A study of group dynamics in the South African dairy industry: A sequential Malmquist approach

This study presents a sequential Malmquist index for twenty members of an Eastern Cape dairy study group for the period 2010 to 2013. On average these farms were at efficiency levels of 95% and more during this period. The group’s mean technical progress was 11% per year. This resulted in productivity growth of almost 14% per year. However, these estimates are probably inflated as they were obtained with the combination of a small dataset and a large model. The group is a success because it transfers knowledge and enables innovation. We found weak support for the belief that it is beneficial to operate mixed breed herds and showed that less intensively managed or smaller herds did better than larger herds or herds managed for the maximum amount of milk per cow. Productivity growth was positively correlated with various proxies for knowledge. It increased with self-sufficiency in hay production and expenditure on concentrates, and was inversely related to the unit hay cost. Rainfall was positively correlated with self-sufficiency but not with unit hay cost or productivity. To conclude: study groups could a useful tool for driving innovation in any industry. Innovation can happen quickly but is complex, and therefore it helps to have a single metric of progress. Good data are needed to develop accurate measures of innovation, but if available could be the difference between noting a potential disaster in time and failing altogether

Flow

Within us and around us flows the power to heal ~ open through song, image, poetry & breath

The Development of a New Scale to Measure Food Insecurity Among Older Adults Using the International Classification of Functioning, Disability, and Health (ICF) Framework

Background: Older adults face different barriers to accessing adequate food, and none of the current food security scales address the unique issues that aging could present to food security among this population. Purpose: This study aims to understand the components of nutrition functioning in relation to food insecurity among older adults to develop a food insecurity screening tool specific to the older adult population. Methods: Cross-sectional qualitative study with semi-structured interviews. The interviews occurred via Google Voice and were simultaneously recorded using Zoom. Two researchers coded transcriptions from interview audio recordings separately, and thematic analysis based on the International Classification of Functioning, Disability, and Health (ICF) was used to analyze the data. The findings were deliberated between all the researchers, and the final themes, subthemes, and representative quotes were mutually agreed upon. Results: Twenty-three older adults living in independent senior living facilities were interviewed. Nine themes (transportation, access/variety, housing, mobility & aging, preparing food, interpersonal relationship, food assistance, dentition/ingestion/digestion, health conditions) and twenty-two subthemes were identified. The results demonstrated that lack of transportation, interpersonal relationships, health-related conditions, and financial constraints were this population\u27s principal barriers to accessing and preparing adequate food. Discussion: Food insecurity among older adults is a multi-dimension issue. A new scale to measure food insecurity among older adults was created to provide a more accurate assessment of food security risk in this population. Future research should validate this scale in different settings

Measuring the Phytochemical Richness of Meat: Effects of Grass/Grain Finishing Systems and Grapeseed Extract Supplementation on the Fatty Acid and Phytochemical Content of Beef

Grass-finished beef (GFB) can provide beneficial bioactive compounds to healthy diets, including omega-3 polyunsaturated fatty acids (n-3 PUFAs), conjugated linoleic acid (CLA), and secondary bioactive compounds, such as phytochemicals. The objective of this study was to compare fatty acids (FAs), micronutrients, and phytochemicals of beef fed a biodiverse pasture (GRASS), a total mixed ration (GRAIN), or a total mixed ration with 5% grapeseed extract (GRAPE). This was a two-year study involving fifty-four Red Angus steers (n = 54). GFB contained higher levels of n-3 PUFAs, vitamin E, iron, zinc, stachydrine, hippuric acid, citric acid, and succinic acid than beef from GRAIN and GRAPE (p \u3c 0.001 for all). No differences were observed in quantified phytochemicals between beef from GRAIN and GRAPE (p \u3e 0.05). Random forest analysis indicated that phytochemical and FA composition of meat can predict cattle diets with a degree of certainty, especially for GFB (5.6% class error). In conclusion, these results indicate that GFB contains higher levels of potentially beneficial bioactive compounds, such as n-3 PUFAs, micronutrients, and phytochemicals, compared to grain-finished beef. Additionally, the n-6:n-3 ratio was the most crucial factor capable of separating beef based on finishing diets

Natriuresis guided therapy in acute heart failure:rationale and design of the Pragmatic Urinary Sodium-based Treatment algoritHm in Acute Heart Failure (PUSH-AHF) trial

AIMS: Insufficient diuretic response frequently occurs in patients admitted for acute heart failure (HF) and is associated with worse clinical outcomes. Recent studies have shown that measuring natriuresis early after hospital admission could reliably identify patients with a poor diuretic response during hospitalization who might require enhanced diuretic treatment. This study will test the hypothesis that natriuresis guided therapy in patients with acute HF improves natriuresis and clinical outcomes. METHODS: The Pragmatic Urinary Sodium-based Treatment algoritHm in Acute Heart Failure (PUSH-AHF) is a pragmatic, single-centre, randomized, controlled, open-label study, aiming to recruit 310 acute HF patients requiring treatment with intravenous loop diuretics. Patients will be randomized to natriuresis guided therapy or standard of care. Natriuresis will be determined at set time points after initiation of intravenous loop diuretics, and treatment will be adjusted based on the urinary sodium levels in the natriuresis guided group using a pre-specified stepwise approach of increasing doses of loop diuretics and the initiation of combination diuretic therapy. The co-primary endpoint is 24-hour urinary sodium excretion after start of loop diuretic therapy and a combined endpoint of all-cause mortality or first HF rehospitalization at 6 months. Secondary endpoints include 48- and 72-hour sodium excretion, length of hospital stay, and percentage change in N-terminal pro Brain Natriuretic Peptide at 48 and 72 hours. CONCLUSION: The PUSH-AHF study will investigate whether natriuresis guided therapy, using a pre-specified stepwise diuretic treatment approach, improves natriuresis and clinical outcomes in patients with acute HF. This article is protected by copyright. All rights reserved

Natriuresis-guided diuretic therapy in acute heart failure:a pragmatic randomized trial

Measurement of natriuresis has been suggested as a reliable, easily obtainable biomarker for assessment of the response to diuretic treatment in patients with acute heart failure (AHF). Here, to assess whether natriuresis-guided diuretic therapy in patients with AHF improves natriuresis and clinical outcomes, we conducted the pragmatic, open-label Pragmatic Urinary Sodium-based algoritHm in Acute Heart Failure trial, in which 310 patients (45% female) with AHF requiring treatment with intravenous loop diuretics were randomly assigned to natriuresis-guided therapy or standard of care (SOC). In the natriuresis-guided arm, natriuresis was determined at set timepoints, prompting treatment intensification if spot urinary sodium levels were &lt;70 mmol l -1. The dual primary endpoints were 24 h urinary sodium excretion and a combined endpoint of time to all-cause mortality or adjudicated heart failure rehospitalization at 180 days. The first primary endpoint was met, as natriuresis in the natriuresis-guided and SOC arms was 409 ± 178 mmol arm versus 345 ± 202 mmol, respectively (P = 0.0061). However, there were no significant differences between the two arms for the combined endpoint of time to all-cause mortality or first heart failure rehospitalization, which occurred in 46 (31%) and 50 (31%) of patients in the natriuresis-guided and SOC arms, respectively (hazard ratio 0.92 [95% confidence interval 0.62-1.38], P = 0.6980). These findings suggest that natriuresis-guided therapy could be a first step towards personalized treatment of AHF. ClinicalTrials.gov registration: NCT04606927 . </p

Natriuresis-guided diuretic therapy in acute heart failure:a pragmatic randomized trial

Measurement of natriuresis has been suggested as a reliable, easily obtainable biomarker for assessment of the response to diuretic treatment in patients with acute heart failure (AHF). Here, to assess whether natriuresis-guided diuretic therapy in patients with AHF improves natriuresis and clinical outcomes, we conducted the pragmatic, open-label Pragmatic Urinary Sodium-based algoritHm in Acute Heart Failure trial, in which 310 patients (45% female) with AHF requiring treatment with intravenous loop diuretics were randomly assigned to natriuresis-guided therapy or standard of care (SOC). In the natriuresis-guided arm, natriuresis was determined at set timepoints, prompting treatment intensification if spot urinary sodium levels were &lt;70 mmol l -1. The dual primary endpoints were 24 h urinary sodium excretion and a combined endpoint of time to all-cause mortality or adjudicated heart failure rehospitalization at 180 days. The first primary endpoint was met, as natriuresis in the natriuresis-guided and SOC arms was 409 ± 178 mmol arm versus 345 ± 202 mmol, respectively (P = 0.0061). However, there were no significant differences between the two arms for the combined endpoint of time to all-cause mortality or first heart failure rehospitalization, which occurred in 46 (31%) and 50 (31%) of patients in the natriuresis-guided and SOC arms, respectively (hazard ratio 0.92 [95% confidence interval 0.62-1.38], P = 0.6980). These findings suggest that natriuresis-guided therapy could be a first step towards personalized treatment of AHF. ClinicalTrials.gov registration: NCT04606927 . </p

Clinical importance of urinary sodium excretion in acute heart failure

Aims: Urinary sodium assessment has recently been proposed as a target for loop diuretic therapy in acute heart failure (AHF). We aimed to investigate the time course, clinical correlates and prognostic importance of urinary sodium excretion in AHF. Methods and results: In a prospective cohort of 175 consecutive patients with an admission for AHF we evaluated urinary sodium excretion 6 h after initiation of loop diuretic therapy. Clinical outcome was all-cause mortality or heart failure rehospitalization. Mean age was 71 ± 14 years, and 44% were female. Median urinary sodium excretion was 130 (67–229) mmol at 6 h, 347 (211–526) mmol at 24 h, and decreased from day 2 to day 4. Lower urinary sodium excretion was independently associated with male gender, younger age, renal dysfunction and pre-admission loop diuretic use. There was a strong association between urinary sodium excretion at 6 h and 24 h urine volume (beta = 0.702, P < 0.001). Urinary sodium excretion after 6 h was a strong predictor of all-cause mortality after a median follow-up of 257 days (hazard ratio 3.81, 95% confidence interval 1.92–7.57; P < 0.001 for the lowest vs. the highest tertile of urinary sodium excretion) independent of established risk factors and urinary volume. Urinary sodium excretion was not associated with heart failure rehospitalization. Conclusion: In a modern, unselected, contemporary AHF population, low urinary sodium excretion during the first 6 h after initiation of loop diuretic therapy is associated with lower urine output in the first day and independently associated with all-cause mortality