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In maintaining the distinction between capital and income first instituted by legislation nearly two centuries ago, the courts have occasionally faced intractable problems where pragmatism has necessarily triumphed over analysis. Sir Owen Dixon's famous Sun Newspapers test for distinguishing between revenue and capital outgoings is one example, where in reality a number of unweighted considerations were suggested, with but vague illustrations for their application. The proper manner of apportioning outgoings, and the role of purpose and intention, are others. Yet a fourth, and the subject of this paper is the characterisation of receipts derived from the sale or loss of intangible rights.
Reconstructing the value puzzle in health technology assessment (HTA) of new technologies is an ongoing discussion among different stakeholders. Little progress has been made toward consistently and transparently incorporating additional value elements, such as health equity, or moving the focus beyond the traditional value elements of clinical benefit and economic cost associated with the introduction of new technologies.
Methods
The objective was to conduct a series of pragmatic reviews of recent HTA guidance documents, international organizations, and previous systematic reviews to answer the following research questions.
• Would increased familiarity with real-world evidence, advanced analytics, and expanded forms of economic modeling create the forum for HTA bodies to reconsider their processes and include health equity when assessing new products?
• Which methods innovations would facilitate changes in HTA methods and processes to consistently and transparently assess health equity value elements?
Results were documented and qualitatively synthesized by outlining missed opportunities and highlighting potential barriers to integrating equity-informed HTA processes.
Results
Our findings were grouped into three main parts: HTA guidance summaries, trends summarized by key organizations (HTAi, ISPOR, and others), and peer reviewed publications. HTA bodies have increasingly emphasized health equity concerns and the importance of standardizing methods to support health equity considerations but have not recommended explicit quantitative methods. Our database search found previous systematic literature reviews explicitly referring to methods of integrating real-world evidence into comparative effectiveness assessments, whereas modeling techniques such as distributional, augmented, or cost-effectiveness analyses, and multicriteria decision-making can integrate health equity effects for both patients and healthcare systems.
Conclusions
Our research showcases the gap between recognizing health equity as a missing element in HTA and incorporating methods to implement such considerations into real-life decision-making. Greater familiarity with health equity methods may move the discussion from “whether” to “how” additional value elements such as health equity can inform decision-making.
Epilepsy remains the most common neurologic disorder in childhood and adolescence, with certain epilepsy syndromes such as childhood absence epilepsy (CAE) and juvenile myoclonic epilepsy (JME) being more common in girls. Psychiatric disorders are a common comorbidity in children with epilepsy, especially two behavioral conditions: attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder. In addition, psychosocial issues of stigma, bullying and violence remain potent disruptors of patients’ development at this stage in their lives. Emerging information on how cultural, ethnical and gender diversity may affect care should also be taken into consideration and proactively addressed. As the care of children and adolescents with epilepsy has grown more complex over the past decades, the transition from pediatric to adult care systems needs to become purposeful, such as the medical, psychosocial, educational and vocational needs of young adults with long-term medical conditions are actively
Modern financial crises are difficult to explain because they do not always involve bank runs, or the bank runs occur late. For this reason, the first year of the Great Depression, 1930, has remained a puzzle. Industrial production dropped by 20.8 percent despite no nationwide bank run. Using cross-sectional variation in external finance dependence, we demonstrate that banks’ decision to not use the discount window and instead cut back lending and invest in safe assets can account for the majority of this decline. In effect, the banks ran on themselves before the crisis became evident.
There are numerous challenges pertaining to epilepsy care across Ontario, including Epilepsy Monitoring Unit (EMU) bed pressures, surgical access and community supports. We sampled the current clinical, community and operational state of Ontario epilepsy centres and community epilepsy agencies post COVID-19 pandemic. A 44-item survey was distributed to all 11 district and regional adult and paediatric Ontario epilepsy centres. Qualitative responses were collected from community epilepsy agencies. Results revealed ongoing gaps in epilepsy care across Ontario, with EMU bed pressures and labour shortages being limiting factors. A clinical network advising the Ontario Ministry of Health will improve access to epilepsy care.
The Cædmon Manuscript is one of three extant anthologies of English Christian poetry produced in England before 1000 CE. It is a collection of four religious poems in Old English based on Biblical materials. They have the editorial names Genesis, Exodus, Daniel and Christ and Satan. This edition consists of an Introduction, Bibliography, Codicological and Paleographical Analysis, an Art-Historical Commentary and an edition of the four poems.
Egeria, a late fourth century Christian pilgrim to Jerusalem, describes a dramatic ritual on the morning of Good Friday. This text is remarkable on several counts: it is written by a female, it has an early date (soon after Constantine’s initiatives in establishing Christian pilgrimage) and it provides a wonderfully detailed description of the areas visited in Jerusalem during Holy Week. She and the other pilgrims venerate the wood of the cross, the inscription over Jesus’s head, the horn used to anoint the kings of Israel, and the ring of Solomon. Throughout her account, Egeria stresses the importance of pilgrims being assured of the truth of their faith by encountering physical landscapes and tangible objects. Theatrical studies in dramaturgy and stagecraft affirm the role which props play in helping actors activate memory and achieve a rich performance. This chapter examines the network of symbols in these artifacts using ritual studies, theatre analysis and space and place theory, demonstrating how these objects were used as props in a complex ritual drama, which offered material, sensory and embodied experiences for religious pilgrims.
Robyn Muir provides an examination of the worldwide Disney Princess commercial and cultural phenomenon in its key representations: films, merchandising and marketing, and park experiences. The book provides a lens through which to view and understand how this franchise has contributed to the depiction of femininity within popular culture.
Given that at least 75% of traumatic brain injuries in the U.S. are mild, concussions are a serious public health concern that cause significant neurological damage and negatively impact individuals’ quality of life. Due to the rotational forces that occur during a concussion, immediate damage to the corpus callosum is common, resulting in neurological and behavioral deficits. However, the longitudinal damage to the integrity of the corpus callosum is unclear and may differ across sections of the corpus callosum. Our primary aim was to compare the white matter integrity across eight corpus callosum tracts in concussed individuals to healthy controls 3-4 weeks after injury and at a 10-month follow-up.
Participants and Methods:
Seventeen concussed participants completed a diffusion tensor imaging (DTI) scan 3-4 weeks after receiving a concussion and again 10 months after injury. Nineteen control participants completed a single DTI scan. DTI data were analyzed using the automated fiber quantification (AFQ) pipeline, which extracts fractional anisotropy (FA) values from 100 nodes in eight tracts of the corpus callosum (listed anterior to posterior): orbital frontal, anterior frontal, superior frontal, motor, superior parietal, posterior parietal, occipital, and temporal. Given the non-linearity, high multicollinearity, and large number of data points, a cubic smoothing spline was used to fit a penalized regression to the FA values in each tract, allowing us to compare the FA values of each node in each tract between groups and across time. To assess acute damage, a spline model for the concussed participants at 3-4 weeks was compared to a spline model for the control participants in each tract. To assess longitudinal damage, a spline model of the FA difference value (10-month minus acute visit) in concussed participants was compared to a spline model of the FA difference value for controls (zero, representative of a theoretical no change in FA values). Significant nodes were defined as p-values less than 0.006 (alpha of .05/8, given 8 tracts).
Results:
Acutely following injury, concussed participants showed lower FA values than controls in the anterior frontal, posterior parietal, occipital, and temporal tracts. In the orbital frontal tract, concussed participants had higher FA values on the left, but decreased FA values compared to controls in the middle. Longitudinally, concussed participants showed continued decreased white matter integrity in the orbital frontal, superior parietal, and occipital tracts, but improved white matter integrity in the anterior frontal and superior frontal tracts. The motor, posterior parietal, and temporal tracts showed mixed longitudinal results of decreased or improved white matter integrity within each tract.
Conclusions:
Concussed individuals show decreased white matter integrity across the corpus callosum acutely after injury. Longitudinally, the most anterior and posterior portions of the corpus callosum (i.e., genu and splenium) show continued damaged while the more medial sections of the corpus callosum may show some recovery. Results suggest the corpus callosum displays differential patterns of damage acutely and longitudinally following concussion, with some tracts improving while others continue to deteriorate.
1 The Work, its Date, Provenance and Subsequent History
The manuscript presented here is Oxford, Bodleian Library, MS Junius 11. From the beginning it was intended that Junius 11 be an extensively, if not lavishly, illustrated book of Christian poetry; it was perhaps commissioned by a wealthy secular or ecclesiastical patron. It was to be comprised of three poems on the subjects of Creation and the Genesis story down to Abraham and Isaac, the Crossing of the Red Sea recorded in Exodus, and the prophet Daniel; soon after the copying of these poems was completed, however, the final gathering of the manuscript was enlarged and a fourth poem in three sections, dealing with the Fall of the Rebel Angels, the Harrowing of Hell, and the Temptation of Christ was added (whether these were originally three separate poems is discussed later). As was the practice in Anglo- Saxon England, none of the poems was given a title when recorded in the manuscript; they are known today by the names assigned to them by modern editors – Genesis (comprised of two poems designated A and B), Exodus, Daniel and Christ and Satan. The entire manuscript was to be illustrated, but sadly the project was never completed; thus there are blank spaces throughout it where the intended illustrations are lacking (after the final original illustration on p. 88). Two artists were responsible for the Anglo-Saxon illustrations; a third artist of lesser ability added a small number of extra drawings in the twelfth century. One of these, on p. 96, attempts to illustrate an episode in the poem (depicting ‘Abraham and the Messenger', it seems), which indicates that the poems were still being read in the late twelfth century. When other manuscripts in the vernacular (i.e. Old English) were no longer being read and were suffering neglect and falling into disrepair, and even being stripped of their bindings so that they could be reused on newly-recorded texts, MS Junius 11 was rebound, indicating that it was still valued; this enduring interest in the manuscript was probably because it was illustrated – a number of its drawings had already been excised by the thirteenth century.
This edition of Oxford, Bodleian Library, MS Junius 11 supersedes all previous editions, including the present editor's own digital edition of 2004 published as Bodleian Digital Texts 1, in that it is a completely new analysis of the manuscript based on a thorough paleographical and codicological re-examination. Readers today have online access to the complete set of high resolution scans made for the 2004 edition so there is no need to reproduce details of the manuscript itself, including its much admired and commented upon decorated and zoomorphic initials.
The analysis of the manuscript presented here may include a plethora of information not required by individual readers, but it aims to meet the needs of a variety of users for many years to come. For example, the edition reproduces every accent mark in the manuscript because scholars today are still uncertain of their use and relevance, but tomorrow someone may deduce why the scribes and correctors went to the trouble of including them on every page of the manuscript.
So too, a translation of the texts is not included here because Anlezark 2002 presents a new translation of Genesis A and B, Exodus and Daniel. Christ and Satan is available elsewhere (e.g. Gordon rev. 1954) and since it is not an Old Testament retelling and versification in Old English it is not considered by Anlezark. Other recent translations are included in the online 'Old English Poetry Project’ (q.v.).
The maxim ‘Pride goes before a fall’ would be an appropriate subtitle for this anthology of Christian poetry since this is the overriding theme of all four poems, which are about falls resulting from disobedience due to excessive pride and a lack of humility.
Christ and Satan presents a special case since it has been corrected by a later hand, perhaps the scribe of earlier poems in the anthology. Either this corrector or a later reader also added (mostly squeezed in) a plethora of punctuation marks, and those resembling an inverted semicolon (./ – the punctus elevatus) can easily be confused for an accent mark by readers not used to this.