Information, Perceptions and Exporting - Evidence from a Randomized Controlled Trial

We present novel evidence from the results of a randomized controlled trial on the role that information plays in the perceptions of the benefits and costs of exporting. We first present results from a baseline survey of approximately 1,000 UK manufacturing firms to show that non-exporters hold substantially more negative beliefs about the costs and benefits of exporting relative to exporters. We then explore the extent to which these differences in perceptions are due to a biased understanding of the true costs and benefits of exporting on the part of non-exporters, or are instead a reflection of underlying differences in performance characteristics across firms, the view assumed by most theories of international trade. To do this, we make targeted information available to a randomly selected subset of these firms in the form of information from the UK's export promotion agency about the benefits and costs of exporting. The results of our intervention reveal a surprising, asymmetric response on the part of exporters and non-exporters. Instead of revising their negative perceptions upward, treated non-exporters become more likely to report lower perceived benefits and higher perceived barriers compared to non-treated non-exporters. In contrast, the attitudes of existing exporters improve. We discuss different behavioral and non-behavioral explanations for this result and highlight possible implications for export promotion policies

Effects of different antibiotic classes on airway bacteria in stable COPD using culture and molecular techniques: a randomised controlled trial

Long-term antibiotic therapy is used to prevent exacerbations of COPD but there is uncertainty over whether this reduces airway bacteria. The optimum antibiotic choice remains unknown. We conducted an exploratory trial in stable patients with COPD comparing three antibiotic regimens against placebo

The association of cold weather and all-cause and cause-specific mortality in the island of Ireland between 1984 and 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.This article has been made available through the Brunel Open Access Publishing Fund.Background This study aimed to assess the relationship between cold temperature and daily mortality in the Republic of Ireland (ROI) and Northern Ireland (NI), and to explore any differences in the population responses between the two jurisdictions. Methods A time-stratified case-crossover approach was used to examine this relationship in two adult national populations, between 1984 and 2007. Daily mortality risk was examined in association with exposure to daily maximum temperatures on the same day and up to 6 weeks preceding death, during the winter (December-February) and cold period (October-March), using distributed lag models. Model stratification by age and gender assessed for modification of the cold weather-mortality relationship. Results In the ROI, the impact of cold weather in winter persisted up to 35 days, with a cumulative mortality increase for all-causes of 6.4% (95%CI=4.8%-7.9%) in relation to every 1oC drop in daily maximum temperature, similar increases for cardiovascular disease (CVD) and stroke, and twice as much for respiratory causes. In NI, these associations were less pronounced for CVD causes, and overall extended up to 28 days. Effects of cold weather on mortality increased with age in both jurisdictions, and some suggestive gender differences were observed. Conclusions The study findings indicated strong cold weather-mortality associations in the island of Ireland; these effects were less persistent, and for CVD mortality, smaller in NI than in the ROI. Together with suggestive differences in associations by age and gender between the two Irish jurisdictions, the findings suggest potential contribution of underlying societal differences, and require further exploration. The evidence provided here will hope to contribute to the current efforts to modify fuel policy and reduce winter mortality in Ireland

Use of low-dose oral theophylline as an adjunct to inhaled corticosteroids in preventing exacerbations of chronic obstructive pulmonary disease: study protocol for a randomised controlled trial.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with high morbidity, mortality, and health-care costs. An incomplete response to the anti-inflammatory effects of inhaled corticosteroids is present in COPD. Preclinical work indicates that 'low dose' theophylline improves steroid responsiveness. The Theophylline With Inhaled Corticosteroids (TWICS) trial investigates whether the addition of 'low dose' theophylline to inhaled corticosteroids has clinical and cost-effective benefits in COPD. METHOD/DESIGN: TWICS is a randomised double-blind placebo-controlled trial conducted in primary and secondary care sites in the UK. The inclusion criteria are the following: an established predominant respiratory diagnosis of COPD (post-bronchodilator forced expiratory volume in first second/forced vital capacity [FEV1/FVC] of less than 0.7), age of at least 40 years, smoking history of at least 10 pack-years, current inhaled corticosteroid use, and history of at least two exacerbations requiring treatment with antibiotics or oral corticosteroids in the previous year. A computerised randomisation system will stratify 1424 participants by region and recruitment setting (primary and secondary) and then randomly assign with equal probability to intervention or control arms. Participants will receive either 'low dose' theophylline (Uniphyllin MR 200 mg tablets) or placebo for 52 weeks. Dosing is based on pharmacokinetic modelling to achieve a steady-state serum theophylline of 1-5 mg/l. A dose of theophylline MR 200 mg once daily (or placebo once daily) will be taken by participants who do not smoke or participants who smoke but have an ideal body weight (IBW) of not more than 60 kg. A dose of theophylline MR 200 mg twice daily (or placebo twice daily) will be taken by participants who smoke and have an IBW of more than 60 kg. Participants will be reviewed at recruitment and after 6 and 12 months. The primary outcome is the total number of participant-reported COPD exacerbations requiring oral corticosteroids or antibiotics during the 52-week treatment period. DISCUSSION: The demonstration that 'low dose' theophylline increases the efficacy of inhaled corticosteroids in COPD by reducing the incidence of exacerbations is relevant not only to patients and clinicians but also to health-care providers, both in the UK and globally. TRIAL REGISTRATION: Current Controlled Trials ISRCTN27066620 was registered on Sept. 19, 2013, and the first subject was randomly assigned on Feb. 6, 2014

Clothing insulation and temperature, layer and mass of clothing under comfortable environmental conditions

This study was designed to investigate the relationship between the microclimate temperature and clothing insulation (Icl) under comfortable environmental conditions. In total, 20 subjects (13 women, 7 men) took part in this study. Four environmental temperatures were chosen: 14??C (to represent March/April), 25??C (May/June), 29??C (July/August), and 23??C (September/October). Wind speed (0.14ms-1) and humidity (45%) were held constant. Clothing microclimate temperatures were measured at the chest (Tchest) and on the interscapular region (Tscapular). Clothing temperature of the innermost layer (Tinnermost) was measured on this layer 30 mm above the centre of the left breast. Subjects were free to choose the clothing that offered them thermal comfort under each environmental condition. We found the following results. 1) All clothing factors except the number of lower clothing layers (Llower), showed differences between the different environmental conditions (P<0.05). The ranges of Tchest were 31.6 to 33.5??C and 32.2 to 33.4??C in Tscapular. The range of Tinnermost was 28.6 to 32.0??C. The range of the upper clothing layers (Lupper) and total clothing mass (Mtotal) was 1.1 to 3.2 layers and 473 to 1659 g respectively. The range of Icl was 0.78 to 2.10 clo. 2) Post hoc analyses showed that analysis of Tinnermost produced the same results as for that of Icl. Likewise, the analysis of Lupper produced the same result as the analysis of the number of total layers (Ltotal) within an outfit. 3) Air temperature (ta) had positive relationships with Tchest and Tscapular and with Tinnermost but had inverse correlations with Icl, Mtotal, Lupper and Ltotal. Tchest, Tscapular, and Tinnermost increased as ta rose. 4) Icl had inverse relationships with Tchest and Tinnermost, but positive relationships with Mtotal, Lupper and Ltotal. Icl could be estimated by Mtotal, Lupper, and Tscapular using a multivariate linear regression model. 5) Lupper had positive relationships with Icl and Mtotal, but Llower did not. Subjects hardly changed Llower under environmental comfort conditions between March and October. This indicates that each of the Tchest, Mtotal, and Lupper was a factor in predicting Icl. Tinnermost might also be a more influential factor than the clothing microclimate temperature.open1

Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life

Exacerbations of chronic obstructive pulmonary disease (COPD) represent a significant clinical problem, and are associated with decreased lung function, worsening quality of life and decreased physical activity levels, with even a single exacerbation having detrimental effects. The occurrence of COPD exacerbations can also have a considerable impact on healthcare costs and mortality rates, with over one-fifth of patients hospitalized for a COPD exacerbation for the first time dying within one year of discharge. This highlights the need for COPD exacerbations to be a major focus in clinical practice. Furthermore, the substantial effect that COPD exacerbations can have on patient mental health should not be underestimated. Despite their clinical importance, COPD exacerbations are poorly recognized and reported by patients, and improving patient understanding and reporting of exacerbations to ensure prompt treatment may minimize their deleterious effects. Renewed focus on improving current clinical practice with support from evidence-based guidelines is required. This also raises a challenge to payors, healthcare systems and government policies to do more to tackle the considerable outstanding burden of COPD exacerbations