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Cardiopulmonary bypass-induced inflammation is associated with poor postoperative outcomes. Bypass exposure has been associated with shifts in lymphocyte populations. This study aimed to describe two cytokine profiles associated with T and NK cells and their effects on clinical markers of postoperative cardiovascular dysfunction in children undergoing cardiac surgery with cardiopulmonary bypass.
Methods:
Children from two major children’s hospitals undergoing corrective cardiac surgery with cardiopulmonary bypass were included. Plasma was collected pre-, 0 to 4 hours post- and 24 hours (when available) postoperatively. Plasma concentrations of cytokines were quantified using enzyme-linked immunosorbent assays. Delta cytokine concentrations were compared to vasoactive infusion score and percent fluid balance on postoperative day one. Vascular reactivity was assessed in a subset of the cohort. Confirmation of endothelial-specific effects of interferon-γ and interleukin-17A was performed in microvascular endothelial cells, assessing cytokine levels by enzyme-linked immunosorbent assays or trans-endothelial electrical resistance.
Results:
A total of 26 children were included in the analysis. Interferon-γ was inversely associated with vasoactive infusion score (p < 0.05), whereas interleukin-17A and interleukin-23 were associated with greater cumulative postoperative fluid balance (p < 0.01 and 0.03, respectively). Peak vascular reactivity is strongly associated with interferon-γ (p = 0.001), but not with circulating interleukin-17A. Human microvascular endothelial cell exposure to interferon-γ increased endothelial permeability and cytokine production.
Conclusions:
Interferon-γ and interleukin-17A may be associated with cardiovascular dysfunction in children after exposure to cardiopulmonary bypass, albeit with differential clinical features. Interferon-γ may directly impact vascular measures, while the impact of interleukin-17A may relate to fluid accumulation.
Law in Europe developed firmly within a religious framework. The law's dependence on that framework, which can still be traced, has permeated European culture in all its visible and invisible aspects. The itinerary of the convict, from the moment of his arrest to his execution, illustrates the inextricable link between punishment and redemption. Class played an important role in the mode of execution, decapitation or hanging, and the crime for which one was being put to death determined the treatment that the body would undergo before and after execution. This chapter reviews historical source materials to illustrate the role of judicial torture in the handling of offenders. In the model of suspicion/denunciation/persecution, under judicial torture the convict was pushed to denounce innocent friends or foes in order to be relieved from pain, and the judges accepted this testimony as fact.
There is a widespread perception among academics, doctors and patients that the common law can effectively drive the development and incorporation of patients’ autonomy-based rights into medical practice. However, there is reason to doubt that this is correct.
We present a critical analysis of this view, prompted by themes that emerged from interviews with n=31 lawyers and n=24 doctors as part of a larger interdisciplinary study. We focus on the limitations of case law in driving autonomy-respecting clinical practice. Part I examines how the development and impact of decided cases is dominated by practical and economic considerations. It also considers the lack of understanding of case law among clinicians and the extent to which this limits its ability to drive change. Part II sets out our reasons for treating these limitations as a cause for concern. In Part III, we conclude by considering different levers for supporting case law in creating or confirming autonomy-respecting norms in medical practice, suggesting ways in which these might be developed further.
We argue that clinical negligence litigation is important as a guide to clinical practice and a means of enforcing autonomy-based patient rights but that it cannot be relied upon to drive changes in practice. Both professional guidance and legislation can augment case law but, for them to be effective, proper communication between doctors and legislators, courts, lawyers and insurance organizations is essential.
This chapter explores the tactic of entrism within the British Labour Party pursued by the Revolutionary Socialist League and the Militant Tendency between 1955 and 1991. It also explores Labour’s response to such tactics by assessing the impact of the party’s internal investigations into Militant in the 1970s and 1980s, particularly the expulsion of the Militant Editorial Board in 1983, and the Inquiry into the Militant Tendency in Liverpool in 1985-6. Through an examination of the Militant newspaper, the group’s penetration of Labour’s youth wing, and its activities in Liverpool, this study analyses the extent of Militant’s infiltration of the Labour Party.
Given the symmetry between the changes within football and the larger structural changes in the Mancunian and English economy, Manchester United fans provide an excellent site through which to perceive how urban economic transformations have been understood and responded to. This chapter explores this process through an investigation of a particular group of Manchester United fans, who in 2005 formed a breakaway club 'FC United of Manchester' in response to a transnational debt-leveraged buy-out of their club. Distinctions between Manchester United's and FC United's modes of exchange were most straightforwardly articulated by Paul who told the author that 'FC United is a community club whereas Manchester United is a business'. 'Community' then becomes a political language but one that was used to contest a process of capitalist transformation and to bring a new reality into being. Since the 1980s, the club has become a sporting global brand.
The Rohingya refugee crisis, a major humanitarian tragedy in contemporary global politics, has gradually precipitated major security challenges to Bangladesh and other states. This paper employs the Copenhagen School’s securitization theory to examine how securitization, especially by the Bangladeshi government and media, has framed these challenges as existential threats. It makes two basic contributions to existing literature on the Rohingya crisis. Firstly, it provides a theory-informed analysis of the security dimensions of the crisis, considering the interplay between the refugee crisis and national and regional security dynamics. Secondly, the paper explores how the refugees securitize their current plight. Empirically, the study utilizes interview data from 60 local residents, law enforcement agencies, and employees of local and international NGOs. The discussion suggests the possibilities and limitations of the securitization theory in the field of refugee or forced migration studies in the Global South.
Internal waves are an important feature of stratified fluids, both in oceanic and lake basins and in other settings. Many works have been published on the generic feature of internal wave trapping onto planar wave attractors and super-attractors in two and three dimensions and the exceptional class of standing global internal wave modes. However, most of these works did not deal with waves that escape trapping. By using continuous symmetries, we analytically prove the existence of internal wave whispering gallery modes (WGMs), internal waves that propagate continuously without getting trapped by attractors. The WGM’s neutral stability with respect to different perturbations enables whispering gallery beams, a continuum of rays propagating together coherently. The systems’ continuous symmetries also enable projection onto two-dimensional planes that yield effective two-dimensional billiards preserving the original dynamics. By examining rays deviating from these WGMs in parabolic channels, we discover a new type of wave attractor that is located along the channel’s critical depth – the depth at which the bottom slope is identical to the ray slope, instead of cross-channel, as in previous works. This new critical-slope wave attractor leads to a new understanding of WGMs as sitting at the border between the two basins of attraction. Finally, both critical-slope wave attractors and whispering gallery beams are used to propose explanations for along-channel energy fluxes in submarine canyons and tidal energy intensification near critical slopes.
This paper re-evaluates the significance of José Vicente Asuar (1933–2017), a pioneering figure in Latin American computer music, shifting the focus from the hardware construction of his COMDASUAR system to the innovative software he developed for algorithmic composition. While Asuar’s hybrid digital-analog computer is noteworthy, the true core of his contribution lies in his original machine language programs designed for the Intel 8080 microprocessor. This study examines how Asuar thought about and designed algorithms specifically created for generating musical structures, processing symbolic data in real-time, and enabling interactive performance. By analyzing newly discovered handwritten notebooks containing his meticulous code documentation, we uncover Asuar’s deep engagement with low-level programming to express complex musical ideas. His approach, focused on the computer as an “amplifier of the imagination,” prioritized the development of software to facilitate generative composition and real-time manipulation of musical parameters. This paper argues that Asuar’s legacy rests not solely on the COMDASUAR hardware but primarily on his visionary software architecture, which transformed the computer into a dynamic compositional partner. In doing so, he anticipated later developments in interactive music systems, demonstrating a pioneering approach to computer music that placed software innovation at its center.
Exceptionalism is a dominant theme in intellectual histories of American foreign policy. Hans Morgenthau clearly viewed American pluralist politics, liberal philosophy, and political science with the same combination of derision, despair, and foreboding shared by a range of emigre thinkers such as Leo Strauss, Eric Vogelin and others. The ideas laid down in American political culture by the founding generations of its institutional, social and religious framework might have some part to play in why the US response to that second modernity ultimately was different from that of Europe. As an intellectual lineage in US foreign policy, realism is generally portrayed as the great refusal of exceptionalist seductions and liberal, rationalist illusions. The notion that US foreign policy debates in the Cold War context were largely framed as a realist critique of the New World's (liberal) delusions of exceptionality and virtue is a well-rehearsed truism.
This chapter is concerned with the ways in which functional models of community and sociability were being framed spatially in post-war Britain, focusing on the design and provision of housing on post-war housing estates like Manchester’s famous Wythenshawe estate as well as on Hull’s less famous examples. It argues that concerns about the nature of society were bound up in the designs and promotion of new housing schemes. The study of housing and community design functions as a lens through which historiographical concerns about modernity, consumerism and town planning might be analysed. The chapter examines the design of shopping centres to shed light upon the mechanisms of sociability and interaction that were being programmed into the design of housing, concluding that a combination of consumer habits, retailer opposition and planning naivety worked to reduce the effectiveness of the plans in producing functional estates.
This article examines the participation of women as authors in five leading law journals of a generalist nature in the UK. For its data points, it takes each author of an article in the Cambridge Law Journal, the Journal of Law and Society, Legal Studies, the Modern Law Review and the Oxford Journal of Legal Studies. From 2016 to 2020, around 900 authors have published over 700 articles in these five journals. The analysis of these results reveals discrepancies in women’s participation in legal publishing. It shows that those journals which publish fewer articles, publish fewer women authors. The article situates its data in a description of gender patterns within the academy generally and specifically within the UK law school. It draws on the experiences of gender publishing disparity in other disciplines where the debate is more established. It concludes with suggestions for changes in the publication process and further research to develop the picture of women’s publishing in law.
Social anxiety disorder (SAD) is one of the most common anxiety disorders and is associated with significant impairment and societal costs. The association between SAD and mortality remains poorly understood, partly because in epidemiological research it is rarely studied independently from other anxiety disorders. In this population-based matched cohort and sibling control study, we estimated the risk of all-cause and cause-specific mortality in individuals with SAD.
Methods
From a population of individuals born from 1932 and living in Sweden between 1997 and 2020, we identified all cases of SAD (Swedish ICD-10 code F40.1) in the National Patient Register. Each of these individuals was matched on sex, birth year and county of residence with 10 individuals who had never received a diagnosis. Mortality data were extracted from the Cause of Death Register. Risks were estimated using Cox proportional hazards regression models. Models adjusted for sociodemographic covariates and other lifetime psychiatric disorders. We also identified all clusters of full siblings and conducted within-sibling comparisons to account for unmeasured familial confounding.
Results
The matched cohort included 57,360 individuals with SAD and 573,600 unexposed individuals. During the follow-up, 2355 deaths were registered within the exposed cohort vs. 7800 deaths in the matched cohort (crude mortality rates, 5.25 and 1.73 per 1000 person-years, respectively). The full cohort was followed up for a mean of 7.87 years (standard deviation 5.23). In models adjusting for sociodemographic variables, individuals with SAD had a 2.24-fold increased hazard of all-cause mortality (95% confidence interval [CI], 2.13–2.35). The increased risk was observed for both natural (adjusted hazard ratio [HR], 1.62; 95% CI 1.52–1.72) and unnatural causes of death (HR, 4.18; 95% CI 3.82–4.58). The results were robust to additional adjustment for psychiatric comorbidities, but the magnitude of the associations was attenuated, particularly when adjusting for substance use disorders. In the sibling cohort, 39,993 individuals with SAD were compared with their 64,640 unaffected siblings. While the estimates were also attenuated, they remained statistically significant (HR for all-cause mortality, 1.40; 95% CI 1.36–1.45).
Conclusions
Individuals with SAD face an increased risk of mortality, attributable primarily to unnatural causes of death, such as suicide, but also to natural causes, even after adjusting for socioeconomic variables. Psychiatric comorbidities, particularly substance use disorders, and shared familial factors may also contribute to this excess death. Further study of underlying mechanisms may inform prevention and early intervention strategies to reduce mortality in this vulnerable population.