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Acting upon the early recognition of dying facilitates advanced care planning, allowing better end-of-life (EOL) care to be delivered in more appropriate settings.[1][1] Commonly cited barriers to discussing EOL care with patients include fear of causing distress, lack of confidence and limited time

Because linguistic communication is inherently noisy and uncertain, adult language comprehenders integrate bottom-up cues from speech perception with top-down expectations about what speakers are likely to say. Further, in line with the predictions of ideal-observer models, past results have shown that adult comprehenders flexibly adapt how much they rely on these two kinds of cues in proportion to their changing reliability. Do children also show evidence of flexible, expectation-based language comprehension? We presented preschoolers with ambiguous utterances that could be interpreted in two different ways, depending on whether the children privileged perceptual input or top-down expectations. Across three experiments, we manipulated the reliability of both their perceptual input and their expectations about the speaker’s intended meaning. As predicted by noisy-channel models of speech processing, results showed that 4- and 5-year-old—but perhaps not younger—children flexibly adjusted their interpretations as cues changed in reliability.

Objective: To explore perceptions of pharmacy graduates and preceptors regarding a new undergraduate pharmacy degree. Method: Data from focus groups and interviews with pharmacy graduates and preceptors were qualitatively analysed by thematic coding. Results: Participants identified strengths such as clinical knowledge and research skills; areas needing improvement were communications and calculations. Other areas identified by both graduates and preceptors included organization and management skills, longer externship experiential learning and extemporaneous compounding. It was suggested that extending the duration of the externship experience would facilitate the shift into the workplace and consolidate undergraduate learning. The internship programme was considered essential for personal development and for putting theory into practice. Conclusion: Both preceptors and graduates were satisfied with the undergraduate program. The knowledge, skills and attitudes displayed by graduates were considered to be adequate, providing a firm foundation for future practice.

A 65 year old man presented to the emergency department with a 10 day history of dark urine, general malaise, and progressive shortness of breath. He had a history of rheumatic heart disease and had been on warfarin since he had a metallic mitral valve replacement in 1984. He was a retired teacher, drank a minimal amount of alcohol, and was a non-smoker. He had no family history of cancer. On examination he was jaundiced with a sinus tachycardia (120 beats/min) and a pansystolic murmur. His other vital signs were normal. On examination, his other systems were normal except for mild suprapubic tenderness, as were the results of a digital rectal examination. His urine was rust coloured (fig 1⇓) with no blood clots. Urine dipstick was positive for blood (3+), protein (3+), and leucocytes (3+), but negative for nitrites. No red blood cells or casts were noted during microscopy. Fig 1 Patient’s urine on admission The table⇓ shows the results of his initial laboratory investigations. A peripheral blood film showed red cell fragments, polychromasia, and normal platelets (a representative smear is shown in fig 2⇓). The results of chest radiography, computed tomography of the kidneys, and ultrasound of the urinary tract were also unremarkable. Serial sepsis screens and three sets of blood cultures for endocarditis were all negative. View this table: Laboratory test results on admission Fig 2 A representative blood film showing red cell fragments (arrows) ### 1. What are the causes of dark urine? #### Answer Haematuria, menstrual contamination, haemoglobinuria, and myoglobinuria will cause dark urine that is positive for blood on urine dipstick testing. Red cells …