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As a psychologist and an ethicist, we have explored empirically newborn screening consent and communication processes. In this paper we consider the impact on families if newborn screening uses whole genome sequencing. We frame this within the World Health Organization's definition of health and contend that proposals to use whole genome sequencing in newborn screening take into account the ethical, practical and psychological impact of such screening. We argue that the important psychological processes occurring in the neonatal phase necessitate a clear justification that providing risk information at this stage provides a health benefit. We illustrate how research on current newborn screening can inform whole genome sequencing debates, whilst highlighting important gaps. Obtaining explicit, voluntary, and sufficiently informed consent for newborn screening is challenging, however we stress that such consent is ethically and legally appropriate and psychologically and practically important. We conclude by outling how this might be done.

In many parts of the world, limited water and climate change are significant challenges to the future of peanut production, and much work remains in developing heat- and drought-tolerant cultivars. To this end, we evaluated 21 accessions of the U.S. peanut mini-core under water-limited conditions in 2018 and 2019 in Oklahoma, Texas, and Virginia. These accessions were identified as potentially exhibiting phenotypic extremes for ten drought stress traits, and therefore may be useful for identifying genetic markers associated with drought tolerance. Results indicated that plant wilting and paraheliotropism (leaf folding) were less affected by genotype by environment interactions than SCMR (SPAD chlorophyll meter readings), flower counts, yield, TSMK (total sound mature kernels), and seed weight. No differences among genotypes were observed with canopy temperature, canopy temperature depression, or NDVI (normalized difference vegetation index). Paraheliotropism was moderately correlated (|r| = 0.40 to 0.52, P < 0.01) with SCMR and flower counts in the Southwest; SCMR was also correlated with yield and TSMK (r = 0.48, P < 0.01). Despite environmental differences between subhumid Virginia and the semiarid Southwest, the locations shared genotypes at the extremes for most traits. This information may be useful for future studies by highlighting traits associated with drought tolerance that may be more stable in different production environments, as well as divergent genotypes for those traits.

Purpose: Online reviews have become increasingly common for consumers to share their experiences about products and to assist potential consumers with decision making. The current study was aimed to understand the hearing aid user experience from online consumer reviews using qualitative analysis. Method: The study used a qualitative thematic analysis to analyze open text responses from consumers leaving hearing aid reviews on the http://www.HearingTracker.com website. One thousand three hundred seventy-eight online consumer hearing aid reviews (open-text responses) were extracted and analyzed. Results: Three domains emerged within the data set, containing 11 themes and 136 subthemes. Domain one (Clinical Processes) contained two themes: Hearing Assessment and Hearing Aid Acquisition. Domain two (The Device) contained five themes: Function, Performance, Physical, Device Management, and Maintenance. Domain three (The Person) contained four themes: Satisfaction, Quality of Life, Personal Adjustment, and Knowledge. The themes gave an understanding that there were a contribution of factors that formed part of a consumers hearing aid user experience. Conclusions: Hearing aid users described a range of positive, negative, and neutral descriptions online about their hearing aid user experience and gave advice to fellow hearing aid users helping clinicians improve their hearing aid fitting skills in practice. These findings have implications to future product development as well as service delivery model in terms of developing strategies for fostering patient-centered audiological practice.

Previous studies on the impacts of racism on adolescent development have largely overlooked Indigenous youth. We conducted a scoping review of the empirical literature on racism against Indigenous adolescents to determine the nature and scope of this research and to establish associations with developmental outcomes. Our literature search resulted in 32 studies with samples from the United States, Canada, Australia and New Zealand. Studies were limited to self-reported experiences of racism and thus primarily focused on perceived discrimination. Quantitative studies found small to moderate effects of perceived discrimination on adolescent psychopathology and academic outcomes. Qualitative studies provided insight into structural forms of racism. We offer recommendations for future investigations into the impacts of overt and covert racism on Indigenous adolescents.

A 53 year old female presented with rapidly enlarging right breast mass. In the setting of rapid growth and concern for intraoperative bleeding the decision was made to consult interventional radiology for preoperative embolization. This case was managed with transradial arterial access and gelfoam embolization using cone beam CT to obtain successful embolization.

To conduct the first phases in the development of a self-report measure of empowerment on the hearing health journey, specifically, item generation and content evaluation of the initial pool of items generated. A content expert panel survey and cognitive interviews were conducted. Descriptive statistics were obtained for the quantitative data, and the cognitive interviews were analysed using thematic analysis. Eleven researchers and clinicians participated in the content expert surveys. Sixteen experienced hearing aid users participated in the cognitive interviews, recruited from the USA and Australia. The items underwent five iterations based on feedback from the survey and interview data. This resulted in a set of 33 quality-tested potential survey items that were rated highly for relevance (mean = 3.96), clarity (mean = 3.70) and fit to dimensions of empowerment (mean = 3.92) (scale 0-4, where 4 was the maximum rating). Involving stakeholders in item generation and content evaluation increased relevance, clarity, fit to dimension, comprehensiveness, and acceptability of the items. This preliminary version of the 33-item measure underwent further psychometric refinement (Rasch analysis and traditional classical test theory testing) to validate it for clinical and research use (reported separately).

This dissertation theorizes the “graphic” as a term seemingly at odds with itself. On one hand, “graphic” demarcates the provocative, upsetting excess of visual and/or verbal works that inadequately temper their taboo-violating content. This graphic is gross, sticky, shocking. On the other hand, “graphic” promises the geometrically streamlined—information mastered on a coordinate plane or in sleekly simplified visuals, through which people and places can be appraised from a comfortable distance. This sort of “graphic” is about calculations and schematics, detachment and diagrams, and disinterested evaluation. I examine twentieth-century American texts (primarily post-45) that perplexingly and provocatively encompass these extremes of the graphic at the same time. These are texts at once viscerally grotesque and coolly clinical. In them, readers are forced into the affective bind of a mode of identification that is simultaneously classificatory and empathic. It is only when we think about famously graphic twentieth-century American literature as disinterested and disgusting at once that we can expose the unseemliness of the lust, in our contemporary culture of information, for epistemological mastery of the bodies of others. I analyze the “double graphic” along three specific axes: the ethnographic, the pornographic, and the infographic. Whether dealing primarily with race, sex, or data, each manifestation is marked by the discomfiting affective ambivalence of coercive identification. We both empathize with and clinically document other people in moments of taboo overexposure. So we see the conflation of racial classification and racial violence in Edgar Alan Poe’s Tslalians in The Narrative of Arthur Gordon Pym (1838), later reimagined by Mat Johnson in Pym (2011), and evident in the visual work of Kara Walker. In these texts, uncannily animated ethnographic silhouettes—racial others reduced to flat icons—become available for both classification and laceration: produced by cutting and perhaps apt, too, to cut back. I uncover the antiseptic titillation of pornographic sex dolls in Vladimir Nabokov’s Lolita (1955), Fran Ross’s Oreo (1974), and the work of contemporary “avant-porn” performance artist Narcissister. The sex doll—which can be uncanny, repulsive, erotic, or hilarious—materializes the lust for “the ‘knowledge-pleasure’ of sexuality” that Linda Williams locates at the core of the pornographic, replacing complex people with fully knowable things. Finally, the peripatetic protagonists of Thomas Pynchon’s Crying of Lot 49 (1966) and Teju Cole’s Open City (2011) each engage in an infographic mode of tangential narration that becomes grossly parasitic on the intimate stories and secrets of others, transcribing personal trauma into cool data. In the graphic moment, I argue, people shift unsettlingly into and back out of things—be they flat black silhouettes, hollow dolls, or dimensionless sets of data points—and we don’t quite know how we are meant to feel about it.

The differentiation between bloodstain patterns resulting from impact events and those from the expiration of blood can be crucial to crime scene reconstruction. Physical characteristics used to di...

In the UK, it has been proposed that alongside the current advice to abstain from alcohol completely in pregnancy, there should be increased screening of pregnant women for alcohol consumption in order to prevent instances of fetal alcohol spectrum disorder. The Scottish Intercollegiate Guidelines Network published guidelines in 2019 recommending that standardised screening questionnaires and associated use of biomarkers should be considered to identify alcohol exposure in pregnancy. This was followed in 2020 by the National Institute for Health and Care Excellence Draft Quality Standard, which recommended that pregnant women should have information on their alcohol consumption recorded throughout their pregnancy and this information transferred to the child’s health records. Most recently, Public Health England has stated that the alcohol intake of all women should be recorded throughout pregnancy, not just at the initial booking appointment and that tools such as blood biomarkers and meconium testing should be researched in order to determine true prevalence rates of alcohol in pregnancy. We argue that this proposed enhanced screening undermines women’s autonomy and their legal right to be sufficiently informed to consent to screening. We argue that there is no evidence that this kind of screening will result in a reduction of fetal harm and there is a danger that undermining the autonomy of women and the trust relationship between women and healthcare professionals may even increase harm to future children.

To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being.A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change).Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3).Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients' lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician's limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss.Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.

Successive generations of First Nation scholars have critiqued the ongoing institutional and disciplinary complicity of Higher Education to support settler colonialism. These critiques extend to include Cultural Studies, despite the field’s inter (anti)disciplinary efforts to expose power and inequality in social relations, dominant institutions, popular culture, and everyday life. As part of the university-machine, Cultural Studies is disconnected from the inherently pedagogical experiences and knowledge of Culture and Country for many Aboriginal and Torres Strait Islander peoples. With an emphasis on praxis, we critique three autoethnographic examples of interactions between Indigenous agents and the settler colonial academe as a call to mobilize Cultural Studies literacies as a pedagogy of critical allyship to Aboriginal and Torres Strait Islander scholars. Cultural Studies as critical allyship pedagogy supports non-Indigenous agents to conduct rigorous critique of internalized and institutional settler colonial hegemony, identifying absences and erasures of Indigenous agency, autonomy, and self-determination. These gaps and silences are not for allies–or Cultural Studies–to fill; rather the project is to leverage Cultural Studies methodologies to cede epistemological space in the academe to Indigenous ways of knowing and being without intervention, assimilation, or academic critique.

Objective:To compare the cost and affordability of two fortnightly diets (representing the national guidelines and current consumption) across areas containing Australia’s major supermarkets.Design:The Healthy Diets Australian Standardised Affordability and Pricing protocol was used.Setting:Price data were collected online and via phone calls in fifty-one urban and inner regional locations across Australia.Participants:Not applicable.Results:Healthy diets were consistently less expensive than current (unhealthy) diets. Nonetheless, healthy diets would cost 25–26 % of the disposable income for low-income households and 30–31 % of the poverty line. Differences in gross incomes (the most available income metric which overrepresents disposable income) drove national variations in diet affordability (from 14 % of the median gross household incomes in the Australian Capital Territory and Northern Territory to 25 % of the median gross household income in Tasmania).Conclusions:In Australian cities and regional areas with major supermarkets, access to affordable diets remains problematic for families receiving low incomes. These findings are likely to be exacerbated in outer regional and remote areas (not included in this study). To make healthy diets economically appealing, policies that reduce the (absolute and relative) costs of healthy diets and increase the incomes of Australians living in poverty are required.

Prospective, quality-improvement. To evaluate pain management following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and Scheuermann’s Kyphosis (SK) determine the optimal opioid and benzodiazepine prescription amounts, and implement a multimodal post-operative pain regimen. The incidence of prescription opioid abuse is increasing in the United States. Orthopedic spine surgeons often prescribe large quantities of opioids post-operatively for pain control. Previous efforts on pain control have focused on in-patient post-operative regimens after PSF. Between 2/1/17 and 5/30/18 patients with AIS or SK were sent home with pain diaries after discharge to document daily narcotic, benzodiazepine, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen and gabapentin use following PSF. Diaries were collected at the 4 week post-operative visit. Data from two cohorts were reviewed: pre-intervention and post-intervention. Our prescription intervention went into effect 9/1/17. Twenty-four (30%) patients returned pain diaries. The pre-intervention cohort consisted of 12 patients (7 female; 5 males; 14.9 years (range 12–19)). Patients were prescribed on average 80 × 5 mg tabs (26–140) of oxycodone but used on average 45 tabs (12–129) over an average of 17.5 days (9–33). They were prescribed an average of 30 × 2 mg tabs (0–150) of diazepam, used on average 4.8 (0–105) tabs over 12.5 (5–25) days. The post-intervention cohort consists of 12 patients (9 female; 3 male; 14.8 years (12–19)). They were prescribed on average 50 × 5 mg tabs (35–80) of oxycodone, used 20.5 (0–39.5) tabs over 8.5 days (3–16). They were prescribed on average 18 × 2 mg tabs of diazepam (0–43), used 5.4 tabs (0–19) over 10 days (5–14). This analysis has directly impacted clinical practice. Prescribed opioid and benzodiazepine doses have been decreased by over 50%, and more resources are being directed towards determining the disparity between the amount of medications prescribed and consumed in our post-operative patients.

Objective We retrospectively studied the clinical presentations and outcomes of endovascular management in a mixed pediatric and adult Klippel-Trenaunay syndrome (KTS) population at a single academic medical center. Methods We performed a retrospective study of patients with KTS who had been referred for endovascular intervention after evaluation and diagnosis by a multidisciplinary team at a single academic medical center during a 10-year period. The patient demographics, areas affected, presenting symptoms, previous treatments, imaging modalities, endovascular treatment types, number of treatments, and complications were assessed. The technical and clinical success rates were calculated. Results Twenty-six patients with suspected KTS were evaluated. Of these 26 patients, 20, aged 2 to 75 years, had been diagnosed with KTS using the International Society for the Study of Vascular Anomalies criteria and referred for endovascular management. The left lower extremity was affected most often. The presenting symptoms were pain (80%), edema (70%), bleeding (10%), numbness (25%), and claudication (25%). Of the 20 patients, 16 (80%) had undergone treatment of KTS before presenting to our institution. Magnetic resonance imaging and ultrasound (US) were the most common imaging modalities. Fifteen patients underwent 46 endovascular treatments during the study period. The treatments included 5 endovenous ablations only, 4 US-guided sclerotherapies with endovenous ablation, 5 US-guided sclerotherapies only, and 32 catheter-directed venograms with additional interventions. Localized intravascular coagulopathy was the only procedure-related complication and occurred in one patient after three treatments. The technical success rate was 97.8%, and the clinical success rate was 100%. Conclusions Endovascular intervention is safe and effective for KTS patients for whom conservative management has failed. Pain and edema were the most common presenting symptoms. Presenting symptoms may be related to pathology of anomalous veins, orthotopic superficial veins or deep veins. Venous claudication can be present in those with KTS despite patency of the deep venous system. Magnetic resonance imaging and duplex US are frequently used modalities for venous assessment. The complications of endovascular treatment are rare but include localized intravascular coagulopathy.

Functional electrical stimulation is commonly used as a rehabilitation therapy to support the movement of individuals who have suffered traumatic spinal cord injury. Recently, there has been a focused interest on the development of textile electrodes, as they pose many benefits over traditional electrodes. This study presents design considerations and the feasibility of a wearable FES garment sleeve using flexible and extensible screen-printed electrodes.

Objectives. To examine the prevalence and magnitude of price promotions in a major Australian supermarket and how they differ between core (healthy) and discretionary (less healthy) food categories. Methods. Weekly online price data (regular retail price, discount price, and promotion type) on 1579 foods were collected for 1 year (April 2017 to April 2018) from the largest Australian supermarket chain. Products audited were classified according to Australian Dietary Guidelines definitions of core and discretionary foods and according to their Health Star Rating (a government-endorsed nutrient profiling scheme). Results. On average, 15.1% (95% confidence interval [CI] = 14.7%, 15.3%) of core foods and 28.8% (95% CI = 28.6%, 29.0%) of discretionary foods were price promoted during a given week. Average discounts were −15.4% (95% CI = −16.4, −14.4) for core products and −25.9% (95% CI = −26.8, −25.1) for discretionary products. The percentage of products on price promotion and the size of the discount were larger for products with a lower Health Star Rating (P Conclusions. Price promotions were more prevalent and greater in magnitude for discretionary foods than for core foods. Policies to reduce the prevalence and magnitude of price promotions on discretionary foods could improve the healthiness of food purchased from supermarkets.

OBJECTIVES: Expansion of newborn bloodspot screening (NBS) within England, which practices an informed consent model, justified examining acceptability and effectiveness of alternative consent models.STUDY DESIGN: Qualitative focus groups.METHODS: Forty-five parents and 37 screening professionals (SPs) participated. Data were analysed using thematic analysis.RESULTS: Parents and SPs initially appeared to have differing views about appropriate consent models. Most parents accepted assumed consent, if adequately informed; however, once aware of bloodspot storage, informed consent was wanted. SPs valued informed consent, but acknowledged it was difficult to obtain. Both samples wanted parents to be informed but were unclear how this could be achieved. Most parents felt NBS was not presented as optional.CONCLUSION: The simultaneous exploration of parents and SPs views, in real time is original. This rigour avoided the reliance on retrospective accounts which make it difficult to establish how decisions were made at the time. It is also unique in providing pre-interview consent models to drive the depth of data. It was rigorous in member checking. Findings suggested a preference for full disclosure of all information with some parents valuing this more than choice. Both samples queried whether current consent was sufficiently informed and voluntary. Results suggest differing tolerances of consent type if screening is solely for diagnostic purposes vs bloodspot storage. Results highlight the need for caution when examining consent model preferences without also checking knowledge, as opinions may be based on incomplete knowledge. Future research is needed to examine efficacy of proposed changes.FUNDING: National Institute for Health Research Health Technology Assessment HTAProgramme (11/62/02).TRIAL REGISTRATION: ISRCTN70227207.

Policies to restrict unhealthy food and beverage price promotions have been recommended, as part of a broader strategy to reduce obesity, but little evidence underpins such recommendations. We aimed to synthesize the literature on the prevalence of healthy and unhealthy food and beverage price promotions and their potential influence on purchasing behaviour. Eight scientific databases (covering health, business, and marketing) and grey literature were systematically searched using search terms related to "food and beverage price promotions" up until July 2019. Articles were included if they examined prevalence of, and/or consumer response to, food and non-alcoholic beverage price promotions, from a nutritional perspective. Of the 16 included studies, eight examined the prevalence of price promotions and eight examined the potential influence of price promotions on purchasing behaviour. Seven of the "prevalence" studies found that price promotions were more common for unhealthy foods and beverages. Seven "influence" studies found a greater proportion of price-promoted purchases were for unhealthy compared with healthy products. Policies that reduce the prevalence and/or influence of price promotions on unhealthy foods and beverages may shift consumer purchasing away from unhealthy foods and beverages. Empirical studies are required to better understand how consumers and industry may respond to such policies.

Newborn bloodspot screening is a routine procedure that is undertaken in most developed countries in order to identify nine different conditions, including sickle cell disease and cystic fibrosis. It is a procedure that requires parental consent, although studies have shown that parents may be unaware that they are also consenting to the storage of bloodspot samples. As part of a wider study aiming to identify the best means of communicating with parents, this article will examine how midwives can ensure that parents are informed and consent is valid.

Context Dietary risks are leading contributors to global morbidity and mortality and disproportionately burden individuals of lower socioeconomic positions. Objective The aim of this review is to understand, holistically, what factors are perceived to influence healthy eating and to determine whether perceived factors differ when comparing the general population with lower socioeconomic subgroups. Data sources Four academic databases (MEDLINE, CINAHL, PsycINFO, Cochrane Library) and 3 gray literature databases were searched systematically, along with reference lists. Study selection Studies were included if they were qualitative and were conducted with community-dwelling adults in high-income countries and if they focused specifically on healthy eating. Eligibility was determined through author consensus. Data extraction Thirty-nine eligible studies (of 11 641 records screened) were identified. Study characteristics were extracted using a standard template, and quality appraisal was conducted using the Critical Appraisal Skills Program tool. Data synthesis was conducted using meta-ethnography, with themes categorized according to the socioecological model. Results Factors across the individual, social, lived, and food environments were perceived to influence healthy eating. Meta-ethnography revealed that multiple environmental and social factors were frequently reported as barriers to healthy eating. While factors were largely generalizable, diet affordability and the lower availability of stores offering healthy food appeared to be more salient barriers for lower socioeconomic groups. Conclusions Actions to improve population diets should mitigate the barriers to healthy eating to create environments that support healthy eating across the socioeconomic gradient. Systematic Review Registration: PROSPERO registration number CRD42017065243.

Since the first MOOC was launched at the University of Manitoba in 2008, this new form of the massification of higher education has been a rollercoaster ride for the university sector. The New York Times famously declared 2012 to be the year of the MOOC. However, by 2014, the number of academic leaders who believed the model was unsustainable doubled to more than 50%. While the MOOC hype has somewhat subsided, the attitudes and anxieties of this peak time can still be seen influencing universities and their administrations. This is the first volume that addresses Massive Open Online Courses from a post-MOOC perspective. We move beyond the initial hype and revolutionary promises of the peak-MOOC period and take a sober look at what endures in an area that is still rapidly growing, albeit without the headlines. This book explores the future of the MOOC in higher education by examining what went right, what went wrong and where to next for the massification of higher education and online learning and teaching. The chapters in this collection address these questions from a wide variety of different backgrounds, methodologies and regional perspectives. They explore learner experiences, the move towards course for credit, innovative design, transformations and implications of the MOOC in turn. This book is valuable reading for students and academics interested in education, eLearning, globalisation and information services.

The increasing availability of multi-dimensional remote-sensing data covering large geographical areas is generating a new wave of landscape-scale research that promises to be as revolutionary as the application of aerial photographic survey during the twentieth century. Data are becoming available to historic environment professionals at higher resolution, greater frequency of acquisition and lower cost than ever before. To take advantage of this explosion of data, however, a paradigm change is needed in the methods used routinely to evaluate aerial imagery and interpret archaeological evidence. Central to this is a fuller engagement with computer-aided methods of feature detection as a viable way to analyse airborne and satellite data. Embracing the new generation of vast datasets requires reassessment of established workflows and greater understanding of the different types of information that may be generated using computer-aided methods.

The Principle of Procreative Beneficence (PPB) claims that we have a moral obligation, where choice is possible, to choose to create the best child we can. The existence of this moral obligation has been proposed by John Harris and Julian Savulescu and has proved controversial on many levels, not least that it is eugenics, asking us to produce the best children we can, not for the sake of that child's welfare, but in order to make a better society. These are strong claims that require robust justification that can be open to scrutiny and debate. This article argues that robust justifications are currently lacking in the work of Savulescu and Harris. The justifications provided for their conclusions about this obligation to have the best child possible rely heavily on Derek Parfit's Non-Identity Problem and the intuitive response this provokes in many of us. Unfortunately Harris and Savulescu do not embrace the entirety of the Non-Identity Problem and the puzzle that it presents. The Non-Identity Problem actually provides a refutation of PPB. In order to establish PPB as a credible and defendable principle, Harris and Savulescu need to find what has eluded Parfit and many others: a solution to the Non-Identity Problem and thus an overturning of the refutation it provides for PPB. While Harris and Savulescu do hint at possible but highly problematic solutions to the Non-Identity Problem, these are not developed or defended. As a result their controversial is left supported by little more than intuition.

The new generation of aerial photographers is using different wavelengths to sense archaeological features. This is effective but can be expensive. Here the authors use data already collected for environmental management purposes, and evaluate it for archaeological prospection on pasture. They explore the visibility of features in different seasons and their sensitivity to different wavelengths, using principal components analysis to seek out the best combinations. It turns out that this grassland gave up its secrets most readily in January, when nothing much was growing, and overall the method increased the number of known sites by a good margin. This study is of the greatest importance for developing the effective survey of the world's landscape, a quarter of which is under grass.

In an effort to improve the care of a dying child in the hospital, research was conducted to identify factors associated with the staff's perception of high-quality dying and death. The research used a unique electronic survey that was administered to clinical staff caring for children within the final 3 days of their life in the hospital. Positive death experiences were associated with absence of patient pain, dyspnea, anxiety, or agitation and the presence of spiritual, psychological, and culturally appropriate care for the patient and family. A positive correlation with quality was noted if there was clarity about goals of care and appropriate directives were in place to alleviate suffering. When clinicians felt their needs were met and they had more end-of-life education, they also perceived the quality of the experience as higher and had less distress from the event. Variability in perceived quality of the death experience was noted between different units of the hospital. Providing a supportive environment for pediatric deaths is enhanced by ensuring certain processes are in place and clinicians have the education and support to deliver high-quality care at the end of life.

The identification of archaeological remains via the capture of localized soil and vegetation change in aerial imagery is a widely used technique for the prospection of new features. The near infrared (NIR) region has been shown by environmental applications to exhibit the signs of vigour and stress better than reflectance in the visible region, and this has led to interest in the application of digital spectral data for archaeological prospection. In this study we assess quantitatively the application of 12 common vegetation indices to archive Compact Airborne Spectrographic Imager digital spectral data acquisitions from January and May 2001 in a grassland environment. The indices are compared with the true colour composite (TCC), best performing spectral band (711.2 ± 4.9 nm NIR) and the transcription of the aerial photographic archive. The results of the study illustrate that the calculation of a number of vegetation indices can assist with the identification of archaeological features in spectral data. However, the performance of the indices varies by season and although the features detected are shown to be complementary to those detected by the TCC, few indices out-perform the TCC in terms of feature numbers identified. It was also shown that the Normalised Difference Vegetation Index (NDVI), the most commonly applied index in archaeological prospection to date, performed poorly in comparison to indices such as the Modified Red Edge Simple Ratio Index, Simple Ratio Index and Modified Red Edge Normalized Difference Vegetation Index. It is therefore recommended that the application of appropriate vegetation indices can enhance archaeological feature detection when combined with the TCC but that the calculation of the NDVI alone is insufficient to detect additional features. Copyright © 2012 John Wiley & Sons, Ltd.

Those teaching music to American schoolchildren faced a fissure of sorts during the 1930s and 1940s. On one side of this divide stood Carl Seashore and the music educators who embraced his philosophy. They promoted a sometimes arduous form of music teaching and believed that the results of this tutelage could be quantitatively assessed. On the other side stood music pedagogues influenced by the era's burgeoning learner-centered philosophy, educators who embraced the more individualized and friendly approach advocated by James Mursell and Mabelle Glenn. This well-known binary paradigm was born just as a middlebrow impulse swept through America. The increasingly popular listening lessons billed as "music appreciation" became not just an aspect of in-school education for children but also a veritable music-appreciation industry targeting adults. It is my contention that the fissure in music education, while certainly reflective of specific pedagogical trends and debates, also related to a more basic dialogue about what it meant to appreciate music. In this article, I will connect the Seashore-Mursell/Glenn binary to contemporaneous discourse about the meaning of extracurricular music appreciation--discourse that occurred in many musical fields and also affected life across the Atlantic. More importantly, I will demonstrate that this discourse also played out within the pages of music-appreciation literature. This exploration will ultimately show that, while music teachers were certainly grappling with new ideas about learner-centered education, this process was also influenced by and reflective of larger skirmishes about the nature of highbrow achievement that accompanied the middlebrow fervor of the 1930s and 1940s. Debating Appreciation in Middlebrow America and American Schools Some comments about terminology must precede the analysis. While the phrase music appreciation was prevalent in several contexts in early twentieth-century America, two uses predominated. On the one hand, schoolteachers often used this descriptor in reference to the era's increasingly popular lessons in listening. On the other hand, the term music appreciation was also applied more generally to music education offered to the adult layperson. While these two understandings are complex, the terrain of early twentieth-century appreciation is even thornier because there was a good deal of overlap between its curricular and extracurricular varieties. Many instructional books, for example, were written by renowned music educators but were nevertheless aimed at both young students and adult laypeople. Nonetheless, terminology must be adopted to help readers make the distinction. I most often employ the phrase music education to indicate school music teaching (of appreciation, performance, or anything else). The term music teachers will also be used in reference to official music education within the school. The terms appreciation and middlebrow education, meanwhile, will generally be used in discussions of the appreciation industry and its wares. Words such as educational and pedagogical will be utilized more generally. Discussion of the term middlebrow is also needed. As others have chronicled the history of this term (1) and as its negative connotations burgeoned after the period discussed in this article, here I will unpack its meaning only briefly. The term became widely pejorative during the middle of the twentieth century through the writings of authors such as Russell Lynes and Dwight MacDonald. (2) MacDonald is especially important because he arguably brought criticism of the "midcult" and the "middlebrow" to new heights. Janice Radway has summarized MacDonald's critique of the Book-of-the-Month Club in a manner that astutely captures his overall perspective: " [In 1960] MacDonald railed against the spreading 'tepid ooze of Midcult' and identified the Book-of-the-Month Club and its judges . …

The uptake of airborne laser scanned (ALS) data (commonly known as airborne lidar) for heritage landscape assessment has grown rapidly in the past decade as data have become increasingly available. Likewise there has been a recent upsurge in published techniques for modelling the ground surface from ALS data to highlight archaeological features. However, many end-users of the data are not trained in remote sensing and visualization techniques and the lack of comparative assessment of techniques has increased the complexity of interpretation of the ALS-derived models. This study quantitatively compares five visualization techniques ranging from the commonly used shaded relief model to newer local relief and sky view factor modelling for a study area in the UK. Outputs are compared with the baseline data of the English Heritage National Mapping Programme aerial photographic archive transcription and assessed with respect to percentage visibility of feature length. Ancillary aspects of the outputs are discussed, such as geospatial shift of features, suitability for profile mapping, ease of interpretation and ability to combine with other data sources. It is concluded that although the overall performance of the models in terms of feature recognition is relatively even, consideration of all factors enables more transparent modelling choices to be made and facilitates critical interpretation of the features recorded. Copyright © 2012 John Wiley & Sons, Ltd.

In this article, we consider the prohibition on the use of preimplantation genetic diagnosis to select an embryo on the basis of its sex for non -: medical reasons. We use this as a case study to explore the role that public consultations have and should play in ethico-legal decision-making. Until the Human Fertilisation and Embryology Act 1990 was amended by the Human Fertilisation and Embryology Act 2008, non-medical sex selection of an embryo was not statutorily regulated, but it was the policy of the Human Fertilisation and Embryology Authority that such selection should not occur. However, since 2009, it has been a criminal offence to select an embryo on the basis of its sex for non-medical reasons. We consider the reasons given for this change and explore the role that 'public opinion' had in the decision-making process. On the face of it, asking the public what they think seems reasonable, fair and democratic, and those who are not in favour of public consultations being accorded great weight in matters of policy may appear out of touch and as wanting to impose their moral views on the public at large. But there are problems with doing so, especially when seeking to regulate ethically controversial issues. We discuss whether regulation should be influenced by public opinion obtained via 'public consultations', and utilise sex selection for non-medical reasons as an example of how (apparently) public opinion was used to support the criminalisation of this practice.

Infection is a major complication of cerebrospinal fluid (CSF) shunting procedures. Recently, rifampin-impregnated and clindamycin-impregnated silicone catheters have been developed in an attempt to prevent and/or reduce the incidence of shunt infections. In vitro and in vivo animal studies have shown their efficacy in reducing bacterial colonization of catheters. However, these shunts are yet to be evaluated in clinical trials and their safety and efficacy in preventing shunt infections is unknown. Between April 2002 and April 2003, 31 children (age range 6 months to 17 years, mean 4.5 years) underwent implantation of an antibiotic-impregnated silicone catheter for CSF diversion. All surgeries were performed by a single neurosurgeon (HSM) at a single medical center. The Codman Hakim Bactiseal silicone catheter was used in all children. Thirty-two catheters were implanted in 31 children. All children have been followed since surgery (for an average of 19 months). For comparison, the previous 46 standard implanted shunts over a similar period of time were reviewed (average follow-up 31 months). Of the 32 implanted catheters, 11 involved placement of a new complete shunt system, 8 were distal revisions, and 13 were proximal/ventricular revisions. There were fewer early and late complications than in the standard shunt group (12.5 and 18.8% vs. 23.9 and 34.8%). There was no local reaction from implantation of the catheters. One child contaminated his distal catheter by disrupting his abdominal incision. None of the other patients have developed any evidence of shunt infection to date. Rifampin-impregnated and clindamycin-impregnated silicone catheters appear to be safe and well tolerated in children. Preliminary results suggest a low incidence of shunt infection. Longer follow-up and a larger number of patients are needed to more accurately assess the efficacy of these catheters compared with traditional silicone catheters.

OBJECTIVE: Ventricular shunt infections are a major contributor to morbidity in patients being treated for hydrocephalus. The majority of these infections are from Staphylococcus epidermidis. Prevention of bacterial adhesion to the silicone surface of a ventricular catheter could decrease shunt infections. We studied the effectiveness of a surfactant and/or 2% odine prewash on preventing bacterial adhesion to Silastic catheter material. METHODS: in a laboratory setting, various concentrations of a surfactant, Poloxamer-188 (P188), and a bactericidal agent, iodine, were compared against a control solution in their ability to prevent bacterial adhesion of 5, epidermidis to a silicone surface, Silicone wafers were soaked for 1 hour in the test solution, then inoculated and incubated with S. epidermidis for 24 hours. Bacterial counts were then obtained and compared. RESULTS: The most effective method tested in this study was 20% P188, which allowed only 3.02% bacterial adhesion compared with 22.2% bacterial adhesion in the control (P < 0.0001). P188 at a 10% concentration or 20% mixed with iodine had the next most effective inhibition. Of the germicidal solutions, a 5-ppm solution of iodine was the most effective. The most ineffective method tested was 2 ppm iodine. which allowed 13.2% bacterial adhesion CONCLUSION: Use of a surfactant and/or a germicidal will provide some protection against bacteria attaching to silicone surfaces before they are surgically implanted. The use of a surfactant soak of 20% P188 or iodine at a concentration of 5 ppm before inoculation with S. epidermidis significantly decreased the bacterial adhesion to silicone wafers. This finding has relevance to clinical practice because it highlights a simple step undertaken before implanting a ventricular catheter that could reduce the adhesion rate of the most common contaminant of these catheters. This step may become an important factor in decreasing infection rates in shunt-dependent patients.