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Limited evidence on relative effectiveness is common in Health Technology Assessment (HTA), often due to sparse evidence on the population of interest or study-design constraints. When evidence directly relating to the policy decision is limited, the evidence base could be extended to incorporate indirectly related evidence. For instance, a sparse evidence base in children could borrow strength from evidence in adults to improve estimation and reduce uncertainty. In HTA, indirect evidence has typically been either disregarded (‘splitting’; no information-sharing) or included without considering any differences (‘lumping’; full information-sharing). However, sophisticated methods that impose moderate degrees of information-sharing have been proposed. We describe and implement multiple information-sharing methods in a case-study evaluating the effectiveness, cost-effectiveness and value of further research of intravenous immunoglobulin for severe sepsis and septic shock. We also provide metrics to determine the degree of information-sharing. Results indicate that method choice can have significant impact. Across information-sharing models, odds ratio estimates ranged between 0.55 and 0.90 and incremental cost-effectiveness ratios between £16,000–52,000 per quality-adjusted life year gained. The need for a future trial also differed by information-sharing model. Heterogeneity in the indirect evidence should also be carefully considered, as it may significantly impact estimates. We conclude that when indirect evidence is relevant to an assessment of effectiveness, the full range of information-sharing methods should be considered. The final selection should be based on a deliberative process that considers not only the plausibility of the methods’ assumptions but also the imposed degree of information-sharing.
Deployment of law enforcement operational canines (OpK9s) risks injuries to the animals. This study’s aim was to assess the current status of states’ OpK9 (veterinary Emergency Medical Services [VEMS]) laws and care protocols within the United States.
Methods:
Cross-sectional standardized review of state laws/regulations and OpK9 VEMS treatment protocols was undertaken. For each state and for the District of Columbia (DC), the presence of OpK9 legislation and/or care protocols was ascertained. Information was obtained through governmental records and from stakeholders (eg, state EMS medical directors and state veterinary boards).
The main endpoints were proportions of states with OpK9 laws and/or treatment protocols. Proportions are reported with 95% confidence intervals (CIs). Fisher’s exact test (P <.05) assessed whether presence of an OpK9 law in a given jurisdiction was associated with presence of an OpK9 care protocol, and whether there was geographic variation (based on United States Census Bureau regions) in presence of OpK9 laws or protocols.
Results:
Of 51 jurisdictions, 20 (39.2%) had OpK9 legislation and 23 (45.1%) had state-wide protocols for EMS treatment of OpK9s. There was no association (P = .991) between presence of legislation and presence of protocols. There was no association (P = .144) between presence of legislation and region: Northeast 66.7% (95% CI, 29.9-92.5%), Midwest 50.0% (95% CI, 21.1-78.9%), South 29.4% (95% CI, 10.3-56.0%), and West 23.1% (95% CI, 5.0-53.8%). There was significant (P = .001) regional variation in presence of state-wide OpK9 treatment protocols: Northeast 100.0% (95% CI, 66.4-100.0%), Midwest 16.7% (95% CI, 2.1-48.4%), South 47.1% (95% CI, 23.0-72.2%), and West 30.8% (95% CI, 9.1-61.4%).
Conclusion:
There is substantial disparity with regard to presence of OpK9 legal and/or clinical guidance. National collaborative guidelines development is advisable to optimize and standardize care of OpK9s. Additional attention should be paid to educational and training programs to best utilize the limited available training budgets.
The next generation of high-power lasers enables repetition of experiments at orders of magnitude higher frequency than what was possible using the prior generation. Facilities requiring human intervention between laser repetitions need to adapt in order to keep pace with the new laser technology. A distributed networked control system can enable laboratory-wide automation and feedback control loops. These higher-repetition-rate experiments will create enormous quantities of data. A consistent approach to managing data can increase data accessibility, reduce repetitive data-software development and mitigate poorly organized metadata. An opportunity arises to share knowledge of improvements to control and data infrastructure currently being undertaken. We compare platforms and approaches to state-of-the-art control systems and data management at high-power laser facilities, and we illustrate these topics with case studies from our community.
Localized contamination from research-related activities and its effects on macrofauna communities in the marine environment were investigated at Palmer Station, a medium-sized Antarctic research station. Relatively low concentrations of polycyclic aromatic hydrocarbons (PAHs; 32–302 ng g-1) and total petroleum hydrocarbons (TPHs; 0.9–8.9 μg g-1) were detected in sediments adjacent to the sewage outfall and pier, where most human activities were expected to have occurred, and at even lower concentrations at two seemingly reference areas (PAHs 6–30 ng g-1, TPHs 0.03–5.1 μg g-1). Elevated concentrations of PAHs in one sample taken in one reference area (816 ng g-1) and polychlorinated biphenyls (353 ng g-1) and dichloro-diphenyl-trichloroethane (3.2 and 25.3 ng g-1) in two samples taken adjacent to the sewage outfall indicate spatial heterogeneity of localized sediment contamination. Limpet (Nacella concinna) tissues collected adjacent to Palmer Station had high concentrations of PAHs, copper, lead, zinc and several other metals relative to outlying islands. Sediment and limpet tissue contaminant concentrations have decreased since the early 1990s following the Bahía Paraíso spill. Natural sediment characteristics affected macrofaunal community composition more than contamination adjacent to Palmer Station, presumably because of the low overall contamination levels.
Two introduced carnivores, the European red fox Vulpes vulpes and domestic cat Felis catus, have had extensive impacts on Australian biodiversity. In this study, we collate information on consumption of Australian birds by the fox, paralleling a recent study reporting on birds consumed by cats. We found records of consumption by foxes on 128 native bird species (18% of the non-vagrant bird fauna and 25% of those species within the fox’s range), a smaller tally than for cats (343 species, including 297 within the fox’s Australian range, a subset of that of the cat). Most (81%) bird species eaten by foxes are also eaten by cats, suggesting that predation impacts are compounded. As with consumption by cats, birds that nest or forage on the ground are most likely to be consumed by foxes. However, there is also some partitioning, with records of consumption by foxes but not cats for 25 bird species, indicating that impacts of the two predators may also be complementary. Bird species ≥3.4 kg were more likely to be eaten by foxes, and those <3.4 kg by cats. Our compilation provides an inventory and describes characteristics of Australian bird species known to be consumed by foxes, but we acknowledge that records of predation do not imply population-level impacts. Nonetheless, there is sufficient information from other studies to demonstrate that fox predation has significant impacts on the population viability of some Australian birds, especially larger birds, and those that nest or forage on the ground.
of this study was to examine the Twitter experiences and networks of six adults with cognitive-communication disability after a traumatic brain injury (TBI).
Method:
Using mixed methods, the study integrated: (a) quantitative analysis of Twitter networks using computational and manual coding of tweets; and (b) narrative analysis of in-depth interviews.
Results:
Diverse experiences were evident, with two experienced and four novice users of the platform. However, all reported feeling connected and included, and identified both positive and negative experiences in their use of Twitter. Developing a supportive network facilitated higher frequency of tweets and increased feelings of enjoyment and connectedness. All expressed a desire to continue using or learning to use Twitter but novices lacked support from rehabilitation professionals or experienced Twitter users, and relied instead on a “trial and error” approach.
Conclusion:
Proactive integration of Twitter use during rehabilitation after TBI is warranted to support safe, enjoyable, and meaningful use.
This article presents and analyzes the most comprehensive database to date of significant acts of Congress—from 1789 to 2010—to test whether divided party control of government affects the number of important acts Congress passes. We find that unified control corresponds with one additional significant act passed per Congress in the nineteenth century and four additional such acts in the twentieth century. However, party control of government cannot explain the broad historical trends in the rate at which Congress passes significant legislation. Nixon in 1969 was far more successful with a Democratic Congress than was McKinley in 1897 with a Republican one.
A single bed at the base of the Jordan Sandstone in a road cut at Arcadia, Wisconsin, yielded an undescribed Late Sunwaptan (Saukia Zone) trilobite fauna that includes at least four species from the families Dikelocephalidae Miller, 1889 and Eurekiidae Hupé, 1953. Arcadiaspis bispinata n. gen. and sp. is a distinctive eurekiid that is characterized by paired occipital and thoracic axial spines, long genal spines, and a nonspinose pygidial margin. Other genera present are the dikelocephalids, Dikelocephalus Owen, 1852 and Calvinella Walcott, 1914, and the eurekiid, Eurekia Walcott, 1916. Type material of Calvinella spiniger (Hall, 1863) is illustrated photographically for the first time. A new eurekiid species, Corbinia burkhalteri from the Fort Sill Formation, Oklahoma, is also described.
In 2005, we (Westrop and Palmer, in Westrop et al.) proposed the name Arcadiaspis for a new genus of eurekiid trilobite from the Jordan Sandstone of Wisconsin. We thank Jonathan Adrain, John Page, and John Paterson, all of whom pointed out that this name is preoccupied by Arcadiaspis Bognibova (in Chernysheva, 1971), a trilobite genus from the Middle Cambrian of Russia. We propose the name Wisarcadiaspis which refers to the collecting locality at Arcadia, Wisconsin, as a replacement.
We present first imaging results from the PALM-3000 adaptive optics system and PHARO camera on the Hale 5 m telescope. Observations using a vector vortex coronagraph have given us direct detections of the two-ring dusty debris system around the star HD 141569. Our observations reveal the inner clearing in the disk to unprecedentedly small angular separations, and are the most sensitive yet at the H and K bands. We are for the first time able to measure and compare the colors of the scattered light in the inner and outer dust rings, and find that the outer ring is significantly bluer than the inner ring.
Ethical issues facing anesthesiologists are more far-reaching than those involving virtually any other medical specialty. In this clinical ethics textbook, authors from across the USA, Canada and Europe draw on ethical principles and practical knowledge to provide a realistic understanding of ethical anesthetic practice. The result is a compilation of expert opinion and international perspectives from clinical leaders in anesthesiology. Building on real-life, case-based problems, each chapter is clinically focused and addresses both practical and theoretical issues. Topics include general operating room care, pediatric and obstetrical patient care, the intensive care unit, pain practice, research and publication, as well as discussions of lethal injection, disclosure of errors, expert witness testimony, triage in disaster and conflicts of interest with industry. An important reference tool for any anesthesiologist, whether clinical or research-oriented, this book is especially valuable for physicians involved in teaching residents and students about the ethical aspects of anesthesia practice.
Twins achieved through in-vitro fertilisation often undergo a viability ultrasound at 6–9 weeks of gestation. The presence of inter-twin crown-rump length discordance at this stage is not an uncommon finding; however the clinical significance of this is unknown. We analyzed 218 dichorionic twin pregnancies, producing two live fetuses > 24 weeks gestation, to determine whether inter-twin discordance (≥ 85th centile) in the mid-first trimester was associated with birthweight discordance (> 20%), or small for gestational age (< 10th centile). The incidence of birthweight discordance and small for gestational age infants were determined, with no increased risk found for the discordant population. This may provide some reassurance to treating clinicians.
Longer-term follow-up of patients with borderline personality disorder have found favourable clinical outcomes, with long-term reduction in symptoms and diagnosis.
Aims
We examined the 6-year outcome of patients with borderline personality disorder who were randomised to 1 year of cognitive–behavioural therapy for personality disorders (CBT–PD) or treatment as usual (TAU) in the BOSCOT trial, in three centres across the UK (trial registration: ISRCTN86177428).
Method
In total, 106 participants met criteria for borderline personality disorder in the original trial. Patients were interviewed at follow-up by research assistants masked to the patient's original treatment group, CBT–PD or TAU, using the same measures as in the original randomised trial. Statistical analyses of data for the group as a whole are based on generalised linear models with repeated measures analysis of variance type models to examine group differences.
Results
Follow-up data were obtained for 82% of patients at 6 years. Over half the patients meeting criteria for borderline personality disorder at entry into the study no longer did so 6 years later. The gains of CBT–PD over TAU in reduction of suicidal behaviour seen after 1-year follow-up were maintained. Length of hospitalisation and cost of services were lower in the CBT–PD group compared with the TAU group.
Conclusions
Although the use of CBT–PD did not demonstrate a statistically significant cost-effective advantage, the findings indicate the potential for continued long-term cost-offsets that accrue following the initial provision of 1 year of CBT–PD. However, the quality of life and affective disturbance remained poor.