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An early economic evaluation to inform the translation into clinical practice of a spectroscopic liquid biopsy for the detection of brain cancer. Two specific aims are (1) to update an existing economic model with results from a prospective study of diagnostic accuracy and (2) to explore the potential of brain tumor-type predictions to affect patient outcomes and healthcare costs.
A cost-effectiveness analysis from a UK NHS perspective of the use of spectroscopic liquid biopsy in primary and secondary care settings, as well as a cost–consequence analysis of the addition of tumor-type predictions was conducted. Decision tree models were constructed to represent simplified diagnostic pathways. Test diagnostic accuracy parameters were based on a prospective validation study. Four price points (GBP 50-200, EUR 57-228) for the test were considered.
In both settings, the use of liquid biopsy produced QALY gains. In primary care, at test costs below GBP 100 (EUR 114), testing was cost saving. At GBP 100 (EUR 114) per test, the ICER was GBP 13,279 (EUR 15,145), whereas at GBP 200 (EUR 228), the ICER was GBP 78,300 (EUR 89,301). In secondary care, the ICER ranged from GBP 11,360 (EUR 12,956) to GBP 43,870 (EUR 50,034) across the range of test costs.
The results demonstrate the potential for the technology to be cost-effective in both primary and secondary care settings. Additional studies of test use in routine primary care practice are needed to resolve the remaining issues of uncertainty—prevalence in this patient population and referral behavior.
The COVID-19 pandemic and mitigation measures are likely to have a marked effect on mental health. It is important to use longitudinal data to improve inferences.
To quantify the prevalence of depression, anxiety and mental well-being before and during the COVID-19 pandemic. Also, to identify groups at risk of depression and/or anxiety during the pandemic.
Data were from the Avon Longitudinal Study of Parents and Children (ALSPAC) index generation (n = 2850, mean age 28 years) and parent generation (n = 3720, mean age 59 years), and Generation Scotland (n = 4233, mean age 59 years). Depression was measured with the Short Mood and Feelings Questionnaire in ALSPAC and the Patient Health Questionnaire-9 in Generation Scotland. Anxiety and mental well-being were measured with the Generalised Anxiety Disorder Assessment-7 and the Short Warwick Edinburgh Mental Wellbeing Scale.
Depression during the pandemic was similar to pre-pandemic levels in the ALSPAC index generation, but those experiencing anxiety had almost doubled, at 24% (95% CI 23–26%) compared with a pre-pandemic level of 13% (95% CI 12–14%). In both studies, anxiety and depression during the pandemic was greater in younger members, women, those with pre-existing mental/physical health conditions and individuals in socioeconomic adversity, even when controlling for pre-pandemic anxiety and depression.
These results provide evidence for increased anxiety in young people that is coincident with the pandemic. Specific groups are at elevated risk of depression and anxiety during the COVID-19 pandemic. This is important for planning current mental health provisions and for long-term impact beyond this pandemic.
We describe 14 yr of public data from the Parkes Pulsar Timing Array (PPTA), an ongoing project that is producing precise measurements of pulse times of arrival from 26 millisecond pulsars using the 64-m Parkes radio telescope with a cadence of approximately 3 weeks in three observing bands. A comprehensive description of the pulsar observing systems employed at the telescope since 2004 is provided, including the calibration methodology and an analysis of the stability of system components. We attempt to provide full accounting of the reduction from the raw measured Stokes parameters to pulse times of arrival to aid third parties in reproducing our results. This conversion is encapsulated in a processing pipeline designed to track provenance. Our data products include pulse times of arrival for each of the pulsars along with an initial set of pulsar parameters and noise models. The calibrated pulse profiles and timing template profiles are also available. These data represent almost 21 000 h of recorded data spanning over 14 yr. After accounting for processes that induce time-correlated noise, 22 of the pulsars have weighted root-mean-square timing residuals of
in at least one radio band. The data should allow end users to quickly undertake their own gravitational wave analyses, for example, without having to understand the intricacies of pulsar polarisation calibration or attain a mastery of radio frequency interference mitigation as is required when analysing raw data files.
Chapter 8 examines presidential remarks concerning Court cases prior to the modern presidency. This chapter enables us to place modern presidents in historical perspective and to illuminate how constitutional and political concerns motivated early presidents to discuss Court decisions. We examine all presidential remarks related to Supreme Court cases from 1789 through 1953 (Washington to Truman). We show that historic presidents rarely discussed the Court’s cases in their public rhetoric, choosing instead to share their opinions about the Court’s cases in their private correspondences. However, Theodore Roosevelt’s tenure marked the end of this norm, which was eviscerated by Franklin Delano Roosevelt, who was in regular conflict with the Court.
Chapter 4 examines the tone of presidential discussions of Supreme Court cases, focusing on why presidents discuss cases in positive, negative, and neutral lights. We argue that presidents alter the tone of their remarks about the Court’s decisions in an effort to build public support for their presidencies, shape how the public views the constitutional issues at play, and influence the implementation of the Court’s decisions in the bureaucracy and in Congress. For example, a president happy with the Court’s decision can praise the decision and assure the country that he will take all steps necessary to ensure it is implemented. Conversely, a president displeased with a decision can criticize that decision and encourage Congress to take action to alter or reverse the decision, thus signaling that the fight over the case has not ended. Consistent with our theoretical expectations, we find that presidents criticize cases they disagree with ideologically; those that declare laws unconstitutional; and those decided by minimum winning coalitions. Conversely, presidents tend to praise salient Supreme Court decisions that support their preferred ideological positions.
Chapter 3 explores presidential rhetoric on cases that have already been decided by the Supreme Court. To investigate this, we examine all mentions of Supreme Court cases, by month, from 1953 to 2017. We differentiate written and spoken comments and show that while the former are used almost exclusively to direct the implementation of the Court’s decisions, the latter are designed to allow presidents to take positions on Court cases that are important to their electoral bases given the primacy of presidential speeches to presidents’ permanent campaigns for public support. Often, presidents will comment on recently decided cases to speak to issues that are timely and salient to the national policy conversation in an effort to guide those conversations. Indeed, we find that the presidents are especially likely to discuss Supreme Court cases during reelection years and when those cases garner media attention.
We conclude the book in Chapter 9. We begin by presenting data on the first 21.5 months of the Trump Administration and situate that information in light of our findings with regard to previous presidents as a way of bringing our empirical conclusions to life. We find that President Trump’s remarks on the Court’s cases are similar to previous presidents in many ways, but his rhetoric toward courts as institutions and lower-court judges is more vitriolic than his predecessors. We then review our key findings with regard to normative theoretical debates about judicial independence and the coordinate construction of the Constitution, and discuss their contributions to the study of the rhetorical presidency. We ultimately conclude that taking positions on Supreme Court decisions is a perfectly appropriate presidential governance strategy. We close by offering suggestions for future research on the important subject of executive-judicial relations in the US and across the globe.
Chapter 7 examines the relationship between presidential discussions of Supreme Court decisions and public opinion in two ways. First, we investigate whether presidents can influence the public’s views of the Supreme Court and its decisions through their public remarks. Second, we analyze whether presidents lead or follow public attitudes when they take positions on the Court’s cases. Using an original survey experiment, we find that presidents can shape public support for the Court’s decisions in low-salience issue areas, but they have a hard time molding public opinion in high-salience cases, such as immigration. We further find that presidents tend to take positions on the Court’s decisions that are congruent with public opinion on the issue areas featured in those cases, indicating that presidents are democratically responsive actors.
Chapter 2 explores the motivations for going public on pending Supreme Court decisions and the effect of these speeches on case outcomes. Though presidents commonly use speeches to shape the actions of Congress and the bureaucracy, this is a risky tactic with regard to the Supreme Court, since it makes the president susceptible to attacks for violating the norm of judicial independence. Moreover, it is not entirely clear why a president would turn to public speeches to influence the justices when the Solicitor General is available to litigate cases or file amicus curiae (“friend of the court”) briefs before the Court on behalf of the administration. We conclude that presidents’ primary motivation to speak about pending cases is not to influence their outcomes, but rather to take public positions that demonstrate their commitment to the policies implicated in the litigation, including shaping how the public understands the constitutional issues involved in the cases.
Chapter 6 examines the relationship between presidential remarks on Supreme Court cases and news coverage of those remarks. We argue that presidents make concerted efforts to influence media coverage of their perspectives to mold how the public thinks about the constitutional issues involved in the Court’s cases. We examine the ability of presidents to shape the volume of news attention to the Court’s cases, as well as the tone of newspaper coverage of the president’s remarks (using Lexicoder text analysis software) for all New York Times coverage of presidential speeches on Supreme Court decisions from 1953 to 2017. We find that presidents are capable of influencing the volume of news coverage of their discussions of Court cases, with coverage associated with the length and type of the presidential statement, the tone presidents use to describe the cases, and the timing and location of the speech, among other factors. However, presidents are generally incapable of affecting the tone of media coverage of their remarks.
Our introductory chapter has several goals. First, we introduce the topic, identifying the popular conception that presidents discuss Supreme Court decisions in an effort to influence case outcomes. Second, we develop our theoretical argument, which begins with the well-grounded assumption that presidents pursue three primary goals while in office: good public policy, reelection, and historical achievement. In turn, presidents use their legitimate power and authority to realize these goals. Third, we preview the central motivation of the book: understanding why presidents discuss Supreme Court decisions in their public rhetoric and the impact of those statements. This includes examining whether presidents use their remarks to influence cases pending before the Court, or whether presidents comment on Supreme Court cases after they have been handed down in an effort to promote their reelection, policy goals, and historical legacies, as well as affect the implementation of the decisions and the public’s understanding of the Constitution. This chapter also presents survey data on Americans’ attitudes toward presidential discussions of Supreme Court decisions, and a discussion of the original database used throughout the book.