1,059 research outputs found

    Is there overutilisation of cataract surgery in England?

    Get PDF
    <b>Objectives:</b> Following a 3.7-fold increase in the rate of cataract surgery in the UK between 1989 and 2004, concern has been raised as to whether this has been accompanied by an excessive decline in the threshold such that some operations are inappropriate. The objective was to measure the impact of surgery on a representative sample of patients so as to determine whether or not overutilisation of surgery is occurring. <b>Design:</b> Prospective cohort assessed before and 3 months after surgery. <b>Setting:</b> Ten providers (four NHS hospitals, three NHS treatment centres, three independent sector treatment centres) from across England. <b>Participants:</b> 861 patients undergoing first eye (569) or second eye (292) cataract surgery provided preoperative data of whom 745 (87%) completed postoperative questionnaires. <b>Main outcome measures:</b> Patient-reported visual function (VF-14); general health status and quality of life (EQ5D); postoperative complications; overall view of the operation and its impact. <b>Results:</b> Overall, visual function improved (mean VF-14 score increased from 83.2 (SD 17.3) to 93.7 (SD 13.2)). Self-reported general health status deteriorated (20.3% fair or poor before surgery compared with 25% afterwards) which was reflected in the mean EQ5D score (0.82 vs 0.79; p = 0.003). At least one complication was reported by 66 (8.9%) patients, though this probably overestimated the true incidence. If the appropriateness of surgery is based on an increase in VF-14 score of 5.5 (that corresponds to patients’ reporting being "a little better"), 30% of operations would be deemed inappropriate. If an increase of 12.2 (patients’ reports of being "much better") is adopted, the proportion inappropriate is 49%. Using a different approach to determining a minimally important difference, the proportion inappropriate would be closer to 20%. Although visual function (VF-14) scores were unchanged or deteriorated in 25% of patients, 93.1% rated the results of the operation as "good," "very good" or "excellent," and 93.5% felt their eye problem was "better." This partly reflects inadequacies in the validity of the VF-14. <b>Conclusions:</b> Improvement in the provision of cataract surgery has been accompanied by a reduction in the visual function threshold. However, methodological difficulties in measuring the impact of cataract surgery on visual function and quality of life mean it is impossible to determine whether or not overutilisation of cataract surgery is occurring. N Black1, J Browne1, J van der Meulen1, L Jamieson2, L Copley2 and J Lewsey

    A Bjorken sum rule for semileptonic Ωb\Omega_b decays to ground and excited charmed baryon states

    Full text link
    We derive a Bjorken sum rule for semileptonic Ωb\Omega_b decays to ground and low-lying negative-parity excited charmed baryon states, in the heavy quark limit. We discuss the restriction from this sum rule on form factors and compare it with some models.Comment: 10 pages, RevTex, no figure, Alberta Thy--26--9

    A Neutron Elastic Diffuse Scattering Study of PMN

    Full text link
    We have performed elastic diffuse neutron scattering studies on the relaxor Pb(Mg1/3_{1/3}Nb2/3_{2/3})O3_3 (PMN). The measured intensity distribution near a (100) Bragg peak in the (hk0) scattering plane assumes the shape of a butterfly with extended intensity in the (110) and (11ˉ\bar{1}0) directions. The temperature dependence of the diffuse scattering shows that both the size of the polar nanoregions (PNR) and the integrated diffuse intensity increase with cooling even for temperatures below the Curie temperature TC∌213T_C \sim 213 K.Comment: Submitted to PR

    QL4 THE CONTENT VALIDITY OF CLINICIAN DERIVED PATIENT REPORTED OUTCOMES (PRO) MEASURES: THE ROLAND MORRIS DISABILITY QUESTIONNAIRE

    Get PDF

    Sexually monomorphic maps and dimorphic responses in rat genital cortex

    Get PDF
    Author Posting. © The Author(s), 2015. This is the author's version of the work. It is posted here for personal use, not for redistribution. The definitive version was published in Current Biology 26 (2016): 106-113, doi:10.1016/j.cub.2015.11.041.Mammalian external genitals show sexual dimorphism [1,2] and can change size and shape upon sexual arousal. Genitals feature prominently in the oldest pieces of figural art [3] and phallic depictions of penises informed psychoanalytic thought about sexuality [4, 5]. Despite this longstanding interest, the neural representations of genitals are still poorly understood [6]. In somatosensory cortex specifically, many studies did not detect any cortical representation of genitals [7-9]. Studies in humans debate, if genitals are represented displaced below the foot of the cortical body map [10-12], or if they are represented somatotopically [13-15]. We wondered, what a high-resolution mapping of genital representations might tell us about the sexual differentiation of the mammalian brain. We identified genital responses in rat somatosensory cortex in a region previously assigned as arm/leg cortex. Genital responses were more common in males than in females. Despite such response dimorphism, we observed a stunning anatomical monomorphism of cortical penis and clitoris input maps revealed by cytochrome-oxidasestaining of cortical layer-4. Genital representations were somatotopic, bilaterally symmetric and their relative size increased markedly during puberty. Size, shape and erect posture give the cortical penis representation a phallic appearance pointing to a role in sexually aroused states. Cortical genital neurons showed unusual multi-body-part responses and sexually dimorphic receptive fields. Specifically, genital neurons were coactivated by distant body regions, which are touched during mounting in the respective sex. Genital maps indicate a deep homology of penis and clitoris representations in line with a fundamentally bi-sexual layout [16] of the vertebrate brain.This work was supported by Marine Biological Laboratory, Humboldt UniversitÀt zu Berlin and Neurocure. M.B. was a recipient of a Gottfried Wilhelm Leibniz Prize

    A systematic review identifying outcome measures used in evaluating adults sustaining cervical spine fractures.

    Get PDF
    OBJECTIVE: To assess the outcome measures used in studies investigating cervical spine fractures in adults, with or without associated spinal cord injury, to inform development of a core outcome set. METHODS: Medline, Embase and Scopus were searched for relevant studies until May 28, 2022, without a historic limit on study date. Study characteristics, population characteristics and outcomes reported were extracted and analyzed. RESULTS: Our literature search identified 536 studies that met criteria for inclusion, involving 393,266 patients. Most studies were single center (87.3%), retrospective studies (88.9%) and involved a median of 40 patients (range 6-167,278). Treatments assessed included: surgery (55.2%), conservative (6.2%), halo immobilization (4.9%), or a mixture (33.2%). Median study duration was 84 months (range 3-564 months); the timing of clinical and/or radiological follow-up assessment after injury was reported in 56.7%. There was significant heterogeneity in outcomes used, with 79 different reported outcomes measures. Differences in use were identified between smaller/larger, retro-/prospective and single/multicenter cohorts. Over time, the use of radiological outcomes has declined with greater emphasis on patient-reported outcome measures (PROMs). Studies of conservative management were more likely to detail PROMs and mortality, whereas surgical studies reported Frankel/ASIA grade, radiological fusion, complication rates, duration of hospital stay and re-operation rates more frequently. In studies assessing the elderly population (> 65 years), use of PROMs, mortality, hospital stay and discharge destination were more common, whereas fusion was reported less often. Response rates for outcome assessments were lower in studies assessing elderly patients, and studies using PROMs. CONCLUSIONS: We have classified the various outcome measures used for patients with cervical spine fractures based on the COMET outcome taxonomy. We also described the contexts in which different outcomes are more commonly employed to help guide decision-making when designing future research endeavors

    Analysis of the Dynamics of Liquid Aluminium: Recurrent Relation Approach

    Full text link
    By use of the recurrent relation approach (RRA) we study the microscopic dynamics of liquid aluminium at T=973 K and develop a theoretical model which satisfies all the corresponding sum rules. The investigation covers the inelastic features as well as the crossover of our theory into the hydrodynamical and the free-particle regimes. A comparison between our theoretical results with those following from a generalized hydrodynamical approach is also presented. In addition to this we report the results of our molecular dynamics simulations for liquid aluminium, which are also discussed and compared to experimental data. The received results reveal that (i) the microscopical dynamics of density fluctuations is defined mainly by the first four even frequency moments of the dynamic structure factor, and (ii) the inherent relation of the high-frequency collective excitations observed in experimental spectra of dynamic structure factor S(k,ω)S(k,\omega) with the two-, three- and four-particle correlations.Comment: 11 pages, 4 figure
    • 

    corecore