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This friendly guide is the companion you need to convert pure mathematics into understanding and facility with a host of probabilistic tools. The book provides a high-level view of probability and its most powerful applications. It begins with the basic rules of probability and quickly progresses to some of the most sophisticated modern techniques in use, including Kalman filters, Monte Carlo techniques, machine learning methods, Bayesian inference and stochastic processes. It draws on thirty years of experience in applying probabilistic methods to problems in computational science and engineering, and numerous practical examples illustrate where these techniques are used in the real world. Topics of discussion range from carbon dating to Wasserstein GANs, one of the most recent developments in Deep Learning. The underlying mathematics is presented in full, but clarity takes priority over complete rigour, making this text a starting reference source for researchers and a readable overview for students.
Pediatric anesthesiologists will encounter numerous challenges when caring for children, as their work involves more than simply adjusting drug dosages and equipment for smaller patients. In response, this practical book provides clinical guidance in an easily accessible and digestible question-answer format. Case Studies in Pediatric Anesthesia reviews the entire breadth of pediatric anesthesia and pain management, taking a case-based approach. Each chapter commences with a clinical case or scenario, guiding the reader through a tailored discussion. The chapters review the pathophysiology, anesthetic techniques, and surgical and perioperative considerations. High quality tables and figures feature throughout to help solidify key concepts. The chapters are prepared to be read in isolation and for reference when appropriate. Case Studies in Pediatric Anesthesia is aimed at anesthesiologists of all levels, from the trainee on their first pediatric rotation, to the pediatric fellow preparing for boards examination to the seasoned clinician.
India's urban slums exhibit dramatic variation in their access to local public goods and services - paved roads, piped water, trash removal, sewers, and streetlights. Why are some vulnerable communities able to demand and secure development from the state while others fail? Drawing on more than two years of fieldwork in the north Indian cities of Bhopal and Jaipur, Demanding Development accounts for the uneven success of India's slum residents in securing local public goods and services. Auerbach's theory centers on the political organization of slum settlements and the informal slum leaders who spearhead resident efforts to make claims on the state - in particular, those slum leaders who are party workers. He finds striking variation in the extent to which networks of party workers have spread across slum settlements. Demanding Development shows how this variation in the density and partisan distribution of party workers across settlements has powerful consequences for the ability of residents to politically mobilize to improve local conditions.
Popular music subcultures have acknowledged, engaged with, or rejected digital platforms to varying degrees; their relationship to it is often made fraught, ambivalent and ironic by projections of the Internet as inauthentic or impersonal and their inheritance of Romantic-influenced countercultural aesthetics. The genre vaporwave offers a key example of this, especially given that it emerged and exists almost exclusively on digital platforms. Vaporwave addresses its own digital nature and historicity in sound and image, as recent scholarship on it has observed. Its life online represents not an abandonment of traditional formulations of the relationship between culture, technology and authenticity, but a new arena in which to negotiate them.
In 1969 on a riverside near the Lenyardi caves (about 5 kilometres from present-day Junnar, in the Indian state of Maharashtra), Dr Satish Deshmukh discovered an alabaster object in the form of half an egg (longitudinally cut) with a young male child lying inside it (with small traces of red paint on the right side of the object). This high-quality oval object (figures 1 and 2) measures about 5 cm × 3.4 cm and is usually interpreted as an item that was originally manufactured in the Mediterranean world before being brought to India, rather than a piece of artwork produced in India itself. One possible, and largely accepted, interpretation is that this figure represents the birth of the god Eros. However, identification of the figure within the egg-like structure is not easily made. While the figure does bear similarities to the putto-style representation of Eros in instances of Greek and Roman art, it does not possess any clear identifying features (such as the wings with which Eros is often depicted). The figure's resemblance to Eros in some of his other iconographic depictions and the egg-like structure around him suggest a possible identification of this infant with Eros and the myth of his birth from an egg. However, without evidence from other iconography of a more clearly identifiable Eros in similar contexts, the figure cannot be said to be him with any certainty. As Dhavalikar notes, this object ‘is the only one of its kind among the classical antiquities so far found in the Indian subcontinent and perhaps has no parallel in the classical world’. Thus the identification of this sculpture as a depiction of Eros in the egg is possible, but not certain.
Is democracy in crisis? The current threats to democracy are not just political: they are deeply embedded in the democracies of today, in current economic, social, and cultural conditions. In Crises of Democracy, Adam Przeworski presents a panorama of the political situation throughout the world of established democracies, places it in the context of past misadventures of democratic regimes, and speculates on the prospects. Our present state of knowledge does not support facile conclusions. 'We should not believe the flood of writings that have all the answers'. Avoiding technical aspects, this book is addressed not only to professional social scientists, but to everyone concerned about the prospects of democracy.
The objective of this study was to systematically assess the literature regarding postnatal healthcare utilization and barriers/facilitators of healthcare in neonatal abstinence syndrome (NAS) children.
A systematic search was performed in PubMed, Cochrane Database of Systematic Reviews, PsychINFO, CINAHL, and Web of Science to identify peer-reviewed research. Eligible studies were peer-reviewed articles reporting on broad aspects of primary and specialty healthcare utilization and access in NAS children. Three investigators independently reviewed all articles and extracted data. Study bias was assessed using the Newcastle-Ottawa Assessment Scale and the National Institute of Health Study Quality Assessment Tool.
This review identified 14 articles that met criteria. NAS children have poorer outpatient appointment adherence and have a higher rate of being lost to follow-up. These children have overall poorer health indicated by a significantly higher risk of ER visits, hospital readmission, and early childhood mortality compared with non-NAS infants. Intensive multidisciplinary support provided through outpatient weaning programs facilitate healthcare utilization and could serve as a model that could be applied to other healthcare fields to improve the health among this population.
This review investigated the difficulties in accessing outpatient care as well as the utilization of such care for neonatal abstinence syndrome infants. NAS infants tend to have decreased access to, and utilization of outpatient healthcare following hospital birth discharge. Outpatient weaning programs have proven to be effective; however, these programs require intensive resources and care coordination that has yet to be implemented into other healthcare areas for NAS children.
To determine the effect of three psycholinguistic variables—lexical frequency, age of acquisition (AoA), and neighborhood density (ND)—on lexical-semantic processing in individuals with non-fluent (nfvPPA), logopenic (lvPPA), and semantic primary progressive aphasia (svPPA). Identifying the scope and independence of these features can provide valuable information about the organization of words in our mind and brain.
We administered a lexical decision task—with words carefully selected to permit distinguishing lexical frequency, AoA, and orthographic ND effects—to 41 individuals with PPA (13 nfvPPA, 14 lvPPA, 14 svPPA) and 25 controls.
Of the psycholinguistic variables studied, lexical frequency had the largest influence on lexical-semantic processing, but AoA and ND also played an independent role. The results reflect a brain-language relationship with different proportional effects of frequency, AoA, and ND in the PPA variants, in a pattern that is consistent with the organization of the mental lexicon. Individuals with nfvPPA and lvPPA experienced an ND effect consistent with the role of inferior frontal and temporoparietal regions in lexical analysis and word form processing. By contrast, individuals with svPPA experienced an AoA effect consistent with the role of the anterior temporal lobe in semantic processing.
The findings are in line with a hierarchical mental lexicon structure with a conceptual (semantic) and a lexeme (word-form) level, such that a selective deficit at one of these levels of the mental lexicon manifests differently in lexical-semantic processing performance, consistent with the affected language-specific brain region in each PPA variant.
The notational treatises of Johannes Tinctoris are among the most important texts on late fifteenth-century musical practice. His monumental treatise on the art of counterpoint, De arte contrapuncti, affords modern scholars a great insight into the intricacies of counterpoint practice on the cusp of the era of printed music theory. In the examples for this text, Tinctoris regularly uses additional markers to specify the key passages he is discussing. These signs often closely resemble signa congruentiae, though their function in these theoretical contexts is somewhat different from the deployment of such symbols in practical music sources. This article re-examines the historical justification for the term signa congruentiae, offering a new perspective on Tinctoris’s usage of such signs to explicate the rich text–example relationship underpinning his theoretical arguments and drawing attention to some novel uses of these signs that underpin these relationships.
The pessimistic arguments May challenges depend on an anti-Kantian philosophical assumption. That assumption is that what I call philosophical optimists about moral reason are also committed to empirical optimism, or what May calls “optimistic rationalism.” I place May's book in the literature by explaining how that assumption is resisted by Christine Korsgaard, one of May's examples of a contemporary Kantian.
Reassurance seeking (RS) in obsessive compulsive disorder (OCD) is commonly addressed in cognitive behavioural therapy (CBT) using a technique called reducing accommodation. Reducing accommodation is a behaviourally based CBT intervention that may be effective; however, there is a lack of controlled research on its use and acceptability to clients/patients, and case studies suggest that it can be associated with negative emotional/behavioural consequences. Providing support to encourage coping with distress is a cognitively based CBT intervention that may be an effective alternative, but lacks evidence regarding its acceptability.
This study aimed to determine whether support provision may be a more acceptable/endorsed CBT intervention for RS than a strict reducing accommodation approach.
Participants and familiar partners (N = 179) read vignette descriptions of accommodation reduction and support interventions, and responded to measures of perceived intervention acceptability/adhereability and endorsement, before completing a forced-choice preference task.
Overall, findings suggested that participants and partners gave significantly higher ratings for the support than the accommodation reduction intervention (partial η2 = .049 to .321). Participants and partners also both selected the support intervention more often than the traditional reducing accommodation intervention when given the choice.
Support provision is perceived as an acceptable CBT intervention for RS by participants and their familiar partners. These results have implications for cognitive behavioural theory and practice related to RS.
This paper discusses the need for consistency in mass-gathering research and evaluation from an environmental reporting perspective.
Mass gatherings occur frequently throughout the world. Having an understanding of the complexities of mass gatherings is important to inform health services about the possible required health resources. Factors within the environmental, psychosocial, and biomedical domains influence the usage of health services at mass gatherings. A minimum data set (MDS) has been proposed to standardize collection of biomedical data across various mass gatherings, and there is a need for an environmental component. The environmental domain includes factors such as the nature of the event, availability of drugs or alcohol, venue characteristics, and meteorological factors.
This research used an integrative literature review design. Manuscripts were collected using keyword searches from databases and journal content pages from 2003 through 2018. Data were analyzed and categorized using the existing MDS as a framework.
In total, 39 manuscripts were identified that met the inclusion criteria.
In collecting environmental data from mass gatherings, there must be an agreed-upon MDS. A set of variables can be used to collect de-identified environmental variables for the purpose of making comparisons across societies for mass-gathering events (MGEs).
To develop a physiological data-driven model for early identification of impending cardiac arrest in neonates and infants with cardiac disease hospitalised in the cardiovascular ICU.
We performed a single-institution retrospective cohort study (11 January 2013–16 September 2015) of patients ≤1 year old with cardiac disease who were hospitalised in the cardiovascular ICU at a tertiary care children’s hospital. Demographics and diagnostic codes of cardiac arrest were obtained via the electronic health record. Diagnosis of cardiac arrest was validated by expert clinician review. Minute-to-minute physiological monitoring data were recorded via bedside monitors. A generalized linear model was used to compute a minute by minute risk score. Training and test data sets both included data from patients who did and did not develop cardiac arrest. An optimal risk-score threshold was derived based on the model’s discriminatory capacity for impending arrest versus non-arrest. Model performance measures included sensitivity, specificity, accuracy, likelihood ratios, and post-test probability of arrest.
The final model consisting of multiple clinical parameters was able to identify impending cardiac arrest at least 2 hours prior to the event with an overall accuracy of 75% (sensitivity = 61%, specificity = 80%) and observed an increase in probability of detection of cardiac arrest from a pre-test probability of 9.6% to a post-test probability of 21.2%.
Our findings demonstrate that a predictive model using physiologic monitoring data in neonates and infants with cardiac disease hospitalised in the paediatric cardiovascular ICU can identify impending cardiac arrest on average 17 hours prior to arrest.
The SCN5A gene is implicated in many arrhythmogenic and cardiomyopathic processes. We identified a novel SCN5A variant in a family with significant segregation in individuals affected with progressive sinus and atrioventricular nodal disease, atrial arrhythmia, dilated cardiomyopathy, and early sudden cardiac arrest.
A patient pedigree was created following the clinical evaluation of three affected individuals, two monozygotic twins and a paternal half-brother, which lead to the evaluation of a paternal half-sister (four siblings with the same father and three mothers) all of whom experienced varying degrees of atrial arrhythmias, conduction disease, and dilated cardiomyopathy in addition to a paternal history of unexplained death in his 50s with similar autopsy findings. The index male underwent sequencing of 58 genes associated with cardiomyopathies. Sanger sequencing was used to provide data for bases with insufficient coverage and for bases in some known regions of genomic segmental duplications. All clinically significant and novel variants were confirmed by independent Sanger sequencing.
All relatives tested were shown to have the same SCN5A variant of unknown significance (p. Asp197His) and the monozygotic twins shared a co-occurring NEXN (p. Glu575*). Segregation analysis demonstrates likely pathogenic trait for the SCN5A variant with an additional possible role for the NEXN variant in combination.
There is compelling clinical evidence suggesting that the SCN5A variant p. Asp197His may be re-classified as likely pathogenic based on the segregation analysis of our family of interest. Molecular mechanism studies are pending.
Hurricane Maria caused catastrophic damage in Puerto Rico, increasing the risk for morbidity and mortality in the post-impact period. We aimed to establish a syndromic surveillance system to describe the number and type of visits at 2 emergency health-care settings in the same hospital system in Ponce, Puerto Rico.
We implemented a hurricane surveillance system by interviewing patients with a short questionnaire about the reason for visit at a hospital emergency department and associated urgent care clinic in the 6 mo after Hurricane Maria. We then evaluated the system by comparing findings with data from the electronic medical record (EMR) system for the same time period.
The hurricane surveillance system captured information from 5116 participants across the 2 sites, representing 17% of all visits captured in the EMR for the same period. Most visits were associated with acute illness/symptoms (79%), followed by injury (11%). The hurricane surveillance and EMR data were similar, proportionally, by sex, age, and visit category.
The hurricane surveillance system provided timely and representative data about the number and type of visits at 2 sites. This system, or an adapted version using available electronic data, should be considered in future disaster settings.
Non-tuberculous mycobacterium encephalitis is rare. Since 2013, a global outbreak of Mycobacterium chimaera infection has been attributed to point-source contamination of heater cooler units used in cardiac surgery. Disseminated M. chimaera infection has presented many unique challenges, including non-specific clinical presentations with delays in diagnosis, and a high mortality rate among predominantly immunocompetent adults. Here, we describe three patients with fatal disseminated Mycobacterium chimaera infection showing initially non-specific, progressively worsening neurocognitive decline, including confusion, delirium, depression and apathy. Autopsy revealed widespread granulomatous encephalitis of the cerebrum, brain stem and spinal cord, along with granulomatous chorioretinitis. Cerebral involvement and differentiation between mycobacterial granulomas and microangiopathic changes can be assessed best on MRI with contrast enhancement. The prognosis of M. chimaera encephalitis appears to be very poor, but might be improved by increased awareness of this new syndrome and timely antimicrobial treatment.
This presentation will enable the learner to:
1.Describe the clinical, radiological and neuropathological findings of Mycobacterium chimaera encephalitis
2.Be aware of this rare form of encephalitis, and explain its diagnosis, prognosis and management