The reproductive biology and habit at requirements of aloe peglerae, a montane endemic aloe of the Magaliesberg mountain range, South Africa.

In this study I investigated the reproductive biology and pollination ecology of Aloe peglerae, an endangered endemic succulent species of the Magaliesberg Mountain Range in South Africa. The aim was to determine the pollination system of A. peglerae, the effects of flowering plant density on plant reproduction and the suitable microhabitat conditions for this species. Aloe peglerae possesses floral traits that typically conform to the bird-pollination syndrome. Pollinator exclusion experiments showed that reproduction is enhanced by opportunistic avian nectar-feeders, mainly the Cape Rock-Thrush (Monticola rupestris) and the Dark-capped Bulbul (Pycnonotus tricolor). Insect pollinators did not contribute significantly to reproductive output. Small-mammals were observed visiting flowers at night, however, the importance of these visitors as pollinators was not quantified in this study. Interannual variation in flowering patterns dictated annual flowering plant densities in the population. The first flowering season represented a typical mass flowering event resulting in high seed production, followed by a second low flowering year of low seed production. Reproductive success was significantly related to flowering plant densities at a spatial scale of 30.0-35.0m in 2011, corresponding to the scale at which flowering plant density influenced diurnal (bird) visitation rates (25.0-40.0m). In the second flowering season, neither plant reproduction nor diurnal visitation rates were related to flowering plant densities. Nocturnal (small-mammal) visitation rates were not related to flowering plant densities in both years and this is perceived to be a reflection of the smaller home/forage range of small-mammals. However, further investigation is required to confirm the hypothesis that small-mammal visitations contribute to reproductive success in A. peglerae. Aloe occupancy was generally associated with “safe site” microhabitat conditions (i.e. high rock cover, low grass cover and biomass). This is expected to be a fire-survival strategy of A. peglerae, where the persistence of individual plants in less vulnerable microsites over time is favoured. However, plant morphology might also confer adaptations, such as vegetative recovery at the apical meristem, to tolerate the harsh effects of fire

Expanding grasslands? Structural biome shifts in the dryland rangelands of the eastern Karoo revealed through long-term observation of climate, vegetation and land use change

Biome shifts caused by climate and land use change threaten global dryland ecosystems and the provision of services needed to sustain human livelihoods. The overarching drivers of early 20th century dryland degradation in South Africa have been attributed to high stocking rates and overgrazing by domestic livestock. Predictions of an eastward encroachment of shrublands into the semiarid grasslands, and resultant declines in productivity, emerged in the 1950s based on concerns that livestock overgrazing would persist. In response to these concerns, appropriate research and government interventions were implemented to address rangeland and livestock mismanagement. However, the role of long-term climate as a driver of semiarid vegetation change was poorly understood, particularly for changes occurring at the interface of the NamaKaroo and Grassland biomes where shrubland encroachment could be detected along a gradient of increasing annual rainfall. It is this gradient that controls the natural biome transition from shrub-dominance to grass-dominance. However, the prediction of shrubland encroachment was refuted when research in the early 1990s revealed that the vegetation of this region (known as the ‘eastern Karoo') had undergone an increase in grass cover; a trend that persisted into the early 2000s. Questions around the influence of changing rainfall patterns on driving this increase in grassiness have since been investigated at a single location in the eastern Karoo. Findings indicated that an increase in annual rainfall drove the increase in grass cover, but the generality of this relationship across the broader rainfall gradient of the biome transition has not been examined. In addition to rainfall, grazing by domestic livestock has had a significant influence on the relative proportion of grasses and shrubs in the eastern Karoo. While other studies have alluded to changes in land use, few data have been presented and the relative influence of land use change has usually been under-estimated. The availability of historical data from past vegetation surveys, climate station records and magisterial district livestock censuses makes it possible to develop a more comprehensive synthesis of how vegetation has changed across the rainfall gradient in order to address questions around biome shifts. This thesis, therefore, aimed to determine whether a biome shift is related to a broader shift in the climate regime through the assessment of long-term vegetation change along the rainfall gradient, in relation to climate and land use change since the early 20th century. Annual and seasonal trend analysis was applied to monthly rainfall, temperature, pan evaporation, evapotranspiration and wind speed data. Trends indicated that 32% of sites in the eastern Karoo showed an increase in annual rainfall between 1874 and 2019, which was also defined by a significant shift to increasing early summer rainfall. A concomitant trend of decreasing annual, and late summer rainfall, was detected at 32% of sites located on the mesic end of the rainfall gradient. Monthly maximum temperature between 1971 and 2019 also increased by 1.0 °C at a rate of 0.04 ± 0.06 °Cy-1 and monthly minimum temperature decreased by 0.3 °C at a rate of -0.03 ± 0.11 °Cy-1 . Wind speed, an important driver of evaporative processes, decreased at 44% of sites since 1971 and decreasing trends in A-Pan evaporation were found at all sites. No discernible trends in evapotranspiration were detected. Declines in wind speed and evaporation were suggested to promote an increase in vegetation cover which may restore ecosystem processes and improve rangeland productivity. An analysis of multidecadal wet-dry phases in the climate record was also undertaken using the Standardised Precipitation Index. Through this, it was observed that the rainfall regime over the eastern Karoo is defined by three significant phases over the last century: an early wet phase (1886- 1902), a 70-year long dry phase (1902-1970), followed by the recent wet phase (1970-2014) that commenced with heavy rains in the mid-1970s across the summer rainfall region of southern Africa. Long-term changes in the cover and composition of plant species and growth forms were compared between 1962 and 2018 at 27 sites using the point intercept method. Changes in species composition were determined from Bray-Curtis similarity distances. The dominant growth forms were organised along a rainfall-edaphic gradient and plant communities were further defined by altitude. Hierarchical clustering of species cover per site recognised this underlying gradient. Thus, sites were categorised into three vegetation units: ‘Karoo', ‘Escarpment' and ‘Grassland'. Results showed that vegetation cover increased, and bare ground cover decreased, significantly at all but one site. Perennial grasses increased by 20%, 24% and 35% at Karoo, Escarpment and Grassland sites, respectively. Palatable dwarf shrubs increased by 15% at Karoo sites. These growth form changes translated to a broader-scale shift in the relative dominance of dwarf shrubs to grasses at 59% of sites in the Nama-Karoo biome, coinciding with the spatial pattern of increasing early summer rainfall and temperature. However, a multivariate analysis provided minimal evidence of species shifts between vegetation units or biomes, suggesting that compositional stability was maintained across the rainfall gradient. Percent changes in the cover of grasses and dwarf shrubs were analysed in relation to the climatic and edaphic parameters using multiple regression analysis, but no significant linear relationships were found. However, summer rainfall and temperature combined explained 26% of the variation in the percent change in grass cover. The effect of these changes on rangeland grazing capacity (ha/Large Stock Unit) was also evaluated using the ecological index method of the assessment of veld condition. There was a fivefold improvement in grazing capacity at Karoo sites and a twofold improvement at Escarpment and Grassland sites. Changes in the cover of grasses, dwarf shrubs and trees were additionally determined through fixed-point repeat photography at 85 sites on two different landforms, plains and hillslopes. A shift towards grass dominance relative to dwarf shrubs was estimated at 90% of sites located on the plains and at 100% of sites located on the hillslopes in the NamaKaroo. Variable trends were found at Grassland sites in both landforms. Tree cover remained unchanged in both biomes. Agricultural livestock census data at the magisterial district-level showed a fivefold decrease in sheep numbers between 1911 and 2017 while the number of cattle and equine animals remained largely unchanged. Goat numbers fluctuated over time in response to the demands for Angora mohair. Supporting perceptions of significant reductions in livestock numbers since the 1960s were conveyed by 18 local landowners as derived from semi-structured interviews. The introduction of conservation-friendly grazing systems, seasonal rainfall shifts, and increased drought frequency were also perceived as important drivers of vegetation change. However, a number of socio-ecological challenges, for example, livestock losses to theft, vermin, or fire, emerged as having significantly influenced management decisions. Therefore, the persistent structural shift in growth forms across the rainfall gradient since the 1960s has largely coincided with significant climatic shifts in rainfall and temperature. A secondary influence of long-term reductions in livestock numbers, and a change to conservation-friendly management practices, is suggested to have supported the recovery of vegetation, especially that of perennial grasses, and rangeland productivity

Addressing the needs of clinical teachers: action research

It is important to recognise the barriers that face teachers and provide solutions Selected participants were invited to be part of one of two focus groups If clinical teachers\u27 concerns can be addressed, learners\u27 experiences may improve Positive comments included clinical teachers liking the teaching they were asked to do Improved communication between the school and clinicians was frequently raised as an issue The participants have ownership of the solutions which provided value to their contributio

Approaches to derive dietary variables in exploring diet-health relationship: a methodological review

What dietary variables can be derived from dietary assessment data to explore the diet-health relationship

Health system costs of falls of older adults in Western Australia

The aim of this study was to determine the health system costs associated with falls in older adults who had attended an emergency department (ED) in Western Australia. The data relating to the ED presentations and hospital admissions were obtained from population-based hospital administrative records for 2001-2002. The type of other health services (eg, outpatient, medical, community, ancillary and residential care), the quantity, and their cost were estimated from the literature. In adults aged 65 years and above, there were18 706 ED presentations and 6222 hospital admissions for fall-related injuries. The estimated cost of falls to the health system was $86.4 million, with more than half of this attributable to hospital inpatient treatment. Assuming the current rate of falls remains constant for each age group and gender, the projected health system costs of falls in older adults will increase to$181 million in 2021 (expressed in 2001-02 Australian dollars). The economic burden to the health services imposed by falls in older adults is substantial, and a long-term strategic approach to falls prevention needs to be adopted. Policy in this area should be targeted at both reducing the current rate of falls through preventing injury in people from high-risk groups and reducing the future rate of falls through reducing population risk

Adapting to Teaching During a Pandemic: Pedagogical Adjustments for the Next Semester of Teaching During COVID-19 and Future Online Learning

COVID-19 has altered public health higher education and its impact on pedagogy will be felt long into the future. In response to social distancing measures, teaching academics implemented a number of changes to curricula. It is important to better understand and begin to evaluate these changes, as well as set a course for future changes to public health curricula both during and after the pandemic to best enable transformative learning. Teaching academics have an understanding of academic hierarchies and student perceptions and are well placed to provide insights into current and future changes to pedagogy in response to the pandemic. A survey was developed to examine changes that academics had made to their teaching in response to COVID-19. Responses were received from 63 public health teaching academics from five universities in Australia, the United States, and Canada. Public health teaching academics rapidly implemented a number of changes to their teaching, including alterations that enabled online teaching. The great majority of changes to teaching were related to tools or techniques, such as synchronous tutorials delivered in a video meeting room. There remains further work for the public health pedagogy community in reevaluating teaching aims and teaching philosophies in light of the COVID-19 pandemic. This could include examination of the weighting of different topics, including communicable diseases, in curricula. A series of questions to assist academics reformulating their curricula is provided. Public health teaching evolved rapidly to meet the challenges of COVID-19; however, ongoing adaptation is necessary to further enhance pedagogy

Evaluation of prescription medication changes following sleeve gastrectomy surgery

Abstract Objective The increasing global prevalence of obesity, coupled with its association with chronic health conditions and rising healthcare costs, highlights the need for effective interventions; however, despite the availability of treatment options, the ongoing success of primary interventions in maintaining long‐term weight loss remains limited. This study examined the prescription medication dispensing changes following sleeve gastrectomy in Australians aged 45 years and over. Methods In a retrospective analysis of 847 bariatric surgery patients from the New South Wales 45 and Up Study, the assessment of medication patterns categorizing into three groups: gastrointestinal, metabolic, cardiorespiratory, musculoskeletal, and nervous systems was conducted. Each drug class was analyzed, focusing on patients with dispensing records within the 12 months before surgery. This study employed interrupted time‐series analysis to compare pre‐ and post‐surgery medication usage. Results With a predominantly female population (76.9%) and an average age of 57.2 (standard deviation 5.71), there were statistically significant reductions in both unique medications (12.5% decrease, p = 0.004) and total medications dispensed (15.9% decrease, p = 0.003) from 12 months before surgery to 13–24 months after bariatric surgery. All medication categories, except opioids, showed reductions. Notably, the most significant reductions were observed in diabetes (38.6%), agents acting on the renin‐angiotensin system (40.4%), lipid modifying agents (26.5%), anti‐inflammatory products (46.3%), and obstructive airway diseases (53.3%) medications during this time frame. Conclusion These findings suggest that sleeve gastrectomy provides an effective therapeutic intervention for patients with comorbidities requiring multiple medications, especially for obesity‐related diseases such as diabetes, cardiovascular, respiratory and musculoskeletal disorders

Adapting to Teaching During a Pandemic: Pedagogical Adjustments for the Next Semester of Teaching During COVID-19 and Future Online Learning

COVID-19 has altered public health higher education and its impact on pedagogy will be felt long into the future. In response to social distancing measures, teaching academics implemented a number of changes to curricula. It is important to better understand and begin to evaluate these changes, as well as set a course for future changes to public health curricula both during and after the pandemic to best enable transformative learning. Teaching academics have an understanding of academic hierarchies and student perceptions and are well placed to provide insights into current and future changes to pedagogy in response to the pandemic. A survey was developed to examine changes that academics had made to their teaching in response to COVID-19. Responses were received from 63 public health teaching academics from five universities in Australia, the United States, and Canada. Public health teaching academics rapidly implemented a number of changes to their teaching, including alterations that enabled online teaching. The great majority of changes to teaching were related to tools or techniques, such as synchronous tutorials delivered in a video meeting room. There remains further work for the public health pedagogy community in reevaluating teaching aims and teaching philosophies in light of the COVID-19 pandemic. This could include examination of the weighting of different topics, including communicable diseases, in curricula. A series of questions to assist academics reformulating their curricula is provided. Public health teaching evolved rapidly to meet the challenges of COVID-19; however, ongoing adaptation is necessary to further enhance pedagogy

Opening the Black Box of an mHealth Patient-Reported Outcome Tool for Diabetes Self-Management: Interview Study Among Patients With Type 2 Diabetes

BackgroundMobile health (mHealth) tools are used to collect data on patient-reported outcomes (PROs) and facilitate the assessment of patients’ self-management behaviors outside the clinic environment. Despite the high availability of mHealth diabetes tools, there is a lack of understanding regarding the underlying reasons why these mHealth PRO tools succeed or fail in terms of changing patients’ self-management behaviors. ObjectiveThis study aims to identify the factors that drive engagement with an mHealth PRO tool and facilitate patients’ adoption of self-management behaviors, as well as elicit suggestions for improvement. MethodsThis qualitative study was conducted within the context of a randomized controlled trial designed to evaluate the efficacy of an mHealth PRO tool (known as i-Matter) versus usual care regarding reduction in glycated hemoglobin (HbA1c) levels and adherence to self-management behaviors at 12 months among patients with uncontrolled type 2 diabetes. Patients randomized to i-Matter participated in semistructured interviews about their experiences at the 3-, 6-, 9-, and 12-month study visits. A qualitative analysis of the interviews was conducted by 2 experienced qualitative researchers using conventional qualitative content analysis. ResultsThe sample comprised 71 patients, of whom 67 (94%) completed at least one interview (n=48, 72% female patients; n=25, 37% identified as African American or Black; mean age 56.65 [SD 9.79] years). We identified 4 overarching themes and 6 subthemes. Theme 1 showed that the patients’ reasons for engagement with i-Matter were multifactorial. Patients were driven by internal motivating factors that bolstered their engagement and helped them feel accountable for their diabetes (subtheme 1) and external motivating factors that helped to serve as reminders to be consistent with their self-management behaviors (subtheme 2). Theme 2 revealed that the use of i-Matter changed patients’ attitudes toward their disease and their health behaviors in 2 ways: patients developed more positive attitudes about their condition and their ability to effectively self-manage it (subtheme 3), and they also developed a better awareness of their current behaviors, which motivated them to adopt healthier lifestyle behaviors (subtheme 4). Theme 3 showed that patients felt more committed to their health as a result of using i-Matter. Theme 4 highlighted the limitations of i-Matter, which included its technical design (subtheme 5) and the need for more resources to support the PRO data collected and shared through the tool (subtheme 6). ConclusionsThis study isolated internal and external factors that prompted patients to change their views about their diabetes, become more engaged with the intervention and their health, and adopt healthy behaviors. These behavioral mechanisms provide important insights to drive future development of mHealth interventions that could lead to sustained behavior change