Evaluation of a multidisciplinary Tier 3 weight management service for adults with morbid obesity, or obesity and comorbidities, based in primary care

A multidisciplinary Tier 3 weight management service in primary care recruited patients with a body mass index ≥40 kg·m−2, or 30 kg·m−2 with obesity-related co-morbidity to a 1-year programme. A cohort of 230 participants was recruited and evaluated using the National Obesity Observatory Standard Evaluation Framework. The primary outcome was weight loss of at least 5% of baseline weight at 12 months. Diet was assessed using the two-item food frequency questionnaire, activity using the General Practice Physical Activity questionnaire and quality of life using the EuroQol-5D-5L questionnaire. A focus group explored the participants' experiences. Baseline mean weight was 124.4 kg and mean body mass index was 44.1 kg·m−2. A total of 102 participants achieved 5% weight loss at 12 months. The mean weight loss was 10.2 kg among the 117 participants who completed the 12-month programme. Baseline observation carried forward analysis gave a mean weight loss of 5.9 kg at 12 months. Fruit and vegetable intake, activity level and quality of life all improved. The dropout rate was 14.3% at 6 months and 45.1% at 1 year. Focus group participants described high levels of satisfaction. It was possible to deliver a Tier 3 weight management service for obese patients with complex co-morbidity in a primary care setting with a full multidisciplinary team, which obtained good health outcomes compared with existing services

The role of election competition in strengthening Pakistan’s fledgling local democracy

Using results and original survey data from the November 2015 local government elections in the Sargodha District of rural Punjab, Pakistan, insights are offered into the institutional and organisational responses that can help strengthen local democracy. These results form part of a larger research project being conducted by the Institute of Development and Economic Alternatives (IDEAS), which examines how voters make choices broadly. It explores the relative weight voters give to party performance vs. candidates’ political and bureaucratic connections. It highlights the need for reporting, debate and a rule-based separation of functions and finances to strengthen local democracy in Pakistan

THREaD Mapper Studio: a novel, visual web server for the estimation of genetic linkage maps

The estimation of genetic linkage maps is a key component in plant and animal research, providing both an indication of the genetic structure of an organism and a mechanism for identifying candidate genes associated with traits of interest. Because of this importance, several computational solutions to genetic map estimation exist, mostly implemented as stand-alone software packages. However, the estimation process is often largely hidden from the user. Consequently, problems such as a program crashing may occur that leave a user baffled. THREaD Mapper Studio (http://cbr.jic.ac.uk/threadmapper) is a new web site that implements a novel, visual and interactive method for the estimation of genetic linkage maps from DNA markers. The rationale behind the web site is to make the estimation process as transparent and robust as possible, while also allowing users to use their expert knowledge during analysis. Indeed, the 3D visual nature of the tool allows users to spot features in a data set, such as outlying markers and potential structural rearrangements that could cause problems with the estimation procedure and to account for them in their analysis. Furthermore, THREaD Mapper Studio facilitates the visual comparison of genetic map solutions from third party software, aiding users in developing robust solutions for their data sets

The Relative Importance of Clinical, Economic, Patient Values and Feasibility Criteria in Cancer Drug Reimbursement in Canada:A Revealed Preferences Analysis of Recommendations of the Pan-Canadian Oncology Drug Review 2011–2017

Background: Most Canadian provinces and territories rely on the pan-Canadian Oncology Drug Review (pCODR) to provide recommendations regarding public reimbursement of cancer drugs. The pCODR review process considers four dimensions of value—clinical benefit, economic evaluation, patient-based values and adoption feasibility—but they do not define weights for individual decision criteria or an acceptable threshold for any of the criteria. Given this implicit review process, it is of interest to understand which factors appear to carry the most weight in pCODR recommendations using a revealed preferences approach. Methods: Using publicly available decision summaries (n = 91) describing submissions and resulting recommendations 2011–2017, we extracted ten attributes that characterized each submission. Using logistic regression, we identified statistically significant attributes and estimated their relative impact in final recommendations. Results: Clinical aspects appear to carry the greatest weight in the decision to reject or not reject, along with aspects of patient value (treatments with no alternatives were less likely to be rejected). Cost effectiveness does not appear to play a role in the initial decision to reject or not reject but is critical in full versus conditional approvals. There is evidence of a maximum acceptable threshold of around $Can140,000 per quality-adjusted life-year (QALY) gained. Conclusion: A set of factors driving pCODR recommendations is identifiable, supporting the consistency of the review process. However, the implicit nature of the review process and the difficulty of extracting and interpreting some of the attribute levels used in the analysis suggests that the process may still lack full transparency

Growth and yield of elite genotypes of chilli (Capsicum annuum L.) in diverse agroclimatic zones of Punjab

Eleven elite genotypes of chilli along with one check (Punjab Surkh) were evaluated at two diverse locations of Punjab, India. The G × E interaction was significant for red ripe fruit yield, fruit width and fruit weight and genotype Acc-33-1 was the most stable across locations. The pooled analysis showed that the genotype, SD 463 had the maximum red ripe fruit yield (0.586 kg plant-1) and fruit weight (4.1 g); Mehma Sarja had the highest plant height (93.5 cm) and fruit width (13.4 mm); Selection 7 exhibited the lowest plant height (37.6 cm) and fruit width (7.0 mm); PC-6-1 had the longest fruits (8.6 cm); DCL 524 possessed maximum number of seeds fruit-1 (43.5); Selection 36-1 produced the maximum seed weight (0.211 g fruit-1). The low broad sense heritability (h2) for number of seeds fruit-1 and dried seed weight fruit-1 revealed that these traits were highly influenced by environment. High heritability coupled with high genetic advance for red ripe fruit yield, fruit weight, plant height, fruit length and fruit width indicated the important role played by additive gene effects. &nbsp

Growth and yield of elite genotypes of chilli (Capsicum annuum L.) in diverse agroclimatic zones of Punjab

Eleven elite genotypes of chilli along with one check (Punjab Surkh) were evaluated at two diverse locations of Punjab, India. The G × E interaction was significant for red ripe fruit yield, fruit width and fruit weight and genotype Acc-33-1 was the most stable across locations. The pooled analysis showed that the genotype, SD 463 had the maximum red ripe fruit yield (0.586 kg plant-1) and fruit weight (4.1 g); Mehma Sarja had the highest plant height (93.5 cm) and fruit width (13.4 mm); Selection 7 exhibited the lowest plant height (37.6 cm) and fruit width (7.0 mm); PC-6-1 had the longest fruits (8.6 cm); DCL 524 possessed maximum number of seeds fruit-1 (43.5); Selection 36-1 produced the maximum seed weight (0.211 g fruit-1). The low broad sense heritability (h2) for number of seeds fruit-1 and dried seed weight fruit-1 revealed that these traits were highly influenced by environment. High heritability coupled with high genetic advance for red ripe fruit yield, fruit weight, plant height, fruit length and fruit width indicated the important role played by additive gene effects. &nbsp

IMCI and ETAT Integration at a Primary Healthcare Facility in Malawi:A Human Factors Approach

Abstract Background Integrated Management of Childhood Illness (IMCI) and Emergency Triage, Assessment and Treatment (ETAT) are guidelines developed by the World Health Organization to reach targets for reducing under-5 mortality. They were set out in the Millennium Development Goals. Each guideline was established separately so the purpose of this study was to understand how these systems have been integrated in a primary care setting and identify barriers and facilitators to this integration using a systems approach. Method Interviews were carried out with members of staff of different levels within a primary healthcare clinic in Malawi. Along with observations from the clinic this provided a well-rounded view of the running of the clinic. This data was then analysed using the SEIPS 2.0 work systems framework. The work system elements specified in this model were used to identify and categorise themes that influenced the clinic’s efficiency. Results A process map of the flow of patients through the clinic was created, showing the tasks undertaken and the interactions between staff and patients. In their interviews, staff identified several organisational elements that served as barriers to the implementation of care. They included workload, available resources, ineffective time management, delegation of roles and adaptation of care. In terms of the external environment there was a lack of clarity over the two sets of guidelines and how they were to be integrated which was a key barrier to the process. Under the heading of tools and technology a lack of guideline copies was identified as a barrier. However, the health passport system and other forms of recording were highlighted as being important facilitators. Other issues highlighted were the lack of transport provided, challenges regarding teamwork and attitudes of members of staff, patient factors such as their beliefs and regard for the care and education provided by the clinic. Conclusions This study provides the first information on the challenges and issues involved in combining IMCI and ETAT and identified a number of barriers. These barriers included a lack of resources, staff training and heavy workload. This provided areas to work on in order to improve implementation

Comparing Alternative Route Planning Techniques: A Comparative User Study on Melbourne, Dhaka and Copenhagen Road Networks

Many modern navigation systems and map-based services do not only provide the fastest route from a source location s to a target location t but also provide a few alternative routes to the users as more options to choose from. Consequently, computing alternative paths has received significant research attention. However, it is unclear which of the existing approaches generates alternative routes of better quality because the quality of these alternatives is mostly subjective. Motivated by this, in this paper, we present a user study conducted on the road networks of Melbourne, Dhaka and Copenhagen that compares the quality (as perceived by the users) of the alternative routes generated by four of the most popular existing approaches including the routes provided by Google Maps. We also present a web-based demo system that can be accessed using any internet-enabled device and allows users to see the alternative routes generated by the four approaches for any pair of selected source and target. We report the average ratings received by the four approaches and our statistical analysis shows that there is no credible evidence that the four approaches receive different ratings on average. We also discuss the limitations of this user study and recommend the readers to interpret these results with caution because certain factors may have affected the participants' ratings.Comment: Extended the user study to also include the road networks of Dhaka and Copenhagen (the previous version only had Melbourne road network