Finding qualitative research: an evaluation of search strategies

BACKGROUND: Qualitative research makes an important contribution to our understanding of health and healthcare. However, qualitative evidence can be difficult to search for and identify, and the effectiveness of different types of search strategies is unknown. METHODS: Three search strategies for qualitative research in the example area of support for breast-feeding were evaluated using six electronic bibliographic databases. The strategies were based on using thesaurus terms, free-text terms and broad-based terms. These strategies were combined with recognised search terms for support for breast-feeding previously used in a Cochrane review. For each strategy, we evaluated the recall (potentially relevant records found) and precision (actually relevant records found). RESULTS: A total yield of 7420 potentially relevant records was retrieved by the three strategies combined. Of these, 262 were judged relevant. Using one strategy alone would miss relevant records. The broad-based strategy had the highest recall and the thesaurus strategy the highest precision. Precision was generally poor: 96% of records initially identified as potentially relevant were deemed irrelevant. Searching for qualitative research involves trade-offs between recall and precision. CONCLUSIONS: These findings confirm that strategies that attempt to maximise the number of potentially relevant records found are likely to result in a large number of false positives. The findings also suggest that a range of search terms is required to optimise searching for qualitative evidence. This underlines the problems of current methods for indexing qualitative research in bibliographic databases and indicates where improvements need to be made

Functional dairy protein supplements for elite athletes

Elite athletes require a greater dietary protein intake than recreationally active people to maintain optimal muscular function. The timing of protein ingestion relative to exercise is critical to maximizing its physiological impact on skeletal muscles. Sports protein supplements provide a convenient means of supplying athletes with an adequate and timely source of quality dietary protein. There is now strong evidence that not all dietary proteins are equipotent in their effects on various aspects of athletic performance and specific protein isolates can provide benefits to athletes beyond simple supply of nutritional amino acids. Thus, there is an opportunity to develop new functional protein supplements to maximize athletic performance. This paper outlines the clinical evidence for the benefits of dairy proteins in sports performance and describes the development of new dairy protein supplements to build muscle strength, and to expedite recovery of strength following muscle-damaging eccentric exercise.<br /

Effect of ageing and exercise training on myokine expression responses to acute exercise

Age-related muscle loss is a major contributor to falls, fraility and mortality. It has been widely suggested that chronic, age-related inflammation contributes to the gradual loss of skeletal muscle mass that occurs with ageing. Indeed, ageing is associated with elevations in a number of circulating inflammatory proteins, many of which have detrimental effects on skeletal muscle growth and protein balance. Exercise training has been shown to reduce chronic inflammation and, therefore, may represent an appropriate means to reduce age-related inflammation and counteract sarcopenia. Yet few studies have evaluated the effect of aging on skeletal muscle expression of inflammatory proteins and the effect of acute and repeated exercise on these factors. The aim of the current study was to determine the effect of 12 weeks of resistance exercise training on the levels of myokines within skeletal muscle, both at rest and following an acute bout of exercise and to examine how these responses may vary in young and older subjects, thus evaluating the potential for exercise to reduce age-related muscle inflammation. Six healthy young (aged 18-25 years) and 8 healthy older men (aged 60-75 years) completed 12 weeks of resistance exercise training. Muscle biopsies were collected before and 2 h after an acute exercise bout at the beginning and the end of the 12 week training period. Muscle tissue was analyzed for the expression of key inflammatory (MCP-1, IL-8, IL-6 and TNF-α) and anti-inflammatory cytokines (IL-10, IL-13 and IL-4) via bead-based multiplex analysis. Acute exercise increased the expression of inflammatory myokines, while anti-inflammatory myokines remained unchanged. In contrast to the hypothesis for this study, neither age nor training had a significant effect on the expression of myokines within skeletal muscle either in the resting state or 2 hours following exercise. However, older individuals displayed an increased inflammatory response to exercise prior to training when compared to younger individuals. Twelve weeks of resistance exercise training appeared to normalize this difference. Given the variability in myokine levels between individuals and the small subject number in the current study, further research is required to confirm this findin

Assessing molecular simulation for the analysis of lipid monolayer reflectometry

Using molecular simulation to aid in the analysis of neutron reflectometry measurements is commonplace. However, reflectometry is a tool to probe large-scale structures, and therefore the use of all-atom simulation may be irrelevant. This work presents the first direct comparison between the reflectometry profiles obtained from different all-atom and coarse-grained molecular dynamics simulations. These are compared with a traditional model layer structure analysis method to determine the minimum simulation resolution required to accurately reproduce experimental data. We find that systematic limits reduce the efficacy of the MARTINI potential model, while the Berger united-atom and Slipids all-atom potential models agree similarly well with the experimental data. The model layer structure gives the best agreement, however, the higher resolution simulation-dependent methods produce an agreement that is comparable. Finally, we use the atomistic simulation to advise on possible improvements that may be offered to the model layer structures, creating a more realistic monolayer model.Comment: Electronic Supplementary Information (ESI) available: All analysis/plotting scripts and figure files, allowing for a fully reproducible, and automated, analysis workflow for the work presented is available at \url{https://github.com/arm61/sim_vs_trad} (DOI: 10.5281/zenodo.2600729) under a CC BY-SA 4.0 licens

Four-dimensional imaging of moisture dynamics during landslide reactivation

Landslides pose significant risks to communities and infrastructure, and mitigating these risks relies on understanding landslide causes and triggering processes. It has been shown that geophysical surveys can significantly contribute to the characterization of unstable slopes. However, hydrological processes can be temporally and spatially heterogeneous, requiring their related properties to be monitored over time. Geoelectrical monitoring can provide temporal and volumetric distributions of electrical resistivity, which are directly related to moisture content. To date, studies demonstrating this capability have been restricted to 2D sections, which are insufficient to capture the full degree of spatial heterogeneity. This study is the first to employ 4D (i.e., 3D time-lapse) resistivity imaging on an active landslide, providing long-term data (three years) highlighting the evolution of moisture content prior to landslide reactivation and showing its decline post reactivation. Crucially the time-lapse inversion methodology employed here incorporates movements of the electrodes on the unstable surface. Although seasonal characteristics dominate the shallow moisture dynamics during the first two years with surficial drying in summer and wetting in winter, in the months preceding reactivation, moisture content increased by more than 45 % throughout the slope. This is in agreement with independent data showing a significant rise in piezometric heads and shallow soil moisture contents as a result of prolonged and intense rainfall. Based on these results, remediation measures could be designed and early-warning systems implemented. Thus, resistivity monitoring that can allow for moving electrodes provides a new means for the effective mitigation of landslide risk

ACHE : the Arthroplasty Candidacy Help Engine : using PROMs data to identify thresholds for referral in hip and knee replacement surgery

Background: At present there is no evidence to support the use of the Oxford PROM scores to set pre-operative thresholds for referral for hip and knee replacement surgery. Despite this the practice has been widespread in the NHS. Objectives/Research Questions: Can the Oxford Hip/Knee scores (OKS/OHS) be used to set referral thresholds for hip/knee replacement surgery? Does the choice of threshold affect the cost effectiveness of the procedure? Methods: Thresholds for the Oxford scores were calculated, based on a capacity to benefit model linking pre-operative OKS/OHS to the probability of a good outcome – creating an online ACHE tool. Markov models were constructed to assess how the cost-effectiveness of TKA and THA compared with no arthroplasty varies with pre-operative OKS/OHS over a 10-year time horizon from a UK NHS perspective. Results: The absolute threshold for the OHS was 41 and 42 for the OKS. A model was created that used preoperative Oxford scores to estimate the probability of a good outcome allowed – e.g. an OHS of 35 or an OKS of 30 offers a patient a 70% probability of achieving a good outcome. The economic evaluation demonstrated that TKA and THA cost 99.9% of patients who currently undergo surgery. It is cost-effective to conduct TKA on patients with OKS of 43 (95% credible interval, CrI: 43,44) or less and on patients with THA of 45 or less (95% CrI: 44, 45). Conclusion: Using the ACHE tool the Oxford Hip/Knee Scores can be used to assess an individual patients suitability for hip or knee replacement surgery. On a population level both interventions are highly cost-effective right up to the absolute threshold for intervention. The ACHE tool appears to be a useful evidence based clinical tool to aid referral from primary to secondary care

Meniscal Transplant surgery or Optimised Rehabilitation full randomised trial (MeTeOR2): a study protocol

Introduction: Pain and disability after meniscectomy can be a substantial lifelong problem. There are few treatment options, especially for young people. Non-surgical management (rehabilitation) is an option but increasingly surgeons are performing meniscal allograft transplants (MATs) for these individuals. However, this is still an uncommon procedure, and availability and usage of MAT vary widely both in the UK and internationally. It is not known which treatment option is the most effective and cost-effective. Methods and analysis: The Meniscal Transplant surgery or Optimised Rehabilitation trial is an international, multicentre, randomised controlled trial. The aim is to compare the clinical and cost effectiveness of MAT versus an optimised package of individualised, progressive, rehabilitation that we have called personalised knee therapy (PKT). Participants will be recruited from sites across the UK, Australia, Canada and Belgium. The planned 144 participants provide at least 90% power to detect a 10-point difference in the Knee injury and Osteoarthritis Outcome Score (KOOS4) at 24-months post randomisation (primary outcome). A prospectively planned economic evaluation will be conducted from a healthcare system and personal social services perspective. Secondary outcome data including health utility, occupational status, sports participation, mental well-being, further treatment, and adverse events will be collected at 3, 6, 12, 18, and 24 months. Analysis will be on an intention-to-treat basis and reported in-line with the Consolidated Standards of Reporting Trials statement. Ethics and dissemination: The trial was approved by the London—Bloomsbury Research Ethics Committee on 19 August 2022 (22/LO/0327) and Northern Sydney Local Health District Human Research Ethics Committee, NSW, Australia on the 13 March 2023 (2022/ETH01890). Trial results will be disseminated via peer-reviewed publications, presentations at international conferences, in lay summaries and using social media as appropriate. This protocol adheres to the recommended Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist. Trial registration number: ISRCTN87336549

No Effect of a Whey Growth Factor Extract during Resistance Training on Strength, Body Composition, or Hypertrophic Gene Expression in Resistance-Trained Young Men

Growth factors can be isolated from bovine milk to form a whey growth factor extract (WGFE). This study examined whether WGFE promoted activation of the AKT/mTOR pathway enabling increased lean tissue mass and strength in resistance trained men. Forty six men with \u3e6 months of resistance training (RT) experience performed 12 weeks of RT. Participants consumed 20 g/day of whey protein and were randomised to receive either 1.6 g WGFE/day (WGFE; n = 22) or 1.6 g cellulose/day (control, CONT; n = 24). The primary outcome was leg press one-repetition maximum (LP1-RM) which was assessed at baseline, 6 and 12 weeks. At baseline and 12 weeks body composition was assessed by dual energy x-ray absorptiometry, and muscle protein synthesis and gene expression were assessed (vastus lateralis biopsy) in a sub-sample (WGFE n = 10, CONT n = 10) pre- and 3 hr post-training. RT increased LP1-RM (+34.9%) and lean tissue mass (+2.3%; p \u3c 0.05) with no difference between treatments (p \u3e 0.48, treatment x time). Post-exercise P70s6k phosphorylation increased acutely, FOXO3a phosphorylation was unaltered. There were no differences in kinase signalling or gene expression between treatments. Compared with CONT, WGFE did not result in greater increases in lean tissue mass or strength in experienced resistance trained men

The complete management of extremity vascular injury in a local population: A wartime report from the 332nd Expeditionary Medical Group/Air Force Theater Hospital, Balad Air Base, Iraq

Background: Although the management of vascular injury in coalition forces during Operation Iraqi Freedom has been described, there are no reports on the in-theater treatment of wartime vascular injury in the local population. This study reports the complete management of extremity vascular injury in a local wartime population and illustrates the unique aspects of this cohort and management strategy. Methods: From September 1, 2004, to August 31, 2006, all vascular injuries treated at the Air Force Theater Hospital (AFTH) in Balad, Iraq, were registered. Those in non-coalition troops were identified and retrospectively reviewed. Results: During the study period, 192 major vascular injuries were treated in the local population in the following distribution: extremity 70% (n = 134), neck and great vessel 17% (n = 33), and thoracoabdominal 13% (n = 25). For the extremity cohort, the age range was 4 to 68 years and included 12 pediatric injuries. Autologous vein was the conduit of choice for these vascular reconstructions. A strict wound management strategy providing repeat operative washout and application of the closed negative pressure adjunct was used. Delayed primary closure or secondary coverage with a split-thickness skin graft was required in 57% of extremity wounds. All patients in this cohort remained at the theater hospital through definitive wound healing, with an average length of stay of 15 days (median 11 days). Patients required an average of 3.3 operations (median 3) from the initial injury to definitive wound closure. Major complications in extremity vascular patients, including mortality, were present in 15.7% (n = 21). Surgical wound infection occurred in 3.7% (n = 5), and acute anastomotic disruption in 3% (n = 4). Graft thrombosis occurred in 4.5% (n = 6), and early amputation and mortality rates during the study period were 3.0% (n = 4) and 1.5% (n = 2), respectively. Conclusions: To our knowledge, this study represents the first large report of wartime extremity vascular injury management in a local population. These injuries present unique challenges related to complex wounds that require their complete management to occur in-theater. Vascular reconstruction using vein, combined with a strict wound management strategy, results in successful limb salvage with remarkably low infection, amputation and mortality rates

A Comprehensive Economic Stimulus for our Failing Economy

This paper presents a comprehensive plan to fix the ailing American economy, through a five-step approach. First, the Federal Reserve must continue to broaden the scope of monetary policy, by purchasing and selling long-term securities. Manipulating expectations through FOMC statements is another tool at the Federal Reserve’s disposal. Secondly, the government must enact fiscal stimulus to stabilize the economy in the short and medium runs, through investment in infrastructure projects, green technology, fusion technology, and science education. Additionally, the new fiscal policy must tackle the mortgage meltdown, which is weighing down the entire economy. Third, the regulatory system must be changed to reduce the likelihood of another financial collapse, starting with the nationalization of the ratings agencies. Ratings should be updated faster, with a numeric grading system rather than the pre-existing letter grades. Fourth, our globalized economy insures that a coordinated globalized response is necessary to recover. Global cooperation to reduce inflation and avoid protectionist policies is vital. Finally, the American bailout policy must be made clear, only giving bailouts to companies that are sound but financially strapped and those that are too big to fail