24-hour metabolisms of sedentary people

No Abstract

Updated recommendations for HER2 testing in the UK

This paper serves to update previously published guidance on rationale and methodology for HER2 laboratory testing following the recommendation for the use of HER2 targeted treatment in the management of advanced breast cancer in the UK. Emphasis is placed on the standardisation of methodology and assessment and strategies to achieve high quality performance. A two phase testing algorithm based on first line immunocytochemistry evaluation and second line fluorescence in situ hybridisation assessment of borderline cases is recommended. To ensure maintenance of expertise, an annual caseload volume of at least 250 cases is recommended for laboratories providing a testing service

Eclecticism, postmodernism, subversion: new perspectives on English experimental music

This thesis investigates the use of reference and quotation in English experimental music. Observing that these phenomena are also common in other areas of music, it attempts to make firm distinctions between various manifestations and offer reasons why eclectic compositions emanating from the experimental tradition are the more effective, both in purely musical terms and in the maintaining of a subversive stance. Chapter One explores the extent to which pluralism in the arts is a direct result of postmodernism. The social effects of postmodernism and their influence on the arts are documented, leading to the conclusion that all instances of eclecticism in contemporary art and music could be categorised as postmodernist in some measure. The idea is then introduced that postmodernism is more than an environmental phenomenon and is an artistic aesthetic in its own right. Works which fall into this category are introduced, and ethical criticisms of them discussed. The idea is asserted that music from the experimental tradition is not connected to this problematic aesthetic. Chapter Two seeks to prove the last point by investigating the history of English experimental music and its independence from the modernist and postmodernist mainstream. After demonstrating this detachment it goes on to suggest ways in which its own history may have provided seeds for the later pluralistic tendencies. Chapter Three focuses on attitudes to history which are peculiar to composers of the experimental tradition. The influence of certain romantic composers is demonstrated with regard to the recent prevalence of transcription and arrangement, and eclectic works which stem from the admiration of earlier composers are discussed in detail. Chapter Four deals with ways in which composers from the experimental tradition have referred to source material from popular culture. It demonstrates how Satie and Ives have been important role models and gives details of compositions which utilise idioms from background music and 'muzak'. Chapter Five presents a methodology for the analysis of pluralistic music which rests on the principles of semiotics. It shows how the methodology could be used to reveal the interaction of references within a work, and suggests how conclusions could be interpreted to serve a better critical awareness of pluralistic music

The Supernova Relic Neutrino Background

An upper bound to the supernova relic neutrino background from all past Type II supernovae is obtained using observations of the Universal metal enrichment history. We show that an unambiguous detection of these relic neutrinos by the Super-Kamiokande detector is unlikely. We also analyze the event rate in the Sudbury Neutrino Observatory (where coincident neutrons from anti-nu_e + D --> n + n + e+ might enhance background rejection), and arrive at the same conclusion. If the relic neutrino flux should be observed to exceed our upper bound and if the observations of the metal enrichment history (for z<1) are not in considerable error, then either the Type II supernova rate does not track the metal enrichment history or some mechanism may be responsible for transforming anti-nu_{mu,tau} --> anti-nu_e.Comment: Matches version accepted for publication in Phys. Rev.

Improving adherence to acute low back pain guideline recommendations with chiropractors and physiotherapists: the ALIGN cluster randomised controlled trial

Background Acute low back pain is a common condition, has high burden, and there are evidence-to-practice gaps in the chiropractic and physiotherapy setting for imaging and giving advice to stay active. The aim of this cluster randomised trial was to estimate the effects of a theory- and evidence-based implementation intervention to increase chiropractors’ and physiotherapists’ adherence to a guideline for acute low back pain compared with the comparator (passive dissemination of the guideline). In particular, the primary aim of the intervention was to reduce inappropriate imaging referral and improve patient low back pain outcomes, and to determine whether this intervention was cost-effective. Methods Physiotherapy and chiropractic practices in the state of Victoria, Australia, comprising at least one practising clinician who provided care to patients with acute low back pain, were invited to participate. Patients attending these practices were included if they had acute non-specific low back pain (duration less than 3 months), were 18 years of age or older, and were able to understand and read English. Practices were randomly assigned either to a tailored, multi-faceted intervention based on the guideline (interactive educational symposium plus academic detailing) or passive dissemination of the guideline (comparator). A statistician independent of the study team undertook stratified randomisation using computer-generated random numbers; four strata were defined by professional group and the rural or metropolitan location of the practice. Investigators not involved in intervention delivery were blinded to allocation. Primary outcomes were X-ray referral self-reported by clinicians using a checklist and patient low back pain-specific disability (at 3 months). Results A total of 104 practices (43 chiropractors, 85 physiotherapists; 755 patients) were assigned to the intervention and 106 practices (45 chiropractors, 97 physiotherapists; 603 patients) to the comparator; 449 patients were available for the patient-level primary outcome. There was no important difference in the odds of patients being referred for X-ray (adjusted (Adj) OR: 1.40; 95% CI 0.51, 3.87; Adj risk difference (RD): 0.01; 95% CI − 0.02, 0.04) or patient low back pain-specific disability (Adj mean difference: 0.37; 95% CI − 0.48, 1.21, scale 0–24). The intervention did lead to improvement for some key secondary outcomes, including giving advice to stay active (Adj OR: 1.96; 95% CI 1.20, 3.22; Adj RD: 0.10; 95% CI 0.01, 0.19) and intending to adhere to the guideline recommendations (e.g. intention to refer for X-ray: Adj OR: 0.27; 95% CI 0.17, 0.44; intention to give advice to stay active: Adj OR: 2.37; 95% CI 1.51, 3.74). Conclusions Intervention group clinicians were more likely to give advice to stay active and to intend to adhere to the guideline recommendations about X-ray referral. The intervention did not change the primary study outcomes, with no important differences in X-ray referral and patient disability between groups, implying that hypothesised reductions in health service utilisation and/or productivity gains are unlikely to offset the direct costs of the intervention. We report these results with the caveat that we enrolled less patients into the trial than our determined sample size. We cannot recommend this intervention as a cost-effective use of resources

The assess facility descriptor module

The Facility Descriptor (Facility) module is part of the Analytic System and Software for Evaluating Safeguards and Security (ASSESS). Facility is the foundational software application in the ASSESS system for modelling a nuclear facility's safeguards and security system to determine the effectiveness against theft of special nuclear material. The Facility module provides the tools for an analyst to define a complete description of a facility's physical protection system which can then be used by other ASSESS software modules to determine vulnerability to a spectrum of insider and outsider threats. The analyst can enter a comprehensive description of the protection system layout including all secured areas, target locations, and detailed safeguards specifications. An extensive safeguard component catalog provides the reference data for calculating delay and detection performance. Multiple target locations within the same physical area may be specified, and the facility may be defined for two different operational states such as dayshift and nightshift. 6 refs., 5 figs

Height and risk of death among men and women: aetiological implications of associations with cardiorespiratory disease and cancer mortality

OBJECTIVES: Height is inversely associated with cardiovascular disease mortality risk and has shown variable associations with cancer incidence and mortality. The interpretation of findings from previous studies has been constrained by data limitations. Associations between height and specific causes of death were investigated in a large general population cohort of men and women from the West of Scotland. DESIGN: Prospective observational study. SETTING: Renfrew and Paisley, in the West of Scotland. SUBJECTS: 7052 men and 8354 women aged 45-64 were recruited into a study in Renfrew and Paisley, in the West of Scotland, between 1972 and 1976. Detailed assessments of cardiovascular disease risk factors, morbidity and socioeconomic circumstances were made at baseline. MAIN OUTCOME MEASURES: Deaths during 20 years of follow up classified into specific causes. RESULTS: Over the follow up period 3347 men and 2638 women died. Height is inversely associated with all cause, coronary heart disease, stroke, and respiratory disease mortality among men and women. Adjustment for socioeconomic position and cardiovascular risk factors had little influence on these associations. Height is strongly associated with forced expiratory volume in one second (FEV1) and adjustment for FEV1 considerably attenuated the association between height and cardiorespiratory mortality. Smoking related cancer mortality is not associated with height. The risk of deaths from cancer unrelated to smoking tended to increase with height, particularly for haematopoietic, colorectal and prostate cancers. Stomach cancer mortality was inversely associated with height. Adjustment for socioeconomic position had little influence on these associations. CONCLUSION: Height serves partly as an indicator of socioeconomic circumstances and nutritional status in childhood and this may underlie the inverse associations between height and adulthood cardiorespiratory mortality. Much of the association between height and cardiorespiratory mortality was accounted for by lung function, which is also partly determined by exposures acting in childhood. The inverse association between height and stomach cancer mortality probably reflects Helicobacter pylori infection in childhood resulting inor being associated withshorter height. The positive associations between height and several cancers unrelated to smoking could reflect the influence of calorie intake during childhood on the risk of these cancers

Professional closure by proxy: the impact of changing educational requirements on class mobility for a cohort of Big 8 partners

Closure events impacting on class mobility may include mechanisms initiated by bodies other than the professional body. The research examines if the introduction of full-time study requirements at universities for aspiring accountants effectively introduced a closure mechanism in the accounting profession. Data was derived from an Oral History study of partners in large firms. The younger partners (born after the Second World War) completed full-time degree study at university, but did not provide evidence of class mobility into the profession. The older cohort, born between 1928 and 1946, completed part-time studies only, few completed a degree, and, in contrast to the younger cohort, shows a perceptible upward movement from lower socio-economic classes into the professional class. This suggests that changing the preferred educational routes for new accountants entering the large chartered accounting (CA) firms compromised the "stepping stone" function of accounting as a portal into the professional class

New fossil remains of Homo naledi from the Lesedi Chamber, South Africa

The Rising Star cave system has produced abundant fossil hominin remains within the Dinaledi Chamber, representing a minimum of 15 individuals attributed to Homo naledi. Further exploration led to the discovery of hominin material, now comprising 131 hominin specimens, within a second chamber, the Lesedi Chamber. The Lesedi Chamber is far separated from the Dinaledi Chamber within the Rising Star cave system, and represents a second depositional context for hominin remains. In each of three collection areas within the Lesedi Chamber, diagnostic skeletal material allows a clear attribution to H. naledi. Both adult and immature material is present. The hominin remains represent at least three individuals based upon duplication of elements, but more individuals are likely present based upon the spatial context. The most significant specimen is the near-complete cranium of a large individual, designated LES1, with an endocranial volume of approximately 610 ml and associated postcranial remains. The Lesedi Chamber skeletal sample extends our knowledge of the morphology and variation of H. naledi, and evidence of H. naledi from both recovery localities shows a consistent pattern of differentiation from other hominin species.SP201