Rethinking pediatric ethics consultations

Johnson and colleagues (2015) report a retrospective review of the experience of an ethics consultation service at a single, highly specialized children's hospital over an 11-year period. Despite its methodologic limitations, the results of this study are worthy of note. The St. Jude Children's Research Hospital ethics consultation service consulted on a range of complex cases, including the management of conflict between parents and physicians, futility, parental demands, treatment nonadherence, and, less commonly, end-of-life issues. The number of case consultations was small, fewer than five per year, and did not increase over time. The retrospective nature of the study prevented eliciting how often consultations altered treatment or other decisions. No record was kept of clinical staff, parent, or patient perception of the value of the ethics consultation, nor of the frequency or value of informal (curb side) ethics consultations. The St. Jude ethics consultation process is consistent with “standard” models in the field. An ethics team comprising two to five staff members, including an ethicist, performs the initial ward consultation, which is then discussed with the formal clinical ethics committee of 21 people. Other involved services participate via interdisciplinary meetings. The types of consultation are consistent with many other services, including both formal and informal consultations using a range of methods to assist resolution of cases, including mediation and arbitration. Despite open access to requesting consultations, including anonymous enquiries, almost all requests came from physicians, often the same ones. Only a few came from nurses and none from parents or patients. Importantly, nurses appeared to be subject to repercussions from physicians if they requested consultations, an important issue that requires further attention but goes beyond the scope of our commentary. We suggest that the experience of the St. Jude service illustrates both the limitations of ethics consultation and the need to evaluate the importance and impact of an ethics service using metrics other than simply the number of case consultations

Licensed control does not reduce local Cormorant Phalacrocorax carbo population size in winter

Cormorants Phalacrocorax carbo have increased on European freshwaters, creating conflicts with fishing interests. As a result, control measures have been implemented in several countries, although their effect on the English population has yet to be determined. Wetland Bird Survey data was used to derive population growth rates (PGR) of non-coastal Cormorant populations in England. PGR was analysed in relation to control intensity at different scales (5- to 30-km radius) from 2001 to 2009 in order to determine (1) the extent to which control intensity (proportion of the local population shot per winter) was associated with site-level population change, and (2) whether potential effects of control intensity were evident on Special Protection Areas (SPAs). There were no clear differences in PGR when comparing sites which had experienced control versus sites where control had never been carried out. The few significant relationships between control intensity and Cormorant PGR detected were mostly positive, i.e. population growth was associated with higher control intensity. Control intensity was not related to Cormorant numbers in SPAs. Positive associations with control may arise because control is reactive, or because non-lethal effects cause greater dispersal of Cormorants. These results provide no evidence that Cormorant removal at local scales is having an effect on longer term (i.e. year-to-year) population size at a site level. They also suggest that control measures have not affected national population trends, although a better understanding of site use and movements of individual Cormorants needs to be developed at smaller scales (including those due to disturbance caused by control measures) to more fully understand processes at larger scales. Further research is also needed into the extent to which lethal and non-lethal effects of control on Cormorants are having the desired impact on predation rates of fish, and so help resolve the conflict between Cormorants and fisheries.</p

An indoor test methodology for solar-powered wireless sensor networks

Repeatable and accurate tests are important when designing hardware and algorithms for solar-powered wireless sensor networks (WSNs). Since no two days are exactly alike with regard to energy harvesting, tests must be carried out indoors. Solar simulators are traditionally used in replicating the effects of sunlight indoors - however, solar simulators are expensive, have lighting elements that have short lifetimes, and are usually not designed to carry out the types of tests that hardware and algorithm designers require. As a result, hardware and algorithm designers use tests that are inaccurate and not repeatable (both for others and also for the designers themselves). In this article we propose an indoor test methodology which does not rely on solar simulators. The test methodology has its basis in astronomy and photovoltaic (PV) cell design. We present a generic design for a test apparatus which can be used in carrying out the test methodology. We also present a specific design which we use in implementing an actual test apparatus. We test the efficacy of our test apparatus and, to demonstrate the usefulness of the test methodology, perform experiments akin to those required in projects involving solar-powered WSNs. Results of the said tests and experiments demonstrate that the test methodology is an invaluable tool for hardware and algorithm designers working with solar-powered WSNs

Compact graphene mode-locked wavelength-tunable erbium-doped fiber lasers: from all anomalous dispersion towards all normal dispersion

Soliton operation and soliton wavelength tuning of erbium-doped fiber lasers mode locked with atomic layer graphene was experimentally investigated under various cavity dispersion conditions. It was shown that not only wide range soliton wavelength tuning but also soltion pulse width variation could be obtained in the fiber lasers. Our results show that the graphene mode locked erbium-doped fiber lasers provide a compact, user friendly and low cost wavelength tunable ultrahsort pulse source

Cultural Identity Conflict Informs Engagement with Self-Management Behaviours for South Asian Patients Living with Type-2 Diabetes: A Critical Interpretative Synthesis of Qualitative Research Studies

The prevalence of type-2 diabetes (T2D) is increasing, particularly among South Asian (SA) communities. Previous research has highlighted the heterogeneous nature of SA ethnicity and the need to consider culture in SA patients’ self-management of T2D. We conducted a critical interpretative synthesis (CIS) which aimed to a) develop a new and comprehensive insight into the psychology which underpins SA patients’ T2D self-management behaviours and b) present a conceptual model to inform future T2D interventions. A systematic search of the literature retrieved 19 articles, including 536 participants. These were reviewed using established CIS procedures. Analysis identified seven constructs, from which an overarching synthesizing argument ‘Cultural Conflict’ was derived. Our findings suggest that patients reconstruct knowledge to manage their psychological, behavioural, and cultural conflicts, impacting decisional conflicts associated with T2D self-management and health professional advice (un)consciously. Those unable to resolve this conflict were more likely to default towards cultural identity, continue to align with cultural preferences rather than health professional guidance, and reduce engagement with self-management. Our synthesis and supporting model promote novel ideas for self-management of T2D care for SA patients. Specifically, health professionals should be trained and supported to explore and mitigate negative health beliefs to enable patients to manage social-cultural influences that impact their self-management behaviours. Keywords: type 2 diabetes; South Asian; culture; conflict; healthcare; qualitative; evidence synthesi

Intrinsic response time of graphene photodetectors

Graphene-based photodetectors are promising new devices for high-speed optoelectronic applications. However, despite recent efforts, it is not clear what determines the ultimate speed limit of these devices. Here, we present measurements of the intrinsic response time of metal-graphene-metal photodetectors with monolayer graphene using an optical correlation technique with ultrashort laser pulses. We obtain a response time of 2.1 ps that is mainly given by the short lifetime of the photogenerated carriers. This time translates into a bandwidth of ~262 GHz. Moreover, we investigate the dependence of the response time on gate voltage and illumination laser power

Health-related quality of life following surgical attenuation of congenital portosystemic shunts versus a healthy control population of dogs

OBJECTIVES: To design a health-related quality of life questionnaire for dogs with congenital portosystemic shunts, use it in a cohort of dogs treated with suture attenuation and compare results with those obtained from a healthy control cohort. MATERIALS AND METHODS: Data were collected from the hospital records of dogs treated with suture ligation of an intrahepatic or extrahepatic congenital portosystemic shunt at two referral centres. Owners were asked to complete a questionnaire assessing their dog's health-related quality of life preoperatively (retrospectively) and at the time of follow-up. Owners of control dogs also completed the questionnaire. RESULTS: One hundred and twenty-eight dogs with congenital portosystemic shunts and 131 control dogs were recruited. Median follow-up time was 64 months (range 19.7 to 157.2). The median long-term health-related quality of life score was excellent for both intrahepatic and extrahepatic shunt cases and similar to that of control dogs. The long-term portosystemic shunt clinical sign scores for both intrahepatic and extrahepatic congenital portosystemic shunt dogs were significantly worse than the those of the control group. CLINICAL SIGNIFICANCE: Suture attenuation of congenitial portosystemic shunts is associated with an excellent health-related quality of life score at long-term follow-up

Health professionals interface with cultural conflict in the delivery of type 2 diabetes care.

OBJECTIVE: This study explored the knowledge and experiences of health professionals (HPs) caring for South Asian patients with type 2 diabetes (T2D). DESIGN: Fourteen HPs, who supported patients with T2D, were interviewed. The recruitment strategy employed purposeful and theoretical sampling methods to recruit HPs who worked across primary and secondary care settings. MAIN OUTCOME MEASURES: Grounded Theory (GT) methodology and analysis generated a theoretical framework that explored HP's perceptions and experiences of providing diabetes care for South Asian patients. RESULTS: A GT, presenting a core category of Cultural Conflict in T2D care, explores the influences of HP's interactions and delivery of care for South Asian patients. This analysis is informed by four categories: (1) Patient Comparisons: South Asian vs White; (2) Recognising the Heterogeneous Nature of South Asian Patients; (3) Language and Communication; (4) HPs' Training and Experience. CONCLUSIONS: The findings consider how the role of social comparison, social norms, and diminished responsibility in patient self-management behaviours influence HPs' perceptions, implicit and explicit bias towards the delivery of care for South Asian patients. There was a clear call for further support and training to help HPs recognise the cultural-ethnic needs of their patients