Systematic review of incidence studies of pneumonia in persons with spinal cord injury

Pneumonia continues to complicate the course of spinal cord injury (SCI). Currently, clinicians and policy-makers are faced with only limited numbers of pneumonia incidence in the literature. A systematic review of the literature was undertaken to provide an objective synthesis of the evidence about the incidence of pneumonia in persons with SCI. Incidence was calculated per 100 person-days, and meta-regression was used to evaluate the influence of the clinical setting, the level of injury, the use of mechanical ventilation, the presence of tracheostomy, and dysphagia. For the meta-regression we included 19 studies. The incidence ranged from 0.03 to 7.21 patients with pneumonia per 100 days. The main finding of this review is that we found large heterogeneity in the reporting of the incidence, and we therefore should be cautious with interpreting the results. In the multivariable meta-regression, the incidence rate ratios showed very wide confidence intervals, which does not allow a clear conclusion concerning the risk of pneumonia in the different stages after a SCI. Large longitudinal studies with a standardized reporting on risk factors, pneumonia, and detailed time under observation are needed. Nevertheless, this review showed that pneumonia is still a clinically relevant complication and pneumonia prevention should focus on the ICU setting and patients with complete tetraplegia

Multi vegetation model evaluation of the Green Sahara climate regime

During the Quaternary, the Sahara desert was periodically colonized by vegetation, likely because of orbitally induced rainfall increases. However, the estimated hydrological change is not reproduced in climate model simulations, undermining confidence in projections of future rainfall. We evaluated the relationship between the qualitative information on past vegetation coverage and climate for the mid-Holocene using three different dynamic vegetation models. Compared with two available vegetation reconstructions, the models require 500–800 mm of rainfall over 20°–25°N, which is significantly larger than inferred from pollen but largely in agreement with more recent leaf wax biomarker reconstructions. The magnitude of the response also suggests that required rainfall regime of the early to middle Holocene is far from being correctly represented in general circulation models. However, intermodel differences related to moisture stress parameterizations, biases in simulated present-day vegetation, and uncertainties about paleosoil distributions introduce uncertainties, and these are also relevant to Earth system model simulations of African humid periods

A systematic review and meta-analysis of selected motor learning principles in physiotherapy and medical education

Background Learning of procedural skills is an essential component in the education of future health professionals. There is little evidence on how procedural skills are best learnt and practiced in education. There is a need for educators to know what specific interventions could be used to increase learning of these skills. However, there is growing evidence from rehabilitation science, sport science and psychology that learning can be promoted with the application of motor learning principles. The aim of this review was to systematically evaluate the evidence for selected motor learning principles in physiotherapy and medical education. The selected principles were: whole or part practice, random or blocked practice, mental or no additional mental practice and terminal or concurrent feedback. Methods CINAHL, Cochrane Central, Embase, Eric and Medline were systematically searched for eligible studies using pre-defined keywords. Included studies were evaluated on their risk of bias with the Cochrane Collaboration's risk of bias tool. Results The search resulted in 740 records, following screening for relevance 15 randomised controlled trials including 695 participants were included in this systematic review. Most procedural skills in this review related to surgical procedures. Mental practice significantly improved performance on a post-acquisition test (SMD: 0.43, 95 % CI 0.01 to 0.85). Terminal feedback significantly improved learning on a transfer test (SMD: 0.94, 95 % CI 0.18 to 1.70). There were indications that whole practice had some advantages over part practice and random practice was superior to blocked practice on post-acquisition tests. All studies were evaluated as having a high risk of bias. Next to a possible performance bias in all included studies the method of sequence generation was often poorly reported. Conclusions There is some evidence to recommend the use of mental practice for procedural learning in medical education. There is limited evidence to conclude that terminal feedback is more effective than concurrent feedback on a transfer test. For the remaining parameters that were reviewed there was insufficient evidence to make definitive recommendations.Britain has a serious shortage of nurses, as well as problems in recruiting and retaining them It is not simply that there are too few nurses; some key skills shortages also exist, with increasing demand for more qualified staff in some areas Much better planning of the workforce is required, and this needs to be more integrated with the planning for other groups in healthcare A change in the pay system may help, but the creation of better work environments may be part of the solution The rapid pace of change in the nursing profession has produced a challenge that the NHS needs to addresssch_phy16pub4254pub1

Late Holocene climate: Natural or anthropogenic?

For more than a decade, scientists have argued about the warmth of the current interglaciation. Was the warmth of the preindustrial late Holocene natural in origin, the result of orbital changes that had not yet driven the system into a new glacial state? Or was it in considerable degree the result of humans intervening in the climate system through greenhouse gas emissions from early agriculture? Here we summarize new evidence that moves this debate forward by testing both hypotheses. By comparing late Holocene responses to those that occurred during previous interglaciations (in section 2), we assess whether the late Holocene responses look different (and thus anthropogenic) or similar (and thus natural). This comparison reveals anomalous (anthropogenic) signals. In section 3, we review paleoecological and archaeological syntheses that provide ground truth evidence on early anthropogenic releases of greenhouse gases. The available data document large early anthropogenic emissions consistent with the anthropogenic ice core anomalies, but more information is needed to constrain their size. A final section compares natural and anthropogenic interpretations of the δ13C trend in ice core CO2

Process-Tracing as a Tool to Analyse Discretion

status: publishe

Political & Quasi-Adjudicative Dispute Settlement Models in European Union Free Trade Agreements - Is the Quasi-Adjudicative Model a Trend or is it Just Another Model?

In this paper, interpretation and application dispute settlement provisions of European Union (EU) Free Trade Agreements (FTAs) signed between 1963 and 2006 are analysed. This will be through the two models of Dispute Settlement in International Law: the political and adjudicative. Political elements of dispute settlement mechanisms in Public International Law and General Agreement of Tariffs and Trade (GATT) served to establish those of the EU FTAs. Adjudicative and quasi-adjudicative elements of dispute settlement mechanisms of Public International Law and World Trade Organization (WTO) Law were used as parameters to set up those of the EU FTAs. These parameters also helped to define a new and unique hybrid model. The features of this model were found in Agreements with trade issues other than FTAs. It is possible, however, for future FTAs to incorporate them. The hybrid model is based on an adjudicative framework and includes both political and adjudicative elements. In conclusion, it was found that even though WTO Members incorporated adjudicative elements in the Dispute Settlement Understanding (DSU), the EU did not incorporate them bilaterally for a further five years. Furthermore, since the creation of the DSU in 1995, the EU has established more FTAs based on a political model than on a quasi-adjudicative. Consequently, the quasi-adjudicative dispute settlement model has not represented a clear trend in EU FTAs