What Contractors Wish We Knew

From design to construction, utility coordination is a hot topic. The coordination in design is a vital part of the coordination efforts, since design affects construction. This presentation will focus on the Contractor’s perspective of utility coordination and how designers can better coordinate with utilities in design to positively impact construction

Biomolecular Evidence of Early Human Occupation of a High-Altitude Site in Western Central Asia During the Holocene

Reconstructions of early human occupation of high-altitude sites in Central Asia and possible migration routes during the Holocene are limited due to restricted archeological sample material. Consequently, there is a growing interest in alternative approaches to investigate past anthropogenic activity in this area. In this study, fecal biomarkers preserved in lake sediments from Lake Chatyr Kol (Tian Shan, Kyrgyzstan) were analyzed to reconstruct the local presence of humans and pastoral animals in this low-human-impact area in the past. Spanning the last ∼11,700 years, this high-altitude site (∼3,500 m above sea level) provides a continuous record of human occupancy in Western Central Asia. An early increase of human presence in the area during the mid-Holocene is marked by a sharp peak of the human fecal sterol coprostanol and its epimer epicoprostanol in the sediments. An associated increase in 5β-stigmastanol, a fecal biomarker deriving from herbivores indicates a human occupancy that most probably largely depended upon livestock. However, sterol profiles show that grazing animals had already occupied the catchment area of Lake Chatyr Kol before and also after a significant presence of humans. The biomarker evidence in this study demonstrates an early presence of humans in a high-altitude site in Central Asia at ∼5,900–4,000 a BP. Dry environmental conditions during this period likely made high altitude regions more accessible. Moreover, our results help to understand human migration in Western Central Asia during the early and mid-Holocene as part of a prehistoric Silk Road territory

Perceived efficacy of herbal remedies by users accessing primary healthcare in Trinidad

BACKGROUND: The increasing global popularity of herbal remedies requires further investigation to determine the probable factors driving this burgeoning phenomenon. We propose that the users' perception of efficacy is an important factor and assessed the perceived efficacy of herbal remedies by users accessing primary health facilities throughout Trinidad. Additionally, we determined how these users rated herbal remedies compared to conventional allopathic medicines as being less, equally or more efficacious. METHODS: A descriptive cross-sectional study was undertaken at 16 randomly selected primary healthcare facilities throughout Trinidad during June-August 2005. A de novo, pilot-tested questionnaire was interviewer-administered to confirmed herbal users (previous or current). Stepwise multiple regression analysis was done to determine the influence of predictor variables on perceived efficacy and comparative efficacy with conventional medicines. RESULTS: 265 herbal users entered the study and cited over 100 herbs for the promotion of health/wellness and the management of specific health concerns. Garlic was the most popular herb (in 48.3% of the sample) and was used for the common cold, cough, fever, as 'blood cleansers' and carminatives. It was also used in 20% of hypertension patients. 230 users (86.8%) indicated that herbs were efficacious and perceived that they had equal or greater efficacy than conventional allopathic medicines. Gender, ethnicity, income and years of formal education did not influence patients' perception of herb efficacy; however, age did (p = 0.036). Concomitant use of herbs and allopathic medicines was relatively high at 30%; and most users did not inform their attending physician. CONCLUSION: Most users perceived that herbs were efficacious, and in some instances, more efficacious than conventional medicines. We suggest that this perception may be a major contributing factor influencing the sustained and increasing popularity of herbs. Evidence-based research in the form of randomized controlled clinical trials should direct the proper use of herbs to validate (or otherwise) efficacy and determine safety. In the Caribbean, most indigenous herbs are not well investigated and this points to the urgent need for biomedical investigations to assess the safety profile and efficacy of our popular medicinal herbs

Antibiotic research and development: business as usual?

This article contends that poor economic incentives are an important reason for the lack of new drugs and explains how the DRIVE-AB intends to change the landscape by harnessing the expertise, motivation and diversity of its partner

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

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

Estimation of an indicator of the representativeness of survey response

Nonresponse is a major source of estimation error in sample surveys. The response rate is widely used to measure the quality of a sample survey associated with nonresponse. It is, however, inadequate as an indicator because of its limited relation with nonresponse bias. Schouten et al. (2009) proposed an alternative indicator, which they refer to as an indicator of representativeness or R-indicator. This indicator measures the variability of the probabilities of response for units in the population. This paper develops methods for the estimation of this R-indicator assuming that values of a set of auxiliary variables are observed for both respondents and nonrespondents. In particular, we consider the bias of point estimators proposed by Schouten et al. (2009) and propose bias adjustments and linearization variance estimators. The proposed procedures are evaluated in a simulation study and their use is illustrated in an application to two business surveys at Statistics Netherlands

Indicators for monitoring and improving representativeness of response

The increasing efforts and costs required to achieve survey response have led to a stronger focus on survey data collection monitoring by means of paradata and to the rise of adaptive and responsive survey designs. Indicators that support data collection monitoring, targeting and prioritizing in such designs are not yet available. Subgroup response rates come closest but do not account for subgroup size, are univariate and are not available at the variable level.We present and investigate indicators that support data collection monitoring and effective decisions in adaptive and responsive survey designs. As they are natural extensions of R-indicators, they are termed partial R-indicators. We make a distinction between unconditional and conditional partial R-indicators. Conditional partial R-indicators provide a multivariate assessment of the impact of register data and paradata variables on representativeness of response.We propose methods for estimating partial indicators and investigate their sampling properties in a simulation study.. The use of partial indicators for monitoring and targeting nonresponse is illustrated for both a a household and business survey. Guidelines for the use of the indicators are given.<br/

Estimation of an indicator of the representativeness of survey response

Nonresponse is a major source of estimation error in sample surveys. The response rate is widely used to measure survey quality associated with nonresponse, but is inadequate as an indicator because of its limited relation with nonresponse bias. Schouten et al. (2009) proposed an alternative indicator, which they refer to as an indicator of representativeness or R-indicator. This indicator measures the variability of the probabilities of response for units in the population. This paper develops methods for the estimation of this R-indicator assuming that values of a set of auxiliary variables are observed for both respondents and nonrespondents. We propose bias adjustments to the point estimator proposed by Schouten et al. (2009) and demonstrate the effectiveness of this adjustment in a simulation study where it is shown that the method is valid, especially for smaller sample sizes. We also propose linearization variance estimators which avoid the need for computer-intensive replication methods and show good coverage in the simulation study even when models are not fully specified. The use of the proposed procedures is also illustrated in an application to two business surveys at Statistics Netherlands