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Do patients with acute illness admitted to the hospital and treated with liberal oxygen therapy compared with those treated with conservative oxygen therapy have differences in mortality and morbidity?
Chu DK, Kim LH, Young PJ, et al. Mortality and morbidity in acutely ill adults treated with liberal versus conservative oxygen therapy (IOTA): a systematic review and meta-analysis. Lancet 2018;391(10131):1693–705.
To analyse the existing literature to assess the potential benefits or harms of supplemental oxygen use in acutely ill patients.
Since US President Donald J. Trump took office in January 2017, the future of the global economy has looked distinctly uncertain. This is not because a process of clear and purposeful change can be said to be underway. Instead, it is because of a pattern of piecemeal, inconsistent and contradictory fragments of policy, both domestic and international in orientation, in the arenas of trade, taxation, business relations, finance and banking, social and welfare provision, immigration, and environmental protection, whose cumulative significance remains unclear. The modest task of this essay is therefore to sketch the contours, patterns, inconsistencies and confusions presented by the Trump administration's approach to shaping the US economy and, by extension, the global economic order, and on that basis to offer an interpretation of its emerging implications for inequality both within the United States and across the world.
The Monte Carlo software CASINO has been expanded with new modules for the simulation of complex beam scanning patterns, for the simulation of cathodoluminescence (CL), and for the calculation of electron energy deposition in subregions of a three-dimensional (3D) volume. Two examples are presented of the application of these new capabilities of CASINO. First, the CL emission near threading dislocations in gallium nitride (GaN) was modeled. The CL emission simulation of threading dislocations in GaN demonstrated that a better signal-to-noise ratio was obtained with lower incident electron energy than with higher energy. Second, the capability to simulate the distribution of the deposited energy in 3D was used to determine exposure parameters for polymethylmethacrylate resist using electron-beam lithography (EBL). The energy deposition dose in the resist was compared for two different multibeam EBL schemes by changing the incident electron energy.
There are few evaluations of strategies to improve rates of early
detection and treatment of patients with first-episode psychosis
To evaluate the effectiveness of a general practitioner (GP) education
programme and an early detection assessment team (the Lambeth Early Onset
Crisis Assessment Team; LEO CAT) in reducing delays in accessing
treatment for first-episode psychosis patients.
46 clusters of GP practices randomised to GP education in early detection
with direct access to LEO CATv. care as usual. Primary
outcome measures were GP referral rates, duration of untreated psychosis
(DUP) and delays in receiving treatment. Results 150
patients with first-episode psychosis were recruited; 113 were registered
with the study GPs, who referred 54 (47.7%) directly to mental health
services. Significantly more intervention group GPs (86.1%
v. 65.7%) referred their patients directly to mental
health services and fewer patients experienced long delays in receiving
treatment. However, their overall DUP was unaffected
Educating GPs improves detection and referral rates of first-episode
psychosis patients. An early detection team reduces the long delays in
initial assessment and treatment. However, these only impact on the later
phases of the DUP. Broader measures, such as public health education, are
needed to reduce the earlier delays in DUP.
The concept of ‘securitization’ has become particularly influential in the post-9/11 world. This paper aims to scrutinize and, ultimately, reject an emerging set of claims about political economy which draw upon this framework. The contention that US foreign economic policy is increasingly subject to a process of securitization misrepresents the substance of contemporary US foreign policy, the political environment in which it is articulated and the process by which it is made. Pursuing this argument, the paper sets out a framework within which to understand the evolution of contemporary US policy, paying attention to distinctive forms of the economic–security nexus; the form of ‘ad hoc reactivism’ that has consistently characterized US foreign economic policy; the set of commercial and wider economic goals to which policy responds; and the dynamics of competition for leadership in key regions.
This article examines the nature of the emerging regional economic regime in the Americas and argues that the dominant approach to economic governance is one defined by the assertion of U.S. power in the region and oriented toward distinctively U.S. interests and preferences. This has been clearly evident in the evolution of the Free Trade Area of the Americas but also, with the deceleration and fragmentation of that process during 2002 and 2003, in the growing prioritization of bilateralism. The leverage afforded by the bilateral negotiation of trade agreements acts to situate primary influence in shaping the rules that constitute the regional economic regime, and the primary functions associated with governing in this context, firmly within the agencies of the U.S. state. This essay therefore explores how the hegemonic power of the United States manifests itself in the substance of the hemispheric project and the shape of the economic regime associated with it.
Primary cerebellopontine angle (CPA) cholesteatoma grows slowly and silently in the subarachnoidal spaces. The diagnosis is often late, when the lesion has reached large dimensions. Surgical removal is the only available therapy. Fifteen consecutive cases of CPA cholesteatoma managed at a tertiary otoneurosurgical referral unit between September 1985 and April 1999 were reviewed. The study population, consisting of seven males and eight females, had a mean age of 44 years of age (range 21–69) at the time of surgery. The clinical, audiological and radiological presentations were examined. The tumours were classified according to the Moffat classification of CPA cholesteatomas. In 67 per cent of cases the presenting symptom was related to the vestibulo-cochlear nerve. The average duration of symptoms was 23 months (ranging from one month–10 years). The hearing preservation approaches were utilized the most (11 cases), while the translabyrinthine approach alone, or in association with a middle fossa craniotomy, was performed in four cases. Tumour removal was total in 12 cases and subtotal in three cases. In cases undergoing hearing preservation surgery the mean pre-operative pure tone average (PTA) for the frequencies 0.5, 1, 2, and 3 kHz was 19.3 dB HL (SD 13.84) and the mean pre-operative speech discrimination score (SDS) was 89.8 per cent (SD 5.97). In 44.4 per cent of patients the hearing was preserved and the mean post-operative PTA was 20.29 dB HL (SD 15.84). In five patients post-operative complications occurred. No peri- or post-operative death occurred in this series, one patient developed a recurrence 15 years after the initial surgery.