Evaluation of a new extraction system for rapid measurement of surface lipid content of rice for degree of milling estimation

Few fruit thinners have been certified for organic fruit growers. Previous studies have shown that herbicides or shade are capable of reducing photosynthesis and are effective fruit-thinning techniques, although impractical. This project evaluated use of a model plant system of vegetative apple trees grown under controlled conditions to study photosynthetic inhibitors, which could be used as potential organic thinning agents. Various concentrations of osmotics, salts, and oils (lime-sulfur, potassium bisulfite, potassium bicarbonate, sodium chloride, soybean oil) were applied to actively growing apple trees and showed a reduced trend on the rate of apple tree photosynthetic assimilation (Pn), evapotranspiration (Et), and stomatal conductance (gs). From two studies, it was observed that treatments of 2% lime-sulfur (LS) + 2% soybean oil (SO), 4% SO, 8% LS, 5% potassium bicarbonate (KHCO3), and 5% potassium bisulfite (KHSO4) all significantly reduced Pn. The 4% LS + 2% SO, 4% LS + 4% SO, 0.5% sodium chloride (NaCl), and 2% NaCl did not significantly reduce Pn. The response of Et was significantly reduced by 2% LS + 2% SO, 5% KHCO3, and 4% SO. In a second study, trees had reduced Pn, Et, and gs after the application of 4% LS + 4% SO, 2% NaCl, 5% KHCO3, and 5% KHSO4. Stem weight, total plant weight, average leaf weight, and leaf surface area of the treated plants, although reduced, were not significantly so when compared to the control 20 d after treatment

Case 11 : Knowledge Dissemination and Private Well Water Testing in Middlesex County, Ontario

The Middlesex-London Health Unit (MLHU) is challenged with regards to influencing health behaviours of private well water users. Private well owners are responsible for the testing of their water, and it is recommended by Public Health Ontario to do so three times per year. However, testing rates are either declining or at best, remaining stagnant across Middlesex County. It appears that well owners are unaware of the risks of not testing their drinking water, or if they are, they have become complacent. In short, the health unit is lacking an appropriate knowledge and education dissemination strategy that is suitable and well-adjusted for the target population. The unique characteristics of the target population made this group especially challenging to engage with. Such features are associated with the agriculture industry: seasonal work patterns, limited visits to town, distrust in government, varying education and literacy levels, resilient and “tough” attitudes towards health, remote residential areas, and more. The case introduces the steps taken by the protagonist and his summer student in order to determine the knowledge level of well water testing information, attitudes towards the program, and needs of local community members around this issue. Background information on well water testing services provided by the MLHU and Province of Ontario, history from the Walkerton Tragedy, and importance of well water testing are provided. The reader is left with the challenge of developing strategic ways to engage in knowledge exchange with the community, design and deliver appropriate communication tools, and work with the community to address health behaviour change

Finitary isomorphisms of Poisson point processes

As part of a general theory for the isomorphism problem for actions of amenable groups, Ornstein and Weiss (J. Anal. Math. 48 (1987) 1–141) proved that any two Poisson point processes are isomorphic as measure-preserving actions. We give an elementary construction of an isomorphism between Poisson point processes that is finitary

Headroom approach to device development: Current and future directions

OBJECTIVES: The headroom approach to medical device development relies on the estimation of a value-based price ceiling at different stages of the development cycle. Such price-ceilings delineate the commercial opportunities for new products in many healthcare systems. We apply a simple model to obtain critical business information as the product proceeds along a development pathway, and indicate some future directions for the development of the approach. METHODS: Health economic modelling in the supply-side development cycle for new products. RESULTS: The headroom can be used: initially as a 'reality check' on the viability of the device in the healthcare market; to support product development decisions using a real options approach; and to contribute to a pricing policy which respects uncertainties in the reimbursement outlook. CONCLUSIONS: The headroom provides a unifying thread for business decisions along the development cycle for a new product. Over the course of the cycle attitudes to uncertainty will evolve, based on the timing and manner in which new information accrues. Within this framework the developmental value of new information can justify the costs of clinical trials and other evidence-gathering activities. Headroom can function as a simple shared tool to parties in commercial negotiations around individual products or groups of products. The development of similar approaches in other contexts holds promise for more rational planning of service provision

Educational interventions for the management of cancer-related fatigue in adults

Background: Cancer-related fatigue is reported as the most common and distressing symptom experienced by patients with cancer. It can exacerbate the experience of other symptoms, negatively affect mood, interfere with the ability to carry out everyday activities, and negatively impact on quality of life. Educational interventions may help people to manage this fatigue or to cope with this symptom, and reduce its overall burden. Despite the importance of education for managing cancer-related fatigue there are currently no systematic reviews examining this approach. Objectives: To determine the effectiveness of educational interventions for managing cancer-related fatigue in adults. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, OTseeker and PEDro up to 1st November 2016. We also searched trials registries. Selection criteria: We included randomised controlled trials (RCTs) of educational interventions focused on cancer-related fatigue where fatigue was a primary outcome. Studies must have aimed to evaluate the effect of educational interventions designed specifically to manage cancer-related fatigue, or to evaluate educational interventions targeting a constellation of physical symptoms or quality of life where fatigue was the primary focus. The studies could have compared educational interventions with no intervention or wait list controls, usual care or attention controls, or an alternative intervention for cancer-related fatigue in adults with any type of cancer. Data collection and analysis: Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. Trial authors were contacted for additional information. A third independent person checked the data extraction. The main outcome considered in this review was cancer-related fatigue. We assessed the evidence using GRADE and created a 'Summary of Findings' table. Main results: We included 14 RCTs with 2213 participants across different cancer diagnoses. Four studies used only 'information-giving' educational strategies, whereas the remainder used mainly information-giving strategies coupled with some problem-solving, reinforcement, or support techniques. Interventions differed in delivery including: mode of delivery (face to face, web-based, audiotape, telephone); group or individual interventions; number of sessions provided (ranging from 2 to 12 sessions); and timing of intervention in relation to completion of cancer treatment (during or after completion). Most trials compared educational interventions to usual care and meta-analyses compared educational interventions to usual care or attention controls. Methodological issues that increased the risk of bias were evident including lack of blinding of outcome assessors, unclear allocation concealment in over half of the studies, and generally small sample sizes. Using the GRADE approach, we rated the quality of evidence as very low to moderate, downgraded mainly due to high risk of bias, unexplained heterogeneity, and imprecision. There was moderate quality evidence of a small reduction in fatigue intensity from a meta-analyses of eight studies (1524 participants; standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.52 to -0.04) comparing educational interventions with usual care or attention control. We found low quality evidence from twelve studies (1711 participants) that educational interventions had a small effect on general/overall fatigue (SMD -0.27, 95% CI -0.51 to -0.04) compared to usual care or attention control. There was low quality evidence from three studies (622 participants) of a moderate size effect of educational interventions for reducing fatigue distress (SMD -0.57, 95% CI -1.09 to -0.05) compared to usual care, and this could be considered clinically significant. Pooled data from four studies (439 participants) found a small reduction in fatigue interference with daily life (SMD -0.35, 95% CI -0.54 to -0.16; moderate quality evidence). No clear effects on fatigue were found related to type of cancer treatment or timing of intervention in relation to completion of cancer treatment, and there were insufficient data available to determine the effect of educational interventions on fatigue by stage of disease, tumour type or group versus individual intervention. Three studies (571 participants) provided low quality evidence for a reduction in anxiety in favour of the intervention group (mean difference (MD) -1.47, 95% CI -2.76 to -0.18) which, for some, would be considered clinically significant. Two additional studies not included in the meta-analysis also reported statistically significant improvements in anxiety in favour of the educational intervention, whereas a third study did not. Compared with usual care or attention control, educational interventions showed no significant reduction in depressive symptoms (four studies, 881 participants, SMD -0.12, 95% CI -0.47 to 0.23; very low quality evidence). Three additional trials not included in the meta-analysis found no between-group differences in the symptoms of depression. No between-group difference was evident in the capacity for activities of daily living or physical function when comparing educational interventions with usual care (4 studies, 773 participants, SMD 0.33, 95% CI -0.10 to 0.75) and the quality of evidence was low. Pooled evidence of low quality from two of three studies examining the effect of educational interventions compared to usual care found an improvement in global quality of life on a 0-100 scale (MD 11.47, 95% CI 1.29 to 21.65), which would be considered clinically significant for some. No adverse events were reported in any of the studies. Authors' conclusions: Educational interventions may have a small effect on reducing fatigue intensity, fatigue's interference with daily life, and general fatigue, and could have a moderate effect on reducing fatigue distress. Educational interventions focused on fatigue may also help reduce anxiety and improve global quality of life, but it is unclear what effect they might have on capacity for activities of daily living or depressive symptoms. Additional studies undertaken in the future are likely to impact on our confidence in the conclusions. The incorporation of education for the management of fatigue as part of routine care appears reasonable. However, given the complex nature of this symptom, educational interventions on their own are unlikely to optimally reduce fatigue or help people manage its impact, and should be considered in conjunction with other interventions. Just how educational interventions are best delivered, and their content and timing to maximise outcomes, are issues that require further research

Case 5 : Let’s Agree to Agree: Management Techniques in Calibrating Oral Health Screening Systems

In 2014, Lisa Montebello, a Registered Dental Hygienist and Master of Public Health candidate at the Interfaculty program in Public Health, Western University, was working during her practicum with Dr. Mark Gracey, Oral Health Manager of the Middlesex-London Health Unit (MLHU), in London, Ontario, Canada. Her objective was to formulate a clinical calibration assessment and recommendation report. Clinical calibration is a comparison of agreement between clinicians, or against a verified standard, to achieve a clinical gold standard. Dr. Gracey was responsible for following the Ontario Public Health Standards (OPHS) protocols to ensure that all Grade 2 children in the Middlesex-London area were receiving equitable access to oral health care services through oral health screenings. There were over 120 schools with five registered dental hygienists (RDHs), along with five dental assistants (DAs) providing this service through the school screening program. After a calibration review slide session the year before, it was found that the RDHs were rating the oral health care needs of children inconsistently. This posed a dilemma for both Dr. Gracey and Lisa, as vulnerable children with urgent dental care needs may be missed as a result. There was also no standardized recommended statistical analysis in place at MLHU to analyze the data from the calibration sessions. Lisa needed to come up with a best practice guideline for clinical calibration, including statistical analysis recommendations, so that the MLHU could ensure that no child was overlooked due to inconsistent measurement outputs. Lisa had just 8 weeks to observe and assess the entire current calibration system in place, and to formulate a report for the oral health team at the MLHU