"You don’t get side effects from social prescribing”— a qualitative study exploring community pharmacists’ attitudes to social prescribing

Objectives: Social prescribing is an approach that enables the referral of patients to non-clinical support and places a focus on holistic care. This study explored views of community pharmacists regarding social prescribing in pharmacies. Study design: A qualitative phenomenological approach was used. Methods: A convenience sample of eleven community pharmacists from Northern England were recruited via social media (Twitter, Facebook) and took part in a semi-structured, one-to-one qualitative interviews that asked about their knowledge of social prescribing, the advantages of community pharmacist involvement and any barriers they predicted to its implementation. Interviews were transcribed verbatim and thematically analysed. Results: The sample included largely male pharmacists (63.3%) with less than five years’ experience (45.5%) and included pharmacists working as employees (63.6%), locums (27.3%) and owners (9%) in both chain (36%) and independent stores (54.5%). The main findings indicate an enthusiasm for but limited understanding of social prescribing. Factors which appeared to influence involvement were training requirements and time available to complete an additional service in busy pharmacies. Opportunities centred on the broader pharmacy team’s role to optimise health outcomes. Conclusions: The findings indicate pharmacists may be an underused resource due to a poor understanding of the full scale and scope of social prescribing beyond health promotion, lifestyle interventions. Further work is needed to explore the transferability of the findings to the broader pharmacy workforce to understand how social prescribing can be positioned within pharmacy practice

Root production is determined by radiation flux in a temperate grassland community

Accurate knowledge of the response of root turnover to a changing climate is needed to predict growth and produce carbon cycle models. A soil warming system and shading were used to vary soil temperature and received radiation independently in a temperate grassland dominated by Holcus lanatus L. Minirhizotrons allowed root growth and turnover to be examined non-destructively. In two short-term (8 week) experiments, root responses to temperature were seasonally distinct. Root number increased when heating was applied during spring, but root death increased during autumnal heating. An experiment lasting 12 months demonstrated that any positive response to temperature was short-lived and that over a full growing season, soil warming led to a reduction in root number and mass due to increased root death during autumn and winter. Root respiration was also insensitive to soil temperature over much of the year. In contrast, root growth was strongly affected by incident radiation. Root biomass, length, birth rate, number and turnover were all reduced by shading. Photosynthesis in H. lanatus exhibited some acclimation to shading, but assimilation rates at growth irradiance were still lower in shaded plants. The negative effects of shading and soil warming on roots were additive. Comparison of root data with environmental measurements demonstrated a number of positive relationships with photosynthetically active radiation, but not with soil temperature. This was true both across the entire data set and within a shade treatment. These results demonstrate that root growth is unlikely to be directly affected by increased soil temperatures as a result of global warming, at least in temperate areas, and that predictions of net primary productivity should not be based on a positive root growth response to temperature

Targeted full energy and protein delivery in critically ill patients : A pilot randomized controlled trial (FEED Trial)

Background International guidelines recommend greater protein delivery to critically ill patients than they currently receive. This pilot randomized clinical trial aimed to determine whether a volume-target enteral protocol with supplemental protein delivered greater amounts of protein and energy to critically ill patients compared with standard care. Methods Sixty participants received either the intervention (volume-based protocol, with protein supplementation) or standard nutrition care (hourly-rate-based protocol, without protein supplementation) in the intensive care unit (ICU). Coprimary outcomes were average daily protein and energy delivery. Secondary outcomes included change in quadriceps muscle layer thickness (QMLT, ultrasound) and malnutrition (subjective global assessment) at ICU discharge. Results Mean (SD) protein and energy delivery per day from nutrition therapy for the intervention were 1.2 (0.30) g/kg and 21 (5.2) kcal/kg compared with 0.75 (0.11) g/kg and 18 (2.7) kcal/kg for standard care. The mean difference between groups in protein and energy delivery per day was 0.45 g/kg (95% CI, 0.33–0.56; P < .001) and 2.8 kcal/kg (95% CI, 0.67–4.9, P = .01). Muscle loss (QMLT) at discharge was attenuated by 0.22 cm (95% CI, 0.06–0.38, P = .01) in patients receiving the intervention compared with standard care. The number of malnourished patients was fewer in the intervention [2 (7%) vs 8 (28%); P = .04]. Mortality and duration of admission were similar between groups. Conclusions A high-protein volume-based protocol with protein supplementation delivered greater amounts of protein and energy. This intervention was associated with attenuation of QMLT loss and reduced prevalence of malnutrition at ICU discharge

Cognitive Impairment Predicts Fatal Incident Stroke: Findings from a National Sample of Older Adults

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87016/1/j.1532-5415.2011.03494.x.pd

Effects of isometric resistance training on resting blood pressure: individual participant data meta-analysis

Background: Previous meta-analyses based on aggregate group-level data report anti-hypertensive effects of isometric resistance training (IRT). However, individual participant data meta-analyses provide more robust effect size estimates and permit examination of demographic and clinical variables on IRT effectiveness. Methods: We conducted a systematic search and individual participant data (IPD) analysis, using both a one-step and two-step approach, of controlled trials investigating ≥3 weeks of IRT on resting systolic, diastolic and mean arterial blood pressure. Results: Anonymised individual participant data were provided from 12 studies (14 intervention group comparisons) involving 326 participants (52.7% medicated for hypertension); 191 assigned to IRT and 135 controls, 25.2% of participants had diagnosed coronary artery disease. IRT intensity varied (8-30% MVC) and training duration ranged from 3-12 weeks. The IPD (one-step) meta-analysis showed a significant treatment effect for the exercise group participants experiencing a reduction in resting systolic blood pressure (SBP) of -6.22 mmHg (95% CI -7.75, -4.68; p<0.00001); diastolic blood pressure (DBP) of -2.78 mmHg (95% CI -3.92, -1.65; p=0.002); and mean arterial blood pressure (MAP) of -4.12 mmHg (95% CI -5.39, -2.85; p<0.00001). The two-step approach yielded similar results for change in SBP -7.35 mmHg (-8.95, -5.75; p<0.00001), DBP MD -3.29 mmHg (95% CI -5.12, -1.46; p=0.0004) and MAP MD -4.63 mmHg (95% CI -6.18, -3.09: p<0.00001). Sub-analysis revealed that neither clinical, medication, nor demographic participant characteristics, or exercise program features, modified the IRT treatment effect. Conclusion: This individual patient analysis confirms a clinically meaningful and statistically significant effect of IRT on resting systolic, diastolic and mean arterial blood pressure

Differential effects of natural palm oil, chemically- and enzymatically-modified palm oil on weight gain, blood lipid metabolites and fat deposition in a pediatric pig model

<p>Abstract</p> <p>Background</p> <p>Increasing prevalence of obesity and overweight in the Western world, continue to be a major health threat and is responsible for increased health care costs. Dietary intervention studies show a strong positive association between saturated fat intake and the development of obesity and cardiovascular disease. This study investigated the effect of positional distribution of palmitic acid (Sn-1, 2 & 3) of palm oil on cardiovascular health and development of obesity, using weaner pigs as a model for young children.</p> <p>Methods</p> <p>Male and female weaner piglets were randomly allocated to 4 dietary treatment groups: 1) pork lard (LRD); 2) natural palm olein (NPO); 3) chemically inter-esterified PO (CPO) and 4) enzymatically inter-esterified PO (EnPO) as the fat source. Diets were formulated with 11% lard or with palm olein in order to provide 31% of digestible energy from fat in the diet and were balanced for cholesterol, protein and energy across treatments.</p> <p>Results</p> <p>From 8 weeks onwards, pigs on EnPO diet gained (P < 0.05) more weight than all other groups. Feed conversion efficiency (feed to gain) over the 12 week experimental period did not vary between treatment groups. Plasma LDL-C content and LDL-C/HDL-C ratio in pigs fed natural PO tended to be lower compared to all other diets. The natural PO lowered (P < 0.02) the plasma triglyceride (TG) content relative to the lard or EnPO diets, but was not different from the CPO diet. The natural PO diet was associated with lower (P < 0.05) saturated fat levels in subcutaneous adipose tissue than the CPO and EnPO diets that had lower saturated fat levels than the lard diet. Female pigs had lower lean and higher fat and fat:lean ratio in the body compared with male pigs. No difference in weight gain or blood lipid parameters was observed between sexes.</p> <p>Conclusions</p> <p>The observations on plasma TG, muscle and adipose tissue saturated fatty acid contents and back fat (subcutaneous) thickness suggest that natural palm oil may reduce deposition of body fat. In addition, dietary supplementation with natural palm oil containing palmitic acid at different positions in meat producing animals may lead to the production of meat and meat products with lower saturated fats. An increase in fat content and a decrease in lean content in female pigs resulted in an increased body fat:lean ratio but gender had no effect on blood lipid parameters or insulin concentrations.</p

An evaluation of the barotropic and internal tides in a high-resolution global ocean circulation model

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94189/1/jgr_shriveretal_hycomaltimetrytidecomparison_2012.pd

Estimating fine-root production by tree species and understorey functional groups in two contrasting peatland forests

Background and aims Estimation of root-mediated carbon fluxes in forested peatlands is needed for understanding ecosystem functioning and supporting greenhouse gas inventories. Here, we aim to determine the optimal methodology for utilizing ingrowth cores in estimating annual fine-root production (FRP) and its vertical distribution in trees, shrubs and herbs. Methods We used 3-year data obtained with modified ingrowth core method and tested two calculation methods: 'ingrowth-dividing' and `ingrowth-subtracting'. Results The ingrowth-dividing method combined with a 2-year incubation of ingrowth cores can be used for the 'best estimate' of FRP. The FRP in the nutrient-rich fen forest (561 g m(-2)) was more than twice that in the nutrient-poor bog forest (244 g m(-2)). Most FRP occurred in the top 20-cm layer (76-82 %). Tree FRP accounted for 71 % of total FRP in the bog and 94 % in the fen forests, respectively, following the aboveground vegetation patterns; however, in fen forest the proportions of spruce and birch in FRP were higher than their proportions in stand basal area. Conclusions Our methodology may be used to study peatland FRP patterns more widely and will reduce the volume of labour-intensive work, but will benefit from verification with other methods, as is the case in all in situ FRP studies.Peer reviewe

Priority III: top 10 rapid review methodology research priorities identified using a James Lind Alliance Priority Setting Partnership

Objectives A rapid review is a form of evidence synthesis considered a resource-efficient alternative to the conventional systematic review. Despite a dramatic rise in the number of rapid reviews commissioned and conducted in response to the coronavirus disease 2019 pandemic, published evidence on the optimal methods of planning, doing, and sharing the results of these reviews is lacking. The Priority III study aimed to identify the top 10 unanswered questions on rapid review methodology to be addressed by future research. Study Design and Setting A modified James Lind Alliance Priority Setting Partnership approach was adopted. This approach used two online surveys and a virtual prioritization workshop with patients and the public, reviewers, researchers, clinicians, policymakers, and funders to identify and prioritize unanswered questions. Results Patients and the public, researchers, reviewers, clinicians, policymakers, and funders identified and prioritized the top 10 unanswered research questions about rapid review methodology. Priorities were identified throughout the entire review process, from stakeholder involvement and formulating the question, to the methods of a systematic review that are appropriate to use, through to the dissemination of results. Conclusion The results of the Priority III study will inform the future research agenda on rapid review methodology. We hope this will enhance the quality of evidence produced by rapid reviews, which will ultimately inform decision-making in the context of healthcare