88 research outputs found
Cost effectiveness of a community based exercise programme in over 65 year olds: cluster randomised trial
OBJECTIVE: To assess the cost effectiveness of a community based exercise programme as a population
wide public health intervention for older adults.
DESIGN: Pragmatic, cluster randomised community intervention trial.
Setting: 12 general practices in Sheffield; four randomly selected as intervention populations, and eight as
control populations.
PARTICIPANTS: All those aged 65 and over in the least active four fifths of the population responding to a
baseline survey. There were 2283 eligible participants from intervention practices and 4137 from control
practices.
INTERVENTION: Eligible subjects were invited to free locally held exercise classes, made available for two
years.
MAIN OUTCOME MEASURES: All cause and exercise related cause specific mortality and hospital service use
at two years, and health status assessed at baseline, one, and two years using the SF-36. A cost utility
analysis was also undertaken.
RESULTS: Twenty six per cent of the eligible intervention practice population attended one or more exercise
sessions. There were no significant differences in mortality rates, survival times, or admissions. After
adjusting for baseline characteristics, patients in intervention practices had a lower decline in health status,
although this reached significance only for the energy dimension and two composite scores (p,0.05). The
incremental average QALY gain of 0.011 per person in the intervention population resulted in an
incremental cost per QALY ratio of J17 174 (95% CI =J8300 to J87 120).
CONCLUSIONS: Despite a low level of adherence to the exercise programme, there were significant gains in
health related quality of life. The programme was more cost effective than many existing medical
interventions, and would be practical for primary care commissioning agencies to implement
Nutrients in Wastewater from a Phosphate Fertilizer Manufacturing Plant Stored for Irrigation
Wastewater from a fertilizer manufacturing plant in southern Idaho
was pumped into a storage impoundment during the winter months and stored
for irrigating and fertilizing agricultural crops the next summer. Analyses of
water samples from the impoundment taken monthly showed the following
mean annual nutrient concentrations: Total Kjeldahl Nitrogen (TKN) 94,
NH+4-N 61, NO-3–N 8, total P 17, ortho P 15, and K 17 mg/L. The impoundment
surface area averaged 10.5 ha with a maximum pond volume during the
year of 362,000 m3 . Accumulated nutrients in the impounded wastewater
available for irrigating and fertilizing agricultural crops at the beginning of the
growing season was TKN 30.2, NH+4–N 23.2, NO3-N 4.3, total P 9.7, and K 6.2
metric tons. Nitrification in the pond was minimal. Redox potentials were
between 480 and 500 mv at all depths and locations measured in the pond in
the summer and denitrification was minimal. The redox potential indicated that
the water was near oxygen saturation
Spin dependent scattering of a domain-wall of controlled size
Magnetoresistance measurements in the CPP geometry have been performed on
single electrodeposited Co nanowires exchange biased on one side by a sputtered
amorphous GdCo layer. This geometry allows the stabilization of a single domain
wall in the Co wire, the thickness of which can be controlled by an external
magnetic field. Comparing magnetization, resistivity, and magnetoresistance
studies of single Co nanowires, of GdCo layers, and of the coupled system,
gives evidence for an additional contribution to the magnetoresistance when the
domain wall is compressed by a magnetic field. This contribution is interpreted
as the spin dependent scattering within the domain wall when the wall thickness
becomes smaller than the spin diffusion length.Comment: 9 pages, 13 figure
Can forest management based on natural disturbances maintain ecological resilience?
Given the increasingly global stresses on forests, many ecologists argue that managers must maintain ecological resilience: the capacity of ecosystems to absorb disturbances without undergoing fundamental change. In this review we ask: Can the emerging paradigm of natural-disturbance-based management (NDBM) maintain ecological resilience in managed forests? Applying resilience theory requires careful articulation of the ecosystem state under consideration, the disturbances and stresses that affect the persistence of possible alternative states, and the spatial and temporal scales of management relevance. Implementing NDBM while maintaining resilience means recognizing that (i) biodiversity is important for long-term ecosystem persistence, (ii) natural disturbances play a critical role as a generator of structural and compositional heterogeneity at multiple scales, and (iii) traditional management tends to produce forests more homogeneous than those disturbed naturally and increases the likelihood of unexpected catastrophic change by constraining variation of key environmental processes. NDBM may maintain resilience if silvicultural strategies retain the structures and processes that perpetuate desired states while reducing those that enhance resilience of undesirable states. Such strategies require an understanding of harvesting impacts on slow ecosystem processes, such as seed-bank or nutrient dynamics, which in the long term can lead to ecological surprises by altering the forest's capacity to reorganize after disturbance
Daratumumab, lenalidomide, and dexamethasone in relapsed/refractory myeloma: a cytogenetic subgroup analysis of POLLUX
High cytogenetic risk abnormalities confer poor outcomes in multiple myeloma patients. In POLLUX, daratumumab/lenalidomide/dexamethasone (D-Rd) demonstrated significant clinical benefit versus lenalidomide/dexamethasone (Rd) in relapsed/refractory multiple myeloma (RRMM) patients. We report an updated subgroup analysis of POLLUX based on cytogenetic risk. The cytogenetic risk was determined using fluorescence in situ hybridization/karyotyping; patients with high cytogenetic risk had t(4;14), t(14;16), or del17p abnormalities. Minimal residual disease (MRD; 10–5) was assessed via the clonoSEQ® assay V2.0. 569 patients were randomized (D-Rd, n = 286; Rd, n = 283); 35 (12%) patients per group had high cytogenetic risk. After a median follow-up of 44.3 months, D-Rd prolonged progression-free survival (PFS) versus Rd in standard cytogenetic risk (median: not estimable vs 18.6 months; hazard ratio [HR], 0.43; P < 0.0001) and high cytogenetic risk (median: 26.8 vs 8.3 months; HR, 0.34; P = 0.0035) patients. Responses with D-Rd were deep, including higher MRD negativity and sustained MRD-negativity rates versus Rd, regardless of cytogenetic risk. PFS on subsequent line of therapy was improved with D-Rd versus Rd in both cytogenetic risk subgroups. The safety profile of D-Rd by cytogenetic risk was consistent with the overall population. These findings demonstrate the improved efficacy of daratumumab plus standard of care versus standard of care in RRMM, regardless of cytogenetic risk
Chronic lymphocytic leukaemia Australasian consensus practice statement
Chronic lymphocytic leukaemia (CLL) is the most common haematological malignancy in Australia and New Zealand (ANZ). Considerable changes to diagnostic and management algorithms have occurred within the last decade. The availability of next-generation sequencing and measurable residual disease assessment by flow cytometry allow for advanced prognostication and response assessments. Novel therapies, including inhibitors of Bruton's tyrosine kinase (BTKi) and B-cell lymphoma 2 (BCL2) inhibitors, have transformed the treatment landscape for both treatment-naïve and relapsed/refractory disease, particularly for patients with high-risk genetic aberrations. Recommendations regarding appropriate supportive management continue to evolve, and special considerations are required for patients with CLL with respect to the global SARS-CoV-2 pandemic. The unique funding and treatment environments in Australasia highlight the need for specific local guidance with respect to the investigation and management of CLL. This consensus practice statement was developed by a broadly representative group of ANZ experts in CLL with endorsement by peak haematology bodies, with a view to providing this standardised guidance
Irish cardiac society - Proceedings of annual general meeting held 20th & 21st November 1992 in Dublin Castle
Autoecologia das espécies florestais em regime de plantio de enriquecimento em linha na floresta primária da Amazônia Central
- …