583 research outputs found

    Should Research Ethics Encourage the Production of Cost-Effective Interventions?

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    This project considers whether and how research ethics can contribute to the provision of cost-effective medical interventions. Clinical research ethics represents an underexplored context for the promotion of cost-effectiveness. In particular, although scholars have recently argued that research on less-expensive, less-effective interventions can be ethical, there has been little or no discussion of whether ethical considerations justify curtailing research on more expensive, more effective interventions. Yet considering cost-effectiveness at the research stage can help ensure that scarce resources such as tissue samples or limited subject popula- tions are employed where they do the most good; can support parallel efforts by providers and insurers to promote cost-effectiveness; and can ensure that research has social value and benefits subjects. I discuss and rebut potential objections to the consideration of cost-effectiveness in research, including the difficulty of predicting effectiveness and cost at the research stage, concerns about limitations in cost-effectiveness analysis, and worries about overly limiting researchers’ freedom. I then consider the advantages and disadvantages of having certain participants in the research enterprise, including IRBs, advisory committees, sponsors, investigators, and subjects, consider cost-effectiveness. The project concludes by qualifiedly endorsing the consideration of cost-effectiveness at the research stage. While incorporating cost-effectiveness considerations into the ethical evaluation of human subjects research will not on its own ensure that the health care system realizes cost-effectiveness goals, doing so nonetheless represents an important part of a broader effort to control rising medical costs

    The pervasive role of biological cohesion in bedform development

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    Sediment fluxes in aquatic environments are crucially dependent on bedform dynamics. However, sediment-flux predictions rely almost completely on clean-sand studies, despite most environments being composed of mixtures of non-cohesive sands, physically cohesive muds and biologically cohesive extracellular polymeric substances (EPS) generated by microorganisms. EPS associated with surficial biofilms are known to stabilize sediment and increase erosion thresholds. Here we present experimental data showing that the pervasive distribution of low levels of EPS throughout the sediment, rather than the high surficial levels of EPS in biofilms, is the key control on bedform dynamics. The development time for bedforms increases by up to two orders of magnitude for extremely small quantities of pervasively distributed EPS. This effect is far stronger than for physical cohesion, because EPS inhibit sand grains from moving independently. The results highlight that present bedform predictors are overly simplistic, and the associated sediment transport processes require re-assessment for the influence of EPS

    Simulation of gait asymmetry and energy transfer efficiency between unilateral and bilateral amputees

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    Efficient walking or running requires symmetrical gait. Gait symmetry is one of the key factors in efficient human dynamics, kinematics and kinetics. The desire of individuals with a lower-limb amputation to participate in sports has resulted in the development of energy-storing and-returning (ESR) feet. This paper analyses a case study to show the effect of symmetry and asymmetry as well as energy transfer efficiency during periodic jumping between simulated bilateral and unilateral runners. A custom gait analysis system is developed as part of this project to track the motion of the body of a physically active subject during a set of predefined motions. Stance and aerial times are accurately measured using a high speed camera. Gait frequency, the level of symmetry and the non-uniform displacement between left and right foot and their effects on the position of the Centre of Mass (CM) were used as criteria to calculate both peak energies and transformation efficiency. Gait asymmetry and discrepancy of energy transfer efficiency between the intact foot and the ESR are observed. It is concluded that unilateral runners require excessive effort to compensate for lack of symmetry as well as asymmetry in energy transfer, causing fatigue which could be a reason why bilateral amputee runners using ESR feet have a superior advantage over unilateral amputees

    Sprint start kinetics of amputee and non-amputee sprinters

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    The purpose of this study was to explore the relationship between the forces applied to the starting blocks and the start performances (SPs) of amputee sprinters (ASs) and non-amputee sprinters (NASs). SPs of 154 male and female NASs (100-m personal records [PRs], 9.58–14.00 s) and 7 male ASs (3 unilateral above knee, 3 unilateral below knee, 1 bilateral below knee; 100 m PRs, 11.70–12.70 s) with running specific prostheses (RSPs) were analysed during full-effort sprint starts using instrumented starting blocks that measured the applied forces in 3D. Using the NAS dataset and a combination of factor analysis and multiple regression techniques, we explored the relationship between force characteristics and SP (quantified by normalized average horizontal block power). Start kinetics were subsequently compared between ASs and NASs who were matched based on their absolute 100 m PR and their 100 m PR relative to the world record in their starting class. In NASs, 86% of the variance in SP was shared with five latent factors on which measured parameters related to force application to the rear and front blocks and the respective push-off directions in the sagittal plane of motion were loaded. Mediolateral force application had little influence on SP. The SP of ASs was significantly reduced compared to that of NASs matched on the basis of relative 100-m PR (−33.8%; d = 2.11, p < 0.001), while a non-significant performance reduction was observed when absolute 100-m PRs were used (−17.7%; d = 0.79, p = 0.09). These results are at least partially explained by the fact that force application to the rear block was clearly impaired in the affected legs of ASs

    A multi-scale hierarchical framework for developing understanding of river behaviour to support river management

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    The work leading to this paper was funded through the European Union’s FP7 programme under Grant Agreement No. 282656 (REFORM). The framework methodology was developed within the context of Deliverable D2.1 of the REFORM programme, and all partners who contributed to the development of the four parts of this deliverable are included in the author list of this paper. More details on the REFORM framework can be obtained from part 1 of Deliverable D2.1 (Gurnell et al. 2014), which is downloadable from http://​www.​reformrivers.​eu/​results/​deliverables

    Indicators of river system hydromorphological character and dynamics: understanding current conditions and guiding sustainable river management

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    The work leading to this paper received funding from the EU’s FP7 programme under Grant Agreement No. 282656 (REFORM). The Indicators were developed within the context of REFORM deliverable D2.1, therefore all partners involved in this deliverable contributed to some extent to their discussion and development
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