Book Reviews : Social Experiments: Method for Design and Evaluation, Leonard Saxe, and Michelle Fine, with introduction by Donald T. Campbell. Beverly Hills, California, Sage Pub lications, 1981, 266 pp

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68123/2/10.1177_109019818601300109.pd

RCTs: How compatible are they with policy-making?

Randomised controlled trials (RCTs) have been promoted as a means of improving policy-making by testing new policies. While testing before full-scale roll-out is commendable, this paper discusses the challenges of using RCTs in contemporary (national) health policy-making in England. There are at least two challenges in particular that are currently underrepresented in the debate: The first arises from the complexity of many policies which are often too diffuse and unclear in focus to allow for the clear distinction between a policy ‘mechanism’ and its context to be drawn that is required for a RCT. The second challenge relates to the timing of RCTs, which tend to take place either too early in the life of a policy to be meaningful or too late to have an effect on policy formulation. We therefore encourage policy-makers and researchers to be clear about the types of uncertainties ‘field experiments’ are meant to address which may be addressed better by other types of knowledge generation

Primary care management for optimized antithrombotic treatment [PICANT]: study protocol for a cluster-randomized controlled trial

Background: Antithrombotic treatment is a continuous therapy that is often performed in general practice and requires careful safety management. The aim of this study is to investigate whether a best practice model that applies major elements of case management, including patient education, can improve antithrombotic management in primary health care in terms of reducing major thromboembolic and bleeding events. Methods: This 24-month cluster-randomized trial will be performed in 690 adult patients from 46 practices. The trial intervention will be a complex intervention involving general practitioners, health care assistants and patients with an indication for oral anticoagulation. To assess adherence to medication and symptoms in patients, as well as to detect complications early, health care assistants will be trained in case management and will use the Coagulation-Monitoring-List (Co-MoL) to regularly monitor patients. Patients will receive information (leaflets and a video), treatment monitoring via the Co-MoL and be motivated to perform self-management. Patients in the control group will continue to receive treatment-as-usual from their general practitioners. The primary endpoint is the combined endpoint of all thromboembolic events requiring hospitalization, and all major bleeding complications. Secondary endpoints are mortality, hospitalization, strokes, major bleeding and thromboembolic complications, severe treatment interactions, the number of adverse events, quality of anticoagulation, health-related quality of life and costs. Further secondary objectives will be investigated to explain the mechanism by which the intervention is effective: patients' assessment of chronic illness care, self-reported adherence to medication, general practitioners' and health care assistants' knowledge, patients' knowledge and satisfaction with shared decision making. Practice recruitment is expected to take place between July and December 2012. Recruitment of eligible patients will start in July 2012. Assessment will occur at three time points: baseline (T0), follow-up after 12 (T1) and after 24 months (T2). Discussion: The efficacy and effectiveness of individual elements of the intervention, such as antithrombotic interventions, self-management concepts in orally anticoagulated patients and the methodological tool, case-management, have already been extensively demonstrated. This project foresees the combination of several proven instruments, as a result of which we expect to profit from a reduction in the major complications associated with antithrombotic treatment

Semi-fortified palatial complexes in Central Asia: new work at the Great Kyz Kala, Merv, Turkmenistan

Within Central Asia there is an unusual group of earthen buildings (köshks), usually constructed on raised platforms, with vertical engaged columns forming iconic ‘corrugations’ on the exterior walls. The complexes are semi-fortified, with a second storey entrance, and often with asymmetrical ranges of rooms around an internal courtyard. Little systematic archaeological work has taken place on these monuments, which have mainly been studied as relatively eroded standing structures. However, recent work at the Great Kyz Kala at Merv, Turkmenistan, the largest surviving monumental köshk in Central Asia, has provided more details of construction and use. The excavations suggest that this complex was constructed in the 8th/9th century CE, with well-appointed rooms on the second storey, including a large hall, and functional rooms and storage spaces around a courtyard on the lower floor. The complex was set within an enclosure, containing gardens and possibly ancillary buildings. This particular köshk may have acted as an elite palatial suburban residence, perhaps for the governor of Merv

Cavity mode enhancement of terahertz emission from equilateral triangular microstrip antennas of the high-TcT_c superconductor Bi2_2Sr2_2CaCu2_2O8+δ_{8 + δ}

We study the transverse magnetic (TM) electromagnetic cavity mode wave functions for an ideal equilateral triangular microstrip antenna (MSA) exhibiting $C_{3v}$ point group symmetry. When the $C_{3v}$ operations are imposed upon the antenna, the TM($m,n$) modes with wave vectors $\alpha \sqrt[ ]{m^2 + nm + n^2}$ are much less dense than commonly thought. The $R_3$ operations restrict the integral $n$ and $m$ to satisfy $\mid m - n \mid$ = 3$p$, where $p \geq$ 0 and $p \geq$ 1 for the modes even and odd under reflections about the three mirror planes, respectively. We calculate the forms of representative wave functions and the angular dependence of the output power when these modes are excited by the uniform and non-uniform ac Josephson current sources in thin, ideally equilateral triangular MSAs employing the intrinsic Josephson junctions in the high transition temperature $T_c$ superconductor Bi$_2$Sr$_2$CaCu$_2$O$_{8 + \delta}$, and fit the emissions data from an earlier sample for which the $C_{3v}$ symmetry was apparently broken.UCF RAMP program, JSPS Research Fellowship for young scientists, CREST-JST (Japan Science and Technology Agency), WPI (World Premier International Research Center Initiative)- MANA (Materials Nanoarchitectonics) project (NIMS

Cavity mode enhancement of terahertz emission from equilateral triangular microstrip antennas of the high-TcT_c superconductor Bi2_2Sr2_2CaCu2_2O8+δ_{8 + δ}

We study the transverse magnetic (TM) electromagnetic cavity mode wave functions for an ideal equilateral triangular microstrip antenna (MSA) exhibiting $C_{3v}$ point group symmetry. When the $C_{3v}$ operations are imposed upon the antenna, the TM($m,n$) modes with wave vectors $\alpha \sqrt[ ]{m^2 + nm + n^2}$ are much less dense than commonly thought. The $R_3$ operations restrict the integral $n$ and $m$ to satisfy $\mid m - n \mid$ = 3$p$, where $p \geq$ 0 and $p \geq$ 1 for the modes even and odd under reflections about the three mirror planes, respectively. We calculate the forms of representative wave functions and the angular dependence of the output power when these modes are excited by the uniform and non-uniform ac Josephson current sources in thin, ideally equilateral triangular MSAs employing the intrinsic Josephson junctions in the high transition temperature $T_c$ superconductor Bi$_2$Sr$_2$CaCu$_2$O$_{8 + \delta}$, and fit the emissions data from an earlier sample for which the $C_{3v}$ symmetry was apparently broken.UCF RAMP program, JSPS Research Fellowship for young scientists, CREST-JST (Japan Science and Technology Agency), WPI (World Premier International Research Center Initiative)- MANA (Materials Nanoarchitectonics) project (NIMS

State of the California current 2013-14: El niño looming

In 2013, the California current was dominated by strong coastal upwelling and high productivity. Indices of total cumulative upwelling for particular coastal locations reached some of the highest values on record. Chlorophyll a levels were high throughout spring and summer. Catches of upwelling-related fish species were also high. After a moderate drop in upwelling during fall 2013, the California current system underwent a major change in phase. Three major basin-scale indicators, the PDO, the NPGO, and the ENSO-MEI, all changed phase at some point during the winter of 2013/14. The PDO changed to positive values, indicative of warmer waters in the North Pacific; the NPGO to negative values, indicative of lower productivity along the coast; and the MEI to positive values, indicative of an oncoming El Niño. Whereas the majority of the California Current system appears to have transitioned to an El Niño state by August 2014, based on decreases in upwelling and chlorophyll a concentration, and increases in SST, there still remained pockets of moderate upwelling, cold water, and high chlorophyll a biomass at various central coast locations, unlike patterns seen during the more major El Niños (e.g., the 97-98 event). Catches of rockfish, market squid, euphausiids, and juvenile sanddab remained high along the central coast, whereas catches of sardine and anchovy were low throughout the CCS. 2014 appears to be heading towards a moderate El Niño state, with some remaining patchy regions of upwellingdriven productivity along the coast. Superimposed on this pattern, three major regions have experienced possibly non-El Niño-related warming since winter: the Bering Sea, the Gulf of Alaska, and offshore of southern California. It is unclear how this warming may interact with the predicted El Niño, but the result will likely be reduced growth or reproduction for many key fisheries species

Genome-wide association study with 1000 genomes imputation identifies signals for nine sex hormone-related phenotypes.

PublishedJournal ArticleResearch Support, Non-U.S. Gov'tThis is the final version of the article. Available from Nature Publishing Group via the DOI in this record.Genetic factors contribute strongly to sex hormone levels, yet knowledge of the regulatory mechanisms remains incomplete. Genome-wide association studies (GWAS) have identified only a small number of loci associated with sex hormone levels, with several reproductive hormones yet to be assessed. The aim of the study was to identify novel genetic variants contributing to the regulation of sex hormones. We performed GWAS using genotypes imputed from the 1000 Genomes reference panel. The study used genotype and phenotype data from a UK twin register. We included 2913 individuals (up to 294 males) from the Twins UK study, excluding individuals receiving hormone treatment. Phenotypes were standardised for age, sex, BMI, stage of menstrual cycle and menopausal status. We tested 7,879,351 autosomal SNPs for association with levels of dehydroepiandrosterone sulphate (DHEAS), oestradiol, free androgen index (FAI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, progesterone, sex hormone-binding globulin and testosterone. Eight independent genetic variants reached genome-wide significance (P<5 × 10(-8)), with minor allele frequencies of 1.3-23.9%. Novel signals included variants for progesterone (P=7.68 × 10(-12)), oestradiol (P=1.63 × 10(-8)) and FAI (P=1.50 × 10(-8)). A genetic variant near the FSHB gene was identified which influenced both FSH (P=1.74 × 10(-8)) and LH (P=3.94 × 10(-9)) levels. A separate locus on chromosome 7 was associated with both DHEAS (P=1.82 × 10(-14)) and progesterone (P=6.09 × 10(-14)). This study highlights loci that are relevant to reproductive function and suggests overlap in the genetic basis of hormone regulation.We thank Roche Diagnostics Australia Pty Limited, Castle Hill, Australia, who provided support for the analysis of the hormones. We thank the volunteer twins for their participation in the study. Twins UK received funding support from NIHR Biomedical Research Centre (grant to Guys’ and St Thomas’ Hospitals and King’s College London); the Chronic Disease Research Foundation; Canadian Institutes of Health Research, the Canadian Foundation for Innovation, the Fonds de la Recherche en Santé Québec, The Lady Davis Institute, the Jewish General Hospital and Ministère du Développement économique, de l'Innovation et de l'Exportation du Quebec. The Australian National Health and Medical Research Council (NHMRC project grants 1010494, 1048216), and Sir Charles Gairdner Hospital Research (grant PP2009/028). This work was supported by funding from the Wellcome Trust (092447/Z/10/Z) and Medical Research Council (MC_U106179472)

Effects on heart pumping function when using foam and gauze for negative pressure wound therapy of sternotomy wounds

<p>Abstract</p> <p>Background</p> <p>Negative pressure wound therapy (NPWT) has remarkable effects on the healing of poststernotomy mediastinitis. Foam is presently the material of choice for NPWT in this indication. There is now increasing interest in using gauze, as this has proven successful in the treatment of peripheral wounds. It is important to determine the effects of NPWT using gauze on heart pumping function before it can be used for deep sternotomy wounds. The aim was to examine the effects of NPWT when using gauze and foam on the heart pumping function during the treatment of a sternotomy wound.</p> <p>Methods</p> <p>Eight pigs underwent median sternotomy followed by NPWT at -40, -70, -120 and -160 mmHg, using foam or gauze. The heart frequency, cardiac output, mean systemic arterial pressure, mean pulmonary artery pressure, central venous pressure and left atrial pressure were recorded.</p> <p>Results</p> <p>Cardiac output was not affected by NPWT using gauze or foam. Heart frequency decreased during NPWT when using foam, but not gauze. Treatment with foam also lowered the central venous pressure and the left atrial pressure, while gauze had no such effects. Mean systemic arterial pressure, mean pulmonary artery pressure and systemic vascular resistance were not affected by NPWT. Similar haemodynamic effects were observed at all levels of negative pressure studied.</p> <p>Conclusions</p> <p>NPWT using foam results in decreased heart frequency and lower right and left atrial filling pressures. The use of gauze in NPWT did not affect the haemodynamic parameters studied. Gauze may thus provide an alternative to foam for NPWT of sternotomy wounds.</p