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With the European Union Regulation on health technology assessment (HTA) approaching, there is concern about how to accommodate the large number of expected population, intervention, comparator, outcome(s), and study type (PICOS) questions and their uncertainty. Navigating uncertainty will prove essential to anticipate evidence requirements. This abstract presents preliminary results of the development of a metric that assesses uncertainty surrounding PICOS questions to eventually guide planning of evidence synthesis for joint clinical assessment (JCA) submission.
Methods
The metric will consist of pillars representing overarching themes of uncertainty. Each pillar will contain several elements influencing uncertainty for proposed PICOS questions. This study was conducted in two phases. In phase one, targeted literature searches of peer-reviewed and gray literature were conducted to identify the overarching metric pillars. These pillars were then validated by expert opinion. Similar research methods were used in phase two to inform the content of each of the pillars. Here we present the findings for phase one.
Results
The targeted literature review in phase one resulted in multiple candidate elements for the uncertainty pillars. Elements were selected based on expert opinion, resulting in five main pillars. These pillars were considered most valuable for the determination of uncertainty surrounding individual PICOS questions and were considered crucial to HTA acceptance. Phase one resulted in the following pillars: (i) indication and subpopulations; (ii) type of intervention and comparators; (iii) societal and patient unmet need; (iv) type and quality of evidence source informing evidence synthesis; and (v) methodology of evidence synthesis.
Conclusions
This study lays the foundation for a metric to assess the uncertainty surrounding proposed PICOS questions for JCAs. The metric identifies existing uncertainties for PICOS questions, assesses potential issues for HTA acceptance, and guides possible evidence synthesis planning. A clear framework for anticipating uncertainty will prove essential in managing resources and expectations.
The chapter examines the issue of civil liability in the framework of damages resulting from the use of such autonomous systems. A particular emphasis is placed on the importance of access to justice – of enhancing access for victims of harm to remedies and relief – rather than more abstract or conceptual considerations of the appropriateness of a particular regulatory solution
During routine parasitological surveillance and monitoring activities within a National Control Programme for control of human schistosomiasis in Uganda, it was noted that cattle grazing in a water meadow immediately adjacent to Tonya primary school, where the prevalence of intestinal schistosomiasis in children was in excess of 90%, were unusually emaciated. To test the hypothesis that there may have been an anthropozoonotic focus of Schistosoma mansoni within the local herd, a young female heifer, clearly emaciated and c. 8 months old, was slaughtered from which schistosome worms were later recovered by dissection. As female worms inspected by microscopy were not gravid, morphological identification proved inconclusive but analysis of cytochome oxidase subunit I (COI) and small subunit (SSU) ribosomal DNA sequences from these worms identified them as Schistosoma bovis Sonsino, 1876. This is the first substantiated report of S. bovis from Lake Albert, western Uganda. Further epidemiological surveys are needed to clarify the extent of bovine schistosomiasis within this region, particularly so since this lakeside plain has been earmarked as a future game reserve.
This paper reports the preliminary results from three seasons of excavations in the Christian cemetery by the Tunisian-British Bulla Regia Archaeological Project. In 2017–2019, excavations in, and around, the Late Antique church in the western cemetery uncovered a complex funerary landscape with a variety of different tomb types, including mosaic caisson tombs, simple masonry tombs, amphora tombs, and earthen graves and multiple funerary mensae. The mosaics, inscriptions and finds (ceramics, glass, coins) studied in 2022 support a fourth to seventh century date for the main period of use of the cemetery.
From the seventh century AD, successive Islamic polities were established around the Mediterranean. Historians have linked these caliphates with the so-called ‘Islamic Green Revolution’—the introduction of new crops and agricultural practices that transformed the economies of regions under Muslim rule. Increasingly, archaeological studies have problematised this largely text-based model of agrarian innovation, yet much of this research remains regionally and methodologically siloed. Focusing on the Western Mediterranean, the authors offer a theoretically informed, integrated environmental archaeology approach through which to contextualise the ecological impact of the Arab-Berber conquests. Its future application will allow a fuller evaluation of the scale, range and significance of agricultural innovations during the ‘medieval millennium’.
The cemetery at Sutton Hoo in East Suffolk includes tumuli dating to the sixth–seventh centuries ad. The largest contained an intact ship-burial. The man commemorated is not identifiable, but is often presumed to be Rædwald, rex Anglorum c ad599–624/5. Excavation was curtailed by the outbreak of war in 1939. Despite subsequent re-excavation and lengthy research, questions remain.
Information dispersed in the definitive publication is correlated and developed. Digital 3D imaging of the ship’s iron fastenings are used here to extrapolate curved lines of missing rivets and superimpose them on the burial chamber plan. A digital roof reconstruction is also presented.
Mechanisms of collapse of the objects are deduced from their positioning and damage, revealing space for access to the chamber. A cross-section depicts the calculated height of the deck and known tilt of the ship. Residues of phosphate, Middle Eastern bitumen, tar and tape cumulatively suggest embalming practices. A temporary coffin and a bed on which possessions were placed are proposed.
The most valuable object relinquished is deduced to be the ship. Fragments of a possible anchor are identified. The suggested identification of the iron stand as a raised light would allow supporting ships to follow.
Six drug regulatory reviewers and 11 pharmaceutical industry scientists were interviewed to explore their perspectives on the obstacles and opportunities for greater implementation of the Three Rs (replacement, reduction, refinement) in drug research and development. Participants generally supported the current level of animal use in the pharmaceutical industry and viewed in vitro methods as supporting, but not replacing, the use of animals. Obstacles to greater use of the Three Rs cited by participants included the lack of non-animal alternatives; requirements for statistical validity; reluctance by industry and regulators to depart from established patterns of animal use; the priority of commercial objectives ahead of the Three Rs; and concern that less animal testing could jeopardise human safety. Opportunities identified for the Three Rs included the development of better animal models including genetically modified (GM) animals; pursuit of more basic knowledge, notably drug action on gene expression; re-use of animals; greater use of pilot studies; using sufficient numbers of animals per test to avoid repeating inconclusive studies; regular review of animal data in regulatory requirements; and following the regulatory option of combining segments of reproductive toxicology studies into one study. In some areas, greater implementation of the Three Rs seemed well aligned with industry priorities, for example, phenotypic characterisation of GM animals and validation of alternative methods. In other areas, wider use of the Three Rs may require building consensus on areas of disagreement including the usefulness of death as an endpoint; the suitability of re-using animals; and whether GM animals and the use of pilot studies contribute to reduction.
The allocation of any benefit that arises from worker-generated innovation is complicated by the importance of three separate areas of law — employment law, intellectual property law and equity — and the distinction between those types of innovation that attract intellectual property rights and those types that do not (the latter being a category that is often referred to as ‘know-how’). The purpose of this article is to engage with the legal scholarship on the principles that are relevant to innovation. To date, the discussion has focused on two distinct approaches — what may be termed the economic and the fairness perspectives. The former may be seen as a justification for the current regime, while the latter has focused on the perceived needs of workers (in large part in opposition to the employers). Our argument is that these two approaches are both incomplete. In an attempt to get closer to a workable framework for the effective allocation of benefits, we offer a third approach; one that is based on the practices that are central to the employer-worker relationship.
Severity classification systems (ie pain scales, categories of invasiveness, degrees of severity etc) are used to classify the adverse effects experienced by animals used for scientific purposes. Currently, eleven countries use severity classification systems. These systems have developed in various ways, depending on each country's process for overseeing the use of animals in science, as well as the particular aspects emphasised by those individuals who have championed their implementation. Severity classification serves four main purposes: as a tool to assist animal ethics committees in ethical review; education of animal users about concepts for humane animal experimentation; provision of data to inform the public about scientific animal use; and provision of data to inform national policies. At a time when the newly accepted European Union Directive will make the reporting of severity data mandatory, we review the characteristics of international severity classification systems and how they have evolved; analyse the effectiveness of some systems; and identify emerging challenges for severity classification.
The Work Choices package of legislative reforms has significantly altered both the institutions and the instruments of the federal regulatory architecture for setting minimum working conditions. This paper surveys the reduced role of awards and of the Australian Industrial Relations Commission, before considering the function and content of the Australian Fair Pay and Conditions Standard and Australian Pay and Classification Scales, as well as the role of the newly created Australian Fair Pay Commission. It argues that the Work Choices reforms have shifted power over the setting of minimum working conditions to the government, which will set many conditions directly, and to employers, who will be entitled to require employees to be party to workplace agreements that displace very many of the minimum working conditions that are otherwise purportedly guaranteed. These shifts have opened up the space for significant reductions in minimum working conditions, as well as for falls in real wages for those not able to benefit from wage bargaining.
Edited by
Philip Czech, Universität Salzburg,Lisa Heschl, Karl-Franzens-Universität Graz, Austria,Karin Lukas, Ludwig Boltzmann Institut für Menschenrechte, Austria,Manfred Nowak, Global Campus of Human Rights, Venice and Universität für angewandte Kunst Wien,Gerd Oberleitner, Karl-Franzens-Universität Graz, Austria
Some advocates of free speech are currently arguing that universities and other organisations are far too prompt to accept curbs on expression or expressive acts in relation to issues such as transgender rights, racism, feminism and religious extremism. Such curbs tend to be aimed at offence-avoidance: as a result, such advocates argue that debate on these and cognate issues is, in some instances, being silenced. But other commentators oppose this view, arguing that merely allowing the airing of all sorts of views offensive to some facilitates intolerance and opposes equal dignity. Against the background of such ongoing debates on the concept of the so-called ‘cancel culture’ affecting some institutions, especially universities, this piece will interrogate various restrictions on expression that some view as linked to that concept. This contribution will then place such restrictions within the European Convention on Human Rights (ECHR) framework by considering the balance to be struck between freedom of expression as protected under Article 10 ECHR, on the one hand, and the interest of minority and/or marginalised groups not to be confronted with opinions or viewpoint-based behaviour that may denigrate them, on the other. The contribution seeks to come to some conclusions on ways to achieve this balance, taking account of the standards set by relevant ECHR jurisprudence. It will ask, fundamentally, whether or how far the concept of curbing lawful but arguably harmful expression is compatible with those standards.
INTRODUCTION
This contribution sets out to scrutinise closely conflicting narratives about so-called ‘cancel culture’ in the UK in educational and employment settings, especially in the campus context. The contested idea that a person can be ‘cancelled’ – their views excluded or expunged from public platforms, or from an employment context – has polarised debate. Certain advocates of free speech are currently arguing that educational organisations, in particular universities, and some employers, have allowed so-called ‘cancel culture’ to stifle free expression. It has been argued that some institutions are far too prompt to accept curbs on expression or expressive acts in relation to issues such as transgender rights, racism, feminism and religious extremism.
Recent scholarship on North African cities has done much to dispel earlier assumptions about late antique collapse and demonstrate significant continuity into the Byzantine and medieval periods. Yet urban changes did not affect North Africa evenly. Far less is known about the differing regional trajectories that shaped urban transformation and the extent to which pre-Roman and Roman micro-regions continued to share meaningful characteristics in subsequent periods. This article provides a preliminary exploration of regional change from the fourth to the eleventh century focused on a zone in the Central Medjerda Valley (Tunisia) containing the well-known sites of Bulla Regia and Chimtou. We place these towns in their wider historical and geographical setting and interrogate urban change by looking at investment in public buildings and spaces, religious buildings and housing, and ceramic networks. The process of comparison identifies new commonalities (and differences) between the sites of this stretch of the Medjerda River and provides a framework for understanding the many transformations of North African cities over the long late antiquity.
Twin, triplet and higher-order multiple pregnancies experience an increased risk of preterm birth, stillbirth and neonatal death compared to singleton pregnancies. The Twins Trust’s Maternity Engagement programme has found that implementation of National Institute for Health and Care Excellence (NICE) guideline and quality standard lowered these rates. However, a survey of care conducted in 2019 showed that the eight quality standards are followed inconsistently across the UK. Furthermore, parents report a severe lack of support from healthcare services in the postnatal period. Multiple pregnancy charities provide services and resources to professionals working in antenatal and neonatal care to improve their practice and adherence to health care guidance. Charities also provide a wealth of resources to parents in order to guide them through the unique situation of becoming a parent to twins, triplets or more, from pregnancy, throughout the early years, school years and adolescence, into adulthood.
Traditional Western science has had little interest in the concept of mind, and has only recently begun to recognise the relationship between spirituality and health. A better understanding of mind has allowed us to establish the scientific concepts behind the spiritual dimension of healing, and the close correlation between religious and spiritual practice and positive changes in a number of stress-related physiological systems. Meditation and prayer have both been shown to improve brain function, and together with practices such as forgiveness and positive thinking, and a supportive social structure, have been shown to benefit both mental and physical health. Meditation has particular clinical applications in those conditions where high arousal and anxiety are a part of the pathology. Controlled studies of prayer have produced mixed outcomes, but prayer is a widespread religious practice and may have positive effects on the person praying – for example, in terms of pain relief.
This chapter provides a summary of human ovarian physiology. The reader is introduced to basic concepts of sex determination, in particular how primordial germ cells and somatic cells differentiate and multiply to establish the reserve of primordial follicles. Key molecular and cellular events associated with primordial and preantral stages of follicle development are described. The chapter then provides an overview of antral follicle development, which is subdivided to consider the morphological changes and the role of granulosa and theca cells in steroidogenesis, along with development of the oocyte. The changes that occur as the follicle matures towards ovulation are also considered, in particular the fundamental role of hormones, cumulus expansion and resumption of meiosis. Finally, establishment and maintenance of the corpus luteum is briefly discussed. Diagrams of steroidogenesis and an overview of follicle formation and development are provided to supplement the text.