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Søren Aabye Kierkegaard (1813–1855) was a prolific author who published his philosophical writings in various styles and often pseudonymously. In this diverse authorship, The Sickness unto Death stands as something of an exception. Although signed pseudonymously – a method that Kierkegaard often used to put distance between his own view and the one expressed in the text – Kierkegaard regarded this book as highly reflective of his own understanding of the religious life. Rapidly written in the spring of 1848 and published in 1849 after some agonizing, the motivation behind The Sickness unto Death, according to Kierkegaard’s journal, was in part a conscientious conviction that the whole of his authorship needed to be curated in the direction of the religious. The appearance of the second edition of Either/Or in particular provoked him to accompany the reissue with a new and more religiously inflected text. “The second edition of Either/Or really can’t be published without something accompanying it,” he fretted in his journal. “Somehow the emphasis must be on the fact that I’ve made up my mind about being a religious author … If this opportunity passes, virtually everything I’ve written, viewed as a totality, will be dragged down into the aesthetic” (KJN 5, NB10:69/SKS 21, 293–294).
One of the nagging uncertainties that besets the interpretation of The Sickness unto Death is the vagueness that attaches to the promised cure for the disease of despair – faith. Presented in algebraic form at the beginning, middle, and end of the book, it is otherwise left without much expatiation. This chapter reconstructs from the text what we might be able to claim confidently about faith as the cure for despair according to Anti-Climacus. Faith has a therapeutic function: It is meant to extirpate from the self the only genuine danger, which is persistence in unforgiven sin, while maturing the self to cope with the ordinary hazards of human life and to avoid its false consolations. This twofold function of faith – positively warning the self against its only real threat and negatively clearing away false consolations and imagined dangers – is grounded in the definition of faith Anti-Climacus supplies, which involves two distinct elements: willing to be yourself and resting transparently in God. This chapter explores the precise sense in which the faithful self relates to God and the therapeutic benefits that come from the faithful person’s ability to genuinely will to be themselves.
The Sickness unto Death (1849) is commonly regarded as one of Kierkegaard's most important works – but also as one of his most difficult texts to understand. It is a meditation on Christian existentialist themes including sin, despair, religious faith and its redemptive power, and the relation and difference between physical and spiritual death. This volume of new essays guides readers through the philosophical and theological significance of the work, while clarifying the complicated ideas that Kierkegaard develops. Some of the essays focus closely on particular themes, others attempt to elucidate the text as a whole, and yet others examine it in relation to other philosophical views. Bringing together these diverse approaches, the volume offers a comprehensive understanding of this pivotal work. It will be of interest to those studying Kierkegaard as well as existentialism, religious philosophy, and moral psychology.
The past decade has witnessed a resurgence of patrimonial rule not only in the developing world but also, more surprisingly, in the developed West. This resurgence carries potentially dire consequences for responding to a range of pressing problems. Understanding the sources of contemporary patrimonialism is hindered by assimilating the phenomenon into the familiar democracy/autocracy typology or by assuming that it is a function of failed modernization. This article identifies the patrimonial phenomenon and explores the contemporary global diffusion of patrimonial rule from its origins in postcommunist Russia, with a focus on how patrimonialism has manifested itself in policy responses to the COVID-19 pandemic. Some signs indicate that reestablishing bureaucratic predictability and expertise may be much harder than demolishing it. In some respects, the task may be more daunting than the salvation of democracy itself.
In 1988, Sibe Mardešić and Andrei Prasolov isolated an inverse system
$\textbf {A}$
with the property that the additivity of strong homology on any class of spaces which includes the closed subsets of Euclidean space would entail that
$\lim ^n\textbf {A}$
(the nth derived limit of
$\textbf {A}$
) vanishes for every
$n>0$
. Since that time, the question of whether it is consistent with the
$\mathsf {ZFC}$
axioms that
$\lim ^n \textbf {A}=0$
for every
$n>0$
has remained open. It remains possible as well that this condition in fact implies that strong homology is additive on the category of metric spaces.
We show that assuming the existence of a weakly compact cardinal, it is indeed consistent with the
$\mathsf {ZFC}$
axioms that
$\lim ^n \textbf {A}=0$
for all
$n>0$
. We show this via a finite-support iteration of Hechler forcings which is of weakly compact length. More precisely, we show that in any forcing extension by this iteration, a condition equivalent to
$\lim ^n\textbf {A}=0$
will hold for each
$n>0$
. This condition is of interest in its own right; namely, it is the triviality of every coherent n-dimensional family of certain specified sorts of partial functions
$\mathbb {N}^2\to \mathbb {Z}$
which are indexed in turn by n-tuples of functions
$f:\mathbb {N}\to \mathbb {N}$
. The triviality and coherence in question here generalise the classical and well-studied case of
$n=1$
.
To develop a physiological data-driven model for early identification of impending cardiac arrest in neonates and infants with cardiac disease hospitalised in the cardiovascular ICU.
Methods:
We performed a single-institution retrospective cohort study (11 January 2013–16 September 2015) of patients ≤1 year old with cardiac disease who were hospitalised in the cardiovascular ICU at a tertiary care children’s hospital. Demographics and diagnostic codes of cardiac arrest were obtained via the electronic health record. Diagnosis of cardiac arrest was validated by expert clinician review. Minute-to-minute physiological monitoring data were recorded via bedside monitors. A generalized linear model was used to compute a minute by minute risk score. Training and test data sets both included data from patients who did and did not develop cardiac arrest. An optimal risk-score threshold was derived based on the model’s discriminatory capacity for impending arrest versus non-arrest. Model performance measures included sensitivity, specificity, accuracy, likelihood ratios, and post-test probability of arrest.
Results:
The final model consisting of multiple clinical parameters was able to identify impending cardiac arrest at least 2 hours prior to the event with an overall accuracy of 75% (sensitivity = 61%, specificity = 80%) and observed an increase in probability of detection of cardiac arrest from a pre-test probability of 9.6% to a post-test probability of 21.2%.
Conclusions:
Our findings demonstrate that a predictive model using physiologic monitoring data in neonates and infants with cardiac disease hospitalised in the paediatric cardiovascular ICU can identify impending cardiac arrest on average 17 hours prior to arrest.
We reviewed all patients who were supported with extracorporeal membrane oxygenation and/or ventricular assist device at our institution in order to describe diagnostic characteristics and assess mortality.
Methods
A retrospective cohort study was performed including all patients supported with extracorporeal membrane oxygenation and/or ventricular assist device from our first case (8 October, 1998) through 25 July, 2016. The primary outcome of interest was mortality, which was modelled by the Kaplan–Meier method.
Results
A total of 223 patients underwent 241 extracorporeal membrane oxygenation runs. Median support time was 4.0 days, ranging from 0.04 to 55.8 days, with a mean of 6.4±7.0 days. Mean (±SD) age at initiation was 727.4 days (±146.9 days). Indications for extracorporeal membrane oxygenation were stratified by primary indication: cardiac extracorporeal membrane oxygenation (n=175; 72.6%) or respiratory extracorporeal membrane oxygenation (n=66; 27.4%). The most frequent diagnosis for cardiac extracorporeal membrane oxygenation patients was hypoplastic left heart syndrome or hypoplastic left heart syndrome-related malformation (n=55 patients with HLHS who underwent 64 extracorporeal membrane oxygenation runs). For respiratory extracorporeal membrane oxygenation, the most frequent diagnosis was congenital diaphragmatic hernia (n=22). A total of 24 patients underwent 26 ventricular assist device runs. Median support time was 7 days, ranging from 0 to 75 days, with a mean of 15.3±18.8 days. Mean age at initiation of ventricular assist device was 2530.8±660.2 days (6.93±1.81 years). Cardiomyopathy/myocarditis was the most frequent indication for ventricular assist device placement (n=14; 53.8%). Survival to discharge was 42.2% for extracorporeal membrane oxygenation patients and 54.2% for ventricular assist device patients. Kaplan–Meier 1-year survival was as follows: all patients, 41.0%; extracorporeal membrane oxygenation patients, 41.0%; and ventricular assist device patients, 43.2%. Kaplan–Meier 5-year survival was as follows: all patients, 39.7%; extracorporeal membrane oxygenation patients, 39.7%; and ventricular assist device patients, 43.2%.
Conclusions
This single-institutional 18-year review documents the differential probability of survival for various sub-groups of patients who require support with extracorporeal membrane oxygenation or ventricular assist device. The indication for mechanical circulatory support, underlying diagnosis, age, and setting in which cannulation occurs may affect survival after extracorporeal membrane oxygenation and ventricular assist device. The Kaplan–Meier analyses in this study demonstrate that patients who survive to hospital discharge have an excellent chance of longer-term survival.
Seven half-day regional listening sessions were held between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide-resistance management. The objective of the listening sessions was to connect with stakeholders and hear their challenges and recommendations for addressing herbicide resistance. The coordinating team hired Strategic Conservation Solutions, LLC, to facilitate all the sessions. They and the coordinating team used in-person meetings, teleconferences, and email to communicate and coordinate the activities leading up to each regional listening session. The agenda was the same across all sessions and included small-group discussions followed by reporting to the full group for discussion. The planning process was the same across all the sessions, although the selection of venue, time of day, and stakeholder participants differed to accommodate the differences among regions. The listening-session format required a great deal of work and flexibility on the part of the coordinating team and regional coordinators. Overall, the participant evaluations from the sessions were positive, with participants expressing appreciation that they were asked for their thoughts on the subject of herbicide resistance. This paper details the methods and processes used to conduct these regional listening sessions and provides an assessment of the strengths and limitations of those processes.
Herbicide resistance is ‘wicked’ in nature; therefore, results of the many educational efforts to encourage diversification of weed control practices in the United States have been mixed. It is clear that we do not sufficiently understand the totality of the grassroots obstacles, concerns, challenges, and specific solutions needed for varied crop production systems. Weed management issues and solutions vary with such variables as management styles, regions, cropping systems, and available or affordable technologies. Therefore, to help the weed science community better understand the needs and ideas of those directly dealing with herbicide resistance, seven half-day regional listening sessions were held across the United States between December 2016 and April 2017 with groups of diverse stakeholders on the issues and potential solutions for herbicide resistance management. The major goals of the sessions were to gain an understanding of stakeholders and their goals and concerns related to herbicide resistance management, to become familiar with regional differences, and to identify decision maker needs to address herbicide resistance. The messages shared by listening-session participants could be summarized by six themes: we need new herbicides; there is no need for more regulation; there is a need for more education, especially for others who were not present; diversity is hard; the agricultural economy makes it difficult to make changes; and we are aware of herbicide resistance but are managing it. The authors concluded that more work is needed to bring a community-wide, interdisciplinary approach to understanding the complexity of managing weeds within the context of the whole farm operation and for communicating the need to address herbicide resistance.