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Pulmonary arteriovenous fistulas are a frequent complication after a Kawashima procedure. We present a 15-year-old patient with a significant left pulmonary arteriovenous fistula managed via embolisation using three Micro Vascular Plugs. This technique achieved effective occlusion through the left internal jugular vein, since these are low-profile flexible devices that accommodate through an acute angle without long and stiff sheath.
This chapter revisits the challenges with which the AML regime is fraught and recasts them in a new light. The chapter begins by addressing law enforcement responses to money laundering, namely the prosecution of money launderers and the confiscation of proceeds of crime. It proceeds to discuss regulatory responses, with a focus on the tensions they entail, namely exclusion versus surveillance, exclusion versus the presumption of innocence and surveillance versus privacy. It then explores the challenges presented by the misalignment between law enforcement priorities and private-sector compliance efforts, including defensive reporting, derisking, the displacement effect and tick-box compliance. The chapter then outlines potential solutions, including a modified reporting regime, public–private partnerships, privacy- enhancing technologies, and the implementation of a risk-based approach. The last substantive topic in this chapter is the special case of the legal profession, which presents particularly difficult choices in connection with both exclusion and surveillance. Finally, the conclusion brings together this analysis to elucidate the limitations of the existing FATF-mandated framework.
This chapter considers the impact of Justinian’s codification on our understanding of Classical Roman law. After reading the introductory constitutions in order to understand how Justinian used the Corpus Iuris to represent himself, I discuss the tendency of constitutions contained within the Codex Justinianus to avoid explicit disagreement. Justinian is the one emperor who regularly criticizes his predecessors in the Codex, which suggests that other conflict was redacted out in the compilation process. I then use a passage of Pomponius, discussing a strange hypothetical involving a cross-dressing senator, to argue that jurists were more engaged with other literary genres (like paradoxography) than is obvious from fragments which survive in the Digest, and that the redactive tendency to treat juristic treatises as sources of law has greater distorting effects than is immediately apparent.
Tumor necrosis factor-α (TNF-α) polymorphisms may influence dyslipidemia, but their role remains unclear. This case-control study investigated associations between TNF-α gene polymorphisms (-1031T/C, -863C/A, -857C/T, -308G/A, and -238G/A) and dyslipidemia in 595 participants (162 cases, 433 controls) from the Chaoshan region of China. Anthropometric, biochemical, and genetic data were analyzed using Chi-squared tests and logistic regression, with the false discovery rate (FDR) method applied to correct for multiple comparisons. Results revealed that only the -1031T/C and -863C/A polymorphisms were significantly associated with dyslipidemia. Carriers of the TC+CC genotype for -1031T/C (odds ratio [OR]=0.48, 95% CI: 0.30-0.78, PFDR=0.006) and the CA+AA genotype for -863C/A (OR=0.41, 95% CI: 0.24-0.70, PFDR=0.004) had lower odds of dyslipidemia. Protective effects were observed for the C allele at -1031T/C (OR=0.58, PFDR=0.012) and the A allele at -863C/A (OR=0.47, PFDR=0.004). Stratified analyses showed that these associations were significant in males but not females. Functional annotation linked these TNF-α gene polymorphisms to transcription factors (e.g., HNF-1A, STAT1β) in the adipogenesis pathway. This study reveals genetic associations between TNF-α polymorphisms and dyslipidemia, particularly in males, and provides mechanistic insights into their role in transcriptional regulation.
This systematic review aimed to analyze studies assessing the extent to which General Practitioners (GPs) engage patients in the decision-making process during consultations.
Background:
Shared Decision Making (SDM) stands at the core of patient-centred care, particularly in primary healthcare, where a diverse array of medical decisions transpires. In a 2015 systematic review summarizing studies on the Observing Patient Involvement in Decision Making (OPTION) instrument to assess SDM objectively across healthcare settings, a notable dearth of patient involvement was observed.
Methods:
A comprehensive literature search encompassing three digital databases was conducted up to November 2023. Inclusion criteria focused on studies employing a comparative study design, centric to primary healthcare, and utilizing the OPTION-5 or -12 instrument to gauge SDM levels. Two investigators independently performed study selection, risk of bias assessment, and data extraction using a list of predefined variables, with discrepancies resolved by a third reviewer. PROSPERO registration-ID: CRD42023475419.
Findings:
Initially, harvesting 447 articles, our review retained 29 studies published between 2003 and 2022. Mean age of GPs was 45.5 (range 33–53) years. Reported baseline OPTION scores varied between 1.5 and 57.2 on a 0–100-point scale, with a median score of 16. Following SDM interventions, OPTION-scores increased significantly to a median of 28.5, range 16–83.
Conclusion:
The overall level of SDM among GPs remains relatively low and has shown minimal improvement over the past decade. However, interventions promoting SDM appear to enhance patient involvement levels. This underscores the necessity for increased education and tools, directed at GPs and patients, to foster and elevate the practice of SDM.
Most religious traditions and movements have majorities of women, but most are led by men and are based on deeply embedded patriarchal assumptions. That underlying reality is played out in multiple different Christian traditions and shapes the subsequent contests for power, representation, and influence. This chapter is animated by a primary question from which other questions naturally flow: What are the characteristics of the religious networks constructed by women and to what extent do they function differently from those built largely by men? In attempting to answer that question, I identify five different kinds of networks representing different varieties of female leadership and participation. It is important to state that this typology should not be read as either an ascension or declension narrative about women’s agency and the role of patriarchy in shaping that agency.
Antimicrobial resistance (AMR) is a significant public health threat. Understanding public knowledge and attitudes toward antibiotic usage is essential for educational campaigns combating AMR. This study evaluates public knowledge and awareness about antibiotics and AMR in Vietnam.
Methods:
A cross-sectional survey was conducted online in December 2021, featuring 20 questions on antibiotics, AMR, and participants’ habits, attitudes, and potential solutions. The survey was distributed via social media platforms such as Facebook, Zalo, Viber, and WhatsApp. The target sample included Vietnamese working adults above 18 years old. Responses were coded and analyzed using SPSS version 21 and Microsoft Excel version 16.5. Participants were categorized into high, intermediate, and low knowledge levels based on their scores (>80%, 51–79%, and <50%).
Results:
A total of 866 Vietnamese adults participated. Most participants (90%) had moderate to high knowledge of antibiotics and AMR. However, only 32.8% knew that 75% of antibiotics are used in agriculture. Knowledge levels varied significantly across demographics such as gender, age, education, profession, and antibiotic use history. Healthcare-related professionals had significantly higher knowledge of antibiotics and AMR than nonhealthcare professionals (p < 0.001). Those with health-focused educational backgrounds also had higher knowledge levels (p < 0.001). Despite being aware that it was inappropriate, many participants reported discontinuing antibiotics before completing the course prescribed by their doctors.
Conclusions:
Age, education, profession, and antibiotic use history positively influenced AMR knowledge. However, even among health-related fields, understanding was only moderate. This indicates a need for enhanced public education to improve knowledge and attitudes toward antibiotics and AMR.
Chapter 9 explores the origins of healing authority and its experiential grounding. Sociological accounts of authority usually refer to institutional power. Many elementary systems of medicine connect healers’ own initiatory illness and affliction to their knowledge and power. This connection is explicit in the Greek myth of Asklepios and was taken up by others in terms of the archetype of the wounded-healer. This ethos of the wounded-healer reflects a relational structure present in the dynamics of the clinical encounter. Healers’ relationship to their own wounds not only conveys symbolic power but can evoke specific psychological and interpersonal dynamics that may contribute to the effectiveness of treatment. In this symbolic logic of healing, the healer’s own wounds become sources of wisdom when they are confronted rather than denied. The ways this attitude may be learned and embodied are illustrated by a series of dreams with images of wounding and healing during psychiatric training. This ethos has implications for understanding the epistemic authority of healers, the training of clinicians, and addressing basic issues in intercultural health care.
Conservatives claim that progressive taxation in America is unfair to the more affluent because it punishes them for working hard and redistributes their income to less affluent people who are lazy, and therefore don’t deserve it. It is true that some of the revenue collected from corporations and the more affluent pays for programs for the less affluent. But this ignores that even poor people pay taxes. It ignores that most people who receive government transfer payments are children, elderly, disabled, and working people, not slackers. And it ignores the many tax breaks, loopholes, subsidies, and bailouts that the affluent and corporations receive from government – a hidden welfare state – that costs taxpayers billions of dollars annually. In fact, cutting taxes and therefore spending on social programs can exacerbate inequality and undermine social cohesion and political stability, none of which is good for the economy or society. These arguments are supported by cross-national and US historical data.
Transcatheter closure of patent ductus arteriosus has an established safety and efficacy in childhood using coils. However, complications and unexpected events are infrequently reported, such as haemolysis, embolisation, and stenosis of the left pulmonary artery or descending aorta. In the current work, we report an unusual obstacle that occurred upon the release of a patent ductus arteriosus coil in a child. Abnormal straightening of the coils on the pulmonary side was encountered, with failure of recoil of the patent ductus arteriosus windings noticed upon the coil release. However, the coil was successfully snared, and another was deployed with an uneventful recovery.