48,818 research outputs found
A decision tool for updating Cochrane reviews
Get PDFThis report describes the development and validation of an updating tool to help assess the need and likely benefits of updating a Cochrane review. The report is presented in five sections. Section 1 describes the background and rationale for the updating tool, including information about when and how to update. Section 2 describes the development of the updating tool and the resulting decision tree and checklist. Section 3 presents the results of the in-house and ongoing formal pilot of the tool, while Sections 4 and 5 provide information about the dissemination of the tool and our key conclusions. This project was funded by the Cochrane Opportunities Fund in 2007
Heterogeneity in search strategies among Cochrane acupuncture reviews: Is there room for improvement?
No full textObjective: Given the international focus and rigorous literature searches employed in Cochrane systematic reviews, this study was undertaken to evaluate strategies employed in Cochrane reviews and protocols assessing acupuncture as a primary or secondary intervention.
Methods: The Cochrane Collaboration of systematic reviews was searched in February 2009 for all reviews and protocols including information on acupuncture. Information was abstracted from all retrieved articles on review status, type and number of English and Chinese language databases searched, participation of at least one Chinese speaking author and language restriction. Frequencies were calculated and bivariate analyses were performed stratifying on interventions of interest to assess differences in search strategy techniques, language restrictions and results.
Results: The search retrieved 68 titles, including 48 completed reviews, 17 protocols and three previously withdrawn titles. Acupuncture was the primary intervention of interest in 44/65 (67.7%) of the retrieved reviews and protocols. While all articles searched at least one English language database, only 26/65 (40.0%) articles searched Chinese language databases. Significantly more articles where acupuncture was the primary intervention of interest searched Chinese language databases (53% vs 9%, p<0.01). Inconclusive findings as to the effectiveness of acupuncture were found in 28/48 (58.3%) of all completed reviews; this type of finding was more common in reviews which did not search any Chinese language databases.
Conclusions: It is important for reviews assessing the effectiveness of acupuncture to search Chinese language databases. The Cochrane Collaboration should develop specific criteria for Chinese language search strategies to ensure the continued publication of high-quality reviews
User involvement in a Cochrane systematic review: using structured methods to enhance the clinical relevance, usefulness and usability of a systematic review update
Get PDFBackground: This paper describes the structured methods used to involve patients, carers and health professionals in an update of a Cochrane systematic review relating to physiotherapy after stroke and explores the perceived impact of involvement.Methods: We sought funding and ethical approval for our user involvement. We recruited a stakeholder group comprising stroke survivors, carers, physiotherapists and educators and held three pre-planned meetings during the course of updating a Cochrane systematic review. Within these meetings, we used formal group consensus methods, based on nominal group techniques, to reach consensus decisions on key issues relating to the structure and methods of the review.Results: The stakeholder group comprised 13 people, including stroke survivors, carers and physiotherapists with a range of different experience, and either 12 or 13 participated in each meeting. At meeting 1, there was consensus that methods of categorising interventions that were used in the original Cochrane review were no longer appropriate or clinically relevant (11/13 participants disagreed or strongly disagreed with previous categories) and that international trials (which had not fitted into the original method of categorisation) ought to be included within the review (12/12 participants agreed or strongly agreed these should be included). At meeting 2, the group members reached consensus over 27 clearly defined treatment components, which were to be used to categorise interventions within the review (12/12 agreed or strongly agreed), and at meeting 3, they agreed on the key messages emerging from the completed review. All participants strongly agreed that the views of the group impacted on the review update, that the review benefited from the involvement of the stakeholder group, and that they believed other Cochrane reviews would benefit from the involvement of similar stakeholder groups.Conclusions: We involved a stakeholder group in the update of a Cochrane systematic review, using clearly described structured methods to reach consensus decisions. The involvement of stakeholders impacted substantially on the review, with the inclusion of international studies, and changes to classification of treatments, comparisons and subgroup comparisons explored within the meta-analysis. We argue that the structured approach which we adopted has implications for other systematic reviews.</p
Proof-of-concept method to sanitize a feed mill contaminated with Porcine Epidemic Diarrhea Virus
Get PDFCitation: Huss, A. R., Schumacher, L. L., Cochrane, R. A., Poulsen, E., Bai, J. F., Woodworth, J. C., . . . Jones, C. K. (2016). Proof-of-concept method to sanitize a feed mill contaminated with Porcine Epidemic Diarrhea Virus. Journal of Animal Science, 94, 102-103. doi:10.2527/msasas2016-217Porcine Epidemic Diarrhea Virus (PEDV) has been linked to transmission by livestock feed or ingredients. Measures to exclude pathogens, prevent cross-contamination, and actively reduce the pathogenic load of feed and ingredients are being developed. However, research thus far has focused on the role of chemicals or thermal treatment to reduce PEDV RNA in feedstuffs, and has not addressed potential residual contamination within the manufacturing facility that may lead to continuous cross-contamination of finished feeds. The objective of this experiment was to evaluate the use of a standardized protocol to sanitize an animal feed manufacturing facility contaminated with PEDV. Environmental swabs were collected throughout the facility during the manufacturing of a swine diet inoculated with PEDV. To monitor facility contamination of the virus, swabs were collected at 5 decontamination steps: 1) baseline before inoculation, 2) after production of the inoculated feed, 3) after application of a quaternary ammonium-glutaraldehyde blend cleaner, 4) after application of a sodium hypochlorite sanitizing solution, and 5) after facility heat-up to 60°C for 48 h. The feed mill was contaminated and decontaminated 3 separate times for a total of 3 replications. Collected swabs were analyzed via RT-qPCR and categorized by surface (plastic, rubber, concrete, and metal), type (equipment and structural), and zone (1, 2, and 3). Decontamination step, surface, type, zone and their interactions were all found to impact the quantity of detectable PEDV RNA (P < 0.05). As expected, all samples collected from direct feed contact surfaces (zone 1) contained PEDV RNA after production of the contaminated feed. Additionally, all swabs collected directly adjacent to direct feed contact surfaces (zone 2) were positive following production of the contaminated feed. Of the remaining swabs collected (zone 3), outside of zones 1 and 2, 88.9% had detectable RNA, emphasizing the potential role dust plays in cross-contamination of pathogens throughout a manufacturing facility. Application of the cleaner, sanitizer, and heat were effective at reducing PEDV RNA (P < 0.05), but did not completely eliminate it. Specifically, 29.6%, 14.8%, and 7.4% of zone 1 swabs had detectable PEDV RNA after decontamination with the cleaner, sanitizer and heat, respectively, during only replication 2. Due to this, decontamination was repeated with no PEDV RNA detected from subsequent swab collection. These findings do provide a method for facility decontamination of PEDV, however, the use of liquid cleaners, sanitizers, and/or facility heat-up may not be applicable for most commercial feed manufacturing facilities
Interventions in the alcohol server setting for preventing injuries.
Get PDFBACKGROUND: Injuries are a significant public health burden and alcohol intoxication is recognised as a risk factor for injuries. There is increasing attention on supply-side interventions, which aim to modify the environment and context within which alcohol is supplied and consumed. OBJECTIVES: To quantify the effectiveness of interventions implemented in the server setting for reducing injuries. SEARCH STRATEGY: We searched the Cochrane Injuries Group Specialised Register (September 2004), Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), MEDLINE (January 1966 to September 2004), EMBASE (1980 to 2004, wk 36), other specialised databases and reference lists of articles. We also contacted experts in the field. SELECTION CRITERIA: Randomised controlled trials (RCTs) and non-randomised controlled studies (NRS) of the effectiveness of interventions administered in the server setting which attempted to modify the conditions under which alcohol is served and consumed, to facilitate sensible alcohol consumption and reduce the occurrence of alcohol-related harm. DATA COLLECTION AND ANALYSIS: Two authors independently screened search results and assessed the full texts of potentially relevant studies for inclusion. Data were extracted and methodological quality was examined. Due to variability in the intervention types investigated, a pooled analysis was not appropriate. MAIN RESULTS: Twenty studies met the inclusion criteria. Overall methodological quality was poor. Five studies used an injury outcome measure; only one of these studies was randomised. The studies were grouped into broad categories according to intervention type. One NRS investigated server training and estimated a reduction of 23% in single vehicle night-time crashes in the experimental area (controlled for crashes in the control area). Another NRS examined the impact of a drink driving service, and reported a reduction in injury road crashes of 15% in the experimental area, with no change in the control; no difference was found for fatal crashes. One NRS investigating the impact of a policy intervention, reported that pre-intervention the serious assault rate in the experimental area was 52% higher than the rate in the control area. After intervention, the serious assault rate in the experimental area was 37% lower than in the control. The only RCT targeting the server setting environment with an injury outcome compared toughened glassware (experimental) to annealed glassware (control) on number of bar staff injuries; a greater number of injuries were detected in the experimental group (relative risk 1.72, 95% CI 1.15 to 2.59). A NRS investigating the impact of a intervention aiming to reduce crime experienced by drinking premises; found a lower rate of all crime in the experimental premises (rate ratio 4.6, 95% CI 1.7 to 12, P = 0.01), no difference was found for injury (rate ratio 1.1. 95% CI 0.1 to 10, P = 0.093). The effectiveness of the interventions on patron alcohol consumption is inconclusive. One randomised trial found a statistically significant reduction in observed severe aggression exhibited by patrons. There is some indication of improved server behaviour but it is difficult to predict what effect this might have on injury risk. AUTHORS' CONCLUSIONS: There is no reliable evidence that interventions in the alcohol server setting are effective in reducing injury. Compliance with interventions appears to be a problem; hence mandated interventions may be more likely to show an effect. Randomised controlled trials, with adequate allocation concealment and blinding are required to improve the evidence base. Further well conducted non-randomised trials are also needed, when random allocation is not feasible
Vitamin K for improved anticoagulation control in patients receiving warfarin
Get PDFBACKGROUND: Effective use of warfarin involves keeping the international normalised ratio (INR) within a relatively narrow therapeutic range. However, patients respond widely to their dose of warfarin. Overcoagulation can lead to an increased risk of excessive bleeding, while undercoagulation can lead to increased clot formation. There is some evidence that patients with a variable response to warfarin may benefit from a concomitant low dose of vitamin K. OBJECTIVES: To assess the effects of concomitant supplementation of low-dose oral vitamin K for anticoagulation control in patients being initiated on or taking a maintenance dose of warfarin. SEARCH METHODS: To identify previous reviews, we searched the Database of Abstracts of Reviews of Effects (DARE via The Cochrane Library, Wiley) (Issue 2, 2011). To identify primary studies, we searched the Cochrane Central Register of Controlled Trials (CENTRAL via The Cochrane Library, Wiley) (Issue 2, 2014), Ovid MEDLINE (R) In-Process and Other Non-Indexed Citations database and Ovid MEDLINE (R) (OvidSP) (1946 to 25 February 2014), Embase (OvidSP) (1974 to week 8 of 2014), Science Citation Index Expanded™ and Conference Proceedings Citation Index - Science (Web of Science™) (1945 to 27 February 2014), and the NHS Economics Evaluations Database (NHS EED) (via The Cochrane Library, Wiley) (Issue 2, 2014). We did not apply any language or date restrictions. We used additional methods to identify grey literature and ongoing studies. SELECTION CRITERIA: Randomised controlled trials comparing the addition of vitamin K versus placebo in patients initiating warfarin or already taking warfarin. DATA COLLECTION AND ANALYSIS: Two review authors independently selected and extracted data from included studies. When disagreement arose, a third author helped reached a consensus. We also assessed risk of bias. MAIN RESULTS: We identified two studies with a total of 100 participants for inclusion in the review. We found the overall risk of bias to be unclear in a number of domains. Neither study reported the time taken to the first INR in range. Only one study (70 participants) reported the mean time in therapeutic range as a percentage. This study found that in the group of participants deemed to have poor INR control, the addition of 150 micrograms (mcg) oral vitamin K significantly improved anticoagulation control in those with unexplained instability of response to warfarin. The second study (30 participants) reported the effect of 175 mcg oral vitamin K versus placebo on participants with high variability in their INR levels. The study concluded that vitamin K supplementation did not significantly improve the stability of anticoagulation for participants on chronic anticoagulation therapy. However, the study was only available in abstract form, and communication with the lead author confirmed that there were no further publications. Therefore, we interpreted this conclusion with caution. Neither study reported any thromboembolic events, haemorrhage, or death from the addition of vitamin K supplementation. AUTHORS' CONCLUSIONS: Two included studies in this review compared whether the addition of a low dose (150 to 175 mcg) of vitamin K given to participants with a high-variability response to warfarin improved their INR control. One study demonstrated a significant improvement, while another smaller study (published in abstract only) suggested no overall benefit. Currently, there are insufficient data to suggest an overall benefit. Larger, higher quality trials are needed to examine if low-dose vitamin K improves INR control in those starting or already taking warfarin
Mapping galaxy evolution at multiple wavelengths and cosmic epochs
Get PDFSome of the most fundamental measurements we can make of the Universe are where and when stars formed in galaxies. In recent years, astronomers have converged on a picture in which the star formation rate density of the Universe peaks at approximately redshift (z) 2, when the Universe is around a quarter of its present age. There, star-forming galaxies harbour large reservoirs of molecular gas, assemble stellar mass rapidly, and typically display disordered morphologies.
In this thesis, I study the evolution of galaxies on large and small scales, with a particular focus on the epoch around the peak of cosmic star formation. My overarching aim is to understand the physical processes that drive and quench star formation in galaxies over cosmic time. In the first half of this thesis, I focus on global measurements of star formation, using the High-z Emission line survey (HiZELS), a deep, near-infrared narrow-band survey, which identifies star-forming galaxies at z=0.8-2.2. I characterise the dark matter halo environments of these galaxies via a clustering analysis, along with a Halo Occupation Distribution model fitting procedure, then study the relationships between host dark matter halo environment and galaxy properties.
I show that the clustering strength and the host dark matter halo masses of the HiZELS galaxies increase linearly with H-alpha luminosity (and, by implication, star formation rate) at all three redshifts. The typical galaxies in our samples are star-forming centrals, residing in dark matter haloes of mass ~10^12M_sol. I find a remarkably tight redshift-independent relation between the H-alpha luminosity scaled by the characteristic luminosity, L_H-alpha/L_H-alpha*(z), and the host dark matter halo mass of central galaxies. Simple analytic modelling suggests that this is consistent with a model in which the dark matter halo environment is a strong driver of galaxy star formation rate and therefore of the evolution of the star formation rate density in the Universe. I investigate this further by distinguishing the stellar mass and star formation rate dependencies of the clustering of HiZELS galaxies. I compare my observational results to the predictions of a pioneering cosmological hydrodynamical simulation, the Virgo Consortium's Evolution and Assembly of GaLaxies and their Environments project, known as EAGLE.
In the subsequent chapters of this thesis, I focus more heavily on simulations of galaxy formation, which are important tools for constraining and understanding the physics at play in galaxies. I use EAGLE to investigate the quenching of star formation in simulated galaxies via a novel application of Principal Component Analysis. I show that the key relations between halo mass, stellar mass and star formation rate are in good agreement with observed low-redshift galaxies.
Having studied the global properties of star-forming galaxies, I then turn to smaller scales, investigating what we can learn from spatially-resolved imaging. I present a detailed study of the spatially-resolved dust continuum emission of realistic simulated high-redshift galaxies. These galaxies, drawn from the FIRE-2 simulations, reach Milky Way masses by z~2. Post-processing them using radiative transfer techniques, I obtain predictions for the full rest-frame far-ultraviolet to far-infrared Spectral Energy Distributions of these simulated galaxies, as well as maps of their emission across the wavelength spectrum. As has been observed in distant galaxies, the rest-frame far-infrared emission of the simulated galaxies is compact, spanning half-light radii of ~0.5-4kpc. The derived morphologies of simulated galaxies are notably different in different wavebands; a galaxy can appear clumpy and extended in the far-ultraviolet yet compact at far-infrared wavelengths.
Finally, I perform a multi-wavelength study of a single observed galaxy, SHiZELS-14 (z=2.24), drawn from the HiZELS survey and subsequently imaged at 0.15'' resolution at multiple wavelengths. The data comprise kpc-resolution imaging in three different widely used tracers of star formation: the H-alpha emission line (from SINFONI/VLT), rest-frame far-ultraviolet continuum (from HST F606W imaging), and the rest-frame far-infrared (from ALMA), as well as the rest-frame optical (from HST F140W imaging). SHiZELS-14 displays a compact, dusty centre, as well as extended emission in both H-alpha and the rest-frame FIR. The ultraviolet emission is spatially offset from the extended dust emission, and appears to trace holes in the dust distribution. I find that the dust attenuation varies across the spatial extent of the galaxy, reaching up to ~5 magnitudes of extinction at H-alpha wavelengths in the most dusty regions. Global star formation rates inferred using standard calibrations to the different tracers vary from ~10-1000M_sol, and are particularly discrepant in the galaxy's dusty centre. This galaxy highlights the biased view of galaxy evolution provided by short-wavelength data in the absence of long-wavelength data, and is in line with my simulations
Barbiturates for acute traumatic brain injury.
Get PDFBACKGROUND: Raised intracranial pressure (ICP) is an important complication of severe brain injury, and is associated with high mortality. Barbiturates are believed to reduce ICP by suppressing cerebral metabolism, thus reducing cerebral metabolic demands and cerebral blood volume. However, barbiturates also reduce blood pressure and may, therefore, adversely effect cerebral perfusion pressure. OBJECTIVES: To assess the effects of barbiturates in reducing mortality, disability and raised ICP in people with acute traumatic brain injury. To quantify any side effects resulting from the use of barbiturates. SEARCH METHODS: The following electronic databases were searched on 26 September 2012: CENTRAL (The Cochrane Library), MEDLINE (Ovid SP), PubMed, EMBASE (Ovid SP), PsycINFO (Ovid SP), PsycEXTRA (Ovid SP), ISI Web of Science: Science Citation Index and Conference Proceedings Citation Index-Science. Searching was not restricted by date, language or publication status. We also searched the reference lists of the included trials and review articles. We contacted researchers for information on ongoing studies. SELECTION CRITERIA: Randomised controlled trials of one or more of the barbiturate class of drugs, where study participants had clinically diagnosed acute traumatic brain injury of any severity. DATA COLLECTION AND ANALYSIS: Two review authors screened the search results, extracted data and assessed the risk of bias in the trials. MAIN RESULTS: Data from seven trials involving 341 people are included in this review.For barbiturates versus no barbiturate, the pooled risk ratio (RR) of death from three trials was 1.09 (95% confidence interval (CI) 0.81 to 1.47). Death or disability, measured using the Glasgow Outcome Scale was assessed in two trials, the RR with barbiturates was 1.15 (95% CI 0.81 to 1.64). Two trials examined the effect of barbiturate therapy on ICP. In one, a smaller proportion of patients in the barbiturate group had uncontrolled ICP (68% versus 83%); the RR for uncontrolled ICP was 0.81 (95% CI 0.62 to 1.06). In the other, mean ICP was also lower in the barbiturate group. Barbiturate therapy results in an increased occurrence of hypotension (RR 1.80; 95% CI 1.19 to 2.70). For every four patients treated, one developed clinically significant hypotension. Mean body temperature was significantly lower in the barbiturate group.In one study of pentobarbital versus mannitol there was no difference in death between the two study groups (RR 1.21; 95% CI 0.75 to 1.94). Pentobarbital was less effective than mannitol for control of raised ICP (RR 1.75; 95% CI 1.05 to 2.92).In one study the RR of death with pentobarbital versus thiopental was 1.78 (95% CI 1.03 to 3.08) in favour of thiopental. Fewer people had uncontrollable ICP with thiopental (RR 1.64; 95% CI 1.03 to 2.60). There was no significant difference in the effects of pentobarbital versus thiopental for death or disability, measured using the Glasgow Outcome Scale (RR 1.31; 95% CI 0.88 to 1.94), or hypotension (RR 0.95; 95% CI 0.81 to 1.12). AUTHORS' CONCLUSIONS: There is no evidence that barbiturate therapy in patients with acute severe head injury improves outcome. Barbiturate therapy results in a fall in blood pressure in one in four patients. This hypotensive effect will offset any ICP lowering effect on cerebral perfusion pressure
Involving consumers in research and development agenda setting for the NHS: developing an evidence-based approach
No full textObjectivesThe objectives of the study were to:1) look at the processes and outcomes of identification and prioritisation in both national and regional R&D programmes in health and elsewhere, drawing on experiences of success and failure2)identify the barriers to, and facilitators of, meaningful participation by consumers in the research identification and prioritisation.Framework for examining consumer involvementWe devised a framework for examining the diverse ways of involving consumers in research. It identified key distinguishing features as: the types of consumers involved; whether consumers or researchers initiated the involvement; the degree of consumer involvement (consultation, collaboration or consumer control); forums for communication (e.g. committees, surveys, focus groups); methods for decision-making; and the practicalities for implementation. We considered context (institutional, geographical and historical setting) and underpinning theories as important variables for analysing examples of consumer involvement.We translated the principles for minimising bias and maximising transparency to reviewing a body of literature that is largely descriptive or reflective rather than based on systematic research methods. We assumed, conventionally, that well-conducted research studies would be less biased and more reliable. In order to draw on other reports where necessary, we assumed that reports where consumers shared authorship with researchers would be less biased, that reports originating in the UK would be more relevant and that findings supported by more reports or by reports originating from both the UK and elsewhere would be more generalisable.MethodsWe systematically sought literature through databases, handsearching and citation tracking, and also through people in the UK who were (a) known to have worked to identify or prioritise health research topics or (b) recognised consumer specialists or advocates.We included reports if they explicitly mentioned consumer involvement in identifying or prioritising research topics. We also interviewed consumers and research programme managers from some UK examples. We applied the innovative framework to review data from interviews and reports.ResultsWe found 286 documents explicitly mentioning consumer involvement in identifying or prioritising research topics. Of these, 91 were general discussions, some of which included a theoretical analysis or a critique of research agendas from a consumer perspective, 160 reported specific efforts to include consumers in identifying or prioritising research topics and a further 51 reported consumers identifying or prioritising research topics in the course of other work. We found detailed reports of 87 specific examples. These included:>inviting consumer groups to collaborate in setting research agendas (13)>consulting consumer groups (12)>inviting individual consumers to collaborate in identifying and/or >prioritising research topics (17)>consulting individual consumers (13)>responding to consumer action with a collaboration (13)>responding to consumer action by consulting with consumers (3)>responding to consumer action by conducting research without consumer input (6)>consumers independently identifying or prioritising research topics (10).Most of this literature was descriptive reports by researchers who were key actors in involving consumers. A few reports were written by consumer participants. Fewer still were by independent researchers. Our conclusions are therefore not based on rigorous research, but implications for policy are drawn from individual reports and comparative analyses.ConclusionsResearch programmes have sufficient collective experience of involving consumers to plan their agendas working directly or indirectly with consumers. Appropriate methods depend upon the tasks to be undertaken, the consumers to be involved and the support required. Productive methods for involving consumers require appropriate skills, resources and time to develop and follow appropriate working practices. The more that consumers are involved in determining how this is to be done, the more research programmes will learn from consumers and about how to work with them.More success might be expected if research programmes embarking on collaborations approach well-networked consumers and provide them with information, resources and support to empower them in key roles for consulting their peers and prioritising topics. To be worthwhile, consultations should engage consumer groups directly and repeatedly in facilitated debate; when discussing health services research, more resources and time are required if consumers are drawn from groups whose main focus of interest is not health.Barriers to consumer involvement include: poor representation of consumers; consumers’ unfamiliarity with research and research programmes’ unfamiliarity with consumers; negative attitudes and poor working relationships; difficulties in communication; and time constraints. These barriers can largely be overcome with good leadership, purposeful outreach to consumers, investing time and effort in good communication, training and support and thereby building good working relationships and building on experience.Organised consumer groups capable of identifying research priorities need to find ways of introducing their ideas into research programmes. They should be aware that consumers making efforts to (re)design structures and procedures have had greater influence over research agendas. Consumers are particularly well placed to reflect on their experience of research agenda setting in order to build the evidence about their priorities and methods for involving them
Geographies and politics of localism: the localism of the United Kingdom's Coalition Government
No full textThere has always been a localist element to British politics. But recently, a particular version of localism has been moved to the foreground by the 2011 Localism Act. This paper identifies various uses and meanings of localism, maps their geographical assumptions and effects, and critiques their politics. It does this using the localism of the United Kingdom’s Coalition Government as a case study of localism in practice. The rationalities, mentalities, programmes, and technologies of this localism are established from Ministerial speeches and press releases, along with Parliamentary Acts, Bills, White Papers, Green Papers, and Statements – all published between May 2010 when the Coalition Government was formed, and November 2011 when the Localism Act became law. We argue that localism may be conceptualised as spatial liberalism, is never straightforwardly local, and can be anti-politica
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