Palliative sedation: an essential place for clinical excellence

The complexities that converge around palliative sedation invite clinicians to work together to differentiate the issues and come to recommendations and decisions that are humane, ethical, legal, and clinically sound. Whether a crisis or long-term situation exists, the work is essentially the same. It must include critical thinking, clinical expertise, multidimensional assessment, and an array of interventions to assist patients and families in situations where symptoms and suffering are sufficiently intense to warrant exploration of sedation. The many issues inherent in the discussion of sedation at end of life require not that we have the answers but rather that we work with our colleagues to raise relevant questions and integrate both expertise and compassion into end-of-life decisions and care.     

Medical Negligence and Resource Allocation in the NHS

The recent growth in medical malpractice claims and in awards for damages has created concern both amongst doctors and health administrators. Steps which have been taken by the Review Body on Doctors’and Dentists’Remuneration and policy now advocated by the BMA suggest a movement away from the current system of negligence and towards a stricter no-fault system of liability. Under the current system, medical negligence occurs when doctors have not met the standards of treatment expected by reference to current professional standards. Under a no-fault system patients would be entitled to compensation for losses which arise from treatment, irrespective of whether negligence had occurred; although the implication is that the amounts of compensation would necessarily be limited. While there are reasons to believe that financial difficulties for doctors and pressures on NHS budgets may be ameliorated by a no-fault system, there are other criteria against which the current system of negligence should be judged. This article attempts to provide a framework within which a negligence system may be assessed. In particular, attention is drawn to the educative role of a negligence system and to the provision of information which may improve decisions on resource allocation. A critique of the current system of medical negligence in the UK suggests that a package of reforms to improve the system would be better than further movements towards non-market solutions.     

Australian University Students' Views of the Nuclear Arms Race: Comparative and Qualitative Analyses

Australian university students' views of the nuclear arms race were analysed in two studies. A sample comparison study used Nuclear Arms Race Questionnaire (NARQ) and Position on Nuclear Weapons (PNW) scales to compare university students' views with those of high school students and community groups. University students' views were more strongly anti-nuclear than middle income and Middle European migrant groups, but not more than high school student and church member groups'. Females' attitudes were more strongly anti-nuclear than males. A qualitative analysis of ten university students' formulations of the arms races problem and Australia's involvement revealed the complex dimensions of perceived relationships between global and national interests and personal nuclear issues. Students' solutions were directly related to their formulations of the major aspects of the arms race problem, with six students who represented the nuclear problem in terms of superpower conflict, seeing individuals as powerless to influence solutions. Quantitative trends are interpreted in light of the varied representations of the problem and the association of students' generally anti-nuclear attitudes with lack of involvement in the peace movement.     

Including children with special educational needs in physical education: has entitlement and accessibility been realised?

The return of the Labour government to power in 1997 brought an increased focus upon inclusive education for children with special educational needs (SEN). Alongside this there has been a desire to enhance the opportunities young people have to access physical education (PE) and school sport. Previous research has shown that children with SEN often have fewer opportunities to access physical activity due to physical, social and emotional barriers to participation. With the advent of a new Con–Lib-Dem government in 2010 and a planned review of inclusion policies and practices, this paper examines the extent to which children with SEN have arrived at utopia in relation to their entitlement and access to PE. The paper identifies four themes central to successful inclusive PE, whilst suggesting there is still some way to go for children with SEN to have the same opportunities in physical activity as their non-disabled peers.     

Relation Between Maternal Cigarette Smoking During Pregnancy and Behavioral and Physiological Measures of Autonomic Regulation in Neonates

The effects of maternal cigarette smoking during pregnancy on behavioral and physiological measures of arousal were examined in a sample of 50 neonates. After the effects of alcohol, caffeine, and maternal demographic variables were statistically controlled, regression analyses showed that maternal smoking during pregnancy was predictive of higher heart rates overall and during quiet and active sleep. Maternal smoking during pregnancy was also predictive of lower heart rate variability and an increased number of tremors and changes in behavioral state. These findings suggest that maternal cigarette smoking during pregnancy affects the regulation of spontaneous autonomic activity in neonates.     

Economic embeddedness and materiality in a financial market setting

The notion of embeddedness (Granovetter, 1985) neglects of the material dimension of economic relations. This paper contributes to the literature of market devices (Callon et al., 2007) with an exploration of the material dimensions of economic embeddedness in the case of the everyday market activities of a group of non‐professional investors in the UK. It examines the attributes of a materially embedded market through the categories of socio‐economic embeddedness specified by Uzzi (1997) and draws attention to the superficial and rhetorical nature of the face‐to‐face social relations encountered in this market. The paper seeks to invigorate the notion of embeddedness by expanding the mechanisms through which socio‐economic relations are understood to arise. The paper offers support to the literature of market devices’ assertion that a concept of materially embedded economic relations can accommodate politics, culture, and regulation, and that it offers a nuanced perspective on agency and identity in the marketplace.     

‘The Bad People Go and Speak to Her’: Young People’s Choice and Agency when Accessing Mental Health Support in School

Concerns about the mental health and well‐being of children and young people have been articulated in health and education policy fields as a call for closer working between schools and providers of mental health support services. Drawing from a Scottish study, this article explores issues of access, when mental health initiatives are sited in formal educational settings. In particular, it focuses on the implications for the agency of children and young people seeking support from those services when and how they choose. The study argues that over‐reliance on teachers as the main referral route to service influences what is deemed to be a problem, who is thought to need support and how the interventions are viewed by the children and young people. Alternative approaches are discussed, which offer opportunities for children and young people to explore the available services and make their own choices about their level of engagement.     

White and nonwhite trends in first birth timing: Comparisons using vital registration and current population surveys

The magnitude of racial differences in first birth timing vary greatly depending upon the data sources from which they are estimated. Vital registration data (Heuser 1976; with updates from the National Center for Health Statistics 1974–1990) show that in recent years nonwhites have higher risks of a first birth at virtually all ages compared to whites. As a result very large and historically novel differentials in childlessness are forecast using these data (see Rindfuss et al. 1988; Chen & Morgan 1991; Morgan & Chen 1992). However, retrospective fertility history data collected from the 1980, 1985 and 1990 Current Population Surveys (CPS) suggest much smaller racial differences in completed childlessness and isolate racial differences in probabilities of first births at young ages. Differences also exist between theses two series for whites prior to the mid-1960s but not afterwards. Reasons for these differing estimates are suggested and examined. We conclude that a substantial portion of the differences result from an accumulation of biases in the vital registration estimates that affect primarily estimates of first birth timing. Thus, the CPS data provide a more firm basis for racial comparisons of first birth timing.