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OBJECTIVES/GOALS: Access to biostatistics expertise is essential for a successful clinical and translational research program. However, demand for statistical support at academic research centers can strain the capacity of biostatistics units. Our objective was to efficiently increase access to statistical expertise. METHODS/STUDY POPULATION: In cooperation with the Cancer Center Biostatistics Shared Resource, we replaced an informal 1-hour drop-in consultation program with structured office hours to provide statistical support to clinical and translational researchers at the University of California, Davis Medical Center. We doubled office hours to 2 hours per week and established six 20-minute appointments. Two Ph.D. level statisticians staff office hours. Researchers schedule appointments through Acuity Scheduling, a free on-line resource. Availability of the service is advertised monthly by sending an informational flyer to various university listservs. RESULTS/ANTICIPATED RESULTS: Prior to implementing the program in 2014, we averaged 91 office hour consults per year. Subsequently, consultations jumped to 171 in 2014 and have averaged 150 per year since then. Office hours attract students, residents, staff and faculty from a wide range of disciplines including the Schools of Medicine, Nursing, Veterinary Medicine and basic science departments. Project types span the clinical and translational spectrum covering lab, animal, clinical and population-level studies. Most consults related to data analysis and interpretation (57%) followed by sample size calculations/study design (29%) and response to reviewers (4%), with general statistical advice as the remainder. DISCUSSION/SIGNIFICANCE OF IMPACT: With 6 micro-consults per week, we can meet with many investigators and triage their statistical support needs. This program has proved very popular and was highly rated in a recent user survey, with several investigators noting that the consults facilitated successful publications and proposals.
Over the past several decades, private sector workers in the USA with employed-sponsored pensions have experienced a dramatic shift from defined benefit (DB) to defined contribution plans, while this trend has been less pronounced for public sector workers. In this paper, we use data from the Health and Retirement Study to explore changes in the retirement incentives and retirement behavior of public and private sector workers over the past quarter-century. We find that both groups have become less likely to report having a DB pension or any pension. Compared to their private sector counterparts, public sector workers have a higher level of retirement wealth and a larger financial gain from continued work at older ages, and these differences by sector are growing across cohorts. Both groups respond to financial incentives in making retirement decisions. However, growing differences by sector in the gain to continued work do not appear to have translated into diverging retirement behavior, as we observe similar trends in the two groups.
The ‘Landscapes of Production and Punishment’ project aims to examine how convict labour from 1830–1877 affected the built and natural landscapes of the Tasman Peninsula, as well as the lives of the convicts themselves.
Understanding predictors of successful ageing is essential to policy development promoting quality-of-life of an ageing population. Initial models precluded successful ageing in the presence of chronic disease/functional disability; however, this is discrepant with self-reported successful ageing. Indicators of social, psychological and physical health in 1,735 people aged 65–74, living in Canada, Columbia, Brazil or Albania, were analysed in the International Mobility in Ageing Study. Multiple logistic regression analysis was performed to estimate the change in self-rated successful ageing in relation to physical health, depression, social connectedness, resilience and site, while controlling for age, gender and income sufficiency. Sixty-five per cent of participants self-rated as ageing successfully; however, this was significantly different across sites (p < 0.0005, range 17–85%) and gender (p = 0.019). Using objective measures, 6 per cent were classified as ‘successful’, with significant variability amongst sites (p < 0.0005, range 0–12%). Subjective successful ageing was associated with fewer (not absence of) chronic diseases, absence of depression and less dysfunction in activities of daily living, but not with objective measures of physical dysfunction. Social connectedness and resilience also aligned with self-rated successful ageing. Traditional definitions of objective successful ageing are likely too restrictive, and thus, do not approximate self-rated successful ageing. International differences suggest that site could be a surrogate for variables other than physical/mental health and social engagement.
This study compared the best available treatment for bulimia nervosa,
cognitive–behavioural therapy (CBT) augmented by fluoxetine if indicated,
with a stepped-care treatment approach in order to enhance treatment
To establish the relative effectiveness of these two approaches.
This was a randomised trial conducted at four clinical centres
(Clinicaltrials.gov registration number: NCT00733525). A total of 293
participants with bulimia nervosa were randomised to one of two treatment
conditions: manual-based CBT delivered in an individual therapy format
involving 20 sessions over 18 weeks and participants who were predicted
to be non-responders after 6 sessions of CBT had fluoxetine added to
treatment; or a stepped-care approach that began with supervised
self-help, with the addition of fluoxetine in participants who were
predicted to be non-responders after six sessions, followed by CBT for
those who failed to achieve abstinence with self-help and medication
Both in the intent-to-treat and completer samples, there were no
differences between the two treatment conditions in inducing recovery (no
binge eating or purging behaviours for 28 days) or remission (no longer
meeting DSM–IV criteria). At the end of 1-year follow-up, the
stepped-care condition was significantly superior to CBT.
Therapist-assisted self-help was an effective first-level treatment in
the stepped-care sequence, and the full sequence was more effective than
CBT suggesting that treatment is enhanced with a more individualised
Depression measures that include somatic symptoms may inflate severity estimates among medically ill patients, including those with cardiovascular disease.
To evaluate whether people receiving in-patient treatment following acute myocardial infarction (AMI) had higher somatic symptom scores on the Beck Depression Inventory–II (BDI–II) than a non-medically ill control group matched on cognitive/affective scores.
Somatic scores on the BDI–II were compared between 209 patients admitted to hospital following an AMI and 209 psychiatry out-patients matched on gender, age and cognitive/affective scores, and between 366 post-AMI patients and 366 undergraduate students matched on gender and cognitive/affective scores.
Somatic symptoms accounted for 44.1% of total BDI–II score for the 209 post-AMI and psychiatry out-patient groups, 52.7% for the 366 post-AMI patients and 46.4% for the students. Post-AMI patients had somatic scores on average 1.1 points higher than the students (P<0.001). Across groups, somatic scores accounted for approximately 70% of low total scores (BDI–II <4) v. approximately 35% in patients with total BDI–II scores of 12 or more.
Our findings contradict assertions that self-report depressive symptom measures inflate severity scores in post-AMI patients. However, the preponderance of somatic symptoms at low score levels across groups suggests that BDI–II scores may include a small amount of somatic symptom variance not necessarily related to depression in post-AMI and non-medically ill respondents.
Some organizations, such as General Electric, currently use or have used forced distribution performance evaluation systems in order to rate employees' performance. This paper addresses the advantages and disadvantages as well as the legal implications of using such a system. It also discusses how an organization might assess whether a forced distribution system would be a good choice and key considerations when implementing such a system. The main concern is whether the organizational culture is compatible with a forced distribution system. When a company implements such a system, some important issues to consider include providing adequate training and ongoing support to managers who will be carrying out the system and also conducting adverse impact analyses to reduce legal risk.
The purpose of this impact evaluation was to measure the influence of a government of Ontario, Canada health promotion initiative, the Northern Fruit and Vegetable Pilot Programme (NFVPP), on elementary school-aged children’s psychosocial variables regarding fruit and vegetables, and fruit and vegetable consumption patterns.
A cluster-randomised controlled trial design was used. The NFVPP consisted of three intervention arms: (i) Intervention I: Free Fruit and Vegetable Snack (FFVS) + Enhanced Nutrition Education; (ii) Intervention II: FFVS-alone; and (iii) Control group. Using the Pro-Children Questionnaire, the primary outcome measure was children’s fruit and vegetable consumption, and the secondary outcome measures included differences in children’s awareness, knowledge, self-efficacy, preference, intention and willingness to increase fruit and vegetable consumption.
Twenty-six elementary schools in a defined area of Northern Ontario were eligible to participate in the impact evaluation. A final sample size of 1277 students in grades five to eight was achieved.
Intervention I students consumed more fruit and vegetables at school than their Control counterparts by 0·49 serving/d (P < 0·05). Similarly, Intervention II students consumed more fruit and vegetables at school than Control students by 0·42 serving/d, although this difference was not statistically significant. Among students in both intervention groups, preferences for certain fruit and vegetables shifted from ‘never tried it’ towards ‘like it’.
The NFVPP resulted in positive changes in elementary school-aged children’s fruit and vegetable consumption at school, and favourable preference changes for certain fruit and vegetables.
Gilbert de Preston was one of the best-known and longest-serving justices in thirteenth-century England, his career spanning from his appointment as a royal justice in 1240 at the age of just over thirty to his death, probably in December 1273, while chief justice of the Common Bench, an office he had held almost continuously from 1260. David Crook found that he served in fifty-five general eyres as a junior justice between 1239 and 1254, and between 1254 and 1272 he was chief justice in twenty-nine eyres. Gilbert was from a Northamptonshire knightly family, which held land in several places in the county and took its name from Preston Deanery, a couple of miles from Northampton. Preston Deanery was a substantial manor with house, gardens, fishpond, dovecot, a wind-mill and over thirty virgates in demesne, thirty-seven customary tenants, twenty-three cottagers and a handful of free tenants. It also had and still has a church that today is virtually unchanged from how Gilbert himself must have known it. Though the records of his work are incomplete, many surviving eyre rolls, assize rolls, bench rolls and feet of fines bear witness to his heavy workload and constant travels. This paper focuses on one of these rolls, the assize roll JUST 1/1197.
JUST 1/1197 is in an excellent state of preservation. Of its twenty-six membranes, twenty are written on both sides, giving forty-six sides of records altogether, though some membranes are not totally filled.
Poetic meter is a pattern of marked linguistic features and their absence that shapes a poetic line. In English these features are most often stresses, and the pattern that emerges between marked and unmarked stresses eventually becomes the overall form that is the poem itself. Although meter is measurable, and to some degree predictable, once it has been established through a series of repetitions, the actual rhythm of a poem converges and departs from this pattern of meter, lending it texture and interest.
As early as Aristotle, such dynamic emergence, or entelechy, of form has been contrasted to structures, or finite shapes, and when we speak of poetic meters and the larger structures that are poetic forms, we must acknowledge their living dimension as well as the fixed repertoire of kinds of poems that we have inherited from literary history. Even in the two dominant forms of meter in English - accentual and accentual-syllabic verse - we find this tension between expected and emerging form. Accentual meter, which measures pure stresses alone, historically is associated with vernacular verse and song traditions, including British nursery rhymes, game chants, and ballads. Because English is isochronous, that is, it tends to have the same intervals of time between stressed syllables no matter how many unstressed syllables are between them, accentual meters follow the natural stresses of spoken language. The varying syllables of such meter, following the Anglo-Saxon line, often are characterized by four beats and a strong medial caesura. Accentual syllabic meters, however, unfold by means of an ideal pattern constituted by the relation between the number of feet, or groups of syllables, in a line and the number of stresses; in any given poem, the actual line may not supply that relation in the expected way, but the reader or listener will bear the ideal pattern in mind.
This chapter considers the pathological changes that may be found in brains examined in non-forensic autopsies, where the pathology falls within the general heading of ‘natural causes’. Following recent organ-retention issues hospital consented autopsy practice has undergone marked change, resulting in a decline in the proportion of hospital deaths that come to autopsy. A recent audit in this hospital showed a fall in the autopsy rate for in-hospital deaths from 7.8% in 1997 to 3.2% in 2001, with a parallel reduction in the number of brains being retained for formal neuropathology examination within the region. In the ‘Guidelines on Autopsy Practice’ (2002) published by The Royal College of Pathologists it is advised that,
‘All major organs (heart, lungs, brain, liver and kidneys) should be dissected in order to facilitate examination of the blood and drainage in addition to relations with adjacent structures. These organs should be separated and weighed. If permitted and clinically relevant, fixation of the intact brain, followed by a detailed examination by a neuropathologist, produces a higher detection rate of abnormalities.’ 
Furthermore, it is suggested that occasions where the contents of the cranial cavity are not examined ‘should be exceptional’. This advice is intended to support a full and thorough approach to autopsy practice at the same time as facilitating training in autopsy techniques.
Toxic anterior segment syndrome (TASS), a complication of cataract surgery, is a sterile inflammation of the anterior chamber of the eye. An outbreak of TASS was recognized at an outpatient surgical center and its affiliated hospital in December 2002.
Medical records of patients who underwent cataract surgery during the outbreak were reviewed, and surgical team members who participated in the operations were interviewed. Potential causes of TASS were identified and eliminated. Feedwater from autoclave steam generators and steam condensates were analyzed by use of spectroscopy and ion chromatography.
During the outbreak, 8 (38%) of 21 cataract operations were complicated by TASS, compared with 2 (0.07%) of 2,713 operations performed from January 1996 through November 2002. Results of an initial investigation suggested that cataract surgical equipment may have been contaminated by suboptimal equipment reprocessing or as a result of personnel changes. The frequency of TASS decreased (1 of 44 cataract operations) after reassignment of personnel and revision of equipment reprocessing procedures. Further investigation identified the presence of impurities (eg, sulfates, copper, zinc, nickel, and silica) in autoclave steam moisture, which was attributed to improper maintenance of the autoclave steam generator in the outpatient surgical center. When impurities in autoclave steam moisture were eliminated, no cases of TASS were observed after more than 1,000 cataract operations.
Suboptimal reprocessing of cataract surgical equipment may evolve over time in busy, multidisciplinary surgical centers. Clinically significant contamination of surgical equipment may result from inappropriate maintenance of steam sterilization systems. Standardization of protocols for reprocessing of cataract surgical equipment may prevent outbreaks of TASS and may be of assistance during outbreak investigations.
Neurofibromatosis type 2 (NF2) remains a challenging diagnosis in childhood where there may be no neurological involvement. A 12-month-old male in whom NF2 was suspected because of characteristic ophthalmological and cutaneous lesions is reported. Cranial MRI showed no tumours. A pathogenic mutation was identified on NF2 gene analysis. The child developed hypertension due to renal vascular disease. Although renal vascular disease is a recognized complication of neurofibromatosis type 1 (NF1), it has not been reported in NF2.
On 28 October 1267, William de Sutwell came before the justices de terris datis at Lewes in Sussex to complain that William de Detling was depriving him of his wardship of a carucate of land in Bodiam, which his father, also William de Detling, had appropriated during the recent civil unrest. William de Detling did not come to answer the complaint and was resummoned to be in court on 31 October, when he again defaulted; the wardship was taken into the king's hand. After further non-appearances, it was adjudged that William de Sutwell should recover the wardship.
William de Sutwell was lord of Bodiam, from whom John de Bodiam held a carucate. John had died at Kenilworth Castle fighting with the rebels who continued resistance after the battle of Evesham, leaving an under-age son to inherit. William de Detling senior, a knight from Folkestone and a loyal supporter of the king, was granted after Evesham, among other modest rewards, the lands and tenements of John de Bodiam. William de Detling died shortly after John de Bodiam, and was succeeded by his son, William, whose inheritance included the wardship of John de Bodiam's heir, which William de Sutwell claimed as lord of the fee.
When William de Detling heard of the judgment, he hastened before the justices by then in session at Chichester to claim his right to redemption payment for the wardship under the terms of the Dictum of Kenilworth. The case was adjourned by request of the parties to Bermondsey on 27 January 1268 but William de Detling again defaulted and the case was heard coram rege at Westminster on 22 April 1268, where William de Detling regained seisin in anticipation of receiving ransom. Before redemption was agreed, claims for damages on both sides had to be assessed by inquest.
Lung transplantation is now a well-established successful surgical treatment for a range of pulmonary diseases for which no alternative therapies exist in the advanced stages . Lung transplantation can take the form of combined heart–lung, bilateral or single lung grafts and is performed for four main categories of lung disease. These are obstructive, restrictive, suppurative and vascular diseases, the latter including both primary and secondary causes . Lung transplantation has enabled the surgical pulmonary pathologist to study whole lungs without the superimposed agonal complications seen in autopsy specimens. The availability of these fresh lungs has proved a valuable resource for research into a range of pulmonary diseases as well as allowing detailed his to pathological study. Lung transplantation has also promoted interest in so called ‘end-stage’ lung diseases, with a greater drive for accurate diagnosis before referral for assessment of potential candidates [2–5]. This chapter examines aspects of the impact of lung transplantation on the diagnosis of pulmonary conditions and research into their aetiology encouraged by this material.
Accuracy of referral diagnosis
Diagnosis of parenchymal lung disease prior to referral for transplantation will have been made on clinical, radiological and/or histopathological criteria. Some patients may have had biopsy material in the form of transbronchial or open lung samples but this may have been obtained relatively late in the course of the disease when specific features are no longer present. Examination of the explanted lungs has enabled more accurate diagnoses to be made in many cases and effectively constitutes an audit of the thoracic medical practice of both the referring and specialist transplant centres.
We conducted a clinical trial to determine if prophylactic anticonvulsants in brain tumour patients (without prior seizures) reduced seizure frequency. We stopped accrual at 100 patients on the basis of the interim analysis.
One hundred newly diagnosed brain tumour patients received anticonvulsants (AC Group) or not (No AC Group) in this prospective randomized unblinded study. Sixty patients had metastatic, and 40 had primary brain tumours. Forty-six (46%) patients were randomized to the AC Group and 54 (54%) to the No AC Group. Median follow-up was 5.44 months (range 0.13 -30.1 months).
Seizures occurred in 26 (26%) patients, eleven in the AC Group and 15 in the No AC Group. Seizure-free survivals were not different; at three months 87% of the AC Group and 90% of the No AC Group were seizure-free (log rank test, p=0.98). Seventy patients died (unrelated to seizures) and survival rates were equivalent in both groups (median survival = 6.8 months versus 5.6 months, respectively; log rank test, p=0.50). We then terminated accrual at 100 patients because seizure and survival rates were much lower than expected; we would need ≥ 900 patients to have a suitably powered study.
These data should be used by individuals contemplating a clinical trial to determine if prophylactic anticonvulsants are effective in subsets of brain tumour patients (e.g. only anaplastic astrocytomas). When taken together with the results of a similar randomized trial, prophylactic anticonvulsants are unlikely to be effective or useful in brain tumour patients who have not had a seizure.