Exploring the barriers and enablers to attendance at rural cardiac rehabilitation programs

Objective: The objectives of this study were to: (i) identify local barriers and enablers to the uptake of hospital-based cardiac rehabilitation (CR) programs, and (ii) identify preferred alternatives for the delivery of CR.

Design: A questionnaire administered by local CR coordinators and focus groups facilitated by the research team.

Setting: Six regional hospitals in south-west Victoria offering hospital-based CR programs.

Participants: Patients and their carers referred to and eligible for local CR programs; health professionals working within local CR programs.

Main outcomes measures: CR attendees and decliners demographics, patient and health professional perceived factors which contribute to enabling hospital-based CR attendance, patient and health professional perceived barriers to CR attendance, and receptiveness and preferences for alternative modes of CR delivery.

Results: This study identified distance to travel to hospital-based CR programs the only statistically significant factor in determining uptake of CR. Easy access to transport (63%) and to a lesser extent family support (49%) and work flexibility (43%) were the primary enablers to attendance. Of the 97 study participants, 38% were receptive to alternative CR methods such as programs in outlying communities, evening facility-based programs, home and GP based programs, telephone support and a patient manual/workbook.

Conclusions: The results of this study provide valuable information for designing strategies to increase utilisation and improve patient acceptability of existing hospital-based CR programs. It provides a basis for pilot testing alternative modes of CR program delivery for cardiac patients in rural areas unable to access hospital-based CR.

Multi-level rural community engagement in health

Community participation in health is consistent with notions of democracy. A systems perspective of engagement can see consumers engaged to legitimise government agendas. Often community participation is via consultation instead of partnership or delegation. A community development approach to engagement can empower communities to take responsibility for their own health care. Understanding rural place facilitates alignment between health programs and community, assists in incorporating community resources into health care and provides information about health needs. Rural communities, health services and other community organisations need skills in working together to develop effective partnerships that transfer some power from health systems. Rural engagement with national/state agendas is a challenge. Community engagement takes time and resources, but can be expected to lead to better health outcomes for rural residents.

Sex-specific developmental plasticity in response to yolk corticosterone in an oviparous lizard

Corticosterone exposure during prenatal development as a result of maternal upregulation of circulating hormone levels has been shown to have effects on offspring development in mammals. Corticosterone has also been documented in egg yolk in oviparous vertebrates, but the extent to which this influences phenotypic development is less studied. We show that maternal corticosterone is transferred to egg yolk in an oviparous lizard (the mallee dragon, Ctenophorus fordi Storr), with significant variation among clutches in hormone levels. Experimental elevation of yolk corticosterone did not affect hatching success, incubation period or offspring sex ratio. However, corticosterone did have a sex-specific effect on skeletal growth during embryonic development. Male embryos exposed to relatively high levels of corticosterone were smaller on average than control males at hatching whereas females from hormone-treated eggs were larger on average than control females. The data thus suggest that males are not just more sensitive to the detrimental effects of corticosterone but rather that the sexes may have opposite responses to corticosterone during development. Positive selection on body size at hatching for both sexes in this species further suggests that increased corticosterone in egg yolk may have sex-specific fitness consequences, with potential implications for sex allocation and the evolution of hormone-mediated maternal effects.

Small rural emergency departments are not simply cut-down large urban emergency departments

 It is important to understand how small rural emergency departments work. They are a significant fraction of a state’s medical system. Although they each see only a few thousand patients a year, as a group they are likely to treat more emergency patients than the largest city hospital. It is a myth that they only deal with minor ailments. 

Integration and coordination of care

The health care systems in Australia are under pressure from workforce shortages, increasing costs and an ageing population with a high prevalence of chronic disease. There is a well-established description of inequity in health outcomes among rural and remote populations. Most of the inequity appears to be due to poorer access to services than higher levels of health risk factors, such as cholesterol, blood pressure or obesity. Over the last 15 years, the science of improvement has led to quality improvement techniques, such as collaboratives, managed clinical networks and collaborative care, all of which have been tried successfully in Australia. Each of these offers ways to reduce the inequity in health outcomes attributed to rurality or remoteness.

Within-population variation in ejaculate characteristics in a prolonged breeder, Peron's tree frog, Litoria peronii

Sperm number is often a good predictor of success in sperm competition; however, it has become increasingly clear that, for some species, variation in probability of paternity cannot be explained by sperm number alone. Intraspecific variation in ejaculate characteristics, such as the number of viable sperm and sperm longevity, may play an equally important role in determining fertilization success. Here, we assess variation among ejaculates in three factors that may contribute to fertilization success (number of sperm per ejaculate, viability, and longevity), in a population of Peron’s tree frog (Litoria peronii). We detected large variation among males in the number of sperm per ejaculate and the proportion of viable sperm within ejaculates, which could not be explained by variation in either male size or body condition. However, the proportion of viable sperm released by males increased over the season. Finally, we assessed sperm longevity (proportion viable sperm determined using a dual-fluorochrome vital dye) at two different temperatures. At 23°C, on average, 75% of sperm remained viable after 2 h, but there were significant differences amongst males with the percentage of viable sperm ranging from 43% to 95%. For sperm incubated at 4°C, ejaculates varied fivefold in sperm longevity with some males having 50% viable sperm after 5 days. Our data suggest that ejaculate characteristics (sperm number, viability, and longevity) vary widely in Peron’s tree frog and may therefore play an important role in determining siring success both in the presence and absence of sperm competition. We discuss the results in relation to selection on ejaculate traits via natural and sexual selection in this and other amphibians.

Male and female effects on fertilization success and offspring viability in the Peron's tree frog, Litoria peronii

There is increasing theoretical and empirical evidence that genetic compatibility among partners is an important determinant of fertilization success and offspring viability. In amphibians, females often actively choose partners from among a variety of males and polyandry is common. Genetic compatibility among partners may therefore be an important determinant of fertilization success and offspring viability in some amphibians. Amphibians also show some of the highest levels of genetic differentiation among neighbouring populations known in vertebrates, and as such, populations may have evolved different co-adapted gene complexes. This means that offspring from among-population crosses may have reduced fitness. It is therefore essential to understand to what extent crossings between and within populations may interfere with successful fertilization and offspring viability. Here, we test whether crossing individuals within and between two different populations of the Australian Peron's tree frog (Litoria peronii) using artificial fertilizations affect fertilization success and offspring viability. Fertilization success per se is strongly influenced by male identity, which is likely to depend at least to some extent on the experimental procedure (e.g. resulting in variation in sperm number per ejaculate), whereas there was no fertilization effect of female identity. More importantly, male and female identity, independently of each other, explained significant variation in offspring viability, whereas no such effect could be linked to population of origin. Thus, our experiments suggest that crossing populations may not always be the most significant factor affecting fertilization success or offspring viability, but may be more influenced by the genetic quality or the genetic compatibility of partners.

The ascent of asymmetric risk in information security: an initial evaluation

Dramatic changes in the information security risk landscape over several decades have not yet been matched by similar changes in organizational information security which is still mainly based on a mindset that security is achieved through extensive preventive controls. As a result, maintenance cost of information security is increasing rapidly, but this increased expenditure has not really made an attack more difficult. The opposite seems to be true, information security attacks have become easier to perpetrate and appear more like information warfare tactics. At the same time, the damage caused by a successful attack has increased significantly and may sometimes become critical to an organization. In this paper we evaluate one particular extremely asymmetric risk where a strongly motivated attacker unleashes a prolonged attack on an organization with the aim to do maximum damage, and suggest that the probability of such an attack is increasing. We discuss how preventive controls are unlikely to ever be effective against such an attack and propose more advanced strategies that aim to limit the damage when such an attack occurs. One crucial lesson to be learned for those organizations that are dependant on their information security, such as critical infrastructure organizations, is the need to deny motivated attackers access to any information about the success of their attack. Successful deception in this area is likely to significantly reduce any potential escalation of the incident.

Plasmodium falciparum possesses two GRASP proteins that are differentially targeted to the Golgi complex via a higher- and lower-eukaryote-like mechanism

Plasmodium falciparum, the causative agent of malaria, relies on a complex protein-secretion system for protein targeting into numerous subcellular destinations. Recently, a homologue of the Golgi re-assembly stacking protein (GRASP) was identified and used to characterise the Golgi organisation in this parasite. Here, we report on the presence of a splice variant that leads to the expression of a GRASP isoform. Although the first GRASP protein (GRASP1) relies on a well-conserved myristoylation motif, the variant (GRASP2) displays a different N-terminus, similar to GRASPs found in fungi. Phylogenetic analyses between GRASP proteins of numerous taxa point to an independent evolution of the unusual N-terminus that could reflect unique requirements for Golgi-dependent protein sorting and organelle biogenesis in P. falciparum. Golgi association of GRASP2 depends on the hydrophobic N-terminus that resembles a signal anchor, leading to a unique mode of Golgi targeting and membrane attachment.