The development of a measure of social care outcome for older people. Funded/commissioned by: Department of Health

An essential element of identifying Best Value and monitoring cost-effective care is to be able to identify the outcomes of care. In the field of health services, use of utility-based health related quality of life measures has become widespread, indeed even required. If, in the new era of partnerships, social care outcomes are to be valued and included we need to develop measures that reflect utility or welfare gain from social care interventions. This paper reports on a study, commissioned as part of the Department of Health’s Outcomes of Social Care for Adults Initiative, that developed an instrument and associated utility indexes that provide a tool for evaluating social care interventions in both a research and service setting. Discrete choice conjoint analysis used to derive utility weights provided us with new insights into the relative importance of the core domains of social care to older people. Whilst discrete choice conjoint analysis is being increasingly used in health economics, this is the first study that has attempted to use it to derive a measure of outcome

Dissipative and Dispersive Optomechanics in a Nanocavity Torque Sensor

Dissipative and dispersive optomechanical couplings are experimentally observed in a photonic crystal split-beam nanocavity optimized for detecting nanoscale sources of torque. Dissipative coupling of up to approximately $500$ MHz/nm and dispersive coupling of $2$ GHz/nm enable measurements of sub-pg torsional and cantilever-like mechanical resonances with a thermally-limited torque detection sensitivity of 1.2$\times 10^{-20} \text{N} \, \text{m}/\sqrt{\text{Hz}}$ in ambient conditions and 1.3$\times 10^{-21} \text{N} \, \text{m}/\sqrt{\text{Hz}}$ in low vacuum. Interference between optomechanical coupling mechanisms is observed to enhance detection sensitivity and generate a mechanical-mode-dependent optomechanical wavelength response.Comment: 11 pages, 6 figure

Association of open-angle glaucoma loci with incident glaucoma in the Blue Mountains Eye Study.

This article is available under the terms of the Creative Commons Attribution License (CC BY). http://creativecommons.org/licenses/by/3.0/ You may distribute and copy the article, create extracts, abstracts, and other revised versions, adaptations or derivative works of or from an article (such as a translation), to include in a collective work (such as an anthology), to text or data mine the article, including for commercial purposes without permission from Elsevier. The original work must always be appropriately credited.PURPOSE: To determine if open-angle glaucoma (OAG)-associated single nucleotide polymorphisms (SNPs) are associated with incident glaucoma and if such genetic information is useful in OAG risk prediction. DESIGN: Case-control from within a population-based longitudinal study. METHODS: study population: Individuals aged over 49 years of age living in the Blue Mountains region west of Sydney and enrolled in the Blue Mountains Eye Study. observation: Cases for this sub-study (n = 67) developed incident OAG between baseline and 10-year visits, in either eye, while controls (n = 1919) had no evidence for OAG at any visit. All participants had an ocular examination and DNA genotyped for reported OAG risk SNPs. main outcome measure: Incident OAG. RESULTS: Two loci also known to be associated with cup-to-disc ratio as well as OAG (9p21 near CDKN2B-AS1 and SIX1/SIX6) were both significantly associated with incident OAG in the Blue Mountains Eye Study cohort (P = .006 and P = .004, respectively). The TMCO1 locus was nominally associated (P = .012), while the CAV1/CAV2 and 8q22 loci were not associated. Multivariate logistic regression and neural network analysis both indicated that the genetic risk factors contributed positively to the predictive models incorporating traditional risk factors. CONCLUSIONS: This study shows that previously reported genetic variations related to OAG and cup-to-disc ratio are associated with the onset of OAG and thus may become useful in risk prediction algorithms designed to target early treatment to those most at risk of developing glaucoma

Prophylactic antibiotic regimens in tumour surgery (PARITY): protocol for a multicentre randomised controlled study.

IntroductionLimb salvage with endoprosthetic reconstruction is the standard of care for the management of lower-extremity bone tumours in skeletally mature patients. The risk of deep postoperative infection in these procedures is high and the outcomes can be devastating. The most effective prophylactic antibiotic regimen remains unknown, and current clinical practice is highly varied. This trial will evaluate the effect of varying postoperative prophylactic antibiotic regimens on the incidence of deep infection following surgical excision and endoprosthetic reconstruction of lower-extremity bone tumours.Methods and analysisThis is a multicentre, blinded, randomised controlled trial, using a parallel two-arm design. 920 patients 15 years of age or older from 12 tertiary care centres across Canada and the USA who are undergoing surgical excision and endoprosthetic reconstruction of a primary bone tumour will receive either short (24 h) or long (5 days) duration postoperative antibiotics. Exclusion criteria include prior surgery or infection within the planned operative field, known colonisation with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus at enrolment, or allergy to the study antibiotics. The primary outcome will be rates of deep postoperative infections in each arm. Secondary outcomes will include type and frequency of antibiotic-related adverse events, patient functional outcomes and quality-of-life scores, reoperation and mortality. Randomisation will be blocked, with block sizes known only to the methods centre responsible for randomisation, and stratified by location of tumour and study centre. Patients, care givers and a Central Adjudication Committee will be blinded to treatment allocation. The analysis to compare groups will be performed using Cox regression and log-rank tests to compare survival functions at α=0.05.Ethics and disseminationThis study has ethics approval from the McMaster University/Hamilton Health Sciences Research Ethics Board (REB# 12-009). Successful completion will significantly impact on clinical practice and enhance patients' lives. More broadly, this trial will develop a network of collaboration from which further high-quality trials in Orthopaedic Oncology will follow

Transnational higher education partnerships and the role of operational faculty members: developing an alternative theoretical approach for empirical research

For too long, transnational higher education (TNE) has been linked to discourse predominately focused upon strategic implementation, quality assurance and pedagogy. Whilst these aspects are important when designing and managing overseas provisions, there is a lack of research focusing on the social interactions that influence the pace and development of TNE partnerships. This gap is particularly evident at the operational phase of TNE partnerships. This conceptual article therefore offers an alternative way in which to research TNE partnerships, in relation to the interactions of faculty members delivering at the operational level. It provides an integrated theoretical framework, comprising of three different theoretical approaches in order to provide a conceptual tool in which to investigate and evaluate TNE partnership development. The article concludes that by understanding how relationships develop between faculty members tasked with delivering TNE, international partnerships can be significantly strengthened in terms of their progression and value

Imperfect Homoclinic Bifurcations

Experimental observations of an almost symmetric electronic circuit show complicated sequences of bifurcations. These results are discussed in the light of a theory of imperfect global bifurcations. It is shown that much of the dynamics observed in the circuit can be understood by reference to imperfect homoclinic bifurcations without constructing an explicit mathematical model of the system.Comment: 8 pages, 11 figures, submitted to PR

The Inheritance of Peripapillary Atrophy

PURPOSE. To estimate the relative importance of genes and environment in peripapillary atrophy type beta (␤-PPA) in a classic twin study. METHODS. Female twin pairs (n ϭ 506) aged 49 to 79 years were recruited from the St. Thomas' UK Adult Twin Registry. Peripapillary atrophy was identified from masked grading of stereoscopic optic disc photographs. Structural equation modeling was performed using Mx with polychoric correlations of ␤-PPA and refractive error (divided into deciles). RESULTS. ␤-PPA prevalence was 25.1% and did not vary with zygosity. Case-wise concordance for right eyes was 0.76 (95% CI, 0.57-0.88) for monozygotic (MZ) and 0.37 (95% CI, 0.15-0.56) for dizygotic (DZ) pairs. Multivariate modeling suggested additive genetic effects and individual environment, with no shared environment or dominant genetic effect. ␤-PPA heritability was 0.70 (95% CI, 0.54 -0.83), and spherical equivalent 0.88 (95% CI, 0.85-0.91); age had no significant effect on variance. The genetic correlation between ␤-PPA and spherical equivalent was Ϫ0.21. However, only 3% of the genetic variance of ␤-PPA was explained by genetic factors in common with refractive error, with 67% explained by specific genetic factors for ␤-PPA. Of the 30% of variance explained by unique environmental factors, only 3% was explained by these factors in common with environmental factors involved in refractive error. CONCLUSIONS. The presence of ␤-PPA, a frequent ocular finding known to be associated with open-angle glaucoma, appears to be under strong genetic control, with only a small amount of this genetic effect shared with genes involved in myopia. (Invest Ophthalmol Vis Sci

Statistical properties of hybrid estimators proposed for GEDI – NASA’s Global Ecosystem Dynamics Investigation

NASA’s Global Ecosystem Dynamics Investigation (GEDI) mission will collect waveform lidar data at a dense sample of ∼25 m footprints along ground tracks paralleling the orbit of the International Space Station (ISS). GEDI’s primary science deliverable will be a 1 km grid of estimated mean aboveground biomass density (Mg ha ^−1 ), covering the latitudes overflown by ISS (51.6 °S to 51.6 °N). One option for using the sample of waveforms contained within an individual grid cell to produce an estimate for that cell is hybrid inference, which explicitly incorporates both sampling design and model parameter covariance into estimates of variance around the population mean. We explored statistical properties of hybrid estimators applied in the context of GEDI, using simulations calibrated with lidar and field data from six diverse sites across the United States. We found hybrid estimators of mean biomass to be unbiased and the corresponding estimators of variance appeared to be asymptotically unbiased, with under-estimation of variance by approximately 20% when data from only two clusters (footprint tracks) were available. In our study areas, sampling error contributed more to overall estimates of variance than variability due to the model, and it was the design-based component of the variance that was the source of the variance estimator bias at small sample sizes. These results highlight the importance of maximizing GEDI’s sample size in making precise biomass estimates. Given a set of assumptions discussed here, hybrid inference provides a viable framework for estimating biomass at the scale of a 1 km grid cell while formally accounting for both variability due to the model and sampling error