Intractable difficulties in caring for people with Sickle Cell Disease

Bergman and Diamond (2013) have articulately and accurately identified many of the reasons why, and the problems associated with, the identification of people with sickle cell disease (SCD) as “difficult patients.” In our view, however, by suggesting that this problem is best dealt with through an ethics service consultation (ESC), they misconstrue the source of the difficulties of SCD and fail to appreciate the limitations of bioethics in seeking to improve the health care experience of people living with SCD. We provide empirical data describing an Australian perspective of SCD care, which highlights not only the complex issues raised by this illness but the challenges it creates for medical decision making and for bioethics. We suggest that the difficulties of SCD are protean in nature and that more can be gained from thinking again about the limits of bioethics and contemporary medicine than it can by seeking solace in clinical ethics consultation

Intractable difficulties in caring for people with Sickle Cell Disease

Bergman and Diamond (2013) have articulately and accurately identified many of the reasons why, and the problems associated with, the identification of people with sickle cell disease (SCD) as “difficult patients.” In our view, however, by suggesting that this problem is best dealt with through an ethics service consultation (ESC), they misconstrue the source of the difficulties of SCD and fail to appreciate the limitations of bioethics in seeking to improve the health care experience of people living with SCD. We provide empirical data describing an Australian perspective of SCD care, which highlights not only the complex issues raised by this illness but the challenges it creates for medical decision making and for bioethics. We suggest that the difficulties of SCD are protean in nature and that more can be gained from thinking again about the limits of bioethics and contemporary medicine than it can by seeking solace in clinical ethics consultation

The Wolf-Rayet population of Westerlund 1

New NTT/SOFI near-IR narrow-band imaging and spectroscopy reveals an additional four Wolf-Rayet (WR) stars in the massive cluster Westerlund 1, bringing the total WR population to 24. Sixteen of the WR stars in Wd1 have been classified WN5–11, while eight are WC8–9. An observed WR to RSG/YHG ratio of ∼3 suggests an age of 4.5–5.0 Myr, with WR stars descended from 40–55MSolar progenitors. On the basis of dust and hard X-ray emission, we estimate that 40–65% are probable members of massive star binary systems

Revealing the nebular properties and Wolf-Rayet population of IC10 with Gemini/GMOS

We present a deep imaging and spectroscopic survey of the Local Group irregular galaxy IC10 using Gemini North and GMOS to unveil its global Wolf-Rayet (WR) population. We obtain a star formation rate (SFR) of 0.045 ± 0.023 M⊙yr−1, for IC10 from the nebular Hα luminosity, which is comparable to the SMC. We also present a revised nebular oxygen abundance of log(O/H) + 12 = 8.40 ± 0.04, comparable to the LMC. It has previously been suggested that for IC10 to follow the WR subtype-metallicity dependance seen in other Local Group galaxies, a large WN population awaits discovery. Our search revealed 3 new WN stars, and 6 candidates awaiting confirmation, providing little evidence to support this claim. The new global WR star total of 29 stars is consistent with the LMC population when scaled to the reduced SFR of IC10. For spectroscopically confirmed WR stars, the WC/WN ratio is lowered to 1.0, however including all potential candidates, and assuming those unconfirmed to be WN stars, would reduce the ratio to ∼0.7. We attribute the high WC/WN ratio to the high star formation surface density of IC10 relative to the Magellanic Clouds, which enhances the frequency of high mass stars capable of producing WC stars

EBM and Epistemological Imperialism: Narrowing the divide between evidence and illness

Evidence Based Medicine (EBM) is an approach to clinical practice that relies on the use of systematically reviewed published clinical research of high quality. Whilst there is some speculation as to whether a true consensus definition of EBM exists (Loughlin (2008)(1)), a commonly cited explanation “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients’ (Sackett et al (1996)(2)). Most approaches to “EBM” incorporate the use of an evidence hierarchy that presupposes that some forms of evidence are better than others (Guyatt and Rennie (2002)(3)), that meta-analyses and randomised controlled trials (RCTs) will guide a better level of care than expert or local knowledge. Although EBM is pervasive throughout all health literature a number of ethical (Gupta (2009)(4)), epistemological (Loughlin (2008)(1)), and clinical practice critiques (Tobin (2008)(5)) have emerged. Criticisms of EBM on ethical grounds have previously been summarised by Kerridge (2010)(6) and include ; “that the implicit and explicit requirement for RCTs may lead to unnecessary research being done where sufficient evidence already exists;... that methods privileged by EBM, most notably the RCT, are methodologically unable to answer questions related to individual patients;.... that evidence hierarchies are inadequate and misleading;.... that the dataset that EBM draws from is systematically bias[ed],.... that the translation of evidence into practice through clinical practice guidelines and decision aids is both ethically and epistemologically problematic...[and] that evidence is not value-neutral and cannot be easily translated into practice.

Luminous Blue Variable Stars In The Two Extremely Metal-Deficient Blue Compact Dwarf Galaxies DDO 68 and PHL 293B

We present photometric and spectroscopic observations of two luminous blue variable (LBV) stars in two extremely metal-deficient blue compact dwarf (BCD) galaxies, DDO 68 with 12+logO/H = 7.15 and PHL 293B with 12+logO/H = 7.72. These two BCDs are the lowest-metallicity galaxies where LBV stars have been detected, allowing to study the LBV phenomenon in the extremely low metallicity regime, and shedding light of the evolution of the first generation of massive stars born from primordial gas. We find that the strong outburst of the LBV star in DDO 68 occurred sometime between February 2007 and January 2008. We have compared the properties of the broad line emission in low-metallicity LBVs with those in higher metallicity LBVs. We find that, for the LBV star in DDO 68, broad emission with a P Cygni profile is seen in both H and He I emission lines. On the other hand, for the LBV star in PHL 293B, P Cygni profiles are detected only in H lines. For both LBVs, no heavy element emission line such as Fe II was detected. The Halpha luminosities of LBV stars in both galaxies are comparable to the one obtained for the LBV star in NGC 2363 (Mrk 71) which has a higher metallicity 12+logO/H = 7.89. On the other hand, the terminal velocities of the stellar winds in both low-metallicity LBVs are high, ~800 km/s, a factor of ~4 higher than the terminal velocities of the winds in high-metallicity LBVs. This suggests that stellar winds at low metallicity are driven by a different mechanism than the one operating in high-metallicity winds.Comment: 26 pages, 5 figures, accepted for publication in the Astrophysical Journa

A Spectroscopic Study of a Large Sample of Wolf-Rayet Galaxies

We analyze long-slit spectral observations of 39 Wolf-Rayet (WR) galaxies with heavy element mass fraction ranging over 2 orders of magnitude, from Zsun/50 to 2Zsun. Nearly all galaxies in our sample show broad WR emission in the blue region of the spectrum (the blue bump) consisting of an unresolved blend of N III 4640, C III 4650, C IV 4658 and He II 4686 emission lines. Broad C IV 5808 emission (the red bump) is detected in 30 galaxies. Additionally, weaker WR emission lines are identified, most often the N III 4512 and Si III 4565 lines, which have very rarely or never been seen and discussed before in WR galaxies. These emission features are characteristic of WN7-WN8 and WN9-WN11 stars respectively. We derive the numbers of early WC (WCE) and late WN (WNL) stars from the luminosities of the red and blue bumps, and the number of O stars from the luminosity of the Hbeta emission line. Additionally, we propose a new technique for deriving the numbers of WNL stars from the N III 4512 and Si III 4565 emission lines. This technique is potentially more precise than the blue bump method because it does not suffer from contamination of WCE and early WN (WNE) stars and nebular gaseous emission. The N(WR)/N(O+WR) ratio decreases with decreasing metallicity, in agreement with predictions of evolutionary synthesis models. The N(WC)/N(WN) ratios and the equivalent widths of the blue bump EW(4650) and of the red bump EW(5808) derived from observations are also in satisfactory agreement with theoretical predictions.Comment: 49 pages, 9 figures, to appear in Astrophys.

Teachers as leaders in a knowledge society: encouraging signs of a new professionalism

[Abstract]: Challenges confronting schools worldwide are greater than ever,and, likewise, many teachers possess capabilities, talents, and formal credentials more sophisticated than ever. However, the responsibility and authority accorded to teachers have not grown significantly, nor has the image of teaching as a profession advanced significantly. The question becomes, what are the implications for the image and status of the teaching profession as the concept of knowledge society takes a firm hold in the industrialized world? This article addresses the philosophical underpinnings of teacher leadership manifested in case studies where schools sought to achieve the generation of new knowledge as part of a process of whole-school revitalization. Specifically, this article reports on Australian research that has illuminated the work of teacher leaders engaged in the IDEAS project, a joint school revitalization initiative of the University of Southern Queensland and the Queensland Department of Education and the Arts

Further Wolf-Rayet stars in the starburst cluster Westerlund 1

We present new low and intermediate-resolution spectroscopic observations of the Wolf Rayet (WR) star population in the massive starburst cluster Westerlund 1. Finding charts are presented for five new WRs - four WNL and one WCL - raising the current total of known WRs in the cluster to 19. We also present new spectra and correct identifications for the majority of the 14 WR stars previously known, notably confirming the presence of two WNVL stars. Finally we briefly discuss the massive star population of Westerlund 1 in comparison to other massive young galactic clusters.Comment: Accepted for publication in Astronomy & Astrophysics. Eight pages, six figures. Replaced with final version, some minor change

Shadowing Ministers: Monitoring Partners in Coalition Governments

In this article the authors study delegation problems within multiparty coalition governments. They argue that coalition parties can use the committee system to “shadow” the ministers of their partners; that is, they can appoint committee chairs from other governing parties, who will then be well placed to monitor and/or check the actions of the corresponding ministers. The authors analyze which ministers should be shadowed if governing parties seek to minimize the aggregate policy losses they suffer as the result of ministers pursuing their own parties’ interests rather than the coalition’s. Based on data from 19 mostly European parliamentary democracies, the authors find that the greater the policy disagreement between a minister’s party and its partners, the more likely the minister is to be shadowed