Ranching with sable antelope (Hippotragus niger niger) in South Africa

Thesis (MScAgric)--Stellenbosch University, 2022.ENGLISH ABSTRACT: This research focuses on aspects not currently known but essential to ranch with sable antelope (Hippotragus niger niger) successfully. This includes determining the metabolizable energy requirements, horn growth traits and how supplemental nutrition affects reproduction and horn growth on sable antelope ranched in South Africa. An investigation into the methodologies presently employed determining carrying capacity of wildlife species illustrates that the large animal unit, grazing unit, and browsing unit methods only use metabolic weight as a factor to determine the energy requirements of game where the large stock unit method uses both metabolic weight and the energy requirements of the animal at a specific well defined physiological production state. The metabolizable energy requirement per day was regressed with weight (kg) using a log-log transformation of the herbivore species to model the suitability of the large animal unit method for defining/determining the metabolizable energy requirements of game. The resulting equations were used to model and compare the calculated metabolizable energy and large stock unit values to the published metabolizable energy and large stock unit values. The physiological production states analysed included calf/lamb, young dry cow/ewe, mature dry cow/ewe, young cow/ewe with calf/lamb, mature cow/ewe with calf/lamb, young bull/ram, and mature bull/ram. Six out of the seven categories have values higher than 0.75 with R 2 values of >0.99, the exception being calf/lamb data with the value of 0.742 with a R2 = 0.97. These results indicate that metabolic weight is neither conceptually correct nor sufficiently accurate to calculate metabolizable energy requirements for game, confirming the acceptance of the alternative hypothesis. Therefore, the large animal unit (metabolic weight method) cannot replace the large stock unit (metabolizable energy method). The derived log-log transformation equation provides a more accurate method for determining the metabolizable energy requirements and dry matter intake values for sable antelope and other game species. A study into horn growth characteristics (traits), horn length, basal circumference, and the number of horn rings of sable antelope in South Africa was conducted to investigate the environmental effects of sex, calving year and season on horn development for animals up to 50 months of age. Horn growth characteristics/traits within the age categories of 0-15 months, 15.1- 36 months, 36.1-50 months were analysed. It was determined that the growth rate in cm per day of horn length between male and female sable antelope differed significantly (P < 0.05) for all age categories: male (0,089 ± 0.002cm; p-value = <0.0001) and female (0,068 ± 0.004cm; p-value = <0.0001) for 0-15 months, male (0.079 ± 0.002cm; p-value = <0.0001) and female (0.042+ 0.001cm; p-value = <0.0001 ) for 15.1-36 months, male (0.044± 0.003cm; p-value = <0.0001 ) and female (0.015± 0.003cm; p-value = <0.0001) for 36.1-50 months respectively. When considering base circumference between male and female sable antelope, a significant difference (P < 0.05) in the age category 0-15 months was observed, where the base circumference growth rate for males was 0.026 cm and females 0.014 cm respectively. The number of horn rings did not differ. Horn length and base circumference results over the whole period, regardless of other environmental effects, illustrate a rapid initial growth for male and female animals. However, horn length and base circumference on males grew faster, while in the female animals, it slowed noticeably once they reached sexual maturity. Supplemental feeding regimes introduced on most farms in 2013 positively affected horn growth traits, resulting in longer horns at maturity. When considering the results, if the metabolizable energy requirements for animals at different states is known, it is possible to estimate the carrying capacity and stocking rates of game reserves and ranches more accurately. Furthermore, knowing the metabolizable energy requirements of the species at different physiological states supplies animal nutritionists with the necessary information to improve supplemental and complete feeds. When considering horn growth, the data clearly shows that horn length increased year after year in both male and female sable antelope, and this was due to ranchers selecting better animals and supplying these animals with a more balanced diet.AFRIKAANSE OPSOMMING: Hierdie navorsing fokus op aspekte wat tans nie bekend is nie, maar noodsaaklik is om met swartwitpense (Hippotragus niger niger) suksesvol te kan boer. Dit sluit die bepaling van metaboliseerbare energievereistes, horinggroei-eienskappe en op welke mate aanvullende voeding reproduksie en horinggroei van swartwitpense in Suid-Afrika beïnvloed in. 'n Ondersoek na die metodologieë wat tans gebruik word om die drakrag van wildspesies te bepaal, het aangedui dat grootdier-eenheid-, wei-eenheid- en blaarvreter-eenheidmetodes slegs metaboliese massa as 'n faktor gebruik om die energiebehoeftes van wild te bepaal. Die grootvee-eenheid metode gebruik egter beide metaboliese massa en die energiebehoefte van die dier by 'n spesifieke goed gedefinieërde fisiologiese produksietoestand in. ’n Regressie van metaboliseerbare energie behoefte per dag met massa (kg) deur gebruik te maak van 'n log-log transformasie van die herkouer spesies om die geskiktheid van die grootdier eenheid metode vir die bepaling van die metaboliseerbare energie vereistes van wild te modelleer is oorweeg. Die gevolglike vergelykings is gebruik om die berekende metaboliseerbare energie en grootvee- eenheidwaardes te modelleer en te vergelyk met die gepubliseerde metaboliseerbare energie en grootvee-eenheidwaardes. Die fisiologiese produksie statusse wat ondersoek is, sluit kalf/lam, jong droë koei/ooi, volwasse droë koei/ooi, jong koei/ooi met kalf/lam, volwasse koei/ooi met kalf/lam, jong bul/ram en volwasse bul/ram in. Ses uit die sewe kategorieë het waardes hoër as 0.75 met R2 -waardes van >0.99 getoon. Die uitsondering was kalf-/lamdata met ‘n waarde van 0.742 met 'n R2 = 0.97. Hierdie resultate dui aan dat metaboliese gewig nie konseptueel korrek of voldoende akkuraat is om metaboliseerbare energievereistes vir wild te kan bepaal nie, en dus die aanvaarding van die alternatiewe hipotese bevestig. Daarom kan die grootdier-eenheid (metaboliese massa-metode) nie die grootvee-eenheid (metaboliseerbare energie-metode) vervang nie. Die afgeleide log-log-transformasievergelyking verskaf 'n meer akkurate metode om die metaboliseerbare energiebehoeftes en droëmateriaal-innamewaardes van swartwitpense en ander wildspesies te bepaal. 'n Studie na horinggroei-eienskappe insluitende horinglengte, basale omtrek en die aantal horingringe van swartwitpense in Suid-Afrika is gedoen om die omgewingseffekte van geslag, kalfjaar en -seisoen op horingontwikkeling van diere tot 50 maande ouderdom te ondersoek. Horinggroei-eienskappe binne die ouderdomskategorieë van 0-15 maande, 15.1-36 maande, 36.1-50 maande is ontleed. Daar is vasgestel dat die horinglengte-groeitempo in cm per dag tussen manlike en vroulike swartwitpense beduidend verskil (P < 0,05) vir alle ouderdomskategorieë: manlik (0,089 ± 0.002cm; p-value = <0.0001) en vroulik (0,068 ± 0.004cm; p-value = <0.0001) vir 0-15 maande, manlik (0,079 ± 0.002cm; p-value = <0.0001) en vroulik (0,042 ± 0.001cm; p-value = <0.0001) vir 15,1-36 maande, manlik (0,044 ± 0.003cm; p-value = <0.0001 cm) en vroulik (0,015 ± 0.003cm; p-value = <0.0001 cm) vir 36,1-50 maande onderskeidelik. Horingbasisomtrek tussen manlike en vroulike swartwitpense het betekenisvolle verskil (P < 0.05) in die ouderdomskategorie 0-15 maande, waar die basisomtrek se groeitempo vir manlik 0.026 cm en vroulik 0.014 cm onderskeidelik was. Die aantal horingringe het egter nie verskil nie. Horinglengte en basisomtrek resultate oor die hele tydperk, ongeag ander omgewingseffekte, dui op 'n aanvanklike vinnige groei vir manlike en vroulike diere. Horinglengte en basisomtrek by mannetjies het egter vinniger gegroei, terwyl dit by die vroulike diere merkbaar verlangsaam het sodra hulle geslagsryp geword het. Aanvullende voedingsstrategië wat in 2013 op die meeste plase ingestel is, het horinggroei-eienskappe positief beïnvloed, wat tot langer horings by volwassenheid gelei het. As die resultate in ag geneem word, is die metaboliseerbare energiebehoeftes vir diere by verskillende fisiologiese status bekend is, is dit moontlik om die drakrag van wildreservate en plase meer akkuraat te voorspel. Verder, om die metaboliseerbare energiebehoeftes van die spesie by verskillende fisiologiese toestande te verstaan, verskaf dit die dierevoedingkundiges die nodige inligting om aanvullende en volledige voeding te verbeter. Wanneer horinggroei in ag geneem word, toon die data duidelik dat horinglengte jaar op jaar by beide manlike en vroulike swartwitpense toegeneem het. Hierdie was ‘n dierekte gevolg van beter seleksie deur telers sowel as die aanwending van 'n meer gebalanseerde dieet.Master

Contamination in trials of educational interventions

Objectives: To consider the effects of contamination on the magnitude and statistical significance (or precision) of the estimated effect of an educational intervention, to investigate the mechanisms of contamination, and to consider how contamination can be avoided. Data sources: Major electronic databases were searched up to May 2005. Methods: An exploratory literature search was conducted. The results of trials included in previous relevant systematic reviews were then analysed to see whether studies that avoided contamination resulted in larger effect estimates than those that did not. Experts’ opinions were elicited about factors more or less likely to lead to contamination. We simulated contamination processes to compare contamination biases between cluster and individually randomised trials. Statistical adjustment was made for contamination using Complier Average Causal Effect analytic methods, using published and simulated data. The bias and power of cluster and individually randomised trials were compared, as were Complier Average Causal Effect, intention-to-treat and per protocol methods of analysis. Results: Few relevant studies quantified contamination. Experts largely agreed on where contamination was more or less likely. Simulation of contamination processes showed that, with various combinations of timing, intensity and baseline dependence of contamination, cluster randomised trials might produce biases greater than or similar to those of individually randomised trials. Complier Average Causal Effect analyses produced results that were less biased than intention-to-treat or per protocol analyses. They also showed that individually randomised trials would in most situations be more powerful than cluster randomised trials despite contamination. Conclusions: The probability, nature and process of contamination should be considered when designing and analysing controlled trials of educational interventions in health. Cluster randomisation may or may not be appropriate and should not be uncritically assumed always to be a solution. Complier Average Causal Effect models are an appropriate way to adjust for contamination if it can be measured. When conducting such trials in future, it is a priority to report the extent, nature and effects of contamination.We are grateful to the National Health Service Research and Development National Coordinating Centre for Research Methodology for funding this research

Preliminary report on osteochondrosis in cattle in the north-western parts of South Africa

The north-western part of South Africa, in particular, is well known for mineral imbalances. Aphosphorosis, resulting in rickets and osteomalacia, received a lot of attention at the turn of the nineteenth century (1882–1912). This was followed in 1997 by research on Vryburg hepatosis, another area-specific mineral imbalance–related disease in young calves reared on manganese-rich soil derived from the weathering of dolomitic (carbonate) rock formations. In 1982, a totally new syndrome (osteochondrosis) manifested in, amongst others, areas in South Africa where aphosphorosis was rife. Osteochondrosis was also identified in the south-western parts of Namibia as well as southern Botswana and other areas in South Africa. Osteochondrosis has a multifactorial aetiology and this study focused on the role of minerals, particularly phosphorus, in the development of the disease. A significant improvement in the clinical signs in experimental animals and a reduction of osteochondrosis occurred on farms where animals received bioavailable trace minerals and phosphorus as part of a balanced lick. An increase in the occurrence of the disease on farms during severe drought conditions in 2012–2013 prompted researchers to investigate the possible role of chronic metabolic acidosis in the pathogenesis of the disease.http://www.ojvr.org/am2016Paraclinical Science

Towards Upright Pedalling to drive recovery in people who cannot walk in the first weeks after stroke: movement patterns and measurement

Objectives: To examine whether people who are within 31 days of stroke onset are able to produce controlled lower limb movement, and phasic activity in antagonistic lower limb muscle groups, during Upright Pedalling (UP). Design: Observational study. Setting: Acute stroke unit within a University Hospital. Participants: Eight adults between 3 and 30 days from stroke onset, with unilateral lower limb paresis and unable to walk without assistance. Participants were considered fit to participate as assessed by a physician-led medical team and were able to take part in UP for one, one minute session. Intervention: Participants took part in one session of instrumented UP at their comfortable cadence, as part of a feasibility study investigating UP early after stroke. Outcome measures: Reciprocal activation of lower limb muscles derived from muscle activity recorded with surface EMG, quantified using Jaccards Coefficient (J); smoothness of pedalling determined from standard deviations of time spent in each of eight 45 degree wheel position bins (“S-Ped”). Motor behavioural measures: Motricity Index, Trunk Control Test, Functional Ambulatory Categories. Results: Participants were all unable to walk (FAC 0) with severe to moderate lower limb paresis (Motricity Index score/100 median 48.5, IQR 32-65.5). Smooth pedalling was observed; some participants pedalling similarly smoothly to healthy older adults, with a variety of muscle activation patterns in the affected and unaffected legs. Conclusion: These observational data indicate that people with substantial paresis early after stroke and who cannot walk, can produce smooth movement during UP using a variety of muscle activation strategies

Automated closed-loop insulin delivery for the management of type 1 diabetes during pregnancy: the AiDAPT RCT

Background There are over 2000 pregnancies annually in women with type 1 diabetes in the UK. Despite recent improvements in diabetes technology, most women cannot achieve and maintain the recommended pregnancy glucose targets. Thus, one in two babies experience complications requiring neonatal care unit admission. Recent studies demonstrate that hybrid closed-loop therapy, in which algorithms adjust insulin delivery according to continuous glucose measurements, is effective for managing type 1 diabetes outside of pregnancy, but efficacy during pregnancy is unclear. Objective To examine the clinical efficacy of hybrid closed-loop compared to standard insulin therapy in pregnant women with type 1 diabetes. Design A multicentre, parallel-group, open-label, randomised, controlled trial in pregnant women with type 1 diabetes. Setting Nine antenatal diabetes clinics in England, Scotland and Northern Ireland. Participants Pregnant women with type 1 diabetes and above-target glucose levels, defined as glycated haemoglobin A1c of ≥ 48 mmol/mol (6.5%) in early pregnancy. Interventions A hybrid closed-loop system compared to standard insulin delivery (via insulin pump or multiple daily injections) with continuous glucose monitoring. Outcome measures The primary outcome is the difference between the intervention and control groups in percentage time spent in the pregnancy glucose target range (3.5–7.8 mmol/l) as measured by continuous glucose monitoring from 16 weeks’ gestation until delivery. Secondary outcomes include overnight time in range, time above range (> 7.8 mmol/l), glycated haemoglobin A1c, safety outcomes (diabetic ketoacidosis, severe hypoglycaemia, adverse device events), psychosocial functioning obstetric and neonatal outcomes. Results The percentage of time that maternal glucose levels were within target range was higher with closed-loop than standard insulin therapy: 68.2 ± 10.5 in closed-loop and 55.6 ± 12.5 in the control group (mean‑adjusted difference 10.5 percentage points, 95% confidence interval 7.0 to 14.0; p < 0.001). Results were consistent in secondary outcomes, with less time above range (−10.2%, 95% confidence interval −13.8 to −6.6%; p < 0.001), higher overnight time in range (12.3%, 95% confidence interval 8.3 to 16.2%; p < 0.001) and lower glycated haemoglobin A1c (−0.31%, 95% confidence interval −0.50 to −0.12%; p < 0.002) all favouring closed-loop. The treatment effect was apparent from early pregnancy and consistent across clinical sites, maternal glycated haemoglobin A1c categories and previous insulin regimen. Maternal glucose improvements were achieved with 3.7 kg less gestational weight gain and without additional hypoglycaemia or total daily insulin dose. There were no unanticipated safety problems (six vs. five severe hypoglycaemia cases, one diabetic ketoacidosis per group) and seven device-related adverse events associated with closed-loop. There were no between-group differences in patient-reported outcomes. There was one shoulder dystocia in the closed-loop group and four serious birth injuries, including one neonatal death in the standard care group. Limitations Our results cannot be extrapolated to closed-loop systems with higher glucose targets, and our sample size did not provide definitive data on maternal and neonatal outcomes. Conclusions Hybrid closed-loop therapy significantly improved maternal glycaemia during type 1 diabetes pregnancy. Our results support National Institute for Health and Care Excellence guideline recommendations that hybrid closed-loop therapy should be offered to all pregnant women with type 1 diabetes. Future work Future trials should examine the effectiveness of hybrid closed-loop started before pregnancy, or as soon as possible after pregnancy confirmation

EVALUATION OF THE QUALITY OF IMMOBILIZATION AND CARDIORESPIRATORY EFFECTS OF ETORPHINE-MEDETOMIDINE-AZAPERONE COMBINATION IN PLAINS ZEBRAS (EQUUS QUAGGA): A PILOT STUDY

Five free-ranging male (subadults, n = 3; adults, n = 2) plains zebras (Equus quagga) were immobilized using a combination of etorphine (0.017 mg/kg), medetomidine (0.017 mg/kg), and azaperone (0.24 mg/kg) by means of a blank cartridge-fired projector. Time to recumbency was recorded and a descriptive score used to assess the quality of immobilization, manipulation, maintenance, and recovery. Physiological parameters were recorded at 5-min intervals for 20 min. At the end of the procedure, naltrexone (0.23 mg/kg) was administered intramuscularly and time to standing documented. The combination evaluated in this study allowed for successful immobilization and safe recovery of all animals, including during the subsequent 15 days. Despite the good outcome in this pilot study, as a result of the periodic apneic events and hypercapnia documented in the zebras, the authors suggest that physiological parameters be thoroughly monitored when using this protocol. Further studies are needed to improve upon chemical immobilization protocols in free-ranging plains zebras

Automated insulin delivery in women with pregnancy complicated by type 1 diabetes

BACKGROUND: Hybrid closed-loop insulin therapy has shown promise for management of type 1 diabetes during pregnancy; however, its efficacy is unclear. METHODS: In this multicenter, controlled trial, we randomly assigned pregnant women with type 1 diabetes and a glycated hemoglobin level of at least 6.5% at nine sites in the United Kingdom to receive standard insulin therapy or hybrid closed-loop therapy, with both groups using continuous glucose monitoring. The primary outcome was the percentage of time in the pregnancy-specific target glucose range (63 to 140 mg per deciliter [3.5 to 7.8 mmol per liter]) as measured by continuous glucose monitoring from 16 weeks’ gestation until delivery. Analyses were performed according to the intention-to-treat principle. Key secondary outcomes were the percentage of time spent in a hyperglycemic state (glucose level >140 mg per deciliter), overnight time in the target range, the glycated hemoglobin level, and safety events. RESULTS: A total of 124 participants with a mean (±SD) age of 31.1±5.3 years and a mean baseline glycated hemoglobin level of 7.7±1.2% underwent randomization. The mean percentage of time that the maternal glucose level was in the target range was 68.2±10.5% in the closed-loop group and 55.6±12.5% in the standard-care group (mean adjusted difference, 10.5 percentage points; 95% confidence interval [CI], 7.0 to 14.0; P<0.001). Results for the secondary outcomes were consistent with those of the primary outcome; participants in the closed-loop group spent less time in a hyperglycemic state than those in the standard-care group (difference, −10.2 percentage points; 95% CI, −13.8 to −6.6); had more overnight time in the target range (difference, 12.3 percentage points; 95% CI, 8.3 to 16.2), and had lower glycated hemoglobin levels (difference, −0.31 percentage points; 95% CI, −0.50 to −0.12). Little time was spent in a hypoglycemic state. No unanticipated safety problems associated with the use of closed-loop therapy during pregnancy occurred (6 instances of severe hypoglycemia, vs. 5 in the standard-care group; 1 instance of diabetic ketoacidosis in each group; and 12 device-related adverse events in the closed-loop group, 7 related to closed-loop therapy). CONCLUSIONS: Hybrid closed-loop therapy significantly improved maternal glycemic control during pregnancy complicated by type 1 diabetes. (Funded by the Efficacy and Mechanism Evaluation Program; AiDAPT ISRCTN Registry number, ISRCTN56898625. opens in new tab.

AiDAPT: automated insulin delivery amongst pregnant women with type 1 diabetes: a multicentre randomized controlled trial - study protocol.

BACKGROUND: Pregnant women with type 1 diabetes strive for tight glucose targets (3.5-7.8 mmol/L) to minimise the risks of obstetric and neonatal complications. Despite using diabetes technologies including continuous glucose monitoring (CGM), insulin pumps and contemporary insulin analogues, most women struggle to achieve and maintain the recommended pregnancy glucose targets. This study aims to evaluate whether the use of automated closed-loop insulin delivery improves antenatal glucose levels in pregnant women with type 1 diabetes. METHODS/DESIGN: A multicentre, open label, randomized, controlled trial of pregnant women with type 1 diabetes and a HbA1c of ≥48 mmol/mol (6.5%) at pregnancy confirmation and ≤ 86 mmol/mol (10%) at randomization. Participants who provide written informed consent before 13 weeks 6 days gestation will be entered into a run-in phase to collect 96 h (24 h overnight) of CGM glucose values. Eligible participants will be randomized on a 1:1 basis to CGM (Dexcom G6) with usual insulin delivery (control) or closed-loop (intervention). The closed-loop system includes a model predictive control algorithm (CamAPS FX application), hosted on an android smartphone that communicates wirelessly with the insulin pump (Dana Diabecare RS) and CGM transmitter. Research visits and device training will be provided virtually or face-to-face in conjunction with 4-weekly antenatal clinic visits where possible. Randomization will stratify for clinic site. One hundred twenty-four participants will be recruited. This takes into account 10% attrition and 10% who experience miscarriage or pregnancy loss. Analyses will be performed according to intention to treat. The primary analysis will evaluate the change in the time spent in the target glucose range (3.5-7.8 mmol/l) between the intervention and control group from 16 weeks gestation until delivery. Secondary outcomes include overnight time in target, time above target (> 7.8 mmol/l), standard CGM metrics, HbA1c and psychosocial functioning and health economic measures. Safety outcomes include the number and severity of ketoacidosis, severe hypoglycaemia and adverse device events. DISCUSSION: This will be the largest randomized controlled trial to evaluate the impact of closed-loop insulin delivery during type 1 diabetes pregnancy. TRIAL REGISTRATION: ISRCTN 56898625 Registration Date: 10 April, 2018

Fall prevention interventions in primary care to reduce fractures and falls in people aged 70 years and over: the PreFIT three-arm cluster RCT.

BACKGROUND: Falls and fractures are a major problem. OBJECTIVES: To investigate the clinical effectiveness and cost-effectiveness of alternative falls prevention interventions. DESIGN: Three-arm, pragmatic, cluster randomised controlled trial with parallel economic analysis. The unit of randomisation was the general practice. SETTING: Primary care. PARTICIPANTS: People aged ??70 years. INTERVENTIONS: All practices posted an advice leaflet to each participant. Practices randomised to active intervention arms (exercise and multifactorial falls prevention) screened participants for falls risk using a postal questionnaire. Active treatments were delivered to participants at higher risk of falling. MAIN OUTCOME MEASURES: The primary outcome was fracture rate over 18 months, captured from Hospital Episode Statistics, general practice records and self-report. Secondary outcomes were falls rate, health-related quality of life, mortality, frailty and health service resource use. Economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit. RESULTS: Between 2011 and 2014, we randomised 63 general practices (9803 participants): 21 practices (3223 participants) to advice only, 21 practices (3279 participants) to exercise and 21 practices (3301 participants) to multifactorial falls prevention. In the active intervention arms, 5779 out of 6580 (87.8%) participants responded to the postal fall risk screener, of whom 2153 (37.3%) were classed as being at higher risk of falling and invited for treatment. The rate of intervention uptake was 65% (697 out of 1079) in the exercise arm and 71% (762 out of 1074) in the multifactorial falls prevention arm. Overall, 379 out of 9803 (3.9%) participants sustained a fracture. There was no difference in the fracture rate between the advice and exercise arms (rate ratio 1.20, 95% confidence interval 0.91 to 1.59) or between the advice and multifactorial falls prevention arms (rate ratio 1.30, 95% confidence interval 0.99 to 1.71). There was no difference in falls rate over 18 months (exercise arm: rate ratio 0.99, 95% confidence interval 0.86 to 1.14; multifactorial falls prevention arm: rate ratio 1.13, 95% confidence interval 0.98 to 1.30). A lower rate of falls was observed in the exercise arm at 8 months (rate ratio 0.78, 95% confidence interval 0.64 to 0.96), but not at other time points. There were 289 (2.9%) deaths, with no differences by treatment arm. There was no evidence of effects in prespecified subgroup comparisons, nor in nested intention-to-treat analyses that considered only those at higher risk of falling. Exercise provided the highest expected quality-adjusted life-years (1.120), followed by advice and multifactorial falls prevention, with 1.106 and 1.114 quality-adjusted life-years, respectively. NHS costs associated with exercise (£3720) were lower than the costs of advice (£3737) or of multifactorial falls prevention (£3941). Although incremental differences between treatment arms were small, exercise dominated advice, which in turn dominated multifactorial falls prevention. The incremental net monetary benefit of exercise relative to treatment valued at £30,000 per quality-adjusted life-year is modest, at £191, and for multifactorial falls prevention is £613. Exercise is the most cost-effective treatment. No serious adverse events were reported. LIMITATIONS: The rate of fractures was lower than anticipated. CONCLUSIONS: Screen-and-treat falls prevention strategies in primary care did not reduce fractures. Exercise resulted in a short-term reduction in falls and was cost-effective. FUTURE WORK: Exercise is the most promising intervention for primary care. Work is needed to ensure adequate uptake and sustained effects. TRIAL REGISTRATION: Current Controlled Trials ISRCTN71002650. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 34. See the NIHR Journals Library website for further project information.This article is freely available online. Click on the 'Additional Link' above to access the full-text via the publisher's site.Published version, accepted version, submitted versio