Studies of cerebral palsy in the childhood population of Edinburgh

This thesis is the result of an investigation of the prevalence, clinical findings and aetiology of cerebral palsy in the childhood population of Edinburgh which was carried out during 1952 and 1953, whilst the author held a George Guthrie Research Fellowship from the University of Edinburgh. The aims of the investigation were, firstly to establish the prevalence of cerebral palsy in the childhood population of the city; secondly to study the clinical features of cerebral palsy and their effects on the patient's way of life; to define some of the important aetiological factors in cerebral palsy in a representative group of children in the community. During the investigation it became increasingly apparent that the currently defined categories included in "Cerebral 'Palsy" did not allow for an accurate classification of cases by neurological findings. Eventually a new classification on the basis of neurological syndromes was evolved. This classification will be described and compared to previous classifications in Section 3. It was possible to establish figures for the prevalence of cerebral palsy in the childhood population of Edinburgh, though a complete ascertainment of all patients was not made. The clinical features of cerebral palsy in the childhood ;community were studied and are described in Section 4. During the survey it became increasingly apparent that "Cerebral Palsy" was no clinical entity. Rather it comprised a number of neurological disorders in which the only common factor appeared to be that there was motor dysfunction due to abnormality of the brain which was present in early life. The clinical features varied widely from category to category. The ways in which patients were handicapped and the extent to which they were printed from taking part in everyday activities were very different. A detailed study was made of the clinical findings and handicaps of patients and they were compared to those described by previous authors. Thus, some idea of the importance of cerebral palsy in the community was obtained, (Section 5). Aetiological factors which were important in one form of cerebral palsy were found to be much less important in others. Many different "causes" of cerebral palsy were found which varied from developmental malformation to traumatic head injury, and from abnormal parturition to the complications of infectious diseases in early life. The multiplicity of aetiological factors in single categories and even single patients was impressive. For example, within the category of "Ataxic Diplegia" patients were found whose disorder appeared to be genetically determined, and patients who were suffering from the effects of birth injury, parainfectious encephalomylitis or meningitis. To take account of the multiplicity of aetiological factors it was necessary to study the heredity and social backgrounds of patients as well as their individual' birth and later histories. The current concept of cerebral palsy as being due predominantly to the effects of birth injury is a misleading simplification of the true position. In the same way as there are many different causes of stillbirth and infant death, !so there are many causes of cerebral palsy in children who survive. The later sections of this thesis are concerned with demonstrating that the aetiological factors in cerebral palsy are as complex as those involved in infant mortality. Social, genetic, obstetric and many unknown factors play a .part. An attempt has been made to define the importance of some of them in Sections 5 and 6

Information architecture for a federated health record server

This paper describes the information models that have been used to implement a federated health record server and to deploy it in a live clinical setting. The authors, working at the Centre for Health Informatics and Multiprofessional Education (University College London), have built up over a decade of experience within Europe on the requirements and information models that are needed to underpin comprehensive multi-professional electronic health records. This work has involved collaboration with a wide range of health care and informatics organisations and partners in the healthcare computing industry across Europe though the EU Health Telematics projects GEHR, Synapses, EHCR-SupA, SynEx and Medicate. The resulting architecture models have fed into recent European standardisation work in this area, such as CEN TC/251 ENV 13606. UCL has implemented a federated health record server based on these models which is now running in the Department of Cardiovascular Medicine at the Whittington Hospital in North London. The information models described in this paper reflect a refinement based on this implementation experience

Prosody of tone Sandhi in Vietnamese reduplications

In this paper we take advantage of the segmental control afforded by full and partial Vietnamese reduplication on a constant carrier phrase to obtain acoustic evidence of assymetrical prominence relations (van der Hulst 2005), in support of a hypothesis that Vietnamese reduplications are phonetically right headed and that tone sandhi is a reduction phenomenon occurring on prosodically weak positions (Shih 2005). Acoustic parameters of syllable duration (onset, nucleus and coda), F0 range, F0 contour, vowel intensity, spectral tilt and vowel formant structure are analyzed to determine: (1) which syllable of the two (base or reduplicant) is more prominent and (2) how the tone sandhi forms differ from their full reduplicated counterparts. Comparison of full and partial reduplicant syllables in tone sandhi forms provide additional support for this analysis

Food Security Twists and Turns: Why Food Systems need Complex Governance

Tipping points and nudges are favoured metaphors of politicians seeking to make sense of complex topics. Food security is possibly the first major challenge for tipping points, combining the politics of population growth, diet, and the globalisation of food production and distribution with the limitations of soil, water, land use availability, and climate change. Food security begins with availability, access, and affordability, but quickly transforms into the economics and sociology of food production, transportation, consumption, and waste, along with diet and health. Ultimately food security is a microcosm of sustainable development, for it captures the paradox of surplus with the rigours of limits in a political and economic framework which cannot embrace either effectively, and which is leading to greater crises of food excess and famine in a world of growing inequality

Towards an interoperable healthcare information infrastructure - working from the bottom up

Historically, the healthcare system has not made effective use of information technology. On the face of things, it would seem to provide a natural and richly varied domain in which to target benefit from IT solutions. But history shows that it is one of the most difficult domains in which to bring them to fruition. This paper provides an overview of the changing context and information requirements of healthcare that help to explain these characteristics.First and foremost, the disciplines and professions that healthcare encompasses have immense complexity and diversity to deal with, in structuring knowledge about what medicine and healthcare are, how they function, and what differentiates good practice and good performance. The need to maintain macro-economic stability of the health service, faced with this and many other uncertainties, means that management bottom lines predominate over choices and decisions that have to be made within everyday individual patient services. Individual practice and care, the bedrock of healthcare, is, for this and other reasons, more and more subject to professional and managerial control and regulation.One characteristic of organisations shown to be good at making effective use of IT is their capacity to devolve decisions within the organisation to where they can be best made, for the purpose of meeting their customers' needs. IT should, in this context, contribute as an enabler and not as an enforcer of good information services. The information infrastructure must work effectively, both top down and bottom up, to accommodate these countervailing pressures. This issue is explored in the context of infrastructure to support electronic health records.Because of the diverse and changing requirements of the huge healthcare sector, and the need to sustain health records over many decades, standardised systems must concentrate on doing the easier things well and as simply as possible, while accommodating immense diversity of requirements and practice. The manner in which the healthcare information infrastructure can be formulated and implemented to meet useful practical goals is explored, in the context of two case studies of research in CHIME at UCL and their user communities.Healthcare has severe problems both as a provider of information and as a purchaser of information systems. This has an impact on both its customer and its supplier relationships. Healthcare needs to become a better purchaser, more aware and realistic about what technology can and cannot do and where research is needed. Industry needs a greater awareness of the complexity of the healthcare domain, and the subtle ways in which information is part of the basic contract between healthcare professionals and patients, and the trust and understanding that must exist between them. It is an ideal domain for deeper collaboration between academic institutions and industry

Voyager Mars planetary quarantine Basic math model report

Basic math model study of planetary quarantine effects on Voyager Mars missio

Trace element geochemistry of peridotites from the Izu-Bonin-Mariana Forearc, Leg 125

Trace element analyses (first-series transition elements, Ti, Rb, Sr, Zr, Y, Nb, and REE) were carried out on whole rocks and minerals from 10 peridotite samples from both Conical Seamount in the Mariana forearc and Torishima Forearc Seamount in the Izu-Bonin forearc using a combination of XRF, ID-MS, ICP-MS, and ion microprobe. The concentrations of incompatible trace elements are generally low, reflecting the highly residual nature of the peridotites and their low clinopyroxene content (n ratios in the range of 0.05-0.25; several samples show possible small positive Eu anomalies. LREE enrichment is common to both seamounts, although the peridotites from Conical Seamount have higher (La/Ce)n ratios on extended chondrite-normalized plots, in which both REEs and other trace elements are organized according to their incompatibility with respect to a harzburgitic mantle. Comparison with abyssal peridotite patterns suggests that the LREEs, Rb, Nb, Sr, Sm, and Eu are all enriched in the Leg 125 peridotites, but Ti and the HREEs exhibit no obvious enrichment. The peridotites also give positive anomalies for Zr and Sr relative to their neighboring REEs. Covariation diagrams based on clinopyroxene data show that Ti and the HREEs plot on an extension of an abyssal peridotite trend to more residual compositions. However, the LREEs, Rb, Sr, Sm, and Eu are displaced off this trend toward higher values, suggesting that these elements were introduced during an enrichment event. The axis of dispersion on these plots further suggests that enrichment took place during or after melting and thus was not a characteristic of the lithosphere before subduction. Compared with boninites sampled from the Izu-Bonin-Mariana forearc, the peridotites are significantly more enriched in LREEs. Modeling of the melting process indicates that if they represent the most depleted residues of the melting events that generated forearc boninites they must have experienced subsolidus enrichment in these elements, as well as in Rb, Sr, Zr, Nb, Sm, and Eu. The lack of any correlation with the degree of serpentinization suggests that low-temperature fluids were not the prime cause of enrichment. The enrichment in the high-field-strength elements also suggests that at least some of this enrichment may have involved melts rather than aqueous fluids. Moreover, the presence of the hydrous minerals magnesio-hornblende and tremolite and the common resorption of orthopyroxene indicate that this high-temperature peridotite-fluid interaction may have taken place in a water-rich environment in the forearc following the melting event that produced the boninites. The peridotites from Leg 125 may therefore contain a record of an important flux of elements into the mantle wedge during the initial formation of forearc lithosphere. Ophiolitic peridotites with these characteristics have not yet been reported, perhaps because the precise equivalents to the serpentinite seamounts have not been analyzed