A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney U (...) test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)

Jian Zhou,* Weiqiang Ju,* Xiaopeng Yuan, Xiaofeng Zhu, Dongping Wang, Xiaoshun HeOrgan Transplant Center, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China *These authors contributed equally to this work: Hyperosmolar nonketotic hyperglycemic coma is a serious, rare complication induced by methylprednisolone pulse therapy for acute rejection after orthotopic liver transplantation. Herein, we report an unusual case of a 58-year-old woman who experienced acute rejection at 30 months after OLT, only one case in which HNKHC resulted in MP (...) pulse therapy for acute rejection in all 913 recipients in our center. The general morbidity of HNKHC was 1.09‰ in this study. HNKHC is characterized by rapid onset, rapid progression, and a lack of specific clinical manifestations. High-dose MP management was a clear risk factor. The principle of treatment included rapid rehydration, low-dose insulin infusion, and correcting disorders of electrolytes and acidosis. In conclusion, clinicians considering MP pulse therapy after OLT should be alert to the occurrence of HNKHC. Keywords: liver transplantation, complications, hyperosmolar nonketotic hyperglycemic coma, methylprednisolone pulse therapy, principle of treatment. (shrink)

At some distance from a high-rate source in an elastic half-space, the dominant wave motion at the free surface is a Rayleigh surface wave. The calculation of surface waves generated by a concentrated force in a half-space is a basic problem in elastodynamics. By straightforward manipulations, the result can be used to obtain surface waves for other kinds of wave-generating body-force arrangements. For example, appropriate combinations of double-forces (or dipoles) can be used to represent the surface loading due to laser (...) irradiation, or due to acoustic emission from the opening of a sub-surface crack or from sliding over a fault surface. The surface wave motion is usually obtained by the application of integral transform techniques and the subsequent extraction of the surface waves as the contributions from poles in the integral for the inverse transform. In this paper, we use a much simpler approach based on the elastodynamic reciprocity theorem. We consider a transversely isotropic solid whose axis of symmetry is normal to the surface of the half-space. Surface wave pulses generated by a single force, by irradiation from a laser source, and by opening of a crack, have been determined. (shrink)

J. J. Valberg; VIII*—Improper Singular Terms, Proceedings of the Aristotelian Society, Volume 71, Issue 1, 1 June 1971, Pages 121–146, https://doi.org/10.1093/a.

The demonstration by E. Wölfflin that between theHistoriesandAnnalsTacitus progressed towards a more archaic and artificial style is well known. From the outset Tacitus adhered to the traditional Roman view that history should be composed in an archaic language remote from everyday usage ; but he was apparently at first not fully aware of the possibilities of the archaizing style. New archaisms and artificial usages suggested themselves as he advanced ; and others, which he had used sporadically even early in theHistories, (...) were allowed to oust ordinary alternatives completely. (shrink)

Was Metaphysik ist, läßt sich nicht apriorisch bestimmen, sondern zeigt sich erst in den denkerischen Entwürfen eines Ersten und Grundlegenden. Metaphysik ist, wie Philosophie überhaupt, von ihrer Geschichte nicht trennbar. Die philosophische Bedeutung der Periode des Mittelalters für den Gang der abendländischen Metaphysik ist in den letzten Jahrzehnten durch zwei klassische Studien herausgestellt worden.