Maximising organ donation and transplantation through the use of organs from increased risk donors

Organ transplantation remains the best treatment for many patients with end organ disease. However, there is a discrepancy between organ supply and demand. Many donor organs are not used for transplantation because of risk attributes in the deceased donor ranging from infectious risks to specific risks associated with the cause of death. The aims of this thesis were to identify the number of deceased donors with risk attributes and then quantify the risks associated with using organs from such donors. This information was then used to provide evidence to the transplant community on which to base their decisions on using organs from such donors. This thesis used data in the UK Transplant Registry, which prospectively collects data on the clinical characteristics and follow-up of all donors and transplant recipients in the UK, and the Potential Donor Audit, which is a prospectively populated registry including all patients who die in UK critical care units of donation age. The main findings of this thesis were that there are a large number of deceased donors with risk attributes, in particular donors with increased risk behaviour for blood borne viral disease or with hepatitis C virus infection, whose organs are currently not used for transplantation, but that could safely be used. The thesis also describes that the transmission of meningitis/encephalitis from deceased donors to transplant recipients is a rare but serious complication of transplantation, but that transplantation of usually excellent organs from such donors should not be contraindicated. Different transplant centres display marked variations in practice in using organs from donors with different risk attributes, but centres that display greater risk appetite in using organs from higher risk donors do not have worse transplant outcomes compared to centres with lower risk appetites. Transplantation of organs from higher risk donors can result in excellent transplant outcomes. Wide variations in practice are seen across the UK, and to address this the UK aide memoire has been developed.NHS Blood and Transplan

Statistics for Policy and Planning in Canadian Higher Education: An Ontario Perspective

Systems of information about higher education in Canada are in a mess. Substantively they are being developed on the basis of doubtful assumptions and confused purposes. Data for administrative and financial control are being confused with data needed for policy and planning purposes. Data systems are designed without due regard to practicality cost and need. A dubious passion for all purpose systems obscures the necessary role of special data sampling projects and special analyses in throwing light upon choices for the future. Planners and policy makers continue to act as if projection methods appropriate for the fifties are still sufficient for the future. Procedures for the development of information systems are being left to people who tend to be preoccupied with day-to-day and technical concerns, unrestrained by university and government policy makers who prefer to ignore or refuse to see that the gathering and presenting of statistical information acts directly on the policy and planning process. The demonstrated lack of interest by most senior leaders in government and in the universities in the assumptions, methods and procedures involved in collecting and analyzing information is illustrated by the failure of both universities and governments to develop separate or joint capacities for continuing analysis on a national basis of what is happening and why. Substantial work done at the provincial and regional level is not brought together for examination from a national perspective. If the universities do not themselves take corrective action, this failure will progressively reinforce the "provincialization" of universities so much deplored by academic leaders as being antithetical to the basic nature of authentic universities. The data needs associated with control should become the responsibility of provincial jurisdictions while the resources of Statistics Canada and the energy of AUCC should be oriented to policy information relating to global, national and interprovincial questions.Les systèmes d'information en matière de l'enseignement supérieur au Canada sont actuellement à l'envers. Plus précisément, leur développement se base sur des hypothèses douteuses et des objectifs confus. Les données de contrôle administratif et économique se mêlent avec celles requises pour les fins de la formulation de la politique et de la planification. Les systèmes de données se proposent sans égards suffisants au caractère pratique, au coût et au besoin. Une passion douteuse, pour un système à tous usages, obscurcit le rôle nécessaire des projets spéciaux d'échantillons de données ainsi que des analyses spéciales pour jeter de la lumière sur des choix pour l'avenir. Les planificateurs et les auteurs de la politique continuent à réagir comme si les méthodes de prévisions appropriées aux années cinquante sont toujours suffisantes pour l'avenir. Les modes de procédure pour le développement des systèmes d'information se placent dans les mains de ceux qui ont tendance à se préoccuper des soucis techniques et au jour le jour, aucune-ment restreints par les auteurs de la politique universitaire ou gouvernementale qui pré-fèrent ne pas vouloir reconnaître ou qui préfèrent refuser de voir que la cueillette et la présentation de données statistiques agissent directement sur la formulation de la politique et sur la planification. Le manque d'intérêt manifesté par les chefs supérieurs, qu gouverne-ment ainsi que dans l'université, à l'égard des présomptions, des méthodes et des modes de procédure dont il est question pour la cueillette et l'analyse des informations s'explique par l'échec des universités et des gouvernements de développer séparément ou conjointe-ment les moyens d'analyse continue, à l'échelle nationale, de ce qui se passe et pourquoi. Des travaux importants effectués aux niveaux provincial et régional ne se coordonnent pas pour permettre un examen dans une perspective nationale. Si les universités elles-mêmes ne prennent pas des démarches correctives, cet échec ira en renforçant la "provincialisation"des universités, tant déplorée par les dirigeants des institutions acadé-miques, vue comme l'antithèse de la nature même des universités authentiques. Les besoins en données coordonnées sous des contrôles devraient se faire la responsabilité des juridictions provinciales tandis que les ressources de Statistiques Canada et les efforts de l'AUCCdevraient s'orienter vers toute question d'intérêt mondial, national et interprovincial. From the 1960s to the 1970s Historically, the Dominion Bureau of Statistics (now Statistics Canada) collected and published statistics on enrolment and educational finance. These provided a basis for plan-ning until provincial governments began to establish more and more complex information systems with the expansion of universities in the sixties. As funding became more directly tied to enrolments, provincial data requirements developed greater emphasis on financial control. The attempt is now being made in Ontario, at least, to combine the Provincial and Statistics Canada data collection and processing in a single all-purpose system. We will examine the implications of this development later. But the collection and presentation of statistical material is of little assistance in policy and planning without continuing critical examination of what the statistics mean and, more importantly, of the assumptions upon which various interpretations are based. Such regular interpretation was provide

Precision calculation of γd→π+nn\gamma d\to \pi^+ nn within chiral perturbation theory

The reaction $\gamma d\to \pi^+ nn$ is calculated up to order $\chi^{5/2}$ in chiral perturbation theory, where $\chi$ denotes the ratio of the pion to the nucleon mass. Special emphasis is put on the role of nucleon--recoil corrections that are the source of contributions with fractional power in $\chi$. Using the known near threshold production amplitude for $\gamma p\to \pi^+ n$ as the only input, the total cross section for $\gamma d\to \pi^+ nn$ is described very well. A conservative estimate suggests that the theoretical uncertainty for the transition operator amounts to 3 % for the computed amplitude near threshold.Comment: 28 page

Lattice calculations for A=3,4,6,12 nuclei using chiral effective field theory

We present lattice calculations for the ground state energies of tritium, helium-3, helium-4, lithium-6, and carbon-12 nuclei. Our results were previously summarized in a letter publication. This paper provides full details of the calculations. We include isospin-breaking, Coulomb effects, and interactions up to next-to-next-to-leading order in chiral effective field theory.Comment: 38 pages, 11 figures, final publication versio

Loop calculations in quantum-mechanical non-linear sigma models sigma models with fermions and applications to anomalies

We construct the path integral for one-dimensional non-linear sigma models, starting from a given Hamiltonian operator and states in a Hilbert space. By explicit evaluation of the discretized propagators and vertices we find the correct Feynman rules which differ from those often assumed. These rules, which we previously derived in bosonic systems \cite{paper1}, are now extended to fermionic systems. We then generalize the work of Alvarez-Gaum\'e and Witten \cite{alwi} by developing a framework to compute anomalies of an $n$-dimensional quantum field theory by evaluating perturbatively a corresponding quantum mechanical path integral. Finally, we apply this formalism to various chiral and trace anomalies, and solve a series of technical problems: $(i)$ the correct treatment of Majorana fermions in path integrals with coherent states (the methods of fermion doubling and fermion halving yield equivalent results when used in applications to anomalies), $(ii)$ a complete path integral treatment of the ghost sector of chiral Yang-Mills anomalies, $(iii)$ a complete path integral treatment of trace anomalies, $(iv)$ the supersymmetric extension of the Van Vleck determinant, and $(v)$ a derivation of the spin-$3\over 2$ Jacobian of Alvarez-Gaum\'{e} and Witten for Lorentz anomalies.Comment: 67 pages, LaTeX, with one figure (needs epsfig

Hosts and hostages: Mass immigration and the power of hospitality in post-war British and Caribbean literature

This article examines the challenge to colonialist centre-periphery relations in post-war novels by white British and Caribbean writers. Concentrating on the relationship between political debates surrounding mass immigration and the marginalization of non-white migrants within British communities, I analyse texts that depict the threshold of the home as the politicized site of racial tension, namely Sam Selvon’s The Lonely Londoners (1956), V.S. Naipaul’s The Mimic Men (1967), Alan Sillitoe’s Saturday Night and Sunday Morning (1958), and Anthony Burgess’s The Right to an Answer (1960). In varying ways, these texts depict the durability of centre-periphery relations at local levels through the informal segregation of the colonizer and the colonized. In doing so they point to what Jacques Derrida has outlined, in Of Hospitality (2000), as the power relationship inherent in policies of immigration, whereby the host-nation remains in control of the conditions upon which hospitality rests

Geometry of the physical phase space in quantum gauge models

The physical phase space in gauge systems is studied. Effects caused by a non-Euclidean geometry of the physical phase space in quantum gauge models are described in the operator and path integral formalisms. The projection on the Dirac gauge invariant states is used to derive a necessary modification of the Hamiltonian path integral in gauge theories of the Yang-Mills type with fermions that takes into account the non-Euclidean geometry of the physical phase space. The new path integral is applied to resolve the Gribov obstruction. Applications to the Kogut-Susskind lattice gauge theory are given. The basic ideas are illustrated with examples accessible for non-specialists.Comment: A review (Phys. Rep.), 170 pages, 9 figures, plain Late

Valorizing the 'Irulas' traditional knowledge of medicinal plants in the Kodiakkarai Reserve Forest, India

A mounting body of critical research is raising the credibility of Traditional Knowledge (TK) in scientific studies. These studies have gained credibility because their claims are supported by methods that are repeatable and provide data for quantitative analyses that can be used to assess confidence in the results. The theoretical importance of our study is to test consensus (reliability/replicable) of TK within one ancient culture; the Irulas of the Kodiakkarai Reserve Forest (KRF), India. We calculated relative frequency (RF) and consensus factor (Fic) of TK from 120 Irulas informants knowledgeable of medicinal plants. Our research indicates a high consensus of the Irulas TK concerning medicinal plants. The Irulas revealed a diversity of plants that have medicinal and nutritional utility in their culture and specific ethnotaxa used to treat a variety of illnesses and promote general good health in their communities. Throughout history aboriginal people have been the custodians of bio-diversity and have sustained healthy life-styles in an environmentally sustainable manner. However this knowledge has not been transferred to modern society. We suggest this may be due to the asymmetry between scientific and TK, which demands a new approach that considers the assemblage of TK and scientific knowledge. A greater understanding of TK is beginning to emerge based on our research with both the Irulas and Malasars; they believe that a healthy lifestyle is founded on a healthy environment. These aboriginal groups chose to share this knowledge with society-at-large in order to promote a global lifestyle of health and environmental sustainability

ECM receptors in neuronal structure, synaptic plasticity, and behavior

During central nervous system development, extracellular matrix (ECM) receptors and their ligands play key roles as guidance molecules, informing neurons where and when to send axonal and dendritic projections, establish connections, and form synapses between pre- and postsynaptic cells. Once stable synapses are formed, many ECM receptors transition in function to control the maintenance of stable connections between neurons and regulate synaptic plasticity. These receptors bind to and are activated by ECM ligands. In turn, ECM receptor activation modulates downstream signaling cascades that control cytoskeletal dynamics and synaptic activity to regulate neuronal structure and function and thereby impact animal behavior. The activities of cell adhesion receptors that mediate interactions between pre- and postsynaptic partners are also strongly influenced by ECM composition. This chapter highlights a number of ECM receptors, their roles in the control of synapse structure and function, and the impact of these receptors on synaptic plasticity and animal behavior