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Monochorionic (MC) twin pregnancy is associated with special complications that are unique to the shared placenta and vascular anastomoses. These complications include twin-to-twin transfusion syndrome (TTTS), selective fetal growth restriction (sFGR), twin reverse arterial perfusion sequence (TRAPS), twin anemia-polycythemia sequence (TAPS), and conjoined twins . Furthermore, the incidence of discordant structural anomalies is more common in MC twins (6–8%) than in dichorionic (DC) twins (1–2%). In these conditions, selective reduction of one of the MC twins may have to be considered to maximize the chance of survival of the co-twin, or to minimize the risk to it. Unlike DC twin pregnancies in which their placentas have no vascular anastomoses, MC twins are connected via multiple vascular channels between their fused placenta . Therefore, intracardiac KCl injection is not a feasible option in MC twin pregnancies . Hence selective reduction must aim specifically at stopping the target twin’s umbilical blood flow, either at the umbilical cord level, or at the intra-abdominal portion of its vessels just beneath its insertion site (intrafetal), using more sophisticated methods. In this chapter, various indications and different surgical methods of selective reduction, as well as the comparison between the methods, are discussed.
Navigational accidents (collisions and groundings) account for approximately 85% of mari-time accidents, and consequence estimation for such accidents is essential for both emergency resource allocation when such accidents occur and for risk management in the framework of a formal safety assessment. As the traditional Bayesian network requires expert judgement to develop the graphical structure, this paper proposes a mutual information-based Bayesian network method to reduce the requirement for expert judgements. The central premise of the proposed Bayesian network method involves calculating mutual information to obtain the quantitative element among multiple influencing factors. Seven-hundred and ninety-seven historical navigational accident records from 2006 to 2013 were used to validate the methodology. It is anticipated the model will provide a practical and reasonable method for consequence estimation of navigational accidents.
Nudging in microbiology is an antimicrobial stewardship strategy to influence decision making through the strategic reporting of microbiology results while preserving prescriber autonomy. The purpose of this scoping review was to identify the evidence that demonstrates the effectiveness of nudging strategies in susceptibility result reporting to improve antimicrobial use.
A search for studies in Ovid MEDLINE, Embase, PsycINFO, and All EBM Reviews was conducted. All simulated and vignette studies were excluded. Two independent reviewers were used throughout screening and data extraction.
Of a total of 1,346 citations screened, 15 relevant studies were identified. Study types included pre- and postintervention (n = 10), retrospective cohort (n = 4), and a randomized controlled trial (n = 1). Most studies were performed in acute-care settings (n = 13), and the remainder were in primary care (n = 2). Most studies used a strategy to alter the default antibiotic choices on the antibiotic report. All studies reported at least 1 outcome of antimicrobial use: utilization (n = 9), appropriateness (n = 7), de-escalation (n = 2), and cost (n = 1). Moreover, 12 studies reported an overall benefit in antimicrobial use outcomes associated with nudging, and 4 studies evaluated the association of nudging strategy with subsequent antimicrobial resistance, with 2 studies noting overall improvement.
The number of heterogeneous studies evaluating the impact of applying nudging strategies to susceptibility result reports is small; however, most strategies do show promise in altering prescriber’s antibiotic selection. Selective and cascade reporting of targeted agents in a hospital setting represent the majority of current research. Gaps and opportunities for future research identified from our scoping review include performing prospective randomized controlled trials and evaluating other approaches aside from selective reporting.
Parent-adolescent conflict seems to be common when adolescents negotiate power with their parents. Forum theatre (FT), an interactive and participatory theatre form, is recommended as a community-based intervention to assist Chinese parents in managing the challenges of parent-adolescent interaction. FT proposes that solutions to daily struggles can be reached through concerted efforts of the participants. This article documents the impact of FT on parents who took on the role of ‘spect-actor’. The spect-actor is an active spectator who acts on stage to test solutions to a problem. The results indicate that parents gained more awareness of their children’s needs, which helped them to relax their control over their children. FT is recommended as a means of parent education in schools.
L2 sounds present different kinds of challenges to learners at the phonetic, phonological, and lexical levels, but previous studies on L2 tone learning mostly focused on the phonetic and lexical levels. The present study employs an innovative technique to examine the role of prior tonal experience and musical training on forming novel abstract syllable-level tone categories. Eighty Cantonese and English musicians and nonmusicians completed two tasks: (a) AX tone discrimination and (b) incidental learning of artificial tone-segment connections (e.g., words beginning with an aspirated stop always carry a rising tone) with synthesized stimuli modeled on Thai. Although the four participant groups distinguished the target tones similarly well, Cantonese speakers showed abstract and implicit knowledge of the target tone-segment mappings after training but English speakers did not, regardless of their musical experience. This suggests that tone language experience, but not musical experience, is crucial for forming novel abstract syllable-level tone categories.
Current research on the psychological health of near-centenarians (95−99 years old) and centenarians remains limited. Existing studies have mainly characterized their physical, cognitive, and social health. Results on the anxiety and depression of near-centenarians and centenarians (more than 95 years old) have been mixed with some studies, finding higher rates of anxiety and depression among those older than 95 years and others reporting no difference in rates compared with younger age groups. This study aims to synthesize the existing literature on the prevalence and predictors of anxiety and depression in near-centenarians and centenarians.
A systematic review was conducted using Ovid Medline, Embase, PsycINFO, CINAHL, SCOPUS, and the Cochrane database. Common and conflicting findings among the literature were examined.
Thirty-eight studies met the inclusion criteria. Six studies examined the prevalence and predictors of anxiety, and 37 studies investigated the prevalence and predictors of depression. Five studies examined both anxiety and depression in the same sample. Prevalence data on anxiety and depression varied significantly, as did comparisons with rates in younger populations. Findings on predictors of anxiety and depression were contradictory.
There is a large degree of heterogeneity among studies of centenarians’ psychological status. Findings conflict on the prevalence and predictors of anxiety and depression and rates compared with younger age groups. Variation in findings may result from the different inclusion criteria, sampling methods, and measurement tools. Better harmonization of centenarian study methodologies may improve consistency of findings to aid in developing clinical interventions.
This chapter studies the fortune of historical knowledge under the rise of the Qin empire from the mid-fourth century to the end of the third century BCE. It begins with a discussion of the founding of the Qin empire, and how the infamous episode of the “Burning of the Books” points to its desire to exercise dominion not just over the space but also the time of the empire. Then, it turns to a discussion of the ambivalent, problematic role that history had long played in the Legalist tradition of political thought, as seen in writings by various prominent Qin officials, especially Shang Yang and Han Feizi. Then, under the Qin empire and the First Emperor, we saw not only an inheritance and forceful application of this Legalist vision of the state, but also a willful radicalization of its key principles. The Qin empire built on the Legalist legacy and finally arrived at a vision of itself as the effective “end of history,” a supposed cessation of all material change in human history henceforth that also worked as an effective dismissal of the entire historical field as ultimatley useless and irrelevant.
The Epilogue summarizes the key findings of each chapter, and reflects on some of the larger implications of the basic argument of the book, namely that engagements with the past in early China were less a matter of cultural attitude than they were deliberate ideological mobilization towards various political ends.