaries, enclosures, pit alignments, and other forms of land division have been used to shape and delineate the landscape over thousands of years. While these divisions are critical for understanding economies and subsistence, the organization of tenure and property, social structure and identity, and their histories of use have remained unclear. Here, the authors present the first robust, Bayesian statistical chronology for land division over three millennia within a study region in England. Their innovative approach to investigating long-term change demonstrates the unexpected scale of later ‘prehistoric’ land demarcation, which may correspond to the beginnings of increasing social hierarchy.
Psychotherapy is an overarching term for any type of professional treatment for psychological and physical distress using verbal and nonverbal communication. Talking together, the patient and therapist engage collaboratively to understand the source of a dysfunction or suffering in order to reverse either maladaptive self-regulatory processes or to adapt and develop psychological strengths to cope with pathological conditions, developmental concerns, or trauma. Psychotherapy addresses multiple levels of functioning, including the neurobiology of the brain itself, the perception of the self to itself, the relationship of the self to others, the role of the individual in the social world, and the conceptual frameworks and beliefs that also may affect emotions and behavior.
We present continuous estimates of snow and firn density, layer depth and accumulation from a multi-channel, multi-offset, ground-penetrating radar traverse. Our method uses the electromagnetic velocity, estimated from waveform travel-times measured at common-midpoints between sources and receivers. Previously, common-midpoint radar experiments on ice sheets have been limited to point observations. We completed radar velocity analysis in the upper ~2 m to estimate the surface and average snow density of the Greenland Ice Sheet. We parameterized the Herron and Langway (1980) firn density and age model using the radar-derived snow density, radar-derived surface mass balance (2015–2017) and reanalysis-derived temperature data. We applied structure-oriented filtering to the radar image along constant age horizons and increased the depth at which horizons could be reliably interpreted. We reconstructed the historical instantaneous surface mass balance, which we averaged into annual and multidecadal products along a 78 km traverse for the period 1984–2017. We found good agreement between our physically constrained parameterization and a firn core collected from the dry snow accumulation zone, and gained insights into the spatial correlation of surface snow density.
Existing peer-reviewed literature describing emergency medical technician (EMT) acquisition and transmission of 12-lead electrocardiograms (12L-ECGs), in the absence of a paramedic, is largely limited to feasibility studies.
Study Objective:
The objective of this retrospective observational study was to describe the impact of EMT-acquired 12L-ECGs in Suffolk County, New York (USA), both in terms of the diagnostic quality of the transmitted 12L-ECGs and the number of prehospital percutaneous coronary intervention (PCI)-center notifications made as a result of transmitted 12L-ECGs demonstrating a ST-elevation myocardial infarction (STEMI).
Methods:
A pre-existing database was queried for Emergency Medical Services (EMS) calls on which an EMT acquired a 12L-ECG from program initiation (January 2017) through December 31, 2019. Scanned copies of the 12L-ECGs were requested in order to be reviewed by a blinded emergency physician.
Results:
Of the 665 calls, 99 had no 12L-ECG available within the database. For 543 (96%) of the available 12L-ECGs, the quality was sufficient to diagnose the presence or absence of a STEMI. Eighteen notifications were made to PCI-centers about a concern for STEMI. The median time spent on scene and transporting to the hospital were 18 and 11 minutes, respectively. The median time from PCI-center notification to EMS arrival at the emergency department (ED) was seven minutes (IQR 5-14).
Conclusion:
In the event a cardiac monitor is available, after a limited educational intervention, EMTs are capable of acquiring a diagnostically useful 12L-ECG and transmitting it to a remote medical control physician for interpretation. This allows for prehospital PCI-center activation for a concern of a 12L-ECG with a STEMI, in the event that a paramedic is not available to care for the patient.
According to the stress inoculation hypothesis, successfully navigating life stressors may improve one's ability to cope with subsequent stressors, thereby increasing psychiatric resilience.
Aims
Among individuals with no baseline history of post-traumatic stress disorder (PTSD) and/or major depressive disorder (MDD), to determine whether a history of a stressful life event protected participants against the development of PTSD and/or MDD after a natural disaster.
Method
Analyses utilised data from a multiwave, prospective cohort study of adult Chilean primary care attendees (years 2003–2011; n = 1160). At baseline, participants completed the Composite International Diagnostic Interview (CIDI), a comprehensive psychiatric diagnostic instrument, and the List of Threatening Experiences, a 12-item questionnaire that measures major stressful life events. During the study (2010), the sixth most powerful earthquake on record struck Chile. One year later (2011), the CIDI was re-administered to assess post-disaster PTSD and/or MDD.
Results
Marginal structural logistic regressions indicated that for every one-unit increase in the number of pre-disaster stressors, the odds of developing post-disaster PTSD or MDD increased (OR = 1.21, 95% CI 1.08–1.37, and OR = 1.16, 95% CI 1.06–1.27 respectively). When categorising pre-disaster stressors, individuals with four or more stressors (compared with no stressors) had higher odds of developing post-disaster PTSD (OR = 2.77, 95% CI 1.52–5.04), and a dose–response relationship between pre-disaster stressors and post-disaster MDD was found.
Conclusions
In contrast to the stress inoculation hypothesis, results indicated that experiencing multiple stressors increased the vulnerability to developing PTSD and/or MDD after a natural disaster. Increased knowledge regarding the individual variations of these disorders is essential to inform targeted mental health interventions after a natural disaster, especially in under-studied populations.
Interpretive and biographical essays by a major authority on Bach and Mozart probe for clues to the driving forces and experiences that shaped the character and the extraordinary artistic achievements of these iconic composers.
Cardiac Fibromas are primary cardiac tumours more common in children than in adults. Surgical intervention is often not required except in the case of limited cardiac output or significant arrhythmia burden. We present a symptomatic 3-month-old infant who had successful surgical intervention for a giant right ventricle fibroma found on prenatal imaging.
When Mozart died at 12:55 on the morning of December 5, 1791, the score of the Requiem lay unfinished on his desk. In addition, the torsos of over 150 further unfinished works were scattered in his Vienna apartment. Some were the briefest jottings; others represented substantial portions of incipient masterpieces. Among them one finds virtually every musical genre of the late eighteenth century: composi-tions for the church, German and Italian operas, concert arias, Lieder, symphonies, chamber music, concertos, sonatas, and pieces for a colorful variety of instrumental combinations and soloists. Many of these works would certainly have been com-pleted had Mozart lived longer.
Mozart's remarkably long list of unfinished works reflects the poignant fact that his life itself was unfinished—cut off at the height of his powers at the age of not quite thirty-six. It is hard to disagree with the common view that Mozart's early death was probably the most tragic single event in the history of music. And it is understandable that music lovers in their more morbid and whimsical moments wonder: What if he had lived longer? For obvious reasons scholars and biographers are less likely to permit themselves to entertain speculations on a question of this kind. But what if one were to take the question seriously for a moment? Doing so not only has its idle fascination but also its share of surprises and ironies.
To get things started, let us first consider another intriguing hypothetical proposi-tion—in fact the exact converse of our chosen question—namely, what if Mozart had died even earlier, say, when he was Franz Schubert's age? Here there is no need for speculation. Franz Schubert (January 31, 1797, to November 19, 1828) died two months before his thirty-second birthday. If Mozart had died at Schubert's age, he would have departed this world in November 1787. His last work would have been Don Giovanni, K. 527, completed October 28, 1787. This means that the last hundred-plus compositions listed in the Köchel catalog would never have been writ-ten: among them the operas Così fan tutte, La clemenza di Tito, and Die Zauberflöte, and also the Clarinet Quintet, the Clarinet Concerto, the last two piano concertos, the “Prussian” string quartets, the last three symphonies, and, of course, all of the Requiem.
Johann Sebastian Bach and Wolfgang Amadeus Mozart represent the antipodes of eighteenth-century musical genius. According to the traditional view, Bach's music was the culmination of the so-called Baroque era during the first half of the century; Mozart's, conversely, was the culmination of the antithetical Classical style, during the second half. The antithesis is not just a technical matter of the contrast between the late Baroque and high Classical styles. It extends into their personal lives as well. We know almost nothing about Bach's private life; we know almost too much about Mozart's. Bach was an orphan; Mozart was all-too-much the son of an autocratic father. Bach was the product of the Lutheran tradition of northern Germany. Mozart was born into the Catholic tradition of Austria; but he clearly belonged even more to the secular, aesthetic, tradition that had its origins in Renaissance Italy. These starkly contrasting personal backgrounds inevitably affected their existential values: their understanding of their “purpose in life,” their artistic missions. This understanding, in turn, inevitably touched on the purpose and, ultimately, the meaning of their music. Why did Bach and Mozart bother to compose at all? What did the effort and the resulting work mean to them? What were their fundamental objectives as artists?
I should like to begin exploring these issues somewhat indirectly. Rather than talking immediately about Bach or about Mozart, let us consider Mozart's Bach—a matter we shall consider even more extensively in chapter 14. As it turns out, Mozart instinctively understood a great deal about the creative impulse informing the music of Bach. In April of 1789, on the occasion of his visit to Leipzig (and his perfor-mance on the organ of the Thomaskirche—Bach's own organ), Mozart experienced a close encounter of the revelatory kind with the church music of J. S. Bach. The event was recorded by Friedrich Rochlitz (1769–1842), a pupil at the Thomasschule at the time of Mozart's visit, and later the founding editor of the influential Leipzig journal Allgemeine Musikalische Zeitung. Rochlitz writes:
On the initiative of the late [Johann Friedrich] Doles, then Kantor of the Thomas-Schule, the choir surprised Mozart with a performance of the double-chorus motet, Singet dem Herrn ein neues Lied [BWV 225], by Sebastian Bach…. Hardly had the choir sung a few measures when Mozart sat up startled; a few measures more and he called out: “What is this?”
During his lifetime, and for sometime thereafter, Bach was a contemporary com-poser. That means, among other things, that he had not yet acquired the status of immortality and was not beyond criticism. In the year 1737, at the very pin-nacle of his career, and only six months after having been conferred the lofty title of “Composer to the Court Chapel of His Royal Majesty in Poland” (Compositeur bey der Königlichen HofCapelle), Bach was taken severely to task, in print, by his former pupil, Johann Adolph Scheibe (1708–76), in the following terms:
This great man would be the admiration of whole nations if [his music] had more charm, if he did not take away the natural element in his pieces by giving them a turgid and confused style, and if he did not darken their beauty by an excess of art…. He demands that singers and instrumentalists should be able to do with their throats and instruments whatever he can play on the clavier…. Every ornament, every little grace … he expresses completely in notes; and this not only takes away from his pieces the beauty of harmony but completely covers the melody throughout. All the voices must work with each other and be of equal difficulty, and none of them can be recognized as the principal voice…. Turgidity has led [him] from the natural to the artificial, from the lofty to the somber; one admires the onerous labor and uncommon effort—which, however, are vainly employed, since they conflict with Nature.
Scheibe's critique, of course, is one of the most famous documents of its kind in the history of music, not least because it was far more than simply one man's opin-ion. It was also an ideological manifesto to which we shall return in due course.
Bach himself was by no means unaware of the unusual difficulty his music posed. Referring to his church compositions in an official document written less than a year before Scheibe's attack, Bach described them as “incomparably more difficult and more intricate” (ohngleich schwerer und intricater) than those by other composers.
In his provocative essay, “Carl Philipp Emanuel Bach and the Aesthetics of Patricide,” Richard Kramer remarks, “Everywhere, Emanuel felt the need to speak of his father. In his music, he fails to do so. The patrimony is not acknowledged there.” Kramer demonstrates this in a perceptive analysis of one of Emanuel's challenging keyboard compositions, the Sonata in C Major, H. 248 (1775).
Coping with that patrimony could not have been a picnic for the male offspring of Johann Sebastian Bach. The towering shadow cast by J. S. Bach on the lives, careers, and ambitions of all five of them was undoubtedly overwhelming. Kramer's comment invites us to ponder the various tactics and strategies these uniquely privi-leged—and uniquely challenged—offspring developed to come to terms with that intimidating legacy. He has also offered an intriguing way to assess and understand the meaning of the careers of the Bach sons: namely, by determining the degree to which—and the manner in which—they succeeded in emerging from their father's shadow. Much of what follows will be conjectural; but very little is not conjectural in historical or biographical writing concerned with comprehending the meaning of events centuries old. On the other hand, much of it will be a matter of reasonably “connecting dots”—that is, documented facts—which we may have become overly reluctant to connect or account for in rather obvious ways.
Bach and His Sons
According to at least one eighteenth-century author, there was an abundance of mutual disdain between Johann Sebastian Bach and his musical sons. Carl Friedrich Cramer (1752–1807), the editor of the important Magazin der Musik, personally knew both Philipp Emanuel and Friedemann. In his autobiography, written in 1792–93, Cramer mentions: “The old Sebastian had three sons. He was satisfied only with Friedemann, the great organist. Even about Carl Philipp Emanuel he said (unjustly!): ‘’Tis Berlin blue! It fades!’—Regarding the London Chrétien, [Sebastian] Bach was wont to cite the verse by Gellert: ‘The boy is sure to thrive owing to his stupidity!’ In fact, among the three Bach sons this one had the greatest success.—I have these opinions from Friedemann himself.”
Johann Sebastian Bach's reputation as one of the supreme figures of Western musical history rests primarily on the legacy of his keyboard music. Whereas the composer's church music and ensemble compositions, including such masterpieces as the Mass in B Minor, the Passions, and the Brandenburg Concertos, fell virtually into oblivion after his death, the Inventions and Sinfonias, the harpsichord suites, the Goldberg Variations, the chorale settings, and the preludes and fugues of The Well-Tempered Clavier have been the objects of unbroken study, veneration, and emulation by gen-erations of musicians—amateur and professional—from Bach's day to the present.
During his lifetime Bach had already been celebrated as the greatest living keyboard player. But it is essential to recognize that for Bach and his contempo-raries, harpsichordists and organists were, more often than not, the same people. In the early eighteenth century, as throughout the seventeenth, the term “clavier” was generic and embraced all keyboard instruments, whether they were attached to strings or pipes. And it followed that a “clavier” player was equally at home on all the available keyboard instruments.
Defining the Repertoire
Naturally enough, during the Baroque era the various keyboard instruments, includ-ing the organ, shared a common repertoire to a significant extent. This is true not only for the earlier masters but also—far more than has generally been acknowl-edged—for much of the “clavier” music of Bach. This means specifically that we must abandon the deeply entrenched “binary” categorization that is literally cen-turies old but nonetheless an anachronistic one. We must recognize, rather, that with regard to performance medium, Bach's keyboard compositions do not fall into two strictly separated categories—consisting of works either for the organ or for the stringed keyboard instruments—but rather into three: works exclusively or primarily for organ, works exclusively or primarily for harpsichord, and works for “clavier,” that is, for any keyboard instrument. Only such a three-part division of Bach's keyboard repertory does full justice to the explicit designations contained in the sources and to the historical circumstances of keyboard performance in the Baroque era.