Management of COVID-19 in the community and the role of primary care: how the pandemic has shone light on a fragmented health system

[Extract] The Australian health care system is well regarded on the global stage in terms of the balance between investment in health care and outcomes delivered, particularly in terms of universal access, quality and safety.1 However, there is considerable fragmentation and poor coordination of care and communication between hospitals and primary care, which limits further improvement.2, 3 Geographical barriers, workforce shortages and issues relating to acceptability of services limit health care access for residents of rural, regional and remote communities, Aboriginal peoples and Torres Strait Islanders, and together with an inadequate focus on prevention, limit progress towards health equity. Australian responses to the coronavirus disease 2019 (COVID-19) pandemic through both public health responses and the acute health sector have been viewed as among the best in the world. Nevertheless, challenges in the structure, organisatIon and financing of the Australian health care system have been brought into stark relief by the evolution of responses to the pandemic

Pre-Big Bang Scenario on Self-T-Dual Bouncing Branes

We consider a new class of 5-dimensional dilatonic actions which are invariant under T-duality transformations along three compact coordinates, provided that an appropriate potential is chosen. We show that the invariance remains when we add a boundary term corresponding to a moving 3-brane, and we study the effects of the T-duality symmetry on the brane cosmological equations. We find that T-duality transformations in the bulk induce scale factor duality on the brane, together with a change of sign of the pressure of the brane cosmological matter. However, in a remarkable analogy with the Pre-Big Bang scenario, the cosmological equations are unchanged. Finally, we propose a model where the dual phases are connected through a scattering of the brane induced by an effective potential. We show how this model can realise a smooth, non-singular transition between a pre-Big Bang superinflationary Universe and a post-Big Bang accelerating Universe.Comment: 18 pages, minor typos corrected, Sec. 2 expanded with more details on the self-T-dual background, Sec.4 and 5 revised accordingly. Version to appear on JCA

Farmer perception of benefits, constraints and opportunities for silvoarable systems: preliminary insights from Bedfordshire, England

Silvoarable agroforestry integrates the use of trees and arable crops on the same area of land, and such systems can be supported by national governments under the European Union’s (EU) Rural Development Regulations (2014–2020). In order to improve the understanding of farmers’ perceptions of such systems, detailed face-to-face interviews were completed with 15 farmers in Bedfordshire, England. Most of these farmers thought that silvoarable systems would not be profitable on their farms and that benefits would tend to be environmental or social rather than economic. Most farmers also thought that management and use of machinery would become more difficult. They felt that the tree component could potentially disrupt field operations and drainage and expressed concerns over the uncertain and long-term nature of timber revenue and the effect of intercrop yield reductions on crop revenue. Even so, 20% of the farmers stated they would use silvoarable systems if convinced that they were more profitable than conventional arable farming. A further 20% said they would farm the intercrop area belonging to someone else, if the rent was reduced to compensate for crop yield reductions. These results suggest that for most arable farmers, an economic advantage over current practice needs to exist before silvoarable systems are likely to be adopted. However, a minority might rent the crop component of a silvoarable system from another party or implement a full system for perceived environmental or social benefits

Coffee Consumption and Cardiovascular Diseases: A Mendelian Randomization Study.

Coffee consumption has been linked to a lower risk of cardiovascular disease in observational studies, but whether the associations are causal is not known. We conducted a Mendelian randomization investigation to assess the potential causal role of coffee consumption in cardiovascular disease. Twelve independent genetic variants were used to proxy coffee consumption. Summary-level data for the relations between the 12 genetic variants and cardiovascular diseases were taken from the UK Biobank with up to 35,979 cases and the FinnGen consortium with up to 17,325 cases. Genetic predisposition to higher coffee consumption was not associated with any of the 15 studied cardiovascular outcomes in univariable MR analysis. The odds ratio per 50% increase in genetically predicted coffee consumption ranged from 0.97 (95% confidence interval (CI), 0.63, 1.50) for intracerebral hemorrhage to 1.26 (95% CI, 1.00, 1.58) for deep vein thrombosis in the UK Biobank and from 0.86 (95% CI, 0.50, 1.49) for subarachnoid hemorrhage to 1.34 (95% CI, 0.81, 2.22) for intracerebral hemorrhage in FinnGen. The null findings remained in multivariable Mendelian randomization analyses adjusted for genetically predicted body mass index and smoking initiation, except for a suggestive positive association for intracerebral hemorrhage (odds ratio 1.91; 95% CI, 1.03, 3.54) in FinnGen. This Mendelian randomization study showed limited evidence that coffee consumption affects the risk of developing cardiovascular disease, suggesting that previous observational studies may have been confounded

Built and natural environment planning principles for promoting health: An umbrella review

© 2018 The Author(s). Background: The built and natural environment and health are inextricably linked. However, there is considerable debate surrounding the strength and quality of the evidence base underpinning principles of good practice for built and natural environment design in promoting health. This umbrella review aimed to assess relationships between the built and natural environment and health, concentrating on five topic areas: neighbourhood design, housing, food environment, natural and sustainable environment, and transport. Methods: A structured search was conducted for quantitative systematic reviews and stakeholder reviews published between January 2005 and April 2016. Seven databases and the websites of 15 relevant and respected stakeholder organisations known to publish review-level documentation were searched. Searches were limited to English-language publications and duplicate references were removed. Evidence quality and strength was appraised using validated techniques. Findings were used to develop a diagram for each topic area, illustrating relationships between built and natural environment planning principles and health-related outcomes. Results: A total of 117 systematic reviews and review-level documents were eligible for inclusion. The quality of evidence was mixed; much of the evidence examined relied on findings from cross-sectional studies, making it difficult to draw clear causal links between built environment exposures and health-related impacts and outcomes. Fourteen actionable planning principles associated with positive health-related outcomes were identified across the five topic areas. For example, neighbourhoods that enhanced walkability, were complete and compact in design, and those which enhanced connectivity through safe and efficient infrastructure were associated with better health-related outcomes relating to physical activity, social engagement, mental health, perceptions of crime, and road traffic collisions. Evidence for the effectiveness of planning principles across different topic areas and on reducing health inequalities was sparse and inconclusive. Conclusions: Findings provide an up-to-date overview of relationships between the built and natural environment and health and present logical, evidence-based messages to aid communication between public health and planning professionals

Smart Knowledge Capture for Developing Adaptive Management Systems

In this paper we describe how a welldesigned Spatial Decision Support System (SDSS) may facilitate initial (immediate) decision making, while establishing a robust foundation and framework for improving effectiveness over time as new data and knowledge becomes available. \u27Smart Knowledge Capture\u27 is a set of methods for rapidly developing a strong SDSS for adaptive management. We review some of the MIS tools used in Smart Knowledge Capture: multicriteria decision analysis (MCDA) tools, online surveys, online knowledge portals, ontology systems, and describe the architecture of an SDSS that stores and utilizes this knowledge. We illustrate these concepts using our recent work supporting the development of a revised desert tortoise recovery plan

Insulin-like growth factor-1 and site-specific cancers: A Mendelian randomization study.

Insulin-like growth factor-1 (IGF-1) is involved in several processes relevant to carcinogenesis. We used 416 single-nucleotide polymorphisms robustly associated with serum IGF-1 levels to assess the potential causal associations between this hormone and site-specific cancers through Mendelian randomization. Summary-level genetic association estimates for prostate, breast, ovarian, and lung cancer were obtained from large-scale consortia including individuals of European-descent. Furthermore, we estimated genetic associations with 14 site-specific cancers in European-descent individuals in UK Biobank. Supplementary analyses were conducted for six site-specific cancers using summary-level data from the BioBank Japan Project. Genetically predicted serum IGF-1 levels were associated with colorectal cancer. The odds ratio (OR) per standard deviation increase of IGF-1 levels was 1.11 (95% confidence interval [CI] 1.01-1.22; P = .03) in UK Biobank and 1.22 (95% CI 1.09-1.36; P = 3.9 × 10-4 ) in the BioBank Japan Project. For prostate cancer, the corresponding OR was 1.10 (95% CI 1.01-1.21; P = .04) in UK Biobank, 1.03 (95% CI 0.97-1.09; P = .41) in the prostate cancer consortium, and 1.08 (95% CI 0.95-1.22; P = .24) in the BioBank Japan Project. For breast cancer, the corresponding OR was 0.99 (95% CI 0.92-1.07; P = .85) in UK Biobank and 1.08 (95% CI 1.02-1.13; P = 4.4 × 10-3 ) in the Breast Cancer Association Consortium. There was no statistically significant association between genetically predicted IGF-1 levels and 14 other cancers. This study found some support for a causal association between elevated serum IGF-1 levels and increased risk of colorectal cancer. There was inconclusive or no evidence of a causal association of IGF-1 levels with prostate, breast, and other cancers