| 751. |
- Hartfiel, N., et al.
(author)
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Cost-effectiveness of yoga for managing musculoskeletal conditions in the workplace
- 2017
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In: Occupational Medicine. - : Oxford University Press (OUP). - 0962-7480 .- 1471-8405. ; 67:9, s. 687-695
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Journal article (peer-reviewed)abstract
- Background Back pain and musculoskeletal conditions negatively affect the health-related quality of life (HRQL) of employees and generate substantial costs to employers. Aims To assess the cost-effectiveness of yoga for managing musculoskeletal conditions. Methods A randomized controlled trial evaluated an 8-week yoga programme, with a 6-month follow-up, for National Health Service (NHS) employees. Effectiveness in managing musculoskeletal conditions was assessed using repeated-measures generalized linear modelling for the Roland-Morris Disability Questionnaire (RDQ) and the Keele STarT Back Screening Tool. Cost-effectiveness was determined using area-under-the-curve linear regression for assessing HRQL from healthcare and societal perspectives. The incremental cost per quality-adjusted life year (QALY) was also calculated. Sickness absence was measured using electronic staff records at 6 months. Results There were 151 participants. At 6 months, mean differences between groups favouring yoga were observed for RDQ [-0.63 (95% CI, -1.78, 0.48)], Keele STarT [-0.28 (95% CI, -0.97, 0.07)] and HRQL (0.016 QALY gain). From a healthcare perspective, yoga yielded an incremental cost-effectiveness ratio of £2103 per QALY. Given a willingness to pay for an additional QALY of £20 000, the probability of yoga being cost-effective was 95%. From a societal perspective, yoga was the dominant treatment compared with usual care. At 6 months, electronic staff records showed that yoga participants missed a total of 2 working days due to musculoskeletal conditions compared with 43 days for usual care participants. Conclusions Yoga for NHS employees may enhance HRQL, reduce disability associated with back pain, lower sickness absence due to musculoskeletal conditions and is likely to be cost-effective. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved.
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| 752. |
- Hartfiel, Ned, et al.
(author)
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Yoga for reducing perceived stress and back pain at work.
- 2012
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In: Occupational Medicine. - : Oxford University Press (OUP). - 0962-7480 .- 1471-8405. ; 62:8, s. 606-612
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Journal article (peer-reviewed)abstract
- Background Stress and back pain are two key factors leading to sickness absence at work. Recent research indicates that yoga can be effective for reducing perceived stress, alleviating back pain, and improving psychological well-being. Aims To determine the effectiveness of a yoga-based intervention for reducing perceived stress and back pain at work. Methods Participants were recruited from a British local government authority and randomized into a yoga group who received one 50min Dru Yoga session each week for 8 weeks and a 20min DVD for home practice and a control group who received no intervention. Baseline and end-programme measurements of self-reported stress, back pain and psychological well-being were assessed with the Perceived Stress Scale, Roland Morris Disability Questionnaire and the Positive and Negative Affect Scale. Results There were 37 participants in each group. Analysis of variance and multiple linear regression showed that in comparison to the control group, the yoga group reported significant reductions in perceived stress and back pain, and a substantial improvement in psychological well-being. When compared with the control group at the end of the programme, the yoga group scores were significantly lower for perceived stress, back pain, sadness and hostility, and substantially higher for feeling self-assured, attentive and serene. Conclusions The results indicate that a workplace yoga intervention can reduce perceived stress and back pain and improve psychological well-being. Larger randomized controlled trials are needed to determine the broader efficacy of yoga for improving workplace productivity and reducing sickness absence.
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| 753. |
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| 754. |
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| 755. |
- Healy, P., et al.
(author)
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Process evaluation for OptiBIRTH, a randomised controlled trial of a complex intervention designed to increase rates of vaginal birth after caesarean section
- 2018
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In: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 19
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Journal article (peer-reviewed)abstract
- Background: Complex interventions encompassing several interconnecting and interacting components can be challenging to evaluate. Examining the underlying trial processes while an intervention is being tested can assist in explaining why an intervention was effective (or not). This paper describes a process evaluation of a pan-European cluster randomised controlled trial, OptiBIRTH (undertaken in Ireland, Italy and Germany), that successfully used both quantitative and qualitative methods to enhance understanding of the underlying trial mechanisms and their effect on the trial outcome. Methods: We carried out a mixed methods process evaluation. Quantitative and qualitative data were collected from observation of the implementation of the intervention in practice to determine whether it was delivered according to the original protocol. Data were examined to assess the delivery of the various components of the intervention and the receipt of the intervention by key stakeholders (pregnant women, midwives, obstetricians). Using ethnography, an exploration of perceived experiences from a range of recipients was conducted to understand the perspective of both those delivering and those receiving the intervention. Results: Engagement by stakeholders with the different components of the intervention varied from minimal intensity of women's engagement with antenatal classes, to moderate intensity of engagement with online resources, to high intensity of clinicians' exposure to the education sessions provided. The ethnography determined that, although the overall culture in the intervention site did not change, smaller, more individual cultural changes were observed. The fidelity of the delivery of the intervention scored average quality marks of 80% and above on repeat assessments. Conclusion: Nesting a process evaluation within the trial enabled the observation of the mode of action of the intervention in its practice context and ensured that the intervention was delivered with a good level of consistency. Implementation problems were identified as they arose and were addressed accordingly. When dealing with a complex intervention, collecting and analysing both quantitative and qualitative data, as we did, can greatly enhance the process evaluation.
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| 756. |
- Hopkins, H., et al.
(author)
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Impact of introduction of rapid diagnostic tests for malaria on antibiotic prescribing: analysis of observational and randomised studies in public and private healthcare settings
- 2017
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In: Bmj-British Medical Journal. - : BMJ. - 1756-1833 .- 0959-8138. ; 356
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Journal article (peer-reviewed)abstract
- OBJECTIVES To examine the impact of use of rapid diagnostic tests for malaria on prescribing of antimicrobials, specifically antibiotics, for acute febrile illness in Africa and Asia. Analysis of nine preselected linked and codesigned observational and randomised studies (eight cluster or individually randomised trials and one observational study). Public and private healthcare settings, 2007-13, in Afghanistan, Cameroon, Ghana, Nigeria, Tanzania, and Uganda. Proportions of patients for whom an antibiotic was prescribed in trial groups who had undergone rapid diagnostic testing compared with controls and in patients with negative test results compared with patients with positive results. A secondary aim compared classes of antibiotics prescribed in different settings. Antibiotics were prescribed to 127 052/238 797 (53%) patients in control groups and 167 714/283 683 (59%) patients in intervention groups. Antibiotics were prescribed to 40% (35 505/89 719) of patients with a positive test result for malaria and to 69% (39 400/57 080) of those with a negative result. All but one study showed a trend toward more antibiotic prescribing in groups who underwent rapid diagnostic tests. Random effects meta-analysis of the trials showed that the overall risk of antibiotic prescription was 21% higher (95% confidence interval 7% to 36%) in intervention settings. In most intervention settings, patients with negative test results received more antibiotic prescriptions than patients with positive results for all the most commonly used classes: penicillins, trimethoprim-sulfamethoxazole (one exception), tetracyclines, and metronidazole. Introduction of rapid diagnostic tests for malaria to reduce unnecessary use of antimalarials-a beneficial public health outcome-could drive up untargeted use of antibiotics. That 69% of patients were prescribed antibiotics when test results were negative probably represents overprescription. This included antibiotics from several classes, including those like metronidazole that are seldom appropriate for febrile illness, across varied clinical, health system, and epidemiological settings. It is often assumed that better disease specific diagnostics will reduce antimicrobial overuse, but they might simply shift it from one antimicrobial class to another. Current global implementation of malaria testing might increase untargeted antibiotic use and must be examined.
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| 757. |
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| 758. |
- Hutchings, Jeffrey A., et al.
(author)
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Life-history variability and conservation status of landlocked Atlantic salmon : an overview
- 2019
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In: Canadian Journal of Fisheries and Aquatic Sciences. - : Canadian Science Publishing. - 0706-652X .- 1205-7533. ; 76:10, s. 1697-1708
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Journal article (peer-reviewed)abstract
- Nonanadromous Atlantic salmon (Salmo salar) exhibit a combination of variation in life history, habitat, and species co-existence matched by few vertebrates. Distributed in eastern North America and northern Europe, habitat ranges from hundreds of metres of river to Europe’s largest lakes. As juveniles, those with access to a lake usually migrate to feed and grow prior to reproduction. Prey such as smelt (Osmerus mordax, Osmerus eperlanus) and vendace (Coregonus albula) facilitate large body size (50–85 cm at maturity) and persistence in high-diversity (>20 fish species) environments; small-bodied salmon (10–30 cm at maturity), relying on insects as prey, coexist with few (fewer than five) other fishes. At maturity, weight varies more than 400-fold (17 to 7200 g) among populations, fecundity more than 150-fold (33 to 5600), and longevity almost fivefold (3 to 14 years). Landlocked salmon are managed to support sustainable fishing, achieve conservation and restoration targets, and mitigate threats; successes are evident but multiple challenges persist. Extraordinary variability in life history coupled with extensive breadth of habitat and species co-existence render landlocked Atlantic salmon singularly impressive from a biodiversity perspective.
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| 759. |
- Jauhiainen, Jyrki, et al.
(author)
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Reviews and syntheses: Greenhouse gas exchange data from drained organic forest soils-A review of current approaches and recommendations for future research
- 2019
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In: Biogeosciences. - : Copernicus GmbH. - 1726-4170 .- 1726-4189. ; 16:23, s. 4687-4703
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Journal article (peer-reviewed)abstract
- © Author(s) 2019. Drained organic forest soils in boreal and temperate climate zones are believed to be significant sources of the greenhouse gases (GHGs) carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O), but the annual fluxes are still highly uncertain. Drained organic soils exemplify systems where many studies are still carried out with relatively small resources, several methodologies and manually operated systems, which further involve different options for the detailed design of the measurement and data analysis protocols for deriving the annual flux. It would be beneficial to set certain guidelines for how to measure and report the data, so that data from individual studies could also be used in synthesis work based on data collation and modelling. Such synthesis work is necessary for deciphering general patterns and trends related to, e.g., site types, climate, and management, and the development of corresponding emission factors, i.e. estimates of the net annual soil GHG emission and removal, which can be used in GHG inventories. Development of specific emission factors also sets prerequisites for the background or environmental data to be reported in individual studies. We argue that wide applicability greatly increases the value of individual studies. An overall objective of this paper is to support future monitoring campaigns in obtaining high-value data.We analysed peer-reviewed public cations presenting CO2, CH4 and N2O flux data for drained organic forest soils in boreal and temperate climate zones, focusing on data that have been used, or have the potential to be used, for estimating net annual soil GHG emissions and removals. We evaluated the methods used in data collection and identified major gaps in background or environmental data. Based on these, we formulated recommendations for future research.
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| 760. |
- Johnson, Christopher M, et al.
(author)
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Thermodynamics of Denaturation of Mutants of Barnase with Disulfide Crosslinks
- 1997
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In: Journal of Molecular Biology. - : Elsevier BV. - 1089-8638 .- 0022-2836. ; 268:1, s. 198-208
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Journal article (peer-reviewed)abstract
- We have measured the effects of disulfide crosslinks on the thermodynamics of denaturation of three mutants of barnase that contain cystine and the corresponding single and double cysteine mutants. At first sight, the data are consistent with the hypothesis that disulfide crosslinks stabilise proteins through entropic destabilisation of the denatured state, but the decreases in the entropy of denaturation are larger than predicted and are accompanied by decreases in the enthalpy of denaturation. These effects are not a unique feature of the disulfide crosslink and are observed in a range of non-crosslinked mutants of barnase as part of a general enthalpy-entropy compensation phenomenon. Similarly, effects on the heat capacity change for denaturation (@DCpd), determined from the slope of the enthalpy of denaturation versus temperature, are not confined to mutants with disulfide crosslinks. The value of @DCpd is lower in four stabilised mutants than in wild-type barnase, irrespective of the presence of a disulfide crosslink, while the @DCpd remains unchanged in a destabilised mutant containing a disulfide. The variation in @DCpd may result from an inherent temperature-dependence of @DCpd, since it is measured for each mutant over a different temperature range. The thermodynamics of denaturation of the disulfide mutant with a crosslink between positions 70 and 92 change anomalously with pH but in a similar way to that of the D93N mutant of barnase, which lacks the D93-R69 salt-bridge present in the wild-type. This finding confirms initial observations in the X-ray structure of this disulfide mutant that the salt-bridge has been disrupted by the introduced crosslink.
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