Systems for describing congenital cardiac malformations have frequently been based on embryological concepts and theories. As useful as these systems have been, they have often had the effect of confusing the clinician, rather than clarifying the basic anatomy of a given lesion. As far as the surgeon is concerned, the essence of a particular malformation lies not in its presumed morphogenesis, but in the underlying anatomy. An effective system for describing this anatomy must be based on the morphology as it is observed. At the same time, it must be capable of accounting for all congenital cardiac conditions, even those that, as yet, might not have been encountered. To be useful clinically, the system must be not only broad and accurate, but also clear and consistent. The terminology used, therefore, should be unambiguous. It should be as simple as possible. The sequential segmental approach provides such a system.1

The latter years of Spain’s neutrality during the war (1759–62) saw an even greater deterioration in Anglo-Spanish relations. Ministers from both Courts attempted to preserve and salvage Spanish neutrality, but unresolved diplomatic grievances, as well as the deaths of both the Spanish king, Ferdinand VI, and the British monarch, George II, foiled their efforts and any gains made by the case of the San Juan Baptista. The increasing decay and eventual breakdown of Anglo-Spanish relations during the war demonstrate that the tactics used to ensure Dutch neutrality could not so easily be transferred to maintain Spanish neutrality. This chapter begins with the appellate case of the Jesús, Maria, y José and a close look at the legal arguments presented for both the Spanish shipowners and the British privateers who took the ship as prize. The proceedings of the court are analysed alongside the political developments between the Spanish and British ministries, and illustrate how they influenced one another. The case demonstrates Hardwicke’s continued attempts to make legal arguments that would set the Rule of the War of 1756 as the standard rule for how Britain’s prize court system would judge the legality of enemy goods carried in neutral ships.

In spite of numerous studies about fluid management and hemodynamic monitoring in thoracic anesthesia, the heterogeneity of the results has led to the fact that there is still no strong evidence on this topic. The historical recommendation of restricted fluid management has been replaced by normovolemia, but there are still many unsolved problems. Most importantly, not only the amount of the fluid, but also its indication, timing, the addition of a vasopressor and/or inotrope, its dosage, protection of glycocalyx layer and several other parameters play a role in the relationship of fluid strategy and overall outcome. Regarding the postoperative outcome, fluid management in its extensive form should be considered as an important part of a strategy.

Goal-directed therapy (GDT) is associated with certain limitations, mainly because “open thorax” can affect the cardiopulmonary interaction. Still, it can give objective hints to achieve stable hemodynamics, protection of glycocalyx, prevention of pulmonary edema and avoidance of postoperative organ injury.

Karl Popper attempted to give an account of scientific research as the rational pursuit of the truth about nature without any appeal to what he took to be the fictitious notion of non-demonstrative or inductive support. Deductive inference can be seen to be inference enough for science, he claimed, once we appreciate the power of data to refute theory. Many of the standard objections to Popper’s account purport to show that his deductivism actually entails a radical scepticism about the possibility of scientific knowledge. Some of these objections appear unanswerable in the context of the traditional analysis of knowledge as justified true belief; but this is neither a conception of knowledge that Popper himself accepted nor one that is currently in fashion. Reliabilism, the view that knowledge is a true belief generated by a reliable method, is now a popular replacement for the traditional analysis and one that is closer to Popper’s own conception of knowledge. My aim in this essay is to consider in brief compass the prospects of a reliabilist reading of Popper’s account of science. Such a reading makes it possible to turn some of the standard objections and helps to show which of Popper’s views should be accepted and which rejected.

This chapter analyzes the relationship between entrepreneurs and capitalists. It argues that the function of capitalists is to select entrepreneurs, and without capitalists there would be no entrepreneurs. The government can replace neither entrepreneurs nor capitalists. State-owned enterprises cannot produce entrepreneurs. The chapter also discusses corporate governance. Existing corporate governance theories focus exclusively on conflicts of interests between investors or shareholders and operators. In fact, there are two types of conflicts. One is the conflict of interests, and the other is the conflict of cognitions. Given that the future is uncertain and indeterminate, and that different people have different imagination and judgements, the conflict of cognitions is more challenging than the conflict of interests. The best corporate governance structure allows entrepreneurship to play the biggest role, as opposed to incentivizing and disciplining professional managers. The legal rules of corporate governance must be general, flexible, and entrepreneur friendly.

The main aim of a perioperative fluid therapy is to maintain or normalize the patient’s homeostasis. Small children have higher fluid volumes, metabolic rates and fluid needs than adults. Therefore, short perioperative fasting periods (formula milk 4 hours, breast milk 3 hours, clear fluids 1 hour) are important to avoid iatrogenic dehydration, hypotension, ketoacidosis and uncooperative behavior. Balanced electrolyte solutions with 1–2.5% glucose are favored for intraoperative maintenance infusion. Glucose- free balanced electrolyte solutions should then be added as needed to replace intraoperative fluid deficits or minor blood loss. Gelatin solutions or hydroxyethyl starch are useful in hemodynamically unstable patients or those with major blood loss, especially when crystalloids alone are not effective and blood products are not indicated. The monitoring should focus on the maintenance or restoration of a stable tissue perfusion.In nonsurgical or postoperative children, balanced electrolyte solutions should be used instead of hypotonic solutions, both with 5% glucose, as recent clinical studies and reviews showed a lower incidence of hyponatremia.

The Earth’s radiation balances are being altered by a number of changes in the composition of the atmosphere, and as a consequence the climate system is being ‘forced’, almost certainly in the direction of higher temperatures. In earlier chapters we examined the physics of the processes involved. What are likely to be the effects of such changes? The only way to answer questions such as this is to model the Climate System in sufficient detail. Firstly, we need to model the atmosphere, something we have been doing for half a century to forecast the weather. Because of the significant exchanges of both heat and water between the ocean and the atmosphere, it is clearly necessary to couple an ocean model. Ice sheets are likely to be affected by warming, as they are one of the key feedback processes just mentioned. The land surface also has significant interactions on various timescales.

We experience weather in the air around us, and that implies climate: the statistics of weather. But if we are to understand climate, and especially how it changes, we need to examine all its interactions with the planet. In the previous chapter we looked at the role of sea-surface temperature. If we are to go further, we need to look at other components of our planet and their atmospheric interactions. When we see the range of interconnections, we realise that we are dealing with a complex system, with multiple interactions between components. Whenever we see such a system, we must realise the potential for one interaction between components to end up impacting back on another: this is feedback. If we are to understand climate, we must understand these feedbacks. In the last sections we will illustrate one of the most important of these processes with a ‘relatively simple’ model.

Organ dysfunction often occurs in the perioperative setting and in sepsis. Alterations in systemic hemodynamics may play a role, but even when these are within therapeutic goals, organ dysfunction may still occur. Microcirculatory alterations, a key determinant of tissue perfusion and of mitochondrial dysfunction, may play a role in the development of organ dysfunction. In this chapter, we discuss the evidence for alterations in microcirculatory and mitochondrial functions and their relevance, in circulatory failure and in the perioperative setting.

The Introduction provides an overview of the conceptual background and main themes of the book. It briefly considers the advances in assisted reproduction technology (e.g. in vitro fertilisation and pre-implantation genetic diagnosis) and their benefits for aspiring parents. It suggests that these scientific developments not only have led to the emergence of new trends in bioethical politics, but have also inspired claims in the international human rights arena. In fact, an increasing number of legal cases, most notably in the European Convention on Human Rights system, has started to establish a set of rights in connection with access to medically assisted procreation; they are an extension of autonomy rights, the right to respect for family life and non-discrimination rights. The Introduction offers a synopsis of each chapter, outlining the key bioethical and legal controversies examined therein, as well as the central arguments proposed by the book in light of international litigation.