Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol

Introduction: Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years. Methods and analysis: Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is <10th percentile or has decreased by 50 percentiles since 18-32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children's Abilities-Revised questionnaire. Ethics and dissemination: The Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy. Trial registration number: Main sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200

Search for dark matter produced in association with bottom or top quarks in √s = 13 TeV pp collisions with the ATLAS detector

A search for weakly interacting massive particle dark matter produced in association with bottom or top quarks is presented. Final states containing third-generation quarks and miss- ing transverse momentum are considered. The analysis uses 36.1 fb−1 of proton–proton collision data recorded by the ATLAS experiment at √s = 13 TeV in 2015 and 2016. No significant excess of events above the estimated backgrounds is observed. The results are in- terpreted in the framework of simplified models of spin-0 dark-matter mediators. For colour- neutral spin-0 mediators produced in association with top quarks and decaying into a pair of dark-matter particles, mediator masses below 50 GeV are excluded assuming a dark-matter candidate mass of 1 GeV and unitary couplings. For scalar and pseudoscalar mediators produced in association with bottom quarks, the search sets limits on the production cross- section of 300 times the predicted rate for mediators with masses between 10 and 50 GeV and assuming a dark-matter mass of 1 GeV and unitary coupling. Constraints on colour- charged scalar simplified models are also presented. Assuming a dark-matter particle mass of 35 GeV, mediator particles with mass below 1.1 TeV are excluded for couplings yielding a dark-matter relic density consistent with measurements

The economics of pain management

Thesis: Ph. D., Massachusetts Institute of Technology, Department of Economics, 2016.Cataloged from PDF version of thesis.Includes bibliographical references (pages 131-136).This thesis consists of three chapters on the economics of pain management, focusing on the effects of public policies that reduce availability of opioid pain relievers. In each of the three chapters, I exploit state-level variation in the introduction of Prescription Monitoring Program (PMP) laws as a source of plausibly exogenous variation in availability of prescription opioids. I employ several rich data sources, including individual-level administrative medical claims data linked to work absences and disability experience, and National Vital Statistics System mortality data, to investigate a series of questions regarding the optimal regulation of opioid pain relievers. In Chapter 1, I document important welfare tradeoffs in the regulation of prescription opioids. I find that prescribing restrictions achieve a key policy goal in reducing opioid overdose deaths by about 12%, but also find substantial costs, including increased pain in the hospital setting, more missed work days for injured and disabled workers, and increased total medical spending. A back-of-the-envelope welfare calculation suggests welfare losses and gains from regulation are on the same order of magnitude - approximately $12.1 billion per year in increased costs from inpatient and outpatient medical spending plus lost wages, compared to$7.3 billion per year in benefits from lives saved from opioid overdose. In Chapter 2, I consider illicit opioid and heroin abuse. I investigate the determinants of the nearly 40% year-on-year increase in heroin mortality since 2010, focusing on the relationship between prescription opioids and heroin, by decomposing demand- and supply-side effects of recent crackdowns on prescription opioids. I utilize a county-border strategy that tests for and then exploits cross-state spillovers from neighboring-state crackdowns. I find evidence that heroin is a short-run substitute and long-run complement for prescription opioids. Underlying this relationship are two opposing forces: a reduction in illicit opioid supply drives up use of heroin, but a reduction in medical provision of opioids reduces that demand in the long run. Finally, in Chapter 3, I apply machine learning techniques to study heterogeneous responses to prescribing restrictions, identifying, characterizing, and studying more closely the marginal patients who lose access to prescription opioids after PMP introduction.by Angela E. Kilby.Ph. D

Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome:an open-label randomised controlled trial

Developmen

The impact of socio-political and economic environments on private sector participation in energy infrastructure delivery in Ghana

Purpose: Investment in power and electricity generation for replacing aging infrastructure with new represents a major challenge for developing countries. This paper therefore aims to examine infrastructure projects’ characteristics and how socio-political and economic investment environments interplay to influence the degree of private sector participation (PPP) in infrastructure delivery in Ghana. Design/methodology/approach: Using World Bank Public-private infrastructure advisory facility (PPIAF) and private participation in infrastructure (PPI) project database data from 1994 to 2013, binary logistic regression was used to: determine the probability of a higher or lower degree of PPP; and examine the significance of factors that are determinants of private investments. Findings: The findings reveal that the private sector is more likely to invest in a higher degree of PPP infrastructure projects through greenfield and concession vehicles as opposed to management and leasing contracts. From the extant literature, drivers of PPP included infrastructure project characteristics and the social–economic–political health of the host country. However, the significance, direction and magnitude of these drivers vary. Originality/value: This paper identifies investment drivers to PPP advisors and project managers and seeks to engender discussion among government policymakers responsible for promoting and managing PPP projects. Direction for future work seeks to explore competitive routes to infrastructure debt and equity finance options that finance energy projects