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Abstract Skinks are the most diverse component of the reptile fauna in the mountains of New Guinea and many seemingly specialised high-elevation species remain undescribed. Here we describe two spectacular new gold-patterned skinks in the montane-specialist genus Papuascincus. Both species can be diagnosed from all congeners by their distinctive colouration, in addition to aspects of scalation and body size. One new species is mainly recorded from lower montane forest in karst habitats spanning more than five hundred kilometres along the southern edge of New Guinea’s Central Cordillera and is likely to warrant an IUCN conservation status of Least Concern. The second new species has thus far only been recorded from cloud forest on the summit of Mt. Menawa in the North Coastal Ranges and we suggest it should be considered Data Deficient. However, if further survey work confirms a restricted distribution with little scope for upslope elevational retreat under future warming climates it will likely qualify for Endangered or Critically Endangered status.

Different things are at stake when organizations face difficult decisions amidst value conflicts. Individuals who participate in those decisions bring their own values to the table that they weigh against the values that their organization promotes. How should we weigh personal values versus collective values when they are in conflict?

Melanesia, centred on the vast tropical island of New Guinea, is shown to have the most diverse and intact insular frog fauna in the world.

For this open issue of the Etikk i Praksis: Nordic Journal of Applied Ethics, we put together a broad mix of different articles tackling current important issues in the field.

One of the obstacles in the company recruitment process is the change of labor force generation. Indonesia has already shifted the labor force to generation Z. This research aims to examine the influence of employer branding dimensions consisting of work environment, compensation and benefits, corporate reputation, corporate vision and leadership, and corporate social responsibility in attracting work interests. This cross-sectional study with an online questionnaire to 306 fresh graduate respondents domiciled in Jakarta, Bogor, Depok, Tangerang, South Tangerang, and Bekasi (Jabodetabek). Data analysis uses linear regression methods. The study results indicate that all employer branding variables positively affect the intention to apply for a job. This aspect needs to be considered by the company in increasing the intention to apply for a job from fresh graduate employees’ candidates who are currently generation Z. The work environment has the highest average value towards applying for a job. It can be due to the primary purpose of generation Z is choosing the company where they will work in the comfort of the workplace atmosphere.

The data provided here are related to the article “Resolving the Deep Phylogeny: Implications for Early Adaptive Radiation, Cryptic, and Present-day Ecological Diversity of Papuan Microhylid Frogs” [1]. The dataset is based on 233 tissue samples of the subfamily Asteroprhyinae, with representatives from all recognized genera, in addition to three outgroup taxa. The sequence dataset contains over 2400 characters per sample for five genes: three nuclear (Seventh in Absentia (SIA), Brain Derived Neurotrophic Factor (BDNF), Sodium Calcium Exchange subunit-1 (NXC-1)), and two mitochondrial loci (Cytochrome oxidase b (CYTB), and NADH dehydrogenase subunit 4 (ND4)); and is 99% complete. New primers were designed for all loci and accession numbers for the raw sequence data are provided. The sequences are used with geological time calibrations to produce time-calibrated Bayesian inference (BI) and Maximum Likelihood (ML) phylogenetic reconstructions using BEAST2 and IQ-TREE. Lifestyle data (arboreal, scansorial, terrestrial, fossorial, semi-aquatic) were collected from the literature and field notes and used to infer ancestral character states for each lineage. Collection location and elevation data were used to verify sites where multiple species or candidate species co-occur. All sequence data, alignments, and associated metadata (voucher specimen number, species identification, type locality status, global positioning system [GPS] coordinates, elevation, site with species list, and lifestyle) as well as the code to produce all analyses and figures are provided.

As the year 2022 ends, we continue to face challenging issues and uncertainties about what should be the right approach to various ethical problems society face. In approaching these problems we reflect on our existing guiding values but also discover new ones. We then try to figure out how our actions and decisions could align with our well-considered judgments until we achieve some degree of reflective equilibrium.

In addition to higher learning, universities are expected to also ‘do’ employability and help students transition from education to employment. Accordingly, a wide range of approaches have emerged and we, as academics, dedicate substantial efforts to designing and implementing attractive employability offerings for our degree programmes. We spend considerably less time (and have considerably less time to spend) on reflecting whether these provisions are truly transformational. Brazilian philosopher and educator, Paulo Freire, argued that this transformation can only be achieved through praxis. As the combination of action and reflection into an act of radical agency, praxis is authentic being at both the individual and social level. Praxis is the self-determined creation of one’s own future, while accepting accountability to fellow human beings. In this opinion piece we contend that praxis should be placed at the heart of employability of the future – employability 3.0. We propose that employability 3.0 should incorporate but go beyond current best practices such as cross-curriculum ‘connectedness’ and the ‘embeddedness’ of community of practice learning. It should be a programme of active learning and reflection, which enables students to rewrite their futures by improving their wellbeing, employment prospects and place in society.

The Blue Economy is an emerging paradigm with the potential to foster balanced socio-economic development of the world’s oceans and coastal areas, but it requires an understanding of the stakeholder landscape at a national and at an international sea basin scale, so that we can model potential equitable and collaborative economic development. Applying a novel, mixed-method approach we collected, collated and analysed spatial and non-spatial stakeholder information from five countries (United Kingdom, Ireland, France, Spain and Portugal), that border the North East Atlantic sea basin. Through the development of Blue Economy stakeholder directory for the North East Atlantic area more than 600 local, regional, national and international (EU wide and global) stakeholders were analysed in terms of their Blue Economy alignment and to determine their respective enabling role (financier, service providers, research/innovators and regulators/policy makers). Results show 72% of the North East Atlantic sea basin stakeholders fail to recognise the socio-economic potential of the Blue Economy, regardless of the new policy instruments and a strategic focus from the European Commission. We also identify that public and research/academic institutions currently dominate the landscape of Blue Economy stakeholders; but note this is inconsistent, when compared with other economic sectors in maritime territories. Based on the results, we discuss the key challenges facing equitable growth of the Blue Economy in the North East Atlantic area.

The editorial introduces original articles, a commentary and book review.

This special issue of Etikk i Praksis – Nordic Journal of Applied Ethics features four articles that address a number of urgent ethical issues that arise in the COVID-19 pandemic.

Modeling patient-individual resistance to immunotherapy is challenging. Here, the authors use a syngeneic experimental hypermutated orthotopic glioma model to define radiological and biological features that can predict or explain the mechanistic differences between responders and non-responders to immunotherapy.

This open issue of the Nordic Journal of Applied Ethics consists of four papers that discuss topics covering fetal diagnostics ethics, value conflicts in the use of artificial intelligence, abortion and population ethics.

Introduction: One of the most important skills in anaesthesia is securing the airway with an endotracheal tube. Difficult tracheal intubation however is considered one of the major contributors of anaesthesia related morbidity and mortality. Video laryngoscopy offers several advantages during endotracheal intubation. The view of the glottis provided by Videolaryngoscopes is better compared to the Macintosh laryngoscope in difficult airways which makes it more attractive for routine difficult airway intubations. Aim: To compare the time taken for intubation between two Videolaryngoscopes, namely C-MAC D-blade and Airtraq and to assess the quality of laryngoscopy view between the two groups. Materials and Methods: This was a randomised clinical trial conducted in 116 American Society of Anesthesiologists 1 (ASA1) and ASA2 patients undergoing elective surgeries in Pondicherry Institute of Medical Sciences. Patients are randomised into two groups, Group C-MAC D-blade and Group Airtraq by computer randomisation. Statistical analysis was performed using t-test, Repeated measures of ANOVA was used to find the significance from preinduction to 10 mins period for each group and Bonferoni’s correction for intergroup comparison. Results: The time taken for intubation was comparable in two study groups (Group C-MAC D-blade 41.88 secs) and (Group Airtraq -40.78 sec) with p-value of 0.734. Laryngoscopic view was not statistically significant with p-value of 0.083. Optimisation maneuvers were required in 63.8% in Group Airtraq on comparison with 44.8% in Group C-MAC D-blade. In both Group C-MAC D-blade and Group Airtraq, there was a significant rise in the heart rate and BP at 0 minute compared to preinduction. But after 5 minutes, the heart rate and BP were back to preinduction values. Conclusion: Both the Videolaryngoscopes, C-MAC D-blade and Airtraq performed equally, with respect to time taken for intubation and laryngoscopic view. However, External Laryngeal Manipulation (ELM) was required more in Group Airtraq and was statistically significant.

This open issue of the Nordic Journal of Applied Ethics consists of four papers that discuss the topics covering vaccination, sustainability, development ethics research and family ethics. It also includes a book review.

Hasta ahora se han tenido grandes avances en el área médica que conducen a diagnósticos más exactos. pero la realidad es que aún falta mucho por hacer en cuanto al diagnóstico oportuno y no invasivo. El detectar y caracterizar partículas pequeñas, como los virus en el aire o bacterias en alimentos, es de suma importancia y se ha reportado que de entre las técnicas de diagnóstico y análisis de muestras biológicas existentes, aquellas que se basan en biosensores de guías de onda, presentan ventajas significativas como mayor resolución, detección en tiempo real y son no invasivas. Las características físicas y geométricas de la guía de onda determinarán su utilidad en cada aplicación. En este trabajo se presenta la metodología para el modelado de guías de onda utilizando el software gratuito Metric; se modelaron guías de nitruro de silicio (Si3N4) con el fin de estudiar su potencial como biosensores

The current issue provides readers with a range of perspectives on sustainable governance and related matters, such as the ethics and politics of climate change. The articles display the complexity of environmental problems, while offering guidance on how to deal with them. We hope to inspire further discussion of the important topics raised by the authors. The open section brings to light some well-reasonded responses to ethical issues in healthcare financing and delivery that we need to address in Scandinavian societies. These discussions are very relevant to the ethical challenges faced by healthcare systems in the rest of the world as well.

This issue provides readers the opportunity to broaden understanding of methods used in applied ethics. We hope you will be inspired to decide on which method, or a combination of different ones, to use towards achieving reflective balance that can enhance understanding of all considerations relevant to deciding what should be done. Like tools, methods are used because they are well suited to the task we seek to accomplish.

Male condoms are important to prevent transmission of HIV (and other STIs) and unwanted pregnancies. Research was conducted to evaluate the quality of male condoms available in the Dominican Republic market based on preliminary concerns of suspect product. Based on international testing standards (ISO 4074 and ASTM D 3492-08), condoms were sampled across ten prominent brands within the market and evaluated for airburst pressure / volume, freedom from holes, visual defects, package seal integrity, packaging and marking, lubricant quantity, and dimensions. Five of the brands were found to have extensive quality problems, where holes were found in 5.7% to 17.5% of the condoms (depending on the brand). Between 5.1% and 30.5% of these condoms failed to meet the requirements for airburst properties, and violations in regulatory labeling where observed. Three additional brands were compliant for the other tests, but were found to have the same challenges with labeling violations as the previous five brands. Two brands were found to be fully compliant with all aspects of the evaluation. The level of defects observed in these samples would greatly increase the risk of HIV transmission (and other STIs) and unwanted pregnancies. When projected on the annual market of male condoms sold in the Dominican Republic (~26 million), potentially over 1 million condoms could be estimated to adversely impact the health risk of the end-user. These results prompted action by the Dominican Republic regulatory authorities to investigate and remove poor quality product from the market. This research study emphasizes the need for continued vigilance towards increased regulatory and market surveillance efforts to better protect public health interests.

Four papers are included in this November 2018 special issue Open Section. First is by Bjørn Hofmann and Siri Granum Carson titled Filosofiens rolle i det offentlige ordskiftet: Hvordan har debatten om sorteringssamfunnet i 2017 påvirket forholdet mellom filosofi og samfunn? En innholdsanalyse (The role of philosophy in public debate - A content analysis of the debate on the "sorting society" in Norway in 2017). Second, Provokativ offentlig filosofi (Provocative Public Philosophy) by Aksel Braanen Sterri. Third, Steinar Bøyum’s The Democratic Duty to Educate Oneself. And fourth, Jonas Jakobsen and Kjersti Fjørtoft’s In defence of moderate Inclusivism: Revisiting Rawls and Habermas.

Melioidosis is caused by gram negative bacilli called Burkholderia pseudomallei. It is an infectious threat to southeast Asian population. It predominantly affects the diabetic people who have got exposure to the contaminated soil. As it affects multiple organs, it mimics other disease like-tuberculosis. Here we report an unusual pulmonary manifestation of Burkholderia infection in a diabetic patient. A 46-year-old male presented with neck swelling and bilateral pulmonary nodules with pneumothorax. His blood culture and pus culture from neck swelling confirmed Burkholderia pseudomallei. He was managed with bilateral intercostal drainage, sensitive antibiotics and showed improvement. Melioidosis causing bilateral pneumothorax with nodules and its complete recovery was not reported earlier.

This open themed issue of Etikk i praksis compiles five diverse papers that overlap at key conceptual intersections around trust, care and responsibilities across national boundaries. Our globalized social environments have become more and more complex, and the information needed to understand society and our moral responsibilities have grown ever more challenging. The ‘fake news’ buzzword, used by various societal actors to cast doubt on political rivals, is shaking the trust needed to be confident about institutional sources of information. The caring attitude that serves to cement social groups and communities seems to be weakening in certain contexts, resulting in individual acts of unimaginable violence that shock us to the core. On the other hand, we are inspired when the same caring attitude mobilizes groups and individuals to reach across national boundaries and aid those who are suffering. In sorting through the generalizations and attempts to categorize the many highly complex social phenomena that occur in our interconnected global realities, we apply careful analysis of both facts and values that facilitate ethical reflection, helping us to make ethical decisions.

The editors of Etikk i praksis are pleased to introduce six papers in this open-themed issue for the journal’s 10th year anniversary.

We describe from the Muller Range of New Guinea three new species of microhylid frogs, one each in the genera Albericus, Cophixalus, and Oreophryne. The new Albericus is unique in its combination ofan infrequent peeping call, oblique lores, wide snout and finger discs, and distinct tympanum. The new Cophixalus is distinguished by its combination of finger discs larger than toe discs, third toe longer than fifth, distinct tympanum, curved scapular ridges, dark postocular stripe, dark W-shaped mark above the shoulders, anda call consisting of a rapid series of 6–9 musical peeps. The Oreophryne is unique in its combination ofa cartilaginous connection of the procoracoid to the scapula, no webbing between the toes, fifth toe longer than third, short snout, dark face, and call consisting of an extended multi-note chuckle or cackle. Each species was either common or abundant. The new Cophixalus shows a predilection for caves, although it is not restricted to them. Many frogs occurring in the central highlands of New Guinea are wide-ranging across much of this high-elevational region, but others are of restricted distribution. The species described herein are likely members of the latter group, although it remains to be determined whether each will prove endemic to the Muller Range.

How should national societies build legitimate and inclusive collective identities amidst prolific multiculturalism and linguistic diversity? We argue that cultural ownership of particular ways of framing ethics should be part of this collective identity building process. We should avoid unfair domination of minority cultural identities, but how do we do this when ethical discourses themselves tend to be shaped by particular dominant identities? We look into the case of the challenges that a particular multicultural society, the Philippines, faces in its ongoing collective identity building project on three levels: (1) ethnic and linguistic differences (e.g. differences between Tagalog, Cebuano, Maranao, etc.), (2) the historical layers of foreign culture (e.g. Islamic, Spanish, and American) that have each influenced these distinct cultural identities in different degrees, and (3) the apparent domination of Tagalog linguistic culture over others. Our answer to the question of legitimate and inclusive collective identity comes from an inter-linguistic dialogue that can be effected between cultures by harnessing similarities of ethical concepts, without compromising cultural differences. We present three different possible approaches under the following headings: (1) Pilipino ethics, (2) Filipino ethics and (3) Philippine ethics, each representing a particular stance to the dominant Tagalog linguistic culture. We argue for the third option, which is the most inclusive because of how it equalizes the status of all participating cultures in the dialogue. We also draw from the possibilities afforded by the phenomena of Scandinavian semicommunication (Haugen 1966) and what this practice offers in making collective identity building more inclusive.

Dette nummeret av tidsskriftet er et åpent nummer. Der fire av fem bidrag handler om profesjonsetikk. Ett av disse drøfter profesjonsetikk mer generelt, mens de andre tre fokuserer på bestemte profesjoner. Det ene bidraget drøfter spionvirksomhet, mens de andre to ser på toppfotball og global helseetikk. I tillegg har vi et bidrag som sammenlikner etikk og identitetsbygging innenfor ulike nasjonale kontekster.

Background: Recent studies on public attitudes toward life extension technologies show a mix of ambivalence toward and support for extending the human lifespan (Partridge 2009; Dragojlovic 2013; Funk et al. 2013). Attitudes toward genetic modification of organisms and technological enhancements may be used to categorize individuals according to political or ideological orientation such as technoprogressive or conservative (Hughes 2010) and it could be easy to assume that these categories are related to more general categorizations related to culture, e.g. between Traditional and Secular-rational values in the World Values Survey (Ingelhart & Welzel 2010). This paper discusses how attitudes toward aspects of radical life extension may be related to cultural values as revealed in an online deliberative survey among university students conducted between January 2012 to January 2013. Survey results suggest that attitudes toward radical life extension tend to be mixed among groups categorized as Traditional, Secular-rational, Survivalist, and Self-expressionist. The study explored the relation between responses of 326 university students to 5 key questions on radical life extension (RLE) and the cultural values they tend to favor as indicated by their response to 20 statements from the World Values Survey. Design and Method: The survey consisted of 3 stages: an online pre-discussion survey, face-to-face discussion, and post-discussion survey. After completing the 5 main survey questions in stage 1, participants were presented two additional questionnaires: one on cultural attitudes using 20 statements from the 2004-2008 World Values Survey (WVS) and another on health attitudes with 12 statements from Dutta-Bergman’s 2004 study. In stage 2, participants were engaged in a face-to-face discussion in class focusing on their responses to the five key questions. After the discussion, they were invited to reconsider the choices and reasons they posted in stage 1 in the light of the face-to-face class discussion in stage 2. Results: Responses to the five survey questions showed that there tended to be more individuals across groups who disagreed with adopting technologies that radically extend the human lifespan beyond the current limit of 120 years. Attitudes toward radical life extension did not correspond to cultural attitudes indicated by responses to the WVS questions. The proportion of agreement/disagreement to statements presented in each of the five questions varied across cultural groups and there tended to be more individuals who disagreed with radical life extension in all groups. Changes in responses after the discussion stage were not significant and most respondents maintained their prior views. Discussion: Cultural attitudes associated with familiar technologies may not correspond with attitudes toward newer technologies since beliefs and values may need to be adapted to new imagined situations that the new technologies elicit. Moral understandings associated with familiar technological habits and beliefs are not necessarily carried over to new technologies.

This special issue of Etikk i praksis features papers that articulate and discuss approaches and methodology that seek to make normative research activity and research output productive in contexts of ongoing societal and technological decision-making. The articles in various ways and to a varying degree exemplify and reflect on the methodology of the study of normativity in innovation.

Living vertebrates vary drastically in body size, yet few taxa reach the extremely minute size of some frogs and teleost fish. Here we describe two new species of diminutive terrestrial frogs from the megadiverse hotspot island of New Guinea, one of which represents the smallest known vertebrate species, attaining an average body size of only 7.7 mm. Both new species are members of the recently described genus Paedophryne, the four species of which are all among the ten smallest known frog species, making Paedophryne the most diminutive genus of anurans. This discovery highlights intriguing ecological similarities among the numerous independent origins of diminutive anurans, suggesting that minute frogs are not mere oddities, but represent a previously unrecognized ecological guild.

Abstract Background Food security is an issue that has come under renewed scrutiny amidst concerns that substantial yield increases in cereal crops are required to feed the world’s booming population. Wheat is of fundamental importance in this regard being one of the three most important crops for both human consumption and livestock feed; however, increase in crop yields have not kept pace with the demands of a growing world population. In order to address this issue, plant breeders require new molecular tools to help them identify genes for important agronomic traits that can be introduced into elite varieties. Studies of the genome using next-generation sequencing enable the identification of molecular markers such as single nucleotide polymorphisms that may be used by breeders to identify and follow genes when breeding new varieties. The development and application of next-generation sequencing technologies has made the characterisation of SNP markers in wheat relatively cheap and straightforward. There is a growing need for the widespread dissemination of this information to plant breeders. Description CerealsDB is an online resource containing a range of genomic datasets for wheat (Triticum aestivum) that will assist plant breeders and scientists to select the most appropriate markers for marker assisted selection. CerealsDB includes a database which currently contains in excess of 100,000 putative varietal SNPs, of which several thousand have been experimentally validated. In addition, CerealsDB contains databases for DArT markers and EST sequences, and links to a draft genome sequence for the wheat variety Chinese Spring. Conclusion CerealsDB is an open access website that is rapidly becoming an invaluable resource within the wheat research and plant breeding communities.

Abstract Background This study examined augmenting atomoxetine with extended-release methylphenidate in children whose attention-deficit/hyperactivity disorder (ADHD) previously failed to respond adequately to stimulant medication. Methods Children with ADHD and prior stimulant treatment (N = 25) received atomoxetine (1.2 mg/kg/day) plus placebo. After 4 weeks, patients who were responders (n = 4) were continued on atomoxetine/placebo while remaining patients were randomly assigned to either methylphenidate (ATX/MPH) (1.1 mg/kg/day) or placebo augmentation (ATX/PB) for another 6 weeks. Patients and sites were blind to timing of active augmentation. Safety measures included vital signs, weight, and adverse events. Efficacy was assessed by ADHD rating scales. Results Categorical increases in vital signs occurred for 5 patients (3 patients in ATX/MPH, 2 patients in ATX/PBO). Sixteen percent discontinued the study due to AE, but no difference between augmentation groups. Atomoxetine treatment was efficacious on outcome measures (P ≤ .001), but methylphenidate did not enhance response. Conclusion Methylphenidate appears to be safely combined with atomoxetine, but conclusions limited by small sample. With atomoxetine treatment, 43% of patients achieved normalization on ADHD ratings.

Abstract Background An important issue in pediatric pharmacology is the determination of whether medications affect cardiac rhythm parameters, in particular the QT interval, which is a surrogate marker for the risk of adverse cardiac events and sudden death. To evaluate changes while on medication, it is useful to have a comparison of age appropriate values while off medication. The present meta-analysis provides baseline ECG values (i.e., off medication) from approximately 6000 children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods Subjects were aged 6–18 years and participated in global trials within the atomoxetine registration program. Patients were administered a 12-lead ECG at study screening and cardiac rhythm parameters were recorded. Baseline QT intervals were corrected for heart rate using 3 different methods: Bazett's, Fridericia's, and a population data-derived formula. Results ECG data were obtained from 5289 North American and 641 non-North American children and adolescents. Means and percentiles are presented for each ECG measure and QTc interval based on pubertal status as defined by age and sex. Prior treatment history with stimulants and racial origin (Caucasian) were each associated with significantly longer mean QTc values. Conclusion Baseline ECG and QTc data from almost 6000 children and adolescents presenting with ADHD are provided to contribute to the knowledge base regarding mean values for pediatric cardiac parameters. Consistent with other studies of QT interval in children and adolescents, Bazett correction formula appears to overestimate the prevalence of prolonged QTc in the pediatric population.

Abstract Background Domperidone, a drug that enhances upper gastric motility, is an anti-dopaminergic medication that also elevates prolactin levels. It has been shown to safely increase the milk supply of lactating women. To date, researchers have analyzed the effects of domperidone on lactating woman with respect to the quantity of their milk production, adverse effects, and drug levels in the breast milk. However, the effect of domperidone on the macronutrient composition of breast milk has not been studied and current guidelines for fortification of human milk for premature infants do not distinguish between those women using or those not using domperidone. The purpose of this study is to evaluate the effect of domperidone (given to lactating mothers of very preterm infants) on the macronutrient composition of breast milk. Methods/Design Mothers of infants delivered at less than 31 weeks gestation, who are at least 3 weeks postpartum, and experiencing lactational failure despite non-pharmacological interventions, will be randomized to receive domperidone (10 mg three times daily) or placebo for a 14-day period. Breast milk samples will be obtained the day prior to beginning treatment and on days 4, 7 and 14. The macronutrient (protein, fat, carbohydrate and energy) and macromineral content (calcium, phosphorus and sodium) will be analyzed and compared between the two groups. Additional outcome measures will include milk volumes, serum prolactin levels (measured on days 0, 4, and 10), daily infant weights and breastfeeding rates at 2 weeks post study completion and at discharge. Forty-four participants will be recruited into the study. Analysis will be carried out using the intention to treat approach. Discussion If domperidone causes significant changes to the nutrient content of breast milk, an alteration in feeding practices for preterm infants may need to be made in order to optimize growth, nutrition and neurodevelopment outcomes.

Abstract Background It is generally accepted that the risk of cerebral palsy decreases with increasing gestational age of live born infants. However, recent studies have shown that cerebral palsy often has prenatal antecedents including congenital malformations, vascular insults and maternal infection. Cerebral palsy is therefore better viewed as occurring among fetuses, rather than among infants. We explored the epidemiologic implications of this change in perspective. Methods We used recently published data from Shiga Prefecture, Japan and from North-East England to examine the pattern of gestational age-specific rates of cerebral palsy under these alternative perspectives. We first calculated gestational age-specific rates of cerebral palsy as per convention, by dividing the number of cases of cerebral palsy identified among live births within any gestational age category by the number of live births in that gestational age category. Under the alternative formulation, we calculated gestational age-specific rates of cerebral palsy by dividing the number of cases of cerebral palsy identified among live births within any gestational age category by the number of fetuses who were at risk of being born at that gestation and being afflicted with cerebral palsy. Results Under the conventional formulation, cerebral palsy rates decreased with increasing gestational age from 63.9 per 1,000 live births at Conclusions The fetuses-at-risk approach is the appropriate epidemiologic formulation for calculating the gestational age-specific rate of cerebral palsy from a causal perspective. It shows that the risk of cerebral palsy increases as gestational duration increases. This compelling view of cerebral palsy risk may help refocus research aimed at understanding and preventing cerebral palsy.

Abstract Background Birth weight- and gestational age-specific perinatal mortality curves intersect when compared across categories of maternal smoking, plurality, race and other factors. No simple explanation exists for this paradoxical observation. Methods We used data on all live births, stillbirths and infant deaths in Canada (1991–1997) to compare perinatal mortality rates among singleton and twin births, and among singleton births to nulliparous and parous women. Birth weight- and gestational age-specific perinatal mortality rates were first calculated by dividing the number of perinatal deaths at any given birth weight or gestational age by the number of total births at that birth weight or gestational age (conventional calculation). Gestational age-specific perinatal mortality rates were also calculated using the number of fetuses at risk of perinatal death at any given gestational age. Results Conventional perinatal mortality rates among twin births were lower than those among singletons at lower birth weights and earlier gestation ages, while the reverse was true at higher birth weights and later gestational ages. When perinatal mortality rates were based on fetuses at risk, however, twin births had consistently higher mortality rates than singletons at all gestational ages. A similar pattern emerged in contrasts of gestational age-specific perinatal mortality among singleton births to nulliparous and parous women. Increases in gestational age-specific rates of growth-restriction with advancing gestational age presaged rising rates of gestational age-specific perinatal mortality in both contrasts. Conclusions The proper conceptualization of perinatal risk eliminates the mortality crossover paradox and provides new insights into perinatal health issues.

Anticoagulant use is prevalent and associated with significant potential for harm. Anticoagulation stewardship practice has emerged to address care gaps and promote safe, effective, and cost-conscious anticoagulation use across health care systems. We present 4 patient cases describing common challenges in anticoagulation management: inappropriate dosing of direct oral anticoagulants, the diagnosis and management of heparin-induced thrombocytopenia, periprocedural anticoagulation management, and heavy menstrual bleeding on anticoagulation. We discuss available examples of successful stewardship programs that can address the challenges of each case, demonstrating how an investment in anticoagulation stewardship can improve patient outcomes., Competing Interests: Declaration of competing interests B.T.S.B., C.O., K.W.S. have no conflicts of interest to declare. A.L.A. has received speaking honoraria from AstraZeneca. S.K. has served as a consultant for Janssen, Pfizer, Bristol Myers Squibb, AstraZeneca, Gilead, Phase Bio, Boston Scientific, Inari, and Anthos; and received research funding (to institution) from Janssen, Bristol Myers Squibb, Osmosis Research, and Bayer. J.E.M., A.L.A., C.O., and S.K. are members of the Board of Directors of the Anticoagulation Forum., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)