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Edited by
James Ip, Great Ormond Street Hospital for Children, London,Grant Stuart, Great Ormond Street Hospital for Children, London,Isabeau Walker, Great Ormond Street Hospital for Children, London,Ian James, Great Ormond Street Hospital for Children, London
This chapter describes the principles and practice of anaesthesia for radiological imaging and interventional procedures. A comprehensive account of the assessment, planning and conduct of anaesthesia for these patients is given. Commonly performed interventional radiology procedures and their associated conditions are considered in detail. Consideration of the challenges of providing anaesthesia in ‘remote sites’, such as the imaging suite, is offered.
Hospitals play a significant and important role in funding high-cost medicines so patients can access treatments they need. High-cost medicines are often specialty medicines, which contribute to a significant and increasing portion of the hospital budget. It is imperative that these expensive medicines are governed and managed with a fair, standardized evidence-based process. We aim to provide a framework for Drugs and Therapeutics Committees (DTCs).
Methods
During 2021, Guiding Principles were developed following a literature review and survey of current practices by DTCs in Australia. An Expert Advisory Group (EAG) was convened, comprising individuals with expertise in quality use of medicines, evidence-based medicine and medicines governance. The guiding principles were drafted by the EAG, in consultation with a range of stakeholders and relevant external organizations. All feedback was collated, reviewed and discussed to refine the content of the final Guiding Principles released in January 2022.
Results
Seven overarching principles provide key recommendations for the governance of high-cost medicines:
(i) A definition of high‑cost medicines should be determined and clearly articulated for use by each medicines governance committee.
(ii) Review of high-cost medicines requires members with relevant expertize to facilitate good and effective decision-making.
(iii) The committee should engage directly with the applicant prior to review to ensure a full understanding of the rationale for the request.
(iv) consistent, robust and transparent procedure for the assessment of high-cost medicine applications should be defined and implemented for use by each medicines governance committee to ensure fair process.
(v) Ethical considerations fundamentally underpin deliberations around high-cost medicines.
(vi) The decisions and outcomes of the decision making should be transparent and appropriately communicated to the various audiences.
(vii) The high-quality assessment of high-cost medicines requires appropriate training and resourcing.
Conclusions
These national Guiding Principles promote consistent, evidence-based use of high-cost medicines and provide a framework for DTCs to assess and achieve effective governance for the quality use of high‑cost medicines.
In the general population, irritability is associated with later depression. Despite irritability being more prevalent in autistic children, the long-term sequelae are not well explored. We tested whether irritability in early childhood predicted depression symptoms in autistic adolescents, and whether associations could be explained by difficulties in peer relationships and lower educational engagement. Analyses tested the longitudinal associations between early childhood irritability (ages 3–5) and adolescent depression symptoms (age 14) in a prospective inception cohort of autistic children (N = 390), followed from early in development shortly after they received a clinical diagnosis. Mediators were measured in mid-childhood (age 10) by a combination of measures, from which latent factors for peer relationships and educational engagement were estimated. Results showed early childhood irritability was positively associated with adolescent depression symptoms, and this association remained when adjusting for baseline depression. A significant indirect pathway through peer relationships was found, which accounted for around 13% of the association between early childhood irritability and adolescent depression, suggesting peer problems may partially mediate the association between irritability and later depression. No mediation effects were found for education engagement. Results highlight the importance of early screening and intervention for co-occurring irritability and peer problems in young autistic children.
Extensions of Rayleigh–Bloch waves above the cutoff frequency are studied via the discrete spectrum of a transfer operator for a channel containing a single cylinder with quasi-periodic side-wall conditions. Above the cutoff, the Rayleigh–Bloch wavenumber becomes complex valued and an additional wavenumber appears. For small- to intermediate-radius values, the extended Rayleigh–Bloch waves are shown to connect the Neumann and Dirichlet trapped modes before embedding in the continuous spectrum. A homotopy method involving an artificial damping term is proposed to identify the discrete spectrum close to the embedding. Moreover, Rayleigh–Bloch waves vanish beyond some frequency but reappear at higher frequencies for small and large cylinders. The existence and properties of the Rayleigh–Bloch waves are connected with finite-array resonances.
Diamondback moth, Plutella xylostella (Linnaeus) (Lepidoptera: Plutellidae), a globally important pest of Brassicaceae crops, migrates into all provinces of Canada annually. Life tables were used to determine the mortality levels contributed by the parasitoid complexes associated with diamondback moth in British Columbia, Ontario, Prince Edward Island, and insular Newfoundland. Overall, diamondback moth populations showed high generational mortality (> 90%) in all provinces, although parasitism levels were generally low. The net reproductive rate of increase in diamondback moth was less than 1.0 (populations declined) in both years in British Columbia and in each of two years in Newfoundland and Ontario, but it was greater than 1.0 in all three years in Prince Edward Island. Lower parasitism levels were found in Prince Edward Island (3.0–6.3%) compared with other provinces (8.4–17.6%, except one year in British Columbia). Diadegma insulare was the main larval parasitoid found; it was present in all provinces. Microplitis plutellae was present in all provinces except British Columbia. Oomyzus sokolowskii was found in British Columbia and Ontario. The parasitoid community documented from sentinel sampling was less diverse than that found through destructive sampling. Hypotheses are provided to explain the presence of major parasitoids. Increasing larval parasitism would have the largest effect on diamondback moth population growth in Canada.
Current first-line treatments for paediatric depression demonstrate mild-to-moderate effectiveness. This has spurred a growing body of literature on lifestyle recommendations pertaining to nutrition, sleep and exercise for treating paediatric depression.
Aims
Paediatric depression clinical practice guidelines (CPGs) were reviewed for quality and to catalogue recommendations on nutrition, sleep and exercise made by higher-quality CPGs.
Method
Searches were conducted in Medline, EMBASE, PsycINFO, Web of Science and CINAHL, and grey literature CPGs databases for relevant CPGs. Eligible CPGs with a minimum or high-quality level, as determined by the Appraisal of Guidelines for Research and Evaluation, Second Edition instrument, were included if they were (a) paediatric; (b) CPGs, practice parameter or consensus or expert committee recommendations; (c) for depression; (d) the latest version and (e) lifestyle recommendations for nutrition, sleep or exercise. Key information extracted included author(s), language, year of publication, country, the institutional body issuing the CPG, target disorder, age group, lifestyle recommendation and the methods used to determine CPG lifestyle recommendations.
Results
Ten paediatric CPGs for depression with a minimum or high-quality level contained recommendations on nutrition, sleep or exercise. Lifestyle recommendations were predominately qualitative, with quantitative details only outlined in two CPGs for exercise. Most recommendations were brief general statements, with 50% lacking supporting evidence from the literature.
Conclusions
Interest in lifestyle interventions for treatment in child and youth depression is growing. However, current CPG lifestyle recommendations for nutrition, sleep or exercise are based on expert opinion rather than clinical trials.
Diamondback moth, Plutella xylostella (Linnaeus) (Lepidoptera: Plutellidae), was first recorded in North America from Europe about 150 years ago and can be a significant pest of canola in Western Canada. Because parasitism of P. xylostella in Canada is generally low, the introduction of one or more additional exotic parasitoids from Europe is being considered to increase the suppression of P. xylostella populations. Life table studies to determine the impact of parasitoids on diamondback moth populations in Europe were conducted in northwestern Switzerland in 2014–2016. Net reproductive rates were found to be less than one in seven out of eight life tables, suggesting that P. xylostella populations in Switzerland are mostly driven by immigration and recolonisation. In total, seven primary parasitoid species and one hyperparasitoid were associated with diamondback moth. Pupal parasitism by D. collaris reached up to 30%, but because generational mortality was mainly driven by abiotic mortality factors and predation of larvae, the overall contribution of pupal parasitism was low (< 6%). In regions of Canada, where P. xylostella may have increasing populations and low larval mortality, the addition of D. collaris may be a promising approach. Life table studies across Canada are necessary to determine the need for such intervention.
While the image of David’s military prowess was ubiquitous, the figure of David as penitent also provided a model for Louis’s kingship. This chapter explores a number of musical settings of centonized psalm texts composed for the singers of the chambre in the difficult circumstances surrounding his early reign that engage with the idea of a penitent king, a king responding to adversity through an intensification of personal devotion. As part of this process, Psalm 19, Exaudiat te Dominus came into particular focus, being appended to the celebration of Mass at the chapelle royale from the 1580s, and gradually becoming part of the wider liturgy of the French church. But although this psalm would later become associated with the chapelle royale of Louis XIV, it is clear that from the very earliest times it was heard as a prayer for the king in times of adversity or when he was under military threat.
This chapter explores how music and liturgy intersected with models of the monarchy that emphasized military prowess and strength. Shortly after Louis XIII had had Concino Concini assassinated in 1617, the figure of Saint Louis IX, crusader, model king, and literal forbear of Louis XIII came to prominence, with the elevation of his feast and with a new liturgy and hymns that emphasized how the saint emulated David’s model of kingship. At the same time, David himself, frequently portrayed as a musician, featured widely in pamphlets and psalm translations or paraphrases that invited the reader or listener to consider how Louis battled heresy as David battled Goliath. In musical terms, this interest was not manifest in the liturgy of the chapelle royale, but the musicians of the chambre and chapelle nonetheless sang psalms together at the king’s mealtimes in the liturgy of Benedictio mensae, and in non-liturgical performances of psalm settings by Artus Auxcousteaux and others.
In comparison to Italy, chant reform in France after the Council of Trent followed a relatively haphazard path, with no centralized efforts to align chant declamation with humanist practice. At the Abbey of Montmartre, however, a cadre of clerics and nobles associated with members of the Guise family provided an environment in which chant reform may have followed strict humanist principles. Part of a strategy to bring the saint to whom the Abbey was dedicated, Saint Denis (now conflated with Saint Dionysius and even Pseudo-Dionysius), to greater prominence, the reform of this chant was also accompanied by the building of a large priory dedicated to Saint Denis and the Eucharist, and the composition (by Antoine Boësset) of a body of polyphonic music based on it. At the same time, another religious foundation, the Congregation of the Oratory of Jesus Christ, developed its own ‘reformed’ chant, this time abandoning the rhythms of antiquity for something much more flexible and ‘modern’. While both institutions were closely associated with the king, the chant of the Oratorians explicitly celebrated the idea of kingship, while the chant at Montmartre actively undermined it.
In the mid 1630s, as France faced an existential threat from the Spanish forces threatening from the Netherlands, Richelieu and Louis XIII turned to the Virgin Mary for protection. Having first expressed an interest in Mary in the early 1630s, by 1637 the situation was so dire that Louis began taking steps to dedicate the whole kingdom to the Queen of Heaven, formalizing this devotion in the famous Vow of 1638. That same year, Nicolas Formé published or prepared for publication three volumes of music: the famous Missa Aeternae Henrici Magni, two volumes of Musica simplex, and a set of eight Magnificats. All three works reflect a change in the devotional orientation of the court to a more Christocentric position, a position that is also reflected in paintings by Champaigne and Vouet that, though ostensibly relating to the Virgin Mary, place Louis prominently at Christ’s side. In this light, the motet added in to the mass, Ecce tu pulchra es, seems clearly to frame Louis as a new Christ, a model of kingship now more appropriate to the religious circumstances of the era.
In the context of musical ideologies based on either Biblical or Classical/Neoplatonic models, the introduction sets out how a study of the music produced as a response to the figure of Louis XIII might contribute to the wider discourse on ceremonial, power, and absolutism in early modern France. Although the issue of music and power is well-trodden territory for the reign of Louis XIV, there is almost no (music) scholarship exploring how the mechanism of ‘the arts’ and power might function during this earlier period. But taking Beetham’s reformulation of Weber’s famous definition of power as a starting point, it is clear that the liturgy of the Catholic Church acted as a legitimating framework, allowing the people of France to signal their approval of a conceptual system that taught that the anointed king ruled with God’s express consent. While musical sources that participate in this framework (indeed all musical sources) are relatively rare, by exploring previously overlooked fragments and incomplete works, it is possible to show how music, as ‘sounding’ liturgy, was used to highlight facets of a liturgical text that were considered significant, and how in turn it contributed to the broader framework of power.
A tradition and practice dating back centuries by which a monarch was welcomed into a loyal city by its dignitaries, clerics, and citizenry, the typical entrée in the hands of the last Valois kings was a spectacular festival, calling on all the creative resources of a city – artists, poets, architects, set designers, composers, and musicians – to produce a visual and aural feast that is generally considered to have given expression to the king’s power. Yet the concluding ceremony that took place in the city’s cathedral, in which a Te Deum was sung, has received almost no attention from scholars. This chapter identifies the liturgy used at this event and considers the role of the psalm central to the ceremony, typically Psalm 19, Exaudiat te Dominus. At the same time, a corollary ceremony, the ‘Te Deum’ was also frequently performed in Paris, it too placing frequently placing Psalm 19 at its center. In contrast to Fogel’s reading of these events, both were as much prayers for the safekeeping of the king in a time of profound national turmoil as they were celebrations of his victories.
Beginning with an analysis of the ceremonies held to celebrate Louis XIII’s capture of La Rochelle in 1628, this chapter explores how the psalms became central to the identity of the French monarch over the course of the sixteenth century. Originally ‘shared’ between Catholics and Huguenots, translations of the psalms into French began to adopt a more sharply divided confessional identity by the 1560s. At the same time, the concept of kingship, which had for some time been inspired by humanist writings, began to reflect Biblical models more closely. Jean Bodin’s seminal Six livres de la république of 1576, for example, was followed by numerous other treatises that framed the king as an agent of God in the temporal domain, especially after the assassinations of Henri III and Henri IV. By the time Louis XIII came to the throne, then, King David, author of the psalms, agent of the Holy Spirit, and known for his musical talents, had become the preferred model of kingship, a model that provided the context for numerous psalm translations, and for the identity of Louis XIII himself, now viewed as the perfect musician, warrior, and king.