Restoring connectivity – how the Sea to Hume fishways will help achieve the environmental outcomes of the Murray-Darling Basin Plan

In Australia, the key reform in the management of water is the Water Act (2007). As part of the Water Act (2007), the Murray-Darling Basin Plan sets out the management framework for the waterways in Australia’s most economically important river system. The Murray-Darling Basin Plan (2012), hereafter the Basin Plan, aims to restore and maintain the health of important water-dependant ecosystems within Australia’s Murray-Darling Basin. To achieve these objectives, ‘water for the environment’ is to be managed under a Basin-wide Environmental Watering Strategy (MDBA 2014), (the Strategy) that articulates the basin-scale outcomes that will achieve the objectives of the Basin Plan. One of the key outcomes targeted by the Strategy is connectivity, both lateral and longitudinal. Longitudinal connectivity is of particular importance to Australian native fish species, many of which move hundreds of kilometres upstream and downstream at different stages of their life-cycle. The River Murray is now characterised by barrages at its estuary, and weirs and dams along its length, creating a series of barriers to upstream fish migration, and consequently impacting on the reproductive success of a number of Australian native fish species. Our understanding of the life-cycles of two large-bodied, recreational fish species (silver perch and golden perch) and two diadromous lamprey species (short-headed lamprey; pouched lamprey) demonstrates the importance of longitudinal connectivity at the river basin scale. It is these species that emphasise the importance of basin-scale management of river flows, basin-scale fish passage, and the interactions between the two. The outcomes from natural flow events and environmental watering actions targeting these species in the River Murray will be used to demonstrate the interdependencies between river flows and the Sea to Hume fishways. Demonstrating the importance of the Sea to Hume fishways, and Basin-scale fish passage more broadly, to the environmental outcomes of the Basin Plan

Design, management and completion of the hypoCOMPaSS RCT evaluating potential for restoration of hypoglycaemia awareness in type 1 diabetes using conventional vs novel technologie : and exploration of potential phenotypes predicting persistent impaired awareness despite study intervention

M.DAim: To explore the extent to which impaired awareness of hypoglycaemia (IAH) can be improved using currently available treatment regimens in individuals with long-standing type 1 diabetes mellitus (T1DM), and to characterise those individuals whose awareness of hypoglycaemia did not improve. Methods: A multicentre, 2x2 factorial 24-week RCT (HypoCOMPaSS) comparing multiple daily injections (MDI) and continuous subcutaneous insulin infusion therapy (CSII) with or without real-time continuous glucose monitoring (RT) in a population with T1DM and IAH was designed. The study was undertaken in five UK centres using established and novel outcome measures to assess hypoglycaemia awareness, glycaemic control and treatment satisfaction. A second analysis was undertaken characterising individuals within the HypoCOMPaSS population as responders and non-responders. Complication status, autonomic symptom profile and hyperglycaemia avoidance scores were assessed. Results: Overall, hypoglycaemia awareness improved, and biochemical hypoglycaemia, severe hypoglycaemia rate and insulin doses reduced without deterioration in HbA1c. There were no significant differences in awareness comparing MDI with CSII; and RT with conventional glucose monitoring. Between-group analyses demonstrated comparable reductions in severe hypoglycaemia, biochemical hypoglycaemia, fear of hypoglycaemia and insulin doses with equivalent HbA1c. Treatment satisfaction was highest with CSII. In the second study there was a suggestion that longer diabetes duration and increased age may impair ability to respond to the interventions but this did not correlate with severity of autonomic symptoms. Conclusions: Hypoglycaemia awareness can be improved and recurrent severe hypoglycaemia prevented in long-standing T1DM without relaxing HbA1c. Similar biomedical outcomes can be attained with conventional MDI and SMBG regimens compared with CSII / RT. All individuals may benefit from biomedical interventions to improve awareness of hypoglycaemia. This ii research provides a basis for further studies investigating impact of new technologies on severe hypoglycaemia and underlines the importance of tailoring treatment to avoid biochemical hypoglycaemia without relaxing overall control

The Virtue and Evolution of Localism with Corporate Social Responsibility

This paper empirically examines the impact of historical, cultural and societal context of localism within the case study of Marks and Spencer's. The empirical analysis is informed by three central principles; discourse, institutional and stakeholder. These are integrated within an analytical framework to express the evolutionary process an ideology, such as localism exists as a phenomenon, is constructed through language and then institutionalised to be taken-for-granted truth within everyday life. These steps identified show the evolution of the process from different periods of time creating new constructs of localism. This is due to changing market, cultural and political conditions that are essentially repositories of meaning for localism. Discourse analysis was used to investigate the media and corporate material communicated localism to the public and how this has changed over time. The findings suggest not only different portrayals of the concept by stakeholder groups, but also new meanings of the term have occurred by trends, issues and events that have caused institutional change. It concludes with implications that corporate involvement has on the construct with a process of ‘amoralisation’ weakening the moral connotations of the term for profit

Rapid change in parasite infection traits over the course of an epidemic in a wild host-parasite population

By combining a field study with controlled laboratory experimentation, we examined how infection traits of the sterilizing bacterium, Pasteuria ramosa, changed over the course of a growing season in a natural population of its crustacean host Daphnia magna. The number of parasite transmission spores per infected host increased ten-fold over the course of the season, concomitant with a decline in the density of infected hosts. Plausible explanations for this variation include changes in environmental conditions, changes in host quality, or that parasite migration or natural selection caused a genetic change in the parasite population. We sought to distinguish some of these possibilities in a laboratory experiment. Thus, we preserved field-collected parasite spores throughout the season, and later exposed a set of hosts to a fixed dose of these spores under controlled laboratory conditions. Parasites collected late in the season were more infectious and grew more rapidly than parasites collected early in the season. This result is compatible with the hypothesis that the observed increase in infectivity in the field was due to genetic change, i.e. evolution in the P. ramosa population

A global systematic review of the effects of suicide prevention interventions in Indigenous Peoples.

Objective Suicide rates are often higher in Indigenous than in non-Indigenous peoples. This systematic review assessed the effects of suicide prevention interventions on suicide-related outcomes in Indigenous populations worldwide. Methods We searched CINAHL, Embase, PubMed, PsycINFO, ProQuest Dissertations & Theses and Web of Science from database inception to April 2020. Eligible were English language, empirical and peer-reviewed studies presenting original data assessing the primary outcomes of suicides and suicide attempts and secondary outcomes of suicidal ideation, intentional self-harm, suicide or intentional self-harm risk, composite measures of suicidality or reasons for life in experimental and quasi-experimental interventions with Indigenous populations worldwide. We assessed the risk of bias with the Cochrane Risk of Bias Tool and the Risk of Bias Assessment for Non-randomised Studies. Findings We included 24 studies from Australia, Canada, New Zealand and the USA, comprising 14 before-after studies, 4 randomised controlled trials (RCTs), 3 non-randomised controlled trials, 2 interrupted time-series designs and 1 cohort study. Suicides decreased in four and suicide attempts in six before-after studies. No studies had a low risk of bias. There was insufficient evidence to confirm the effectiveness of any one suicide prevention intervention due to shortage of studies, risk of bias, and population and intervention heterogeneity. Review limitations include language bias, no grey literature search and data availability bias. Conclusion For the primary outcomes of suicides and suicide attempts, the limited available evidence supports multilevel, multicomponent interventions. However, there are limited RCTs and controlled studies

Supporting Self-management Among Young People With Acne Vulgaris Through a Web-Based Behavioral Intervention: Development and Feasibility Randomized Controlled Trial

Background: Acne is a common skin condition that is most prevalent in young people. It can have a substantial impact on the quality of life, which can be minimized with the appropriate use of topical treatments. Nonadherence to topical treatments for acne is common and often leads to treatment failure. Objective: The aim of this study is to develop a web-based behavioral intervention to support the self-management of acne and to assess the feasibility of recruitment, retention, and engagement of users with the intervention. Methods: The intervention was developed iteratively using the LifeGuide software and following the person-based approach for intervention development. The target behavior was appropriate use of topical treatments. Barriers and facilitators identified from the qualitative research and evidence from the wider literature were used to identify techniques to improve and promote their use. Young people with acne aged 14-25 years who had received treatment for acne in the past 6 months were invited to participate through mail-out from primary care practices in the South of England in a parallel, unblinded randomized trial. Participants were automatically randomized using a computer-generated algorithm to usual care or to usual care plus access to the web-based intervention. Usage data was collected, and a series of questionnaires, including the primary outcome measure for skin-specific quality of life (Skindex-16), were collected at baseline and at the 4- and 6-week follow-ups. Results: A total of 1193 participants were invited, and 53 young people with acne were randomized to usual care (27/53, 51%) or usual care plus intervention (26/53, 49%). The response rate for the primary outcome measure (Skindex-16) was 87% at 4 weeks, 6 weeks, and at both time points. The estimate of mean scores between groups (with 95% CI) using linear regression showed a trend in the direction of benefit for the web-based intervention group in the primary outcome measure (Skindex-16) and secondary measures (Patient Health Questionnaire-4 and the Problematic Experiences of Therapy Scale). Intervention usage data showed high uptake of the core module in the usual care plus web-based intervention group, with 88% (23/26) of participants completing the module. Uptake of the optional modules was low, with less than half visiting each (myth-busting quiz: 27%; living with spots or acne: 42%; oral antibiotics: 19%; what are spots or acne: 27%; other treatments: 27%; talking to your general practitioner: 12%). Conclusions: This study demonstrated the feasibility of delivering a trial of a web-based intervention to support self-management in young people with acne. Additional work is needed before a full definitive trial, including enhancing engagement with the intervention, recruitment, and follow-up rates

NSAID prescribing and adverse outcomes in common infections: a population-based cohort study.

OBJECTIVES: Infections in primary care are often treated with non-steroidal anti-inflammatory drugs (NSAIDs). This study evaluates whether NSAID prescribing is associated with adverse outcomes for respiratory (RTIs) or urinary track (UTI) infections. OBJECTIVES: To determine whether there is an association between NSAID prescribing and the rate of adverse outcomes for infections for individual consulting in primary care. DESIGN: Cohort study of electronic health records. SETTING: 87 general practices in the UK Clinical Practice Research Datalink GOLD. PARTICIPANTS: 142 925 patients consulting with RTI or UTI. PRIMARY AND SECONDARY OUTCOME MEASURES: Repeat consultations, hospitalisation or death within 30 days of the initial consultation for RTI or UTI. Poisson models estimated the associations between NSAID exposure and outcome. Rate ratios were adjusted for gender, age, ethnicity, deprivation, antibiotic use, seasonal influenza vaccination status, comorbidities and general practice. Since prescribing variations by practice are not explained by case mix-hence, less impacted by confounding by indication-both individual-level and practice-level analyses are included. RESULTS: There was an increase in hospital admission/death for acute NSAID prescriptions (RR 2.73, 95% CI 2.10 to 3.56) and repeated NSAID prescriptions (6.47, 4.46-9.39) in RTI patients, and for acute NSAID prescriptions for UTI (RR 3.03; 1.92 to 4.76). Practice-level analysis, controlling for practice population characteristics, found that for each percentage point increase in NSAID prescription, the percentages of hospital admission/death within 30 days increased by 0.32 percentage points (95% CI 0.16 to 0.47). CONCLUSIONS: In this non-randomised study, prescription of NSAIDs at consultations for RTI or UTIs in primary care is infrequent but may be associated with increased risk of hospital admission. This supports other observational and limited trial data that NSAID prescribing might be associated with worse outcomes following acute infection and should be prescribed with caution