Search

Realist evaluation is a method increasingly adopted to provide an understanding of how and why a program works, for whom, and under what circumstances. Initial program theories (IPT) are the crucial starting point of any realist evaluation, however descriptions about how they are developed in practice remain under-reported in the published literature. This article argues for the value of genuine research-group conversations using David Bohm's concept of dialogue in realist research. We label it the realist dialogic approach. We draw out the relational qualities as well as the contextual circumstances of dialogue through our development of IPT and interview guides for a research study on the implementation and scaling of a large-system value-based program to transform complex health services. We selected the relevant middle-range theories, conducted a literature review, and drew on informal discussions with key stakeholders, to develop IPT through research-group conversations. The benefits of this approach were: 1) development of rigorous, novel, deep and well-tailored IPT, 2) detailed understanding of the complex intervention under investigation and development of rapport and networks with participants, 3) empirically grounded Context-Mechanism-Outcome (CMO) configurations, predicated on suitable abstract and contextually-contingent middle-range theories, and 4) productive research team interactions which supported the entire research process. The challenges of this approach include: 1) establishing and retaining a sense of humility across the research team, 2) contextual circumstances can hinder dialogic relationship, and 3) time and resource heavy. This paper uses middle-range theory and ethnographic insights to advance the existing practice of realist evaluations and offer transferable lessons to other scholars considering similar approaches. Moreover, we content that the use of middle-range theory to extend the methodological literature is a novel contribution to realist work. [ABSTRACT FROM AUTHOR]

Implementation science in healthcare aims to understand how to get evidence into practice. Once this is achieved in one setting, it becomes increasingly difficult to replicate elsewhere. The problem is often attributed to differences in context that influence how and whether implementation strategies work. We argue that realist research paradigms provide a useful framework to express the effect of contextual factors within implementation strategy causal processes. Realist studies are theory-driven evaluations that focus on understanding how and why interventions work under different circumstances. They consider the interaction between contextual circumstances, theoretical mechanisms of change and the outcomes they produce, to arrive at explanations of conditional causality (i.e., what tends to work, for whom, under what circumstances). This Commentary provides example applications using preliminary findings from a large realist implementation study of system-wide value-based healthcare initiatives in New South Wales, Australia. If applied judiciously, realist implementation studies may represent a sound approach to help optimise delivery of the right care in the right setting and at the right time. [ABSTRACT FROM AUTHOR]

Background: Commercial delivery cyclists represent a uniquely vulnerable and poorly understood road user. The primary aim of this study was to pilot whether cycling injuries could be categorised as either commercial or non-commercial using documentation entered into routine hospital medical records, in order to determine the feasibility of conducting a large cohort study of commercial cycling injuries in the future. A secondary aim was to determine which key demographic, incident and injury characteristics were associated with commercial versus non-commercial cycling injuries in emergency. Methods: Pilot retrospective cohort study of adults presenting to an acute public hospital emergency department between May 2019 and April 2020 after sustaining a cycling-related injury. Multinomial logistic regression was used to examine the demographic, incident and injury characteristics associated with commercial compared to non-commercial cycling. Results: Of the 368 people presenting to the emergency department with a cycling-related injury, we were able to categorise 43 (11.7%) as commercial delivery cyclists, 153 (41.6%) as non-commercial cyclists and the working status of 172 (46.7%) was unable to be confirmed. Both commercial and unconfirmed cyclists were more likely to be younger than non-commercial cyclists. Compared to non-commercial cyclists, commercial cyclists were 11 times more likely to speak a language other than English (AOR 11.3; 95% CI 4.07–31.30; p<0.001), less likely to be injured from non-collision incidents than vehicle collisions (AOR 0.36; 95% CI 0.15–0.91; p=0.030) and were over 13 times more likely to present to the emergency department between 8.00pm and 12.00am compared to the early morning hours (12.00 to 8.00am) (AOR 13.43; 95% CI 2.20–82.10; p=0.005). Conclusions: The growth of commercial cycling, particularly through online food delivery services, has raised concern regarding commercial cyclist safety. Improvements in the recording of cycling injury commercial status is required to enable ongoing surveillance of commercial cyclist injuries and establish the extent and risk factors associated with commercial cycling. [ABSTRACT FROM AUTHOR]

Neuronal ceroid lipofuscinoses (NCL; Batten disease) are a group of inherited neurodegenerative diseases with a common set of symptoms including cognitive and motor decline and vision loss. Naturally occurring sheep models of CLN5 and CLN6 disease display the key clinical features of NCL, including a progressive loss of vision. We assessed retinal histology, astrogliosis, and lysosomal storage accumulation in CLN5 affected (CLN5−/−) and CLN6 affected (CLN6−/−) sheep eyes and age-matched controls at 3, 6, 12, and 18 months of age to determine the onset and progression of retinal pathology in NCL sheep. The retina of CLN5−/− sheep shows progressive atrophy of the outer retinal layers, widespread gliosis, and accumulation of lysosomal storage in retinal ganglion cells late in disease. In contrast, CLN6−/− retina shows significant atrophy of all retinal layers, progressive gliosis, and earlier accumulation of lysosomal storage. This study has highlighted the differential vulnerability of retinal layers and the time course of retinal atrophy in two distinct models of NCL disease. This data will be valuable in determining potential targets for ocular therapies and the optimal timing of these therapies for protection from retinal dysfunction and degeneration in NCL. [ABSTRACT FROM AUTHOR]

Background: Implementing evidence into clinical practice is a key focus of healthcare improvements to reduce unwarranted variation. Dissemination of evidence-based recommendations and knowledge brokering have emerged as potential strategies to achieve evidence implementation by influencing resource allocation decisions. The aim of this study was to determine the effectiveness of these two research implementation strategies to facilitate evidence-informed healthcare management decisions for the provision of inpatient weekend allied health services.Methods and Findings: This multicentre, single-blinded (data collection and analysis), three-group parallel cluster randomised controlled trial with concealed allocation was conducted in Australian and New Zealand hospitals between February 2018 and January 2020. Clustering and randomisation took place at the organisation level where weekend allied health staffing decisions were made (e.g., network of hospitals or single hospital). Hospital wards were nested within these decision-making structures. Three conditions were compared over a 12-month period: (1) usual practice waitlist control; (2) dissemination of written evidence-based practice recommendations; and (3) access to a webinar-based knowledge broker in addition to the recommendations. The primary outcome was the alignment of weekend allied health provision with practice recommendations at the cluster and ward levels, addressing the adoption, penetration, and fidelity to the recommendations. The secondary outcome was mean hospital length of stay at the ward level. Outcomes were collected at baseline and 12 months later. A total of 45 clusters (n = 833 wards) were randomised to either control (n = 15), recommendation (n = 16), or knowledge broker (n = 14) conditions. Four (9%) did not provide follow-up data, and no adverse events were recorded. No significant effect was found with either implementation strategy for the primary outcome at the cluster level (recommendation versus control β 18.11 [95% CI -8,721.81 to 8,758.02] p = 0.997; knowledge broker versus control β 1.24 [95% CI -6,992.60 to 6,995.07] p = 1.000; recommendation versus knowledge broker β -9.12 [95% CI -3,878.39 to 3,860.16] p = 0.996) or ward level (recommendation versus control β 0.01 [95% CI 0.74 to 0.75] p = 0.983; knowledge broker versus control β -0.12 [95% CI -0.54 to 0.30] p = 0.581; recommendation versus knowledge broker β -0.19 [-1.04 to 0.65] p = 0.651). There was no significant effect between strategies for the secondary outcome at ward level (recommendation versus control β 2.19 [95% CI -1.36 to 5.74] p = 0.219; knowledge broker versus control β -0.55 [95% CI -1.16 to 0.06] p = 0.075; recommendation versus knowledge broker β -3.75 [95% CI -8.33 to 0.82] p = 0.102). None of the control or knowledge broker clusters transitioned to partial or full alignment with the recommendations. Three (20%) of the clusters who only received the written recommendations transitioned from nonalignment to partial alignment. Limitations include underpowering at the cluster level sample due to the grouping of multiple geographically distinct hospitals to avoid contamination.Conclusions: Owing to a lack of power at the cluster level, this trial was unable to identify a difference between the knowledge broker strategy and dissemination of recommendations compared with usual practice for the promotion of evidence-informed resource allocation to inpatient weekend allied health services. Future research is needed to determine the interactions between different implementation strategies and healthcare contexts when translating evidence into healthcare practice.Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000029291. [ABSTRACT FROM AUTHOR]

Background: Health and medical research funding agencies are increasingly interested in measuring the impact of funded research. We present a research impact case study for the first four years of an Australian National Health and Medical Research Council funded Centre of Research Excellence in Cardiovascular Outcomes Improvement (2016-2020). The primary aim of this paper was to explore the application of a research impact matrix to assess the impact of cardiovascular outcomes improvement research.Methods: We applied a research impact matrix developed from a systematic review of existing methodological frameworks used to measure research impact. This impact matrix was used as a bespoke tool to identify and understand various research impacts over different time frames. Data sources included a review of existing internal documentation from the research centre and publicly available information sources, informal iterative discussions with 10 centre investigators, and confirmation of information from centre grant and scholarship recipients.Results: By July 2019, the impact on the short-term research domain category included over 41 direct publications, which were cited over 87 times (median journal impact factor of 2.84). There were over 61 conference presentations, seven PhD candidacies, five new academic collaborations, and six new database linkages conducted. The impact on the mid-term research domain category involved contributions towards the development of a national cardiac registry, cardiovascular guidelines, application for a Medicare Benefits Schedule reimbursement item number, introduction of patient-reported outcome measures into several databases, and the establishment of nine new industry collaborations. Evidence of long-term impacts were described as the development and use of contemporary management for aortic stenosis, a cardiovascular risk prediction model and prevention targets in several data registries, and the establishment of cost-effectiveness for stenting compared to surgery.Conclusions: We considered the research impact matrix a feasible tool to identify evidence of academic and policy impact in the short- to midterm; however, we experienced challenges in capturing long-term impacts. Cost containment and broader economic impacts represented another difficult area of impact to measure. [ABSTRACT FROM AUTHOR]

Abstract Protea punctata and P. venusta are closely related, but morphologically distinct, species that naturally hybridize in the wild. Here we examined patterns of hybridization and cryptic introgression in seedlings grown from seeds collected at Blesberg Mountain in the Swartberg Mountain range. We used restriction site associated genotyping by sequencing (RAD-Seq) to identify 7185 single nucleotide polymorphisms (SNPs) to characterize genetic identity. We found evidence for extensive introgression in seedlings within maternal families, more than can be explained by mating between pure parental species. We conclude that there is cryptic introgression between these two species and that morphological identification in the field underestimates the extent of hybridization in this system. Highlights • Protea punctata and P. venusta naturally hybridize in the wild. • Intensive genetic work reveals extensive introgression within maternal lines. • Maternal morphology often conceals cryptic introgression and variation in offspring. [ABSTRACT FROM AUTHOR]

Suppose that we disagree about a matter of constitutional law. Say that one of us contends, and the other denies, that transgender persons have constitutional rights to be treated in accord with their gender identity. It appears that we disagree about "what the law is." And, most probably, we disagree about what the law is on this matter because we disagree about what generally makes it the case that our constitutional law is this rather than that. Constitutional theory should provide guidance. Theorists should try to explain what gives our constitutional rules the contents that they have, or what makes true constitutional propositions true; they should aim to provide what I will call a "constitutive theory" of constitutional law. It is obvious that we do not all share a constitutive theory. It is less obvious, and strikingly underappreciated, that we have precious few candidates to choose from. Few of our many prescriptive theories regarding how judges should exercise the power of judicial review have straightforward constitutive implications. This Article presents an original constitutive theory of American constitutional law (and of law generally), founded on the familiar distinction between two types of constitutional norms: "principles" and "rules." It argues: first, that rules are determined by the interaction of principles, in a manner that can be loosely modeled as force addition; and second, that the principles are "grounded" in mental states, speech-acts, and behaviors of persons who make up the constitutional community, much as rules of fashion or of billiards are grounded in behaviors of persons who make up their normative communities. In short: social facts determine constitutional principles, and constitutional principles determine constitutional rules. I call the account "principled positivism." It is positivist, pluralist, and dynamic. Principled positivism maintains that we can come to know our constitutional rules by discerning the contents, contours, and weights of our constitutional principles. Accordingly, the Article offers a preliminary and partial inventory of our constitutional principles--principles concerning the legal significance of what the enacted text says and what its authors intended; principles about the force of judicial precedents and of extra-judicial practices; principles of popular sovereignty, the distribution of governing power, and the demands of liberty and equality. It then puts the principles to work, illustrating how they operate in diverse constitutional controversies, from same-sex marriage to the scope of Congress's commerce power. [ABSTRACT FROM AUTHOR]

The article discusses what law and sport have something to teach each other. It explains the reliance of sports and legal systems on the same type of tool to achieve a diversity of ends within a diversity of constraints. Some of the lessons that lawyers and law students can learn from sport, including those related to the use of rules to their advantage and those related to the imposition of penalties on cheaters.

Background: It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors.Methods: An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data.Results: After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarchal flow was described from (1) establishing an imperative for practice change, (2) building trust between implementation stakeholders and (3) developing a shared vision, to (4) actioning change mechanisms. This was underpinned by the (5) employment of effective communication strategies and (6) provision of resources to support change.Conclusions: Evidence is developing to support the use of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The design of future implementation strategies should be based on the inter-relating factors perceived to be associated with effective strategies.Trial Registration: This systematic review was registered with Prospero (record number: 42016032947). [ABSTRACT FROM AUTHOR]

Monoamine uptake inhibitors are common treatments for depression; however, the therapeutic efficacy of these drugs varies widely. Two factors that are commonly linked to clinical outcome are age and serotonin transporter ( SERT) genotype. Mouse models provide powerful tools to study consequences of age and genotype on antidepressant-like efficacy; however, to date, systematic studies of this nature are lacking. Here, we used the tail suspension test ( TST), a preclinical assay for antidepressant efficacy, to gain insight into age and SERT genotype dependency of immobility time in the TST under control conditions (saline injection) and in response to the tricyclic antidepressant, desipramine ( DMI). Immobility after saline injection in juvenile, adolescent, adult, mature adult and middle-aged mice (postnatal days 21, 28, 90, 210 and 300, respectively) significantly increased with age; however, the rate of increase was slower for SERT null (−/−) mice than for wild-type (+/+) or heterozygote (+/−) mice. Desipramine reduced immobility across ages and SERT genotypes. Middle-aged, but not adult, SERT−/− mice were significantly more sensitive to DMI than age-matched SERT+/+ or SERT+/− mice. Desipramine was less potent in middle-aged SERT+/+ and SERT+/− mice than in adult SERT+/+ or SERT+/− mice. Regardless of age, DMI's maximal effects were greater in SERT−/− mice than in SERT+/+ or SERT+/− mice. These results show that immobility time in the TST varies as a function of age and SERT genotype, underscoring the utility of the TST as a potential model to examine age- and SERT genotype-dependent influences on antidepressant response. [ABSTRACT FROM AUTHOR]

Background: Weanimix is an important food for children in Ghana. Mothers are trained to prepare homemade weanimix from beans, groundnuts and maize for their infants. Groundnuts and maize are prone to aflatoxin contamination while fumonisin contaminates maize. Aflatoxin, is produced by the Asperguillus fungi while fumonisin, is produced by Fusarium fungi. These mycotoxins occur in tropical areas worldwide due to favorable climate for their growth. Objective: The objective of the study was to determine the levels of aflatoxin and fumonisin in homemade weanimix in the Ejura-Sekyedumase district in the Ashanti Region of Ghana. Methods: Thirty six homemade weanimix samples (50g each) were collected from households. Aflatoxin and fumonisin were measured using a fluorometric procedure described by the Association of Official Analytical Chemist (AOAC official method 993.31, V1 series 4). Results: Aflatoxin and fumonisin were detected in all 36 samples, range 7.9-500ppb. Fumonisin levels range: 0.74-11.0ppm). Thirty (83.3%) of the thirty six samples were over the action limit of 20ppb for aflatoxin with an overall mean of 145.2 ppb whiles 58.3% of the samples had fumonisins above the action limit of 4 ppm with an overall mean of 4.7 ppm . Conclusion: There were significant aflatoxin and fumonisin contamination of homemade weanimix. Children fed on this nutritional food were being exposed to unacceptable levels of aflatoxin and fumonisin. Therefore there is a critical need to educate mothers on the dangers of mycotoxin exposure and to develop strategies to eliminate exposure of children fed homemade weanimix to aflatoxin and fumonisin. [ABSTRACT FROM AUTHOR]

The article discusses pluralistic nonoriginalism and a reported combinability problem in regards to U.S. constitutional law and the originalism theory of constitutional interpretation as of June 2013. Other topics include constitutional theorists, the U.S. Supreme Court case Marbury v. Madison, and legal philosopher H.L.A. Hart's book "The Concept of Law." Fellow philosopher and legal theorist Ronald Dworkin is also mentioned.

The ITER magnet procurement is now well underway. The magnet systems consist of 4 superconducting coil sets (toroidal field (TF), poloidal field (PF), central solenoid (CS) and correction coils (CC)) which use both NbTi and Nb3Sn-based conductors. The magnets sit at the core of the ITER machine and are tightly integrated with each other and the main vacuum vessel. The total weight of the system is about 10000 t, of which about 500 t are Nb3Sn strands and 250 t, NbTi. The reaction of the magnetic forces is a delicate balance that requires tight control of tolerances and the use of high-strength, fatigue-resistance steel forgings. Integration and support of the coils and their supplies, while maintaining the necessary tolerances and clearance gaps, have been completed in steps, the last being the inclusion of the feeder systems. Twenty-one procurement agreements have now been signed with 6 of the ITER Domestic Agencies for all of the magnets together with the supporting feeder subsystems. All of them except one (for the CS coils) are so-called Build to Print agreements where the IO provides the detailed design including full three-dimensional CAD models. The production of the first components is underway (about 175 t of Nb3Sn strand was finished by July 2011) and manufacturing prototypes of TF coil components are being completed. The paper will present a design overview and the manufacturing status. [ABSTRACT FROM PUBLISHER]

This Essay explores a question of superficial triviality: when sports use instant replay technology to review on-field calls, what standard of review should they employ? The conventional view is that on-field calls should be entrenched against reversal such that, if the reviewing official has any doubt about the correctness of the initial call, he must let it stand even if he thinks it very probably wrong. Indeed, in the wake of officiating debacles at last summer's FIFA World Cup, commentators proposed not only that soccer employ instant replay, but also that it follow the NFL in directing officials to overturn on-field calls only when "indisputable visual evidence" (IVE) reveals that call to be mistaken. This Essay argues that common wisdom in favor of IVE overlooks important considerations against entrenchment and likely rests upon mistaken premises, and it offers several concrete proposals for reform. A lengthy investigation into the optimal standard of review for instant replay in sports might seem frivolous. But it serves a deeper ambition. We are in the early years of sports' colonization by econometricians, as legal theorists remain watching from the sidelines. That is unfortunate. Formal organized sports are, in effect, legal systems, and legal theorists might find much both to teach and to learn by paying closer attention to competitive athletics. In short, legal theorists would benefit from a sustained engagement with what I have termed, in previous work, "the jurisprudence of sport." As a case study in this nascent field, this Essay reveals that the problem of appellate review in sports is surprisingly rich and complex-implicating profound questions concerning the relationships among desert, entitlement, and justice; the difference between mistake and error; and the contours of loss aversion and omission bias, among other things. But it shows even more than that. The jurisprudence of sport maintains that sporting practices and norms can teach lessons for ordinary legal systems as surely as the other way around. illustrating that claim, this Essay draws from football replay practices an argument to reform the criminal trial system to accommodate two verdicts of acquittal, not just one. [ABSTRACT FROM AUTHOR]

The article focuses on the jurisprudence and philosophy of sports law. Topics include the rules of "no harm, no foul," and "no harm, no penalty," in sports games such as football and hockey, the legal theory of temporal variance in sports law, athletic virtues and behavior of players, and rules about faults in the game.

The partial defense of provocation provides that a person who kills in the heat of passion brought on by legally adequate provocation is guilty of manslaughter rather than murder. The defense traces back to the twelfth century and exists today, in some form, in almost every U.S. state and other common law jurisdictions. But long history and wide application have not produced agreement on the rationale for the doctrine. To the contrary, the search for a coherent and satisfying rationale remains among the main occupations of criminal law theorists. The dominant scholarly view holds that provocation is best explained and defended as a partial excuse on the grounds that the killer's inflamed emotional state so compromised his ability to conform his conduct to the demands of reason and law as to render him substantially less blameworthy for his conduct. In contrast, a small minority of scholars have maintained, without significant argumentative support, that provocation is best understood as a partial justification on the ground that the provoked killing is less wrongful than is an unprovoked killing, ceteris paribus. Recently, other commentators have argued that provocation mitigation is neither partial excuse nor partial justification. Against all of these familiar positions, we argue that partial excuse and partial justification are necessary and sufficient conditions for provocation manslaughter. In our view, an intentional killing deserves to be punished and labeled as manslaughter rather than murder only when, because of provocation, this particular killing is significantly less wrongful than the standard intentional killing and when, because of the actor's partial lack of control, he is less blameworthy for committing an act that remains all-things-considered wrongful. In elaborating and defending our account, we rebut the oft-repeated but rarely challenged propositions that justification and excuse, even in partial forms, are mutually exclusive, and that the very notion of partial justification is incoherent. We also draw forth implications for how the sentencing ranges for murder and manslaughter should be related. [ABSTRACT FROM AUTHOR]

An essay on the construction of constitutional texts and how they relate to the constitutional decision and implementation is presented. It addresses the originalist views on linguistic meaning with regards to the constitutional texts, the constraints imposed by the law and the view of pragmatists on the fundamental mistake of the taxonomic project. It concludes that portions of the U.S. Constitution could be distinguished as legal or linguistic interpretation if they could not always be identical in legal meaning or semantic content.

Objectives: This study aimed to identify an early marker of functional impairment after an implantable cardioverter-defibrillator (ICD) shock as a predictor of heart failure progression. Background: The ICD population has substantial risk of death due to progressive pump failure. Methods: Near-field (NF) bipolar right ventricular (RV) electrograms (EGMs) during induced ventricular fibrillation (VF) and 10 s after rescue ICD shock were analyzed in 310 patients (mean age 59 ± 14.5 years, 219 men [71%]) with structural heart disease, New York Heart Association functional class I to III, and implanted with a single- or dual-chamber Medtronic (Minneapolis, Minnesota) ICD for primary (245 patients, 79%) or secondary prevention of sudden cardiac arrest. A local injury current (LIC) on NF RV EGM was defined as a deviation of EGM potential ≥1 mV or ≥15% of the preceding R-wave peak-to-peak amplitude. Results: During mean follow-up of 29.3 ± 15.0 months, the combined end point of death or hospitalization due to congestive heart failure (CHF) exacerbation was documented in 40 patients (12.9%, or 5.3% per person-year of follow-up). LIC was observed in 106 patients. In multivariate risk analysis, after adjustment for baseline prognostic factors (ejection fraction, history of atrial fibrillation, diabetes mellitus) and appropriate ICD shocks during follow-up, patients with observed LIC after induced VF rescue ICD shock at ICD implantation were more likely to die or to be hospitalized (hazard ratio: 2.69; 95% confidence interval: 1.41 to 5.14; p = 0.003). Conclusions: Transient LIC on bipolar NF RV EGM after induced VF rescue ICD shock is associated with increased risk of CHF progression, future hospitalizations due to CHF exacerbation, and subsequent heart failure death. [Copyright &y& Elsevier]

Abstract: The central solenoid (CS) of the ITER tokamak contributes to the inductive flux to drive the plasma, to the shaping of the field lines in the divertor region and to vertical stability control. It is made of 6 independent coils, using a Nb3Sn cable-in-conduit superconducting conductor, held together by a vertical precompression structure. This design enables ITER to access a wide operating window of plasma parameters, up to 17MA and covering inductive and non-inductive operation. Each coil is based on a stack of multiple pancake winding units to minimise joints. A glass–polyimide electrical insulation, impregnated with epoxy resin, is giving a high voltage operating capability, tested up to 29kV. The CS performance is fatigue driven mainly by the stress levels in the conductor jacket and in the precompression structure needed to keep the modules in contact during the repulsive forces which can arise in operation. A rigid connection to the TF coils provided at one end and a centering support at the other end allow to resist net vertical forces as well as unbalanced radial forces while avoiding torsion transmission from the TF Coils to the CS assembly. [Copyright &y& Elsevier]

Electronic access to research information for health professionals is a key component in developing evidence-based healthcare. As nurses take on extended roles and work more autonomously, it is assumed that they will take increasing advantage of these technologies. However, little is known about the decisions that nurses make and the information needs that arise within the context of those decisions. This article presents an analysis of 410 nurse-patient consultations and interviews with 76 primary care nurses, and explores nurses' information needs and their use of electronic information tools. The findings suggest that, if we wish to encourage nurses to use research information in clinical practice, we need to move from ;pull' to ;push' technology. [ABSTRACT FROM AUTHOR]

The diffuse plasma that fills galaxy groups and clusters (the intracluster medium) is a by-product of galaxy formation. The present thermal state of this gas results from a competition between gas cooling and heating. The heating comes from two distinct sources: gravitational heating associated with the collapse of the dark matter halo and additional thermal input from the formation of galaxies and their black holes. A long-term goal of this research is to decode the observed temperature, density and entropy profiles of clusters and to understand the relative roles of these processes. However, a long-standing problem has been that cosmological simulations based on smoothed particle hydrodynamics (SPH) and Eulerian mesh-based codes predict different results even when cooling and galaxy/black hole heating are switched off. Clusters formed in SPH simulations show near power-law entropy profiles, while those formed in Eulerian simulations develop a core and do not allow gas to reach such low entropies. Since the cooling rate is closely connected to the minimum entropy of the gas distribution, the differences are of potentially key importance. In this paper, we investigate the origin of this discrepancy. By comparing simulations run using theGADGET-2 SPH code and theFLASH adaptive Eulerian mesh code, we show that the discrepancy arises during the idealized merger of two clusters and that the differences are not the result of the lower effective resolution of Eulerian cosmological simulations. The difference is not sensitive to the minimum mesh size (in Eulerian codes) or the number of particles used (in SPH codes). We investigate whether the difference is the result of the different gravity solvers, the Galilean non-invariance of the mesh code or an effect of unsuitable artificial viscosity in the SPH code. Instead, we find that the difference is inherent to the treatment of vortices in the two codes. Particles in the SPH simulations retain a close connection to their initial entropy, while this connection is much weaker in the mesh simulations. The origin of this difference lies in the treatment of eddies and fluid instabilities. These are suppressed in the SPH simulations, while the cluster mergers generate strong vortices in the Eulerian simulations that very efficiently mix the fluid and erase the low-entropy gas. We discuss the potentially profound implications of these results. [ABSTRACT FROM AUTHOR]

Critical analysis of originalism should start by confronting a modest puzzle: Most commentators suppose that originalism is deeply controversial, while others complain that it means too many things to mean anything at all. Is one of these views false? If not, how can we square the term's ambiguity with the sense that it captures a subject of genuine debate?, Perhaps self-professed originalists champion a version of originalism that their critics don't reject, while the critics challenge a version that proponents don't maintain. Contemporary originalists disagree about many things: which feature of the Constitution's original character demands fidelity (framers' intent, ratifiers' understanding, or public meaning); why such fidelity is required; and whether this interpretive obligation binds judges alone or citizens, legislators, and executive officials too. But on one dimension of potential variability-the dimension of strength-originalists are mostly united: They believe that those who follow some aspect of a provision's original character must give that original aspect priority over all other considerations (with a possible exception for continued adherence to non-originalist judicial precedents). That is, when the original meaning (or intent, etc.) is adequately discernible, the interpreter must follow it. This is the thesis that self-professed originalists maintain and that their critics (the non-originalists) deny. Non-originalists have challenged this thesis on varied wholesale grounds, which include: that the target of the originalist search is undiscoverable or nonexistent; that originalism is self-refuting because the framers intended that the Constitution not be interpreted in an originalist vein; and that originalism yields bad outcomes. This Article proceeds differently. Instead of mounting a global objection—one purporting to hold true regardless of the particular arguments on which proponents of originalism rely-1 endeavor to catalogue and critically assess the varied arguments proffered in originalism's defense. Those arguments are of two broad types-hard and soft. Originalism is "hard" when grounded on reasons that purport to render it (in some sense) inescapably true; it is "soft" when predicated on contingent and contestable weighings of its costs and benefits relative to other interpretive approaches. That is, hard arguments seek to show that originalism reflects some sort of conceptual truth or follows logically from premises the interlocutor already can be expected to accept; soft arguments aim to persuade others to revise their judgments of value or their empirical or predictive assessments. The most common hard arguments contend that originalism is entailed either by intentionalism or by binding constitutionalism. Soft arguments claim that originalist interpretation best serves diverse values like democracy and the rule of law. I seek to show that the hard arguments for originalism are false and that the soft arguments are implausible. The upshot is not that constitutional interpretation should disregard framers' intentions, ratifiers' understandings, or original public meanings. Of course we should care about these things. But originalism is a demanding thesis. We can take the original character of the Constitution seriously without treating it as dispositive. That original intents and meanings matter is not enough to render originalism true. [ABSTRACT FROM AUTHOR]

Nurses are increasingly working more autonomously in extended roles, yet we know little about the nature of the decisions they make. Decisions vary in terms of complexity, ambiguity and presentation, and the nature of the decision task impacts on the process of decision making, such as the likelihood of using a decision tool. Thus, knowledge about the nature of nursing decisions is essential for development of effective decision tools. This article presents an analysis of 410 nurse-patient consultations and interviews with 76 primary care nurses, and explores the nature of the decisions that primary care nurses make and the impact of that on their use of and attitudes towards decision tools. Copyright c 2009 SAGE Publications Ltd. [ABSTRACT FROM AUTHOR]

Abstract: The first 2 years of the ITER IO has seen substantial progress towards the construction of the magnets, in three main areas. Firstly, the design has been developed under the conflicting constraints to minimise construction costs and to maximise plasma physics performance. Building construction momentum while updating the design to take account of new physics assessments of the coil requirements has been challenging. Secondly, with a stabilising design, it has been possible for the Domestic Agencies to launch the first industrial procurement contracts. And thirdly, critical R&D to confirm the performance of the Nb3Sn cable in conduit design is proceeding successfully. The design consolidation has been accompanied by design reviews involving the international community. The reviews conducted by magnet experts have enabled a consensus to be built on choosing between some of the design options in the original ITER basic design in 2001. The major design decisions were to maintain the circular Nb3Sn conductor embedded in radial plates for the toroidal field (TF) coils and to maintain NbTi-based conductors for the PF coils. Cold testing, at low current, is also being introduced for quality control purposes for all coils. [Copyright &y& Elsevier]

A means of deriving a disturbance index reflecting forest use history is demonstrated here to establish a disturbance gradient and enable comparison of different forest areas within and across individual forests. Detailed reference is made to Kakamega Forest in western Kenya for which a long-term time series has been established, although the study is spread to four further forests in Kenya and Uganda. A wide variety of sources are drawn upon for spatially resolved data that are integrated in a geographic information system. Three indices are derived: for commercial disturbance, local disturbance, and forest cover change. Results show a wide range of disturbance values (from low to heavy) for the research sites within Kakamega Forest, while results for Budongo and Mabira Forest sites show low and moderate levels, respectively. Correlations of low disturbance levels with nature or national reserves appear to be marked, while a correlation of disturbance with differing management authority is also suggested with Kenya Wildlife Service achieving the lowest disturbance levels. Results from the index are reviewed against other means of estimating disturbance with the conclusion that disturbance evaluations should be both spatially resolved and long-term in nature. [ABSTRACT FROM AUTHOR]

An R&D program is being carried out in view of the qualification of the Toroidal Field (TF) coil conductor. It consists of an extensive characterization of several Nb3Sn strand candidates, the cabling of those strands into prototype TF conductors with various combinations of twist pitch and void fraction and the measurement of the performance of conductor short samples in representative condition of transport current, magnetic field and temperature. Industries and laboratories are involved worldwide in this R&D program which is expected to provide the basis to finalize the TF conductor design. The Nb3Sn strands proposed by each of the six Participant Teams involved in the procurement of the TF conductor will then be qualified in the final cable configuration by the successful test of a short sample in the Sultan facility. The status and the first results of the R&D program are presented together with the qualification plan. [ABSTRACT FROM AUTHOR]

Procurement of the ITER magnets is due to start at the end of 2007/early 2008, with the launch of the longest lead time items, the Nb3 Sn conductor and the TF coil windings. The base design for procurement was established in 2001, and the build up of the Cadarache ITER team has been accompanied by a review of the most critical, or controversial, features of the 2001 design. At the same time, an urgent R&D program has been launched to complete the necessary verification of the design solutions that are proposed. In this paper an overview will be presented of the main design features and drivers, and some of the recent issues and R&D results will be summarized. [ABSTRACT FROM AUTHOR]

The article presents an integrated dualist theory of punishment. The theory's assumption is that the road to a satisfactory account of punishment's justifiability should start by examining with seriousness the common point of departure already noted. A differentiation between core and peripheral cases of punishment is explored. It discusses the justification of punishment by analyzing justification.

The author asserts that the debate over originalism presented by Jack Balkin concerns whether constitutional interpretation must be a search for the original understanding or intent. He examines whether the correct meaning of the constitution can change even absent constitutional amendment. Jack Balkin says that interpretation is influenced by social movements over interpretation by judges. Balkin's reasons for concluding that the originalist answer is better than the non-originalist answer rather than that the two answers should be studied.

Abstract: The ITER magnets are a complex system involving interfaces between many advanced technologies (superconductors, forging/welding/machining of massive structures, cryogenics, composites and moulding, high voltage electrical), yet at the same time form part of the ITER ‘basic machine’ which is required to operate at the design parameters, broadly failure free, for the design life of the tokamak. This imposes special quality control problems for the ITER project integration by the ITER International Team (IT) through the design, fabrication and operation. The magnets are not a test bed for new technology but in spite of this must use it, successfully. There is little previous experience of such a system but full functionality is required from the start, with limited opportunity for adjustment. And, finally, costs and schedule must be contained. The procurement strategy for the machine, with magnet components being supplied ‘in kind’, requires particular attention to the specifications, scheduling and quality control (QC). Special issues here are the testing requirements on magnet components, especially before final installation but also at critical intermediate stages. Unnecessary or ineffective quality control procedures cause delay and high costs, and divert attention from critical items. The main points of the magnet QC programme are summarised, including the use of codes and standards, qualification, manufacturing quality assurance, commissioning and in-service inspection. [Copyright &y& Elsevier]

The problem of how representative a short Nb3Sn conductor sample is for simulating conductor-in-coil conditions in the ITER magnets is addressed here by considering the particular case of the Central Solenoid Model Coil (CSMC), tested in 2001-2003 at JAERI Naka, Japan, and its associated Good Joint IGJ) sample (tested in 1999 in the SULTAN facility). While the basic thermal-hydraulic conditions are interpreted from experimental data by the M&M code, the sensitivity of the voltage-temperature characteristics to mechanical effects (due to the strain sensitivity of the Nb3Sn) is investigated by analysis. The results are used to assess the errors to be expected in predicting coil performance from measurements made on conductor samples. [ABSTRACT FROM AUTHOR]

Objectives: To determine the short-term effects of cardiac resynchronization therapy (CRT) on measurements of left ventricular (LV) diastolic function in patients with severe heart failure. Background: Cardiac resynchronization therapy improves systolic performance; however, the effects on diastolic function by load-dependent pulsed-wave Doppler transmitral indices has been variable. Methods: Fifty patients with severe heart failure were evaluated by two-dimensional Doppler echocardiography immediately prior to and 4 ± 1 month after CRT. Measurements included LV volumes and ejection fraction (EF), pulsed-wave Doppler (PWD)-derived transmitral filling indices (E- and A-wave velocities, E/A ratio, deceleration time [DT], diastolic filling time [DFT], and isovolumic relaxation time). Tissue Doppler imaging was used for measurements of systolic and diastolic (Em) velocities at four mitral annular sites; mitral E-wave/Em ratio was calculated to estimate LV filling pressure. Color M-mode flow propagation velocities were also obtained. Results: After CRT, LV volumes decreased significantly (p < 0.001) and LVEF increased >5% in 28 of 50 patients (56%) and were accompanied by reduction in PWD mitral E-wave velocity and E/A ratio (both p < 0.01), increased DT and DFT (both p < 0.01), and lower filling pressures (i.e., E-wave/Em septal; p < 0.01). Patients with LVEF response ≤5% after CRT had no significant changes in measurements of diastolic function; LV relaxation (i.e., Em velocities) worsened in this group. Conclusions: In heart failure patients receiving CRT, improvement in LV diastolic function is coupled to the improvement in LV systolic function. [Copyright &y& Elsevier]

The effect of applied and thermal strain on the superconducting performance of Nb3Sn strands is well known. Prediction of the strand performance depends on an accurate knowledge of the strand strain state. As well as operating strains due to mechanical loads on the conductor, the strand has a complex system of internal strains due to the fabrication process and partial annealing at the reaction heat treatment temperature (about 600 C). Nb3Sn strands are now available with a range of different matrices around the superconducting filaments, varying both in mechanical properties and geometry. Starting from a database of mechanical properties, this paper will use finite element analysis to model the elasto-plastic behavior of the matrix, predicting the filament multi-axial strain state. [ABSTRACT FROM AUTHOR]

In the design of CIC conductors using NbTi or Nb3Sn strands cooled with supercritical He, the choice of stability criteria for near steady state operation presents a problem. The disturbances are small, under 10 mJ/cm³ of cable material, too small for design significance. The main parameters affected by the choice of stability criteria are temperature margin and Cu:nonCu ratio, both of which strongly affect cable cost and overall current density. Methods quantifying the copper required for stability have been elementary, mostly using cryogenic stability (the well-cooled condition). Recent experimental and analytical work on the electric field achieved before quench Eq suggest a more exact method. Cable quench is modeled by a simple stability simulation, including copper conduction and the superconducting transition. A heat transfer coefficient is derived from ITER model coil data. As an example it is applied to conductor design (Fig. 1) for the ITER fusion reactor magnets. [ABSTRACT FROM AUTHOR]

For generations, American constitutional theorists and judges have struggled with problems of constitutional interpretation, exploring how meaning is properly derived from the Constitution and, in so far as the answer may be different, how courts ought to derive such meaning. Recent years, however, have seen an upsurge in scholarship addressed to a related but distinct subject. Without entirely abandoning debates over constitutional interpretation, constitutional theorists have started increasingly to wonder about those judicial outputs that feature in the enterprise of constitutional adjudication and yet are something other than a court's determination as to what any given provision of the Constitution means. Theorists have turned their attention from constitutional meaning to what they may call, at least on a first pass, constitutional doctrine.

: ObjectivesWe evaluated in humans the safety and efficacy of a novel magnetic guidance system (MGS) for electrophysiological mapping, pacing, and ablation.: BackgroundCatheter ablation of atrial fibrillation and other complex arrhythmias requires precise catheter manipulation and stabilization. We have shown in animals that the MGS can precisely manipulate a mapping catheter within the heart with an external magnetic field rather than manual catheter control.: MethodsThirty-one adults referred for diagnostic electrophysiology studies were enrolled in a prospective trial of the MGS. The magnetic catheter was navigated to preselected sites in the right atrium (RA) and right ventricle (RV) in the first 20 patients. Electrograms were recorded at each target site, and pacing thresholds were measured. In a subset of five patients, RA and RV electrograms and stimulation thresholds were recorded with both a standard ablation catheter and the magnetic catheter. Eleven additional patients were recruited for supraventricular tachycardia (SVT) mapping, and seven of these underwent ablation.: ResultsNavigation was successful in 200 of 202 predetermined right-sided navigation targets and 13 of 13 targets in the left atria. Pacing thresholds and electrogram amplitudes in the RA and RV were not significantly different between the standard and magnetic catheters. The SVT mapping with the magnetic catheter was successful in 13 patients, including 4 with left-sided accessory pathways. The MGS was used for successful ablation of SVT in seven of seven patients. There were no procedural complications.: ConclusionsThese results demonstrate that the MGS can be used for intracardiac mapping, pacing, and ablation safely and effectively. [Copyright &y& Elsevier]

Anglo-American theorists of the criminal law have concentrated on-one is tempted to say "obsessed over"-the distinction between justification and excuse for a good quarter-century and the scholarly attention has purchased unusually widespread agreement. Justification defenses are said to apply when the actor's conduct was not morally wrongful; excuse defenses lie when the actor did engage in wrongful conduct but is not morally blameworthy. A near consensus thus achieved, theorists have turned to subordinate matters, joining issue most notably on the question of whether justifications are "subjective"-turning upon the actor's reasons for acting-or "objective"-involving only facts independent of the actor's beliefs and motives. This Article seeks to demonstrate that the prevailing understanding is wrong. Drawing on the well-known distinction between conduct rules and decision rules, it argues that the distinction between justification and excuse, for purposes of a criminal law taxonomy, is only this: A justified action is not criminal, whereas an excused defendant has committed a criminal act but is not punishable. To readers only marginally acquainted with the relevant literature, this claim may seem far from extravagant, for occasional statements to the same effect can be found in the case law and commentary. In fact, however, theorists have not appreciated just how this articulation of the distinction differs from the orthodox one, nor what consequences follow. This Article attempts to remedy that defect. One lesson of a systematic investigation into these competing formulations is that the long-running debate over whether justifications, properly understood, are "subjective" or "objective" is misconceived. This is a debate over policy broadly conceived, not (as it so often purports to be) a matter of conceptual analysis. More generally, this Article's examination of justification and excuse constitutes a case study in the complex relationship between legal and moral reasoning, and highlights the importance of distinguishing arguments that advance substantive value judgments from those that purport to analyze our conceptual apparatus. It may be that conceptual analysis is no less contestable or value-laden than is substantive normative argument (though perhaps it is). In any event, they are not the very same enterprise and a first step to clear thinking-in the criminal law and elsewhere-is to keep them distinct. [ABSTRACT FROM AUTHOR]

Testing of the five International Thermonuclear Experimental Reactor (ITER) model coils is nearly complete and it is possible to produce an overall summary of the conductor performance assessment. The interpretation is supported by a large database of tests on components (especially strand) and by analysis of the two main phenomena that influence the strand performance in the cable (current non-uniformity and mechanical loads). Individually, interpretation of individual coils is difficult but taken together the results enable conclusions to be drawn about the expected behaviour of conductors in the ITER coils. The conductor design has successfully resolved many of the problems of stability and pulsed current behaviour associated with large multi-strand cables, and the performance is better than expected in these areas. The current sharing behaviour is below expectations, probably due to an extra unexpected strain effect in the Nb3Sn strands arising from the local magnetic loads, and the paper concentrates on this issue. Design modifications are required to recover the performance and updated design criteria to implement these are proposed. [Copyright &y& Elsevier]

Examines the ruling of the U.S. Supreme Court under chief justice William Rehnquist on the case South Dakota versus Dole, which deals with federal spending. Background of the case; Laws and facts being disputed in the case; Argument taken by the Supreme Court for its decision.

Focuses on the statutory advertising ban and implementing regulations of casino gambling in Puerto Rico. Prohibitions on the use of the word 'casino' on matchbooks and interoffice correspondence; Application of the mid-level scrutiny for regulations of commercial speech; Advancement in the substantial governmental interest in reducing demand for casinos.

Examines the causes for the premature voltage development of superconducting magnet central solenoid insert coil. Variation of strand current and field; Nonuniform current distribution; Self-magnetic field effects.

Discusses the unconstitutional dimensions of coercive proposals under the Twenty-First Amendment to the United States Constitution. Description of the conditional offer problem; Dimensions of constitutional violation; Key components to appraise the constitutionality of individual conditional governmental proposals; Analysis on the several United States Supreme Court cases dealing with the issue.

Presents an analysis of the impact of strand joints and copper location on the current distribution and stability in cable-in-conduit conductors. Use of a time dependent model of current diffusion and heat transfer; Contribution to cable stability by separate copper strands; Current ramping with joined strands; Effects of separate copper strands.

Describes the design of the Nb[sub 3]Sn and NbTi cable-in-conduit conductors of the International Thermonuclear Experimental Reactor magnets. Optimization of the amount of superconducting strand; Conductor thermohydraulic analysis; Consideration of non-uniform current distribution among superconducting strands; Conductor design rules; Heat deposition; Conductor parameters.

Focuses on the predicted thermohydraulic performance of the International Thermonuclear Experimental Reactor Central Solenoid Model Coil in Japan. Expected cable performance; Simulation of the conductor performance; Possible increase in conductor temperature; Correlation of strand and conductor data base with thermohydraulic behavior.

Cells expressing features of senescence, including upregulation of p21 and p16, appear transiently following tissue injury, yet the properties of these cells or how they contrast with age-induced senescent cells remains unclear. Here, we used skeletal injury as a model and identified the rapid appearance following fracture of p21+ cells expressing senescence markers, mainly as osteochondroprogenitors (OCHs) and neutrophils. Targeted genetic clearance of p21+ cells suppressed senescence-associated signatures within the fracture callus and accelerated fracture healing. By contrast, p21+ cell clearance did not alter bone loss due to aging; conversely, p16+ cell clearance, known to alleviate skeletal aging, did not affect fracture healing. Following fracture, p21+ neutrophils were enriched in signaling pathways known to induce paracrine stromal senescence, while p21+ OCHs were highly enriched in senescence-associated secretory phenotype factors known to impair bone formation. Further analysis revealed an injury-specific stem cell–like OCH subset that was p21+ and highly inflammatory, with a similar inflammatory mesenchymal population (fibro-adipogenic progenitors) evident following muscle injury. Thus, intercommunicating senescent-like neutrophils and mesenchymal progenitor cells were key regulators of tissue repair in bone and potentially across tissues. Moreover, our findings established contextual roles of p21+ versus p16+ senescent/senescent-like cells that may be leveraged for therapeutic opportunities. [ABSTRACT FROM AUTHOR]

Variation in response to the Guignard pictate test may be detected within wild British populations of Brassica oleracea L. subsp. oleracea. Plants with the greatest reaction are the least frequent. In different seasons, individuals react differently to the test, possibly in response to temperature fluctuations. In B. oleracea the picrate test is perhaps responding to allyl derivatives of the glucosinolate sinigrin; HCN was not detected. [ABSTRACT FROM AUTHOR]

The possible involvement of flavour volatiles in the resistance of Brassica oleracea L. seedlings to cabbage downy mildew (Peronospora parasitica (Pers. ex Fr.) Fr.) was investigated using seedlings of a number of commercial Brassica oleracea cultivars. Flavour volatiles are primarily released as a result of tissue damage in brassicas. Only one cultivar tested was resistant to the disease and its tissue maccrates yielded the greatest concentration of volatiles. One of these compounds, allyl isothiocyanate, proved to be highly toxic to the pathogen and was produced in much greater concentrations in maccrates of cotyledon than first leaf tissue. The ability of seedlings to produce ally! isothiocyanate in large amounts following tissue damage may inhibit the growth of Peronospora parasitica in resistant seedlings. Wild populations of Brassica oleracea L. subsp. oleracea (wild cabbage) were also tested for disease resistance, and the highest proportions of resistant seedlings were found in those populations containing high levels of flavour volatiles. The longest established wild populations possessed the highest average concentrations of flavour volatiles, and it is suggested that selective breeding has resulted in a reduction in the amounts of these compounds in cultivated forms. This change may be a contributory factor towards the lack of resistance shown by modern cultivars. [ABSTRACT FROM AUTHOR]