Decrease in shunt volume in patients with cryptogenic stroke and patent foramen ovale

<p>Abstract</p> <p>Background</p> <p>In patients with patent foramen ovale (PFO) there is evidence supporting the hypothesis of a change in right-to-left shunt (RLS) over time. Proven, this could have implications for the care of patients with PFO and a history of stroke. The following study addressed this hypothesis in a cohort of patients with stroke and PFO.</p> <p>Methods</p> <p>The RLS volume assessed during hospitalisation for stroke (index event/T0) was compared with the RLS volume on follow-up (T1) (median time between T0 and T1 was 10 months). In 102 patients with a history of stroke and PFO the RLS volume was re-assessed on follow-up using contrast-enhanced transcranial Doppler/duplex (ce-TCD) ultrasound. A change in RLS volume was defined as a difference of ≥20 microembolic signals (MES) or no evidence of RLS during ce-TCD ultrasound on follow-up.</p> <p>Results</p> <p>There was evidence of a marked reduction in RLS volume in 31/102 patients; in 14/31 patients a PFO was no longer detectable. An index event classified as cryptogenic stroke (P < 0.001; OD = 39.2, 95% confidence interval 6.0 to 258.2) and the time interval to the follow-up visit (P = 0.03) were independently associated with a change in RLS volume over time.</p> <p>Conclusions</p> <p>RLS volume across a PFO decreases over time, especially in patients with cryptogenic stroke. These may determine the development of new strategies for the management in the secondary stroke prevention.</p

Play and the exhibition:the problematic fun of showcasing of videogames in informal and formal contexts

Video games are inherently problematic as cultural artefacts, presenting issues of stability, currency, interaction and participation (to name but a few) in their curation. These issues are not necessarily unique to video games in an exhibition context, but their combination with the on-going debate about the status of video games as an art form inspire discussion and debate. Despite the issues presented by video games, there have been countless video game exhibitions in formal and informal contexts, typically focussing upon the historical narrative around games or their position as artefacts with cultural value. It is only in the last few years that artistic and academic study of this problematic field has developed traction, through both an emerging body of literature looking to formalise video games exhibitions practices and practitioner debate. 2019 sees the inaugural Game Arts International Assembly “a think tank for the international games arts ecosystem” bringing together leading curators and makers working at the forefront of public display of interactive arts and playful media.This paper contributes to the developing body of knowledge which analyses video games exhibition methods by formalising and evaluating the methods utilised within informal and formal contexts of video games exhibition from the perspective of reception theory. The study of both large scale exhibition such as those orchestrated by the Victoria and Albert museum and the Smithsonian American Art Museum alongside the one night indie game night or play party is a unique contribution to the field, with studies typically focussing on approaches within one given context. Reception theory provides a lens through which the active participative role of the attendee or visitor in meaning making can be evaluated and allows consideration of the connection between selected methods of exhibition and the resulting meaning making opportunities possible for a range of potential audiences

Idiographische und nomothetische Forschung in wissenschaftstheoretischer Sicht

Die Biographik als Forschungsrichtung rekonstruiert also sowohl die Regeln, die in Biographien exemplifiziert sind, als auch die spezifische Art, wie diese Regeln im Leben des Biographierten modifiziert werden. Allerdings wird diese Blickrichtung nicht durch einen direkten Bezug zum "Leben" ermöglicht, denn dieses liegt ja nicht als Gegenstand, sondern nur in Zeichen vor. Auch dieser Blick ist also auf das Zeichenmaterial der Biographie angewiesen, sieht es jedoch unter dem Gesichtspunkt, der gerade nicht auf die Einstimmigkeit des Regelvollzug abhebt, sondern auf die Vielschichtigkeit und Widersprüchlichkeit der Äußerungen, in denen diese Regeln modifiziert werden

Towards an ethical ecology of international service learning

International Service-Learning (ISL) is a pedagogical activity that seeks to blend student learning with community engagement overseas and the development of a more just society. ISL programmes have grown as educational institutions and non-governmental organisations have sought to achieve the goal of developing ‘global citizens’. However, Service Learning (SL) in general and International Service-Learning (ISL) in particular remain deeply under theorised. These educational initiatives provide policy makers with a practical response to their quest for a ‘Big Society’and present alluring pedagogical approaches for Universities as they react to reforms in Higher Education and seek to enhance both the student learning experience and graduate employability. After outlining the development of ISL in policy and practice, this paper draws on the rich tradition of ISL at one British university to argue that ISL is a form of engagement that has the potential to be ethical in character although we identify a number of factors that militate against this. Our contention is that ISL which promotes rationaland instrumental learning represents a deficit model and we therefore conceptualise ISL here as a transformative learning experience that evinces distinctly aesthetic and even spiritual dimensions. Upon this theoretical groundwork we lay the foundations for conceptualizing ISL in ways that ensure its ethical integrity

Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis

Background: Activity-based funding (ABF) of hospitals is a policy intervention intended to re-shape incentives across health systems through the use of diagnosis-related groups. Many countries are adopting or actively promoting ABF. We assessed the effect of ABF on key measures potentially affecting patients and health care systems: mortality (acute and post-acute care); readmission rates; discharge rate to post-acute care following hospitalization; severity of illness; volume of care. &nbsp; &nbsp; Methods: We undertook a systematic review and meta-analysis of the worldwide evidence produced since 1980. We included all studies reporting original quantitative data comparing the impact of ABF versus alternative funding systems in acute care settings, regardless of language. We searched 9 electronic databases (OVID MEDLINE, EMBASE, OVID Healthstar, CINAHL, Cochrane CENTRAL, Health Technology Assessment, NHS Economic Evaluation Database, Cochrane Database of Systematic Reviews, and Business Source), hand-searched reference lists, and consulted with experts. Paired reviewers independently screened for eligibility, abstracted data, and assessed study credibility according to a pre-defined scoring system, resolving conflicts by discussion or adjudication. &nbsp; &nbsp; Results: Of 16,565 unique citations, 50 US studies and 15 studies from 9 other countries proved eligible (i.e. Australia, Austria, England, Germany, Israel, Italy, Scotland, Sweden, Switzerland). We found consistent and robust differences between ABF and no-ABF in discharge to post-acute care, showing a 24% increase with ABF (pooled relative risk = 1.24, 95% CI 1.18–1.31). Results also suggested a possible increase in readmission with ABF, and an apparent increase in severity of illness, perhaps reflecting differences in diagnostic coding. Although we found no consistent, systematic differences in mortality rates and volume of care, results varied widely across studies, some suggesting appreciable benefits from ABF, and others suggesting deleterious consequences. &nbsp; &nbsp; Conclusions: Transitioning to ABF is associated with important policy- and clinically-relevant changes. Evidence suggests substantial increases in admissions to post-acute care following hospitalization, with implications for system capacity and equitable access to care. High variability in results of other outcomes leaves the impact in particular settings uncertain, and may not allow a jurisdiction to predict if ABF would be harmless. Decision-makers considering ABF should plan for likely increases in post-acute care admissions, and be aware of the large uncertainty around impacts on other critical outcomes