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991.
Helen R. Sofaer Phillip L. Chapman T. Scott Sillett Cameron K. Ghalambor 《Journal of avian biology》2013,44(5):469-478
Our understanding of avian growth rates can benefit from the use of two statistical approaches that explicitly model the sources of intraspecific variation. First, random effects can evaluate whether there are consistent differences between individuals and groups of siblings within a population, and also account for any lack of statistical independence among data points. Second, nonlinear fixed‐effect functions can be extended to test specific biological hypotheses of interest, such as for differences between groups or populations. We illustrate the advantages of these methods by using nonlinear mixed models to study variation in the growth trajectories of nestling orange‐crowned warblers Oreothylpis celata. Specifically, we quantify the sources of variation within populations, analyze the effects of asynchronous hatching, and test for a difference in the growth rates of populations in Alaska and California, which are at the northern and southern limits of the species’ breeding distribution. We found that growth rates did not consistently vary between nests and individuals within populations and were not affected by asynchronous hatching, but were higher in Alaska than in California. Our extensions of traditional methods allowed us to accurately quantify this difference between populations, which is consistent with life history theory but has rarely been demonstrated in previous comparisons of intraspecific passerine populations. The methods we present can be applied to any taxonomic group and adjusted to fit any nonlinear function, and we provide code and implementation advice to facilitate the use of this analytical framework in future studies. 相似文献
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Noah M Ivers Jacqueline Young Jill J Francis Jan Barnsley Baiju R Shah Ross E Upshur Jeremy M Grimshaw Merrick Zwarenstein 《Implementation science : IS》2013,8(1):142
Background
Audit and feedback to physicians is a commonly used quality improvement strategy, but its optimal design is unknown. This trial tested the effects of a theory-informed worksheet to facilitate goal setting and action planning, appended to feedback reports on chronic disease management, compared to feedback reports provided without these worksheets.Methods
A two-arm pragmatic cluster randomized trial was conducted, with allocation at the level of primary care clinics. Participants were family physicians who contributed data from their electronic medical records. The ‘usual feedback’ arm received feedback every six months for two years regarding the proportion of their patients meeting quality targets for diabetes and/or ischemic heart disease. The intervention arm received these same reports plus a worksheet designed to facilitate goal setting and action plan development in response to the feedback reports. Blood pressure (BP) and low-density lipoprotein cholesterol (LDL) values were compared after two years as the primary outcomes. Process outcomes measured the proportion of guideline-recommended actions (e.g., testing and prescribing) conducted within the appropriate timeframe. Intention-to-treat analysis was performed.Results
Outcomes were similar across groups at baseline. Final analysis included 20 physicians from seven clinics and 1,832 patients in the intervention arm (15% loss to follow up) and 29 physicians from seven clinics and 2,223 patients in the usual feedback arm (10% loss to follow up). Ten of 20 physicians completed the worksheet at least once during the study. Mean BP was 128/72 in the feedback plus worksheet arm and 128/73 in the feedback alone arm, while LDL was 2.1 and 2.0, respectively. Thus, no significant differences were observed across groups in the primary outcomes, but mean haemoglobin A1c was lower in the feedback plus worksheet arm (7.2% versus 7.4%, p<0.001). Improvements in both arms were noted over time for one-half of the process outcomes.Discussion
Appending a theory-informed goal setting and action planning worksheet to an externally produced audit and feedback intervention did not lead to improvements in patient outcomes. The results may be explained in part by passive dissemination of the worksheet leading to inadequate engagement with the intervention.Trial registration
ClinicalTrials.gov NCT00996645999.
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