Systematic overview of economic evaluations of health-related rehabilitation

Background: Health related rehabilitation is instrumental in improving functioning and promoting participation by people with disabilities. To make clinical and policy decisions about health-related rehabilitation, resource allocation and cost issues need to be considered. Objectives: To conduct an overview of systematic reviews (SRs) on economic evaluations of health-related rehabilitation. Methods: We searched multiple databases to identify relevant SRs of economic evaluations of health-related rehabilitation. Review quality was assessed by AMSTAR checklist. Results: We included 64 SRs, most of which included economic evaluations alongside randomised controlled trials (RCTs). The review quality was low to moderate (AMSTAR score 5-8) in 35, and high (score 9-11) in 29 of the included SRs. The included SRs addressed various health conditions, including spinal or other pain conditions (n=14), age-related problems (11), stroke (7), musculoskeletal disorders (6), heart diseases (4), pulmonary (3), mental health problems (3), and injury (3). Physiotherapy was the most commonly evaluated rehabilitation intervention in the included SRs (n=24). Other commonly evaluated interventions included multidisciplinary programmes (14); behavioural, educational or psychological interventions (11); home-based interventions (11); complementary therapy (6); self-management (6); and occupational therapy (4). Conclusions: Although the available evidence is often described as limited, inconsistent or inconclusive, some rehabilitation interventions were cost-effective or showed cost-saving in a variety of disability conditions. Available evidence comes predominantly from high income countries, therefore economic evaluations of health-related rehabilitation are urgently required in less resourced settings

Pentaborate(1-) Salts and a Tetraborate(2-) Salt Derived from C 2- or C 3-Linked Bis(alkylammonium) Dications:Synthesis, Characterization, and Structural (XRD) Studies.

The synthesis of a number of pentaborate(1-) salts from cations arising from N-substituted α,α-, α,β-, and α,-diaminoalkanes has been attempted in aqueous solution from B(OH)3 and the appropriate diammine in a 10:1 ratio. Despite relatively mild work-up conditions the pentaborate(1-) salts prepared were not always as anticipated and the following compounds were isolated in good yield: [Me2NH(CH2)2NHMe2][B5O6(OH)4]2 (1), [Et2NH(CH2)2NHEt2][B5O6(OH)4]2 (2), [Et2NH2][B5O6(OH)4] (3), [Me2NH2][B5O6(OH)4] (4), [Me2NH(CH2)3NHMe2][B5O6(OH)4]2 (5), [Et2NH(CH2)3NHEt2][B5O6(OH)4]2 (6), [Me3NCH2CH=CH2][B5O6(OH)4] (7), and [Me3N(CH2)3NMe3] [B5O6(OH)4]2.0.5H2O (8). The tetraborate(2-) salt, [Me3N(CH2)2NMe3][B4O5(OH)4].2B(OH)3 .2H2O (9) was obtained in moderate yield (41%) from a 3:1 reaction of B(OH)3 with [Me3N(CH2)2NMe3](OH)2. All compounds were characterized by spectroscopy (1H, 11B, 13C NMR and IR) and thermal gravimetric analysis (TGA). BET analysis on materials derived thermally from selected samples (1, 2, 6, 7) all had porosities of &lt; 1 m2/g, demonstrating that they were non-porous. Single-crystal XRD structures were obtained for 2, 3, 7, 8 and 9 and all contain extensive H-bonded polyborate lattices.</p

The emergence of heat and humidity too severe for human tolerance

Humans’ ability to efficiently shed heat has enabled us to range over every continent, but a wet-bulb temperature (TW) of 35°C marks our upper physiological limit, and much lower values have serious health and productivity impacts. Climate models project the first 35°C TW occurrences by the mid-21st century. However, a comprehensive evaluation of weather station data shows that some coastal subtropical locations have already reported a TW of 35°C and that extreme humid heat overall has more than doubled in frequency since 1979. Recent exceedances of 35°C in global maximum sea surface temperature provide further support for the validity of these dangerously high TW values. We find the most extreme humid heat is highly localized in both space and time and is correspondingly substantially underestimated in reanalysis products. Our findings thus underscore the serious challenge posed by humid heat that is more intense than previously reported and increasingly severe

Prehospital randomised assessment of a mechanical compression device in cardiac arrest (PaRAMeDIC) trial protocol

Background Survival after out-of-hospital cardiac arrest is closely linked to the quality of CPR, but in real life, resuscitation during pre-hospital care and ambulance transport is often suboptimal. Mechanical chest compression devices deliver consistent chest compressions, are not prone to fatigue and could potentially overcome some of the limitations of manual chest compression. However, there is no high-quality evidence that they improve clinical outcomes, or that they are cost effective. The Pre-hospital Randomised Assessment of a Mechanical Compression Device In Cardiac Arrest (PARAMEDIC) trial is a pragmatic cluster randomised study of the LUCAS-2 device in adult patients with non-traumatic out-of-hospital cardiac arrest. Methods The primary objective of this trial is to evaluate the effect of chest compression using LUCAS-2 on mortality at 30 days post out-of-hospital cardiac arrest, compared with manual chest compression. Secondary objectives of the study are to evaluate the effects of LUCAS-2 on survival to 12 months, cognitive and quality of life outcomes and cost-effectiveness. Methods: Ambulance service vehicles will be randomised to either manual compression (control) or LUCAS arms. Adult patients in out-of-hospital cardiac arrest, attended by a trial vehicle will be eligible for inclusion. Patients with traumatic cardiac arrest or who are pregnant will be excluded. The trial will recruit approximately 4000 patients from England, Wales and Scotland. A waiver of initial consent has been approved by the Research Ethics Committees. Consent will be sought from survivors for participation in the follow-up phase. Conclusion The trial will assess the clinical and cost effectiveness of the LUCAS-2 mechanical chest compression device. Trial Registration: The trial is registered on the International Standard Randomised Controlled Trial Number Registry (ISRCTN08233942)

Seasonal associations with light pollution trends for nocturnally migrating bird populations

This project was supported by The Leon Levy Foundation, The Wolf Creek Charitable Foundation, Lyda Hill Philanthropies, Amon G. Carter Foundation, National Aeronautics and Space Administration (80NSSC21K1143), and National Science Foundation (ABI sustaining DBI-1939187, GCR-2123405). Computing support was provided by the National Science Foundation (CNS-1059284 and CCF-1522054), and the Extreme Science and Engineering Discovery Environment (XSEDE; National Science Foundation, ACI-1548562) through allocation TG-DEB200010 run on Bridges at the Pittsburgh Supercomputing Center.Artificial light at night (ALAN) is adversely affecting natural systems worldwide, including the disorienting influence of ALAN on nocturnally migrating birds. Understanding how ALAN trends are developing across species' seasonal distributions will inform mitigation efforts, such as Lights Out programs. Here, we intersect ALAN annual trend estimates (1992-2013) with weekly estimates of relative abundance for 42 nocturnally migrating passerine bird species that breed in North America using observations from the eBird community science database for the combined period 2005-2020. We use a cluster analysis to identify species with similar weekly associations with ALAN trends. Our results identified three prominent clusters. Two contained species that occurred in northeastern and western North America during the breeding season. These species were associated with moderate ALAN levels and weak negative ALAN trends during the breeding season, and low ALAN levels and strong positive ALAN trends during the nonbreeding season. The difference between the breeding and nonbreeding seasons was lower for species that occurred in northern South America and greater for species that occurred in Central America during the nonbreeding season. For species that occurred in South America during the nonbreeding season, positive ALAN trends increased in strength as species migrated through Central America, especially in the spring. The third cluster contained species whose associations with positive ALAN trends remained high across the annual cycle, peaking during migration, especially in the spring. These species occurred in southeastern North America during the breeding season where they were associated with high ALAN levels, and in northern South America during the nonbreeding season where they were associated with low ALAN levels. Our findings suggest reversing ALAN trends in Central America during migration, especially in the spring, would benefit the most individuals of the greatest number of species. Reversing ALAN trends in southeastern North America during the breeding season and Central America during the nonbreeding season would generate the greatest benefits outside of migration.Publisher PDFPeer reviewe