WISDOM: history and early demise - was it inevitable?

In 1989, the UK Medical Research Council (MRC) agreed that, if feasible, a randomized controlled trial to assess the long-term risks and benefits of hormone replacement therapy (HRT) was a priority. Feasibility work began in 1990 and demonstrated that a large-scale multicenter trial was possible. An application for funding for a main trial was submitted to MRC in 1993 and, after extensive review, funding was released in late 1996. Set-up work for the trial - the Women's International Study of long Duration Oestrogen after Menopause (WISDOM) - began in 1997 with recruitment in 1999. In October 2002, following the early discontinuation of one arm of the US Women's Health Initiative HRT trial, the MRC decided to stop the WISDOM trial. This article, by the principal UK investigators of WISDOM, sets out the background and history of the trial

The Northern True Katydid, Pterophylla camellifolia (Orthoptera: Pseudophyllidae), at Ottawa, Ontario

Five males of the Northern True Katydid (Pterophylla camellifolia) are reported from Ottawa, Ontario (approximately 45°25'N, 75°42'W), in 2001 and 2002 at three separate locations. Based on its distribution and habits extralimital occurrences in Ottawa are likely due to chance introduction

A burden of knowledge: A qualitative study of experiences of neonatal intensive care nurses’ concerns when keeping information from parents

© 2014, © The Author(s) 2014. Improved life-sustaining technology in the neonatal intensive care has resulted in an increased probability of survival for extremely premature babies. In the neonatal intensive care, the condition of a baby can deteriorate rapidly. Nurses and parents are together for long periods at the bedside and so form close and trusting relationships. Neonatal nurses as the constant caregivers may be presented with contradictory demands in attempting to meet the baby’s needs and being a patient and family advocate. This article aims to explore the issues arising for neonatal nurses when holding information about changes to a condition of a baby that they are unable to share with parents. Data were collected via interviews with 24 neonatal nurses in New South Wales, Australia. A qualitative approach was used to analyse the data. The theme ‘keeping secrets’ was identified and comprised of three sub-themes ‘coping with potentially catastrophic news’, ‘fear of inadvertent disclosure’ and ‘a burden that could damage trust’. Keeping secrets and withholding information creates internal conflict in the nurses as they balance the principle of confidentiality with the parent’s right to know information. The neonatal nurses experienced guilt and shame when they were felt forced by circumstances to keep secrets or withhold information from the parents of extremely premature babies

Transition to turbulence in particulate pipe flow

We investigate experimentally the influence of suspended particles on the transition to turbulence. The particles are monodisperse and neutrally-buoyant with the liquid. The role of the particles on the transition depends both upon the pipe to particle diameter ratios and the concentration. For large pipe-to-particle diameter ratios the transition is delayed while it is lowered for small ratios. A scaling is proposed to collapse the departure from the critical Reynolds number for pure fluid as a function of concentration into a single master curve.Comment: 4 pages, 4 figure

The Hudson Bay Lithospheric Experiment (HuBLE) : Insights into Precambrian Plate Tectonics and the Development of Mantle Keels

The UK component of HuBLE was supported by Natural Environment Research Council (NERC) grant NE/F007337/1, with financial and logistical support from the Geological Survey of Canada, Canada–Nunavut Geoscience Office, SEIS-UK (the seismic node of NERC), and First Nations communities of Nunavut. J. Beauchesne and J. Kendall provided invaluable assistance in the field. Discussions with M. St-Onge, T. Skulski, D. Corrigan and M. Sanborne-Barrie were helpful for interpretation of the data. D. Eaton and F. A. Darbyshire acknowledge the Natural Sciences and Engineering Research Council. Four stations on the Belcher Islands and northern Quebec were installed by the University of Western Ontario and funded through a grant to D. Eaton (UWO Academic Development Fund). I. Bastow is funded by the Leverhulme Trust. This is Natural Resources Canada Contribution 20130084 to its Geomapping for Energy and Minerals Program. This work has received funding from the European Research Council under the European Unions Seventh Framework Programme (FP7/2007-2013)/ERC Grant agreement no. 240473 ‘CoMITAC’.Peer reviewedPublisher PD

Monitoring sound levels in the intensive care unit: A mixed-methods system development project to optimize design features for a new electronic interface in the healthcare environment.

BACKGROUND: Intensive care units (ICU) are busy round the clock and it is difficult to maintain low sound levels that support patient rest. To help ICU staff manage activities we developed a visual display that monitors and reports sound levels in real-time. This facilitates immediate feedback, encouraging proactive behavior change to limit disturbances. METHODS: Following the principles of user-centered design practices we created our 'user persona' to understand the needs and goals of potential users of the system. We then conducted iterative user testing with current members of the ICU team, primarily using the 'think aloud' method to refine the design and functionality of our novel system. Ethnography evaluated team use of the display. RESULTS: The final design was simple, clear, and efficient, and both functional and aesthetically pleasing for the key user demographic. We identified challenges in the implementation and adoption process that were separate from the 'usability' of the system itself. CONCLUSIONS: Embedding the design process within the core user demographic ensured the final product delivered relevant information for key users, and that this information was intuitive to interpret. Initiating sustainable change is not straightforward. It requires recognition of cultural practices within teams, departments, professions, organizations, and strategies to maximize engagement

Valuing seasonal climate forecasts in the northern Australia beef industry

Seasonal climate forecasts (SCFs) provide opportunities for pastoralists to align production decisions to climatic conditions, as SCFs offer economic value by increasing certainty about future climatic states at decision-making time. Insufficient evidence about the economic value of SCFs was identified as a major factor limiting adoption of SCFs in Australia and abroad. This study examines the value of SCFs to beef production system management in northern Australia by adopting a theoretical probabilistic climate forecast system. Stocking rate decisions in October, before the onset of the wet season, were identified by industry as a key climate sensitive decision. The analysis considered SCF value across economic drivers (steer price in October) and environmental drivers (October pasture availability). A range in forecast value was found (0-$14/head) dependent on pasture availability, beef price and SCF skill. Skilful forecasts of future climate conditions offered little value with medium or high pasture availability, as in these circumstances, pastures were rarely over-utilised. In contrast, low pasture availability provided conditions for alternative optimal stocking rates and for SCFs to be valuable. Optimal stocking rates under low pasture availability varied the most with climate state (i.e. wet or dry), indicating that producers have more to gain from a skilful SCF at these times. Although the level of pasture availability in October was the major determinant of stocking rate decisions, beef price settings were also found to be important. This analysis provides insights into the potential value of SCFs to extensive beef enterprises and can be used by pastoralists to evaluate the cost-benefit of using a SCF in annual management

Role of co-trimoxazole prophylaxis in reducing mortality in HIV infected adults being treated for tuberculosis: randomised clinical trial

Objective To assess the impact of prophylactic oral co-trimoxazole in reducing mortality in HIV positive Zambian adults being treated for pulmonary tuberculosis