Initiatives to increase colonoscopy capacity - is there an impact on polyp detection? A UK National Endoscopy Database analysis

\ua9 2023 Georg Thieme Verlag. All rights reserved.Background Mismatch between routine endoscopy capacity and demand means centres often implement initiatives to increase capacity, such as weekend working or using locums/agency staff (insourcing). There are concerns about whether increasing workload to meet demand could negatively impact quality. We investigated polyp detection, a key quality metric, in weekend vs weekday and insourced vs standard procedures using data from the UK National Endoscopy Database (NED). Methods We conducted a national retrospective cross-sectional study of diagnostic colonoscopies undertaken 01/01-04/04/2019. The primary outcome was mean number of polyps (MNP) and the secondary, polyp detection rate (PDR). Multi-level mixed-effect regression, fitting endoscopist as a random effect, was used to examine associations between procedure day (weekend/weekday) and type (insourced/standard) and these outcomes, adjusting for patient age, sex and indication. Results 92,879 colonoscopies (weekends: 19,977 (21.5%); insourced: 9,909 (10.7%)) were performed by 2,496 endoscopists. For weekend colonoscopies, patients were more often female and less often having screening-related procedures; for insourced colonoscopies, patients were younger and less often attending for screening-related procedures (all p<0.05). Case-mix adjusted MNP was significantly lower for weekend vs weekday (IRR=0.86, (95%CI 0.83-0.89)) and for insourced vs standard procedures (IRR=0.91, (95%CI 0.87-0.95)). MNP was highest for weekday standard procedures and lowest for weekend insourced procedures, but there was no interaction between procedure day and type. Similar associations were found for PDR. Conclusions Strategies to increase colonoscopy capacity may have adverse effects on polyp detection. Routine quality monitoring should be undertaken following such initiatives. Meantime, reasons for this unwarranted variation require investigation

Pathways to economic well-being among teenage mothers in Great Britain

The present study examines pathways to independence from social welfare among 738 teenage mothers, participants of the 1970 British Cohort Study, who were followed up at age 30 years. Using a longitudinal design, a pathway model is tested, examining linkages between family social background, cognitive ability, school motivation, and individual investments in education, as well as work- and family-related roles. The most important factors associated with financial independence by age 30 are continued attachment to the labor market as well as a stable relationship with a partner (not necessarily the father of the child). Pathways to financial independence, in turn, are predicted through own cognitive resources, school motivation, and family cohesion. Implications of findings for policy making are discussed.© 2010 Hogrefe Publishing

Spatial Scale of Heterogeneity Affects Diet Choice but Not Intake in Beef Cattle

Previous research has shown that sheep (Champion et al., 1998) and dairy cattle (Nuthall et al., 2000) have a partial preference for clover of 70%, and achieve higher daily intakes when offered grass and clover as separate but adjacent monocultures compared with animals grazing mixed swards. This intake benefit could be utilised to increase intake and production on farms by grazing from adjacent strips of the two herbages. This study aimed to establish the minimum strip width required to achieve the benefits of monocultures

Intake characteristics of perennial ryegrass varieties when grazed by yearling beef cattle under rotational grazing management

Four intermediate-heading perennial ryegrass (Lolium perenne L.) varieties, which in previous studies had been associated with high- or low-intake characteristics when swards containing them had been continuously stocked with sheep, were sown as monocultures. They were rotationally grazed, using 1-d paddocks, with core groups of four yearling Simmental x Holstein beef heifers in 2002 and 2003 and ingestive and ruminative behaviour, and sward factors, were measured. There were two diploid (Belramo and Glen) and one tetraploid (Rosalin) perennial ryegrass varieties and one tetraploid hybrid (Lolium x boucheanum Kunth) (AberExcel) variety. Intake rate (IR) was significantly higher in August 2003 for heifers grazing Glen than those grazing Belramo [27.5 vs. 20.6 g dry matter (DM) min(-1); P = 0.019], but there were no significant differences between varieties in two other measurement periods. This is in contrast to previous results with sheep when IR were significantly higher for Glen than Belramo and for AberExcel than Rosalin. Total jaw movement rates during grazing were significantly higher for heifers on the tetraploid swards than those on the diploid swards (87.7 vs. 83.6 jaw movements min(-1); P = 0.023) in September 2002. Ruminating time was significantly lower for heifers on the tetraploid swards than those on the diploid swards (453 vs. 519 min 24 h(-1); P = 0.012) in July 2002. Digestibility of grass snips was significantly higher on the tetraploid than the diploid swards [697 vs. 680 g digestible organic matter (DOM) kg(-1) DM; P = 0.042] in September 2003 and, within diploids, was significantly higher for Glen than Belramo (696 vs. 663 g DOM kg(-1) DM; P = 0.014). There were significant differences in sheath tube and leaf lengths and in the population density of tillers between and within ploidies, which might have been expected to have influenced intake characteristics, but this was not generally found under rotational grazing with cattle. In order to separate the effects of defoliation interval from those of grazing style of the different ruminant species, it is suggested that grass variety evaluations using continuously stocked cattle swards are required

Total energy differences between SiC polytypes revisited

The total energy differences between various SiC polytypes (3C, 6H, 4H, 2H, 15R and 9R) were calculated using the full-potential linear muffin-tin orbital method using the Perdew-Wang-(91) generalized gradient approximation to the exchange-correlation functional in the density functional method. Numerical convergence versus k-point sampling and basis set completeness are demonstrated to be better than 1 meV/atom. The parameters of several generalized anisotropic next-nearest-neighbor Ising models are extracted and their significance and consequences for epitaxial growth are discussed.Comment: 8 pages, 3 figures, Latex, uses epsfig and revte