446 research outputs found
Letter from Roger Clegg, Deputy Assistant Attorney General, Civil Rights Division to Dorothy Nakamura, April 12, 1991
No full textCorrespondence from Roger Clegg to Dorothy Nakamura regarding the status of Nakamura's appeal for redress payments.The Japanese American Archival Collection documents the people, places, and daily life of Japanese Americans, primarily those who lived in the once thriving community of pre-war Florin in the Sacramento region, as well as the conditions in American incarceration camps during World War II. The approximately 7,000 original items include personal and official letters, photographs, diaries, arts and crafts, newsletters, textiles, camps artifacts, yearbooks and other publications
Systematic review of cognitive behavioural therapy for the management of headaches and migraines in adults
No full textAim: This systematic review aimed to establish if cognitive behavioural therapy (CBT) can reduce thephysical symptoms of chronic headache and migraines in adults.Methods: Evidence from searches of eight databases was systematically sought, appraised and synthesised.Screening of title and abstracts was conducted independently by two reviewers. Full papers werescreened, data extracted and quality assessed by one reviewer and checked by a second. Data were synthesisednarratively by intervention due to the heterogeneity of the studies. The inclusion criteria specifiedrandomised controlled trials with CBT as an intervention in adults suffering from chronic headaches/migraines not associated with an underlying pathology/medication overuse. CBT was judged on the basisof authors describing the intervention as CBT. The diagnosis of the condition had to be clinician verified.Studies had to include a comparator and employ headache/migraine-specific outcomes such as patientreportedheadache days.Results: Out of 1126 screened titles and abstracts and 20 assessed full papers, 10 studies met the inclusioncriteria of the review. Some studies combined CBT with another intervention, as well as employing varyingnumbers of comparators. CBT was statistically significantly more effective in improving some headachesrelatedoutcomes in CBT comparisons with waiting lists (three studies), in combination with relaxationcompared with relaxation only (three studies) or antidepressant medication (one study), with no statisticallysignificant differences in three studies.Conclusions: The findings of this review were mixed, with some studies providing evidence in support ofthe suggestion that people experiencing headaches or migraines can benefit from CBT, and that CBT canreduce the physical symptoms of headache and migraines. However, methodology inadequacies in the evidencebase make it difficult to draw any meaningful conclusions or to make any recommendations
The quantum age: how the physics of the very small has transformed our lives
No full textAcclaimed popular science author Brian Clegg demonstrates how quantum physics underpins everyday life
Psychosocial aspects of DNA testing for hereditary hemochromatosis in at-risk individuals: a systematic review
No full textAim: to review the psychosocial benefits and harms of DNA testing for HFE-related hereditary hemochromatosis (HH) in at-risk individuals. Background: HH is a common genetic disease in people of European descent. DNA-based predisposition testing is used for diagnosis or in the context of family testing, but there are concerns about potential psychosocial consequences. Methods: fifteen electronic databases (including Medline and Cochrane) were searched from inception to April 2007 to identify any quantitative or qualitative primary research that considered DNA testing of individuals considered at-risk of HH and reported psychosocial outcomes. Inclusion criteria, data extraction, and quality assessment were undertaken by standard methodology. Results: three observational studies met the inclusion criteria of the review; each had methodological limitations. On receipt of test results, anxiety levels fell or were unchanged; general health-related quality-of-life outcomes improved in some aspects, or were unchanged with respect to pretest result values. Outcomes were not reported separately for those referred for diagnosis and those with family history of HH. Results suggest that genetic testing for HH in at-risk individuals is accompanied by few negative psychosocial outcomes. Conclusion: the evidence on the psychosocial aspects of DNA testing for HH in at-risk individuals is limited. Further research might be required if other factors influencing the natural history of the disease phenotype are identifie
Infliximab for the treatment of adults with psoriasis. Evidence Review Group Report for NICE's Single Technology Appraisal process
No full textThis paper presents a summary of the evidence review group (ERG) report into the clinical and cost-effectiveness of infliximab for the treatment of moderate to severe plaque psoriasis, in accordance with the licensed indication, based on the evidence submission from Schering-Plough to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal (STA) process. The outcomes stated in the manufacturer's definition of the decision problem were severity [Psoriasis Area and Severity Index (PASI) score], remission rates, relapse rates and health-related quality of life. The main evidence in the submission comes from four randomised controlled trials (RCT) comparing infliximab with placebo and eight RCTs comparing either etanercept or efalizumab with placebo. At week 10, patients on infliximab had a significantly higher likelihood of attaining a reduction in PASI score than placebo patients. There were also statistically significant differences between infliximab and placebo in the secondary outcomes. In the comparator trials both the efalizumab and etanercept arms included a significantly higher proportion of patients who achieved a reduction in PASI score at week 12 than the placebo arms. No head-to-head studies were identified directly comparing infliximab with etanercept or efalizumab. The manufacturer carried out an indirect comparison, but the ERG had reservations about the comparison because of the lack of information presented and areas of uncertainty in relation to the included data. The economic model presented by the manufacturer was appropriate for the disease area and given the available data. The cost-effectiveness analysis estimates the mean length of time that an individual would respond to infliximab compared with continuous etanercept and the utility gains associated with this response. The base-case incremental cost-effectiveness ratio (ICER) for infliximab compared with continuous etanercept for patients with severe psoriasis was £26,095 per quality-adjusted life-year. A one-way sensitivity analysis, a scenario analysis and a probabilistic sensitivity analysis were undertaken by the ERG. The ICER is highly sensitive to assumptions about the costs and frequency of inpatient stays for non-responders of infliximab. The guidance issued by NICE in August 2007 as a result of the STA states that infliximab within its licensed indication is recommended for the treatment of adults with very severe plaque psoriasis, or with psoriasis that has failed to respond to standard systematic therapies. Infliximab treatment should be continued beyond 10 weeks in people whose psoriasis has shown an adequate response to treatment within 10 weeks. In addition, when using the Dermatology Life Quality Index (DLQI), care should be taken to take into account the patient's disabilities, to ensure DLQI continues to be an accurate measure
The Language of Power and the Power of Language
No full textIn this paper earlier research by the author (Clegg 1975) is used as an occasion for reflecting more generally on the adequacy of approaches to the study of language and power in organization analysis. Three approaches, the ethnographic, conversation analysis and a materialist approach, are discussed. The limitations, both in practical and analytic terms, of a language approach to power are drawn from a discussion of the inclemency rule and other data
The effectiveness of interventions to treat severe acute malnutrition in young children: a systematic review
No full textSevere acute malnutrition (SAM) arises as a consequence of a sudden period of food shortage and is associated with loss of a person’s body fat and wasting of their skeletal muscle. Many of those affected are already undernourished and are often susceptible to disease. Infants and young children are the most vulnerable as they require extra nutrition for growth and development, have comparatively limited energy reserves and depend on others. Undernutrition can have drastic and wide-ranging consequences for the child’s development and survival in the short and long term. Despite efforts made to treat SAM through different interventions and programmes, it continues to cause unacceptably high levels of mortality and morbidity. Uncertainty remains as to the most effective methods to treat severe acute malnutrition in young children.ObjectivesTo evaluate the effectiveness of interventions to treat infants and children aged < 5 years who have SAM.Data sourcesEight databases (MEDLINE, EMBASE, MEDLINE In-Process & Other Non-Indexed Citations, CAB Abstracts Ovid, Bioline, Centre for Reviews and Dissemination, EconLit EBSCO and The Cochrane Library) were searched to 2010. Bibliographies of included articles and grey literature sources were also searched. The project expert advisory group was asked to identify additional published and unpublished references.Review methodsPrior to the systematic review, a Delphi process involving international experts prioritised the research questions. Searches were conducted and two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full texts of retrieved papers by one reviewer and checked independently by a second. Included studies were mapped to the research questions. Data extraction and quality assessment were undertaken by one reviewer and checked by a second reviewer. Differences in opinion were resolved through discussion at each stage. Studies were synthesised through a narrative review with tabulation of the results.ResultsA total of 8954 records were screened, 224 full-text articles were retrieved, and 74 articles (describing 68 studies) met the inclusion criteria and were mapped. No evidence focused on treatment of children with SAM who were human immunodeficiency virus sero-positive, and no good-quality or adequately reported studies assessed treatments for SAM among infants < 6 months old. One randomised controlled trial investigated fluid resuscitation solutions for shock, with none adequately treating shock. Children with acute diarrhoea benefited from the use of hypo-osmolar oral rehydration solution (H-ORS) compared with the standard World Health Organization-oral rehydration solution (WHO-ORS). WHO-ORS was not significantly different from rehydration solution for malnutrition (ReSoMal), but the safety of ReSoMal was uncertain. A rice-based ORS was more beneficial than glucose-based ORSs, and provision of zinc plus a WHO-ORS had a favourable impact on diarrhoea and need for ORS. Comparisons of different diets in children with persistent diarrhoea produced conflicting findings. For treating infection, comparison of amoxicillin with ceftriaxone during inpatient therapy, and routine provision of antibiotics for 7 days versus no antibiotics during outpatient therapy of uncomplicated SAM, found that neither had a significant effect on recovery at the end of follow-up. No evidence mapped to the next three questions on factors that affect sustainability of programmes, long-term survival and readmission rates, the clinical effectiveness of management strategies for treating children with comorbidities such as tuberculosis and Helicobacter pylori infection and the factors that limit the full implementation of treatment programmes. Comparison of treatment for SAM in different settings showed that children receiving inpatient care appear to do as well as those in ambulatory or home settings on anthropometric measures and response time to treatment. Longer-term follow-up showed limited differences between the different settings. The majority of evidence on methods for correcting micronutrient deficiencies considered zinc supplements; however, trials were heterogeneous and a firm conclusion about zinc was not reached. There was limited evidence on either supplementary potassium or nicotinic acid (each produced some benefits), and nucleotides (not associated with benefits). Evidence was identified for four of the five remaining questions, but not assessed because of resource limitation.LimitationsThe systematic review focused on key questions prioritised through a Delphi study and, as a consequence, did not encompass all elements in the management of SAM. In focusing on evidence from controlled studies with the most rigorous designs that were published in the English language, the systematic review may have excluded other forms of evidence. The systematic review identified several limitations in the evidence base for assessing the effectiveness of interventions for treating young children with severe acute malnutrition, including a lack of studies assessing the different interventions; limited details of study methods used; short follow-up post intervention or discharge; and heterogeneity in participants, interventions, settings, and outcome measures affecting generalisability.ConclusionsFor many of the most highly ranked questions evidence was lacking or inconclusive. More research is needed on a range of topic areas concerning the treatment of infants and children with SAM. Further research is required on most aspects of the management of SAM in children < 5 years, including intravenous resuscitation regimens for shock, management of subgroups (e.g. infants < 6 months old, infants and children with SAM who are human immunodeficiency virus sero-positive) and on the use of antibiotics.FundingThe National Institute for Health Research Technology Assessment programme.<br/
The safety and effectiveness of different methods of ear wax removal: a systematic review and economic evaluation
No full textEar wax (cerumen) is a natural secretion produced to protect the inner ear from dirt and other fragments by moving these particles towards the outer ear. If this process does not happen properly, wax may build up causing blockage in the ear canal and the possibility of impaction. People with a build up of ear wax may suffer from hearing loss, discomfort and, on occasions, infection. It may present problems in assessing hearing, blocking the view of the ear drum during medical examination and interfering with the fitting or function of hearing aids. Although it is thought to affect between 2% and 6% of the population in the England and Wales, some groups may be at a higher risk, such as those using hearing aids or with small ear canals and/or skin conditions. Recurrence is thought to be high among some of these groups. The consequences of the build up of ear wax in the ear canal are thought to be a common reason for consultation and cost in general practice with over 2 million consultations per year in the NHS.Methods of removal of ear wax include drops, flushing with water in general practice, and removal with suction or probes in specialist clinics. The relative safety and benefits of these different methods of removal remains uncertain. This research will systematically review published and unpublished evidence on the clinical and cost effectiveness of different methods for the removal of ear wax. Where appropriate, it will develop an economic model using data from this systematic review and other relevant sources to estimate the relative costs and benefits of different methods. In addition, the project will provide recommendations for future research to try to help answer any remaining areas of uncertainty
The personal created through dialogue: enhancing possibilities through the use of new media
No full textThis paper explores the relationships between a number of different developments in higher education pedagogy, which are subsumed under the broad heading of progress files. The overall concern of the paper is to explore the ways in which personal reflection and learning is enhanced through dialogue. The paper explores the ways learners engage in dialogue in two environments that use different aspects of digital technologies to support the development of portfolios. The findings from the case studies point to the ways in which different technologies facilitated personal reflection mediated through sharing and dialogue. We develop the idea of affordances as a relationship whereby the learner is involved in a purposeful engagement with the possibilities created by their environment. The affordance of digitised technologies in supporting dialogue is, therefore, conceptualised in relation to the characteristics of the learner, not as a simple technology relation
Modifications of a Rail/Wheel Wear Simulator to\ud Measure Rail Curve Lubricant Performance
No full textWear of railroad rolling stock and rails costs\ud
millions of dollars each year in all rail systems\ud
throughout the world. The rail industry has\ud
attempted to address flange wear using lubricants.\ud
The choice of rail curve lubricant is currently not\ud
based on a standards approach. Measuring rail\ud
curve lubricant performance in a laboratory\ud
environment can address this information shortfall\ud
and reduce wear in rail rolling stock and\ud
infrastructure.\ud
The equipment used to measure rail curve\ud
lubricant performance consists of two dissimilar\ud
disks, of matching contact profile, rotating in\ud
contact with one another. The outcome from the\ud
modifications was the ability to quantify rail curve\ud
lubricant performance using three performance\ud
criteria and to measure the changes in apparent\ud
viscosity with respect to accumulated strain\ud
damage.\ud
This paper will provide a description of the\ud
equipment and modifications to the rail/wheel\ud
wear simulator and preliminary results to display\ud
the outcomes of the modifications
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