The impact of universal newborn hearing screening on long-term literacy outcomes: a prospective cohort study

Objective: To determine whether the benefits of universal newborn hearing screening (UNHS) seen at age 8?years persist through the second decade.Design: Prospective cohort study of a population sample of children with permanent childhood hearing impairment (PCHI) followed up for 17?years since birth in periods with (or without) UNHS.Setting: Birth cohort of 100?000 in southern England.Participants: 114 teenagers aged 13-19?years, 76 with PCHI and 38 with normal hearing. All had previously their reading assessed aged 6-10?years.Interventions: Birth in periods with and without UNHS; confirmation of PCHI before and after age 9?months.Main outcome measure: Reading comprehension ability. Regression modelling took account of severity of hearing loss, non-verbal ability, maternal education and main language.Results: Confirmation of PCHI by age 9?months was associated with significantly higher mean z-scores for reading comprehension (adjusted mean difference 1.17, 95% CI 0.36 to 1.97) although birth during periods with UNHS was not (adjusted mean difference 0.15, 95% CI -0.75 to 1.06). The gap between the reading comprehension z-scores of teenagers with early compared with late confirmed PCHI had widened at an adjusted mean rate of 0.06 per year (95% CI -0.02 to 0.13) during the 9.2-year mean interval since the previous assessment.Conclusions: The benefit to reading comprehension of confirmation of PCHI by age 9?months increases during the teenage years. This strengthens the case for UNHS programmes that lead to early confirmation of permanent hearing loss

Highest weight Macdonald and Jack Polynomials

Fractional quantum Hall states of particles in the lowest Landau levels are described by multivariate polynomials. The incompressible liquid states when described on a sphere are fully invariant under the rotation group. Excited quasiparticle/quasihole states are member of multiplets under the rotation group and generically there is a nontrivial highest weight member of the multiplet from which all states can be constructed. Some of the trial states proposed in the literature belong to classical families of symmetric polynomials. In this paper we study Macdonald and Jack polynomials that are highest weight states. For Macdonald polynomials it is a (q,t)-deformation of the raising angular momentum operator that defines the highest weight condition. By specialization of the parameters we obtain a classification of the highest weight Jack polynomials. Our results are valid in the case of staircase and rectangular partition indexing the polynomials.Comment: 17 pages, published versio

Management of imatinib-resistant CML patients

Imatinib has had marked impact on outcomes in chronic myelogenous leukemia (CML) patients for all stages of the disease and is endorsed by international treatment guidelines as the first line option. Although imatinib is highly effective and well tolerated, the development of resistance represents a clinical challenge. Since the most frequently identified mechanism of acquired imatinib resistance is bcr-abl kinase domain point mutations, periodic hematologic, cytogenetic, and molecular monitoring is critical throughout imatinib therapy. Once cytogenetic remission is achieved, residual disease can be monitored by bcr-abl transcript levels as assayed by reverse transcription polymerase chain reaction (RT-PCR). Detection of bcr-abl mutants prior to and during imatinib therapy can aid in risk stratification as well as in determining therapeutic strategies. Thus, mutation screening is indicated in patients lacking or losing hematologic response. Moreover, search for mutations should also be performed when a 3-log reduction of bcr-abl transcripts is not achieved or there is a reproducible increase of transcript levels. In patients harboring mutations which confer imatinib resistance, novel second line tyrosine kinase inhibitors have demonstrated encouraging efficacy with low toxicity. Only the T315I bcr-abl mutant has proved totally resistant to all clinically available bcr-abl inhibitors. Strategies to further increase the rates of complete molecular remissions represent the next frontier in the targeted therapy of CML patients

A Randomized Controlled Trial of Extended Brief Intervention for Alcohol-Dependent Patients in an Acute Hospital Setting

To determine whether alcohol-dependent patients in a hospital setting benefit from extended brief interventions (EBI) delivered by an Alcohol Specialist Nurse. Methods Alcohol-dependent patients recruited via screening at the emergency department (ED) (n = 267), whether or not admitted to hospital, were randomized to EBI (up to six counselling sessions offered) or control. At 6 months, 84.2% of patients were assessed by a researcher blinded to the intervention. The primary outcome was a fall in Severity of Alcohol Dependence Questionnaire. Results There was no difference between groups in the primary outcome [odds ratio (OR) 1.02; 95% confidence interval (CI): 0.38, 2.75, P = 0.97]. Secondary outcomes including alcohol consumption and readiness to change did not show a significant difference between groups. However, all secondary outcome measures improved, on average, in both arms. Conclusions Although EBI can be delivered in an ED or inpatient setting, it was not shown to be an advantage over screening and usual management (which included advice on alternative services), with patients in both groups showing an average improvement

Noise-Induced Phase Space Transport in Two-Dimensional Hamiltonian Systems

First passage time experiments were used to explore the effects of low amplitude noise as a source of accelerated phase space diffusion in two-dimensional Hamiltonian systems, and these effects were then compared with the effects of periodic driving. The objective was to quantify and understand the manner in which ``sticky'' chaotic orbits that, in the absence of perturbations, are confined near regular islands for very long times, can become ``unstuck'' much more quickly when subjected to even very weak perturbations. For both noise and periodic driving, the typical escape time scales logarithmically with the amplitude of the perturbation. For white noise, the details seem unimportant: Additive and multiplicative noise typically have very similar effects, and the presence or absence of a friction related to the noise by a Fluctuation-Dissipation Theorem is also largely irrelevant. Allowing for colored noise can significantly decrease the efficacy of the perturbation, but only when the autocorrelation time becomes so large that there is little power at frequencies comparable to the natural frequencies of the unperturbed orbit. Similarly, periodic driving is relatively inefficient when the driving frequency is not comparable to these natural frequencies. This suggests strongly that noise-induced extrinsic diffusion, like modulational diffusion associated with periodic driving, is a resonance phenomenon. The logarithmic dependence of the escape time on amplitude reflects the fact that the time required for perturbed and unperturbed orbits to diverge a given distance scales logarithmically in the amplitude of the perturbation.Comment: 15 pages, including 13 Figures and 1 Table, uses Phys. Rev. macro

The costs of functional gastrointestinal disorders and related signs and symptoms in infants: a systematic literature review and cost calculation for England

OBJECTIVES: To estimate the cost of functional gastrointestinal disorders (FGIDs) and related signs and symptoms in infants to the third party payer and to parents. STUDY DESIGN: To estimate the cost of illness (COI) of infant FGIDs, a two-stage process was applied: a systematic literature review and a COI calculation. As no pertinent papers were found in the systematic literature review, a 'de novo' analysis was performed. For the latter, the potential costs for the third party payer (the National Health Service (NHS) in England) and for parents/carers for the treatment of FGIDs in infants were calculated, by using publicly available data. In constructing the calculation, estimates and assumptions (where necessary) were chosen to provide a lower bound (minimum) of the potential overall cost. In doing so, the interpretation of the calculation is that the true COI can be no lower than that estimated. RESULTS: Our calculation estimated that the total costs of treating FGIDs in infants in England were at least £72.3 million per year in 2014/2015 of which £49.1 million was NHS expenditure on prescriptions, community care and hospital treatment. Parents incurred £23.2 million in costs through purchase of over the counter remedies. CONCLUSIONS: The total cost presented here is likely to be a significant underestimate as only lower bound estimates were used where applicable, and for example, costs of alternative therapies, inpatient treatments or diagnostic tests, and time off work by parents could not be adequately estimated and were omitted from the calculation. The number and kind of prescribed products and products sold over the counter to treat FGIDs suggest that there are gaps between treatment guidelines, which emphasise parental reassurance and nutritional advice, and their implementation

A numerical approach for determining the variable ascent velocity of a granitoid diapir

A mathematical model for granitoid diapirism has been developed that accounts for the time dependent thermal and rheological conditions encountered by the intruding body. This model is derived by the simultaneous solution of the partial differential equations of energy, continuity, and momentum utilizing scaling analysis. The underlying assumption is that deformation of the surrounding country rock is confined to a relatively thin layer with a temperature dependent Newtonian viscosity. When the country rock is modeled as a power-law fluid, the effective viscosity is dependent upon temperature and shear strain rate. This model allows for realistic temperature gradients within the crust and variable shear strain rates. This is made possible through use of a numerical approximation referred to as the snapshot approach. This method allows the pluton to ascend in finite time increments while the boundary conditions remain fixed. Following each snapshot, the ascent velocity is calculated and new boundary and initial conditions are set for the next increment of time. Several model runs have been performed using a FORTRAN program. The results exhibit time dependent variations in the ascent velocity due to corresponding changes in the overall rheology, and thickness, of the deformation layer. One of the conclusions from this study is that larger plutons ascend at slower rates, but emplace higher in the crust due to the additional energy available relative to smaller plutons

Chaotic mixing in noisy Hamiltonian systems

This paper summarises an investigation of the effects of low amplitude noise and periodic driving on phase space transport in 3-D Hamiltonian systems, a problem directly applicable to systems like galaxies, where such perturbations reflect internal irregularities and.or a surrounding environment. A new diagnsotic tool is exploited to quantify how, over long times, different segments of the same chaotic orbit can exhibit very different amounts of chaos. First passage time experiments are used to study how small perturbations of an individual orbit can dramatically accelerate phase space transport, allowing `sticky' chaotic orbits trapped near regular islands to become unstuck on suprisingly short time scales. Small perturbations are also studied in the context of orbit ensembles with the aim of understanding how such irregularities can increase the efficacy of chaotic mixing. For both noise and periodic driving, the effect of the perturbation scales roughly in amplitude. For white noise, the details are unimportant: additive and multiplicative noise tend to have similar effects and the presence or absence of a friction related to the noise by a Fluctuation- Dissipation Theorem is largely irrelevant. Allowing for coloured noise can significantly decrease the efficacy of the perturbation, but only when the autocorrelation time, which vanishes for white noise, becomes so large that t here is little power at frequencies comparable to the natural frequencies of the unperturbed orbit. This suggests strongly that noise-induced extrinsic diffusion, like modulational diffusion associated with periodic driving, is a resonance phenomenon. Potential implications for galaxies are discussed.Comment: 15 pages including 18 figures, uses MNRAS LaTeX macro

The study of metaphor as part of Critical Discourse Analysis

This article discusses how the study of metaphoric and more generally, figurative language use contributes to critical discourse analysis (CDA). It shows how cognitive linguists’ recognition of metaphor as a fundamental means of concept- and argument-building can add to CDA's account of meaning constitution in the social context. It then discusses discrepancies between the early model of conceptual metaphor theory and empirical data and argues that discursive-pragmatic factors as well as sociolinguistic variation have to be taken into account in order to make cognitive analyses more empirically and socially relevant. In conclusion, we sketch a modified cognitive approach informed by Relevance Theory within CDA