Choosing among residential options: Results of a vignette experiment

Older people who experience declining health are often faced with difficult decisions about possible residential relocation. The research aim was to determine how five distinct dimensions-functional status, features of current housing, social networks, features of retirement communities, and financial considerations-affect decisions to relocate to a retirement community. A vignette experiment with a factorial design was conducted involving both older people and adult children who were concerned with an aging parent. Use of the Internet for administration of the experiment made it possible to deliver information to research participants through video clips. Research participants were influenced by each of the dimensions; however, functional status of the vignette persons had the greatest impact, and financial considerations the least. Adult children were more likely to recommend moves than were older people. The research is suggestive of the potential for use of vignette experiments for a fuller understanding of relocation decisions

Using the internet to administer more realistic vignette experiments

This article illustrates an innovative method of administering stated choice studies (or vignette experiments) using computers and the Internet. The use of video clips to deliver information to research participants makes vignettes more realistic, helps to engage interest of research participants, and can reduce framing effects. The method also provides research participants with interactive options before making judgments. A study to determine the views of older people regarding residential options is used to illustrate the method. Even older people with limited experience in using computers participated successfully. The study findings showed that research participants responded both to the audiovisual characteristics of vignette persons and to the variables in the vignette structure

Scale-invariance in expanding and contracting universes from two-field models

We study cosmological perturbations produced by the most general two-derivative actions involving two scalar fields, coupled to Einstein gravity, with an arbitrary field space metric, that admit scaling solutions. For contracting universes, we show that scale-invariant adiabatic perturbations can be produced continuously as modes leave the horizon for any equation of state parameter $w \ge 0$. The corresponding background solutions are unstable, which we argue is a universal feature of contracting models that yield scale-invariant spectra. For expanding universes, we find that nearly scale-invariant adiabatic perturbation spectra can only be produced for $w \approx -1$, and that the corresponding scaling solutions are attractors. The presence of a nontrivial metric on field space is a crucial ingredient in our results.Comment: 23 pages, oversight in perturbations calculation corrected, conclusions for expanding models modifie

Systematic review and metaanalysis comparing the bias and accuracy of the modification of diet in renal disease and chronic kidney disease epidemiology collaboration equations in community-based population

BACKGROUND The majority of patients with chronic kidney disease are diagnosed and monitored in primary care. Glomerular filtration rate (GFR) is a key marker of renal function, but direct measurement is invasive; in routine practice, equations are used for estimated GFR (eGFR) from serum creatinine. We systematically assessed bias and accuracy of commonly used eGFR equations in populations relevant to primary care. CONTENT MEDLINE, EMBASE, and the Cochrane Library were searched for studies comparing measured GFR (mGFR) with eGFR in adult populations comparable to primary care and reporting both the Modification of Diet in Renal Disease (MDRD) and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations based on standardized creatinine measurements. We pooled data on mean bias (difference between eGFR and mGFR) and on mean accuracy (proportion of eGFR within 30% of mGFR) using a random-effects inverse-variance weighted metaanalysis. We included 48 studies of 26875 patients that reported data on bias and/or accuracy. Metaanalysis of within-study comparisons in which both formulae were tested on the same patient cohorts using isotope dilution-mass spectrometry-traceable creatinine showed a lower mean bias in eGFR using CKD-EPI of 2.2 mL/min/1.73 m2 (95% CI, 1.1–3.2; 30 studies; I2 = 74.4%) and a higher mean accuracy of CKD-EPI of 2.7% (1.6–3.8; 47 studies; I2 = 55.5%). Metaregression showed that in both equations bias and accuracy favored the CKD-EPI equation at higher mGFR values. SUMMARY Both equations underestimated mGFR, but CKD-EPI gave more accurate estimates of GFR

Joint Strength Optimization and Damping Assessment of NiTi-Polymer Matrix Hybrid Composites

Approaches to optimize the adhesive joint strength between shape memory alloy ribbons and carbon fiber-reinforced epoxy composites were investigated for potential use as either an actuating structure or a dampening composite for structural applications. The interfacial bond strength between nickel-titanium (NiTi) and a polymer matrix composite (PMC) was measured by double lap shear testing as a function of NiTi surface treatment and adhesive material. The effect of NiTi surface treatment on damping was investigated using dynamic mechanical analysis. Lap shear data show that treating the surfaces of NiTi ribbons by light sandblasting and primer application increased the interfacial bond strength by 20 percent over the baseline composite structure. Lap shear data also reveal that out of three different film adhesives investigated, samples bonded with AF 191U and Hysol 9696U display the highest adhesive joint strengths. Optical microscopy reveals that most samples failed by either cohesive failure within the adhesive or by adhesive failure at either the adhesive/PMC or NiTi/adhesive interface. Adhering NiTi to the PMC did not appear to negatively impact damping performance; however, a more thorough examination into NiTi's role on vibration damping should be investigated

Restricted access to the NHS during the COVID-19 pandemic : is it time to move away from the rationed clinical response?

Recently a Lancet Commission examined the future prospects of the NHS in the wake of COVID-19. The report cites poor healthcare capacity and chronic staff shortages as key contributing factors to the UK’s inadequate pandemic response. Notable strengths included universal access, the goodwill of staff, and the ability to generate innovative solutions - qualities that are likely to have averted an even deeper national crisis [1]. The prosperity of the NHS is intrinsically connected to the prosperity of the nation. Access to healthcare influences morbidity, mortality, economic activity, and whether or not social restrictions are necessary [2,3]. Public health measures such as timely implementation of social distancing are also important to limit mortality, but going forward it is the capacity to respond in a clinically effective and decisive manner that is vital to diminish the threat associated with the virus [4]. The importance of examining the national clinical response to SARS-CoV-2 cannot be overstated. Arguably the greatest mistake of this pandemic would be failing to prepare for the next. There are also the looming unknowns of SARS-CoV-2 variants [5], the higher rates of Long COVID following more severe disease [6], and the increased healthcare demands associated with delayed presentation of COVID-19 pneumonia [7-11]. Improving the tolerance of society to background levels of SARS-CoV-2 will require an improved clinical response. With this in mind, we examine one aspect of the UK’s clinical response that remains in place today: restricted access to healthcare