Prevalencia de patologías osteomusculares del miembro superior y su relación con factores ocupacionales en trabajadores de una empresa de flores. Bogotá 2015

Antecedentes: Las patologías osteomusculares del miembro superior son una importante causa de morbilidad laboral a nivel mundial y en nuestro país, particularmente en el sector de la floricultura. Del desarrollo de estos desórdenes se derivan importantes costos derivados del ausentismo laboral, incapacidades y secuelas. Objetivo: determinar la prevalencia de patología osteomuscular de miembro superior con calificación de origen de enfermedad laboral, en los trabajadores con diagnóstico de patología musculo esquelética de miembro superior y su relación con algunos factores ocupacionales y demográficos. Metodología: Estudio de corte transversal en el que se revisaron datos secundarios procedentes de una base de datos del servicio de salud ocupacional entre enero y mayo de 2015, correspondiente a 465 operarios (no administrativos) a término indefinido de una empresa floricultora de Bogotá, incluyendo únicamente aquellos trabajadores con patologías osteomusculares de miembro superior, que contaban con la clasificación en el diagnóstico ya sea como enfermedad laboral o enfermedad común y mayores de edad. Se excluyeron 19 trabajadores, quienes habían sido reubicados en nuevos sitios de trabajo y no se contó con la información para determinar su actividad antes de realizar el cambio. Se evaluaron las siguientes variables: sexo, edad, antigüedad y el cargo desempeñados por los operarios. La relación entre variables se realizó con la prueba de chi2 de Pearson. Se midió la magnitud de la asociación por medio de OR con sus respectivos intervalos de confianza del 95%. Resultados: Se incluyó a 373 operarios a término fijo, con una media de edad de 39 años (DE=5.55) y una media de antigüedad en el cargo de 6 años (DE=1.15). El 82.84% correspondió al sexo femenino. La prevalencia de enfermedad laboral osteomuscular de miembro superior fue del 54,4%. En el análisis de relación entre la calificación de la enfermedad, y demás variables (sexo, antigüedad en el cargo, edad, actividad desempeñada, localización de la lesión); se encontró que: estar entre los 40 a 49 años (OR= 1,7; IC-95%:1,12 – 2,79), diagnóstico de síndrome de manguito (OR= 4.45; IC-95%: 2.48 – 8.23) y el síndrome de túnel de carpo (OR= 4.22; IC-95%: 2.45 – 7.41) se asociaron a enfermedad laboral. Conclusiones: La prevalencia de enfermedad laboral de patología osteomuscular de miembro superior en los operarios de un cultivo de flores de la Sabana de Bogotá es del (54,4%). Se encontró una mayor asociación con el síndrome del manguito rotador y enfermedad laboral. No se encontró asociación entre la enfermedad laboral y la actividad desempeñada, el tiempo de exposición, ni con el sexo del trabajador.

Voronoi, Delaunay, and Block-Structured Mesh Refinement for Solution of the Shallow-Water Equations on the Sphere

Alternative meshes of the sphere and adaptive mesh refinement could be immensely beneficial for weather and climate forecasts, but it is not clear how mesh refinement should be achieved. A finite-volume model that solves the shallow-water equations on any mesh of the surface of the sphere is presented. The accuracy and cost effectiveness of four quasi-uniform meshes of the sphere are compared: a cubed sphere, reduced latitude–longitude, hexagonal–icosahedral, and triangular–icosahedral. On some standard shallow-water tests, the hexagonal–icosahedral mesh performs best and the reduced latitude–longitude mesh performs well only when the flow is aligned with the mesh. The inclusion of a refined mesh over a disc-shaped region is achieved using either gradual Delaunay, gradual Voronoi, or abrupt 2:1 block-structured refinement. These refined regions can actually degrade global accuracy, presumably because of changes in wave dispersion where the mesh is highly nonuniform. However, using gradual refinement to resolve a mountain in an otherwise coarse mesh can improve accuracy for the same cost. The model prognostic variables are height and momentum collocated at cell centers, and (to remove grid-scale oscillations of the A grid) the mass flux between cells is advanced from the old momentum using the momentum equation. Quadratic and upwind biased cubic differencing methods are used as explicit corrections to a fast implicit solution that uses linear differencing.

Farmers' attitudes towards techniques for improving oestrus detection in dairy herds in South West England

Unidentified heats contribute to declining fertility rates in English dairy herds. Several techniques have been advocated to improve heat detection rates. Despite demonstrable technical efficacy and cost-effectiveness, uptake is low. A study in South West England used the Theory of Reasoned Action (TORA) to explore dairy farmers' attitudes and beliefs towards heat detection techniques. Few farmers were convinced that following prescribed observation times, milk progesterone testing and using pedometers would fit their system or improve on their current heat detection practices. Perceived difficulty of using a technique was not a constraint on adoption. Without promotion that addresses identified barriers and drivers to adoption, little change in current practice can be expected. (c) 2006 Elsevier B.V. All rights reserved.

Identifying and understanding factors influencing the uptake of new technologies on dairy farms in SW England using the theory of reasoned action

Whilst much is known of new technology adopters, little research has addressed the role of their attitudes in adoption decisions; particularly, for technologies with evident economic potential that have not been taken up by farmers. This paper presents recent research that has used a new approach which examines the role that adopters' attitudes play in identifying the drivers of and barriers to adoption. The study was concerned with technologies for livestock farming systems in SW England, specifically oestrus detection, nitrogen supply management, and, inclusion of white clover. The adoption behaviour is analysed using the social-psychology theory of reasoned action to identify factors that affect the adoption of technologies, which are confirmed using principal components analysis. The results presented here relate to the specific adoption behaviour regarding the Milk Development Council's recommended observation times for heat detection. The factors that affect the adoption of this technology are: cost effectiveness, improved detection and conception rates as the main drivers, whilst the threat to demean the personal knowledge and skills of a farmer in 'knowing' their cows is a barrier. This research shows clearly that promotion of a technology and transfer of knowledge for a farming system need to take account of the beliefs and attitudes of potential adopters. (C) 2006 Elsevier Ltd. All rights reserved.

Cognitive therapy for anxiety disorders: current status and future directions.

This paper reviews recent theoretical, conceptual and practice developments in cognitive-behaviour therapy (CBT) for anxiety disorders. The empirical status of CBT for anxiety disorders is reviewed and recent advances in the field are outlined. Challenges for the future development of CBT for the anxiety disorders are examined in relation to the efficacy, effectiveness and cost-effectiveness of the approach. It is concluded that the major challenge currently facing CBT for anxiety disorders in the UK is how to meet the increased demand for provision whilst maintaining high levels of efficacy and effectiveness. It is suggested that the creation of an evidence base for the dissemination of CBT needs to become a priority for empirical investigation in order effectively to expand the provision of CBT for anxiety disorders.

A systematic review of the routine monitoring of growth in children of primary school age to identify growth-related conditions

Objectives: To clarify the role of growth monitoring in primary school children, including obesity, and to examine issues that might impact on the effectiveness and cost-effectiveness of such programmes. Data sources: Electronic databases were searched up to July 2005. Experts in the field were also consulted. Review methods: Data extraction and quality assessment were performed on studies meeting the review's inclusion criteria. The performance of growth monitoring to detect disorders of stature and obesity was evaluated against National Screening Committee (NSC) criteria. Results: In the 31 studies that were included in the review, there were no controlled trials of the impact of growth monitoring and no studies of the diagnostic accuracy of different methods for growth monitoring. Analysis of the studies that presented a 'diagnostic yield' of growth monitoring suggested that one-off screening might identify between 1: 545 and 1: 1793 new cases of potentially treatable conditions. Economic modelling suggested that growth monitoring is associated with health improvements [ incremental cost per quality-adjusted life-year (QALY) of pound 9500] and indicated that monitoring was cost-effective 100% of the time over the given probability distributions for a willingness to pay threshold of pound 30,000 per QALY. Studies of obesity focused on the performance of body mass index against measures of body fat. A number of issues relating to human resources required for growth monitoring were identified, but data on attitudes to growth monitoring were extremely sparse. Preliminary findings from economic modelling suggested that primary prevention may be the most cost-effective approach to obesity management, but the model incorporated a great deal of uncertainty. Conclusions: This review has indicated the potential utility and cost-effectiveness of growth monitoring in terms of increased detection of stature-related disorders. It has also pointed strongly to the need for further research. Growth monitoring does not currently meet all NSC criteria. However, it is questionable whether some of these criteria can be meaningfully applied to growth monitoring given that short stature is not a disease in itself, but is used as a marker for a range of pathologies and as an indicator of general health status. Identification of effective interventions for the treatment of obesity is likely to be considered a prerequisite to any move from monitoring to a screening programme designed to identify individual overweight and obese children. Similarly, further long-term studies of the predictors of obesity-related co-morbidities in adulthood are warranted. A cluster randomised trial comparing growth monitoring strategies with no growth monitoring in the general population would most reliably determine the clinical effectiveness of growth monitoring. Studies of diagnostic accuracy, alongside evidence of effective treatment strategies, could provide an alternative approach. In this context, careful consideration would need to be given to target conditions and intervention thresholds. Diagnostic accuracy studies would require long-term follow-up of both short and normal children to determine sensitivity and specificity of growth monitoring.

A dual QPSK soft-demapper for ECMA-368 exploiting time-domain spreading and guard interval diversity

When considering the relative fast processing speed and low power requirements for Wireless Personal Area Networks (WPAN) and Wireless Universal Serial Bus (USB) consumer based products, then the efficiency and cost effectiveness of these products become paramount. This paper presents an improved soft-output QPSK demapper suitable for the products above that not only exploits time diversity and guard carrier diversity, but also merges the demapping and symbol combining functions together to minimize CPU cycles, or memory access dependant upon the chosen implementation architecture. The proposed demapper is presented in the context of Multiband OFDM version of UWB (ECMA-368) as the chosen physical implementation for high-rate Wireless USB.

A dual QPSK soft-demapper for multiband OFDM exploiting time-domain spreading and guard interval diversity

When considering the relative fast processing speeds and low power requirements for Wireless Personal Area Networks (WPAN) including Wireless Universal Serial Bus (WUSB) consumer based products, then the efficiency and cost effectiveness of these products become paramount. This paper presents an improved soft-output QPSK demapper suitable for the products above that not only exploits time diversity and guard carrier diversity, but also merges the demapping and symbol combining functions together to minimize CPU cycles, or memory access dependant upon the chosen implementation architecture. The proposed demapper is presented in the context of Multiband OFDM version of Ultra Wideband (UWB) (ECMA-368) as the chosen physical implementation for high-rate Wireless US8(1).

Modelling sediment supply and transport in the River Lugg: strategies for controlling sediment loads

The River Lugg has particular problems with high sediment loads that have resulted in detrimental impacts on ecology and fisheries. A new dynamic, process-based model of hydrology and sediments (INCA- SED) has been developed and applied to the River Lugg system using an extensive data set from 1995–2008. The model simulates sediment sources and sinks throughout the catchment and gives a good representation of the sediment response at 22 reaches along the River Lugg. A key question considered in using the model is the management of sediment sources so that concentrations and bed loads can be reduced in the river system. Altogether, five sediment management scenarios were selected for testing on the River Lugg, including land use change, contour tillage, hedging and buffer strips. Running the model with parameters altered to simulate these five scenarios produced some interesting results. All scenarios achieved some reduction in sediment levels, with the 40% land use change achieving the best result with a 19% reduction. The other scenarios also achieved significant reductions of between 7% and 9%. Buffer strips produce the best result at close to 9%. The results suggest that if hedge introduction, contour tillage and buffer strips were all applied, sediment reductions would total 24%, considerably improving the current sediment situation. We present a novel cost-effectiveness analysis of our results where we use percentage of land removed from production as our cost function. Given the minimal loss of land associated with contour tillage, hedges and buffer strips, we suggest that these management practices are the most cost-effective combination to reduce sediment loads.

The audit of regional policy: 1934‐1939

This paper examines the cost-effectiveness of British regional policy during the 1930s. It takes issue with Correlli Barnett, who has argued that regional policy measures introduced from 1945 were already shown to be inefficient by the failure of similar assistance during the 1930s. The evolution of the main 1930s initiatives that influenced post-war policy is discussed and their effectiveness assessed. When account is taken of savings in government welfare payments these initiatives are shown to have been very cost-effective, producing an annual return to the exchequer of around 56%, or more.

An overview of domestic energy models and a new approach with agent based modelling

Government targets for CO2 reductions are being progressively tightened, the Climate Change Act set the UK target as an 80% reduction by 2050 on 1990 figures. The residential sector accounts for about 30% of emissions. This paper discusses current modelling techniques in the residential sector: principally top-down and bottom-up. Top-down models work on a macro-economic basis and can be used to consider large scale economic changes; bottom-up models are detail rich to model technological changes. Bottom-up models demonstrate what is technically possible. However, there are differences between the technical potential and what is likely given the limited economic rationality of the typical householder. This paper recommends research to better understand individuals’ behaviour. Such research needs to include actual choices, stated preferences and opinion research to allow a detailed understanding of the individual end user. This increased understanding can then be used in an agent based model (ABM). In an ABM, agents are used to model real world actors and can be given a rule set intended to emulate the actions and behaviours of real people. This can help in understanding how new technologies diffuse. In this way a degree of micro-economic realism can be added to domestic carbon modelling. Such a model should then be of use for both forward projections of CO2 and to analyse the cost effectiveness of various policy measures.

A unifying framework for metrics for aggregating the climate effect of different emissions

Multi-gas approaches to climate change policies require a metric establishing ‘equivalences’ among emissions of various species. Climate scientists and economists have proposed four kinds of such metrics and debated their relative merits. We present a unifying framework that clarifies the relationships among them. We show, as have previous authors, that the global warming potential (GWP), used in international law to compare emissions of greenhouse gases, is a special case of the global damage potential (GDP), assuming (1) a finite time horizon, (2) a zero discount rate, (3) constant atmospheric concentrations, and (4) impacts that are proportional to radiative forcing. Both the GWP and GDP follow naturally from a cost–benefit framing of the climate change issue. We show that the global temperature change potential (GTP) is a special case of the global cost potential (GCP), assuming a (slight) fall in the global temperature after the target is reached. We show how the four metrics should be generalized if there are intertemporal spillovers in abatement costs, distinguishing between private (e.g., capital stock turnover) and public (e.g., induced technological change) spillovers. Both the GTP and GCP follow naturally from a cost-effectiveness framing of the climate change issue. We also argue that if (1) damages are zero below a threshold and (2) infinitely large above a threshold, then cost-effectiveness analysis and cost–benefit analysis lead to identical results. Therefore, the GCP is a special case of the GDP. The UN Framework Convention on Climate Change uses the GWP, a simplified cost–benefit concept. The UNFCCC is framed around the ultimate goal of stabilizing greenhouse gas concentrations. Once a stabilization target has been agreed under the convention, implementation is clearly a cost-effectiveness problem. It would therefore be more consistent to use the GCP or its simplification, the GTP.

Dairy farmers’ attitudes and intentions towards improving dairy cow foot health

Dairy cow foot health is a subject of concern because it is considered to be the most important welfare problem in dairy farming and causes economic losses for the farmer. In order to improve dairy cow foot health it is important to take into account the attitude and intention of dairy farmers. In our study the objective was to gain insight into the attitude and intention of dairy farmers to take action to improve dairy cow foot health and determine drivers and barriers to take action, using the Theory of Planned Behavior. Five hundred Dutch dairy farmers were selected randomly and were invited by email to fill in an online questionnaire. The questionnaire included questions about respondents’ intentions, attitudes, subjective norms and perceived behavioral control and was extended with questions about personal normative beliefs. With information from such a framework, solution strategies for the improvement of dairy cow foot health can be proposed. The results showed that almost 70% of the dairy farmers had an intention to take action to improve dairy cow foot health. Most important drivers seem to be the achievement of better foot health with cost-effective measures. Possible barriers to taking action were labor efficiency and a long interval between taking action and seeing an improvement in dairy cow foot health. The feed advisor and foot trimmer seemed to have most influence on intentions to take action to improve dairy cow foot health. Most farmers seemed to be satisfied with the foot health status at their farm, which probably weakens the intention for foot health improvement, especially compared to other issues which farmers experience as more urgent. Subclinical foot disorders (where cows are not visibly lame) were not valued as important with respect to animal welfare. Furthermore, 25% of the respondents did not believe cows could suffer pain. Animal welfare, especially the provision of good care for the cows, was valued as important but was not related to intention to improve dairy cow foot health. The cost-effectiveness of measures seemed to be more important. Providing more information on the effects of taking intervention measures might stimulate farmers to take action to achieve improvement in dairy cow foot health.

Pollination deficits in UK apple orchards

Apple production in the UK is worth over £100 million per annum and this production is heavily dependent on insect pollination. Despite its importance, it is not clear which insect pollinators carry out the majority of this pollination. Furthermore, it is unknown whether current UK apple production, in terms of both yield and quality, suffers pollination deficits and whether production value could be increased through effective management of pollination services. The present study set out to address some of these unknowns and showed that solitary bee activity is high in orchards and that they could be making a valuable contribution to pollination. Furthermore, fruit set and apple seed number were found to be suffering potential pollination deficits although these were not reflected in apple quality. Deficits could be addressed through orchard management practices to improve the abundance and diversity of wild pollinators. Such practices include provision of additional floral resources and nesting habitats as well as preservation of semi-natural areas. The cost effectiveness of such strategies would need to be understood taking into account the potential gains to the apple industry.

A randomised controlled trial of positive memory training for the treatment of depression within schizophrenia

Abstract Background: Depression is highly prevalent within individuals diagnosed with schizophrenia, and is associated with an increased risk of suicide. There are no current evidence based treatments for low mood within this group. The specific targeting of co-morbid conditions within complex mental health problems lends itself to the development of short-term structured interventions which are relatively easy to disseminate within health services. A brief cognitive intervention based on a competitive memory theory of depression, is being evaluated in terms of its effectiveness in reducing depression within this group. Methods/Design: This is a single blind, intention-to-treat, multi-site, randomized controlled trial comparing Positive Memory Training plus Treatment as Usual with Treatment as Usual alone. Participants will be recruited from two NHS Trusts in Southern England. In order to be eligible, participants must have a DSM-V diagnosis of schizophrenia or schizo-affective disorder and exhibit at least a mild level of depression. Following baseline assessment eligible participants will be randomly allocated to either the Positive Memory Training plus Treatment as Usual group or the Treatment as Usual group. Outcome will be assessed at the end of treatment (3-months) and at 6-month and 9-month post randomization by assessors blind to group allocation. The primary outcome will be levels of depression and secondary outcomes will be severity of psychotic symptoms and cost-effectiveness. Semi-structured interviews will be conducted with all participants who are allocated to the treatment group so as to explore the acceptability of the intervention. Discussion: Cognitive behaviour therapy is recommended for individuals diagnosed with schizophrenia. However, the number of sessions and length of training required to deliver this intervention has caused a limit in availability. The current trial will evaluate a short-term structured protocol which targets a co-morbid condition often considered of primary importance by service users. If successful the intervention will be an important addition to current initiatives aimed at increasing access to psychological therapies for people diagnosed with severe mental health problems. Trial registration: Current Controlled Trials. ISRCTN99485756. Registered 13 March 2014.