The effects of land ownership on the development of mineral resources in England and Wales, 1760-1960.

The thesis studies the various changes in the patterns of land ownership over a span of two hundred years, with special reference to mineral ownership in England and Wales. In order to sensibly appraise past developments and make recommendations for the future it has been necessary to review events which have taken place before and after the period under consideration. In Part One the rights and responsibilities of mineral owners are explained and the use of selected cases illustrate the uniqueness of this aspect of the law of property. The similarities to other ownerships of real property are explained as well as the peculiarities and exceptions arising from ancient and local customs. To counter these restrictions it has been sometimes necessary to take legislative measures which have slowly emerged, but not always to the benefit of the mineral owner or developer. Throughout the latter part of the period many Commissions and Committees have reported on various aspects of mineral ownership, such as working rights, safety, planning and development. These are reviewed and compared with subsequent legislation. The State Control of some mineral resources is analysed against the background of individual rights and interests. Mineral resources are a national asset but cannot be developed in vacuo and the effects of external factors at home and overseas are given consideration. Part Two contains three contrasting case studies which are examined in depth with reference to rights of ownership and support. These critical appraisals include alternative courses of action which might have been pursued.Finally Part Three gives an overall analysis of the sequence of events and concludes by making some recommendations for future developments, which the author considers necessary if indigenous mineral resources are to play a viable part in the national economy

Automated Medical Literature Retrieval

Background The constantly growing publication rate of medical research articles puts increasing pressure on medical specialists who need to be aware of the recent developments in their field. The currently used literature retrieval systems allow researchers to find specific papers; however the search task is still repetitive and time-consuming. Aims In this paper we describe a system that retrieves medical publications by automatically generating queries based on data from an electronic patient record. This allows the doctor to focus on medical issues and provide an improved service to the patient, with higher confidence that it is underpinned by current research. Method Our research prototype automatically generates query terms based on the patient record and adds weight factors for each term. Currently the patient’s age is taken into account with a fuzzy logic derived weight, and terms describing blood-related anomalies are derived from recent blood test results. Conditionally selected homonyms are used for query expansion. The query retrieves matching records from a local index of PubMed publications and displays results in descending relevance for the given patient. Recent publications are clearly highlighted for instant recognition by the researcher. Results Nine medical specialists from the Royal Adelaide Hospital evaluated the system and submitted pre-trial and post-trial questionnaires. Throughout the study we received positive feedback as doctors felt the support provided by the prototype was useful, and which they would like to use in their daily routine. Conclusion By supporting the time-consuming task of query formulation and iterative modification as well as by presenting the search results in order of relevance for the specific patient, literature retrieval becomes part of the daily workflow of busy professionals

Intravenous aminoglycoside usage and monitoring of patients with cystic fibrosis in Australia. What's new?

Background: The aim of this study was to determine the current situation regarding aminoglycoside use and monitoring in patients with cystic fibrosis (CF) throughout Australia. Methods: A questionnaire was sent out to all CF units. Information gathered included patient characteristics, aminoglycoside use, dosing, therapeutic drug-monitoring methods, toxicity monitoring and incidence of occurrence. Results: Responses were obtained from 27 of the 28 units identified. Tobramycin was the aminoglycoside of choice. All but three centres were using once-daily dosing for aminoglycoside administration. Initial dosing in tobramycin-naïve patients was based on bodyweight (range 7–12 mg/kg). Patients being readmitted were mainly prescribed the dose that they had received on their previous admission. All units gave i.v. doses by infusion with five units using bolus dosing as well. The method of therapeutic drug monitoring varied greatly. A computer programme was used by 15 units. Toxicity monitoring usually coincided with therapeutic drug monitoring. Nephrotoxicity was reported as having occurred in 13 units and ototoxicity in 15 units. The highest incidence of toxicity was ototoxicity in 20% of patients in one CF unit. Conclusion: Aminoglycoside dosing regimens have changed since the last survey was carried out in 1999. There has been an increase in the use of once-daily dosing from 54 to 88% of units. The reporting of both ototoxicity and renal toxicity has also increased (from 27 to 75% and from 19 to 65%, respectively). Standardization of management protocols for antibiotic use and patient monitoring may help reduce the risk of cumulative toxicity to aminoglycosides in CF patients.

Changes in cystic fibrosis mortality in Australia, 1979-2005

Objective: To assess mortality trends among people with cystic fibrosis (CF) in Australia. Design and setting: We augmented Australian summary data for deaths from CF registered during 1979-2005 with information from Australian transplant centres on lung transplantation among CF patients for 1989-2005 to allow us to follow trends in all "mortality events" (death or lung transplantation). Main outcome measure: Age at death or lung transplantation. Results: Between 1979 and 2005, the mean age at death increased from 12.2 years to 27.9 years for males and from 14.8 years to 25.3 years for females. Overall, female deaths in childhood (0-14 years) occurred at an age-standardised rate of 0.40 per 100 000 (95% CI, 0.34-0.45) during 1979-2005, which exceeded the corresponding rate for males of 0.24 (95% CI, 0.20-0.28) per 100 000. Among 0-14-year-old boys, event rates declined markedly after 1989, but they declined later and more gradually for girls, with the result that the age-standardised rate for girls was 2.38 times that of boys during 1989-2005 (95% CI, 1.69-3.36). Conclusions: The pattern of CF mortality in Australia has changed substantially. Mortality rates continue to be higher for girls than for boys, but death in childhood has become uncommon. Survival has increased since 1979, but females continue to have reduced length of life

Non-specific Mechanisms in Orthodox and CAM management of back pain (MOCAM)

Introduction: Non-specific effects can have substantial effects on pain and disability. We have designed a major mixed-methods cohort study to investigate and compare non-specific components in physiotherapy, osteopathy, and acupuncture for low back pain (LBP). This project will extend current evidence by identifying the most powerful non-specific components, providing a deeper understanding of the pathways through which they generate positive patient outcomes.Aims:• Identify the most powerful non-specific treatment components (largest effect on patient outcomes)• Compare the magnitude of non-specific effects across orthodox and CAM therapies• Test which theoretically-derived mechanistic pathways explain their effects• Compare patient-practitioner interactions across the three therapiesMethods: We will recruit 1548 adults with LBP attending acupuncturists, physiotherapists, and osteopaths in private and NHS clinics. A quantitative longitudinal questionnaire-based study will use multi-level modelling to test hypothesized relationships between non-specific components, key theoretically derived mediators and patient outcomes. A randomised sample of 63 consultations (21 per treatment) will be audio-recorded and analysed using the quantitative Roter Interactional Analysis System and inductive qualitative analysis, to identify treatment-enhancing communication practices.Conclusions: Evidence suggests that non-specific components are important for patient outcomes across diverse conditions including LBP. The context of CAM therapies may contribute to their effectiveness and CAMs might be particularly good at enhancing non-specific components. To better understand the role of non-specifics in the management of LBP we will study multiple non-specific factors simultaneously, comparing them within different treatments and relating the findings to pain theories, to understand to how they contribute to the consultation

Pulmonary gas exchange during exercise in highly trained cyclists with arterial hypoxemia

The causes of exercise-induced hypoxemia (EIH) remain unclear. We studied the mechanisms of EIH in highly trained cyclists. Five subjects had no significant change from resting arterial[Formula: see text]([Formula: see text]; 92.1 ± 2.6 Torr) during maximal exercise (C), and seven subjects (E) had a &gt;10-Torr reduction in [Formula: see text] (81.7 ± 4.5 Torr). Later, they were studied at rest and during various exercise intensities by using the multiple inert gas elimination technique in normoxia and hypoxia (13.2% O2). During normoxia at 90% peak O2 consumption,[Formula: see text] was lower in E compared with C (87 ± 4 vs. 97 ± 6 Torr, P &lt; 0.001) and alveolar-to-arterial O2tension difference (a-[Formula: see text]) was greater (33 ± 4 vs. 23 ± 1 Torr, P &lt; 0.001). Diffusion limitation accounted for 23 (E) and 13 Torr (C) of thea-[Formula: see text]( P &lt; 0.01). There were no significant differences between groups in arterial[Formula: see text]([Formula: see text]) or ventilation-perfusion (V˙a/Q˙) inequality as measured by the log SD of the perfusion distribution (logSDQ˙). Stepwise multiple linear regression revealed that lung O2 diffusing capacity ([Formula: see text]), logSDQ˙, and[Formula: see text] each accounted for ∼30% of the variance in [Formula: see text]( r = 0.95, P &lt; 0.001). These data suggest that EIH has a multifactorial etiology related to[Formula: see text],V˙a/Q˙inequality, and ventilation. </jats:p