Soliciting additional concerns in the primary care consultation and the utility of a brief communication intervention to aid solicitation: A qualitative study

Objective To investigate the perspectives of general practitioners (GPs) on the practice of soliciting additional concerns (ACs) and the acceptability and utility of two brief interventions (prompts) designed to aid the solicitation. Methods Eighteen GPs participating in a feasibility randomised controlled trial were interviewed. Interviews were semi-structured and audio-recorded. Data were analysed using a Framework Approach. Results Participants perceived eliciting ACs as important for: reducing the need for multiple visits, identifying serious illness early, and increasing patient and GP satisfaction. GPs found the prompts easy to use and some continued their use after the study had ended to aid time management. Others noted similarities between the intervention and their usual practice. Nevertheless, soliciting ACs in every consultation was not unanimously supported. Conclusion The prompts were acceptable to GPs within a trial context, but there was disagreement as to whether ACs should be solicited routinely. Some GPs considered the intervention to aid their prioritisation efficiency within consultations. Practice implications Some GPs will find prompts which encourage ACs to be solicited early in the consultation enable them to better organise priorities and manage time-limited consultations more effectively.

Management Guidelines for New Warm-Season Grasses in Australia

After more than 30 years in which ‘Tifgreen’ and ‘Tifdwarf’ were the only greens-quality varieties available, the choice for golf courses and bowls clubs in northern Australia has been expanded to include six new Cynodon hybrids [Cynodon dactylon (L.) Pers x Cynodon transvaalensis Burtt-Davy]. Five of these – ‘Champion Dwarf’ (Texas), ‘MS-Supreme’ (Mississippi), FloraDwarf™ (Florida), ‘TifEagle’ (Georgia), MiniVerde™ (Arizona) - are from US breeding programs, while the sixth, ‘TL2’ (marketed as Novotek™) was selected in north Queensland. The finer, denser and lower growing habit of the “ultradwarf” cultivars allows very low mowing heights (e.g. 2.5 mm) to be imposed, resulting in denser and smoother putting and bowls surfaces. In addition to the Cynodon hybrids, four new greens quality seashore paspalum (Paspalum vaginatum O. Swartz) cultivars including ‘Sea Isle 2000’, Sea Isle Supreme™, Velvetene™ and Sea Dwarf™ (where tolerance of salty water is required) expands the range of choices for greens in difficult environments. The project was developed to determine (a) the appropriate choice of cultivar for different environments and budgets, and (b) best management practices for the new cultivars which differ from the Cynodon hybrid industry standards ‘Tifgreen’ and ‘Tifdwarf’. Management practices, particularly fertilising, mowing heights and frequency, and thatch control were investigated to determine optimum management inputs and provide high quality playing surfaces with the new grasses. To enable effective trialling of these new and old cultivars it was essential to have a number of regional sites participating in the study. Drought and financial hardship of many clubs presented an initial setback with numerous clubs wanting to be involved in the study but were unable to commit due to their financial position at the time. The study was fortunate to have seven regional sites from Queensland, New South Wales, Victoria and South Australia volunteer to be involved in the study which would add to the results being collected at the centralised test facility being constructed at DEEDI’s Redlands Research Station. The major research findings acquired from the eight trial sites included: • All of the new second generation “ultradwarf” couchgrasses tend to produce a large amount of thatch with MiniVerde™ being the greatest thatch producer, particularly compared to ‘Tifdwarf’ and ‘Tifgreen’. The maintenance of the new Cynodon hybrids will require a program of regular dethatching/grooming as well as regular light dustings of sand. Thatch prevention should begin 3 to 4 weeks after planting a new “ultradwarf” couchgrass green, with an emphasis on prevention rather than control. • The “ultradwarfs” produced faster green speeds than the current industry standards ‘Tifgreen’ and ‘Tifdwarf’. However, all Cynodon hybrids were considerably faster than the seashore paspalums (e.g. comparable to the speed diference of Bentgrass and couchgrass) under trial conditions. Green speed was fastest being cut at 3.5 mm and rolled (compared to 3.5 mm cut, no roll and 2.7 mm cut, no roll). • All trial sites reported the occurrence of disease in the Cynodon hybrids with the main incidence of disease occurring during the dormancy period (autumn and winter). The main disease issue reported was “patch diseases” which includes both Gaumannomyces and Rhizoctonia species. There was differences in the severity of the disease between cultivars, however, the severity of the disease was not consistent between cultivars and is largely attributed to an environment (location) effect. In terms of managing the occurrence of disease, the incidence of disease is less severe where there is a higher fertility rate (about 3 kgN/100m2/year) or a preventitatve fungicide program is adopted. • Cynodon hybrid and seashore paspalum cultivars maintained an acceptable to ideal surface being cut between 2.7 mm and 5.0 mm. “Ultradwarf” cultivars can tolerate mowing heights as low as 2.5 mm for short periods but places the plant under high levels of stress. Greens being maintained at a continually lower cutting height (e.g. 2.7 mm) of both species is achievable, but would need to be cut daily for best results. Seashore paspalums performed best when cut at a height of between 2.7 mm and 3.0 mm. If a lower cutting height is adopted, regular and repeated mowings are required to reduce scalping and produce a smooth surface. • At this point in time the optimum rate of nitrogen (N) for the Cynodon hybrids is 3 kg/100m2/year and while the seashore paspalums is 2 to 3 kg/100m2/year. • Dormancy occurred for all Cynodon and seashore paspalum culitvars from north in Brisbane (QLD) to south in Mornington Peninsula (VIC) and west to Novar Gardens (SA). Cynodon and Paspalum growth in both Victoria and South Australia was less favourable as a result of the cooler climates. • After combining the data collected from all eight sites, the results indicated that there can be variation (e.g. turfgrass quality, colour, disease resistance, performace) depending on the site and climatic conditions. Such evidence highlights the need to undertake genotype by environment (G x E) studies on new and old cultivars prior to conversion or establishment. • For a club looking to select either a Cynodon hybrid or seashore paspalum cultivar for use at their club they need to: - Review the research data. - Look at trial plots. - Inspect greens in play that have the new grasses. - Select 2 to 3 cultivars that are considered to be the better types. - Establish them in large (large enough to putt on) plots/nursery/practice putter. Ideally the area should be subjected to wear. - Maintain them exactly as they would be on the golf course/lawn bowls green. This is a critical aspect. Regular mowing, fertilising etc. is essential. - Assess them over at least 2 to 3 years. - Make a selection and establish it in a playing green so that it is subjected to typical wear.

Warm-season greens grass trial - Environmental and management guidelines suited for new and old cultivars

The Horticulture Australia funded project, Management Guidelines for Warm-Season Grasses in Australia (TU05001), has allowed a detailed greens grass study to take place and enabled researchers and superintendents to work together to collect meaningful data on a range of Cynodon dactylon (L.) Pers. x Cynodon transvaalensis Burtt-Davy (Cynodon hybrid) and Paspalum vaginatum O. Swartz (seashore paspalum) cultivars suitable for golf or lawn bowls use. The end result provides superintendents and greenkeepers with additional knowledge to accompany their skills in managing or upgrading their greens to produce a denser, smoother and faster putting or bowls surface. However, neither turfgrass selection nor finely tuned management program will overcome unrealistic expectations (especially in relation to usage), poor growing environments, or limitations due to improper construction techniques.

Rice flower production guidelines for growers

Rice flower, an Australian native species, has been cultivated in appreciable quantities as a cut flower crop since 1991. Although the plant can be highly productive, achieving consistently high commercial yields can prove elusive. Rice Flower production guidelines for growers is essential reading for producers who would aspire to grow and market rice flower well. For anyone with an interest in new crop development, this book provides a valuable insight into the intricacies of growing an indigenous species commercially.

Weaning management of beef calves - practical guidelines for northern Australian

The ‘Weaning management of beef calves – practical guidelines for northern Australian beef producers‘ book or simply ‘the weaner book’ is a compilation of all the research, demonstration and practical knowledge available on weaning and weaner management in northern Australia. Most of this information has been available for some years, but it has not been collated in a single document that is practical and easy to understand. It has been difficult for property owners, managers and their staff to access. The end result of this project is an easy to read guide that has all the available information in one publication. Compiling this information has also highlighted areas where information is limited or non existent or where available information is not being implemented across the whole industry. This has been evaluated and included in recommendations for further research and or demonstration work.

Management guidelines for warm-season greens grasses

Golf green, turf.

Age-related changes in hepatic function: An update on implications for drug therapy

The accumulation of deficits with increasing age results in a decline in the functional capacity of multiple organs and systems. These changes can have a significant influence on the pharmacokinetics and pharmacodynamics of prescribed drugs. Although alterations in body composition and worsening renal clearance are important considerations, for most drugs the liver has the greatest effect on metabolism. Age-related change in hepatic function thereby causes much of the variability in older people’s responses to medication. In this review, we propose that a decline in the ability of the liver to inactivate toxins may contribute to a proinflammatory state in which frailty can develop. Since inflammation also downregulates drug metabolism, medication prescribed to frail older people in accordance with disease-specific guidelines may undergo reduced systemic clearance, leading to adverse drug reactions, further functional decline and increasing polypharmacy, exacerbating rather than ameliorating frailty status. We also describe how increasing chronological age and frailty status impact liver size, blood flow and protein binding and enzymes of drug metabolism. This is used to contextualise our discussion of appropriate prescribing practices. For example, while the general axiom of ‘start low, go slow’ should underpin the initiation of medication (titrating to a defined therapeutic goal), it is important to consider whether drug clearance is flow or capacity-limited. By summarising the effect of age-related changes in hepatic function on medications commonly used in older people, we aim to provide a guide that will have high clinical utility for practising geriatricians.

Grazing for Healthy Coastal Wetlands: Guidelines for managing coastal wetlands in grazing systems.

Grazing for Healthy Coastal Wetlands has been developed to provide graziers, landowners and extension officers with information on managing grazing in and around Queensland’s coastal wetlands to maintain healthy coastal wetlands and productive grazing enterprises. It provides practical advice on how grazing and associated land management practices can be implemented to support the long-term health of coastal wetlands whilst maintaining production. The guidelines have been compiled from published literature, grazier knowledge, wetlands managers and the experience of extension and natural resource management professionals. They reflect the current knowledge of suitable management practices for coastal wetlands. They are designed to complement and be considered in conjunction with existing information resources including the EDGEnetwork Grazing Land Management series and best management practice guidelines from regional Natural Resource Management (NRM) groups. While the recommendations apply broadly to Queensland’s coastal wetlands, regional, catchment and landscape-scale variations in wetland characteristics and the objectives of the individual grazing enterprise should be taken into account in planning and deciding management actions for wetlands. An individual grazing property may even have a range of wetland types with different management needs and objectives which should be identified during whole of property planning. Specific land and wetland management advice should also be sought from local grazing extension officers and NRM professionals.

Using fire in spotted gum - ironbark forests for production and biodiversity outcomes. Guidelines for landholders

This guide applies to spotted gum - ironbark forests and woodlands. Topics covered in the guide include: *The spotted gum - ironbark ecosystem; *General effects of burning practices; *Understandinng the effects of fire management; *Timber production; *Livestock grazing production; *Balancing production and biodiversity; *Fire management planning for the property; *Recommendtaions for landholders. These guidelines have been prepared for spotted gum - ironbark forests and woodlands and are not necessarily applicable to other forest and woodland ecosystems. The recommendations provided in these guidelines should be used as a guide only.

Small nerve fiber quantification in the diagnosis of diabetic sensorimotor polyneuropathy: Comparing corneal confocal microscopy with intraepidermal nerve fiber density

OBJECTIVE Quantitative assessment of small fiber damage is key to the early diagnosis and assessment of progression or regression of diabetic sensorimotor polyneuropathy (DSPN). Intraepidermal nerve fiber density (IENFD) is the current gold standard, but corneal confocal microscopy (CCM), an in vivo ophthalmic imaging modality, has the potential to be a noninvasive and objective image biomarker for identifying small fiber damage. The purpose of this study was to determine the diagnostic performance of CCM and IENFD by using the current guidelines as the reference standard. RESEARCH DESIGN AND METHODS Eighty-nine subjects (26 control subjects and 63 patients with type 1 diabetes), with and without DSPN, underwent a detailed assessment of neuropathy, including CCM and skin biopsy. RESULTS Manual and automated corneal nerve fiber density (CNFD) (P < 0.0001), branch density (CNBD) (P < 0.0001) and length (CNFL) (P < 0.0001), and IENFD (P < 0.001) were significantly reduced in patients with diabetes with DSPN compared with control subjects. The area under the receiver operating characteristic curve for identifying DSPN was 0.82 for manual CNFD, 0.80 for automated CNFD, and 0.66 for IENFD, which did not differ significantly (P = 0.14). CONCLUSIONS This study shows comparable diagnostic efficiency between CCM and IENFD, providing further support for the clinical utility of CCM as a surrogate end point for DSPN.

Step based physical activity guidelines for preschool-aged children

OBJECTIVE Public health organizations recommend that preschool-aged children accumulate at least 3h of physical activity (PA) daily. Objective monitoring using pedometers offers an opportunity to measure preschooler's PA and assess compliance with this recommendation. The purpose of this study was to derive step-based recommendations consistent with the 3h PA recommendation for preschool-aged children. METHOD The study sample comprised 916 preschool-aged children, aged 3 to 6years (mean age=5.0+/-0.8years). Children were recruited from kindergartens located in Portugal, between 2009 and 2013. Children wore an ActiGraph GT1M accelerometer that measured PA intensity and steps per day simultaneously over a 7-day monitoring period. Receiver operating characteristic (ROC) curve analysis was used to identify the daily step count threshold associated with meeting the daily 3hour PA recommendation. RESULTS A significant correlation was observed between minutes of total PA and steps per day (r=0.76, p<0.001). The optimal step count for >/=3h of total PA was 9099 steps per day (sensitivity (90%) and specificity (66%)) with area under the ROC curve=0.86 (95% CI: 0.84 to 0.88). CONCLUSION Preschool-aged children who accumulate less than 9000 steps per day may be considered Insufficiently Active.

Structural Veneer Based Composite Products from Hardwood Thinning - Part II: Testing of Hollow Utility Poles

Australian utility pole network is aging and reaching its end of life, with 70% of the 5 million poles currently in-service nationally installed within the 20 years following the end of World War II. The estimated investment required for the replacement or remedial maintenance of the aging 3.5 millions poles is as high as 1.75 billion dollars. Additionally, an estimated 21,700 high-durability new poles are required each year, representing further investment of 13.5 million dollars per year. Yet, agreements which progressively phase out logging of native forests around Australia have been signed, giving the industry about 25 years to make the transition from Crown native forests to plantations and private forests. As utility poles were traditionally cut from native forest hardwood species, finding solutions to source new poles currently presents a challenge. This paper presents tests on Veneer Based Composite hardwood hollow utility poles manufactured from Gympie messmate (Eucalyptus cloeziana) plantation thinning. Small diameter poles of nominal 115 mm internal diameter and 15 mm wall-thickness were manufactured in two half-poles butt jointed together, using 9 veneers per halfpole. The poles were tested in bending and shear, and experimental test results are presented. The mechanical performance of the hollow poles is discussed and compared to hardwood poles cut from mature trees and of similar size. Future research and different options for improving the current concept are proposed in order to provide a more reliable and cost effective technical solution to the current shortage of utility poles. © RILEM 2014.

Principles and guidelines for managing cattle grazing in the grazing lands of northern Australia: stocking rates, pasture resting, prescribed fire, paddock size and water points - a review

Beef cattle grazing is the dominant land use in the extensive tropical and sub-tropical rangelands of northern Australia. Despite the considerable knowledge on land and herd management gained from both research and practical experience, the adoption of improved management is limited by an inability to predict how changes in practices and combinations of practices will affect cattle production, economic returns and resource condition. To address these issues, past Australian and international research relating to four management factors that affect productivity and resource condition was reviewed in order to identify key management principles. The four management factors considered were stocking rates, pasture resting, prescribed fire, and fencing and water point development for managing grazing distribution. Four management principles for sound grazing management in northern Australia were formulated as follows: (1) manage stocking rates to meet goals for livestock production and land condition; (2) rest pastures to maintain them in good condition or to restore them from poor condition to increase pasture productivity; (3) devise and apply fire regimes that enhance the condition of grazing land and livestock productivity while minimising undesirable impacts; and (4) use fencing and water points to manipulate grazing distribution. Each principle is supported by several more specific guidelines. These principles and guidelines, and the supporting research on which they are based, are presented.

Veneer based composite hollow utility poles manufactured from hardwood plantation thinned trees

Australia’s utility pole network is aging and approaching its end of life. It is estimated that 70% of the 5 million poles currently in-service nationally were installed within the 20 years following the end of World War II and require replacement or remedial maintenance. Additionally, an estimated 21,700 high-durability new poles are required each year to support the expansion of the energy network. Utility poles were traditionally cut from native forest hardwood species. However, due to agreements which progressively phase out logging of native forests around Australia, finding new sources for utility poles presents a challenge. This paper presents the development of veneer based composite hardwood hollow utility poles manufactured from mid-rotation Gympie messmate (Eucalyptus cloeziana) plantation thinned trees (also referred to as “thinning”), as an alternative to solid hardwood poles. The incentives behind the project and benefits of the proposed products are introduced in the paper. Small diameter poles, of nominal 115 mm internal diameter and 15 mm wall-thickness, were manufactured in two half-poles butt jointed together, using 9 hardwood veneers per half-pole. The poles were tested in bending and shear, and experimental test results are presented. The mechanical performance of the hollow poles is discussed and compared to hardwood poles sourced from mature trees and of similar size. Additionally, the required dimensions of the proposed hollow pole to replace actual solid poles are estimated. Results show that the proposed product represents a viable technical solution to the current shortage of utility poles. Future research and different options for improving the current concept are proposed in order to provide a more reliable and cost effective product for structural and architectural applications in general.