A Web/Grid Services Approach for Integration of Virtual Clinical & Research Environments

Clinicans have responsibilities for audit and research, often participating in projects with basic scientist colleagues. Our work in a regional teaching hospital setting involves collaboration with the medical school computer services and builds upon work developed in computer science department as part of the Collaborative Orthopaedic Research Environment (CORE) project[1]. This has established a pilot study for proof of concept work. Users are mapped to a personal profile implemented using XML and a service oriented architecture (SOA)[2,3]. This bridges the e-Health and e-Science domains, addressing some of the basic questions of security and uptake

Measuring and modelling occupancy time in NHS continuing healthcare

Background - Due to increasing demand and financial constraints, NHS continuing healthcare systems seek to find better ways of forecasting demand and budgeting for care. This paper investigates two areas of concern, namely, how long existing patients stay in service and the number of patients that are likely to be still in care after a period of time. Methods - An anonymised dataset containing information for all funded admissions to placement and home care in the NHS continuing healthcare system was provided by 26 (out of 31) London primary care trusts. The data related to 11289 patients staying in placement and home care between 1 April 2005 and 31 May 2008 were first analysed. Using a methodology based on length of stay (LoS) modelling, we captured the distribution of LoS of patients to estimate the probability of a patient staying in care over a period of time. Using the estimated probabilities we forecasted the number of patients that are likely to be still in care after a period of time (e.g. monthly). Results - We noticed that within the NHS continuing healthcare system there are three main categories of patients. Some patients are discharged after a short stay (few days), some others staying for few months and the third category of patients staying for a long period of time (years). Some variations in proportions of discharge and transition between types of care as well as between care groups (e.g. palliative, functional mental health) were observed. A close agreement of the observed and the expected numbers of patients suggests a good prediction model. Conclusions - The model was tested for care groups within the NHS continuing healthcare system in London to support Primary Care Trusts in budget planning and improve their responsiveness to meet the increasing demand under limited availability of resources. Its applicability can be extended to other types of care, such as hospital care and re-ablement. Further work will be geared towards updating the dataset and refining the results

The role of temperament in stuttering frequency and impact in children under 7

Introduction Increased emotional reactivity and decreased regulation have been associated with increased stuttering severity and frequency in preschool children who stutter (CWS) and may be predictors for the development of negative reactions to stuttering in young children. Understanding which children are likely to be impacted to a greater or lesser degree has implications for clinical decision making. Associations between temperament and stuttering impact have been explored with older CWS, but not with preschool CWS. Aim To investigate the relationship between temperament (specifically emotional reactivity and regulation) and both stuttering frequency and stuttering impact in preschool CWS. Methods Data collected at initial assessment for 119 young CWS (age range= 3;00–6;11 years) at a specialist centre for stuttering in London, UK were analysed. The following measures were completed: The Children's Behaviour Questionnaire-Short Form (Putnam & Rothbart, 2006); Palin Parent Rating Scales (Millard & Davis, 2016); The Communication Attitude Test for Preschool and Kindergarten Children Who Stutter (Vanryckeghem & Brutten, 2007); and a stuttering frequency measure. Results Emotional reactivity and regulation were not significantly associated with stuttering frequency. Higher scores on negative reactivity were significantly associated with an increased impact of stuttering on the child (from parents’ perspective), but not significantly associated with child-reported communication attitude. Positive reactivity was not significantly associated with parent-reported impact of stuttering or child-reported communication attitude. Additional investigation revealed negative affect as a significant predictor of parent-reported impact of stuttering before and after adjusting for age. Discussion The results provide evidence to support the role of temperament on the impact that stuttering has in the early years. While the directionality of the relationship between negative reactivity and impact of stuttering is unknown, the importance of targeting emotional reactions in therapy for young CWS is implicated

Assessment of Abundance, Biomass and Production of the Lower Trophic Levels in the Eastern Basin of Lake Erie, 1994

The Lake Erie Biomonitoring (LEB) program conducted in 1994, focused on the eastern basin of the lake, resampling the same sites as in 1993. Nutrient conditions were similar in the two years. Responses differed between the stratified offshore and unstratified nearshore. At the offshore station, seasonal phytoplankton biomass was 56% higher in 1994 than in 1993 and apparently resulted from a reduction in grazing pressure by Dreissena. Dreissena biomass and their potential clearance rates at the offshore station were much lower in the spring of 1994 than in the spring of 1993 (2.5 vs. 14.9 m3·m·2·d·\u27), respectively. Despite this increase in phytoplankton biomass, chlorophyll (Chi) and phytoplankton photosynthesis (PP) were not significantly higher in 1994. Dinoflagellates, which have lower Chl:C and lower photosynthesis:Chl ratios than other groups of phytoplankton, accounted for much of the increase in biomass. Rotifer biomass decreased by 50% and zooplankton biomass by 40% between the two years. Calanoids were responsible for much of the decrease in zooplankton biomass. Composition also shifted towards larger bodied cladocerans, such as Daphnia and Bythotrephes, and away from Bosmina. This shift coincided with changes in predation pressure. Age-one smelt abundance was extremely high in 1993 and low in 1994, while the reverse was true of the YOY smelt. Age-one smelt consume mainly cladocerans and the YOY, copepods (REF). At the nearshore stations, seasonal PP and Chi were well below that expected given the total phosphorus (TP) concentration, indicating that Dreissena had an important impact on phytoplankton photosynthesis in this region. Low transparency due to suspended sediments also contributed to the low PP at station El. Zooplankton biomass was lower in 1994 than in 1993, and species composition and size shifted. Daphnia increased and calanoids and Bosmina decreased in the nearshore as in the offshore, presumably in response to changes in the smelt population. However, Bythotrephes decreased and rotifer biomass increased unlike in the offshore

Lake Erie 1993, Western, West Central and Eastern Basins: Change in Trophic Status, and Assessment of the Abundance, Biomass and Production of the Lower Trophic Levels

The western and west central basins were mesotrophic and the eastern basin was oligotrophic, based on many biological and chemical parameters measured in 1993. Gradients were observed for most parameters, with chlorophyll a, nitrogen, phosphorus, silica, and light extinction decreasing from west to east. In the western basin, phytoplankton biomass declined by 51% from 1983-85. Phytoplankton photosynthesis (g C·m-2), predicted from total phosphorus (TP) using a relationship developed in other offshore productivity studies in Lake Ontario, declined by 35% in 1993, without a corresponding decline in phosphorus (P) loading or TP. Diatoms decreased and there was a shift towards smaller phytoplankton species. These changes were attributed to zebra mussel filtration, but were not of sufficient magnitude to reduce zooplankton biomass. In the west central basin, the reductions in phytoplankton biomass were modest. Photosynthesis (g C·m-2) in 1993, was in line with that predicted by TP and the empirical relationship developed in other offshore studies. Limited mussel populations in the west central basin, resulting from low hypolimnetic oxygen concentrations, caused little change in the phytoplankton. There also were no reductions in mean biomass of zooplankton from 1984-87. In the eastern basin, phytoplankton biomass declined by 49% from 1983-85. Photosynthesis (g C·m-2) declined by 50% from the value predicted, from TP and the empirical relationship developed for other studies, for 1983-85, without a decline in P-leading. TP was lower in 1993 and was attributed to filtering by Dreissena and subsequent redirection of pelagic material to the sediments. Phytoplankton species indicative of eutrophy were reduced and there was an overall shift towards smaller species. Zooplankton biomass was also reduced. Mean zooplankton community size and the loss of Daphnia sp. suggest that predation by planktivores as well as a reduced food supply, affected zooplankton biomass in 1993. The Dreissena population also affected the benthic community structure as Diporeia were virtually eliminated from the eastern basin and Gammarus increased in all basins. Benthic biomass was 40% higher on average than in 1979. Dreissena dominated benthic production at all stations except offshore in the west-central basin

An Early Catalog of Planet Hosting Multiple Star Systems of Order Three and Higher

We present a catalog (status July 1, 2022) of triple and higher order systems identified containing exoplanets based on data from the literature, including various analyses. We explore statistical properties of the systems with focus on both the stars and the planets. So far, about 30 triple systems and one to three quadruple systems, including (mildly) controversial cases, have been found. The total number of planets is close to 40. All planet-hosting triple star systems are highly hierarchic, consisting of a quasi-binary complemented by a distant stellar component, which is in orbit about the common center of mass. Furthermore, the quadruple systems are in fact pairs of close binaries (``double-doubles"), with one binary harboring a planet. For the different types of star-planet systems, we introduce a template for the classifications of planetary orbital configurations in correspondence to the hierarchy of the system and the planetary host. The data show that almost all stars are main-sequence stars, as expected. However, the stellar primaries tend to be more massive (i.e., corresponding to spectral types A, F, and G) than expected from single star statistics, a finding also valid for stellar secondaries but less pronounced. Tertiary stellar components are almost exclusively low-mass stars of spectral type M. Almost all planets have been discovered based on either the Radial Velocity or the Transit method. Both gas giants (the dominant type) and terrestrial planets (including super-Earths) have been identified. We anticipate the expansion of this data base in the light of future planetary search missions.Comment: Accepted by ApJS; 59 pages, including 11 figures and 12 table

Multivisceral intestinal transplantation: Surgical pathology

We report the diagnostic surgical pathology of two children who underwent multivisceral abdominal transplantation and survived for 1 month and 6 months. There is little relevant literature, and diagnostic criteria for the various clinical possibilities are not established; this is made more complicated by the simultaneous occurrence of more than one process. We based our interpretations on conventional histology, augmented with immunohistology, including HLA staining that distinguished graft from host cells in situ. In some instances functional analysis of T cells propagated from the same biopsies was available and was used to corroborate morphological interpretations. A wide spectrum of changes was encountered. Graft-versus-host disease, a prime concern before surgery, was not seen. Rejection was severe in 1 patient, not present in the other, and both had evidence of lymphoproliferative disease, which was related to Epstein-Barr virus. Bacterial translocation through the gut wall was also a feature in both children. This paper documents and illustrates the various diagnostic possibilities.. © 1989 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted

Regional policy spillovers : the national impact of demand-side policy in an interregional model of the UK economy

UK regional policy has been advocated as a means of reducing regional disparities and stimulating national growth. However, there is limited understanding of the interregional and national effects of such a policy. This paper uses an interregional computable general equilibrium model to identify the national impact of a policy-induced regional demand shock under alternative labour market closures. Our simulation results suggest that regional policy operating solely on the demand side has significant national impacts. Furthermore, the effects on the nontarget region are particularly sensitive to the treatment of the regional labour market

Explorations in anatomy: the remains from Royal London Hospital

This paper considers the faunal remains from recent excavations at the Royal London Hospital. The remains date to the beginning of the 19th century and offer an insight into the life of the hospital's patients and practices of the attached medical school. Many of the animal remains consist of partially dissected skeletons, including the unique finds of Hermann's tortoise (Testudo hermanni) and Cercopithecus monkey. The hospital diet and developments in comparative anatomy are discussed by integrating the results with documentary research. They show that zooarchaeological study of later post-medieval material can significantly enhance our understanding of the exploitation of animals in this perio

Proceedings of US - PRC international TOGA symposium

A series of 12 meridional transect along longitude 165°E in the Western Equatorial Pacific ocean were made between mid-1986 and mi-1988 : a time interval spanning an El Nino/Southern Oscillation (ENSO) event. Data collected on these cruises provide a detailed (albeit temporally sparse) view of the oceanic changes which occur in the Western Pacific during an ENSO event. The present work focuses on the evolution of the upper ocean thermohaline and zona velocity fields as revealed by high resolution hydrographic casts and direct near surface velocity measurements. (D'après résumé d'auteur