Bonfires and barbecues:coalition governance and the politics of Quango reform

The use of arm's-length bodies to deliver certain services, to regulate certain sectors or to assume responsibility for particularly salient political issues is neither new in historical terms or a feature unique to the UK in comparative terms. What is particularly distinctive, however, is the Coalition Government's attempts since 2010 to reduce the number of ‘quangos’ while also strengthening the capacity of the core executive and sponsor departments to control and co-ordinate this dense and fragmented sphere of delegated governance. Drawing upon the findings of the first research project to analyse the current Public Bodies Reform Agenda, this article provides an account of the ‘filling-in’ of the ‘hollowing out’. It argues that when viewed through a historical lens, the Coalition Government has adopted a distinctive approach to ‘the quango problem’

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Breaking the Silence: South African Muslim Responses to HIV/AIDS and a Theology of Compassion

HIV/AIDS is not merely a disease, but an illness that is shaped by social, cultural, economic, and political circumstances. A variety of approaches to prevention and treatment have been implemented throughout the world, but in many cases have failed to stop the spread of the epidemic. In Africa, religious organizations play a significant role in providing health care infrastructure as well as material and human resources. Positive Muslims is an example of a religious organization that is grounded in a clear theological framework. In contrast to Muslim responses to HIV/AIDS in South Africa and other parts of the Muslim world, Positive Muslims emphasizes compassion and non-judgment in both discourse and practice. This theology of compassion has been strongly influenced by liberation theology developed during the anti-apartheid movement. Although aspects of religion are highly variable, and may also contribute to stigmatization of those living with HIV/AIDS, religious organizations may be ideally situated to intervene against stigma. A framework that deals with these theological challenges is therefore essential to effective compassionate religious responses. This thesis is an investigation of one particular organization, Positive Muslims, as an example of such a response

Exploring the Use of Peer Tutors in Introducing Software to Young Children

Two primary school children, acting as peer tutors were videotaped introducing the game, The Logical Journey of the Zoombinis, to classmates. This popular problem solving mathematical software immerses children in dynamic learning environments. The peer tutors were effective. Unlike traditional peer tutoring situations, the power of the computer to change the variables modified the role of the tutors. They became actively engaged in problem solving. We recommend peer tutoring as it benefits children, peer tutors and teachers. Management issues surrounding the use of computers in classrooms may also be reduced by allowing the teacher to become more of a facilitator

Metaphors as a Vehicle for Exploring Preservice Teachers' Perceptions of Mathematics

Many elementary preservice teachers begin our mathematics methods course anxious about learning and teaching mathematics. Students often approach us privately during the first week of class to talk about their past experiences. They explain that they dislike mathematics because they struggled in school or had poor mathematics teachers. Some express apprehension about the content of the course and ask questions such as, "Are we going to be doing much work with fractions or algebra?" Many of these students tell us that their anxiety began in elementary school. We often find that these anxious students are reluctant to participate in class, even though we model constructivist principles throughout the course by actively engaging the students in learning and encouraging oral and written discourse. Loewenberg Ball (1990, p. 12) states that "teachers, equipped with vivid images to guide their actions, are inclined to teach just as they were taught." Our challenge is to help preservice teachers confront their past experiences and anxieties about the teaching and learning of mathematics. If these are openly dealt with during their university education, fewer teachers may be content to teach just as they have been taught. To learn and to teach, one must have an awareness of leaving something behind while reaching toward something new (Greene 1995). This year, we tried a new approach to addressing mathematics anxiety issues. Our goal was to have students examine their past experiences as mathematics learners and begin to explore the impact of these experiences on their future teaching. This article describes the use of metaphors to explore perceptions of the learning and teaching of mathematics

Development of a quantitative fluorescence lateral flow immunoassay (LFIA) prototype for point-of-need detection of anti-Müllerian hormone

Objective: Anti-Müllerian Hormone (AMH) is a quantitative marker for ovarian reserve and is used to predict response during ovarian stimulation. Streamlining testing to the clinic or even to the physician's office would reduce inconvenience, turnaround time, patient stress and potentially also the total cost of testing, allowing for more frequent monitoring. In this paper, AMH is used as a model biomarker to describe the rational development and optimization of sensitive, quantitative, clinic-based rapid diagnostic tests. Design and Methods: We developed a one-step lateral-flow europium (III) chelate-based fluorescent immunoassay (LFIA) for the detection of AMH on a portable fluorescent reader, optimizing the capture/detection antibodies, running buffer, and reporter conjugates. Results: A panel of commercial calibrators was used to develop a standard curve to determine the analytical sensitivity (LOD = 0.41 ng/ml) and the analytical range (0.41–15.6 ng/ml) of the LFIA. Commercial controls were then tested to perform an initial evaluation of the prototype performance and showed a high degree of precision (Control I CV 2.18%; Control II CV 3.61%) and accuracy (Control I recovery 126%; Control II recovery 103%). Conclusions: This initial evaluation suggests that, in future clinical testing, the AMH LFIA will likely have the capability of distinguishing women with low ovarian reserve (6 ng/ml)

Expression and Characterization of Intein-Cyclized Trimer of <i>Staphylococcus aureus</i> Protein A Domain Z

Staphylococcus aureus protein A (SpA) is an IgG Fc-binding virulence factor that is widely used in antibody purification and as a scaffold to develop affinity molecules. A cyclized SpA Z domain could offer exopeptidase resistance, reduced chromatographic ligand leaching after single-site endopeptidase cleavage, and enhanced IgG binding properties by preorganization, potentially reducing conformational entropy loss upon binding. In this work, a Z domain trimer (Z3) was cyclized using protein intein splicing. Interactions of cyclic and linear Z3 with human IgG1 were characterized by differential scanning fluorimetry (DSF), surface plasmon resonance (SPR), and isothermal titration calorimetry (ITC). DSF showed a 5 ℃ increase in IgG1 melting temperature when bound by each Z3 variant. SPR showed the dissociation constants of linear and cyclized Z3 with IgG1 to be 2.9 nM and 3.3 nM, respectively. ITC gave association enthalpies for linear and cyclic Z3 with IgG1 of −33.0 kcal/mol and −32.7 kcal/mol, and −T∆S of association 21.2 kcal/mol and 21.6 kcal/mol, respectively. The compact cyclic Z3 protein contains 2 functional binding sites and exhibits carboxypeptidase Y-resistance. The results suggest cyclization as a potential approach toward more stable SpA-based affinity ligands, and this analysis may advance our understanding of protein engineering for ligand and drug development