Because of the low nurse-to-patient ratio on surgical wards and the intermittent nature of blood pressure spot-checks, there is increasing evidence that hemodynamic deterioration may be overlooked for hours. Several non-obtrusive systems have recently been developed to monitor blood pressure continuously and non-invasively. They may help to free nurses from time-consuming and repetitive tasks and to detect clinical deterioration earlier, decrease the number of rapid response team interventions, ICU admissions, cardiac arrests, and deaths. From a sensor standpoint, wireless wearables are emerging as the ideal solution for monitoring on the wards because they are patient friendly andenable early mobilization,a key element of enhanced recovery programs. Clinical studies are needed to clarify what are the best strategies to effectively respond to early deterioration alerts. Such strategies may include the quick assessment of cardiac function with a POCUS device.

As demonstrated throughout this book and supported by relevant data, the interface between energy and the environment gains importance under international economic law. As the facts in reviewed cases and discussions suggest, any energy source, whether dirty or clean, must undergo environmentally sound activities for associated measures to be accepted on environmental grounds. From a legal standpoint, the energy–environment nexus has raised a multitude of issues often crossing both trade and investment law domains. In Conclusion, this book distinguishes three groups of trade and investment rules, notably ‘permissions’, ‘restrictions’ and ‘commands’ and, based on the preceding chapters, highlights some areas needing improvements in each of these categories. While ‘greening’ improvements can be pursued within the existing regimes, such as the WTO, the ECT, IIAs, RTAs and others, the book also proposes a holistic consideration of the energy–environment nexus under a single trade and investment framework. The idea here is to establish a new multi-party Sustainable Energy Trade and Investment Agreement.

Chapter 1 argues that parenthood aspirations, including those reliant on novel reproductive techniques, have started to evolve into justiciable rights. It challenges the view that human rights law cannot adequately address bioethical issues and examines commonalities and mutual influences between human rights and bioethical discourse. The chapter first analyses international case law establishing (predominantly negative) obligations in relation to natural procreative capacity. As regards medically assisted procreation, it observes that, perhaps counter-intuitively, most of the claims raised in Strasbourg litigation have been assessed by the European Court of Human Rights as involving active interferences as opposed to lacunae. The chapter provides a catalogue of (alleged) negative and positive obligations as they emerge from the case law; it examines the rationale for the Court’s treatment of a claim through the lens of negative or positive obligations while suggesting that that classification does not have a significant practical impact on the outcome of the case.

Fluid administration is one of the basic components in the management of neurosurgical patients. However, there is still debate on the ideal fluid. Issues related to adequate volume replacement and effects on the intracranial pressure persist. Studies have demonstrated the harmful effects of colloids over crystalloids. Normal saline has remained a fluid of choice but there is now emerging evidence that it, too, is not free of its harmful effects. Hypertonic saline has also been accepted by many practitioners, but its use and administration require close monitoring. There is now growing evidence on the use of balanced solutions for neurosurgical patients. However, this evidence comes from a small number of studies. Hemodynamic monitoring for fluid therapy in these patients is prudent as these patients are prone to hypovolemia. Dynamic parameters like stroke volume variance and pulse pressure variance are considered more reliable to monitor fluid therapy in comparison to static parameters. This chapter briefly covers various clinical situations in neurosciences with respect to fluid therapy and use of hemodynamic monitoring while providing fluid therapy and its effect on patient outcome.

Though he was both friend and collaborator of Johann Wolfgang Goethe in Weimar, Schiller was not significantly influenced by his fellow playwright. We find no allusion in his quasi-Aristotelian definition of ‘Tragedy’ to the famous triad canonized some thirty years later by the master of Weimar: Epos, Lyrik, Drama – the ‘three natural and authentic forms of poetry’. Admittedly, Goethe was at pains to nuance his thesis precisely in relation to ‘das ältere griechische Trauerspiel’, ‘the ancient Greek tragedy’. He explained that in a first phase of development of the genre the three natural forms of poetry merged into one, inasmuch as the main character was still the chorus and the lyric mode was predominant. Later, the three forms tended to diverge and to organize themselves in sequence within individual tragedies. Goethe therefore found within the genre of tragedy the clarity of narrative epic, the exaltation of lyric emotion and the personal action of drama.

To get to the root of the grave misunderstanding underlying modern notions of the lyric mode we must revisit this chapter in the history of tragic criticism.

When we describe the heart in this chapter, and in subsequent chapters, our account will be based on the organ as viewed in its anatomical position.1 Where appropriate, the heart will be illustrated as it would be viewed by the surgeon during an operative procedure, irrespective of whether the pictures are taken in the operating room, or are photographs of autopsied hearts. When we show an illustration in non-surgical orientation, this will be clearly stated.

In the normal individual, the heart lies in the mediastinum, with two-thirds of its bulk to the left of the midline (Figure 1.1). The surgeon can approach the heart, and the great vessels, either laterally through the thoracic cavity, or directly through the mediastinum anteriorly. To make such approaches safely, knowledge is required of the salient anatomical features of the chest wall, and of the vessels and the nerves that course through the mediastinum (Figure 1.2).

Apart from a tiny amount of energy generated in the core by radioactive decay, and tidal energy from the gravitational interaction of the Moon, the Earth generates no energy of its own. Yet this is a planet full of life, both biological, and physical – assuming we may stretch the language, and call atmospheric circulation, and the hydrological cycle, forms of ‘physical life’. (James Lovelock’s Gaia hypothesis treats the entire planet as a living organism.)

Like the preceding chapter, Chapter 12 investigates the relationship between the center and the periphery in the waging of lawfare, with a particular emphasis on resistance to the gacaca project. Although some observers have come to speak of “Rwanda’s Leviathan,” the label causes one to overlook the few – but nonetheless really existing – spaces of everyday resistance to authoritarian rule. To render this resistance visible, the chapter assembles empirical vignettes from the field. These vignettes are about the “the art of not being governed,” as James Scott has memorably put it. To ward off the danger of mistaking enforced compliance with the gacaca project for genuine commitment to it, the chapter gives pride of place to “quiet agency.”