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Frank Jackson’s (1986) Mary is confined in a room in which the visual stimuli are all grayscale, so that her visual experiences have all been achromatic. Nonetheless, from books and television lectures, she has gotten all factual knowledge one can get from any source that pertains to the having of conscious visual experiences. It could indeed be “everything [factual] there is to know about the physical nature of the world,” based on “completed” science. But, Jackson writes, “[i]t seems … that Mary does not know all there is to know. For when she is let out of the black-and-white room or given a color television, she will learn what it is like to see something red, say” (1986, 291; emphasis Jackson’s).
We provide a comparative case study of rehabilitation counselling across the U.S., Japan and Taiwan focusing on the common challenges facing international constituents in the field. Through interviews with students, faculty and administrators from each of the respective countries, we use thematic coding analysis to identify key points of tension. Emergent themes comprise (a) systemic challenges, (b) student and faculty mobility, (c) cultural and linguistic differences and (d) lack of sustainable international leadership. We further discuss mitigation of these recurrent challenges and conclude collaborative research, student exchange and institutional partnerships may advance teaching, research and service scholarship of rehabilitation counselling programs, and, in turn, enhance the lives of people with chronic illness and disability worldwide.
To validate a system to detect ventilator associated events (VAEs) autonomously and in real time.
Retrospective review of ventilated patients using a secure informatics platform to identify VAEs (ie, automated surveillance) compared to surveillance by infection control (IC) staff (ie, manual surveillance), including development and validation cohorts.
The Massachusetts General Hospital, a tertiary-care academic health center, during January–March 2015 (development cohort) and January–March 2016 (validation cohort).
Ventilated patients in 4 intensive care units.
The automated process included (1) analysis of physiologic data to detect increases in positive end-expiratory pressure (PEEP) and fraction of inspired oxygen (FiO2); (2) querying the electronic health record (EHR) for leukopenia or leukocytosis and antibiotic initiation data; and (3) retrieval and interpretation of microbiology reports. The cohorts were evaluated as follows: (1) manual surveillance by IC staff with independent chart review; (2) automated surveillance detection of ventilator-associated condition (VAC), infection-related ventilator-associated complication (IVAC), and possible VAP (PVAP); (3) senior IC staff adjudicated manual surveillance–automated surveillance discordance. Outcomes included sensitivity, specificity, positive predictive value (PPV), and manual surveillance detection errors. Errors detected during the development cohort resulted in algorithm updates applied to the validation cohort.
In the development cohort, there were 1,325 admissions, 479 ventilated patients, 2,539 ventilator days, and 47 VAEs. In the validation cohort, there were 1,234 admissions, 431 ventilated patients, 2,604 ventilator days, and 56 VAEs. With manual surveillance, in the development cohort, sensitivity was 40%, specificity was 98%, and PPV was 70%. In the validation cohort, sensitivity was 71%, specificity was 98%, and PPV was 87%. With automated surveillance, in the development cohort, sensitivity was 100%, specificity was 100%, and PPV was 100%. In the validation cohort, sensitivity was 85%, specificity was 99%, and PPV was 100%. Manual surveillance detection errors included missed detections, misclassifications, and false detections.
Manual surveillance is vulnerable to human error. Automated surveillance is more accurate and more efficient for VAE surveillance.
We aimed to compare the procedural and mid-term performance of a specifically designed self-expanding stent with balloon-expandable stents in patients undergoing hybrid palliation for hypoplastic left heart syndrome and its variants.
The lack of specifically designed stents has led to off-label use of coronary, biliary, or peripheral stents in the neonatal ductus arteriosus. Recently, a self-expanding stent, specifically designed for use in hypoplastic left heart syndrome, has become available.
We carried out a retrospective cohort comparison of 69 neonates who underwent hybrid ductal stenting with balloon-expandable and self-expanding stents from December, 2005 to July, 2014.
In total, 43 balloon-expandable stents were implanted in 41 neonates and more recently 47 self-expanding stents in 28 neonates. In the balloon-expandable stents group, stent-related complications occurred in nine patients (22%), compared with one patient in the self-expanding stent group (4%). During follow-up, percutaneous re-intervention related to the ductal stent was performed in five patients (17%) in the balloon-expandable stent group and seven patients (28%) in self-expanding stents group.
Hybrid ductal stenting with self-expanding stents produced favourable results when compared with the results obtained with balloon-expandable stents. Immediate additional interventions and follow-up re-interventions were similar in both groups with complications more common in those with balloon-expandable stents.
The purpose of this study was to test the usefulness of the attribution model (Corrigan, Markowitz, Watson, Rowan & Kubiak, 2003; Weiner, 1995) in a Chinese cultural context to explain Chinese college students’ perceptions of discrimination toward people with mental illness. A total of 293 college students (male = 142; female = 151; age from 18 to 22) completed an Attribution Questionnaire (AQ) after reading vignettes, consisting of a male who either used illicit drugs or had a traumatic brain injury. Data were analysed using a hierarchical regression to determine the amount of variance accounted for in discriminatory behaviours by the attribution model. The results showed, when controlling for all other factors, that controllability and the three emotions (pity, anger, and fear) were found to be significant predictors of discrimination. The relationship between controllability, responsibility, and discrimination was not consistent with the attribution model since responsibility did not mediate the controllability of cause. These results provide support for the idea that disability attributions are culturally influenced.
Extracorporeal cardiopulmonary resuscitation may be defined as the use of extracorporeal membrane oxygenation for the support of patients who do not respond to conventional cardiopulmonary resuscitation. Data from national and international paediatric databases indicate that the use of extracorporeal cardiopulmonary resuscitation is increasing. Guidelines from the American Heart Association suggest that any patient with refractory cardiopulmonary resuscitation and potentially reversible causes of cardiac arrest is a candidate for extracorporeal cardiopulmonary resuscitation. One possible framework for selection of patients for extracorporeal cardiopulmonary resuscitation includes dividing patients on the basis of favourable or unfavourable characteristics. Favourable characteristics include cardiac disease, witnessed event in the intensive care unit, ability to deliver effective cardiopulmonary resuscitation, active patient monitoring present, favourable arterial blood gases, and early institution of extracorporeal membrane oxygenation. Unfavourable characteristics potentially include non-cardiac disease, an unwitnessed cardiac arrest, ineffective cardiopulmonary resuscitation, and severely acidotic arterial blood gases. Considering the significant resources and cost involved in the use of extracorporeal cardiopulmonary resuscitation, its use needs to be critically examined to improve outcomes, assess neurological recovery and quality of life, and help identify populations and other factors that may help guide in the selection of patients for successful extracorporeal cardiopulmonary resuscitation.
The use of extracorporeal membrane oxygenation in infants and children with cardiac disease who develop refractory cardiogenic shock, cyanosis, or cardiac arrest is increasing. Early mortality in children with cardiac disease who require extracorporeal membrane oxygenation remains an important issue, as only 40% of cannulated patients survive to discharge from the hospital. However, it is encouraging that 90% children who are discharged alive from the hospital after extracorporeal membrane oxygenation are still alive at intermediate-term follow-up. Surviving patients are at risk for long-term dysfunction of multiple organ systems related to their underlying cardiac disease, non-cardiac comorbidities, treatment-related complications, and exposure to extracorporeal membrane oxygenation. Among the most important acute complications related to support with extracorporeal membrane oxygenation is injury to the central nervous system, which may contribute to adverse neurodevelopmental outcomes. All of these factors, in turn, influence quality of life. Many survivors remain medically complex related to their underlying cardiac disease, comorbidities, and sequelae of complications acquired over their lifetime. Neurological morbidity clearly plays an important role in approximately one-third of survivors, with significant deficits in approximately 10%. The limited data about quality of life data that are available for survivors of cardiac extracorporeal membrane oxygenation suggests that approximately 15–30% of survivors have at least moderately decreased quality of life. Overall, published data support the ongoing use of support with extracorporeal membrane oxygenation in children with acute cardiac failure, most of whom would die without it. However, programmatic efforts to improve the selection of patients and the preservation of the function of end organs during extracorporeal membrane oxygenation are clearly needed in order to improve long-term outcomes.
The higher-order thought (HOT) theory holds that a state's being conscious consists in one's having a suitable thought that one is, oneself, in that state. The HOT theory explains not only how we are aware of our conscious mental states, but also how it is that we are thereby aware of ourselves. This chapter shows how HOTs can accommodate essentially indexical awareness of oneself without invoking any special, antecedent self-awareness. It argues that a crucial assumption that underlies the claim of immunity to error through misidentification is unfounded, namely, the assumption that no self-identification figures in our awareness of our own conscious states. Finally, the chapter discusses the particular kind of identification of self that figures in our higher-order awareness of our conscious states and how that relates to the self-identification that underlies our first-person thoughts generally.
In 1522, the artisan festive ‘kingdom’ of the Biliemme put up the biggest street tabernacle in Florence. German textile workers were behind the tabernacle and this article argues that, at a time of crisis for German workers, these men looked to reassert their place in Florence through their participation in a citywide artisan festive subculture. Forty years later, Germans in the Biliemme district had largely been replaced by textile migrants from other parts of Italy. Nonetheless the kingdom remained a important vehicle for creating neighbourhood solidarities and for incorporating these new migrants into the artisan and civic world.
I argue that the partial-report results Block cites do not establish that phenomenology overflows cognitive accessibility, as Block maintains. So, without additional argument, the mesh he sees between psychology and neuroscience is unsupported. I argue further that there is reason to hold, contra Block, that phenomenology does always involve some cognitive access to the relevant experience.
Even if A-consciousness and P-consciousness were conceptually
distinct, it is no fallacy for researchers relying on a suitable
theory to infer one from the other. But P-consciousness conceptually
implies A-consciousness – unless one or the other is mere ersatz
consciousness. And we can best explain mental states' being conscious,
in any intuitively natural sense, by appeal to higher-order
Scanning transmission electron microscopy (STEM) coupled with energy dispersive x-ray analysis (EDX) and electron energy-loss spectroscopy (EELS) has been used to characterize the elemental composition and oxidation conditions of various soot samples. The STEM employed in this investigation was the Vacuum Generators HB603, with a microanalytical resolution approaching 1 rnm, that allowed the analysis of individual soot particles and aggregates. The aim of this research is quantification of the EDX spectra which is possible after background and absorption corrections. This information can then be used for comparative studies of different fuels and combustion processes. EELS has been employed to determine the amount of graphitic carbon in a soot particulate, and the detection of trace elements of low atomic number. It has been shown in soot that for Carbon the energy-loss of the p shell electrons increases with the amount of oxidation at high temperatures. Analysis and characterization of gas turbine soot, collected from an engine exhaust duct of a 737-300 aircraft showed an abundance of different elements. Some of these elements originated from the fuel and combustion processes, while other elements were components of the engine itself that combined with the soot particulates during the combustion process. The study showed that soot impurities were found in all discrete sections of aggregates, and that only one or two small soot particulates were necessary to obtain a chemical fingerprint. Other investigations include; coal soot, diesel soot at different engine operating conditions and soot produced from wood burning. The richness of the spectra obtained and the ability to quantify results represents an opportunity to accomplish source identification in a novel, powerful way.
Hospital-based “firms” provide a means for combatting the fragmentation experienced by both patients and caregivers in the modern teaching hospital environment. A “firm” is an academic group practice that includes attending physicians, physician trainees, nurses, other staff, and patients. Each person's relationship with a firm lasts throughout his or her association with a particular institution. This article describes the firm system that was recently implemented on the Medical Service of the Cleveland VAMC. This system incorporates both inpatient and outpatient general medical services and provides for unbiased assignment of patients, physicians, and nurses.