Catalogue Search | MBRL
Are you sure you want to remove the book from the shelf?
{{itemTitle}}
235
result(s) for
"Pennington, Mark"
Sort by:
Wolverine
\"Marvel's favorite mutant, by one of his most explosive creators! Dark corners, dead bodies, and drug dealers--that's a typical day for Logan when he isn't hanging with the X-Men. But when reality is rewritten by the events of House of M, it proves a revelatory experience--and sets Wolverine on a path to uncover his origins! But who has been hiding in the shadows, pulling Logan's strings for decades? Armed with the one weapon that can kill him, Logan embarks on the first leg of a long and bloody quest for vengeance!\"--Page [4] of cover, volume 1.
Book
Foucault and Hayek on public health and the road to serfdom
This paper draws on the work of Michel Foucault and Friedrich Hayek to understand threats to personal and enterprise freedom, arising from public health governance. Whereas public choice theory examines the incentives these institutions provide to agents, the analysis here understands those incentives as framed by discursive social constructions that affect the identity, power, and positionality of different actors. It shows how overlapping discourses of scientific rationalism may generate a ‘road to serfdom’ narrowing freedom of action and expression across an expanding terrain. As such, the paper contributes to the growing literature emphasising the importance of narratives, stories and metaphors as shaping political economic action in ways feeding through to outcomes and institutions.
Journal Article
Avengers arena : the complete collection
\"Trapped on an isolated island, sixteen superhuman teens -- including members of the Runaways and Avengers Academy -- are given a chilling ultimatum by their demented captor. And only one of them will make it out alive! Thus begins a primal battle that tests each combatant's skills, stamina, and morals. Welcome to Arcade's Murderworld -- where secrets are plenty, alliances are fleeting, and the key to victory might be rewriting the rules of the game\"--Page [4] of cover.
Book
Associations between neighbourhood social cohesion and subjective well-being in two different informal settlement types in Delhi, India: a quantitative cross-sectional study
ObjectivesTo evaluate the relationships between neighbourhood cohesion and subjective well-being (SWB) in two different informal settlement types.DesignCross-sectional analysis of a community-based survey.SettingCommunities in two districts, Sanjay Colony, Okhla Phase II and Bhalswa in Delhi, India.Participants328 residents in Bhalswa and 311 from Sanjay Colony.MeasurementsNeighbourhood social cohesion scale measured on an 18-point scale and the SWB scale made up of four subjective measures—hedonic, eudaemonic, evaluative and freedom of choice. Sociodemographic characteristics and trust were used as covariates.ResultsIn both neighbourhood types there was a statistically significant positive bivariate correlation between neighbourhood cohesion and SWB (Sanjay: r=0.145, p<0.05; Bhalswa: r=0.264, p<0.01). Trust and neighbourhood cohesion were strongly correlated (Sanjay: r=0.618, p<0.01; Bhalswa: r=0.533, p<0.01) and the longer the resident had lived in the community the greater the feeling of neighbourhood cohesion (Sanjay: r=0.157, p<0.01; Bhalswa: r=0.171, p<0.05). Only in the resettlement colony (Bhalswa) was SWB negatively correlated with length of residency (r=−0.117, p<0.05). Residents who chose their settlement type (Sanjay residents) were 22.5 percentage points (pp) more likely to have a feeling of belonging to their neighbourhood than residents that had been resettled (Bhalswa) (Cohen’s d effect size 0.45). Sanjay residents had a greater likelihood to feel more satisfied with life (4.8 pp, p<0.01) and having greater perceived freedom of choice (4.8 pp, p<0.01).ConclusionsOur findings contribute to the general knowledge about neighbourhood cohesion and SWB within different informal settlement types in a mega-city such as New Delhi, India. Interventions that promote sense of belonging, satisfaction with life and freedom of choice have the potential to significantly improve people’s well-being.
Journal Article
Clinical services for adults with an intellectual disability and epilepsy: A comparison of management alternatives
Intellectual disability (ID) is relatively common in people with epilepsy, with prevalence estimated to be around 25%. Surprisingly, given this relatively high frequency, along with higher rates of refractory epilepsy than in those without ID, little is known about outcomes of different management approaches/clinical services treating epilepsy in adults with ID-we investigate this area.
We undertook a naturalistic observational cohort study measuring outcomes in n = 91 adults with ID over a 7-month period (recruited within the period March 2008 to April 2010). Participants were receiving treatment for refractory epilepsy (primarily) in one of two clinical service settings: community ID teams (CIDTs) or hospital Neurology services.
The pattern of comorbidities appeared important in predicting clinical service, with Neurologists managing the epilepsy of relatively more of those with neurological comorbidities whilst CIDTs managed the epilepsy of relatively more of those with psychiatric comorbidities. Epilepsy-related outcomes, as measured by the Glasgow Epilepsy Outcome Scale 35 (GEOS-35) and the Epilepsy and Learning Disabilities Quality of Life Scale (ELDQoL) did not differ significantly between Neurology services and CIDTs.
In the context of this study, the absence of evidence for differences in epilepsy-related outcomes amongst adults with ID and refractory epilepsy between mainstream neurology and specialist ID clinical services is considered. Determining the selection of the service managing the epilepsy of adults with an ID on the basis of the skill sets also required to treat associated comorbidities may hence be a reasonable heuristic.
Journal Article
Pharmacokinetics and pharmacodynamics of intranasal and intramuscular administration of naloxone in working dogs administered fentanyl
Abstract
Background
Working dogs exposed to narcotics might require reversal in the field.
Objective
To explore the pharmacokinetic and pharmacodynamic effects of naloxone administered intramuscularly (IM) or intranasally (IN) to reverse fentanyl sedation in working dogs.
Animals
Ten healthy, working dogs aged 1.7 ± 1 year and weighing 26 ± 3 kg.
Methods
In this randomized, controlled cross-over study dogs received either 4 mg of naloxone IN or IM 10 minutes after fentanyl (0.3 mg IV) administration. Sedation was assessed at baseline and 5 minutes after fentanyl administration, then at 5, 10, 15, 20, 25, 30, 60 and 120 minutes after reversal with naloxone. Blood samples for naloxone detection were obtained at 0, 5, 10, 30, 60 and 120 minutes. Pharmacokinetic parameters and sedation scores were compared between IM and IN naloxone groups.
Results
There was a significant increase in sedation score from baseline (0.25 [−4 to 1] IM; 0 [−2 to 1] IN) after fentanyl administration (11 [5-12] IM; 9.25 [4-11] IN), followed by a significant reduction at 5 (0.5 [−0.5 to 1.5] IM; 1.25 [−1.5 to 4.5] IN) through 120 minutes (−0.5 [−2 to 1] IM; 0 [−4.5 to 1] IN) after reversal with naloxone. Route of administration had no significant effect on sedation score. Maximum plasma concentration was significantly lower after IN administration (11.7 [2.8-18.8] ng/mL IN, 36.7 [22.1-56.4] ng/mL IM, P < .001) but time to reach maximum plasma concentration was not significantly different from IM administration.
Conclusion and Clinical Importance
Although IM administration resulted in higher naloxone plasma concentrations compared to IN, reversal of sedation was achieved via both routes after administration of therapeutic doses of fentanyl.
Journal Article
Hayek on complexity, uncertainty and pandemic response
This paper draws on Hayek’s distinction between simple and complex phenomena to understand the nature of the challenge facing policymakers in responding to the new coronavirus pandemic. It shows that while government action is justifiable there may be few systemic mechanisms that enable policymakers to distinguish better from worse policy responses, or to make such distinctions in sufficient time. It then argues that this may be a more general characteristic of large-scale public policy making procedures and illustrates the importance of returning to a market-based political economy at the earliest convenience.
Journal Article
Cost-effectiveness of alternative minimum recall intervals between whole blood donations
The INTERVAL trial showed shorter inter-donation intervals could safely increase the frequency of whole-blood donation. We extended the INTERVAL trial to consider the relative cost-effectiveness of reduced inter-donation intervals.
Our within-trial cost-effectiveness analysis (CEA) used data from 44,863 whole-blood donors randomly assigned to 12, 10 or 8 week (males), and 16, 14 or 12 week inter-donation intervals (females). The CEA analysed the number of whole-blood donations, deferrals including low- haemoglobin deferrals, and donors' health-related quality of life (QoL) to report costs and cost-effectiveness over two years.
The mean number of blood donation visits over two years was higher for the reduced interval strategies, for males (7.76, 6.60 and 5.68 average donations in the 8-, 10- and 12- week arms) and for females (5.10, 4.60 and 4.01 donations in the 12-, 14- and 16- week arms). For males, the average rate of deferral for low haemoglobin per session attended, was 5.71% (8- week arm), 3.73% (10- week), and 2.55% (12- week), and for females the rates were: 7.92% (12-week), 6.63% (14- week), and 5.05% (16- week). Donors' QoL was similar across strategies, although self-reported symptoms were increased with shorter donation intervals. The shorter interval strategies increased average cost, with incremental cost-effectiveness ratios of £9.51 (95% CI 9.33 to 9.69) per additional whole-blood donation for the 8- versus 12- week interval for males, and £10.17 (95% CI 9.80 to 10.54) for the 12- versus 16- week interval arm for females.
Over two years, reducing the minimum donation interval could provide additional units of whole-blood at a small additional cost, including for those donor subgroups whose blood type is in relatively high demand. However, the significance of self-reported symptoms needs to be investigated further before these policies are expanded.
Journal Article
Cost-effectiveness of early intervention in psychosis in Latin America: economic evaluation of Chilean services
International evidence suggests that Early Intervention for Psychosis (EIP) services are both effective and cost-effective. Such evidence, however, comes almost exclusively from high-income countries.
Our aim was to estimate the cost-effectiveness of EIP services in a Latin American setting.
We compared EIP services against community mental health teams (CMHT) from the Chilean health system perspective. We developed a six-state Markov model to estimate the costs, benefits (measured as quality-adjusted life-years (QALYs)) and incremental cost-effectiveness ratio (ICER) for a 10-year time horizon. The model was populated with data from a Chilean EIP cohort, published literature and expert opinion. We characterised uncertainty through probabilistic sensitivity analysis and calculated the value of information to reduce such uncertainty.
In the base case analysis, EIP was cost-effective compared with CMHT, with an ICER of 5 550 044 Chilean pesos per QALY (USD 13 742 adjusted for purchasing power parity). Uncertainty analysis revealed an 80% probability of EIP services being the most cost-effective option at a willingness-to-pay threshold of one gross domestic product per capita (USD 15 923). Sensitivity analysis showed that the results were sensitive to parameters such as intervention effectiveness and cost, suggesting that a new trial might be worthwhile to reduce uncertainty.
This model suggests that implementing EIP services in Chile may cost more, but it is likely to be cost-effective. Nonetheless, more evidence about affordability, equity and broader perspectives is needed to improve the economic case of implementing EIP services in less-resourced settings, such as in Latin America.
Journal Article
Cost-Effectiveness of Five Commonly Used Prosthesis Brands for Total Knee Replacement in the UK: A Study Using the NJR Dataset
There is a lack of evidence on the effectiveness or cost-effectiveness of alternative brands of prosthesis for total knee replacement (TKR). We compared patient-reported outcomes, revision rates, and costs, and estimated the relative cost-effectiveness of five frequently used cemented brands of unconstrained prostheses with fixed bearings (PFC Sigma, AGC Biomet, Nexgen, Genesis 2, and Triathlon).
We used data from three national databases for patients who had a TKR between 2003 and 2012, to estimate the effect of prosthesis brand on post-operative quality of life (QOL) (EQ-5D-3L) in 53 126 patients at six months. We compared TKR revision rates by brand over 10 years for 239 945 patients. We used a fully probabilistic Markov model to estimate lifetime costs and quality-adjusted life years (QALYs), incremental cost effectiveness ratios (ICERs), and the probability that each prosthesis brand is the most cost effective at alternative thresholds of willingness-to-pay for a QALY gain.
Revision rates were lowest with the Nexgen and PFC Sigma (2.5% after 10 years in 70-year-old women). Average lifetime costs were lowest with the AGC Biomet (£9 538); mean post-operative QOL was highest with the Nexgen, which was the most cost-effective brand across all patient subgroups. For example, for 70-year-old men and women, the ICERs for the Nexgen compared to the AGC Biomet were £2 300 per QALY. At realistic cost per QALY thresholds (£10 000 to £30 000), the probabilities that the Nexgen is the most cost-effective brand are about 98%. These results were robust to alternative modelling assumptions.
AGC Biomet prostheses are the least costly cemented unconstrained fixed brand for TKR but Nexgen prostheses lead to improved patient outcomes, at low additional cost. These results suggest that Nexgen should be considered as a first choice prosthesis for patients with osteoarthritis who require a TKR.
Journal Article