“Should parental refusals of newborn screening be accepted?”

For over four decades, knowledge that symptoms of some inherited diseases can be prevented or reduced via early detection and treatment in newborns has underpinned state-funded screening programs in most developed countries. 1 Conditions for which newborn screening is now a recognized preventative public health initiative include phenylketonuria (PKU), congenital hypothyroidism (CHT), and, more recently, cystic fibrosis (CF) and sickle cell disorder (SCD). The use of tandem mass spectrometry to detect conditions such as amino-acidopathies and fatty-acid oxidation defects is also becoming increasingly prevalent. 2 The early identification of children who are at risk for these conditions can have very positive implications. To take the most significant example, a child born with mutations that would otherwise lead to symptoms of PKU will have a vastly different kind of life if the condition is detected in early infancy rather than later. The introduction of a modified diet at this time, although cumbersome, will prevent the onset of severe mental impairment, allowing the child to lead a virtually normal life. 3 Although clinical indications are sometimes more contentious when justifying screening for other conditions, by and large newborn screening is clinically valid and carries only minimal risk. However, it is sometimes declined by parents, presenting healthcare professionals with an ethical, legal, and practical dilemma. Consider the following scenario: Emma and Tom both work as pediatricians in a large city hospital. They have recently had their third child, a daughter named Clare. During a postnatal visit to their home by a midwife, Emma indicates that she and Tom do not want Clare to have any newborn screening. Emma reports there is no family history of any of the diseases being screened for, and she feels strongly that the probability Clare will have any of the conditions is so low that it cannot justify subjecting her to an invasive test. This scenario gives rise to three issues, each addressed below. First, is Emma and Tom’s refusal of newborn screening for Clare justifiable? Second, should the law ever mandate newborn screening over parental objections? Third, howshould such refusals be managed in practice? Using the example of PKU screening, it is argued that although refusals are often difficult to defend, legal intervention is unjustified as a means of compelling parents to allow their infant to be screened. Nevertheless, the state may be justified in exercising some degree of “influence” over parental decisionmaking, via the practices of health professionals involved in newborn screening.This article was written by Dr Ainsley Newson during the time of her employment with the University of Bristol, UK (2006-2012). Self-archived in the Sydney eScholarship Repository with permission of Bristol University, Sept 2014

Solution to problem 82-4 : A volume problem

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Application of the radio-iodine rose bengal test in liver disease in infancy and childhood

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Augmenting Distillation by Membranes: Developments and Prospects

The growing consciousness for sustainable industrial processes has resulted in industrially developed countries in supporting research efforts toward thorough evaluation of possibilities for improving efficiency of energy intensive separations implying also significant reduction of related carbon dioxide emissions. Being inherently thermodynamically inefficient, distillation, which is by far the most widely utilised and energy intensive separation technology in chemical process industries, has become primary target of energy conservation projects in refining, petrochemical and chemical industries. Improvement is an ongoing activity, replacing still beyond comprehension and a great deal of academic effort is oriented towards augmenting distillation by combining it, where appropriate, with membranes, i.e. pervaporation or vapour permeation, which in conjunction with polymeric membranes proved to be an industrially viable alternative to conventional processes for dehydration of alcohols. Present paper addresses recent developments along this line striving for larger fluxes in alcohol dehydrations by utilising ceramic membranes, with focus on vapour permeation, as well as the potential for the recovery of organic solvents and reactants forming azeotropes with other organics

Strategische vernieuwing in Nederlandse non-profit organisaties

Strategische vernieuwing in ondernemingen staat hoog op de agenda van managers en onderzoekers. De aandacht voor nonprofit-organisaties in dit verband is echter beperkt. Zo is er weinig bekend over de mate, de oorzaken en de implicaties van strategische vernieuwing. Dit artikel gaat in op dit thema. Met behulp van een enquête en twee casestudies wordt voor het eerst de vernieuwingsdynamiek van Nederlandse nonprofit-organisaties in kaart gebracht. De resultaten laten zien dat strategische vernieuwing door nonprofit-organisaties leidt tot een hoger prestatieniveau. Druk vanuit het management en/ of bestuur en druk vanuit de sociale omgeving blijken belangrijke determinanten voor de mate van strategische vernieuwin

Implicit measures of association in psychopathology research

Studies obtaining implicit measures of associations in Diagnostic and Statistical Manual of Mental Disorders (4th ed., Text Revision; American Psychiatric Association, 2000) Axis I psychopathology are organized into three categories: (a) studies comparing groups having a disorder with controls, (b) experimental validity studies, and (c) incremental and predictive validity studies. In the first category, implicit measures of disorder-relevant associations were consistent with explicit beliefs for some disorders (e.g., specific phobia), but for other disorders evidence was either mixed (e.g., panic disorder) or inconsistent with explicit beliefs (e.g., pain disorder). For substance use disorders and overeating, expected positive and unexpected negative associations with craved substances were found consistently. Contrary to expectation, implicit measures of self-esteem were consistently positive for patients with depressive disorder, social phobia, and body dysmorphic disorder. In the second category, short-term manipulations of disorder-relevant states generally affected implicit measures as expected. Therapeutic interventions affected implicit measures for one type of specific phobia, social phobia, and panic disorder, but not for alcohol use disorders or obesity. In the third category, implicit measures had predictive value for certain psychopathological behaviors, sometimes moderated by the availability of cognitive resources (e.g., for alcohol and food, only when cognitive resources were limited). The strengths of implicit measures include (a) converging evidence for dysfunctional beliefs regarding certain disorders and consistent new insights for other disorders and (b) prediction of some psychopathological behaviors that explicit measures cannot explain. Weaknesses include (a) that findings were inconsistent for some disorders, raising doubts about the validity of the measures, and (b) that understanding of the concept "implicit" is incomplete