Unusual association of ST-T abnormalities, myocarditis and cardiomyopathy with H1N1 influenza in pregnancy: two case reports and review of the literature.

Introduction Myocarditis is rarely reported as an extra-pulmonary manifestation of influenza while pregnancy is a rare cause of cardiomyopathy. Pregnancy was identified as a major risk factor for increased mortality and morbidity due to H1N1 influenza in the pandemic of 2009 to 2010. However, to the best of our knowledge there are no previous reports in the literature linking H1N1 with myocarditis in pregnancy. Case presentation We report the cases of two pregnant Caucasian women (aged 29 and 30), with no pre-existing illness, presenting with respiratory manifestations of H1N1 influenza virus infection in their third trimester. Both women developed evidence of myocarditis. One woman developed acute respiratory distress syndrome, almost reaching the point of requiring extra-corporeal membrane oxygenation, and subsequently developed persistent cardiomyopathy; the other recovered without any long-term consequence. Conclusions While it is not possible to ascertain retrospectively if myocarditis was caused by either infection with H1N1 virus or as a result of pregnancy (in the absence of endomyocardial biopsies), the significant association with myocardial involvement in both women demonstrates the increased risk of exposure to H1N1 influenza virus in pregnant women. This highlights the need for health care providers to increase awareness amongst caregivers to target this 'at risk' group aggressively with vaccination and prompt treatment

Promoting positive communication environments: a service evaluation.

Purpose The purpose of this paper is to present an evaluation of a programme of training and support provided to staff, which aimed to encourage supported communication environments for people with learning disabilities. Design/methodology/approach Training, monitoring and support for communication, specifically augmentative and alternative communication (AAC) strategies, was provided by speech and language therapy staff to two residential services over 46 weeks. Staff and service user communications were observed pre- and post-intervention. Findings In one provision there was an increase in service user initiations and the use of some AAC strategies by support staff. In the other provision there was no change in service user initiations and a decrease in the range of AAC strategies used. It appears that some forms for AAC remain challenging for staff to implement. Originality/value This evaluation explores ways of using specialist support services to improve communication environments for people with learning difficulties. Possible reasons for differences in the outcome of the intervention are discussed. Future research into the types of communication interactions experienced by people with learning disabilities across the range of communication styles may be useful so that support staff can be better helped to provide sustained and enriched communication environments

Long-range temporal organisation of limb movement kinematics in human neonates

Objective: Movement provides crucial sensorimotor information to the developing brain, evoking somatotopic cortical EEG activity. Indeed, temporal-spatial organisation of these movements, including a diverse repertoire of accelerations and limb combinations (e.g. unilateral progressing to bilateral), predicts positive sensorimotor outcomes. However, in current clinical practice, movements in human neonates are qualitatively characterised only during brief periods (a few minutes) of wakefulness, meaning that the vast majority of sensorimotor experience remains unsampled. Here our objective was to quantitatively characterise the long-range temporal organisation of the full repertoire of newborn movements, over multi-hour recordings. Methods: We monitored motor activity across 2–4 h in 11 healthy newborn infants (median 1 day old), who wore limb sensors containing synchronised tri-axial accelerometers and gyroscopes. Movements were identified using acceleration and angular velocity, and their organisation across the recording was characterised using cluster analysis and spectral estimation. Results: Movement occurrence was periodic, with a 1-hour cycle. Peaks in movement occurrence were associated with higher acceleration, and a higher proportion of movements being bilateral. Conclusions: Neonatal movement occurrence is cyclical, with periods consistent with sleep-wake behavioural architecture. Movement kinematics are organised by these fluctuations in movement occurrence. Recordings that exceed 1-hour are necessary to capture the long-range temporal organisation of the full repertoire of newborn limb movements. Significance: Future work should investigate the prognostic value of combining these movement recordings with synchronised EEG, in at-risk infants

Participatory Book Art: Establishing Connections with Dialogue, Representation and Value

This thesis provides visibility to a series of projects that I term ‘participatory book art’. Participatory book art involves artists collaborating with particular social groups in the creation of book art. This thesis argues that participatory book art projects represent a new form of collaborative book art and participatory art practice. To form this argument and investigate the participatory book art case studies within this thesis, I constructed an original critical framework from the fields of ‘book art’ and ‘participatory art’. This framework acknowledges the formal properties of the books (composition, content and texture), whilst explaining the social and collaborative processes surrounding their making. The framework also allows case studies to speak to the theoretical communities practicing in these fields, whilst contradicting and expanding some of their dominant narratives. Chapter one contextualises participatory book art within a history of community arts and art education to readdress how they are often absent in participatory art narratives. I contest writing which treats the workshop as a neutral or predictable format, by investigating how the design and management of the method in participatory book art is imbued with certain ideologies that influence collaboration. The final three chapters are focused on distinct participatory book art case studies. Each project is investigated through a thematic lens, including: Representation in The Homeless Library, Dialogue in Unfolding Projects and Value in Crafting Women’s Stories. Case study analysis utilises the theoretical framework and wider literature to account for the various operations, processes and methods occurring in projects. Chapter two addresses the homeless participant’s use of book art in The Homeless Library to deconstruct or reiterate essentialist depictions of homelessness. In chapter three on Unfolding Projects, I explore how the books as gifts creates an emancipatory dialogue between two groups of women who never physically meet and challenges existing theories that assert face-to-face interaction and spoken word as the primary emancipatory form (Kester, Bourriaud and Lacy). Chapter four on Crafting Women’s Stories problematises evaluating participatory art through predetermined values. Utilising the theoretical ideas of Barbara Hernstein-Smith and Erin Manning, I trace how value is ‘contingent’ in this project on a range of interacting variables and agent’s personal economies which are emergent, fluctuating and sometimes difficult to predict/recognise

Event-related potentials following contraction of respiratory muscles in pre-term and full-term infants

Objective: Involuntary isolated body movements are prominent in pre-term and full-term infants. Proprioceptive and tactile afferent feedback following limb muscle contractions is associated with somatotopic EEG responses. Involuntary contractions of respiratory muscles, primarily the diaphragm – hiccups – are also frequent throughout the human perinatal period during active behavioural states. Here we tested whether diaphragm contraction provides afferent input to the developing brain, as following limb muscle contraction. / Methods: In 13 infants on the neonatal ward (30–42 weeks corrected gestational age), we analysed EEG activity (18-electrode recordings in six subjects; 17-electrode recordings in five subjects; 16-electrode recordings in two subjects), time-locked to diaphragm contractions (n = 1316) recorded with a movement transducer affixed to the trunk. / Results: All bouts of hiccups occurred during wakefulness or active sleep. Each diaphragm contraction evoked two initial event-related potentials with negativity predominantly across the central region, and a third event-related potential with positivity maximal across the central region. / Conclusions: Involuntary contraction of the diaphragm can be encoded by the brain from as early as ten weeks prior to the average time of birth. / Significance: Hiccups – frequently observed in neonates – can provide afferent input to developing sensory cortices in pre-term and full-term infants

Clinical value of cortical bursting in preterm infants with intraventricular haemorrhage

Background: In healthy preterm infants, cortical burst rate and temporal dynamics predict important measures such as brain growth. We hypothesised that in preterm infants with germinal matrix-intraventricular haemorrhage (GM-IVH), cortical bursting could provide prognostic information. / Aims: We determined how cortical bursting was influenced by the injury, and whether this was related to developmental outcome. / Study design: Single-centre retrospective cohort study at University College London Hospitals, UK. / Subjects: 33 infants with GM-IVH ≥ grade II (median gestational age: 25 weeks). / Outcome measures: We identified 47 EEGs acquired between 24 and 40 weeks corrected gestational age as part of routine clinical care. In a subset of 33 EEGs from 25 infants with asymmetric injury, we used the least-affected hemisphere as an internal comparison. We tested whether cortical burst rate predicted survival without severe impairment (median 2 years follow-up). / Results: In asymmetric injury, cortical burst rate was lower over the worst- than least-affected hemisphere, and bursts over the worst-affected hemisphere were less likely to immediately follow bursts over the least-affected hemisphere than vice versa. Overall, burst rate was lower in cases of GM-IVH with parenchymal involvement, relative to milder structural injury grades. Higher burst rate modestly predicted survival without severe language (AUC 0.673) or motor impairment (AUC 0.667), which was partly mediated by structural injury grade. / Conclusions: Cortical bursting can index the functional injury after GM-IVH: perturbed burst initiation (rate) and propagation (inter-hemispheric dynamics) likely reflect associated grey matter and white matter damage. Higher cortical burst rate is reassuring for a positive outcome

Altered cortical processing of somatosensory input in pre-term infants who had high-grade germinal matrix-intraventricular haemorrhage

High-grade (large) germinal matrix-intraventricular haemorrhage (GM-IVH) is one of the most common causes of somatomotor neurodisability in pre-term infants. GM-IVH presents during the first postnatal week and can impinge on somatosensory circuits resulting in aberrant somatosensory cortical events straight after injury. Subsequently, somatosensory circuits undergo significant plastic changes, sometimes allowing the reinstatement of a somatosensory cortical response. However, it is not known whether this restructuring results in a full recovery of somatosensory functions. To investigate this, we compared somatosensory responses to mechanical stimulation measured with 18-channels EEG between infants who had high-grade GM-IVH (with ventricular dilatation and/or intraparenchymal lesion; n = 7 studies from 6 infants; mean corrected gestational age = 33 weeks; mean postnatal age = 56 days) and age-matched controls (n = 9 studies from 8 infants; mean corrected gestational age = 32 weeks; mean postnatal age = 36 days). We showed that infants who had high-grade GM-IVH did not recruit the same cortical source configuration following stimulation of the foot, but their response to stimulation of the hand resembled that of controls. These results show that somatosensory cortical circuits are reinstated in infants who had GM-IVH, during the several weeks after injury, but remain different from those of infants without brain injury. An important next step will be to investigate whether these evidences of neural reorganisation predict neurodevelopmental outcome

Somatosensory-evoked delta brush activity in very pre-term infants

INTRODUCTION: Delta brushes - slow waves with over-riding alpha-beta oscillations - are a hallmark of the pre-term EEG, and can be evoked by somatosensory stimulation (Whitehead et al., 2017). As such, they may be a biomarker of early sensory processing, with their attenuation indicating maturation of somatosensory circuits. In animal models, the somatosensory system is known to mature in a rostro-caudal progression, with hindlimb somatosensation last to develop, but little is known about the development of somatosensory processing in the human infant brain. Here we investigated the attenuation of delta brush activity following tactile stimulation of hands and feet over the pre-term period. METHODS: We recorded 16-channels EEG and evaluated the somatosensory evoked response following tactile mechanical stimulation of hands and feet in 38 pre-term infants at low-risk of adverse neurodevelopment (exclusion: (i) intra-ventricular haemorrhage ⩾ grade III; (ii) severe growth restriction (defined as <2nd birth weight centile)). We then looked at changes in the amplitude of the slow delta wave and of the over-riding alpha-beta oscillations in the evoked response between very pre-term (28 + 2 − 31 + 2 weeks + days, n = 13) and moderately pre-term (32 + 2 − 35 + 4 weeks + days, n = 25) infants using point-by-point t-tests (statistical significance set at p < 0.01 to account for multiple comparisons). RESULTS: Tactile stimulation of hands and feet evoked a long-lasting diffuse negative delta slow wave, with onset latency at ∼100 ms, peak latency at ∼500 ms, and peak amplitude of ∼100 μV and ∼50 μV for hand and foot stimulation respectively, and an increase in alpha-beta oscillations concurrent with the peak latency of this slow wave. We first looked at changes in the amplitude of the slow delta wave. This delta wave attenuated in amplitude in the older age group most prominently over the contralateral parietal-temporal region for hand stimulation, and most prominently over the midline parietal and bilateral temporal regions for foot stimulation. Next, we looked at changes in the amplitude of the alpha-beta oscillations which co-occurred with the peak latency of this slow delta wave. Alpha-beta oscillations attenuated in amplitude in the older age group over bilateral parietal regions for hand stimulation, while there was no difference between the age groups for foot stimulation. CONCLUSION: This is the first developmental study of delta brushes evoked by stimulation of the upper and lower limbs. Our results indicate that in very pre-term infants tactile stimulation evokes diffuse delta brush activity, which attenuates across development most markedly over the parietal-temporal regions. Interestingly, delta brush alpha-beta oscillations only decrease with development for hand stimulation, but not foot stimulation, suggesting that somatosensory maturation may occur earlier for the hands in line with studies of older infants (Whitehead et al., submitted for publication), and animal models

Particle-in-cell simulations of rf breakdown

Breakdown voltages of a capacitively coupled radio frequency argon discharge at 27 MHz are studied. We use a one-dimensional electrostatic PIC code to investigate the effect of changing the secondary emission properties of the electrodes on the breakdown voltage, particularly at low pd values. Simulation results are compared with the available experimental results and a satisfactory agreement is found.Comment: 12th International Congress on Plasma Physics, 25-29 October 2004, Nice (France