More effective social services

In June 2014, the Productivity Commission was asked to look at ways to improve how government agencies commission and purchase social services. The final report was released in mid-September 2015. It makes several recommendations about how to make social services more responsive, client-focused, accountable and innovative. The final inquiry report has two key messages. First, system-wide improvement can be achieved and should be pursued. Second, New Zealand needs better ways to join up services for those with multiple, complex needs. Capable clients should be empowered with more control over the services they receive. Those less capable need close support and a response tailored to their needs, without arbitrary distinctions between services and funds divided into “health”, “education”, etc. These are significant, but extremely worthwhile, changes for New Zealand

What makes palliative care needs “complex”?:a multisite sequential explanatory mixed methods study of patients referred for specialist palliative care

Background: Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service. Methods: Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results: Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly. Conclusions: Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input

The effect of the branched-chain amino acids on the in-vitro activity of bovine intestinal alkaline phosphatase

Branched-chain amino acids (BCAA) are used as nutritional support for patients with a range of conditions including liver cirrhosis and in-born errors of amino acid metabolism, and are commonly used “sports”/exercise supplements. The effects of the BCAA on the in-vitro activity of calf intestinal alkaline phosphatase (EC. 3.1.3.1) were studied. All three BCAA were found to be uncompetitive inhibitors of the enzyme with L-leucine being the most potent (Ki’ = 24.9mM) and L-valine, the least potent (Ki’ = 37mM). Mixed BCAA are able to act in combination to inhibit the enzyme. Given the important role of intestinal alkaline phosphatase in gut homeostasis, these findings have potential implications for those taking high levels of BCAA as supplements

The Same Story or a Unique Novel? Within-Participant Principle Component Analysis of Training Load Measures in Professional Rugby Union Skills Training.

PURPOSE: The study aimed to identify which combination of external and internal training load (TL) metrics capture similar or unique information for individual professional players during skills training in rugby union using principal component analysis (PCA). METHOD: TL data were collected from twenty-one male professional rugby union players across a competitive season. This included PlayerLoad™, total distance (TD), and individualised high-speed distance (HSD; >61% maximal velocity; all external TL) obtained from a micro-technology device worn by each player (Optimeye X4, Catapult Innovations, Melbourne, Australia) and the session-rating of perceived exertion (sRPE; internal TL). PCA was conducted on each individual to extract the underlying combinations of the four TL measures that best describe the total information (variance) provided by the measures. TL measures with PC "loadings" (PCL) above 0.7 were deemed to possess well-defined relationships with the extracted PC. RESULTS: The findings show that from the four TL measures, the majority of an individual's TL information (1st PC: 55 to 70%) during skills training can be explained by either sRPE (PCL: 0.72 to 0.95), TD (PCL: 0.86 to 0.98) or PlayerLoad™ (PCL: 0.71 to 0.98). HSD was the only variable to relate to the 2nd PC (PCL: 0.72 to 1.00), which captured additional TL information (+19 to 28%). CONCLUSIONS: Findings suggest practitioners could quantify the TL of rugby union skills training with one of PlayerLoad™, TD, or sRPE plus HSD whilst limiting omitted information of the TL imposed during professional rugby union skills training

The examination of mental toughness, sleep, mood and injury rates in an Arctic ultra-marathon

There is scarcity of research examining the physiological and psychological effects of ultra-endurance racing on athletes in extreme conditions. The purpose of the current study was to identify common injury patterns and illness, profile mood states and sleep patterns and finally examine the relationships between mental toughness, sleep, mood and injury rates during a 120 mile, three-day Arctic ultra-marathon. Twelve participants (3 females, 9 males) with a mean age of 42 ± 5.35 yrs participated in the study. Mental toughness was measured using the MT18 questionnaire. Injuries were clinically assessed and recorded each day. Temperatures ranged from −20 to −6 degrees Celsius throughout the race. Sleep quantity and mood state were recorded using the BRUMS questionnaire. 10 out of the 12 participants experienced injuries; almost half of the participants had injuries that carried over a number of days. Mean sleep duration over the three days was 4.07 h, with an average of 0.78 injuries per day. Significant changes in mood were recorded across the three days, specifically a reduction in vigour (p = .029) and increase in fatigue (p = .014). Neither sleep quantity nor mental toughness was correlated with injury rate. Interestingly, sleep quantity was not related to changes in mood, as previously shown in ultra-marathons. Mental toughness had a moderate negative correlation (p

Magnesium biofortification of Italian ryegrass (Lolium multiflorum L.) via agronomy and breeding as a potential way to reduce grass tetany in grazing ruminants

© 2019, The Author(s). Aim: Magnesium (Mg) deficiency (known as grass tetany) is a serious metabolic disorder that affects grazing ruminants. We tested whether Mg-fertiliser can increase Mg concentration of Italian ryegrasses (Lolium multiflorum L.) including a cultivar (cv. Bb2067; ‘Magnet’), bred to accumulate larger concentrations of Mg. Methods: Under controlled environment (CE) conditions, three cultivars (cv. Bb2067, cv. Bb2068, cv. RvP) were grown in low-nutrient compost at six fertiliser rates (0–1500μM MgCl2.6H2O). Under field conditions, the three cultivars in the CE condition and cv. Alamo were grown at two sites, and four rates of MgSO4 fertiliser application rates (0–200kgha−1 MgO). Multiple grass cuts were taken over two-years. Results: Grass Mg concentration increased with increasing Mg-fertiliser application rates in all cultivars and conditions. Under field conditions, cv. Bb2067 had 11–73% greater grass Mg concentration and smaller forage tetany index (FTI) than other cultivars across the Mg-fertiliser application rates, sites and cuts. Grass dry matter (DM) yield of cv. Bb2067 was significantly (p < 0.05) smaller than cv. Alamo. The effect of Mg-fertiliser rate on DM yield was not significant (p ≥ 0.05). Conclusions: Biofortification of grass with Mg through breeding and agronomy can improve the forage Mg concentration for grazing ruminants, even in high-growth spring grass conditions when hypomagnesaemia is most prevalent. Response to agronomic biofortification varied with cultivar, Mg-fertiliser rate, site and weather. The cost:benefit of these approaches and farmer acceptability, and the impact on cattle and sheep grazing on grasses biofortified with Mg requires further investigation

APRIL is a novel clinical chemo-resistance biomarker in colorectal adenocarcinoma identified by gene expression profiling

<p>Abstract</p> <p>Background</p> <p>5-Fluorouracil(5FU) and oral analogues, such as capecitabine, remain one of the most useful agents for the treatment of colorectal adenocarcinoma. Low toxicity and convenience of administration facilitate use, however clinical resistance is a major limitation. Investigation has failed to fully explain the molecular mechanisms of resistance and no clinically useful predictive biomarkers for 5FU resistance have been identified. We investigated the molecular mechanisms of clinical 5FU resistance in colorectal adenocarcinoma patients in a prospective biomarker discovery project utilising gene expression profiling. The aim was to identify novel 5FU resistance mechanisms and qualify these as candidate biomarkers and therapeutic targets.</p> <p>Methods</p> <p>Putative treatment specific gene expression changes were identified in a transcriptomics study of rectal adenocarcinomas, biopsied and profiled before and after pre-operative short-course radiotherapy or 5FU based chemo-radiotherapy, using microarrays. Tumour from untreated controls at diagnosis and resection identified treatment-independent gene expression changes. Candidate 5FU chemo-resistant genes were identified by comparison of gene expression data sets from these clinical specimens with gene expression signatures from our previous studies of colorectal cancer cell lines, where parental and daughter lines resistant to 5FU were compared. A colorectal adenocarcinoma tissue microarray (n = 234, resected tumours) was used as an independent set to qualify candidates thus identified.</p> <p>Results</p> <p>APRIL/TNFSF13 mRNA was significantly upregulated following 5FU based concurrent chemo-radiotherapy and in 5FU resistant colorectal adenocarcinoma cell lines but not in radiotherapy alone treated colorectal adenocarcinomas. Consistent withAPRIL's known function as an autocrine or paracrine secreted molecule, stromal but not tumour cell protein expression by immunohistochemistry was correlated with poor prognosis (p = 0.019) in the independent set. Stratified analysis revealed that protein expression of APRIL in the tumour stroma is associated with survival in adjuvant 5FU treated patients only (n = 103, p < 0.001), and is independently predictive of lack of clinical benefit from adjuvant 5FU [HR 6.25 (95%CI 1.48-26.32), p = 0.013].</p> <p>Conclusions</p> <p>A combined investigative model, analysing the transcriptional response in clinical tumour specimens and cancers cell lines, has identified APRIL, a novel chemo-resistance biomarker with independent predictive impact in 5FU-treated CRC patients, that may represent a target for novel therapeutics.</p

Etiology of Severe Non-malaria Febrile Illness in Northern Tanzania: A Prospective Cohort Study.

The syndrome of fever is a commonly presenting complaint among persons seeking healthcare in low-resource areas, yet the public health community has not approached fever in a comprehensive manner. In many areas, malaria is over-diagnosed, and patients without malaria have poor outcomes. We prospectively studied a cohort of 870 pediatric and adult febrile admissions to two hospitals in northern Tanzania over the period of one year using conventional standard diagnostic tests to establish fever etiology. Malaria was the clinical diagnosis for 528 (60.7%), but was the actual cause of fever in only 14 (1.6%). By contrast, bacterial, mycobacterial, and fungal bloodstream infections accounted for 85 (9.8%), 14 (1.6%), and 25 (2.9%) febrile admissions, respectively. Acute bacterial zoonoses were identified among 118 (26.2%) of febrile admissions; 16 (13.6%) had brucellosis, 40 (33.9%) leptospirosis, 24 (20.3%) had Q fever, 36 (30.5%) had spotted fever group rickettsioses, and 2 (1.8%) had typhus group rickettsioses. In addition, 55 (7.9%) participants had a confirmed acute arbovirus infection, all due to chikungunya. No patient had a bacterial zoonosis or an arbovirus infection included in the admission differential diagnosis. Malaria was uncommon and over-diagnosed, whereas invasive infections were underappreciated. Bacterial zoonoses and arbovirus infections were highly prevalent yet overlooked. An integrated approach to the syndrome of fever in resource-limited areas is needed to improve patient outcomes and to rationally target disease control efforts