500 research outputs found
Effectiveness and cost-effectiveness of a telehealth intervention to support the management of long-term conditions:study protocol for two linked randomized controlled trials
As the population ages, more people are suffering from long-term health conditions (LTCs). Health services around the world are exploring new ways of supporting people with LTCs and there is great interest in the use of telehealth: technologies such as the Internet, telephone and home self-monitoring
Factors contributing to high performance of sows in free farrowing systems
BackgroundPressure to abolish farrowing crates is increasing, and producers are faced with decisions about which alternative system to adopt. For sow welfare, well designed free farrowing systems without close confinement are considered optimal but producers have concerns about increased piglet mortality, particularly crushing by the sow. Reporting accurate performance figures from commercial farms newly operating such systems could inform the transition process. This study investigated performance on three commercial farms operating four different zero-confinement systems, three of which were newly installed. A total of 3212 litters from 2920 sows were followed from farrowing to weaning over a three-year period with key performance indicators (KPIs) recorded. Mixed Models (LMMs, GLMMs) determined the influence of different factors (e.g. farrowing system, sow parity, management aspects) and litter characteristics on performance, including levels and causes of piglet mortality.ResultsPiglet mortality was significantly influenced by farm/system. Live-born mortality ranged from 10.3 to 20.6% with stillbirths ranging from 2.5 to 5.9%. A larger litter size and higher parity resulted in higher levels of mortality regardless of system. In all systems, crushing was the main cause of piglet mortality (59%), but 31% of sows did not crush any piglets, whilst 26% crushed only one piglet and the remaining sows (43%) crushed two or more piglets. System significantly influenced crushing as a percentage of all deaths, with the system with the smallest spatial footprint (m2) compared to the other systems, recording the highest levels of crushing. Time from the start of the study influenced mortality, with significant reductions in crushing mortality (by ~ 4%) over the course of the three-year study. There was a highly significant effect of length of time (days) between moving sows into the farrowing accommodation and sows farrowing on piglet mortality (P < 0.001). The less time between sows moving in and farrowing, the higher the levels of piglet mortality, with ~ 3% increase in total mortality every five days. System effects were highly significant after adjusting for parity, litter size, and days pre-farrowing.ConclusionThese results from commercial farms demonstrate that even sows that have not been specifically selected for free farrowing are able, in many cases, to perform well in these zero-confinement systems, but that a period of adaptation is to be expected for overall farm performance. There are performance differences between the farms/systems which can be attributed to individual farm/system characteristics (e.g. pen design and management, staff expertise, pig genotypes, etc.). Higher parity sows and those producing very large litters provide a greater challenge to piglet mortality in these free farrowing systems (just as they do in crate systems). Management significantly influences performance, and ensuring sows have plenty of time to acclimatise between moving in to farrowing accommodation and giving birth is a critical aspect of improving piglet survival
Reconciling competing priorities in commissioning: the future of bone densitometry service for North Wales
BACKGROUND: Osteoporosis creates brittle bones susceptible to fracture, with resulting high levels of morbidity and mortality. Poor access to bone densitometry services for the residents of North Wales led to the Welsh Assembly Government offering capital to purchase a dual-energy X-ray absorptiometry (DXA) scanner, used to diagnose osteoporosis, for the region. The commissioning question for the six Local Health Boards across North Wales was where to site the new scanner. This decision needed to reflect current inequalities in access to services and concerns over inappropriate prescribing relative to Welsh norms. METHODS: Epidemiological, corporate and comparative healthcare needs assessments were performed. In addition, two cross-sectional surveys were conducted to determine the views of general practices and users of bone densitometry services resident in North Wales. An option appraisal and sensitivity analysis of 13 costed options for DXA scanning was conducted. RESULTS: We estimated that only 31% of the people in North Wales who met national guidelines were receiving DXA scans. There was definite inequity of access to the current service provided by area of residence. There was also evidence of inequity of access by age and sex. The most suitable option identified in the option appraisal was a bone densitometry service based in the central location of Llandudno. CONCLUSION: The assessment identified significant unmet need for DXA scanning. A recommendation was made to improve access through the introduction of a new bone densitometry service based at Llandudno. This would double scanning provision provided and reduce travel costs and time for many North Wales residents. This recommendation was adopted by a joint commissioning group established by the six Local Health Boards in North Wales at the end of 2004 – evidence based commissioning in practice
Changing population characteristics, effect-measure modification, and cancer risk factor identification
Epidemiologic studies have identified a number of lifestyle factors, e.g. diet, obesity, and use of certain medications, which affect risk of colon cancer. However, the magnitude and significance of risk factor-disease associations differ among studies. We propose that population trends of changing prevalence of risk factors explains some of the variability between studies when factors that change prevalence also modify the effect of other risk factors. We used data collected from population-based control who were selected as study participants for two time periods, 1991–1994 and 1997–2000, along with data from the literature, to examine changes in the population prevalence of aspirin and non-steroidal anti-inflammatory medication (NSAID) use, obesity, and hormone replacement therapy (HRT) over time. Data from a population-based colon cancer case-control study were used to estimate effect-measurement modification among these factors. Sizeable changes in aspirin use, HRT use, and the proportion of the population that is obese were observed between the 1980s and 2000. Use of NSAIDs interacted with BMI and HRT; HRT use interacted with body mass index (BMI). We estimate that as the prevalence of NSAIDs use changed from 10% to almost 50%, the colon cancer relative risk associated with BMI >30 would change from 1.3 to 1.9 because of the modifying effect of NSAIDs. Similarly, the relative risk estimated for BMI would increase as the prevalence of use of HRT among post-menopausal women increased. In conclusion, as population characteristics change over time, these changes may have an influence on relative risk estimates for colon cancer for other exposures because of effect-measure modification. The impact of population changes on comparability between epidemiologic studies can be kept to a minimum if investigators assess exposure-disease associations within strata of other exposures, and present results in a manner that allows comparisons across studies. Effect-measure modification is an important component of data analysis that should be evaluated to obtain a complete understanding of disease etiology
A note on the use of drag partition in aeolian transport models
Sediment transport equations used in wind erosion and dust emission models generally incorporate a threshold for particle motion (u*t) with a correction function to account for roughness-induced momentum reduction and aerodynamic sheltering. The prevailing approach is to adjust u*t by the drag partition R, estimated as the ratio of the bare soil threshold (u*ts) to that of the surface in the presence of roughness elements (u*tr). Here, we show that application of R to adjust only the entrainment threshold (u*t = u*ts/R) is physically inconsistent with the effect of roughness on the momentum partition as represented in models and produces overestimates of the sediment flux density (Q). Equations for Q typically include a friction velocity scaling term (u*n). As Q scales with friction velocity at the soil surface (us*), rather than total friction velocity (u*) acting over the roughness layer, u*n must be also adjusted for roughness effects. Modelling aeolian transport as a function of us* represents a different way of thinking about the application of some drag partition schemes but is consistent with understanding of aeolian transport physics. We further note that the practice of reducing Q by the vegetation cover fraction to account for the physically-protected surface area constitutes double accounting of the surface protection when R is represented through the basal-to-frontal area ratio of roughness elements (σ) and roughness density (λ). If the drag partition is implemented fully, additional adjustment for surface protection is unnecessary to produce more accurate aeolian transport estimates. These findings apply equally to models of the vertical dust flux
Depression in Visual Impairment Trial (DEPVIT): A Randomized Clinical Trial of Depression Treatments in People With Low Vision
Purpose: The purpose of this study was to compare two interventions for depression, problem solving treatment (PST) and referral to the patient\u27s physician, with a waiting-list control group in people with sight loss and depressive symptoms.
Methods: This was an assessor-masked, exploratory, multicenter, randomized clinical trial, with concurrent economic analysis. Of 1008 consecutive attendees at 14 low-vision rehabilitation centers in Britain, 43% (n = 430) screened positive for depressive symptoms on the Geriatric Depression Scale and 85 of these attendees participated in the trial. Eligible participants were randomized in the ratio 1:1:1 to PST, referral to their physician, or a waiting-list control arm. PST is a manualized talking intervention delivered by a trained therapist who teaches people over six to eight sessions to implement a seven-step method for solving their problems. Referral to the physician involved sending a referral letter to the person\u27s physician, encouraging him or her to consider treatment according to the stepped care protocol recommended by the U.K.\u27s National Institute of Health and Care Excellence. The primary outcome was change in depressive symptoms (6 months after baseline) as determined by the Beck Depression Inventory.
Results: At 6 months, Beck Depression Inventory scores reduced by 1.05 (SD 8.85), 2.11 (SD 7.60), and 2.68 (SD 7.93) in the waiting-list control, referral, and PST arms, respectively. The cost per patient of the PST intervention was £1176 in Wales and £1296 in London.
Conclusions: Depressive symptoms improved most in the PST group and least in the control group. However, the change was small and the uncertainty of the measurements relatively large
Trans-Pacific doctoral success: A collaborative cohort model
The San Jose Gateway PhD program is a doctoral partnership between the School of Information at San Jose State University (SJSU) in the USA, and the Information Systems School at the Queensland University of Technology (QUT) in Australia. Because of Californian legislation, SJSU has not been able to offer PhD degrees. The Gateway Program therefore provides a research pathway for SJSU’s coursework students. It also helps the School to grow the research capacity of academic staff. For QUT, the Program provides the opportunity to advance research agendas and to build strong international connections and partnerships. The Program began in 2008. It is a distance-delivered cohort-based scheme with new students commencing in August of each year. All students are enrolled as part-time students in QUT’s Doctor of Philosophy. Each student is assigned supervisors from both universities. In addition to individual and group supervisory meetings, all students and supervisors meet in a virtual meeting space once a month. The online monthly meetings are supplemented by two residential events each year: (i) a one week face to face residential in August at San Jose State University, and; (ii) an online residential in March. This paper will critically reflect upon this unique Program, which has led to high quality research outcomes, rapid completions, and noteworthy graduate employments. Critical consideration of the challenges and future proofing of the approach will also be explored
A Value-Based Approach to Increase Breast Cancer Screening and Health-Directed Behaviors among American Indian Women
American Indian/Alaska Native (AI/AN) women have the lowest cancer-screening rate of any ethnic or racial group; AI/AN women in all regions are less likely than non-Hispanic white women to be diagnosed with localized breast cancer; and those AI/AN women presenting with breast cancer have the lowest 5-year survival rate compared to other ethnic groups. This study found that cultural beliefs are more of a factor in mammography screening behavior than other barriers such as access; and that a more holistic educational intervention designed by AI/AN women prompted individual intent and actions to seek mammograms among AI/AN women >40 and to change unhealthy eating and sedentary lifestyles
3C. 3-Ketosteroid receptors (version 2019.4) in the IUPHAR/BPS Guide to Pharmacology Database
Steroid hormone receptors (nomenclature as agreed by the NC-IUPHAR Subcommittee on Nuclear Hormone Receptors [65, 193]) are nuclear hormone receptors of the NR3 class, with endogenous agonists that may be divided into 3-hydroxysteroids (estrone and 17β-estradiol) and 3-ketosteroids (dihydrotestosterone [DHT], aldosterone, cortisol, corticosterone, progesterone and testosterone)
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