Low-value clinical practices in adult traumatic brain injury : an umbrella review protocol

Introduction Traumatic brain injury (TBI) leads to 50 000 deaths, 85 000 disabilities and costs $60 billion each year in the USA. Despite numerous interventions and treatment options, the outcomes of TBI have improved little over the last three decades. In a previous scoping review and expert consultation survey, we identified 13 potentially low-value clinical practices in acute TBI. The objective of this umbrella review is to synthesise the evidence on potentially low-value clinical practices in the care of acute TBI. Methods and analysis Using umbrella review methodology, we will search Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, International Prospective Register of Systematic Reviews (PROSPERO) and PubMed to identify systematic reviews evaluating the effect of potential intrahospital low-value practices using tailored population, intervention, comparator, outcome and study design questions based on the results of a previous scoping review. We will present data on the methodological quality of these reviews (Assessing the Methodological Quality of Systematic Reviews-2), reported effect sizes and strength of evidence (Grading of Recommendations, Assessment, Development and Evaluation). Ethics and dissemination Ethics approval is not required as original data will not be collected. Knowledge users from five healthcare quality organisations and clinical associations are involved in the design and conduct of the study. Results will be disseminated in a peer-reviewed journal, at international scientific meetings and to clinical, healthcare quality and patient–partner associations. This work will support the development of metrics to measure the use of low-value practices, inform policy makers on potential targets for deimplementation and in the long term reduce the use of low-value clinical practices in acute TBI care

Stone-built heritage inventory and ‘performance in use’ condition assessment of stonework

An academic–industrial partnership was formed with the aim of constructing a natural stone database for Northern Ireland that could be used by the public and practitioners to understand both the characteristics of the stone used in construction across Northern Ireland and how it has performed in use, and, through a linked database of historical quarries, explore the potential for obtaining locally sourced replacement stone. The aims were to improve the level of conservation specification by those with a duty of care for historical structures, and to enhance the quality of the conservation work undertaken by archi- tects and contractors through their improved knowledge of stone and stone decay processes

Migration patterns of Thomson's gazelles and cheetahs on the Serengeti Plains

Monthly changes in abundance of Thomson's gazelles at 142 locations on the Serengeti Plains are presented over a 3½ year period. Numbers of gazelles on the eastern plains were strongly correlated with rainfall, whereas numbers in the central and western plains appeared to be related to other variables. Movements of female cheetahs and non-resident male cheetahs corresponded closely to the movements of Thomson's gazelles but those of resident male cheetahs remained relatively independent of the gazelle migration.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74314/1/j.1365-2028.1988.tb00978.x.pd