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There are no published estimates of the health state utility values (HSUVs) for a broad range of eating disorders (EDs). HSUVs are used in economic evaluations to determine quality-adjusted life years or as a measure of disorder burden. The main objective of the current study is to present HSUVs for a broad range of EDs based on DSM-5 diagnoses.
We used pooled data of two Health Omnibus Surveys (2015 and 2016) including representative samples of individuals aged 15 + years living in South Australia. HSUVs were derived from the SF-6D (based on the SF-12 health-related quality of life questionnaire) and analysed by ED classification, ED symptoms (frequency of binge-eating or distress associated to binge eating) and weight status. Multiple linear regression models, adjusted for socio-demographics, were used to test the differences of HSUVs across ED groups.
Overall, 18% of the 5609 individuals met criteria for ED threshold and subthreshold. EDs were associated with HSUV decrements, especially if they were severe disorders (compared to non-ED), binge ED: −0.16 (95% CI −0.19 to −0.13), bulimia nervosa: −0.12, (95% CI −0.16 to −0.08). There was an inverse relationship between distress related binge eating and HSUVs. HSUVs were lower among people with overweight/obese compared to those with healthy weight regardless of ED diagnosis.
EDs were significantly associated with lower HSUVs compared to people without such disorders. This study, therefore, provides new insights into the burden of EDs. The derived HSUVs can also be used to populate future economic models.
To identify discrete approaches to specialist healthcare support for older care home residents in the UK and to estimate their prevalence.
Internationally, a range of new initiatives are emerging to meet the multiple and complex healthcare needs of care home residents. However, little is known about their relative effectiveness and, given their heterogeneity, a classification scheme is required to enable research staff to explore this.
A UK survey collected information on the funding, age, coverage, aims, staffing and activities of 64 specialist care home support services. Latent class analysis (LCA) was used to allocate the sample into subgroups with similar characteristics.
Three classes were identified. Class 1 (55% of sample) contained services with a high probability of providing scheduled input (regular preplanned visits) and support for all residents and a moderate probability of undertaking medication management, but a low probability of training care home staff (‘predominantly direct care’). Class 2 (23% of sample) had a moderate/high probability of providing scheduled input, support for all residents, medication management and training (‘direct and indirect care’). Class 3 (22% of sample) had a low probability of providing scheduled input, support for all residents and medication management, but a high probability of providing training for care home staff (‘predominantly indirect care’). Consultants were more likely to be members of services in Class 1 than Class 2, and Class 2 than Class 3.
LCA offers a promising approach to the creation of a taxonomy of specialist care home support services. The skills and knowledge required by healthcare staff vary between classes, raising important issues for service design. The proposed classification can be used to explore the extent to which different organisational forms are associated with better resident, process and service outcomes.
Remarkably few attempts have been made to estimate contemporary effective population size (Ne) for parasitic species, despite the valuable perspectives it can offer on the tempo and pace of parasite evolution as well as coevolutionary dynamics of host–parasite interactions. In this study, we utilized multi-locus microsatellite data to derive single-sample and temporal estimates of contemporary Ne for a cestode parasite (Schistocephalus solidus) as well as three-spined stickleback hosts (Gasterosteus aculeatus) in lakes across Alaska. Consistent with prior studies, both approaches recovered small and highly variable estimates of parasite and host Ne. We also found that estimates of host Ne and parasite Ne were sensitive to assumptions about population genetic structure and connectivity. And, while prior work on the stickleback–cestode system indicates that physiographic factors external to stickleback hosts largely govern genetic variation in S. solidus, our findings indicate that stickleback host attributes and factors internal to the host – namely body length, genetic diversity and infection – shape contemporary Ne of cestode parasites.
Little is known about terrestrial climate dynamics in the Levant during the penultimate interglacial-glacial period. To decipher the palaeoclimatic history of the Marine Oxygen Isotope Stage (MIS) 6 glacial period, a well-dated stalagmite (~194 to ~154 ka) from Kanaan Cave on the Mediterranean coast in Lebanon was analyzed for its petrography, growth history, and stable isotope geochemistry. A resolved climate record has been recovered from this precisely U–Th dated speleothem, spanning the late MIS 7 and early MIS 6 at low resolution and the mid–MIS 6 at higher resolution. The stalagmite grew discontinuously from ~194 to ~163 ka. More consistent growth and higher growth rates between ~163 and ~154 ka are most probably linked to increased water recharge and thus more humid conditions. More distinct layering in the upper part of the speleothem suggests strong seasonality from ~163 ka to ~154 ka. Short-term oxygen and carbon isotope excursions were found between ~155 and ~163 ka. The inferred Kanaan Cave humid intervals during the mid–MIS 6 follow variations of pollen records in the Mediterranean basins and correlate well with the synthetic Greenland record and East Asian summer monsoon interstadial periods, indicating short warm/wet periods similar to the Dansgaard-Oeschger events during MIS 4–3 in the eastern Mediterranean region.
Meeting the societal demand for food, bioproducts and water under climate change is likely to greatly challenge the maize-soybean agriculture of the Midwest USA, which is a globally significant resource. New agricultural systems are needed that can meet this challenge. Innovations in water management engineering and cropping system diversification may provide a way forward, enabling transformation to highly multifunctional agricultural watersheds that expand both agricultural production and water-related services to society, and which provide scalable units of climate adaptation in agriculture and water systems. Implementation and refinement of such watersheds require corresponding social innovation to create supportive social systems, in economic, political and cultural terms. A range of emerging social innovations can drive the emergence of highly multifunctional agricultural watersheds, by enabling robust cooperation, resource exchange and coordinated innovation across multiple societal sectors and scales. We highlight relevant innovations and opportunities for their exploratory implementation and refinement in the Midwest.
We present the first description of an antimicrobial stewardship program (ASP) used to successfully manage a multi-antimicrobial drug shortage. Without resorting to formulary restriction, meropenem utilization decreased by 69% and piperacillin-tazobactam by 73%. During the shortage period, hospital mortality decreased (P=.03), while hospital length of stay remained unchanged.
Palmer amaranth is a highly invasive weed species causing huge economic
losses in agricultural cropping systems under a broad range of environmental
conditions. Sensitivity of this species to ozone (O3) air
pollution and to soil water deficit, relative to native species or competing
crops, may affect its competitiveness and invasive potential. In recent
years, both high tropospheric O3 and soil water deficiency have
become common in the San Joaquin Valley of California. Responses to these
environmental parameters may help predict the invasiveness of this species
and have implications for landscape hydrology. We assessed the impact of
O3 and soil water deficit on Palmer amaranth. Five- to
seven-leaf–stage potted plants were placed in continuous stirred tank
reactor chambers and maintained for 30 to 35 d under 12-h mean daylight
O3 exposures (0700–1900 hours) of 4, 59, or 114 ppb
O3. Within the chambers the plants were either well-watered
(WW) or exposed to regulated deficit irrigation (RDI) and grown for about 7
wk. Dry weights of the leaves, stems, roots, and leaf area were determined.
Day- and nighttime stomatal conductances (gs) were measured at 1.5-h intervals. Nocturnal gs was about 16 to 29% of daytime gs; this suggests that the species could have substantial
nighttime water loss, uncoupled from carbon gain in the weed, and could
affect water availability for crops and reduce irrigation efficiency.
Nocturnal gs was lower in the RDI than in the WW, but daytime
gs was not affected by O3 or irrigation regime. Neither
O3 nor irrigation regime affected root or shoot parameters. As
O3 and drought are two key stressors in the San Joaquin
Valley, to which potential competing species have been found to be
sensitive, Palmer amaranth may proliferate and become more invasive in the
future, potentially altering landscape hydrology and reducing irrigation
In no other society in the world have urbanisation and industrialization been as comprehensively based on migrant labour as in South Africa. Rather than focusing on the well-documented narrative of displacement and oppression, A Long Way Home captures the humanity, agency and creative modes of self-expression of the millions of workers who helped to build and shape modern South Africa. The book spans a three-hundred-year history beginning with the exportation of slave labour from Mozambique in the eighteenth century and ending with the strikes and tensions on the platinum belt in recent years. It shows not only the age-old mobility of African migrants across the continent but also, with the growing demand for labour in the mining industry, the importation of Chinese indentured migrant workers. Contributions include 18 essays and over 90 artworks and photographs that traverse homesteads, chiefdoms and mining hostels, taking readers into the materiality of migrant life and its customs and traditions, including the rituals practiced by migrants in an effort to preserve connections to “home” and create a sense of “belonging”. The essays and visual materials provide multiple perspectives on the lived experience of migrant labourers and celebrate their extraordinary journeys. A Long Way Home was conceived during the planning of an art exhibition entitled ‘Ngezinyawo: Migrant Journeys’ at Wits Art Museum. The interdisciplinary nature of the contributions and the extraordinary collection of images selected to complement and expand on the text make this a unique collection.
Advances in overall management have led to an increasing number of adolescents with congenital heart disease reaching adulthood. This study aimed to evaluate the health-related quality of life in adolescents with heart disease, and examine its relationship with the adolescents’ knowledge and understanding of their congenital heart disease, its severity, and its relationship to the degree of anxiety and depression, feeling of optimism and sense of coherence experienced by the adolescents together with their social support.
Methods and results
Adolescents with heart disease were recruited from an ambulatory setting at a tertiary centre. Patients completed self-report questionnaires including the Paediatric Quality of Life Inventory 3.0-Cardiac Module, a questionnaire assessing the adolescents’ knowledge of their cardiac condition, the Hospital Anxiety and Depression Scale, Multidimensional Scale of Perceived Social Support, Life Orientation Test-Revised, and Sense of Coherence-13, supplemented by clinical information provided by the attending cardiologists. A total of 114 patients aged 12–20 years were recruited over 15 months. In all, 98% of patients were in New York Heart Association class I. Their health-related quality of life was found to positively correlate with a low level of anxiety and depression (Pearson correlation, r = −0.57, p < 0.001), a good knowledge of their cardiac condition (r = 0.31, p < 0.01), feelings of optimism (r = 0.39, p < 0.001), adequate social support (r = 0.27, p < 0.01), and a strong sense of coherence (r = 0.24, p < 0.01).
Adolescents’ knowledge and understanding of their cardiac abnormality together with an improved sense of well-being had a positive influence on their health-related quality of life.
The IntCal09 and Marine09 radiocarbon calibration curves have been revised utilizing newly available and updated data sets from 14C measurements on tree rings, plant macrofossils, speleothems, corals, and foraminifera. The calibration curves were derived from the data using the random walk model (RWM) used to generate IntCal09 and Marine09, which has been revised to account for additional uncertainties and error structures. The new curves were ratified at the 21st International Radiocarbon conference in July 2012 and are available as Supplemental Material at www.radiocarbon.org. The database can be accessed at http://intcal.qub.ac.uk/intcal13/.