Holding and restraining children for clinical procedures within an acute care setting: an ethical consideration of the evidence

This critical reflection on the ethical concerns of current practice is underpinned by a systematic synthesis of current evidence focusing on why and how children are held or restrained for clinical procedures within acute care and the experiences of those present when a child is held against their wishes. Empirical evidence from a range of clinical settings internationally demonstrates that frequently children are held for procedures to be completed; younger children and those requiring procedures perceived as urgent are more likely to be held. Parents and health professionals express how holding children for procedures can cause feelings of moral distress expressed as uncertainty, guilt and upset and that this act breaches the trusting and protective relationship established with children. Despite this, children’s rights and alternatives to holding are not always respected or explored. Children’s experiences and perceptions are absent from current literature. Children and young people have a moral right to have their voice and protests heard and respected and for these to inform judgements of their best interests and the actions of health professionals. Without robust evidence, debate and recognition that children are frequently held against their wishes in clinical practice for procedures which may not be urgent, children’s rights will continue to be compromised

Stratigraphy and chronology of a 15ka sequence of multi-sourced silicic tephras in a montane peat bog, eastern North Island, New Zealand.

We document the stratigraphy, composition, and chronology of a succession of 16 distal, silicic tephra layers interbedded with lateglacial and Holocene peats and muds up to c. 15 000 radiocarbon years (c. 18 000 calendar years) old at a montane site (Kaipo Bog) in eastern North Island, New Zealand. Aged from 665 +/- 15 to 14 700 +/- 95 14C yr BP, the tephras are derived from six volcanic centres in North Island, three of which are rhyolitic (Okataina, Taupo, Maroa), one peralkaline (Tuhua), and two andesitic (Tongariro, Egmont). Correlations are based on multiple criteria: field properties and stratigraphic interrelationships, ferromagnesian silicate mineral assemblages, glass-shard major element composition (from electron microprobe analysis), and radiocarbon dating. We extend the known distribution of tephras in eastern North Island and provide compositional data that add to their potential usefulness as isochronous markers. The chronostratigraphic framework established for the Kaipo sequence, based on both site-specific and independently derived tephra-based radiocarbon ages, provides the basis for fine-resolution paleoenvironmental studies at a climatically sensitive terrestrial site from the mid latitudes of the Southern Hemisphere. Tephras identified as especially useful paleoenvironmental markers include Rerewhakaaitu and Waiohau (lateglacial), Konini (lateglacial-early Holocene), Tuhua (middle Holocene), and Taupo and Kaharoa (late Holocene)

Linear, Deterministic, and Order-Invariant Initialization Methods for the K-Means Clustering Algorithm

Over the past five decades, k-means has become the clustering algorithm of choice in many application domains primarily due to its simplicity, time/space efficiency, and invariance to the ordering of the data points. Unfortunately, the algorithm's sensitivity to the initial selection of the cluster centers remains to be its most serious drawback. Numerous initialization methods have been proposed to address this drawback. Many of these methods, however, have time complexity superlinear in the number of data points, which makes them impractical for large data sets. On the other hand, linear methods are often random and/or sensitive to the ordering of the data points. These methods are generally unreliable in that the quality of their results is unpredictable. Therefore, it is common practice to perform multiple runs of such methods and take the output of the run that produces the best results. Such a practice, however, greatly increases the computational requirements of the otherwise highly efficient k-means algorithm. In this chapter, we investigate the empirical performance of six linear, deterministic (non-random), and order-invariant k-means initialization methods on a large and diverse collection of data sets from the UCI Machine Learning Repository. The results demonstrate that two relatively unknown hierarchical initialization methods due to Su and Dy outperform the remaining four methods with respect to two objective effectiveness criteria. In addition, a recent method due to Erisoglu et al. performs surprisingly poorly.Comment: 21 pages, 2 figures, 5 tables, Partitional Clustering Algorithms (Springer, 2014). arXiv admin note: substantial text overlap with arXiv:1304.7465, arXiv:1209.196

Speckle Suppression Through Dual Imaging Polarimetry, and a Ground-Based Image of the HR 4796A Circumstellar Disk

We demonstrate the versatility of a dual imaging polarimeter working in tandem with a Lyot coronagraph and Adaptive Optics to suppress the highly static speckle noise pattern--the greatest hindrance to ground-based direct imaging of planets and disks around nearby stars. Using a double difference technique with the polarimetric data, we quantify the level of speckle suppression, and hence improved sensitivity, by placing an ensemble of artificial faint companions into real data, with given total brightness and polarization. For highly polarized sources within 0.5 arcsec, we show that we achieve 3 to 4 magnitudes greater sensitivity through polarimetric speckle suppression than simply using a coronagraph coupled to a high-order Adaptive Optics system. Using such a polarimeter with a classical Lyot coronagraph at the 3.63m AEOS telescope, we have obtained a 6.5 sigma detection in the H-band of the 76 AU diameter circumstellar debris disk around the star HR 4796A. Our data represent the first definitive, ground-based, near-IR polarimetric image of the HR 4796A debris disk and clearly show the two outer ansae of the disk, evident in Hubble Space Telescope NICMOS/STIS imaging. We derive a lower limit to the fractional linear polarization of 29% caused by dust grains in the disk. In addition, we fit simple morphological models of optically thin disks to our data allowing us to constrain the dust disk scale height to 2.5{+5.0}_{-1.3} AU and scattering asymmetry parameter (g=0.20^{+.07}_{-.10}). These values are consistent with several lines of evidence suggesting that the HR 4796A disk is dominated by a micron-sized dust population, and are indeed typical of disks in transition between those surrounding the Herbig Ae stars to those associated with Vega-like stars.Comment: Accepted to ApJ, 8 pages, 4 figures, minor typos fixed, one reference adde

Discovery and Characterization of a Faint Stellar Companion to the A3V Star Zeta Virginis

Through the combination of high-order Adaptive Optics and coronagraphy, we report the discovery of a faint stellar companion to the A3V star zeta Virginis. This companion is ~7 magnitudes fainter than its host star in the H-band, and infrared imaging spanning 4.75 years over five epochs indicates this companion has common proper motion with its host star. Using evolutionary models, we estimate its mass to be 0.168+/-.016 solar masses, giving a mass ratio for this system q = 0.082. Assuming the two objects are coeval, this mass suggests a M4V-M7V spectral type for the companion, which is confirmed through integral field spectroscopic measurements. We see clear evidence for orbital motion from this companion and are able to constrain the semi-major axis to be greater than 24.9 AU, the period > 124$ yrs, and eccentricity > 0.16. Multiplicity studies of higher mass stars are relatively rare, and binary companions such as this one at the extreme low end of the mass ratio distribution are useful additions to surveys incomplete at such a low mass ratio. Moreover, the frequency of binary companions can help to discriminate between binary formation scenarios that predict an abundance of low-mass companions forming from the early fragmentation of a massive circumstellar disk. A system such as this may provide insight into the anomalous X-ray emission from A stars, hypothesized to be from unseen late-type stellar companions. Indeed, we calculate that the presence of this M-dwarf companion easily accounts for the X-ray emission from this star detected by ROSAT.Comment: 9 pages, 6 figures, Accepted to Ap

The influence of alkalosis on repeated high-intensity exercise performance and acid–base balance recovery in acute moderate hypoxic conditions

Purpose Exacerbated hydrogen cation (H⁺) production is suggested to be a key determinant of fatigue in acute hypoxic conditions. This study, therefore, investigated the effects of NaHCO3 ingestion on repeated 4 km TT cycling performance and post-exercise acid–base balance recovery in acute moderate hypoxic conditions. Methods Ten male trained cyclists completed four repeats of 2 × 4 km cycling time trials (TT1 and TT2) with 40 min passive recovery, each on different days. Each TT series was preceded by supplementation of one of the 0.2 g kg⁻¹ BM NaHCO3 (SBC2), 0.3 g kg⁻¹ BM NaHCO3 (SBC3), or a taste-matched placebo (0.07 g kg⁻¹ BM sodium chloride; PLA), administered in a randomized order. Supplements were administered at a pre-determined individual time to peak capillary blood bicarbonate concentration ([HCO3⁻]). Each TT series was also completed in a normobaric hypoxic chamber set at 14.5% FiO2 (~ 3000 m). Results Performance was improved following SBC3 in both TT1 (400.2 ± 24.1 vs. 405.9 ± 26.0 s; p = 0.03) and TT2 (407.2 ± 29.2 vs. 413.2 ± 30.8 s; p = 0.01) compared to PLA, displaying a very likely benefit in each bout. Compared to SBC2, a likely and possible benefit was also observed following SBC3 in TT1 (402.3 ± 26.5 s; p = 0.15) and TT2 (410.3 ± 30.8 s; p = 0.44), respectively. One participant displayed an ergolytic effect following SBC3, likely because of severe gastrointestinal discomfort, as SBC2 still provided ergogenic effects. Conclusion NaHCO3 ingestion improves repeated exercise performance in acute hypoxic conditions, although the optimal dose is likely to be 0.3 g kg⁻¹ BM

Is late-onset Alzheimer's disease really a disease of midlife?

AbstractIntroductionIncreasing evidence suggests that Alzheimer's disease (AD) may begin decades before evidence of dementia, indicating that it may be a disorder of midlife rather than old age.MethodsIn the absence of long-term prospective studies from early adulthood specifically designed to address this question, a group of international experts examined evidence presently available from previous clinical and population studies to provide an evidence-based opinion as to whether such a change in conceptualization may be justified.ResultsAlthough still lacking confirmation from dedicated prospective biomarker studies, there is already considerable evidence to suggest both risk factor exposure and brain changes may be already present in midlife.DiscussionCurrent evidence suggests (1) that a change in clinical approach notably involving promotion of cardiovascular health in persons with a family history of AD may considerably reduce disease risk and (2) that the development of biomarkers at this early stage will lead to the possibility of clinical trials at a much earlier stage

Whose names count? Jacques Rancière on Alfredo Jaar’s Rwanda Project

This article focuses on Jacques Rancière’s reflections on Alfredo Jaar’s The Rwanda Project in the context of wider discussions of the politics of naming the dead. Against the claim that his reflections reveal a depoliticizing, universalist commitment to naming all the dead, it contends that foregrounding the relation between naming and counting in this discussion shows Rancière’s focus to be the policing and politics of naming. In an original argument, it focuses specifically on how, for Rancière, in this context, individualized proper names function politically and dissensually. To do so it explores (i) Rancière’s analysis of the role of the mainstream media during the Rwandan genocide in perpetuating the police order (or order of grievability) which divided nameable individuals from anonymous masses, thereby constituting living and dead Rwandans as of little or no account, and (ii) his account of how Jaar’s art is able to disrupt the ‘partition of the sensible’ underpinning this count. The article concludes by considering how Rancière’s ideas about the relationship between naming and counting and between politics and police serve as a useful supplement to and extension of existing discussions of grievability

Uranium mobility in organic matter-rich sediments: A review of geological and geochemical processes

Uranium (U) is of enormous global importance because of its use in energy generation, albeit with potential environmental legacies. While naturally occurring U is widespread in the Earth's crust at concentrations of ~1 to 3 ppm, higher concentrations can be found, includingwithin organicmatter (OM)-rich sediments, leading to economic extraction opportunities. The primary determinants of U behaviour in ore systems are pH, Eh, U oxidation state (U(IV), U(VI)) and the abundance of CO3 2– ions. The concentration/availability and interrelationships among such determinants vary, and the solubility and mobility of ions (e.g. OH-, CO3 2–, PO4 3-, SiO4 4-, SO4 2-) that compete for U (primarily as U(VI)) will also influence the mobility of U. In addition, the presence of OM can influence U mobility and fate by the degree of OMsorption to mineral surfaces (e.g. Fe- and Si- oxides and hydroxides). Within solid-phase OM, microbes can influence U oxidation state and U stability through direct enzymatic reduction, biosorption, biomineralisation and bioaccumulation. The biogenic UO2 product is, however, reported to be readily susceptible to reoxidation and therefore more likely remobilised over longer time periods. Thus several areas of uncertainty remain with respect to factors contributing to U accumulation, stability and/or (re)mobilisation. To address these uncertainties, this paper reviews U dynamics at both geological and molecular scales. Here we identify U-OMbond values that are in agreement, relatively strong, independent from ionic strength and which may facilitate either U mobilisation or immobilisation, depending on environmental conditions. We also examine knowledge gaps in the literature, with U-OM solubility data generally lacking in comparison to data for U sorption and dissolution, and little information available on multi-component relationships, such as UOM-V (V as vanadate). Furthermore, the capability ofOMto influence the oxidation state of U at near surface conditions remains unclear, as it can be postulated that electron shuttling by OM may contribute to changes in U redox state otherwise mediated by bacteria. Geochemical modelling of the environmental mobility of U will require incorporation of data from multi-corporation studies, as well as from studies of U-OM microbial interactions, all of which are considered in this review

A review of soil NO transformation: associated processes and possible physiological significance on organisms

NO emissions from soils and ecosystems are of outstanding importance for atmospheric chemistry. Here we review the current knowledge on processes involved in the formation and consumption of NO in soils, the importance of NO for the physiological functioning of different organisms, and for inter- and intra-species signaling and competition, e.g. in the rooting zone between microbes and plants. We also show that prokaryotes and eukaryotes are able to produce NO by multiple pathways and that unspecific enzymo-oxidative mechanisms of NO production are likely to occur in soils. Nitric oxide production in soils is not only linked to NO production by nitrifying and denitrifying microorganisms, but also linked to extracellular enzymes from a wide range of microorganisms. Further investigations are needed to clarify molecular mechanisms of NO production and consumption, its controlling factors, and the significance of NO as a regulator for microbial, animal and plant processes. Such process understanding is required to elucidate the importance of soils as sources (and sinks) for atmospheric NO