IT and the NHS: Investigating different perspectives of IT using soft systems methodology

The UK NHS National Programme for IT has been criticized for a lack of clinical engagement. This paper uses a soft systems methodology (SSM) analysis of a case study from the use of electronic systems within a National Health Service (NHS) Mental Health Trust in the United Kingdom (UK) to explore the legal and ethical implications of the failure to develop clinical systems which are fit for purpose. Soft systems methodology (SSM) was used as a theoretical model both to derive deeper insights into the survey data and suggest how communication between those producing information and those using it, could be improved. Multiple methods were employed which included a postal survey and participant interviews to triangulate the data The use of SSM reinforced the concept that the national IT programme is based on a 'hard' systems view and does not take local factors (which are related to 'soft systems' thinking) into account. The study found administrative staff to be a crucial link between clinicians and information departments and highlighted the need for a joint-up information strategy and integrated systems. The article concludes with a discussion of the legal and ethical implications of the findings and the lessons for the broader UK national programme. It argues that the failure to deliver systems that are fit for purpose is not value neutral but an ethical issue

Vascular complications of cancer chemotherapy

Development of new anticancer drugs has resulted in improved mortality rates and 5-year survival rates in patients with cancer. However, many of the modern chemotherapies are associated with cardiovascular toxicities that increase cardiovascular risk in cancer patients, including hypertension, thrombosis, heart failure, cardiomyopathy, and arrhythmias. These limitations restrict treatment options and might negatively affect the management of cancer. The cardiotoxic effects of older chemotherapeutic drugs such as alkylating agents, antimetabolites, and anticancer antibiotics have been known for a while. The newer agents, such as the antiangiogenic drugs that inhibit vascular endothelial growth factor signalling are also associated with cardiovascular pathology, especially hypertension, thromboembolism, myocardial infarction, and proteinuria. Exact mechanisms by which vascular endothelial growth factor inhibitors cause these complications are unclear but impaired endothelial function, vascular and renal damage, oxidative stress, and thrombosis might be important. With increasing use of modern chemotherapies and prolonged survival of cancer patients, the incidence of cardiovascular disease in this patient population will continue to increase. Accordingly, careful assessment and management of cardiovascular risk factors in cancer patients by oncologists and cardiologists working together is essential for optimal care so that prolonged cancer survival is not at the expense of increased cardiovascular events

Drug treatment of hypertension: focus on vascular health

Hypertension, the most common preventable risk factor for cardiovascular disease and death, is a growing health burden. Serious cardiovascular complications result from target organ damage including cerebrovascular disease, heart failure, ischaemic heart disease and renal failure. While many systems contribute to blood pressure (BP) elevation, the vascular system is particularly important because vascular dysfunction is a cause and consequence of hypertension. Hypertension is characterised by a vascular phenotype of endothelial dysfunction, arterial remodelling, vascular inflammation and increased stiffness. Antihypertensive drugs that influence vascular changes associated with high BP have greater efficacy for reducing cardiovascular risk than drugs that reduce BP, but have little or no effect on the adverse vascular phenotype. Angiotensin converting enzyme ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) improve endothelial function and prevent vascular remodelling. Calcium channel blockers also improve endothelial function, although to a lesser extent than ACEIs and ARBs. Mineralocorticoid receptor blockers improve endothelial function and reduce arterial stiffness, and have recently become more established as antihypertensive drugs. Lifestyle factors are essential in preventing the adverse vascular changes associated with high BP and reducing associated cardiovascular risk. Clinicians and scientists should incorporate these factors into treatment decisions for patients with high BP, as well as in the development of new antihypertensive drugs that promote vascular health

Clinical and Experimental Studies of the Fetal and Uteroplacental Circulations Using Doppler Ultrasound

Doppler ultrasound is finding an increasing use in perinatal medicine. Unfortunately, its value in clinical practice has yet to be fully established. A more thorough understanding of the Doppler flow velocity waveform in various fetal and placental vessels is required before adapting this technology into clinical decision making processes. The studies involved in this thesis were designed with the following aims: 1. To perform calibration studies on the equipment used to investigate the fetal and uteroplacental circulations. 2. To establish normal values throughout normal human gestation for the fetal aorta, inferior vena cava, umbilical artery and the maternal uteroplacental artery. 3. To study the variability of Doppler recordings at different sites of the umbilical artery and fetal aorta. 4. To examine the possibility of investigating ovine pregnancy using Doppler ultrasound and to compare the gestational age influences on the flow velocity waveform with those seen in the human pregnancy. 5. To investigate pregnancies complicated by hypertension with Doppler ultrasound in order to determine the value of this technique in detecting signs of fetal compromise before the standard tests of assessing fetal well being. 6. To investigate derangements of the fetal heart seen in human pregnancy with Doppler ultrasound and to prepare a guide for clinicians managing such problems. 7. To create an animal model of fetal hydrops using atrial pacing and to investigate the development of the condition using Doppler ultrasound. (Abstract shortened by ProQuest.)

Tidal disruption of inviscid protoplanets

Roche showed that equilibrium is impossible for a small fluid body synchronously orbiting a primary within a critical radius now termed the Roche limit. Tidal disruption of orbitally unbound bodies is a potentially important process for planetary formation through collisional accumulation, because the area of the Roche limit is considerably larger then the physical cross section of a protoplanet. Several previous studies were made of dynamical tidal disruption and different models of disruption were proposed. Because of the limitation of these analytical models, we have used a smoothed particle hydrodynamics (SPH) code to model the tidal disruption process. The code is basically the same as the one used to model giant impacts; we simply choose impact parameters large enough to avoid collisions. The primary and secondary both have iron cores and silicate mantles, and are initially isothermal at a molten temperature. The conclusions based on the analytical and numerical models are summarized

A general study of Minoan frescoes with particular reference to unpublished wall painting from Knossos

PhD ThesisThis four-part dissertation considers Minoan frescoes in their own right for a first time, with reference to unpublished paintings and nearly fifty new restorations, with a view to providing a new basis for historical reconstruction drawn from that source. Earliest developments begin with Neolithic architectural muse of mud plasters, the first painted plasters occuring in EM II settlements and simple decorative schemes in the First Palaces (1900-1700 B.C.). The sudden rise of pictorial naturalism in MM IIIA is explained by native cultural developments of the First Palace Period, not by foreign influences or "eideticism" which is rejected altogether. A review of the motival repertory leads to considerations of six main "cycles of ideas" whence the painters derived their themes. The most important, confined to Knossos palace, depicts a major festival of grand processions and athletic activities before the chief Minoan goddess, and it illuminates the palatial architechural design. But five different systems of mural decoration characterise Minoan architecture as a whole, with regional and perhaps autonomous variations at Cycadic sites. Technical considerations confirm "buon fresco" as the normal painting technique and distinguish Knossian town house and palace murals in construction and purpose. Similar distinctions in compositional design are also described. A review of eleven "schools" of Knossian painters and of regional artists precedes a detailed reconstruction of the dates of the frescoes on stratigraphical, stylistic and comparative evidence. Sir Arthur Evans's fresco dating should generally be lowered by one Minoan phase. Minoan pictorial painting ceases with the palace destruction at Knossos, c.1375 B.C. Major differences appear between pre- and post-LM IB frescoes, tentatively explained on the evidence of Aegean and Egyption pictorial representations by the arrival at Knossos of a Mycenaean military dynasty, c.1450 B.C. Minoan wall painting finally disappeared in the LM IIIB period