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Pulmonary embolism (PE) is a disease representing partial or complete obstruction by various types of emboli of one or more of the pulmonary bed vessels. It is relatively rare in childhood, but in recent years it is found more often in children. The aim of the study was to perform a retrospective analysis of age distribution, predisposing factors, clinical presentation, and manage-ment in children with proven PE not directly related to cardiac surgery over a 10-year period. Data of 14 children with a total of 15 episodes of pulmonary thromboembolism (PTE), hospitalized in the Clinic of Pediatric Cardiology, National Heart Hospital, Sofia, Bulgaria with evidence of pulmonary embolism for a period of 10 years were analysed. The children with PTE are 7 girls and 7 boys, aged 3 months to 17.5 years. In two of the cases (13%), PTE occurred under the age of 3 years, in 5 cases (33%) between the ages of 6 and 13 years, and in 8 (53%) between the ages of 13 and 18 years. The clinical manifestations included: tachypnea and dyspnea – 73% (n = 11), chest pain – 73% (n = 11), tachycardia – 67% (n = 10), asthenia/fatigue – 60% (n = 9), hypoxemia (SatO2 < 95%) – 53% (n = 8), hemoptysis – 13% (n = 2), acute hemodynamic collapse – 7% (n = 1). In the acute phase of the disease, the patients were treated using unfractionated heparin, low molecular weight heparin, interventional treatment with thromboaspiration and local fibrinolysis, as well as systemic fibrinolysis. The increasing incidence and the severity of the disease require a good knowledge of risk factors and symptoms, as well as the development of age-specific recommendations for diagnosis, management, and follow-up of the disease.

Infective endocarditis (IE) is a rare entity in children and predominantly affects patients with congenital heart defects (CHD). Our study assesses the association between the time to diagnosis of IE and the time to surgery and outcome. The mean period from initial symptom presentation to diagnosis confirmation was 38 days (3-180 days). 12 patients (60%) had an early diagnosis (< 30 days), while in 8 cases (40%) the diagnosis was delayed (>30 days). 75% of the patients with a delayed diagnosis had received prior antibiotic therapy vs. 58% of the children with an early diagnosis. All 3 children with lethal outcomes had received prior antibiotic therapy, in two of the cases the diagnosis of IE was early, and in one case it was delayed. In conclusion, empiric antibiotic therapy is associated with a delayed diagnosis of infective endocarditis, and the longer the time to surgery the greater the risk for unfavorable patient outcome.

Mitochondrial diseases are rare and heterogeneous conditions frequently affecting the heart. They are caused by mutations in nuclear or mitochondrial DNA with maternal inheritance or de novo occurrence. We present a case of 13-year-old girl with malignant mitochondrial cardiomyopathy. First presentation of the disease is with tamponade and atrial fibrillation. Cardiac imaging shows non-specific changes of the left ventricle that cannot be explained by any cardiomyopathy: hypertrophy, dilation, hypertrabeculation. These findings raised the suspicion for mitochondrial cardiomyopathy. The patient is examined by neurologist due to multisystem character of the disease. Electromyography reveals myopathy. Serum lactate and creatine phosphokinase are elevated. Acute inflammation is excluded with endomyocardial biopsy which also discovers complex III deficiency. Genetic testing identified likely pathogenic mutation in mitochondrial DNA with maternal inheritance. Two years after initial presentation patient was referred for cardiac transplantation due to fast progression of the disease. Mitochondrial cardiomyopathies have variable clinical manifestation which impedes the diagnosis and makes impossible the creation of unified criteria. The disease often affects various organs with high oxygen demand. Multiparametric approach and multidisciplinary team are recommended to increase diagnostic accuracy.

The fenestration in Fontan operation consists in creation of a communication between venous circulation and the pulmonary venous atrium, allowing direct passage of blood from the venous to the systemic circulation (right-to-left shunt). There is no general agreement concerning the mean pulmonary artery pressure (mPAP) level above which fenestration is indicated. There are no strict guidelines for the indications for fenestration closure as well. Here we present our data about invasive hemodynamic assessment before and after temporary closure of the fenestration in patients after Fontan operation. Our recommendations regarding comprehensive evaluation of patients with fenestrations after Fontan surgery are also presented.

This paper explores children's encounters with migration in global contexts through storytelling. Children from two primary schools in Manchester, UK and Cape Town, South Africa, developed stories of self through object elicitation, poetry and self-made artefacts. The children had either directly or indirectly experienced migration across borders. We combined objects that were brought from home, drawings and annotations in exploring the significance of children's ordinary everyday encounters. While the children's story work captures their individual perceptions of self, the collections of objects, drawings and artefacts reflect ideas about what it means to be a child in a world of mobility where human and more-than-human are entangled together. We explore children's stories in relation to mobility, belonging and more-than-human connections. However, we acknowledge that the interpretation of the 'final' stories is incomplete as they continue to change in a process of becoming.

This article explores the use of learning walks with children as a participatory research method to make sense of school experiences through prompts from the environment. The method was utilized as a tool to build relationships with the research participants and provide insight into their experiences of school. Seven children learning English as an additional language (EAL) participated in three learning walks and debriefing activities. Key concepts from Laura Lundy's participation model (2007, 'Voice' is not enough: conceptualising Article 12 of the United Nations Convention on the Rights of the Child, "British educational research journal", 33 (6), 927-942. doi: 10.1080/01411920701657033) were utilized to elicit and amplify children's voices. The learning walks offered space and time for dialogue outside of the classroom and pedagogic structure, an audience that informed the research and influence communicated back to teachers. Children's experiences of school included accounts of language, belonging and relationships with peers and adults. Offering children the tools and conditions to explore and share their experiences leads to empowerment and a sense of being 'seen' within school contexts.

BackgroundProstate cancer risk stratification using single-nucleotide polymorphisms (SNPs) demonstrates considerable promise in men of European, Asian, and African genetic ancestries, but there is still need for increased accuracy. We evaluated whether including additional SNPs in a prostate cancer polygenic hazard score (PHS) would improve associations with clinically significant prostate cancer in multi-ancestry datasets.MethodsIn total, 299 SNPs previously associated with prostate cancer were evaluated for inclusion in a new PHS, using a LASSO-regularized Cox proportional hazards model in a training dataset of 72,181 men from the PRACTICAL Consortium. The PHS model was evaluated in four testing datasets: African ancestry, Asian ancestry, and two of European Ancestry-the Cohort of Swedish Men (COSM) and the ProtecT study. Hazard ratios (HRs) were estimated to compare men with high versus low PHS for association with clinically significant, with any, and with fatal prostate cancer. The impact of genetic risk stratification on the positive predictive value (PPV) of PSA testing for clinically significant prostate cancer was also measured.ResultsThe final model (PHS290) had 290 SNPs with non-zero coefficients. Comparing, for example, the highest and lowest quintiles of PHS290, the hazard ratios (HRs) for clinically significant prostate cancer were 13.73 [95% CI: 12.43-15.16] in ProtecT, 7.07 [6.58-7.60] in African ancestry, 10.31 [9.58-11.11] in Asian ancestry, and 11.18 [10.34-12.09] in COSM. Similar results were seen for association with any and fatal prostate cancer. Without PHS stratification, the PPV of PSA testing for clinically significant prostate cancer in ProtecT was 0.12 (0.11-0.14). For the top 20% and top 5% of PHS290, the PPV of PSA testing was 0.19 (0.15-0.22) and 0.26 (0.19-0.33), respectively.ConclusionsWe demonstrate better genetic risk stratification for clinically significant prostate cancer than prior versions of PHS in multi-ancestry datasets. This is promising for implementing precision-medicine approaches to prostate cancer screening decisions in diverse populations.

The Salamanca Statement and subsequent international calls to action around inclusive education aim to meet Education for All goals and foster inclusive communities for learners within mainstream education. However, there are diverse interpretations of what inclusion means in practice that vary across local, national and international contexts. In developing inclusive pedagogies with teachers at the forefront of providing support, the use of labels to categorise particular groups of learners according to perceived learning needs can further marginalise them, affecting their sense of belonging in school and their academic and social identities. We present case studies drawn from two doctoral studies conducted in contextually and culturally different settings to understand learners' experiences of marginalisation in education. The experiences of learners of English as an additional language transferring from primary to secondary school in England illustrate marginalised positioning assigned by teachers' perceptions. The ability to 'settle in' to school of street-connected children transitioning (back) into education in Kenya is influenced by their interactions with peers, teachers and the wider community on and after the street. Findings emphasise the need for understanding experiences through shared narratives and dialogue, starting with learners' experiences to develop pedagogies and foster inclusive communities within and beyond schools.

Background: Primary nonparasitic splenic cysts (NPSC) are typically diagnosed incidentally. The management of large ([greater than or equal to] 5 cm) asymptomatic cysts remains controversial; there is a lack of evidence guiding management. The purpose of this study was to describe the outcomes of nonoperative management of large NPSC. Methods: Patients diagnosed with NPSC between January 2004 and December 2019 were identified at our academic institution. Adult patients with an NPSC of at least 5 cm who had at least 1 additional hospital visit were included. Data are presented as medians with interquartile ranges (IQR). Results: We identified 512 medical records that included the term splenic cyst during the study period. Sixty-eight of the patients had no reported cyst size, 410 had cysts smaller than 5 cm, 1 patient underwent an elective splenectomy at another institution and 12 patients were excluded for other reasons; 21 patients with cysts of at least 5 cm were included in the study. Eight symptomatic patients underwent surgery at our institution. Of these, 2 presented acutely: 1 with hemoperitoneum who required admission for transfusions and later underwent elective laparoscopic splenectomy and 1 with increasingly severe abdominal pain who underwent laparoscopic cyst unroofing. The remaining 6 symptomatic patients had elective surgery for pain (4 cyst unroofing, 1 total splenectomy, 1 partial splenectomy). Thirteen patients were asymptomatic (10 female, median age 49.2 [IQR 38.1 to 64.6] yr). Two of these patients chose to undergo elective surgery. The remaining 11 asymptomatic patients, with a median initial cyst size of 8.0 (IQR 5.3 to 10.8) cm, were followed for a median of 31.0 (IQR 23.5 to 71.0) months. There was no change in median cyst size (0 [IQR -1 to 0] cm), and none of these patients underwent intervention for their NPSC. Conclusion: Asymptomatic patients managed nonoperatively for large NPSC did not become symptomatic or require intervention during the study period. This supports watchful waiting with serial radiologic and clinical monitoring for asymptomatic large NPSC. Contexte : Les kystes spléniques non parasitaires primaires (KSNPP) sont généralement découverts fortuitement. La prise en charge des kystes volumineux ([greater than or equal to] 5 cm) asymptomatiques ne fait pas l'unanimité; les données probantes manquent pour orienter le traitement. Cette étude avait pour but de décrire les résultats d'une prise en charge non chirurgicale des KSNPP. Méthodes : Nous avons identifié les patients ayant reçu un diagnostic de KSNPP entre janvier 2004 et décembre 2019 dans notre établissement universitaire. Nous avons inclus les patients adultes porteurs d'un KSNPP d'au moins 5 cm qui avaient consulté au moins 1 autre fois à l'hôpital. Les données sont présentées sous forme de médianes et d'écarts interquartiles (ÉI). Résultats : Nous avons recensé 512 dossiers médicaux incluant le terme kyste splénique durant la période de l'étude. Chez 68 patients, la taille du kyste n'était pas indiquée; 410 avaient un kyste de moins de 5 cm; 1 patient a subi une splénectomie non urgente dans un autre établissement et 12 ont été exclus pour d'autres raisons; 21 patients porteurs d'un kyste d'au moins 5 cm ont été retenus pour l'étude. Huit patients symptomatiques ont subi une chirurgie dans notre établissement. Parmi eux, 2 étaient des cas urgents : 1 cas d'hémopéritoine pour lequel le patient a dû être hospitalisé pour des transfusions et a ensuite subi une splénectomie laparoscopique non urgente, et 1 cas d'intense douleur abdominale croissante pour lequel le patient a subi une fenestration laparoscopique. Les 6 autres patients symptomatiques ont subi une chirurgie non urgente pour la douleur (4 fenestrations, 1 splénectomie totale, 1 splénectomie partielle). Treize patients étaient asymptomatiques (10 femmes, âge médian 49,2 [écart interquartile (ÉI) de 38,1 à 64,6] ans). Deux d'entre eux ont opté pour la chirurgie non urgente. Les 11 patients asymptomatiques restants, dont la taille médiane des kystes initiaux était de 8,0 (EI de 5,3 à 10,8) cm, ont été suivis pendant une durée médiane de 31,0 (ÉI de 23,5 à 71,0) mois. On n'a noté aucun changement de la taille médiane des kystes (0 [ÉI de -1 à 0] cm) et aucun de ces patients n'a subi d'intervention pour son KSNPP. Conclusion : Les patients asymptomatiques traités non chirurgicalement pour un KSNPP volumineux ne sont pas devenus symptomatiques et n'ont pas été obligés d'être opérés pendant la période de l'étude. Cela milite en faveur de l'attente vigilante, avec suivi radiologique et clinique, pour les cas de KSNPP volumineux asymptomatiques., Hydatid cysts are the most common subtype of splenic cysts worldwide. (1) However, in North America, splenic cysts are relatively rare, given the low prevalence of echinococcal disease. In fact, [...]

BackgroundPolygenic hazard scores (PHS) can identify individuals with increased risk of prostate cancer. We estimated the benefit of additional SNPs on performance of a previously validated PHS (PHS46).Materials and method180 SNPs, shown to be previously associated with prostate cancer, were used to develop a PHS model in men with European ancestry. A machine-learning approach, LASSO-regularized Cox regression, was used to select SNPs and to estimate their coefficients in the training set (75,596 men). Performance of the resulting model was evaluated in the testing/validation set (6,411 men) with two metrics: (1) hazard ratios (HRs) and (2) positive predictive value (PPV) of prostate-specific antigen (PSA) testing. HRs were estimated between individuals with PHS in the top 5% to those in the middle 40% (HR95/50), top 20% to bottom 20% (HR80/20), and bottom 20% to middle 40% (HR20/50). PPV was calculated for the top 20% (PPV80) and top 5% (PPV95) of PHS as the fraction of individuals with elevated PSA that were diagnosed with clinically significant prostate cancer on biopsy.Results166 SNPs had non-zero coefficients in the Cox model (PHS166). All HR metrics showed significant improvements for PHS166 compared to PHS46: HR95/50 increased from 3.72 to 5.09, HR80/20 increased from 6.12 to 9.45, and HR20/50 decreased from 0.41 to 0.34. By contrast, no significant differences were observed in PPV of PSA testing for clinically significant prostate cancer.ConclusionsIncorporating 120 additional SNPs (PHS166 vs PHS46) significantly improved HRs for prostate cancer, while PPV of PSA testing remained the same.

During the period 2009–2016, brown hares (Lepus europeus L.) from different regions of Bulgaria were investigated for infections with liver parasites as well as for seroprevalence of protozoan Toxoplasma gondii. Three helminth species were found in the liver: one trematode – Dicrocoelium dendriticum, one cestode – larval form of Taenia pisiformis – Cysticercus pisiformis and one nema¬tode – Micipsella numidica. Dicrocoeliasis was found in all parts of the country with infected hares originating mainly from the western regions. The total prevalence of infection with D. dendriticum was 10.59%. The intensity of infection ranged from 1 to 184, 26.67 on the average. The total prevalence of infection with C. pisiformis was 16.8%. The prevalence of infection was highest among hares from the southern parts of the country, and no cysticercosis was registered in the western parts. The extent of infestation with cysticerci was different – from single cysticerci on the omentum or serosa of some organs in the abdominal cavity to innumerable ones that affected also the organs in the thoracic cavity. However, cases in which the animals were slightly affected, predominated. The total prevalence of infection with M. numidica was 5.31%, and the intensity of infection varied between 1 and 6 parasites in one animal. The nematodiasis was established mainly in hares from southern Bulgaria. The total seroprevalence of T. gondii was 6.15% and the protozoan-positive animals originated from three districts: Stara Zagora, Plovdiv, and Burgas. The current studies also showed that the prevalence of D. dendriticum infection among animals increased with age. No correlation was observed between prevalence of infection with C. pisiformis and M. numidica and host age. No correlation was found between the prevalence of the helminth infections and sex of the animals.

The article is aimed at systematizing the experience of formation and implementation of tax policy in the European Union Member States, defining the main dominants of this policy. The article analyzes the level of tax burden (the tax-to-GDP ratio) for the EU-27 countries for the period of 1995–2021 and determines that the average value of the indicator in the mentioned sample is 40.48%. The relationship between the tax burden and economic growth rates is examined. Although it is believed that the level of taxation is one of the main reasons for the existence of the shadow economy, the study proves that in countries where the level of tax burden is one of the lowest (Bulgaria, Romania, Lithuania, and Latvia), the shadow economy is twice as high as in Sweden, where the level of taxation is higher by more than 15% of GDP. In 27 of the EU countries, labor taxes occupy the highest share in the tax structure. The lowest level of labor taxation is present in Bulgaria and Romania – 10.0%, while in nine another EU countries the marginal rate of personal income tax exceeds 50%. Consumption taxes are the second most fiscally important component of tax revenues in the EU countries. There is a tendency to increase the standard VAT rate in the EU countries. In the European Union, a regime of reduced VAT rates is applied, aimed at reducing the tax burden, stimulating consumption and business activity, which is of great social significance. It is determined that in the EU when administering VAT, the issues of using digital products and technologies are of great importance. This allows to increase the fiscal efficiency of the tax by improving the quality of tax control, which is based on the risk-oriented approach. The EU has unified the rules for calculating and paying excise duty in the terms of excisable goods, as well as the procedure and conditions for their storage, movement, control over the production and circulation of excisable products. It is noted that the tax climate, together with the fundamental institutional foundations for economic development, are guidelines for entrepreneurs regarding the possibilities of opening or scaling a business. That is why recently there has been a further reduction in corporate tax rates – by an average of 9 percentage points. Ensuring fairness of taxation and criteria for equality of the tax system are among the important benchmarks of the EU fiscal policy. Property taxes are important in the tax systems of the EU member States. These taxes are the basis for filling local budgets with their own revenues, the relevant revenues are quite stable and predictable. It is concluded that, in general, the tax policy of the EU Member States is constantly adapting to socioeconomic conditions, which is manifested in changes in the parameters of rates, base, provision of targeted benefits, etc. This together is aimed at creating incentives for economic growth and ensuring social justice.

Genetic models for cancer have been evaluated using almost exclusively European data, which could exacerbate health disparities. A polygenic hazard score (PHS1) is associated with age at prostate cancer diagnosis and improves screening accuracy in Europeans. Here, we evaluate performance of PHS2 (PHS1, adapted for OncoArray) in a multi-ethnic dataset of 80,491 men (49,916 cases, 30,575 controls). PHS2 is associated with age at diagnosis of any and aggressive (Gleason score ≥ 7, stage T3-T4, PSA ≥ 10 ng/mL, or nodal/distant metastasis) cancer and prostate-cancer-specific death. Associations with cancer are significant within European (n = 71,856), Asian (n = 2,382), and African (n = 6,253) genetic ancestries (p

We determined the effect of sample size on performance of polygenic hazard score (PHS) models in prostate cancer. Age and genotypes were obtained for 40,861 men from the PRACTICAL consortium. The dataset included 201,590 SNPs per subject, and was split into training and testing sets. Established-SNP models considered 65 SNPs that had been previously associated with prostate cancer. Discovery-SNP models used stepwise selection to identify new SNPs. The performance of each PHS model was calculated for random sizes of the training set. The performance of a representative Established-SNP model was estimated for random sizes of the testing set. Mean HR98/50 (hazard ratio of top 2% to average in test set) of the Established-SNP model increased from 1.73 [95% CI: 1.69-1.77] to 2.41 [2.40-2.43] when the number of training samples was increased from 1 thousand to 30 thousand. Corresponding HR98/50 of the Discovery-SNP model increased from 1.05 [0.93-1.18] to 2.19 [2.16-2.23]. HR98/50 of a representative Established-SNP model using testing set sample sizes of 0.6 thousand and 6 thousand observations were 1.78 [1.70-1.85] and 1.73 [1.71-1.76], respectively. We estimate that a study population of 20 thousand men is required to develop Discovery-SNP PHS models while 10 thousand men should be sufficient for Established-SNP models.

BackgroundA polygenic hazard score (PHS), the weighted sum of 54 SNP genotypes, was previously validated for association with clinically significant prostate cancer and for improved prostate cancer screening accuracy. Here, we assess the potential impact of PHS-informed screening.MethodsUnited Kingdom population incidence data (Cancer Research United Kingdom) and data from the Cluster Randomized Trial of PSA Testing for Prostate Cancer were combined to estimate age-specific clinically significant prostate cancer incidence (Gleason score ≥7, stage T3-T4, PSA ≥10, or nodal/distant metastases). Using HRs estimated from the ProtecT prostate cancer trial, age-specific incidence rates were calculated for various PHS risk percentiles. Risk-equivalent age, when someone with a given PHS percentile has prostate cancer risk equivalent to an average 50-year-old man (50-year-standard risk), was derived from PHS and incidence data. Positive predictive value (PPV) of PSA testing for clinically significant prostate cancer was calculated using PHS-adjusted age groups.ResultsThe expected age at diagnosis of clinically significant prostate cancer differs by 19 years between the 1st and 99th PHS percentiles: men with PHS in the 1st and 99th percentiles reach the 50-year-standard risk level at ages 60 and 41, respectively. PPV of PSA was higher for men with higher PHS-adjusted age.ConclusionsPHS provides individualized estimates of risk-equivalent age for clinically significant prostate cancer. Screening initiation could be adjusted by a man's PHS.ImpactPersonalized genetic risk assessments could inform prostate cancer screening decisions.

The aim of this study was to investigate the potential association of rs11206510 in PCSK9 gene with coronary artery disease (CAD) and myocardial infarction (MI) in Bulgarians.

Maria Kaneva,1,&ast; Mihajlo Jakovljevic2– 4,&ast; 1Institute of Economics and Industrial Engineering of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia; 2Institute of Advanced Manufacturing Technologies Peter the Great St. Petersburg Polytechnic University, Saint Petersburg, Russia; 3Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan; 4Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia&ast;These authors contributed equally to this workCorrespondence: Maria Kaneva, Institute of Economics and Industrial Engineering of the Siberian Branch of the RAS, 17 Academician Lavrentiev Avenue, office 373, Novosibirsk, Russia, Tel +7 993 028 8421, Email kaneva@iep.ruPurpose: Despite much attention within the literature, the multiple risk factors associated with CVD mortality in Russia are still not fully understood. Drawing on the Health Belief Model as a theoretical framework, we aim to elicit socioeconomic and behavioral determinants of cardiovascular risks in Russian men and women.Methods: Using the Know Your Heart project data, we utilize regression analysis and then structural equation modeling (latent class analysis and mediation analysis) to study the determinants of CVD risks.Results: OLS and ordered logit regressions show that the key factors defining cardiovascular health behaviors in Russia are health-related actions to reduce the perceived threat of diseases (physical activity and GP visits), perceived barriers to behavioral change (financial constraints), and cues to action (awareness of the federal health check-up program). The latent class analysis further identifies three distinct groups of the population with different CVD risk levels. Over one-third of respondents belong to the “high CVD risk” class characterized by the highest share of smokers and alcohol abusers who evade contact with primary care and face financial constraints. In the mediation analysis, we find that employment mediates the relationship between physical activity and CVD risks: physically active individuals have a greater chance of employment, and employment further mitigates CVD risks. We also find an indication of the selection of the healthy into employment in the causal relationship between GP visits, having a job, and CVD risks.Conclusion: A corresponding set of policy actions stem from these findings. These include reinforcing the change of perceptions of CVD risks and lowering barriers to health care; raising awareness of the free preventive check-up program in the “high CVD risk” group; making sports and exercise accessible to the elderly; and using off-putting labels on alcohol products as behavioral nudges among “physically active but drinking” males.Keywords: Health Belief Model, cardiovascular risks, health behaviors, structural equation modeling, Russia

There has been little explication of how university lecturers who are responsible for educating future practitioners approach the complexity and conceptual messiness of 'voice'. There are dangers of objectification if curricula simply foreground the UNCRC and are only concerned with utterances and the need to listen to children. This paper explores our conceptual approach to avoid this and a limiting conceit by ignoring our own power. Specifically, we work from a feminist standpoint; in particular, we foreground Tronto's [1993. "Moral Boundaries. A Political Argument for an Ethic of Care." London: Routledge. ISBN: 978-0415906425] ethic of care as the foundation for student learning in our 'Finding a Voice' module. The framework recognises the diverse needs of different participants in the module -- students, lecturers, the university, and the young children who are absent from the university classroom yet who are the subject of learning -- and posits understanding voice as a relation between discourse, its organising power and the social practices of people. The module explores the complexity of voice and recognises the bifurcated nature of the students' experience. They are simultaneously required to be attentive to how they action children's voice in undertaking a small piece of research with children for assessment while being conscious of their own voice. The focus here is on our attentiveness to voice in the application of learning involving a conceptual framework and our and our students' work. There are dangers, in the complexity and conceptual messiness of voice, of objectification if curricula simply foreground the UNCRC and are only concerned with utterances and the need to listen to children.