Sharing risk management: an implementation model for cardiovascular absolute risk assessment and management in Australian general practice

Purpose: Despite considerable work in developing and validating cardiovascular absolute risk (CVAR) algorithms, there has been less work on models for their implementation in assessment and management. The aim of our study was to develop a model for a joint approach to its implementation based on an exploration of views of patients, general practitioners (GPs) and key informants (KIs). Methods: We conducted six focus group (three with GPs and three with patients) and nine KI interviews in Sydney. Thematic analysis was used with comparison to highlight the similarities and differences in perspectives of participants. Results: Conducting CVAR was seen as more acceptable for regular patients rather than new patients for whom GPs had to attract their interest and build rapport before doing so at the next visit. GPs' interest and patients' positive attitude in managing risk were important in implementing CVAR. Long consultations, good communication skills and having a trusting relationship helped overcome the barriers during the process. All the participants supported engaging patients to self-assess their risk before the consultation and sharing decision making with GPs during consultation. Involving practice staff to help with the patient self-assessment, follow-up and referral would be helpful in implementing CVAR assessment and management, but GPs, patients and practices may need more support for this to occur. Conclusions: Multiple strategies are required to promote the better use of CVAR in the extremely busy working environment of Australian general practice. An implementation model has been developed based on our findings and the Chronic Care Model. Further research needs to investigate the effectiveness of the proposed model

The long-term effects of alfalfa on soil water content in the Loess Plateau of northwest China

Soil desiccation is the most serious problem in forest vegetations and grassland, which lead to widespread land degradation in the Loess Plateau of China. The soil water variations at 0 to 1000 cm depth of different vegetations were studied to explore the hydrological effects of vegetations and determine the optimal length of alfalfa (Medicago sativa L.) phase at the Zhenyuan Agri-ecological Station of the Loess Plateau in China. Eight treatments were designed in this study: waste land, wheat land and six continuous growing alfalfa treatments, including 4-year-old (4 year), 6-year-old (6 year), 8- year-old (8 year), 12-year-old (12 year), 18-year-old (18 year) and 26-year-old (26 year) alfalfa grasslands.  Results showed that the wheat field had the best soil water content and no dry soil layer, while slightly dry soil layer occurred in wasteland and 4, 6 and 8 year alfalfa grasslands. After alfalfa grew for > 8 years, moderately dry soil layer appeared in the grassland and expanded beyond 500 cm soil depth. The result also showed that wheat field, wasteland and the alfalfa grasslands growing for 4, 6 and 8 years had no unfavorable impacts on the ecological environments of the soil moisture but the grasslands for 12, 18 and 26 years did exert relatively stronger unfavorable influences on the hydrological effects. Considering all the factors, this study recommends that the optimal length of alfalfa phase should be 8 years.Key words: Different vegetation, alfalfa grasslands, soil water content, ecological effect, soil desiccation, Loess Plateau of China

Geoarchaeological evidence of the AD 1642 Yellow River flood that destroyed Kaifeng, a former capital of dynastic China

Rising global temperatures will increase the number of extreme weather events, creating new challenges for cities around the world. Archaeological research on the destruction and subsequent reoccupation of ancient cities has the potential to reveal geological and social dynamics that have historically contributed to making urban settings resilient to these extreme weather events. Using a combination of archaeological and geological methods, we examine how extreme flood events at Kaifeng, a former capital of dynastic China, have shaped the city’s urban resilience. Specifically, we focus on an extreme Yellow River flood event in AD 1642 that historical records suggest killed around 300,000 people living in Kaifeng. Our recent archaeological excavations have discovered compelling geological and archaeological evidence that corroborates these documents, revealing that the AD 1642 Yellow River flood destroyed Kaifeng’s inner city, entombing the city and its inhabitants within meters of silt and clay. We argue that the AD 1642 flood was extraordinarily catastrophic because Kaifeng’s city walls only partly collapsed, entrapping most of the flood waters within the city. Both the geology of the Yellow River floods as well as the socio-political context of Kaifeng shaped the city’s resilience to extreme flood events

Typhoon disaster risk assessment based on emergy theory: A case study of Zhuhai City, Guangdong Province, China

Typhoons and cyclones are the most impacting and destructive natural disasters in the world. To address the shortcomings of a previous typhoon disaster risk assessment (for example, human factors were involved in determining weights by importance, and this affected the experimental results), an emergy method, which converts energy flows of different properties into the same solar energy basis for a convenient comparison, was used to assess the risk of regional typhoon disasters. Typhoon disaster-related data from 2017 were used to develop an index system including resilience, potential strength, and sensitivity which was in turn applied to assess typhoon disaster risks in Zhuhai City, Guangdong Province, China. The results showed that the spatial distribution of the typhoon disaster risks in Zhuhai significantly differed, with the highest risk in Xiangzhou district, the second highest risk in Doumen district, and the lowest risk in Jinwan district. In addition, improving the level of regional resilience can effectively reduce risks from typhoon disasters. The application of the emergy method in a typhoon disaster risk assessment may provide some theoretical support for national and regional governmental strategies for disaster prevention and reduction

Diverse supramolecular structures formed by self-assembling proteins of the B acillus subtilis spore coat

Bacterial spores (endospores), such as those of the pathogens Clostridium difficile and Bacillus anthracis, are uniquely stable cell forms, highly resistant to harsh environmental insults. Bacillus subtilis is the best studied spore-former and we have used it to address the question of how the spore coat is assembled from multiple components to form a robust, protective superstructure. B. subtilis coat proteins (CotY, CotE, CotV and CotW) expressed in Escherichia coli can arrange intracellularly into highly stable macro-structures through processes of self-assembly. Using electron microscopy, we demonstrate the capacity of these proteins to generate ordered one-dimensional fibres, two-dimensional sheets and three-dimensional stacks. In one case (CotY), the high degree of order favours strong, cooperative intracellular disulfide cross-linking. Assemblies of this kind could form exquisitely adapted building blocks for higher-order assembly across all spore-formers. These physically robust arrayed units could also have novel applications in nano-biotechnology processes