Training Livestock to Avoid Specific Forage

This fact sheet provides the basics of aversion training for livestock

Fetal programming and epigenetics

Accumulating evidence suggests that the intrauterine environment can have an impact on long-term offspring health, so-called �fetal programming�. A number of environmental stressors have been studied in humans including maternal nutrition, smoking, substance misuse and mental illness. Although various biological mechanisms are likely to underpin fetal programming effects, there has been a particular focus on epigenetic modifications as potential mediators of observed associations between early environmental exposures and later health outcomes. In this review, we give an overview of evidence supporting a role for epigenetics in fetal programming, highlighting key human and animal studies. We also discuss challenges for research in this area, along with recommendations for future work, and potential therapeutic applications

Erratum to: The clinical and cost effectiveness of group art therapy for people with non-psychotic mental health disorders: a systematic review and cost-effectiveness analysis.

Background The majority of mental health problems are non-psychotic (e.g., depression, anxiety, and phobias). For some people, art therapy may be a more acceptable alternative form of psychological therapy than standard forms of treatment, such as talking therapies. This study was part of a health technology assessment commissioned by the National Institute for Health Research, UK and aimed to systematically appraise the clinical and cost-effective evidence for art therapy for people with non-psychotic mental health disorders. Methods Comprehensive literature searches for studies examining art therapy in populations with non-psychotic mental health disorders were performed in May 2013. A quantitative systematic review of clinical effectiveness and a systematic review of studies evaluating the cost-effectiveness of group art therapy were conducted. Results Eleven randomised controlled trials were included (533 patients). Meta-analysis was not possible due to clinical heterogeneity and insufficient comparable data on outcome measures across studies. The control groups varied between studies but included: no treatment/wait-list, attention placebo controls and psychological therapy comparators. Art therapy was associated with significant positive changes relative to the control group in mental health symptoms in 7 of the 11 studies. A de novo model was constructed and populated with data identified from the clinical review. Scenario analyses were conducted allowing comparisons of group art therapy with wait-list control and group art therapy with group verbal therapy. Group art-therapy appeared cost-effective compared with wait-list control with high certainty although generalisability to the target population was unclear; group verbal therapy appeared more cost-effective than art therapy but there was considerable uncertainty and a sizeable probability that art therapy was more cost effective. Conclusions From the limited available evidence art therapy was associated with positive effects compared with control in a number of studies in patients with different clinical profiles. The included trials were generally of poor quality and are therefore likely to be at high risk of bias. Art therapy appeared to be cost-effective versus wait-list but further studies are needed to confirm this finding in the target population. There was insufficient evidence to make an informed comparison of the cost-effectiveness of group art therapy with group verbal therapy. Trial registration HTA project no. 12/27/16; PROSPERO registration no. CRD42013003957

The Extrapolation Performance of Survival Models for Data With a Cure Fraction: A Simulation Study

Objectives: Curative treatments can result in complex hazard functions. The use of standard survival models may result in poor extrapolations. Several models for data which may have a cure fraction are available, but comparisons of their extrapolation performance are lacking. A simulation study was performed to assess the performance of models with and without a cure fraction when fit to data with a cure fraction. Methods: Data were simulated from a Weibull cure model, with 9 scenarios corresponding to different lengths of follow-up and sample sizes. Cure and noncure versions of standard parametric, Royston-Parmar, and dynamic survival models were considered along with noncure fractional polynomial and generalized additive models. The mean-squared error and bias in estimates of the hazard function were estimated. Results: With the shortest follow-up, none of the cure models provided good extrapolations. Performance improved with increasing follow-up, except for the misspecified standard parametric cure model (lognormal). The performance of the flexible cure models was similar to that of the correctly specified cure model. Accurate estimates of the cured fraction were not necessary for accurate hazard estimates. Models without a cure fraction provided markedly worse extrapolations. Conclusions: For curative treatments, failure to model the cured fraction can lead to very poor extrapolations. Cure models provide improved extrapolations, but with immature data there may be insufficient evidence to choose between cure and noncure models, emphasizing the importance of clinical knowledge for model choice. Dynamic cure fraction models were robust to model misspecification, but standard parametric cure models were not

Advanced Kidney Disease Patient Portal:Implementation and Evaluation with Haemodialysis Patients

Patients on haemodialysis face complex care pathways, a high treatment burden and lower quality-of-life. Working with multidisciplinary domain experts, we have conducted several iterative development cycles to design, develop and evaluate a portal for patients on haemodialysis that can help them better understand and navigate their care pathways. A key functionality of the portal is to improve data and information sharing with clinicians, including on key aspects of quality-of-life through Patients Reported Outcome Measures. A case study was conducted with multidisciplinary experts and patients in the NHS Greater Glasgow and Clyde health board (Scotland), using interviews combined with the System Usability Scale (n=26). Patients' feedback and system use observations were used to further refine the system design requirements and functionalities. Key lessons include: a wide preference for tablet-based input vs paper, identification of case-specific accessibility issues and situational impairment, benefits of self-completed digital data collection in overcoming such issues and promoting patient independence and privacy, with considerations for maintaining perceived value and engagement with such systems and when to offer alternatives

Caffeine Alters RPE-Based Intensity Production

International Journal of Exercise Science 12(6): 412-424, 2019. This study examined effects of caffeine (CAF) on power output (PO) selection and associated physiological responses during cycling at moderate and high intensities prescribed by RPE (0-10 scale). Participants (n = 9) (VO2peak: 55.4 ± 6.32 mL · kg-1 · min-1) cycled for 20 min at RPE4 and 20 min at RPE7 separated by 10 min recovery following caffeine (CAF) (6 mg · kg-1) and placebo (PLA) ingestion. PO, HR, serum lactate [La], VO2, VE, and RER were recorded every 5 min. Session RPE (S-RPE) was recorded following 10 min recovery. Repeated-measures ANOVA’s, 2 (trial) x 4 (time pt), showed significantly greater PO during RPE4 for CAF (130 ± 23 W) vs PLA (112 ± 26 W) and during RPE7 (CAF: 165 ± 37 vs PLA: 143 ± 41 W). Overall HR, VO2, and VE were significantly greater for CAF vs PLA during RPE7. RER for RPE4 and RPE7 were not significantly different (CAF vs PLA). Overall [La] was significantly greater for CAF during RPE4 (CAF: 2.32 ± 0.94 vs PLA: 1.73 ± 1.09) and RPE7 (CAF: 3.22 ± 1.44 vs PLA: 2.22 ± 1.49). Paired T-tests for S-RPE revealed no significant difference for RPE4 (CAF: 4.0 ± 0.5 vs PLA: 3.7 ± 0.5) or RPE7 (CAF: 7.1 ± 0.3 vs PLA: 6.9 ± 0.6) despite greater PO for CAF. Although individual responses varied, the current study indicates caffeine ingestion results in elevated self-selected PO with significant systematic changes in associated physiological responses particularly at a higher intensity (RPE7)

Trusting the results of model-based economic analyses: is there a pragmatic validation solution?

Models have become a nearly essential component of health technology assessment. This is because the efficacy and safety data available from clinical trials are insufficient to provide the required estimates of impact of new interventions over long periods of time and for other populations and subgroups. Despite more than five decades of use of these decision-analytic models, decision makers are still often presented with poorly validated models and thus trust in their results is impaired. Among the reasons for this vexing situation are the artificial nature of the models, impairing their validation against observable data, the complexity in their formulation and implementation, the lack of data against which to validate the model results, and the challenges of short timelines and insufficient resources. This article addresses this crucial problem of achieving models that produce results that can be trusted and the resulting requirements for validation and transparency, areas where our field is currently deficient. Based on their differing perspectives and experiences, the authors characterize the situation and outline the requirements for improvement and pragmatic solutions to the problem o