62880 research outputs found
Sort by
Contemporary outcomes of childhood aortic coarctation interventions: a national registry analysis of mortality, reinterventions and hospital resource use
Get PDFBackground Coarctation of the aorta (CoA) has good modern results, but large multicentre longitudinal data on outcomes, especially hospital resource utilisation through childhood and adolescence, are not available.
Methods All patients with CoA treated between 2000 and 2017 in England and Wales were linked to hospital and outpatient records through the Linking AUdit and National datasets in Congenital HEart Services (LAUNCHES) project. Mortality, reintervention and hospital stay were described, and associated risk factors were explored using multivariable regression models for each of these three outcomes (Cox regression, Fine-Gray subdistribution hazard model and quantile regression at median, respectively).
Results A total of 3321 patients were included: n=669 (20.1%) had CoA with ventricular septal defect (VSD), n=331 (10.0%) had CoA with small VSD and n=2321 (69.9%) had isolated CoA. Mortality and cardiac reintervention at 10 years (from birth and CoA repair, respectively) were 3.7% (95% CI 3.0%; 4.4%) and 13.3% (12.1%; 14.5%), respectively. Compared with isolated surgical repair, isolated catheter repair (HR 3.7, (95% CI 2.2; 6)) and concomitant VSD closure (HR 1.34, (1; 1.9)) or pulmonary artery banding (HR 3.5, (2.4; 5.1)) had higher risk of reintervention. During the first year of life, the median time in hospital was 26 days (IQR 17; 44), decreasing to 1 (0; 2) day beyond 8 years. CoA with large VSD (−12, (−16; −8)), premature birth (−50, (−60; −40)), congenital comorbidity (−31, (−37; −25)), low weight (−23/kg, (−37; −11)) and younger age at first procedure (−6/year (−7; −5)) were associated with fewer days spent at home.
Conclusions Subgroups of patients with CoA are still at risk of unfavourable outcomes during childhood and adolescence follow-up, especially cardiac reintervention at a distance from initial repair. Hospital resource utilisation remains low beyond the first year of life in the majority of patients. Identified factors, while non-modifiable, remain useful in risk stratification and counselling
Human security must remain on the NATO agenda
No full textSince 2022 NATO has endorsed a Human Security approach in relation to its core tasks. Yet its 2025 Summit fell silent on this, among many other issues. Alexander Gilder makes the case for why Human Security must stay on NATO’s agenda in order to bolster the Atlantic alliance’s legitimacy and effectiveness
Inequity and food insecurity and effects on obesity and associated co-morbidities: meeting report and research priorities
Get PDFA Rank Forum was convened to discuss the evidence around food insecurity (FIS), its impact
on health, and interventions which could make a difference both at individual and societal
level, with a focus on the UK. This paper summarises the proceedings and recommendations.
Speakers highlighted the growing issue of FIS due to current economic and social pressures.
It was clear that the health implications of FIS varied geographically since food insecure
women in higher income regions tend to be living with overweight or obesity, in contrast to
those living in low-to-middle income countries. This paradox could be due to stress and/or
metabolic or behavioural responses to an unpredictable food supply. The gut microbiota may
play a role given the negative effects of low fibre diets on bacterial diversity, species balance
and chronic disease risk. Solutions to FIS involve individual behavioural change, targeted
services and societal/policy change. Obesity-related services are currently difficult to access.
Whilst poverty is the root cause of FIS, it cannot be solved simply by making healthy food
cheaper due to various ingrained beliefs, attitudes and behaviours in target groups. Person-centred models, such as Capability-Opportunity-Motivation Behavioural Change Techniques
and Elicit-Provide-Elicit communication techniques are recommended. Societal change or
improved resilience through psychological support may be more equitable ways to address
FIS and can combine fiscal or food environment policies to shift purchasing towards healthier
foods. However, policy implementation can be slow to enact due to the need for strong
evidence, consultation and political will. Eradicating FIS must involve co-creation of
interventions and policies to ensure that all stakeholders reach a consensus on solutions
Evaluating meteorological reanalysis for identifying fair weather conditions in historical atmospheric electricity data
Get PDFSurface atmospheric electricity measurements, particularly of the vertical electric field (or Potential Gradient, PG) began in the 1770s, becoming more widespread in the UK during the nineteenth century. In the twentieth century, PG measurements were systematically obtained by the Met Office, at their observatory sites of Kew, Eskdalemuir and Lerwick. These records’ importance is now increasingly recognized, due to the inherent global atmospheric electric circuit (GEC) information, which is an embedded part of the climate system. Earlier data has the limitation that, until about 1960, preferred daily PG data values were selected using the geomagnetically-informed approach of identifying quiet and disturbed days. It is now known that classification by local weather conditions, identifying the data recorded during “fair weather” (FW) or dry, “no hydrometeors” (NH) circumstances, is superior for obtaining GEC signals. However, the necessary weather information is only available at a subset of PG measurement sites globally. For other sites, meteorological reanalysis – and many such data products are available spanning different times and scales –offers a new approach for retrospective weather-based classification of PG data. This work investigates applying ERA5 reanalysis to selecting PG data obtained during FW and NH conditions by using the Lerwick site as a testbed, comparing with direct weather observations (including wind speed, precipitation, cloud base height, and pressure) which were originally used for PG data selection. ERA5-based PG data selection is shown to yield quality improvements, especially for data downgraded by the geomagnetic approach e.g. our method reclassifies 20% of disturbed weather data as fair weather. This offers a general route to improving long-term atmospheric electricity data obtained at non-meteorological sites globally
Sector briefing: AI in the Film and Television Sector, Report commissioned by Pavis Consultancy to inform the report to UNESCO, 'Re-centering culture in AI policy and practice'
Get PDFThis sector report focuses on the uses in the world's film and television industries of Generative AI (GenAI), intelligent systems able to generate novel content. It analyses the adoption and impact of GenAI across the film production value chain, from concept and development, through financing and commissioning, preproduction, production, postproduction and marketing and distribution. The report considers the opportunities and challenges of AI for the film and television sector, as well as the ethics and risks involved
Agreement between the United Kingdom and Mauritius concerning the Chagos Archipelago including Diego Garcia
Get PDFMarket failure, information asymmetries, and monopoly profits: the Barranquilla Railway and Pier Company in Colombia, 1888–1933
Get PDFThis article presents a business history of the Barranquilla Railway and Pier Company (BRPC) and its impact on Colombia’s Caribbean region. It explores the company’s operations, profitability, shareholders, infrastructure development, and competition with other coastal railways for insights into the role of foreign capital in regional growth. The BRPC’s railway and port infrastructure connected the coastal city of Barranquilla with the Colombian interior, allowing the city to supplant Cartagena as the country’s principal international port. Statistical analysis reveals the railway’s remarkable profitability, which attracted transnational investors, who consolidated majority control. The company’s ability to leverage engineering expertise and capital underscored its strategic significance, yet its interests centered on protecting its transport monopoly. The railway’s lack of visibility in London and information asymmetries shaped investor perceptions. Extending the pier demonstrated BRPC’s role in accommodating rising export volumes during Colombia’s “ despegue cafetero .” However, the railway faced obsolescence, as the government opened the obstructing Bocas de Ceniza sandbank and pursued railway nationalization. The railway’s redundancy, demographic shifts, and rise of Buenaventura underscore its eventual decline. This paper reveals the complex dynamics between foreign capital, infrastructure, and trade monopolies in shaping uneven development. It highlights the BRPC’s overlooked yet fundamental role in Colombia’s export economy and Barranquilla’s ascendancy
Developing and testing a DEA-based index for the evaluation of value for money in the hospitality industry
No full textPurpose The purpose of this study is to: 1) develop a brand-new index of value for money (VFM) leveraging Data Envelopment Analysis (DEA) methodology: the “DEA VFM”; 2) validate the “DEA VFM” index; 3) compare the “DEA VFM” with the Booking.com VFM index, thus demonstrating the superiority of the proposed index for managerial decision-making. Design/methodology/approach PIM-DEA software was used to develop an input-oriented DEA model with one input (i.e. the median price) and six outputs (i.e. the standardized scores of cleanliness, staff, location, facilities, free Wi-Fi, comfort) on 613 Italian hotels. Both input and outputs are based on Booking.com data related to hotels located in four different popular destinations: Rome, Florence, Milan and Venice. Findings The authors developed and validated a new index of VFM based on DEA methodology: the “DEA VFM.” The DEA VFM shows a very low correlation with Booking VFM scores, and it demonstrates a superior performance when assessing hotels’ VFM. Booking VFM essentially measures perceived value rather than the relationship between price and value. Originality/value To the best of the authors’ knowledge, this is the only and first study in the hospitality management literature that develops and validates a new index of VFM based on the DEA methodology: the “DEA VFM”. Moreover, we demonstrate the superiority of the DEA VFM index on the Booking.com VFM
