Reference and Representation in Down's Syndrome

Merged with duplicate record 10026.1/1290 on 10.04.2017 by CS (TIS)Merged with duplicate record 10026.1/1290 Submitted by Collection Services ([email protected]) on 2013-02-11T09:11:56Z No. of bitstreams: 1 1996MoorePHD.pdf: 49481100 bytes, checksum: b3d3efc37826e75b5d5bd1ec2683cc99 (MD5) Approved for entry into archive by Collection Services([email protected]) on 2013-02-11T09:17:59Z (GMT) No. of bitstreams: 1 1996MoorePHD.pdf: 49481100 bytes, checksum: b3d3efc37826e75b5d5bd1ec2683cc99 (MD5) Made available in DSpace on 2013-02-11T09:17:59Z (GMT). No. of bitstreams: 1 1996MoorePHD.pdf: 49481100 bytes, checksum: b3d3efc37826e75b5d5bd1ec2683cc99 (MD5) Previous issue date: 1996-12Previous research has highlighted a different pattern in the use of grammatical forms to successfully maintain coherent discourse by individuals with Down's syndrome. To maintain coherent discourse both linguistic and non-linguistic information must be integrated and maintained in a mental representation of current discourse. The ability of children with Down's syndrome to use such a mental representation has been assessed in this study. The ability of adults with Down's syndrome to comprehend and produce a range of grammatical forms was initially assessed, using a grammaticality judgement task, an imitation task, and a spontaneous speech sample. Results indicated that the production and comprehension of pronouns was found moderately difficult. The successful use of a pronoun depends on the ability to use a mental representation to retain information about its antecedent in order to assist correct interpretation and avoid ambiguity. A narrative task was used to investigate the use of referential forms by children with Down's syndrome and typically developing children. The effects of certain contextual features on the use of referential forms were investigated: the status of each character and the number of characters in the story; the method of presenting the story; and the position of a listener while the story was narrated. When narrating a story typically developing children distinguished the status of characters in the stories by consistently using different referential forms for each. As age increased this strategy was used more successfully and flexibly. Children with Down's syndrome did not use referential forms in the same way as typically developing children. It is likely that this is a consequence of a difficulty in maintaining information about the whole story-where many sources of information must be accessed, integrated and maintained in a mental representation. At a local level within the story, children with Down's syndrome used referential strategies successfully, demonstrating an ability to integrate limited amounts of information about characters in a story. The inability to maintain information in a mental representation across longer periods of discourse indicates the importance of short term memory in language production

Optimisation of spore production by the potential fungal biocontrol agent for aphids, Erynia Neoaphidis

A thesis submitted for the degree of Masters of Science by Research of the University of LutonThe optimisation of spore production by the potential fungal biological control agent for aphids, Erynia neoaphidis Remaudiere and Hennebert (Zygomycetes: Entomophthoraceae) was studied. The fungus was able to grow in semi-defined Frynia medium (SDEM) containing glucose, yeast extract, mycological peptone, and 0.02% oleic acid buffered to a pH 6. Oleic acid was fungicidal at 0.1 % (v/v) while 0.02% (v/v) oleic acid was the optimum for radial grovvth. Plugs cut 5-10 mm from the margin ofa colony produced more conidia than plugs cut 13-20 mm from the colony margin. Renewed grovvth continued through two subcultures on solid SDEM lacking yeast extract (SDEML YE), and SDEM lacking mycological peptone (SDEMLMP). The continued growth was attributed to the carry over of nutrient in the inoculum. Growth was supported on SDEMNH4S04 when ammonium sulphate was used as the nitrogen source instead of mycological peptone suggesting that the fungus could obtain the growth factors it required from yeast extract. When chitin was added to SDEM in insoluble powder form instead ofglucose (SDEMC 1 & SDEMC2), the absence of a clearing zone around the developing colony suggested that chitin was not metabolised by E. neoaphidis. Biomass grown on SEMA and on SDEMDG (containing double the original concentration ofglucose 3 2grl), resulted in production of fewer conidia oflarger volume compared to SDEMDMP containing double and half the original concentration of mycological peptone (SDEMHP), SDEM containing halfthe original concentration ofglucose (SDEMHG). Increasing the glucose to double the original concentration resulted to an increase in biomass. Erynia neoaphidis grown on aphid cadavers produced many, smaller conidia. Mycelial mats harvested from biomass grown in fed-batch liquid fermenter culture in SDEMDG at the end ofthe exponential phase and placed on water agar discharged conidia at a rate of 6,700 conidia mm -2 h-1which persisted for approximately 3 days. When E. neoaphidis was subcultured onto SDEM from SEMA medium, the colony growth rate increased on the second subculture on SDEM where more lipases and aminopeptidases were detected at higher concentrations using the API ZYM system. This shows that attenuation might have taken place by either a phenotypic or genotypic (eg mutation) change or both when E. neoaphidis was grown on SDEM from SEMA medium. Growth in GASP medium resulted in the production of more biomass and a delay in the onset of decline phase compared to cultures grown in SDEM. Fewer enzymes were detected at a lower concentration in cultures grown in GASP compared to cultures grown in SDEM, this difference might be more likely to relate to the balance of nutrients and the fact that GASP medium is more similar in composition to the nutrients found in the haemocoel of an aphid. Based on this research. It is recommend that E. neoaphidis be grown in SDEM liquid cultures containing 32 grl glucose instead of 16 grl glucose. Biomass for field applications should be harvested at the end ofthe exponential growth and mycelial mats made. The mycelial mats should be maintained at high relative humidity and can be expected to discharge conidia for 3 days

Influence of life-style choices on locomotor disability, arthritis and cardiovascular disease in older women: prospective cohort study.

BACKGROUND: many chronic conditions have their roots in modifiable health-related behaviours. METHODS: a total of 4,286 women aged 60-79 in the British Women's Heart and Health Study are followed up for incident cardiovascular disease (CVD), arthritis and locomotor disability over 7 years. Self-reported smoking, alcohol consumption, exercise and fruit intake at baseline is also available. Associations between these and each outcome, plus a composite outcome, are investigated in those without prevalent disease at baseline using logistic regression with multiple imputation. RESULTS: ex-smokers and current smokers showed increased odds of locomotor disability, CVD and the combined outcome. Less regular exercisers had increased odds of all outcomes, particularly locomotor disability. There was no evidence that alcohol or fruit intake was associated with any outcome. Population attributable fractions (PAFs) suggest in addition to the influence of smoking and alcohol, exercise accounts for 9% of incident locomotor disability, 5% of CVD and 4% of arthritis. All four lifestyle factors combined account for 17% of incident locomotor disability and 9% of incident conditions combined. CONCLUSIONS: never smokers and regular exercisers had substantially reduced odds of 7-year disability onset. Low PAFs suggest changes in health-related behaviours in older women would result in only modest reductions in common chronic conditions

Tuberculosis Infection among Young Nursing Trainees in South India

BackgroundAmong healthcare workers in developing countries, nurses spend a large amount of time in direct contact with tuberculosis (TB) patients, and are at high risk for acquisition of TB infection and disease. To better understand the epidemiology of nosocomial TB among nurses, we recruited a cohort of young nursing trainees at Christian Medical College, a large, tertiary medical school hospital in Southern India.Methodology/Principal FindingsAmong 535 nursing students enrolled in 2007, 468 gave consent to participate, and 436 underwent two-step tuberculin skin testing (TST). [...] (50.2%, 95% CI: 45.4–55.0) were TST positive using the 10 mm or greater cut-off. Based on the LCA, the prevalence of LTBI was 47.8% (95% credible interval 17.8% to 65.6%). In the multivariate analysis, TST positivity was strongly associated with time spent in health care, after adjusting for age at entry into healthcare.ConclusionsOur study showed a high prevalence of LTBI even in young nursing trainees. With the recent TB infection control (TBIC) policy guidance from the World Health Organization as the reference, Indian healthcare providers and the Indian Revised National TB Control Programme will need to implement TBIC interventions, and enhance capacity for TBIC at the country level. Young trainees and nurses, in particular, will need to be targeted for TBIC interventions

Quantifying long-term health and economic outcomes for survivors of group B Streptococcus invasive disease in infancy: protocol of a multi-country study in Argentina, India, Kenya, Mozambique and South Africa.

Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa.  The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were also noted with few studies from low- and middle- income countries (LMIC), where the GBS burden is estimated to be the highest. In this paper we present the protocol for a multi-country matched cohort study designed to estimate the risk of long-term neurodevelopmental impairment (NDI), socioemotional behaviors, and economic outcomes for children who survive invasive GBS disease in Argentina, India, Kenya, Mozambique, and South Africa. Children will be identified from health demographic surveillance systems, hospital records, and among participants of previous epidemiological studies. The children will be aged between 18 months to 17 years. A tablet-based custom-designed application will be used to capture data from direct assessment of the child and interviews with the main caregiver. In addition, a parallel sub-study will prospectively measure the acute costs of hospitalization due to neonatal sepsis or meningitis, irrespective of underlying etiology. In summary, these data are necessary to characterize the consequences of iGBS disease and enable the advancement of effective strategies for survivors to reach their developmental and economic potential. In particular, our study will inform the development of a full public health value proposition on maternal GBS immunization that is being coordinated by the World Health Organization

South African Children: A Matched Cohort Study of Neurodevelopmental Impairment in Survivors of Invasive Group B Streptococcus Disease Aged 5 to 8 Years.

BACKGROUND: Invasive group B Streptococcus (iGBS) sepsis and meningitis are important causes of child mortality, but studies on neurodevelopmental impairment (NDI) after iGBS are limited. Using Griffiths Mental Development Scales-Extended Revised (GMDS-ER), we described NDI in iGBS survivors and non-iGBS children from South Africa, as part of a 5-country study. METHODS: We identified children aged 5-8 years with a history of iGBS and children with no history of iGBS between October 2019 and January 2021. Children were matched on sex, and birth data (month, year) (matched cohort study). Moderate or Severe NDI was the primary outcome as a composite of GMDS-ER motor, GMDS-ER cognition, hearing, and vision. Secondary outcomes included mild NDI, any emotional-behavioral problems, and GMDS-ER developmental quotients (DQ) calculated by dividing the age equivalent GMDS-ER score by the chronological age. RESULTS: In total, 160 children (iGBS survivors, 43; non-iGBS, 117) were assessed. Among iGBS survivors 13 (30.2%) had meningitis, and 30 (69.8%) had sepsis. Six (13.9%) iGBS survivors, and 5 (4.3%) non-iGBS children had moderate or severe NDI. Children who survived iGBS were 5.56 (95% confidence interval [CI]: 1.07-28.93; P = .041) times more likely to have moderate or severe NDI at 5-8 years than non-iGBS children. Compared to the non-iGBS children, iGBS meningitis survivors had a significantly lower global median DQ (P < .05), as well as a lower median DQ for the language GMDS-ER subscale and performance GMDS-ER subscale (P < .05). CONCLUSIONS: Children surviving iGBS, particularly meningitis, are more likely to have NDI at 5-8 years compared to non-iGBS children. Further research is required to improve detection and care for at-risk newborns

Countdown to 2030 : tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH

Rheumatoid arthritis - treatment: 180. Utility of Body Weight Classified Low-Dose Leflunomide in Japanese Rheumatoid Arthritis

Background: In Japan, more than 20 rheumatoid arthritis (RA) patients died of interstitial pneumonia (IP) caused by leflunomide (LEF) were reported, but many of them were considered as the victims of opportunistic infection currently. In this paper, efficacy and safety of low-dose LEF classified by body weight (BW) were studied. Methods: Fifty-nine RA patients were started to administrate LEF from July 2007 to July 2009. Among them, 25 patients were excluded because of the combination with tacrolimus, and medication modification within 3 months before LEF. Remaining 34 RA patients administered 20 to 50 mg/week of LEF were followed up for 1 year and enrolled in this study. Dose of LEF was classified by BW (50 mg/week for over 50 kg, 40 mg/week for 40 to 50 kg and 20 to 30 mg/week for under 40 kg). The average age and RA duration of enrolled patients were 55.5 years old and 10.2 years. Prednisolone (PSL), methotrexate (MTX) and etanercept were used in 23, 28 and 2 patients, respectively. In case of insufficient response or adverse effect, dosage change or discontinuance of LEF were considered. Failure was defined as dosages up of PSL and MTX, or dosages down or discontinuance of LEF. Last observation carried forward method was used for the evaluation of failed patients at 1 year. Results: At 1 year after LEF start, good/ moderate/ no response assessed by the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score, including a 28-joint count (DAS28)-C reactive protein (CRP) were showed in 14/ 10/ 10 patients, respectively. The dosage changes of LEF at 1 year were dosage up: 10, same dosage: 5, dosage down: 8 and discontinuance: 11 patients. The survival rate of patients in this study was 23.5% (24 patients failed) but actual LEF continuous rate was 67.6% (11 patients discontinued) at 1 year. The major reason of failure was liver dysfunction, and pneumocystis pneumonia was occurred in 1 patient resulted in full recovery. One patient died of sepsis caused by decubitus ulcer infection. DAS28-CRP score was decreased from 3.9 to 2.7 significantly. Although CRP was decreased from 1.50 to 0.93 mg/dl, it wasn't significant. Matrix metalloproteinase (MMP)-3 was decreased from 220.0 to 174.2 ng/ml significantly. Glutamate pyruvate transaminase (GPT) was increased from 19 to 35 U/l and number of leukocyte was decreased from 7832 to 6271 significantly. DAS28-CRP, CRP, and MMP-3 were improved significantly with MTX, although they weren't without MTX. Increase of GPT and leukopenia were seen significantly with MTX, although they weren't without MTX. Conclusions: It was reported that the risks of IP caused by LEF in Japanese RA patients were past IP history, loading dose administration and low BW. Addition of low-dose LEF is a potent safe alternative for the patients showing unsatisfactory response to current medicines, but need to pay attention for liver function and infection caused by leukopenia, especially with MTX. Disclosure statement: The authors have declared no conflicts of interes

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment