Foreword

Thank you to the Georgia Law Review and the University ofGeorgia School of Law for inviting me to discuss evidence reformin the State of Georgia. As a trial lawyer, it is both an honor-anda daunting task-to address such a distinguished group ofevidence scholars as have gathered here today.More than 150 years ago, the author of Georgia\u27s first evidencecode, Judge David Irwin, began with a simple principle: Theobject of all legal investigation is the discovery of truth. 2 If that isso, and I believe that it is, then an evidence code is a lens thatfocuses the discovery and that brings truth into perspective. Therules of evidence filter information, controlling what evidence ajury may, and may not, hear as it weighs the claims before it.They focus the jury\u27s perception of the evidence before it, settingthe parameters of what a given piece of evidence does, or does not,establish. They are fundamental to our system of justice andaffect, in a very real way, the manner in which legal proceedingsare conducted and whether the ultimate outcome is fair and just

The OscSNS White Paper

There exists a need to address and resolve the growing evidence for short-baseline neutrino oscillations and the possible existence of sterile neutrinos. Such non-standard particles require a mass of $\sim 1$ eV/c$^2$, far above the mass scale associated with active neutrinos, and were first invoked to explain the LSND $\bar \nu_\mu \rightarrow \bar \nu_e$ appearance signal. More recently, the MiniBooNE experiment has reported a $2.8 \sigma$ excess of events in antineutrino mode consistent with neutrino oscillations and with the LSND antineutrino appearance signal. MiniBooNE also observed a $3.4 \sigma$ excess of events in their neutrino mode data. Lower than expected neutrino-induced event rates using calibrated radioactive sources and nuclear reactors can also be explained by the existence of sterile neutrinos. Fits to the world's neutrino and antineutrino data are consistent with sterile neutrinos at this $\sim 1$ eV/c$^2$ mass scale, although there is some tension between measurements from disappearance and appearance experiments. In addition to resolving this potential major extension of the Standard Model, the existence of sterile neutrinos will impact design and planning for all future neutrino experiments. It should be an extremely high priority to conclusively establish if such unexpected light sterile neutrinos exist. The Spallation Neutron Source (SNS) at Oak Ridge National Laboratory, built to usher in a new era in neutron research, provides a unique opportunity for US science to perform a definitive world-class search for sterile neutrinos.Comment: This white paper is submitted as part of the SNOWMASS planning proces

CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes

<p>Abstract</p> <p>Background</p> <p>Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures.</p> <p>Methods/design</p> <p>Sixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model.</p> <p>Discussion</p> <p>By focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00636675">NCT00636675</a></p

Foreword

Thank you to the Georgia Law Review and the University ofGeorgia School of Law for inviting me to discuss evidence reformin the State of Georgia. As a trial lawyer, it is both an honor-anda daunting task-to address such a distinguished group ofevidence scholars as have gathered here today.More than 150 years ago, the author of Georgia\u27s first evidencecode, Judge David Irwin, began with a simple principle: Theobject of all legal investigation is the discovery of truth. 2 If that isso, and I believe that it is, then an evidence code is a lens thatfocuses the discovery and that brings truth into perspective. Therules of evidence filter information, controlling what evidence ajury may, and may not, hear as it weighs the claims before it.They focus the jury\u27s perception of the evidence before it, settingthe parameters of what a given piece of evidence does, or does not,establish. They are fundamental to our system of justice andaffect, in a very real way, the manner in which legal proceedingsare conducted and whether the ultimate outcome is fair and just

Determining When to Add Nonstatin Therapy : A Quantitative Approach

Background: Nonstatin costs and uncertainty about benefits currently limit their use. Estimation of the potential for net benefit may better guide the addition of nonstatin therapy. Objective: Identify groups of patients who might benefit from the addition of a nonstatin to background statin therapy. Methods: Systematic reviews of subgroup analyses from randomized trials and observational studies were used to determine the estimated 10-year absolute risk of atherosclerotic cardiovascular disease (ASCVD) to define high and very high risk patient groups. Calculated relative risk reductions for the addition of a nonstatin were used to determine the number-needed-to-treat to prevent one ASCVD event (NNT)over 5 years for each patient group to allow comparisons to 5-year cost analyses. Number-needed-to-harm and net benefit were evaluated. Results: 10-year ASCVD risk for statin-treated participants with clinical ASCVD with comorbidities is at least 30% (very high risk), and 20-29% (high risk) for those with ASCVD without comorbidities or who have heterozygous familial hypercholesterolemia. Adding ezetimibe to reduce LDL-C by 20% would provide a 5-year NNT130 mg/dl or high risk patients with LDL-C >190 mg/dl and an NNT160 mg/dl. Adding a PCSK9 monoclonal antibody (mAb) to lower LDL-C by at least 50% would provide an NNT70 mg/dl, and an NNT130 mg/d. From the payer’s perspective, PCSK9 mAbs may be cost effective in very high risk and high risk patients depending on the baseline LDL-C level and magnitude of discounting. Conclusions: Quantitative guidance is provided to determine the potential for a net benefit over 5 years from adding ezetimibe or a PCSK9 mAb to maximally tolerated statin therapy from the perspective of clinicians, patients, and payers

Tranquilliser use as a risk factor for falls in hospital patients

This study looked at associations of tranquilliser use and falls risk in a hospital population of confused and nonconfused patients. In a prospective observational study in a rehabilitation hospital for elderly patients, we followed 1025 consecutive patients. The number of fallers, recurrent fallers and total falls was recorded. Confused patients (p?&lt;?0.0001) and patients on tranquillisers (p?=?0.001) were significantly more likely to fall than nonconfused patients and patients off tranquillisers. Confused patients on tranquillisers were significantly more likely to have recurrent falls (p?=?0.026) when compared with confused patients off tranquillisers. The risk was apparent from admission, persisting throughout the first 30 days of stay. This was not noted for nonconfused patients. We identified a stratification of risk for falls with nonsignificant trends for confused and nonconfused patients on tranquillisers to be fallers and to have more falls compared with patients off tranquillisers. These data are associational and do not necessarily imply causality. There is however no evidence to recommend the routine withdrawal of tranquillisers from all patients. Any future research needs to include confused patients