Priority setting for research in health care: An application of value of information analysis to glycoprotein IIb/IIIa antagonists in non-ST elevation acute coronary syndrome

The purpose of this study is to explain the rationale for the value of information approach to priority setting for research and to describe the methods intuitively for those familiar with basic decision analytical modeling. A policy-relevant case study is used to show the feasibility of the method and to illustrate the type of output that is generated and how these might be used to frame research recommendations. The case study relates to the use of glycoprotein IIb/IIIa antagonists for the treatment of patients with non-ST elevation acute coronary syndrome. This is an area that recently has been appraised by the National Institute for Health and Clinical Excellence

Extending clothing lifetimes: an exploration of design and supply chain challenges

The environmental impact of clothing could be reduced if average garment lifetimes were increased. The paper explores the design and supply chain implications of clothing longevity, adapting models from sustainable clothing design research, and evidence from interviews and expert roundtables. The research concludes that the process of design for longevity could be adopted by clothing retailers and brands, but that the principles behind adopting this strategy lack credence in industry, because the mandate to do so, and robust business models, are lacking. The paper identifies a range of conflicting priorities between commercial and sustainable practice that must be addressed to reduce the environmental impact of clothing by extending its useful life, and makes recommendations for industry and future research. However, the limitations to adopting more sustainable practice relate to fashion and market segment, are systemic within the clothing supply chain and attempts to resolve these require a commercial imperative

Product development and supply: help or hindrance to clothing longevity?

Designing longer lasting clothing helps to reduce unsustainable levels of product disposal and subsequent waste. This has led to a call for retailers to enhance clothing longevity, supported by new business models to reduce any impact on competitiveness. While some research suggests that a significant proportion of consumers would buy longer lasting clothes, this view is not necessarily accepted by industry strategists. This paper, which reports on research undertaken for WRAP (Waste and Resources Action Programme), explores conflicting priorities between commercial and sustainable practice, and problematic trade-offs in the supply chain between commercial, technical and design aspects of reducing the environmental impact of clothing. The study adopted a mixed methodology, incorporating qualitative interviews and a survey, and encompasses views of retailers, manufacturers and suppliers from different segments of the UK fashion market. The findings confirm that retailers and brands drive the new product development process and set standards for their supply chains, but globalization, product churn and testing regimes challenge the critical path schedule. Although current tests confirm product quality (WRAP, 2013), there is a perception within industry that designing for longevity increases testing, inflating the risk of failure and extending lead-times, resulting in a mismatch between cost, time and longevity priorities that limits adoption of design for longevity. Meanwhile, clothing longevity is not perceived to add value for many consumers and therefore is not prioritised. While it is technically possible to enhance clothing longevity, the findings demonstrate empirically that this deviates from current commercial drivers of global clothing supply chains. By combining different perspectives on supply chains, new product development and sustainability, inherent conflicts are revealed

Success Despite Socioeconomics: A Case Study of a High-Achieving, High-Poverty School

Effective school leadership is becoming more difficult than ever with the challenges of increased accountability and high stakes testing that are components of federal No Child Left Behind (NCLB) legislation. These challenges are more pronounced in schools with high rates of poverty. This was a case study of a high performing, high poverty school that has consistently been one of the highest performing elementary schools in the state. The purpose of the study was to describe the leadership that exists at the school, the culture of the school, and programs that contribute to the school’s success. The researcher conducted observations at the school site and interviews with school personnel. School personnel also completed the School Culture Survey and the Vanderbilt Assessment of Leadership in Education (VAL-ED). The study revealed school leadership that had high expectations for staff members and emphasized small group instruction, collaboration, and continuous improvement in instructional practices. The culture of the school was that of excellence, continuous improvement, school pride, and collaboration

Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery.

BACKGROUND: Stroke is the major cause of adult disability. Selective serotonin reuptake inhibitors (SSRIs) have been used for many years to manage depression. Recently, small trials have demonstrated that SSRIs might improve recovery after stroke, even in people who are not depressed. Systematic reviews and meta-analyses are the least biased way to bring together data from several trials. Given the promising effect of SSRIs on stroke recovery seen in small trials, a systematic review and meta-analysis is needed. OBJECTIVES: To determine whether SSRIs improve recovery after stroke, and whether treatment with SSRIs was associated with adverse effects. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (August 2011), Cochrane Depression Anxiety and Neurosis Group Trials Register (November 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 8), MEDLINE (from 1948 to August 2011), EMBASE (from 1980 to August 2011), CINAHL (from 1982 to August 2011), AMED (Allied and Complementary Medicine) (from 1985 to August 2011), PsycINFO (from 1967 to August 2011) and PsycBITE (Pyschological Database for Brain Impairment Treatment Efficacy) (March 2012). To identify further published, unpublished and ongoing trials we searched trials registers, pharmaceutical websites, reference lists, contacted experts and performed citation tracking of included studies. SELECTION CRITERIA: We included randomised controlled trials that recruited stroke survivors (ischaemic or haemorrhagic) at any time within the first year. The intervention was any SSRI, given at any dose, for any period. We excluded drugs with mixed pharmacological effects. The comparator was usual care or placebo. In order to be included, trials had to collect data on at least one of our primary (dependence and disability) or secondary (impairments, depression, anxiety, quality of life, fatigue, healthcare cost, death, adverse events and leaving the trial early) outcomes. DATA COLLECTION AND ANALYSIS: We extracted data on demographics, type of stroke, time since stroke, our primary and secondary outcomes, and sources of bias. For trials in English, two review authors independently extracted data. For Chinese papers, one review author extracted data. We used standardised mean differences (SMD) to estimate treatment effects for continuous variables, and risk ratios (RR) for dichotomous effects, with their 95% confidence intervals (CIs). MAIN RESULTS: We identified 56 completed trials of SSRI versus control, of which 52 trials (4059 participants) provided data for meta-analysis. There were statistically significant benefits of SSRI on both of the primary outcomes: RR for reducing dependency at the end of treatment was 0.81 (95% CI 0.68 to 0.97) based on one trial, and for disability score, the SMD was 0.91 (95% CI 0.60 to 1.22) (22 trials involving 1343 participants) with high heterogeneity between trials (I(2) = 87%; P < 0.0001). For neurological deficit, depression and anxiety, there were statistically significant benefits of SSRIs. For neurological deficit score, the SMD was -1.00 (95% CI -1.26 to -0.75) (29 trials involving 2011 participants) with high heterogeneity between trials (I(2) = 86%; P < 0.00001). For dichotomous depression scores, the RR was 0.43 (95% CI 0.24 to 0.77) (eight trials involving 771 participants) with high heterogeneity between trials (I(2) = 77%; P < 0.0001). For continuous depression scores, the SMD was -1.91 (95% CI -2.34 to -1.48) (39 trials involving 2728 participants) with high heterogeneity between trials (I(2) = 95%; P < 0.00001). For anxiety, the SMD was -0.77 (95% CI -1.52 to -0.02) (eight trials involving 413 participants) with high heterogeneity between trials (I(2) = 92%; P < 0.00001). There was no statistically significant benefit of SSRI on cognition, death, motor deficits and leaving the trial early. For cognition, the SMD was 0.32 (95% CI -0.23 to 0.86), (seven trials involving 425 participants) with high heterogeneity between trials (I(2) = 86%; P < 0.00001). The RR for death was 0.76 (95% CI 0.34 to 1.70) (46 trials involving 3344 participants) with no heterogeneity between trials (I(2) = 0%; P = 0.85). For motor deficits, the SMD was -0.33 (95% CI -1.22 to 0.56) (two trials involving 145 participants). The RR for leaving the trial early was 1.02 (95% CI 0.86 to 1.21) in favour of control, with no heterogeneity between trials. There was a non-significant excess of seizures (RR 2.67; 95% CI 0.61 to 11.63) (seven trials involving 444 participants), a non-significant excess of gastrointestinal side effects (RR 1.90; 95% CI 0.94 to 3.85) (14 trials involving 902 participants) and a non-significant excess of bleeding (RR 1.63; 95% CI 0.20 to 13.05) (two trials involving 249 participants) in those allocated SSRIs. Data were not available on quality of life, fatigue or healthcare costs.There was no clear evidence from subgroup analyses that one SSRI was consistently superior to another, or that time since stroke or depression at baseline had a major influence on effect sizes. Sensitivity analyses suggested that effect sizes were smaller when we excluded trials at high or unclear risk of bias.Only eight trials provided data on outcomes after treatment had been completed; the effect sizes were generally in favour of SSRIs but CIs were wide. AUTHORS' CONCLUSIONS: SSRIs appeared to improve dependence, disability, neurological impairment, anxiety and depression after stroke, but there was heterogeneity between trials and methodological limitations in a substantial proportion of the trials. Large, well-designed trials are now needed to determine whether SSRIs should be given routinely to patients with stroke

New product development and testing strategies for clothing longevity

Many garments have short life-spans, contributing to excessive carbon emissions, water consumption and waste. This paper reports on a research project which aimed to identify expectations of clothing longevity, examine the NPD process within the supply chain and identify opportunities for change, evaluate the potential for innovative technologies and improved product testing, and explore business practices aimed at more sustainable approaches to NPD. The paper provides an overview of the two-year project, presenting key findings from data collection that included interviews with 31 industry practitioners, three consumer focus groups, three industry and consumer round tables, an expert workshop, and four pilot actions undertaken with UK clothing retailers to evaluate key issues. The research identified and explored themes relating to NPD that could enable increased garment lifetimes, which were consolidated into six areas: the adoption of advanced textile processes and finishing techniques, action to overcome constraints on appropriate product testing, the potential for retailers to influence consumer behaviour, a loss of technical expertise and lack of multi-disciplinary collaboration, failure to embed good practice early in the NPD process, and evidence to encourage retailers and brands to adopt new business models. Industry and government policy recommendations were proposed to improve knowledge-sharing, strengthen the business case and influence consumer behaviour, while further research may be needed on the adoption of new garment and textile technologies, the business case and the global context of the clothing industry

Challenges for Novice School Leaders: Facing Today’s Issues in School Administration

Challenges for novice school leaders evolve as information is managed differently and as societal and regulatory expectations change. This study addresses unique challenges faced by practicing school administrators (n=159) during their first three years in a school leadership position. It focuses on their perceptions, how perceptions of present novices compare to those of experienced school leaders, and how pre-service programs can better prepare them for these challenges. Findings showed that perceptions of present novice school leaders vary somewhat from those of experienced school leaders. Two themes shared relatively the same prominence among experienced leaders as they did with novices: navigating politics and gaining a sense of credibility. Experienced leaders expounded more on specific political hurdles with school boards, other teachers, and parents, and—regarding these same populations—experienced leaders voiced that they wished they had been more successful in their earlier years in developing credibility more quickly with stakeholders. A theme not occurring at all among present novices but noted by five experienced leaders was that of adjusting to the culture of a new school as its leader. This phenomenon may be explained by the value more seasoned leaders have developed for factors inherent in a campus culture

Pilling in knitwear – a clothing longevity problem beyond design

The environmental impact of clothing could be reduced by extending garment lifetimes, and many clothing retailers are now exploring design for longevity as a sustainable approach. In order for products to meet durable design standards consistently, global supply chain processes must be managed and controlled to avoid quality problems and early product failure. This paper uses a single case study to explore the challenges of meeting specified durable product standards in production by tracing and observing the identification and resolution of a quality issue affecting the durability of luxury knitwear. The research demonstrates that new tests and processes could enable durable products to be produced more consistently, but also identifies the obstacles and limitations to implementing these enhanced procedures. The paper proposes that effective production management of durable clothing may be more difficult within global supply chains where differences in business culture, operational practice and knowledge exist between companies. Supply chain models that emphasise shared values, knowledge and information exchange, trust and collaboration are considered as the most effective in delivering sustainable products. It concludes by identifying a range of conflicting priorities between commercial and sustainable practice that must be addressed to achieve consistency in durable clothing production, and makes recommendations for industry and future research

Clothing Longevity Protocol: final

The Clothing Longevity Protocol offers guidelines for good practice in order to aid moves towards garments that will last longer and thus to help protect brand value, screen out garments which fail prematurely and reduce the environmental impact of the clothing sector

Chemical genetic identification of CDKL5 substrates reveals its role in neuronal microtubule dynamics.

Loss-of-function mutations in CDKL5 kinase cause severe neurodevelopmental delay and early-onset seizures. Identification of CDKL5 substrates is key to understanding its function. Using chemical genetics, we found that CDKL5 phosphorylates three microtubule-associated proteins: MAP1S, EB2 and ARHGEF2, and determined the phosphorylation sites. Substrate phosphorylations are greatly reduced in CDKL5 knockout mice, verifying these as physiological substrates. In CDKL5 knockout mouse neurons, dendritic microtubules have longer EB3-labelled plus-end growth duration and these altered dynamics are rescued by reduction of MAP1S levels through shRNA expression, indicating that CDKL5 regulates microtubule dynamics via phosphorylation of MAP1S. We show that phosphorylation by CDKL5 is required for MAP1S dissociation from microtubules. Additionally, anterograde cargo trafficking is compromised in CDKL5 knockout mouse dendrites. Finally, EB2 phosphorylation is reduced in patient-derived human neurons. Our results reveal a novel activity-dependent molecular pathway in dendritic microtubule regulation and suggest a pathological mechanism which may contribute to CDKL5 deficiency disorder