Randomized clinical trials have shown that risedronate and alendronate reduce fractures among women with osteoporosis. The aim of this observational study was to observe, in clinical practice, the ...incidence of hip and nonvertebral fractures among women in the year following initiation of once-a-week dosing of either risedronate or alendronate.
Using records of health service utilization from July 2002 through September 2004, we created two cohorts: women (ages 65 and over) receiving risedronate (n = 12,215) or alendronate (n = 21,615). Cox proportional hazard modeling was used to compare the annual incidence of nonvertebral fractures and of hip fractures between cohorts, adjusting for potential differences in risk factors for fractures.
There were 507 nonvertebral fractures and 109 hip fractures. Through one year of therapy, the incidence of nonvertebral fractures in the risedronate cohort (2.0%) was 18% lower (95% CI 2% - 32%) than in the alendronate cohort (2.3%). The incidence of hip fractures in the risedronate cohort (0.4%) was 43% lower (95% CI 13% - 63%) than in the alendronate cohort (0.6%). These results were consistent across a number of sensitivity analyses.
Patients receiving risedronate have lower rates of hip and nonvertebral fractures during their first year of therapy than patients receiving alendronate.
Abstract
Background
The provision of independent prescribing rights for United Kingdom (UK) pharmacists has enabled them to prescribe within their area of competence. The aim of this study was to ...evaluate an evidence-based training programme designed to prepare Pharmacist Independent Prescribers (PIPs) to safely and effectively assume responsibility for pharmaceutical care of older people in care homes in the UK, within a randomised controlled trial.
Methods
The training and competency assessment process included two training days, professional development planning against a bespoke competency framework, mentor support, and a viva with an independent General Practitioner (GP). Data on the PIPs’ perceptions of the training were collected through evaluation forms immediately after the training days and through online questionnaires and interviews after delivery of the 6-month intervention. Using a mixed method approach each data set was analysed separately then triangulated providing a detailed evaluation of the process. Kaufman’s Model of Learning Evaluation guided interpretations.
Results
All 25 PIPs who received the training completed an evaluation form (
N
= 25). Post-intervention questionnaires were completed by 16 PIPs and 14 PIPs took part in interviews. PIPs reported the training days and mentorship enabled them to develop a personalised portfolio of competence in preparation for discussion during a viva with an independent GP. Contact with the mentor reduced as PIPs gained confidence in their role. PIPs applied their new learning throughout the delivery of the intervention leading to perceived improvements in residents’ quality of life and medicines management. A few PIPs reported that developing a portfolio of competence was time intensive, and that further training on leadership skills would have been beneficial.
Conclusions
The bespoke training programme was fit for purpose. Mentorship and competency assessment were resource intensive but appropriate. An additional benefit was that many PIPs reported professional growth beyond the requirement of the study.
Trial registration
The definitive RCT was registered with the ISRCTN registry (registration number
ISRCTN 17,847,169
).
We present the extension of a previous study where, assuming a simple free bosonic gas supplemented with a relativistic mean-field model to describe the pure nucleonic part of the equation of state, ...we studied the consequences that the first non-trivial hexaquark
d
*
(2380) could have on the properties of neutron stars. Compared to that exploratory work, we employ a standard non-linear Walecka model including additional terms that describe the interaction of the
d
*
(2380) di-baryon with the other particles of the system through the exchange of
σ
- and
ω
-meson fields. Our results show that the presence of the
d
*
(2380) leads to maximum masses compatible with recent observations of ∼2
M
⊙
millisecond pulsars if the interaction of the
d
*
(2380) is slightly repulsive or the
d
*
(2380) does not interact at all. An attractive interaction makes the equation of state too soft to be able to support a 2
M
⊙
neutron star whereas an extremely repulsive one induces the collapse of the neutron star into a black hole as soon as the
d
*
(2380) appears.
Considerable interspecific variation in female social relationships occurs in gregarious primates, particularly with regard to agonism and cooperation between females and to the quality of female ...relationships with males. This variation exists alongside variation in female philopatry and dispersal. Socioecological theories have tried to explain variation in female-female social relationships from an evolutionary perspective focused on ecological factors, notably predation and food distribution. According to the current "ecological model", predation risk forces females of most diurnal primate species to live in groups; the strength of the contest component of competition for resources within and between groups then largely determines social relationships between females. Social relationships among gregarious females are here characterized as Dispersal-Egalitarian, Resident-Nepotistic, Resident-Nepotistic-Tolerant, or Resident-Egalitarian. This ecological model has successfully explained differences in the occurrence of formal submission signals, decided dominance relationships, coalitions and female philopatry. Group size and female rank generally affect female reproduction success as the model predicts, and studies of closely related species in different ecological circumstances underscore the importance of the model. Some cases, however, can only be explained when we extend the model to incorporate the effects of infanticide risk and habitat saturation. We review evidence in support of the ecological model and test the power of alternative models that invoke between-group competition, forced female philopatry, demographic female recruitment, male interventions into female aggression, and male harassment. Not one of these models can replace the ecological model, which already encompasses the between-group competition. Currently the best model, which explains several phenomena that the ecological model does not, is a "socioecological model" based on the combined importance of ecological factors, habitat saturation and infanticide avoidance. We note some points of similarity and divergence with other mammalian taxa; these remain to be explored in detail.
When compressing soil, there is a characteristic relationship between compressive stress and volume change that can be used to define important soil mechanical properties. Two defining features can ...be determined – the compression index (
C
c – the modulus of the slope of the linear virgin compression curve) and the precompression stress (
σ
′
p
– the transition point between the elastic rebound curve and the virgin compression curve). These are indicators of compressibility and stress history respectively. The purpose of this paper is to evaluate different ways of estimating these indicators based on laboratory test data.
Repacked soils with a range of textures were subjected to sequential compressions of 50, 100 and 200
kPa, which provided two compression characteristics with “known”
σ
′
p
of 50 and 100
kPa. Three functions were fitted to the measured test data (fourth-order polynomial, symmetrical logistic sigmoidal and asymmetrical Gompertz sigmoidal). Values of
C
c were estimated by linear regression (for the data later fitted with a polynomial function) or by the tangent at the inflection point derived from model parameters (logistic and Gompertz functions). Three estimates of
σ
′
p
were calculated for each of the three functions: the standard Casagrande method (C), the intercept of the virgin compression curve and the initial (no stress) horizontal line (V–I), and the point of maximum curvature (MC) derived from the curvature function (
κ).
The accuracy of estimating
σ
′
p
and the magnitude of
C
c generally increased with clay content. Estimates of
C
c based on sigmoidal curves did not differ greatly from the linear regression estimate. Sigmoidal curves yielded
σ
′
p
estimates with lower absolute deviations from known values than polynomial-based estimates. The MC calculation based on the Gompertz function gave the most accurate estimate of
σ
′
p
. The lower asymptote of sigmoidal curves may also correspond to the water-filled pore space. Thus, despite the fact that all three functions fitted the measured data equally well, characteristics based on the sigmoidal curves were deemed to be most appropriate. The greater accuracy of the prediction of
σ
′
p
favoured the Gompertz function. Wider applicability of this was further checked with data selected from an independent database on subsoil compaction.
We recommend fitting the Gompertz function to measured soil compression characteristic test data, and to define
C
c objectively as the modulus of the slope of the tangent at the inflection point, providing this lies within the measured data range, and
σ
′
p
as the point of maximum curvature as defined by
κ.
The surfactant-free synthesis of vinyl polymer−silica nanocomposite particles has been achieved in aqueous alcoholic media at ambient temperature in the absence of auxiliary comonomers. Styrene, ...methyl methacrylate, methyl acrylate, n-butyl acrylate, and 2-hydroxypropyl methacrylate were homopolymerized in turn in the presence of three commercially available ultrafine alcoholic silica sols. Stable colloidal dispersions with reasonably narrow size distributions were obtained, with silica contents of up to 58% by mass indicated by thermogravimetric analysis. Particle size distributions were assessed using both dynamic light scattering and disk centrifuge photosedimentometry. The former technique indicated that the particle size increased for the first 1−2 h at 25 °C and thereafter remained constant. Particle morphologies were studied using electron microscopy. Most of the colloidal nanocomposites comprised approximately spherical particles with relatively narrow size distributions, but in some cases more polydisperse or nonspherical particles were obtained. Selected acrylate-based nanocomposites were examined in terms of their film formation behavior. Scanning electron microscopy studies indicated relatively smooth films were obtained on drying at 20 °C, with complete loss of the original particle morphology. The optical clarity of solution-cast 10 μm nanocomposite films was assessed using visible absorption spectrophotometry, with 93−98% transmission being obtained from 400 to 800 nm; the effect of long-term immersion of such films in aqueous solutions was also examined. X-ray photoelectron spectroscopy studies indicated that the surface compositions of these nanocomposite particles are invariably silica-rich, which is consistent with their long-term colloidal stability and also with aqueous electrophoresis measurements. FT-IR studies suggested that in the case of the poly(methyl methacrylate)−silica nanocomposite particles, the carbonyl ester groups in the polymer are hydrogen-bonded to the surface silanol groups. According to differential scanning calorimetry studies, the glass transition temperatures of several poly(methyl methacrylate)−silica and polystyrene−silica nanocomposites can be either higher or lower than those of the corresponding homopolymers, depending on the nature of the silica sol.
Wild chimpanzees, Pan troglodytes, frequently hunt and share meat. Despite widespread interest and considerable study, continued controversy exists regarding the factors that influence chimpanzee ...hunting decisions and meat sharing. Three hypotheses invoke the importance of ecological, reproductive and social factors. A nutritional shortfall hypothesis suggests that chimpanzees hunt to compensate for seasonal shortages in food availability. A second hypothesis argues that male chimpanzees hunt to obtain meat that they swap for matings. A third hypothesis proposes that males use meat as a social tool to develop and maintain alliances with other males. We tested these hypotheses using observations of an unusually large community of chimpanzees at Ngogo in Kibale National Park, Uganda. Results did not support the nutritional shortfall or meat-for-sex hypotheses. The Ngogo chimpanzees hunted primarily during times of food abundance rather than scarcity. The presence of oestrous females did not predict the tendency of chimpanzees to hunt. Furthermore, meat-for-sex exchanges occurred infrequently, and males did not gain a mating advantage through sharing meat. Additional observations were consistent with the male social bonding hypothesis. At Ngogo, male chimpanzees were likely to hunt when accompanied by other males. Males shared meat nonrandomly and reciprocally among themselves, and males exchanged meat for agonistic support. Although several factors are likely to affect chimpanzee hunting decisions and meat sharing, these results indicate that primary causes will not be found through invoking simple energetic or reproductive considerations.
Although an increase in soil fertility is the most frequently reported benefit linked to adding biochar to soils, there is still a need to pursue additional research that will improve our ...understanding on the impact of soil fertility enhancement because the effect could vary greatly between switchgrass (Panicum virgatum, L) residues (USG) and switchgrass biochars (SG). We hypothesized that SG with supplemental nitrogen (N) would deliver more positive effects on carbon (C) and N mineralization than USG. The objective of this study was to evaluate the effects of USG and SG, with or without supplemental inorganic N fertilizer on C and N mineralization in highly weathered Coastal Plain Ultisols. The application rate for SG and USG based on a corn yield goal of 112 kg ha−1 was 40 Mg ha−1. Inorganic N was added at the rate of 100 kg N ha−1, also based on a corn yield of 7.03 tons ha−1. Experimental treatments were: control (CONT) soil; control with N (CONT + N); switchgrass residues (USG); USG with N (USG + N); switchgrass biochars at 250 °C (250SG); SG at 250 °C with N (250SG + N); SG at 500 °C (500SG); and SG at 500 °C with N (500SG + N). Cumulative and net CO2–C evolution was increased by the additions of SG and USG especially when supplemented with N. Soils treated with 250SG (8.6 mg kg−1) had the least concentration of total inorganic nitrogen (TIN) while the greatest amount of TIN was observed from the CONT + N (19.0 mg kg−1). Our results suggest that application of SG in the short term may cause N immobilization resulting in the reduction of TIN.
•Carbon dioxide evolution was increased by the additions of switchgrass biochars and residues.•Application of switchgrass biochar may cause N immobilization.•Biochar application may need supplemental N to avoid crop growth retardation.
•Thyrotropin releasing hormone-stimulation tests were performed twice at two locations in Australia.•The results between the winter and summer solstices were similar to those in the northern ...hemisphere.•The results between the summer and winter solstices were highly variable in healthy horses.
Thyrotropin releasing hormone (TRH)-stimulation testing for pituitary pars intermedia dysfunction (PPID) in horses is only recommended at certain times of the year. Current diagnostic cut-off values reflect testing in the northern hemisphere during this time. The aims of this study were to evaluate TRH stimulation testing during two different phases of the circannual pituitary cycle and to determine whether diagnostic cut-off values developed in the northern hemisphere are appropriate in Australia. Thirteen clinically normal horses at Perth, Western Australia, and 23 horses at Townsville, Queensland, Australia, had TRH stimulation tests performed at two different time points during the circannual pituitary cycle. At both locations, post-TRH adrenocorticotropic hormone (ACTH) concentrations were significantly different between testing time points (Perth: P=0.001; Townsville: P<0.0001). In Perth, the mean ACTH concentrations 10min post-TRH in September and March were 51.4pg/mL (95% confidence interval, CI, 46.4–56.4pg/mL) and 248.5pg/mL (95% CI 170.2–326.9pg/mL), respectively. The median percentage change in ACTH concentrations in March was 361.9%. In Townsville, the mean ACTH concentrations 30min post-TRH in September and April were 35.3pg/mL (95% CI 29.6–40.9pg/mL) and 112.3pg/mL (95% CI 93.4–131.2pg/mL), respectively. The median percentage change in ACTH concentrations in April was 144.7%. The ACTH cut-off value after TRH stimulation in normal horses in September in Perth and Townsville was similar to the values established in the northern hemisphere. However, TRH stimulation testing in March/April was highly variable at both locations.
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