Experimental evaluation of beef breed utilization strategies

International audienc

Instrumental variable methods to assess quality of care the marginal effects of process-of-care on blood pressure change and treatment costs

Background: Hypertension is poorly controlled. Team-based care and changes in the process of care have been proposed to address these quality problems. However, assessing care processes is difficult because they are often confounded even in randomized behavioral studies by unmeasured confounders based on discretion of health care providers. Objective: To evaluate the effects of process measures including number of counseling sessions about lifestyle modification and number of antihypertensive medications on blood pressure change and payer-perspective treatment costs. Methods: Data were obtained from two prospective, cluster randomized controlled clinical trials (Trial A and B) implementing physician-pharmacist collaborative interventions compared with usual care over six months in community-based medical offices in the Midwest. Multivariate linear regression models with both instrumental variable methods and as-treated methods were utilized. Instruments were indicators for trial and study arms. Models of blood pressure change and costs included both process measures, demographic variables, and clinical variables. Results: The analysis included 496 subjects. As-treated methods showed no significant associations between process and outcomes. The instruments used in the study were insufficient to simultaneously identify distinct process effects. However, the post-hoc instrumental variable models including one process measure at a time while controlling for the other process demonstrated significant associations between the processes and outcomes with estimates considerably larger than as-treated estimates. Conclusions: Instrumental variable methods with combined randomized behavioral studies may be useful to evaluate the effects of different care processes. However, substantial distinct process variation across studies is needed to fully capitalize on this approach. Instrumental variable methods focusing on individual processes provided larger and stronger outcome relationships than those found using as-treated methods which are subject to confounding

Responding to the needs of people who have learning disabilities and have been raped : co-prooduction in action

Purpose The paper discusses a project that explored why mainstream rape support services are still failing to meet the needs of women with learning disabilities. Principles of co-production and action learning enabled a group of women, including women with learning disabilities, to share knowledge and skills and develop easy-read information leaflets. Design/methodology/approach The project included representatives from a University, a Third sector Organisation and a Rape Crisis Centre. Action learning methods were used to bring together a broad range of experience and expertise. The project was co-led by a woman with a learning disability and a lecturer in social work with people with learning disabilities. Findings Three organisations had been toiling with a similar issue, that of responses to women with learning disabilities who had been raped. Each had previously examined the problem from their own perspective. An action learning process enabled them to explore the issues from a range of experiences, sharing knowledge and expertise and enabling them to begin to develop better service responses. Co-production of knowledge highlights competing priorities in and between organisations. It can also provide the means of managing these tensions. Social implications The project demonstrates the importance of co-production. By working together each organisation learned about the needs of the other. This resulted in shared understanding of the barriers experienced by women with learning disabilities who experience rape and of the challenges experienced by workers who aim to support them. This shared understanding enabled the Action Learning Set to develop bespoke training and literature. Originality value All of the participants shared the goal of developing more accessible services for women with learning disabilities who had experienced rape. The project included people with learning disabilities from inception. It was based on expressed need of a group of women with learning disabilities who had been raped and experienced other forms of domestic violence. The project demonstrates the importance of working with people with learning disabilities in order to develop services that truly meet their needs. Key words Learning disability, action-learning, easy -read information, domestic violence, co-production, organisational identity

GRB optical and IR rapid follow-up with the 2 m Liverpool Robotic Telescope

The Liverpool Telescope, owned and operated by Liverpool John Moores University and situated at Roque de los Muchachos, La Palma, is the first 2-m, fully instrumented robotic telescope. We plan to use the LT in conjunction with Gamma Ray Observatories (HETE-2, INTEGRAL, Swift) to study GRB physics. A special over-ride mode will enable observations commencing less than a minute after the GRB alert, including optical and near infrared imaging and spectroscopy. These observations, together with systematic monitoring of the burst through the afterglow, will help to unravel the nature of prompt optical flashes, short bursts, optically dark bursts, redshift distribution, GRB - supernova connection and other questions related to the GRB phenomenon. In particular, the combination of aperture, instrumentation and rapid automated response makes the Liverpool Telescope excellently suited to the investigation of optically dark bursts and currently optically unstudied short bursts

Necrotic gangrenous intrathoracic appendix in a marfanoid adult patient: a case report

BACKGROUND: A diaphragmatic hernia is defined as a defect in part of the diaphragm through which abdominal contents can protrude into the thorax. It may be congenital or acquired. In this case report, we aim to demonstrate a congenital diaphragmatic hernia in an adult marfanoid patient which required emergency treatment CASE PRESENTATION: A 43 year old woman was admitted with classical appendicitis requiring surgery. She incidentally had Marfan's clinical features with a positive family history for the syndrome. At operation she had grossly abnormal abdominal anatomy. Radiological investigations demonstrated a large right congenital diaphragmatic hernia with an intrathoracic hernial sac containing a perforated gangrenous appendix. The hernial sac was opened surgically and the appendix excised. The patient made a full recovery. CONCLUSION: Diaphragmatic hernias are usually congenital in nature often requiring early corrective surgery for future survival. We have demonstrated the presence of an unusually large diaphragmatic defect, almost a hemidiaphragmatic defect, of unknown direct etiology, but of some possible association with Marfan's syndrome in an adult patient presenting with an acute perforated gangrenous appendix requiring emergency life-saving surgery

Associations between reliable changes in depression and changes in BMI, total body fatness and visceral adiposity during a 12-month weight loss trial.

We investigated associations between changes in depression and body composition over a 12-month weight loss trial. Of the 298 adults (BMI > 27 m/kg2), 219 with complete depression and body composition data were included. A 10-item Center for Epidemiologic Studies Depression Scale measured depression; dual-energy X-ray absorptiometry measured body composition. Multinomial logistic regression predicted reliable changes in depression by BMI, body fat (BF) and visceral adiposity (VAT). Multiplicative interaction terms tested modification by sex and ethnicity. Participants with increases in body composition were less likely to experience improvements in depression (BMI: RRR = 0.79 (0.68-0.91), p < 0.01; BF: RRR = 0.97 (0.94 - 0.99), p = 0.01; VAT: RRR = 0.99 (0.98-1.00), p = 0.02), but not worsening of depression (BMI: RRR = 1.29 (0.96-1.73), p = 0.10; BF: RRR = 1.04 (0.99-1.09), p = 0.15; VAT: RRR = 1.01 (1.00-1.03), p = 0.18). Sex and ethnicity interaction terms were not significant. However, the relationship was only significant among females, among non-Latinos for BMI and BF, and among Latinos for VAT. Our study supports the association between depression and obesity and highlights the need for longitudinal studies investigating VAT and depression in diverse ethnic groups

Morphological changes of the lateral meniscus in end-stage lateral compartment osteoarthritis of the knee.

OBJECTIVE: The aim of this study was to evaluate the morphological changes of the lateral meniscus in end-stage lateral compartment osteoarthritis (OA) of the knee. METHODS: One hundred fifty-eight knee joints from 133 patients that subsequently underwent total knee joint arthroplasty from January 2008 to December 2009 were enrolled. There were 26 men and 107 women. Their ages ranged from 56 to 81 (mean 67.4 + 6.5 years). All study participants had complete obliteration of the lateral joint space identified by weight-bearing radiography. Meniscal position was assessed by measuring meniscal subluxation and meniscal height. The meniscal morphology was assessed using a modification of the whole-organ magnetic resonance imaging score (WORMS). The frequency of different meniscal morphology and their respective positions was calculated. RESULTS: The predominant type (42.4%, 53.8% and 52.5% in the anterior horn, mid-body and posterior horn, respectively) of abnormal meniscal morphology was a complete maceration/destruction or complete resection. The anterior horn of non-macerated lateral meniscus was more subluxed than that of the non-macerated medial meniscus in patients with lateral OA. CONCLUSION: This study suggests that the lateral meniscus in persons with end-stage lateral OA are mostly macerated or destroyed. Also, unlike isolated end-staged medial compartment OA, the anterior horn of the lateral meniscus in isolated end-stage lateral OA is commonly affected. Copyright 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved

Influence of dietary nitrate supplementation on physiological and muscle metabolic adaptations to sprint interval training

This is the author accepted manuscript. The final version is available from the American Physiological Society via the DOI in this record.We hypothesized that 4 wk of dietary nitrate supplementation would enhance exercise performance and muscle metabolic adaptations to sprint interval training (SIT). Thirty-six recreationally active subjects, matched on key variables at baseline, completed a series of exercise tests before and following a 4-wk period in which they were allocated to one of the following groups: 1) SIT and NO3--depleted beetroot juice as a placebo (SIT+PL); 2) SIT and NO3--rich beetroot juice (∼13 mmol NO3-/day; SIT+BR); or 3) no training and NO3--rich beetroot juice (NT+BR). During moderate-intensity exercise, pulmonary oxygen uptake was reduced by 4% following 4 wk of SIT+BR and NT+BR (P 0.05). The relative proportion of type IIx muscle fibers in the vastus lateralis muscle was reduced in SIT+BR only (P < 0.05). These findings suggest that BR supplementation may enhance some aspects of the physiological adaptations to SIT. NEW & NOTEWORTHY We investigated the influence of nitraterich and nitrate-depleted beetroot juice on the muscle metabolic and physiological adaptations to 4 wk of sprint interval training. Compared with placebo, dietary nitrate supplementation reduced the O2 cost of submaximal exercise, resulted in greater improvement in incremental (but not severe-intensity) exercise performance, and augmented some muscle metabolic adaptations to training. Nitrate supplementation may facilitate some of the physiological responses to sprint interval training.PepsiC