Compression-tension Hysteretic Response of Cold-formed Steel C-stection Framing Members

This paper summarizes results from an experimental program designed to evaluate the tension-compression cyclic axial response of cold-formed steel C-section structural framing members. A new cyclic loading protocol for cold formed steel members is presented that defines the target axial displacement based on elastic buckling parameters. The protocol is used to explore the cyclic response of members experiencing local buckling, distortional buckling, and global buckling deformation. In the experiments, post-bucking energy dissipation was observed along with tension stretching and softening. The quantity of dissipated energy per cycle increased as cross-section and global slenderness decreased. Specimens experiencing local and distortional buckling dissipated more energy per half-wavelength than those experiencing global buckling

Getting evidence into policy: The need for deliberative strategies?

Getting evidence into policy is notoriously difficult. In this empirical case study we used document analysis and key informant interviews to explore the Australian federal government’s policy to implement a national bowel cancer screening programme, and the role of evidence in this policy. Our analysis revealed a range of institutional limitations at three levels of national government: within the health department, between government departments, and across the whole of government. These limitations were amplified by the pressures of the 2004 Australian federal election campaign. Traditional knowledge utilisation approaches, which rely principally on voluntarist strategies and focus on the individual, rather than the institutional level, are often insufficient to ensure evidence-based implementation. We propose three alternative models, based on deliberative strategies which have been shown to work in other settings: review of the evidence by a select group of experts whose independence is enshrined in legislation and whose imprimatur is required before policy can proceed; use of an advisory group of experts who consult widely with stakeholders and publish their review findings; or public discussion of the evidence by the media and community groups who act as more direct conduits to the decision-makers than researchers. Such deliberative models could help overcome the limitations on the use of evidence by embedding public review of evidence as the first step in the institutional decision-making processes. Highlights  Achieving evidence-based policy implementation is much harder than the rhetoric suggests.  Our case study showed traditional voluntarist approaches are not enough to overcome institutional filtering of the evidence.  Deliberative strategies open up the decision-making processes to greater expert and public scrutiny.  Our framework illustrates the potential for deliberative strategies to increase the relative weight of evidence in policy.  This article challenges researchers and policy-makers to acknowledge and address the institutional context of decision-making. Keywords: Australia; Health policy; Decision-making; Evidence; Knowledge utilisation; Bowel cancer; Screening; DeliberativeNHMR

Food Insecurity and Lived Experience of Students (FILES)

This paper provides evidence of the impact of Covid-19 on higher education students’ levels of food security and lived experiences. We surveyed higher education students, attending three universities in the UK and one in the USA, from 1st April to 30th April 2020, during the Covid-19 pandemic and after universities closed the majority of their buildings and ceased campus-based teaching. A total of 1,234 surveys were returned. The preliminary findings show that nearly 35% of students surveyed reported low or very low levels of food security and 41% of students were worried that their food would run out. We also found high levels of poor mental health and well-being; and mental health was associated with level of food security. The best predictor of the level of food security was students’ living arrangements during the Covid-19 pandemic. Students who were living on their own or with other students were more likely to experience low or very low levels of food insecurity compared to those students living with family members. The financial data collected show that many students relied on employment as their main source of income, and students are very worried about their current financial security. Furthermore, we found a relatively high reliance on ultra-processed foods as the main food type in students’ diets. The data from open-ended questions lend further support to the quantitative findings reported and provide further insight into students’ lived experiences. Finally, this paper concludes with key recommendations for policy makers, universities and student unions. (Submitted to the Education Select Committee Inquiry on The impact of COVID-19 on education and children’s services, 03 June 2020) FILES is a research collaboration involving a number of academics and student union officers from across England, Northern Ireland and the USA. The group’s key objective is to research food insecurity and lived experiences of students in Higher Education. Food insecurity has been explored in other populations, but no evidence has been presented that examines food insecurity and lived experiences of students in higher education following Covid-19 lockdown. Authors: Professor Greta Defeyter, Professor Paul Stretesky, Dr Mike Long, Dr Sinéad Furey, Dr Christian Reynolds, Dr Alyson Dodds, Dr Debbie Porteous, Dr Emily Mann, Mrs Christine Stretesky, Ms Anna Kemp, Mr James Fox, Mr Andrew McAnalle

UK Cochlear Implant Study Group. Criteria of candidature for unilateral cochlear implantation in post-lingually deafened adults II: Cost-effectiveness analysis.

Objectives: The objectives of this study were to estimate the cost-effectiveness of unilateral cochlear implantation for postlingually deafened adults; to study the impact on cost-effectiveness of relaxing criteria of candidacy to include patients who benefit from acoustic hearing aids; and to study the further impact of age at implantation and duration of profound deafness before implantation. Design: This prospective cohort study was carried out in 13 hospitals with four groups of severely to profoundly hearing-impaired subjects distinguished by their preoperative ability to identify words in prerecorded sentences when aided acoustically. The groups represent a progressive relaxation of criteria of candidacy: Group I (N = 134) scored 0% correct without lipreading and did not improve their lipreading score significantly when aided; group II (N = 93) scored 0% without lipreading but did improve their lipreading score significantly when aided; group III (N = 53) scored 0% without lipreading when the ear to be given an implant was aided but between 1% and ~50% when the other ear was aided; and group IV (N = 31) scored between 1% and ~50% without lipreading when the ear to be given an implant was aided. Lifetime costs to the UK National Health Service of providing and maintaining a cochlear implant were estimated for each subject. The gain in health utility from cochlear implantation was estimated with the Mark III Health Utilities Index and was combined with life expectancy to estimate the number of quality-adjusted life-years (QALYs) that would be gained from cochlear implantation. Cost/QALY ratios were calculated by means of the Net Benefit technique and were compared with an upper limit of acceptability of [Euro sign]50,000/QALY. Results: Averaged over the whole cohort, the cost of gaining a QALY was [Euro sign]27,142 (95% confidence interval, [Euro sign]24,532 to [Euro sign]30,323); 203 of 311 (67%) of the cohort displayed cost/QALY ratios more favorable than [Euro sign]50,000/QALY. The average cost of gaining a QALY increased from group I ([Euro sign]24,032) to groups II ([Euro sign]27,062) and IV ([Euro sign]27,092) to group III ([Euro sign]39,009). Cost/QALY varied with age at implantation from [Euro sign]19,223 for subjects who were younger than 30 yr of age to [Euro sign]45,411 for subjects who were older than 70 yr of age. Cost/QALY was unacceptable because of minimal gain in health utility for the subset of groups I and II, who were given implants in ears that had been profoundly deaf for more then 40 yr and for the subset of groups III and IV, who were given implants in ears that had been profoundly deaf for more than 30 yr. Conclusions: Cochlear implantation was a cost-effective intervention for the majority of subjects, including the group given implants when older than 70 yr of age. Relaxation of criteria of candidacy for cochlear implantation reduces cost-effectiveness. Prioritization of the provision of cochlear implantation should take duration of profound deafness in the ear to be given an implant into account, as well as preoperative word recognition performance

Criteria of candidacy for unilateral cochlear implantation in postlingually deafened adults III: Prospective evaluation of an actuarial approach to defining a criterion

Objective: Outcomes from unilateral cochlear implantation in postlingually deafened adults are variable and difficult to predict precisely from data gathered before surgery. The objective was to derive and validate a method for specifying criteria of candidacy for implantation that takes this variability into account. Design: Accuracy of identifying words in prerecorded sentences without lipreading was measured in 480 users of unilateral multichannel cochlear implants. These patients had all scored zero before surgery on prerecorded open-set tests of word recognition in sentences with acoustic hearing aids. Statistical models were derived that calculated the odds that a patient would score higher with an implant than a criterion score, given knowledge of the duration of profound deafness in the implanted ear. The accuracy of the models was evaluated prospectively with two new groups of patients who scored between 1% and ~50% correct before surgery in one or both ears with acoustic hearing aids. Group I (N = 53) was implanted in an ear that scored zero. Group II (N = 31) was implanted in an ear that scored above zero. Benefits from implantation, measured as changes in word recognition performance and in health utility, were compared with the odds calculated by the statistical models. Results: The preferred model was based on data from 376 subjects. It made accurate predictions of the proportion of patients in group I, and, disregarding minor exceptions, accurate predictions of the proportion of patients in group II, who improved on their preoperative word recognition score. Benefit from implantation was low for patients implanted with odds less favorable than 4:1 (4 chances out of 5). Conclusions: Adoption of odds of 4:1 as the criterion of candidacy for unilateral cochlear implantation would be likely to maintain acceptable benefit and cost-effectiveness while being explicit and informative for patients, clinicians, and commissioners of health care

Self-reported benefits from successive bilateral cochlear implantation in post-lingually deafened adults: randomised controlled trial. Beneficios auto-reportados en la implantación coclear bilateral consecutiva en adultos ensordecidos postlingüísticos: prueba aleatoria controlada

Adult users of unilateral Nucleus CI24 cochlear implants with the SPEAK processing strategy were randomised either to receive a second identical implant in the contralateral ear immediately, or to wait 12 months while they acted as controls for late-emerging benefits of the first implant. Twenty four subjects, twelve from each group, completed the study. Receipt of a second implant led to improvements in self-reported abilities in spatial hearing, quality of hearing, and hearing for speech, but to generally non-significant changes in measures of quality of life. Multivariate analyses showed that positive changes in quality of life were associated with improvements in hearing, but were offset by negative changes associated with worsening tinnitus. Even in a best-case scenario, in which no worsening of tinnitus was assumed to occur, the gain in quality of life was too small to achieve an acceptable cost-effectiveness ratio. The most promising strategies for improving the cost-effectiveness of bilateral implantation are to increase effectiveness through enhanced signal processing in binaural processors, and to reduce the cost of implant hardware

Criteria of candidacy for unilateral cochlear implantation in postlingually deafened adults I: Theory and measures of effectiveness

Objectives: The objectives of this study were to distinguish the equivalent-effectiveness, health-economic, and actuarial approaches to specifying criteria of candidacy for medical interventions; to apply the equivalent-effectiveness approach to unilateral cochlear implantation for postlingually deafened adults; and to determine whether the criterion should take age at implantation and duration of profound deafness into account. Design: The study was designed as a prospective cohort study in 13 hospitals with four groups of severely-profoundly hearing-impaired subjects distinguished by their preoperative ability to identify words in sentences when aided acoustically. The groups represent a progressive relaxation of criteria of candidacy: Group I (N = 134) scored 0% correct without lipreading and did not improve their lipreading score significantly when aided; group II (N = 93) scored 0% without lipreading but did improve their lipreading score significantly when aided; group III (N = 53) scored 0% without lipreading when the to-be-implanted ear was aided but between 1% and ~50% when the other ear was aided. Group IV (N = 31) scored between 1% and ~50% without lipreading when the to-be-implanted ear was aided. Measures of speech intelligibility, health utility, and otologically relevant quality of life were obtained before surgery and 9 mo after surgery from each subject. Measures of effectiveness were calculated as the difference between 9-mo and preoperative scores. Results: Effectiveness differed only slightly between groups. Effectiveness was not strongly associated with age at the time of implantation. Greater effectiveness was associated with implantation in the ear with the shorter duration of profound deafness. Cochlear implantation was least effective when the preoperative audiological status of the better-hearing ear was good and the duration of profound deafness of the implanted ear was long. As a result, effectiveness was not significant for the subsets of groups III and IV, who were given implants in ears that had been profoundly deaf for more than 30 yr. Conclusions: The effectiveness of cochlear implantation differs little between groups of candidates who score zero with acoustic hearing aids before surgery and groups who score up to ~50% correct, thereby justifying a relaxation of the criterion of candidacy to embrace some members of the latter groups. The criterion should be based not only on preoperative speech intelligibility but also on duration of profound deafness in the to-be-implanted ear