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To examine the costs and cost-effectiveness of mirtazapine compared to placebo over 12-week follow-up.
Economic evaluation in a double-blind randomized controlled trial of mirtazapine vs. placebo.
Community settings and care homes in 26 UK centers.
People with probable or possible Alzheimer’s disease and agitation.
Primary outcome included incremental cost of participants’ health and social care per 6-point difference in CMAI score at 12 weeks. Secondary cost-utility analyses examined participants’ and unpaid carers’ gain in quality-adjusted life years (derived from EQ-5D-5L, DEMQOL-Proxy-U, and DEMQOL-U) from the health and social care and societal perspectives.
One hundred and two participants were allocated to each group; 81 mirtazapine and 90 placebo participants completed a 12-week assessment (87 and 95, respectively, completed a 6-week assessment). Mirtazapine and placebo groups did not differ on mean CMAI scores or health and social care costs over the study period, before or after adjustment for center and living arrangement (independent living/care home). On the primary outcome, neither mirtazapine nor placebo could be considered a cost-effective strategy with a high level of confidence. Groups did not differ in terms of participant self- or proxy-rated or carer self-rated quality of life scores, health and social care or societal costs, before or after adjustment.
On cost-effectiveness grounds, the use of mirtazapine cannot be recommended for agitated behaviors in people living with dementia. Effective and cost-effective medications for agitation in dementia remain to be identified in cases where non-pharmacological strategies for managing agitation have been unsuccessful.
Cultural theory has been heavily influenced in the postmodern era by the idea that an incredulity towards meta-narratives shapes experience and that sceptical cultural consumers are aware of this. Melodrama offers an alternative conceptual frame for understanding global structures of feeling in a mass media age. This paper argues that the relationship between the melodramatic worldview and the postmodern is dialectical rather than oppositional. The mutually constitutive relationship between absolute and relative ideologies has tended to evade even those theorists of ‘post-postmodernism’ who have sought to reinstate the importance of belief into prevailing intellectual narratives of scepticism or suspicion. Drawing on Vermeulen and van den Akker's concept of ‘metamodernism’, this paper identifies a contemporary form of melodrama that we could label ‘metamodern’ – a term which indicates a dual sensibility which incorporates both scepticism and belief. Focusing on reality TV and sports broadcasting, this paper argues that melodrama is the modern form of the utopic, rooted in the belief system of myth, yet born in response to what Peter Brooks calls ‘the void’ of the modern world.
Kiwifruit is a carbohydrate food of low glycaemic potency which could potentially be exchanged for starch-based foods in management of postprandial glycaemia. The effect of equicarbohydrate partial exchange of kiwifruit varieties ‘Hayward’ green (GR) and ‘Zesy002’ (SunGold; SG) for a starchy wheat-based breakfast cereal (WB) on the characteristics of the postprandial glycaemic response and satiety was therefore determined. A total of twenty non-diabetic subjects (mean age 36 years; mean BMI 24·5 kg/m2) consumed four meals, each containing 40 g available carbohydrate, in random order, after an overnight fast. The meals were: (1) glucose; (2) 70·29 g breakfast cereal; (3) 200 g of GR plus breakfast cereal (30·93 g); and (4) 200 g of SG plus breakfast cereal (27·06 g). Throughout the 180 min postprandial period, capillary blood glucose concentrations were monitored, and satiety rated by a visual analogue scale. Partial kiwifruit substitution of WB significantly reduced postprandial glycaemic response amplitude (glucose, 3·91; WB, 3·66; WB + GR, 2·36; WB + SG, 2·31 mmol/l; least significant difference (LSD) 0·64; P < 0·001) and incremental area under the blood glucose response curve (0–120 min) (glucose, 228; WB, 180; WB + GR, 133; WB + SG, 134 mmol/l × min; LSD 22·7; P < 0·001). The area between baseline and response remained positive in kiwifruit-substituted meals but became negative after 120 min with glucose and WB, indicating that kiwifruit improved homeostatic control. Kiwifruit substitution of cereal did not significantly reduce satiety. We conclude that either ‘Hayward’ or ‘Zesy002’ kiwifruit may be used in equicarbohydrate partial substitution of starchy staple foods to reduce glycaemic response and improve glucose homeostasis without decreasing satiety.
To evaluate the efficacy of a new monochloramine generation system for control of Legionella in a hospital hot water distribution system
A 495-bed tertiary care hospital in Pittsburgh, Pennsylvania. The hospital has 12 floors covering approximately 78,000 m2.
The hospital hot water system was monitored for a total of 29 months, including a 5-month baseline sampling period prior to installation of the monochloramine system and 24 months of surveillance after system installation (postdisinfection period). Water samples were collected for microbiological analysis (Legionella species, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Acinetobacter species, nitrifying bacteria, heterotrophic plate count [HPC] bacteria, and nontuberculous mycobacteria). Chemical parameters monitored during the investigation included monochloramine, chlorine (free and total), nitrate, nitrite, total ammonia, copper, silver, lead, and pH.
A significant reduction in Legionella distal site positivity was observed between the pre- and postdisinfection periods, with positivity decreasing from an average of 53% (baseline) to an average of 9% after monochloramine application (P > .05). Although geometric mean HPC concentrations decreased by approximately 2 log colony-forming units per milliliter during monochloramine treatment, we did not observe significant changes in other microbial populations.
This is the first evaluation in the United States of a commercially available monochloramine system installed on a hospital hot water system for Legionella disinfection, and it demonstrated a significant reduction in Legionella colonization. Significant increases in microbial populations or other negative effects previously associated with monochloramine use in large municipal cold water systems were not observed.
Infect Control Hosp Epidemiol 2014;35(11):1356–1363
On the centenary in 1970 of Dickens's death, his image appeared on the postage stamps of thirteen British Commonwealth countries. For over a decade (1992–2003), Dickens was the face of the British ten-pound note and the image of a cricket match at Dingley Dell from The Pickwick Papers formed its background. As I write this Introduction in 2011 on the eve of the bicentenary of Dickens's birth, new Dickens adaptations, biographies, press stories, events, conferences and exhibitions are already announcing themselves all over the world. Dickens's continued cultural prominence and the ‘brand recognition’ achieved by his image and images seem to suggest that his vision has a certain consonance in the post-Victorian world. But how modern was Dickens? This question gives rise to no simple answer but to a myriad of paradoxes and contradictions. To the general public, Dickens has come to represent all that is not modern; he has become synonymous with a Victorian age defined in opposition to the present. It is notable that though Dickens is the most adapted author of all time for the screen, whereas it is a familiar experience to view ‘modern’ Shakespeare adaptations, there are relatively few Dickens adaptations that eschew costume for contemporary dress and settings; significantly, those that do so are often set and directed abroad. The viewing public likes to fix Dickens in a particular vision of a Victorian period which it associates with ‘the past’ as well as with a distinctive brand of Englishness or Britishness.
The scale of the 2012 bicentenary celebrations of Dickens's birth is testimony to his status as one of the most globally popular literary authors the world has ever seen. Yet Dickens has also become associated in the public imagination with a particular version of the Victorian past and with respectability. His continued cultural prominence and the "brand recognition" achieved by his image and images suggest that his vision reaches out beyond the Victorian period. Yet what is the relationship between Dickens and the modern world? Do his works offer a consoling version of the past or are they attuned to that state of uncertainty and instability we associate with the nebulous but resonant concept of modernity? This volume positions Dickens as both a literary and a cultural icon with a complex relationship to the cultural landscape in his own period and since. It seeks to demonstrate that oppositions which have pervaded approaches to Dickens - Victorian vs modern, artist vs entertainer, culture vs commerce - are false, by exploring the diversity and multiplicity of Dickens's textual and extra-textual lives. A specially commissioned Afterword by Florian Schweizer, Director of the Dickens 2012 celebrations, offers a fascinating insight into the shaping of this year-long public programme of commemoration of Dickens. Like the volume as a whole, it asks us to consider the nature of our connection with "this quintessentially Victorian writer" and what it is about Dickens that still appeals to people around the world. Professor Juliet John holds the Hildred Carlile Chair of English Literature, Royal Holloway, University of London. Contributors: Jay Clayton, Holly Furneaux, John Drew, Michaela Mahlberg, Juliet John, Michael Hollington, Joss Marsh, Carrie Sickmann, Kim Edwardes Keates, Dominic Rainsford, Florian Schweizer.
We next went to the School of Language, where three Professors sate in Consultation upon improving that of their country.
The first Project was to shorten discourse by cutting Polysyllables into one, and leaving out Verbs and Participles, because in reality all things imaginable are but Nouns.
The other Project was a Scheme for entirely abolishing all Words whatsoever; and this was urged as a great Advantage in point of Health as well as Brevity. […] An Expedient was therefore offered, that since Words are only Names for Things, it would be more convenient for all Men to carry about them, such Things as were necessary to express the particular Business they are to discourse on. […M]any of the most Learned and Wise adhere to this New Scheme of expressing themselves by Things, which hath only this Inconvenience attending it, that if a Man's Business be very great, and of various kinds, he must be obliged in Proportion to carry a greater Bundle of Things upon his Back, unless he can afford one or two strong servants to attend him. I have often beheld two of these Sages almost sinking under the Weight of their Packs, like Pedlers among us; who when they met in the Streets would lay down their Loads, open their Sacks and hold Conversation for an hour together; then put up their Implements, help each other to resume their Burthens, and take their Leave.
Demography plays a central role in ecology, and accurate estimation of demographic parameters is essential to testing basic theories of life-history evolution, population regulation, and species coexistence, as well as applying ecological theory to a broad range of practical issues including species conservation, predicting shifts in species distribution due to climate change, and understanding the emergence and spread of new diseases. Our goals in this chapter are twofold: first, to demonstrate a problem with estimating demographic parameters that stems from ignoring dispersal, and second, to propose a solution to this problem. We illustrate the problem with a simulation model that shows how ignoring dispersal may lead to the misclassification of sources and sinks; we attempt to solve the problem by using generalized linear models to differentiate population change due to fecundity from population change due to dispersal, thereby helping to improve source and sink classification. We believe that the particular example discussed is only one of a number of parameter-estimation problems limiting our ability to test and apply ecological theories in field systems and that an approach to parameter estimation similar to that used here may be broadly useful in narrowing the gap between ecological theory and field testing of that theory.
For a century, melodrama was virtually ignored by literary criticism. What makes this silence particularly strange is that melodrama was the most popular kind of theatrical entertainment for much of the nineteenth century, and ‘more people went to the theatre during the nineteenth century than at any time in history’. Dickens was one of those people; indeed, he watched, wrote and acted in stage melodramas. In his journalism, popular drama was a recurrent concern and formed the centrepiece of his journalistic articulation of his social and cultural vision. His seminal two-part essay, ‘The Amusements of the People’, opens with the assertion that ‘nothing will ever root out from among the common people an innate love they have for dramatic entertainment’. Dickens sees popular drama as enabling cultural inclusion, and melodrama in particular as offering a common language through which all strata of society can communicate. As Dickens explains in the same essay, melodrama, like ‘the Italian Opera’, speaks through ‘conventional passion’: ‘So do extremes meet’, Dickens writes, ‘and so there is some hopeful congeniality between what will excite mr whelks, and what will rouse a Duchess’. In his novels, Dickens appropriates melodramatic aesthetics to facilitate cultural inclusivity.
Melodrama evolved with an uneducated audience in mind, thus offering Dickens an ideal aesthetic template through which to reach an audience often excluded from serious literature. The word itself, literally meaning ‘music-drama’ or ‘song-drama’, derives from Greek, but reached Britain by way of French.
In the years since Dickens first found fame as an author, his image has been used in many contexts, most suggestively as the face, for over a decade, of the Bank of England's ₤10 note. Dickens's image, like that of Charles Darwin which replaced his on the ₤10 note, was no doubt chosen to convey something of Britain's ‘greatness’, of a national heritage imparting solidity to the flimsiness of paper money. On the Dickens ₤10 note, his image is superimposed on the nostalgic, ‘inimitably English’ scene from The Pickwick Papers (1836–7): the Dingley Dell cricket match. The Dickens ₤10 note captures much about the way in which Dickens's image has been used posthumously by the heritage industry: the note works to promote an association between Dickens and an idea of Englishness that combines cosy communality with reminders of the ‘greatness’ of Britain's past.
The phrase ‘the heritage industry’ was coined by Robert Hewison in his work of that name, and is widely used to refer to the heritage sector in the twentieth and twenty-first centuries. However, the idea of the Victorians as self-conscious engineers and pioneers of a political and commercial sense of national and international ‘heritage’ is widely accepted. John Gardiner has written in engaging terms about the ways in which the Victorians, notably Queen Victoria, ‘anticipated twentieth-century observers in their attitude to heritage’; his description of Victoria's servants as going through a ‘dress rehearsal for the “heritage industry” of today’ is more widely applicable to the role of Victorians in the evolution of the heritage industry.
The UK Food Standards Agency convened an international group of expert scientists to review the Agency-funded projects on diet and bone health in the context of developments in the field as a whole. The potential benefits of fruit and vegetables, vitamin K, early-life nutrition and vitamin D on bone health were presented and reviewed. The workshop reached two conclusions which have public health implications. First, that promoting a diet rich in fruit and vegetable intakes might be beneficial to bone health and would be very unlikely to produce adverse consequences on bone health. The mechanism(s) for any effect of fruit and vegetables remains unknown, but the results from these projects did not support the postulated acid–base balance hypothesis. Secondly, increased dietary consumption of vitamin K may contribute to bone health, possibly through its ability to increase the γ-carboxylation status of bone proteins such as osteocalcin. A supplementation trial comparing vitamin K supplementation with Ca and vitamin D showed an additional effect of vitamin K against baseline levels of bone mineral density, but the benefit was only seen at one bone site. The major research gap identified was the need to investigate vitamin D status to define deficiency, insufficiency and depletion across age and ethnic groups in relation to bone health.
Multiphoton absorption has become a powerful technique for the creation of three-dimensional micro- and nanostructures. Here we review some of our recent progress towards creating functional microdevices with multiphoton absorption. Specific thrusts of our research include development of new resins for multiphoton absorption polymerization, design of novel schemes for metal deposition, and post-fabrication ablation of polymeric structures.