Case study : a patient-clinician collaboration that identified and prioritized evidence gaps and stimulated research development

Copyright © 2013 Elsevier Inc. All rights reserved.Peer reviewedPostprin

U(1)_A symmetry in two-doublet models, U bosons or light scalars, and psi and Upsilon decays

psi and Upsilon decays may be used to search for light neutral spin-1 or spin-0 bosons associated with a broken extra-U(1) symmetry, local or global, acting axially on quarks and leptons, as may be present in supersymmetric theories with a lambda H_1 H_2 S superpotential term. Recent data on Upsilon --> gamma + invisible neutral constrain an axial, pseudoscalar or scalar coupling to b to f_bA < 4 10^-7 m_U(MeV)/ sqrt B_inv, f_bP < 4 10^-3/ sqrt B_inv or f_bS < 6 10^-3/ sqrt B_inv, respectively. This also constrains, from universality properties, couplings to electrons to f_eA < 4 10^-7 m_U(MeV)/ sqrt B_inv, f_eP < 4 10^-7/ sqrt B_inv or f_eS < 6 10^-7/ sqrt B_inv. The pseudoscalar a (possibly traded for a light gauge boson, or scalar particle) should then be, for invisible decays of the new boson, for > 96 % singlet and < 4 % doublet, for tan beta > 1. Or, more generally, < 4 % /(tan^2 beta B_inv) doublet, which implies a very small rate for the corresponding psi decay, B (psi --> gamma + neutral) B_inv <~ 10^-6/ tan^4 beta. Similar results are obtained for new spin-1 or spin-0 neutral bosons decaying into mu+ mu-.Comment: 10 pages, to appear in Physics Letters

Relationships Between Stream Order and Management Priority: a Water Quality Case Study

Seagrass, which once dominated the habitat of Oyster Harbour on the south coast of Western Australia has been replaced by macroalgae because of increased nutrient and sediment discharge from the rural dominated catchment. Total Phosphorus (TP), Total Nitrogen (TN), Suspended Sediment (SS) and Electrical Conductivity (EC) concentrations from a catchment – wide (168 sites), event-driven snapshot, water quality monitoring program conducted from 1994 to 1996, were analysed in relation to stream order and published survey data on riparian zone condition. This analysis was performed to examine relationships between stream order, riparian zone condition and water quality, and implications for the allocation of limited resources for stream fencing, rehabilitation and stock exclusion towards the moderation of nutrient loss for the benefit of the harbour at the catchment exit. Eighty percent of the stream length was in low order streams (stream order 1 and 2) and the remainder in order 3 and above. Riparian zone condition worsened as stream order decreased. Total Phosphorus, and to a lesser degree TN and SS, decreased with increasing stream order, whilst EC increased with increasing stream order. Amongst many factors, one factor influencing the change in water quality is that low order streams exhibit the poorest riparian zone condition and therefore have little capacity to moderate paddock nutrient runoff. The systematic change in EC implies that low order streams are dominated proportionally more by surface runoff than groundwater, and hence represent a greater relative opportunity to moderate surface derived nutrients and sediment. In summary, low order streams in this case study represent the greatest length, have the poorest condition, show the highest nutrient and sediment concentrations, have greater surface runoff, and therefore are priority candidates for the purpose of minimising the downstream impacts of nutrients when limited funds are available

New postnatal urinary incontinence: obstetric and other risk factors in primparae.

Objective To identify obstetric and other risk factors for urinary incontinence which occurs during pregnancy or after childbirth. Design Questionnaire survey of women. Setting Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand). Population 3405 primiparous women with singleton births delivered during one year. Methods Questionnaire responses and obstetric casenote data were analysed using multivariate analysis to identify associations with urinary incontinence. Main outcome measures Urinary incontinence at three months after delivery first starting in pregnancy or after birth. Results The prevalence of urinary incontinence was 29%. New incontinence first beginning after delivery was associated with higher maternal age (oldest versus youngest group, odds ratio, OR 2.02, 95% CI 1.35 to 3.02); and method of delivery (caesarean section versus spontaneous vaginal delivery, OR 0.28, 95% CI 0.19 to 0.41). There were no significant associations with forceps delivery (OR 1.18, 95% CI 0.92 to 1.51) or vacuum delivery (OR 1.16, 95% CI 0.83 to 1.63). Incontinence first occurring during pregnancy and still present at three months was associated with higher maternal body mass index (BMI > 25, OR 1.68, 95% CI 1.16 to 2.43), and heavier babies (birthweight in top quartile, OR 1.56, 95% CI 1.12 to 2.19). In these women, caesarean section was associated with less incontinence (OR 0.39, 95% CI 0.27 to 0.58) but incontinence was not associated with age. Conclusions Women have less urinary incontinence after a first delivery by caesarean section whether or not that first starts during pregnancy. Older maternal age was associated with new postnatal incontinence, and higher body mass index and heavier babies with incontinence first starting during pregnancy. The effect of further deliveries may modify these findings

The introduction of new interventional procedures in the British National Health Service : A qualitative study

Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.Peer reviewedPostprin

The Energy Sector and Groundwater

No abstract available

Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial:Quantitative examination of variation between practices in recruitment, implementation and effectiveness

Objectives: - The cluster randomised trial of the Data-driven Quality Improvement in Primary Care (DQIP) intervention showed that education, informatics and financial incentives for general medical practices to review patients with ongoing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets reduced the primary end point of high-risk prescribing by 37%, where both ongoing and new high-risk prescribing were significantly reduced. This quantitative process evaluation examined practice factors associated with (1) participation in the DQIP trial, (2) review activity (extent and nature of documented reviews) and (3) practice level effectiveness (relative reductions in the primary end point). Setting/participants: - Invited practices recruited (n=33) and not recruited (n=32) to the DQIP trial in Scotland, UK. Outcome measures: - (1) Characteristics of recruited versus non-recruited practices. Associations of (2) practice characteristics and 'adoption? (self-reported implementation work done by practices) with documented review activity and (3) of practice characteristics, DQIP adoption and review activity with effectiveness. Results: - (1) Recruited practices had lower performance in the quality and outcomes framework than those declining participation. (2) Not being an approved general practitioner training practice and higher self-reported adoption were significantly associated with higher review activity. (3) Effectiveness ranged from a relative increase in high-risk prescribing of 24.1% to a relative reduction of 77.2%. High-risk prescribing and DQIP adoption (but not documented review activity) were significantly associated with greater effectiveness in the final multivariate model, explaining 64.0% of variation in effectiveness. Conclusions: - Intervention implementation and effectiveness of the DQIP intervention varied substantially between practices. Although the DQIP intervention primarily targeted review of ongoing high-risk prescribing, the finding that self-reported DQIP adoption was a stronger predictor of effectiveness than documented review activity supports that reducing initiation and/or re-initiation of high-risk prescribing is key to its effectiveness