Goals-of-Care & End-of-Life Quality in Relapsed High-Risk Leukemia: Silent Conversations

BACKGROUND: The distorted association of “end of life (EOL)” with “goals of care (GOC)” has “silenced” crucial goals discussions in patients with relapsed high-risk leukemia, which raises concerns for the provision of care that is inconsistent with patient’s values and preferences. AIM: The two main goals of this study were to quantify hematologists rate of participation in a GOC pathway initiative during two separate months, then explore their definition and barriers to having/documenting GOC discussions. DESIGN: Mixed-methods, explanatory sequential design (follow-up explanations variant). SAMPLE: Quan: Hematology inpatient admissions during the months of October 2020 and January 2021. Qual: Eighteen leukemia hematologists from one dedicated cancer in the United States. RESULTS: During the two months, an average of 36% of admissions met criteria for GOC pathway initiation, 19% of those had an appropriate initiation order, of which 15.5% had a properly documented and billed GOC discussion. Nine hematologists responded to the SurveyMonkey with two questions. All nine included clinical situation and communication in their definition/components of GOC discussions. Time required and prognostic uncertainty were the two most mentioned barriers

Developmental and evolutionary origins of the pharyngeal apparatus

The vertebrate pharyngeal apparatus, serving the dual functions of feeding and respiration, has its embryonic origin in a series of bulges found on the lateral surface of the head, the pharyngeal arches. Developmental studies have been able to discern how these structures are constructed and this has opened the way for an analysis of how the pharyngeal apparatus was assembled and modified during evolution. For many years, the role of the neural crest in organizing pharyngeal development was emphasized and, as this was believed to be a uniquely vertebrate cell type, it was suggested that the development of the pharyngeal apparatus of vertebrates was distinct from that of other chordates. However, it has now been established that a key event in vertebrate pharyngeal development is the outpocketing of the endoderm to form the pharyngeal pouches. Significantly, outpocketing of the pharyngeal endoderm is a basal deuterostome character and the regulatory network that mediates this process is conserved. Thus, the framework around which the vertebrate pharyngeal apparatus is built is ancient. The pharyngeal arches of vertebrates are, however, more complex and this can be ascribed to these structures being populated by neural crest cells, which form the skeletal support of the pharynx, and mesoderm, which will give rise to the musculature and the arch arteries. Within the vertebrates, as development progresses beyond the phylotypic stage, the pharyngeal apparatus has also been extensively remodelled and this has seemingly involved radical alterations to the developmental programme. Recent studies, however, have shown that these alterations were not as dramatic as previously believed. Thus, while the evolution of amniotes was believed to have involved the loss of gills and their covering, the operculum, it is now apparent that neither of these structures was completely lost. Rather, the gills were transformed into the parathyroid glands and the operculum still exists as an embryonic entity and is still required for the internalization of the posterior pharyngeal arches. Thus, the key steps in our phylogenetic history are laid out during the development of our pharyngeal apparatus

Changes in child exposure to secondhand smoke after implementation of smoke-free legislation in Wales: a repeated cross-sectional study.

Background: Smoke-free legislation was introduced in Wales in April 2007. In response to concerns regarding potential displacement of smoking into the home following legislation, this study assessed changes in secondhand smoke (SHS) exposure amongst non-smoking children. Methods: Approximately 1,750 year 6 (aged 10-11) children from 75 Welsh primary schools were included in cross-sectional surveys immediately pre-legislation and one year later. Participants completed self-report questionnaires and provided saliva samples for cotinine assay. Regression analyses assessed the impact of legislation on children's SHS exposure at the population level, and amongst subgroups defined by parental figures who smoke within the home. Results: Geometric mean salivary cotinine concentrations were 0.17 ng/ml (95% CI 0.15,0.20) pre-legislation and 0.15 ng/ml (95% CI 0.13,0.17), post-legislation, although this change was not statistically significant. Significant movement was however observed from the middle (0.10-0.50 ng/ml) to lower tertile, though not from the higher end (>0.51 ng/ml) to the middle. Reported exposure to SHS was greatest within the home. Home-based exposure did not change significantly post-legislation. Reported exposure in cafés or restaurants, buses and trains, and indoor leisure facilities fell significantly. The proportion of children reporting that parent figures smoked in the home declined (P = 0.03), with children with no parent figures who smoke in the home significantly more likely to provide saliva with cotinine concentrations of <0.10 ng/ml post-legislation. Amongst children with no parent figures who smoke in the home, the likelihood of 'not knowing' or 'never' being in a place where people were smoking increased post-legislation. Conclusion: Smoke-free legislation in Wales did not increase SHS exposure in homes of children aged 10-11. Reported SHS exposure in public places fell significantly. The home remained the main source of children's SHS exposure. The legislation was associated with an unexpected reduction in cotinine levels among children with lower SHS exposure pre-legislation. The findings indicate positive rather than harmful effects of legislation on children's SHS exposure, but highlight the need for further action to protect those children most exposed to SHS

Singing and Social Identity in Young Children

A range of studies suggest that singing activities with young children can have a beneficial impact on other aspects of their development. However, there is little research examining the relationship between young children’s singing and their developing social identity. In the current study, data were captured of young children’s singing and social identity as part of a larger-scale, longitudinal evaluation of the nationwide Sing Up programme in England. Participants were 720 children aged 5-8 years old. The assessment of young children’s singing ability employed an established measure and was undertaken individually. With adult support, the children were also asked to complete a simple questionnaire that focused on selected aspects of their social identity, both in general terms and also related to singing. Key themes embraced their attitudes to singing (at home, in school and in informal settings), singer identity (emotional engagement with singing and self-concept), and perceptions of self (self-efficacy, self-esteem, social integration). Comparative data were collected from young children of a similar age outside the programme. Findings suggested that the programme had a positive impact on children’s singing ability, both overall and including the youngest children. The data analyses suggest that children could be identified as either “pupils with positive singing identity” or “pupils with less positive, or still developing singing identity.” Overall, pupils with a more positive singer identity—irrespective of Sing Up-related experience—tended to report more positive attitudes toward singing at school and other settings, had higher perceived levels of self-esteem and social integration, as well as more positive evaluations of their singing ability. Furthermore, the research suggests that successful participation in high-quality singing activities is likely to have a positive impact on young children’s singing ability and, by implication, such positive singing development will also be associated with aspects of self that are related to contexualised singer identity and their sense of social inclusion

The National Singing Programme for primary schools in England: an initial baseline study

The ‘Sing Up’ National Singing Programme for Primary schools in England was launched in November 2007 under the UK Government’s ‘Music Manifesto’. ‘Sing Up’ is a four-year programme whose overall aim is to raise the status of singing and increase opportunities for children throughout the country to enjoy singing as part of their everyday lives, in and out of school. As part of the Programme’s research evaluation, a key focus has been to build an initial picture of singing in Primary schools across England. This information could then be used as a ‘baseline’ by which the programme’s subsequent impact could be judged, including ‘before’ and ‘after’ measures of schools that receive particular ‘Sing Up’ input. This paper reports an overview of key outcomes of first five months of baseline profiling (October, 2007 to February 2008), embracing analyses of the singing behaviours of 3,472 children in 76 Primary schools. These findings are complimented by additional analyses of children’s views on singing in and out of school; and the self-efficacy of their class teachers’ (n=90), both as singers and as teachers of singing

Prospectivity Mapping for Epithermal Deposits of Western Milos Using a Fuzzy Multi Criteria Evaluation Approach Parameterized by Airborne Hyperspectral Remote Sensing Data

A Mineral prospectivity mapping (MPM) approach using a GIS-based weighted linear combination implementation of a Multi-Criteria Evaluation approach utilising a fuzzy Analytical Hierarchy Process to elucidate expert knowledge has been implemented to analyse the spatial distribution of epithermal deposits on the Island of Milos, Greece and model their association with exploration evidence data with the aim of providing insights into the controls on ore deposition. An integrated field and Digital Airborne Imaging Spectrometer (DAIS) hyperspectral and thermal multispectral airborne remote sensing dataset supported by field mapping and laboratory analyses, has been utilised to resolve hydrothermal alteration and parameterise the MPM. This study has highlighted the intimate spatial relationship between topographic highs and locations with high grade silicified alteration at a number of locations. The ability of high spatial resolution multispectral Thermal InfraRed (TIR) remote sensing imagery, integrated with topographic data, to resolve these silicified topographic highs provides an additional tool in the exploration of epithermal deposits. The spatial relationships between silicified lithocaps, high-grade altered rocks, faulting and topographic highs were utilised in the development of the MPM model. A close association between the modelled results and the hydrothermal alteration mapped in the field supports the accuracy of this MPM approach.Funded by Natural Environment Research Council (NERC) GA/09f/139-RMS E355

Exposure to secondhand smoke in cars and e-cigarette use among 10-11 year old children in Wales: CHETS Wales 2 key findings report

No abstract available