The effect of low volume sprint interval training in patients with non-alcoholic fatty liver disease

Objectives: Exercise is an important part of disease management in patients with non-alcoholic fatty liver disease (NAFLD), but adherence to current exercise recommendations is poor. Novel low-volume sprint interval training (SIT) protocols with total training time commitments of ≤30 min per week have been shown to improve cardiometabolic risk and functional capacity in healthy sedentary participants, but the efficacy of such protocols in the management of NAFLD remains unknown. The aim of the present study was to examine whether a low-volume SIT protocol can be used to improve liver function, insulin resistance, body composition, physical fitness, cognitive function and general well-being in patients with NAFLD.Methods: In the present study, 7 men and 2 women with NAFLD (age: 45±8 y, BMI: 28.7±4.1 kg·m−2) completed a 6-week control period followed by 6 weeks of twice-weekly SIT sessions (5-10×6-s ‘all-out’ cycle sprints). Body composition, blood pressure, liver function, metabolic function, functional capacity, cognitive function and quality of life were assessed at baseline, following the control period, and following the SIT intervention.Results: Walking speed during the walk test (+12%), estimated V̇O2max (+8%), verbal fluency (+44%), and blood platelet count (+12%; all p<0.05) significantly increased during the control period. These measures remained significantly raised compared to baseline following the SIT intervention, but did not significantly change any further compared to the post-control time-point. Diastolic blood pressure decreased from 87±10 to 77±8 mm Hg from the end of the control period to the end of the SIT intervention (p<0.05).Conclusion: This study does not support the use of 6 weeks of a low volume SIT protocol involving twice-weekly sessions with 5-10×6-s ‘all-out’ cycle sprints as an intervention for NAFLD disease management

Strategies for the treatment of Hepatitis C in an era of interferon-free therapies: what public health outcomes do we value most?

Objective: The expense of new therapies for HCV infection may force health systems to prioritise the treatment of certain patient groups over others. Our objective was to forecast the population impact of possible prioritisation strategies for the resource-rich setting of Scotland. Design: We created a dynamic Markov simulation model to reflect the HCV-infected population in Scotland. We determined trends in key outcomes (e.g. incident cases of chronic infection and severe liver morbidity (SLM)) until the year 2030, according to treatment strategies involving prioritising, either: (A) persons with moderate/advanced fibrosis or (B) persons who inject drugs (PWID). Results: Continuing to treat the same number of patients with the same characteristics will give rise to a fall in incident infection (from 600 cases in 2015 to 440 in 2030) and a fall in SLM (from 195 cases in 2015 to 145 in 2030). Doubling treatment-uptake and prioritising PWID will reduce incident infection to negligible levels (<50 cases per year) by 2025, while SLM will stabilise (at 70–75 cases per year) in 2028. Alternatively, doubling the number of patients treated, but, instead, prioritising persons with moderate/advanced fibrosis will reduce incident infection less favourably (only to 280 cases in 2030), but SLM will stabilise by 2023 (i.e. earlier than any competing strategy). Conclusions: Prioritising treatment uptake among PWID will substantially impact incident transmission, however, this approach foregoes the optimal impact on SLM. Conversely, targeting those with moderate/advanced fibrosis has the greatest impact on SLM but is suboptimal in terms of averting incident infection

RISK AND MARKET PARTICIPANT BEHAVIOR IN THE U.S. SLAUGHTER-CATTLE MARKET

Incomplete information generates uncertainty for market participants in the slaughter-cattle market. Buyer and seller behavior in the presence of that uncertainty is examined. Statistically significant risk premiums are charged by packers when buying slaughter cattle on either a live- or dressed-weight basis compared to buying on a grade-and-yield basis. Pratt-Arrow risk-aversion coefficients are calculated for buyers and these remain constant over all marketing methods. Sellers market cattle under all three marketing methods, suggesting producersÂ’' attitudes toward risk (risk-aversion coefficients) vary.Risk and Uncertainty,

Agricultural economists and world poverty: progress and prospects

New development paradigms come and go, seemingly with increasing rapidity, yet poverty remains the scourge of the developing nations. As we enter the new millennium, we fear that still more development fads and fancies will emerge, to be taken up and then dropped by the development community. These swings in fashion bring with them the danger that the ‘basics’ of effective development strategies for poverty reduction will be neglected. In this article, we advance some personal and perhaps controversial views about the virtues of getting agriculture moving as a means of reducing poverty, and about the role that agricultural economists can and should play in that endeavour.Food Security and Poverty,

Retained Ownership Revisited: Balancing Market Prices and Genetic Potential

Retained ownership is a marketing strategy that involves maintaining ownership of young cattle beyond calf weaning, a traditional marketing time for many producers. Numerous retained ownership strategies exist. It is extremely important for producers and their lenders to clearly understand the advantages and disadvantages of a specific retained ownership strategy in order to fully evaluate profit potential. The advantages and disadvantages of retained ownership have been discussed by several authors. Advantages include 1) compensation for superior genetics, 2) reduction in market inefficiencies, 3) increased quality control in beef, 4) reduction in market risk for frost or drought damaged crops and 5) reduction in profitability peaks and valleys associated with cattle cycles. Retained ownership of cattle is not without problems. Disadvantages include 1) increased risk of poor performance due to poor genetics, health problems or deteriorating environmental conditions, 2) increased market risk, 3) increased financing requirements and 4) potential tax problems. Nearly every economic analysis of retained ownership has shown an increase in profitability over traditional cow-calf operations. Data adapted from the Kansas Steer Futurity (Simms and Maddux, 1990) are displayed in Table 1. Average annual net returns per cow through weaning were $4.84 from 1974-1988. Negative returns averaging -$43.81 were observed for 8 of the 14 years. Average annual returns per cow for the feedlot phase of production were $27.13. Negative returns averaging -$35.56 were observed in 5 of the 14 years. Returns for the combined cow-calf and feedlot phases of production averaged $31.97. This represents a 6.6-fold increase in profitability as compared to marketing the calf crop at weaning. Losses averaging -$40.69 were observed in 6 of the 14 years. A 1990-91 South Dakota Retained Ownership Demonstration Program (Wagner et al., 1991) showed average profits of $38.75 and$16.69 for an accelerated finishing program and a traditional two-phased growing and finishing program, respectively. The variability in profitability between groups of cattle representing different genetic and management backgrounds was tremendous. Profitability ranged from -$56.57 to$131.36 per head and 7 of 51 groups of five steers in the accelerated pen lost money

The Changing Nature of Regional Poverty

We’re witnessing a dramatic change in the social geography of greater Richmond. It’s becoming more like that of the global south, where wealth is centered in the cities and poverty rings the outskirts of the city

Long-term risk factors for developing Barrett's oesophagus in patients with gastro-oesophageal reflux disease:a longitudinal cohort study

Background and aims: Several characteristics are known to affect the risk of Barrett's oesophagus (BO) in the general population, with symptomatic gastro-oesophageal reflux disease (GORD) being a critical risk factor. In this study, we examined factors that influence BO development in people living with GORD.Design: People living with GORD were recruited from an endoscopy unit with lifestyle, medical and prescribing history collected. Logistic regression analysis was undertaken to assess the effects of multiple parameters on the likelihood of developing BO.Results: 1197 participants were recruited. Most were Caucasian (n=1188, 99%), had no formal educational qualifications (n=714; 59.6%) and lived with overweight (mean body mass index &gt;25 kg/m2). Many lived in areas of least socioeconomic resource (n=568; 47.4%). 139 (11.6%) had BO at baseline. In adjusted baseline analysis (n=1197), male sex (adjusted OR, aOR 2.04 (95% CI 1.92 to 4.12), p≤0.001), increasing age (aOR 1.03 (95% CI 1.01 to 1.04), p≤0.0001) and proton pump inhibitor use (aOR 3.03 (95% CI 1.80 to 5.13), p≤0.0001) were associated with higher odds of BO. At follow-up (n=363), 22 (6.1%) participants developed BO; male sex (aOR 3.18 (95% CI 1.28 to 7.86), p=0.012), pack-years cigarettes smoked (aOR 1.04 (95% CI 1.00 to 1.08), p=0.046) and increased alcohol intake (aOR 1.02 (95% CI 1.00 to 1.04), p=0.013), were associated with increased odds of BO.Conclusion: Male sex, pack-years cigarettes smoked, and increasing alcohol intake, were independently associated with increased odds of developing BO over 20-year follow-up. These results align with research linking male sex and smoking with BO and extend this by implicating the potential role of alcohol in developing BO, which may require communication through public health messaging.</p

Long-term risk factors for developing Barrett's oesophagus in patients with gastro-oesophageal reflux disease:a longitudinal cohort study

Background and aims: Several characteristics are known to affect the risk of Barrett's oesophagus (BO) in the general population, with symptomatic gastro-oesophageal reflux disease (GORD) being a critical risk factor. In this study, we examined factors that influence BO development in people living with GORD.Design: People living with GORD were recruited from an endoscopy unit with lifestyle, medical and prescribing history collected. Logistic regression analysis was undertaken to assess the effects of multiple parameters on the likelihood of developing BO.Results: 1197 participants were recruited. Most were Caucasian (n=1188, 99%), had no formal educational qualifications (n=714; 59.6%) and lived with overweight (mean body mass index &gt;25 kg/m2). Many lived in areas of least socioeconomic resource (n=568; 47.4%). 139 (11.6%) had BO at baseline. In adjusted baseline analysis (n=1197), male sex (adjusted OR, aOR 2.04 (95% CI 1.92 to 4.12), p≤0.001), increasing age (aOR 1.03 (95% CI 1.01 to 1.04), p≤0.0001) and proton pump inhibitor use (aOR 3.03 (95% CI 1.80 to 5.13), p≤0.0001) were associated with higher odds of BO. At follow-up (n=363), 22 (6.1%) participants developed BO; male sex (aOR 3.18 (95% CI 1.28 to 7.86), p=0.012), pack-years cigarettes smoked (aOR 1.04 (95% CI 1.00 to 1.08), p=0.046) and increased alcohol intake (aOR 1.02 (95% CI 1.00 to 1.04), p=0.013), were associated with increased odds of BO.Conclusion: Male sex, pack-years cigarettes smoked, and increasing alcohol intake, were independently associated with increased odds of developing BO over 20-year follow-up. These results align with research linking male sex and smoking with BO and extend this by implicating the potential role of alcohol in developing BO, which may require communication through public health messaging.</p

A systematic review and meta-analysis of community and primary-care-based hepatitis C testing and treatment services that employ direct acting antiviral drug treatments

Background Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (Sustained Viral response, SVR) on completion of treatment, in non-specialist environments should be feasible. We investigated the English-language literature evaluating community and primary care-based pathways using DAAs to treat HCV infection. Methods Databases (Cinahl; Embase; Medline; PsycINFO; PubMed) were searched for studies of treatment with DAAs in non-specialist settings to achieve SVR. Relevant studies were identified including those containing a comparison between a community and specialist services where available. A narrative synthesis and linked meta-analysis were performed on suitable studies with a strength of evidence assessment (GRADE). Results Seventeen studies fulfilled the inclusion criteria: five from Australia; two from Canada; two from UK and eight from USA. Seven studies demonstrated use of DAAs in primary care environments; four studies evaluated integrated systems linking specialists with primary care providers; three studies evaluated services in locations providing care to people who inject drugs; two studies evaluated delivery in pharmacies; and one evaluated delivery through telemedicine. Sixteen studies recorded treatment uptake. Patient numbers varied from around 60 participants with pathway studies to several thousand in two large database studies. Most studies recruited less than 500 patients. Five studies reported reduced SVR rates from an intention-to-treat analysis perspective because of loss to follow-up before the final confirmatory SVR test. GRADE assessments were made for uptake of HCV treatment (medium); completion of HCV treatment (low) and achievement of SVR at 12 weeks (medium). Conclusion Services sited in community settings are feasible and can deliver increased uptake of treatment. Such clinics are able to demonstrate similar SVR rates to published studies and real-world clinics in secondary care. Stronger study designs are needed to confirm the precision of effect size seen in current studies. Prospero: CRD42017069873

Sustainability levels in Irish dairy farming: a farm typology according to sustainable performance indicators

Feeding the world’s population in a sustainable manner is one of the key challenges facing the future of global agriculture. The recent removal of the milk quota regime in the European Union has prompted an expansionary phase in dairy farming, especially in Ireland. Achieving this expansion in a sustainable manner is crucial to the long-term survival and success of the Irish dairy sector. In this paper we examine the sustainability of Irish dairy farming, defining ‘sustainability’ as economically profitable, environmentally friendly and socially efficient. A typology of Irish dairy farms has been created using data on profitability, environmental efficiency and social integration derived from the Teagasc National Farm Survey. Economic, social and environmental performance indicators were determined and aggregated and then used in a multivariate analysis for the identification and classification of farm clusters. The purpose of this study to classify Irish dairy farms using performance indicators, thereby, assisting policy makers in identifying patterns in farm performance with a view to formulating more targeted policies. Two of the three clusters elicited from the analysis were similar in regards to their respective indicator scores. However, the remaining cluster was found to perform poorly in comparison. The results indicate a clear distinction between ‘good’ and ‘weak’ performers, and the positive relationship between the economic, environmental and social performance of Irish dairy farms is evident