Background. Mood, baseline functioning, and cognitive abilities as well as psychotropic medications may contribute to mortality in adults with and without Down Syndrome (DS). Methods. Population-based (nonclinical), community-dwelling adults with intellectual disabilities (IDs) were recruited between 1995 and 2000, assessed individually for 1–4 times, and then followed by yearly phone calls. Results. 360 participants (116 with DS and 244 without DS) were followed for an average of 12.9 years (range 0–16.1 years as of July 2011). 108 people died during the course of the followup, 65 males (31.9% of all male participants) and 43 females (27.6% of all female participants). Cox proportional hazards modeling showed that baseline practical skills, seizures, anticonvulsant use, depressive symptoms, and cognitive decline over the first six years all significantly contributed to mortality, as did a diagnosis of DS, male gender, and higher age at study entry. Analysis stratified by DS showed interesting differences in mortality predictors. Conclusion. Although adults with DS have had considerable improvements in life expectancy over time, they are still disadvantaged compared to adults with ID without DS. Recognition of potentially modifiable factors such as depression may decrease this risk.
Melanocytic naevi (MN) are recognised risk factors for malignant melanoma but the epidemiology of MN is poorly understood. Some MN are present at birth and the study of congenital lesions is an important first step toward understanding the development of MN in early life. In this study, the prevalence and characteristics of congenital pigmented lesions were documented in 1012 White caucasian newborn babies at a maternity hospital in Oxford. Only 12 babies (1.2%) were found to have pigmented skin marks and each of these had only one lesion and no other abnormalities. MN were identified with certainty in only five babies (0.5% of the population; 95% CI, 0.06%-0.93%) thus confirming the relatively low prevalence of this lesion. Four of the MN were noted to be 'small' (less than 15 mm diameter) and all five were less than or equal to 20 mm in diameter. In other respects, the MN displayed a diversity of features. Of the other lesions there were two Mongolian blue spots, one melanocytic pustule, one 'probable' MN and three unusual skin marks where the diagnosis was uncertain but considered unlikely to be MN. During the course of the study, examinations were also carried out incidentally on 39 non-White babies. Twenty-two of these were noted to have Mongolian spots (57%) and three had other pigmented lesions (8%).
<p>Small states are perceived as lacking military power. Nevertheless, most maintain military forces. Given their shortfalls in power and capacity what choices do small states make about maintaining military forces and what utility do they gain from them? This issue is not well addressed in small state literature which considers the security of small states but focuses less on their defence planning or the military instruments they maintain. This thesis addresses that issue by examining how small states structure their military forces, why they do so, and whether they provide for relevant and credible military capabilities. This is achieved by examining the structural balance of small state military forces; developing and applying a methodology to describe the process and priorities within the military systems of small states; and developing expectations for military forces in small states from small state literature and military theory as testable propositions to provide a basis for comparison of their military capabilities. The results of this comparison are then analysed with regard to the utility that small states may gain from their military forces and related to wider themes within the field of small state studies to ascertain the benefit that they may gain from them. Four cases of small state military force structures are used. Ireland provides limited military capabilities to meet discrete tasks and roles within a benign strategic environment and its policy of military neutrality. New Zealand, like Ireland, does not face a direct military threat but it has a wide range of security interests. This is reflected in a broad force structure, albeit with modest capabilities based on utility and the benefits of its international partnerships. Norway, on the other hand, does perceive a direct military threat and functions within the NATO security alliance. It maintains forces that are able to operate throughout the conflict continuum as part of the NATO framework but, as a small member of the alliance, it faces the challenges of balancing defence concerns within the alliance framework. Singapore also perceives itself to be strategically and militarily vulnerable. However, unlike Norway, it does not participate in a military alliance and instead provides the most capable military forces of the four cases as it aims to be self-reliant in the face of perceived vulnerability. The four cases possess markedly different military force structures as a result of their varying assessments of strategic discretion and differences in their approaches to the various security environments they encounter. All four face challenges with economies of scale, critical mass and fixed costs in providing for their military capabilities. However, the extent of these challenges differs between each of the four cases and they gain different utility and benefit from maintaining their military instruments. Hence while small states have some common military characteristics they cannot be considered as a homogenous group. This should affect the manner in which they, other states and international organisations perceive them.</p>
<p>Small states are perceived as lacking military power. Nevertheless, most maintain military forces. Given their shortfalls in power and capacity what choices do small states make about maintaining military forces and what utility do they gain from them? This issue is not well addressed in small state literature which considers the security of small states but focuses less on their defence planning or the military instruments they maintain. This thesis addresses that issue by examining how small states structure their military forces, why they do so, and whether they provide for relevant and credible military capabilities. This is achieved by examining the structural balance of small state military forces; developing and applying a methodology to describe the process and priorities within the military systems of small states; and developing expectations for military forces in small states from small state literature and military theory as testable propositions to provide a basis for comparison of their military capabilities. The results of this comparison are then analysed with regard to the utility that small states may gain from their military forces and related to wider themes within the field of small state studies to ascertain the benefit that they may gain from them. Four cases of small state military force structures are used. Ireland provides limited military capabilities to meet discrete tasks and roles within a benign strategic environment and its policy of military neutrality. New Zealand, like Ireland, does not face a direct military threat but it has a wide range of security interests. This is reflected in a broad force structure, albeit with modest capabilities based on utility and the benefits of its international partnerships. Norway, on the other hand, does perceive a direct military threat and functions within the NATO security alliance. It maintains forces that are able to operate throughout the conflict continuum as part of the NATO framework but, as a small member of the alliance, it faces the challenges of balancing defence concerns within the alliance framework. Singapore also perceives itself to be strategically and militarily vulnerable. However, unlike Norway, it does not participate in a military alliance and instead provides the most capable military forces of the four cases as it aims to be self-reliant in the face of perceived vulnerability. The four cases possess markedly different military force structures as a result of their varying assessments of strategic discretion and differences in their approaches to the various security environments they encounter. All four face challenges with economies of scale, critical mass and fixed costs in providing for their military capabilities. However, the extent of these challenges differs between each of the four cases and they gain different utility and benefit from maintaining their military instruments. Hence while small states have some common military characteristics they cannot be considered as a homogenous group. This should affect the manner in which they, other states and international organisations perceive them.</p>
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