In a portion of the coastal waters of northeastern Florida, North Atlantic right whales (Eubalaena glacialis) occur close to shore from December through March. These waters are included within the ...designated critical habitat for right whales. Data on swim speed, behavior, and direction of movement--with photo-identification of individual whales--were gathered by a volunteer sighting network working alongside experienced scientists and supplemented by aerial observations. In seven years (2001-2007), 109 tracking periods or "follows" were conducted on right whales during 600 hours of observation from shore-based observers. The whales were categorized as mother-calf pairs, singles and non-mother-calf pairs, and groups of 3 or more individuals. Sample size and amount of information obtained was largest for mother-calf pairs. Swim speeds varied within and across observation periods, individuals, and categories. One category, singles and non mother-calf pairs, was significantly different from the other two--and had the largest variability and the fastest swim speeds. Median swim speed for all categories was 1.3 km/h (0.7 kn), with examples that suggest swim speeds differ between within-habitat movement and migration-mode travel. Within-habitat right whales often travel back-and-forth in a north-south, along-coast, direction, which may cause an individual to pass by a given point on several occasions, potentially increasing anthropogenic risk exposure (e.g., vessel collision, fishing gear entanglement, harassment). At times, mothers and calves engaged in lengthy stationary periods (up to 7.5 h) that included rest, nursing, and play. These mother-calf interactions have implications for communication, learning, and survival. Overall, these behaviors are relevant to population status, distribution, calving success, correlation to environmental parameters, survey efficacy, and human-impacts mitigation. These observations contribute important parameters to conservation biology, predictive modeling, and management. However, while we often search for predictions, patterns, and means, the message here is also about variability and the behavioral characteristics of individual whales.
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The ALFA Roman Pot detectors of ATLAS Khalek, S. Abdel; Allongue, B.; Anghinolfi, F. ...
Journal of instrumentation,
11/2016, Volume:
11, Issue:
11
Journal Article
Peer reviewed
Open access
The ATLAS Roman Pot system is designed to determine the total proton-proton cross section as well as the luminosity at the Large Hadron Collider (LHC) by measuring elastic proton scattering at very ...small angles. The system is made of four Roman Pot stations, located in the LHC tunnel in a distance of about 240 m at both sides of the ATLAS interaction point. Each station is equipped with tracking detectors, inserted in Roman Pots which approach the LHC beams vertically. The tracking detectors consist of multi-layer scintillating fibre structures read out by Multi-Anode-Photo-Multipliers.
Parental discretion Hain, Richard D W
Archives of disease in childhood,
10/2022, Volume:
107, Issue:
10
Journal Article
Peer reviewed
Correspondence to Prof Richard D W Hain, Department of Paediatrics, Cardiff and Vale University LHB, Cardiff CF14 4XN, Wales, UK; richard.hain@southwales.ac.uk Introduction: principles In children, ...respect for autonomy is secondary to an obligation to consider a child’s interests and to make them paramount.1 What happens to the child will inevitably impact on the whole family.2 A parent’s exercise of personal autonomy does not, however, extend directly to making decisions about a child, because, whether or not she can express them, the child has some interests which are separable from those of her parents. There are, however, other occasions when the paediatrician is right to believe that the course parents prefer is unreasonable: that is, the likelihood and extent of harm to the child that it offers is too great relative to its benefit. In Principles of Biomedical Ethics, Beauchamp and Childress point out that, while veracity is not necessarily a fundamental principle in itself (it is possible to envisage circumstances under which it might be wrong to tell the whole truth), in practice most patients do expect healthcare professionals to be honest.5 The UK’s General Medical Council explicitly expects doctors to be committed to truth telling, on the grounds that good medical care relies on a patient being able to trust her doctor.6 Leaving parents with the impression that they are making decisions, when in reality they are being manipulated, is a clear failure to meet the obligations of candour. Resolving the tension: parental discretion The ‘zone of parental discretion’ (ZPD) represents the extent to which a paediatrician should act in accordance with parental preferences, even when she feels they are not for what is ideal.7 The ZPD affirms that there are some courses of action that parents might prefer but which doctors should not take.
Euthanasia: 10 myths Hain, Richard DW
Archives of disease in childhood,
09/2014, Volume:
99, Issue:
9
Journal Article
Peer reviewed
Over the two decades that have elapsed since I first became interested in the ethics of euthanasia and physician-assisted suicide, I have changed my mind. Since the demonstrable result of legalising ...euthanasia is that incurably ill patients are removed, making more resources available to people who can be restored to full health, utilitarian medical ethics must logically hasten progress down the slope, rather than retarding it.
Quality of life: what matters? Hain, Richard D W; Turner, Stephen W
Archives of disease in childhood,
06/2022, Volume:
107, Issue:
6
Journal Article
Peer reviewed
National Institute for Health and Care Excellence (NICE) evaluates cost-effectiveness using a measure that combines the likelihood of prolonging an individual’s life and improving her QL: ‘QALYs ...(Quality-Adjusted Life Years) are calculated by estimating the years of life remaining for a patient and weighting each year with a quality-of-life score (on a 0 to 1 scale)’.8 NICE will usually recommend a treatment which costs £20 000–30 000 per QALY. The future benefits and harms of puberty-blocking drugs, for example, will extend over several decades and need to be appropriately weighted when considered alongside their effects on the child’s QL in the present moment. Since contributors to the quality of a child’s life, and its normal duration, are both different from those of an adult, it is perhaps surprising that there is no specifically paediatric QALY ‘tariff’ set by NICE. Summary Most paediatricians intuitively recognise that compassionate medical care should not restrict itself to curing a child’s condition but should also attend to enabling her to enjoy her life as much as possible (for example, treating enuresis to allow sleep-overs). The role of Response-Shift in studies assessing quality of life outcomes among cancer patients: a systematic review.
Children's hospices offer support to children and their families according to a model that is quite different from adult hospices and has evolved in parallel with specialist paediatric palliative ...medicine services.
Published research, Together for Short Lives.
The services hospices offer are highly valued by families.
It is not always clear that hospices can be described as 'specialist', which can make it difficult for hospices to negotiate appropriate commissioning arrangements with the statutory sector.
Children's palliative care generally is poorly developed compared with the adult specialty, and local providers should work with hospices to help redress the inequity that children face in accessing specialist palliative care.
If hospices are to continue to be important providers of palliative care in children they must develop robust and fair relationships with local healthcare providers. That would be facilitated by development of a funding formula for children that properly acknowledges the part hospices already play in palliative care.
In the majority of cases in these decisions are made jointly by parents and clinicians.4 However, disagreements leading to conflict can sometimes develop between professionals and families in the ...context of critical illness both in children and adults.5 6 End-of-life decision making and communication failure are the common areas of dispute.6 7 Conflict is also prevalent in children’s inpatient wards8 where staff report communication breakdown, disagreements over treatment and unrealistic expectations as the most common causes. The Royal College of Paediatrics and Child Health (RCPCH) has previously produced guidelines on limitations of treatment, including guidance around decision making and managing disagreement.12 However, recent cases of entrenched disagreement have been associated with intense media coverage and demonstrations outside children’s hospitals.13 This can have profound effects on staff, children and their families. In this document we have tried to summarise practical recommendations for those working with children and young people both to prevent and manage conflict, in effect to achieve consensus in decision making with families. Since evidence about the best ways of achieving consensus in healthcare is limited, these recommendations, endorsed by the RCPCH, are necessarily based on opinion and experience. ...opinions can be most successful when families have a chance first to meet the clinician/s giving the second opinion before they see the child.
Many children with palliative care needs experience difficulty in managing pain. Perhaps none more so than those with severe neurological impairment. For many years; behaviours in these children were ...misunderstood. As a result; pain was poorly recognised and inadequately managed. Significant advances have been made in the assessment and management of pain in this challenging group of patients. We summarise these advances; drawing on our own experience working with infants; children and young adults with palliative care needs within a UK tertiary paediatric palliative care service. We expand on the recent understanding of 'Total Pain'; applying a holistic approach to pain assessment and management in children with severe neurological impairment.
No randomised controlled trials have been conducted for breakthrough pain in paediatric palliative care and there are currently no standardised outcome measures. The DIPPER study aims to establish ...the feasibility of conducting a prospective randomised controlled trial comparing oral and transmucosal administration of opioids for breakthrough pain. The aim of the current study was to achieve consensus on design aspects for a small-scale prospective study to inform a future randomised controlled trial of oral morphine, the current first-line treatment, versus transmucosal diamorphine.
The nominal group technique was used to achieve consensus on best practice for mode of administration, dose regimen and a range of suitable pain intensity outcome measures for transmucosal diamorphine in children and young people with breakthrough pain. An expert panel of ten clinicians in paediatric palliative care and three parent representatives participated. Consensus was achieved when agreement was reached and no further comments from participants were forthcoming.
The panel favoured the buccal route of administration, with dosing according to the recommendations in the Association for Paediatric Palliative Medicine formulary (fifth Edition, 2020). The verbal Numerical Rating Scale was selected to measure pain in children 8 years old and older, the Faces Pain Scale-Revised for children between 4 and 8 years old, and Face, Legs, Activity, Cry and Consolability (FLACC)/FLACC-Revised as the observational tools.
The nominal group technique allowed consensus to be reached for a small-scale, prospective, cohort study and provided information to inform the design of a randomised controlled trial.
Summary
Background: Morphine is one of the most widely used opioid analgesics for controlling pain in cancer and post‐operative patients.
Objective: This study aimed at finding a sensitive method ...for measuring morphine.
Method: A one‐step solid phase extraction was developed for extracting morphine from various samples, and morphine concentration was measured using a high‐performance liquid chromatographic system with electrochemical detection. The sensitivity of the assay was 1·53 ng/mL with a recovery of 93·4% ± 0·01. The mean intra‐assay and inter‐assay test for three concentrations was 10·54 and 7·47, respectively. The assay showed no cross‐reaction with a wide range of compounds.
Conclusion: This method for morphine in small biological samples is easy, sensitive and reproducible with low cross‐reactivity.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
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