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Perinatal and paediatric autopsy rates are at historically low levels with declining uptake due to dislike of the invasiveness of the procedure, and religious objections particularly amongst Muslim and Jewish parents. Less invasive methods of autopsy including imaging with and without tissue sampling have been shown to be feasible alternatives. We sought to investigate attitudes including religious permissibility and potential uptake amongst members of the Muslim and Jewish communities in the United Kingdom. Semi-structured interviews with religious and faith-based authorities (n = 16) and bereaved parents from the Jewish community (n = 3) as well as 10 focus groups with community members (60 Muslim participants and 16 Jewish participants) were conducted. Data were analysed using thematic analysis to identify key themes. Muslim and Jewish religious and faith-based authorities agreed that non-invasive autopsy with imaging was religiously permissible because it did not require incisions or interference with the body. A minimally invasive approach was less acceptable as it still required incisions to the body, although in those circumstances where it was required by law it was more acceptable than a full autopsy. During focus group discussions with community members, the majority of participants indicated they would potentially consent to a non-invasive autopsy if the body could be returned for burial within 24 hours, or if a family had experienced multiple fetal/pregnancy losses and the information gained might be useful in future pregnancies. Minimally invasive autopsy was less acceptable but around half of participants might consent if a non-invasive autopsy was not suitable, with the exception of the Jewish Haredi community who unanimously stated they would decline this alternative. Our research suggests less invasive autopsy offers a viable alternative to many Muslim and Jewish parents in the UK who currently decline a full autopsy. The findings may be of importance to other countries with significant Muslim and/or Jewish communities as well as to other religious communities where concerns around autopsy exist. Awareness-raising amongst religious leaders and community members will be important if these methods become routinely available.

The thymus is a primary lymphoid organ, essential for T cell maturation and selection. There has been long-standing interest in processes underpinning thymus generation and the potential to manipulate it clinically, because alterations of thymus development or function can result in severe immunodeficiency and autoimmunity. Here, we identify epithelial-mesenchymal hybrid cells, capable of long-term expansion in vitro, and able to reconstitute an anatomic phenocopy of the native thymus, when combined with thymic interstitial cells and a natural decellularised extracellular matrix (ECM) obtained by whole thymus perfusion. This anatomical human thymus reconstruction is functional, as judged by its capacity to support mature T cell development in vivo after transplantation into humanised immunodeficient mice. These findings establish a basis for dissecting the cellular and molecular crosstalk between stroma, ECM and thymocytes, and offer practical prospects for treating congenital and acquired immunological diseases. The thymus is essential for T cell maturation and selection, and thymic defects result in severe immune problems. Here the authors identify a thymus cell population that is expandable in vitro, and can repopulate natural thymic matrix to generate tissue that supports mature T cell development in vitro and in vivo.

ObjectiveTo assess health professionals’ and coroners’ attitudes towards non-minimally and minimally invasive autopsy in the perinatal and paediatric setting.MethodsA qualitative study using semistructured interviews. Data were analysed thematically.ResultsTwenty-five health professionals (including perinatal/paediatric pathologists and anatomical pathology technologists, obstetricians, fetal medicine consultants and bereavement midwives, intensive care consultants and family liaison nurses, a consultant neonatologist and a paediatric radiologist) and four coroners participated. Participants viewed less invasive methods of autopsy as a positive development in prenatal and paediatric care that could increase autopsy rates. Several procedural and psychological benefits were highlighted including improved diagnostic accuracy in some circumstances, potential for faster turnaround times, parental familiarity with imaging and laparoscopic approaches, and benefits to parents and faith groups who object to invasive approaches. Concerns around the limitations of the technology such not reaching the same levels of certainty as full autopsy, unsuitability of imaging in certain circumstances, the potential for missing a diagnosis (or misdiagnosis) and de-skilling the workforce were identified. Finally, a number of implementation issues were raised including skills and training requirements for pathologists and radiologists, access to scanning equipment, required computational infrastructure, need for a multidisciplinary approach to interpret results, cost implications, equity of access and acceptance from health professionals and hospital managers.ConclusionHealth professionals and coroners viewed less invasive autopsy as a positive development in perinatal and paediatric care. However, to inform implementation a detailed health economic analysis and further exploration of parental views, particularly in different religious groups, are required.

The family Boettgerillidae, represented by the Eurasian slug Boettgerilla pallens Simroth, 1912, is first recorded for Newfoundland and Labrador, Canada—a range extension of almost exactly 5000 km within the Americas. Compiled, within an appendix, to provide a national perspective for the Newfoundland and Labrador record, are 13 previously unpublished B. pallens records from British Columbia, Canada. Incidentally recorded is the second eastern Canadian outdoor occurrence of the European slug Deroceras invadens. This paper is the first in a series that will treat all of the terrestrial molluscs of Newfoundland and Labrador.

When animals can choose from a range of feeding options, often those options with a higher energetic gain carry a higher risk of predation. This paper analyses the optimal trade-off between food and predation. We are primarily interested in how an animal’s decisions and its state change over time. Our models are very general. They can be applied to growth decisions, such as choice of habitat, in which case we might consider how the state variable size changes over an animal’s lifetime. Equally our models are applicable to short-term foraging decisions, such as vigilance level, in which case we might consider how energy reserves vary over a day. We concentrate on two cases: (i) the animal must reach a fixed state, its fitness depending on when this is attained; (ii) the animal must survive to a fixed time, its fitness depending on its final state. In case (i) minimization of m ortality per unit increase of state is optimal under certain baseline conditions. In case (ii) behaviour is constant over time under baseline conditions (the 'Risk-spreading Theorem’). We analyse how these patterns are modified by complicating factors, e.g. time penalties, premature termination of the food supply, stochasticity in food supply or in metabolic expenditure, and state-dependence in the ability to obtain food, in metabolic expenditure and in predation risk. From this analysis we obtain a variety of possible explanations for why an animal should reduce its intake rate over time (i.e. show satiation). We show how earlier work can be viewed as special cases of our results.

We consider animals whose feeding rate depends on the size of structures that grow only by moulting (e.g. spiders' legs). Our Investment Principle predicts optimum size increases at each moult; under simplifying assumptions these are a function of the scaling of feeding rate with size, the efficiency of moulting and the optimum size increase at the preceding moult. We show how to test this quantitatively, and make the qualitative prediction that size increases and instar durations change monotonically through development. Thus, this version of the model does not predict that proportional size increases necessarily remain constant, which is the pattern described by Dyar's Rule. A literature survey shows that in nature size increases tend to decline and instar durations to increase, but exceptions to monotonicity occur frequently: we consider how relaxing certain assumptions of the model could explain this. Having specified various functions relating fitness to adult size and time of emergence, we calculate (using dynamic programming) the effect of manipulating food availability, time of hatching and size of the initial (or some intermediate) instar. The associated norms of reaction depend on the fitness function and differ from those when growth follows Dyar's Rule or is continuous. We go on to consider optimization of the number of instars. The Investment Principle then predicts upper and lower limits to observed size increases and explains why increases usually change little or decline through development. This is thus a new adaptive explanation for Dyar's Rule and for the most common deviation from the Rule.

The name Deroceras panormitanum is generally applied to a terrestrial slug that has spread worldwide and can be a pest; earlier this tramp species had been called Deroceras caruanae. Neither name is appropriate. The taxonomic descriptions apply to a species from Sicily and Malta. This true D. panormitanum and the tramp species are distinct in morphology and mating behaviour. For instance, the penial caecum of D. panormitanum is more pointed, everting faster at copulation. The size of the penial lobe varies considerably in preserved specimens but is always prominent at copulation. D. panormitanum is distinct from the Maltese endemic Deroceras golcheri, but a phylogeny based on mtDNA COI sequences implies that they are more closely related than is the tramp species. D. golcheri has a still closer counterpart on Sicily, but we leave the taxonomy of this \"species X\" unresolved. In interspecific crosses, D. panormitanum may transfer sperm to the partner's sarcobelum whereas the partner fails to evert its penis (D. golcheri) or to transfer sperm (the tramp species). Names previously applied to the tramp species originally referred to D. panormitanum or are otherwise invalid, so it is here formally redescribed as D. invadens. Deroceras giustianum Wiktor, 1998 is synonymised with D. panormitanum.

These discussions are selected from the weekly staff conferences in the Department of Medicine, University of California Medical Center, San Francisco. Taken from transcriptions, they are prepared by Drs. Martin J. Cline and Hibbard E. Williams, Associate Professors of Medicine, under the direction of Dr. Lloyd H. Smith, Jr., Professor of Medicine and Chairman of the Department of Medicine. Images

A cost analysis and study were done of patient survival after inhospital cardiopulmonary resuscitation during one year at a university hospital. The immediate survival rate in 128 patients was 52 percent. Survival to discharge and six-month survival rates were 19 percent and 15.6 percent, respectively. In all, 23 patients (18 percent) had multiple arrests (two to four per patient) during the same hospital stay. Immediate and six-month survival rates in this group were 52 percent (12 patients) and 9 percent (two patients), respectively. Gender or location where cardiopulmonary arrests occurred in the hospital did not influence survival. The cost of a Code Blue (direct expenses only) was $366. We conclude that the outcome following resuscitation at this university hospital compares favorably with the experience of others, and that the direct cost is modest in relation to the results obtained.