SurgiCal Obesity Treatment Study (SCOTS): protocol for a national prospective cohort study of patients undergoing bariatric surgery in Scotland.

Introduction The efficacy of bariatric surgery for large-scale, long-term weight loss is well established. However, many questions remain over the continual benefits and cost-effectiveness of that weight loss for overall health, particularly when accounting for potential complications and adverse events of surgery. Health research institutes in the UK and the USA have called for high-quality longitudinal cohort studies of patients undergoing bariatric surgery, assessing outcomes such as surgical complications, mortality, diabetes remission, microvascular complications, cardiovascular events, mental health, cost and healthcare use. Methods and analysis SurgiCal Obesity Treatment Study (SCOTS) is a national, prospective, observational, cohort study of patients undergoing primary bariatric surgical procedures in Scotland. This study aims to recruit 2000 patients and conduct a follow-up for 10 years postbariatric surgery using multiple data collection methods: surgeon-recorded data, electronic health record linkage, and patient-reported outcome measures. Outcomes measured will include: mortality, weight change, diabetes, surgical, cardiovascular, cancer, behavioural, reproductive/urological and nutritional variables. Healthcare utilisation and economic productivity will be collected to inform cost-effectiveness analysis. Ethics and dissemination The study has received a favourable ethical opinion from the West of Scotland Research Ethics committee. All publications arising from this cohort study will be published in open-access peer-reviewed journals. All SCOTS investigators (all members of the research team at every recruiting site) will have the ability to propose research suggestions and potential publications using SCOTS data; a publications committee will approve all requests for use of SCOTS data and propose writing committees and timelines. Lay-person summaries of all research findings will be published simultaneously on the SCOTS website (http://www.scotsurgeystudy.org.uk)

Standardization as situation-specific achievement: regulatory diversity and the production of value in intercontinental collaborations in stem cell medicine

The article examines the role and challenges of scientific self-governance and standardization in inter-continental clinical research partnerships in stem cell medicine. The paper shows that – due to a high level of regulatory diversity – the enactment of internationally recognized standards in multi-country stem cell trials is a complex and highly situation-specific achievement. Standardization is imposed on a background of regulatory, institutional and epistemic-cultural heterogeneity, and implemented exclusively in the context of select clinical projects. Based on ethnographic data from the first trans-continental clinical trial infrastructure in stem cell medicine between China and the USA, the article demonstrates that locally evolved and international forms of experimental clinical research practices often co-exist in the same medical institutions. Researchers switch back and forth between these schemas, depending on the purposes of their research, the partners they work with, the geographic scale of research projects, and the contrasting demands for regulatory review, that result from these differences. Drawing on Birch’s analysis of the role of standardization in international forms of capital production in the biosciences, the article argues that the integration of local knowledge institutions into the global bioeconomy does not necessarily result in the shutting down of localized forms of value production. In emerging fields of medical research, that are regulated in highly divergent ways across geographical regions, the coexistence of distinct modes of clinical translation allows also for the production of multiple forms of economic value, at varying spatial scales. This is especially so in countries with lenient regulations. As this paper shows, the long-standing absence of a regulatory framework for clinical stem cell applications in China, permits the situation-specific adoption of internationally recognized standards in some contexts, while enabling the continuation of localized forms of value production in others

The Wnt5a Receptor, Receptor Tyrosine Kinase-Like Orphan Receptor 2, Is a Predictive Cell Surface Marker of Human Mesenchymal Stem Cells with an Enhanced Capacity for Chondrogenic Differentiation

Multipotent mesenchymal stem cells (MSCs) have enormous potential in tissue engineering and regenerative medicine. However until now their development for clinical use has been severely limited as they are a mixed population of cells with varying capacities for lineage differentiation and tissue formation. Here we identify ROR2 as a cell surface marker expressed by those MSCs with an enhanced capacity for cartilage formation. We generated clonal human MSC populations with varying capacities for chondrogenesis. ROR2 was identified through screening for upregulated genes in the most chondrogenic clones. When isolated from un-cloned populations, ROR2+ve MSCs were significantly more chondrogenic than either ROR2-ve or unfractionated MSCs. In a sheep cartilage-repair model they produced significantly more defect filling with no loss of cartilage quality compared with controls. ROR2+ve MSCs/perivascular cells were present in developing human cartilage, adult bone marrow and adipose tissue. Their frequency in bone marrow was significantly lower in patients with osteoarthritis than in controls. However after isolation of these cells and their initial expansion in vitro, there was greater ROR2 expression in the population derived from osteoarthritis patients compared with controls. Furthermore, osteoarthritis-derived MSCs were better able to form cartilage than MSCs from control patients in a tissue engineering assay. We conclude that MSCs expressing high levels of ROR2 provide a defined population capable of predictably enhanced cartilage production. This article is protected by copyright. All rights reserved

Venue Shift Following Devolution: When Reserved Meets Devolved in Scotland

This article examines the means used to address blurred or shifting boundaries between reserved UK and devolved Scottish policy. It outlines the main issues of multi-level governance and intergovernmental relations in Scotland and the initial problems faced in identifying responsibility for policy action. While it suggests that legislative ambiguities are now mainly resolved with the use of ‘Sewel motions', it highlights cases of Scottish action in reserved areas, including the example of smoking policy in which the Scottish Executive appears to ‘commandeer' a previously reserved issue. However, most examples of new Scottish influence suggest the need for UK support or minimal UK interest

The diffusion of policy in contexts of practice : flexible delivery in Australian vocational education and training

Significant changes have occurred over the last decade within the Australian Vocational Education and Training (VET) system. Not least amongst these has been a shift from a predominantly traditional face-to-face classroom model of programme delivery to more flexible models informed by the needs of clients. To lead this revolution, in 1991 the Australian Commonwealth and State Ministers for Training established the Flexible Delivery Working Party. A series of reports followed that sought to develop a policy framework, including a definition of flexible delivery, and its principles and characteristics. Despite these efforts, project funding and national staff development initiatives, several difficulties have been experienced in the ‘take-up’ of flexible delivery; problems that we argue are related to how the dissemination of innovative practice is conceived. Specifically, the literature and research on the diffusion of innovations points to the efficacy of informal social networks ‘in which individuals adopt the new idea as a result of talking with other individuals who have already adopted it’ (Valente, 1995, p. ix). Following a discussion of these issues, the article concludes by arguing the need for research of innovative practice transfer within VET in Australia, using qualitative case study in order to develop an in-depth and rich description of the process, and facilitate greater understanding of how it works in practice

Referral patterns and attitudes of Primary Care Physicians towards chiropractors

BACKGROUND: Despite the increasing usage and popularity of chiropractic care, there has been limited research conducted to examine the professional relationships between conventional trained primary care physicians (PCPs) and chiropractors (DCs). The objectives of our study were to contrast the intra-professional referral patterns among PCPs with referral patterns to DCs, and to identify predictors of PCP referral to DCs. METHODS: We mailed a survey instrument to all practicing PCPs in the state of Iowa. Descriptive statistics were used to summarize their responses. Multivariable logistic regression analyses were conducted to identify demographic factors associated with inter-professional referral behaviors. RESULTS: A total of 517 PCPs (33%) participated in the study. PCPs enjoyed strong intra-professional referral relationships with other PCPs. Although patients exhibited a great deal of interest in chiropractic care, PCPs were unlikely themselves to make formal referral relationships with DCs. PCPs in a private practice arrangement were more likely to exhibit positive referral attitudes towards DCs (p = 0.01). CONCLUSION: PCPs enjoy very good professional relationships with other PCPs. However, the lack of direct formalized referral relationships between PCPs and chiropractors has implications for efficiency, continuity, quality, and patient safety in the health care delivery system. Future research must focus on identifying facilitators and barriers for developing positive relationships between PCPs and chiropractors

An investigation into the validity of cervical spine motion palpation using subjects with congenital block vertebrae as a 'gold standard'

BACKGROUND: Although the effectiveness of manipulative therapy for treating back and neck pain has been demonstrated, the validity of many of the procedures used to detect joint dysfunction has not been confirmed. Practitioners of manual medicine frequently employ motion palpation as a diagnostic tool, despite conflicting evidence regarding its utility and reliability. The introduction of various spinal models with artificially introduced 'fixations' as an attempt to introduce a 'gold standard' has met with frustration and frequent mechanical failure. Because direct comparison against a 'gold standard' allows the validity, specificity and sensitivity of a test to be calculated, the identification of a realistic 'gold standard' against which motion palpation can be evaluated is essential. The objective of this study was to introduce a new, realistic, 'gold standard', the congenital block vertebra (CBV) to assess the validity of motion palpation in detecting a true fixation. METHODS: Twenty fourth year chiropractic students examined the cervical spines of three subjects with single level congenital block vertebrae, using two commonly employed motion palpation tests. The examiners, who were blinded to the presence of congenital block vertebrae, were asked to identify the most hypomobile segment(s). The congenital block segments included two subjects with fusion at the C2–3 level and one with fusion at C5-6. Exclusion criteria included subjects who were frankly symptomatic, had moderate or severe degenerative changes in their cervical spines, or displayed signs of cervical instability. Spinal levels were marked on the subject's skin overlying the facet joints from C1 to C7 bilaterally and the motion segments were then marked alphabetically with 'A' corresponding to C1-2. Kappa coefficients (K) were calculated to determine the validity of motion palpation to detect the congenitally fused segments as the 'most hypomobile' segments. Sensitivity and specificity of the diagnostic procedure were also calculated. RESULTS: Kappa coefficients (K) showed substantial overall agreement for identification of the segment of greatest hypomobility (K = 0.65), with substantial (K = 0.76) and moderate (K = 0.46) agreement for hypomobility at C2-3 and C5-6 respectively. Sensitivity ranged from 55% at the C5-6 CBV to 78% at the C2-3 level. Specificity of the procedure was high (91 – 98%). CONCLUSION: This study indicates that relatively inexperienced examiners are capable of correctly identifying inter-segmental fixations (CBV) in the cervical spine using 2 commonly employed motion palpation tests. The use of a 'gold standard' (CBV) in this study and the substantial agreement achieved lends support to the validity of motion palpation in detecting major spinal fixations in the cervical spine

Herbage nutritive value of binary- and multi-species swards relative to single-species swards in intensive silage systems

peer-reviewedThe nutritive value of sown binary- and multi-species grassland mixtures may differ from the values expected based on single-species swards of their constituent species. Field plots were established in a split-plot design to assess the nutritive value of binary- and multi-species mixtures compared to single-species swards of three grass species and red clover (RC) (Trifolium pratense L.) managed for intensive silage production. The nutritive value of grass–legume binary mixtures reflected the values of the constituent species grown on their own, and thus may be predicted from monoculture values. The relatively low digestibility (dry matter digestibility [DMD]) and crude protein (CP) content of the Italian ryegrass (Lolium multiflorum L.) sward compared to perennial ryegrass (Lolium perenne L.) and timothy (Phleum pratense L.) suggests that it may have a limited role in binary- or multi-species swards. Herbage nutritive value in the multi-species swards (Mix 1: perennial ryegrass, timothy, RC and white clover [Trifolium repens L.]; Mix 2: perennial ryegrass, timothy, RC, ribwort plantain [Plantago lanceolata L.] and chicory [Cichorium intybus L.] ) appeared to be influenced more by the presence of legumes than herbs. Compared to perennial ryegrass, the multi-species swards had a slower rate of DMD decline prior to Cut 1, but subsequently had lower DMD values at the mid-season harvests. Both multi-species mixtures exhibited DMD, water-soluble carbohydrate (WSC) and CP values that would not have been predicted from their constituent species and thus need to be measured on herbage from field plots growing these mixtures