Effectiveness Of Different Approaches Research Articles

Group-based pelvic floor muscle training for all women during pregnancy is more cost-effective than postnatal training for women with urinary incontinence: cost-effectiveness analysis of a systematic review

What is the most cost-effective way of providing pelvic floor muscle training (PFMT) to prevent or treat postpartum incontinence? Meta-analysis and cost-effectiveness analysis of models of care included in a recent Cochrane systematic review. Pregnant and postnatal women. Supervised PFMT for preventing or treating urinary and/or faecal incontinence. Postpartum urinary or faecal incontinence. We examined the comparative incremental cost effectiveness of different approaches to successfully prevent or cure one case of incontinence. Costs were valued in Australian dollars using publicly available market rates and enterprise agreements as of 2019. Comparisons involving group-based treatment approaches were subject to sensitivity analyses where the numbers of patients attending each group were varied to identify thresholds where recommendations change. Seventeen trials were included for meta-analysis. Three models of care were clinically effective: individually supervised PFMT during pregnancy to prevent urinary incontinence (Model 1), group-based PFMT during pregnancy to prevent or treat urinary incontinence (Model 2) and individually supervised postnatal PFMT to treat urinary incontinence and prevent or treat faecal incontinence (Model 3). The health service costs per urinary incontinence case prevented or cured were $768 for Model 1, and $1,970 for Model 3. However, Model 2 generated a cost saving of $14 if there were eight participants per session, with greater savings if more participants attend. The health service cost per faecal incontinence case prevented or cured was $2,784 (Model 3). Providing group-based PFMT for all women during pregnancy is likely more efficient than individual PFMT for incontinent women postnatally; however, providing PFMT for postnatal women with urinary incontinence should not be discounted because of the added known benefit for preventing and treating faecal incontinence.

Supporting Mathematical Argumentation and Proof Skills: Comparing the Effectiveness of a Sequential and a Concurrent Instructional Approach to Support Resource-Based Cognitive Skills.

An increasing number of learning goals refer to the acquisition of cognitive skills that can be described as ‘resource-based,’ as they require the availability, coordination, and integration of multiple underlying resources such as skills and knowledge facets. However, research on the support of cognitive skills rarely takes this resource-based nature explicitly into account. This is mirrored in prior research on mathematical argumentation and proof skills: Although repeatedly highlighted as resource-based, for example relying on mathematical topic knowledge, methodological knowledge, mathematical strategic knowledge, and problem-solving skills, little evidence exists on how to support mathematical argumentation and proof skills based on its resources. To address this gap, a quasi-experimental intervention study with undergraduate mathematics students examined the effectiveness of different approaches to support both mathematical argumentation and proof skills and four of its resources. Based on the part-/whole-task debate from instructional design, two approaches were implemented during students’ work on proof construction tasks: (i) a sequential approach focusing and supporting each resource of mathematical argumentation and proof skills sequentially after each other and (ii) a concurrent approach focusing and supporting multiple resources concurrently. Empirical analyses show pronounced effects of both approaches regarding the resources underlying mathematical argumentation and proof skills. However, the effects of both approaches are mostly comparable, and only mathematical strategic knowledge benefits significantly more from the concurrent approach. Regarding mathematical argumentation and proof skills, short-term effects of both approaches are at best mixed and show differing effects based on prior attainment, possibly indicating an expertise reversal effect of the relatively short intervention. Data suggests that students with low prior attainment benefited most from the intervention, specifically from the concurrent approach. A supplementary qualitative analysis showcases how supporting multiple resources concurrently alongside mathematical argumentation and proof skills can lead to a synergistic integration of these during proof construction and can be beneficial yet demanding for students. Although results require further empirical underpinning, both approaches appear promising to support the resources underlying mathematical argumentation and proof skills and likely also show positive long-term effects on mathematical argumentation and proof skills, especially for initially weaker students.

Comparison of the effectiveness of different approaches to osteoporosis diagnosis organizing and identification of patients at high fracture risk in the Russian population

Comparison of the effectiveness of different approaches to osteoporosis diagnosis organizing and identification of patients at high fracture risk in the Russian population

Transforming Gerontological Research by Meaningfully Engaging Persons Living With Dementia

Whereas persons living with dementia have commonly been subjects of gerontological research, participation of persons with dementia in designing and conducting studies and in scientific research meetings has been rare in the United States. In recent years, person-centered research models have arisen which give persons with dementia and their caregivers core roles in the research enterprise. As “co-researchers” with academic/professional researchers, persons with dementia and their caregivers are engaged in all aspects of the research enterprise, jointly developing research questions and study designs, collecting and analyzing data, planning research meetings, and disseminating results. International studies have shown that conducting research in collaboration with the population that is being studied has potential to enhance the quality and appropriateness of research and has been identified as an essential component of studies examining the effectiveness of different approaches to care. This session spotlights innovative advances in gerontological research that meaningfully engages persons with dementia. First, the engagement of persons with dementia in scientific meetings is addressed drawing on the examples of the 2017 and 2020 National Research Summits on Care Services and Supports for Persons with Dementia and their Caregivers (i.e., Summits). Next, a study using a patient engagement framework for caregivers and individuals with mild cognitive impairment living at home is discussed. Finally, the Empowering Partnerships program, which prepares researchers, persons with dementia, and care partners to collaborate in conducting research is reviewed. Outcomes and challenges of these innovations are examined, and the need for academic/professional researcher roles to evolve is discussed.

Участие дальневосточных епархий Русской православной церкви в социокультурной жизни Дальнего Востока в 1990-е гг.

The paper, using archival sources and media materials, examines the participation of the Far Eastern eparchies of the Russian Orthodox Church of the Moscow Patriarchate in the socio-cultural life of the Far East in the 1990s. The main forms of education of representatives of diocesan structures and individual clergy among the population of the region are noted. The effectiveness of different approaches to the organization of cultural and scientific events organized by the secular authorities together representatives of Orthodoxy is analyzed. The authors come to the conclusion that the peculiarity of the revitalization of religion in the Far East in the 1990s was the demand of the population in gaining new knowledge about the history of the region, the history of Christianity and the ROC MP. Moreover, it was as the desire of Far Eastern eparchies to organize educational activities, expand their sphere of influence, using a variety of forms of work.

Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study

BackgroundLow back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found be cost-effective for treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiropractic care is uncertain. To date, little has been published regarding the cost effectiveness of different approaches to chiropractic care. Thus, the current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain.MethodsWe employed a retrospective cohort design to examine costs of chiropractic care among patients diagnosed with acute or subacute low back pain. The study time period ranged between 07/01/2016 and 12/22/2017. We compared cost outcomes for patients of two cohorts of chiropractors within health care system: Cohort 1) a general network of providers, and Cohort 2) a network providing conservative evidence-based care for rapid resolution of pain. We used generalized linear regression modeling to estimate the comparative influence of demographic and clinical factors on expenditures.ResultsA total of 25,621 unique patients were included in the analyses. The average cost per patient for Cohort 2 (mean allowed amount $252) was lower compared to Cohort 1 (mean allowed amount $326; 0.77, 95% CI 0.75–0.79, p < .001). Patient and clinician related factors such as health plan, provider region, and sex also significantly influenced costs.ConclusionsThis study comprehensively analyzed cost data associated with the chiropractic care of adults with acute or sub-acute low back pain cared by two cohorts of chiropractic physicians. In general, providers in Cohort 2 were found to be significantly associated with lower costs for patient care as compared to Cohort 1. Utilization of a clinical model characterized by a patient-centered clinic approach and standardized, best-practice clinical protocols may offer lower cost when compared to non-standardized clinical approaches to chiropractic care.

Approaches to cervical spine mobilization for neck pain: a pilot randomized controlled trial

Study designPilot randomized controlled trial.BackgroundBetter understanding of the relative effectiveness of different approaches to cervical spine mobilization has been identified as a research priority in manual therapy practice. Two distinct approaches to the practice of mobilization have emerged in recent years, based on different reasoning models for selection of mobilization techniques. The objective of this pilot study was to assess feasibility aspects for a future randomized clinical trial by exploring short-term pain and disability outcomes after a single treatment with pragmatic versus prescriptive approaches to cervical mobilization for people with recent-onset neck pain at 48-h follow-up after randomization.MethodsTwenty adults with a new episode of mechanical neck pain were randomly allocated to either pragmatic or prescriptive mobilization intervention groups. The pragmatic group received a single treatment of cervical mobilization with the technique, target segment, and grade selected by their treating therapist. The prescriptive group received a single treatment of standardized mobilization with techniques similar to a previous mobilization clinical trial. Feasibility outcomes were recruitment rates, randomization audit and completion of treatment and follow-up per protocol. The primary clinical outcome of interest was disability level measured at 48-h follow-up after randomization.ResultsRecruitment rates were approximately 2.5 participants per week and 100% of eligible participants were deemed suitable for treatment with cervical mobilization. There was sufficient variety in the range of pragmatic treatments selected and the data collection process imposed minimal burden on participants.ConclusionsOur results provide supporting evidence for the feasibility of a future larger scale randomized clinical trial.Trial registrationTrial registration: Australian New Zealand Clinical Trials Registry (ACTRN12616000446460). Registered 6th April 2016. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370448&isReview=true

Medication Discontinuation Following Transurethral Prostatectomy: an Unrecognized Effectiveness Measure?

Freedom from medication is a common goal for patients undergoing surgical treatment of benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS). Knowing medication discontinuation rates following various forms of transurethral prostatectomy may aid patient counseling and assessing the comparative effectiveness of different approaches. This review examined discontinuation rates of BPH/LUTS medications following transurethral prostatectomy. Rates of BPH/LUTS medication use after transurethral resection of the prostate varied from 15% to 55%, and discontinuation rates were 54-95% across medications and follow-up periods. For laser prostatectomy, approximately 18% of patients continued medications postoperatively and discontinuation rates ranged from 53% to 75%. Minimal data on holmium laser enucleation existed. For reference, medication discontinuation rates after transurethral needle ablation or microwave therapy were only 15-28%. No recommendations or best practices inform the use of medical therapy following BPH surgery. Rates of BPH/LUTS medication use following transurethral prostatectomy are considerable.

Effectiveness of different approaches for in situ measurements of organic carbon using visible and near infrared spectrometry in the Poyang Lake basin area

AbstractResearch on soil carbon dynamics and content in the Poyang Lake basin area is important because of their effects on the soil carbon pool and soil carbon cycle. Visible and near infrared (VNIR) diffuse reflectance spectroscopy can provide analytical dense soil data reflecting multiple physical and chemical properties of soil under in situ conditions. The effective use of in situ VNIR in the Poyang Lake basin area would greatly improve the collection of high‐resolution and spatially explicit soil data and, thus, hasten the monitoring process. We collected two data sets S1 and S2 in 2016–2018. A dataset from S1 was used to develop the in situ correction matrix using laboratory and in situ spectra. Spectra from the Chinese Soil Spectroscopic Database (CSSD) and dataset of S1 in dry laboratory conditions were used for calibration (CSSD‐local calibration). The dataset from S2 was utilized as the validation dataset. Four in situ correction methods, external parameter orthogonalization (EPO), piecewise direct standardization, direct standardization, and generalized least squares weighting, were used to remove the in situ effect on the spectra. In addition, partial least squares regression and support vector machine (SVM), were used to test the effectiveness of the prediction. We also compared the prediction results by calibration of the CSSD, CSSD‐local and CSSD combined with four in situ samples from the validation datasets with extra‐weighting (CSSD‐EX). The results showed that EPO was the most effective method for removing the in situ effect. EPO and SVM with the calibration of CSSD‐EX yielded the best prediction result with the lowest root mean squared error at 1.71 g kg−1 and the highest Lin's concordance correlation coefficient at 0.88. The CSSD with EPO and SVM would allow the in situ estimation of soil organic carbon in the Poyang Lake basin area at a reasonable cost.

Development of a testable logic model for community supervision home and field contacts

Field contacts are at the core of community supervision practice in nearly all community supervision agencies in the United States; however, the nature of field contacts varies widely across agencies. Without a standard definition, it is impossible to draw conclusions about the impact of field contacts on individual outcomes or public safety. Therefore, prior to conducting research to test the effectiveness of field contacts, it is critical to first establish an in-depth understanding of the nature and purpose of field work as part of community supervision and develop a theoretical framework for future testing. This study aimed to develop a logic model for community supervision field work by exploring and describing the nature and purpose of field contacts. We used qualitative methods of data collection including a field contact checklist completed by community supervision officers, focus groups with officers, and interviews with agency leaders, to unpack the various approaches to field work in two states and to identify patterns of reasoning behind the different approaches. The findings from this study can be used to design rigorous tests of field contact components on various outcomes in order to inform policymakers about the relative effectiveness of different approaches to field work.

Сomparative Analysis of Polynomial Maximization and Maximum Likelihood Estimates for Data with Exponential Power Distribution

The work is devoted to the estimate accuracy comparative analysis of the experimental data parameters with exponential power distribution (EPD) using the classical Maximum Likelihood Estimation (MLE) and the original Polynomial Maximization Method (PMM). In contrast to the parametric approach of MLE, which uses the description in the form of probability density distribution, PMM is based on a partial description in the of higher-order statistics form and the mathematical apparatus of Kunchenko's stochastic polynomials. An algorithm for finding PMM estimates using 3rd order stochastic polynomials is presented. Analytical expressions allowing to determine the variance of PMM-estimates of the asymptotic case parameters and EPD parameters with a priori information are obtained. It is shown that the relative theoretical estimates accuracy of different methods significantly depends on the EPD shape parameter and matches only for a separate case of Gaussian distribution. The effectiveness of different approaches (including valuation of mean values estimates) both with and without a priori information on EPD properties was investigated by repeated statistical tests (through Monte Carlo Method). The greatest efficiency areas for each of methods depending on EPD shape parameter and sample data volume are constructed.

65‐1: Invited Paper: Enhanced Efficiency of InP‐based Red and Green Quantum‐Dot Light‐emitting Diodes

Due to the inherent toxicity of cadmium selenide (CdSe)‐based quantum dots (QDs), Cd‐free alternatives are being widely investigated. Indium phosphide (InP) QDs have shown great potential as a replacement for CdSe QDs in display applications. However, the performance of InP‐based quantum dot light emitting diodes (QLEDs) is still far behind that of the CdSe‐based devices. In this study, we wanted to show the effects of different approaches to improve the performance of InP‐based QLED devices. We investigated the effect of magnesium (Mg) doping in ZnO nanoparticles, which is used as an n‐type electron transport layer, in balancing the charge transfer in InP‐based QLED devices. We found that an increasing Mg doping level can broaden the ZnO band gap, shift its energy levels, but most importantly, increase its resistivity; as a result, the electron current density is significantly reduced and the device efficiency is improved. We also investigated the effect of high‐photoluminescence quantum yield emitters and different QLED architectures on the device performance. Through optimizing QD structures and devices, red InP QLEDs with the current efficiencies reaching 11.6 cd/A and green InP QLEDs with the current efficiencies reaching 37.0 cd/A were fabricated.

Caring for Newborns Born to Mothers With COVID-19: More Questions Than Answers.

* Abbreviations: AAP — : American Academy of Pediatrics CDC — : Centers for Disease Control and Prevention COVID-19 — : coronavirus disease 2019 PCR — : polymerase chain reaction SARS-CoV-2 — : severe acute respiratory syndrome coronavirus 2 WHO — : World Health Organization As the coronavirus disease 2019 (COVID-19) pandemic continues, its impact on newborns remains uncertain. Early reports from China suggested that although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could be associated with adverse pregnancy outcomes, newborns did not appear to show clinical signs of infection and had negative viral testing results.1,2 More recent reports suggest that, although low, risk of neonatal infection does exist. A recent (as we write this commentary) review identified 27 publications describing 217 newborns born to mothers with COVID-19, of which 21 publications describing 187 newborns were from China.3 Of the 217 newborns, 7 (3%) had evidence of SARS-CoV-2 infection: 3 had positive serum levels of immunoglobulin G and immunoglobulin M antibodies with negative polymerase chain reaction (PCR) test results, and 4 had positive PCR test results. Beyond the immediate postnatal period, in several case studies, authors report positive SARS-CoV-2 test results in symptomatic newborns in the first month of life, and new reports are published frequently.3–7 The mechanism of neonatal infection is unclear. Vertical transmission during pregnancy is not thought to be likely; SARS-CoV-2 test results on placenta, umbilical cord, amniotic fluid, vaginal secretions, and breast milk samples have uniformly been negative.8 More likely is postnatal infection through horizontal transmission. This uncertainty around neonatal infection risk has led to notable variations in care practices for newborns born to mothers with COVID-19. Hospitals, professional organizations, and public health agencies have interpreted the limited available data in the context of their local environments to develop practice recommendations that then are applied to a wide range of clinical and social conditions. Although there is … Address correspondence to Munish Gupta, MD, MMSc, Beth Israel Deaconess Medical Center and Harvard Medical School, Harvard University, 330 Brookline Ave, Rose 339, Boston, MA 02215. E-mail: mgupta{at}bidmc.harvard.edu

Exploring point zero: a study of 20 Chinese cities

ABSTRACT A point zero represents a central geographical location of a city, which is essential for not only measuring distances, but also understanding the historical and/or cultural origin of a city. Although extensive studies have focused on delineating city centers, to our knowledge, no studies have paid attention to determining the location for a point zero. Here, our goal is to investigate various potential approaches for identifying such a location. Specifically, three typical approaches, geometric-based, topological-based, and thematic-based, are proposed to recommend point zeros and different scales, administrative divisions, kernel density surfaces, and regions enclosed by ring roads are used for analysis. The effectiveness of different approaches and scales are evaluated and compared by calculating an offset distance between recommended and actual point zero locations in 20 Chinese cities. Using the different approaches, the average offset distance for most Chinese cities is 2–4 km, and the thematic-based approach performs best. Both the topological-based and thematic-based approaches are less sensitive to the analyzed scale than the geometric-based approach. The results indicate that it is possible to determine the approximate location for a point zero from geographical data. Based on the buffer zone of such a location, an actual point zero may further be recommended.

The Influence of Fasting and Energy Restricting Diets on Blood Pressure in Humans: A Systematic Review and Meta-Analysis.

To the best of our knowledge, no comprehensive meta-analysis has been carried out to investigate the effect of different approaches of fasting and calorie restriction on blood pressure. AIM: Thus, the present systematic review and meta-analysis was designed to examine the effect of fasting and energy restricting diets on blood pressure in adult subjects. We searched PubMed/Medline, Scopus, the Cochrane Library, and Google Scholar up to June 2019. The clinical trials that examined the effects of fasting and energy restricting diets on Blood Pressure was identified using MESH and non-MESH terms. 23 studies, including a total of 1397 participants, reported SBP and DBP as an outcome measure. Overall results from the random-effects model indicated that fasting and energy restricting administration elicited significant changes in SBP (weight mean difference (WMD): - 1.88mmHg, 95% CI - 2.50, - 1.25) and DBP (WMD - 1.32mmHg, 95% CI - 1.81, - 0.84, p = 0.000). Subgroup analyses displayed that intervention duration ≤ 12weeks more effectively reduced SBP (WMD: -3.26mmHg) and DBP (WMD - 1.32mmHg). In addition, these analyses showed that fasting regimens (WMD - 3.26mmHg) more effectively reduced SBP than energy restricting diets (WMD - 1.09mmHg). The principal finding of this study was that fasting and energy restricting diets elicited, overall, significant reductions in SBP and DBP. Subsequent subgroup analyses revealed that intervention duration ≤ 12weeks and fasting regimens more effectively reduced SBP and DBP.

The Effect of Different Approaches to Learning Strategy Instruction on Vocabulary Development by EFL learners

This research falls within the area of teaching English as a foreign language (FL). It focuses on the short-term effects of memory and cognitive strategies on learning vocabulary and sheds light on the approaches adopted by EFL teachers while teaching these strategies. It investigates whether these strategies are taught implicitly, explicitly or both. To conduct this study, two main tools were applied: the first was a questionnaire to evaluate the memory and cognitive strategies used by EFL teachers and intermediate learners; the second was a vocabulary test to investigate the effect of using memory and cognitive strategies on vocabulary learning. These tools were applied to the sample that included 36 intermediate learners who were divided into experimental and control groups and 30 EFL teachers. The data obtained was dealt with descriptively and analytically. The findings show that training students to use memory and cognitive strategies explicitly enhances vocabulary learning more than implicit instruction.

Robot-assisted radical cystectomy with intracorporeal urinary diversion decreases postoperative complications only in highly comorbid patients: findings that rely on a standardized methodology recommended by the European Association of Urology Guidelines

The available studies comparing robot-assisted radical cystectomy (RARC) with intracorporeal (ICUD) vs. extracorporeal (ECUD) urinary diversion have not relied on a standardized methodology to report complications and did not assess the effect of different approaches on postoperative outcomes. Two hundred and sixty seven patients treated with RARC at a single center were assessed. A retrospective analysis of data prospectively collected according to a standardized methodology was performed. Multivariable logistic regression models (MVA) assessed the impact of ICUD vs. ECUD on intraoperative complications, prolonged length of stay (LOS), 30-day Clavien Dindo (CD) ≥ 2 complications and readmission rate. Interaction terms tested the impact of the approach on different patient subgroups. Lowess graphically depicted the probability of CD ≥ 2 after ICUD or ECUD according to patient baseline characteristics. Overall, 162 ICUD vs 105 ECUD (61 vs. 39%) were performed. Intraoperative complications were recorded in 24 patients. The median LOS and readmission rate were 11 vs. 13 (p = 0.02) and 24 vs. 22% (p = 0.7) in ICUD vs. ECUD, respectively. Overall, 227 postoperative complications were recorded. The overall rate of CD ≥ 2 was 35 and 43% in patients with ICUD vs. ECUD, respectively (p = 0.2). At MVA, the approach type was not an independent predictor of any postoperative outcomes (all p ≥ 0.4). Age-adjusted Charlson Comorbidity Index (ACCI) was associated with an increased risk of CD ≥ 2 (OR: 1.2, p = 0.006). We identified a significant interaction term between ACCI and approach type (p = 0.04), where patients with ICUD had lower risk of CD ≥ 2 relative to those with ECUD with increasing ACCI. Relying on a standardized methodology to report complications, we observed that highly comorbid patients who undergo ICUD have lower risk of postoperative complications relative to those patients who received ECUD.

Berberine prevents primary peritoneal adhesion and adhesion reformation by directly inhibiting TIMP-1

Peritoneal adhesions are fibrous tissues that tether organs to one another or to the peritoneal wall and represent the major cause of postsurgical morbidity. Enterolysis at repeat surgeries induces adhesion reformation that is more difficult to prevent than primary adhesion. Here we studied the preventive effects of different approaches of berberine treatment for primary adhesion, and its effects on adhesion reformation compared to Interceed. We found the primary adhesion was remarkably prevented by berberine through intraperitoneal injection 30 min before abrasive surgery (pre-berberine) or direct addition into injured cecum immediately after the surgery (inter-berberine). Rats with adhesion reformation had a more deteriorative collagen accumulation and tissue injury in abrasive sites than rats with primary adhesion. The dysregulated TIMP-1/MMP balance was observed in patients after surgery, as well as adhesion tissues from primary adhesion or adhesion reformation rats. Inter-berberine treatment had a better effect for adhesion reformation prevention than Interceed. Berberine promoted the activation of MMP-3 and MMP-8 by directly blocking TIMP-1 activation core, which was reversed by TIMP-1 overexpression in fibroblasts. In conclusion, this study suggests berberine as a reasonable approach for preventing primary adhesion formation and adhesion reformation.

Vitamin D deficiency in western dwelling South Asian populations: an unrecognised epidemic.

Vitamin D deficiency (25-hydroxyvitamin D; 25(OH)D) is at epidemic proportions in western dwelling South Asian populations, including severe deficiency (<12⋅5 nmol/l) in 27-60% of individuals, depending on season. The paper aimed to review the literature concerning vitamin D concentrations in this population group. Research from the UK and Europe suggests a high prevalence of South Asians with 25(OH)D concentration <25 nmol/l, with most having a 25(OH)D concentration of <50 nmol/l. In Canada, South Asians appear to have a slightly higher 25(OH)D concentration. There are few studies from the United States, South Africa and Australasia. Reasons for vitamin D deficiency include low vitamin D intake, relatively high adiposity, sun exposure avoidance and wearing of a covered dress style for cultural reasons. Possible health effects of deficiency include bone diseases such as rickets and hypocalcaemia in children and osteomalacia in adults. Vitamin D deficiency may also increase the risk of other chronic diseases. Increased fortification of food items relevant to South Asian groups (e.g. chapatti flour), as well as increased use of vitamin D supplements may help reduce this epidemic. Introducing culturally acceptable ways of increasing skin exposure to the sun in South Asian women may also be beneficial but further research is needed to assess the effectiveness of different approaches. There may be a need for a South Asian specific vitamin D dietary intake guideline in western countries. To conclude, vitamin D deficiency is epidemic in South Asians living in western countries and there is a clear need for urgent public health action.

Flow control of non-slender delta wings by leading-edge modifications

Different concepts for controlling a non-slender delta wing are considered and compared with each other. The concepts are based on geometrical modifications of the leading edges. The strategy aims at producing an asymmetric distribution of lift due to vortices on the left and right wing half and thus, for example, rolling moments to be used in controlling the model. The effectiveness of different approaches is determined in low-speed wind tunnel tests both by measuring forces and moments acting on the model and by investigating the flow field around the model by particle image velocimetry and oil-flow visualization of skin friction lines. Two approaches are pursued. One is based on static and dynamic actuators acting at the left leading-edge. The other uses different combinations of leading edge shapes on the two halves of the model. Finally, the effect of asymmetric boundary layer tripping is briefly considered.