Delimiting industrial specialization regions in Georgia
In: University of Georgia. Institute of Community and Area Development. Publication, no. 19
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In: University of Georgia. Institute of Community and Area Development. Publication, no. 19
In: The political quarterly, Band 31, Heft 2, S. 132-141
ISSN: 1467-923X
In: The political quarterly: PQ, Band 31, S. 132-141
ISSN: 0032-3179
In: The political quarterly: PQ, Band 31, Heft 2, S. 132-141
ISSN: 0032-3179
Undue concentration on the misleading figures of divorce petitions has led to exaggeration of their signif. There is no evidence in the British statistics of a flight from stability in marriage, & the contrast between the remarkably stable institution of marriage & the sickness perceived by moralists must be ascribed to the fact that theological expectations require disintegrating homes, & to the influence which the past excessive but necessary preoccupation of the soc sci's with deviant behavior now exercises on churchmen, moralists & policy makers. Att's which regard citizens as potential moral delinquents are contemptuous & pol'ly dangerous, & serve as an obstacle to much-needed reforms, such as enabling courts to look at the soc facts of broken marriage, instead of merely taking into account the commission of a matrimonial offense, as well as rhanves in the system of maintenance. IPSA.
In: The political quarterly, Band 22, Heft 2, S. 154-163
ISSN: 1467-923X
In: Policy studies journal: an international journal of public policy, Band 14, Heft 2, S. 233, 244
ISSN: 0190-292X
In: Biometeorology 1
Biometeorology has long been concerned with describing and understanding the impacts of weather and climate on humans and their activities and the natural (biosphere) system. Applied biometeorologists have focused on how best to prepare for and cope with weather and climate abnormalities. However, they have tended to pursue their research in relative isolation from each other. There is now a need to better understand the commonalities as well as the differences within the broad field of applied biometeorology. The driving force is that biometeorologists are faced with a common problem how best to provide advice on how to adapt to or cope with climate change. Adaptation is a cross cutting theme. It is an issue which biometeorologists are increasingly engaging with and learning about from each other. Biometeorology, because of its focus on the sensitivity of human and biophysical systems to atmospheric variations and change clearly has something to contribute to the wider agenda of managing the impacts of climate change. The purpose of this collection of papers on biometeorology and adaptation is therefore to: (1) Communicate some of the basic ideas and concepts of the sub-fields of biometeorology as they relate to climate change. (2) Explore ideas, concepts, and practice within the field of biometeorology that may be developed in common. (3) Provide a basis for a new vision for biometeorology that will help to communicate its understanding and expertise, as well as enhance its utility.
In: European policy analysis: EPA, Band 8, Heft 4, S. 370-393
ISSN: 2380-6567
AbstractThe relationships of influence and activity between academics and other actors (public, private, and non‐governmental) in the policy process are complex. Although older work often argued academic research at best had an indirect "environmental" or "enlightenment" effect on policy‐makers, (May et al. (2016). Journal of Public Policy, 36, 195) recently argued that in the US case previous studies misconstrued the role of academic policy advice because they surveyed "average" academics and in so doing missed the significant impact of a small elite group of "hyper‐experts" within an already small group of "super‐users" interacting on a constant basis with government policy‐makers. This article draws upon data from a survey of academics in four fields (Business, Engineering, Health and Politics) in six major Canadian Universities to map out the relationships existing between academics and other actors in the public, private, and non‐governmental sectors and test for the existence of this elite pattern of interaction in a second country.
In: Natural hazards and earth system sciences: NHESS, Band 13, Heft 12, S. 3271-3279
ISSN: 1684-9981
Abstract. The climate characteristics of summer human thermal discomfort in Athens and its connection to atmospheric circulation are studied for the period 1954–2012. The human thermal discomfort is examined in terms of the Predicted Mean Vote (PMV) discomfort index for calm and light wind (3 ms-1) conditions. Its inter-annual variability is characterised by a significant increase from the middle 1980s to the end of the study period. The onset and the cessation of the discomfort period are found to take place around the beginning of July and the end of August respectively, but from middle 1980s the dates of onset and cessation have slightly moved earlier and later, respectively, leading to a longer summer discomfort period. The connection between human thermal discomfort and atmospheric circulation is studied by examining the distribution of discomfort cases across six objectively defined circulation types over Europe, based on Athens weather characteristics. High values of the PMV discomfort index are mainly associated with two typical high-summer pressure patterns with the intensity of discomfort depending on the pressure gradient over the Aegean Sea. On the contrary, low PMV discomfort index values prevail mainly on days typified by the other four circulation types, which are more frequent during May, June, and September.
In: BMJ OPEN
Objectives The British Government is acting on recommendations to overhaul postgraduate training to meet the needs of the changing population, to produce generalist doctors undergoing shorter broad-based training (Greenaway Review). Only 45 doctors in training were involved in the consultation process. This study aims to obtain a focused perspective on the proposed reforms by doctors in training from across specialities. Design Prospective, questionnaire-based cross-sectional study. Setting/participants Following validation, a 31-item electronic questionnaire was distributed via trainee organisations and Postgraduate Local Education and Training Board (LETB) mailing lists. Throughout the 10-week study period, the survey was publicised on several social media platforms. Results Of the 3603 demographically representative respondents, 69% knew about proposed changes. Of the respondents, 73% expressed a desire to specialise, with 54% keen to provide general emergency cover. A small proportion (12%) stated that current training pathway length is too long, although 86% felt that it is impossible to achieve independent practitioner-level proficiency in a shorter period of time than is currently required. Opinions regarding credentialing were mixed, but tended towards disagreement. The vast majority (97%) felt credentialing should not be funded by doctors in training. Respondents preferred longer placement lengths with increasing career progression. Doctors in training value early generalised training (65%), with suggestions for further improvement. Conclusions This is the first large-scale cross-specialty study regarding the Shape of Training Review. Although there are recommendations which trainees support, it is clear that one size does not fit all. Most trainees are keen to provide a specialist service on an emergency generalist background. Credentialing is a contentious issue; however, we believe removing aspects from curricula into post-Certificate of Completion of Training (CCT) credentialing programmes with shortened specialty training routes only degrades the current consultant expertise, and does not serve the population. Educational needs, not political winds, should drive changes in postgraduate medical education and all stakeholders should be involved.
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This work was supported by the Department of Health via the National Institute for Health Research Comprehensive Biomedical Research Centre award to Guy's and St Thomas' NHS Foundation Trust in partnership with King's College London and King's College Hospital NHS Foundation Trust. This work was also supported by the British Heart Foundation (BHF; grant RG/13/12/30395 ), the European Union 7th Framework Programme ( EU FP7 ), Cancer Research UK/NIHR in England and DoH in Scotland, the Wales and Northern Ireland Experimental Cancer Medicine Centre ( C10355/A15587 ), and the Medical Research Council ( MR/L023091/1 ). Accession Numbers
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In: Cerebral Cortex Communications, Band 1, Heft 1
ISSN: 2632-7376
Abstract
As plans develop for Mars missions, it is important to understand how long-duration spaceflight impacts brain health. Here we report how 12-month (n = 2 astronauts) versus 6-month (n = 10 astronauts) missions impact brain structure and fluid shifts. We collected MRI scans once before flight and four times after flight. Astronauts served as their own controls; we evaluated pre- to postflight changes and return toward preflight levels across the 4 postflight points. We also provide data to illustrate typical brain changes over 7 years in a reference dataset. Twelve months in space generally resulted in larger changes across multiple brain areas compared with 6-month missions and aging, particularly for fluid shifts. The majority of changes returned to preflight levels by 6 months after flight. Ventricular volume substantially increased for 1 of the 12-month astronauts (left: +25%, right: +23%) and the 6-month astronauts (left: 17 ± 12%, right: 24 ± 6%) and exhibited little recovery at 6 months. Several changes correlated with past flight experience; those with less time between subsequent missions had larger preflight ventricles and smaller ventricular volume increases with flight. This suggests that spaceflight-induced ventricular changes may endure for long periods after flight. These results provide insight into brain changes that occur with long-duration spaceflight and demonstrate the need for closer study of fluid shifts.
Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
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Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
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