Spinoza

"Spinoza", second edition. Encyclopedia entry for the Springer Encyclopedia of EM Phil and the Sciences, ed. D. Jalobeanu and C. T. Wolfe

Long Term Outcomes and Durability of Fenestrated Endovascular Aneurysm Repair: A Meta-analysis of Time to Event Data

Objective Despite widespread use, long term outcomes for fenestrated endovascular aneurysm repair (FEVAR) are uncertain. This meta-analysis reports long term survival, freedom from re-intervention, target vessel patency, and one year sac regression after FEVAR. Data Sources Systematic review and meta-analysis to pool time to event data according to PRISMA guidelines. The study was registered with the international prospective register of systematic reviews (PROSPERO) (ID: CRD42023401468). Review Methods Medline, Embase, and Cochrane databases were searched 1992 – 2023; articles were independently screened by two authors. Publication of complete time to event data for any outcome of interest was an inclusion criterion. Raw Kaplan–Meier probabilities were directly extracted from published curves and pooled by random effects. Risk of bias was assessed using ROBINSI and certainty with GRADE. Results A total of 3 569 records were retrieved, 2 869 screened after duplicate removal, yielding 37 included studies (n = 4 371). Pooled mean age was 73.2 years (interquartile range [IQR] 72.2, 73.7) and 87.4% male (95% confidence interval [CI] 85.8 – 88.9). Pooled Kaplan–Meier estimated probabilities of survival (n = 34 studies, n = 4 192 patients) at one, three, and five years were 91.6% (95% CI 90.2 – 92.9), 80.8% (95% CI 78.0 – 83.2), and 65.1% (95% CI 60.9 – 69.1). For freedom from re-intervention (n = 24, n = 3 211 patients) at one, three, and five years these were 90.2% (95% CI 87.3 – 92.7), 80.9% (95% CI 76.5 – 84.9), and 73.8% (95% CI 67.1 – 79.6). For target vessel patency (n = 13, n = 5805 target vessels) at one, three, and five years, these were 96.6% (95% CI 94.9 – 98.0), 94.5% (95% CI 91.7 – 96.7), and 93.1% (95% CI 89.3 – 96.0). Pooled estimate of sac regression (n = 8, n = 560) at one year was 40.2% (95% CI 28.9 – 52.7). Risk of bias was judged as moderate in 11 studies and low for the remaining 26. Conclusion There are moderate to low certainty data supporting reasonable long term outcome estimates following fenestrated endovascular aneurysm repair. Beyond five years there is a lack of data in the literature

Teleology and Realism in Leibniz's Philosophy of Science

This paper argues for an interpretation of Leibniz’s claim that physics requires both mechanical and teleological principles as a view regarding the interpretation of physical theories. Granting that Leibniz’s fundamental ontology remains non-physical, or mentalistic, it argues that teleological principles nevertheless ground a realist commitment about mechanical descriptions of phenomena. The empirical results of the new sciences, according to Leibniz, have genuine truth conditions: there is a fact of the matter about the regularities observed in experience. Taking this stance, however, requires bringing non-empirical reasons to bear upon mechanical causal claims. This paper first evaluates extant interpretations of Leibniz’s thesis that there are two realms in physics as describing parallel, self-sufficient sets of laws. It then examines Leibniz’s use of teleological principles to interpret scientific results in the context of his interventions in debates in seventeenth-century kinematic theory, and in the teaching of Copernicanism. Leibniz’s use of the principle of continuity and the principle of simplicity, for instance, reveal an underlying commitment to the truth-aptness, or approximate truth-aptness, of the new natural sciences. The paper concludes with a brief remark on the relation between metaphysics, theology, and physics in Leibniz

Nickel hypersensitivity and endovascular devices: a systematic review and meta-analysis

Objective Nickel allergy is common; endovascular specialists are often confronted with nickel allergic patients ahead of the implantation of endovascular devices, many of which are nickel-containing. Our aim was to elucidate whether nickel hypersensitivity is significantly associated with worse or adverse outcomes after placement of a nickel-containing endovascular device. Methods Inclusion criteria were: endovascular and transcatheter procedures for coronary, structural heart, neurovascular and peripheral vascular pathology involving nickel-allergic patients. All adverse outcomes were included as defined by included studies. A systematic review and meta-analysis were undertaken using a random-effects model. Searches of MEDLINE and EMBASE were conducted for articles published 1947–2019. Results 190 records were identified, 78 articles were included for qualitative synthesis and 15 met criteria for meta-analysis. Patch-test confirmed nickel allergy was associated with an increased risk of adverse outcomes following implantation of a nickel-containing endovascular device (n=14 articles, 1740 patients; OR 2.61, 95% CI 1.41 to 4.85). This finding further was observed in coronary (n=12 articles, 1624 patients; OR 1.94, 95% CI 1.16 to 3.23) and structural heart subgroups (n=2 articles, 83 patients; OR 52.28, 95% CI 1.31 to 2079.14), but not in the neurovascular subgroup (n=1 article, 33 patients; OR 3.04, 95% CI 0.59 to 15.72) or with a patient-reported history of nickel allergy (n=2 articles, 207 patients; OR 2.14, 95% CI 0.23 to 19.70). Conclusions Patch-tested nickel allergy is associated with an increased risk of adverse outcomes following endovascular device implantation and alternative treatment options should be considered. Specialists faced with patients’ self-reporting nickel allergy should consider proceeding to diagnostic patch-testing

Testing residual gas profiler at SARAF

A Residual Gas Monitor (RGM) developed at GANIL was tested with pulsed and CW proton beams at currents up to 1 mA at SARAF Phase I. Response of the detector as a function of beam current and duty cycle was measured. Beam profiles were measured at different beam size and position values and compared with measurements performed with a multi-wire grid profiler. Influence of the low-energy beam transfer (LEBT) optical settings on intense CW beams was studied for the first time. The obtained data enabled a better analysis and understanding of the current ramp-up process

A feasibility trial of HoloLens 2™; Using mixed reality headsets to deliver remote bedside teaching during COVID-19

Background COVID-19 has had a catastrophic impact measured in human lives. Medical education has also been impacted: appropriately stringent infection control policies have precluded medical trainees from attending clinical teaching. Lecture-based education has been easily transferred to a digital platform, but bedside teaching has not. This study aims to assess the feasibility of using a mixed reality (MR) headset to deliver remote bedside teaching. Methods Two MR sessions were led by senior doctors wearing the HoloLens™ headset. The trainers selected patients requiring their specialist input. The headset allowed bi-directional audio-visual communication between the trainer and trainee doctors. Trainee doctor conceptions of bedside teaching, impact of COVID-19 on bedside teaching and the MR sessions were evaluated using pre- and post-round questionnaires, using Likert scales. Data related to clinician exposure to at risk patients and use of PPE were collected. Results Pre-questionnaire respondents (n=24) strongly agreed that bedside teaching is key to educating clinicians (7, IQR 6-7). Post-session questionnaires showed that overall users subjectively agreed the MR session was helpful to their learning (6, IQR 5.25 – 7) and that it was worthwhile (6, IQR 5.25 – 7). Mixed-reality versus in-person teaching led to a 79.5% reduction in cumulative clinician exposure time and 83.3% reduction in PPE use. Conclusions This study is proof of principle that HoloLens™ can be used effectively to deliver clinical bedside teaching This novel format confers significant advantages in terms of: minimising exposure of trainees to COVID-19; saving PPE; enabling larger attendance; and convenient accessible real-time clinical training

Centrifugal instability in the regime of fast rotation

International audienc