Revista Jurídica Digital UANDES
Not a member yet
69002 research outputs found
Sort by
Increasing the Value of Orthodontic Research Through the Use of Dental Patient-Reported Outcomes
No full textTen years ago, Chalmers and Glasziou pointed out in Lancet that 85% of all biomedical research was being avoidably wasted due to imbalanced research question / outcome selection, as well as poor study design, execution and reporting. According to findings of recent “research on research” studies, a high level of such kind of avoidable waste should also exist in orthodontic research. This warrants efforts to improve each stage of the research production and reporting process
Coupled iterated function systems that contract on average
No full textWe consider iterated function systems (IFSs) acting on a phase space X that, whilst not necessarily uniformly contracting, do satisfy a ‘contraction on average’ condition. We introduce the notion of a coupled IFS acting on a new phase space formed by taking infinite (when X is compact) or finite (when X is not compact) products, in analogy with coupled map lattices. For appropriate couplings, we prove the existence of a unique invariant probability measure for the coupled system and show that it depends continuously on the coupling as the coupling tends to zero. We also prove an ergodic theorem and a central limit theorem for the coupled IFS. The methodology is to introduce a family of transfer operators acting quasi-compactly on an appropriate function space and use results of Keller-Liverani [KL1] to prove continuity of their spectral properties in the perturbation
Cognitive-behavioural therapy for clozapine-resistant schizophrenia:The FOCUS RCT
No full text© Queen’s Printer and Controller of HMSO 2019. Background: Clozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population. Objectives: To evaluate the clinical effectiveness and cost-effectiveness of cognitive-behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome. Design: The Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU). Setting: Secondary care mental health services in five cities in the UK. Participants: People with CRS aged = 16 years, with an International Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms. Interventions: Individual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services. Main outcome measures: The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs. Results: Participants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) -3.32 to 1.55 points; p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (-2.40 points, 95% CI -4.79 to -0.02 points; p = 0.049). CBT was associated with a net cost of £5378 (95% CI -£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability <50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46; p = 0.58). Conclusions: Cognitive-behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained
Do music festival communities address environmental sustainability and how? A Scottish case study
No full textThis article discusses the findings of an Arts and Humanities Research Council project researching how music festival communities in Scotland can address issues of environmental sustainability and climate change. It investigates how music festival communities are constructed with a focus on what role, if any, they might play in responding to the global challenge of environmental sustainability. Using music festivals in Scotland as a case study, we employed a variety of research methods to interrogate different constituents in music festival communities about their views and behaviours regarding climate change and environmental sustainability. These included festival audiences via onsite questionnaires; festival organisers and promoters via interviews and focus groups; and musicians via creative practice-led research. We conclude that rather than necessarily being a site for progressive or utopian socio-cultural experimentation (as they are occasionally portrayed in festival literature), music festival communities engage in complex and often contradictory behaviours when it comes to responding to - and making sense of - their own complicity in social challenges such as climate change.</p
Kuznets revisited:What do we know about the relationship between structural transformation and inequality?
No full textThis paper revisits the Kuznets postulate that structural transformation will be associated with increasing inequality using comparable time series data for 32 developing and recently developed economies for the post-1950 period. We find that structural transformation in the majority of our economies has resulted in the movement of workers from agriculture to services, and not to manufacturing. Economies show different paths of structural transformation that cut across geographical regions, being either structurally underdeveloped, structurally developing, or structurally developed. We see clear differences in the structural transformation-inequality relationship depending on the stage of structural transformation that a particular economy is in, as well as across regions. We do not see a Kuznets-type relationship between manufacturing employment share and inequality when we take into account the different paths of industrialization that economies in our dataset have followed. On the other hand, inequality unambiguously increases with structural transformation if the movement of workers from agriculture is to services.</p
High fluxes of deep volatiles from ocean island volcanoes: Insights from El Hierro, Canary Islands
No full textBasaltic volcanism contributes significant fluxes of volatiles (CO2, H2O, S, F, Cl) to the Earth’s surface environment. Quantifying volatile fluxes requires initial melt volatile concentrations to be determined, which can be accessed through crystal-hosted melt inclusions. However, melt inclusions in volatile-rich mafic alkaline basalts, such as those erupted at ocean islands, often trap partially degassed melts, meaning that magmatic volatile fluxes from these tectonic settings are often significantly underestimated. We have measured major, trace element and volatile concentrations in melt inclusions from a series of young (<20 ka) basanites from El Hierro, Canary Islands. Our melt inclusions show some of the highest CO2 (up to 3600 ppm) and S (up to 4290 ppm) concentrations measured in ocean island basalts to date, in agreement with data from the recent 2011-2012 eruption. Volatile enrichment is observed in melt inclusions with crystallisation-controlled major element compositions and highly variable trace element ratios such as La/Yb. We use volatile-trace element ratios to calculate original magmatic CO2 contents up to 4.2 wt%, which indicates at least 65% of the original CO2 was degassed prior to melt inclusiontrapping. The trace element contents and ratios of El Hierro magmas are best reproduced by 1-8% partial melting of a garnet lherzolite mantle source. Our projected CO2 (200- 680 ppm) and S (265-450 ppm) concentrations for the source are consistent with upper estimates for primitive mantle. However, El Hierro magmas have elevated F/Nd and F/Cl in comparison with melts from a primitive mantle, indicating that the mantle must also contain a component enriched in F and other volatiles, most probably recycled oceanic lithosphere. Our modelled original magmatic CO2 contents indicates that, per mass unit, volatile fluxes from El Hierro magmas are up to two orders of magnitude greater than from typical mid-ocean ridge basalts and 1.5 to 7 times greater than from recent Icelandic eruptions, indicating large variability in the primary volatile content of magmas formed in different geodynamic settings, or even within different ocean islands. Our results highlight the importance of characterising mantle heterogeneity in order to accurately constrain both short- and long-term magmatic volatile emissions and fluxes from ocean island volcanoes
Bariatric surgery as a model to explore the basis and consequences of the Reaven hypothesis:Small, dense low-density lipoprotein and interleukin-6
No full text Background: Reaven originally described the clustering of insulin resistance/hyperinsulinaemia, obesity (particularly visceral), altered cytokine levels, glucose intolerance, hypertriglyceridaemia and low high-density lipoprotein cholesterol. Subsequently, a potentially highly atherogenic small, dense low-density lipoprotein was also reported. We have studied the effect of bariatric surgery on this and other risk factors for atherosclerosis. Methods: Forty patients (20 with type 2 diabetes mellitus) undergoing bariatric surgery were studied before and 1 year after bariatric surgery. Results: Twelve months after bariatric surgery, median body mass index had decreased from 49.5 to 36.5 kg/m 2 , fasting insulin from 21.3 to 7.8 mU/L and insulin resistance (homeostatic model assessment of insulin resistance) from 5.9 to 1.8 (all p < 0.001). Thirteen out of 20 patients had remission from type 2 diabetes mellitus. Highly sensitive C-reactive protein, interleukin-6, fasting triglycerides (p < 0.001) and small, dense low-density lipoprotein (p < 0.001) decreased, while high-density lipoprotein cholesterol increased (p < 0.001) significantly, irrespective of having type 2 diabetes mellitus and/or being treated with statin therapy before surgery. Conclusion: The association between marked weight loss and change in insulin resistance and hyperinsulinaemia with the change in small, dense low-density lipoprotein and interleukin-6 warrants further investigation. Bariatric surgery provides a model for investigating the mechanisms linking insulin resistance/hyperinsulinaemia to atherosclerosis. </p
Perceived fatigue and cognitive performance change in multiple sclerosis:Uncovering predictors beyond baseline fatigue
No full textBackground: Fatigue is a common and disabling symptom in multiple sclerosis (MS) with a variety of direct and indirect influences, but remains poorly understood. Perceived fatigue and cognitive performance fatigability may only be weakly correlated and may have independent predictors. We adopted a multifactorial approach, utilising a measure of concurrent cognitive performance change in order to examine the clinical, psychological, and cognitive factors influencing perceived and cognitive performance fatigability in MS. Methods: Individuals with adult-onset MS were identified from a regional patient database and invited to complete an assessment battery during a home visit. Baseline perceived fatigue was measured using the Modified Fatigue Impact Scale, Fatigue Assessment Instrument, and a Visual Analogue Scale (VAS). The Conners Continuous Performance Test 3 (CCPT3) and VAS were administered before and after our intervention of roughly 2.5 hours of assessment, which represented a period of cognitive effort. The differences in scores formed measures of cognitive performance fatigability and perceived fatigue change, respectively. We examined differences across baseline fatigue, fatigue change and performance change classifications, using regression analysis to uncover predictors of perceived fatigue and performance change. Results: The sample comprised 61 participants who were recruited from an existing cohort of MS patients. Positive relationships with depression and emotion-focused coping, and a negative one with sleep, each predicted baseline perceived fatigue with the model explaining 53.5% of variance. Increased perceived fatigue change was not associated with baseline fatigue, cognitive impairment, disease variables or levels of disability, but was linked with higher anxiety, lower self-efficacy and gender. Most CCPT3 performance change variables did not show significant correlations with baseline clinical, psychological, or fatigue variables. However, two variables were predicted by positive relationships with estimated intelligence, whilst a negative relationship with self-efficacy and a positive one with post-intervention fatigue predicted one each. Conclusion: Fatigue in MS is a multifactorial construct, with perceived fatigue and cognitive performance fatigability largely influenced by indirect psychological and cognitive factors. Future studies need to take these influences into account when developing fatigue assessment tools. Further, targeting influential fatigue drivers such as psychological variables may improve the burden of fatigue and quality of life of people with MS.</p
Perspectives on successful ageing: The views of Chinese older adults living in Australia on what it means to age well
No full textObjectives: High immigration has resulted in a culturally diverse aging population. This study aims to examine the meaning of successful aging among late-life immigrants aging in a new cultural environment.Methods: Semi-structured interviews focused on the subjective experience of aging well were conducted with 11 Chinese older adults who had moved to Australia in later life. Interviews were conducted in participants’ native language and analysed using thematic analysis.Results: Eleven themes were identified. A collectivist cultural ideal relating to avoiding burden to children underpinned a number of themes, including the importance of good health and financial security. Preferences regarding retaining or relinquishing traditional cultural expectations of dependence on adult children varied between participants, suggesting some post-migration shift in values.Conclusions: This study provides insights into the nuances of aging from a novel cultural perspective, and highlights the role of post-migration adaptation in cultural values
Prospects for Low-power Acceleration of HPC Workloads in EuroExa: FPGA Acceleration of a Numerical Weather Forecast Code
No full textThe EuroExa project proposes a High-Performance Computing (HPC) architecture which is both scalable to Exascale performance levels and delivers world-leading power efficiency. This is achieved through the use of low-power ARM processors accelerated by closely-coupled FPGA programmable components. In order to demonstrate the efficacy of the design, the EuroExa project includes application porting work across a rich set of applications. One such application is the new weather and climate model, LFRic (named in honour of Lewis Fry Richardson), which is being developed by the UK Met Office and its partners for operational deployment in the middle of the next decade. Much of the run-time of the LFRic model consists of compute intensive operations which are suitable for acceleration using FPGAs. We have selected the Xilinx Vivado toolset including High-Level Synthesis (HLS) which generates IP blocks that can be combined with other standard IP blocks in Vivado Design Studio and a bitstream generated for programming the FPGA. A design using twelve matrix-vector IP blocks achieves 5.34 double precision Gflop/s. We shall discuss the implementation, the performance achieved and the prospects for acceleration of the full LFRic weather model