460 research outputs found
What is Law?
You broke the law. There should be a law. Loi du 29 juillet 1881 sur la
liberte de la presse. It is the law of God. It is the law of our ancestors. It
is a law of nature. It is the second law of thermodynamics. It is the tax code.
What is law? What common concept is expressed in the many uses of the word law
and its synonyms? What single concept of law is encompassed in its encoding in
scientific, judicial, and customary forms? Since understandings of law can be
culture specific, what concept of law is common across social systems? This
paper will develop a definition of law--and a way to measure the binding power
of a law or legal system--that is applicable across forms and civilizations. In
developing the definition, the paper will demonstrate that a QBist
understanding of quantum mechanics can serve as a Rosetta Stone which allows us
to reconcile Western and non-Western scientific systems.Comment: Minor corrections and updates. 16 page
The U.S. - U.S.S.R. Nuclear Balance: Present and Future
The purpose of this paper will be to arrive at some sort of understanding about the real importance of nuclear weapons in the hands of the U.S. and the U.S.S.R., something which has not been done heretofore in as skilled a fashion as is possible. There are a number of reasons for this, some of which are worth looking into because of the impact they have had on the actual policies of the United States
Physical Activity and Quality of Life in Retinitis Pigmentosa
Purpose. Aerobic exercise has been found to be neuroprotective in animal models of retinal degeneration. This study aims to report physical activity levels in patients with RP and investigate the relationship between physical activity and vision-related quality-of-life (QOL). Materials and Methods. A retrospective study of adult patients with RP examined in 2005–2014. Physical activity levels were assessed using the Godin Exercise Questionnaire. The NEI-Visual Function Questionaire-25 (VFQ-25), SF-36 General Health survey, and Pepper Assessment Tool for Disability (PAT-D) were administered. Results. 143 patients participated. 81 (56.6%) patients were classified as “active” and 62 (43.4%) as “insufficiently active” by Godin score. VFQ-25 revealed statistically significant differences between the active and insufficiently active patients, including overall visual function (53.3 versus 45.1, p=0.010), color vision (73.8 versus 52.9, p<0.001), and peripheral vision (34.3 versus 23.8, p=0.021). The physical component of the SF-36 and the PAT-D survey also demonstrated statistically significant differences (47.2 versus 52.9, p=0.002; 24.3 versus 30.0, p=0.010). Active patients had a higher initial Goldmann visual field (GVF) score (74.8 versus 60.1 degrees, p=0.255) and final GVF score (78.7 versus 47.1 degrees, p=0.069) but did not reach statistical significance. Conclusions. In RP, increased physical activity is associated with greater self-reported visual function and QOL
An Open Letter to Congressman Gingrich
We urge you to reconsider your proposal to amend the House Rules to require a three-fifths vote for enactment of laws that increase income taxes. This proposal violates the explicit intentions of the Framers. It is inconsistent with the Constitution\u27s language and structure. It departs sharply from traditional congressional practice. It may generate constitutional litigation that will encourage Supreme Court intervention in an area best left to responsible congressional decision.
Unless the proposal is withdrawn now, it will serve as an unfortunate precedent for the proliferation of supermajority rules on a host of different subjects in the future. Over time, we will see the continuing erosion of our central constitutional commitments to majority rule and deliberative democracy
Automated telephone communication systems for preventive healthcare and management of long-term conditions
Background
Automated telephone communication systems (ATCS) can deliver voice messages and collect health-related information from patients
using either their telephone’s touch-tone keypad or voice recognition software. ATCS can supplement or replace telephone contact
between health professionals and patients. There are four different types of ATCS: unidirectional (one-way, non-interactive voice
communication), interactive voice response (IVR) systems, ATCS with additional functions such as access to an expert to request advice
(ATCS Plus) and multimodal ATCS, where the calls are delivered as part of a multicomponent intervention.
Objectives
To assess the effects of ATCS for preventing disease and managing long-term conditions on behavioural change, clinical, process,
cognitive, patient-centred and adverse outcomes.
Search methods
We searched 10 electronic databases (the Cochrane Central Register of Controlled Trials; MEDLINE; Embase; PsycINFO; CINAHL;
Global Health; WHOLIS; LILACS; Web of Science; and ASSIA); three grey literature sources (Dissertation Abstracts, Index to Theses,
Australasian Digital Theses); and two trial registries (www.controlled-trials.com; www.clinicaltrials.gov) for papers published between
1980 and June 2015.
Selection criteria
Randomised, cluster- and quasi-randomised trials, interrupted time series and controlled before-and-after studies comparing ATCS
interventions, with any control or another ATCS type were eligible for inclusion. Studies in all settings, for all consumers/carers, in any
preventive healthcare or long term condition management role were eligible.
Data collection and analysis
We used standard Cochrane methods to select and extract data and to appraise eligible studies.
Main results
We included 132 trials (N = 4,669,689). Studies spanned across several clinical areas, assessing many comparisons based on evaluation
of different ATCS types and variable comparison groups. Forty-one studies evaluated ATCS for delivering preventive healthcare, 84 for
managing long-term conditions, and seven studies for appointment reminders. We downgraded our certainty in the evidence primarily
because of the risk of bias for many outcomes. We judged the risk of bias arising from allocation processes to be low for just over half
the studies and unclear for the remainder. We considered most studies to be at unclear risk of performance or detection bias due to
blinding, while only 16% of studies were at low risk. We generally judged the risk of bias due to missing data and selective outcome
reporting to be unclear.
For preventive healthcare, ATCS (ATCS Plus, IVR, unidirectional) probably increase immunisation uptake in children (risk ratio (RR)
1.25, 95% confidence interval (CI) 1.18 to 1.32; 5 studies, N = 10,454; moderate certainty) and to a lesser extent in adolescents (RR
1.06, 95% CI 1.02 to 1.11; 2 studies, N = 5725; moderate certainty). The effects of ATCS in adults are unclear (RR 2.18, 95% CI
0.53 to 9.02; 2 studies, N = 1743; very low certainty).
For screening, multimodal ATCS increase uptake of screening for breast cancer (RR 2.17, 95% CI 1.55 to 3.04; 2 studies, N = 462;
high certainty) and colorectal cancer (CRC) (RR 2.19, 95% CI 1.88 to 2.55; 3 studies, N = 1013; high certainty) versus usual care.
It may also increase osteoporosis screening. ATCS Plus interventions probably slightly increase cervical cancer screening (moderate
certainty), but effects on osteoporosis screening are uncertain. IVR systems probably increase CRC screening at 6 months (RR 1.36,
95% CI 1.25 to 1.48; 2 studies, N = 16,915; moderate certainty) but not at 9 to 12 months, with probably little or no effect of IVR
(RR 1.05, 95% CI 0.99, 1.11; 2 studies, 2599 participants; moderate certainty) or unidirectional ATCS on breast cancer screening.
Appointment reminders delivered through IVR or unidirectional ATCS may improve attendance rates compared with no calls (low
certainty). For long-term management, medication or laboratory test adherence provided the most general evidence across conditions
(25 studies, data not combined). Multimodal ATCS versus usual care showed conflicting effects (positive and uncertain) on medication
adherence. ATCS Plus probably slightly (versus control; moderate certainty) or probably (versus usual care; moderate certainty) improves
medication adherence but may have little effect on adherence to tests (versus control). IVR probably slightly improves medication
adherence versus control (moderate certainty). Compared with usual care, IVR probably improves test adherence and slightly increases
medication adherence up to six months but has little or no effect at longer time points (moderate certainty). Unidirectional ATCS,
compared with control, may have little effect or slightly improve medication adherence (low certainty). The evidence suggested little or
no consistent effect of any ATCS type on clinical outcomes (blood pressure control, blood lipids, asthma control, therapeutic coverage)
related to adherence, but only a small number of studies contributed clinical outcome data.
The above results focus on areas with the most general findings across conditions. In condition-specific areas, the effects of ATCS
varied, including by the type of ATCS intervention in use.
Multimodal ATCS probably decrease both cancer pain and chronic pain as well as depression (moderate certainty), but other ATCS
types were less effective. Depending on the type of intervention, ATCS may have small effects on outcomes for physical activity,
weight management, alcohol consumption, and diabetes mellitus. ATCS have little or no effect on outcomes related to heart failure,
hypertension, mental health or smoking cessation, and there is insufficient evidence to determine their effects for preventing alcohol/
substance misuse or managing illicit drug addiction, asthma, chronic obstructive pulmonary disease, HIV/AIDS, hypercholesterolaemia,
obstructive sleep apnoea, spinal cord dysfunction or psychological stress in carers.
Only four trials (3%) reported adverse events, and it was unclear whether these were related to the intervention
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