A dietetic consultation is a structured process aimed at supporting individual patients to modify their dietary behaviors to improve health outcomes. The body of evidence on the effectiveness of ...nutrition care provided by dietitians in primary health care settings has not previously been synthesized. This information is important to inform the role of dietitians in primary health care service delivery.
The aim of this systematic review was to evaluate the evidence of the effectiveness of individual consultations provided exclusively by dietitians in primary care to support adult patients to modify dietary intake and improve health outcomes.
ProQuest Family Health, Scopus, PubMed Central, Medline, the Cumulative Index to Nursing and Allied Health Literature, and Cochrane databases were searched for English language systematic reviews or randomized controlled trials published before October 2016. The key terms used identified the provision of nutrition care exclusively by a dietitian in a primary health care setting aimed at supporting adult patients to modify dietary behaviors and/or improve biomarkers of health. Interventions delivered to patients aged younger than 18 years, in hospital, via telephone only, in a group or lecture setting, or by a multidisciplinary team were excluded. The methodologic quality of each study was appraised using the Cochrane Risk of Bias tool and the body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual.
Outcomes included the effectiveness of dietetic interventions in terms of anthropometry, clinical indicators, and dietary intake. A statistically significant between-group difference was used to indicate intervention effectiveness (P<0.05).
Twenty-six randomized controlled studies met eligibility criteria, representing 5,500 adults receiving dietetic consultations in a primary care setting. Eighteen of 26 included studies showed statistically significant differences in dietary, anthropometric, or clinical indicators between intervention and comparator groups. When focusing specifically on each study’s stated aim, significant improvements favoring the intervention compared with control were found for the following management areas: glycemic control (four out of four studies), dietary change (four out of four studies), anthropometry (four out of seven studies), cholesterol (two out of eight studies), triglycerides (one out of five), and blood pressure (zero out of three) studies.
Dietetic consultations for adults in primary care settings appear to be effective for improvement in diet quality, diabetes outcomes (including blood glucose and glycated haemoglobin values), and weight loss outcomes (eg, changes in weight and waist circumference) and to limit gestational weight gain (Grade II: Fair evidence). Research evaluated in this review does not provide consistent support for the effectiveness of direct dietetic counseling alone in achieving outcomes relating to plasma lipid levels and blood pressure (Grade III: Limited evidence). Therefore, to more effectively control these cardiovascular disease risk factors, future research might explore novel nutrition counseling approaches as well as dietitians functioning as part of multidisciplinary teams.
Soliton solutions of the KP equation have been studied since 1970, when Kadomtsev and Petviashvili proposed a two-dimensional nonlinear dispersive wave equation now known as the KP equation. It is ...well-known that one can use the Wronskian method to construct a soliton solution to the KP equation from each point of the real Grassmannian
G
r
k
,
n
. More recently, several authors (Biondini and Chakravarty, J Math Phys 47:033514,
2006
; Biondini and Kodama, J. Phys A Math Gen 36:10519–10536,
2003
; Chakravarty and Kodama, J Phys A Math Theor 41:275209,
2008
; Chakravarty and Kodama, Stud Appl Math 123:83–151,
2009
; Kodama, J Phys A Math Gen 37:11169–11190,
2004
) have studied the
regular
solutions that one obtains in this way: these come from points of the totally non-negative part of the Grassmannian
(
G
r
k
,
n
)
≥
0
. In this paper we exhibit a surprising connection between the theory of total positivity for the Grassmannian, and the structure of regular soliton solutions to the KP equation. By exploiting this connection, we obtain new insights into the structure of KP solitons, as well as new interpretations of the combinatorial objects indexing cells of
(
G
r
k
,
n
)
≥
0
(Postnikov,
http://front.math.ucdavis.edu/math.CO/0609764
). In particular, we completely classify the spatial patterns of the soliton solutions coming from
(
G
r
k
,
n
)
≥
0
when the absolute value of the time parameter is sufficiently large. We demonstrate an intriguing connection between soliton graphs for
(
G
r
k
,
n
)
>
0
and the
cluster algebras
of Fomin and Zelevinsky (J Am Math Soc 15:497–529,
2002
), and we use this connection to solve the
inverse problem
for generic KP solitons coming from
(
G
r
k
,
n
)
>
0
. Finally we construct all the soliton graphs for
(
G
r
2
,
n
)
>
0
using the triangulations of an
n
-gon.
BackgroundPatient-centred care (PCC) is care that is respectful and responsive to the wishes of patients. The body of literature on PCC delivered by general practitioners (GPs) has increased steadily ...over time. There is an opportunity to advance the work on GP-delivered PCC through qualitative research involving both patients and providers.AimTo explore the perceptions and experiences of PCC by patient advocates and GPs.Design and settingQualitative description in a social constructivist paradigm. Participants were sampled from six primary care organisations in south east Queensland/northern New South Wales, Australia.MethodPurposive sampling was used to recruit English-speaking adult participants who were either practising GPs or patient advocates. Focus group sessions explored participants’ perceptions and experiences of PCC. Data were analysed thematically using a constant-comparative approach.ResultsThree focus groups with 15 patient advocates and three focus groups with 12 practising GPs were conducted before thematic saturation was obtained. Five themes emerged: (1) understanding of PCC is varied and personal, (2) valuing humanistic care, (3) considering the system and collaborating in care, (4) optimising the general practice environment and (5) needing support for PCC that is embedded into training.ConclusionPatient advocates’ and GPs’ understanding of PCC are diverse, which can hinder strategies to implement and sustain PCC improvements. Future research should explore novel interventions that expose GPs to unique feedback from patients, assess the patient-centeredness of the environment and promote GP self-reflection on PCC.
The principal nature-based solution for offsetting relative sea-level rise in the Ganges-Brahmaputra delta is the unabated delivery, dispersal, and deposition of the rivers' ~1 billion-tonne annual ...sediment load. Recent hydrological transport modeling suggests that strengthening monsoon precipitation in the 21st century could increase this sediment delivery 34-60%; yet other studies demonstrate that sediment could decline 15-80% if planned dams and river diversions are fully implemented. We validate these modeled ranges by developing a comprehensive field-based sediment budget that quantifies the supply of Ganges-Brahmaputra river sediment under varying Holocene climate conditions. Our data reveal natural responses in sediment supply comparable to previously modeled results and suggest that increased sediment delivery may be capable of offsetting accelerated sea-level rise. This prospect for a naturally sustained Ganges-Brahmaputra delta presents possibilities beyond the dystopian future often posed for this system, but the implementation of currently proposed dams and diversions would preclude such opportunities.
We study some geometric and combinatorial aspects of the solution to the full Kostant–Toda (f-KT) hierarchy, when the initial data is given by an arbitrary point on the totally non-negative (tnn) ...flag variety of
S
L
n
(
R
)
. The f-KT flows on the tnn flag variety are complete, and we show that their asymptotics are completely determined by the cell decomposition of the tnn flag variety given by Rietsch (Total positivity and real flag varieties. Ph.D. Thesis, Massachusetts Institute of Technology, Cambridge,
1998
). Our results represent the first results on the asymptotics of the f-KT hierarchy (and even the f-KT lattice); moreover, our results are not confined to the generic flow, but cover non-generic flows as well. We define the f-KT flow on the weight space via the moment map, and show that the closure of each f-KT flow forms an interesting convex polytope which we call a
Bruhat interval polytope
. In particular, the Bruhat interval polytope for the generic flow is the permutohedron of the symmetric group
S
n
. We also prove analogous results for the full symmetric Toda hierarchy, by mapping our f-KT solutions to those of the full symmetric Toda hierarchy. In the appendix we show that Bruhat interval polytopes are
generalized permutohedra
, in the sense of Postnikov (Int. Math. Res. Not. IMRN (6):1026–1106,
2009
).
The presence of memory for rejected distractors during visual search has been heavily debated in the literature and has proven challenging to investigate behaviorally. In this research, we used an ...electrophysiological index of working memory (contralateral delay activity) to passively measure working memory activity during visual search. Participants were asked to indicate whether a novel target was present or absent in a lateralized search array with three visual set sizes (2, 4, or 6). If rejected distractors are maintained in working memory during search, working memory activity should increase with the number of distractors that need to be evaluated. Therefore, we predicted the amplitude of the contralateral delay activity would be larger for target-absent trials and would increase with visual set size until WM capacity was reached. In Experiment
1
, we found no evidence for distractor maintenance in working memory during search for real-world stimuli. In Experiment
2
, we found partial evidence in support of distractor maintenance during search for stimuli with high target/distractor similarity. In both experiments, working memory capacity did not appear to be a limiting factor during visual search. These results suggest the role of working memory during search may depend on the visual search task in question. Maintaining distractors in working memory appears to be unnecessary during search for realistic stimuli. However, there appears to be a limited role for distractor maintenance during search for artificial stimuli with a high degree of feature overlap.
Behavior change theories frameworks provide the theoretical underpinning for effective health care. The extent to which they are applied in contemporary dietetics interventions has not been explored.
...To systematically review the evidence of behavior change theory-based interventions delivered by credentialed nutrition and dietetics practitioners in primary health care settings.
Medline, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Embase, and Cochrane databases were searched for English language, randomized controlled trials before August 2019. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. Eligible interventions included adults (aged ≥18 years) receiving face-to-face dietetics care underpinned by behavior change theories in primary health care settings with outcome measures targeting changes in health behaviors or health outcomes. Screening was conducted independently in duplicate and data were extracted using predefined categories. The quality of each study was assessed using the Cochrane Risk of Bias tool. The body of evidence was assessed using the Academy of Nutrition and Dietetics Evidence Analysis Manual Conclusion Grading Table.
Thirty articles reporting on 19 randomized controlled trials met the eligibility criteria, representing 5,172 adults. Thirteen studies (68%) showed significant improvements for the primary outcome measured. Social cognitive theory was the behavior change theory most commonly applied in interventions (n=15) with 11 finding significant intervention effects. Goal setting, problem solving, social support, and self-monitoring were the most commonly reported techniques (n=15, n=14, n=11, and n=11, respectively). Most studies had a high (n=11) or unclear (n=8) risk of bias. There was fair evidence (Grade II) supporting the use of behavior change theories to inform development of dietetics interventions.
Interventions delivered by credentialed nutrition and dietetics practitioners that were underpinned by behavior change theories and utilizing various behavior change techniques were found to have potential to be more effective at improving patient health outcomes than dietary interventions without theoretical underpinnings. Findings from this review should inform future primary health care research in the area of dietary behavior change. In addition, findings from this review highlight the need for stronger documentation of use of behavior change theory and techniques that map on to the theory within dietetics practice.
Objectives
To describe the incidence of head and neck trauma related to electric bicycles and to characterize head and neck injury patterns seen in electric bicycle (eBike) users versus pedal ...bicyclists in the United States.
Methods
The National Electronic Injury Surveillance System (NEISS) was queried from 2009 to 2020 for patients with head and neck injuries related to electric and pedal bicycles. Extracted data included patient demographics, injury patterns, hospital admission, and helmet use. Univariate chi‐squared analyses were performed to compare demographics and injury patterns between bicycle groups. Effect sizes were reported with Cramer V values (V).
Results
The incidence of eBike‐related head and neck injuries increased from 2993 in 2009 to 9916 in 2020. Compared to pedal bicycle users, eBike users were more likely to have head injuries (60.4% vs. 52.0%) and fractures (10.9% vs. 6.0%), and were more likely to require hospitalization (20.6% vs. 10.4%). The effect size of helmet use was significantly greater in eBike users compared to pedal bicyclists when examining distributions of age group (V = 0.203 vs. V = 0.079), injury location (V = 0.220 vs. V = 0.082), and injury type (V = 0.162 vs. V = 0.059). Helmeted injuries in eBike users more commonly involved neck injuries and sprains, rather than head injuries and fractures.
Conclusion
Head and neck trauma related to eBike use is increasing in the United States. Injury patterns and admission rates reflect greater injury severity in eBike users compared to pedal bicyclists. Helmet use may be particularly beneficial in mitigating head and neck injury in eBike users.
Level of Evidence
3 Laryngoscope, 134:2734–2740, 2024
This study compares the types of head and neck injuries sustained by individuals who were treated in emergency departments across the United States after both electric and conventional bicycle injuries. eBike users were more likely to have severe injuries requiring hospitalization. Helmet use had a greater effect on the distribution of injury patterns in eBike users compared to pedal bicyclists.
Abstract
Consider a lattice of n sites arranged around a ring, with the $n$ sites occupied by particles of weights $\{1,2,\ldots ,n\}$; the possible arrangements of particles in sites thus correspond ...to the $n!$ permutations in $S_n$. The inhomogeneous totally asymmetric simple exclusion process (or TASEP) is a Markov chain on $S_n$, in which two adjacent particles of weights $i<j$ swap places at rate $x_i - y_{n+1-j}$ if the particle of weight $j$ is to the right of the particle of weight $i$. (Otherwise, nothing happens.) When $y_i=0$ for all $i$, the stationary distribution was conjecturally linked to Schubert polynomials 18, and explicit formulas for steady state probabilities were subsequently given in terms of multiline queues 4, 5. In the case of general $y_i$, Cantini 7 showed that $n$ of the $n!$ states have probabilities proportional to double Schubert polynomials. In this paper, we introduce the class of evil-avoiding permutations, which are the permutations avoiding the patterns $2413, 4132, 4213,$ and $3214$. We show that there are $\frac {(2+\sqrt {2})^{n-1}+(2-\sqrt {2})^{n-1}}{2}$ evil-avoiding permutations in $S_n$, and for each evil-avoiding permutation $w$, we give an explicit formula for the steady state probability $\psi _w$ as a product of double Schubert polynomials. (Conjecturally, all other probabilities are proportional to a positive sum of at least two Schubert polynomials.) When $y_i=0$ for all $i$, we give multiline queue formulas for the $\textbf {z}$-deformed steady state probabilities and use this to prove the monomial factor conjecture from 18. Finally, we show that the Schubert polynomials arising in our formulas are flagged Schur functions, and we give a bijection in this case between multiline queues and semistandard Young tableaux.
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