Study protocol for a double blind, randomised, placebo-controlled trial of continuous subpectoral local anaesthetic infusion for pain and shoulder function following mastectomy: SUB-pectoral Local anaesthetic Infusion following MastEctomy (SUBLIME) study.

INTRODUCTION: Over 16 000 mastectomies are performed in England and Wales annually. Acute postoperative pain and nausea are common. The most frequently occurring long-term complications are chronic pain (up to 50%) and reduced shoulder function (reported at 35%). Regional techniques that improve acute postoperative pain relief may reduce the incidence of these complications. This study assesses the effectiveness of a 24-hour continuous local anaesthetic in the subpectoral plane in improving postoperative pain and quality of life in patients undergoing mastectomy. METHODS AND ANALYSIS: This is a randomised, double blind, placebo-controlled, two-centre, parallel group trial in women undergoing mastectomy with or without axillary involvement. One hundred and sixty participants will be randomised in a 1:1 ratio to receive either 0.25% levobupivacaine or 0.9% saline by subpectoral infusion postoperatively for 24 h. All participants will be provided with an intravenous morphine patient-controlled analgesia (PCA) system. Participants will be followed-up for 24 h in hospital and at approximately 14 days and 6 months postoperatively. Joint primary outcome measures are total morphine consumption and total pain score (captured via patient-recorded visual analogue scale (VAS) 4 hourly) during the first 24 h postoperatively. Primary statistical analysis of total pain is based on the area under the curve of pain versus time graph. Secondary outcomes include PCA attempts in first 24 h; VAS pain scores and shoulder function by goniometry at 24 h, 14 days (approximately) and 6 months; Verbal Rating Scale pain scores in first 24 h; Brief Pain Inventory and Oxford Shoulder Score at 6 months; duration of hospital stay; incidence of postoperative nausea and vomiting; cost-effectiveness. ETHICS AND DISSEMINATION: The study is approved by the South West England Research Ethics Committee (12/SW/0149). RESULTS: will be published in a peer-reviewed journal and presented at local, national and international scientific meetings. TRIAL REGISTRATION: ISRCTN46621916. EudraCT 2011-005775-16

Measurement of web tension distribution by point source pulse excitation

A web is a material that is produced as a continuous sheet and stored in wound roll form. Mechanics of web material handling in production, coating or conditioning, and winding operations affect web uniformity and the material stress/strain state, thus affecting roll quality. In an effort to improve all aspects of web handling procedures, much attention has been focused on acquisition and utilization of on-line web handling process information such as web tension. Tension is a quantity basic to web production and processing yet historically has been difficult to measure except in an average sense. Improvements in on-line tension measurement accuracy have foreseeable application to automated tension control systems and winder maintenance used in modern day web production/processing facilities. This paper describes a new means of noncontacting, local web tension measurement through use of a point source pneumatic excitation coupled to signal acquisition and processing schemes. Advantages of this new system include variable web excitation rate, variable system tuning for different applications, high lateral tension distribution resolution, and compact, easily serviceable transducer head assembly. This work was sponsored through the Web Handling Research Center (WHRC), an NSF funded research facility located at Oklahoma State University in Stillwater, Oklahoma.Mechanical and Aerospace Engineerin

From ‘Young Women’ to ‘Female Adolescents’:Dutch Advice Literature during the Long Nineteenth Century

In late eighteenth-century Europe, there was a rapid expansion in the publication of advice books directed at young adult women. Based on an examination of conduct books published in the Netherlands, this chapter traces the changing format of the genre from the last quarter of the eighteenth century through to the early decades of the twentieth century. It explores how women pedagogues in the nineteenth century developed new ways of advising young women that gave readers greater control over their life choices. In the early twentieth century, the emerging social sciences drew attention to the physical and emotional changes involved in female adolescence, prescribing for the young woman strict forms of behaviour

An evaluation of Bradfordizing effects

The purpose of this paper is to apply and evaluate the bibliometric method Bradfordizing for information retrieval (IR) experiments. Bradfordizing is used for generating core document sets for subject-specific questions and to reorder result sets from distributed searches. The method will be applied and tested in a controlled scenario of scientific literature databases from social and political sciences, economics, psychology and medical science (SOLIS, SoLit, USB Köln Opac, CSA Sociological Abstracts, World Affairs Online, Psyndex and Medline) and 164 standardized topics. An evaluation of the method and its effects is carried out in two laboratory-based information retrieval experiments (CLEF and KoMoHe) using a controlled document corpus and human relevance assessments. The results show that Bradfordizing is a very robust method for re-ranking the main document types (journal articles and monographs) in today’s digital libraries (DL). The IR tests show that relevance distributions after re-ranking improve at a significant level if articles in the core are compared with articles in the succeeding zones. The items in the core are significantly more often assessed as relevant, than items in zone 2 (z2) or zone 3 (z3). The improvements between the zones are statistically significant based on the Wilcoxon signed-rank test and the paired T-Test

London governance and the politics of neighbourhood planning: a case for investigation

The Localism Act 2011 has successfully devolved planning powers to over 2,500 English communities, involving 14 million people, with over 700 ‘made’ neighbourhood plans legitimised by referendum. In London, however, there are less than one-tenth of the made plans than in the rest of England. Institutional resistance and policy choices may be implicated. Two national studies of neighbourhood planning are reviewed. The role of the local authority is found to be a crucial factor in determining progress, and issues of social deprivation and unequal access are highlighted. Theorisation is considered by reference to a range of academic studies of localism and neighbourhood planning. Distinctions made between ‘representative’ and ‘community’ localism, and objections to anti-political effects, are noted. There has been remarkably little research into borough governance and neighbourhood planning in the capital. Based upon evidence of anomalous and differentiated governance practice, a study in London is called for

‘If independence goes, the planning system goes’: New Political Governance and the English Planning Inspectorate

Radical restructuring of 'arms-length' government bodies following the 2010 UK national election signalled a change in relations between government and the civil service. This was seen as a major shift in modes of governance from 'new public management' to a more politicised mode of 'new political governance'. This paper presents an analysis of the impacts of these shifts on the English Planning Inspectorate, an executive agency central to the land-use planning system. It identifies measures by ministers to increase control over the Inspectorate that represent a shift in governance culture and a shift in the planning system itself

Conservation of grassland birds in North America: understanding ecological processes in different regions

Many species of birds that depend on grassland or savanna habitats have shown substantial overall population declines in North America. To understand the causes of these declines, we examined the habitat requirements of birds in six types of grassland in different regions of the continent. Open habitats were originally maintained by ecological drivers (continual and pervasive ecological processes) such as drought, grazing, and fire in tallgrass prairie, mixed-grass prairie, shortgrass prairie, desert grassland, and longleaf pine savanna. By contrast, grasslands were created by occasional disturbances (e.g., fires or beaver [Castor canadensis] activity) in much of northeastern North America. The relative importance of particular drivers or disturbances differed among regions. Keystone mammal species grazers such as prairie-dogs (Cynomys spp.) and bison (Bison bison) in western prairies, and dam-building beavers in eastern regions of the continent. Deciduous forests played a crucial, and frequently unappreciated, role in maintaining many grassland systems. Although fire was important in preventing invasion of woody plants in the tallgrass and moist mixed prairies, grazing played a more important role in maintaining the typical grassland vegetation of shortgrass prairies and desert grasslands. Heavy grazing by prairiedogs or bison created a low \u27grazing lawn\u27 that is the preferred habitat for many grassland bird species that are restricted to the shortgrass prairie and desert grasslands. Ultimately, many species of grassland birds are vulnerable because people destroyed their breeding, migratory, and wintering habitat, either directly by converting it to farmland and building lots, or indirectly by modifying grazing patterns, suppressing fires, or interfering with other ecological processes that originally sustained open grassland. Understanding the ecological processes that originally maintained grassland systems is critically important for efforts to improve, restore, or create habitat for grassland birds and other grassland organisms. Consequently, preservation of large areas of natural or seminatural grassland, where these processes can be studied and core populations of grassland birds can flourish, should be a high priority. However, some grassland birds now primarily depend on artificial habitats that are managed to maximize production of livestock, timber, or other products. With a sound understanding of the habitat requirements of grassland birds and the processes that originally shaped their habitats, it should be possible to manage populations sustainably on \u27working land\u27 such as cattle ranches, farms, and pine plantations. Proper management of private land will be critical for preserving adequate breeding, migratory, and winter habitat for grassland and savanna species