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Generation of high-quality evidence on medical devices through clinical trials can be challenging. The United Kingdom's National Institute for Health and Care Excellence (NICE) has developed a research commissioning framework for producing clinical evidence where gaps in the literature prevent definitive recommendations in their medical technology guidance and diagnostics guidance. The research commissioning framework involves NICE's external assessment centers collaborating with clinical researchers to secure funding and to design, conduct, and publish a study to address research recommendations within 3 years of guidance publications. We aimed to describe the early results of the framework.
Publically available information and results from an informal survey of NICE's external assessment centers were reviewed.
As of December 2016, NICE has published a total of thirty medical technology guidance topics and twenty-four diagnostics guidance topics, five and twenty of which have research recommendations, respectively. A total of fourteen research commissioning framework-facilitated projects have been initiated. Two research projects have successfully secured external funding for a clinical trial: (i) non-contact low frequency ultrasound therapy for wound healing; and (ii) Parafricta bootees for pressure ulcer prevention. Further projects have produced published outputs without external funding. Four projects have been completed and undergone guidance review; one guidance topic was withdrawn and three have been transferred to the “static list”. Early experiences of NICE's research commissioning framework suggest that securing financial support from manufacturers or funding bodies for interventional clinical trials to answer single technology research questions within a short time frame is challenging but possible. The value of early feasibility studies to assess the likelihood of obtaining funding and of addressing NICE's research recommendations was recognised.
NICE can facilitate independent research through its research commissioning framework initiative. Securing funding has proved challenging but recent successes have shown that approach is possible. Outputs which fill the evidence gap to an extent where a definitive guidance update is possible have been rare.
To test modifications to nutrition label serving size information on understanding of energy (calorie) content among youth and young adults.
Participants completed two online experiments. First, participants were randomly assigned to view a beverage nutrition label with a reference amount of per serving (250 ml), per container (473 ml) or a dual-column format with both reference amounts. Participants were then randomized to view a cracker nutrition label which specified a single serving in small font, a single serving in large font, or the number of servings per bag with single serving information below. In both experiments, participants estimated energy content. Logistic regression analysis modelled correct energy estimation. Finally, participants reported their preference for serving size display format.
Canadian youth and young adults (n 2008; aged 16–24 years).
In experiment 1, participants randomized to view the nutrition label with per container or dual column were more likely to correctly identify energy content than those using per serving information (P<0·01). For experiment 2, the serving size display format had no association with correct energy estimation. The majority of participants (61·9 %) preferred the serving size format that included servings per package.
Labelling foods with nutrition information using a serving size reference amount for the entire container increased understanding of energy content. Consumers prefer nutrition labels that include more prominently featured serving size information. Additional modifications that further improve consumers’ accuracy should be examined. These results have direct implications for nutrition labelling policy.
The paper reports on the fourth (2010) season of fieldwork of the Cyrenaican Prehistory Project, and on further results of analyses of artefacts and organic materials collected in the 2009 season. Ground-based LiDar has provided both an accurate 3D scan of the Haua Fteah cave and information on the cave's morphometry or origins. The excavations in the cave focussed on Middle Palaeolithic or Middle Stone Age ‘Pre-Aurignacian’ layers below the base of the Middle Trench beside the McBurney Deep Sounding (Trench D) and on Final Palaeolithic ‘Oranian’ layers beside the upper part of the Middle Trench (Trench M). Although McBurney referred to the upper part of the Deep Sounding as more or less sterile, the 2010 excavations found evidence for small-scale but regular human presence in the form of stone artefacts and debitage, though given the sedimentary context the latter are unlikely to represent in situ knapping. The excavations of Trench M extended from the basal Capsian layers investigated in 2009 through Oranian layers to the transition with the Dabban Upper Palaeolithic. Some 17,000 lithic pieces have been studied from the Capsian and Oranian layers excavated in Trench M, in an area measuring less than 2 m by 1 m by 1.1 m deep, along with numerous animal bones, molluscs, and macrobotanical remains, as well as occasional shell beads. Preliminary studies of the lithics, bones, molluscs, and plant remains are revealing the changing character of late Pleistocene (Oranian) and early Holocene (Capsian) occupation in the Haua Fteah. Alongside the work in the Haua Fteah, the project continued its assessment of the Quaternary and archaeological sequences of the Cyrenaican coastland and completed a transect survey of surface lithic materials and their landform contexts from the pre-desert across the Gebel Akhdar to the coast, with a new focus on the al-Marj basin. Significant differences are emerging in patterns of Middle Palaeolithic and later hominin occupation and palaeodemography.
To compare energy (calories), total and saturated fats, and Na levels for ‘kids’ menu’ food items offered by four leading multinational fast-food chains across five countries.
A content analysis was used to create a profile of the nutritional content of food items on kids’ menus available for lunch and dinner in four leading fast-food chains in Australia, Canada, New Zealand, the UK and the USA.
Food items from kids’ menus were included from four fast-food companies: Burger King, Kentucky Fried Chicken (KFC), McDonald's and Subway. These fast-food chains were selected because they are among the top ten largest multinational fast-food chains for sales in 2010, operate in high-income English-speaking countries, and have a specific section of their restaurant menus labelled ‘kids’ menus’.
The results by country indicate that kids’ menu foods contain less energy (fewer calories) in restaurants in the USA and lower Na in restaurants in the UK. The results across companies suggest that kids’ menu foods offered at Subway restaurants are lower in total fat than food items offered at Burger King and KFC, and food items offered at KFC are lower in saturated fat than items offered at Burger King.
Although the reasons for the variation in the nutritional quality of foods on kids’ menus are not clear, it is likely that fast-food companies could substantially improve the nutritional quality of their kids’ menu food products, translating to large gains for population health.
Only about 19 of the 70 or so skeletons excavated at Cerro Portezuelo were brought back to UCLA, and adequate information is lacking for most of these. A detailed analysis of the excavation and curation records, as well as of the skeletons, was conducted in an attempt to identify their contexts and to evaluate their potential for contribution to our knowledge of the Cerro Portezuelo community. Although subadult dental health was good, adult levels of caries and antemortem loss were comparable to those of other Mesoamerican populations. Oxygen-isotope data suggest only limited long-distance immigration into the area. Further interpretation, however, is hampered by poor contextual data and the inability to assign most individuals to a specific period.
Despite formidable challenges and few successes in reintroducing large cats from captivity to the wild, the release of captives has widespread support from the general public and local governments, and continues to occur ad hoc. Commercial so-called lion Panthera leo encounter operations in Africa exemplify the issue, in which the captive breeding of the lion is linked to claims of reintroduction and broader conservation outcomes. In this article we assess the capacity of such programmes to contribute to in situ lion conservation. By highlighting the availability of wild founders, the unsuitability of captive lions for release and the evidence-based success of wild–wild lion translocations, we show that captive-origin lions have no role in species restoration. We also argue that approaches to reintroduction exemplified by the lion encounter industry do not address the reasons for the decline of lions in situ, nor do they represent a model that can be widely applied to restoration of threatened felids elsewhere.
In this article, we discuss new stable isotope data obtained from human dental tissue at the Krieger site, a Late Woodland Western Basin Tradition occupation from southwestern Ontario, Canada. These data point to significant maize consumption within an otherwise diffuse subsistence economy and settlement pattern geared toward the occupation of short-term campsites. The degree of maize consumption at Krieger implies the necessity for storage and year-round use. We suggest that maize horticultural practices during this time were as intensive as those suggested for contemporary and more sedentary Iroquoian groups to the east yet were accommodated without major changes to other aspects of the subsistence-settlement regime. Furthermore, the absence of a breastfeeding signal in the dental tissue not only implicates women in the role of maize production but might also imply demographic consequences. Accordingly, and with reference to comparative data, we suggest that notions of food production be recast and decoupled from the advent of sedentary lifeways in the lower Great Lakes region.
In the absence of any identified solid phase host (other than the original glass), boron has been assumed to accumulate in the fluid during the reaction of borosilicate glass waste forms with aqueous fluids. Using this assumption, it is possible to define a boron index which can be used to monitor the amount of glass that has been dissolved and to provide a worst-case measure of the degradation of the primary glass waste form. Several boron-containing silicate phases have been identified thus invalidating the assumption that boron does not precipitate. The effect is apparently small and the assumption that boron release is a direct measure of degree of alteration of borosilicate glass is still probably a good one.
The findings from several studies suggest that palliative care patients with advanced cancer experience multiple symptoms, and that these symptoms may be related to demographic and clinical factors as well as to patient outcomes. However, no systematic review has summarized the findings from studies that assessed multiple symptoms, predictors, and outcomes in these patients. The purposes of this review, focused on palliative care patients with advanced cancer, are to: 1) describe the relationships among multiple symptoms; 2) describe the predictors of multiple symptoms; and 3) describe the relationships between multiple symptoms and patient outcomes.
Comprehensive literature searches were completed using the following databases: PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsychInfo. The key words: cancer or advanced cancer or neoplasm, AND palliative care or terminal care or hospice or end-of-life, AND symptoms or multiple symptoms or symptom clusters were combined.
Twenty-two studies met the inclusion criteria and examined at least one of our purposes. The majority of these studies were descriptive and used one of four common symptom assessment scales. Fifty-six different signs and symptoms were evaluated across various dimensions (i.e., prevalence, severity, distress, frequency, control). Pain, dyspnea, and nausea were the only symptoms measured in all 22 studies. Relationships among concurrent symptoms were examined in nine studies. Relationships among symptoms and predictors (i.e., demographics, cancer type, healthcare delivery environment) were examined in seven studies. Relationships among symptoms and outcomes (i.e., functional status, psychological status, quality-of-life, survival time) were examined in 14 studies. Significant methodological variation was found among these studies.
Significance of results:
It is difficult to draw conclusions about the relationships among multiple symptoms, predictors, and outcomes due to the heterogeneity of these studies. Future research is needed to determine which symptoms and symptom dimensions to assess in order to better understand how multiple symptoms relate to each other as well to as predictors and outcomes in palliative care patients with advanced cancer.