Nomenclatural notes on New South Wales flannel flowers (Actinotus spp., Umbelliferae/Apiaceae) and Leopold Trattinnick’s other Australian plant-names

After a thorough consideration of the history of the European collection and subsequent early cultivation of the commercial flannel flower, a lectotype is designated for Actinotus helianthi Labill. (Umbelliferae/Apiaceae) and the earliest publication (by Trattinnick in 1814) of A. minor (Sm.) Tratt. pinpointed. Other neglected names coined by Trattinnick, including generic ones, applied to Australian and other plants, and published on (generally) plagiarised plates, are discussed and disposed of. One such plate is a copy of the iconotype of Amaryllis × johnsoniana Ker Gawl., an earlier epithet for Hippeastrum × johnsonii (Gowen) Herb. (Amaryllidaceae), a bulbous plant long cultivated in Australia and whose name should be conserved with the later spelling. Attention is drawn to confusions in localities on labels attached to specimens of species (in various families) collected on both D’Entrecasteaux’s and Baudin’s voyages to Australia

Lectotypification of Actinotus paddisonii R.T.Baker (Apiaceae: Mackinlayoideae)

A lectotype is here designated for Actinotus paddisonii R.T.Baker (Apiaceae: Mackinlayoideae), a species occurring in Queensland, New South Wales and probably Western Australia

Ironplant (Astrotricha hamptonii, Araliaceae): an enigmatic species with a rich history in bioprospecting

Astrotricha hamptonii F.Muell. (Araliaceae) is essentially restricted to the Hamersley Range in the Pilbara region of Western Australia where it grows on cliffs in rock fissures. This distinctive plant almost always grows in association with high-grade iron ore deposits on banded ironstone formations. Recognisable from the air, this species was used by mining company owner Lang Hancock’s prospecting partner, Ken McCamey, to accurately map the distribution of many of the richest iron ore deposits in the Hamersley Range in Western Australia. This paper provides the first detailed taxonomic description of this species to be published in English, and reviews its relationships in the Australian endemic genus Astrotricha DC. A summary of its use for bioprospecting is provided

Status of names of Mitrasacme species occurring outside Australia

Species of Mitrasacme occurring in Australia were revised for the Flora of Australia project in 1996, but the genus has never been revised as a whole. A checklist of the names of Mitrasacme species that occur outside Australia is presented here, together with their taxonomic status, known distribution and notes on their morphological affinities

Molecular phylogenetics reveals a new species of Prostanthera from tropical Queensland with links to more southerly taxa

Prostanthera eungella B.J.Conn & K.M.Proft (Lamiaceae) is described as a new species from the South Kennedy botanical region of northern Queensland. Concatenated nuclear (ETS) and chloroplast (trnH–psbA) sequence data for 38 species of Prostanthera were analysed using maximum-likelihood and Bayesian-inference methods. These combined data recovered P. eungella as part of a polytomy that included P. galbraithiae, P. howelliae¸ and a P. tallowa + P. lasianthos clade. A detailed description, photograph of holotype specimen, and distribution map of P. eungella are provided

Information from the Internet and the doctor-patient relationship: the patient perspective – a qualitative study

Background: Both doctors and patients may perceive the Internet as a potential challenge to existing therapeutic relationships. Here we examine patients' views of the effect of the Internet on their relationship with doctors.Methods: We ran 8 disease specific focus groups of between 2 and 8 respondents comprising adult patients with diabetes mellitus, ischaemic heart disease or hepatitis C.Results: Data are presented on (i) the perceived benefits and (ii) limitations of the Internet in the context of the doctor-patient relationship, (iii) views on sharing information with doctors, and (iv) the potential of the Internet for the future. Information from the Internet was particularly valued in relation to experiential knowledge.Conclusion: Despite evidence of increasing patient activism in seeking information and the potential to challenge the position of the doctor, the accounts here do not in any way suggest a desire to disrupt the existing balance of power, or roles, in the consultation. Patients appear to see the Internet as an additional resource to support existing and valued relationships with their doctors. Doctors therefore need not feel challenged or threatened when patients bring health information from the Internet to a consultation, rather they should see it as an attempt on the part of the patient to work with the doctor and respond positively

Sarcopenia: etiology, clinical consequences, intervention, and assessment

The aging process is associated with loss of muscle mass and strength and decline in physical functioning. The term sarcopenia is primarily defined as low level of muscle mass resulting from age-related muscle loss, but its definition is often broadened to include the underlying cellular processes involved in skeletal muscle loss as well as their clinical manifestations. The underlying cellular changes involve weakening of factors promoting muscle anabolism and increased expression of inflammatory factors and other agents which contribute to skeletal muscle catabolism. At the cellular level, these molecular processes are manifested in a loss of muscle fiber cross-sectional area, loss of innervation, and adaptive changes in the proportions of slow and fast motor units in muscle tissue. Ultimately, these alterations translate to bulk changes in muscle mass, strength, and function which lead to reduced physical performance, disability, increased risk of fall-related injury, and, often, frailty. In this review, we summarize current understanding of the mechanisms underlying sarcopenia and age-related changes in muscle tissue morphology and function. We also discuss the resulting long-term outcomes in terms of loss of function, which causes increased risk of musculoskeletal injuries and other morbidities, leading to frailty and loss of independence

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme