Use of a patient-centred educational exchange (PCEE) to improve patient's self-management of medicines after a stroke: a randomised controlled trial study protocol

Introduction: National and international guidelines make recommendations for secondary prevention of stroke including the use of medications. A strategy which engages patients in a conversation to personalise evidence-based educational material (patient-centred educational exchange; PCEE) may empower patients to better manage their medications. Methods and analysis: This protocol outlines a non-blinded randomised controlled trial. Consenting patients admitted with a diagnosis of stroke or transient ischaemic attack will be randomised 1:1 to receive either a PCEE composed of two sessions, one at the bedside before discharge and one by telephone at least 10 days after discharge from hospital in addition to usual care (intervention) or usual care alone (control). The primary aim of this study is to determine whether a PCEE improves adherence to antithrombotic, antihypertensive and lipid-lowering medications prescribed for secondary prevention of stroke over the 3 months after discharge, measured using prescription-refill data. Secondary aims include investigation of the impact of the PCEE on adherence over 12 months using prescription-refill data, self-reported medication taking behaviour, self-reported clinical outcomes (blood pressure, cholesterol, adverse medication events and readmission), quality of life, the cost utility of the intervention and changes in beliefs towards medicines and illness. Ethics and dissemination: Communication of the trial results will provide evidence to aid clinicians in conversations with patients about medication taking behaviour related to stroke prevention. The targeted audiences will be health practitioners and consumers interested in medication taking behaviour in chronic diseases and in particular those interested in secondary prevention of stroke. The trial has ethics approval from Metro South Human Research Ethics Committee (HREC/15/QPAH/531) and The University of Queensland Institutional Human Research Ethics (2015001612). Trial registration number: ACTRN12615000888561; Pre-results

Greening the Grey: A Framework for Integrated Green Grey Infrastructure (IGGI)

This report presents innovations from academia and practice designed to green grey infrastructure assets such as bridges, street furniture and coastal engineering structures that need to remain primarily grey for their essential function. We call this integrated green grey infrastructure (IGGI). We collated material on these innovations and assessed them using a critical success factors (CSF) framework that we –co-developed with a team of practitioners in government agencies and companies to help better evaluate the potential benefits and limitations of using IGGI measures compared to traditional grey engineering solutions. The CSF framework is outlined and demonstrated by assessing the engineering performance and ecosystem services benefits of ecological enhancements used in specific operational scale case studies. The case studies presented in this report show that simple, inexpensive ecological enhancement and green engineering solutions can deliver more multifunctional benefits than business as usual solutions for similar or reduced costs. These ecological enhancements and green engineering options have been compiled and assessed for historic conservation areas, urban areas, estuaries and at the coast. This report is intended to support asset managers, engineers, conservation and biodiversity teams, decision-makers, and other end-users to help them better identify IGGI options and evaluate these against business as usual grey engineering approaches

Genome-wide Association Study Identifies New Loci for Resistance to Leptosphaeria maculans in Canola

Blackleg, caused by Leptosphaeria maculans, is a significant disease which affects the sustainable production of canola. This study reports a genome-wide association study based on 18,804 polymorphic SNPs to identify loci associated with qualitative and quantitative resistance to L. maculans. Genomic regions delimited with 503 significant SNP markers, that are associated with resistance evaluated using 12 single spore isolates and pathotypes from four canola stubble were identified. Several significant associations were detected at known disease resistance loci including in the vicinity of recently cloned Rlm2/LepR3 genes, and at new loci on chromosomes A01/C01, A02/C02, A03/C03, A05/C05, A06, A08, and A09. In addition, we validated statistically significant associations on A01, A07 and A10 in four genetic mapping populations, demonstrating that GWAS marker loci are indeed associated with resistance to L. maculans. One of the novel loci identified for the first time, Rlm12, conveys adult plant resistance and mapped within 13.2 kb from Arabidopsis R gene of TIR-NBS class. We showed that resistance loci are located in the vicinity of R genes of A. thaliana and B. napus on the sequenced genome of B. napus cv. Darmor-bzh. Significantly associated SNP markers provide a valuable tool to enrich germplasm for favorable alleles in order to improve the level of resistance to L. maculans in canola

Inclusive growth? The relationship between economic growth and poverty in British cities

There is growing concern in many developed economies that the benefits of economic growth are not shared equitably. This is particularly the case in the UK, where economic growth has been geographically uneven and often biased towards already affluent cities. Yet there is relatively little evidence on the relationship between growth and poverty in the UK. This paper addresses this gap with an analysis of the links between economic growth and poverty in British cities between 2000 – 2008. We find little evidence that output growth reduced poverty. While growth was associated with wage increases at the top of the distribution, it was not associated with wage growth below the median. And there was no relationship between economic growth and the low skilled employment rate. These results suggest that growth in this period was far from inclusive

The geography of wage inequality in British cities

There is widespread concern about the scale and implications of urban inequality in Great Britain, but little evidence on which cities are the most unequal and why. This paper investigates patterns of wage inequality in 60 British cities. It has two principal goals: (1) to describe which cities are most unequal and (2) to assess the important determinants of inequality. The results show a distinct geography of wage inequality, the most unequal cities tend to be affluent and located in parts of the Greater South East of England. A central determinant of these patterns is the geography of highly skilled workers. Because of this, the geography of urban wage inequality reflects the geography of affluence more generally