Miracle-dz/UniFAR-FTUs huggingface dataset:
Prospective study of trends in referral patterns in fundholding and non-fundholding practices in the Oxford region, 1990-4

Abstract Objective: To compare outpatient referral patterns in fundholding and non-fundholding practices before and after the NHS reforms in April 1991. Design: Prospective collection of data on general practitioners' referrals to specialist outpatient clinics between June 1990 and January 1994 and detailed comparisons of three phases--October 1990 to March 1991 (phase 1), October 1991 to March 1992 (phase 2), and October 1993 to January 1994 (phase 3). Setting: 10 first wave fundholding practices and six non-fundholding practices in the Oxford region. Subjects: Patients referred to consultant outpatient clinics. Results: NHS referral rates increased in fundholding practices in phase 2 and phase 3 of the study by 8.1/1000 patients a year (95% confidence interval 5.7 to 10.5), anincrease of 7.5% from phase 1 (107.3/1000) to phase 3 (115.4/1000). Non-fundholders' rates increased significantly, by 25.3/1000 patients (22.5-28.1), an increase of 26.6% from phase 1 (95.0/1000) to phase 3 (120.3/1000). The fundholders' referral rates to private clinics decreased by 8.8%, whereas those from non-fundholding practices increased by 12.2%. The proportion of referrals going outside district boundaries did not change significantly. Three of the four practices entering the third and fourth wave of fundholding increased their referral rates significantly in the year before becoming fundholders. Conclusions: No evidence existed that budgetary pressures caused first wave fundholders to reduce referral rates, although the method of budget allocation may have encouraged general practitioners to inflate their referral rates in the preparatory year. Despite investment in new practice based facilities, no evidence yet exists that fundholdingencourages a shift away from specialist care.
Effect of a tailored physical activity intervention delivered in general practice settings: results of a randomized controlled trial.

OBJECTIVES We evaluated the effectiveness of a minimal intervention physical activity strategy (physician-based assessment and counseling for exercise [PACE]) applied in general practice settings in the Netherlands. METHODS Randomization took place at the general practice level. Participants were patients aged 18-70 years of age who had been diagnosed with hypertension, hypercholesterolemia, or non-insulin-dependent diabetes and had not been regularly physically active in the past 6 months. Outcome measures were assessed at baseline and at 8-week, 6-month, and 1-year follow-ups. RESULTS No significant intervention effect over time was observed on physical activity level or stage of change for regular physical activity, and an inverse intervention effect was observed for waist circumference. However, the study population as a whole exhibited a significant increase in physical activity and a borderline significant decrease in body weight at the 1-year follow-up. CONCLUSIONS Positive effects on physical activity level and body weight were observed, but the PACE intervention was not more effective than the standard physical activity advice.
A cost-effectiveness analysis of reducing ventilator-associated pneumonia at a Danish ICU with ventilator bundle

Abstract Background: More than 100,000 patients each year in Denmark experience nosocomial infections, erroneous medication, or pressure ulcers while hospitalized. The Danish Safer Hospital Program includes 12 bundles for improving patient safety through the introduction and maintenance of evidence-based routine treatment or standard procedures. Objective: To determine cost-effectiveness of implementing the Ventilator bundle (VB), thereby reducing ventilator-associated pneumonia (VAP), when treating a ventilated patient, compared to standard procedure. Setting and patients: A hypothetical population of intensive care patients in a Danish ICU, ventilated for >48 h. Methods: Cost-effectiveness analysis of the implementation of VB. The outcomes were prevention of VAP and prevention of death. Model inputs were evidence based from literature along with data from Kolding Hospital. A hypothetical population of intensive care patients in a Danish ICU, ventilated for >48 h was used. Results: The cost per VAP episode prevented was ∼€4451, and cost per death prevented was ∼€31,792. The incremental cost-effectiveness scatter plot showed that VB was more effective in 99.9%, and 42.6% have lower cost and better outcome for prevention of VAP. The incremental cost-effectiveness scatter plot showed that VB was more effective in 85.9%, and 31.6% have lower cost and better outcome for death prevented. Limitations: The study was a retrospective cost analysis where incidence rates were based on best evidence, even if it did not cover all elements in the VB. The perspective of this study was seen from a third-party payer, e.g., the hospital, thus societal costs and direct medical costs post-hospitalization for patients with VAP were not considered. Conclusion: We found that implementation of VB is potentially cost-effective when considering prevention of one case of VAP or death, based on a Danish ICU as a case study.
Performance and Kinematic Differences in Putting between Healthy and Disabled Elite Golfers

Abstract Golfers with disability are limited in the execution of the full golf swing, but their performance in putting may be comparable because this stroke does not demand significant strength, balance and range of motion. Therefore, the aim of this study was to compare putting performance, kinetic and kinematic consistency between golfers with different disabilities and healthy athletes. The participants consisted of three disabled athletes (perinatal cerebral palsy, multiple sclerosis, below knee lower limb amputee) and three healthy golfers (age 34 ± 4.5 years, body height 178 ± 3.3 cm, body mass 83 ± 6.2 kg). The golfers’ movements were recorded by active 3D markers for kinematic analyses; the subjects performed 10 trials of a 6 m putting task while standing on separate force platforms placed under each lower limb. Putting performance was measured by the distance of the final ball position to the centre of the hole. ANOVA analyses did not show any differences in clubhead speed and total ball distance from the hole. The consistency of those two parameters expressed by the coefficient of variation (CV) was CV = 0.5% or better in both groups for clubhead speed and ranged from CV = 0.40 to 0.61% in healthy and CV = 0.21 to 0.55% in disabled athletes for total error distance. The main effect ANOVA showed differences in weight shift, hip and shoulder kinematics (p < 0.05) between healthy players and all players with disability. All disabled athletes shifted their weight toward the healthy side (towards the healthy lower limb) and alternated the end of the swing. The player with below knee amputation had the lowest range of motion in the shoulder joint during the putting stroke. The players with perinatal cerebral palsy and multiple sclerosis had the largest range of motion in the hips. Putting performance of disabled golfers was similar to healthy athletes. During training of disabled players, coaches should pay attention to the specificity of a particular disability when focused on putting performance. However, individual technique should achieve the same consistency as observed in healthy players.
Interplay of discharge and gas flow in atmospheric pressure plasma jets

Interplay of discharge and gas flow in the atmospheric pressure plasma jets generated with three different discharge modes [N. Jiang, A. L. Ji, and Z. X. Cao, J. Appl. Phys. 106, 013308 (2009); N. Jiang, A. L. Ji, and Z. X. Cao, J. Appl. Phys. 108, 033302 (2010)] has been investigated by simultaneous photographing of both plasma plumes and gas flows in the ambient, with the former being visualized by using an optical schlieren system. Gas flow gains a forward momentum from discharge except for the case of overflow jets at smaller applied voltages. Larger applied voltage implies an elongated plasma jet only for single-electrode mode; for dielectric barrier discharge jet the plume length maximizes at a properly applied voltage. These findings can help understand the underlying processes, and are useful particularly for the economic operation of tiny helium plasma jets and jet arrays.
Energy balance of laying hens selected on residual food consumption.

1. Energy balance of adult hens divergently selected for high (R + ) or low (R- ) residual food consumption was investigated using indirect calorimetry. Three experiments were conducted: feeding behaviour of individual hens, hens having free access to food or fasting and hens tube-fed at 70, 100 or 130% of the control intake of both lines. 2. R + hens ate significantly more than R- (+ 48%). This difference was maximum at the onset of the light (+ 120%) and not significant during the rest of the light period. Although both lines spent the same total time eating, R + hens exhibited more frequent but shorter meals than R- ones, suggesting a higher feeding activity in R + hens. 3. True metabolisable energy (TME) intake was 28% greater in R+ than in R- birds. Basal heat production did not differ significantly between genotypes. Heat increment of feeding (HI) or diet-induced thermogenesis was significantly enhanced in R + birds: + 23.9 vs 13.7 kJ/100 kJ TME intake in R- . 4. When tube-fed and placed in darkness.
A completed audit cycle on post-tonsillectomy haemorrhage rate: Coblation versus standard tonsillectomy

Conclusion. A significant reduction in post-tonsillectomy secondary haemorrhage rate was observed after coblation tonsillectomy was abandoned in our department. Objective. Comparison of the postoperative haemorrhage rate following coblation tonsillectomy and routine dissection tonsillectomy. Patients and methods. This was a retrospective study. In the first audit period, 441 sequential tonsillectomies between January and September 2002 were reviewed. Coblation was compared with cold steel and diathermy dissection with either ties and/or diathermy used for haemostasis. Coblation tonsillectomy was subsequently abandoned in our unit and, in the second audit period, all tonsillectomies (n=416) between July 2003 and August 2004 were included. Statistical analysis was performed using the χ2 test. Results. The overall primary haemorrhage rate in the first audit cycle was 1.8% (8/441). In the second cycle with no coblation procedures, 1.4% of patients (6/416) suffered from primary haemorrhage (c.f. 8/441 (1.8%) in the first cycle, p=0.666). Secondary haemorrhage, was seen among 15.4% of patients (68/441) in the first audit cycle. In the second cycle, after coblation was discontinued, the secondary haemorrhage rate fell significantly (p<0.001) to 5.8% (24/416). A breakdown of the results of cold steel/diathermy and coblation techniques in both adults and children is also presented.
The third analysis of cancer mortality among Japanese nuclear workers, 1991–2002: estimation of excess relative risk per radiation dose

The present study estimated excess relative risk per sievert (ERR/Sv) of cancer mortality among the cohort of 200 583 male Japanese nuclear workers, with an average individual cumulative dose of 12.2 mSv (<10 mSv, 75.4%; 100 + mSv, 2.6%), conducting Poisson regression using dose category specific observed and expected numbers of deaths, and average doses obtained from the official report of the Radiation Effects Association (REA) on the analysis of mortality of Japanese nuclear industry workers for 1991–2002, which reported the estimates of ERR/Sv for leukaemia but not for all cancers or any other cancer site. The possible confounding biases from drinking alcohol and smoking tobacco were evaluated by examining the association of cumulative radiation dose with the mortality of cancers related to drinking or smoking. For leukaemia (80 deaths), the estimate of ERR/Sv was − 1.93 (95% confidence interval (CI) = − 6.12, 8.57). For all cancers excluding leukaemia (2636 deaths), while the ERR/Sv was estimated to be 1.26 (95%CI = − 0.27, 3.00), confounding by alcohol consumption was suspected since the ERR/Sv estimate of alcohol-related cancers was 4.64 (95%CI = 1.13, 8.91) and the ERR/Sv estimate of all cancers excluding leukaemia and alcohol-related cancers was 0.20 (95%CI = − 1.42, 2.09). In conclusion, confounding by important lifestyle factors related to cancer risk may have a substantial effect on risk estimates, especially when conducting studies of low cumulative dose and, accordingly, low statistical power. Pooled analysis or meta-analysis of nuclear workers for solid cancers needs to take this point into account.
Effects of salt loading and potassium supplement on the circadian blood pressure profile in salt-sensitive Chinese patients

Background and objective Salt-sensitive (SS) patients more frequently showed a nondipper blood pressure pattern and were associated with more serious target organ damage than non-SS patients. We aimed to investigate whether potassium supplement can improve the blunted nocturnal blood pressure fall in SS patients exposed to a high-salt diet. Patients and methods Approximately 49 normotensive and mildly hypertensive Chinese patients received a study protocol of a 3 days of baseline examination, 7 days of a low-salt diet (3 g NaCl/day), 7 days of a high-salt diet (18 g NaCl/day), and 7 days of a high-salt diet with a potassium supplement (18 g NaCl and 4.5 g KCl/day). The 24 h ambulatory blood pressure was determined at the end of each period. Results A total of 14 patients were classified as SS according to the at least 10% increase in their 24-h mean arterial pressure after high-salt loading. The night-to-day blood pressure ratio was significantly higher in SS patients than in non-SS patients during the high-salt loading period (systolic 0.96±0.01 vs. 0.89±0.01, P<0.01; diastolic 0.96±0.01 vs. 0.92±0.01, P<0.05). Compared with the high-salt loading period, the night-to-day blood pressure ratio was significantly reversed by potassium supplement in SS patients (systolic 0.91±0.01 vs. 0.96±0.01, P<0.05; diastolic 0.91±0.01 vs. 0.96±0.01, P<0.05). Conclusion Potassium supplement can improve the blunted nocturnal blood pressure fall in SS patients exposed to a high-salt diet, but the related mechanism needs to be studied further.
Thiazide diuretics enhance nocturnal blood pressure fall and reduce proteinuria in immunoglobulin A nephropathy treated with angiotensin II modulators

Objective We examined whether thiazide diuretics could restore nocturnal blood pressure (BP) decline and reduce urinary protein excretion in patients with glomerulopathy treated with angiotensin II modulators (angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers). Methods Twenty-five Japanese outpatients (11 men, 14 women; mean age 43 ± 12 years) with biopsy-proven immunoglobulin (Ig)A nephropathy, preserved renal function (serum creatinine concentration ≤1.2 mg/dl), stable non-nephrotic proteinuria (0.5–3 g daily), and treatment with angiotensin II modulators were studied. The patients received a diuretic, trichlormethiazide (2 mg daily) for 4 weeks after a baseline period lasting for 4 weeks. Results Diuretic therapy significantly reduced conventional, 24-h, daytime and night-time blood pressures. Nocturnal blood pressure fall was significantly enhanced by diuretic therapy and a significant interaction existed between diuretic therapy and nocturnal fall in mean arterial pressure, which indicated that the degree of nocturnal blood pressure fall was affected by diuretic therapy. The urinary protein excretion rate was significantly reduced from 1.10 ± 0.62 to 0.63 ± 0.39 g/day by diuretic therapy. Diuretic/baseline ratio of urinary protein excretion rate was not correlated with diuretic/baseline ratio of conventional, 24-h and daytime mean arterial pressures, but with diuretic/baseline ratio of night-time mean arterial pressure (r = 0.54, P = 0.006). Conclusions Diuretics enhanced nocturnal BP decline and reduced urinary protein excretion in patients with IgA nephropathy treated with angiotensin II modulators. The combination of angiotensin II modulators and diuretics may have additional therapeutic advantages in relieving the renal and cardiovascular risks by reducing nocturnal high blood pressure.
Measuring immigrant integration: the case of Belgium.

Belgium, like its neighbours, has received preand post-war European and nonEuropean labour immigrants and their families, whose children are forming an emerging second generation. Likewise, Belgium attracts an increasingly diverse inflow of refugees, asylum seekers, undocumented migrants and EU free movers. As a multination state, however, Belgium is also unique. Specifically, it stands out by the late and diffuse implementation of official integration policies, with considerable discrepancies in policy practices between the semi-autonomous regions of Flanders, Wallonia and Brussels. This review presents the main national data sources on the integration of immigrant communities in the 1990s, including the 1991 census and a series of special surveys. The main part of the paper discusses exemplary measures and findings pertaining to socio-economic, cultural and political dimensions of immigrant integration. The analyses document contextual variation in enduring socioeconomic disadvantage, along with cultural pluralism and multiple identities in ethnic relations between immigrants and hosts. We conclude that the Belgian case has wider comparative relevance: it is demonstrated that the varying contexts of immigration and settlement, and more or less conflicted ethnic relations between immigrants and hosts, make the difference between integration and exclusion. 1 Correspondence should be addressed to Karen Phalet, Ercomer – ICS, Faculty of Social Sciences, Utrecht University, P.O. box 80.140, NL – 3508 TC Utrecht. We are grateful to Els Witte (CISB, VU Brussels) for hosting our 'Belgian' research and to Ron Lesthaeghe and Patric Deboosere (Interface Demgraphy, VU Brussels) for helping us to access and handle Belgian data.
PRL Receptor-Mediated Effects in Female Mouse Adipocytes: PRL Induces Suppressors of Cytokine Signaling Expression and Suppresses Insulin-Induced Leptin Production in Adipocytes in Vitro.

PRL has been reported to regulate fat metabolism in several species. We recently reported PRL receptor (PRLR) expression in mouse adipocytes and increased levels of PRLR expression in the adipose tissue of lactating and PRL-transgenic mice compared with controls. These results suggest PRLR-mediated effects in adipose tissue. However, to date most studies have been performed in vivo, and it is unclear whether PRL has direct effects on adipocytes. The PRLR belongs to the cytokine receptor family, and a family of suppressors of cytokine signaling (SOCS) was recently identified. The present study was performed to investigate whether PRL has direct effects on adipocytes. The expression of cytokine-inducible SH2-domain-containing protein (CIS), SOCS-3, and SOCS-2 mRNA and protein was analyzed using ribonuclease protection assay and immunoblotting, respectively. Ovine PRL induced CIS mRNA expression and a combination of oPRL and insulin induced SOCS-3 mRNA expression in adipocytes cultured in vitro for 0–240 min.
Robust H∞-output feedback control of decoupled automobile active suspension systems

H/sup /spl infin//-output feedback control is applied to the control of automobile active suspensions based on a dynamic model of the full vehicle. The output feedback control is desirable from the viewpoint of implementation in the sense that it reduces the number of measurements drastically compared with state feedback used currently in suspension control. In this paper, the authors show that a linearized model can be block-decoupled by a similarity transformation, which reduces the controller complexity significantly. The uncertainties of the vehicle model are properly taken into account in the derivation of the H/sup /spl infin// controller. The controller is actually implemented in a commercial car, and the performance is evaluated both by simulations and experiments. The performance obtained proves to be quite satisfactory.
The isoflavone content of commercially-available feline diets in New Zealand

Abstract AIM: To identify and quantify concentrations of the isoflavones genistein, daidzein, biochanin A and formononetin in commercially-prepared feline diets sold in New Zealand. METHODS: Feline diets (n=138) were collected from supermarkets, pet stores and veterinary clinics in New Zealand. Diets were classified into five categories based on the following criteria: the presence/absence of soy, the presence/absence of non-soy plant material, and dry matter (DM) content. A high performance liquid chromatography (HPLC)-based assay was developed and validated to identify and quantify concentrations of the isoflavones genistein, daidzein, biochanin A and formononetin. RESULTS: Isoflavones were detected in all categories of diet, and at quantifiable concentrations in 104/138 (75%) of the diets tested. More dry diets (127/138; 92%) contained isoflavones at quantifiable concentrations than moist diets (83/138; 60%, p<0.001). Of the isoflavone-positive diets, moist diets that contained soy had the highest median isoflavone content (71.1 mg/kg DM and 0.018 mg/kcal metabolisable energy; ME) whilst moist meat-onlydietshadthelowest(3.24mg/kgDMand0.0004mg/kcal ME). Isoflavone contents varied similarly between categories of diet whether evaluated on a DM or ME basis. High isoflavone contents were associated with diets containing soy and those of low cost. Biochanin A and formononetin were found at concentrations above the detection limit of the assay in 25/138 (18%) and 7/138 (5%) of the diets analysed, respectively. The estimated median daily isoflavone exposure for cats consuming feline diets sold in New Zealand ranged from 0.03 mg/kg bodyweight (BW) for moist meat-only diets to 1.47 mg/kg BW for moist diets containing soy, whilst the diet with the highest isoflavone content would provide daily exposure of 8.13 mg/kg BW. CONCLUSIONS: Isoflavones are present in commercially-prepared feline diets sold in New Zealand at concentrations that have elicited physiological responses in the reproductive, endocrine, and immune systems of other mammalian species. Since isoflavones appear to be a common constituent of feline diets, further investigation of the biological activities of these dietary compounds in cats is warranted.