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Registry-based trials have emerged as a potentially cost-saving study methodology. Early estimates of cost savings, however, conflated the benefits associated with registry utilisation and those associated with other aspects of pragmatic trial designs, which might not all be as broadly applicable. In this study, we sought to build a practical tool that investigators could use across disciplines to estimate the ranges of potential cost differences associated with implementing registry-based trials versus standard clinical trials.
We built simulation Markov models to compare unique costs associated with data acquisition, cleaning, and linkage under a registry-based trial design versus a standard clinical trial. We conducted one-way, two-way, and probabilistic sensitivity analyses, varying study characteristics over broad ranges, to determine thresholds at which investigators might optimally select each trial design.
Registry-based trials were more cost effective than standard clinical trials 98.6% of the time. Data-related cost savings ranged from $4300 to $600,000 with variation in study characteristics. Cost differences were most reactive to the number of patients in a study, the number of data elements per patient available in a registry, and the speed with which research coordinators could manually abstract data. Registry incorporation resulted in cost savings when as few as 3768 independent data elements were available and when manual data abstraction took as little as 3.4 seconds per data field.
Registries offer important resources for investigators. When available, their broad incorporation may help the scientific community reduce the costs of clinical investigation. We offer here a practical tool for investigators to assess potential costs savings.
Lamb live weight is one of the key drivers of profitability on sheep farms. Previous studies in Ireland have estimated genetic parameters for live weight and carcass composition traits using a multi-breed population rather than on an individual breed basis. The objective of the present study was to undertake genetic analyses of three lamb live weight and two carcass composition traits pertaining to purebred Texel, Suffolk and Charollais lambs born in the Republic of Ireland between 2010 and 2017, inclusive. Traits (with lamb age range in parenthesis) considered in the analyses were: pre-weaning weight (20 to 65 days), weaning weight (66 to 120 days), post-weaning weight (121 to 180 days), muscle depth (121 to 180 days) and fat depth (121 to 180 days). After data edits, 137 402 records from 50 372 lambs across 416 flocks were analysed. Variance components were derived using animal linear mixed models separately for each breed. Fixed effects included for all traits were contemporary group, age at first lambing of the dam, parity of the dam, a gender by age of the lamb interaction and a birth type by rearing type of the lamb interaction. Random effects investigated in the pre-weaning and weaning weight analyses included animal direct additive genetic, dam maternal genetic, litter common environment, dam permanent environment and residual variances. The model of analysis for post-weaning, muscle and fat depth included an animal direct additive genetic and litter common environment effect only. Significant direct additive genetic variation existed in all cases. Direct heritability for pre-weaning weight ranged from 0.14 to 0.30 across the three breeds. Weaning weight had a direct heritability ranging from 0.17 to 0.27 and post-weaning weight had a direct heritability ranging from 0.15 to 0.27. Muscle and fat depth heritability estimates ranged from 0.21 to 0.31 and 0.15 to 0.20, respectively. Positive direct correlations were evident for all traits. Results revealed ample genetic variation among animals for the studied traits and significant differences between breeds to suggest that genetic evaluations could be conducted on a per-breed basis.
The practice of anchoritism - religious enclosure which was frequently solitary and voluntarily embraced, very often in a permanent capacity - was widespread in many areas of Europe throughout the middle ages. Originating in the desert withdrawal of the earliest Christians and prefiguring even the monastic life, anchoritism developed into an elite vocation which was popular amongst both men and women. Within this reclusive vocation, the anchorite would withdraw, either alone or with others like her or him, to a small cell or building, very frequently attached to a church or other religious institution, where she or he would - theoretically at least - remain locked up until death. In the later period it was a vocation which was particularly associated with pious laywomen who appear to haveopted for this extreme way of life in their thousands throughout western Europe, often as an alternative to marriage or remarriage, allowing them, instead, to undertake the role of 'living saint' within the community.
This volume brings together for the first time in English much of the most important European scholarship on the subject to date. Tracing the vocation's origins from the Egyptian deserts of early Christian activity through to its multiple expressions in western Europe, it also identifies some of those regions - Wales and Scotland, for example - where the phenomenon doesnot appear to have been as widespread. As such, the volume provides an invaluable resource for those interested in the theories and practices of medieval anchoritism in particular, and the developmentof medieval religiosity more widely.
Dr LIZ HERBERT MCAVOY is Senior Lecturer in Gender in English and Medieval Studies at Swansea University.
CONTRIBUTORS: Anneke B. Mulder-Bakker, Gabriela Signori, M. Sensi, G. Cavero Dominguez, P. L'Hermite-Leclercq, Mari Hughes-Edwards, Colman O Clabaigh, Anna McHugh, Liz Herbert McAvoy.
In a particular success for translational research agendas, characterization of the neuronal circuits underlying fear extinction, and basic research in animal extinction paradigms, has led to intervention studies examining the use of D-cycloserine (DCS) to enhance therapeutic learning from exposure-based cognitive-behavioral therapy (CBT). In this article, we review these intervention studies, and discuss DCS augmentation of CBT relative to more traditional combination-treatment strategies in the treatment of anxiety disorders. We offer an accounting, based on evidence for internal context effects, of current limitations in the combination of antidepressant or benzodiazepine medications with CBT and discuss the advantages of isolated-dosing strategies with DCS relative to these limitations. This strategy is contrasted with the chronic-dosing applications of DCS for schizophrenia and Alzheimer's disease, and future directions for isolated-dosing strategies are discussed.
The objectives of this retrospective study were to (1) examine the predictive value of employer's disability management (DM) perceptions and DM policies in return-to-work outcomes for the injured worker, (2) examine factors that influence employer's DM perceptions, polices and return-to-work outcomes, and (3) examine the relationship between demographic factors of the individual and return-to-work outcomes. Employers from a northern British Columbia, Canada community were randomly selected to participate. The findings of the study supported the hypothesis that company perception towards DM is a significant contributing factor to the presence of DM policies in the workplace and that DM polices are predictive of return-to-work outcomes for injured workers.
The practice and management of subsurface drip irrigation (SDI) on heavy clay soils is poorly understood. Over-irrigation can lead to excessive runoff and drainage, with associated negative environmental consequences. Experiments were conducted in 2001/2002 and 2002/2003 on cotton (Gossypium hirsutum) in a Vertisol in Australia to evaluate the effect of SDI at various application rates on cotton yield and quality, and the results were compared with those for conventional furrow irrigation. Irrigating with SDI that supplied 50% or 75% of daily crop evapotranspiration (ETc) maintained a dry upper soil profile throughout the season. SDI at 50% ETc could potentially capture 250mm more rain during the season compared to SDI 90% ETc, and even more than furrow irrigation. However, supplying only 50% ETc with SDI hastened the maturity of the crop by on average 25 days compared with furrow irrigation and higher SDI rates, fewer bolls were set and yields were lower than in the other treatments. Nevertheless, a shorter season, if yield sacrifice is acceptable, favours logistics when integrating winter crops with summer cotton. It also reduces the number and cost of pesticide sprays and irrigation. Yield plateaued when 75% or more of daily ETc was supplied by SDI. The two drier treatments (SDI at 50% and 75% of ETc) had consistently higher water use efficiencies (WUE) for lint production compared with those of the two wetter SDI treatments (SDI at 90% and 105/120% ETc). All SDI treatments were also more efficient in the first year in the use of water for lint production than was furrow irrigation, but improved irrigation management in the form of faster irrigation and reduction of tail water in the second year obviated the advantage of SDI. Irrigation of cotton with SDI at 75% ETc offered significant benefits in terms of saved irrigation water over wetter SDI treatments, resulted in the highest average WUE for lint production over the two years, and reduced drainage and runoff compared with higher SDI rates and furrow irrigation.
Background and objective: In October 2000, we conducted a national postal survey of consultant day case anaesthetists in the UK to explore the range and variation in the practice of anaesthetizing a patient for day case surgery (paediatrics, urology and orthopaedics). The survey was carried out as part of a larger study that comprised a major two-centre randomized controlled trial designed to investigate the costs and outcome of several anaesthetic techniques during day care surgery in paediatric and adult patients (cost-effectiveness study of anaesthesia in day case surgery). We report the findings of this national survey of adult urology and orthopaedic day case anaesthetic practice in the UK.
Methods: The survey used a structured postal questionnaire and collected data on the duration of the surgical procedure; the use of premedication; the anaesthetic agents used for induction and maintenance; the fresh gas flows used for anaesthesia; the use of antiemetics; and the administration of local anaesthesia and analgesia.
Results: The overall response rate for the survey was 74% (63% for urology, 67% for orthopaedics). The survey indicated the following practice in adult urology and adult orthopaedic day case surgery: 6 and 12% used premedication; propofol was the preferred induction agent (96 and 97%) and isoflurane the preferred maintenance agent (56 and 58%); 32 and 41% used prophylactic antiemetics; 86 and 93% used a laryngeal mask.
Conclusions: This survey identifies the variation in current clinical practice in adult day surgery anaesthesia in the UK and discusses this variation in the context of current published evidence.
Background and objective: In October 2000, we conducted a national postal survey of day case consultant anaesthetists in the UK to explore the range and variation in practice of anaesthetizing a patient for day case surgery (paediatrics, urology and orthopaedics). This paper reports the findings of this national survey of paediatric day case anaesthetic practice carried out as part of a major two-centre randomized controlled trial designed to investigate the costs and outcome of several anaesthetic techniques during day care surgery in paediatric and adult patients (cost-effectiveness study of anaesthesia in day case surgery).
Methods: The survey used a structured postal questionnaire and collected data on the duration of surgical procedure; the use of premedication; the anaesthetic agents used for induction and maintenance; the fresh gas flow rates used for general anaesthesia; the use of antiemetics; and the administration of local anaesthesia and analgesia.
Results: The overall response rate for the survey was 74 and 63% for the paediatric section of the survey. Respondents indicated that 19% used premedication, 63% used propofol for induction, 54% used isoflurane for maintenance, 24% used prophylactic antiemetics and 85% used a laryngeal mask. The findings of this national survey are discussed and compared with published evidence.
Conclusions: This survey identifies the variation in clinical practice in paediatric day surgery anaesthesia in the UK.
This article discusses the mechanical properties of vapor-grown carbon fiber (VGCF)/nylon and VGCF/polypropylene composites. Fibers in the as-produced condition yielded composites with marginally improved mechanical properties. Microscopic examination of these composites clearly showed regions of uninfiltrated fibers, which could account for the unsatisfactory mechanical properties. The infiltration of the fibers by both polymers was improved by carefully ball milling the raw fiber so as to reduce the diameter of the fiber clumps to less than 300 μm. Properties of composites made with ball-milled material were improved in every respect. VGCF reinforcement in nylon slightly improved the tensile strength and doubled the modulus, while VGCF in polypropylene doubled the tensile strength and quadrupled the modulus compared to unreinforced material. Moreover, the composites were sufficiently improved that differences in fiber surface preparation became important. For example, air-etched fibers and fibers covered with low concentrations of aromatics produced polypropylene composites with significantly better mechanical properties than did fibers whose surfaces were heavily coated with aromatics. Both the tensile strength and the modulus of the composites fabricated with clean fibers exceeded theoretical values for composites made with fibers randomly oriented in three dimensions, indicating that the injection-molding process oriented the fibers to some extent.
A gravitational wave background (GWB) of sufficient strength, characterized by Ω, the energy density per logarithmic frequency interval in units of the closure density, would introduce timing residuals in the most stable millisecond pulsars. For a description pertaining to the observations of PSR’s 1937+21 and 1855+09 see Kaspi, Taylor and Ryba (1994), hereafter KTR, and references therein. Thorsett and Dewey (1996, see also this volume) present a method for placing a statistical upper limit on Ω. Their method however, cannot correctly account for the presence of a known level of white measurement noise in the timing residuals. We use a Bayesian approach which can best account for this white noise along with our lack of previous knowledge on the parameter Ω (McHugh, Zalamansky, Vernotte and Lantz, submitted).
Containerless processing of YBa2Cu3O7−δ was performed using an aero-acoustic levitation technique. Upon solidification from the liquid, spheres of size 2.5 mm diameter undercooled and recalesced, forming tetragonal YBa2Cu3O7−δ directly from the melt. Subsequent to solidification processing, these samples were annealed to single phase YBa2Cu3O7−δ with orthorhombic symmetry as indicated by powder XRD, SQUID magnetometer measurements indicate a sharp superconducting transition at approximately 85 K. Magnetic Jc values, calculated using the Bean critical state model, indicate that the spheres can carry critical current densities on the order of 104 A cm−2. Microstructural characterization has been performed on both the as-solidified and annealed spheres.
Synchrotron radiation from the Cornell High Energy Synchrotron Source (CHESS) was used to probe the alignment kinetics of a class of thermotropic siloxane-based liquid crystals under the influence of an electric field. The high flux allows for real-time investigation of microstructural changes as a function of frequency and temperature. The packing behavior of a pentamethylcyclosiloxane ring with pendant biphenyl mesogens was thoroughly investigated. The director orientation parameter, Sd, typically increased with decreasing temperature and was not strongly affected by frequency. Electric-field induced changes in the director orientation were also monitored. Upon application of an electric field, the nematic system exhibited a tendency to pack in columns with short-range correlation of the mesogens. Column correlation lengths are examined as a function of temperature for two frequencies. At the low temperature end of the mesophase, a tendency for the mesogens to layer pack was observed.