The epileptology of William Aldren Turner

William Aldren Turner (1864-1945), in his day Physician to the National Hospital, Queen Square, and to King's College Hospital, London, was one of the major figures in the world of epileptology in the period between Hughlings Jackson in the latter part of the 19th century and the advent of electroencephalography in the 1930s. Although he also made contributions to knowledge in other areas of neurology, and with Grainger Stewart wrote a competent textbook on that subject, Turner's main professional interest throughout his career seems to have been epilepsy. On the basis of a series of earlier, rather heavily statistical, personal publications dealing with various aspects of the disorder, he authored what became a well-accepted monograph entitled Epilepsy-a study of the idiopathic disorder, which appeared in 1907, and he also gave the 1910 Morison lectures in Edinburgh on the topic. His writings on epilepsy over a period of three decades consolidated knowledge rather than led to significant advances, but helped maintain interest in the disorder during a rather long fallow phase in the development of the understanding of its nature. (C) 2005 Elsevier Ltd. All rights reserved.

The internal cranial anatomy of the Plesiosauria (Reptilia, Sauropterygia): evidence for a functional secondary palate

In the late 19th Century, the choanae (or internal nares) of the Plesiosauria were identified as a pair of palatal openings located rostral to the external nares, implying a rostrally directed respiratory duct and air path inside the rostrum. Despite obvious functional shortcomings, this idea was firmly established in the scientific literature by the first decade of the 20th Century. The functional consequences of this morphology were only re-examined by the end of the 20th Century, leading to the conclusion that the choanae were not involved in respiration but instead in underwater olfaction, the animals supposedly breathing with the mouth agape. Re-evaluation of the palatal and internal cranial anatomy of the Plesiosauria reveals that the traditional identification of the choanae as a pair of fenestrae situated rostral to the external nares appears erroneous. These openings more likely represent the bony apertures of ducts that lead to internal salt glands situated inside the maxillary rostrum. The 'real' functional choanae (or caudal interpterygoid vacuities), are situated at the caudal end of the bony palate between the sub-temporal fossae, as was suggested in the mid-19th Century. The existence of a functional secondary palate in the Plesiosauria is therefore strongly supported, and the anatomical, physiological, and evolutionary implications of such a structure are discussed.

Measurement of the aerodynamic performance of a scramjet-powered vehicle in a shock tunnel

A force balance system for measuring lift, thrust and pitching moment has been used to measure the performance of fueled scramjet-powered vehicle in the T4 Shock Tunnel at The University of Queensland. Detailed measurements have been made of the effects of different fuel flow rates corresponding to equivalence ratios between 0.0 and 1.5. For proposed scramjet-powered vehicles, the fore-body of the vehicle acts as part of the inlet to the engine and the aft-body acts as the thrust surface for the engine. This type of engine-integrated design leads to a strong coupling between the performance of the engine and the lift and trim characteristics of the vehicle. The measurements show that the lift force increased by approximately 50% and centre-of-pressure changed by approximately 10% of the chord of the vehicle when the equivalence ratio varied from 0.0 to 1.0. The results demonstrate the importance of engine performance to the overall aerodynamic characteristics of engine-integrated scramjet vehicles and that such characteristics can be measured in a shock tunnel.

The Mechanisms of wear of the video head

      This thesis examines the mechanism of wear occuring to the video head and their effect on signal reproduction. in particular it examines the wear occuring to manganese-zinc ferrite heads in sliding contact with iron oxide media.       A literature survey is presented, which covers magnetic recording technologies, focussing on video recording. Existing work on wear of magnetic heads is also examined, and gaps in the theoretical account of wear mechanisms presented in the literature are identified.       Pilot research was carrried out on the signal degradation and wear associated witha number of commercial video tapes, containing a range of head cleaning agents. From this research, the main body of the research was identified. A number of methods of wear measurement were examined for use in this project. Knoop diamond indentation was chosen because experimentation showed it to be capable of measuring wear occuring in situ. This technique was then used to examine the wear associated with different levels of A12O3 and Cr2O3 head cleaning agents.      The results of the research indicated that, whilst wear of the video head increases linearly with increasing HCA content, signal degradation does not vary significantly. The most significant differences in wear and signal reproduction were observed between the two HCAs. The signal degradation of heads worn with tape samples containing A12O3 HCA was found to be lower than heads worn with tapes containing Cr2O3 HCA.      The results also indicate that the wear to the head is an abrasive process characterised by ploughing of the ferrite surface and chipping of the edges of the head gap. Both phenomena appear to be caused by poor iron oxide and head cleaning particles, which create isolated asperities on the tape surface.   

Origins of molecular neurobiology:The role of the physicists

The revolution in the foundations of physics at the beginning of the twentieth century suggested to several of its most prominent workers that biology was ripe for something similar. In consequence, a number of physicists moved into biology. They were highly influential in initiating a molecular biology in the 1950s. Two decades later it seemed to several of these migrants, and those they had influenced, that the major problems in molecular biology had been solved, and that it was time to move on to what seemed to them the final problem: the nervous system, consciousness, and the age-old mind-body problem. This paper reviews this "double migration" and shows how the hopes of the first generation of physicist-biologists were both realized and dashed. No new physical principles were discovered at work in the foundations of biology or neuroscience. On the other hand, the mind-set of those trained in physics proved immensely valuable in analyzing fundamental issues in both biology and neuroscience. It has been argued that the outcome of the molecular biology of the 1950s was a change in the concept of the gene from that of "a mysterious entity into that of a real molecular object" (Watson, 1965, p.6); the gates and channels which play such crucial roles in the functioning of nervous systems have been transformed in a similar way. Studies on highly simplified systems have also opened the prospect of finding the neural correlatives of numerous behaviors and neuropathologies. This increasing understanding at the molecular level is invaluable not only in devising rational therapies but also, by defining the material substrate of consciousness, in bringing the mind-body problem into sharper focus. Copyright © Taylor & Francis Inc.

Solids mixing and segregation in a gas spout-fluid bed-effect of the distributor design

This work is concerned with the assessment of a newer version of the spout-fluid bed where the gas is supplied from a common plenum and the distributor controls the operational phenomenon. Thus the main body of the work deals with the effect of the distributor design on the mixing and segregation of solids in a spout-filled bed. The effect of distributor design in the conventional fluidised bed and of variation of the gas inlet diameter in a spouted bed were also briefly investigated for purpose of comparison. Large particles were selected for study because they are becoming increasingly important in industrial fluidised beds but have not been thoroughly investigated. The mean particle diameters of the fraction ranged from 550 to 2400 mm, and their specific gravity from 0.97 to 2.45. Only work carried out with binary systems is reported here. The effect of air velocity, particle properties, bed height, the relative amount of jetsam and flotsam and initial conditions on the steady-state concentration profiles were assessed with selected distributors. The work is divided into three sections. Sections I and II deal with the fluidised bed and spouted bed systems. Section III covers the development of the spout-filled bed and its behaviour with reference to distributor design and it is shown how benefits of both spouting and fluidising phenomena can be exploited. In the fluidisation zone, better mixing is achieved by distributors which produce a large initial bubble diameter. Some common features exist between the behaviour of unidensity jetsam-rich systems and different density flotsam-rich systems. The shape factor does not seem to have an affect as long as it is only restricted to the minor component. However, in the case of the major component, particle shape significantly affects the final results. Studies of aspect ratio showed that there is a maximum (1.5) above which slugging occurs and the effect of the distributor design is nullified. A mixing number was developed for unidensity spherical rich systems, which proved to be extremely useful in quantifying the variation in mixing and segregation with changes in distributor design.

Organizational weaknesses of the Greek Manufacturing industry: a case study of footwear

This thesis is concerned with those factors influencing the present performance of Greek manufacturing industry and the ways in which improvements could be realized after Greece joins European Communities..Detailed examination is made of the Greek footwear industry and its problems as the country emerges from a semi developed state to a position approaching parity with Western European countries. Particular attention is paid to the technology employed, capital deployment, industrial structure and managerial performance. In order to illustrate the path of development of the Greek footwear industry a comparison is undertaken with the British footwear industry which has a longer history and has employed larger scale methods since the 19th century. This comparison illustrates the opportunities and pitfalls likely to face the Greek industry in coming years. One section of the thesis is also concerned with trading relationships between the U.K. and Greece and identifies the market opportunities available to Greek industrialists. A detailed analysis is undertaken of the available secondary sources of information particularly official statistical data relating to production, capital expenditure, imports and exports, employment and consumption. Use is also made of various surveys of trade and production in footwear undertaken by trade associations and other bodies. The field research study has been largely directed towards practicing managers in companies of various size and is concerned with exposing standards of management and of relating efficiency to organization structure. The thesis is also concerned with the many wide issues affecting the development of manufacturing industry in Greece including the influence of social structure and social institutions, the values of modern Greek society and the complex organizational problems which Greece needs to overcome in order to take its place amongst the more established states of Europe.

Commandeering Aesop’s Bamboo Canon: A 19th Century Confederacy of Creole Fugitive Fables

In my thesis, “Commandeering Aesop’s Bamboo Canon: A 19th Century Confederacy of Creole Fugitive Fables,” I ask and answer the ‘Who? What? Where? When? Why?” of Creole Literature using the 19th century production of Aesopian fables as clues to resolve a set of linguistic, historical, literary, and geographical enigmas pertaining the ‘birth-place(s)’ of Creolophone Literatures in the Caribbean Sea, North and South America, as well as the Indian Ocean. Focusing on the fables in Martinique (1846), Reunion Island (1826), and Mauritius (1822), my thesis should read be as an attempt capture the links between these islands through the creation of a particular archive defined as a cartulary-chronicle, a diplomatic codex, or simply a map in which I chart and trace the flight of the founding documents relating to the lives of the individual authors, editors, and printers in order to illustrate the articulation of a formal and informal confederation that enabled the global and local institutional promotion of Creole Literature. While I integrate various genres and multi-polar networks between the authors of this 19th century canon comprised of sacred and secular texts such as proclamations, catechisms, and proverbs, the principle literary genre charted in my thesis are collections of fables inspired by French 17th century French Classical fabulist, Jean de la Fontaine. Often described as the ‘matrix’ of Creolophone Literature, these blues and fables constitute the base of the canon, and are usually described as either ‘translated,’ ‘adapted,’ and even ‘cross-dressed’ into Creole in all of the French Creolophone spaces. My documentation of their transnational sprouting offers proof of an opaque canonical formation of Creole popular literature. By constituting this archive, I emphasize the fact that despite 200 years of critical reception and major developments and discoveries on behalf of Creole language pedagogues, literary scholars, linguists, historians, librarians, archivist, and museum curators, up until now not only have none have curated this literature as a formal canon. I also offer new empirical evidence in order to try and solve the enigma of “How?” the fables materially circulated between the islands, and seek to come to terms with the anonymous nature of the texts, some of which were published under pseudonyms. I argue that part of the confusion on the part of scholars has been the result of being willfully taken by surprise or defrauded by the authors, or ‘bamboozled’ as I put it. The major paradigmatic shift in my thesis is that while I acknowledge La Fontaine as the base of this literary canon, I ultimately bypass him to trace the ancient literary genealogy of fables to the infamous Aesop the Phrygian, whose biography – the first of a slave in the history of the world – and subsequent use of fables reflects a ‘hidden transcript’ of ‘masked political critique’ between ‘master and slave classes’ in the 4th Century B.C.E. Greece.

This archive draws on, connects and critiques the methodologies of several disciplinary fields. I use post-colonial literary studies to map the literary genealogies Aesop; use a comparative historical approach to the abolitions of slavery in both the 19th century Caribbean and the Indian Ocean; and chart the early appearance of folk music in early colonial societies through Musicology and Performance Studies. Through the use of Sociolinguistics and theories of language revival, ecology, and change, I develop an approach of ‘reflexive Creolistics’ that I ultimately hope will offer new educational opportunities to Creole speakers. While it is my desire that this archive serves linguists, book collectors, and historians for further scientific inquiry into the innate international nature of Creole language, I also hope that this innovative material defense and illustration of Creole Literature will transform the consciousness of Creolophones (native and non-native) who too remain ‘bamboozled’ by the archive. My goal is to erase the ‘unthinkability’ of the existence of this ancient maritime creole literary canon from the collective cultural imaginary of readers around the globe.

Beyond Black and White: The grisaille exterior of the Netherlandish triptych

This thesis is a study of fifteenth- to mid sixteenth-century Netherlandish triptych exteriors, focusing on the so-called ‘grisaille’ technique. During this period, altarpieces produced in the Low Countries were typically constructed in a tripartite format with folding wings. This arrangement created the opportunity for pictorial representations on both sides of the hinged panels. Painters emphasized the distinction between the triptych’s two faces by executing the exteriors in a strikingly more subdued palette than the interiors. Particular iconographic subject matter was favoured for grisailles, which often depict the Annunciation or saints that reflect the triptych’s patronage or intended location. Jan van Eyck was notable for his emphasis on imitating stone statuary and created three important grisailles, one of which would influence triptych exteriors for years to come. Hieronymus Bosch, an artist working at the turn of the sixteenth century, also brought innovation to his grisailles, further expanding the potential of these reduced-palette paintings. This thesis examines the creative process involved in the production of grisailles and compares the underdrawings of triptych exteriors to those of the corresponding polychromatic interiors. In this study, grisailles are situated in their context as part of multifaceted artworks as well as within the broader church environment. New infrared reflectograms were generated using Queen’s OSIRIS infrared camera to document works in Belgium and the Netherlands. While some aspects of underdrawings could indicate that the figure was meant to imitate statuary, this distinction was not directly linked to triptych exteriors and was related instead to efforts at a trompe-l’oeil effect. Such attempts at mimicry can also be found on triptych interiors. Through a close examination of the underdrawing stage of these paintings it appears that this part of the creative process was not distinguished in any significant way from the underdrawings of triptych interiors.

Negative Archaeology. The Archaeological Borders of the Present

Nowadays, archaeology is trying to redefine its relation with objects. This change is taking place at the same time as the West is breaking once and for all with the generation who did the rural exodus in the mid of the twentieth century. The present paper proposes a revision of the conditions that allow us to both define this rupture and at the same time determine our affinity with materiality. This is done through a reconsideration of the relation between the past and the present and the dynamics marking this difference. We are situated in a moment when the experience of time is shifting and thus so is the integrity of archaeological objects. Under the name of Negative Archaeology, the border between past and present is explored. This border determines the creation of the past in a present which intends to homogenise changes. Archaeology is a unique discipline which could prevent this process, or at least bear witness to the dynamics to which objects seem to be subjected. Obscolescence is introduced as a concept in an attempt to name the aforementioned problem.

Civic Humanism and the Classical Tradition in the Early Republic of Chile

The first decades of the 19th century constituted a period of profound change for Chile, the principal results of which were to be seen in the consolidation of the process of independence from Spanish dominion in 1818. The consequences were not limited to a revolution of military and political nature; they also included a renovation of the cultural panorama -at least among the educated patriots who made an effort to distance themselves ideologically from the Monarchy-, with the implicit challenge of establishing a new order for Chile, based on legitimate and universally recognizable foundations. The inspirational framework for these efforts is usually associated with other revolutionary examples -France and the United States- that preceded the emancipation processes in Spanish America, as well as with the discourses of illustrated liberalism. As we will attempt to demonstrate in this study, a new reading of the texts written by the Creoles that lead the Chilean independence process may, nonetheless, also reveal the relevance of the classical tradition as a model for the configuration and legitimization of the first Republican projects that especially admired the ideals of Republicanism.

Mutations of the Ideal Sociability in the Eighteenth Century: From Insel Felsenburg to Goethe

In Insel Felsenburg, the most popular of the German Robinsonades, the link between this novelistic subgenre and utopia becomes obvious, because, unlike what had been the case in Robinson Crusoe, the island functions as a contrast with respect to the starting point: Europe, conceived as unmoral and far away from God. The Felsenburg Island becomes a symbol of a patriarchal-bourgeois ideal society, whose centre is the family. It is conceivable that this idealized sociability form is reelaborated in the last third of the 18th Century, when the utopian story is temporalized and the Robinsonades lose their force. Novels such as Anton Reiser and Wilhem Meisters Lehjahre testify for these transformations.

The Transition of World Cashew Industry and the Challenges to India

Cashew is an important commodity traded across the continents and the world cashew industry is the livelihood of more than three million people worldwide, the majority of whom are womenfolk from the socially and economically backward community of the developing nations. Cashew tree was originally planted to prevent soil erosion and it was during the beginning of the 19th century that cashew kernels attained the status of a food item. Further, the cashew kernels attained the status of an international commodity with India exporting its first consignment of cashew kernels to U.S.A. in 1920. India was the first country to hit the world market with cashew as a commodity and it was she who pioneered cashew processing as an industry. For decades together India was enjoying a monopoly in the world cashew industry in the fields of raw nut production (cultivation), processing and the market share in the international trade. The liberalisation of international trade has brought in a big transition in the world of cashew. India started to benefit from the trade policy, that improved her supply positions of raw nuts from other producing countries, accelerated her growth in processing of raw nuts and exports of cashew kernels. On the other side, her domestic consumption started growing up that by the beginning of the new century, she emerged out as the world’s largest consumer of cashew kernels as well.

Mechanisms underlying activation of neural stem cells in the adult central nervous system

À la fin du 19e siècle, Dr. Ramón y Cajal, un pionnier scientifique, a découvert les éléments cellulaires individuels, appelés neurones, composant le système nerveux. Il a également remarqué la complexité de ce système et a mentionné l’impossibilité de ces nouveaux neurones à être intégrés dans le système nerveux adulte. Une de ses citations reconnues : “Dans les centres adultes, les chemins nerveux sont fixes, terminés, immuables. Tout doit mourir, rien ne peut être régénérer” est représentative du dogme de l’époque (Ramón y Cajal 1928). D’importantes études effectuées dans les années 1960-1970 suggèrent un point de vue différent. Il a été démontré que les nouveaux neurones peuvent être générés à l’âge adulte, mais cette découverte a créé un scepticisme omniprésent au sein de la communauté scientifique. Il a fallu 30 ans pour que le concept de neurogenèse adulte soit largement accepté. Cette découverte, en plus de nombreuses avancées techniques, a ouvert la porte à de nouvelles cibles thérapeutiques potentielles pour les maladies neurodégénératives. Les cellules souches neurales (CSNs) adultes résident principalement dans deux niches du cerveau : la zone sous-ventriculaire des ventricules latéraux et le gyrus dentelé de l’hippocampe. En condition physiologique, le niveau de neurogenèse est relativement élevé dans la zone sous-ventriculaire contrairement à l’hippocampe où certaines étapes sont limitantes. En revanche, la moelle épinière est plutôt définie comme un environnement en quiescence. Une des principales questions qui a été soulevée suite à ces découvertes est : comment peut-on activer les CSNs adultes afin d’augmenter les niveaux de neurogenèse ? Dans l’hippocampe, la capacité de l’environnement enrichi (incluant la stimulation cognitive, l’exercice et les interactions sociales) à promouvoir la neurogenèse hippocampale a déjà été démontrée. La plasticité de cette région est importante, car elle peut jouer un rôle clé dans la récupération de déficits au niveau de la mémoire et l’apprentissage. Dans la moelle épinière, des études effectuées in vitro ont démontré que les cellules épendymaires situées autour du canal central ont des capacités d’auto-renouvellement et de multipotence (neurones, astrocytes, oligodendrocytes). Il est intéressant de noter qu’in vivo, suite à une lésion de la moelle épinière, les cellules épendymaires sont activées, peuvent s’auto-renouveller, mais peuvent seulement ii donner naissance à des cellules de type gliale (astrocytes et oligodendrocytes). Cette nouvelle fonction post-lésion démontre que la plasticité est encore possible dans un environnement en quiescence et peut être exploité afin de développer des stratégies de réparation endogènes dans la moelle épinière. Les CSNs adultes jouent un rôle important dans le maintien des fonctions physiologiques du cerveau sain et dans la réparation neuronale suite à une lésion. Cependant, il y a peu de données sur les mécanismes qui permettent l'activation des CSNs en quiescence permettant de maintenir ces fonctions. L'objectif général est d'élucider les mécanismes sous-jacents à l'activation des CSNs dans le système nerveux central adulte. Pour répondre à cet objectif, nous avons mis en place deux approches complémentaires chez les souris adultes : 1) L'activation des CSNs hippocampales par l'environnement enrichi (EE) et 2) l'activation des CSNs de la moelle épinière par la neuroinflammation suite à une lésion. De plus, 3) afin d’obtenir plus d’information sur les mécanismes moléculaires de ces modèles, nous utiliserons des approches transcriptomiques afin d’ouvrir de nouvelles perspectives. Le premier projet consiste à établir de nouveaux mécanismes cellulaires et moléculaires à travers lesquels l’environnement enrichi module la plasticité du cerveau adulte. Nous avons tout d’abord évalué la contribution de chacune des composantes de l’environnement enrichi à la neurogenèse hippocampale (Chapitre II). L’exercice volontaire promeut la neurogenèse, tandis que le contexte social augmente l’activation neuronale. Par la suite, nous avons déterminé l’effet de ces composantes sur les performances comportementales et sur le transcriptome à l’aide d’un labyrinthe radial à huit bras afin d’évaluer la mémoire spatiale et un test de reconnaissante d’objets nouveaux ainsi qu’un RNA-Seq, respectivement (Chapitre III). Les coureurs ont démontré une mémoire spatiale de rappel à court-terme plus forte, tandis que les souris exposées aux interactions sociales ont eu une plus grande flexibilité cognitive à abandonner leurs anciens souvenirs. Étonnamment, l’analyse du RNA-Seq a permis d’identifier des différences claires dans l’expression des transcripts entre les coureurs de courte et longue distance, en plus des souris sociales (dans l’environnement complexe). iii Le second projet consiste à découvrir comment les cellules épendymaires acquièrent les propriétés des CSNs in vitro ou la multipotence suite aux lésions in vivo (Chapitre IV). Une analyse du RNA-Seq a révélé que le transforming growth factor-β1 (TGF-β1) agit comme un régulateur, en amont des changements significatifs suite à une lésion de la moelle épinière. Nous avons alors confirmé la présence de cette cytokine suite à la lésion et caractérisé son rôle sur la prolifération, différentiation, et survie des cellules initiatrices de neurosphères de la moelle épinière. Nos résultats suggèrent que TGF-β1 régule l’acquisition et l’expression des propriétés de cellules souches sur les cellules épendymaires provenant de la moelle épinière.

An investigation of the clinical utility of preoperative cardiopulmonary exercise testing in patients undergoing major pancreatic surgery

Pancreaticoduodenectomy with or without adjuvant chemotherapy remains the only modality of possible cure in patients with cancer involving the head of the pancreas and the periampullary region. While mortality rates after pancreaticoduodenectomy have improved considerably over the course of the last century, morbidity remains high. Patient selection is of paramount importance in ensuring that major surgery is offered to individuals who will most benefit from a pancreaticoduodenectomy. Moreover, identifying preoperative risk factors provides potential targets for prehabilitation and optimisation of the patient's physiology before undertaking surgery. In addition to this, early identification of patients who are likely to develop postoperative complications allows for better allocation of critical care resources and more aggressive management high risk patients. Cardiopulmonary exercise testing is becoming an increasingly popular tool in the preoperative risk assessment of the surgical patient. However, very little work has been done to investigate the role of cardiopulmonary exercise testing in predicting complications after pancreaticoduodenectomy. The impact of jaundice, systemic inflammation and other preoperative clinicopathological characteristics on cardiopulmonary exercise physiology has not been studied in detail before in this cohort of patients. The overall aim of the thesis was to examine the relationships between preoperative clinico-pathological characteristics including cardiopulmonary exercise physiology, obstructive jaundice, body composition and systemic inflammation and complications and the post-surgical systemic inflammatory response in patients undergoing pancreaticoduodenectomy. Chapter 1 reviews the existing literature on preoperative cardiopulmonary exercise testing, the impact of obstructive jaundice, perioperative systemic inflammation and the importance of body composition in determining outcomes in patients undergoing major surgery with particular reference to pancreatic surgery. Chapter 2 reports on the role of cardiopulmonary exercise testing in predicting postoperative complications after pancreaticoduodenectomy. The results demonstrate that patients with V˙O2AT less than 10 ml/kg/min are more likely to develop a postoperative pancreatic fistula, stay longer in hospital and less likely to receive adjuvant therapy. These results emphasise the importance of aerobic fitness to recover from the operative stress of major surgery without significant morbidity. Cardiopulmonary exercise testing may prove useful in selecting patients for intensive prehabilitation programmes as well as for other optimisation measures to prepare them for major surgery. Chapter 3 evaluates the relationship between cardiopulmonary exercise physiology and other clinicopathological characteristics of the patient. A detailed analysis of cardiopulmonary exercise test parameters in jaundiced versus non-jaundiced patients demonstrates that obstructive jaundice does not impair cardiopulmonary exercise physiology. This further supports emerging evidence in contemporary literature that jaundiced patients can proceed directly to surgery without preoperative biliary drainage. The results of this study also show an interesting inverse relationship between body mass index and anaerobic threshold which is analysed in more detail in Chapter 4. Chapter 4 examines the relationship between preoperative cardiopulmonary exercise physiology and body composition in depth. All parameters measured at cardiopulmonary exercise test are compared against body composition and body mass index. The results of this chapter report that the current method of reporting V˙O2, both at peak exercise and anaerobic threshold, is biased against obese subjects and advises caution in the interpretation of cardiopulmonary exercise test results in patients with a high BMI. This is particularly important as current evidence in literature suggests that postoperative outcomes in obese subjects are comparable to non-obese subjects while cardiopulmonary exercise test results are also abnormally low in this very same cohort of patients. Chapter 5 analyses the relationship between preoperative clinico-pathological characteristics including systemic inflammation and the magnitude of the postoperative systemic inflammatory response. Obstructive jaundice appears to have an immunosuppressive effect while elevated preoperative CRP and hypoalbuminemia appear to have opposite effects with hypoalbuminemia resulting in a lower response while elevated CRP in the absence of hypoalbuminemia resulted in a greater postoperative systemic inflammatory response. Chapter 6 evaluates the role of the early postoperative systemic inflammatory response in predicting complications after pancreaticoduodenectomy and aims to establish clinically relevant thresholds for C-Reactive Protein for the prediction of complications. The results of this chapter demonstrate that CRP levels as early as the second postoperative day are associated with complications. While post-operative CRP was useful in the prediction of infective complications, this was the case only in patients who did not develop a post-operative pancreatic fistula. The predictive ability of inflammatory markers for infectious complications was blunted in patients with a pancreatic fistula. Chapter 7 summarises the findings of this thesis, their place in current literature and future directions. The results of this thesis add to the current knowledge regarding the complex pathophysiological abnormalities in patients undergoing pancreaticoduodenectomy, with specific emphasis on the interaction between cardiopulmonary exercise physiology, obstructive jaundice, systemic inflammation and postoperative outcomes. The work presented in this thesis lays the foundations for further studies aimed at improving outcomes after pancreaticoduodenectomy through the development of individualised, goal-directed therapies that are initiated well before this morbid yet necessary operation is performed.