Thinking territory historically.

BACKGROUND: While the randomised controlled trial (RCT) is generally regarded as the design of choice for assessing the effects of health care, within the social sciences there is considerable debate about the relative suitability of RCTs and non-randomised studies (NRSs) for evaluating public policy interventions. // OBJECTIVES: To determine whether RCTs lead to the same effect size and variance as NRSs of similar policy interventions; and whether these findings can be explained by other factors associated with the interventions or their evaluation. // METHODS: Analyses of methodological studies, empirical reviews, and individual health and social services studies investigated the relationship between randomisation and effect size of policy interventions by: 1) Comparing controlled trials that are identical in all respects other than the use of randomisation by 'breaking' the randomisation in a trial to create non-randomised trials (re-sampling studies). 2) Comparing randomised and non-randomised arms of controlled trials mounted simultaneously in the field (replication studies). 3) Comparing similar controlled trials drawn from systematic reviews that include both randomised and non-randomised studies (structured narrative reviews and sensitivity analyses within meta-analyses). 4) Investigating associations between randomisation and effect size using a pool of more diverse RCTs and NRSs within broadly similar areas (meta-epidemiology). // RESULTS: Prior methodological reviews and meta-analyses of existing reviews comparing effects from RCTs and nRCTs suggested that effect sizes from RCTs and nRCTs may indeed differ in some circumstances and that these differences may well be associated with factors confounded with design. Re-sampling studies offer no evidence that the absence of randomisation directly influences the effect size of policy interventions in a systematic way. No consistent explanations were found for randomisation being associated with changes in effect sizes of policy interventions in field trials

Teaching percutaneous renal biopsy using unfixed human cadavers

Background: Percutaneous renal biopsy (PRB) is an important diagnostic procedure. Despite advances in its safety profile there remains a small but significant risk of bleeding complications. Traditionally, operators train to perform PRB through tutor instruction and directly supervised PRB attempts on real patients. We describe an approach to teaching operators to perform PRB using cadaveric simulation. Methods: We devised a full day course hosted in the Clinical Anatomy Skills Centre, with places for nine candidates. Course faculty consisted of two Consultant Nephrologists, two Nephrology trainees experienced in PRB, and one Radiologist. Classroom instruction included discussion of PRB indications, risk minimisation, and management of complications. Two faculty members acted as models for the demonstration of kidney localisation using real-time ultrasound scanning. PRB was demonstrated using a cadaveric model, and candidates then practised PRB using each cadaver model. Results: Written candidate feedback was universally positive. Faculty considered the cadaveric model a realistic representation of live patients, while the use of multiple cadavers introduced anatomical variation. Conclusions: Our model facilitates safe simulation of a high risk procedure. This might reduce serious harm associated with PRB and improve patient safety, benefiting trainee operators and patients alike

Controls on the spatial distribution of oceanic <i>δ</i>¹³C_DIC

We describe the design and evaluation of a large ensemble of coupled climate–carbon cycle simulations with the Earth system model of intermediate complexity GENIE. This ensemble has been designed for application to a range of carbon cycle questions, including the causes of late- Quaternary fluctuations in atmospheric CO2. Here we evaluate the ensemble by applying it to a transient experiment over the recent industrial era (1858 to 2008 AD). We employ singular vector decomposition and principal component emulation to investigate the spatial modes of ensemble variability of oceanic dissolved inorganic carbon (DIC) δ13C, considering both the spun-up pre-industrial state and the transient change. These analyses allow us to separate the natural (preindustrial) and anthropogenic controls on the δ13CDIC distribution. We apply the same dimensionally reduced emulation techniques to consider the drivers of the spatial uncertainty in anthropogenic DIC. We show that the sources of uncertainty related to the uptake of anthropogenic δ13CDIC and DIC are quite distinct. Uncertainty in anthropogenic δ13C uptake is controlled by air–sea gas exchange, which explains 63% of modelled variance. This mode of variability is largely absent from the ensemble variability in CO2 uptake, which is rather driven by uncertainties in thermocline ventilation rates. Although the need to account for air–sea gas exchange is well known, these results suggest that, to leading order, uncertainties in the ocean uptake of anthropogenic 13C and CO2 are governed by very different processes. This illustrates the difficulties in reconstructing one from the other, and furthermore highlights the need for careful targeting of both δ13CDIC and DIC observations to better constrain the ocean sink of anthropogenic CO2

The Polyakov Loop and its Relation to Static Quark Potentials and Free Energies

It appears well accepted in the literature that the correlator of Polyakov loops in a finite temperature system decays with the "average" free energy of the static quark-antiquark system, and can be decomposed into singlet and adjoint (or octet for QCD) contributions. By fixing a gauge respecting the transfer matrix, attempts have been made to extract those contributions separately. In this paper we point out that the "average" and "adjoint" channels of Polyakov loop correlators are misconceptions. We show analytically that all channels receive contributions from singlet states only, and give a corrected definition of the singlet free energy. We verify this finding by simulations of the 3d SU(2) pure gauge theory in the zero temperature limit, which allows to cleanly extract the ground state exponents and the non-trivial matrix elements. The latter account for the difference between the channels observed in previous simulations.Comment: 14 pages, 3 figures, 1 table; note and reference adde

Texture mediated grain boundary network design in two dimensions

While materials design in the context of texture dependent properties is well developed, theoretical tools for microstructure design in the context of grain boundary sensitive properties have not yet been established. In the present work, we present an invertible relationship between texture and grain boundary network structure for the case of spatially uncorrelated two-dimensional textures. By exploiting this connection, we develop mathematical tools that permit the rigorous optimization of grain boundary network structure. Using a specific multi-objective materials design case study involving elastic, plastic and kinetic properties, we illustrate the utility of this texture mediated approach to grain boundary network design. We obtain a microstructure that minimizes grain boundary network diffusivity while simultaneously improving yield strength by an amount equal to half of the theoretically possible range. The theoretical tools developed here could complement experimental grain boundary engineering efforts to help accelerate the discovery of materials with improved performance.United States. Department of Energy. Office of Basic Energy Sciences (Grant DE-SC0008926

The Changing Context of American Seapower

The Expansion of Force. Among the more important of the new complexities confronting both analysis and policy are those surrounding the use of force. For almost 300 years prior to the end of World War II, the pursuit of security by nation-states has been the central dynamic of international politics, The correlative of this condition has been an expansion of the capacity of the nation-state to deploy and use military power. During the last 150 years of this expansionist phase 1 of the role of military power in international politics an important paradox emerged: the use of military power could result in enormous disorder but, under certain circumstances, order as well

The Evolution of International Order and the Future of the American Naval Presence Mission

Much attention has been given to the role of seapower and naval forces in the conduct of war. The Navy\u27s combat capability is obvious and its rationale is increasingly discussed in terms both of the deterrence of conflict and of the political uses of seapower

'It's a Form of Freedom': The experiences of people with disabilities within equestrian sport

This paper explores the embodied, gendered experiences of disabled horse‐riders. Drawing on data from five in‐depth interviews with paradressage riders, the ways in which their involvement in elite disability sport impacts upon their sense of identity and confidence are explored, as well as the considerable health and social benefits that this involvement brings. Social models of disability are employed and the shortcomings of such models, when applied to disability sport, are highlighted. The data presented here demonstrates the necessity of seeing disability sport as an embodied experience and acknowledging the importance of impairment to the experiences of disabled athletes. Living within an impaired body is also a gendered experience and the implications of this when applied to elite disability sport are considered