Farm-based recreation in England and Wales

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An Economic Evaluation of Valsartan for Post-MI Patients in the UK Who Are Not Suitable for Treatment with ACE Inhibitors

AbstractObjectivesThe overall objective of this study was to estimate the costs and outcomes associated with treatment with valsartan for post-myocardial infarction (post-MI) patients with left ventricular systolic dysfunction, heart failure, or both, who are not suitable for treatment with angiotensin-converting enzyme (ACE) inhibitors, compared to placebo.MethodsA Markov model, using data drawn from the Valsartan in Acute Myocardial Infarction (VALIANT) trial and other trials, was developed to predict the future health pathways, resource use, and costs for patients who have recently experienced an MI. Patients received either valsartan (mean dose 247 mg) or placebo. Cost data were drawn from national databases and published literature, although health outcome utility weights were derived from existing studies. Patient outcomes were modeled for 10 years, and incremental cost-effective ratios were calculated for valsartan compared with placebo.ResultsOver a period of 10 years, a cohort of 1000 patients treated with valsartan experienced 147 fewer cardiovascular deaths, 37 fewer nonfatal MIs, and 95 fewer cases of heart failure than a cohort who received placebo. The incremental cost of valsartan, compared with placebo, was £2680 per patient, although the incremental effectiveness of valsartan was 0.5021 quality-adjusted life-years (QALYs) gained per patient. Therefore, the incremental cost per QALY for treatment with valsartan was £5338. When analysis was undertaken using life-years rather than QALYs, the cost per life-year gained was £4672.ConclusionsFor patients who are not suitable for treatment with ACE inhibitors, valsartan is a viable and cost-effective treatment for their management after an MI

Évaluation des compétences en réanimation en séance de simulation et en milieu de travail : analyse descriptive et comparative de trois spécialités

Background: Simulation-based assessment can complement workplace-based assessment of rare or difficult to assess Entrustable Professional Activities (EPAs). We aimed to compare the use of simulation-based assessment for resuscitation-focused EPAs in three postgraduate medical training programs and describe faculty perceptions of simulation-based assessment. Methods: EPA assessment scores and setting (simulation or workplace) were extracted from 2017-2020 for internal medicine, emergency medicine, and surgical foundations residents at the transition to discipline and foundations of discipline stages. A questionnaire was distributed to clinical competency committee members. Results: Eleven percent of EPA assessments were simulation-based. The proportion of simulation-based assessment did not differ between programs but differed between transition (38%) and foundations (4%) stages within surgical foundations only. Entrustment scores differed between settings in emergency medicine at the transition level only (simulation: 4.82 ± 0.60 workplace: 3.74 ± 0.93). 70% of committee members (n=20) completed the questionnaire. Of those that use simulation-based assessment, 45% interpret them differently than workplace-based assessments. 73% and 100% trust simulation for high-stakes and low-stakes assessment, respectively. Conclusions: The proportion of simulation-based assessment for resuscitation focused EPAs did not differ between three postgraduate medical training programs. Interpretation of simulation-based assessment data between committee members was inconsistent. All respondents trust simulation-based assessment for low-stakes, and the majority for high-stakes assessment. These findings have practical implications for the integration simulation into programs of assessment.Contexte : Pour les activités professionnelles confiables (APC) qui sont rarement observées ou difficiles à évaluer, l’évaluation dans les séances de simulation peut compléter l’évaluation en milieu de travail. Nous avons comparé l’utilisation de l’évaluation lors de simulations pour les APC axées sur la réanimation dans trois programmes de formation médicale postdoctorale et décrit les perceptions de membres du corps professoral concernant cette modalité d’évaluation. Méthodes : Nous avons extrait les scores et le cadre (simulation ou lieu de travail) d’évaluation des APC de 2017 à 2020 pour les résidents en médecine interne, en médecine d’urgence et en fondements chirurgicaux aux étapes de transition vers la discipline et de fondements de la discipline. Un questionnaire a été distribué aux membres du comité des compétences cliniques. Résultats : Onze pour cent des évaluations d’APC étaient faites lors de séances de simulation. Cette proportion était la même pour tous les programmes, mais dans le cadre des fondements chirurgicaux, elle était différente selon qu’il s’agissait de l’étape de transition (38 %) ou de l’étape des fondements (4 %). Les scores de confiance différaient selon le cadre de l’évaluation uniquement pour les résidents en médecine d’urgence à l’étape de la transition (simulation : 4,82 ± 0,60; lieu de travail : 3,74 ± 0,93). Le questionnaire a été rempli par 70 % des membres du comité (n=20). Parmi ceux qui avaient utilisé l’évaluation en séance de simulation, 45 % avaient interprété les données de l’évaluation différemment de la façon dont ils interprètent les données d’évaluation en milieu de travail. Soixante-treize pour cent et 100 % d’entre eux font confiance à la simulation pour les évaluations à enjeux élevés et à faibles enjeux, respectivement. Conclusions : La proportion d’évaluations en séance de simulation pour les APC axées sur la réanimation était la même pour trois programmes de formation médicale postdoctorale. Les membres du comité n’ont pas interprété les données de ce type d’évaluation de manière uniforme. Tous les répondants font confiance à l’évaluation en séance de simulation pour les évaluations à faible enjeu, et la plupart d’entre eux pour les évaluations à enjeu élevé. Ces résultats ont des incidences pratiques sur l’intégration de la simulation dans les programmes d’évaluation

Taxonomy and conservation of grassland earless dragons:New species and an assessment of the first possible extinction of a reptile on mainland Australia

Taxonomic research is of fundamental importance in conservation management of threatened species, providing an understanding of species diversity on which management plans are based. The grassland earless dragon lizards (Agamidae: <i>Tympanocryptis</i>) of south-eastern Australia have long been of conservation concern but there have been ongoing taxonomic uncertainties. We provide a comprehensive taxonomic review of this group, integrating multiple lines of evidence, including phylogeography (mtDNA), phylogenomics (SNPs), external morphology and micro x-ray CT scans. Based on these data we assign the lectotype of <i>T. lineata</i> to the Canberra region, restrict the distribution of <i>T. pinguicolla</i> to Victoria and name two new species: <i>T. osbornei sp. nov.</i> (Cooma) and <i>T. mccartneyi sp. nov.</i> (Bathurst). Our results have significant conservation implications. Of particular concern is <i>T. pinguicolla</i>, with the last confident sighting in 1969, raising the possibility of the first extinction of a reptile on mainland Australia. However, our results are equivocal as to whether <i>T. pinguicolla</i> is extant or extinct, emphasizing the immediate imperative for continued surveys to locate any remaining populations of <i>T. pinguicolla</i>. We also highlight the need for a full revision of conservation management plans for all the grassland earless dragons

Are short-term variations in solar oscillation frequencies the signature of a second solar dynamo?

In addition to the well-known 11-year solar cycle, the Sun's magnetic activity also shows significant variation on shorter time scales, e.g. between one and two years. We observe a quasi-biennial (2-year) signal in the solar p-mode oscillation frequencies, which are sensitive probes of the solar interior. The signal is visible in Sun-as-a-star data observed by different instruments and here we describe the results obtained using BiSON, GOLF, and VIRGO data. Our results imply that the 2-year signal is susceptible to the influence of the main 11-year solar cycle. However, the source of the signal appears to be separate from that of the 11-year cycle. We speculate as to whether it might be the signature of a second dynamo, located in the region of near-surface rotational shear.Comment: 6 pages, 2 figures, proceedings for SOHO-24/GONG 2010 conference, to be published in JPC

Understanding farmers’ motivations for providing unsubsidised environmental benefits

This paper examines farmers’ motivations for voluntary unsubsidised practices that benefit the environment. It identifies amongst a group of English farmers the amount of unsubsidised environmental activities on mainly arable land, and explores the extent to which motivations are extrinsic and intrinsic for undertaking this unsubsidised activity. Using responses from a national survey in England of 1,345 farmers, in-depth face-to-face interviews with 60 farmers and an analysis of existing agri-environment scheme data, the extent to which subsidised and unsubsidised environmental activity is undertaken on arable land was identified. Furthermore, it was also possible to identify and compare the motivations behind subsidised and unsubsidised environmental activity and to understand the interaction between these two types of activity at the farm scale. The research found that around 25% of all environmental activity undertaken on arable farms in England is unsubsidised, although some of this activity sits alongside subsidised activity. There were clear differences between the motivations for undertaking subsidised and unsubsidised environmental activities. Financial reasons dominated farmers’ motivations for engaging in subsidised agri-environment scheme practices, whilst agronomic and environmental motivations were of greater importance for unsubsidised activity. Data analysis also revealed over-subscription in agri-environment schemes, with a considerable amount of environmental activity occurring without payment. From a policy perspective it is helpful to understand motivations for existing unsubsidised environmental activity as this can inform the design of advice and message framing to encourage uptake of more widespread voluntary environmental behaviour

The K2 Mission: Characterization and Early results

The K2 mission will make use of the Kepler spacecraft and its assets to expand upon Kepler's groundbreaking discoveries in the fields of exoplanets and astrophysics through new and exciting observations. K2 will use an innovative way of operating the spacecraft to observe target fields along the ecliptic for the next 2-3 years. Early science commissioning observations have shown an estimated photometric precision near 400 ppm in a single 30 minute observation, and a 6-hour photometric precision of 80 ppm (both at V=12). The K2 mission offers long-term, simultaneous optical observation of thousands of objects at a precision far better than is achievable from ground-based telescopes. Ecliptic fields will be observed for approximately 75-days enabling a unique exoplanet survey which fills the gaps in duration and sensitivity between the Kepler and TESS missions, and offers pre-launch exoplanet target identification for JWST transit spectroscopy. Astrophysics observations with K2 will include studies of young open clusters, bright stars, galaxies, supernovae, and asteroseismology.Comment: 25 pages, 11 figures, Accepted to PAS