Transgenic cotton research paves the way for a new industry in the Kimberley

The use of transgenic cotton varieties (INGARD®) in conjunction with t_x integrated pest management (IPM) systems in the Kimberley region is producing excellent yield and quality prospects for an emerging cotton industry in Western Australia. Geoff Strickland and Amanda Annells report on the value of transgenic cotton and the additional benefits being gained from the use of multi-faceted IPM systems

Developing a web-based information resource for palliative care: an action-research inspired approach

Background : General Practitioners and community nurses rely on easily accessible, evidence-based online information to guide practice. To date, the methods that underpin the scoping of user-identified online information needs in palliative care have remained under-explored. This paper describes the benefits and challenges of a collaborative approach involving users and experts that informed the first stage of the development of a palliative care website.Method : The action research-inspired methodology included a panel assessment of an existing palliative care website based in Victoria, Australia; a pre-development survey (n = 197) scoping potential audiences and palliative care information needs; working parties conducting a needs analysis about necessary information content for a redeveloped website targeting health professionals and caregivers/patients; an iterative evaluation process involving users and experts; as well as a final evaluation survey (n = 166).Results : Involving users in the identification of content and links for a palliative care website is time-consuming and requires initial resources, strong networking skills and commitment. However, user participation provided crucial information that led to the widened the scope of the website audience and guided the development and testing of the website. The needs analysis underpinning the project suggests that palliative care peak bodies need to address three distinct audiences (clinicians, allied health professionals as well as patients and their caregivers).Conclusion : Web developers should pay close attention to the content, language, and accessibility needs of these groups. Given the substantial cost associated with the maintenance of authoritative health information sites, the paper proposes a more collaborative development in which users can be engaged in the definition of content to ensure relevance and responsiveness, and to eliminate unnecessary detail. Access to volunteer networks forms an integral part of such an approach.<br /

An exploration of tutors’ experiences of facilitating problem-based learning. Part 2: Implications for the facilitation of problem-based learning

YesThis paper is the second of two parts exploring a study that was undertaken to investigate the role of the tutor in facilitating problem-based learning (PBL). The first part focussed on the methodological underpinnings of the study. This paper aims to focus on the findings of the study and their implications for the facilitation of PBL. Six essential themes emerged from the findings that described the facilitation role. The tutors believed that their facilitation role was essentially structured around the decision of when to intervene and how to intervene in the PBL process. Modelling and non-verbal communication were seen as essential strategies for the facilitator. Underpinning these decisions was the need to trust in the philosophy of PBL. However, within many of the themes, there was a divergence of opinion as to how the role should actually be undertaken. Despite this, these findings have implications for the future role of PBL facilitators in Health Professional Education

Protocol for a pilot randomised controlled clinical trial to compare the effectiveness of a graduated three layer straight tubular bandaging system when compared to a standard short stretch compression bandaging system in the management of people with venous ulceration: 3VSS2008

<p>Abstract</p> <p>Background</p> <p>The incidence of venous ulceration is rising with the increasing age of the general population. Venous ulceration represents the most prevalent form of difficult to heal wounds and these problematic wounds require a significant amount of health care resources for treatment. Based on current knowledge multi-layer high compression system is described as the gold standard for treating venous ulcers. However, to date, despite our advances in venous ulcer therapy, no convincing low cost compression therapy studies have been conducted and there are no clear differences in the effectiveness of different types of high compression.</p> <p>Methods/Design</p> <p>The trial is designed as a pilot multicentre open label parallel group randomised trial. Male and female participants aged greater than 18 years with a venous ulcer confirmed by clinical assessment will be randomised to either the intervention compression bandage which consists of graduated lengths of 3 layers of elastic tubular compression bandage or to the short stretch inelastic compression bandage (control). The primary objective is to assess the percentage wound reduction from baseline compared to week 12 following randomisation. Randomisation will be allocated via a web based central independent randomisation service (nQuery v7) and stratified by study centre and wound size ≤ 10 cm²or >10 cm². Neither participants nor study staff will be blinded to treatment. Outcome assessments will be undertaken by an assessor who is blinded to the randomisation process.</p> <p>Discussion</p> <p>The aim of this study is to evaluate the efficacy and safety of two compression bandages; graduated three layer straight tubular bandaging (3L) when compared to standard short stretch (SS) compression bandaging in healing venous ulcers in patients with chronic venous ulceration. The trial investigates the differences in clinical outcomes of two currently accepted ways of treating people with venous ulcers. This study will help answer the question whether the 3L compression system or the SS compression system is associated with better outcomes.</p> <p>Trial Registration</p> <p>ACTRN12608000599370</p

Patients’ and kidney care team’s perspectives of treatment burden and capacity in older people with chronic kidney disease: a qualitative study

Objective: Chronic kidney disease (CKD) is often a multimorbid condition and progression to more severe disease is commonly associated with increased management requirements, including lifestyle change, more medication, and greater clinician involvement. This study explored patients’ and kidney care team’s perspectives of the nature and extent of this workload (treatment burden) and factors that support capacity (the ability to manage health) for older individuals with CKD. Design: Qualitative semi-structured interview and focus group study Setting and Participants: Adults (aged 60+) with pre-dialysis CKD stages G3-5 (identified in two general practitioner surgeries and two renal clinics) and a multi-professional secondary kidney care team in the United Kingdom.Results: 29 individuals and 10 kidney team members were recruited. Treatment burden themes were: (a) understanding CKD, its treatment and consequences, (b) adhering to treatments and management, and (c) interacting with others (e.g.: clinicians) in the management of CKD. Capacity themes were: (a) personal attributes (e.g. optimism, pragmatism), (b) support network (family/friends, service providers), (c) financial capacity, environment (e.g.: geographical distance to unit) and life responsibilities (e.g.: caring for others). Patients reported poor provision of CKD information and lack of choice in treatment, whereas kidney care team members discussed health literacy issues. Patients reported having to withdraw from social activities and loss of employment due to CKD, which further impacted their capacity. Conclusion: Improved understanding of and measures to reduce the treatment burden (e.g. clear information, simplified medication, joined up care, free parking) associated with CKD in individuals as well as assessment of their capacity and interventions to improve capacity (social care, psychological support) will likely improve patient experience and their engagement with kidney care services

Systematic care for caregivers of people with dementia in the ambulatory mental health service: designing a multicentre, cluster, randomized, controlled trial

Contains fulltext : 81435.pdf (publisher's version ) (Open Access)BACKGROUND: Care for people with dementia and their informal caregivers is a challenging aim in healthcare. There is an urgent need for cost-effective support programs that prevent informal caregivers of people with dementia from becoming overburdened, which might result in a delay or decrease of patient institutionalization. For this reason, we have developed the Systematic Care Program for Dementia (SCPD). The SCPD consists of an assessment of caregiver's sense of competence and suggestions on how to deal with competence deficiencies. The efficiency of the SCPD will be evaluated in our study. METHODS AND DESIGN: In our ongoing, cluster, randomized, single-blind, controlled trial, the participants in six mental health services in four regions of the Netherlands have been randomized per service. Professionals of the ambulatory mental health services (psychologists and social psychiatric nurses) have been randomly allocated to either the intervention group or the control group. The study population consists of community-dwelling people with dementia and their informal caregivers (patient-caregiver dyads) coming into the health service. The dyads have been clustered to the professionals. The primary outcome measure is the patient's admission to a nursing home or home for the elderly at 12 months of follow-up. This measure is the most important variable for estimating cost differences between the intervention group and the control group. The secondary outcome measure is the quality of the patient's and caregiver's lives. DISCUSSION: A novelty in the SCPD is the pro-active and systematic approach. The focus on the caregiver's sense of competence is relevant to economical healthcare, since this sense of competence is an important determinant of delay of institutionalization of people with dementia. The SCPD might be able to facilitate this with a relatively small cost investment for caregivers' support, which could result in a major decrease in costs in the management of dementia. Implementation on a national level will be started if the SCPD proves to be efficient. TRIAL REGISTRATION: NCT00147693

Geological evolution of the Neoproterozoic Bemarivo Belt, northern Madagascar

The broadly east-west trending, Late Neoproterozoic Bemarivo Belt in northern Madagascar has been re-surveyed at 1: 100 000 scale as part of a large multi-disciplinary World Bank-sponsored project. The work included acquisition of fourteen U-Pb zircon dates and whole-rock major and trace element geochemical data of representative rocks. The belt has previously been modelled as a juvenile Neoproterozoic arc and our findings broadly support that model. The integrated datasets indicate that the Bemarivo Belt is separated by a major ductile shear zone into northern and southern “terranes”, each with different lithostratigraphy and ages. However, both formed as Neoproterozoic arc/marginal basin assemblages that were translated southwards over the north-south trending domains of “cratonic” Madagascar, during the main collisional phase of the East African Orogeny at ca. 540 Ma. The older, southern terrane consists of a sequence of high-grade paragneisses (Sahantaha Group), which were derived from a Palaeoproterozoic source and formed a marginal sequence to the Archaean cratons to the south. These rocks are intruded by an extensive suite of arc-generated metamorphosed plutonic rocks, known as the Antsirabe Nord Suite. Four samples from this suite yielded U-Pb SHRIMP ages at ca. 750 Ma. The northern terrane consists of three groups of metamorphosed supracrustal rocks, including a possible Archaean sequence (Betsiaka Group: maximum depositional age approximately 2477 Ma) and two volcano-sedimentary sequences (high grade Milanoa Group: maximum depositional age approximately 750 Ma; low grade Daraina Group: extrusive age = 720 to 740 Ma). These supracrustal rocks are intruded by another suite of arc-generated metamorphosed plutonic rocks, known as the Manambato Suite, 4 samples of which gave U-Pb SHRIMP ages between 705 to 718 Ma. Whole-rock geochemical data confirm the calc-alkaline, arc-related nature of the plutonic rocks. The volcanic rocks of the Daraina and Milanoa groups also show characteristics of arc-related magmatism, but include both calc-alkaline and tholeiitic compositions. It is not certain when the two Bemarivo terranes were juxtaposed, but ages from metamorphic rims on zircon suggest that both the northern and southern terranes were accreted to the northern cratonic margin of Madagascar at about 540 to 530 Ma. Terrane accretion included the assembly of the Archaean Antongil and Antananarivo cratons and the high-grade Neoproterozoic Anaboriana Belt. Late- to post tectonic granitoids of the Maevarano Suite, the youngest plutons of which gave ca. 520 Ma ages, intrude all terranes in northern Madagascar showing that terrane accretion was completed by this time