University of East Anglia

About: University of East Anglia is a education organization based out in Norwich, Norfolk, United Kingdom. It is known for research contribution in the topics: Population & Climate change. The organization has 13250 authors who have published 37504 publications receiving 1669060 citations. The organization is also known as: UEA.

Clinical effectiveness and cost-effectiveness of bone morphogenetic proteins in the non-healing of fractures and spinal fusion: a systematic review.

Abstract: Objectives To assess the clinical effectiveness and cost-effectiveness of bone morphogenetic protein (BMP) for the treatment of spinal fusions and the healing of fractures compared with the current standards of care. Data sources Electronic databases, related journals and references from identified studies were searched in January 2006, with an updated search only for randomised controlled trials (RCTs) in November 2006. Review methods A systematic review of available data was conducted. The data from selected studies were then analysed and graded according to quality and processed to give a value to the efficacy of BMP. Existing models were modified or updated to evaluate the cost-effectiveness of BMP for open tibial fractures and spinal fusion. Results All selected trials were found to have several methodological weaknesses. Insufficient sample size in most trials, meant that patient baseline comparability between trial arms was not achieved and the statistical power to detect a moderate effect was low. Data did indicate that BMP increased fracture union among patients with acute tibial fractures and found that high-dose BMP is more effective than a lower dose for open tibial fractures. The healing rate in the BMP group was not found to be statistically significantly different from that in the autogenous bone grafting group for patients with tibial non-union fractures, but BMP reduced the number of secondary interventions in patients with acute tibial fractures compared with controls. There was very limited evidence that BMP in scaphoid non-union was safe and may help to accelerate non-union healing when used in conjunction with either autograft or allograft. There was evidence that BMP-2 is more effective than autogenous bone graft for radiographic fusion in patients with single-level degenerative disc disease. No significant difference was found when BMP-7 was compared with autograft for degenerative spondylolisthesis with spinal stenosis and spondylolysis. The use of BMP was associated with a reduced operating time, improvement in clinical outcomes and a shorter hospital stay as compared with autograft. The proportion of secondary interventions tended to be lower in the BMP group than the control, but not of statistical significance. Trial data on time to return to work postoperatively were sometimes difficult to interpret because of unclear or inappropriate data analysis methods. The incremental cost of BMP for open tibial fractures was estimated to be about 3.5 million pounds per year in the UK. The estimated incremental cost per quality-adjusted life-year (QALY) gained is 32,603 pounds. The probability that cost per QALY gained is less than 30,000 pounds for open tibial fracture is 35.5%. The cost-effectiveness ratio is sensitive to the price of BMP and the severity of open tibial fractures. The use of recombinant human bone morphogenetic protein for spinal fusion surgery may increase the cost to the UK NHS by about 1.3 million pounds per year. The estimated incremental cost per QALY gained was about 120,390 pounds. The probability that BMP is cost-effective (i.e. cost/QALY less than 30,000 pounds) was only 6.4%. From the societal perspective, the estimated total cost of using BMP for spinal fusion is about 4.2 million pounds per year in the UK. Conclusions Additional BMP treatment plus conventional intervention is more effective than conventional intervention alone for union of acute open tibial fractures. The cost-effectiveness of additional BMP may be improved if the price of BMP is reduced or if BMP is mainly used in severe cases. BMP may eliminate the need for autogenous bone grafting so that costs and complications related to harvesting autograft can be avoided. In non-unions, there is no evidence that BMP is more or less effective than bone graft; however, it is currently used when bone graft and other treatments have failed. The use of BMP-2 in spinal fusion surgery seems to be more effective than autogenous bone graft in terms of radiographic spinal fusion among patients with single-level degenerative disc disease. There is a lack of evidence about the effectiveness of BMP for other spinal disorders including spondylolisthesis and spinal stenosis. There was limited evidence showing that BMP is associated with greater improvement in clinical outcomes. According to the results of economic evaluation, the use of BMP for spinal fusion is unlikely to be cost-effective. The following areas would benefit from further research: clinical trials of BMP that include formal economic evaluation, a multicentre RCT of fracture non-union and of interbody and/or posterolateral spinal fusion, trials of non-tibial acute long bone fractures, and RCTs comparing BMP-2, BMP-7 and controls.

Attribution of observed surface humidity changes to human influence

Abstract: Water vapour is the most important contributor to the natural greenhouse effect, and the amount of water vapour in the atmosphere is expected to increase under conditions of greenhouse-gas-induced warming, leading to a significant feedback on anthropogenic climate change1, 2, 3. Theoretical and modelling studies predict that relative humidity will remain approximately constant at the global scale as the climate warms, leading to an increase in specific humidity1, 4, 5. Although significant increases in surface specific humidity have been identified in several regions6, 7, 8, 9, and on the global scale in non-homogenized data10, it has not been shown whether these changes are due to natural or human influences on climate. Here we use a new quality-controlled and homogenized gridded observational data set of surface humidity, with output from a coupled climate model, to identify and explore the causes of changes in surface specific humidity over the late twentieth century. We identify a significant global-scale increase in surface specific humidity that is attributable mainly to human influence. Specific humidity is found to have increased in response to rising temperatures, with relative humidity remaining approximately constant. These changes may have important implications, because atmospheric humidity is a key variable in determining the geographical distribution11, 12, 13 and maximum intensity14 of precipitation, the potential maximum intensity of tropical cyclones15, and human heat stress16, and has important effects on the biosphere17 and surface hydrology17, 18.

Workplace resources to improve both employee well-being and performance: A systematic review and meta-analysis

Abstract: Organizations are becoming increasingly aware of the importance of employees in gaining and maintaining competitive advantage. The happy worker-productive worker thesis suggests that workers who experience high levels of well-being also perform well and vice versa, however, organizations need to know how to ensure such happy and productive workers. The present review and meta-analysis identifies workplace resources at the individual, the group, the leader and the organizational levels that are related to both employee well-being and organizational performance. We examine which types of resources are most important in predicting both employee well-being and performance. We identified 84 quantitative studies published in print and online from 2003 to November 2015. Resources at either of the four levels were related to both employee well-being and performance. We found no significant differences in employee well-being and organizational performance between the four levels of workplace resources, suggesting that interventions may focus on any of these levels. Cross-sectional studies showed stronger relationships with well-being and performance than longitudinal studies. Studies using objective performance ratings provided weaker relationships between resources and performance than self-rated and leader/third party rated studies.

Assessment of urbanization effects in time series of surface air temperature over land

Abstract: RECORDS of hemispheric average temperatures from land regions for the past 100 years provide crucial input to the debate over global warming1–4. Despite careful use of the basic station data in some of these compilations of hemispheric temperature1,2,4–6, there have been suggestions7,8 that a proportion of the 0.5 °C warming seen on a century timescale may be related to urbanization influences—local warming caused by the effects of urban development. We examine here an extensive set of rural-station temperature data for three regions of the world: European parts of the Soviet Union, eastern Australia and eastern China. When combined with similar analyses for the contiguous United States9,10, the results are representative of 20% of the land area of the Northern Hemisphere and 10% of the Southern Hemisphere. The results show that the urbanization influence in two of the most widely used hemispheric data sets1,2,4 is, at most, an order of magnitude less than the warming seen on a century timescale.