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Background: Extracorporeal cardiopulmonary resuscitation (ECPR), has demonstrated promise in the management of refractory out-of-hospital cardiac arrest (OHCA). However, evidence from observational studies and clinical trials are conflicting and the factors influencing outcome have not been well established. Methods: We conducted a systematic review and meta-analysis summarizing the association between pre-ECPR prognostic factors and likelihood of good functional outcome among adult patients requiring ECPR for OHCA. We searched Medline and Embase databases from inception to February 28, 2023 and screened studies with two independent reviewers. We performed meta-analyses of unadjusted and adjusted odds ratios, adjusted hazard ratios and mean differences separately. We assessed risk of bias using the QUIPS tool and certainty of evidence using the GRADE approach. Findings: We included 29 observational and randomized studies involving 7,397 patients. Factors with moderate or high certainty of association with increased survival with favourable functional outcome include pre-arrest patient factors, such as younger age (odds ratio (OR) 2.13, 95% CI 1.52 to 2.99) and female sex (OR 1.37, 95% CI 1.11 to 1.70), as well as intra-arrest factors, such as shockable rhythm (OR 2.79, 95% CI 2.04 to 3.80), witnessed arrest (OR 1.68 (95% CI 1.16 to 2.42), bystander CPR (OR 1.55, 95% CI 1.19 to 2.01), return of spontaneous circulation (OR 2.81, 95% CI 2.19 to 3.61) and shorter time to cannulation (OR 1.14, 95% CI 1.17 to 1.69 per 10 minutes). Interpretation: The findings of this review confirm several clinical concepts wellestablished in the cardiac arrest literature and their applicability to the patient for whom ECPR is considered – that is, the impact of pre-existing patient factors, the benefit of timely and effective CPR, as well as the prognostic importance of minimizing low-flow time. We advocate for the thoughtful consideration of these prognostic factors as part of a risk st

Although the use of free samples is extensive across industries, the effects of free samples across individuals with varying levels of usage have yet to be systematically examined. The models discussed in the literature consider targeting only the current nonusers of a product. In this research, we examine the question of targeting the current users both analytically and empirically for an experience good. Our analytical discussions highlight the reasons why some current users may be effective targets for free-sample promotions. We then conduct an empirical analysis using a data set on pre- and post-free-sample promotion mobile data usage provided by a telecom firm. The empirical findings are consistent with our analytical results. Specifically, we find the initial usage level to be a key determinant of both the redemption rate of a free-sample offer and the subsequent change in usage owing to free-sample redemption. In our context, the redemption rate increased from the low-percentile users to the high-percentile users. We also find that the change in usage was (weakly) monotonically increasing up to the 90th percentile of usage distribution. Beyond the 90th percentile, the effect was generally not significant. We discuss the managerial and policy implications of our findings.

Aim: To describe the phenotypic spectrum in patients with diagnostic type 4 collagen variants, and to determine phenocopies of Alport Syndrome (AS). Background(s): AS is the second most common form of genetic kidney disease (GKD). Recently, Medicare approved testing for the three genes associated with AS. Pursuing genetic diagnosis has important clinical implications. Method(s): We compared the suspected diagnosis prior to ES with the genomic diagnosis in patients with suspected AS from a cohort of 204 patients with suspected GKD. We also compared the suspected diagnosis to the molecular diagnosis in patients who were found to have type 4 collagen variants following ES. Result(s): 80/204(39%) had diagnostic variants in genes related to kidney disease. 26/80(33%) had diagnostic type 4 collagen variants. Most patients (n = 13) had autosomal dominant (AD) COL4A3/4 nephropathy. Eleven had X-Linked dominant AS and 2 had autosomal recessive AS. ES reclassified the diagnosis in 7/26(27%) of patients with type 4 collagen variants. Furthermore, 3 patients who had clinical symptoms suspicious of AS were found to have an alternate diagnosis following ES (2 had X-linked recessive Dent Disease and 1 had AD hypoparathyroidism, sensorineural deafness and renal dysplasia). Conclusion(s): ES revealed type 4 collagen variants in 6 patients with alternate clinical diagnoses suspected at referral. Three additional patients who were thought to have AS were subsequently given an alternate diagnosis. We suggest that AS is underdiagnosed, and testing should be considered in patients with a suspected monogenic cause of hematuria. We also highlight the importance of expanding analysis to additional genes in the evaluation of patients with suspected AS, in addition to those reimbursed by Medicare. ES allows easier subsequent reanalysis of genomic data.

Although it is generally accepted that human tissue biobanks are important to facilitate progress in health and medical research, many academic biobanks face sustainability challenges. We propose that biobank sustainability is challenged by a lack of available data describing the outputs and benefits that are produced by biobanks, as reflected by a dearth of publications that enumerate biobank outputs. We further propose that boosting the available information on biobank outputs and using a broader range of output metrics will permit economic analyses such as cost-consequence analyses of biobank activity. Output metrics and cost-consequence analyses can allow biobanks to achieve efficiencies, and improve the quality and/or quantity of their outputs. In turn, biobank output measures provide all stakeholders with explicit and accountable data on biobank value, which could contribute to the evolution of biobank operations to best match research needs, and mitigate some threats to biobank sustainability.

© 2019 John Wiley & Sons Ltd Aims and objectives: This study aimed to reduce indwelling urinary catheter (IDC) use and duration through implementation of a multifaceted “bundled” care intervention. Background: Indwelling urinary catheters present a risk for patients through the potential development of catheter-associated urinary tract infection (CAUTI), with duration of IDC a key risk factor. Catheter-associated urinary tract infection is considered preventable yet accounts for over a third of all hospital-acquired infections. The most effective CAUTI reduction strategy is to avoid IDC use where ever possible and to remove the IDC as early as appropriate. Design: A cluster-controlled pre- and poststudy at a facility level with a phased intervention implementation approach. Methods: A multifaceted intervention involving a “No CAUTI” catheter care bundle was implemented, in 4 acute-care hospitals, 2 in metropolitan and 2 in rural locations, in New South Wales, Australia. Indwelling urinary catheter point prevalence and duration data were collected at the bedside on 1,630 adult inpatients at preintervention and 1,677 and 1,551 at 4 and 9 months postintervention. This study is presented in line with the StaRI checklist (see Appendix S1). Results: A nonsignificant trend towards reduction in IDC prevalence was identified, from 12% preintervention to 10% of all inpatients at 4 and 9 months. Variability in preintervention IDC prevalence existed across hospitals (8%–16%). Variability in reduction was evident across hospitals at 4 months (between −2% and 4%) and 9 months (between 0%–8%). Hospitals with higher preintervention prevalence showed larger decreases, up to 50% when preintervention prevalence was 16%. Indwelling urinary catheter duration increased as more of the short-term IDC placements were avoided. Conclusions: Implementation of a multifaceted intervention resulted in reduced IDC use in four acute-care hospitals in Australia. This result was not statistically sig

Mobile devices play a growing role in the everyday lives of children around the world, prompting important questions about their effects on childhood experiences. Exploring the recent global trends in children’s use of smartphone devices, we examine the reconfiguring of children’s communicative practices and cultures of connectivity, documenting the opportunities and risks that smartphone technology affords. Throughout the chapter we challenge the notion of “digital childhoods,” drawing on the most reliable research on children and smartphones including findings from Global Kids Online, which suggest that digital divides intersect with existing social inequalities, exacerbating the barriers for less privileged children. This raises further questions about the long-term consequences for children’s development, rights, and future access to opportunities and resources.

Background: The aim of this systematic literature review is to identify and critique full economic evaluations of interventions for high risk young people with the purpose of informing the design of future rigorous economic evaluations of such intervention programs. Methods: A PRISMA compliant search of the literature between 2000 and April 2018 was conducted to identify full economic evaluations of youth focussed interventions for at risk young people. Duplicates were removed and two researchers independently screened the article titles and abstracts according to PICOS criteria for exclusion and inclusion. The remaining full text articles were assessed for eligibility and a quality assessment of the included articles was conducted using the Drummond checklist. Results: The database, grey literature and hand searches located 488 studies of interventions for at risk young people. After preliminary screening of titles and abstracts, 104 studies remained for full text examination and 29 empirical studies containing 32 separate economic evaluations were judged eligible for inclusion in the review. These comprised 13 cost-benefit analyses (41%), 17 cost-effectiveness analyses (53%), one cost-utility analysis (3%) and a social return on investment (3%). Three main methodological challenges were identified: 1. attribution of effects; 2. measuring and valuing outcomes; and 3. identifying relevant costs and consequences. Conclusions: A cost-benefit analysis would best capture the dynamic nature of a multi-component intervention for high risk young people, incorporating broader intersectoral outcomes and enabling measurement of more domains of risk. Prospective long-term data collection and a strong study design that incorporates a control group contribute to the quality of economic evaluation. Extrapolation of impact into the future is important for this population, in order to account for the time lag in effect of many impacts and benefits arising from youth interventions.

BACKGROUND: Little research has been conducted into the cost and prevention of self-harm in the workplace. AIMS: To quantify the economic cost of self-harm and suicide among New South Wales (NSW) construction industry (CI) workers and to examine the potential economic impact of implementing Mates in Construction (MIC). METHOD: Direct and indirect costs were estimated. Effectiveness was measured using the relative risk ratio (RRR). In Queensland (QLD), relative suicide risks were estimated for 5-year periods before and after the commencement of MIC. For NSW, the difference between the expected (i.e., using NSW pre-MIC [2008-2012] suicide risk) and counterfactual suicide cases (i.e., applying QLD RRR) provided an estimate of potential suicide cases averted in the post-MIC period (2013-2017). Results were adjusted using the average uptake (i.e., 9.4%) of MIC activities in QLD. Economic savings from averted cases were compared with the cost of implementing MIC. RESULTS: The cost of self-harm and suicide in the NSW CI was AU $527 million in 2010. MIC could potentially avert 0.4 suicides, 1.01 full incapacity cases, and 4.92 short absences, generating annual savings of AU $3.66 million. For every AU $1 invested, the economic return is approximately AU $4.6. CONCLUSION: MIC represents a positive economic investment in workplace safety.

Attitudes to animals have been extensively studied for people in developed countries, but not for those in developing countries. The attitudes of prospective stakeholders in the livestock sectors in south-east and east Asia toward transport and slaughter were examined by surveying university students studying veterinary medicine and animal science in Malaysia, Thailand, China and Vietnam, with a total of 739 students taking part. Students had greater acceptability of transport than slaughter issues for livestock, and female students found most transport and slaughter issues of greater concern than male students. Veterinary students were more accepting of several issues than animal science students, in particular killing animals that were injured or ill. Religion had a major effect on attitudes. Muslim students found using animals that died naturally for products least acceptable. Compared to them, Hindu students were less accepting of killing injured or ill animals and Buddhist students less accepting of euthanasing healthy pets. Students with more experience of pets were less accepting of both transport and slaughter issues. It is concluded that concern was exhibited by future stakeholders in the SE and E Asian livestock industries for slaughter and, to a lesser extent, transport issues, although attitudes were influenced by their religion, gender and experience of pet-keeping.

Non-perturbative proof is presented of a unique version of Goldstone theorem, that electromagnetism contributes to the masses of spinless particles of quark-antiquark bound states in the form of a commutator of the quark electric matrix and a coefficient factor which may be expressed simply in terms of a three-body Bethe-Salpeter amplitude, in the case where the Lagrangian conserves an approximate $SU(3)$ chiral symmetry. The coupled Bethe-Salpeter equation and Dyson-Schwinger equation in the ladder-rainbow approximation are layed out with every ingredient renormalized, which are applied to the problem of evaluating the mass differences of some charged and neutral pseudoscalar and vector mesons. The numerical results yield satisfactory agreement with experimental observations for the mass spectrum and meson decay constants. Estimates of the light quark masses are also given in the Bethe-Salpeter formalism., Comment: 20 pages

Written by the surgeons of the Exeter Hip Team and their colleagues from around the world, this book describes 40 years of innovation and development with cemented hip replacement. Topics covered include the basic science behind successful cemented hip replacement, modern surgical techniques and recent advances. There is also extensive coverage of the revision techniques developed at Exeter and elsewhere, focussing on femoral and acetabular impaction grafting. Each chapter is a self-contained article with an emphasis, where appropriate, on practical techniques and surgical tips, supported by line drawings and intra-operative photographs.

Written by the surgeons of the Exeter Hip Team and their colleagues from around the world, this book describes 40 years of innovation and development with cemented hip replacement. Topics covered include the basic science behind successful cemented hip replacement, modern surgical techniques and recent advances. There is also extensive coverage of the revision techniques developed at Exeter and elsewhere, focussing on femoral and acetabular impaction grafting. Each chapter is a self-contained article with an emphasis, where appropriate, on practical techniques and surgical tips, supported by line drawings and intra-operative photographs.

Written by the surgeons of the Exeter Hip Team and their colleagues from around the world, this book describes 40 years of innovation and development with cemented hip replacement. Topics covered include the basic science behind successful cemented hip replacement, modern surgical techniques and recent advances. There is also extensive coverage of the revision techniques developed at Exeter and elsewhere, focussing on femoral and acetabular impaction grafting. Each chapter is a self-contained article with an emphasis, where appropriate, on practical techniques and surgical tips, supported by line drawings and intra-operative photographs.

Written by the surgeons of the Exeter Hip Team and their colleagues from around the world, this book describes 40 years of innovation and development with cemented hip replacement. Topics covered include the basic science behind successful cemented hip replacement, modern surgical techniques and recent advances. There is also extensive coverage of the revision techniques developed at Exeter and elsewhere, focussing on femoral and acetabular impaction grafting. Each chapter is a self-contained article with an emphasis, where appropriate, on practical techniques and surgical tips, supported by line drawings and intra-operative photographs.

BOOK: Written by the surgeons of the Exeter Hip Team and their colleagues from around the world, this book describes 40 years of innovation and development with cemented hip replacement. Topics covered include the basic science behind successful cemented hip replacement, modern surgical techniques and recent advances. There is also extensive coverage of the revision techniques developed at Exeter and elsewhere, focussing on femoral and acetabular impaction grafting. Each chapter is a self-contained article with an emphasis, where appropriate, on practical techniques and surgical tips, supported by line drawings and intra-operative photographs.

Changes in iron supply to oceanic plankton are thought to have a significant effect on concentrations of atmospheric carbon dioxide by altering rates of carbon sequestration, a theory known as the 'iron hypothesis'. For this reason, it is important to understand the response of pelagic biota to increased iron supply. Here we report the results of a mesoscale iron fertilization experiment in the polar Southern Ocean, where the potential to sequester iron-elevated algal carbon is probably greatest. Increased iron supply led to elevated phytoplankton biomass and rates of photosynthesis in surface waters, causing a large drawdown of carbon dioxide and macronutrients, and elevated dimethyl sulphide levels after 13 days. This drawdown was mostly due to the proliferation of diatom stocks. But downward export of biogenic carbon was not increased. Moreover, satellite observations of this massive bloom 30 days later, suggest that a sufficient proportion of the added iron was retained in surface waters. Our findings demonstrate that iron supply controls phytoplankton growth and community composition during summer in these polar Southern Ocean waters, but the fate of algal carbon remains unknown and depends on the interplay between the processes controlling export, remineralisation and timescales of water mass subduction.

The idea that iron might limit phytoplankton growth in large regions of the ocean has been tested by enriching an area of 64 km2 in the open equatorial Pacific Ocean with iron. This resulted in a doubling of plant biomass, a threefold increase in chlorophyll and a fourfold increase in plant production. Similar increases were found in a chlorophyll-rich plume down-stream of the Galapagos Islands, which was naturally enriched in iron. These findings indicate that iron limitation can control rates of phytoplankton productivity and biomass in the ocean.

The idea that iron might limit phytoplankton growth in large regions of the ocean has been tested by enriching an area of 64 km in the open equatorial Pacific Ocean with iron. This resulted in a doubling of plant biomass, a threefold increase in chlorophyll and a fourfold increase in plant production. Similar increases were found in a chlorophyll-rich plume down-stream of the Galapagos Islands, which was naturally enriched in iron. These findings indicate that iron limitation can control rates of phytoplankton productivity and biomass in the ocean.

The small sample performance of several AR(1) estimators is investigated through the use of Monte Carlo comparison studies. The performance of these estimators is compared with respect to the criteria of bias, mean squared error, mean absolute error, and mean squared prediction error. Statistical performance groupings at various fixed parameter values from (0,1) are determined based on pairwise multiple comparisons of estimator performance results. Two types of two-step adaptive estimators are developed. One type relies on the use of only standard estimators, while the other type includes ad hoc modifications to standard estimators. The efficacy of performance of these estimators is validated through the use of additional Monte Carlo runs based on three different conditions of parameter selection for data generation. The sensitivity of these estimators to their use with larger sample sizes is also investigated. Based on the various simulation results, recommendations regarding estimator selection for use in applied estimation are given. The applicability of the adaptive estimators is discussed and an example illustrating their application in forecasting an economic series is given. (Author)

Several one-pass and two-pass algorithms for the computation of sample means and variances are compared by their performance on sets of randomly generated data and systematically generated data with random noise. The relation between the performance of each algorithm and the coefficient of variation of the population from which random data sets are generated is explored.

Statistics based on a theory of random graphs have been proposed to be used as an analytic aid to assess the randomness of a clustered structure. Probability tables for two such statistics are tabulated. Exact values of P sub(n,v), the cumulative probabilities of the minimum number of edges needed to connect a random graph, are tabulated for n = 10(1)30(5)60. Exact and approximate values of E sub(n,v), the expected number of components in a random graph with n vertices and v edges, are tabulated for n = 10(1)30(5)100.

Current clustering techniques possess several common features which seem undesirable. For example, a 'cluster' remains an undefined concept; each clustering technique tends to work properly only under unstated, but often restrictive, implied assumptions; and the nonexistence of clustering statistics or the lack of theory about the sampling distributions of the statistics (when they do exist) makes the assessment of the statistical significance of a cluster quite impossible. In this paper after a brief review and critique of the clustering methods that are most widely used, definitions of a cluster and its related concepts are proposed. The clusters so defined and their associated statistics will remain invariant under any monotonic transformation of the elements of the data matrix on which they depend. Their sampling distributions are investigated by analytic and Monte Carlo methods. Both aritificial and real data are employed to illustrate the methodology and probability theory of the proposed clustering method. (Author)