Utility of PINP to monitor osteoporosis treatment in primary care, the POSE study (PINP and Osteoporosis in Sheffield Evaluation).

PURPOSE: In Sheffield (UK), we introduced the PINP monitoring algorithm for the management of osteoporosis treatment delivered in primary care. Our aims were to evaluate whether this algorithm was associated with better osteoporosis outcomes and was cost-effective compared to standard care. METHODS: Inclusion criteria were referral from Sheffield GPs, BMD scans performed between 2012 and 2013 and a report advising initiation of oral bisphosphonate and PINP monitoring. 906 patients were identified and retrospectively divided into Group A (intention to monitor, with baseline PINP, n = 588) and Group B (no intention to monitor, without baseline PINP, n = 318). The model described by Davis and colleagues was used to extrapolate life-time costs and quality-adjusted life-years (QALYs). RESULTS: No differences were found in baseline characteristics between groups (age, gender, BMI, BMD and major risk factors for fractures). More patients in Group A started oral treatment (77.4% vs 49.1%; p < 0.001), but there were no differences between groups in the presence of a gap in treatment >3 months or in treatment duration. Patients in Group A were more likely to have follow-up DXA scan at 4-6 years from baseline (46.9% vs 29.2%; p < 0.000) and had a greater increase in total hip BMD (+2.74% vs + 0.42%; p value = 0.003). Fewer new fractures occurred in Group A but this was not statistically significant, but the numbers of fractures were small. Patients in Group A were more likely to change management (p = 0.005) including switching to zoledronate (p = 0.03). The PINP measurement and increased prescribing in Group A resulted in increases in both costs (£30.19) and QALYs (0.0039) relative to Group B, giving an incremental cost effectiveness ratio (ICER) of £7660 in the probabilistic sensitivity analysis. CONCLUSIONS: Patients monitored with PINP are more likely to start oral bisphosphonate treatment, switch to zoledronate, have follow-up DXA scans and a greater increase of hip BMD. PINP monitoring has the potential to be cost-effective in a UK NHS setting given that interventions with an ICER under £20,000 are generally considered to be cost-effective.

Emotional labor and professional practice in sports medicine and science.

The aim of this study was to explore how sport medicine and science practitioners manage their emotions through emotional labor when engaging in professional practice in elite sport. To address the research aim a semistructured interview design was adopted. Specifically, eighteen professional sport medicine and science staff provided interviews. The sample comprised sport and exercise psychologists (n=6), strength and conditioning coaches (n=5), physiotherapists (n=5), one sports doctor and one generic sport scientist. Following a process of thematic analysis, the results were organized into the following overarching themes: (a) factors influencing emotional labor enactment, (b) emotional labor enactment, and (c) professional and personal outcomes. The findings provide a novel contribution to understanding the professional demands faced by practitioners and are discussed in relation to the development of professional competencies and the welfare and performance of sport medics and scientists.

Qualitative experiences of disengagement in assertive outreach teams, in particular for "black" men: Clinicians' perspectives.

This study is a follow-on study to a study into the experiences of disengagement from mental health services for men who described their ethnic identity as "black." The aim of this study was to understand the same phenomenon from a clinician's perspective. WHAT IS KNOWN ON THE SUBJECT?: Literature highlights that people from ethnic minority backgrounds experience some difficulties engaging with mental health services; Disengagement from mental health services is a complex phenomenon that occurs for a variety of different reasons; Only one paper previously has investigated clinicians' perspective on disengagement from mental health services; WHAT THE STUDY ADDS TO EXISTING KNOWLEDGE?: This study demonstrates that clinicians are aware that stigma and medication impact upon engagement with mental health services, which were also important components of the patients experience. A finding of the former study was that patients' attitudes towards mental health services change over time, with patients engaging more as they get older, a finding was supported by wider literature. However, in this study, the participants were not certain that this was the case. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The implications for practice from this study are that staff should persist with efforts to reduce the stigma surrounding mental health, carefully consider the significance and impact of medication and have an awareness of how patients' attitudes towards mental illness and mental health services change and develop over time. Continued support for an AO approach to practice for people who find it difficult to engage with services, where a multidisciplinary "team" approach can focus on service user-centred recovery goals and a positive space for collaboration. ABSTRACT: Introduction Engagement with services is often poor amongst people with severe mental health problems, yet key to improving clinical outcomes. Aims This study explores the perception of clinicians on patients with severe mental health problems, in particular the experiences of black men, who disengage from mental health services. Method Two focus groups consisting of a combined total of twelve, mainly white, experienced clinicians in the UK were recruited. Transcripts were analysed using interpretative phenomenological analysis. Results Clinicians understood that patients' awareness of stigma impacted upon engagement with mental health services. Clinicians were aware that medication negatively impacted on engagement. The passage of time was perceived as impacting upon engagement. Discussion The perspectives of the clinicians in this study and the experiences of the patients in a former study converged. The participants had an understanding of the complexities that black men faced when engaging with mental health services. Implications for practice This is the first study to highlight that AOT staff need to be aware of the key role that stigma plays in engagement in treatment, continue to focus on efforts to reduce the stigma surrounding mental health, consider the significance medication and be aware of how patients' attitudes towards mental health services develop over time.

A multistudy examination of organizational stressors, emotional labor, burnout, and turnover in sport organizations.

While a growing body of research has examined the types of organizational stressors encountered by individuals and their allied responses, little is known about how such individuals manage their emotional responses to these stressors or the consequences of such behaviors. This article presents novel findings from two studies examining the moderating role that emotional labor plays in the relationship between the frequency of organizational stressor experience, burnout, turnover intentions, and actual turnover in sport. In study 1, participants (n=487) completed measures of organizational stressors (OSI-SP), emotional labor (ELS), burnout (ABQ), and turnover intentions. In study 2, a 6-month longitudinal design was used to examine measures of organizational stressors (OSI-SP), emotional labor (ELS), turnover intentions, and actual turnover. Study 1 showed that surface acting moderated the relationship between the frequency of organizational stressors and burnout in sport. Further, surface acting acted as an important mechanism through which burnout mediated the relationship between the frequency of organizational stressors and turnover intentions. Study 2 showed that surface acting moderated the relationship between the organizational stressor frequency and turnover intentions-but not actual turnover-over time. These results highlight the importance of surface acting in understanding how individuals respond to organizational stressors encountered in sport, expanding our understanding of the positive and negative responses component of the meta-model of stress, emotions, and performance. These findings also highlight potentially deleterious emotion-management behaviors that practitioners might consider when aiming to support individuals encountering organizational stressors in sport.

Perception of bitterness, sweetness and liking of different genotypes of lettuce.

Lettuce is an important leafy vegetable, consumed across the world, containing bitter sesquiterpenoid lactone (SL) compounds that may negatively affect consumer acceptance and consumption. We assessed liking of samples with differing absolute abundance and different ratios of bitter:sweet compounds by analysing recombinant inbred lines (RILs) from an interspecific lettuce mapping population derived from a cross between a wild (L. serriola acc. UC96US23) and domesticated lettuce (L. sativa, cv. Salinas). We found that the ratio of bitter:sweet compounds was a key determinant of bitterness perception and liking. We were able to demonstrate that SLs, such as 8-deoxylactucin-15-sulphate, contribute most strongly to bitterness perception, whilst 15-p-hydroxylphenylacetyllactucin-8-sulphate does not contribute to bitter taste. Glucose was the sugar most highly correlated with sweetness perception. There is a genetic basis to the biochemical composition of lettuce. This information will be useful in lettuce breeding programmes in order to produce leaves with more favourable taste profiles.

Sport medicine and sport science practitioners' experiences of organizational change.

Despite the emergence of and widespread uptake of a growing range of medical and scientific professions in elite sport, such environs present a volatile professional domain characterized by change and unprecedentedly high turnover of personnel. This study explored sport medicine and science practitioners' experiences of organizational change using a longitudinal design over a 2-year period. Specifically, data were collected in three temporally defined phases via 49 semi-structured interviews with 20 sport medics and scientists employed by three organizations competing in the top tiers of English football and cricket. The findings indicated that change occurred over four distinct stages; anticipation and uncertainty, upheaval and realization, integration and experimentation, normalization and learning. Moreover, these data highlight salient emotional, behavioral, and attitudinal experiences of medics and scientists, the existence of poor employment practices, and direct and indirect implications for on-field performance following organizational change. The findings are discussed in line with advances to extant change theory and applied implications for prospective sport medics and scientists, sport organizations, and professional bodies responsible for the training and development of neophyte practitioners.

The efficacy of 12 weeks supervised exercise in obesity management.

The objective of this randomized controlled trial was to investigate the effect of adding either aerobic training (AT) or resistance training (RT) to a multidisciplinary teamed (MDT) educational weight management programme on the health-related fitness of morbidly obese individuals. Males (n = 9) and females (n = 24) aged between 24 and 68 years with a body mass index (BMI) of ≥40 kg m(2) (≥35 kg m(2) with comorbidities) undertaking a weight management programme were recruited (Completion: M = 8, F = 19). Participants were randomly allocated to either AT (n = 12), RT (n = 11) or CON (n = 10). AT and RT undertook three structured ∼60 min moderate intensity sessions weekly, two supervised gym-based and one structured home-based session for 12 weeks; CON undertook usual care alone. Anthropometric, psychological and functional capacity measures were obtained pre- and post-intervention. Both exercise interventions elicited improvements compared with CON in the: shuttle walk test (AT [Δ 207.0 ± 123.0 metres, 68.0%, P = 0.04], RT [Δ 165.0 ± 183.3 m, 48.8%, P = 0.06], CON [Δ -14.3 ± 38.7 m, -6.2%]), triceps skin-fold (P ≤ 0.001), self-efficacy (P = 0.005) and interest/enjoyment (P = 0.006). RT displayed additional improvements compared with CON in BMI (RT [Δ -1.02 ± 0.91 kg·m(2) , -2.5%, P = 0.033], AT [Δ -1.84 ± 2.70 kg·m(2) , -4.3%, P = 0.142], CON [Δ -0.31 ± 1.47 kg·m(2) , -0.6%]), waist circumference (P = 0.022), competence (P = 0.019), biceps skin-fold (P = 0.012) and medial calf skin-fold (P = 0.013). No significant differences were observed between exercise modalities. Regardless of exercise mode, the addition of supervised and structured exercise to a MDT weight management programme significantly improved anthropometric, functional and psychological measures in obese participants with a BMI of ≥35 kg·m(2) .

The use of mutants to probe models of gravitropism.

It has been widely believed for more than 70 years that auxin plays a central role in the induction of differential growth which causes gravitropic curvature. However, this long-standing consensus about a role for auxin in gravitropism has only been achieved by allowing several mutually exclusive models to coexist. Furthermore, because there is no detailed model which is unchallenged by evidence, consensus is now centred on ill-defined models which have a low predictive value, hence are harder to challenge experimentally. An increasing number of mutants with abnormal gravitropic behaviour are becoming available. Such mutants should be very helpful in challenging existing models of gravitropism and in providing new evidence on which to build improved, more precise models. However, to date, most studies of mutants with abnormal gravitropism have been guided, experimentally and conceptually, by the old inadequate and vague models. Consequently, the full potential of modern molecular analysis in aiding our understanding of gravitropism has yet to be realized.

Potential acuity meter results in cataract patients.

PURPOSE: To determine the ability of the potential acuity meter (PAM) to predict potential visual acuity through lenticular opacities in a group of cataract patients without significant other ocular pathology. METHODS: This prospective study undertook PAM measurements on each eye of 84 subjects during preoperative hospital visits to either A Scan or Primary Care clinics. PAM results were compared to best corrected visual acuity findings obtained at least 6 weeks post-cataract extraction. RESULTS: Comparison of PAM result to visual outcome showed poor correlation (rho = 0.41, P = 0.0005). Using predictive estimates, 49% of subjects' PAM results underestimated visual outcome as determined by a difference of greater than 2 Snellen acuity lines in these results. Factors such as preoperative vision level, cataract type and pupil dilation did not significantly influence the predictive power of the PAM. Preoperative pinhole results were also correlated with visual outcome (rho = 0.42, P = 0.0006). Vison in the fellow eye of subjects with 6/9 or better was correlated to the PAM result indicating a moderate to good predictive power in 'normal' eyes. CONCLUSIONS: PAM results were considered to be poor for a clinical test. The results of this study indicate that this instrument has only a limited usefulness as part of the standard preoperatve examination in patients undergoing cataract extraction.

The effects of narcotics on fetal acid base status.

This paper reports two randomized control trials on the effects of nalorphine, pethidine, morphine and heroin on fetal and maternal acid base status. The drugs decreased pH and increased pCO2 in the mother, and decreased pH and base excess in the fetus. The changes in the fetus were independent of the changes in the mother. In equivalent dosages, nalorphine increased maternal pCO2 more than pethidine and morphine. The effects of heroin were found to be greater than that of other drugs, and we suggest that heroin should be avoided where the fetus is already at risk.