Charting the survival, health and development of extremely preterm infants: EPICure and beyond

Major technological advances and improvements in neonatal medicine in the 1970s and 1980s resulted in significant reductions in mortality rates for babies born at extremely low gestations. In 1992, the gestational age for defining stillbirth in the UK was reduced from 28 weeks to 24 weeks reflecting the marked increase in survival for extremely preterm births. However, as the ‘limits of viability’ were pushed back ever further, there was increasing recognition of the high risk for residual disability amongst extremely preterm survivors. By the mid-1990s, clinicians were aware that the landscape had changed considerably for extremely preterm infants, but wide variation in survival rates between single centres and a lack of standardized developmental follow-up meant that it was difficult to gauge the impact of extremely preterm birth on a national level and to counsel parents as to the likely outcomes for their child. So in 1995, a team of neonatologists in the UK undertook the challenge of carrying out the first national epidemiological study of survival and outcomes following extremely preterm birth, and from that the EPICure Studies were born. Over the last 20 years these and other national cohort studies have helped shape neonatal care and advance our understanding of the life course consequences of extreme prematurity. Here we provide an overview of the key findings from the EPICure Studies and discuss the future challenges faced by clinicians and academics in tackling the causes, consequences and care of extremely preterm births

Informality and Formality in Medium-sized Companies: Contestation and Synchronization

Accounts of managerial practice in small and medium-sized firms frequently draw upon notions of formality and informality. In this paper, we explore the relationship between these concepts through an analysis of managerial approaches to employment relations practice in six growing, medium-sized organizations. Drawing on recent conceptual work on informality and formality, we argue that the use of the terms in previous analyses tends to neglect the co-dependency of both the concepts and managerial approaches to the employment relationship. We present an alternative conceptualization of formalization and informalization processes that emphasizes synchronization through interactional practices. Through this analysis, we suggest that debate in this area can be reframed through thinking of informality and formality as a dualism rather than a dichotomy, and challenge the notion that small firms must, should or inevitably do move from informality to formality. From this, we construct an inclusive model of formality and informality that better reflects practice and enables further analytical development

A Bayesian Analogue of Gleason's Theorem

We introduce a novel notion of probability within quantum history theories and give a Gleasonesque proof for these assignments. This involves introducing a tentative novel axiom of probability. We also discuss how we are to interpret these generalised probabilities as partially ordered notions of preference and we introduce a tentative generalised notion of Shannon entropy. A Bayesian approach to probability theory is adopted throughout, thus the axioms we use will be minimal criteria of rationality rather than ad hoc mathematical axioms.Comment: 14 pages, v2: minor stylistic changes, v3: changes made in-line with to-be-published versio

Death is not a success: reflections on business exit

This article is a critical evaluation of claims that business exits should not be seen as failures, on the grounds that may constitute voluntary liquidation, or because they are learning opportunities. This can be seen as further evidence of bias affecting entrepreneurship research, where failures are repackaged as successes. This article reiterates that the majority of business exits are unsuccessful. Drawing on ideas from the organisational life course, it is suggested that business ‘death’ is a suitable term for describing business closure. Even cases of voluntary ‘harvest liquidation’ such as retirement can be meaningfully described as business deaths

Does angiotensin-1 converting enzyme genotype influence motor or cognitive development after pre-term birth?

BACKGROUND: Raised activity of the renin-angiotensin system (RAS) may both amplify inflammatory and free radical responses and decrease tissue metabolic efficiency and thus enhance cerebral injury in the preterm infant. The angiotensin-converting enzyme (ACE) DD genotype is associated with raised ACE and RAS activity as well as potentially adverse stimuli such as inflammation. The DD genotype has been associated with neurological impairments in the elderly, and thus may be also associated with poorer motor or cognitive development amongst children born preterm prematurely. METHODS: The association of DD genotype with developmental progress amongst 176 Caucasian children born at less than 33 weeks gestation (median birthweight 1475 g, range 645–2480 g; gestation 30 weeks, range 22–32; 108 male) was examined at 2 and 5 1/2 years of age. Measured neuro-cognitive outcomes were cranial ultrasound abnormalities, cerebral palsy, disability, Griffiths Developmental Quotient [DQ] at 2 yrs, and General Cognitive Ability [British Ability Scales-11] and motor performance [ABC Movement], both performed at 5 1/2 yrs. All outcomes were correlated with ACE genotype. RESULTS: The DD genotype was not associated with lower developmental quotients even after accounting for important social variables. CONCLUSION: These data do not support either a role for ACE in the development of cognitive or motor function in surviving infants born preterm or inhibition of ACE as a neuroprotective therapy

Growing pains: managing the employment relationship in medium-sized enterprises

Since the early 1990s, growing attention has been afforded to employment relations in smaller firms. Generally, such organisations are more likely to adopt an informal approach to labour management facilitated by the proximity between employers and employees, idiosyncratic intervention by firms owners and a reluctance to employ professional HR managers. However, as firms grow, this approach is difficult to sustain as the employment relationship becomes increasingly intricate. This paper explores the management of employment relations within growing firms. Using a qualitative approach to explore how change is managed as firms become more complex, owners, Chief Executives, managers, HR managers and employees from six medium sized firms have been interviewed at length to ascertain their experiences and views upon this process

CFHT AO Imaging of the CLASS Gravitational Lens System B1359+154

We present adaptive optics imaging of the CLASS gravitational lens system B1359+154 obtained with the Canada-France-Hawaii Telescope (CFHT) in the infrared K band. The observations show at least three brightness peaks within the ring of lensed images, which we identify as emission from multiple lensing galaxies. The results confirm the suspected compound nature of the lens, as deduced from preliminary mass modeling. The detection of several additional nearby galaxies suggests that B1359+154 is lensed by the compact core of a small galaxy group. We attempted to produce an updated lens model based on the CFHT observations and new 5-GHz radio data obtained with the MERLIN array, but there are too few constraints to construct a realistic model at this time. The uncertainties inherent with modeling compound lenses make B1359+154 a challenging target for Hubble constant determination through the measurement of differential time delays. However, time delays will offer additional constraints to help pin down the mass model. This lens system therefore presents a unique opportunity to directly measure the mass distribution of a galaxy group at intermediate redshift.Comment: 12 pages including 3 figures; ApJL accepte

Investigation of quantitative measures related to reading disability in a large sample of sib-pairs from the UK

We describe a family-based sample of individuals with reading disability collected as part of a quantitative trait loci (QTL) mapping study. Eighty-nine nuclear families (135 independent sib-pairs) were identified through a single proband using a traditional discrepancy score of predicted/actual reading ability and a known family history. Eight correlated psychometric measures were administered to each sibling, including single word reading, spelling, similarities, matrices, spoonerisms, nonword and irregular word reading, and a pseudohomophone test. Summary statistics for each measure showed a reduced mean for the probands compared to the co-sibs, which in turn was lower than that of the population. This partial co-sib regression back to the mean indicates that the measures are influenced by familial factors and therefore, may be suitable for a mapping study. The variance of each of the measures remained largely unaffected, which is reassuring for the application of a QTL approach. Multivariate genetic analysis carried out to explore the relationship between the measures identified a common factor between the reading measures that accounted for 54% of the variance. Finally the familiality estimates (range 0.32–0.73) obtained for the reading measures including the common factor (0.68) supported their heritability. These findings demonstrate the viability of this sample for QTL mapping, and will assist in the interpretation of any subsequent linkage findings in an ongoing genome scan

Educational outcomes in extremely preterm children : neuropsychological correlates and predictors of attainment

This study assessed the impact of extremely preterm birth on academic attainment at 11 years of age, investigated neuropsychological antecedents of attainment in reading and mathematics, and examined early predictors of educational outcomes. Children born extremely preterm had significantly poorer academic attainment and a higher prevalence of learning difficulties than their term peers. General cognitive ability and specific deficits in visuospatial skills or phoneme deletion at 6 years were predictive of mathematics and reading attainment at 11 years in both extremely preterm and term children. Phonological processing, attention, and executive functions at 6 years were also associated with academic attainment in children born extremely preterm. Furthermore, social factors, neonatal factors (necrotizing enterocolitis, breech delivery, abnormal cerebral ultrasound, early breast milk provision), and developmental factors at 30 months (head circumference, cognitive development), were independent predictors of educational outcomes at 11 years. Neonatal complications combined with assessments of early cognitive function provide moderate prediction for educational outcomes in children born extremely preterm