Taking Stock: An Approach to Engaging the Australian Dairy Industry in Farm Business Management

This paper describes the development and achievements of a farm management service available to all dairy farmers in Australia. Dairy businesses in Australia came under severe pressure between the years 2002 and 2004 when three events coincided: a prolonged drought; deregulation which removed protection on milk prices; a downturn in the global commodity price for milk. Taking Stock was developed as a farm management service to help businesses respond to these pressures. Significant development challenges were encountered to ensure services reached 9,500 farmers who were scattered across 7,682,300 square kilometres using vastly different production systems to farm under temperate, sub-tropical or Mediterranean climate zones. These businesses were receiving varying degrees of support from a variety of organisations in the service sector. We ask the question, to what extent can a program like Taking Stock build industry confidence and enable an industry to develop a more inquisitive business culture? We conclude that progress can be made as a whole of industry towards building confidence and to improve the level of inquiry among farmers if seven development factors are addressed by the program.Livestock Production/Industries,

Intensity-modulated stereotactic radiosurgery for arteriovenous malformations: guidance for treatment planning.

BackgroundStereotactic Radiosurgery (SRS) is a common tool used to treat Arteriovenous Malformations (AVMs) in anatomical locations associated with a risk of surgical complications. Despite high rates of clinical effectiveness, SRS carries a risk of toxicity as a result of radiation injury to brain tissue. The use of intensity-modulated radiotherapy (IMRT) has increased because it may lead to improved PTV conformity and better Normal Tissue (NT) sparing compared to 3D Conformal Radiotherapy (3DCRT). The aim of this study was twofold: 1) to develop simple patient stratification rules for the recommendation of IMRT planning strategies over 3DCRT in the treatment of AVMs with SRS; and 2) to estimate the impact of IMRT in terms of toxicity reduction using retrospectively reported data for symptomatic radiation injury following SRS.MethodsThirty-one AVM patients previously treated with 3DCRT were replanned in a commercial treatment planning system using 3DCRT and static gantry IMRT with identical beam arrangements. The radiotherapy planning metrics analyzed included AVM volume, diameter, and volume to surface area ratio. The dosimetric endpoints analyzed included conformity index improvements and NT sparing measured by the maximum NT dose, and the volume of surrounding tissue that received 7Gy and 12Gy.ResultsOur analysis revealed stratified subsets of patients for IMRT that were associated with improved conformity, and those that were associated with decreased doses to normal tissue. The stratified patients experienced an improvement in conformity index by -6-68%, a reduction in the maximum NT dose by -0.5-12.3%, a reduction in the volume of NT receiving 7Gy by 1-8 cc, and a reduction in the volume of NT receiving 12Gy by 0-3.7 cc. The reduction in NT receiving 12Gy translated to a theoretical decrease in the probability of symptomatic injury by 0-9.3%.ConclusionsThis work indicates the potential for significant patient improvements when treating AVMs and provides rules to predict which patients are likely to benefit from IMRT

Relational continuity and patients’ perception of GP trust and respect:a qualitative study

BACKGROUND: Despite the benefits of relational continuity of care, particularly for patients with multimorbidity, the traditional model of continuity is changing. Revisiting what patients with ongoing problems want from relational continuity could encourage initiatives to achieve these within a modern healthcare system. AIM: To examine the attributes of GPs that patients with long-term conditions value most, and which attributes patients believe are facilitated by relational continuity. DESIGN AND SETTING: Qualitative study in UK general practice. METHOD: A thematic analysis was carried out, based on secondary analysis of interviews with 25 patients with long-term conditions that were originally conducted to inform a patient-reported outcome measure for primary care. RESULTS: Patients with long-term conditions wanted their GPs to be clinically competent, to examine, listen to, care for, and take time with them, irrespective of whether they have seen them before. They believed that relational continuity facilitates a GP knowing their history, giving consistent advice, taking responsibility and action, and trusting and respecting them. Patients acknowledged practical difficulties and safety issues in achieving the first three of these without relational continuity. However, patients felt that GPs should trust and respect them even when continuity was not possible. CONCLUSION: Policy initiatives promoting continuity with a GP or healthcare team should continue. Many patients see continuity as a safety issue. When patients experience relationship discontinuity, they often feel that they are not taken seriously or believed by their GP. GPs should therefore consistently seek to visibly demonstrate trust in their patients, particularly when they have not seen them before

Development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ)

OBJECTIVE: To develop and validate a new scale to assess treatment burden (the effort of looking after one's health) for patients with multimorbidity. DESIGN: Mixed-methods. SETTING: UK primary care. PARTICIPANTS: Content of the Multimorbidity Treatment Burden Questionnaire (MTBQ) was based on a literature review and views from a patient and public involvement group. Face validity was assessed through cognitive interviews. The scale was piloted and the final version was tested in 1546 adults with multimorbidity (mean age 71 years) who took part in the 3D Study, a cluster randomised controlled trial. For each question, we examined the proportion of missing data and the distribution of responses. Factor analysis, Cronbach's alpha, Spearman's rank correlations and longitudinal regression assessed dimensional structure, internal consistency reliability, construct validity and responsiveness, respectively. We assessed interpretability by grouping the global MTBQ scores into zero and tertiles (>0) and comparing participant characteristics across these categories. RESULTS: Cognitive interviews found good acceptability and content validity. Factor analysis supported a one-factor solution. Cronbach's alpha was 0.83, indicating internal consistency reliability. The MTBQ score had a positive association with a comparator treatment burden scale (rs 0.58, P<0.0001) and with self-reported disease burden (rs 0.43, P<0.0001), and a negative association with quality of life (rs-0.36, P<0.0001) and self-rated health (rs-0.36, P<0.0001). Female participants, younger participants and participants with mental health conditions were more likely to have high treatment burden scores. Changes in MTBQ score over 9-month follow-up were associated, as expected, with changes in measures of quality of life (EuroQol five dimensions, five level questionnaire) and patient-centred care (Patient Assessment of Chronic Illness Care). CONCLUSION: The MTBQ is a 10-item measure of treatment burden for patients with multimorbidity that has demonstrated good content validity, construct validity, reliability and responsiveness. It is a useful research tool for assessing the impact of interventions on treatment burden. TRIAL REGISTRATION NUMBER: ISRCTN06180958

Towards Accurate Multi-person Pose Estimation in the Wild

We propose a method for multi-person detection and 2-D pose estimation that achieves state-of-art results on the challenging COCO keypoints task. It is a simple, yet powerful, top-down approach consisting of two stages. In the first stage, we predict the location and scale of boxes which are likely to contain people; for this we use the Faster RCNN detector. In the second stage, we estimate the keypoints of the person potentially contained in each proposed bounding box. For each keypoint type we predict dense heatmaps and offsets using a fully convolutional ResNet. To combine these outputs we introduce a novel aggregation procedure to obtain highly localized keypoint predictions. We also use a novel form of keypoint-based Non-Maximum-Suppression (NMS), instead of the cruder box-level NMS, and a novel form of keypoint-based confidence score estimation, instead of box-level scoring. Trained on COCO data alone, our final system achieves average precision of 0.649 on the COCO test-dev set and the 0.643 test-standard sets, outperforming the winner of the 2016 COCO keypoints challenge and other recent state-of-art. Further, by using additional in-house labeled data we obtain an even higher average precision of 0.685 on the test-dev set and 0.673 on the test-standard set, more than 5% absolute improvement compared to the previous best performing method on the same dataset.Comment: Paper describing an improved version of the G-RMI entry to the 2016 COCO keypoints challenge (http://image-net.org/challenges/ilsvrc+coco2016). Camera ready version to appear in the Proceedings of CVPR 201