An official American thoracic society research statement: Comparative effectiveness research in pulmonary, critical care, and sleep medicine

Background: Comparative effectiveness research (CER) is intended to inform decision making in clinical practice, and is central to patientcentered outcomes research (PCOR). Purpose: To summarize key aspects of CER definitions and provide examples highlighting the complementary nature of efficacy and CER studies in pulmonary, critical care, and sleep medicine. Methods: An ad hoc working group of the American Thoracic Society with experience in clinical trials, health services research, quality improvement, and behavioral sciences in pulmonary, critical care, and sleepmedicinewas convened. The group used an iterative consensus process, including a reviewbyAmerican Thoracic Society committees and assemblies. Results: The traditional efficacy paradigm relies on clinical trials with high internal validity to evaluate interventions in narrowly defined populations and in research settings. Efficacy studies address the question, "Can it work in optimal conditions?" The CER paradigm employs a wide range of study designs to understand the effects of interventions in clinical settings. CER studies address the question, "Does it work in practice?" The results of efficacy and CER studies may or may not agree. CER incorporates many attributes of outcomes research and health services research, while placing greater emphasis on meeting the expressed needs of nonresearcher stakeholders (e.g., patients, clinicians, and others). Conclusions: CER complements traditional efficacy research by placing greater emphasis on the effects of interventions in practice, and developing evidence to address the needs of the many stakeholders involved in health care decisions. Stakeholder engagement is an important component of CER. Copyright © 2013 by the American Thoracic Society.

Studying Gender in Conference Talks -- data from the 223rd meeting of the American Astronomical Society

We present a study on the gender balance, in speakers and attendees, at the recent major astronomical conference, the American Astronomical Society meeting 223, in Washington, DC. We conducted an informal survey, yielding over 300 responses by volunteers at the meeting. Each response included gender data about a single talk given at the meeting, recording the gender of the speaker and all question-askers. In total, 225 individual AAS talks were sampled. We analyze basic statistical properties of this sample. We find that the gender ratio of the speakers closely matched the gender ratio of the conference attendees. The audience asked an average of 2.8 questions per talk. Talks given by women had a slightly higher number of questions asked (3.2$\pm$0.2) than talks given by men (2.6$\pm$0.1). The most significant result from this study is that while the gender ratio of speakers very closely mirrors that of conference attendees, women are under-represented in the question-asker category. We interpret this to be an age-effect, as senior scientists may be more likely to ask questions, and are more commonly men. A strong dependence on the gender of session chairs is found, whereby women ask disproportionately fewer questions in sessions chaired by men. While our results point to laudable progress in gender-balanced speaker selection, we believe future surveys of this kind would help ensure that collaboration at such meetings is as inclusive as possible.

American Society of Anesthesiologists Score: Still Useful After 60 Years? Results of the EuSOS Study

OBJECTIVE: The European Surgical Outcomes Study described mortality following in-patient surgery. Several factors were identified that were able to predict poor outcomes in a multivariate analysis. These included age, procedure urgency, severity and type and the American Association of Anaesthesia score. This study describes in greater detail the relationship between the American Association of Anaesthesia score and postoperative mortality. METHODS: Patients in this 7-day cohort study were enrolled in April 2011. Consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery with a recorded American Association of Anaesthesia score in 498 hospitals across 28 European nations were included and followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Decision tree analysis with the CHAID (SPSS) system was used to delineate nodes associated with mortality. RESULTS: The study enrolled 46,539 patients. Due to missing values, 873 patients were excluded, resulting in the analysis of 45,666 patients. Increasing American Association of Anaesthesia scores were associated with increased admission rates to intensive care and higher mortality rates. Despite a progressive relationship with mortality, discrimination was poor, with an area under the ROC curve of 0.658 (95% CI 0.642 - 0.6775). Using regression trees (CHAID), we identified four discrete American Association of Anaesthesia nodes associated with mortality, with American Association of Anaesthesia 1 and American Association of Anaesthesia 2 compressed into the same node. CONCLUSION: The American Association of Anaesthesia score can be used to determine higher risk groups of surgical patients, but clinicians cannot use the score to discriminate between grades 1 and 2. Overall, the discriminatory power of the model was less than acceptable for widespread use.

Race and american society, 1865-1970s.

Cumple con los requisitos para la especificación OCR AS de Historia, unidad F983, opción B. Las distintas partes del recurso estudian: la raza y la sociedad americana: cambio y continuidad; la raza y la sociedad americana: examen de las pruebas; cambio desde arriba: evidencia sobre el papel de las autoridades estatales y federales; resistencia desde arriba: evidencia sobre el papel de los grupos y las organizaciones; ideas y acciones: evidencia sobre el papel de los individuos; el movimiento de derechos civiles: protesta integracionista y no violenta; y la lucha por los derechos civiles: separatistas, supremacistas y terroristas. Incluye actividades que ayudan a la comprensión del contenido y a desarrollar en los estudiantes habilidades con la historia, análisis de situaciones y acontecimientos, breves biografías de personajes clave de la época, definiciones de palabras nuevas y consejos prácticos para los exámenes.

Primary immunodeficiency diseases in Latin America: Proceedings of the Second Latin American Society for Immunodeficiencies (LASID) Advisory Board

Early diagnosis and appropriate therapy are essential for the best prognosis and quality of life in patients with primary immunodeficiency diseases (PIDDs). Experts from several Latin American countries have been meeting on a regular basis as part of an ongoing effort to improve the diagnosis and treatment of PIDD in this region. Three programmes are in development that will expand education and training and improve access to testing facilities throughout Latin America. These programmes are: an educational outreach programme (The L-Project); an immunology fellowship programme; and the establishment of a laboratory network to expand access to testing facilities. This report provides the status of these programmes based on the most recent discussions and describes the next steps toward full implementation of these programmes. (C) 2010 SEICAP. Published by Elsevier Espana, S.L. All rights reserved.

Where did all these books come from? The Publishing Industry and American Intellectual Life

The American book publishing industry shapes the character of American intellectual life. While the newspaper and television industries have been accused of and investigated for bias and lowering America’s intellectual standards, book publishing has gone largely unexamined by scholars. The existing studies of the publishing industry have focused on finance, procedure and history. “There are few ‘theories’ of publishing – efforts to understand the ‘whys’ as well as the ‘hows.’ Few scholarly scientists have devoted significant scholarly attention to publishing” (Altbach and Hoshino, xiii). There are many possible reasons for this lacuna. First, there is a perception that books have always been around, that they are an “old” technology and therefore they don’t appear to have had as much of an impact on our society as television and other media (which were developed quickly and suddenly) seem to have had (Altbach and Hoshino, xiv). Also, despite books’ present and past popularity, television, radio, and now the internet reach more people more easily, and are therefore more topical points of study and observation. In studying the effects of mass media on everyday American life, television and the internet may be the most logical points of study. Regarding public intellectual life however, books play a much more important role. Public intellectual life has always been associated with independent thinkers publishing their work for the masses. For this reason, this I focus on trade publishing. Trade publishing produces fiction and non-fiction works for the general reading public, as opposed to technical manuals, textbooks, and other fiction and nonfiction books targeted to small and specific audiences. Although, quantitatively speaking, “the largest part of book publishing business is embodied in that great complex of companies and activities producing educational, business, scientific, technical, and reference books and materials,” (Tebbel 1987, 439) the trade industry publishes most of the books that most people read. It is the most public segment of the industry, and the most likely place to find public intellectualism. Trade publishing is not only the most public segment of the industry, but it is also the most susceptible to corruption and lowered intellectual standards. Unlike specialty publishing, which caters to a specific, known segment of society, trade publishers must compete with countless other publications, as well as with other forms of media, for the patronage of the general public. As John Tebbel (author of a widely referenced history of the publishing industry) puts it, “The textbook, scientific, or technical book is subjected to much more rigorous scrutiny by buyers and users, and in an intensively competitive market inferior products are quickly lost" (Tebbel 1987, xiv). Since the standards for trade publishing are not nearly as specific – trade books simply need to catch the attention of a significant number of readers, they don’t have to measure up to a given level of quality – the quality of trade books is much more variable. And yet, a successful trade publication can have a much greater impact on society than the most rigorously researched and edited textbook or scholarly study.