Individual patient data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients

<p><b>Background and Purpose:</b> Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred.</p> <p><b>Methods:</b> Trials were identified from searches of the Cochrane Library and other sources. The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) score at the end of intervention. Secondary outcome measures included the Barthel Index or the Rivermead ADL (Personal ADL), General Health Questionnaire (GHQ), Nottingham Leisure Questionnaire (NLQ), and death. Data were analyzed using linear or logistic regression with a random effect for trial and adjustment for age, gender, baseline dependency, and method of follow-up. Subgroup analyses compared any occupational therapy intervention with control.</p> <p><b>Results:</b> We included 8 single-blind randomized controlled trials incorporating 1143 patients. Occupational therapy was associated with higher NEADL scores at the end of intervention (weighted mean difference [WMD], 1.30 points, 95% confidence intervals [CI], 0.47 to 2.13) and higher leisure scores at the end of intervention (WMD, 1.51 points; 95% CI, 0.24 to 2.79). Occupational therapy emphasizing activities of daily living (ADL) was associated with improved end of intervention NEADL (WMD, 1.61 points; 95% CI, 0.72 to 2.49) and personal activities of daily living (odds ratio [OR], 0.65; 95% CI, 0.46 to 0.91), but not NLQ. Leisure-based occupational therapy improved end of intervention NLQ (WMD, 1.96 points; 95% CI, 0.27 to 3.66) but not NEADL or PADL.</p> <p><b>Conclusions:</b> Community occupational therapy significantly improved personal and extended activities of daily living and leisure activity in patients with stroke. Better outcomes were found with targeted interventions.</p&gt

Growth performance, carcass characteristics and meat quality of group-penned surgically castrated, immunocastrated (Improvac®) and entire male pigs and individually penned entire male pigs

The objective of the study was to compare growth performance, carcass characteristics, meat quality and fatty acid composition of the adipose tissue of group-penned barrows, immunocastrated boars and entire males. Furthermore, the effect of housing of entire males on the aforementioned parameters was evaluated. At 55.2 days of age, 52 Swiss Large White pigs were blocked by litter and assigned by BW to four experimental groups: barrows (C), immunocastrated boars (IC), entire males (EMG) reared in group pens and entire males (EMP) reared in individual pens. In experiment 1, the effects of the method of castration were investigated (experimental groups C, IC and EMG). In experiment 2, the effects of housing on entire male pigs were evaluated (experimental groups EMG and EMP). All pigs had ad libitum access to standard diets from weaning to 107 kg BW. The two vaccinations (Improvac®) were applied to the IC pigs at an average BW of 22.6 and 73.0 kg. In experiment 1, average daily gain (ADG) did not (P > 0.05) differ among the experimental groups. However, EMG consumed less feed and had a better feed-conversion ratio than C (P 0.05) differ between EMP and EMG. However, EMP pigs consumed more feed than EMG pigs and had a poorer feed efficiency (P < 0.01 for each). In conclusion, EMG pigs had a better feed efficiency than IC pigs and their carcasses were leaner, but the risk of boar tainted pork was elevated. Group-housing negatively affected average daily feed intake but not ADG of entire males. At the moment, immunocastration offers a good approach to avoid castration and minimize the risk of boar tain

Performances, meat quality and boar taint of castrates and entire male pigs fed a standard and a raw potato starch-enriched diet

In Europe there is increasing concern about the common practice of surgical castration of piglets without anaesthesia. One possible alternative to completely avoid castration is entire male pig production. Thus, the objective of the study was to compare the growth performance, carcass characteristics, organ weights, meat quality traits, fat score and boar taint compounds in the adipose tissue of group-penned entire male pigs and castrates. Furthermore, the effect of raw potato starch (RPS) fed for 7 days prior to slaughter was determined. Pigs (n = 36) were blocked by BW into 12 blocks (3 littermates/block) and assigned to three experimental groups: surgical castrates (C); entire males (EM); and entire males offered RPS (30 g RPS/100 g diet) for 7 days prior to slaughter (EM+). Pigs had ad libitum access to the feed from 22 to 107 kg, individual feed intake was recorded daily and BW once a week. Entire males grew slower (EM: 771, EM+: 776 v. C: 830 g/day; P 0.05) differ among experimental groups but the adipose tissue was more unsaturated in entire males than in C as indicated by the higher fat scores (EM: 69.1, EM+: 67.2 v. C: 63.6; P < 0.01). Feeding RPS reduced (P = 0.04) the skatole tissue concentrations (expressed in μg/g lipid) in EM+ (0.22) compared to EM (0.85), whereas androstenone and indole levels were not (P 0.60) affected (EM: 1.7 and 0.10, EM+: 2.0 and 0.09, respectively). Although the current results confirmed the high efficiency of entire males compared to castrates, the observed high androstenone levels represent a major challenge to implement entire males productio

Pareto versus lognormal: a maximum entropy test

It is commonly found that distributions that seem to be lognormal over a broad range change to a power-law (Pareto) distribution for the last few percentiles. The distributions of many physical, natural, and social events (earthquake size, species abundance, income and wealth, as well as file, city, and firm sizes) display this structure. We present a test for the occurrence of power-law tails in statistical distributions based on maximum entropy. This methodology allows one to identify the true data-generating processes even in the case when it is neither lognormal nor Pareto. The maximum entropy approach is then compared with other widely used methods and applied to different levels of aggregation of complex systems. Our results provide support for the theory that distributions with lognormal body and Pareto tail can be generated as mixtures of lognormally distributed units

Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis

BACKGROUND: Food allergy is a common cause of anaphylaxis, but the incidence of fatal food anaphylaxis is not known. The aim of this study was to estimate the incidence of fatal food anaphylaxis for people with food allergy and relate this to other mortality risks in the general population. METHODS: We undertook a systematic review and meta-analysis, using the generic inverse variance method. Two authors selected studies by consensus, independently extracted data and assessed the quality of included studies using the Newcastle-Ottawa assessment scale. We searched Medline, Embase, PsychInfo, CINAHL, Web of Science, LILACS or AMED, between January 1946 and September 2012, and recent conference abstracts. We included registries, databases or cohort studies which described the number of fatal food anaphylaxis cases in a defined population and time period and applied an assumed population prevalence rate of food allergy. RESULTS: We included data from 13 studies describing 240 fatal food anaphylaxis episodes over an estimated 165 million food-allergic person-years. Study quality was mixed, and there was high heterogeneity between study results, possibly due to variation in food allergy prevalence and data collection methods. In food-allergic people, fatal food anaphylaxis has an incidence rate of 1.81 per million person-years (95%CI 0.94, 3.45; range 0.63, 6.68). In sensitivity analysis with different estimated food allergy prevalence, the incidence varied from 1.35 to 2.71 per million person-years. At age 0–19, the incidence rate is 3.25 (1.73, 6.10; range 0.94, 15.75; sensitivity analysis 1.18–6.13). The incidence of fatal food anaphylaxis in food-allergic people is lower than accidental death in the general European population. CONCLUSION: Fatal food anaphylaxis for a food-allergic person is rarer than accidental death in the general population

The Mersey Estuary : sediment geochemistry

This report describes a study of the geochemistry of the Mersey estuary carried out between April 2000 and December 2002. The study was the first in a new programme of surveys of the geochemistry of major British estuaries aimed at enhancing our knowledge and understanding of the distribution of contaminants in estuarine sediments. The report first summarises the physical setting, historical development, geology, hydrography and bathymetry of the Mersey estuary and its catchment. Details of the sampling and analytical programmes are then given followed by a discussion of the sedimentology and geochemistry. The chemistry of the water column and suspended particulate matter have not been studied, the chief concern being with the geochemistry of the surface and near-surface sediments of the Mersey estuary and an examination of their likely sources and present state of contamination

Morphometric traits to estimate brain and liver weight and their ratio for the diagnosis of intrauterine growth restriction in newborn piglets

Intrauterine growth restriction (IUGR) is defined as inadequate foetal growth during gestation. In response to placenta insufficiency, IUGR piglets prioritise brain development as a survival mechanism. This adaptation leads to a higher brain-to-liver weight ratio (BrW/LW) at birth. This study assessed the potential of using morphometric traits to estimate brain (BrW) and liver (LW) weights, enabling non-invasive diagnosis of IUGR in newborn piglets. At birth, body weight (BtW) of individual piglets (n = 144) was recorded. One day (± 1) after birth, BrW and LW were measured with computed tomography (n = 94) or by weighing the organs after natural death or euthanasia (n = 50). Additionally, 20 morphometric traits were captured from images of each piglet and correlated with the BrW and LW. The morphometric traits that showed a r ≥ 0.70 in linear correlation with the BrW or LW were selected. Each selected trait was combined as an independent variable with BtW to develop multiple linear regression models to predict the BrW and LW. Six models were chosen based on the highest adjusted R2 value: three for estimating BrW and three for LW. The dataset was then randomly divided into a training (75% of the data) and a testing (remaining 25%) subsets. Within the training subset, three equations to predict the BrW and three to predict the LW were extrapolated from the six selected models. The equations were then applied to the testing subset. The accuracy of the equations in predicting organ weight was assessed by calculating mean absolute and mean absolute percentage error (MAE and MAPE) between predicted and actual BrW and LW. To predict the BrW/LW, an equation including BtW and the two morphometric traits which better predicted BrW and LW was used. In the testing dataset, the equation combining ear distance and BtW better estimated the BrW. The equation performed with a MAE of 1.95 and a MAPE of 0.06 between the true and estimated weight of the brain. For the liver, the equation combining the abdominal area delimited by a square and BtW displayed the best performance, with a MAE of 9.29 and a MAPE of 0.17 between the true and estimated weight. Finally, the MAE and MAPE between the actual and estimated BrW/LW were 0.14 and 0.17, respectively. These findings suggest that specific morphometric traits can be used to estimate brain and liver weights, facilitating accurate and non-invasive identification of IUGR in newborn piglets

Intrauterine growth restriction defined by increased brain-to-liver weight ratio affects postnatal growth and protein efficiency in pigs

Intrauterine growth restriction (IUGR) refers to impaired foetal growth during gestation, resulting in permanent stunting effects on the offspring. This study aimed to investigate the effects of IUGR on growth performance, body composition, blood metabolites, and meat quality of pigs from birth (n = 268) to slaughter (n = 93). IUGR piglets have prioritised brain development as a foetal adaptive reaction to placental insufficiency. This survival mechanism results in a higher brain-to-liver weight ratio (BrW/LW). One day (±1) after birth, computed tomography (CT) was performed on each piglet to assess their brain and liver weights. A threshold value of 0.78 (mean + SD) was chosen to divide the piglets into two categories – NORM (BrW/LW &lt; 0.78) and IUGR (BrW/LW &gt; 0.78). Moreover, each piglet was classified as either normal (score 1), mild IUGR (score 2), or severe IUGR (score 3) based on the head morphology. BW was recorded weekly, and average daily gain (ADG) was calculated for lactation, starter, grower, and finisher periods. Body composition was assessed after weaning (29.6 ± 0.7 d), at 20 kg (64 ± 7.2 d), 100 kg (165 ± 12.3 d), and on the carcasses using Dual-energy X-ray absorptiometry (DXA). Content and deposition rates of single nutrients, as well as energy and CP efficiency, were measured at 20 and 100 kg. Feed intake was recorded from 20 kg to slaughter. Meat quality was assessed on the carcasses. A total of 70% of the piglets assigned a score of 3 were NORM according to their BrW/LW. The IUGR category showed a lower ADG in the lactation (P &lt; 0.01), starter (P = 0.07), and grower phases (P &lt; 0.05) and a reduced CP efficiency in the grower–finisher period (P &lt; 0.01) compared to the NORM group. IUGR pigs had a lower gain-to-feed ratio in the finisher period (P = 0.01) despite similar average daily feed intake, and they required more days (P &lt; 0.01) to reach the slaughter weight. Additionally, their meat was darker (P = 0.01) than that of NORM pigs. The BrW/LW was inversely proportional to the ADG from birth to slaughter and negatively correlated with the CP deposition rate and efficiency in the grower–finisher period (P &lt; 0.01). Furthermore, the higher the BrW/LW, the longer it took the pigs to reach the slaughter weight (P &lt; 0.01). In conclusion, the identification of IUGR piglets based on the head morphology does not always agree with an increased BrW/LW. IUGR affects growth performance from birth to slaughter, CP efficiency in the grower–finisher period and meat quality

Change management: The case of the elite sport performance team

The effective and efficient implementation of change is often required for both successful performance and management survival across a host of contemporary domains. However, although of major theoretical and practical significance, research to date has overlooked the application of change management (hereafter CM) knowledge to the elite sport performance team environment. Considering that the success of ‘off-field’ sports businesses are largely dependent on the performances of their ‘on-field’ team, this article explores the application of current CM theorizing to this specific setting and the challenges facing its utility. Accordingly, we identify the need and importance of developing theory specific to this area, with practical application in both sport and business, through examination of current knowledge and identification of the domain's unique, dynamic and contested properties. Markers of successful change are then suggested to guide initial enquiry before the article concludes with proposed lines of research which may act to provide a valid and comprehensive theoretical account of CM to optimize the research and practice of those working in the field

Two-Dimensional QCD in the Wu-Mandelstam-Leibbrandt Prescription

We find the exact non-perturbative expression for a simple Wilson loop of arbitrary shape for U(N) and SU(N) Euclidean or Minkowskian two-dimensional Yang-Mills theory regulated by the Wu-Mandelstam-Leibbrandt gauge prescription. The result differs from the standard pure exponential area-law of YM_2, but still exhibits confinement as well as invariance under area-preserving diffeomorphisms and generalized axial gauge transformations. We show that the large N limit is NOT a good approximation to the model at finite N and conclude that Wu's N=infinity Bethe-Salpeter equation for QCD_2 should have no bound state solutions. The main significance of our results derives from the importance of the Wu-Mandelstam-Leibbrandt prescription in higher-dimensional perturbative gauge theory.Comment: 7 pages, LaTeX, REVTE