Limitations in the extent and depth of the physician-patient relationship appear to be the most frequent impediments to writing DNR orders in our institution.

Objective: In England, 27,500 children are referred annually to hospital with constipation. An objective measure of whole gut transit time (WGTT) could aid management. The current standard WGTT assessment, the x-ray radiopaque marker (ROM) test, gives poor definition of colonic anatomy and the radiation dose required is undesirable in children. Our objective was to develop an alternative magnetic resonance imaging (MRI) WGTT measure to the x-ray ROM test and to demonstrate its initial feasibility in paediatric constipation. Methods: With the Nottingham Young Person's Advisory Group we developed a small (8 × 4 mm), inert polypropylene capsule shell filled with MRI-visible fat emulsion. The capsule can be imaged using MRI fat and water in-phase and out-of-phase imaging. Sixteen patients with constipation and 19 healthy participants aged 7 to 18 years old were recruited. Following a common ROM protocol, the participants swallowed 24 mini-capsules each day for 3 days and were imaged on days 4 and 7 using MRI. The number of successful studies (feasibility) and WGTT were assessed. Participants’ EuroQoL Visual Analogue Scale were also collected and compared between the day before the taking the first set of mini-capsules to the day after the last MRI study day. Results: The mini-capsules were imaged successfully in the colon of all participants. The WGTT was 78 ± 35 hours (mean ± standard deviation) for patients, and 36 ± 16 hours, P < 0.0001 for healthy controls. Carrying out the procedures did not change the EuroQoL Visual Analogue Scale scores before and after the procedures. Conclusions: Magnetic Resonance Imaging in Paediatric Constipation was a first-in-child feasibility study of a new medical device to measure WGTT in paediatric constipation using MRI. The study showed that the new method is feasible and is well tolerated.

Background There is often a great urgency to be inclusive when conducting research and to focus efforts with groups and communities that can be referred to as marginalised. This is especially the case in research concerning medical devices aimed at children and young people (CYP). Although involvement methodology has developed over the last two decades, it can be challenging to involve and engage CYP with confidence and clarity of purpose. Main body Our aim was to provide a reflective narrative account of the involvement of CYP, over a period of 5 years, in a research project from conception of a new paediatric medical device through to practical application. We explored a model of patient and public involvement (PPI) through the Nottingham Young Persons Advisory Group (YPAG), part of the National Institute for Health Research (NIHR) GenerationR Alliance, in a NIHR funded research project. The YPAG designed and created a model of the human gut, co-designed the Transicap™ mini-capsules and their packaging, co-produced patient information sheets, came up with the idea to disseminate through a project website and co-wrote and created animation videos. The YPAG involvement continued through the writing and award of the follow-on research grant (MAGIC2). During this process the YPAG modified the clinical study protocol insisting that all participants in the control arm were given the imaging test results as well, save for a delayed reading compared to the intervention arm. Conclusion Involvement of the YPAG over the last 5 years, led to the development of a mutually beneficial partnership, enabling genuine knowledge exchange between researchers and CYP. This influenced the design, plans and actions of the MAGIC study and well into the subsequent MAGIC2 follow-on project. Moreover, these involvement models applied within a feasibility study setting, have enhanced the realism and pragmatism of the study, contributing to the project’s overall success.

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JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org. This content downloaded from 128.226.37.5 on FriMICHAEL LAMBERT MCOMBER' S 'Phonemic pharyngealization' (233-58) erroneously analyzes Arabic /1/ as a pharyngealized glottal stop. Arabic ?ain is often a voiced approximant, and some stop varieties are made by closing the epiglottis against the back wall of the pharynx. This is the reason why both [h] and [V] have been called 'epiglottal' rather than 'pharyngeal' by Peter Ladefoged and Ian Maddieson (The sounds of the world's languages, Oxford: Blackwell, 1996:168).This volume is typical of the PAL series in that only a few of the offerings advance the fields of Arabic dialectology and linguistics. The reader should be forewarned that it also contains numerous typographical and editorial infelicities.The Blackfoot language of Alberta and Montana, which has a typically Algonquian structure but a highly divergent (and etymologically often opaque) lexicon, has been unusually well-served by dictionaries, with notable documentary contributions by Ferdinand Vandeveer Hayden in 1862, Rev. John William Tims in 1889, and C. C. Uhlenbeck in 1930. Although it does not claim to incorporate the full resources of its predecessors (xi), this book is probably the richest-and certainly the most accurate-Blackfoot dictionary in existence. A considerably revised and expanded version of a synonymous work first issued in 1989, it represents over three decades' work by Frantz, a generative linguist and a fluent second-language speaker of Blackfoot. His collaborator, a native speaker of Blackfoot, and more than thirty other speakers have provided material which has found its way into the dictionary. The principal dialect represented in the dictionary is that spoken by members of Blood Reserve, between Cardston and Lethbridge in Alberta, though the other forms of Blackfoot, namely Siksika and Piegan, are mutually intelligible with this (certainly Uhlenbeck's work on Southern Peigan documents a very similar form of speech).After prefatory material which explains the structure of entries and the abbreviations used, the main body of the work (1-270) is a Blackfoot-English dictionary in which entries are presented as whole words in blocks of hanging paragraphs. Often third and first person singular past forms of verbs are presented in order to provide information about the structure of relevant paradigmatic forms, and a number of sample MICHAEL LAMBERT MCOMBER' S 'Phonemic pharyngealization' (233-58) erroneously analyzes Arabic /1/ as a pharyngealized glottal stop. Arabic ?ain is often a voiced approximant, and some stop varieties are made by closing the epiglottis against the back wall of the pharynx. This is the reason why both [h] and [V] have been called ...