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Synchronized cardioversion is an internationally accepted standard therapy for unstable tachyarrhythmias, but it is conventionally an in-hospital physician-led intervention. Increasingly, it is being brought forward into the prehospital setting as part of a specialist paramedic scope of practice; however, very little literature exists regarding the epidemiology or efficacy in this setting.
All patients receiving cardioversion within a United Kingdom (UK) ambulance service were identified using an electronic database. The period of inclusion was March 1, 2017 through October 31, 2020. These data were then interrogated to provide demographic, physiological, and efficacy data, and then a sub-group was created to identify those who presented with a primary arrhythmia (as opposed to post-cardiac arrest).
From a total of 93 patients, prehospital synchronized cardioversion successfully terminated the tachyarrhythmia in 96% of patients presenting with a primary arrhythmia (85% in the allcomers group) with a predominance towards males (82% of patients) and an average age of 67 years. Hypotension and reduced level of consciousness were the most commonly documented unstable features (84.4% and 44.4%).
Cardioversion within a paramedic-led service results in efficacy rates of 96% in patients presenting with a primary tachyarrhythmia. This is a similar efficacy rate to traditional doctor-led therapies. Demographic data show that males make up over 80% of the patient population, in keeping with previously published work across the spectrum of cardiac interventions.
Typhlocoelum cucumerinum is a tracheal parasite of birds widely distributed across the globe. Nevertheless, aspects of the biology of this cyclocoelid are still poorly understood. Herein, we report the finding of T. cucumerinum in definitive and intermediate hosts from an urban waterbody of Brazil. The parasite was initially detected during the necropsy of domestic Muscovy ducks (Cairina moschata) found dead in the locality. Coproparasitological tests in live animals revealed that 12/47 (25.53%) Muscovy ducks and 2/8 (25%) mallards (Anas platyrhynchos platyrhynchos) were infected with T. cucumerinum. Moreover, rediae and metacercariae morphologically similar to T. cucumerinum were found in 3/248 (1.33%) Biomphalaria straminea collected in the same waterbody frequented by the birds. The conspecificity between the adult and the larval stages was confirmed molecularly (100% similarity in Cox-1). Moreover, the phylogenetic position of T. cucumerinum was determined for the first time based on partial fragments of the 28S, Cox-1 and Nad-1 genes. The species grouped with other members of the subfamily Typhlocoelinae with sequences available, but the data obtained do not support the distinctiveness of the genera Typhlocoelum and Tracheophilus. Further studies involving a broader range of species can result in taxonomic rearrangements in Typhlocoelinae.
Despite a growing body of literature on integrated land–sea management (ILSM), very little critical assessment has been conducted in order to evaluate ILSM in practice on island systems. Here we develop indicators for assessing 10 integrated island management principles and evaluate the performance of planning and implementation in four island ILSM projects from the tropical Pacific across different governance structures. We find that where customary governance is still strongly respected and enabled through national legislation, ILSM in practice can be very effective at restricting access and use according to fluctuations in resource availability. However, decision-making under customary governance systems may be vulnerable to mismanagement. Government-led ILSM processes have the potential to design management actions that address the spatial scale of ecosystem processes and threats within the context of national policy and legislation, but may not fully capture broad stakeholder interests, and implementation may be poorly coordinated across highly dispersed island archipelagos. Private sector partnerships offer unique opportunities for resourcing island ILSM, although these are highly likely to be geared towards private sector interests that may change in the future and no longer align with community and/or national objectives. We identify consistent challenges that arise during island ILSM planning and implementation and offer recommendations for improvement.
We describe bright microwave events that were first detected with the Parkes 64-m telescope at 8.4 or 22 GHz from six active-chromosphere stars. In some flares spectral data were obtained over a large frequency range from simultaneous measurements with the Parkes reflector (8.4 or 22 GHz), the Tidbinbilla interferometer (8.4 and 2.29 GHz), the Fleurs synthesis telescope (1.42 GHz) and the Molonglo Observatory synthesis telescope (0.843 GHz). Data on circular polarization were obtained from the Parkes observations at 8.4 GHz.
The stars were in a wide variety of evolutionary states, ranging from a single pre-main-sequence star (HD 36705), two RS CVn binaries (HD 127535, HD 128171), an Algol (HD 132742) and two apparently single K giants (HD 32918 and HD 196818). Their high brightness temperatures, positive spectral indices and low polarization are consistent with optically thick gyrosynchrotron emission from mildly relativistic electrons with average energies 0.5 to 3 MeV gyrating in inhomogeneous magnetic fields of 5 to 100 G.
Very sensitive low-noise amplifiers designed to receive transmissions from spacecraft are not necessarily suitable receivers for radio astronomy. In the former case a good signalto- noise ratio is required so that high data rates can be achieved. In the latter the ratio of signal to noise power may be as low as 10-4 and the stability of receiver gain and that of ail sources of noise during long integration times become of equal importance.
This paper describes a novel solution to the problem, which allowed important astronomy to be performed while the ruby maser receivers belonging to the European Space Agency were installed on the Parkes radio telescope for an extended period of time.
We present an overview of the survey for radio emission from active stars that has been in progress for the last six years using the observatories at Fleurs, Molonglo, Parkes and Tidbinbilla. The role of complementary optical observations at the Anglo-Australian Observatory, Mount Burnett, Mount Stromlo and Siding Spring Observatories and Mount Tamborine are also outlined. We describe the different types of star that have been included in our survey and discuss some of the problems in making the radio observations.
We present some preliminary results of an optical and radio study of the very active RS CVn binary HD 127535. Photometric measurements show the presence of a large amplitude wave which exhibits marked changes in shape and range on time scales as short as a few months. This photometric variation is almost certainly due to large cool starspots on the cooler, more luminous component. As part of a survey of southern active-chromosphere stars with the Parkes radio telescope, HD 127535 has been observed at 5, 8.4 and 22 GHz. No detection was made at 5 GHz, possibly because of confusion due to the angular proximity of the star to the galatic plane. However, it is one of the strongest sources detected in the 8.4 GHz survey, and is one of only two stars detected at 22 GHz. Photometry obtained two cycles before the 8.4 GHz observations suggest a possible correlation between the radio emission and the photometric wave, i.e. spot visibility, but more data are needed.
Properties of the microwave emission from HR1099 are examined in an attempt to determine whether the emission arises as gyro-synchrotron radiation from mildly relativistic electrons trapped in magnetic fields above starspots on the active K subgiant component. It is shown that radio curves do not exhibit a systematic variation in phase with the rotation rate, as one might expect for emission from a source situated above a long-lived starspot. However, there is some evidence that the radio flaring occurs at two preferred longitude zones. Whether these zones agree with starspot locations remains to be determined by light curve modelling. What we can say with confidence is that the measured spectral index of the microwave emission does not fit a simple gyro-synchrotron source model, such as that proposed to explain the observed reversal with frequency of the sense of circular polarization.
Shakespeare's many patrons included magnates who lent their names or the names of their offices to his playing company; dedicatees of literary works; and powerful individuals for whom he performed specific services. In each case the question arises: did patronage involve personal acquaintance, or even grow into friendship?
Without a patron, early modern stage-players risked being classified as masterless men, no better than rogues and vagabonds. While knights or minor lords might patronise players in the middle of the sixteenth century, the privilege became restricted to barons and earls during the reign of Elizabeth (1558–1603), and to members of the royal family during the reign of James (1603–25) (Chambers 1923, 4, pp. 269–71).
Shakespeare's playing company was patronised by the Lord Chamberlain from about 1594, and by King James from 1603. During the years leading up to 1594 Shakespeare can be connected, with varying degrees of certainty, to a plethora of patrons. His Titus Andronicus, according to the title-page of its first edition (1594), was performed by the players of three earls: Derby, Pembroke, and Sussex. Philip Henslowe's contemporary ‘Diary’ (Foakes 2002, pp. 21–2) reports that the same play was performed by players of the Earl of Sussex, the Lord Admiral and the Lord Chamberlain.
At the very beginning of 1594 the Earl of Derby was Ferdinando Stanley (d. 16 April 1594), styled Lord Strange until his father's death on 25 September 1593. Pembroke was William Herbert (d. 1601). Sussex was Robert Radcliffe, who succeeded at the death of his father, Henry, on 4 December 1593. The Lord Admiral was Charles Howard, Baron Howard of Effingham: his patronage of the Admiral's Men extended from 1576 to 1603. The Lord Chamberlain was Henry Carey (d. 4 July 1596), 1st Baron Hunsdon; succeeded by Sir William Brooke (d. 6 March 1597), 10th Baron Cobham; and by George Carey (d. 9 September 1603), 2nd Baron Hunsdon (ODNB 2004; Cokayne 1910–59).
Macroevolutionary and macroecological studies must account for biases in the fossil record, especially when questions concern the relative abundance and diversity of taxa that differ in preservation and sampling potential. Using Cenozoic marine mollusks from a temperate setting (New Zealand), we find that much of the long-term temporal variation in gastropod versus bivalve occurrences is correlated with the stage-level sampling probabilities of aragonitic versus calcitic taxa. Average sampling probabilities are higher for calcitic species, but this contrast is time-varying in a predictable way, being concentrated in stages with widespread carbonate deposition.
To understand these results fully, we link them with analyses at the level of individual point occurrences. Doing so reveals that aragonite bias is effectively absent in terrigenous clastic sediments. In limestones, by contrast, calcitic species have at least twice the odds of sampling as aragonitic species. This result is most pronounced during times of widespread carbonate deposition, where the difference in the per-collection odds of sampling species is a factor of eight. During carbonate-rich intervals, calcitic taxa also have higher odds of sampling in clastics. At first glance this result may suggest simple preservational bias against aragonite. However, comparing relative odds of aragonitic versus calcitic sampling with absolute sampling rates shows that the positive calcite bias during carbonate-rich times reflects higher than average occurrence rates for calcitic taxa (rather than lower rates for aragonitic taxa) and that the negative aragonite bias in limestones reflects lower than average occurrence rates for aragonitic taxa (rather than higher rates for calcitic taxa).
Our results therefore indicate a time-varying interplay of two main factors: (1) taphonomic loss of aragonitic species in carbonate sediments, with no substantial bias in terrigenous clastics; and (2) an ecological preference of calcitic taxa for environments characteristic of periods with pervasive carbonate deposition, irrespective of lithology per se.
Primitive notions are most familiar from the celebrated letters Descartes exchanged with Princess Elisabeth of Bohemia on the topic of mind-body interaction, but they figure prominently in many of Descartes’ writings. Descartes sometimes introduces them as notions orideas, making it is clear that either word is acceptable (e.g., AT III 691, CSMK 226; cf. AT VII 440, CSM II 296 and AT VIIIB 358, CSM I 303). In the early Rules for the Direction of the Mind, he refers to “primary seeds of truth [prima veritatum semina] naturally implanted in human minds” (AT X 376, CSM I 18; cf. The World AT XI 47, CSM 2 97). The “seeds of truth which are naturally in our souls” return in the Discourse on Method (1637) as “primary truths” (AT VI 64, 76; CSM I 144, 150). In the first of the famous pair of letters to Elisabeth, Descartes crucially relies on primitive notions (notions primitives), also called “simple notions” (notions simples), that the soul “possesses by nature” as “ready-made” (AT III 666–67, CSMK 219). And in the letter to Voetius written at the same time as the exchange with Elisabeth, we again have “notions” that are “innate” in virtue of being “implanted” in the soul (AT VIIIB 166, CSM I 222). In the Principles of Philosophy, the principles referred to in the title are characterized in much the same way. They can be clearly and distinctly perceived or intuited, and they enable the deduction of “all other things” (AT IXB 9–11, CSM 1 183–84). This treatment of principles is not surprising given that the words translated as “primitive,” “primary,” and “principle” can be synonymous in both Latin and French. Finally, in August 1649, less than half a year before his death, Descartes makes use of primitive notions in a letter to More (AT V 402–3, CSMK 381).
Despite these continuities, Descartes does not settle on an exact characterization of primitive notions, nor does he supply a detailed and absolutely complete inventory. It is abundantly clear that primary notions are innate, but this affords little help because Descartes’ treatment of innate ideas is notoriously difficult.
Ideas are modes of thought that function in various important ways in Descartes’ philosophy. It is in virtue of ideas that thought is intentional and gives meaning to words. Ideas are the subject matter for true and false judgments that are expressed in propositional forms, and they are the basis of the certain foundations of knowledge (scientia). This variety of functions is correlated with a complex set of theoretical distinctions that apply to ideas. Most of these are first explained rather than just used in the Third Meditation of the Meditations on First Philosophy:
First, however, considerations of order appear to dictate that I now classify my thoughts into definite kinds, and ask which of them can properly be said to be the bearers of truth and falsity. Some of my thoughts are as it were the images of things [tanquam rerum imagines], and it is only in these cases that the term “idea” is strictly appropriate – for example when I think of a man, or a chimera, or the sky, or an angel, or God.
(AT VII 36–37, CSM II 25–26)
This passage continues by noting that some thoughts have “additional forms,” which include volitional aspects. So all modes of thought include an ideational aspect in the “strictly appropriate” sense, while some include volitional aspects as well (AT VIIIA 17, CSM I 204; cf. AT III 295, CSMK 172). That contrast is important in the Fourth Meditation's theodicy of error (see error, theodicies of). The quoted Third Meditation passage goes on to introduce the question of truth and falsity:
Now as far as ideas are concerned, provided they are considered solely in themselves and I do not refer them to anything else, they cannot strictly speaking be false; for whether it is a goat or a chimera that I am imagining, it is just as true that I imagine the former as the latter.
I have one further worry, namely how the author avoids reasoning in a circle when he says that we are sure that what we clearly and distinctly perceive is true only because God exists. But we can be sure that God exists only because we clearly and distinctly perceive this. Hence, before we can be sure that God exists, we ought to be able to be sure that whatever we perceive clearly and evidently is true.
(AT VII 214, CSM II 150)
The circular argument or strategy identified here has come to be known as the Cartesian Circle. The Circle is constructed from two arcs. The first is that certainty of the truth of clear and distinct perceptions depends on God's attributes. In the Fourth Meditation, for example, Descartes uses the Third Meditation understanding of God to prove the rule that everything perceived with clarity and distinctness is true. The second arc is that certainty of God's existence depends on a proof from clear and distinct premises.
Descartes was not impressed by Arnauld's observation. He responded by saying that an adequate explanation was found in his Second Replies and added:
To begin with, we are sure that God exists because we attend to the arguments which prove this; but subsequently it is enough for us to remember that we perceived something clearly in order for us to be certain that it is true. This would not be sufficient if we did not know that God exists and is not a deceiver.
(AT VII 246, CSM II 171)
A vast literature has accumulated as the result of attempts to understand Descartes’ response and evaluate how successful it is. It is an attractive problem for scholars because it is, on the surface, so simple to formulate, and Descartes’ explicit treatments of the Circle are brief and cryptic. Moreover, the problem gains depth from its connection to central issues of doubt,method, clear and distinct perception, scientia, and the knowledge of God.