The global stock of research evidence relevant to health systems policymaking

Background: Policymakers and stakeholders need immediate access to many types of research evidence to make informed decisions about the full range of questions that may arise regarding health systems. Methods: We examined all types of research evidence about governance, financial and delivery arrangements, and implementation strategies within health systems contained in Health Systems Evidence (HSE) (http://www.healthsystemsevidence.org). The research evidence types include evidence briefs for policy, overviews of systematic reviews, systematic reviews of effects, systematic reviews addressing other questions, systematic reviews in progress, systematic reviews being planned, economic evaluations, and health reform and health system descriptions. Specifically, we describe their distribution across health system topics and domains, trends in their production over time, availability of supplemental content in various languages, and the extent to which they focus on low- and middle-income countries (LMICs), as well as (for systematic reviews) their methodological quality and the availability of user-friendly summaries. Results: As of July 2013, HSE contained 2,629 systematic reviews of effects (of which 501 are Cochrane reviews), 614 systematic reviews addressing other questions, 283 systematic reviews in progress, 186 systematic reviews being planned, 140 review-derived products (evidence briefs and overviews of systematic reviews), 1,669 economic evaluations, 1,092 health reform descriptions, and 209 health system descriptions. Most systematic reviews address topics related to delivery arrangements (n = 2,663) or implementation strategies (n = 1,653) with far fewer addressing financial (n = 241) or governance arrangements (n = 231). In addition, 2,928 systematic reviews have been quality appraised with moderate AMSTAR ratings found for reviews addressing governance (5.6/11), financial (5.9/11), and delivery (6.3/11) arrangements and implementation strategies (6.5/11); 1,075 systematic reviews have no independently produced user-friendly summary and only 737 systematic reviews have an LMIC focus. Literature searches for half of the systematic reviews (n = 1,584, 49%) were conducted within the last five years. Conclusions: Greater effort needs to focus on assessing whether the current distribution of systematic reviews corresponds to policymakers’ and stakeholders’ priorities, updating systematic reviews, increasing the quality of systematic reviews, and focusing on LMICs

The effect of cyclic-loading generated intergranular strains on the creep deformation of a polycrystalline material

Intergranular strains are generated due to the incompatible deformations at grain length-scales during plastic loading in a polycrystalline material. Estimating the effects of intergranular strains on the creep life of the material is of interest for accurate life prediction of high-temperature structural systems. In this study, the effect of the cyclic loading generated intergranular strains on the creep deformation behaviour of Type 316H austenitic stainless steel was studied using in-situ neutron diffraction. The load-controlled creep dwells introduced at various positions during tension-compression cyclic loading with different intergranular strain state but under the same applied stress showed markedly different behaviours. It is inferred that the intergranular strains are a significant contributor to the observed differences in creep deformation behaviour. Comparing the evolution of intergranular strains in various grain families during plastic and creep deformation, it was found that the grain families which deformed relatively more or less during plastic deformation behaved similarly during creep deformation. The present work shows that intergranular strains, which contribute to accelerating/decelerating creep deformation rates, need to be accounted for in current creep life assessment procedures, to obtain a more realistic creep deformation prediction under cyclic loading conditions

Gastric-type adenocarcinoma of the cervix in a patient with Lynch syndrome: A case report

• Lynch syndrome (LS) is an uncommon, genetic disorder which predisposes affected individuals to colorectal, endometrial and ovarian malignancies. • We report a case of cervical gastric-type adenocarcinoma in a patient with LS. • Immunohistochemistry for mismatch repair proteins is a useful screening tool in tumours suspected to be associated with LS

Origin of the Bauschinger effect in a polycrystalline material

There is a long and lively debate in the literature about the origin of the Bauschinger effect in polycrystalline materials, the most widely accepted explanation being the easier movement of dislocations during reverse loading causing the reduction of the yield stress. Other explanations include incompatible deformation at the grain scale and change of dislocation cell structures during forward and reverse loading, but recent publications show these phenomenological explanations of the Bauschinger effect are not holistic. In the experimental work presented here, we have investigated the role of micro residual lattice strain on the origin of the Bauschinger effect in type 316H austenitic stainless steel using in-situ neutron diffraction. Standard cylindrical specimens were tension-compression load cycled at room temperature with the loading interrupted at incrementally larger compressive and tensile strains followed by reloading to the tensile loop peak strain. Mirror symmetric compression-tension cyclic tests were also performed with tensile and compressive load interruptions followed by compressive reloading to the compressive loop peak strain. A strong correlation is demonstrated between the evolution of residual lattice strain in the grain families and the change in magnitude in macroscopic yield stress, peak stress and the shape of the yielding part of the stress-strain curve for both the cyclic tension yield and compression yield tests. This implies that the residual lattice strain generated by grain scale elastic and plastic deformation anisotropy is the primary source of the Bauschinger kinematic hardening effect observed in type 316H austenitic stainless steel

Age-related cognitive decline and the olfactory identification deficit are associated to increased level of depression

Purpose: Previous studies reported a correlation between olfactory function and depression. However, in literature, no data are available for the correlation between depression and all other factors such as age, sex, olfactory, gustatory, and cognitive function in healthy subjects taken together. The aim of this study was to provide a systematic account regarding the association between those variables in a nonclinical population. Methods: Two hundred and seventy-three participants were recruited with an age range of 19–84 years. Olfactory, gustatory, cognitive function, and depression level were evaluated by means of the following tests: the Sniffin’ Sticks test, Taste Strips test, Montreal Cognitive Assessment (MoCA), and Beck Depression Inventory (BDI). Results: In our data, an age-related decrease in olfactory and gustatory function and a decline in cognitive functions such as attention, memory, and language were observed. Instead, no significant differences were observed for the depression level in relation to the different age ranges. However, our results indicated that the depression level could be associated to sex, odor identification impairment, and decreased attention and language. Conclusion: Sex, the odor identification impairment, and an age-related decrease in attention and language are associated with increased level of depression in healthy subjects. Our data can be useful and informative for health care workers, that is, to have adequate preventive strategies to be used whenever these conditions are detected and recognized

Towards a better understanding of the nomenclature used in information-packaging efforts to support evidence-informed policymaking in low- and middle-income countries

Background: The growing recognition of the importance of concisely communicating research evidence and other policy-relevant information to policymakers has underpinned the development of several information-packaging efforts over the past decade. This has led to a wide variability in the types of documents produced, which is at best confusing and at worst discouraging for those they intend to reach. This paper has two main objectives: to develop a better understanding of the range of documents and document names used by the organizations preparing them; and to assess whether there are any consistencies in the characteristics of sampled documents across the names employed to label (in the title) or describe (in the document or website) them. Methods: We undertook a documentary analysis of web-published document series that are prepared by a variety of organizations with the primary intention of providing information to health systems policymakers and stakeholders, and addressing questions related to health policy and health systems with a focus on low- and middle-income countries. No time limit was set. Results: In total, 109 individual documents from 24 series produced by 16 different organizations were included. The name ‘policy brief/briefing’ was the most frequently used (39%) to label or describe a document, and was used in all eight broad content areas that we identified, even though they did not have obviously common traits among them. In terms of document characteristics, most documents (90%) used skimmable formats that are easy to read, with understandable, jargon-free, language (80%). Availability of information on the methods (47%) or the quality of the presented evidence (27%) was less common. One-third (32%) chose the topic based on an explicit process to assess the demand for information from policy makers and even fewer (19%) engaged with policymakers to discuss the content of these documents such as through merit review. Conclusions: This study highlights the need for organizations embarking on future information-packaging efforts to be more thoughtful when deciding how to name these documents and the need for greater transparency in describing their content, purpose and intended audience

Cost-utility of transcatheter aortic valve implantation for inoperable patients with severe aortic stenosis treated by medical management: a UK cost-utility analysis based on patient-level data from the ADVANCE study.

OBJECTIVE: To use patient-level data from the ADVANCE study to evaluate the cost-effectiveness of transcatheter aortic valve implantation (TAVI) compared to medical management (MM) in patients with severe aortic stenosis from the perspective of the UK NHS. METHODS: A published decision-analytic model was adapted to include information on TAVI from the ADVANCE study. Patient-level data informed the choice as well as the form of mathematical functions that were used to model all-cause mortality, health-related quality of life and hospitalisations. TAVI-related resource use protocols were based on the ADVANCE study. MM was modelled on publicly available information from the PARTNER-B study. The outcome measures were incremental cost-effectiveness ratios (ICERs) estimated at a range of time horizons with benefits expressed as quality-adjusted life-years (QALY). Extensive sensitivity/subgroup analyses were undertaken to explore the impact of uncertainty in key clinical areas. RESULTS: Using a 5-year time horizon, the ICER for the comparison of all ADVANCE to all PARTNER-B patients was £13 943 per QALY gained. For the subset of ADVANCE patients classified as high risk (Logistic EuroSCORE >20%) the ICER was £17 718 per QALY gained). The ICER was below £30 000 per QALY gained in all sensitivity analyses relating to choice of MM data source and alternative modelling approaches for key parameters. When the time horizon was extended to 10 years, all ICERs generated in all analyses were below £20 000 per QALY gained. CONCLUSION: TAVI is highly likely to be a cost-effective treatment for patients with severe aortic stenosis

Assessing the Geographical Structure of Species Richness Data with Interactive Graphics

Understanding species richness is an important aspect of biodiversity studies and conservation planning, but varying collection effort often results in insufficient data to have a complete picture of species richness. Species accumulation curves can help assess collection completeness of species richness data, but these are usually considered by discrete area and do not consider the geographical structure of collection. We consider how these can be adapted to assess the geographical structure of species richness over geographical space. We design and implement two interactive visualisation approaches to help assess how species richness data varies over continuous geographical space. We propose these designs, critique them, report on the reactions of four ecologists and provide perspectives on their use for assessing geographical incompleteness in species richness

A new method for quantifying anisotropic martensitic transformation strains accumulated during constrained cooling

Martensitic phase transformations during welding can play a major role in determining the final residual stresses and they can be anisotropic if the transformation occurs under stress. Traditionally, the Satoh test has been used to quantify the response, but it suffers from the fact that the temperature is not uniform along the specimen length, making it difficult to interpret the data. This shortcoming is overcome in our new experimental method using digital image correlation (DIC) to quantify the temperature dependent evolution of the transformation strain locally both parallel and perpendicular to an applied load, in this case for a high-strength low alloy (HSLA) steel and a tough, low transformation temperature weld consumable designed to mitigate tensile weld residual stresses. The method is able to separate the volumetric component of the transformation strain from the deviatoric transformation plasticity component. The volumetric component is shown to be independent of applied load, while the deviatoric component varies approximately linearly with applied load. For the HSLA steel studied here the method also reveals that the transformation start temperature rises under both tensile and compressive loading, confirming previous work. From a weld modelling viewpoint our method provides sufficient information to include the stress dependency of the anisotropic transformation strain in numerical finite element models of the weld process

Large-scale forcing of the European Slope Current and associated inflows to the North Sea

Drifters drogued at 50?m in the European Slope Current at the Hebridean shelf break follow a wide range of pathways, indicating highly variable Atlantic inflow to the North Sea. Slope Current pathways, timescales and transports over 1988–2007 are further quantified in an eddy-resolving ocean model hindcast. Particle trajectories calculated with model currents indicate that Slope Current water is largely ''recruited'' from the eastern subpolar North Atlantic. Observations of absolute dynamic topography and climatological density support theoretical expectations that Slope Current transport is to first order associated with meridional density gradients in the eastern subpolar gyre, which support a geostrophic inflow towards the slope. In the model hindcast, Slope Current transport variability is dominated by abrupt 25–50?% reductions of these density gradients over 1996–1998. Concurrent changes in wind forcing, expressed in terms of density gradients, act in the same sense to reduce Slope Current transport. This indicates that coordinated regional changes of buoyancy and wind forcing acted together to reduce Slope Current transport during the 1990s. Particle trajectories further show that 10–40?% of Slope Current water is destined for the northern North Sea within 6 months of passing to the west of Scotland, with a clear decline in this Atlantic inflow over 1988–2007. The influence of variable Slope Current transport on the northern North Sea is also expressed in salinity, which declines through the hindcast period, and there is evidence for a similar freshening trend in observational records. A proxy for Atlantic inflow may be found in sea level records. Variability of Slope Current transport is implicit in mean sea level differences between Lerwick (Shetland) and Torshavn (Faeroes), in both tide gauge records and a longer model hindcast spanning 1958–2013. Potential impacts of this variability on North Sea biogeochemistry and ecosystems, via associated changes in seasonal stratification and nutrient fluxes, are discussed