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Traces of George Orwell’s critiques of totalitarian society, in both blunt and subtle forms, exist throughout video games. Major themes of dystopia, surveillance culture, technologies of control, authoritarianism, and the oppression of a large underclass exist in innumerable game narratives and environments. Do games like the BioShock series (2007– ), Remember Me (2013), Watch Dogs series (2014– ), We Happy Few (2018), Orwell (2016–), Inside (2016), and Papers, Please (2013) encourage critical thought around the eventuality of totalitarianism, of which Orwell warned? Or, are these games merely systems in which to practise a kind of entrapment, in which so-called ‘freedom’ may be performed within a medium that is exceedingly ordered in its very constitution? Through the stories games tell, as well as in the very form of video games, is it even possible to truly stimulate a model of criticality? This chapter proposes that the critical influence of Nineteen Eighty-Four exists not only in video game narratives and the constitution of their navigable spaces, but also in the wide variety of strategies, rule-based systems, rhetorical capacities, ethical problematics and – most importantly – their strategic kinds of failure.
Depression and coronary heart disease (CHD) are highly comorbid conditions. Brain-derived neurotrophic factor (BDNF) plays an important role in cardiovascular processes. Depressed patients typically show decreased BDNF concentrations. We analyzed the relationship between BDNF and depression in a sample of patients with CHD, and additionally distinguished between cognitive-affective and somatic depression symptoms. We also investigated whether BDNF was associated with somatic comorbidity burden, acute coronary syndrome (ACS), or congestive heart failure (CHF).
The following variables were assessed for 225 hospitalized patients with CHD: BDNF concentrations, depression (Patient Health-Questionnaire-9), somatic comorbidity (Charlson Comorbidity Index), CHF, ACS, platelet count, smoking status, antidepressant treatment.
Regression models revealed that BDNF was not associated with severity of depression: Although depressed patients (PHQ-9 score >7) had significantly lower BDNF concentrations compared to non-depressed patients (p=.04), this was not statistically significant after controlling for confounders (p=.15). Cognitive-affective symptoms and somatic comorbidity burden each closely missed a statistically significant association with BDNF concentrations (p=.08, p=.06, respectively). BDNF was reduced in patients with CHF (p=.02). There was no covariate-adjusted, significant association between BDNF and ACS.
Serum BDNF concentrations are associated with cardiovascular dysfunction. Somatic comorbidities should be considered when investigating the relationship between depression and BDNF.
A practical bit condition monitoring system is a necessary component of autonomous drilling. Tricone bits are widely used in blasthole drilling in mining. Bits experience a variety of wear mechanisms during the operation and rolling element failure is the dominant catastrophic failure mode of tricone bits. Bit lifetime and performance significantly vary based on the working condition and the critical components of the bit i.e. rolling elements, are invisible to the direct condition monitoring systems. At McGill University, extensive research work is conducted to develop an indirect bit condition monitoring and failure prediction approach relying on the vibration signals and the technology is currently patent pending. This article presents real-world experimental evidence to show the unreliability of conservative bit changing strategy based on the bit operation life or drop in the rate of penetration (ROP) and ineffectiveness of direct wear monitoring techniques to cover the dominant failure mode.
To demonstrate the unreliability of tricone bit replacement relying on bit operation life or ROP measurement and ineffectiveness of vision-based monitoring techniques for autonomous drilling.
In this chapter we reflect on the experiences and knowledge gained by instructors and administrators within the first five years of the Borderless Higher Education Project for Refugees (BHER) in Dadaab, Kenya. We are interested in the ethical reshaping of institutional and pedagogical praxis and use and develop the term ‘equity failure’ to refer to moments that reveal gaps in the foundations and planning for equity within the project. These gaps make evident how the work put towards developing ethical relationships does not always enable equity. ‘Equity failure’, therefore, is the metaphor we adopt to point to the productive challenges brought about by the continuous reencounters between different worldviews, positionalities and, as well, the logistical challenges of coordinating higher education in a context rife with many reproducing marginalisations and that play out in a variety of ways. The chapter begins by detailing the history of the BHER project. This is followed by a discussion of two project spaces where issues related to the tuition-free aspects of the BHER initiative and classroom discussions about the construction of identity and forced migration are raised. We conclude by reiterating the importance of learning from equity failure to engender more ethical relationships within North–South partnerships that may unintentionally replicate power and knowledge disparities.
In 2009, the Institute of Medicine published guidelines for implementation of Crisis Standards of Care (CSC) at the state level in the United States (US). Based in part on the then concern for H1N1 pandemic, there was a recognized need for additional planning at the state level to maintain health system preparedness and conventional care standards when available resources become scarce. Despite the availability of this framework, in the years since and despite repeated large-scale domestic events, implementation remains mixed.
Coronavirus disease 2019 (COVID-19) rejuvenates concern for how health systems can maintain quality care when faced with unrelenting burden. This study seeks to outline which states in the US have developed CSC and which areas of care have thus far been addressed.
An online search was conducted for all 50 states in 2015 and again in 2020. For states without CSC plans online, state officials were contacted by email and phone. Public protocols were reviewed to assess for operational implementation capabilities, specifically highlighting guidance on ventilator use, burn management, sequential organ failure assessment (SOFA) score, pediatric standards, and reliance on influenza planning.
Thirty-six states in the US were actively developing (17) or had already developed (19) official CSC guidance. Fourteen states had no publicly acknowledged effort. Eleven of the 17 public plans had updated within five years, with a majority addressing ventilator usage (16/17), influenza planning (14/17), and pediatric care (15/17), but substantially fewer addressing care for burn patients (9/17).
Many states lacked publicly available guidance on maintaining standards of care during disasters, and many states with specific care guidelines had not sufficiently addressed the full spectrum of hazard to which their health care systems remain vulnerable.
We report a 10-month-old girl with KCNT1 (c1420C > T; p. Arg474Cys, R474C) mutation-associated epileptic encephalopathy, systemic-to-pulmonary artery “collateralopathy”, and intermittent QTc prolongation. Spontaneous regression of systemic-to-pulmonary artery collateral-mediated left heart dilation was noted in this patient, a finding which was ominous as it heralded the onset of severe pulmonary hypertension. The structural and electrical phenotypic features of KCNT1 mutation-associated heart disease, including the novel findings noted in our patient, are discussed in detail.
Patients with respiratory failure are usually mechanically ventilated, mostly with fraction of inspired oxygen (FiO2) > 0.21. Minimizing FiO2 is increasingly an accepted standard. In underserved nations and disasters, salvageable patients requiring mechanical ventilation may outstrip oxygen supplies.
The hypothesis of the present study was that mechanical ventilation with FiO2 = 0.21 is feasible. This assumption was tested in an Acute Respiratory Distress Syndrome (ARDS) model in pigs.
Seventeen pigs were anesthetized, intubated, and mechanically ventilated with FiO2 = 0.4 and Positive End Expiratory Pressure (PEEP) of 5cmH2O. Acute Respiratory Distress Syndrome was induced by intravenous (IV) oleic acid (OA) infusion, and FiO2 was reduced to 0.21 after 45 minutes of stable moderate ARDS. If peripheral capillary oxygen saturation (SpO2) decreased below 80%, PEEP was increased gradually until maximum 20cmH2O, then inspiratory time elevated from one second to 1.4 seconds.
Animals developed moderate ARDS (mean partial pressure of oxygen [PaO2]/FiO2 = 162.8, peak and mean inspiratory pressures doubled, and lung compliance decreased). The SpO2 decreased to <80% rapidly after FiO2 was decreased to 0.21. In 14/17 animals, increasing PEEP sufficed to maintain SpO2 > 80%. Only in 3/17 animals, elevation of FiO2 to 0.25 after PEEP reached 20cmH2O was needed to maintain SpO2 > 80%. Animals remained hemodynamically stable until euthanasia one hour later.
In a pig model of moderate ARDS, mechanical ventilation with room air was feasible in 14/17 animals by elevating PEEP. These results in animal model support the potential feasibility of lowering FiO2 to 0.21 in some ARDS patients. The present study was conceived to address the ethical and practical paradigm of mechanical ventilation in disasters and underserved areas, which assumes that oxygen is mandatory in respiratory failure and is therefore a rate-limiting factor in care capacity allocation. Further studies are needed before paradigm changes are considered.
This chapter examines the resulting trust. It is a type of implied trust and it arises by operation of law either because of the presumed intention of the parties or because of the failure of an express trust. A presumed resulting trust arises where land is purchased in the name of one party but the purchase monies have been provided by another party. The presumption can be rebutted by evidence of a gift or advancement to a close family member of a loan. Evidence of an illegal motive was once inadmissible to use to rebut a presumption but today the court uses its discretion as to whether it will be admitted. Automatic resulting trusts usually arise where a purpose has failed. A new type of trust 'the Quistclose trust' was created when Quistclose successfully recovered money loaned to pay dividends to a company which went bankrupt. Sometimes a surplus remains after the purpose of the trust has been carried out this will result back to the settlor and where a trust fails to conform with key requirements of a trust then the property will usually revert back to the settlor although in some cases the trust property has been found to be an absolute gift.
To explore the epidemiology and outcomes of takotsubo cardiomyopathy in children.
A retrospective analysis of the Healthcare Cost and Utilization 2012 and 2016 Kids’ Inpatient Database was performed. Patients admitted with the diagnosis of takotsubo cardiomyopathy in the age group of 1 month–20 years were identified using International Classification of Diseases (ICD)-9 code 429.83 and ICD-10 code I51.81.
Among a total of 4,860,859 discharges, there were 153 with the diagnosis of takotsubo cardiomyopathy (3.1 per 100,000 discharges). Among patients with takotsubo cardiomyopathy, 55.0% were male, 62.4% were white, and 16.7% were black. Eighty-nine percent of patients were between 12 and 20 years. Psychiatric diagnosis was documented in 46% and substance use disorder in 36.2%. Sepsis was documented in 22.8% of patients. The median length of stay was 5 days (interquartile range: 2.7–15), and median total charges were $75,080 (interquartile range: 32,176–198,336). The overall mortality for takotsubo cardiomyopathy was 7%. On multivariable regression analysis, mortality was higher in the presence of anoxic injury (odds ratio = 34.42, 95% confidence interval: 4.85–320.11, p = 0.00).
Takotsubo cardiomyopathy is uncommon in children and carries a mortality rate of 7%. Most children with takotsubo cardiomyopathy are adolescent males, many of whom have psychiatric disorder or substance use disorder or both. Takotsubo cardiomyopathy should be considered in the differential diagnosis for patients who present with cardiac dysfunction and have underlying psychiatric disorders or drug abuse.
The UK, and England in particular, has suffered egregiously poor outcomes in managing the Covid-19 pandemic. This short perspective points to the explanation in terms of both current British politics and the public health policy inheritance. Boris Johnson's Premiership was born in an opportunistic assertion of British exceptionalism, and Johnson's initial, fate-tempting reaction to the novel Coronavirus set the UK on the wrong path. Furthermore, the gradual erosion of professionalism in (especially health) policy-making over almost four decades, and the hollowing-out of the health protection infrastructure, both facilitated and accentuated a toxic approach to managing Covid-19.
Residual deformation and failure are two critical issues in powder bed fusion (PBF) additive manufacturing (AM) of metal products. Residual deformation caused by the non-uniform residual stress distribution dramatically affects the quality of AM product and can result in catastrophic failure in operation. Therefore, the development of an effective numerical approach to predict residual deformation and failure characteristics of AM product is always a major concern in industrial applications.
In this paper, a numerical approach in predicting residual distortion, stress and failure in AM products is presented. The conventional inherent strain method used in welding process is modified to consider the specific characteristic of AM process, such as the influences of reheating and scanning pattern. This approach consists of three simulation steps including a detailed process simulation in small-scale, a onetime static mechanical finite element analysis in part-scale, and a material failure analysis. First, the inherent strains are calculated from a thermo-mechanical process simulation in small-scale, which considers AM process parameters, such as laser power, scanning speed and path. The physical state in deposited materials including powder, liquid and solid states are taken into account in the simulation by specifying the solidus and liquidus temperature and corresponding material properties. Then the inherent strains are applied layer by layer to the part-scale simulation, where the residual distortion and stress can be predicted efficiently. Finally, a Lagrange particle method is utilized to study the failure characteristics of AM products. Numerical examples are studied to investigate the effectiveness and applicability of present approach.
We critically review potential involvement of trimethylamine N-oxide (TMAO) as a link between diet, the gut microbiota and CVD. Generated primarily from dietary choline and carnitine by gut bacteria and hepatic flavin-containing mono-oxygenase (FMO) activity, TMAO could promote cardiometabolic disease when chronically elevated. However, control of circulating TMAO is poorly understood, and diet, age, body mass, sex hormones, renal clearance, FMO3 expression and genetic background may explain as little as 25 % of TMAO variance. The basis of elevations with obesity, diabetes, atherosclerosis or CHD is similarly ill-defined, although gut microbiota profiles/remodelling appear critical. Elevated TMAO could promote CVD via inflammation, oxidative stress, scavenger receptor up-regulation, reverse cholesterol transport (RCT) inhibition, and cardiovascular dysfunction. However, concentrations influencing inflammation, scavenger receptors and RCT (≥100 µm) are only achieved in advanced heart failure or chronic kidney disease (CKD), and greatly exceed pathogenicity of <1–5 µm levels implied in some TMAO–CVD associations. There is also evidence that CVD risk is insensitive to TMAO variance beyond these levels in omnivores and vegetarians, and that major TMAO sources are cardioprotective. Assessing available evidence suggests that modest elevations in TMAO (≤10 µm) are a non-pathogenic consequence of diverse risk factors (ageing, obesity, dyslipidaemia, insulin resistance/diabetes, renal dysfunction), indirectly reflecting CVD risk without participating mechanistically. Nonetheless, TMAO may surpass a pathogenic threshold as a consequence of CVD/CKD, secondarily promoting disease progression. TMAO might thus reflect early CVD risk while providing a prognostic biomarker or secondary target in established disease, although mechanistic contributions to CVD await confirmation.
We report the successful use of levosimendan in the treatment of heart failure in a patient with the univentricular heart. The presented case was atypical because our patient had systemic right ventricle. To our knowledge, it is the first reported such case with intermittent levosimendan administration as an effective treatment and bridge to successful heart transplant in a patient with functionally univentricular heart.
This chapter explores the emergence of a new culture of corporate credit in the 1970s, one specifically tied to the corporate self and the practices of financialisation that supported it. It examines the ways in which these cultures were supported by the self-affirming logic of neoliberalism that was capable of rejecting the very possibility of perceiving the world outside of its own terms. It argues that William Gaddis’ novel JR draws on an alternative history of post-war economic thought, one associated with Norbert Weiner rather than Milton Friedman, which offers a critique of the positivist triumphalism of 1970s economic thinking. It reads JR through the potently ambivalent idea of entropic failure – one that suggests an entirely different conceptual trajectory for understanding the meaning of the emerging debt cultures in this decade.
To date, “transnational criminal law” has been the dominant paradigm for explaining and mapping rules on corruption in the international legal literature. This Chapter details the limits of transnational criminal conceptions of “anticorruption” through a study of nascent changes to Australian corporate foreign bribery law. Drawing on primary and secondary documentary sources, it shows that the proposed (but for now lapsed) reforms are only partially transnational, as that term is understood in “TCL” theory. Likewise, multilateral suppression conventions and related soft laws were but one impetus for the suggested amendments. Rather, as the transnational legal ordering literature suggests, a recursive process appears to have been at work between international organizations and local legislators, as well as transnational non-state actors. This process was marked, it seems, by moments of borrowing from the US and UK. However, it was also punctuated by themes of modernization, efficiency, and reputation. In addition, if settled, the amendments would result, not just in changes to national criminal law, but also the extension of “new” – and controversial – techniques of governance.
There is a widely held but scarcely challenged belief that most organizational changes fail, especially in mergers and acquisitions (M&A). Failure of M&A is often attributed to factors such as differences in organizational cultures, contested identities, perceived injustice, lack of trust, ineffective leadership and poor communication. A qualitative study was conducted in an acquiring company and two target companies to identify the criteria of a successful change, to explore perceptions of the degree of success of the acquisition(s) they had experienced, and to investigate the factors influencing these perceptions. The findings demonstrated that M&A can be considered successful when attention is paid, not only to integration of practices, but also to socio-cultural factors in managing M&A processes. The overall evaluation of these two acquisitions was that they had been successful. Implications for theory and practice include the possible differences between small- and large-scale M&A experiences.
First do no harm’ is a fine principle; however, most medicines worth using have side effects, so it’s important that the prescriber can assess the risk/benefit ratio. This chapter provides examples of good advice (e.g. not to use NSAIDs in renal or liver impairment), overly cautious advice that may be flouted (e.g. cephalosporins in pencillin allergic patients) and advice that may appear overly cautious but should still be followed as there is a safer alternative (e.g.metformin in renal failure).
Kidneys are sensitive to damage by drugs, with up to 20% of episodes of drug-induced acute renal failure. New prescribers must be able to identify these patients and eliminate these risks when possible; avoid potentially nephrotoxic drugs; and adjust drug doses in patients, where necessary, in those with pre-existing renal impairment to avoid drug accumulation and toxicity. This chapter identifies high-risk drug classes to avoid in renal failure, top tips to avoid drug toxicity, how to treat patients in chronic renal failure and provides a quick reference guide for drug dose reduction in those with renal impairment.
This chapter explores register in the outer movements of the Eroica Symphony. Engaging closely with Schenker’s 1930 analysis, in which the two-line register is understood as the obligate Lage ‘obligatory register’ while the three-line octave is treated as essentially decorative or reinforcing, it argues to the contrary, asserting the structural significance of the latter. By paying particular attention to Beethoven’s scoring for the flute, it develops a narrative of registral ‘failure’ in the finale that is in stark contrast to the standard ‘heroic’ readings of this work.
Paracetamol overdose is common and potentially life-threatening, causing severe hepatocellular failure, acute renal tubular necrosis and death. This chapter lists top tips for its management through metabolic manipulation or decreasing absorption of the drug. Time from ingestion is key, and the reader is provided with treatment strategies based on time of presentation.