The role of androgens in fetal growth: observational study in two genetic models of disordered androgen signalling.

OBJECTIVE: To examine the role of androgens on birth weight in genetic models of altered androgen signalling. SETTING: Cambridge Disorders of Sex Development (DSD) database and the Swedish national screening programme for congenital adrenal hyperplasia (CAH). PATIENTS: (1) 29 girls with XY karyotype and mutation positive complete androgen insensitivity syndrome (CAIS); (2) 43 girls and 30 boys with genotype confirmed CAH. MAIN OUTCOME MEASURES: Birth weight, birth weight-for-gestational-age (birth weight standard deviation score (SDS)) calculated by comparison with national references. RESULTS: Mean birth weight SDS in CAIS XY infants was higher than the reference for girls (mean, 95% CI: 0.4, 0.1 to 0.7; p=0.02) and was similar to the national reference for boys (0.1, -0.2 to 0.4). Birth weight SDS in CAH girls was similar to the national reference for girls (0.0, -0.2 to 0.2) and did not vary by severity of gene mutation. Birth weight SDS in CAH boys was also similar to the national reference for boys (0.2, -0.2 to 0.6). CONCLUSION: CAIS XY infants have a birth weight distribution similar to normal male infants and birth weight is not increased in infants with CAH. Alterations in androgen signalling have little impact on birth weight. Sex dimorphism in birth size is unrelated to prenatal androgen exposure.

Measurement of stressful postures during daily activities: An observational study with older people.

This study measured the postures of older people during cooking and laundry. A sample of men and women aged 75+ years (n=27) was recruited and observed in a home-like environment. Postures were recorded with a measurement system in an objective and detailed manner. The participants were videotaped to be able to see where 'critical' postures occurred, as defined by a trunk inclination of ≥60°. Analysis of data was facilitated by specially developed software. Critical postures accounted for 3% of cooking and 10% of laundry, occurring primarily during retrieving from and putting in lower cabinets, the refrigerator, laundry basket or washing machine as well as disposing into the waste bin. These tasks involve a great variation in postural changes and pose a particular risk to older people. The results suggest that the use of stressful postures may decrease efficiency and increase fatigue, eventually leading to difficulties with daily activities. The specific tasks identified during which critical postures occurred should be targeted by designers in order to improve the activities. A few examples are given of how better design can reduce or eliminate some of the postural constraints.

Infrared Magnitude-Redshift Relations for Luminous Radio Galaxies

Infrared magnitude-redshift relations for the 3CR and 6C samples of radio galaxies are presented for a wide range of plausible cosmological models, including those with non-zero cosmological constant OmegaLambda. Variations in the galaxy formation redshift, metallicity and star formation history are also considered. The results of the modelling are displayed in terms of magnitude differences between the models and no-evolution tracks, illustrating the amount of K-band evolution necessary to account for the observational data. Given a number of plausible assumptions, the results of these analyses suggest that: (i) cosmologies which predict T_0xH_0>1 (where T_0 denotes the current age of the universe) can be excluded; (ii) the star formation redshift should lie in the redshift interval 5

Geotechnical observations of construction OF A large shallow SCL tunnel in soft ground

The Fort Canning Tunnel is the first road tunnel in Singapore to be built using the sprayed concrete lining (SCL) method. The major technical challenge of this was to construct a 15m wide tunnel by mining in soft ground under a shallow overburden of 3m to 9m. This paper describes the geotechnical investigations and monitoring controls for the safe and progressive execution of the works, such as soil investigations, trial forepoling works, surface settlement monitoring, tunnel settlement monitoring, face movement monitoring, and the observational approach to construction. The monitored field data showed the volume loss to range from 0.4% to 2.1%, and the observed surface settlement trough was found to agree well with the theoretical Gaussian trough. Other observations made include substantial surface settlements induced by the stress relief at and ahead of the tunnel face in spite of the forepoling umbrella, and the higher volume losses associated with higher overburden. Tunnel face movements were observed during installation of forepoling. These observations are of interest to engineers planning future SCL tunnels in similar conditions.

Altruistic learning.

The origin of altruism remains one of the most enduring puzzles of human behaviour. Indeed, true altruism is often thought either not to exist, or to arise merely as a miscalculation of otherwise selfish behaviour. In this paper, we argue that altruism emerges directly from the way in which distinct human decision-making systems learn about rewards. Using insights provided by neurobiological accounts of human decision-making, we suggest that reinforcement learning in game-theoretic social interactions (habitisation over either individuals or games) and observational learning (either imitative of inference based) lead to altruistic behaviour. This arises not only as a result of computational efficiency in the face of processing complexity, but as a direct consequence of optimal inference in the face of uncertainty. Critically, we argue that the fact that evolutionary pressure acts not over the object of learning ('what' is learned), but over the learning systems themselves ('how' things are learned), enables the evolution of altruism despite the direct threat posed by free-riders.

Stakeholder challenges in purchasing medical devices for patient safety.

OBJECTIVE: This study identifies the stakeholders who have a role in medical device purchasing within the wider system of health-care delivery and reports on their particular challenges to promote patient safety during purchasing decisions. METHODS: Data was collected through observational work, participatory workshops, and semi-structured qualitative interviews, which were analyzed and coded. The study takes a systems-based and engineering design approach to the study. Five hospitals took part in this study, and the participants included maintenance, training, clinical end-users, finance, and risk departments. RESULTS: The main stakeholders for purchasing were identified to be staff from clinical engineering (Maintenance), device users (Clinical), device trainers (Training), and clinical governance for analyzing incidents involving devices (Risk). These stakeholders display varied characteristics in terms of interpretation of their own roles, competencies for selecting devices, awareness and use of resources for purchasing devices, and attitudes toward the purchasing process. The role of "clinical engineering" is seen by these stakeholders to be critical in mediating between training, technical, and financial stakeholders but not always recognized in practice. CONCLUSIONS: The findings show that many device purchasing decisions are tackled in isolation, which is not optimal for decisions requiring knowledge that is currently distributed among different people within different departments. The challenges expressed relate to the wider system of care and equipment management, calling for a more systemic view of purchasing for medical devices.