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Vanishing twin syndrome is a miscarriage of multiples where one or more fetuses ‘vanishes’ (i.e., partial or full resorption or via calcification) during pregnancy, often before detection via ultrasound. It affects 30−50% of multifetal pregnancies, with most cases resulting in full resorption within the first trimester. Despite its recognition since 1945 and rising occurrence in both natural and assisted pregnancies, standardized clinical guidelines remain inadequate, leading to inconsistent diagnosis, counseling, and communication from healthcare providers. This study examines the experiences of mothers and gestational carriers diagnosed with VTS, focusing on patient-provider communication, risks, and symptom disclosure. A global online survey collected qualitative and quantitative data from 153 participants across 17 countries. Results show that most patients with formal diagnoses experienced negative interactions with healthcare providers, with an average sentiment score of −0.7 (on a scale from −2 to 2). Over 53.4% rated their communication experience as −1, and the average satisfaction score for the amount of information received was 3.5/10. Additionally, 43% of respondents were not informed about chorionicity, a key factor affecting fetal outcomes. Significant discrepancies in care were observed across different countries. The findings highlight major gaps in patient-provider communication and inconsistent clinical practices regarding VTS. Addressing these issues through improved education, clearer protocols, and standardized guidelines could enhance patient experiences and decision-making. Future research should focus on provider training and evidence-based strategies to improve the management of VTS and other types of miscarriage and death of multiples during pregnancy and postpartum.
Scholars of gender have long realized that questions regarding gender, women, and politics require a multi-method, nuanced approach. When a plurality of white women voted for Donald Trump over Hillary Clinton in the 2016 presidential election, social scientists increasingly began to recognize the urgency of undertaking new approaches to understanding gender, race, and voting behavior in the United States.1 Since then, researchers have helped us understand why so many white women support right-wing candidates and policies that aim to suppress their autonomy, offering explanations such as the influence of belief in traditional gender roles (Christley 2022), “possessive investments in white heteropatriarchy” (Strolovitch, Wong, and Proctor 2017, 354), and “gendered nationalism” in American politics (Deckman and Cassese 2021, 278). In more recent years — as election results and polling suggest growing numbers of men of color have shifted rightward — there has been increased interest in employing an intersectional approach to analyze the gulf between men and women of color.
There has been substantial recent renewed interest and investment to assess the therapeutic potential of psychedelic compounds in addiction disorders. This editorial discusses the available evidence from randomised trials and future research directions in the field, together with potential implications for patients, professionals and the wider addiction treatment system.
This article examines the impact of informal intergovernmental relations on the Kenyan government’s handling of the COVID-19 pandemic. It argues that although informality in governance has been perceived negatively by many governance scholars, it nevertheless has the capacity to enhance the effectiveness and legitimacy of government. By virtue of informality’s adaptability and recognition of the centrality of context, it can enhance efficacy particularly in unpredictable circumstances as occurred in the pandemic. Notwithstanding this reality, until recently, literature on informality, mainly informed by Eurocentric colonial perspectives on governance, has focussed on its negative elements, criticizing it for diverse governance ailments. Through the prism of the negotiated order theory, this article challenges this dominant narrative using an analysis of informal intergovernmental relations during the COVID-19 pandemic in Kenya. It argues that though informality was at times applied negatively, overall, it ensured vibrant intergovernmental relations, thus positively impacting health service delivery and enhancing the government’s legitimacy in the management of the pandemic.
We show that dualising transfer maps in Hochschild cohomology of symmetric algebras over complete discrete valuations rings commutes with Tate duality. This is analogous to a similar result for Tate cohomology of symmetric algebras over fields. We interpret both results in the broader context of Calabi–Yau triangulated categories.
To explore current and potential upcoming legal provisions concerning advance healthcare directives in psychiatry in Ireland, with particular focus on clinical challenges and ethical issues (e.g., self-harm, suicide).
Methods:
Review and analysis of selected relevant sections of the Assisted Decision-Making (Capacity) Act 2015, Assisted Decision-Making (Capacity) (Amendment) Act 2022, Mental Health Act 2001, Mental Health Bill 2024, and Criminal Law (Suicide) Act 1993, and relevant publications from Ireland’s Medical Council and Decision Support Service.
Results:
The Assisted Decision-Making (Capacity) Act 2015 outlined new procedures for advance healthcare directives. The Assisted Decision-Making (Capacity) (Amendment) Act 2022 specified that advance healthcare directives relating to mental health are binding for involuntary patients unless involuntary status is based on Section 3(1)(a) of the Mental Health Act 2001 (i.e., the ‘risk’ criteria). The Mental Health Bill 2024 proposes making advance healthcare directives binding for all involuntary patients. In relation to suicide and self-harm, the Criminal Law (Suicide) Act 1993 states that ‘a person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offence’, and the Decision Support Service advises that healthcare professionals are exempted from criminal liability if complying with a valid and applicable advance healthcare directive that refuses life-sustaining treatment, even where the directive-maker has attempted suicide.
Conclusions:
Considerable public and professional education are needed if advance healthcare directives are to be widely used. The ethical dimensions of certain advance directives require additional thought and, ideally, professional ethical guidance.
There is a longstanding belief amongst scholars of psychophysiology that activation is positively associated with attention. However, recent work on news avoidance suggests that activation from negative content is linked to decreased attention. The current study seeks to investigate these different expectations and suggests that both increased and decreased activation can be linked to both attention and avoidance. Using an experiment that employs skin conductance levels and heart rate to evaluate subjects’ media selection choices, the author finds that even as deactivation is most likely to precede the decision to turn away from content, roughly 30% of the time activation precedes turning away. These findings confirm prior conclusions from the psychophysiological communications literature, and in the news avoidance literature, but it also highlights the need for more nuanced expectations where activation and media selection are concerned.
Scalable assessment tools for precision psychiatry are of increasing clinical interest. One clinical risk assessment that might be improved by such approaches is assessment of violence perpetration risk. This is an important adverse outcome to reduce for some people presenting to services for first-episode psychosis. A prediction tool (Oxford Mental Illness and Violence (OxMIV)) has been externally validated in these services, but clinical acceptability and role need to be examined and developed.
Aims
This study aimed to understand clinical use of the OxMIV tool to support violence risk management in early intervention in psychosis services in terms of acceptability to clinicians, patients and carers, practical feasibility, perceived utility, impact and role.
Method
A mixed methods approach integrated quantitative data on utility and patterns of use of the OxMIV tool over 12 months in two services with qualitative data from interviews of 20 clinicians and 12 patients and carers.
Results
The OxMIV tool was used 141 times, mostly in new assessments. Required information was available, with only family history items scored unknown to any notable degree. The OxMIV tool was deemed helpful by clinicians in most cases, especially if there were previous risk concerns. It was acceptable practically, and broadly for the service, for which its concordance with clinical judgement was important. Patients and carers thought it could improve openness. There was some limited impact on plans for clinical support.
Conclusions
The OxMIV tool met an identified clinical need to support clinical assessment for violence risk. Linkage to intervention pathways is a research priority.
Understanding complex three-dimensional cardiac structures is the key to knowing CHD. Many learners have limited access to cadaveric specimens, and most alternative teaching modalities are two-dimensional. Therefore, we have developed virtual cardiac models using photogrammetry of actual heart specimens to address this educational need.
Methods:
A descriptive study was conducted at a single institution during a week-long cardiac morphology conference in October 2022 and 2023. Conference attendees viewed virtual cardiac models via laptop screen and virtual reality headset. Learners were surveyed on their opinions of the virtual models and their perceived effectiveness compared to existing educational materials.
Results:
Forty-six learners completed the survey. Participants reported the virtual cardiac models to be more effective than textbook diagrams (60%), and equally or more effective compared to didactic teaching (78%) and specimen videos (78%). Approximately half of participants (54%) found the virtual models to be less effective than hands-on cadaveric specimen inspection. Attitudes towards the virtual specimens were overall positive with most responders finding the tool engaging (87%) and enjoyable (85%). A majority reported that the models deepened their understanding of cardiac morphology (79%) and that they would recommend them to other trainees (87%).
Conclusions:
This study demonstrates that a novel teaching tool, virtual cardiac specimens, is equivalent to or more effective than many current materials for learning cardiac morphology. While they may not replace direct cadaveric specimen review, virtual models are an engaging alternative with the ability to reach a wider audience.
Organizations and managers often implement workplace training programs aimed at fostering collaboration, belonging, and respect among employees. However, the effectiveness of these programs can be undermined when they are framed in ways that only resonate with some participants while alienating others. We propose that moral reframing can enhance the success of such initiatives by aligning messaging with a broader range of moral perspectives. Drawing on moral foundations theory, we identify five key dimensions, care, fairness, loyalty, authority, and purity, that shape how individuals interpret and respond to workplace training efforts. Although many programs emphasize care and fairness, individuals who prioritize loyalty, authority, and purity may perceive them differently, leading to disengagement, skepticism, or resistance. We argue that strategically framing training initiatives across multiple moral frameworks can foster greater engagement, buy-in, and overall effectiveness. Additionally, we offer practical recommendations for organizations to implement moral reframing strategies, ensuring that training efforts resonate with a wider audience and contribute to a more cohesive and productive workplace.
Contemporary business and management research in China has advanced rapidly, making significant strides in the introduction of theoretical frameworks, research methodologies, local theory development, and practical applications. Much of this research continues to draw on Western theories, and since the reform and opening up, Chinese management research has evolved through distinct stages of globalization and localization. Today, it faces new challenges amid anti-globalization trends. At this critical juncture, the key question is whether China should continue integrating Western theories or capitalize on the opportunity to develop indigenous management theories. This paper explores the differences in scientific development concepts and focuses between China and the West, the historical trajectory of Chinese management research, and the challenges and opportunities that lie ahead. To enhance China's contribution to global management research, we propose that it is essential to sustain international collaboration, deepen understanding of frontline enterprise practices, promote micro-level research and interpretation with Chinese characteristics, and cultivate an open academic community, while optimizing the research evaluation system.
Kant’s position in analytical jurisprudence has not been sufficiently explored. This paper aims to remedy this shortcoming. The main issue in this paper is to which extent Kant’s legal theory is an instance of natural law theory or legal positivism. Robert Alexy is one of the few philosophers who addressed this issue. Alexy believes that Kant defends a version of natural law theory that puts moral limits on legal validity. I show that Alexy’s interpretation is unsuccessful. I argue that Kant defends the positivist separability thesis that norms need not meet moral requirements to qualify as legal norms.