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Varieties of Democracy is the essential user's guide to The Varieties of Democracy project (V-Dem), one of the most ambitious data collection efforts in comparative politics. This global research collaboration sparked a dramatic change in how we study the nature, causes, and consequences of democracy. This book is ambitious in scope: more than a reference guide, it raises standards for causal inferences in democratization research and introduces new, measurable, concepts of democracy and many political institutions. Varieties of Democracy enables anyone interested in democracy - teachers, students, journalists, activists, researchers and others - to analyze V-Dem data in new and exciting ways. This book creates opportunities for V-Dem data to be used in education, research, news analysis, advocacy, policy work, and elsewhere. V-Dem is rapidly becoming the preferred source for democracy data.
This book aims to provide the modern anaesthesiologist and interested clinician with the tools to understand how anaesthesia and surgery influence human physiology, how information about the anaesthetic state and the different homeostatic systems of the human body is collected and processed, and how this information can be integrated to optimize and individualize care to the patient by helping us to swiftly respond to changes: personalized anaesthesia.
Liver surgery can be remarkably safe: a zero mortality rate has been achieved with liver resections when patients are properly selected and with meticulous perioperative care . In order to maintain liver function in individual patients undergoing anaesthesia and surgery, the single most important factor is maintaining its perfusion. In order to avoid hypoxic liver injury, preserving sinusoidal blood flow is best done by maintaining an adequate perfusion pressure and avoiding a high central venous pressure. Reducing intraoperative blood loss and maintaining systemic haemodynamics likely play major roles in avoiding hypoxic liver injury. It is still unknown which vasoactive drugs are preferred when haemodynamic instability occurs; Noradrenaline seems to be well tolerated as long as hypovolaemia is avoided. Ischaemic preconditioning and pharmacological preconditioning and postconditioning are promising, but their clinical relevance remains to be determined. Finally there are no good markers of hepatocyte damage that could be used intraoperatively to optimize anaesthetic management.
Congenital diaphragmatic hernia (CDH) is a life-threatening surgically correctable congenital birth defect (3/10 000 live-born babies) . Survival chances are dependent on the presence of associated malformations and severity of lung hypoplasia. Mortality remains up to 30% . In the previous chapter we have outlined how fetuses with the suspicion of CDH should be assessed, using genetic testing and modern imaging techniques. Individualized prognosis of isolated CDH can be made prenatally by measurement of lung size, the presence of the liver in the thorax, and the side of the defect . Patients with predicted poor prognosis are ideal candidates for an intervention that may improve the outcome. Such intervention is not aiming at repairing the diaphragmatic defect, as it can be easily closed after birth: it rather should reverse pulmonary hypoplasia (i.e. stimulate lung growth) before birth. Historically this was attempted by anatomical repair of the defect in utero, yet results were suboptimal .
Congenital diaphragmatic hernia (CDH) is a developmental anomaly with a prevalence ranging between 1 and 4/10 000 births, hence qualifying as a rare disease (ORPHA: 2140). During embryogenesis the diaphragm fails to form , most often on the left side (85%), rarely on the right (13%), and sporadically bilaterally (2%). Exceptionally there is true agenesis of the hemidiaphragm, but most often the defect is confined to the posterolateral area (Bochdalek hernia). The anterior (Morgagni hernia; 30%) or central areas (2%) are less frequently involved . Occasionally the diaphragm is intact yet thinned and devoid of muscular fibers, and is then called diaphragmatic eventration . In case of a true defect, abdominal viscera can herniate into the thorax, acting as a space-occupying lesion that competes with the developing lungs. In left CDH (LCDH), this typically includes bowel, spleen, stomach, and less often the left lobe of the liver and rarely kidney. In case of a right-sided CDH (RCDH), the liver is virtually always into the thorax . There can be also bowel and right kidney herniation. These structures compromise lung development, leading to variable degrees of pulmonary hypoplasia. The lung ipsilateral to the defect is most affected, however both lungs are in essence hypoplastic. They have a lower number of airways, fewer and smaller alveoli, thickened alveolar walls, and an increased amount of interstitial tissue . This leaves less alveolar airspace, and hence reduces the gas exchange surface area. Parallel to airway changes, there is a similar reduction in arteries, essentially leaving a hypoplastic vascular bed. Morphologically, the vascular wall is thickened by an increase in the arterial media and adventitia, neo-muscularization of small pulmonary arteries [6, 7] and hypermuscularization of midsize and large vessels . These vessels may have an abnormal response to mechanical and chemical stimuli in the postnatal period.
Based on the notion that time, space, and number are part of a generalized magnitude system, we assume that the dual-systems approach to temporal cognition also applies to numerical cognition. Referring to theoretical models of the development of numerical concepts, we propose that children's early skills in processing numbers can be described analogously to temporal updating and temporal reasoning.
The epidemiology of ESBL-producing Enterobacteriaceae (ESBL-PE) has been extensively studied in hospitals, but data on community transmission are scarce. We investigated ESBL-PE cocarriage and acquisition in households using a systematic literature review.
We conducted a systematic literature search to retrieve cross-sectional or cohort studies published between 1990 and 2018 evaluating cocarriage proportions and/or acquisition rates of ESBL-PE among household members, without language restriction. We excluded studies focusing on animal-to-human transmission or conducted in nonhousehold settings. The main outcomes were ESBL-PE cocarriage proportions and acquisition rates, stratified according to phenotypic or genotypic assessment of strain relatedness. Cocarriage proportions of clonally related ESBL-PE were transformed using the double-arcsine method and were pooled using a random-effects model. Potential biases were assessed manually.
We included 13 studies. Among 863 household members of ESBL-PE positive index cases, prevalence of ESBL-PE cocarriage ranged from 8% to 37%. Overall, 12% (95% confidence interval [CI], 8%–16%) of subjects had a clonally related strain. Those proportions were higher for Klebsiella pneumoniae (20%–25%) than for Escherichia coli (10%–20%). Acquisition rates of clonally related ESBL-PE among 180 initially ESBL-PE–free household members of a previously identified carrier ranged between 1.56 and 2.03 events per 1,000 person weeks of follow-up. We identified multiple sources of bias and high heterogeneity (I2, 70%) between studies.
ESBL-PE household cocarriage is frequent, suggesting intrafamilial acquisition. Further research is needed to evaluate the risk and control of ESBL-PE household transmission.
Increasing demands for small-scale radiocarbon (14C) analyses required the installation of a “SO-110 B” type ion source (HVE Europa B.V.) at our 6 MV Tandetron AMS (HVE) dedicated for the direct injection of CO2 using either the gas injection system (GIS) from Ionplus AG or a EuroVector EA 3000 elemental analyzer (EA). We tested both systems with multiple series of 14C-free and modern standards (2.5–50 µg C) combusted in quartz ampoules or EA containers and were able to quantify exogenous C introduced. In EA-GIS-AMS analysis exogenous C is mainly derived from the EA sample containers. Blank values for 50 µg C combusted in solvent-cleaned tin (Sn) vessels were 0.0127 ± 0.0012 F14C (boats) and 0.0090 ± 0.0010 F14C (capsules), while they were much higher for thermally cleaned silver (Ag) capsules. The processing of gas samples for GIS-AMS yields similar blank values corresponding to 0.30 ± 0.08 µg exogenous C with 0.93 ± 0.23 F14C consisting of 0.28 µg C modern and 0.02 µg C fossil C. The combustion of larger amounts of blank material (1 mg C) in a single quartz tube split into aliquots gives lower blanks (0.0064 ± 0.0008 F14C; 50 µg C). Thus, 14C analysis of small, gaseous samples is now possible at CologneAMS.
Mild cognitive impairment (MCI) often precedes Alzheimer’s Disease (AD) and in a high proportion of individuals affected by MCI there are already neuropathological processes ongoing that become more evident when patients progress to AD. Accordingly, there is a need for reliable biomarkers to distinguish between normal aging and incipient AD. Recent research suggests that, in addition to established biomarkers such as CSF Aß42, total tau and hyperphosphorylated tau, resting state connectivity established by fMRI might also be a feasible biomarker for prodromal stages of AD. In order to explore this possibility, we investigated resting state functional connectivity as well as CSF biomarker profiles in patients with mild cognitive impairment (n = 30; age 66.43 ± 7.06 years) and cognitively healthy controls (n = 38; age 66.89 ± 7.12 years). CSF Aß42, total Tau and hyperphosphorylated tau concentrations were correlated with measures of cognitive performance (immediate and delayed recall, global cognition, processing speed). Moreover, MCI related alterations in intrinsic functional connectivity within the Default Mode Network (DMN) were investigated using functional resting state MRI (rs-fMRI). As expected, MCI patients showed decreased CSF Aß42 and increased total Tau concentrations. These alterations were associated with cognitive performance. However, there were no differences between MCI patients and cognitively healthy controls regarding intrinsic functional connectivity. In conclusion, our results indicate, that CSF protein profiles seem to be more closely related to cognitive decline than alterations in resting state activity. Thus, resting state connectivity might not be a reliable biomarker for early stages of AD.
Studies of opera during the Czech national revival of the 1860s and 1870s have understandably focused on the signal works of the burgeoning repertoire by the likes of Smetana, Dvořák and Fibich. But the stage of the Prague Provisional Theatre, the first establishment to perform plays and opera exclusively in Czech, was home to a much more omnivorous spread of works in which operetta played a highly significant role. With the arrival of Offenbach’s Orpheus in the Underworld in 1863, operetta rapidly grew to become a major part of the repertoire. Indeed, by the early 1870s performances of works by Offenbach outstripped those of any other composer. This chapter looks at the development of operetta in the Provisional Theatre, the polyglot nature of the repertoire, including its heavy emphasis on dance and a range other spectacles, and Czech composers’ somewhat ambivalent relationship with the genre; while comic opera certainly flourished among the Czechs, no native tradition of operetta managed to become established in these pioneering years.
A large proportion of older adults are affected by impaired glucose metabolism. Previous studies with fish protein have reported improved glucose regulation in healthy adults, but the evidence in older adults is limited. Therefore, we wanted to assess the effect of increasing doses of a cod protein hydrolysate (CPH) on postprandial glucose metabolism in older adults. The study was a double-blind cross-over trial. Participants received four different doses (10, 20, 30 or 40 mg/kg body weight (BW)) of CPH daily for 1 week with 1-week washout periods in between. The primary outcome was postprandial response in glucose metabolism, measured by samples of serum glucose and insulin in 20 min intervals for 120 min. The secondary outcome was postprandial response in plasma glucagon-like peptide 1 (GLP-1). Thirty-one subjects aged 60–78 years were included in the study. In a mixed-model statistical analysis, no differences in estimated maximum value of glucose, insulin or GLP-1 were observed when comparing the lowest dose of CPH (10 mg/kg BW) with the higher doses (20, 30 or 40 mg/kg BW). The estimated maximum value of glucose was on average 0·28 mmol/l lower when the participants were given 40 mg/kg BW CPH compared with 10 mg/kg BW (P = 0·13). The estimated maximum value of insulin was on average 5·14 mIU/l lower with 40 mg/kg BW of CPH compared with 10 mg/kg BW (P = 0·20). Our findings suggest that serum glucose and insulin levels tend to decrease with increasing amounts of CPH. Due to preliminary findings, the results require further investigation.
Personalized Anaesthesia presents a modern vision of anaesthesia. Integrating technology and knowledge from leading experts in the field, this book will change the way anaesthesia is both taught and practiced. Modern practice requires the anaesthetist to provide patient-specific management. This is the first resource to be organised by the desired physiological effect, rather than by drug groupings, explaining how physiological changes can be produced and controlled according to the characteristics of each patient and the particular surgical context. The book integrates physiology, pharmacology and technology, and applies these concepts in a systematic manner to each homeostatic system. This will optimise drug titration, effect quantification and decision making in anaesthesia practice to match the needs of the individual patient. Complex mathematical and scientific concepts are explained using accessible text, colour illustrations throughout and graphs. This is an essential text for any consultant or trainee working in anaesthesia.
Here we provide an update of the 2013 report on the Nigerian Twin and Sibling Registry (NTSR). The major aim of the NTSR is to understand genetic and environmental influences and their interplay in psychological and mental health development in Nigerian children and adolescents. Africans have the highest twin birth rates among all human populations, and Nigeria is the most populous country in Africa. Due to its combination of large population and high twin birth rates, Nigeria has one of the largest twin populations in the world. In this article, we provide current updates on the NTSR samples recruited, recruitment procedures, zygosity assessment and findings emerging from the NTSR.
Substance use disorders pose a significant global social and economic burden. Although effective interventions exist, treatment coverage remains limited. The lack of an adequately trained workforce is one of the prominent reasons. Recent initiatives have been taken worldwide to improve training, but further efforts are required to build curricula that are internationally applicable. We believe that the training needs of professionals in the area have not yet been explored in sufficient detail. We propose that a peer-led survey to assess those needs, using a standardised structured tool, would help to overcome this deficiency. The findings from such a survey could be used to develop a core set of competencies which is sufficiently flexible in its implementation to address the specific needs of the wide range of professionals working in addiction medicine worldwide.