OBJECTIVEMyelomeningocele (MM) is a neural tube defect complicated by neurological deficits below the level of the spinal lesion and, in many cases, hydrocephalus. Long-term survival of infants treated for MM in a low- and middle-income country has never been reported. This retrospective cohort study reports 10-year outcomes and factors affecting survival for infants undergoing MM repair at CURE Children's Hospital of Uganda.METHODSPatients were traced by telephone or home visit. Survival was estimated using the Kaplan-Meier method. Multivariate survival was analyzed using the Cox proportional hazards model, investigating the following variables: sex, age at surgery, weight-for-age at surgery, motor level, and presence and management of hydrocephalus.RESULTSA total of 145 children underwent MM repair between 2000 and 2004; complete data were available for 133 patients. The probability of 10-year survival was 55%, with 78% of deaths occurring in the first 5 years. Most of the deaths were not directly related to MM; infection and neglect were most commonly described. Lesions at motor level L-2 or above were associated with increased mortality (HR 3.176, 95% CI 1.557–6.476). Compared with repair within 48 hours of birth, surgery at 15–29 days was associated with increased mortality (HR 9.091, 95% CI 1.169–70.698).CONCLUSIONSInfants in low- and middle-income countries with MM can have long-term survival with basic surgical intervention. Motor level and age at surgery were significant factors influencing outcome. Education of local health care workers and families to ensure both urgent referral for initial treatment and subsequent access to basic medical care are essential to survival.
Urinary continence and family size are potentially modifiable, the former by simple and inexpensive medical management. Enhanced investment in community-based rehabilitation and support is urgently needed. Delivery of family planning services is a national priority in Uganda, and should be discussed with families as part of holistic care.
AncientGreek verbal morphology involved extensive allomorphy of lexical morphemes, most of which was phonologically and semantically arbitrary, lexically idiosyncratic, and functionally redundant. In the subsequent history of the language this allomorphy was reduced, partly through analogical levelling, where an allomorphic alternation is eliminated in favour of a single phonological expression of underlying meaning. This kind of reduction of arbitrary complexity is often observed in the development of morphological systems, which has inspired a common view of morphological change as being guided by universal preferences, which nudge morphological systems along paths which will lead them to a more optimal status. This paper uses some systematic empirical data from the history of Greek to put to the test two questions about analogical levelling and the role of 'optimisation'. Firstly, is levelling motivated by a universal preference for a one-to-one alignment of meaning and form in language? Secondly, is the direction of levelling determined by universal preferences for particular ways of marking morphosyntactic distinctions? I will argue that the answer to both questions is no: the changes in the Greek data I have examined are remarkably well predicted by language-specific, formal properties of paradigms, without the need to invoke universal preferences. These facts are best accommodated if speaker competence includes detailed probabilistic information about the predictive structure of paradigms, which has important implications for morphological theory, as well as historical linguistics.
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