Vickrey Auctions for Irregular Distributions

The classic result of Bulow and Klemperer \cite{BK96} says that in a single-item auction recruiting one more bidder and running the Vickrey auction achieves a higher revenue than the optimal auction's revenue on the original set of bidders, when values are drawn i.i.d. from a regular distribution. We give a version of Bulow and Klemperer's result in settings where bidders' values are drawn from non-i.i.d. irregular distributions. We do this by modeling irregular distributions as some convex combination of regular distributions. The regular distributions that constitute the irregular distribution correspond to different population groups in the bidder population. Drawing a bidder from this collection of population groups is equivalent to drawing from some convex combination of these regular distributions. We show that recruiting one extra bidder from each underlying population group and running the Vickrey auction gives at least half of the optimal auction's revenue on the original set of bidders

Effect of acetylcholinesterase (AChE) point-of-care testing in OP poisoning on knowledge, attitudes and practices of treating physicians in Sri Lanka

BACKGROUND: Toxicology and Emergency medicine textbooks recommend measurement of acetylcholinesterase (AChE) in all symptomatic cases of organophosphorus (OP) poisoning but laboratory facilities are limited in rural Asia. The accuracy of point-of-care (POC) acetylcholinesterase testing has been demonstrated but it remains to be shown whether results would be valued by clinicians. This study aims to assess the effect of seeing AChE POC test results on the knowledge, attitudes and practices of doctors who frequently manage OP poisoning. METHODS: We surveyed 23 clinicians, who had different levels of exposure to seeing AChE levels in OP poisoned patients, on a) knowledge of OP poisoning and biomarker interpretation, b) attitudes towards AChE in guiding poison management, oxime therapy and discharge decisions, and c) practices of ordering AChE in poisoning scenarios. RESULTS: An overall high proportion of doctors valued the test (68-89%). However, we paradoxically found that doctors who were more experienced in seeing AChE results valued the test less. Lower proportions valued the test in guidance of acute poisoning management (50%, p = 0.015) and guidance of oxime therapy (25%, p = 0.008), and it was apparent it would not generally be used to facilitate early discharge. The highest proportion of respondents valued it on admission (p < 0.001). A lack of correlation of test results with the clinical picture, and a perception that the test was a waste of money when compared to clinical observation alone were also comments raised by some of the respondents. Greater experience with seeing AChE test results was associated with increased knowledge (p = 0.034). However, a disproportionate lack of knowledge on interpretation of biomarkers and the pharmacology of oxime therapy (12-50%) was noted, when compared with knowledge on the mechanism of OP poisoning and management (78-90%). CONCLUSIONS: Our findings suggest an AChE POC test may not be valued by rural doctors. The practical use of AChE in OP poisoning management is complex, and a poor understanding of how to interpret test results may have affected its perceived utility. Future research should evaluate the impact of providing both AChE and training in interpretation on clinicians’ attitudes and practice.This research was funded by an international collaborative research grant from the Wellcome Trust/National Health and Medical Research Council, Australia (GR071669)

The Effectiveness of a 'Train the Trainer' Model of Resuscitation Education for Rural Peripheral Hospital Doctors in Sri Lanka

BACKGROUND Sri Lankan rural doctors based in isolated peripheral hospitals routinely resuscitate critically ill patients but have difficulty accessing training. We tested a train-the-trainer model that could be utilised in isolated rural hospitals. METHODS Eight selected rural hospital non-specialist doctors attended a 2-day instructor course. These "trained trainers" educated their colleagues in advanced cardiac life support at peripheral hospital workshops and we tested their students in resuscitation knowledge and skills pre and post training, and at 6- and 12-weeks. Knowledge was assessed through 30 multiple choice questions (MCQ), and resuscitation skills were assessed by performance in a video recorded simulated scenario of a cardiac arrest using a Resuci Anne Skill Trainer mannequin. RESULTS/DISCUSSION/CONCLUSION Fifty seven doctors were trained. Pre and post training assessment was possible in 51 participants, and 6-week and 12-week follow up was possible for 43, and 38 participants respectively. Mean MCQ scores significantly improved over time (p<0.001), and a significant improvement was noted in "average ventilation volume", "compression count", and "compressions with no error", "adequate depth", "average depth", and "compression rate" (p<0.01). The proportion of participants with compression depth ≥40mm increased post intervention (p<0.05) and at 12-week follow up (p<0.05), and proportion of ventilation volumes between 400-1000mls increased post intervention (p<0.001). A significant increase in the proportion of participants who "checked for responsiveness", "opened the airway", "performed a breathing check", who used the "correct compression ratio", and who used an "appropriate facemask technique" was also noted (p<0.001). A train-the-trainer model of resuscitation education was effective in improving resuscitation knowledge and skills in Sri Lankan rural peripheral hospital doctors. Improvement was sustained to 12 weeks for most components of resuscitation knowledge and skills. Further research is needed to identify which components of training are most effective in leading to sustained improvement in resuscitation.This research was funded by an international collaborative research Wellcome Trust/National Health and Medical Research Council grant GR071669. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

The rigid syntomic ring spectrum

The aim of this paper is to show that Besser syntomic cohomology is representable by a rational ring spectrum in the motivic homotopical sense. In fact, extending previous constructions, we exhibit a simple representability criterion and we apply it to several cohomologies in order to get our central result. This theorem gives new results for syntomic cohomology such as h-descent and the compatibility of cycle classes with Gysin morphisms. Along the way, we prove that motivic ring spectra induces a complete Bloch-Ogus cohomological formalism and even more. Finally, following a general motivic homotopical philosophy, we exhibit a natural notion of syntomic coefficients.Comment: Final version to appear in the Journal de l'institut des Math\'ematiques de Jussieu. Many typos have been corrected and the exposition has been improved according to the suggestions of the referees: we thank them a lot

Physiotherapist-directed rehabilitation exercises in the outpatient or home setting improve strength, gait speed and cadence after elective total hip replacement: a systematic review

QuestionIn people who have been discharged from hospital after a total hip replacement, do rehabilitation exercises directed by a physiotherapist improve strength, gait, function and quality of life? Are these exercises as effective in an unsupervised home-based setting as they are in a supervised outpatient setting?DesignSystematic review with meta-analysis of randomised trials.ParticipantsAdult patients after elective total hip replacement.InterventionPhysiotherapist-directed rehabilitation exercises after discharge from hospital following total hip replacement.Outcome measuresHip and knee strength, gait parameters, functional measures, and quality of life.ResultsFive studies comprising 234 participants were included in the review. Sufficient data for meta-analysis were only obtained for hip and knee strength, gait speed and cadence. Physiotherapy rehabilitation improved hip abductor strength by a mean of 16Nm (95% CI 10 to 22), gait speed by 6 m/min (95% CI 1 to 11) and cadence by 20 steps/min (95% CI 8 to 32). Favourable but non-significant improvements in strength were noted for other muscle groups at the hip and knee. Function and quality of life could not be meta-analysed due to insufficient data and heterogeneity of measures, but functional measures tended to favour the physiotherapy rehabilitation group. Most outcomes were similar between outpatient and home-based exercise programs.ConclusionPhysiotherapy rehabilitation improves hip abductor strength, gait speed and cadence in people who have been discharged from hospital after total hip replacement. Physiotherapist-directed rehabilitation exercises appear to be similarly effective whether they are performed unsupervised at home or supervised by a physiotherapist in an outpatient setting

The Baum-Connes Conjecture via Localisation of Categories

We redefine the Baum-Connes assembly map using simplicial approximation in the equivariant Kasparov category. This new interpretation is ideal for studying functorial properties and gives analogues of the assembly maps for all equivariant homology theories, not just for the K-theory of the crossed product. We extend many of the known techniques for proving the Baum-Connes conjecture to this more general setting

Evidence for cervical muscle morphometric changes on magnetic resonance images after whiplash: A systematic review and meta-analysis

INTRODUCTION Morphometric changes to cervical musculature in whiplash associated disorder have been reported in several studies with varying results. However, the evidence is not clear because only a limited number of cohorts have been studied and one cohort has been reported in multiple publications. The aim of this study was to assess the evidence for cervical muscle morphometric changes on magnetic resonance (MR) images after whiplash using a systematic review with meta-analysis. MATERIALS AND METHODS PubMed, MEDLINE and Cochrane Library were searched without language restriction using combinations of the MeSH terms "muscles", "whiplash injuries", and "magnetic resonance imaging". Studies of acute and chronic whiplash were included if they compared whiplash and control cervical spine muscle morphometry measurements from MR images. The search identified 380 studies. After screening, eight studies describing five cohorts (one acute, three chronic, one both acute and chronic) met the inclusion criteria. Participant characteristics and outcome measures were extracted using a standard extraction format. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale. Muscle cross-sectional area (CSA) and fat infiltrate (MFI) for acute and chronic whiplash cohorts were compared using mean difference and 95% confidence intervals. Meta-analysis models were created when data from more than two eligible cohorts was available, using inverse-variance random-effects models (RevMan5 version 5.3.5). RESULTS Quality assessment was uniformly good but only two studies blinded the assessor. Analysis of the acute cohorts revealed no consensus with respect to CSA. MFI was not measured in the acute cohorts. Analysis of the chronic cohorts revealed CSA is probably increased in some muscles after whiplash but there is insufficient evidence to confirm whether MFI is also increased. Because the available data were limited, meta-analyses of only multifidus were performed. In chronic whiplash multifidus CSA was significantly increased at C5 (Z = 3.51, p < 0.01) and C6 (Z = 2.66, p < 0.01); and MFI was significantly increased at C7 only (Z = 2.52, p < 0.01) but the heterogeneity was unacceptably high (I2 = 83%). CONCLUSIONS The strength of the evidence for cervical muscle morphometric changes on MR images after whiplash is inconsistent for CSA and MFI. Future study designs should be standardised with quantification of three-dimensional muscle morphometry

Cohomological descent theory for a morphism of stacks and for equivariant derived categories

In the paper we answer the following question: for a morphism of varieties (or, more generally, stacks), when the derived category of the base can be recovered from the derived category of the covering variety by means of descent theory? As a corollary, we show that for an action of a reductive group on a scheme, the derived category of equivariant sheaves is equivalent to the category of objects, equipped with an action of the group, in the ordinary derived category.Comment: 28 page

Gorenstein homological algebra and universal coefficient theorems

We study criteria for a ring—or more generally, for a small category—to be Gorenstein and for a module over it to be of finite projective dimension. The goal is to unify the universal coefficient theorems found in the literature and to develop machinery for proving new ones. Among the universal coefficient theorems covered by our methods we find, besides all the classic examples, several exotic examples arising from the KK-theory of C*-algebras and also Neeman’s Brown–Adams representability theorem for compactly generated categories

Development and validation of a VISA tendinopathy questionnaire for greater trochanteric pain syndrome, the VISA-G

BACKGROUND Greater trochanteric pain syndrome (GTPS) is common, resulting in significant pain and disability. There is no condition specific outcome score to evaluate the degree of severity of disability associated with GTPS in patients with this condition. OBJECTIVE To develop a reliable and valid outcome measurement capable of evaluating the severity of disability associated with GTPS. METHODS A phenomenological framework using in-depth semi structured interviews of patients and medical experts, and focus groups of physiotherapists was used in the item generation. Item and format clarification was undertaken via piloting. Multivariate analysis provided the basis for item reduction. The resultant VISA-G was tested for reliability with the inter class co-efficient (ICC), internal consistency (Cronbach's Alpha), and construct validity (correlation co-efficient) on 52 naïve participants with GTPS and 31 asymptomatic participants. RESULTS The resultant outcome measurement tool is consistent in style with existing tendinopathy outcome measurement tools, namely the suite of VISA scores. The VISA-G was found to be have a test-retest reliability of ICC2,1 (95% CI) of 0.827 (0.638-0.923). Internal consistency was high with a Cronbach's Alpha of 0.809. Construct validity was demonstrated: the VISA-G measures different constructs than tools previously used in assessing GTPS, the Harris Hip Score and the Oswestry Disability Index (Spearman Rho:0.020 and 0.0205 respectively). The VISA-G did not demonstrate any floor or ceiling effect in symptomatic participants. CONCLUSION The VISA-G is a reliable and valid score for measuring the severity of disability associated GTPS.The study was funded through the Australian National University, Monash University and LaTrobe University. Prof Cook was supported by the Australian Centre for Research into Sports Injury and its Prevention, which is one of the International Research Centres for Prevention of Injury and Protection of Athlete Health supported by the International Olympic Committee (IOC). Prof Cook is a NHMRC practitioner fellow (ID 1058493)