194 research outputs found

    Threats to Democracy

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    After a discussion of the literature on the development of societies and of the multiple causality of societies, this paper discusses 12 threats to democracy: autocracy, cultural decline, polarisation, elite paradox, populism, confusion, capitalism, dilemma of benevolence and justice, institutional crowding, sort-termism and depletion, AI and robots

    Social Dynamics

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    What theories are there of social dynamics, of the emergence, adaptation, resilience, collapse or decay, of social systems such as organisations, communities, networks, cliques and teams? In chapter 1, I consider evolutionary theory, in biology, economics, sociology and psychology. In chapter 2 I consult the literature on Complex Adaptive Systems, and its applicability to social systems. Social systems are distinctive, in being intentional and reflexive, with intentions depending on outcomes. In chapter 3 I focus on social systems: their variety, the role of language, the relation between self and other, network effects, and their collapse, resilience and rigidity

    COVID-19 vaccination in patients with immune thrombocytopenia

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    Immune thrombocytopenia (ITP) is an acquired autoimmune disorder that is characterized by low platelet count and increased bleeding risk. COVID-19 vaccination has been described as a risk factor for de novo ITP, but the effects of COVID-19 vaccination in patients with ITP are unknown. We aimed to investigate the effects of COVID-19 vaccination in patients with ITP on platelet count, bleeding complications, and ITP exacerbation (‚Č•50% decline in platelet count, or nadir platelet count 20% decrease from baseline, or use of rescue therapy). Platelet counts in patients with ITP and healthy controls were collected immediately before and 1 and 4 weeks after the first and second vaccinations. Linear mixed-effects modeling was applied to analyze platelet counts over time. We included 218 patients with ITP (50.9% female; mean age, 55 years; and median platelet count, 106 √ó 109/L) and 200 healthy controls (60.0% female; mean age, 58 years; median platelet count, 256 √ó 109/L). Platelet counts decreased by 6.3% after vaccination. We did not observe any difference in decrease between the groups. Thirty patients with ITP (13.8%; 95% confidence interval [CI], 9.5-19.1) had an exacerbation and 5 (2.2%; 95% CI, 0.7-5.3) suffered from a bleeding event. Risk factors for ITP exacerbation were platelet count < 50 √ó 109/L (odds ratio [OR], 5.3; 95% CI, 2.1-13.7), ITP treatment at time of vaccination (OR, 3.4; 95% CI, 1.5-8.0), and age (OR, 0.96 per year; 95% CI, 0.94-0.99). Our study highlights the safety of COVID-19 vaccination in patients with ITP and the importance of the close monitoring of platelet counts in a subgroup of patients with ITP. Patients with ITP with exacerbation responded well on therapy

    COVID-19 vaccination in patients with immune thrombocytopenia

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    Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by low platelet count and increased bleeding risk. COVID-19 vaccination has been described as risk factor for de novo ITP, but the effects of COVID-19 vaccination in patients with ITP are unknown. Our aims were to investigate the effects of COVID-19 vaccination in ITP patients on platelet count, bleeding complications and ITP exacerbation (any of: ‚Č•50% decline in platelet count; or nadir platelet count 20% decrease from baseline; or use of rescue therapy). Platelet counts of ITP patients and healthy controls were collected immediately before, 1 and 4 weeks after first and second vaccination. Linear mixed-effects modelling was applied to analyze platelet counts over time. We included 218 ITP patients (50.9% female, mean age 55 years and median platelet count of 106x109/L) and 200 healthy controls (60.0% female, mean age 58 years and median platelet count of 256x109/L). Platelet counts decreased by 6.3% after vaccination. We observed no difference in decrease between the groups. Thirty ITP patients (13.8%, 95%CI 9.5%-19.1%) had an exacerbation and 5 (2.2%, 95%CI 0.7%-5.3%) suffered from a bleeding event. Risk factors for ITP exacerbation were platelet count <50x109/L (OR 5.3, 95%CI 2.1-13.7), ITP treatment at time of vaccination (OR 3.4, 95%CI 1.5-8.0) and age (OR 0.96 per year, 95%CI 0.94-0.99). Our study highlights safety of COVID-19 vaccination in ITP patients and importance of close monitoring platelet counts in a subgroup of ITP patients. ITP patients with exacerbation responded well on therapy

    Risk factors for adverse outcomes during mechanical ventilation of 1152 COVID-19 patients: a multicenter machine learning study with highly granular data from the Dutch Data Warehouse

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    Background: The identification of risk factors for adverse outcomes and prolonged intensive care unit (ICU) stay in COVID-19 patients is essential for prognostication, determining treatment intensity, and resource allocation. Previous studies have determined risk factors on admission only, and included a limited number of predictors. Therefore, using data from the highly granular and multicenter Dutch Data Warehouse, we developed machine learning models to identify risk factors for ICU mortality, ventilator-free days and ICU-free days during the course of invasive mechanical ventilation (IMV) in COVID-19 patients. Methods: The DDW is a growing electronic health record database of critically ill COVID-19 patients in the Netherlands. All adult ICU patients on IMV were eligible for inclusion. Transfers, patients admitted for less than 24 h, and patients still admitted at time of data extraction were excluded. Predictors were selected based on the literature, and included medication dosage and fluid balance. Multiple algorithms were trained and validated on up to three sets of observations per patient on day 1, 7, and 14 using fivefold nested cross-validation, keeping observations from an individual patient in the same split. Results: A total of 1152 patients were included in the model. XGBoost models performed best for all outcomes and were used to calculate predictor importance. Using Shapley additive explanations (SHAP), age was the most important demographic risk factor for the outcomes upon start of IMV and throughout its course. The relative probability of death across age values is visualized in Partial Dependence Plots (PDPs), with an increase starting at 54 years. Besides age, acidaemia, low P/F-ratios and high driving pressures demonstrated a higher probability of death. The PDP for driving pressure showed a relative probability increase starting at 12 cmH2O. Conclusion: Age is the most important demographic risk factor of ICU mortality, ICU-free days and ventilator-free days throughout the course of invasive mechanical ventilation in critically ill COVID-19 patients. pH, P/F ratio, and driving pressure should be monitored closely over the course of mechanical ventilation as risk factors predictive of these outcomes

    Large-scale ICU data sharing for global collaboration: the first 1633 critically ill COVID-19 patients in the Dutch Data Warehouse

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    The motivations for the adoption of management innovation by local governments and its performance effects

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    This article analyses the economic, political and institutional antecedents and performance effects of the adoption of shared Senior Management Teams (SMTs) ‚Äď a management innovation (MI) that occurs when a team of senior managers oversees two or more public organizations. Findings from statistical analysis of 201 English local governments and interviews with organizational leaders reveal that shared SMTs are adopted to develop organisational capacity in resource‚Äźchallenged, politically risk‚Äźaverse governments, and in response to coercive and mimetic institutional pressures. Importantly, sharing SMTs may reduce rather than enhance efficiency and effectiveness due to redundancy costs and the political transaction costs associated with diverting resources away from a high‚Äźperforming partner to support their lower‚Äźperforming counterpart

    Adaptive Governance: The Role of Loyalty

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    Abstract This paper is concerned with the governance of vertical inter rm relations, i.e. relations between buyers and their suppliers on industrial, intermediate-goods markets. Networks of interacting, adaptive buyers and suppliers are viewed as complex adaptive systems Holland and Miller 1991, which leads to the use of computer simulations to explore the strategies that boundedly rational, adaptive agents learn to use to manage their relations with suppliers. Starting from a static transaction cost economic perspective, the model is extended with allowance for loyal behavior and for trust to build up, with network embeddedness of relations and with the possibility for the agents to adapt their governance to changing circumstances and to the changing relation, rendering economic organization path-dependent. The paper analyzes how relations develop in time: actors making and breaking relations, on the basis of evaluations of expected pro tability and loyalty. When allowance is made for adaptation of the relative w eights attached to each of these criteria, the result is that buyers adaptively shift the weight from pro tability t o l o y alty

    Objects, Relations, Potential and Change

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    This article attempts to develop further the conception of dynamics in Object-Oriented Ontology (OOO): its model of how objects develop and change. Objects are affected by relations between them, and have the potential both to produce and undergo effects, as realised in interaction with other objects. To elaborate on the change of objects in OOO, an idea is adopted from transcendental ontology. A key Hegelian question in this article is how the realisation of existing potential can produce new potential (Schelling: potentialisation, going from the actual to the possible). Stated differently: how can objects change to the point of breaking their identity and generating a new object? One needs to consider that objects are nested at different levels, and that the degree of how radical change may be depends on the perspective of any given level. To address this issue, the article employs the notion of a script: a structure of nodes, each with its own subscripts. The analysis is applied and developed further through a comparative analysis of change in evolution, economics, a theory of discovery, and linguistics. The dual intention of this is to see if OOO can help us understand those phenomena, and to see in turn if those phenomena can inform the further development of OOO
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