An econometric application of the theory of the farm-household

Employing a Cobb-Douglas specification for the production function and a modified linear expenditure system, the paper presents an econometric model of household production, consumption and labor supply behaviour for a semi-commercial farm with a competitive labor market. The model, estimated from primary, cross-sectional, Malaysian data, is used to analyse the impact of migration, output price intervention and technological change on the agricultural sector. In doing so, the wage-rate is treated as an endogenous variable to be determined by the interaction of aggregate labor demand and supply curves obtained from the estimated micro functions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/23670/1/0000638.pd

Comparing alternating pressure mattresses and high-specification foam mattresses to prevent pressure ulcers in high-risk patients: the PRESSURE 2 RCT

Background: Pressure ulcers (PUs) are a burden to patients, carers and health-care providers. Specialist mattresses minimise the intensity and duration of pressure on vulnerable skin sites in at-risk patients. Primary objective: Time to developing a new PU of category ≥ 2 in patients using an alternating pressure mattress (APM) compared with a high-specification foam mattress (HSFM). Design: A multicentre, Phase III, open, prospective, planned as an adaptive double-triangular group sequential, parallel-group, randomised controlled trial with an a priori sample size of 2954 participants. Randomisation used minimisation (incorporating a random element). Setting: The trial was set in 42 secondary and community inpatient facilities in the UK. Participants: Adult inpatients with evidence of acute illness and at a high risk of PU development. Interventions and follow-up: APM or HSFM – the treatment phase lasted a maximum of 60 days; the final 30 days were post-treatment follow-up. Main outcome measures: Time to event. Results: From August 2013 to November 2016, 2029 participants were randomised to receive either APM (n = 1016) or HSFM (n = 1013). Primary end point – 30-day final follow-up: of the 2029 participants in the intention-to-treat population, 160 (7.9%) developed a new PU of category ≥ 2. There was insufficient evidence of a difference between groups for time to new PU of category ≥ 2 [Fine and Gray model HR 0.76, 95% confidence interval (CI) 0.56 to 1.04; exact p-value of 0.0890 and 2% absolute difference]. Treatment phase sensitivity analysis: 132 (6.5%) participants developed a new PU of category ≥ 2 between randomisation and end of treatment phase. There was a statistically significant difference in the treatment phase time-to-event sensitivity analysis (Fine and Gray model HR 0.66, 95% CI 0.46 to 0.93; p = 0.0176 and 2.6% absolute difference). Secondary end points – 30-day final follow-up: new PUs of category ≥ 1 developed in 350 (17.2%) participants, with no evidence of a difference between mattress groups in time to PU development, (Fine and Gray model HR 0.83, 95% CI 0.67 to 1.02; p-value = 0.0733 and absolute difference 3.1%). New PUs of category ≥ 3 developed in 32 (1.6%) participants with insufficient evidence of a difference between mattress groups in time to PU development (Fine and Gray model HR 0.81, 95% CI 0.40 to 1.62; p = 0.5530 and absolute difference 0.4%). Of the 145 pre-existing PUs of category 2, 89 (61.4%) healed – there was insufficient evidence of a difference in time to healing (Fine and Gray model HR 1.12, 95% CI 0.74 to 1.68; p = 0.6122 and absolute difference 2.9%). Health economics – the within-trial and long-term analysis showed APM to be cost-effective compared with HSFM; however, the difference in costs models are small and the quality-adjusted life-year gains are very small. There were no safety concerns. Blinded photography substudy – the reliability of central blinded review compared with clinical assessment for PUs of category ≥ 2 was ‘very good’ (kappa statistic 0.82, prevalence- and bias-adjusted kappa 0.82). Quality-of-life substudy – the Pressure Ulcer Quality of Life – Prevention (PU-QoL-P) instrument meets the established criteria for reliability, construct validity and responsiveness. Limitations: A lower than anticipated event rate. Conclusions: In acutely ill inpatients who are bedfast/chairfast and/or have a category 1 PU and/or localised skin pain, APMs confer a small treatment phase benefit that is diminished over time. Overall, the APM patient compliance, very low PU incidence rate observed and small differences between mattresses indicate the need for improved indicators for targeting of APMs and individualised decision-making. Decisions should take into account skin status, patient preferences (movement ability and rehabilitation needs) and the presence of factors that may be potentially modifiable through APM allocation, including being completely immobile, having nutritional deficits, lacking capacity and/or having altered skin/category 1 PU. Future work: Explore the relationship between mental capacity, levels of independent movement, repositioning and PU development. Explore ‘what works for whom and in what circumstances’. Trial registration: Current Controlled Trials ISRCTN01151335. Funding: This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 52. See the NIHR Journals Library website for further project information

Tales of Yesteryear: an oral history project

FOURTEEN LIVES: A CELEBRATION In contemporary popular culture, with its focus on youth and immediate gratification, aged persons are typically overlooked, neglected and ignored. In current discourse they might indeed be described as an 'underused resource'. Yet they have much to offer in terms of the richness of their lives and wisdom and insight acquired over many decades. Tales of Yesteryear: An Oral History Project 'gives voice' to a group of fourteen residents from Hilltop Gardens, a residential aged care unit located in close proximity to the Kelvin Grove Campus of the Queensland University of Technology (QUT). We sought to learn from and with them about the significant learning experiences in their lives. A major consideration was exploring some of the events and incidents that shaped their world views and fashioned the selves they have become. However, we decided not to focus primarily on formalised schooling because of our strong belief that learning is lifelong and extends from the cradle to the grave, and because we recognised that for many, schooling would have constituted only a small part of the overall picture of their lives. In exchange for these stories, the project team compiled this book to celebrate their lives and times. Professor Brian Hansford, Head of the School of Professional Studies, QUT, and a staunch advocate of community services and of integrating the university more fully into the local community, played a significant part in the conception of this project. From 1995 the School's Community Service Committee has worked closely with Hilltop Gardens (formerly known as Sunsetholme) to provide a range of social activities (morning teas, luncheons, musical concerts ... ) and learning experiences (visits to the One Teacher School Museum, small group discussions ... ). 1999 is the third year that the School has organised a Christmas party for residents and staff ofHilltop Gardens. Applying for a QUT Community Service Grant to work on this project with the residents of Hilltop Gardens was a natural consequence of this relationship. In 1998 the School's Community Service Committee was successful in securing two small grants from QUT. The first was to fund an oral history project, while the second was to organise a series of musical concerts for the residents. The latter project is ongoing, with funding until the end of 2000. The former was led by Dr Merv Fogarty, recently retired Senior Lecturer within the School, and all of the editors (Ehrich, Fogarty, Thomas, Sheehan, Carroll and Mendra) were actively involved in the interview process and compilation of stories. The methodology steering this project was drawn from a kit developed by the Paddington History Group (Anne-Maree Jaggs and Dawn Buckberry). Consent forms, biographical questionnaires, and other procedure lists were adapted from this kit to meet our particular needs in the study. Ethical clearance was obtained from the Queensland University of Technology. All members of the team liaised with Ruth Forrester, Manager of Hilltop Gardens, to identify interested residents and to set up the ensuing interviews. The project team worked in pairs to share the interviewing and sense-making of the data. On average, residents were interviewed twice for about one hour each time. Transcripts were typed up and stories were woven from the essence of their lives. Individual stories were taken back to each participant for comment, correction, and final approval (in the true spirit of 'democratic research'). All of us on the project team felt that the oral histories were too valuable to leave unpublished, so this book is the culmination of our research and our way of acknowledging the rich contribution that the elderly can give to a learning community such as a university. The project has been rewarding and interesting not only because we moved out of schools (the domain in which so much of our work is done) but also because it has touched on an important part of living history. We feel honoured to have played a small part in making these stories come alive. The stories stand for themselves: I commend them to you. Lisa Catherine Ehrich On behalf of the Oral History Project Tea

Original Communications Decreased Plasma Fibronectin during Starvation in Man

ABSTRACT. This study evaluated the effect of 5 days of starvation followed b

The Role of Relationships in the Professional Formation of Physicians

BACKGROUND: Studies of the professional development of physicians highlight the important effect that the learning environment, or \ hidden curriculum,\ has in shaping student attitudes, behaviors, and values. We conducted this study to better understand the role that relationships have in mediating these effects of the hidden curriculum. [See PDF for complete abstract

Melioidosis, Northeastern Brazil

Melioidosis was first recognized in northeastern Brazil in 2003. Confirmation of additional cases from the 2003 cluster in Ceará, more recent cases in other districts, environmental isolation of Burkholderia pseudomallei, molecular confirmation and typing results, and positive serosurveillance specimens indicate that melioidosis is more widespread in northeastern Brazil than previously thought

Pressure RElieving Support SUrfaces: a Randomised Evaluation 2 (PRESSURE 2): study protocol for a randomised controlled trial

Background Pressure ulcers represent a major burden to patients, carers and the healthcare system, affecting approximately 1 in 17 hospital and 1 in 20 community patients. They impact greatly on an individual’s functional status and health-related quality of life. The mainstay of pressure ulcer prevention practice is the provision of pressure redistribution support surfaces and patient repositioning. The aim of the PRESSURE 2 study is to compare the two main mattress types utilised within the NHS: high-specification foam and alternating pressure mattresses, in the prevention of pressure ulcers. Methods/Design PRESSURE 2 is a multicentre, open-label, randomised, double triangular, group sequential, parallel group trial. A maximum of 2954 ‘high-risk’ patients with evidence of acute illness will be randomised on a 1:1 basis to receive either a high-specification foam mattress or alternating-pressure mattress in conjunction with an electric profiling bed frame. The primary objective of the trial is to compare mattresses in terms of the time to developing a new Category 2 or above pressure ulcer by 30 days post end of treatment phase. Secondary endpoints include time to developing new Category 1 and 3 or above pressure ulcers, time to healing of pre-existing Category 2 pressure ulcers, health-related quality of life, cost-effectiveness, incidence of mattress change and safety. Validation objectives are to determine the responsiveness of the Pressure Ulcer Quality of Life-Prevention instrument and the feasibility of having a blinded endpoint assessment using photography. The trial will have a maximum of three planned analyses with unequally spaced reviews at event-driven coherent cut-points. The futility boundaries are constructed as non-binding to allow a decision for stopping early to be overruled by the Data Monitoring and Ethics Committee. Discussion The double triangular, group sequential design of the PRESSURE 2 trial will provide an efficient design through the possibility of early stopping for demonstrating either superiority, inferiority of mattresses or futility of the trial. The trial optimises the potential for producing robust clinical evidence on the effectiveness of two commonly used mattresses in clinical practice earlier than in a conventional design

Contribution of a Common Variant in the Promoter of the 1-α-Hydroxylase Gene (CYP27B1) to Fracture Risk in the Elderly

CYP27B1 encodes mitochondrial 1α-hydroxylase, which converts 25-hydroxyvitamin D to its active 1,25-dihydroxylated metabolite. We tested the hypothesis that common variants in the CYP27B1 promoter are associated with fracture risk. The study was designed as a population-based genetic association study, which involved 153 men and 596 women aged 65–101 years, who had been followed for 2.2 years (range 0.1–5.5) between 1999 and 2006. During the follow-up period, the incidence of fragility fractures was ascertained. Bone ultrasound attenuation (BUA) was measured in all individuals, as were serum 25-hydroxyvitamin D and PTH concentrations; 86% subjects had vitamin D insufficiency. Genotypes were determined for the –1260C>A (rs10877012) and +2838T>C (rs4646536) CYP27B1 polymorphisms. A reporter gene assay was used to assess functional expression of the –1260C>A CYP27B1 variants. The association between genotypes and fracture risk was analyzed by Cox’s proportional hazards model. We found that genotypic distribution of CYP27B1 –1260 and CYP27B1 +2838 polymorphisms was consistent with the Hardy-Weinberg equilibrium law. The two polymorphisms were in high linkage disequilibrium, with D′ = 0.96 and r2 = 0.94. Each C allele of the CYP27B1 –1260 polymorphism was associated with increased risk of fracture (hazard ratio = 1.34, 95% CI 1.03–1.73), after adjustment for age, sex, number of falls, and BUA. In transient transfection studies, a reporter gene downstream of the –1260(A)-containing promoter was more highly expressed than that containing the C allele. These data suggest that a common but functional variation within the CYP27B1 promoter gene is associated with fracture risk in the elderly