Bataille and the poverty of academic form

This paper argues that the dominant modes of academic address, the conference paper, the journal article, and the monograph, reinforce problematic and exclusionary assumptions concerning what counts as legitimate research, whilst also restricting academic enquiry and impoverishing intellectual life. It makes its case by exploring in some detail the intellectual commitments of one the West’s more wayward 20th century thinkers, Georges Bataille. It suggests that Bataille presents not simply a conceptual armoury (and one among many) for critiquing Western logocentrism from within, but offers an example of what a less domesticated, less stylistically narrowed mode of thinking might look like

Community-based complex interventions to sustain independence in older people, stratified by frailty: a systematic review and network meta-analysis

Background Sustaining independence is important for older people, but there is insufficient guidance about which community health and care services to implement. Objectives To synthesise evidence of the effectiveness of community services to sustain independence for older people grouped according to their intervention components, and to examine if frailty moderates the effect. Review design Systematic review and network meta-analysis. Eligibility criteria Studies: Randomised controlled trials or cluster-randomised controlled trials. Participants: Older people (mean age 65+) living at home. Interventions: community-based complex interventions for sustaining independence. Comparators: usual care, placebo or another complex intervention. Main outcomes Living at home, instrumental activities of daily living, personal activities of daily living, care-home placement and service/economic outcomes at 1 year. Data sources We searched MEDLINE (1946–), Embase (1947–), CINAHL (1972–), PsycINFO (1806–), CENTRAL and trial registries from inception to August 2021, without restrictions, and scanned reference lists. Review methods Interventions were coded, summarised and grouped. Study populations were classified by frailty. A random-effects network meta-analysis was used. We assessed trial-result risk of bias (Cochrane RoB 2), network meta-analysis inconsistency and certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation for network meta-analysis). Results We included 129 studies (74,946 participants). Nineteen intervention components, including ‘multifactorial-action’ (multidomain assessment and management/individualised care planning), were identified in 63 combinations. The following results were of low certainty unless otherwise stated. For living at home, compared to no intervention/placebo, evidence favoured: multifactorial-action and review with medication-review (odds ratio 1.22, 95% confidence interval 0.93 to 1.59; moderate certainty) multifactorial-action with medication-review (odds ratio 2.55, 95% confidence interval 0.61 to 10.60) cognitive training, medication-review, nutrition and exercise (odds ratio 1.93, 95% confidence interval 0.79 to 4.77) and activities of daily living training, nutrition and exercise (odds ratio 1.79, 95% confidence interval 0.67 to 4.76). Four intervention combinations may reduce living at home. For instrumental activities of daily living, evidence favoured multifactorial-action and review with medication-review (standardised mean difference 0.11, 95% confidence interval 0.00 to 0.21; moderate certainty). Two interventions may reduce instrumental activities of daily living. For personal activities of daily living, evidence favoured exercise, multifactorial-action and review with medication-review and self-management (standardised mean difference 0.16, 95% confidence interval −0.51 to 0.82). For homecare recipients, evidence favoured the addition of multifactorial-action and review with medication-review (standardised mean difference 0.60, 95% confidence interval 0.32 to 0.88). Care-home placement and service/economic findings were inconclusive. Limitations High risk of bias in most results and imprecise estimates meant that most evidence was low or very low certainty. Few studies contributed to each comparison, impeding evaluation of inconsistency and frailty. Studies were diverse; findings may not apply to all contexts. Conclusions Findings for the many intervention combinations evaluated were largely small and uncertain. However, the combinations most likely to sustain independence include multifactorial-action, medication-review and ongoing review of patients. Some combinations may reduce independence

The implications of competing risks and direct treatment disutility in cardiovascular disease and osteoporotic fracture: risk prediction and cost effectiveness analysis

Background Clinical guidelines commonly recommend preventative treatments for people above a risk threshold. Therefore, decision-makers must have faith in risk prediction tools and model-based cost-effectiveness analyses for people at different levels of risk. Two problems that arise are inadequate handling of competing risks of death and failing to account for direct treatment disutility (i.e. the hassle of taking treatments). We explored these issues using two case studies: primary prevention of cardiovascular disease using statins and osteoporotic fracture using bisphosphonates. Objectives Externally validate three risk prediction tools [QRISK®3, QRISK®-Lifetime, QFracture-2012 (ClinRisk Ltd, Leeds, UK)]; derive and internally validate new risk prediction tools for cardiovascular disease [competing mortality risk model with Charlson Comorbidity Index (CRISK-CCI)] and fracture (CFracture), accounting for competing-cause death; quantify direct treatment disutility for statins and bisphosphonates; and examine the effect of competing risks and direct treatment disutility on the cost-effectiveness of preventative treatments. Design, participants, main outcome measures, data sources Discrimination and calibration of risk prediction models (Clinical Practice Research Datalink participants: aged 25–84 years for cardiovascular disease and aged 30–99 years for fractures); direct treatment disutility was elicited in online stated-preference surveys (people with/people without experience of statins/bisphosphonates); costs and quality-adjusted life-years were determined from decision-analytic modelling (updated models used in National Institute for Health and Care Excellence decision-making). Results CRISK-CCI has excellent discrimination, similar to that of QRISK3 (Harrell’s c = 0.864 vs. 0.865, respectively, for women; and 0.819 vs. 0.834, respectively, for men). CRISK-CCI has systematically better calibration, although both models overpredict in high-risk subgroups. People recommended for treatment (10-year risk of ≥ 10%) are younger when using QRISK-Lifetime than when using QRISK3, and have fewer observed events in a 10-year follow-up (4.0% vs. 11.9%, respectively, for women; and 4.3% vs. 10.8%, respectively, for men). QFracture-2012 underpredicts fractures, owing to under-ascertainment of events in its derivation. However, there is major overprediction among people aged 85–99 years and/or with multiple long-term conditions. CFracture is better calibrated, although it also overpredicts among older people. In a time trade-off exercise (n = 879), statins exhibited direct treatment disutility of 0.034; for bisphosphonates, it was greater, at 0.067. Inconvenience also influenced preferences in best–worst scaling (n = 631). Updated cost-effectiveness analysis generates more quality-adjusted life-years among people with below-average cardiovascular risk and fewer among people with above-average risk. If people experience disutility when taking statins, the cardiovascular risk threshold at which benefits outweigh harms rises with age (≥ 8% 10-year risk at 40 years of age; ≥ 38% 10-year risk at 80 years of age). Assuming that everyone experiences population-average direct treatment disutility with oral bisphosphonates, treatment is net harmful at all levels of risk. Limitations Treating data as missing at random is a strong assumption in risk prediction model derivation. Disentangling the effect of statins from secular trends in cardiovascular disease in the previous two decades is challenging. Validating lifetime risk prediction is impossible without using very historical data. Respondents to our stated-preference survey may not be representative of the population. There is no consensus on which direct treatment disutilities should be used for cost-effectiveness analyses. Not all the inputs to the cost-effectiveness models could be updated. Conclusions Ignoring competing mortality in risk prediction overestimates the risk of cardiovascular events and fracture, especially among older people and those with multimorbidity. Adjustment for competing risk does not meaningfully alter cost-effectiveness of these preventative interventions, but direct treatment disutility is measurable and has the potential to alter the balance of benefits and harms. We argue that this is best addressed in individual-level shared decision-making. Study registration This study is registered as PROSPERO CRD42021249959. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/12/22) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 4. See the NIHR Funding and Awards website for further award information

Instability, crisis, and statecraft in Conservative Britain, 2010–24

This article examines how the Conservative Party dominated British politics from 2010 to 2024 despite this period being one of instability and crisis. It argues that a key source of this turmoil was the Conservative Party itself, which under a succession of Prime Ministers struggled to formulate an effective statecraft strategy. While these leadership failings have been well documented the underlying difficulties run deeper, reflecting tensions for the self-proclaimed natural party of government in adapting its statecraft to the rise of populist and anti-politics pressures. The article exposes these through the lens of statecraft theory, which is applied to the largely overlooked constitutional dimension of Conservative statecraft. This reveals a persistent willingness to prioritize partisan statecraft strategy over adherence to constitutional norms, which portends a slide into populism now the party has returned to opposition

Collecting Hair Samples in Online Panel Surveys: Participation Rates, Selective Participation, and Effects on Attrition

Combining survey data with biological information allows examining complex interrelationships between a person’s physiological status and behavioral or health-related outcomes. Given the increasing importance of online surveys and smartphone-based research, a crucial question is whether biomarker collection can be embedded in online surveys without any face-to-face interaction. The present study addresses this question and investigated participation rates and selective participation in a longitudinal hair collection study that was embedded within an app-based smartphone panel survey on the well-being of German jobseekers. The study further examined the association between participating in the first hair collection wave and panel attrition. The results indicate that the vast majority (81%) of individuals was willing to participate in the first hair collection wave with only a few selection effects. Only older age and higher levels of perceived stress were modestly associated with the stated willingness to participate in the first hair collection wave. The strongest selectivity was induced by the inevitable exclusion of individuals with short hair styles, which led to an underrepresentation of men. Furthermore, respondents’ purported willingness to participate in the first hair collection wave and their actual participation was largely disconnected. This lack of compliance decreased in subsequent collection waves. Notably, participating in the first hair collection wave was positively related to long-term panel participation. Overall, the study underlines the general feasibility of integrating biomarker collections into online surveys

Reaction propagation, leading to developing detonation, in a rapid compression machine

Optical imaging and pressure measurements are employed to indicate the nature of the varied changes occurring subsequent to compression in a Rapid Compression Machine, RCM, prior to their ultimate termination, usually in a detonation. A stoichiometric mixture of i-octane with variable inert diluents was investigated, enabling different compression temperatures to be attained and the varied nature of the subsequent changes to be studied. This was done with eleven i-octane/oxygen stoichiometric mixtures, all with different concentrations. The mixtures included some with an autoignitive Negative Temperature Coefficient, NTC. The mixtures were optically observed after compression to 2.0 MPa and pressures continually recorded until the completion of reaction. The compression temperature, Tc, was progressively increased by changing the compositions of the inert diluents. At the lowest compression temperature laminar flame propagation was observed, with some wrinkling of the flame. As the temperature increased, calculation and observation confirmed a transition to autoignitive propagation, with a progressively increasing propagation speed of the predominantly autoignitively propagating front. At Tc = 740K, in the NTC regime, the autoignitive speed reached a maximum value of about 323 m/s. The NTC had little direct influence upon the ultimate detonation. Further increases in mixture temperature generated increasingly strong acoustic waves. As the acoustic velocity was approached, whether these changes would culminate in a detonation was dependent upon whether the approaching excitation temperature for the necessary accompanying heat release would be sufficient. Ultimately, it depended on whether the value of ξ = a/u_a was low enough, and that of ε = (r_0 )/(aτ_e ) was high enough to reside within the Detonation Peninsula. Ultimately quite strong detonations were obtained, verging on super-knock. As the different changes developed, the pressure records showed fluctuations of increasing amplitude. The normalised pressure fluctuations, ΔP/P, were found to increase with a Detonation Parameter, β=(ε/ξ)

Validation of a new glucocorticoid-specific Patient-Reported Outcome Questionnaire (the Steroid PRO)

Objectives Glucocorticoids used in the treatment of inflammatory rheumatic conditions can impact on healthrelated quality of life. An underpinning qualitative study developed a long-list of candidate items for a treatmentspecific patient-reported outcome (PRO) measure. The objective of this paper is to determine scale structure and psychometric properties of the Steroid PRO. Methods A cross-sectional survey of adults from the UK, USA, Australia and New Zealand, taking glucocorticoids for a rheumatic disease. Initial survey collected demographics, clinical information, 40 Steroid PRO candidate items and EuroQol-5 Dimensions- 5 levels (EQ-5D-5L). Follow-up, 3–5 days later, collected Steroid PRO candidate items and a condition-change (’transition’) question. Analysis included Rasch measurement model, exploratory factor analysis (EFA), and hypothesis testing for discriminative validity, convergence validity and test–retest reliability. Results Total responses 946: UK n=743 (79%); USA n=139 (15%); Australia/New Zealand n=64 (7%); mean age 57.6 (SD=13.6); 833 (88%) women. Participants with inflammatory arthritis n=197 (21%), connective tissue disease and/or vasculitis n=402 (42%), giant cell arteritis and/or polymyalgia rheumatica n=347 (37%). Twenty-five items were removed due to lack of fit to Rasch model. Of the remaining items, EFA suggested four subscales: Social impact (4 items); Impact on appearance (3 items); Psychological impact (5 items); Treatment concerns (3 items). Rasch modelling supported a four-subscale structure and total score, confirming construct validity and reliability. Hypothesis testing confirmed discriminant and convergence validity. Intraclass correlation coefficient (total score) was 0.809 demonstrating excellent (test–retest) reliability. Conclusions The Steroid PRO is a 15-item, valid and reliable scale for measuring the impact of glucocorticoid therapy in people with rheumatic diseases

Quantifying large methane emissions from the Nord Stream pipeline gas leak of September 2022 using IASI satellite observations and inverse modelling

The sudden leaks from the Nord Stream gas pipelines, which began on 26 September 2022, released a substantial amount of methane (CH4) into the atmosphere. From the Infrared Atmospheric Sounding Interferometer (IASI) instrument onboard EUMETSAT's MetOp-B, we document the first satellite-based retrievals of column-average CH4 (XCH4) that clearly show the large CH4 plume emitted from the pipelines. The data display elevations greater than 200 ppb (parts per billion, ∼ 11 %) above observed background values (1882 ± 21 ppb). Based on the IASI data, together with an integrated mass enhancement technique and formal model-based inversions applied for the first time to thermal infrared satellite methane plume data, we quantify the total mass of CH4 emitted into the atmosphere during the first 2 d of the leaks to be 219–427 Gg CH4. Substantial temporal heterogeneity is displayed in our model-derived flux rate, with three or four distinct peaks in emission rate over the first 2 d. Our range overlaps with other previous estimates, which were 75–230 Gg CH4 and were mostly based on inversions that assimilated in situ observations from nearby tower sites. However, our derived values are generally larger than those previous results, with the differences likely due to the fact that our results are the first to use satellite-based observations of XCH4 from the days following the leaks. We incorporate multiple satellite overpasses that monitored the CH4 plume as it was transported across Scandinavia and the North Sea up to the evening of 28 September 2022. We produced model simulations of the atmospheric transport of the plume using the Eulerian atmospheric transport model, TOMCAT, which show good representation of the plume location in the days following the leaks. The performance of simulated CH4 mixing ratios at four nearby in situ measurement sites compared to the observed in situ values is mixed, which highlights the challenges inherent in representing short-term plume movement over a specific location using a model such as TOMCAT with a relatively coarse Eulerian grid. Our results confirm the leak of the Nord Stream pipes to clearly be the largest individual fossil-fuel-related leak of CH4 on record, greatly surpassing the previous largest leak (95 Gg CH4) at the Aliso Canyon gas facility in California in 2015–2016