A central limit theorem for time-dependent dynamical systems

The work [8] established memory loss in the time-dependent (non-random) case of uniformly expanding maps of the interval. Here we find conditions under which we have convergence to the normal distribution of the appropriately scaled Birkhoff-like partial sums of appropriate test functions. A substantial part of the problem is to ensure that the variances of the partial sums tend to infinity (cf. the zero-cohomology condition in the autonomous case). In fact, the present paper is the first one where non-random, i. e. specific examples are also found, which are not small perturbations of a given map. Our approach uses martingale approximation technique in the form of [9]

The construction of identity through visual intertextuality in a Bohemian early modern travelogue

Cultural historians have long been concerned with visual sources. Their research has centred on ways of reading images and how they can most accurately be interpreted. This article focuses on an alternative aspect of these visual sources: on how images were made and used. It analyses how the identity of a Bohemian Catholic, Bed?ich z Donín, is constructed by his use of images in a travelogue based on his pilgrimage in the early 17th century. Highlighting the process of ‘visual intertextuality’, it claims that the ways in which Donín adopts and adapts visual images reveals his association with various affinity groups. The distinction between ‘actual’ and ‘habitual’ intertextuality is applied to the analysis of this historical source and shows how competing voices are present in the images. This article is an example of how historians can use the methodologies of semioticians to benefit their research

Система поддержки принятия врачебных решений при сепсисе как важная часть медико-экономической составляющей стационара

Aim: To evaluate an impact of a clinical decision support system (CDSS) in the clinical practice of a hospital on the quality and costs of treatment of patients with severe sepsis and septic shock.Materials and methods: We performed a retrospective analysis of the database in the medical information system qMS (SP.ARM, Russia, St. Petersburg) from 2015 to 2017 on 37,997 patients. In the first study period from January 2015 to June 2016, we analyzed the results of the conventional treatment regimen. From May to June 2016, the CDSS module was implemented into the qMS and the personnel was trained correspondingly. The data collected during the second study period mirrored the results of sepsis treatment with the use of CDSS. We assessed the average number of in-hospital days, duration of stay in the intensive care unit, number of septic shock cases, mortality, and treatment costs.Results: The diagnosis of sepsis was confirmed in 67 patients: in 1.4‰ (27/18,792) before the CDSS was implemented versus 2.1‰ (40/19,205) after the CDSS implementation (p 0.01). It was found that the use of CDSS integrated into the hospital medical information system reduced the number of cases of septic shock development (p 0.05). Lethality decreased by 10%. The sepsis-associated mortality showed a non-significant trend to decrease by 10% (p 0.1). The implementation of the CDSS incorporated into the qMS helped to reduce the number of septic shock cases from 26% (7/27) to 7.5% (3/40) (p 0.05). There was also a trend towards reduced duration of stay in intensive care unit, as well as towards decreased costs of sepsis treatment by 13% and efferent (extra-corporeal) treatments by 29%; however, the differences were not significant.Conclusion: The CDSS implementation for electronic monitoring of the patient's condition and changes in his/hers parameters allowed for an earlier diagnosis of sepsis. We identified some prerequisites for more rational utilization of medical resources, mainly due to early, targeted treatment of patients with severe sepsis and septic shock; however, additional studies are necessary.Цель – изучить влияние использования системы поддержки принятия врачебных решений (СППВР) в клинической практике стационара на качество и стоимость лечения у пациентов с тяжелым сепсисом и септическим шоком.Материал и методы. За период с 2015 по 2017 г. проведен ретроспективный анализ базы данных медицинской информационной системы qMS («СП.АРМ», Россия), содержащей сведения о 37 997 пациентах. На первом этапе (с января 2015 по июнь 2016 г.) анализировали результаты, получаемые при традиционной схеме лечения. С мая по июнь 2016 г. в медицинской информационной системе был внедрен модуль СППВР и проведено обучение врачебного персонала. Данные второго этапа исследования (с июля 2016 по декабрь 2017 г.) представляли собой результаты лечения сепсиса с использованием СППВР. Оценивали среднее количество койко-дней нахождения пациента в стационаре и в отделении анестезиологии и реанимации, число случаев развития септического шока, летальность и стоимость лечения.Результаты. Диагноз «сепсис» был подтвержден у 67 пациентов: у 1,4‰ (27 / 18 792) до внедрения СППВР против 2,1‰ (40 / 19 205) после внедрения СППВР (p 0,01). Летальность при сепсисе снизилась на 10%, но статистически не значимо (p 0,1). Применение СППВР, интегрированной в медицинскую информационную систему стационара, способствовало уменьшению числа случаев развития септического шока с 26% (7 / 27) до 7,5% (3 / 40) (p 0,05). Наблюдалась также тенденция к снижению продолжительности лечения пациентов в отделении анестезиологии и реанимации, что послужило предпосылкой для сокращения общих сроков пребывания в стационаре, а также уменьшения стоимости терапии сепсиса (на 13%) и эфферентных методов лечения (на 29%), однако различия не достигли уровня статистической значимости.Заключение. Внедрение СППВР, с помощью которой ведется электронное наблюдение за состоянием пациента и изменениями показателей, дало возможность диагностировать развитие сепсиса на ранних этапах. Выявлены предпосылки для более рационального использования ресурсов здравоохранения, преимущественно за счет ранней целенаправленной терапии у пациентов с тяжелым сепсисом и септическим шоком, однако необходимы дополнительные исследования.

The USA Patriot Acts (et al.): convergent legislation and oligarchic isomorphism in the \u27politics of fear\u27 and state crime(s) against democracy (SCADs)

The irrelevance of habeas corpus and the abolition of “double jeopardy,” secret and protracted outsourcing of detention and torture, and increasing geographic prevalence of surveillance technologies across Anglo-American “democracies” have many citizens concerned about the rapidly convergent, authoritarian behavior of political oligarchs and the actual destruction of sovereignty and democratic values under the onslaught of antiterrorism hubris, propaganda, and fear. This article examines synchronic legislative isomorphism in responses to 9/11 in the United States, the United Kingdom and European Union, and Australia in terms of enacted terrorism legislation and, also, diachronic, oligarchic isomorphism in the manufacture of fear within a convergent world by comparing the “Politics of Fear” being practiced today to Stalinist—Russian and McCarthyist—U.S. abuse of “fear.” The immediate future of Anglo-American democratic hubris, threats to civil society, and oligarchic threats to democratic praxis are canvassed. This article also raises the question as to whether The USA PATRIOT Acts of 2001/2006, sanctioned by the U.S. Congress, are examples, themselves, of state crimes against democracy. In the very least, any democratically inclined White House occupant in 2009 would need to commit to repealing these repressive, and counterproductive, acts. Copyright @2009, SAGE Publication