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Human milk and direct breastfeeding provide the optimal, biologically normative nutrition for hospitalised infants, with well-established benefits for immune, gut, cardiac, brain, and maternal health. Despite these benefits, human milk and breastfeeding rates for infants with CHD in high-resource countries are typically low, and there are no formal guidelines to drive CHD breastfeeding practice. Our aim is to (1) summarise the evidence on breastfeeding for infants with CHD, (2) discuss key barriers to and facilitators of breastfeeding in this population, (3) identify critical research and practice gaps to improve breastfeeding care in CHD, and (4) provide recommendations for clinical practice and future research.
Primary breastfeeding barriers for infants with CHD include (1) concern for dysphagia/aspiration, (2) concerns related to weight gain, (3) clinical instability/sickness, (4) developmental considerations, (5) general breastfeeding challenges, and (6) workflow and implementation issues, with racism and health disparities also contributing. The evidence to support these barriers is limited and often conflicting. Breastfeeding facilitators for preterm infants are well described, but facilitators may require modification for infants with CHD. Most lactation interventions have not been tested in CHD populations. Current evidence does not support automatic withholding of breastfeeding from infants with CHD; rather, the benefits of breastfeeding likely outweigh many potential concerns. There is a critical need for research and quality improvement to identify interventions that equitably and effectively support breastfeeding for infants with CHD and to evaluate the effect of breastfeeding on short- and long-term physical, psychological, and developmental outcomes for infants and families.
In the 1990s East Asian experienced a turn toward nationalism that includes an extremist, xenophobic wing, which expanded further during the 2000s. This is true in all three of the major countries in the region; Japan, China, and South Korea. In Japan, for example, Abe Shinzo, whose platform calls for hawkish foreign policies and the rewriting of the postwar constitution based on cultural nationalism, returned as the prime minister in 2012. The anti-Korean slanders that were limited earlier to cyberspace, as discussed by Rumi Sakamoto in her article earlier in this reader, have since taken to the streets in Japanese cities. How to deal with such a phenomenon, described by Tessa Morris-Suzuki as a kind of “mass retreat to the psychological fortresses of ethno-nationalism and racism” (p. 5), is becoming an ever more pertinent issue for all East Asian countries and their nationals.
The following article by Kokita Kiyohito, on the family origins of Kim Jong Un, the leader designate of North Korea, is illuminating above all for the language, assumptions and treatment of issues related to North Korea in contemporary Japanese media, including the Asahi. Two brief commentaries locate some of the issues in broader perspective. The headline and article are taken from the Asahi's weekly Aera; photos have been provided from other sources. The major story addressed in the commentary by Tessa Morris-Suzuki is the collaboration of the Japanese government and the International Red Cross in arranging the migration of more than 93,000 Korean residents of Japan, who had been deprived of Japanese citizenship following Japan's wartime defeat, to North Korea. Mark Selden examines a range of issues related to the perspective of the Japanese journalist on Zainichi Koreans and North Korea.
This is part two of a supplement on South Korea's Kwangju Uprising: Fiction and Film. Part one is Ch'oe Yun and Mark Morris, South Korea's Kwangju Uprising: Fiction and Film.
This essay proposes looking back at a story which is one of the most unusual winners of Japan's best-known literary award, the Akutagawa Prize. Kara Juro's Letters from Sagawa (Sagawa-kun kara no tegami) first appeared in November 1982 in the journal Bungei; it was announced co-winner of the 88th Akutagawa Prize in January 1983, and subsequently reprinted that March in the official prize-confirmation section of the quality monthly which hosts the award, Bungei Shunju. Kara's publisher Kawade Shobo Shinsha had already published a slim single-volume version the preceding January.
For Korea's confident and well-capitalized film industry, summer is a season to pull out the stops and offer the South Korean – and increasingly international – audience the most spectacular products it can produce. In the summer of 2006, one such blockbuster was the film Hanbando (‘The Korean Peninsula‘). It was produced by a syndicate of major companies headed by market leader CJ Entertainment and directed by Kang Woo-suk, well-known for genre action films like the Two Cops franchise and the Public Enemy films, and the nationalistic action thriller Silmido. The film was backed by a huge advertising budget and saturation bookings: it occupied 550 screens during the opening week, roughly one out of every three in South Korea. The film seemed destined to be the phenomenon of the summer releases.
2010 will be a year of commemorations in South Korea. The 25th of June will mark the sixtieth anniversary of the beginning of the Korea War. Midway between 2010 and 1950 was 1980. The Kwangju Uprising of May of that year was an event almost as significant as the US-Korean War in framing the contemporary nation.
Throughout the modern era, issues of nationalism and national identity have lain at the heart of intellectual debate in Japan, but the contours of the debate have repeatedly changed over time.
The first consciousness that a new Korean cultural wave –hallyu– was in motion began to take shape in different forms and at different times in the rest of East Asia. It was the craze for Korean TV drama that represented a sudden apparition of something new from South Korea. Before long, however, this wave grew bigger and far more complex than anyone might have predicted, including Korean pop music and films, animation, online games, smartphones, fashion, cosmetics, etc. There have been resistances to this inundation notably in Japan, a country where several earlier mini-hallyu now seem long forgotten.
The Korean War would generate a wide range of cinematic responses. The fledgling film industry of South Korea produced films that, in sync with an ideology of stark anti-communism, tended to emphasise the immediate physical brutality of the communist enemy. The reaction of American film makers was at first to reproduce the narrative shape and tropes of the very successful films from World War II, usually situated in Europe or the Pacific Islands. Gradually, however, Cold War paranoia about enemies within and about the new insidious threat of ‘brain washing’ took hold in Hollywood, as it swept through other social and political discourses and institutions. This paranoia, a sense of diffuse panic was not limited to the war film genre but leaked out creatively into a new genre of science-fiction features.
Load balancing of constrained healthcare resources has become a critical aspect of assuring access to care during periods of pandemic related surge. These impacts include patient surges, staffing shortages, and limited access to specialty resources. This research focuses on the creation and work of a novel statewide coordination center, the Washington Medical Coordination Center (WMCC), whose primary goal is the load balancing of patients across the healthcare continuum of Washington State.
Methods:
This article discusses the origins, development, and operations of the WMCC including key partners, cooperative agreements, and structure necessary to create a patient load balancing system on a statewide level.
Results:
As of April 21, 2022, the WMCC received 3821 requests from Washington State hospitals. Nearly 90% were received during the pandemic surge. Nearly 75% originated from rural hospitals that are most often limited in their ability to transfer patients when referral centers are also overwhelmed.
Conclusions:
The WMCC served as an effective tool to carry out patient load balancing activities during the COVID-19 pandemic surge in Washington State. It (the WMCC) has been shown to be an equity enhancing, cost effective means of managing healthcare surge events across a broad geographic region.
Data from UK confidential enquiries suggest a declining rate of twin stillbirth in monochorionic (MC) and dichorionic (DC) twin pregnancies with improved outcomes possibly reflecting the establishment of national guidelines for the management of multiple pregnancies. Despite this, twin pregnancies are at greater risk of all pregnancy complications, miscarriage and stillbirth than singleton pregnancies. Monochorionic twins, comprising approximately 20% of twin pregnancies, are at particular risk of fetal loss due to the unique pathological complications of a shared placenta: Twin to Twin Transfusion Syndrome (TTTS), early-onset severe selective growth restriction (sGR) and twin anaemia polycythaemia sequence (TAPS). Furthermore, following single intrauterine fetal demise (sIUFD) surviving monochorionic co-twins are exposed to an increased risk of intrauterine death, neonatal death and neurological disability. This chapter examines single and double fetal loss in DC and MC twin pregnancies, outlining the key facts, and covering the difficult issues and management challenges posed by twin demise.
There are various models for supporting students with disability and their teachers in mainstream schools. In New South Wales, each school has a learning and support teacher allocation and the New South Wales Department of Education recommends each school have a learning support team. This paper draws on in-depth interviews with school staff from 22 schools, including 16 learning and support teachers, 20 class teachers, 25 school executives and other stakeholders. We report here on the role of learning and support teachers and learning support teams in planning, implementing and evaluating adjustments and on the operation of learning support teams. Qualitative analysis of the interview transcripts revealed two kinds of learning support teams: those that focus on a particular student and those that oversee the education and resource provision for all students with disability in a school. Some teams had more of a focus on administration and resourcing, while others dealt more with educational adjustments. Similarly, some learning and support teachers were more involved in administrative and liaison roles, while others were more active in supporting teachers and providing services directly to students. The most detailed descriptions of support were provided by learning and support teachers with special education qualifications.
Diez-Martin and colleagues (2021) experimentally reduce four bifaces and argue that the resultant flakes are smaller and less uniform than those found at the Welling site (33Co2). Welling is an early Paleoindian (Clovis) site excavated by Olaf Prufer over 50 years ago. Based on the experiment, the authors conclude that the site was a “collector-like” base camp and that our previous interpretation must be incorrect. Here, we argue that Diez-Martin and colleagues have mischaracterized our conclusion regarding the purpose of the site, and may have insufficiently addressed data that detract from their new interpretation.
The current study was conducted to examine the types of adjustments used to support students with special educational needs in mainstream classrooms and how schools monitored the effectiveness of the adjustments they use. A range of stakeholders were interviewed in 22 mainstream schools across New South Wales, Australia, and the interviews were analysed for key themes. Some schools had a narrow focus on a few key areas, with teaching assistants being the most commonly reported adjustment. Few schools used formal formative monitoring to evaluate the effectiveness of adjustments. Options for improvement schools could consider include examining the breadth of adjustments, establishing clear measurable goals, considering alternative strategies for use of teaching assistants, and ensuring adjustments are monitored.
A field study was conducted in Mississippi to determine the effect of reduced dicamba rates on sweetpotato crop tolerance and storage root yield, simulating off-target movement or sprayer tank contamination. Treatments included a nontreated control and four rates of dicamba [70 g ae ha−1 (1/8×), 35 g ae ha−1 (1/16×), 8.65 g ae ha−1 (1/64×), and 1.09 g ae ha−1 (1/512×)] applied either 3 d before transplanting (DBP) or 1, 3, 5, or 7 wk after transplanting (WAP). An additional treatment consisted of 560 g ae ha−1 (1×) dicamba applied 3 DBP. Crop injury ratings were taken 1, 2, 3, and 4 wk after treatment (WAT). Across application timings, predicted sweetpotato plant injury 1, 2, 3, and 4 WAT increased from 3T to 22%, 3% to 32%, 2% to 58%, and 1% to 64% as dicamba rate increased from 0 to 70 g ha−1 (1/8×), respectively. As dicamba rate increased from 1/512× to 1/8×, predicted No. 1 yield decreased from 127% to 55%, 103% to 69%, 124% to 31%, and 124% to 41% of the nontreated control for applications made 1, 3, 5, and 7 WAP, respectively. Similarly, as dicamba rate increased from 1/512× to 1/8×, predicted marketable yield decreased from 123% to 57%, 107% to 77%, 121% to 44%, and 110% to 53% of the nontreated control for applications made 1, 3, 5, and 7 WAP, respectively. Dicamba residue (5.3 to 14.3 parts per billion) was detected in roots treated with 1/16× or 1/8× dicamba applied 5 or 7 WAP and 1/64× dicamba applied 7 WAP with the highest residue detected in roots harvested from sweetpotato plants treated at 7 WAP. Collectively, care should be taken to avoid sweetpotato exposure to dicamba especially at 1/8× and 1/16× rates during the growing season.
Medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS) are debilitating to patients. As many specific PPS syndromes share common behavioural, cognitive, and affective influences, transdiagnostic treatments might be effective for this patient group. We evaluated the clinical efficacy and cost-effectiveness of a therapist-delivered, transdiagnostic cognitive behavioural intervention (TDT-CBT) plus (+) standard medical care (SMC) v. SMC alone for the treatment of patients with PPS in secondary medical care.
Methods
A two-arm randomised controlled trial, with measurements taken at baseline and at 9, 20, 40- and 52-weeks post randomisation. The primary outcome measure was the Work and Social Adjustment Scale (WSAS) at 52 weeks. Secondary outcomes included mood (PHQ-9 and GAD-7), symptom severity (PHQ-15), global measure of change (CGI), and the Persistent Physical Symptoms Questionnaire (PPSQ).
Results
We randomised 324 patients and 74% were followed up at 52 weeks. The difference between groups was not statistically significant for the primary outcome (WSAS at 52 weeks: estimated difference −1.48 points, 95% confidence interval from −3.44 to 0.48, p = 0.139). However, the results indicated that some secondary outcomes had a treatment effect in favour of TDT-CBT + SMC with three outcomes showing a statistically significant difference between groups. These were WSAS at 20 weeks (p = 0.016) at the end of treatment and the PHQ-15 (p = 0.013) and CGI at 52 weeks (p = 0.011).
Conclusion
We have preliminary evidence that TDT-CBT + SMC may be helpful for people with a range of PPS. However, further study is required to maximise or maintain effects seen at end of treatment.
Antibiotics are among the most common medications prescribed in nursing homes. The annual prevalence of antibiotic use in residents of nursing homes ranges from 47% to 79%, and more than half of antibiotic courses initiated in nursing-home settings are unnecessary or prescribed inappropriately (wrong drug, dose, or duration). Inappropriate antibiotic use is associated with a variety of negative consequences including Clostridioides difficile infection (CDI), adverse drug effects, drug–drug interactions, and antimicrobial resistance. In response to this problem, public health authorities have called for efforts to improve the quality of antibiotic prescribing in nursing homes.