Knowledge regarding association of dietary branched-chain amino acid (BCAA) and type 2 diabetes (T2D), and the contribution of BCAA from meat to the risk of T2D are scarce. We evaluated associations between dietary BCAA intake, meat intake, interaction between BCAA and meat intake and risk of T2D. Data analyses were performed for 74 155 participants aged 50−79 years at baseline from the Women’s Health Initiative for up to 15 years of follow-up. We excluded from analysis participants with treated T2D, and factors potentially associated with T2D or missing covariate data. The BCAA and total meat intake was estimated from FFQ. Using Cox proportional hazards models, we assessed the relationship between BCAA intake, meat intake, and T2D, adjusting for confounders. A 20 % increment in total BCAA intake (g/d and %energy) was associated with a 7 % higher risk for T2D (hazard ratio (HR) 1·07; 95 % CI 1·05, 1·09). For total meat intake, a 20 % increment was associated with a 4 % higher risk of T2D (HR 1·04; 95 % CI 1·03, 1·05). The associations between BCAA intake and T2D were attenuated but remained significant after adjustment for total meat intake. These relations did not materially differ with or without adjustment for BMI. Our results suggest that dietary BCAA and meat intake are positively associated with T2D among postmenopausal women. The association of BCAA and diabetes risk was attenuated but remained positive after adjustment for meat intake suggesting that BCAA intake in part but not in full is contributing to the association of meat with T2D risk.

Capitalist development involves ongoing technological changes in which a series of innovations develop and diffuse.Wars and other discontinuities periodically break the process, thwarting some innovations and generating others. Wartime experience hence illuminates the question of whether innovation responds to the changing economic environment or maintains earlier directions. The paper examines the roles of peacetime factors and wartime dislocations in the development of three Civil War innovations, firearms, shoe mechanization, and petroleum. Using patent data, government procurement records, and selected firm records to compare antebellum and wartime activities, I argue for the continuity of innovation in its content and in the occupation, network status, and location of patentees. Wartime innovation evolved out of antebellum firms, networks, and inventors. It drew on machinists, engineers, and applied scientists to transfer critical antebellum capabilities into innovating sectors. The war accelerated innovations in firearms and shoe mechanization and may have slowed petroleum innovation. Whereas the North continued antebellum innovation processes during the war, the South, with little capability in any of the sectors, was unable to innovate successfully even when military need was strong.

The objective of this paper is to describe variations in the different models of out of hours general medical services and identify explanations for variation and the possible influence on patient satisfaction and service costs. A cross-sectional survey of all models of out of hours care was undertaken, including co-operatives, deputizing services, practice rotas and rural general practitioners doing their own cover. Fifteen sites were chosen representing 10 models of care, for more detailed case study; 65 semistructured interviews with key informants were conducted within the case study sites. A postal patient satisfaction questionnaire and an economic analysis were also carried out. Out of hours organizations have developed in response to a complex mix of the population served, geography, resources available and political expediency, leading to considerable structural heterogeneity, even within co-operatives. There was little evidence of formal integration with other services. Only the largest co-operatives showed any evidence of utilizing guidelines/protocols or of providing formal staff training. There were clear differences in the structure of out of hours care in urban and rural areas. Increasing the use of centralized call handling and triage will not address the needs of rural GPs, who would still be required to be available for work. Neither patient satisfaction nor costs varied bymodel of service provision. The English out of hours reviewhas outlined an integrated model of service provision with consistent standards within an accountability framework. It would appear that only the largest organizations will be in a position to address these standards and that they are likely to be inappropriate to the needs of GPs in rural areas.

Philip Scranton's important book is the first systematic effort to understand the character and development of specialty producers across the US economy after the Civil War, when they played a significant but little investigated role in industrialization. The book is an effective complement to, and in part a critique of, the thesis that the emergence of mass production and managerial firms generated a new, more guided and progressive kind of capitalist development. Building on the flexible specialization literature, Scranton argues that the focus on mass production and the managerial firm is too narrow because it misses the growth of specialty producers, which he conceives as firms that manufactured to custom order or in small batches. Endless Novelty explores “the industrial and institutional dynamic” of specialty manufacturing in the 1865–1925 period, a dynamic which Scranton maintains was different from but just as important as that of mass production. Ascending before or alongside the managerial firm, specialty producers generated a significantly larger share of manufacturing output—roughly half of all manufacturing value added over the 1890 to 1923 period. Moreover, Scranton argues, they were technologically and organizationally innovative and produced machinery and related elements required for mass production. If the argument is right, Chandler's thesis explains only part of the transformation of American manufacturing and must be complemented and in part underpinned by the history of specialty production.

For techniques diffusing as commodities, sales form a critical medium of technological communication which facilitates secondary invention. While sales may also influence the incentives to invent, I argue that the technical learning associated with selling provides a fuller account of invention for the case of the sewing machine in the United States. A study of some 3,500 patents and forty-eight city directories shows that as sales expanded in extent and location, so did patenting by first-time inventors. Moreover, patent use generated a flow of information back to inventors which increased the likelihood and extent of repeat patenting. In these ways, sales sustained technological change as a cumulative process.