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

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

The Cannabinoid Use in Progressive Inflammatory brain Disease (CUPID) trial: a randomised double-blind placebo-controlled parallel-group multicentre trial and economic evaluation of cannabinoids to slow progression in multiple sclerosis.

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.The Cannabinoid Use in Progressive Inflammatory brain Disease (CUPID) trial aimed to determine whether or not oral Δ(9)-tetrahydrocannabinol (Δ(9)-THC) slowed the course of progressive multiple sclerosis (MS); evaluate safety of cannabinoid administration; and, improve methods for testing treatments in progressive MS.The National Institute for Health Research Health Technology Assessment programmeMedical Research Council Efficacy and Mechanism Evaluation programmeMultiple Sclerosis SocietyMultiple Sclerosis Trus

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

Standing up in Multiple Sclerosis (SUMS): Protocol for a multi-centre randomised controlled trial evaluating the clinical and cost effectiveness of a home-based self-management standing frame programme in people with progressive multiple sclerosis.

This study is funded by the NIHR Health Technology Assessment Programme (14/176/12), United Kingdom.Background:  Impaired mobility is a cardinal feature of multiple sclerosis (MS) and is rated by people with MS as their highest priority. By the secondary progressive phase, balance, mobility and physical activity levels are significantly compromised; an estimated 70% of people with secondary progressive MS fall regularly. Our ongoing research has systematically developed ‘Balance Right in MS’ (BRiMS), an innovative, manualised 13-week guided self-management programme tailored to the needs of people with MS, designed to improve safe mobility and minimise falls. Our eventual aim is to assess the clinical and cost effectiveness of BRiMS in people with secondary progressive MS by undertaking an appropriately statistically powered, multi-centre, assessor-blinded definitive, randomised controlled trial. This feasibility study will assess the acceptability of the intervention and test the achievability of running such a definitive trial. Methods/design:  This is a pragmatic multi-centre feasibility randomised controlled trial with blinded outcome assessment. Sixty ambulant people with secondary progressive MS who self-report two or more falls in the previous 6 months will be randomly allocated (1:1) to either the BRiMS programme plus usual care or to usual care alone. All participants will be assessed at baseline and followed up at 15 weeks and 27 weeks post-randomisation. The outcomes of this feasibility trial include: • Feasibility outcomes, including trial recruitment, retention and completion • Assessment of the proposed outcome measures for the anticipated definitive trial (including measures of walking, quality of life, falls, balance and activity level) • Measures of adherence to the BRiMS programme • Data to inform the economic evaluation in a future trial • Process evaluation (assessment of treatment fidelity and qualitative evaluation of participant and treating therapist experience) Discussion:  The BRiMS intervention aims to address a key concern for MS service users and providers. However, there are several uncertainties which need to be addressed prior to progressing to a full-scale trial, including acceptability of the BRiMS intervention and practicality of the trial procedures. This feasibility trial will provide important insights to resolve these uncertainties and will enable a protocol to be finalised for use in the definitive trial.Publisher PDFPeer reviewe

Where are commodity crops certified, and what does it mean for conservation and poverty alleviation?

Voluntary sustainability standards have expanded dramatically over the last decade. In the agricultural sector, such standards aim to ensure environmentally and socially sustainable production of a variety of commodity crops. However, little is known about where agricultural certification operates and whether certified lands are best located for conserving the world's most important biodiversity and benefiting the most vulnerable producers. To examine these questions we developed the first global map of commodity crop certification, synthesizing data from over one million farms to reveal the distribution of certification in unprecedented detail. It highlights both geographical clusters of certification as well as spatial bias in the location of certification with respect to environmental, livelihood and physical variables. Excluding organic certification, for which spatial data were not available, most certification of commodity crops is in tropical regions. Certification appears to be concentrated in areas important for biodiversity conservation, but not in those areas most in need of poverty alleviation, although there were exceptions to each of these patterns. We argue that the impact of sustainability standards could be increased by identifying places where it would be most beneficial to strengthen, consolidate, and expand certification. To achieve this, standards organizations will need to undertake more rigorous collection of spatial data, and more detailed analysis of their existing reach and impacts, with attention to potential trade-offs between different objectives. Efforts to promote spatial prioritization will require new partnerships to align specific conservation aims with the interests and capabilities of farmers

'So wide and varied': The origins and character of British information science

This paper examines some characteristics of the ‘British School’ of information science. Three main forces driving the development of the new subject in Britain are identified: the documentation movement; special libraries; and the need for better treatment of scientific and technical information. Five characteristics which, taken together, distinguish the early British approach to information science from those adopted elsewhere are identified: its subject-based nature; its broad approach to information and information science; its status as an academic subject with a strong professional remit; its involvement with, but distinction from, information technology; and its involvement with memory institutions. Lessons are drawn for the future development of the information sciences

Aerostructural Optimization of Long Span Bridges: Current Advances and Challenges

Structures Congress 2020. 5-8 abril, 2020. St. Louis, Missouri[Abstract] This paper describes the evolution of deck shape of long span bridges since the Tacoma Narrows collapse trying to avoid undesirable aerodynamic behavior under wind flow and the trend in the last decades to increase the length of the main span of suspension and cable stayed bridges. The necessity to use advanced technologies to help the engineer to obtain the best possible design is highlighted and the advantages of applying optimization methodologies is encouraged. It is explained that this approach requires to use only numerical tools and hence to eliminate experimental studies, as wind tunnel tests using reduced models of full bridge of a segment of the deck, and their substitution by computational fluid dynamics (CFD) simulations. After doing so, the current capabilities of this approach are presented and, finally, the problems that need to be solved to have a fully operational methodology able to be implemented in real structures are outlined.This research has been funded by the Spanish Ministry of Economy and Competitiveness in the frame of the research project BIA2016-76656-R and the Galician regional government (including FEDER Funding) reference ED431C 2017/72. M. Cid Montoya has been funded by the Galician regional government (Xunta de Galicia) with reference ED481B 2018/053 and the Fulbright postdoctoral scholarship programXunta de Galicia; ED431C 2017/72Xunta de Galicia; ED481B 2018/05