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Managing Uncertainty in Decision-Making of Common Congenital Cardiac Defects – ERRATUM
- Colin J. McMahon, Skaistė Sendžikaitė, Anusha Jegatheeswaran, Yiu-Fai Cheung, David S. Majdalany, Vibeke Hjortdal, Andrew N. Redington, Jeffrey P. Jacobs, Maryam Asoodar, Matthew Sibbald, Tal Geva, Jeroen J.G. van Merrienboer, Justin T. Tretter
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- Journal:
- Cardiology in the Young / Volume 33 / Issue 3 / March 2023
- Published online by Cambridge University Press:
- 24 January 2023, p. 502
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Managing uncertainty in decision-making of common congenital cardiac defects
- Colin J. McMahon, Skaistė Sendžikaitė, Anusha Jegatheeswaran, Yiu-Fai Cheung, David S. Majdalany, Vibeke Hjortdal, Andrew N. Redington, Jeffrey P. Jacobs, Maryam Asoodar, Matthew Sibbald, Tal Geva, Jeroen J.G. van Merrienboer, Justin T. Tretter
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- Journal:
- Cardiology in the Young / Volume 32 / Issue 11 / November 2022
- Published online by Cambridge University Press:
- 27 October 2022, pp. 1705-1717
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Decision-making in congenital cardiac care, although sometimes appearing simple, may prove challenging due to lack of data, uncertainty about outcomes, underlying heuristics, and potential biases in how we reach decisions. We report on the decision-making complexities and uncertainty in management of five commonly encountered congenital cardiac problems: indications for and timing of treatment of subaortic stenosis, closure or observation of small ventricular septal defects, management of new-onset aortic regurgitation in ventricular septal defect, management of anomalous aortic origin of a coronary artery in an asymptomatic patient, and indications for operating on a single anomalously draining pulmonary vein. The strategy underpinning each lesion and the indications for and against intervention are outlined. Areas of uncertainty are clearly delineated. Even in the presence of “simple” congenital cardiac lesions, uncertainty exists in decision-making. Awareness and acceptance of uncertainty is first required to facilitate efforts at mitigation. Strategies to circumvent uncertainty in these scenarios include greater availability of evidence-based medicine, larger datasets, standardised clinical assessment and management protocols, and potentially the incorporation of artificial intelligence into the decision-making process.
P.176 Assessing the competence of neurology residents in performing an interphysician telephone consultation.
- AG Florendo-Cumbermack, ME Jenkins, S Chahine, S Vennance, C Yiu-Chia
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 48 / Issue s3 / November 2021
- Published online by Cambridge University Press:
- 05 January 2022, p. S70
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Background: Neurology Residency training in Canada is transitioning to competence based medical education (CBME) in July 2020 and the Royal College Neurology Specialty Committee has identified “providing consultation for and managing patients at outlying centers,” to be an entrustable professional activity (EPA). At Western, neurology telephone consultations, from outlying centres, are attended by both the resident and the staff Neurologist. This scenario provides the ideal situation for direct observation and immediate formative feedback. The resident’s performance is assessed using the ’TeleTool’ which utilizes an entrustment scale and has a short narrative portion. Methods: This mixed methods study aims to determine the reliability and validity of the ’TeleTool’ in assessing the performance of the telephone consultation by senior neurology residents. Informed consent was obtained from residents (9) and staff (7) involved. Scores on the entrustment scale and narrative comments were analysed. Results: Information on 30 encounters (involving 9 residents) was collected. TeleTool results demonstrated higher entrustment scores in PGY4 and PGY5 levels. Overall, ratings were consistent across the 7 consultants assessors. Conclusions: The TeleTool was reliable and valid in assessing competence in the telephone consultation and will be a useful tool for assessment of this EPA.
MP22: Guiding practice transition with a faculty mentorship program
- S. Yiu, M. Yeung, L. Fischer, J. Frank
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S50
- Print publication:
- May 2019
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Innovation Concept: Transition to independent practice is challenging and early career physicians are more prone to burnout and error. Despite recommendations for formal mentorship to support physicians, only 43.6% of US academic Emergency Medicine departments have such programs. We describe an innovative mentorship program designed to support these early career physicians and enhance quality of care, career longevity, and wellness. We operationalized mentorship in which experienced, highly regarded, empathic mentors guide mentees in their personal and professional development. Methods: In this program two Emergency Physician mentors were teamed with each newly hired Emergency Physician. Mentees could request their own mentors, and teams were matched on the basis of shared personal and academic interests. Mentors received academic funding and training on good mentorship practice, roles and responsibilities, and feedback. Teams had to meet formally at least twice a year, with additional contact as needed. While mentees set the meeting agenda, teams were also encouraged to address four main areas. These areas were identified from a targeted needs assessment and literature review. They include: 1) clinical process and care, 2) departmental structure and culture, 3) teaching and scholarship, and 4) physician wellness. After meetings, mentees summarized and submitted the topics discussed and reflected on action plans. An oversight committee supported the program. Curriculum, Tool or Material: All nine (9) newly hired physicians joined the program in Fall 2018. As of December 2018, six (6) teams have had formal meetings. They discussed the following areas: clinical processes and care (50%), departmental structure and culture (100%), teaching and scholarship (67%), and physician wellness (100%). Other areas discussed include: academic career, financial planning, and networking. Teams spent 20-60% of the time formulating steps to achieve mentee career goals. They spent 40-60% of the time discussing skills and resources needed. End of year program evaluation will include outcomes such as satisfaction, value, effectiveness, projects, promotions, and awards. The results will shape future program design. Conclusion: We implemented a mentorship program for newly hired Emergency Physicians. As mentorship is integral to successful transition to independent practice, this program model could be highly beneficial to other academic Emergency Medicine departments.
P001: Continuing professional development and faculty development: launching continuous practice enhancement for academic emergency physicians
- S. Addleman, M. Yeung, S. Yiu, G. Mastoras, S. Tse, J. Frank
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S63
- Print publication:
- May 2019
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Innovation Concept: Emergency medicine physicians must maintain a broad knowledge base and procedural skillset while fulfilling their academic roles as teachers, researchers and administrators. Most academic departments do not have a regular, affordable, formal continuing professional development (CPD) and faculty development (FD) curriculum for their staff. We set out to design and implement a novel continuous practice enhancement program to address this issue. Methods: Strategic planning by the Ottawa academic Department of EM identified CPD and FD as priorities. A program was created to support high quality, monthly CPD/FD courses provided by physicians. We had 5 goals: (1) enhance clinical and academic skills, (2) disseminate group best practices, (3) sustain skills in high impact/low frequency scenarios, (4) support physician academic careers, and (5) acquire new procedural skills. A CPD/FD Committee composed of local meded experts and experienced clinical teachers was tasked with overseeing the creation and evaluation of these sessions. Curriculum, Tool or Material: The longitudinal curriculum was informed by perceived needs (group survey), ascribed needs (M&M rounds, physician metrics and departmental leadership priorities) and participant feedback. The committee identified local experts to present on their areas of expertise in order to promote group best practice. Topics to-date have included clinical skills updates, teaching and coaching strategies and academic career planning. A comprehensive monthly simulation-based curriculum was rolled out simultaneously to give participants the opportunity to develop crisis resource management and critical care skills. Except for sessions requiring advanced equipment or cadavers, sessions are financed by academic funds and free for participants. Conclusion: Faculty academic learning and engagement is an important goal and participation in this curriculum is reviewed at each physician's annual reappointment. To-date, 18 physicians (21% of our group) have presented topics and 92% of physicians have participated in at least one session with 63% having attended three or more. Evaluations have been overwhelmingly positive, and a recent survey identified the CPD/FD program as a significant contributor to our physicians’ wellness. We introduced an innovative, structured CPD/FD program in response to perceived and ascribed needs of our physicians and departmental leadership. Our successful CPD/FD curriculum represents a model for other departments who are considering similar initiatives.
Out-domain Chinese new word detection with statistics-based character embedding
- Yuzhi Liang, Min Yang, Jia Zhu, S. M. Yiu
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- Journal:
- Natural Language Engineering / Volume 25 / Issue 2 / March 2019
- Published online by Cambridge University Press:
- 11 February 2019, pp. 239-255
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Unlike English and other Western languages, many Asian languages such as Chinese and Japanese do not delimit words by space. Word segmentation and new word detection are therefore key steps in processing these languages. Chinese word segmentation can be considered as a part-of-speech (POS)-tagging problem. We can segment corpus by assigning a label for each character which indicates the position of the character in a word (e.g., “B” for word beginning, and “E” for the end of the word, etc.). Chinese word segmentation seems to be well studied. Machine learning models such as conditional random field (CRF) and bi-directional long short-term memory (LSTM) have shown outstanding performances on this task. However, the segmentation accuracies drop significantly when applying the same approaches to out-domain cases, in which high-quality in-domain training data are not available. An example of out-domain applications is the new word detection in Chinese microblogs for which the availability of high-quality corpus is limited. In this paper, we focus on out-domain Chinese new word detection. We first design a new method Edge Likelihood (EL) for Chinese word boundary detection. Then we propose a domain-independent Chinese new word detector (DICND); each Chinese character is represented as a low-dimensional vector in the proposed framework, and segmentation-related features of the character are used as the values in the vector.
P094: A computerized provider order entry strategy to improve the quality of clinical information on neuroimaging requisitions from the emergency department: an interim analysis
- K. Lin, S. K. Dowling, K. Yiu, D. Wang, S. van Gaal, P. Dickhoff
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue S1 / May 2018
- Published online by Cambridge University Press:
- 11 May 2018, p. S90
- Print publication:
- May 2018
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Introduction: Clinical context is critical for accurate radiologic interpretation of neuroimaging investigations. The aim of this study was to determine the impact of a change in the Emergency Department (ED) computerized provider order entry (CPOE) interface on the quality of clinical information conveyed in ED neuroimaging requisitions for suspected stroke patients. Methods: Four local EDs utilizing a common CPOE ED Stroke order set were studied before and after the introduction of a mandatory blank free text field requiring clinical information for the radiologist before a computed tomography angiography (CTA) request could be submitted. Prior to this modification, the indication (acute stroke) was pre-filled in the CTA request for convenience with the option of providing additional information at the discretion of the ordering physician. ED physicians were informed of the change as well as the rationale for its implementation. A retrospective pre (90 days) post (30 days) analysis was conducted across four local EDs to evaluate the impact of the CPOE user interface change on the quality of clinical information provided on neuroimaging orders. Patients aged 18 with CTA head and/or neck orders submitted from the order set were included. Patients were excluded if the CTA order was submitted outside of the ED Stroke order set, if order entry was by non-physician personnel, or if the order was modified by the diagnostic imaging department after ED submission. Clinical information from CTA orders were scored as complete, partial, or absent/uninformative based on a standardized rubric of critical elements, including: description of neurological deficit(s), lateralization, and timing of symptom onset or duration. Results were analyzed using chi square analysis. Results: Pre-implementation data from Oct 1, 2015 Jan 1, 2016 (N=652) was compared to post-implementation data from Nov 1 30, 2016 (N=227). The proportion of complete, partial, and absent/uninformative clinical histories were: 45.3%, 31.4%, and 23.3% in the pre-implementation period and 62.6%, 37.4%, and 0% in the post-implementation period respectively. There was a 38.2% relative increase in complete clinical histories, a 19.1% relative increase in partial clinical histories, and a 100% reduction in absent/uninformative clinical histories (p<0.001). Conclusion: The introduction of a mandatory free text field significantly increased the overall quality of clinical information provided on ED neuroimaging orders. This CPOE strategy has the potential to improve diagnostic accuracy and reduce unnecessary delays to imaging interpretation caused by lack of clinical information.
MP020: Do real-time Twitter metrics correlate with traditional emergency medicine post-conference speaker evaluations?
- S.H. Yiu, S. Dewhirst, C. Lee, A. Jalaili, J.R. Frank
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 18 / Issue S1 / May 2016
- Published online by Cambridge University Press:
- 02 June 2016, p. S73
- Print publication:
- May 2016
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Introduction: Traditional post-conference speaker evaluations are inconsistently completed; meanwhile, real time social media tools such as Twitter are increasingly used in conferences. We sought to determine whether a correlation exists between traditional conference evaluation for a speaker and the number of real-time tweets it generated using data from a CAEP conference. Methods: This study utilized a retrospective design. The hashtag #CAEP14 was prospectively registered with Symplur, an online Twitter management tool, so that all tweets related to CAEP conference 2014 were stored. A tweet was associated with a session if it mentioned the speaker name, or if the tweet content and timing closely matched that of the session in the schedule. A tweet classification system was developed to differentiate original tweets from retweets, and quotes from comments generating further discussion. Two authors assessed and coded the first 200 tweets together to ensure a uniform approach to coding, and then independently coded the remaining tweets. Discrepancies were resolved by consensus. One author reviewed post-conference speaker evaluation, and abstracted the value corresponding to the question “The speaker was an effective communicator”. We present descriptive statistics and correlation analyses. Results: A total of 3,804 tweets were collected, with 2,218 (58.3%) associated with a session. Forty-eight (48%) (131 out of 274) of sessions receiving at least one tweet, with a mean of 11.7 tweets per session (95% CI of 0 to 57.5). In comparison, only 31% (85 out of 274) of sessions received a formal post conference speaker evaluation (p<0.005). For sessions that received at least one traditional post-conference evaluation, there was no significant correlation between the number of tweets and evaluation scores (R=0.087). This can be attributed to the fact that there was minimal variation between evaluation scores (median = 3.6 out of 5, IQR of 3.4 to 3.7). Conclusion: There was no correlation between the number of real-time tweets and traditional post-conference speaker evaluation. However, many sessions which received no formal speaker evaluation generated tweets, and the number of tweets was highly variable between sessions. Thus, Twitter metrics might be useful for conference organizers to supplement formal speaker evaluations.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. Chapman, James H. Charlesworth, Kenneth R. Chase, Chen Zemin, Luciano Chianeque, Philip Chia Phin Yin, Francisca H. Chimhanda, Daniel Chiquete, John T. Chirban, Soobin Choi, Robert Choquette, Mita Choudhury, Gerald Christianson, John Chryssavgis, Sejong Chun, Esther Chung-Kim, Charles M. A. Clark, Elizabeth A. Clark, Sathianathan Clarke, Fred Cloud, John B. Cobb, W. Owen Cole, John A Coleman, John J. Collins, Sylvia Collins-Mayo, Paul K. Conkin, Beth A. Conklin, Sean Connolly, Demetrios J. Constantelos, Michael A. Conway, Paula M. Cooey, Austin Cooper, Michael L. Cooper-White, Pamela Cooper-White, L. William Countryman, Sérgio Coutinho, Pamela Couture, Shannon Craigo-Snell, James L. Crenshaw, David Crowner, Humberto Horacio Cucchetti, Lawrence S. Cunningham, Elizabeth Mason Currier, Emmanuel Cutrone, Mary L. Daniel, David D. Daniels, Robert Darden, Rolf Darge, Isaiah Dau, Jeffry C. Davis, Jane Dawson, Valentin Dedji, John W. de Gruchy, Paul DeHart, Wendy J. Deichmann Edwards, Miguel A. De La Torre, George E. Demacopoulos, Thomas de Mayo, Leah DeVun, Beatriz de Vasconcellos Dias, Dennis C. Dickerson, John M. Dillon, Luis Miguel Donatello, Igor Dorfmann-Lazarev, Susanna Drake, Jonathan A. Draper, N. Dreher Martin, Otto Dreydoppel, Angelyn Dries, A. J. Droge, Francis X. D'Sa, Marilyn Dunn, Nicole Wilkinson Duran, Rifaat Ebied, Mark J. Edwards, William H. Edwards, Leonard H. Ehrlich, Nancy L. Eiesland, Martin Elbel, J. Harold Ellens, Stephen Ellingson, Marvin M. Ellison, Robert Ellsberg, Jean Bethke Elshtain, Eldon Jay Epp, Peter C. Erb, Tassilo Erhardt, Maria Erling, Noel Leo Erskine, Gillian R. Evans, Virginia Fabella, Michael A. Fahey, Edward Farley, Margaret A. Farley, Wendy Farley, Robert Fastiggi, Seena Fazel, Duncan S. Ferguson, Helwar Figueroa, Paul Corby Finney, Kyriaki Karidoyanes FitzGerald, Thomas E. FitzGerald, John R. Fitzmier, Marie Therese Flanagan, Sabina Flanagan, Claude Flipo, Ronald B. Flowers, Carole Fontaine, David Ford, Mary Ford, Stephanie A. Ford, Jim Forest, William Franke, Robert M. Franklin, Ruth Franzén, Edward H. Friedman, Samuel Frouisou, Lorelei F. Fuchs, Jojo M. Fung, Inger Furseth, Richard R. Gaillardetz, Brandon Gallaher, China Galland, Mark Galli, Ismael García, Tharscisse Gatwa, Jean-Marie Gaudeul, Luis María Gavilanes del Castillo, Pavel L. Gavrilyuk, Volney P. Gay, Metropolitan Athanasios Geevargis, Kondothra M. George, Mary Gerhart, Simon Gikandi, Maurice Gilbert, Michael J. Gillgannon, Verónica Giménez Beliveau, Terryl Givens, Beth Glazier-McDonald, Philip Gleason, Menghun Goh, Brian Golding, Bishop Hilario M. Gomez, Michelle A. Gonzalez, Donald K. Gorrell, Roy Gottfried, Tamara Grdzelidze, Joel B. Green, Niels Henrik Gregersen, Cristina Grenholm, Herbert Griffiths, Eric W. Gritsch, Erich S. Gruen, Christoffer H. Grundmann, Paul H. Gundani, Jon P. Gunnemann, Petre Guran, Vidar L. Haanes, Jeremiah M. Hackett, Getatchew Haile, Douglas John Hall, Nicholas Hammond, Daphne Hampson, Jehu J. Hanciles, Barry Hankins, Jennifer Haraguchi, Stanley S. Harakas, Anthony John Harding, Conrad L. Harkins, J. William Harmless, Marjory Harper, Amir Harrak, Joel F. Harrington, Mark W. Harris, Susan Ashbrook Harvey, Van A. Harvey, R. Chris Hassel, Jione Havea, Daniel Hawk, Diana L. Hayes, Leslie Hayes, Priscilla Hayner, S. Mark Heim, Simo Heininen, Richard P. Heitzenrater, Eila Helander, David Hempton, Scott H. Hendrix, Jan-Olav Henriksen, Gina Hens-Piazza, Carter Heyward, Nicholas J. Higham, David Hilliard, Norman A. Hjelm, Peter C. Hodgson, Arthur Holder, M. Jan Holton, Dwight N. Hopkins, Ronnie Po-chia Hsia, Po-Ho Huang, James Hudnut-Beumler, Jennifer S. Hughes, Leonard M. Hummel, Mary E. Hunt, Laennec Hurbon, Mark Hutchinson, Susan E. Hylen, Mary Beth Ingham, H. Larry Ingle, Dale T. Irvin, Jon Isaak, Paul John Isaak, Ada María Isasi-Díaz, Hans Raun Iversen, Margaret C. Jacob, Arthur James, Maria Jansdotter-Samuelsson, David Jasper, Werner G. Jeanrond, Renée Jeffery, David Lyle Jeffrey, Theodore W. Jennings, David H. Jensen, Robin Margaret Jensen, David Jobling, Dale A. Johnson, Elizabeth A. Johnson, Maxwell E. Johnson, Sarah Johnson, Mark D. Johnston, F. Stanley Jones, James William Jones, John R. Jones, Alissa Jones Nelson, Inge Jonsson, Jan Joosten, Elizabeth Judd, Mulambya Peggy Kabonde, Robert Kaggwa, Sylvester Kahakwa, Isaac Kalimi, Ogbu U. Kalu, Eunice Kamaara, Wayne C. Kannaday, Musimbi Kanyoro, Veli-Matti Kärkkäinen, Frank Kaufmann, Léon Nguapitshi Kayongo, Richard Kearney, Alice A. Keefe, Ralph Keen, Catherine Keller, Anthony J. Kelly, Karen Kennelly, Kathi Lynn Kern, Fergus Kerr, Edward Kessler, George Kilcourse, Heup Young Kim, Kim Sung-Hae, Kim Yong-Bock, Kim Yung Suk, Richard King, Thomas M. King, Robert M. Kingdon, Ross Kinsler, Hans G. Kippenberg, Cheryl A. Kirk-Duggan, Clifton Kirkpatrick, Leonid Kishkovsky, Nadieszda Kizenko, Jeffrey Klaiber, Hans-Josef Klauck, Sidney Knight, Samuel Kobia, Robert Kolb, Karla Ann Koll, Heikki Kotila, Donald Kraybill, Philip D. W. Krey, Yves Krumenacker, Jeffrey Kah-Jin Kuan, Simanga R. Kumalo, Peter Kuzmic, Simon Shui-Man Kwan, Kwok Pui-lan, André LaCocque, Stephen E. Lahey, John Tsz Pang Lai, Emiel Lamberts, Armando Lampe, Craig Lampe, Beverly J. Lanzetta, Eve LaPlante, Lizette Larson-Miller, Ariel Bybee Laughton, Leonard Lawlor, Bentley Layton, Robin A. Leaver, Karen Lebacqz, Archie Chi Chung Lee, Marilyn J. Legge, Hervé LeGrand, D. L. LeMahieu, Raymond Lemieux, Bill J. Leonard, Ellen M. Leonard, Outi Leppä, Jean Lesaulnier, Nantawan Boonprasat Lewis, Henrietta Leyser, Alexei Lidov, Bernard Lightman, Paul Chang-Ha Lim, Carter Lindberg, Mark R. Lindsay, James R. Linville, James C. Livingston, Ann Loades, David Loades, Jean-Claude Loba-Mkole, Lo Lung Kwong, Wati Longchar, Eleazar López, David W. Lotz, Andrew Louth, Robin W. Lovin, William Luis, Frank D. Macchia, Diarmaid N. J. MacCulloch, Kirk R. MacGregor, Marjory A. MacLean, Donald MacLeod, Tomas S. Maddela, Inge Mager, Laurenti Magesa, David G. Maillu, Fortunato Mallimaci, Philip Mamalakis, Kä Mana, Ukachukwu Chris Manus, Herbert Robinson Marbury, Reuel Norman Marigza, Jacqueline Mariña, Antti Marjanen, Luiz C. L. Marques, Madipoane Masenya (ngwan'a Mphahlele), Caleb J. D. Maskell, Steve Mason, Thomas Massaro, Fernando Matamoros Ponce, András Máté-Tóth, Odair Pedroso Mateus, Dinis Matsolo, Fumitaka Matsuoka, John D'Arcy May, Yelena Mazour-Matusevich, Theodore Mbazumutima, John S. McClure, Christian McConnell, Lee Martin McDonald, Gary B. McGee, Thomas McGowan, Alister E. McGrath, Richard J. McGregor, John A. McGuckin, Maud Burnett McInerney, Elsie Anne McKee, Mary B. McKinley, James F. McMillan, Ernan McMullin, Kathleen E. McVey, M. Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
- Published online:
- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Seeing as though1
- JOHN R. TAYLOR, KAM-YIU S. PANG
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- Journal:
- English Language & Linguistics / Volume 12 / Issue 1 / March 2008
- Published online by Cambridge University Press:
- 01 March 2008, pp. 103-139
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In this article we address a hitherto unstudied causal conjunction in English, seeing as though. Occurring predominantly in informal registers, the conjunction is typically used to introduce information which the speaker takes to be self-evidently true and on whose basis some further comment, or query, is made. Drawing on data derived from internet searches we draw up a semantic profile of the expression in comparison and contrast with other reason connectives, namely, seeing (that) and since. The data suggest that seeing as though is associated with highly subjective construals of the reason relation. We also address the internal structure of the expression. The use of seeing in a reason conjunction is traced to a common conceptual metaphor, whereby knowing is seeing. More puzzling is the occurrence of as though. While rejecting the possibility of a compositional analysis of the expression, we note that as though is only one of a number of items which can occur with causal seeing. These items have to do with the appearance of things and are in fact able to occur as complementizers after predicates of seeming and appearing. To this extent, as though is consistent with the subjectivity associated with the complex conjunction. In the course of our investigation, we also document the extraordinary proliferation of reason connectives that involve lexical items such as seeing, as, though, and several others, and suggest that this exuberance of new forms may not be unrelated to the subjectivity inherent in the construal of causal relations.
Tornwaldt's cyst formation after concurrent chemoradiotherapy for nasopharyngeal carcinoma
- S-L Chang, T-C Wu, C-Y Yiu
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- Journal:
- The Journal of Laryngology & Otology / Volume 120 / Issue 11 / November 2006
- Published online by Cambridge University Press:
- 18 April 2006, pp. 959-960
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- November 2006
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The complications of concurrent chemoradiotherapy for nasopharyngeal carcinoma include dryness of mouth, sensorineural hearing loss, dental caries, trismus, pituitary dysfunction, myelitis, paralysis of cranial nerves IX–XII, massive neck fibrosis and pharyngeal wall necrosis. Tornwaldt's cyst formation after concurrent chemoradiotherapy for nasopharyngeal carcinoma has not been reported previously in the world literature. Tornwaldt's cyst, a persistent pharyngeal bursa, is found in about 3 per cent of the adult population, although the majority of these are asymptomatic. We describe the previously unreported complication of Tornwaldt's cyst formation after concurrent chemoradiotherapy for nasopharyngeal carcinoma.