The pragmatic motifs of the Jespersen cycle: default, activation, and the history of negation in French

The purpose of this article is to delimit the role of pragmatic specialization in the evolution of negation in French. The change in the marking of sentential negation is believed to proceed in characterized stages that would together constitute the Jespersen cycle. As a marker becomes the default expression of negation, the other markers do not necessarily fade away, and are maintained with specialized roles that include pragmatic functions. One such pragmatic function is that of activation (Dryer 1996), by which a proposition is presented as accessible to the hearer. Activation is shown to motivate the use of preverbal non that competes with 'ne' for several centuries. The claims that the emergence of postverbal pas in early French and the loss of 'ne' in contemporary spoken French are associated with activation are considered on the basis of novel data. It is concluded that pragmatic functions contribute to language change by providing marked options that may be conferred the default status in a grammatical paradigm.

Fertile ground:the history of accounting in hospitals

Editorial

Natural history of retinopathy in children and young people with type 1 diabetes

Purpose: To describe the prevalence and natural history of retinopathy in a cohort of children and young people with type 1 diabetes attending a tertiary hospital diabetes clinic. Methods: We analysed retinopathy screening data from 2008 to 2010 on all eligible children using the 'Twinkle' diabetes database and the regional retinal screening database. Results: A total of 88% (149/169) of eligible children were screened in 2008, median age 14 years, 52% male. The prevalence of retinopathy was 19.5% (30/149). All children had background retinopathy grade R1. There was significant difference in median (range) duration of diabetes, 7.7 years (0.6–13.7) vs 5 years (0.2–12.5) (P<0.001) and median (range) HbA1C, 9.1% (7.2–14) vs 8.6% (5.6–13.1) (P=0.02), between the groups with and without retinopathy. At 2- years follow-up, 12/30 (40%) had unchanged retinopathy grade R1, 10/30 (33.3%) showed resolution of changes (R0), 1/30 progressed to maculopathy, and 7/30 had no follow-up data. Median (range) HbA1C in 2008 and 2010 for the groups with stable vs resolved changes was similar, 9.1% (7.2–14.0) and 9.2% (7–14.0) vs 9.5% (7.8–14.0) and 9.2% (8.7–14.0). Of the 119 without retinopathy in 2008, 27 (22.5%) had developed retinopathy within 2 years, including 1 with pre-proliferative retinopathy and 1 with maculopathy. There was no significant difference in HbA1c between those who progressed to retinopathy (8.7% (7.1–13.1)) (8.7% (7.1–13.1)), and those who did not (8.6% (6.3–12.2)). Conclusions: Prevalence of background retinopathy in our cohort was comparable to the previously published reports, with higher HbA1c and longer duration of diabetes being significant risk factors. On short-term follow-up, Grade 1 retinopathy is likely to resolve in a third of patients and remain unchanged in just over a third.

Seeing and believing: three episodes in the history of neurophysiology

In this contribution I look at three episodes in the history of neurophysiology that bring out the complex relationship between seeing and believing. I start with Vesalius in the mid-sixteenth century who writes that he can in no way see any cavity in nerves, even in the optic nerves. He thus questions the age-old theory (dating back to the Alexandrians in the third century BC) but, because of the overarching psychophysiology of his time, does not press his case. This conflict between observation and theory persisted for a quarter of a millennium until finally resolved at the beginning of the nineteenth century by the discoveries of Galvani and Volta. The second case is provided by the early history of retinal synaptology. Schultze in 1866 had represented rod spherules and bipolar dendrites in the outer plexiform layer as being separated by a (synaptic) gap, yet in his written account, because of his theoretical commitments, held them to be continuous. Cajal later, 1892, criticized Schultze for this pusillanimity, but his own figure in La Cellule is by no means clear. It was only with the advent of the electron microscopy in the mid-twentieth century that the true complexity of the junction was revealed and it was shown that both investigators were partially right. My final example comes from the Hodgkin-Huxley biophysics of the 1950s. Their theory of the action potential depended on the existence of unseen ion pores with quite complex biophysical characteristics. These were not seen until the Nobel-Prize-winning X-ray diffraction analyses of the early twenty-first century. Seeing, even at several removes, then confirmed Hodgkin and Huxley’s belief. The relation between seeing and believing is by no means straightforward.

Epidemiology of myopia in a United Kingdom urban child population

The Aston Eye Study (AES) was instigated in October 2005 to determine the distribution of refractive error and associated ocular biometry in a sample of UK urban school children. The AES is the first study to compare outcome measures separately in White, South Asian and Black children. Children were selected from two age groups (Year 2 children aged 6/7 years, Year8 children aged 12/13 years of age) using random cluster sampling of schools in Birmingham, West Midlands UK. To date, the AES has examined 598 children (302 Year 2,296 Year 8). Using open-field cycloplegic autorefraction, the overall prevalence of myopia (=-0.50D SER in either eye) determined was 19.6%, with a higher prevalence in older (29.4%) compared to younger (9.9%) children (p<0.001). Using multiple logistic regression models, the risk of myopia was higher in Year 8 South Asian compared to White children and higher in children attending grammar schools relative to comprehensive schools. In addition, the prevalence of uncorrected ametropia was found to be high (Year 8: 12.84%, Year 2: 15.23%), which will be of concern to bodies responsible for the implementation of school vision screening strategies. Biometric data using non-contact partial coherence interferometry revealed a contributory effect of axial length (AL) and central corneal radius (CR) on myopic refraction, resulting in a strong coefficient of determination of the AL/CR ratio on refractive error. Ocular biometric measures did not vary significantly as a function of ethnicity, suggesting a greater miscorrelation of components in susceptible ethnic groups to account for their higher myopia prevalence. Corneal radius was found to be steeper in myopes in both age groups, but was found to flatten with increasing axial length. Due to the inextricable link between myopia and axial elongation, the paradoxical finding of the cornea demands further longitudinal investigation, particularly in relation to myopia onset. Questionnaire analysis revealed a history of myopia in parents and siblings to be significantly associated with myopia in Year 8 children, with a dose-dependent rise in the odds ratio of myopia evident with increasing number of myopic parents. By classifying socioeconomic status (SES) using Index of Multiple Deprivation values, it was found that Year 8 children from moderately deprived backgrounds were more at risk of myopia compared with children located at both extremities of the deprivation spectrum. However, the main effect of SES weakened following multivariate analysis, with South Asian ethnicity and grammar schooling remaining associated with Year 8 myopia after adjustment.

Hospital accounting and the history of health-care rationing

Focussing on the period from 1948 to 1997, this paper examines the history of rationing in the British National Health Service (NHS), with special reference to the role of hospital accounting in this context. The paper suggests that concerns regarding rationing first emerged in the 1960s and 1970s in response to the application of economic theories to the health services, and that rationing only became an issue of wider concern when the NHS increasingly came to resemble economic models of health services in the early 1990s. The paper moreover argues that, unlike in the USA, hospital accounting did not play a significant role in allocating or withholding health resources in Britain. Rudimentary information systems as well as resistance from medical professionals are identified as significant factors in this context.