Efficacy and cost-effectiveness of an outcall program to reduce carer burden and depression among carers of cancer patients (PROTECT) : rationale and design of a randomized controlled trial

Published: 6 January 2014BACKGROUND: Carers provide extended and often unrecognized support to people with cancer. The aim of this study is to test the hypothesis that excessive carer burden is modifiable through a telephone outcall intervention that includes supportive care, information and referral to appropriate psycho-social services. Secondary aims include estimation of changes in psychological health and quality of life. The study will determine whether the intervention reduces unmet needs among patient dyads. A formal economic program will also be conducted. METHODS/DESIGN: This study is a single-blind, multi-centre, randomized controlled trial to determine the efficacy and cost-efficacy of a telephone outcall program among carers of newly diagnosed cancer patients. A total of 230 carer/patient dyads will be recruited into the study; following written consent, carers will be randomly allocated to either the outcall intervention program (n = 115) or to a minimal outcall / attention control service (n = 115). Carer assessments will occur at baseline, at one and six months post-intervention. The primary outcome is change in carer burden; the secondary outcomes are change in carer depression, quality of life, health literacy and unmet needs. The trial patients will be assessed at baseline and one month post-intervention to determine depression levels and unmet needs. The economic analysis will include perspectives of both the health care sector and broader society and comprise a cost-consequences analysis where all outcomes will be compared to costs. DISCUSSION: This study will contribute to our understanding on the potential impact of a telephone outcall program on carer burden and provide new evidence on an approach for improving the wellbeing of carers.Patricia M Livingston, Richard H Osborne, Mari Botti, Cathy Mihalopoulos, Sean McGuigan, Leila Heckel, Kate Gunn, Jacquie Chirgwin, David M Ashley and Melinda William

The uptake and use of nitrogen by paddy rice in fallow, cereal, and legume cropping systems

In a previous paper, we reported that prior crops either increased or decreased the yield of paddy rice (Oryza sativa L.) and altered its response to fertiliser N. We considered that rice yield responses to prior crop might have reflected the uptake of crop residue N and the efficiency of its use to produce grain. Experiments consisted of dry-season grain or legume crops, or fallow, followed by wet-season rice (cv. Lemont); and wet-season grain or legume crops, or fallow, followed by dry-season rice. Urea at one-third of the rate required for optimum rice yield was applied at 3 stages of rice crop growth: sowing, permanent flood, and/or panicle initiation. Soil N supplied 4.1 to 6.5 g N/m(2) to the rice crop, depending on the season. Rice also recovered 0 to 0.25 of the N in the residue of a prior maize crop and 0.23 to 0.57 of the N in grain legume residues or a legume green manure crop; the fraction was greater if fertiliser N was not applied. Increased N uptake was the major contributor to heavier yield. The relationship between grain yield and crop N content was mostly linear, and thus physiological efficiency of N use for rice grain production was essentially constant across the range of environments provided by fertiliser N and cropping system treatments in this study. In experiments where fertiliser N was applied, there were small effects of prior cereal and legume cropping treatments on physiological efficiency. In contrast, without fertiliser N application, physiological efficiency was increased by prior cereal and legume crops, which likely resulted from a greater congruence between the N demand of the rice crop, and the N supply from the soil and incorporated residue, when compared with a fallow treatment

Prior crop and residue incorporation time affect the response of paddy rice to fertiliser nitrogen

Crop residues are an important source of nitrogen (N) for rice (Oryza sativa L.). The objective of this research was to determine how the supply of mineral N from different prior crops or fallow might affect the growth and yield of rice. The study also tested whether N use by rice might be improved by timing the application of inorganic fertiliser N to supplement the N mineralised after prior crops. Experiments consisted of fallow, or cereal or legume crops in the dry-season followed by wet-season rice; and fallow, or cereal or legume crops in the wet-season followed by dry-season rice. Urea at one-third of the rate required for optimum rice yield was applied at 3 times during the rice crop: sowing, permanent flood, and/or panicle initiation. The prior fallow and crop treatments significantly influenced the growth and yield of rice crops. After a fallow, the pattern of soil N mineralisation promoted vegetative growth but was limiting during grain-filling. In contrast, after a cereal crop, rice vegetative growth was limited but grain-filling was promoted. Legume prior crops promoted both vegetative and grain growth. The benefits derived from growing the cereal or legume crops before rice, in terms of replacing fertiliser N, were dependent on the time at which fertiliser N was applied to the rice crop. In particular, legume crops frequently nullified the rice growth responses to fertiliser N. The results demonstrated that fallow and prior crops can alter the amount and timing of mineral N supply to a rice crop. Farmers should consider including a legume crop in rotation with rice because legumes supply N, which increases rice yield and reduces the requirement for fertiliser N. Cereal crops also contribute N, although farmers who use a cereal rotation should monitor the soil and crop N status during early rice growth, and supply extra fertiliser N to alleviate N deficiency

Irrigation frequency and nitrogen fertilizers modify cotton yield at Emerald, central Queensland

Four irrigation fRequencies and six nitrogen (N) fertilizer rates (0-300 kg ha) were applied to cotton (Gossypium hirsutum L.) grown on three Vertisols in the Emerald Irrigation Area, central Queensland. The purpose was to describe lint production responses to the plant available water before irrigation and N fertilizer, in terms of the crop N content and the efficiency of crop N use for lint production. Lint yield was greatest when the plant available water before irrigation was 50-80010 of the plant available water capacity (PAWC) of each soil. The rate of N fertilizer for maximum yield varied with plant available water and soil type. Plant available water before irrigation >60% an

Transitions to Working Life: Securing Professional Competence

This chapter examines the transition from education to work as a critical phase of professional career and the development of professional competence Literature on transition to working life has identified several challenges that many graduates meet in the early stages of their career such as: threat of unemployment, inadequate knowledge and skills, decreased self-efficacy and increased stress, instability of professional identity, newcomers’ role and position in a work community, early attrition and changing occupation. The importance of workplace learning in supporting graduates as they transit to the workplace is influential in assisting graduates deal with these challenges. This chapter examines each of these challenges from the professional competence point of view drawing upon examples from several research projects undertaken by the authors to accentuate how these challenges might be addressed. In particular special attention is paid to the role of social partnerships in meeting the challenges.peerReviewe