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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a percutaneous transfemoral balloon technique used in select centers for resuscitation and temporary hemostasis of bleeding patients. Several animal studies demonstrated that its application in non-traumatic cardiac arrest could enhance cerebral and coronary perfusion during cardiopulmonary resuscitation (CPR); despite this, there are few reports of its application in humans. This is a case report of REBOA application during a refractory out-of-hospital cardiac arrest in a 50-year-old man where Advanced Cardiac Life Support (ACLS) alone was unable to maintain a stable return of spontaneous circulation (ROSC) and Extracorporeal Cardiac Life Support (ECLS) was not available.
In this paper we extend the definition of slice-torus invariant to links. We prove a few properties of the newly-defined slice-torus link invariants: the behaviour under crossing change, a slice genus bound, an obstruction to strong sliceness, and a combinatorial bound. Furthermore, we provide an application to the computation of the splitting number. Finally, we use the slice-torus link invariants and the Whitehead doubling to define new strong concordance invariants for links, which are proven to be independent of the corresponding slice-torus link invariant.
The Book of the Courtier outwardly portrays an aura of cordial solidarity as courtiers gathered in Urbino from various regions of Italy attempt to describe the ideal courtier; recently, however, critics have uncovered tensions on various fronts which threaten to expose deep rifts under the elegant courtly veneer. While these “counter” readings have focused primarily on the courtier's relation to the prince and to other courtiers, this essay aims to explore conflicts that arise from the different regional and political affiliations of the group. In particular, I argue that the largely ignored section on joke-telling teaches courtiers how to give vent to their animosity under the cover of humor and dissimulation.
The pharmacy (spezieria) Santa Maria della Scala was founded in Rome by the Discalced Carmelites Order in the 17th century, and during the 18th and 19th centuries it became the official supplier of medicines for Vatican Popes. The laboratory and the cases of this spezieria still preserve glass jars with organic and inorganic materials, which were presumably used for medicine and artistic material preparation, whose composition is unknown to date. A research project was initiated with the aim to study the stored materials and the role that the pharmacy played in regional, national and international contexts. In this manuscript, the compounds were analysed through X-ray powder diffraction with the scope to derive the quantitative mineralogical composition of the inorganic fraction, their possible use in pharmacopoeias and as mineral pigments. Most of the analysed samples are salts (sulphates, chlorides, carbonates, phosphates, borates, sulphides), sulphates being the predominant class; oxides were also detected.
Administrative data (for example, hospital discharge databases, HDDs) can be used as a real world source of clinical and economic evidence for assessing new medical devices (MDs), provided that their use can be identified in the data. In absence of updated classification systems for procedures and diagnoses, which allow to identify the use of new technologies in the data, traceability can still be achieved thanks to authorities coding guidelines (that is, indication on how to combine the existing codes for procedures and/or diagnoses when new technologies are used).
In 2009 Italy adopted version 2007 of the International Classification System of Diseases (ICD-9-CM) and version 24 of Diagnosis Related Groups (DRGs), which are still in use. The aim of this work was to investigate the capacity of the classification system currently used in Italy, which is at high risk of obsolescence, to identify innovative MDs.
To achieve our goal, we performed a systematic search of all the national and regional coding guidelines published from 2009 (that is, the year of introduction of the new classification systems) to 2015. We extracted from each document the list of technologies for which the Ministry of Health and/or the Regional Authorities provided with coding indications.
Our results show that only a few recent technological innovations can be identified in the Italian HDDs. This reduces the possibility for decision makers to measure new technologies outcomes and costs in the real world clinical practice.
The traceability of new MDs' can support Heath Technology Assessment (HTA). Indeed, HTA programs should use real world evidence to re-assess MDs 2–3 years after their introduction in clinical practice. The use of routinely collected data, such as HDD, would allow to measure new technologies' “real” effectiveness in “real” world, on “real” patients in “real” hospitals to complement the evidence from Randomized Controlled Trials.
Conversion of pig slurry to pellets is a desirable fertilizer option for farmers who want to mitigate environmental pollution from slurry accumulation. The goals of the current investigation were to determine the fertilizer properties of pig slurry solid fraction (SF) pellets and to assess its potential to enhance soil properties in order to reduce ammonia (NH3) volatilization and greenhouse gas (GHG) emissions. Various parameters influence SF-based pellet fertilizer effectiveness: bulking agent use during composting, pellet diameter sizing and soil application type (superficially or incorporated into the soil). Two composts from the same pig slurry SF obtained from a screw press separator were prepared: pig SF compost without a bulking agent (SSFC) and pig SF compost with wood chips as the bulking agent (wood chip compost (WCC)). For each compost type, pellets of two different diameters (6 and 8 mm) were produced. A mesocosm experiment, conducted with maize plants, was used to test the fertilizer value of the considered pellets. In total, three compost fertilizers – SSFC, WCC and nitrogen: phosphorus: potassium mineral fertilizer 15 : 15 : 15, plus one unfertilized control treatment – were applied at the same N rate (equivalent to 200 kg/ha) using two different methods (surface and soil incorporation). After 65 days, above-ground biomass, roots and soil samples were collected and analysed. Subsequently, a second mesocosm study was undertaken to measure NH3 and GHG emissions released from pellet fertilization. Ammonia volatilization was determined immediately after pellet application, while carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) emissions were monitored for 57 days. Study results indicated that both pellet types were effective slow-release fertilizers for maize. Additionally, three actions seemed to make the nutrients contained in pig SF compost pellets more available to plants: addition of a bulking agent before composting, use of small diameter pellets and soil incorporation of the fertilizer.
Combinatorial exchanges combine and generalize two different mechanisms: double auctions and combinatorial auctions. In a double auction (DA), multiple buyers and sellers trade units of an identical good (McAfee, 1992). In a combinatorial auction (CA), a single seller has multiple heterogeneous items up for sale (de Vries & Vohra, 2003; Cramton, Shoham, & Steinberg, 2006). Buyer valuations can exhibit complements (“I want A and B”) and substitutes (“I want A or B”) properties. CAs provide an expressive bidding language to describe buyer valuations. A common design goal in DAs and CAs is to implement the efficient allocation, which is the allocation that maximizes social welfare, i.e. the total value.
A combinatorial exchange (CE) (Parkes, Kalagnanam, & Eso, 2001) is a combinatorial double auction and allows multiple buyers and sellers to trade on multiple, heterogeneous goods. A motivating application is to the reallocation of U.S. wireless spectrum from low-volume television stations to digital cell phone services (Cramton, Kwerel, & Williams, 1998; Cramton, Lopez, Malec, & Sujarittanonta, 2015). An incentive auction has been proposed for this application. This auction design uses a reverse auction to buy back existing spectrum rights followed by a forward auction to sell these rights to new owners. (See “Designing the US Incentive Auction” by Mulgrom and Segal.) One advantage of the incentive auction design is that it enables the use of existing CA technology for both the forward and reverse stages. In addition, the proposed design uses optimization to solve the complex repacking problem of shifting incumbent users’ allocation to new bands, which can free up a significant amount of bandwidth (Frechette, Newman, & Leyton-Brown, 2015).
CEs present an alternative design where both demand-side and supply-side price discovery happen in tandem, leading to coordinated information revelation and potential efficiency gains. The separation between stages in an incentive auction opens the possibility of the government purchasing either too little or too much spectrum in the reverse stage for subsequent sale in the forward stage. CEs avoid this problem by enabling the simultaneous purchase and sale of bandwidth by incumbents and new entrants alike. The (approximate) clearing prices obtained in CEs also provide meaningful value estimates for various spectrum combinations. These prices are useful in guiding demand and supply revelation (or preference elicitation, in the language of computer science).
Ever since Nina Vandewalker wrote the first comprehensive history of the American kindergarten in 1908 historians of education have thought of the 1890s as a period of transformation in the theory and practice of kindergarten pedagogy. Historians agree that progressive kindergartners inspired by the child-centered psychologies of G. Stanley Hall and John Dewey initiated a critique of the Froebelian pedagogy upon which the kindergarten curriculum had been based since its introduction into the United States in the 1860s. Historians also agree that by 1920, after a long and sometimes bitter struggle, progressives emerged as victors in the battle with Froebelians for control of the curriculum. What historians have not agreed upon are the social import and educational consequences of this struggle.
The human ability to predict and interpret others’ intentions is crucial to social life. The purpose of this chapter is to consider the proposition that intentions can be understood from observing others’ movements. To this end, we first focus on experimental evidence showing that individual, social and communicative intentions ‘shape’ movement kinematics. Next, we review recent work suggesting that during action observation humans are capable of picking up intention information and using it to predict others’ behavior. In the third section, we address the neural mechanisms that mediate the ability to read intention from movement observation. Based on preliminary data, we argue that mirror neuron areas are sensitive to intention information conveyed by movement kinematics. Finally, we discuss the hypothesis that a deficit in this ability might account for the difficulties in social interaction reported in autism spectrum disorders.
In 1957 the National Bureau of Standards (NBS) agreed, at the request of James R Arnold, to store and distribute an oxalic acid contemporary carbon-14 standard. In 1978 stocks of this standard were practically gone. We approached Chas Pfizer and Company, Inc, which had provided the original 1000 pounds of oxalic acid to Dr Arnold to see if they could provide another one-batch lot of 1000 pounds of oxalic acid to replace the old standard. This they did generously, at no cost to NBS. The oxalic acid was prepared by fermentation of French beet molasses from the 1977 spring, summer, and autumn harvest using Aspergillus niger var. The acid was separated from the broth as the insoluble calcium salt and reconverted to free acid using sulfuric acid. The free acid was then crystallized, redissolved, filtered, recrystallized, and dried.
The DJEHUTY project is an intensive effort at the Lawrence Livermore National Laboratory (LLNL) to produce a general purpose 3-D stellar structure and evolution code to study dynamic processes in whole stars.
Introduction: Cognitive training in Alzheimer's disease (AD) has recently started to demonstrate its efficacy. We used our ‘puzzle-like’ task (GEO) as training for a large group of early-stage AD patients, to detect its effects over time.
Method: AD patients (N = 40) and healthy controls (N = 40) were involved. Participants were administered the Geographical Exercises for cognitive Optimization (GEO) task. Participants underwent individual sessions with GEO three times a week for 2 months, and then their performance was recorded again. Lastly, at the 12-month follow-up the GEO task was administered for the last time.
Results: Patients’ scores were significantly worse than controls’ scores only on a few neuropsychological tests. We ran a repeated measures GLM by considering groups’ performance on the GEO task at the assessment points. Results showed a significant main effect of group, and a significant effect of the interaction between group and time: patients’ performances both at the end of the training and at the follow-up were virtually identical to controls’ performances.
Conclusions: Patients effectively acquired new procedural abilities, and their achievements were stable at follow-up. This study suggests the GEO is a useful strategy for cognitive training in AD, and should prompt further investigations about the degree of generalisability of patients’ acquired skills.