Imaging of both benign and malignant anorectal diseases has traditionally posed a challenge to clinicians, and as a result history and physical exam have been relied on heavily. CT scanning and endorectal ultrasound h...Imaging of both benign and malignant anorectal diseases has traditionally posed a challenge to clinicians, and as a result history and physical exam have been relied on heavily. CT scanning and endorectal ultrasound have become popular in assessment of anatomy and staging of tumors, but have limitations. Magnetic resonance imaging (MRI) has the capability to fill in the gaps left open by more conventional imaging modalities and continues to be promising as the definitive imaging technique in the pelvis, especially with advancement of emerging technologies in this field. A comprehensive review of this topic has been undertaken. Anorectal disease is divided into three broad categories: cancer, fistula/abscess, and pelvic floor disorders. A review of the literature is performed to evaluate the use of MRI and other imaging modalities in these three areas. Preoperative imaging is useful in the evaluation of all three areas of anorectal disease. MRI is an effective tool in delineating anatomy and, when correlating with the specific clinical scenario, is an effective adjunct in clinical decision-making in order to optimize outcome. MRI continues to be a promising and novel approach to imaging various afflictions of the anorectum and the pelvic floor. Its role is more well-established in some areas than in others, and there are still signif icant limitations. As technology advances, MRI will shed more light on a complex anatomical area.展开更多
Patients with long-term type 1 and type 2 diabetes mellitus(DM) can develop skeletal complications or "diabetic osteopathy". These include osteopenia, osteoporosis and an increased incidence of low-stress fr...Patients with long-term type 1 and type 2 diabetes mellitus(DM) can develop skeletal complications or "diabetic osteopathy". These include osteopenia, osteoporosis and an increased incidence of low-stress fractures. In this context, it is important to evaluate whether current anti-diabetic treatments can secondarily affect bone metabolism. Adenosine monophosphateactivated protein kinase(AMPK) modulates multiple metabolic pathways and acts as a sensor of the cellular energy status; recent evidence suggests a critical role for AMPK in bone homeostasis. In addition, AMPK activation is believed to mediate most clinical effects of the insulin-sensitizer metformin. Over the past decade, several research groups have investigated the effects of metformin on bone, providing a considerable body of pre-clinical(in vitro, ex vivo and in vivo) as well as clinical evidence for an anabolic action of metformin on bone. However, two caveats should be kept in mind when considering metformin treatment for a patient with type 2 DM at risk for diabetic osteopathy. In the first place, metformin should probably not be considered an antiosteoporotic drug; it is an insulin sensitizer with proven macrovascular benefits that can secondarily improve bone metabolism in the context of DM. Secondly, we are still awaiting the results of randomized placebo-controlled studies in humans that evaluate the effects of metformin on bone metabolism as a primary endpoint.展开更多
Biomimetic materials have emerged as attractive and competitive alternatives for tissue engineering(TE)and regenerative medicine.In contrast to conventional biomaterials or synthetic materials,biomimetic scaffolds bas...Biomimetic materials have emerged as attractive and competitive alternatives for tissue engineering(TE)and regenerative medicine.In contrast to conventional biomaterials or synthetic materials,biomimetic scaffolds based on natural biomaterial can offer cells a broad spectrum of biochemical and biophysical cues that mimic the in vivo extracellular matrix(ECM).Additionally,such materials have mechanical adaptability,micro-structure interconnectivity,and inherent bioactivity,making them ideal for the design of living implants for specific applications in TE and regenerative medicine.This paper provides an overview for recent progress of biomimetic natural biomaterials(BNBMs),including advances in their preparation,functionality,potential applications and future challenges.We highlight recent advances in the fabrication of BNBMs and outline general strategies for functionalizing and tailoring the BNBMs with various biological and physicochemical characteristics of native ECM.Moreover,we offer an overview of recent key advances in the functionalization and applications of versatile BNBMs for TE applications.Finally,we conclude by offering our perspective on open challenges and future developments in this rapidly-evolving field.展开更多
Public health in England developed during the first half of the nineteenth century with concern for sanitation in urban areas. Since that time environment, behaviour, social relationships, health services and genetic ...Public health in England developed during the first half of the nineteenth century with concern for sanitation in urban areas. Since that time environment, behaviour, social relationships, health services and genetic constitution are all recognized to contribute to health and disease in populations. Sustainable development is now of global concern, and its foundations—economy, environment and society—are similar to the determinants of health. However, while improved environment will have an important contribution to health, the broader social objectives are also needed to avoid the downward cycle of inequality and cultural deterioration that has occurred in some western cities. Epidemiological studies at University College London are particularly concerned with these social dimensions, and research opportunities exist for collaboration with environmental sciences in a number of areas, including intersectoral work, societies in social transition, collaboration with business, and research within through the European Union.展开更多
The final analysis of the phase 3 Targeted Investigational Treatment Analysis of Novel Anti-androgen(TITAN)trial showed improvement in overall survival(OS)and other efficacy endpoints with apalutamide plus androgen de...The final analysis of the phase 3 Targeted Investigational Treatment Analysis of Novel Anti-androgen(TITAN)trial showed improvement in overall survival(OS)and other efficacy endpoints with apalutamide plus androgen deprivation therapy(ADT)versus ADT alone in patients with metastatic castration-sensitive prostate cancer(mCSPC).As ethnicity and regional differences may affect treatment outcomes in advanced prostate cancer,a post hoc final analysis was conducted to assess the efficacy and safety of apalutamide in the Asian subpopulation.Event-driven endpoints were OS,and time from randomization to initiation of castration resistance,prostate-specific antigen(PSA)progression,and second progression-free survival(PFS2)on first subsequent therapy or death.Efficacy endpoints were assessed using the Kaplan–Meier method and Cox proportional-hazards models without formal statistical testing and adjustment for multiplicity.Participating Asian patients received once-daily apalutamide 240 mg(n=111)or placebo(n=110)plus ADT.After a median follow-up of 42.5 months and despite crossover of 47 placebo recipients to open-label apalutamide,apalutamide reduced the risk of death by 32%(hazard ratio[HR]:0.68;95%confidence interval[CI]:0.42–1.13),risk of castration resistance by 69%(HR:0.31;95%CI:0.21–0.46),PSA progression by 79%(HR:0.21;95%CI:0.13–0.35)and PFS2 by 24%(HR:0.76;95%CI:0.44–1.29)relative to placebo.The outcomes were comparable between subgroups with low-and high-volume disease at baseline.No new safety issues were identified.Apalutamide provides valuable clinical benefits to Asian patients with mCSPC,with an efficacy and safety profile consistent with that in the overall patient population.展开更多
Ethnicity might be associated with treatment outcomes in advanced prostate cancer.This study aimed to evaluate the efficacy and safety of androgen deprivation therapy(ADT)combined with apalutamide in East Asians with ...Ethnicity might be associated with treatment outcomes in advanced prostate cancer.This study aimed to evaluate the efficacy and safety of androgen deprivation therapy(ADT)combined with apalutamide in East Asians with metastatic castration-sensitive prostate cancer(mCSPC).The original phase 3 Targeted Investigational Treatment Analysis of Novel Anti-androgen(TITAN)trial was conducted at 260 sites in 23 countries.This subgroup analysis included patients enrolled in 62 participating centers in China,Japan,and Korea.Radiographic progression-free survival(PFS),time to prostate-specific antigen(PSA)progression,and PSA changes from baseline were compared between groups in the East Asian population.The intent-to-treat East Asian population included 111 and 110 participants in the apalutamide and placebo groups,respectively.The 24-month radiographic PFS rates were 76.1%and 52.3%in the apalutamide and placebo groups,respectively(apalutamide vs placebo:hazard ratio[HR]=0.506;95%confidence interval[CI],0.302–0.849;P=0.009).Median time to PSA progression was more favorable with apalutamide than placebo(HR=0.210;95%CI,0.124–0.357;P<0.001).Median maximum percentages of PSA decline from baseline were 99.0%and 73.9%in the apalutamide and placebo groups,respectively.The most common adverse event(AE)was rash in the apalutamide group,with a higher rate than that in the placebo group(37.3%vs 9.1%).The most common grade 3 or 4 AEs were rash(12[10.9%])and hypertension(12[10.9%])for apalutamide.The efficacy and safety of apalutamide in the East Asian subgroup of the TITAN trial are consistent with the global results.展开更多
AIM: To estimate an effect size for the transversus abdominis plane(TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS: The pilot study was a randomized, double ...AIM: To estimate an effect size for the transversus abdominis plane(TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS: The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40(QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. RESULTS: Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range(IQR)] of 175.5(170-189) com-pared to 170(160-175) in the control group(P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median(IQR) of 7.5(2.5-11.5) mg iv morphine equivalents compared to 13(7-21.5) in the control group(P = 0.07). Correlation analysis(Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores,-0.49(P = 0.03). CONCLUSION: The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.展开更多
As cloud service becomes more and more capable, available and powerful, wiseCIO has emerged from an innovative roadmap toward archival Content Management Service (aCMS) and massive Content Delivery Service (mCDS) in s...As cloud service becomes more and more capable, available and powerful, wiseCIO has emerged from an innovative roadmap toward archival Content Management Service (aCMS) and massive Content Delivery Service (mCDS) in support of Anything-as-a-Service (XaaS) via Digital Archiving and Transformed Analytics (DATA);DATA aims to automate UBC with FAST solutions throughout a feasible, analytical, scalable and testable approach. This paper, based on the novel wiseCIO (web-based intelligent service engaging Cloud Intelligence Outlet), presents digital archiving and transformed analytics via machine learning automata for intelligent UBC processes to liaise with Universal interface for human-computer interaction, enable Brewing aggregation (differing from traditional web browsing), and engage Centered user experience. As one of the most practical aspects of artificial intelligence, machine learning is applied to analytical model building and massive and/or multidimensional Online Analytical Processing (mOLAP) for more intelligent cloud service with little explicit coding required. DATA is central to useful information via archival transformation and analytics, and utilizable intelligence for Business, Education and Entertainment (iBEE) in support of decision-making. As a result, DATA orchestrates wiseCIO to promote ACTiVE XaaS that enables accessibility, contextuality and traceability of information for vast engagement with various cloud services, such as aCMS (archival Content Management Service), COSA (Context-Oriented Screening Aggregation), DASH (Deliveries Assembled for fast Search and Hits), OLAS (Online Learning via Analytical Synthesis), REAP (Rapid Extension and Active Presentation), and SPOT (Special Points On Top) with great ease.展开更多
This article addresses the need for anticipatory guidance about death and death education with young children. Children often experience the death of an immediate family member before the age of ten. This number incre...This article addresses the need for anticipatory guidance about death and death education with young children. Children often experience the death of an immediate family member before the age of ten. This number increases if one considers the loss of friends, pets, and other loved ones. However, children experience a death with little or no anticipatory guidance or knowledge about death. Anticipatory guidance can assist the child in having a better understanding of a death when it occurs. Talking about death with children can be difficult for adults. However, it is important to address the topic and realize the impact anticipatory guidance in relation to death can have in assisting with childhood bereavement, anticipatory grief, and anticipatory adaptation. By providing anticipatory education related to death symptoms such as grief, anger, and/or fear, regressive or aggressive behaviors can be prevented or lessened when a death occurs. Age appropriate developmental levels for understanding the concept of death, resources for death education, and literature that can be used for death education are presented. Any resource used for death education with children should be carefully reviewed by the adult for its appropriateness prior to its use.展开更多
文摘Imaging of both benign and malignant anorectal diseases has traditionally posed a challenge to clinicians, and as a result history and physical exam have been relied on heavily. CT scanning and endorectal ultrasound have become popular in assessment of anatomy and staging of tumors, but have limitations. Magnetic resonance imaging (MRI) has the capability to fill in the gaps left open by more conventional imaging modalities and continues to be promising as the definitive imaging technique in the pelvis, especially with advancement of emerging technologies in this field. A comprehensive review of this topic has been undertaken. Anorectal disease is divided into three broad categories: cancer, fistula/abscess, and pelvic floor disorders. A review of the literature is performed to evaluate the use of MRI and other imaging modalities in these three areas. Preoperative imaging is useful in the evaluation of all three areas of anorectal disease. MRI is an effective tool in delineating anatomy and, when correlating with the specific clinical scenario, is an effective adjunct in clinical decision-making in order to optimize outcome. MRI continues to be a promising and novel approach to imaging various afflictions of the anorectum and the pelvic floor. Its role is more well-established in some areas than in others, and there are still signif icant limitations. As technology advances, MRI will shed more light on a complex anatomical area.
文摘Patients with long-term type 1 and type 2 diabetes mellitus(DM) can develop skeletal complications or "diabetic osteopathy". These include osteopenia, osteoporosis and an increased incidence of low-stress fractures. In this context, it is important to evaluate whether current anti-diabetic treatments can secondarily affect bone metabolism. Adenosine monophosphateactivated protein kinase(AMPK) modulates multiple metabolic pathways and acts as a sensor of the cellular energy status; recent evidence suggests a critical role for AMPK in bone homeostasis. In addition, AMPK activation is believed to mediate most clinical effects of the insulin-sensitizer metformin. Over the past decade, several research groups have investigated the effects of metformin on bone, providing a considerable body of pre-clinical(in vitro, ex vivo and in vivo) as well as clinical evidence for an anabolic action of metformin on bone. However, two caveats should be kept in mind when considering metformin treatment for a patient with type 2 DM at risk for diabetic osteopathy. In the first place, metformin should probably not be considered an antiosteoporotic drug; it is an insulin sensitizer with proven macrovascular benefits that can secondarily improve bone metabolism in the context of DM. Secondly, we are still awaiting the results of randomized placebo-controlled studies in humans that evaluate the effects of metformin on bone metabolism as a primary endpoint.
基金supported by the National Natural Science Foundation of China(52003113,31900950,82102334,82002313,82072444)the National Key Research&Development Program of China(2018YFC2001502,2018YFB1105705)+6 种基金the Guangdong Basic and Applied Basic Research Foundation(2021A1515010745,2020A1515110356,2023A1515011986)the Shenzhen Fundamental Research Program(JCYJ20190808120405672)the Key Program of the National Natural Science Foundation of Zhejiang Province(LZ22C100001)the Natural Science Foundation of Shanghai(20ZR1469800)the Integration Innovation Fund of Shanghai Jiao Tong University(2021JCPT03),the Science and Technology Projects of Guangzhou City(202102020359)the Zigong Key Science and Technology Plan(2022ZCNKY07).SXC thanks the financial support under the Startup Grant of the University of Chinese Academy of Sciences(WIUCASQD2021026).HW thanks the Futian Healthcare Research Project(FTWS2022013)the financial support of China Postdoctoral Science Foundation(2021TQ0118).SL thanks the financial support of China Postdoctoral Science Foundation(2022M721490).
文摘Biomimetic materials have emerged as attractive and competitive alternatives for tissue engineering(TE)and regenerative medicine.In contrast to conventional biomaterials or synthetic materials,biomimetic scaffolds based on natural biomaterial can offer cells a broad spectrum of biochemical and biophysical cues that mimic the in vivo extracellular matrix(ECM).Additionally,such materials have mechanical adaptability,micro-structure interconnectivity,and inherent bioactivity,making them ideal for the design of living implants for specific applications in TE and regenerative medicine.This paper provides an overview for recent progress of biomimetic natural biomaterials(BNBMs),including advances in their preparation,functionality,potential applications and future challenges.We highlight recent advances in the fabrication of BNBMs and outline general strategies for functionalizing and tailoring the BNBMs with various biological and physicochemical characteristics of native ECM.Moreover,we offer an overview of recent key advances in the functionalization and applications of versatile BNBMs for TE applications.Finally,we conclude by offering our perspective on open challenges and future developments in this rapidly-evolving field.
文摘Public health in England developed during the first half of the nineteenth century with concern for sanitation in urban areas. Since that time environment, behaviour, social relationships, health services and genetic constitution are all recognized to contribute to health and disease in populations. Sustainable development is now of global concern, and its foundations—economy, environment and society—are similar to the determinants of health. However, while improved environment will have an important contribution to health, the broader social objectives are also needed to avoid the downward cycle of inequality and cultural deterioration that has occurred in some western cities. Epidemiological studies at University College London are particularly concerned with these social dimensions, and research opportunities exist for collaboration with environmental sciences in a number of areas, including intersectoral work, societies in social transition, collaboration with business, and research within through the European Union.
基金The study was funded by Janssen Pharmaceutical Ltd.Writing assistance was provided by Katherine A Lyseng-Williamson and Kerry Dechant,ISMPP CMPP^(TM),on behalf of Content Ed Net,and was funded by Janssen Pharmaceutical Ltd.Janssen Pharmaceutical Ltd.is not involved in the process of experimental design,results,or discussion,and has no competing interests with this study.
文摘The final analysis of the phase 3 Targeted Investigational Treatment Analysis of Novel Anti-androgen(TITAN)trial showed improvement in overall survival(OS)and other efficacy endpoints with apalutamide plus androgen deprivation therapy(ADT)versus ADT alone in patients with metastatic castration-sensitive prostate cancer(mCSPC).As ethnicity and regional differences may affect treatment outcomes in advanced prostate cancer,a post hoc final analysis was conducted to assess the efficacy and safety of apalutamide in the Asian subpopulation.Event-driven endpoints were OS,and time from randomization to initiation of castration resistance,prostate-specific antigen(PSA)progression,and second progression-free survival(PFS2)on first subsequent therapy or death.Efficacy endpoints were assessed using the Kaplan–Meier method and Cox proportional-hazards models without formal statistical testing and adjustment for multiplicity.Participating Asian patients received once-daily apalutamide 240 mg(n=111)or placebo(n=110)plus ADT.After a median follow-up of 42.5 months and despite crossover of 47 placebo recipients to open-label apalutamide,apalutamide reduced the risk of death by 32%(hazard ratio[HR]:0.68;95%confidence interval[CI]:0.42–1.13),risk of castration resistance by 69%(HR:0.31;95%CI:0.21–0.46),PSA progression by 79%(HR:0.21;95%CI:0.13–0.35)and PFS2 by 24%(HR:0.76;95%CI:0.44–1.29)relative to placebo.The outcomes were comparable between subgroups with low-and high-volume disease at baseline.No new safety issues were identified.Apalutamide provides valuable clinical benefits to Asian patients with mCSPC,with an efficacy and safety profile consistent with that in the overall patient population.
基金This study was funded by Janssen Pharmaceutical Ltd.,which designed the study.
文摘Ethnicity might be associated with treatment outcomes in advanced prostate cancer.This study aimed to evaluate the efficacy and safety of androgen deprivation therapy(ADT)combined with apalutamide in East Asians with metastatic castration-sensitive prostate cancer(mCSPC).The original phase 3 Targeted Investigational Treatment Analysis of Novel Anti-androgen(TITAN)trial was conducted at 260 sites in 23 countries.This subgroup analysis included patients enrolled in 62 participating centers in China,Japan,and Korea.Radiographic progression-free survival(PFS),time to prostate-specific antigen(PSA)progression,and PSA changes from baseline were compared between groups in the East Asian population.The intent-to-treat East Asian population included 111 and 110 participants in the apalutamide and placebo groups,respectively.The 24-month radiographic PFS rates were 76.1%and 52.3%in the apalutamide and placebo groups,respectively(apalutamide vs placebo:hazard ratio[HR]=0.506;95%confidence interval[CI],0.302–0.849;P=0.009).Median time to PSA progression was more favorable with apalutamide than placebo(HR=0.210;95%CI,0.124–0.357;P<0.001).Median maximum percentages of PSA decline from baseline were 99.0%and 73.9%in the apalutamide and placebo groups,respectively.The most common adverse event(AE)was rash in the apalutamide group,with a higher rate than that in the placebo group(37.3%vs 9.1%).The most common grade 3 or 4 AEs were rash(12[10.9%])and hypertension(12[10.9%])for apalutamide.The efficacy and safety of apalutamide in the East Asian subgroup of the TITAN trial are consistent with the global results.
基金Supported by Department of Anesthesiology,Northwestern University
文摘AIM: To estimate an effect size for the transversus abdominis plane(TAP) infiltration on quality of recovery in patients undergoing laparoscopic gastric band surgery. METHODS: The pilot study was a randomized, double blinded, placebo controlled trial. Patients undergoing laparoscopic gastric band surgery were randomized to receive a bilateral TAP infiltration with 20 mL of 0.5% ropivacaine or saline. The evaluated outcomes included quality of recovery-40(QoR-40) at 24 h, postoperative opioid consumption and pain. Data was examined using the Mann-Whitney U test. RESULTS: Nineteen subjects were recruited. There was a positive trend favoring the TAP infiltration group in global QoR-40 scores at 24 h after surgery, median [interquartile range(IQR)] of 175.5(170-189) com-pared to 170(160-175) in the control group(P = 0.06). There also a positive trend toward a lower cumulative opioid consumption in the TAP infiltration group, median(IQR) of 7.5(2.5-11.5) mg iv morphine equivalents compared to 13(7-21.5) in the control group(P = 0.07). Correlation analysis(Spearman's Rho) demonstrated an inverse relationship between 24 h cumulative opioid consumption and global QoR-40 scores,-0.49(P = 0.03). CONCLUSION: The use of multimodal analgesic techniques to reduce opioid related side effects is particularly desirable in morbidly obese patients undergoing gastric reduction surgery. The TAP infiltration seems to have a clinically important effect in reducing postoperative opioid consumption and improve quality of recovery after laparoscopic gastric band surgery in morbid obese patients. Future studies to confirm the beneficial effects of the TAP infiltration in these patients are warranted.
文摘As cloud service becomes more and more capable, available and powerful, wiseCIO has emerged from an innovative roadmap toward archival Content Management Service (aCMS) and massive Content Delivery Service (mCDS) in support of Anything-as-a-Service (XaaS) via Digital Archiving and Transformed Analytics (DATA);DATA aims to automate UBC with FAST solutions throughout a feasible, analytical, scalable and testable approach. This paper, based on the novel wiseCIO (web-based intelligent service engaging Cloud Intelligence Outlet), presents digital archiving and transformed analytics via machine learning automata for intelligent UBC processes to liaise with Universal interface for human-computer interaction, enable Brewing aggregation (differing from traditional web browsing), and engage Centered user experience. As one of the most practical aspects of artificial intelligence, machine learning is applied to analytical model building and massive and/or multidimensional Online Analytical Processing (mOLAP) for more intelligent cloud service with little explicit coding required. DATA is central to useful information via archival transformation and analytics, and utilizable intelligence for Business, Education and Entertainment (iBEE) in support of decision-making. As a result, DATA orchestrates wiseCIO to promote ACTiVE XaaS that enables accessibility, contextuality and traceability of information for vast engagement with various cloud services, such as aCMS (archival Content Management Service), COSA (Context-Oriented Screening Aggregation), DASH (Deliveries Assembled for fast Search and Hits), OLAS (Online Learning via Analytical Synthesis), REAP (Rapid Extension and Active Presentation), and SPOT (Special Points On Top) with great ease.
文摘This article addresses the need for anticipatory guidance about death and death education with young children. Children often experience the death of an immediate family member before the age of ten. This number increases if one considers the loss of friends, pets, and other loved ones. However, children experience a death with little or no anticipatory guidance or knowledge about death. Anticipatory guidance can assist the child in having a better understanding of a death when it occurs. Talking about death with children can be difficult for adults. However, it is important to address the topic and realize the impact anticipatory guidance in relation to death can have in assisting with childhood bereavement, anticipatory grief, and anticipatory adaptation. By providing anticipatory education related to death symptoms such as grief, anger, and/or fear, regressive or aggressive behaviors can be prevented or lessened when a death occurs. Age appropriate developmental levels for understanding the concept of death, resources for death education, and literature that can be used for death education are presented. Any resource used for death education with children should be carefully reviewed by the adult for its appropriateness prior to its use.
