Networks among British Immigrants and Accomodation to Canadian Society: Winnipeg, 1900-1914

Recently scholars have begun to explain migration in terms of the mechanisms which immigrants employ as groups to accommodate to new societies. Upon arrival in Canada, British immigrants established a new set of social relationships still strongly informed by their pre-emigration culture. The most important social institution facilitating accommodation was the nuclear family. Families were the basis for networks providing reliable information, emotional solace and material support. Other institutions flourishing in British immigrant communities — churches, benefit societies and boarding-houses — functioned as surrogate families. Networks gave the British a competitive advantage in Canada's heterogeneous society. On a commencé à expliquer la migration en terme de mécanismes d’adaptation des groupes d'immigrants. À leur arrivée au Canada, les immigrants britanniques y ont établi un nouveau mode de relations sociales fondé en grande partie, en fait, sur leur culture d’origine. La famille nucléaire fut la plus importante des institutions sociales facilitant l’adaptation des immigrants. Elle leur fournit des informations provenant de sources fiables, un réconfort affectif et un support matériel. D’autres institutions fleurissant dans la communauté britannique — les églises, les sociétés de bienfaisance et les maisons d’accueil — fonctionnèrent comme des substituts aux familles. Ces réseaux mirent les britanniques dans une position plus compétitive à l’intérieur de la société hétérogène canadienne

Measuring the dynamics and thresholds of tropical deepwater seagrasses

Extensive areas of deepwater (>10m) seagrass meadows are known to occur in many tropical regions. More than 31,000 km2 are found in the Great Barrier Reef Region of Queensland alone and one of the world's largest continuous seagrass meadows has been mapped recently in deeper waters of the Torres Strait. Despite their extensive distribution, little is known about the ecological roles, tolerances and dynamics of these deepwater communities compared with the much more commonly studied shallow seagrass meadows from the same region. Existing information suggests deepwater meadows may be highly productive but also highly dynamic between and within years. Increasingly these meadows are coming under threat from anthropogenic disturbances and it is critical to develop our understanding of the drivers of change and tolerances of these meadows to effectively manage them. We present initial findings from a major research program to establish a better understanding of the drivers of seasonal and interannual dynamics in these seagrass communities, the role of seed banks and seagrass recruitment, and the environmental cues that drive the seasonal patterns of decline and recovery. The research program includes a detailed study of the light requirements of these deepwater species as well as developing a range of tools for monitoring and managing anthropogenic impacts such as dredging

Measuring the dynamics and thresholds of tropical deepwater seagrasses

Extensive areas of deepwater (>10m) seagrass meadows are known to occur in many tropical regions. More than 31,000 km2 are found in the Great Barrier Reef Region of Queensland alone and one of the world's largest continuous seagrass meadows has been mapped recently in deeper waters of the Torres Strait. Despite their extensive distribution, little is known about the ecological roles, tolerances and dynamics of these deepwater communities compared with the much more commonly studied shallow seagrass meadows from the same region. Existing information suggests deepwater meadows may be highly productive but also highly dynamic between and within years. Increasingly these meadows are coming under threat from anthropogenic disturbances and it is critical to develop our understanding of the drivers of change and tolerances of these meadows to effectively manage them. We present initial findings from a major research program to establish a better understanding of the drivers of seasonal and interannual dynamics in these seagrass communities, the role of seed banks and seagrass recruitment, and the environmental cues that drive the seasonal patterns of decline and recovery. The research program includes a detailed study of the light requirements of these deepwater species as well as developing a range of tools for monitoring and managing anthropogenic impacts such as dredging

Cost-effectiveness of alternative methods of surgical repair of inguinal hernia

Objectives: To assess the relative cost-effectiveness of laparoscopic methods of inguinal hernia repair compared with open flat mesh and open non-mesh repair. Methods: Data on the effectiveness of these alternatives came from three systematic reviews comparing: (i) laparoscopic methods with open flat mesh or non-mesh methods; (ii) open flat mesh with open non-mesh repair; and (iii) methods that used synthetic mesh to repair the hernia defect with those that did not. Data on costs were obtained from the authors of economic evaluations previously conducted alongside trials included in the reviews. A Markov model was used to model cost-effectiveness for a five-year period after the initial operation. The outcomes of the model were presented using a balance sheet approach and as cost per hernia recurrence avoided and cost per extra day at usual activities. Results: Open flat mesh was the most cost-effective method of preventing recurrences. Laparoscopic repair provided a shorter period of convalescence and less long-term pain compared with open flat mesh but was more costly. The mean incremental cost per additional day back at usual activities compared with open flat mesh was €38 and €80 for totally extraperitoneal and transabdominal preperitoneal repair, respectively. Conclusions: Laparoscopic repair is not cost-effective compared with open flat mesh repair in terms of cost per recurrence avoided. Decisions about the use of laparoscopic repair depend on whether the benefits (reduced pain and earlier return to usual activities) outweigh the extra costs and intraoperative risks. On the evidence presented here, these extra costs are unlikely to be offset by the short-term benefits of laparoscopic repair.Luke Vale, Adrian Grant, Kirsty McCormack, Neil W. Scott and the EU Hernia Trialists Collaboratio

The long-term impact of the MEMA kwa Vijana adolescent sexual and reproductive health intervention: effect of dose and time since intervention exposure.

BACKGROUND: Despite recent decreases in HIV incidence in many sub-Saharan African countries, there is little evidence that specific behavioural interventions have led to a reduction in HIV among young people. Further and wider-scale decreases in HIV require better understanding of when behaviour change occurs and why. The MEMA kwa Vijana adolescent sexual and reproductive health intervention has been implemented in rural Mwanza, Tanzania since 1999. A long-term evaluation in 2007/8 found that the intervention improved knowledge, attitudes to sex and some reported risk behaviours, but not HIV or HSV2 prevalence. The aim of this paper was to assess the differential impact of the intervention according to gender, age, marital status, number of years of exposure and time since last exposure to the intervention. METHODS: In 2007, a cross-sectional survey was conducted in the 20 trial communities among 13,814 young people (15-30 yrs) who had attended intervention or comparison schools between 1999 and 2002. Outcomes for which the intervention had an impact in 2001 or 2007 were included in this subgroup analysis. Data were analysed using cluster-level methods for stratified cluster-randomised trials, using interaction tests to determine if intervention impact differed by subgroup. RESULTS: Taking into account multiplicity of testing, concurrence with a priori hypotheses and consistency within the results no strong effect-modifiers emerged. Impact on pregnancy knowledge and reported attitudes to sex increased with years of exposure to high-quality intervention. CONCLUSIONS: The desirable long-term impact of the MEMA kwa Vijana intervention did not vary greatly according to the subgroups examined. This suggests that the intervention can have an impact on a broad cross-section of young people in rural Mwanza. TRIAL REGISTRATION: ClinicalTrials.gov NCT00248469

Prevention Research Centers: Contributions to Updating the Public Health Workforce Through Training

Because public health is a continually evolving field, it is essential to provide ample training opportunities for public health professionals. As a natural outgrowth of the Centers for Disease Control and Prevention\u27s Prevention Research Centers Program, training courses of many types have been developed for public health practitioners working in the field. This article describes three of the Prevention Research Center training program offerings: Evidence-Based Public Health, Physical Activity and Public Health for Practitioners, and Social Marketing. These courses illustrate the commitment of the Prevention Research Centers Program to helping create a better trained public health workforce, thereby enhancing the likelihood of improving public health

HDQLIFE: Development and Assessment of Health-Related Quality of Life in Huntington Disease (HD)

PURPOSE: Huntington disease (HD) is a chronic, debilitating genetic disease that affects physical, emotional, cognitive, and social health. Existing patient-reported outcomes (PROs) of health-related quality of life (HRQOL) used in HD are neither comprehensive, nor do they adequately account for clinically meaningful changes in function. While new PROs examining HRQOL (i.e., Neuro-QoL-Quality of Life in Neurological Disorders and PROMIS-Patient-Reported Outcomes Measurement Information System) offer solutions to many of these shortcomings, they do not include HD-specific content, nor have they been validated in HD. HDQLIFE addresses this by validating 12 PROMIS/Neuro-QoL domains in individuals with HD and by using established PROMIS methodology to develop new, HD-specific content. METHODS: New item pools were developed using cognitive debriefing with individuals with HD, and expert, literacy, and translatability reviews. Existing item banks and new item pools were field tested in 536 individuals with prodromal, early-, or late-stage HD. RESULTS: Moderate to strong relationships between Neuro-QoL/PROMIS measures and generic self-report measures of HRQOL, and moderate relationships between Neuro-QoL/PROMIS and clinician-rated measures of similar constructs supported the validity of Neuro-QoL/PROMIS in individuals with HD. Exploratory and confirmatory factor analysis, item response theory, and differential item functioning analyses were utilized to develop new item banks for Chorea, Speech Difficulties, Swallowing Difficulties, and Concern with Death and Dying, with corresponding six-item short forms. A four-item short form was developed for Meaning and Purpose. CONCLUSIONS: HDQLIFE encompasses both validated Neuro-QoL/PROMIS measures, as well as five new scales in order to provide a comprehensive assessment of HRQOL in HD

A pragmatic, multicentre, randomised controlled trial comparing stapled haemorrhoidopexy to traditional excisional surgery for haemorrhoidal disease (eTHoS): study protocol for a randomised controlled trial

Background: Current interventions for haemorrhoidal disease include traditional haemorrhoidectomy (TH) and stapled haemorrhoidopexy (SH) surgery. However, uncertainty remains as to how they compare from a clinical, quality of life (QoL) and economic perspective. The study is therefore designed to determine whether SH is more effective and more cost-effective, compared with TH. Methods/Design: eTHoS (either Traditional Haemorrhoidectomy or Stapled Haemorrhoidopexy for Haemorrhoidal Disease) is a pragmatic, multicentre, randomised controlled trial. Currently, 29 secondary care centres are open to recruitment. Patients, aged 18 year or older, with circumferential haemorrhoids grade II to IV, are eligible to take part. The primary clinical and economic outcomes are QoL profile (area under the curve derived from the EuroQol Group’s 5 Dimension Health Status Questionnaire (EQ-5D) at all assessment points) and incremental cost per quality adjusted life year (QALY) based on the responses to the EQ-5D at 24 months. The secondary outcomes include a comparison of the SF-36 scores, pain and symptoms sub-domains, disease recurrence, complication rates and direct and indirect costs to the National Health Service (NHS). A sample size of n =338 per group has been calculated to provide 90% power to detect a difference in the mean area under the curve (AUC) of 0.25 standard deviations derived from EQ-5D score measurements, with a two-sided significance level of 5%. Allowing for non-response, 400 participants will be randomised per group. Randomisation will utilise a minimisation algorithm that incorporates centre, grade of haemorrhoidal disease, baseline EQ-5D score and gender. Blinding of participants and outcome assessors is not attempted. Discussion: This is one of the largest trials of its kind. In the United Kingdom alone, 29,000 operations for haemorrhoidal disease are done annually. The trial is therefore designed to give robust evidence on which clinicians and health service managers can base management decisions and, more importantly, patients can make informed choices. Trial registration: Current Controlled Trials ISRCTN80061723 (assigned 8 March 2010