External Version Research Articles

Modal weak Kleene logics: axiomatizations and relational semantics

Abstract Weak Kleene logics are three-valued logics characterized by the presence of an infectious truth-value. In their external versions, as they were originally introduced by Bochvar [4] and Halldén [30], these systems are equipped with an additional connective capable of expressing whether a formula is classically true. In this paper we further expand the expressive power of external weak Kleen logics by modalizing them with a unary operator. The addition of an alethic modality gives rise to the two systems $\textsf{B}_{\text{e}}^{\square }$ and $\textsf{PWK}^{\Box }_{\text{e}} $, which have two different readings of the modal operator. We provide these logics with a complete and decidable Hilbert-style axiomatization w.r.t. a three-valued possible worlds semantics. The starting point of these calculi are new axiomatizations for the non-modal bases $\textsf{B}_{\text{e}}$ and $\textsf{PWK}_{\text{e}}$, which we provide using the recent algebraization results about these two logics. In particular, we prove the algebraizability of $\textsf{PWK}_{\text{e}}$. Finally some standard extensions of the basic modal systems are provided with their completeness results w.r.t. special classes of frames.

A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements

The Ex Utero Intrapartum Treatment (EXIT) procedure has long been an invaluable tool in managing complex fetal conditions requiring airway interventions during the transition from intrauterine to extrauterine life. This technical note offers an in-depth examination of the EXIT procedure, emphasizing the refinements and innovations introduced at our center. The technique focuses on meticulous preoperative assessment and uses distinctive techniques and anesthetic methodologies. A multidisciplinary team assembles to plan the EXIT procedure, emphasizing patient communication and risk discussion. Our technique involves atraumatic access to the uterine cavity, achieved through the application of a uterine progressive distractor developed for this purpose. Following the use of this distractor, vascular clamps and a stapling device (Premium Poly Cs-57 Autosuture®, Medtronic) are employed. Our anesthetic approach employs general anesthesia with epidural catheter placement. Maternal operation involves low transverse laparotomy and intraoperative ultrasonography-guided hysterotomy. Fetal exposure includes gentle extraction or external version, ensuring airway access. After securing fetal airway access, umbilical cord clamping and maternal abdominal closure conclude the procedure. By revisiting the core principles of EXIT and incorporating center-specific advancements, we enhance our understanding and technical expertise. To our knowledge, this is the first time a detailed description of the technique has been published.

On Husserl’s Twin Earth

In a 1911 research manuscript, Husserl puts forth an idea that resembles Putnam’s Twin Earth thought experiment presented in the 1970s. In this paper, I study Husserl’s “Twin Earth” passage and assess various readings of it to determine whether Husserl is better understood as an internalist or an externalist. I define internalism as the view that content depends solely on internal factors to the subject, whereas I distinguish between two versions of externalism: weak externalism, according to which content can also depend on other subjects’ conceptions, and strong externalism, which maintains that content can also depend on the real world. Only strong externalism maintains what McGinn calls “the philosophical significance of externalism” because it entails realism about the world. I argue that Husserl is better understood as an externalist when it comes to the “Twin Earth” passage, but the more precise question regarding weak and strong externalism requires further evidence. This additional evidence concerns Husserl’s concepts of the identity of sense (Sinnesidentität) and worldly meaning (weltlicher Sinn). In evaluating externalist Husserl interpretations, I classify Smith’s externalist interpretation as weak, whereas I take Crowell’s externalist interpretation to be ambivalent. Crowell’s excellent but somewhat embryonic interpretation leaves the dependence relation between content and the real world ambiguous. I clarify this relation by assessing McGinn’s argument for the philosophical significance of externalism from the Husserlian viewpoint. Although this study is historical, it also serves a systematic purpose because the externalist interpretation of Husserl calls into question central issues in phenomenology and externalism.

Perbedaan Prenatal Yoga dengan Knee Chest terhadap Perubahan Posisi Janin Sungsang ke Normal pada Kehamilan TM III di Klinik Cibodas

Breech position is one of the four main indications for caesarean section worldwide. This breech location can occur in 3-4% of all deliveries. A breech delivery gives a poor prognosis because it increases the risk of complications for the mother and fetus. There are two ways to manage a breech pregnancy, namely knee chest and external version, but there are physical exercises that can provide abdominal space so that it gives the baby the opportunity to rotate, namely prenatal yoga activities. The purpose of this study was to determine the difference between prenatal yoga and knee chest in changing the position of the breech fetus to normal. The methodology of this research is using post test with control group design. The study population was pregnant women in the third trimester with a breech position as many as 42 people. The sampling technique used purposive sampling as many as 30 people into samples which were divided into 2 groups, namely 15 experimental group (prenatal yoga) and 15 control group (knee chest). The research instrument used the results of Ultrasonography and observation sheets. Data analysis used the Mann-Whitney Test. The results showed that there was a difference in the average time needed to change the position of the fetus by doing prenatal yoga and knee-chest. Prenatal yoga takes a shorter time (10 days) while knee-chest takes longer (15 days) so that prenatal yoga is more effective for pregnant women in improving fetal presentation. Bivariate results showed a ( p-value of 0.002 < 0.005). Conclusions based on the results of the study there was a difference in the average time required to change the position of the fetus by doing prenatal yoga and knee-chest. Prenatal yoga takes a shorter time while knee-chest takes longer to help turn the fetal presentation into a head so that prenatal yoga is more effective in helping to improve fetal presentation.

Helical Static Mixer Simulations for Its Integration in the Pour Plate Method: Mixing Agar and a Nutrient Solution

In microbiology laboratories, it is essential to obtain high-quality samples where the culture media are completely homogeneous. The pour plate method includes having to melt the culture media—a mixture of agar and a nutrient solution—before seeding. A static mixer is designed for this purpose, employing CFD (Computational Fluid Dynamics) with the software OpenFOAM to simulate the fluid’s behaviour in a helical static mixer with both internal and external configurations. The objective is to validate the CFD model by comparing it with the literature and provide a first approach to the mixer design. After satisfactory validation of the model, the results of the initial designs for Reynolds number 14 reveal the notably different behaviour of the fluids during mixing due to their differing properties, since agar and the nutrient solution present a high viscosity ratio. While the mixing efficiency is similar for the internal and external mixers, improved performance is demonstrated in the internal mixer, even for a shorter version. The external version of the mixer reaches a value for a mixing efficiency of 0.89 whereas the internal version performs more homogeneous mixing for the same number of mixing elements. This evaluation is based on a simplified internal design for computational simulations, whereas the external mixer is easier to manufacture but more complex to implement computationally. Finally, homogeneous mixing is achieved for the internal mixer configuration when adjusting its dimensions to those available on the market.

Knowledge as a (Non-factive) Mental State

AbstractThe thesis that knowledge is a factive mental state plays a central role in knowledge-first epistemology, but accepting this thesis requires also accepting an unusually severe version of externalism about the mind. On this strong attitude externalism, whether S is in the mental state of knowledge can and often will rapidly change in virtue of changes in external states of reality with which S has no causal contact. It is commonly thought that this externalism requirement originates in the factivity of knowledge. However, despite a number of recent defenses of non-factive accounts of knowledge, epistemology has yet to consider whether a non-factive approach might produce a version of the mental state thesis that can avoid strong externalism. Here I do just that, exploring how three different proposals for weakening factivity might be adapted to theories of knowledge as a non-factive mental state. Contrary to what we might expect, however, none of these proposals are compatible with anything close to attitude internalism about knowledge—or even a substantially weaker externalism. All told, the widespread view that wraps up the severe externalism required for knowledge to be a mental state in factivity is mistaken. Knowledge’s external-world connection runs far deeper than the factivity constraint.

External version in modern obstetrics: assessment of efficacy and safety

External version in modern obstetrics: assessment of efficacy and safety

Folk Intuitions about Reference Change and the Causal Theory of Reference

In this paper, we present and discuss the findings of two experiments about reference change. Cases of reference change have sometimes been invoked to challenge traditional versions of semantic externalism, but the relevant cases have never been tested empirically. The experiments we have conducted use variants of the famous Twin Earth scenario to test folk intuitions about whether natural kind terms such as ‘water’ or ‘salt’ switch reference after being constantly (mis)applied to different kinds. Our results indicate that this is indeed so. We argue that this finding is evidence against Saul Kripke’s causal-historical view of reference, and at least provisional evidence in favor of the causal source view of reference as suggested by Gareth Evans and Michael Devitt.

Perceptions of Context. Epistemological and Methodological Implications for Meta-Studying Zoo-Communication

Although this study inspects context in general, it is even intended as a prerequisite for a meta-study of contextual time&space in zoo-communication. Moving the scope from linguistics to culture, communication, and semiotics may reveal new similarities between context-perceptions. Paradigmatic historical moves and critical context theories are inspected, asking whether there is a least-common-multiple for perceptions of context. The short answer is that context is relational – a bi-product of attention from a position, creating a focused object, and hence an obscured (back-)ground – the attention’s context. A more comprehensive one is that when the focused phenomenon is culture, semiotics, or communication, context becomes embodied. This recognition triggers new questions: What is the relation between embodied, immanent context and this perception’s external, physical context (its surroundings)? If utterances are regarded as constituted by the triad form-content-act and the dyadic chronotope time&space, what and where is then context? Which challenges will empirical (zoo-)communicational research face if context is split in internal and external versions of context? These questions raise some epistemological and methodological issues. These are discussed based on a framework that regards communication as a micro-macro interplay between utterance and genre. Genres are kinds of communication. More specifically animal genres related to their basic life-functions are called life-genres. A conclusion is that life-genres function as both mental and situational contexts. This complicates empirical research on communication in general, and zoo-communication in particular. The paper concludes that contexts’ relational and embodied nature and the ‘situational’ characteristics of life-genres challenge researchers to validate continuously, shifting between contextualising, decontextualising, and recontextualising.

Relations in the Metaphysics of Science

Abstract In this paper we examine the status of relations in two prominent views in metaphysics of science, i.e. dispositionalism and structuralism, and argue that the current consensus about the metaphysics of relations, according to which relations are to be viewed as internal and as constituting no addition of being over and above their relata, needs to be re-examined. After discussing what we call internalism and externalism about relations, we show that dispositionalism and structuralism lead to opposite but equally controversial accounts of the metaphysics of relations. While we criticise some widespread versions of those views, we identify versions of dispositionalism and structuralism that we deem more promising. A core feature of both of these more promising variants is an externalist view about relations. Against the current internalist consensus, we claim that a version of externalism about relations is the view that best combines metaphysical rigour with a naturalistic stance.

In Praise of Externalism? Spaulding, Dewey, and the Logic of Relations

AbstractThe late nineteenth- and early twentieth-century debate over ‘internal’ and ‘external’ relations is well explored, as far as its course in Britain is concerned. F. H. Bradley’s idealistic internalism, on the one hand, and Bertrand Russell’s realistic externalism, on the other, were at the center of this debate. Less well known, however, is that there was also a discussion about relations in the United States at the time. The central figures in this discussion were Edward Gleason Spaulding and John Dewey. Like Russell, Spaulding advocated a realist-inspired externalism, while Dewey criticized this viewpoint from a pragmatist perspective. The aim of the present paper is to reconstruct the exchange between Spaulding and Dewey and to elaborate the specifics of this exchange. In doing so it will emerge, among other things, (1) that, in contrast to Bradley’s idealist rejection of externalism, Dewey’s pragmatist attempt at a refutation was more in line with common sense and science and (2) that Spaulding’s version of externalism differed markedly from Russell’s in its strong empirical orientation. Overall, an undeservedly forgotten chapter in the history of early twentieth-century American philosophy is revisited and reassessed.

Rebozo and External Cephalic Version in breech presentation (RECEIVE): A randomised controlled study.

To investigate if a hospital-initiated home-based rebozo intervention performed by the pregnant woman and her partner before external cephalic version (ECV) would increase the rate of cephalic presentations at birth. A multicentre randomised controlled trial. Three university hospitals in Copenhagen, Denmark. Pregnant women with a breech or transverse presentation at 35weeks or more of gestation eligible for ECV. We compared rebozo before ECV with ECV alone. The randomisation was computer-generated in blocks and stratified by parity. The woman and her partner were instructed in the technique by a project midwife and performed the technique at home three times daily for 3-5days before the scheduled ECV. Analyses were by intention-to-treat. The number of cephalic presentations at the time of birth. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. A total of 372 women were randomly assigned (1:1) to either rebozo intervention (n=187) or control (n=185). At birth, 95 (51%) in the intervention group versus 112 (62%) in the control group had a fetus in cephalic presentation (OR 0.61; 95% CI 0.40-0.95). No adverse events were observed in relation to the intervention. In breech or transverse presentation, home-based rebozo exercise before ECV lowered the overall rate of cephalic presentation at birth. Home-based rebozo for breech presentation before external version reduces the rate of cephalic presentation at birth.

English

BACKGROUND Uterine rupture is defined as the tearing of the muscular wall of the uterus during pregnancy or labour.1 Often it occurs from the tearing of previous caesarean scar during labour.2 The other known risk factors for uterine rupture include, maternal age, height, body mass index (BMI), education, birth weight, gestational age, induction of labour, instrumental vaginal delivery, interpregnancy interval, congenital uterine anomaly, grand multiparity, previous uterine surgery, fetal macrosomia, fetal malposition, obstructed labour, uterine instrumentation, attempted forceps delivery, external version, and uterine trauma. 2-6This study was done to find out the prevailing risk factors associated with this grave condition in Bundelkhand region, so that mortality and morbidity associated with it could be prevented. METHODS We have studied 37 cases of uterine rupture, operated in our institution from Jan. 2018 to Oct. 2019. During this period a total of 2986 Caesarean sections (CS) were performed. Of these 37 cases, 5 were Nullipara (13.51 %), 16 primipara (31.25 %) and 16 were grand multipara (31.25 %). 24 cases (64.86 %) had previous uterine scar while 13 (35.13 %) had no scar. RESULTS In our study major risk factors for uterine rupture were found to be previous scars (64.68 %). Obstructive labour (23.07 %), malpresentation (7.69 %), grand multiparity (38.46 %) and prolong labour (30.76 %), were responsible for rupture in unscarred uterus. In all cases we first tried to repair the tear and only 9 (24.32 %) needed hysterectomy. In our study 28 patients (75.67 %) required only repair whereas 24.32 % cases needed hysterectomy. Maternal death was just 1 case (2.7 %) and (51.35 %) babies survived. CONCLUSIONS Majority of uterine rupture cases were found in women who had previous CS. So, first CS should be performed after very careful understanding of its indications. 2.7 % maternal mortality and 51.35 % delivery of live birth babies in our study proves that early detection and proper managing of the case can reduce maternal and fetal mortality in uterine rupture cases. KEY WORDS Uterine Rupture, Previous Scar, Inter-Pregnancy Interval

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography.

ISUOG Practice Guidelines (updated): sonographic examination of the fetal central nervous system. Part 2: performance of targeted neurosonography.

Davidson on Self‐Knowledge: A Transcendental Explanation

AbstractDavidson has attempted to offer his own solution to the problem of self‐knowledge, but there has been no consensus between his commentators on what this solution is. Many have claimed that Davidson's account stems from his remarks on disquotational specifications of self‐ascriptions of meaning and mental content, the account which I will call the “Disquotational Explanation.” It has also been claimed that Davidson's account rather rests on his version of content externalism, which I will call the “Externalist Explanation.” I will argue that not only are these explanations of self‐knowledge implausible, but Davidson himself has already rejected them. Thus, neither can be attributed to Davidson as his suggested account of self‐knowledge. I will then introduce and support what I take to be Davidson's official and independent account of self‐knowledge, that is, his “Transcendental Explanation.” I will defend this view against certain potential objections and finally against the objections made by William Child.

Current Approach for External Cephalic Version in Germany.

Introduction Fetal breech presentation at terms occurs in 3 – 6% of pregnancies. External cephalic version can reduce the number of cesarean sections and vaginal breech deliveries. Different approaches are used to carry out external cephalic version. This study looked at the different approaches used in Germany and compared the approach used with the recommendations given in German and international guidelines. Material and Methods An anonymized online survey of 234 hospitals in Germany was carried out in 2018. In addition to asking about hospital structures, questions also focused on how external version was carried out in practice (preparations, tocolysis, anesthetics, etc.), on relative and absolute contraindications and on the success rate. Results 37.2% of the hospitals approached for the survey participated in the study. Of these, 98.8% performed external version procedures. The majority of participating hospitals were university hospitals (26.4%) and maximum care hospitals (35.6%) with an average number of more than 2000 births per year (60.9%). External cephalic version is the preferred (61.7%) obstetrical procedure to deal with breech presentation, rather than vaginal breech birth or primary cesarean section. 45.8% of respondents carry out external version procedures on an outpatient basis, and 42.1% of hospitals perform the procedure as an inpatient intervention, especially from the 37th week of gestation. Prior to performing an external version procedure, 21.6% of surveyed institutions carry out a vaginal examination to evaluate possible fixation of the fetal rump. 95.5% of institutions used fenoterol for tocolytic therapy; the majority using it for continuous tocolysis (70.2%). 1 – 3 attempts at external version (8.4%) were usually carried out by a specific senior physician. In most cases, no analgesics were administered. The reported rate of emergency cesarean sections was very low. The most common indication for emergency C-section was pathological CTG (56,7%). The assessment of relative and absolute contraindications varied, depending on the surveyed hospital. 67.5% asked patients to empty their bladders before carrying out external version, while 10.8% carried out external version when the bladder was filled. The reported success rate was more than 45%. After successful version, only 14.8% of hospitals arranged for patients to wear an abdominal binder. For 32.4%, the decision to apply an abdominal binder was taken on a case-by-case basis. Conclusion The approach used in Germany to carry out external cephalic version is based on the (expired) German guideline on breech presentation. Based on the evidence obtained, a number of individual recommendations should be re-evaluated. More recent international guidelines could be useful to update the standard procedure.

A new argument for the incompatibility of content externalism with justification internalism

Several lines of reasoning have been proposed to show the incompatibility of content externalism with justification internalism. In this paper I examine two such lines of reasoning, which both rely on the general idea that since content externalism is incompatible with certain aspects of the alleged privileged character of self-knowledge, it would tend to undermine justification internalism as well. I shall argue that both lines of reasoning, as they stand, lack plausibility, though the core idea of the second line can be reconstructed into a new argument which shows considerable promise. In particular, relying upon the reliability constraint on knowledge, I shall argue that the so-called ‘two-concept’ version of content externalism is incompatible with ‘the transparency of sameness of content’, and thereby would also undermine justification internalism.

Externalism about Artifactual Words and the Taxonomy of Artifacts

Putnam and others have argued that semantic externalism extends to artifactual kind words such as “pencil” or “doorstop”. I first show that, even with natural kinds, externalism applies (at best) to words for ground level kinds. The issue then arises of which categories of artifacts should be identified as kinds in the relevant, restricted sense. I argue that, though there are natural taxonomies of artifactual categories at least some of which have well-defined ground levels, even words for such kinds do not appear to have externalist semantics, as they do not support ignorance or error arguments. Some think that membership to any kind is determined by objective features. Against this, I argue that the makers’ productive intentions are often crucial in selecting which pattern of features counts as constitutive of a kind. Though externalists may insist that membership to a kind is ultimately determined by sharing objective features, the resulting version of externalism can hardly be distinguished from internalism.

THE NYĀYA ARGUMENT FOR DISJUNCTIVISM

Abstract The Nyāya school of classical Indian epistemology defended (by today’s standards) a radical version of epistemic externalism. The school’s adherents also argued from their epistemological positions to an early version of disjunctivism about perceptual experience. In this paper, I assess the value of such an argument, concluding that a modified version of the Nyaya argument may be defensible.

328: Prediction of success in external cephalic version for breech presentation at term

We aimed at designing a clinically based predictive model for the likelihood of successful external cephalic versions (ECVs) near term. This single-center retrospective study was conducted in a single center between 2016 and 2018 and included all candidates for ECV between 35 and 41 weeks' gestation. The versions were performed by a single experienced obstetrician. Variables that may potentially affect the success rate of external version were collected for all participants and included: BMI, AFI, gestational age, parity, location of placenta, fetal trunk posture, period of time in breech presentation prior to the procedure and the size of the amniotic fluid preceding the fetal presenting part (fore-bag). Patients' characteristics were compared between successful and unsuccessful versions based on multiple logistic regression models in order to generate a discriminative model depicted by a conditional inference classification tree (ctree). Overall 250 pregnant women were eligible and opted for a trial of ECV with a success rate of 64.8%. Variables such as location of the placenta, period of time at breech presentation and previous uterine scar had no statistically significant impact on the success rate of ECV while BMI, size of fore-bag and parity were independent determinants of the final presentation. Prediction model for the outcome of ECV based on the most discriminatory factors is suggested and shown as a classification tree. According to our model, patients with a forebag size of 0 had a predicted probability of 10% for successful version, patients with a forebag size >0 and a BMI >29 had a probability of 0%, patients with a forebag size >1 and BMI <=29 had a probability of 96.3% and patients with forebag size =1 and BMI <=29 and number of previous births>0 had a probability of 81.25%. The model accuracy was 91.9%±5.4% which is significantly better than the no information rate of 64.8% (P<0.001). Sensitivity for predicting successful versions was 0.975 and specificity was 0.818. A prediction model composed of three easily measurable variables enables accurate outcome prediction of ECV at term. Fore-bag was identified as the most important discriminator. Our model holds in internal validation and it can be used to support patient counseling and decision making for ECV.