Dryland salinity in Western Australia: A local government perspective

This study evaluated local government\u27s response to the problem of dryland salinity in the Western Australian Wheatbelt, and to what extent local government has the capacity to meet its statutory obligations. Salinity is a significant environmental problem that has the potential to have a marked effect on Western Australia\u27s economy, environment and social fabric. The problem has been the focus of much Commonwealth and State attention, but the same level of involvement is not apparent in the institution of local government. This is also reflected in the paucity of published literature in the area of local government and salinity. Local government is closest to the salinity problem and bares the brunt of the impacts at a local community level. This study identified what statutory role is available to local authorities, and whether or not local government is well positioned to take an active role in the resolution of this problem. Particular attention was given to the identification of any benefits that local government could contribute to the overall process, development of solutions, and how it could act as a conduit through which the implementation of solutions is achieved. Local government was found to be well placed, and integral to the development of local strategies and responses to salinity. But, these initiatives need to be consistent with both Commonwealth and State strategies and policies. Developing such local strategies will serve to promote greater awareness of salinity issues and encourage broader participation within local communities. Participation, however, should not be restricted to those parties directly affected by salinity. The Shires of Beverley and Corrigin served as case studies of how local authorities are addressing salinity in the landscape. Both Shires are located in the central Wheatbelt, and as local authorities have differing interests and priorities, which influence the manner in which salinity is addressed within these respective municipalities. Some difficulties that confronted these local authorities, effectively stalling their efforts at a local level, were highlighted. There is still more that can be done by local authorities in responding to the challenge presented by salinity. Particularly, the level of co-operation between local and state authorities could be further improved. The results of this study may assist local authorities in develop strategies and responses to salinity in their respective regions. The results can also be used to facilitate improved relations between neighboring local authorities within a broader catchment and whole of landscape approach

Does ergometric stress test induce a procoagulative condition in patients with previous myocardial infarction

A regularly scheduled physical training program seems to have antithrombotic effects. Moreover, the hemostatic changes occurring in patients with coronary artery disease during acute exercise have not been clearly elucidated. Since stress testing is routinely performed in clinical cardiology, it would be helpful to assess whether patients with coronary artery disease are exposed to acute coronary thrombosis during or soon after sustained physical exercise. This study was designed to evaluate the effect of acute physical exercise (stress test by bicycle ergometer) on blood coagulation in a group of patients with previous myocardial infarction, and to determine whether the antithrombotic therapy commonly administered favorably influences hemostatic equilibrium. Our results suggest that exercise testing is not harmful to patients with previous myocardial infarction in regard to hemostasis and fibrinolysis and that antithrombotic therapy reduces postexercise increase in platelets

Neural basis of developing salt taste sensation: Response changes in fetal, postnatal, and adult sheep

To learn whether salt taste responses change during mammalian development, we recorded from multifiber preparations of the chorda tympani while stimulating the anterior tongue in sheep fetuses, lambs, and adults. Stimuli were 0.5 M NH4C1, KC1, NaCl, and LiCl, and 0.05–0.75 M concentration series of the first three salts. Ultrastructural studies were made of taste buds at different ages to determine whether morphological elements such as microvilli and tight junctions are present in young fetuses. Substantial changes occur in relative salt taste responses, throughout development. In fetuses that are beginning the last third of gestation, NaCl and LiCl elicit much smaller response magnitudes than NH4C1 and KC1. Throughout the rest of gestation and postnatally, the NaCl and LiCl responses gradually increase in magnitude relative to NH4C1 and KCL In adults, NaCl, LiCl, and NH4Cl all elicit similar response magnitudes and KC1 is less effective as a taste stimulus. At ages when response ratios for the 0.5 M salts are changing, there are no changes in shapes of the response/concentration functions for individual salts. Furthermore, microvilli are present on taste bud cell apices and tight junctions are found between cells in the youngest fetuses studied. Therefore, initial stimulus-receptor membrane contacts are probably similar to those in adults. Our data suggest that different membrane components interact with the various monochloride salts and that taste receptors contain different proportions of these various membrane components at different developmental stages. Therefore young taste bud cells do not have the same salt response characteristics as mature cells, and a changing neural substrate underlies development of salt taste function, both pre- and postnatally.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/50018/1/902150207_ftp.pd

Trends in Net Survival from Vulvar Squamous Cell Carcinoma in Italy (1990–2015)

Objective: In many Western countries, survival from vulvar squamous cell carcinoma (VSCC) has been stagnating for decades or has increased insufficiently from a clinical perspective. In Italy, previous studies on cancer survival have not taken vulvar cancer into consideration or have pooled patients with vulvar and vaginal cancer. To bridge this knowledge gap, we report the trend in survival from vulvar cancer between 1990 and 2015. (2) Methods: Thirty-eight local cancer registries covering 49% of the national female population contributed the records of 6274 patients. Study endpoints included 1- and 2-year net survival (NS) calculated using the Pohar-Perme estimator and 5-year NS conditional on having survived two years (5|2-year CNS). The significance of survival trends was assessed with the Wald test on the coefficient of the period of diagnosis, entered as a continuous regressor in a Poisson regression model. (3) Results: The median patient age was stable at 76 years. One-year NS decreased from 83.9% in 1990–2001 to 81.9% in 2009–2015 and 2-year NS from 72.2% to 70.5%. Five|2-year CNS increased from 85.7% to 86.7%. These trends were not significant. In the age stratum 70–79 years, a weakly significant decrease in 2-year NS from 71.4% to 65.7% occurred. Multivariate analysis adjusting for age group at diagnosis and geographic area showed an excess risk of death at 5|2-years, of borderline significance, in 2003–2015 versus 1990–2002. (4) Conclusions: One- and 2-year NS and 5|2-year CNS showed no improvements. Current strategies for VSCC control need to be revised both in Italy and at the global level

CONNECT for quality: protocol of a cluster randomized controlled trial to improve fall prevention in nursing homes

<p>Abstract</p> <p>Background</p> <p>Quality improvement (QI) programs focused on mastery of content by individual staff members are the current standard to improve resident outcomes in nursing homes. However, complexity science suggests that learning is a social process that occurs within the context of relationships and interactions among individuals. Thus, QI programs will not result in optimal changes in staff behavior unless the context for social learning is present. Accordingly, we developed CONNECT, an intervention to foster systematic use of management practices, which we propose will enhance effectiveness of a nursing home Falls QI program by strengthening the staff-to-staff interactions necessary for clinical problem-solving about complex problems such as falls. The study aims are to compare the impact of the CONNECT intervention, plus a falls reduction QI intervention (CONNECT + FALLS), to the falls reduction QI intervention alone (FALLS), on fall-related process measures, fall rates, and staff interaction measures.</p> <p>Methods/design</p> <p>Sixteen nursing homes will be randomized to one of two study arms, CONNECT + FALLS or FALLS alone. Subjects (staff and residents) are clustered within nursing homes because the intervention addresses social processes and thus must be delivered within the social context, rather than to individuals. Nursing homes randomized to CONNECT + FALLS will receive three months of CONNECT first, followed by three months of FALLS. Nursing homes randomized to FALLS alone receive three months of FALLs QI and are offered CONNECT after data collection is completed. Complexity science measures, which reflect staff perceptions of communication, safety climate, and care quality, will be collected from staff at baseline, three months after, and six months after baseline to evaluate immediate and sustained impacts. FALLS measures including quality indicators (process measures) and fall rates will be collected for the six months prior to baseline and the six months after the end of the intervention. Analysis will use a three-level mixed model.</p> <p>Discussion</p> <p>By focusing on improving local interactions, CONNECT is expected to maximize staff's ability to implement content learned in a falls QI program and integrate it into knowledge and action. Our previous pilot work shows that CONNECT is feasible, acceptable and appropriate.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00636675">NCT00636675</a></p