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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.
One of the goals of this volume is to present an insight into the influence of English on the people and their language in Germany. In order to be true to the history of English in contemporary Germany, it is reasonable to allow for a chapter that looks at English and its role, if it had any, in the German Democratic Republic (henceforth abbreviated as GDR). Sharing the position that ‘the GDR was a real and complicated homeland [and] a difficult past that is over, but not gone’ (Harsch 2010: 25), the present author would like to apply this position to the presence of English in the GDR. In order to demonstrate and discuss the latter, the chapter will consider various aspects. In the first of the topical sections, the role of English is examined, i.e. the role of English in the educational system and the role that English was given within the ideological boundaries of the political system in the GDR. Moving towards language-related issues, a further section reports on the influence of English on the German language in the GDR. That section reassesses English loans and English-based words that appear in the lexicon of GDR German. More importantly, it will be discussed whether these words and phrases are exclusive to GDR German. The third section of this contribution is devoted to the English language as it was taught to and spoken by GDR citizens. This part is an attempt to give an answer to questions such as the following. Was there a specific East-German foreign language variety of English? And, if so, where can GDR English – given that this nomenclature is permitted – be witnessed? What are perceivable features of that foreign-language variety? The various sections are tied together by a conclusion calling for further research. To begin with, a brief section is offered which clarifies underlying concepts and terminology.
This article outlines a systematic process for developing the different knowledge domains required for teaching sound-based (electroacoustic) music as a new subject area. As a new area within the discipline of music, teachers are novices to the field. This requires epistemological deconstruction of what knowledge teachers need in this new field. Then the analysis outlines how to develop teachers’ new knowledge, which can be constructed as subject content knowledge (SCK), pedagogic content knowledge (PCK) and technology pedagogic content knowledge (TPACK). This epistemological analysis informed our creation of teaching materials that develop these different knowledge domains and take account of the complex interplay between them. This process was demonstrated through the ElectroAcoustic Resource Site Projects, which first built subject content knowledge and then created teacher’s packs to build pedagogic content knowledge, and a bespoke CPD programme, which embedded their inter-relationships and built technology pedagogic content knowledge. Most importantly, creating the teacher’s packs employed a user-centred design approach, putting teachers and pupils in the centre of the development process, thereby giving them voice. Voice is an integral part of empowerment in our model, which disrupts the hegemonic grip of the academic curriculum dominated by the traditional music canon. This article adds to the knowledge-base regarding how to develop the different domains required for teaching a new subject. We argue that sound-based music is accessible to all teachers and learners, thereby increasing inclusivity. This in turn can radically disrupt ways of teaching music in schools and the model created provides the necessary scaffolding for a paradigm shift in music teaching on an international level.
The Single Ventricle Reconstruction Trial randomised neonates with hypoplastic left heart syndrome to a shunt strategy but otherwise retained standard of care. We aimed to describe centre-level practice variation at Fontan completion.
Centre-level data are reported as median or median frequency across all centres and range of medians or frequencies across centres. Classification and regression tree analysis assessed the association of centre-level factors with length of stay and percentage of patients with prolonged pleural effusion (>7 days).
The median Fontan age (14 centres, 320 patients) was 3.1 years (range from 1.7 to 3.9), and the weight-for-age z-score was −0.56 (−1.35 + 0.44). Extra-cardiac Fontans were performed in 79% (4–100%) of patients at the 13 centres performing this procedure; lateral tunnels were performed in 32% (3–100%) at the 11 centres performing it. Deep hypothermic circulatory arrest (nine centres) ranged from 6 to 100%. Major complications occurred in 17% (7–33%). The length of stay was 9.5 days (9–12); 15% (6–33%) had prolonged pleural effusion. Centres with fewer patients (<6%) with prolonged pleural effusion and fewer (<41%) complications had a shorter length of stay (<10 days; sensitivity 1.0; specificity 0.71; area under the curve 0.96). Avoiding deep hypothermic circulatory arrest and higher weight-for-age z-score were associated with a lower percentage of patients with prolonged effusions (<9.5%; sensitivity 1.0; specificity = 0.86; area under the curve 0.98).
Fontan perioperative practices varied widely among study centres. Strategies to decrease the duration of pleural effusion and minimise complications may decrease the length of stay. Further research regarding deep hypothermic circulatory arrest is needed to understand its association with prolonged pleural effusion.
Natural law is part of an ethical theory, guiding our moral actions. The question I would like to discuss in this chapter is the implications of natural law theory for the political order. If someone were to take natural law ethics as a starting point, what principles of political life would flow from it?
This chapter will begin with a description of the fundamental principles of natural law ethics (in its classic form, in Thomas Aquinas), noting the importance of its integral connection with a virtue ethics and a philosophical anthropology. From there, I will try to unfold the moral principles that guide political and social life, drawing the connections between them and general natural law principles.
A brief preliminary point: the classical exposition of natural law in Aquinas’ Summa Theologiae occurs in a theological context, and philosophical and theological arguments overlap a good deal.
The population dynamics of shrimp Pleoticus muelleri was used as a model to verify if the trend of continuous reproduction periodicity, shorter body size and longevity, and early sexual maturity found in tropical regions is corroborated in upwelling regions. Shrimps were sampled in a region under the influence of upwelling (northern coast of Rio de Janeiro State, Brazil). Characteristics of bottom water were registered, and shrimps were measured (carapace length – CL) and classified by sex and gonadal development stages. Reproduction was seasonal, from September to December, and favoured by water mass intrusions of low temperatures and high chlorophyll concentrations. The greatest number of reproductive females preceded periods with the highest chlorophyll concentrations in the water column (cross-correlation; P < 0.05, lag (month) = −3, r = 0.50), suggesting greater developmental success of larval stage due to increase of food availability. Von Bertalanffy growth models resulted in asymptotic carapace length estimates of CL∞ = 40.21 mm and CL∞ = 36.78 mm for females and males, respectively. The reproductive and growth characteristics of the P. muelleri population studied herein were similar to that of populations from higher latitudes, demonstrating that the latitudinal pattern rule cannot be applied in regions influenced by an upwelling phenomenon.
Pulmonary hypertension is a complex and progressive condition that is either idiopathic or heritable, or associated with one or multiple health conditions, with or without congenital or acquired cardiovascular disease. Recent developments have tremendously increased the armamentarium of diagnostic and therapeutic approaches in children and young adults with pulmonary hypertension that is still associated with a high morbidity and mortality. These modalities include non-invasive imaging, pharmacotherapy, interventional and surgical procedures, and supportive measures. The optimal, tailored diagnostic and therapeutic strategies for pulmonary hypertension in the young are rapidly evolving but still face enormous challenges: Healthcare providers need to take the patient’s age, development, disease state, and family concerns into account when initiating advanced diagnostics and treatment. Therefore, there is a need for guidance on core and advanced medical training in paediatric pulmonary hypertension. The Association for European Paediatric and Congenital Cardiology working group “pulmonary hypertension, heart failure and transplantation” has produced this document as an expert consensus statement; however, all recommendations must be considered and applied in the context of the local and national infrastructure and legal regulations.
Compound-specific radiocarbon (14C) dating often requires working with small samples of < 100 µg carbon (µgC). This makes the radiocarbon dates of biomarker compounds very sensitive to biases caused by extraneous carbon of unknown composition, a procedural blank, which is introduced to the samples during the steps necessary to prepare a sample for radiocarbon analysis by accelerator mass spectrometry (i.e., isolating single compounds from a heterogeneous mixture, combustion, gas purification and graphitization). Reporting accurate radiocarbon dates thus requires a correction for the procedural blank. We present our approach to assess the fraction modern carbon (F14C) and the mass of the procedural blanks introduced during the preparation procedures of lipid biomarkers (i.e. n-alkanoic acids) and lignin phenols. We isolated differently sized aliquots (6–151 µgC) of n-alkanoic acids and lignin phenols obtained from standard materials with known F14C values. Each compound class was extracted from two standard materials (one fossil, one modern) and purified using the same procedures as for natural samples of unknown F14C. There is an inverse linear relationship between the measured F14C values of the processed aliquots and their mass, which suggests constant contamination during processing of individual samples. We use Bayesian methods to fit linear regression lines between F14C and 1/mass for the fossil and modern standards. The intersection points of these lines are used to infer F14Cblank and mblank and their associated uncertainties. We estimate 4.88 ± 0.69 μgC of procedural blank with F14C of 0.714 ± 0.077 for n-alkanoic acids, and 0.90 ± 0.23 μgC of procedural blank with F14C of 0.813 ± 0.155 for lignin phenols. These F14Cblank and mblank can be used to correct AMS results of lipid and lignin samples by isotopic mass balance. This method may serve as a standardized procedure for blank assessment in small-scale radiocarbon analysis.
Timely access to care services is crucial to support people with dementia and their family carers to live well. Carers of people with dementia (N = 390), recruited from eight countries, completed semi-structured interviews about their experiences of either accessing or not using formal care services over a 12-month period in the Access to Timely Formal Care (Actifcare) study. Participant responses were summarised using content analysis, categorised into clusters and frequencies were calculated. Less than half of the participants (42.3%) reported service use. Of those using services, 72.8 per cent reported timely access and of those not using services 67.2 per cent were satisfied with this situation. However, substantial minorities either reported access at the wrong time (27.2%), or feeling dissatisfied or mixed feelings about not accessing services (32.8%). Reasons for not using services included use not necessary yet, the carer provided support or refusal. Reasons given for using services included changes in the condition of the person with dementia, the service's ability to meet individual needs, not coping or the opportunity to access services arose. Facilitators and barriers to service use included whether participants experienced supportive professionals, the speed of the process, whether the general practitioner was helpful, participant's own proactive attitude and the quality of information received. To achieve timely support, simplified pathways to use of formal care services are needed.
Cognitive impairment is a core feature of major depressive disorder (MDD). Cognitive remediation may improve cognition in MDD, yet so far, the underlying neural mechanisms are unclear. This study investigated changes in intrinsic neural activity in MDD after a cognitive remediation trial.
In a longitudinal design, 20 patients with MDD and pronounced cognitive deficits and 18 healthy controls (HC) were examined using resting-state functional magnetic resonance imaging. MDD patients received structured cognitive remediation therapy (CRT) over 5 weeks. The whole-brain fractional amplitude of low-frequency fluctuations was computed before the first and after the last training session. Univariate methods were used to address regionally-specific effects, and a multivariate data analysis strategy was employed to investigate functional network strength (FNS).
MDD patients significantly improved in cognitive function after CRT. Baseline comparisons revealed increased right caudate activity and reduced activity in the left frontal cortex, parietal lobule, insula, and precuneus in MDD compared to HC. In patients, reduced FNS was found in a bilateral prefrontal system at baseline (p < 0.05, uncorrected). In MDD, intrinsic neural activity increased in right inferior frontal gyrus after CRT (p < 0.05, small volume corrected). Left inferior parietal lobule, left insula, left precuneus, and right caudate activity showed associations with cognitive improvement (p < 0.05, uncorrected). Prefrontal network strength increased in patients after CRT, but this increase was not associated with improved cognitive performance.
Our findings support the role of intrinsic neural activity of the prefrontal cortex as a possible mediator of cognitive improvement following CRT in MDD.
Objectives: This study aimed to evaluate the influence of lower limb loss (LL) on mental workload by assessing neurocognitive measures in individuals with unilateral transtibial (TT) versus those with transfemoral (TF) LL while dual-task walking under varying cognitive demand. Methods: Electroencephalography (EEG) was recorded as participants performed a task of varying cognitive demand while being seated or walking (i.e., varying physical demand). Results: The findings revealed both groups of participants (TT LL vs. TF LL) exhibited a similar EEG theta synchrony response as either the cognitive or the physical demand increased. Also, while individuals with TT LL maintained similar performance on the cognitive task during seated and walking conditions, those with TF LL exhibited performance decrements (slower response times) on the cognitive task during the walking in comparison to the seated conditions. Furthermore, those with TF LL neither exhibited regional differences in EEG low-alpha power while walking, nor EEG high-alpha desynchrony as a function of cognitive task difficulty while walking. This lack of alpha modulation coincided with no elevation of theta/alpha ratio power as a function of cognitive task difficulty in the TF LL group. Conclusions: This work suggests that both groups share some common but also different neurocognitive features during dual-task walking. Although all participants were able to recruit neural mechanisms critical for the maintenance of cognitive-motor performance under elevated cognitive or physical demands, the observed differences indicate that walking with a prosthesis, while concurrently performing a cognitive task, imposes additional cognitive demand in individuals with more proximal levels of amputation.
We present the second data release (DR2) of the SkyMapper Southern Survey, a hemispheric survey carried out with the SkyMapper Telescope at Siding Spring Observatory in Australia, using six optical filters: u, v, g, r, i, z. DR2 is the first release to go beyond the
) limit of the Shallow Survey released in the first data release (DR1), and includes portions of the sky at full survey depth that reach
mag in g and r filters. The DR2 photometry has a precision as measured by internal reproducibility of 1% in u and v, and 0.7% in griz. More than 21 000
have data in some filters (at either Shallow or Main Survey depth) and over 7 000
have deep Main Survey coverage in all six filters. Finally, about 18 000
have Main Survey data in i and z filters, albeit not yet at full depth. The release contains over 120 000 images, as well as catalogues with over 500 million unique astrophysical objects and nearly 5 billion individual detections. It also contains cross-matches with a range of external catalogues such as Gaia DR2, Pan-STARRS1 DR1, GALEX GUVcat, 2MASS, and AllWISE, as well as spectroscopic surveys such as 2MRS, GALAH, 6dFGS, and 2dFLenS.
Broad-spectrum antibiotic de-escalation before and after implementation of a 72-hour antibiotic time-out alert within the electronic medical record was analyzed. De-escalation occurred significantly more often after the implementation of the alert (55.0% vs 35.1%; 95% confidence interval, −0.3491 to −0.0488; P < .01).
Catholic social thought has always emphasized that the state or government plays an essential role in political, social, and economic life, but government’s role has been increasingly emphasized since 1960. Trends in modern secular thought and political practice that have placed a greater emphasis on government solutions to social problems and are less inclined toward other (and especially free market) solutions, may be one factor in this increased emphasis. As CST has embraced the idea of more active government, it has always qualified that embrace with important limits, some of which are discussed. But in this chapter I ask, “To what extent has CST considered the possibility of government abusing its expanded powers to regulate?” and “What suggestions does it offer for dealing with such abuses?” The answer to both questions is, I suggest, “Not enough.” The primary point I make is not that CST ought to adopt a particular stance regarding the specific institutional limits on government that should be employed, or how much government power ought to be limited, but rather that it is a significant gap in CST that it barely considers this issue at all.