Opening the consultation: how is this achieved between patient and physiotherapist?

Patients often give their reason for seeking health assistance in the opening phase of a health consultation. This opening phase normally involves two parts: first, an opening solicitation spoken by the health professional followed by the patient’s reason for the visit. However, how this is accomplished in real-life physiotherapy consultations is not well understood. That is, there has been limited research that has focused on the detailed discursive practices and strategies physiotherapists and patients use to organise problem presentation within real-life consultations. The aim of this presentation is to address this by identifying the discursive practices and strategies that physiotherapists and patients use in the opening phase of an initial consultation

A randomised, double-blind, placebo-controlled clinical trial assessing the efficacy of bedtime buddy® for the treatment of nocturnal enuresis in children

© 2019 The Author(s). Background: Nocturnal enuresis (NE), or 'bedwetting', is a form of night-time urinary incontinence occurring in younger children. A diagnosis of NE can be socially disruptive and psychologically stressful for a child. The most common strategies used by parents to manage NE are waking the child during the night to use the bathroom and limiting the child's water intake before going to bed. Behavioural or educational therapies for NE such as urotherapy or bladder retraining are widely accepted and considered as a mainstream treatment option for non-neurogenic lower urinary tract dysfunction in children. Pharmacotherapy also plays an ancillary role. However, there is no gold standard therapy or intervention to effectively manage NE. Methods: This study aims to determine the efficacy of a herbal combination in the treatment of NE in children. The target population for this study is 80 children aged between 6 and 14 years old (males and females) who have primary nocturnal enuresis ≥3 per week (wet nights). The active group will receive one or two capsules per day containing 420 mg of a proprietary blend of Urox® (Seipel Group, Brisbane, Australia) containing Cratevox™ (Crataeva nurvala L; Capparidaceae; Varuna) stem bark extract standardised for 1.5% lupeol: Non-standardised Equisetum arvense L. (Equisetaceae; Horsetail) stem extract; and, non-standardised Lindera aggregata Sims. The primary outcome for this study is the frequency of nocturia. Secondary outcomes include safety, quality of life, and daytime incontinence. Each participation will be involved in the trial for 32 weeks including contact with the research team every 2 weeks for the first 8 weeks and then every 8 weeks until trial completion. Discussion: This study examines a novel treatment for an under-researched health condition affecting many children. Despite the availability of several therapies for NE, there is insufficient evidence to support the use of any one intervention and as such this randomised placebo-controlled phase II trial will be an important contribution to understanding potential new treatments for this condition. Trial registration: Australian and New Zealand Clinical Trials Registration Number: 12618000288224. Protocol: 23 February 2018, version 1.1

Interactions between carbon and nitrogen dynamics in estimating net primary productivity for potential vegetation in North America

We use the terrestrial ecosystem model (TEM), a process-based model, to investigate how interactions between carbon (C) and nitrogen (N) dynamics affect predictions of net primary productivity (NPP) for potential vegetation in North America. Data on pool sizes and fluxes of C and N from intensively studied field sites are used to calibrate the model for each of 17 non-wetland vegetation types. We use information on climate, soils, and vegetation to make estimates for each of 11,299 non-wetland, 0.5° latitude × 0.5° longitude, grid cells in North America. The potential annual NPP and net N mineralization (NETNMIN) of North America are estimated to be 7.032 × 1015 g C yr−1 and 104.6 × 1012 g N yr−1, respectively. Both NPP and NETNMIN increase along gradients of increasing temperature and moisture in northern and temperate regions of the continent, respectively. Nitrogen limitation of productivity is weak in tropical forests, increasingly stronger in temperate and boreal forests, and very strong in tundra ecosystems. The degree to which productivity is limited by the availability of N also varies within ecosystems. Thus spatial resolution in estimating exchanges of C between the atmosphere and the terrestrial biosphere is improved by modeling the linkage between C and N dynamics. We also perform a factorial experiment with TEM on temperate mixed forest in North America to evaluate the importance of considering interactions between C and N dynamics in the response of NPP to an elevated temperature of 2°C. With the C cycle uncoupled from the N cycle, NPP decreases primarily because of higher plant respiration. However, with the C and N cycles coupled, NPP increases because productivity that is due to increased N availability more than offsets the higher costs of plant respiration. Thus, to investigate how global change will affect biosphere-atmosphere interactions, process-based models need to consider linkages between the C and N cycles

Potential net primary productivity in South America: application of a global model

We use a mechanistically based ecosystem simulation model to describe and analyze the spatial and temporal patterns of terrestrial net primary productivity (NPP) in South America. The Terrestrial Ecosystem Model (TEM) is designed to predict major carbon and nitrogen fluxes and pool sizes in terrestrial ecosystems at continental to global scales. Information from intensively studies field sites is used in combination with continental—scale information on climate, soils, and vegetation to estimate NPP in each of 5888 non—wetland, 0.5° latitude °0.5° longitude grid cells in South America, at monthly time steps. Preliminary analyses are presented for the scenario of natural vegetation throughout the continent, as a prelude to evaluating human impacts on terrestrial NPP. The potential annual NPP of South America is estimated to be 12.5 Pg/yr of carbon (26.3 Pg/yr of organic matter) in a non—wetland area of 17.0 ° 106 km2. More than 50% of this production occurs in the tropical and subtropical evergreen forest region. Six independent model runs, each based on an independently derived set of model parameters, generated mean annual NPP estimates for the tropical evergreen forest region ranging from 900 to 1510 g°m—2°yr—1 of carbon, with an overall mean of 1170 g°m—2°yr—1. Coefficients of variation in estimated annual NPP averaged 20% for any specific location in the evergreen forests, which is probably within the confidence limits of extant NPP measurements. Predicted rates of mean annual NPP in other types of vegetation ranged from 95 g°m—2°yr—1 in arid shrublands to 930 g°m@?yr—1 in savannas, and were within the ranges measured in empirical studies. The spatial distribution of predicted NPP was directly compared with estimates made using the Miami mode of Lieth (1975). Overall, TEM predictions were °10% lower than those of the Miami model, but the two models agreed closely on the spatial patterns of NPP in south America. Unlike previous models, however, TEM estimates NPP monthly, allowing for the evaluation of seasonal phenomena. This is an important step toward integration of ecosystem models with remotely sensed information, global climate models, and atmospheric transport models, all of which are evaluated at comparable spatial and temporal scales. Seasonal patterns of NPP in South America are correlated with moisture availability in most vegetation types, but are strongly influenced by seasonal differences in cloudiness in the tropical evergreen forests. On an annual basis, moisture availability was the factor that was correlated most strongly with annual NPP in South America, but differences were again observed among vegetation types. These results allow for the investigation and analysis of climatic controls over NPP at continental scales, within and among vegetation types, and within years. Further model validation is needed. Nevertheless, the ability to investigate NPP—environment interactions with a high spatial and temporal resolution at continental scales should prove useful if not essential for rigorous analysis of the potential effects of global climate changes on terrestrial ecosystems

The Australian Complementary Medicine Workforce: A Profile of 1,306 Practitioners from the PRACI Study

© Copyright 2018, Mary Ann Liebert, Inc. 2018. Objectives: This study aims to describe the Australian complementary medicine (CM) workforce, including practice and professional characteristics. Design: National cross-sectional survey. Settings/Location: Australia. Subjects: Any individual who self-identified as a practitioner qualified in any one of 14 CM professions and working in any state or territory of Australia was eligible to participate in the survey. Interventions: A 19-item online survey was developed following a review of existing CM workforce data and in alignment with other CM workforce survey projects in progress at the time. The survey items were presented under three main constructs: demographic characteristics, professional characteristics, and practice characteristics. Statistical analysis: Descriptive statistical analysis, including frequencies and percentages, of multiple choice survey items was used. Open response items were analyzed to determine the mean, standard deviation (SD), minimum, and maximum. The demographic data were evaluated for representativeness based on previously reported CM workforce figures. Results: The survey was completed by 1306 CM practitioners and was found to be nationally representative compared with the most recent registrant data from the Chinese Medicine Board of Australia. Participants primarily practiced in the most populous Australian states and worked in at least one urban clinical location. Most participants held an Advanced Diploma qualification or lower, obtained their qualification ten more years ago, and practiced in a clinical environment alongside at least one other practitioner from another health profession. Participants reported diverse clinical practice specialties and occupational roles. Per week, participants worked an average of 3.7 days and treated 23.6 clients. Conclusions: The results from this survey of practitioners from most complementary professions in Australia provide new insights into the national complementary medicine workforce. Further exploration of the CM workforce is warranted to inform all who provide patient care and develop health policy for better patient and public health outcomes

An Overview of the Practitioner Research and Collaboration Initiative (PRACI): A practice-based research network for complementary medicine

© 2017 The Author(s). Background: The Practitioner Research and Collaboration Initiative (PRACI) is an innovative, multi-modality practice-based research network (PBRN) that represents fourteen complementary medicine (CM) professions across Australia. It is the largest known PBRN for complementary healthcare in the world and was launched in 2015. The purpose of this paper is to provide an update on the progress of the PRACI project, including a description of the characteristics of PRACI members in order to facilitate further sub-studies through the PRACI PBRN. Methods: A CM workforce survey was distributed electronically to CM practitioners across fourteen disciplines, throughout Australia. Practitioners electing to become a member of PRACI were registered on the PBRN database. The database was interrogated and the data analysed to described sociodemographic characteristics, practice characteristics, professional qualification and practice interest of PRACI members. Results: Foundational members of PRACI were found to be predominately female (76.2%) and middle-aged (82.5%). Members were primarily located in urban settings (82.5%) across the Eastern seaboard of Australia (82.5%), with few working remotely. The main modalities represented include massage therapists (58.5%), naturopaths (26.4%) and nutritionists (14.4%). The primary area of clinical interest for PRACI members were general health and well-being (75.4%), musculoskeletal complaints (72%) and pain management (62.6%). Conclusions: PRACI provides an important infrastructure for complementary healthcare research in Australia and its success relies on CM practitioners being involved in the research being conducted through the PBRN. The aim of this database is to ensure that the research conducted through PRACI is rigorous, robust, clinically relevant and reflects the diversity of clinical practice amongst CM practitioners in Australia