The University of Virginia and the Creation of the American Campus

Abstract: The history of collegiate architecture and planning in the United States is a complicated story that ranges from Thomas Jefferson’s University of Virginia which is widely hailed as one of the most cohesive and influential designs ever completed in North American to the opposite extreme of a miscellaneous collection of buildings lacking any overall order. From the initial beginning of American higher education in the 17th century to the present, colleges and universities have grown in size and complexity and have been analyzed in many books and studies. Jefferson’s original design of a large U shaped common ground planted with trees and bordered by rows of columns—larger in from the professor’s pavilions and smaller Tuscan order in front of the student dormitories, and capped by a large domed structure known as the Rotunda at one end still inspires. To understand the significance of Jefferson’s “Academical Village” at the University of Virginia and its impact one must consider the broader context and background of American institutions of higher learning and some of the issues and the special terminology employed. Key Words: Campus, Architecture, University of Virginia, planning, names of architects. Resumen : La historia de la arquitectura académica y su planificación en los Estados Unidos es una historia complicada que arranca de la Universidad de Thomas Jefferson de Virginia, ampliamente considerado como uno de los diseños más cohesionados e influyentes jamás realizados en América del Norte. Desde los comienzos de la educación superior en Estados Unidos en el siglo XVII hasta la actualidad, las universidades han crecido en tamaño y complejidad y se han analizado en muchos libros y estudios. El diseño original de Jefferson de un gran terreno común en forma de U, con árboles, bordeado por hileras de columnas y coronado por una gran estructura en forma de cúpula conocida como la rotonda aún hoy sirve de inspiración. Para entender el significado de lo que Jefferson llamó “Ciudad Universitaria” y, en concreto, su diseño de la Universidad de Virginia debemos considerar el contexto, el funcionamiento y objetivos de las instituciones estadounidenses de educación superior y la terminología empleada. Palabras clave: Campus, arquitectura, Universidad de Virginia, planificación, arquitecto

Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy

Objectives: Ongoing developments in design have improved the outlook for left-ventricular assist device (LVAD) implantation as a therapy in end-stage heart failure. Nevertheless, early cost-effectiveness assessments, based on first-generation devices, have not been encouraging. Against this background, we set out (i) to examine the survival benefit that LVADs would need to generate before they could be deemed cost-effective; (ii) to provide insight into the likelihood that this benefit will be achieved; and (iii) from the perspective of a healthcare provider, to assess the value of discovering the actual size of this benefit by means of a Bayesian value of information analysis. Methods: Cost-effectiveness assessments are made from the perspective of the healthcare provider, using current UK norms for the value of a quality-adjusted life-year (QALY). The treatment model is grounded in published analyses of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial of first-generation LVADs, translated into a UK cost setting. The prospects for patient survival with second-generation devices is assessed using Bayesian prior distributions, elicited from a group of leading clinicians in the field. Results: Using established thresholds, cost-effectiveness probabilities under these priors are found to be low (.2 percent) for devices costing as much as £60,000. Sensitivity of the conclusions to both device cost and QALY valuation is examined. Conclusions: In the event that the price of the device in use would reduce to £40,000, the value of the survival information can readily justify investment in further trials

Choice of Moisturiser for Eczema Treatment (COMET):feasibility study of a randomised controlled parallel group trial in children recruited from primary care

OBJECTIVES: To determine the feasibility of a randomised controlled trial of ‘leave on’ emollients for children with eczema. DESIGN: Single-centre, pragmatic, 4-arm, observer-blinded, parallel, randomised feasibility trial. SETTING: General practices in the UK. PARTICIPANTS: Children with eczema aged 1 month to <5 years. OUTCOME MEASURES: Primary outcome—proportion of parents who reported use of the allocated study emollient every day for the duration of follow-up (12 weeks). Other feasibility outcomes—participant recruitment and retention, data collection and completeness and blinding of observers to allocation. INTERVENTIONS: Aveeno lotion, Diprobase cream, Doublebase gel, Hydromol ointment. RESULTS: 197 children were recruited—107 by self-referral (mainly via practice mail-outs) and 90 by inconsultation (clinician consenting and randomising) pathways. Participants recruited inconsultation were younger, had more severe Patient-Oriented Eczema Measure scores and were more likely to withdraw than self-referrals. Parents of 20 (10%) of all the randomised participants reported using the allocated emollient daily for 84 days. The use of other non-study emollients was common. Completeness of data collected by parent-held daily diaries and at monthly study visits was good. Daily diaries were liked (81%) but mainly completed on paper rather than via electronic (‘app’) form. Major costs drivers were general practitioner consultations and eczema-related prescriptions. Observer unblinding was infrequent, and occurred at the baseline or first follow-up visit through accidental disclosure. CONCLUSIONS: It is feasible in a primary care setting to recruit and randomise young children with eczema to emollients, follow them up and collect relevant trial data, while keeping observers blinded to their allocation. However, reported use of emollients (study and others) has design implications for future trials. TRIAL REGISTRATION NUMBER: ISRCTN21828118/EudraCT2013-003001-26

Choice of Moisturiser for Eczema Treatment (COMET):Study protocol for a randomized controlled trial

BACKGROUND: Eczema is common in children and in the UK most cases are managed in primary care. The foundation of all treatment is the regular use of leave-on emollients to preserve and restore moisture to the skin. This not only improves comfort but may also reduce the need for rescue treatment for ‘flares’, such as topical corticosteroids. However, clinicians can prescribe many different types of emollient and there is a paucity of evidence to guide this choice. One reason for this may be the challenges of conducting a clinical trial: are parents or carers of young children willing to be randomly allocated an emollient and followed up for a meaningful amount of time? DESIGN: This is a single-centre feasibility study of a pragmatic, four-arm, single-masked, randomized trial. Children with eczema who are eligible (from 1 month to less than 5 years of age, not known to be sensitive or allergic to any of study emollients or their constituents) are recruited via their general practices. Participants are allocated Aveeno® lotion, Diprobase® cream, Doublebase® gel or Hydromol® ointment via a web-based system, using a simple randomization process in a 1:1:1:1 fashion. Researchers are masked to the study emollient. Participants are assessed at baseline and followed up for 3 months. Data are collected by daily diaries, monthly researcher visits and review of electronic medical records. Because this is a feasibility study, a formal sample size calculation for the estimation of treatment effectiveness has not be made but we aim to recruit 160 participants. DISCUSSION: Recruitment is on-going. At the end of the study, as well as being able to answer the question, ‘Is it is possible to recruit and retain children with eczema from primary care into a four-arm randomized trial of emollients?’, we will also have collected important data on the acceptability and effectiveness of four commonly used emollients. TRIAL REGISTRATION: Current Controlled Trials ISRCTN21828118 and Clinical Trials Register EudraCT2013-003001-26. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-015-0830-y) contains supplementary material, which is available to authorized users

Adjunctive rifampicin to reduce early mortality from Staphylococcus aureus bacteraemia (ARREST): study protocol for a randomised controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common and serious infection, with an associated mortality of ~25%. Once in the blood, S. aureus can disseminate to infect almost any organ, but bones, joints and heart valves are most frequently affected. Despite the infection's severity, the evidence guiding optimal antibiotic therapy is weak: fewer than 1,500 patients have been included in 16 randomised controlled trials investigating S. aureus bacteraemia treatment. It is uncertain which antibiotics are most effective, their route of administration and duration, and whether antibiotic combinations are better than single agents. We hypothesise that adjunctive rifampicin, given in combination with a standard first-line antibiotic, will enhance killing of S. aureus early in the treatment course, sterilise infected foci and blood faster, and thereby reduce the risk of dissemination, metastatic infection and death. Our aim is to determine whether adjunctive rifampicin reduces all-cause mortality within 14 days and bacteriological failure or death within 12 weeks from randomisation. METHODS: We will perform a parallel group, randomised (1:1), blinded, placebo-controlled trial in NHS hospitals across the UK. Adults (≥ 18 years) with S. aureus (meticillin-susceptible or resistant) grown from at least one blood culture who have received ≤ 96 h of active antibiotic therapy for the current infection and do not have contraindications to the use of rifampicin will be eligible for inclusion. Participants will be randomised to adjunctive rifampicin (600-900 mg/day; orally or intravenously) or placebo for the first 14 days of therapy in combination with standard single-agent antibiotic therapy. The co-primary outcome measures will be all-cause mortality up to 14 days from randomisation and bacteriological failure/death (all-cause) up to 12 weeks from randomisation. 940 patients will be recruited, providing >80% power to detect 45% and 30% reductions in the two co-primary endpoints of death by 14 days and bacteriological failure/death by 12 weeks respectively. DISCUSSION: This pragmatic trial addresses the long-standing hypothesis that adjunctive rifampicin improves outcome from S. aureus bacteraemia through enhanced early bacterial killing. If proven correct, it will provide a paradigm through which further improvements in outcome from S. aureus bacteraemia can be explored.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Conservation physiology of marine fishes: state of the art and prospects for policy

The state of the art of research on the environmental physiology of marine fishes is reviewed from the perspective of how it can contribute to conservation of biodiversity and fishery resources. A major constraint to application of physiological knowledge for conservation of marine fishes is the limited knowledge base; international collaboration is needed to study the environmental physiology of a wider range of species. Multifactorial field and laboratory studies on biomarkers hold promise to relate ecophysiology directly to habitat quality and population status. The 'Fry paradigm' could have broad applications for conservation physiology research if it provides a universal mechanism to link physiological function with ecological performance and population dynamics of fishes, through effects of abiotic conditions on aerobic metabolic scope. The available data indicate, however, that the paradigm is not universal, so further research is required on a wide diversity of species. Fish physiologists should interact closely with researchers developing ecological models, in order to investigate how integrating physiological information improves confidence in projecting effects of global change; for example, with mechanistic models that define habitat suitability based upon potential for aerobic scope or outputs of a dynamic energy budget. One major challenge to upscaling from physiology of individuals to the level of species and communities is incorporating intraspecific variation, which could be a crucial component of species' resilience to global change. Understanding what fishes do in the wild is also a challenge, but techniques of biotelemetry and biologging are providing novel information towards effective conservation. Overall, fish physiologists must strive to render research outputs more applicable to management and decision-making. There are various potential avenues for information flow, in the shorter term directly through biomarker studies and in the longer term by collaborating with modellers and fishery biologists.EU COST Action FA1004 Conservation Physiology of Marine Fishesinfo:eu-repo/semantics/publishedVersio

Reporting conditionals with modals

Conditionals and modals work in tandem in some instances of practical reasoning, or decision making. Consider the following example (from Kratzer 2012): a. I want to become a mayor. b. (q) I will become a mayor only if (p) I go to the pub. c. Therefore, I should go to the pub. Given what the cogniser wants (a) and the relevant circumstances (b), the conclusion that the cogniser goes to the pub comes out as necessary. Hence, the presence of the necessity modal should in (c). Indeed, given the context of (a), the necessity modal in (c) is simply a reflection of the necessity of p for q, which is overtly represented by the use of the ‘only if p, q’ construction. This chapter looks into whether indirect reports of conditionals – in particular, indirect reports which involve the use of a modal verb – are sensitive to the necessity of p for q in cases where necessity is not overtly represented in a conditional, as in ‘if p, q’ formulations. We report on two online experiments into the relation between (i) perceived necessity or sufficiency of the truth of a conditional antecedent for the truth of the consequent, and (ii) the formulation of an indirect report of a conditional with necessity or possibility modals (have to, should, could). In Experiment 1, the ‘necessity/sufficiency of p for q’ variable was manipulated by contextually altering the number of alternative antecedents (e.g. Cummins et al. 1991; Thompson 1994; Politzer 2003). It was found that modals used in indirect reports of ‘if p, q’ conditionals co-vary with the number of alternative antecedents in predictable ways. This suggests that modals used in indirect reports of ‘if p, q’ conditionals may be a diagnostic for biconditional versus material interpretations of conditionals. The aim of Experiment 2 was to find out whether the results of Experiment 1 could be replicated in contexts which lower/eliminate the believability of the conditionals. It was found that manipulating the believability variable has no reliable effect on the results

Indirect Reports in Modern Eastern Armenian

In this work we consider the distribution of complementizers in Modern Eastern Armenian. There are two complementizers: wor and t‘e. They both introduce complement clauses, but t‘e also expresses a dubitative value, implying that the speaker has doubts on the content following the complementizer. Moreover, t‘e, when embedded under verbs of saying, shifts the anchoring of indexicals, moving the anchor from the speaker – better called utterer – to the subject of the saying predicate. On the basis of this and further evidence coming from the analysis of sequence of tense and if-clauses, we will argue that the position of t‘e in the left periphery of the clause occupies a high position in the syntactic hierarchy. The aim of this work is on one hand, a better understanding of indirect reports and their syntax and, on the other, a more precise characterization of indexicals across languages

Mutations in FGF17, IL17RD, DUSP6, SPRY4, and FLRT3 Are Identified in Individuals with Congenital Hypogonadotropic Hypogonadism

Congenital hypogonadotropic hypogonadism (CHH) and its anosmia-associated form (Kallmann syndrome [KS]) are genetically heterogeneous. Among the &gt;15 genes implicated in these conditions, mutations in FGF8 and FGFR1 account for ∼12% of cases; notably, KAL1 and HS6ST1 are also involved in FGFR1 signaling and can be mutated in CHH. We therefore hypothesized that mutations in genes encoding a broader range of modulators of the FGFR1 pathway might contribute to the genetics of CHH as causal or modifier mutations. Thus, we aimed to (1) investigate whether CHH individuals harbor mutations in members of the so-called "FGF8 synexpression" group and (2) validate the ability of a bioinformatics algorithm on the basis of protein-protein interactome data (interactome-based affiliation scoring [IBAS]) to identify high-quality candidate genes. On the basis of sequence homology, expression, and structural and functional data, seven genes were selected and sequenced in 386 unrelated CHH individuals and 155 controls. Except for FGF18 and SPRY2, all other genes were found to be mutated in CHH individuals: FGF17 (n = 3 individuals), IL17RD (n = 8), DUSP6 (n = 5), SPRY4 (n = 14), and FLRT3 (n = 3). Independently, IBAS predicted FGF17 and IL17RD as the two top candidates in the entire proteome on the basis of a statistical test of their protein-protein interaction patterns to proteins known to be altered in CHH. Most of the FGF17 and IL17RD mutations altered protein function in vitro. IL17RD mutations were found only in KS individuals and were strongly linked to hearing loss (6/8 individuals). Mutations in genes encoding components of the FGF pathway are associated with complex modes of CHH inheritance and act primarily as contributors to an oligogenic genetic architecture underlying CHH