Whole grains, legumes, and health

Peer reviewedPublisher PD

Inpatient care utilisation and expenditure associated with objective physical activity:econometric analysis of the UK Biobank

BACKGROUND Physical inactivity increases the risk of chronic disease and mortality. The high prevalence of physical inactivity in the UK is likely to increase financial pressure on the National Health Service. The UK Biobank Study offered an opportunity to assess the impact of physical inactivity on healthcare use and spending using individual-level data and objective measures of physical activity. The objective of this study was to assess the associations between objectively measured physical activity levels and future inpatient days and costs in adults in the UK Biobank study. METHODS We conducted an econometric analysis of the UK Biobank study, a large prospective cohort study. The participants (n = 86,066) were UK adults aged 43-79 who had provided sufficient valid accelerometer data. Hospital inpatient days and costs were discounted and standardised to mean monthly values per person to adjust for the variation in follow-up times. Econometric models adjusted for BMI, long-standing illness, and other sociodemographic factors. RESULTS Mean follow-up time for the sample was 28.11 (SD 7.65) months. Adults in the most active group experienced 0.037 fewer days per month (0.059-0.016) and 14.1% lower inpatient costs ( - £3.81 [ - £6.71 to  - £0.91] monthly inpatient costs) compared to adults in the least active group. The relationship between physical activity and inpatient costs was stronger in women compared to men and amongst those in the lowest income group compared to others. The findings remained significant across various sensitivity analyses. CONCLUSIONS Increasing physical activity levels in the UK may reduce inpatient hospitalisations and costs, especially in women and lower-income groups

A methodology for verified energy savings in manufacturing facilities through changes in operational behaviour

The manufacturing industry is increasingly accountable for the environmental impact resulting from its activities. Manufacturing operations design has shifted from a traditional strictly cost and quality approach to more recently including energy efficiency, zero waste and reduced carbon emissions. Whilst manufacturing companies have focused on reducing energy at a facilities level, research indicates that specific production processes generate a significant environmental impact through energy consumption, resource depletion and greenhouse gas (GHG) emissions. To understand the consumption of energy in a production environment it is important to relate the specific energy usage to the operating processes and production outputs. This allows the identification of auxiliary (non-value added) energy within production which is as the area with the greatest potential for savings through changes in operational behaviour. This paper outlines the monitoring at a factory and at machine level that can identify where and, more importantly, when waste energy occurs. The analysis of the cost of auxiliary energy is shown to be a motivational factor for company management to engage with energy efficiency measures and finally the paper discusses the eight dimensions necessary to engage employees and to drive cultural change in an organisation. The current state of practice in relation to energy in a case-study in the Precision Manufacturing Sector in Ireland was investigated and the proposed approach was applied and has been shown to successfully deliver verifiable savings with low implementation costs

A Stochastic Sequential Quadratic Optimization Algorithm for Nonlinear Equality Constrained Optimization with Rank-Deficient Jacobians

A sequential quadratic optimization algorithm is proposed for solving smooth nonlinear equality constrained optimization problems in which the objective function is defined by an expectation of a stochastic function. The algorithmic structure of the proposed method is based on a step decomposition strategy that is known in the literature to be widely effective in practice, wherein each search direction is computed as the sum of a normal step (toward linearized feasibility) and a tangential step (toward objective decrease in the null space of the constraint Jacobian). However, the proposed method is unique from others in the literature in that it both allows the use of stochastic objective gradient estimates and possesses convergence guarantees even in the setting in which the constraint Jacobians may be rank deficient. The results of numerical experiments demonstrate that the algorithm offers superior performance when compared to popular alternatives

Revisiting the Thermal Stability of Radiation-dominated Thin Disks

The standard thin disk model predicts that when the accretion rate is over a small fraction of the Eddington rate, which corresponds to L \ga 0.06 L_{Edd}, the inner region of the disk is radiation-pressure-dominated and thermally unstable. However, observations of the high/soft state of black hole X-ray binaries with luminosity well within this regime (0.01L_{Edd} \la L \la 0.5L_{Edd}) indicate that the disk has very little variability, i.e., quite stable. Recent radiation magnetohydrodynamic simulations of a vertically stratified shearing box have confirmed the absence of the thermal instability. In this paper, we revisit the thermal stability by linear analysis, taking into account the role of magnetic field in the accretion flow. By assuming that the field responses negatively to a positive temperature perturbation, we find that the threshold of accretion rate above which the disk becomes thermally unstable increases significantly compared with the case of not considering the role of magnetic field. This accounts for the stability of the observed sources with high luminosities. Our model also presents a possible explanation as to why only GRS 1915+105 seems to show thermally unstable behavior. This peculiar source holds the highest accretion rate (or luminosity) among the known high state sources, which is well above the accretion rate threshold of the instability.Comment: 13 pages, 2 figures, accepted by Ap

How Do Psychiatrists Apply the Minimum Clinically Important Difference to Assess Patient Responses to Treatment?

Symptom report scales are used in clinical practice to monitor patient outcomes. Using them permits the definition of a minimum clinically important difference (MCID) beyond which a patient may be judged as having responded to treatment. Despite recommendations that clinicians routinely use MCIDs in clinical practice, statisticians disagree about how MCIDs should be used to evaluate individual patient outcomes and responses to treatment. To address this issue, we asked how clinicians actually use MCIDs to evaluate patient outcomes in response to treatment. Sixty-eight psychiatrists made judgments about whether hypothetical patients had responded to treatment based on their pre- and posttreatment change scores on the widely used Positive and Negative Syndrome Scale. Psychiatrists were provided with the scale’s MCID on which to base their judgments. Our secondary objective was to assess whether knowledge of the patient’s genotype influenced psychiatrists’ responder judgments. Thus, psychiatrists were also informed of whether patients possessed a genotype indicating hyperresponsiveness to treatment. While many psychiatrists appropriately used the MCID, others accepted a far lower posttreatment change as indicative of a response to treatment. When psychiatrists accepted a lower posttreatment change than the MCID, they were less confident in such judgments compared to when a patient’s posttreatment change exceeded the scale’s MCID. Psychiatrists were also less likely to identify patients as responders to treatment if they possessed a hyperresponsiveness genotype. Clinicians should recognize that when judging patient responses to treatment, they often tolerate lower response thresholds than warranted. At least some conflate their judgments with information, such as the patient’s genotype, that is irrelevant to a post hoc response-to-treatment assessment. Consequently, clinicians may be at risk of persisting with treatments that have failed to demonstrate patient benefits