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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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DAI currently lacks a specific treatment beyond what is done for any type of head injury, including stabilizing the patient and trying to limit increases in intracranial pressure (ICP).
DAI is difficult to detect since it does not show up well on CT scans or with other macroscopic imaging techniques, though it shows up microscopically. However, there are characteristics typical of DAI that may or may not show up on a CT scan. Diffuse injury has more microscopic injury than macroscopic injury and is difficult to detect with CT and MRI, but its presence can be inferred when small bleeds are visible in the corpus callosum or the cerebral cortex. MRI is more useful than CT for detecting characteristics of diffuse axonal injury in the subacute and chronic time frames. Newer studies such as Diffusion Tensor Imaging are able to demonstrate the degree of white matter fiber tract injury even when the standard MRI is negative. Since axonal damage in DAI is largely a result of secondary biochemical cascades, it has a delayed onset, so a person with DAI who initially appears well may deteriorate later. Thus injury is frequently more severe than is realized, and medical professionals should suspect DAI in any patients whose CT scans appear normal but who have symptoms like unconsciousness.
MRI is more sensitive than CT scans, but MRI may also miss DAI, because it identifies the injury using signs of edema, which may not be present.
DAI is classified into grades based on severity of the injury. In Grade I, widespread axonal damage is present but no focal abnormalities are seen. In Grade II, damage found in Grade I is present in addition to focal abnormalities, especially in the corpus callosum. Grade III damage encompasses both Grades I and II plus rostral brain stem injury and often tears in the tissue.
The need for imaging in patients who have suffered a minor head injury is debated. A non-contrast CT of the head should be performed immediately in all those who have suffered a moderate or severe head injury, an MRI is also an option. Computed tomography (CT) has become the diagnostic modality of choice for head trauma due to its accuracy, reliability, safety, and wide availability. The changes in microcirculation, impaired auto-regulation, cerebral edema, and axonal injury start as soon as head injury occurs and manifest as clinical, biochemical, and radiological changes.
Most head injuries are of a benign nature and require no treatment beyond analgesics and close monitoring for potential complications such as intracranial bleeding. If the brain has been severely damaged by trauma, neurosurgical evaluation may be useful. Treatments may involve controlling elevated intracranial pressure. This can include sedation, paralytics, cerebrospinal fluid diversion. Second line alternatives include decompressive craniectomy (Jagannathan et al. found a net 65% favorable outcomes rate in pediatric patients), barbiturate coma, hypertonic saline and hypothermia. Although all of these methods have potential benefits, there has been no randomized study that has shown unequivocal benefit.
Clinicians will often consult clinical decision support rules such as the Canadian CT Head Rule or the New Orleans/Charity Head injury/Trauma Rule to decide if the patient needs further imaging studies or observation only. Rules like these are usually studied in depth by multiple research groups with large patient cohorts to ensure accuracy given the risk of adverse events in this area.
MdDS is diagnosed several ways, one being by the symptoms: in particular, the "constant rocking, swaying feeling" and the abatement of this feeling when in motion again and as a matter of exclusion. There are no definitive tests that confirm MdDS, only tests that rule out other conditions. Tests include hearing and balance, and MdDS is generally diagnosed by either a neurologist or an ear nose & throat specialist.
For most balance and gait disorders, some form of displacement exercise is thought helpful (for example walking, jogging, or bicycling but not on a treadmill or stationary bicycle). This has not been well-studied in MdDS. Medications that suppress the nerves and brain circuits involved in balance (for example, the benzodiazepine clonazepam) have been noted to help and can lower symptoms, but it is not a cure. It is not known whether medication that suppress symptoms prolongs symptom duration or not. Vestibular therapy has not proved to be effective in treating MdDS.
Additional research is being undertaken into the neurological nature of this syndrome through imaging studies. The disorder remains incurable and permanent if the symptoms do not remit in a short period of time.
There is as yet no universally accepted diagnostic protocol for reactive attachment disorder. Often a range of measures is used in research and diagnosis. Recognized assessment methods of attachment styles, difficulties or disorders include the Strange Situation Procedure (devised by developmental psychologist Mary Ainsworth), the separation and reunion procedure and the Preschool Assessment of Attachment, the Observational Record of the Caregiving Environment, the Attachment Q-sort and a variety of narrative techniques using stem stories, puppets or pictures. For older children, actual interviews such as the Child Attachment Interview and the Autobiographical Emotional Events Dialogue can be used. Caregivers may also be assessed using procedures such as the Working Model of the Child Interview.
More recent research also uses the Disturbances of Attachment Interview (DAI) developed by Smyke and Zeanah (1999). The DAI is a semi-structured interview designed to be administered by clinicians to caregivers. It covers 12 items, namely "having a discriminated, preferred adult", "seeking comfort when distressed", "responding to comfort when offered", "social and emotional reciprocity", "emotional regulation", "checking back after venturing away from the care giver", "reticence with unfamiliar adults", "willingness to go off with relative strangers", "self-endangering behavior", "excessive clinging", "vigilance/hypercompliance" and "role reversal". This method is designed to pick up not only RAD but also the proposed new alternative categories of disorders of attachment.
RAD is one of the least researched and most poorly understood disorders in the DSM. There is little systematic epidemiologic information on RAD, its course is not well established and it appears difficult to diagnose accurately. There is a lack of clarity about the presentation of attachment disorders over the age of five years and difficulty in distinguishing between aspects of attachment disorders, disorganized attachment or the consequences of maltreatment.
According to the American Academy of Child and Adolescent Psychiatry (AACAP), children who exhibit signs of reactive attachment disorder need a comprehensive psychiatric assessment and individualized treatment plan. The signs or symptoms of RAD may also be found in other psychiatric disorders and AACAP advises against giving a child this label or diagnosis without a comprehensive evaluation. Their practice parameter states that the assessment of reactive attachment disorder requires evidence directly obtained from serial observations of the child interacting with his or her primary caregivers and history (as available) of the child’s patterns of attachment behavior with these caregivers. It also requires observations of the child’s behavior with unfamiliar adults and a comprehensive history of the child’s early caregiving environment including, for example, pediatricians, teachers, or caseworkers. In the US, initial evaluations may be conducted by psychologists, psychiatrists, Licensed Marriage and Family Therapists, Licensed Professional Counselors, specialist Licensed Clinical Social Workers or psychiatric nurses.
In the UK, the British Association for Adoption and Fostering (BAAF) advise that only a psychiatrist can diagnose an attachment disorder and that any assessment must include a comprehensive evaluation of the child’s individual and family history.
According to the AACAP Practice Parameter (2005) the question of whether attachment disorders can reliably be diagnosed in older children and adults has not been resolved. Attachment behaviors used for the diagnosis of RAD change markedly with development and defining analogous behaviors in older children is difficult. There are no substantially validated measures of attachment in middle childhood or early adolescence. Assessments of RAD past school age may not be possible at all as by this time children have developed along individual lines to such an extent that early attachment experiences are only one factor among many that determine emotion and behavior.
There are a variety of mainstream prevention programs and treatment approaches for attachment disorder, attachment problems and moods or behaviors considered to be potential problems within the context of attachment theory. All such approaches for infants and younger children concentrate on increasing the responsiveness and sensitivity of the caregiver, or if that is not possible, changing the caregiver. Such approaches include 'Watch, wait and wonder,' manipulation of sensitive responsiveness, modified 'Interaction Guidance,'. 'Preschool Parent Psychotherapy,'. Circle of Security', Attachment and Biobehavioral Catch-up (ABC), the New Orleans Intervention, and Parent-Child psychotherapy. Other known treatment methods include Developmental, Individual-difference, Relationship-based therapy (DIR) (also referred to as "Floor Time") by Stanley Greenspan, although DIR is primarily directed to treatment of pervasive developmental disorders Some of these approaches, such as that suggested by Dozier, consider the attachment status of the adult caregiver to play an important role in the development of the emotional connection between adult and child. This includes foster parents, as children with poor attachment experiences often do not elicit appropriate caregiver responses from their attachment behaviors despite 'normative' care.
Treatment for reactive attachment disorder for children usually involves a mix of therapy, counseling, and parenting education. These must be designed to make sure the child has a safe environment to live in and to develop positive interactions with caregivers and improves their relationships with their peers.
Medication can be used as a way to treat similar conditions, like depression, anxiety, or hyperactivity; however, there is no quick fix for treating reactive attachment disorder. A pediatrician may recommend a treatment plan. For example, a mix of family therapy, individual psychological counseling, play therapy, special education services and parenting skills classes.
Recognised assessment methods of attachment styles, difficulties or disorders include the Strange Situation procedure (Mary Ainsworth), the separation and reunion procedure and the Preschool Assessment of Attachment ("PAA"), the Observational Record of the Caregiving Environment ("ORCE") and the Attachment Q-sort ("AQ-sort").
More recent research also uses the Disturbances of Attachment Interview or "DAI" developed by Smyke and Zeanah, (1999). This is a semi-structured interview designed to be administered by clinicians to caregivers. It covers 12 items, namely having a discriminated, preferred adult, seeking comfort when distressed, responding to comfort when offered, social and emotional reciprocity, emotional regulation, checking back after venturing away from the care giver, reticence with unfamiliar adults, willingness to go off with relative strangers, self endangering behavior, excessive clinging, vigilance/hypercompliance and role reversal.
In Chinese alchemy, elixir poisoning refers to the toxic effects from elixirs of immortality that contained metals and minerals such as mercury and arsenic. The official "Twenty-Four Histories" record numerous Chinese emperors, nobles, and officials who ironically died from taking elixirs in order to prolong their lifespans. The first emperor to die from elixir poisoning was likely Qin Shi Huang (d. 210 BCE) and the last was Yongzheng (d. 1735). Despite common knowledge that immortality potions could be deadly, fangshi and Daoist alchemists continued the elixir-making practice for two millennia.
Needham and Lu's third justification for taking poisonous elixirs is a drug-induced "temporary death", possibly a trance or coma. In the classic legend (above) about Wei Boyang drinking an elixir of immortality, he appears to die, subsequently revives, and takes more elixir to achieve immortality.
The "Baopuzi" describes a Five Mineral-based multicolored Ninefold Radiance Elixir that can bring a corpse back to life: "If you wish to raise a body that has not been dead for fully three days, bathe the corpse with a solution of one spatula of the blue elixir, open its mouth, and insert another spatula full; it will revive immediately." (tr. Ware 1966:82).
A Tang Daoist text prescribes taking an elixir in doses half the size of a millet grain, but adds, "If one is sincerely determined, and dares to take a whole spatula-full all at once, one will temporarily die ["zànsǐ" 暫死] for half a day or so, and then be restored to life like someone waking from sleep. This however is perilous in the extreme." (tr. Needham and Lu 1974: 295).
The distinction between Hua () and Yi (), also known as Sino–barbarian dichotomy, is an ancient Chinese concept that differentiated a culturally defined "China" (called Hua, Huaxia 華夏, or Xia 夏) from cultural or ethnic outsiders (Yi "barbarians"). Although Yi is often translated as "barbarian", other translations of this term in English include "foreigners",
"ordinary others" "wild tribes", and "uncivilized tribes."
The Hua–Yi distinction asserted Chinese superiority, but implied that outsiders could become "Hua" by adopting Chinese values and customs.
Ancient China was composed of a group of states that arose in the Yellow River valley. According to historian Li Feng, during the Zhou dynasty (ca. 1041–771 BCE), the contrast between the 'Chinese' Zhou and the 'non-Chinese' Xirong or Dongyi was "more political than cultural or ethnic". Lothar von Falkenhausen argues that the perceived contrast between "Chinese" and "Barbarians" was accentuated during the Eastern Zhou period (770–256 BCE), when adherence to Zhou rituals became increasingly recognized as a "barometer of civilization."; a meter for sophistication and cultural refinement. It is widely agreed by historians that the distinction between the Hua and the Yi emerged during that period.
Gideon Shelach claimed that Chinese texts tended to overstate the distinction between the Chinese and their northern neighbors, ignoring many intergroup similarities. He doubted the existence of the Hua–Yi distinction. Nicola di Cosmo doubted the existence of a strong demarcation between the "Zhou Universe" and "a discrete, 'barbarian', non-Zhou universe" and claimed that Chinese historian, Sima Qian's popularized this concept, writing of the "chasm that had always existed between China – the Hua-Hsia [Huaxia] people – and the various alien groups inhabiting the north."
The conclusion of the Warring States period brought the first unified Chinese state-established by the Qin dynasty in 221 BCE-who established the imperial system and forcibly standardized the traditional Chinese script, leading to the first of the distinctions between the refined Hua and the increasingly marginalized Yi. The Han dynasty (221 BCE-206 CE) further contributed to the divide with its creation of a persistent Han cultural identity.
The Han Chinese civilization influenced neighboring states Korea, Japan, Vietnam and Thailand and other Asian countries. Although Han Chinese superiority had only been sporadically reinforced by displays of Chinese military power, the Sinocentric system treated these countries as vassals of the emperor of China, literally "the Son of Heaven" (天子), who was in possession of the Mandate of Heaven (天命), the divine right to rule. Areas outside Sinocentric influence and the divine rule of the Emperor were considered to consist of uncivilized lands inhabited by barbarians.
Throughout history, Chinese frontiers had been periodically attacked by nomadic tribes from the north and west. These people were considered "barbarians" by the Chinese who believed themselves to be more refined and who had begun to build cities and live an urban life based on agriculture. It was in consideration of how best to deal with this threat that the philosopher, Confucius (551 – 479 BCE) was prompted to formulate principles for relationships with the barbarians, briefly recorded in two of his "Analects".
The arrival of European trade and colonialism in the 18th and 19th centuries, exposed Chinese civilization to the developments that had long outstripped China's. As such, the nation was forced to undergo a modification of its traditional views of its relationships with those "barbarians".