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Background: Mild frailty or pre-frailty is common and yet is potentially reversible. Preventing progression to worsening frailty may benefit individuals and lower health/social care costs. However, we know little about effective approaches to preventing frailty progression. Objectives: (1) To develop an evidence- and theory-based home-based health promotion intervention for older people with mild frailty. (2) To assess feasibility, costs and acceptability of (i) the intervention and (ii) a full-scale clinical effectiveness and cost-effectiveness randomised controlled trial (RCT). Design: Evidence reviews, qualitative studies, intervention development and a feasibility RCT with process evaluation. Intervention development: Two systematic reviews (including systematic searches of 14 databases and registries, 1990–2016 and 1980–2014), a state-of-the-art review (from inception to 2015) and policy review identified effective components for our intervention. We collected data on health priorities and potential intervention components from semistructured interviews and focus groups with older people (aged 65–94 years) (n = 44), carers (n = 12) and health/social care professionals (n = 27). These data, and our evidence reviews, fed into development of the ‘HomeHealth’ intervention in collaboration with older people and multidisciplinary stakeholders. ‘HomeHealth’ comprised 3–6 sessions with a support worker trained in behaviour change techniques, communication skills, exercise, nutrition and mood. Participants addressed self-directed independence and well-being goals, supported through education, skills training, enabling individuals to overcome barriers, providing feedback, maximising motivation and promoting habit formation. Feasibility RCT: Single-blind RCT, individually randomised to ‘HomeHealth’ or treatment as usual (TAU). Setting: Community settings in London and Hertfordshire, UK. Participants: A total of 51 community-dwelling adults aged ≥ 65 years with mild frailty. Main outcome measures: Feasibility – recruitment, retention, acceptability and intervention costs. Clinical and health economic outcome data at 6 months included functioning, frailty status, well-being, psychological distress, quality of life, capability and NHS and societal service utilisation/costs. Results: We successfully recruited to target, with good 6-month retention (94%). Trial procedures were acceptable with minimal missing data. Individual randomisation was feasible. The intervention was acceptable, with good fidelity and modest delivery costs (£307 per patient). A total of 96% of participants identified at least one goal, which were mostly exercise related (73%). We found significantly better functioning (Barthel Index +1.68; p = 0.004), better grip strength (+6.48 kg; p = 0.02), reduced psychological distress (12-item General Health Questionnaire –3.92; p = 0.01) and increased capability-adjusted life-years [+0.017; 95% confidence interval (CI) 0.001 to 0.031] at 6 months in the intervention arm than the TAU arm, with no differences in other outcomes. NHS and carer support costs were variable but, overall, were lower in the intervention arm than the TAU arm. The main limitation was difficulty maintaining outcome assessor blinding. Conclusions: Evidence is lacking to inform frailty prevention service design, with no large-scale trials of multidomain interventions. From stakeholder/public perspectives, new frailty prevention services should be personalised and encompass multiple domains, particularly socialising and mobility, and can be delivered by trained non-specialists. Our multicomponent health promotion intervention was acceptable and delivered at modest cost. Our small study shows promise for improving clinical outcomes, including functioning and independence. A full-scale individually RCT is feasible. Future work: A large, definitive RCT of the HomeHealth service is warranted. Study registration: This study is registered as PROSPERO CRD42014010370 and Current Controlled Trials ISRCTN11986672. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 73. See the NIHR Journals Library website for further project information. more...

Legislatures have banned CRT across many states in America, altering the country's campus climate. This case study surveys more than 200 students, faculty, and staff on campus to understand their points of view on CRT. The authors find a "pernicious polarization" dividing the university and suggest that university faculty consider a "Critical Patriotic Civic History" to provide a multi-perspectival pedagogy to prepare our multicultural student body to become our country's next generation of citizens. more...

Epistemology and informal logic have overlapping and broadly similar subject matters. A principle of methodological symmetry is: philosophical theories of sufficiently similar subject matters should engage similar methods. Suppose the best way to do epistemology is in highly formalized ways, with a large role for mathematical methods. The symmetry principle suggests this is also the best way to do the logic of the reasoning and argument, the subject matter of informal logic. A capitulation to mathematics is inimical to informal logicians, yet formal methods and mathematical models are an emerging force in epistemology. What is to be done? What’s sauce for the goose of epistemology is sauce for the gander of informal logic. more...

The use of nicotinic acid to treat dyslipidemia is limited by induction of a “flushing” response, mediated in part by the interaction of prostaglandin D2 (PGD2) with its G-protein coupled receptor, DP1 (Ptgdr). The impact of DP1 blockade (genetic or pharmacologic) was assessed in experimental murine models of atherosclerosis. In Ptgdr−/−ApoE−/− mice versus ApoE−/− mice, both fed a high-fat diet, aortic cholesterol content was modestly higher (1.3- to 1.5-fold, P < 0.05) in Ptgdr−/−ApoE−/− mice at 16 and 24 weeks of age, but not at 32 weeks. In multiple ApoE−/− mouse studies, a DP1-specific antagonist, L-655, generally had a neutral to beneficial effect on aortic lipids in the presence or absence of nicotinic acid treatment. In a separate study, a modest increase in some atherosclerotic measures was observed with L-655 treatment in Ldlr−/− mice fed a high-fat diet for 8 weeks; however, this effect was not sustained for 16 or 24 weeks. In the same study, treatment with nicotinic acid alone generally decreased plasma and/or aortic lipids, and addition of L-655 did not negate those beneficial effects. These studies demonstrate that inhibition of DP1, with or without nicotinic acid treatment, does not lead to consistent or sustained effects on plaque burden in mouse atherosclerotic models. more...

In recent years, such vast archives of video information have become available that human annotation of content is no longer feasible; automation of video content analysis is therefore highly desirable. The recognition of semantic content in images is a problem that relies on prior knowledge and learnt information and that, to date, has only been partially solved. Salient analysis, on the other hand, is statistically based and highlights regions that are distinct from their surroundings, while also being scalable and repeatable. The arrangement of salient information into hierarchical tree structures in the spatial and temporal domains forms an important step to bridge the semantic salient gap. Salient regions are identified using region analysis, rank ordered and documented in a tree for further analysis. A structure of this kind contains all the information in the original video and forms an intermediary between video processing and video understanding, transforming video analysis to a syntactic database analysis problem. This contribution demonstrates the formulation of spatio-temporal salient trees the syntax to index them, and provides an interface for higher level cognition in machine vision. more...

MacColl is the recent subject of three interesting theses. One is that he is the probable originator of pluralism in logic. The other is that his pluralism expresses an underlying instrumentalism. The third is that the first two help explain his post-1909 neglect. Although there are respects in which he is both a pluralist and an instrumentalist, I will suggest that it is difficult to find in MacColl’s writings a pluralism which honours the threefold attribution of having been originated by him, having been rooted in an instrumentalism adapted to logic, and being the occasion of his neglect. more...

Estimates of the number of seamounts occurring worldwide are high and increasing, largely because of improved remote-sensing capabilities. Numbers have grown from a baseline of 15,000 (Wessel, 2001; Marova 2002) to more than 45,000 seamounts worldwide. High-end estimates are in the hundreds of thousands (Hillier and Watts, 2007; Kitchingman et al., 2007; Wessel, 2007; Wessel et al., 2010). So, it is logical to ask: What is the total area of the seamount biome? If the world’s seamount features were assembled into a continuous region, how large would this place be? How would the area of the seamount biome compare to continents, and to other marine biomes? These data would be informative, because terrestrial biomes are fairly well resolved and enumerated (Udvardy, 1975; Woodward, 2003), but marine biomes are less well mapped and understood. more...

This is an examination of similarities and differences between Atocha Aliseda’s semantic tableaux analysis of abduction and Dov Gabbay’s and the present author’s ignorance-preservation model of it. Also discussed is the suitability of these models for the analysis of the logical structure of legal reasoning. more...

To examine risk for mycosis among persons with silicosis, we examined US mortality data for 1979–2004. Persons with silicosis were more likely to die with pulmonary mycosis than were those without pneumoconiosis or those with more common pneumoconioses. Health professionals should consider enhanced risk for mycosis for silica-exposed patients. more...

The communication between network nodes within different protocol domains is often regarded simply as a black box with unknown configuration conditions in the path. We address network heterogeneity using a white box approach and focus on its interconnection processes. To achieve this purpose, a Performance Analysis Framework (PAF) is proposed which is composed of the formalization of the latter using process algebra (PA) and the corresponding teletraffic performance models. In this contribution, we target the IEEE 802.16 and IEEE 802.11 protocols. For the teletraffic models, we extend previous models for such scenario with the inclusion of the following protocol operational parameters (metrics): bit error rate (BER), packet error ratio (PER), and packet length (pl). From the framework teletraffic models, the optimal packet length (OPL), end to end throughput, delay, and packet loss are obtained. The PAF outperforms previous modeling solutions in terms of delay and throughput relative to NS3 simulation results. more...

Notwithstanding their technical virtuosity and growing presence in mainstream thinking, game theoretic logics have attracted a sceptical question: "Granted that logic can be done game theoretically, but what would justify the idea that this is the preferred way to do it?'' A recent suggestion is that at least part of the desired support might be found in the Greek dialectical writings. If so, perhaps we could say that those works possess a kind of foundational significance. The relation of being foundational for is interesting in its own right. In this paper, I explore its ancient applicability to relevant, paraconsistent and nonmonotonic logics, before returning to the question of its ancestral tie, or want of one, to the modern logics of games. more...

Pulmonary hypertension is a common but often overlooked complication associated with thalassemia syndromes. There are limited data on the safety and efficacy of selective pulmonary vasodilators in this at-risk population. We, therefore, designed a 12-week, open-label, phase 1/2, pilot-scale, proof-of-principle trial of sildenafil therapy in 10 patients with β-thalassemia and at increased risk of pulmonary hypertension based on an elevated tricuspid regurgitant jet velocity >2.5 m/s on Doppler-echocardiography. Variables compared at baseline and after 12 weeks of sildenafil treatment included Doppler-echocardiographic parameters, 6-minute walked distance, Borg Dyspnea Score, New York Heart Association functional class, pulmonary function, and laboratory parameters. Treatment with sildenafil resulted in a significant decrease in tricuspid regurgitant jet velocity by 13.3% (3.0±0.7 versus 2.6±0.5 m/s, P=0.04), improved left ventricular end systolic/diastolic volume, and a trend towards a improved New York Heart Association functional class. No significant change in 6-minute walked distance was noted. Sildenafil was well tolerated, although minor expected adverse events were commonly reported. The total dose of sildenafil (mg) was strongly correlated with percent change in nitric oxide metabolite concentration in the plasma (ρ=0.80, P=0.01). There were also significant increases in plasma and erythrocyte arginine concentrations. Our study suggests that sildenafil is safe and may improve pulmonary hemodynamics in patients at risk of pulmonary hypertension; however, it was not demonstrated to improve the distance walked in 6 minutes. Clinical trials are needed to identify the best treatment strategy for pulmonary hypertension in patients with β-thalassemia. (clinicaltrials.gov identifier: NCT00872170) more...

The preclinical model of bleomycin-induced lung fibrosis, used to investigate mechanisms related to idiopathic pulmonary fibrosis (IPF), has incorrectly predicted efficacy for several candidate compounds suggesting that it may be of limited value. As an attempt to improve the predictive nature of this model, integrative bioinformatic approaches were used to compare molecular alterations in the lungs of bleomycin-treated mice and patients with IPF. Using gene set enrichment analysis we show for the first time that genes differentially expressed during the fibrotic phase of the single challenge bleomycin model were significantly enriched in the expression profiles of IPF patients. The genes that contributed most to the enrichment were largely involved in mitosis, growth factor, and matrix signaling. Interestingly, these same mitotic processes were increased in the expression profiles of fibroblasts isolated from rapidly progressing, but not slowly progressing, IPF patients relative to control subjects. The data also indicated that TGFβ was not the sole mediator responsible for the changes observed in this model since the ALK-5 inhibitor SB525334 effectively attenuated some but not all of the fibrosis associated with this model. Although some would suggest that repetitive bleomycin injuries may more effectively model IPF-like changes, our data do not support this conclusion. Together, these data highlight that a single bleomycin instillation effectively replicates several of the specific pathogenic molecular changes associated with IPF, and may be best used as a model for patients with active disease. more...

MR has become a reliable and noninvasive method of hepatic iron quantification. Currently, most of the hepatic iron quantification is performed on 1.5 T MR, and the biopsy measurements have been paired with R2 and R2* values for 1.5 T MR. As the use of 3 T MR scanners is steadily increasing in clinical practice, it has become important to evaluate the practicality of calculating iron burden at 3 T MR. Hepatic iron quantification on 3 T MR requires a better understanding of the process and more stringent technical considerations. The purpose of this work is to focus on the technical challenges in establishing a relationship between T2* values at 1.5 T MR and 3 T MR for hepatic iron concentration (HIC) and to develop an appropriately optimized MR protocol for the evaluation of T2* values in the liver at 3 T magnetic field strength. We studied 22 sickle cell patients using multiecho fast gradient-echo sequence (MFGRE) 3 T MR and compared the results with serum ferritin and liver biopsy results. Our study showed that the quantification of hepatic iron on 3 T MRI in sickle cell disease patients correlates well with clinical blood test results and biopsy results. 3 T MR liver iron quantification based on MFGRE can be used for hepatic iron quantification in transfused patients. more...

There are passages in Fallacies suggesting a skeptical attitude to the very idea of inductive arguments, hence to the existence of inductive fallacies. Although the passages are brief and few in number, it would appear that Hamblin’s resistance stems from doubts about the existence of relations of inductive consequence. This paper attempts to find a case in which such skepticism might plausibly be grounded. The case it proposes is highly conjectural, but important if true. Its greater importance lies in the threat it creates for the whole class of nonmonotonic logics. more...

Commentary: The Cook Islands News is challenging the Prime Minister and his Cabinet for maintaining secrecy and nondisclosure around all of Cabinet’s business in spite of the country’s Official Information Act. And the newspaper is fighting several defamation actions which in legal fees are chewing up the equivalent of a whole annual salary for a senior journalist. This is a waste of limited resources, but the cost of being a ‘free press’. more...

Semantic theorists of fiction typically look for an account of our semantic relations to the fictional within general-purpose theories of reference, privileging an explanation of the semantic over the psychological. In this paper, we counsel a reverse dependency. In sorting out our psychological relations to the fictional, there is useful guidance about how to proceed with the semantics of fiction. A sketch of the semantics follows. more...

In all three of its manifestations, —abusive, circumstantial and tu quoque—the role of the ad hominem is to raise a doubt about the opposite party’s casemaking bona-fides.Provided that it is both presumptive and provisional, drawing such a conclusion is not a logical mistake, hence not a fallacy on the traditional conception of it. More remarkable is the role of the ad hominem retort in seeking the reassurance of one’s opponent when, on the face of it, reassurance is precisely what he would seem to be ill-placed to give. Brief concluding remarks are given over to an examination of rival approaches to the ad hominem, especially those in which it is conceived of as a dialectical error. more...

In criminal cases at common law, juries are permitted to convict on wholly circumstantial evidence even in the face of a reasonable case for acquittal. This generates the highly counterintuitive—if not absurd—consequence that there being reason to think that the accused didn’t do it is not reason to doubt that he did. This is the no-reason-to-doubt problem. It has a technical solution provided that the evidence on which it is reasonable to think that the accused didn’t do it is a different subset of the total evidence from that on which there is no reason to doubt that he did do it. It lies in the adversarial nature of criminal proceedings in the common law tradition that the subsets of the total evidence on which counsel base their opposing arguments are themselves different from and often incompatible with one another. While this solves the no-reason-to-doubt problem, it does so at the cost of triggering a second problem just as bad. It is the no-rival problem, according to which incompatible theories of the case based on incompatible subsets of the evidence cannot be rivals of one another. If neither party’s case contradicts the other’s then, by the burden of proof requirement, criminal convictions are impossible. Once having generated the dilemma, the object of the paper is to determine how it might be escaped. more...