Protocol for the development of a multidisciplinary clinical practice guideline for the care of patients with chronic subdural haematoma

Introduction: A common neurosurgical condition, chronic subdural haematoma (cSDH) typically affects older people with other underlying health conditions. The care of this potentially vulnerable cohort is often, however, fragmented and suboptimal. In other complex conditions, multidisciplinary guidelines have transformed patient experience and outcomes, but no such framework exists for cSDH. This paper outlines a protocol to develop the first comprehensive multidisciplinary guideline from diagnosis to long-term recovery with cSDH. Methods: The project will be guided by a steering group of key stakeholders and professional organisations and will feature patient and public involvement. Multidisciplinary thematic working groups will examine key aspects of care to formulate appropriate, patient-centered research questions, targeted with evidence review using the GRADE framework. The working groups will then formulate draft clinical recommendations to be used in a modified Delphi process to build consensus on guideline contents. Conclusions: We present a protocol for the development of a multidisciplinary guideline to inform the care of patients with a cSDH, developed by cross-disciplinary working groups and arrived at through a consensus-building process, including a modified online Delphi.</p

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Homework 1

HW 1, required submissio

Data-Driven Analyses & Policy Implications in the Transportation World: A Focus on Pennsylvania Inspection & Registration Data and Nationwide Fatal Crash Data

Vehicles are an integral part of today’s society and there is a large dependence on them for both business and pleasure. With the increasing concerns in vehicle congestion, air pollution, costly crashes, and highway funding sources, technological advances in data collection and analysis are now necessary in the transportation sector and must be taken to the next level. This thesis focuses on various analyses that can be performed pertaining to lightduty vehicles by primarily using one, low-cost data source from the annual vehicle safety inspection records in Pennsylvania. It also exemplifies how adding additional, low-cost, data sources can add even more depth and breadth to data-driven transportation analyses. By using these combined data resources, various research and policy questions can be answered through data-driven analyses. Data analyses in transportation studies do not always take into account factors such as urbanity and vehicle age, yet as shown in this thesis, these factors are necessary to make effective policy recommendations. Chapter II of this dissertation assesses various vehicle safety inspection failure rates using the VSIR data by using the data fields resulting from the safety inspections. This information provides both technical measurements and general pass/fail metrics in order to determine if any maintenance was necessary during the inspection. The data show clearly that vehicles require more maintenance for each of the following: the higher the odometer reading, the older the vehicle, and the more rural the registration zip code. Additionally, the claimed 2% failure rate only applied to vehicles within their first year. Failure rates were found to be much higher for all other vehicles with the average found to be around 12%-18%. Chapter III examines whether the vehicles safety inspection program saves lives. It can be concluded safety inspections are statistically effective in reducing fatality rates by approximately 1-2 fatal crashes per billion VMT in a given year. Additionally, urbanity was always found to be significant, which confirms the need for robust VMT estimates. Results show there are approximately 1,540 fatalities avoided in current safety states. On the other hand, in states with no safety program about 2,600 fatalities could be avoided if a program similar to PA were implemented. Chapter IV increases the breadth of analysis with this inspection data by using it to analyze travel patterns for individual vehicles and households with multiple vehicles. The vi primary contribution of this chapter is to provide data-driven insight to annual travel patterns based on age, urbanity, and time, in order to eventually be able to make informed policy decisions in order to distribute funding most efficiently. While average VMT data is publically available as averages for each urban and rural area by state, it is not available on a zip code level nor does it contain ranges or other characteristics of vehicles, such as age. Results from this thesis show that while VMT is generally decreasing in recent years, when observing average VMT by vehicle age, VMT is increasing in recent years. This leads to the conclusion that owners are keeping their older vehicles longer and driving them more than the average. Differences in travel and vehicle ownership at a home zip code level are observed and therefore variations within counties and overall urbanity in the state are also seen. Additionally, we observe that while average annual VMT over time is relatively consistent over many of the years observed and much higher in rural areas, vehicle ages consistently increase each year and are approximately the same in comparing urban versus rural areas. Finally, calculations are made in order to assign vehicles to households. This limited the analyses largely due to low sample sizes and the inability to check for representativeness, but loose conclusions could be drawn between households based on vehicle counts and align with a similar study using NHTS data. Chapter V provides the summary, policy implications of the research, and final conclusions. The vehicle safety inspection program has long been debated within states over the past ten years. This state-driven policy must be analyzed, using a data-driven approach, on a zip code or county level, for the entire U.S. There are questions as to whether this program is effective in keeping roads safe and worth the money being spent. It is calculated that for states without a current safety program, the cost effectiveness (defined in terms of $/life saved) of implementing a safety inspection program similar to PA is about$6.8M ($1.9M -$180M), which falls entirely around the U.S. DOT’s value of a statistical life of $5.2 million to$13 million. It is noted that this calculated cost per life saved is likely an upper bound since the estimate does not include benefits of non-fatal crashes avoided and assumes that every vehicle has some repair performed (versus paying only the inspection cost or a zero repair cost). A bigger question is if these state-mandated vehicle policies make sense, especially in areas where there is a lot of cross-border traveling. The cost-effectiveness in this sense may not be accurate.</p

Effect of dorsal acetabular rim loss on stability of the zurich cementless total hip acetabular cups in dogs

OBJECTIVE: To evaluate magnitude and mode of acute load to failure of the Zurich Cementless acetabular cup prosthesis in cadaveric specimens with and without 50% dorsal acetabular rim loss. STUDY DESIGN: In vitro mechanical study. SAMPLE POPULATION: Cadaveric hemipelves of adult dogs (n = 8). METHODS: Each pair of hemipelves was prepared by dissection of surrounding musculature and implantation of a Zurich Cementless acetabular cup prosthesis. One hemipelvis had the dorsal rim left intact (group 1) and the contralateral hemipelvis had 50% of the dorsal rim excised (group 2). Each hemipelvis underwent acute load to failure with an axial load applied through a prosthetic femoral head. Load at failure was compared between hemipelves with and without dorsal rim loss with a paired t-test; P < .05 was considered significant. RESULTS: Mean failure load was not significantly different between group 1 (3,713 ± 362 N) and group 2 (3,640 ± 751 N; P = .8). Bone fracture (n = 6), ventroversion of the cup (1), and absolute failure unreached at 6,000 N (1) occurred in group 1 and bone fracture (6), ventroversion of cup (1), and cup loosening (1) occurred in group 2. CONCLUSIONS: Zurich Cementless acetabular cup stability does not appear to be compromised by 50% acetabular rim loss at normal physiologic weight bearing loads. Thus, for this system, modifying procedures such as augmentation of the dorsal acetabular rim or deeper reaming for acetabular bed preparation may not be necessary with up to 50% dorsal rim loss with the Zurich Cementless acetabular cup

Vulnerability of grazing and confined livestock in the Northern Great Plains to projected mid and late-twenty-first century climate

The Northern Great Plains (NGP) region of the USA—which comprises Montana, Wyoming, Colorado, North Dakota, South Dakota, and Nebraska—is a largely rural area that provides numerous ecosystem services, including livestock products, cultural services, and conservation of biological diversity. The region contains 25% of the Nation’s beef cattle and approximately one-third of the confined beef cattle, as well as the largest remaining native prairie in the US—the Northern Mixed grass Prairie. With rising atmospheric CO2, the NGP is projected to experience warmer and longer growing seasons, greater climatic variability, and more extreme events (e.g., increased occurrence of large precipitation events). These climatic changes may affect livestock production both directly via physiological impacts on animals and indirectly via modifications to forage, invasion of undesirable plants, and increased exposure to parasites. This raises concerns about the vulnerability of grazing livestock operations and confined livestock operations to projected changes in mid- (2050) and late- (2085) twenty-first century climate. Our objectives are to (1) describe the NGP’s exposure to temperature and precipitation trends, inter-annual variability, and extreme events; (2) evaluate the sensitivity of beef cattle production to direct and indirect effects imposed by these projected climatic changes; and (3) provide a typology of adaptation strategies to minimize adverse consequences of projected changes and maximize beneficial consequences. Agricultural managers have developed considerable adaptive capacity to contend with environmental and economic variability. However, projected climatic changes, especially the increased frequency and magnitude of weather extremes, will require even greater adaptive capacity to maintain viable production systems. Consequently, regional vulnerability to projected climatic changes will be determined not only by ecological responses but also by the adaptive capacity of individual managers. Adaptive capacity in the NGP will differ from other regions, in part because projections suggest some opportunities for increased livestock production. Adaptations in both grazing and confined beef cattle systems will require enhanced decision-making skills capable of integrating biophysical, social, and economic considerations. Social learning networks that support integration of experimental and experiential knowledge—such as lessons learned from early adopters and involvement with science-based organizations—can help enhance decision-making and climate adaptation planning. Many adaptations have already been implemented by a subset of producers in this region, providing opportunities for assessment, further development, and greater adoption. Context-specific decision-making can also be enhanced through science-management partnerships, which aim to build adaptive capacity that recognizes multiple production and conservation/environmental goals