Systematic review: Unmet supportive care needs in people diagnosed with chronic liver disease

Objective People with chronic liver disease, particularly those with decompensated cirrhosis, experience several potentially debilitating complications that can have a significant impact on activities of daily living and quality of life. These impairments combined with the associated complex treatment mean that they are faced with specific and high levels of supportive care needs. We aimed to review reported perspectives, experiences and concerns of people with chronic liver disease worldwide. This information is necessary to guide development of policies around supportive needs screening tools and to enable prioritisation of support services for these patients. Design Systematic searches of PubMed, MEDLINE, CINAHL and PsycINFO from the earliest records until 19 September 2014. Data were extracted using standardised forms. A qualitative, descriptive approach was utilised to analyse and synthesise data. Results The initial search yielded 2598 reports: 26 studies reporting supportive care needs among patients with chronic liver disease were included, but few of them were patient-reported needs, none used a validated liver disease-specific supportive care need assessment instrument, and only three included patients with cirrhosis. Five key domains of supportive care needs were identified: informational or educational (eg, educational material, educational sessions), practical (eg, daily living), physical (eg, controlling pruritus and fatigue), patient care and support (eg, support groups), and psychological (eg, anxiety, sadness). Conclusions While several key domains of supportive care needs were identified, most studies included hepatitis patients. There is a paucity of literature describing the supportive care needs of the chronic liver disease population likely to have the most needs—namely those with cirrhosis. Assessing the supportive care needs of people with chronic liver disease have potential utility in clinical practice for facilitating timely referrals to support services.

Systematic literature review of incidence rates of low-speed vehicle run-over incidents in children

Aim: To systematically review the literature investigating the incidence of fatal and or nonfatal low-speed vehicle run-over (LSVRO) incidents in children aged 0–15 years. Methods: The following databases were searched using specific search terms, from their date of conception up to June 2011: Cochrane Library, Medline, CINAHL, Embase, AMI, Sociological Abstracts, ERIC, PsycArticles, PsycInfo, Urban Studies and Planning; Australian Criminology Database; Dissertations and Thesis; Academic Research Library; Social Services Abstracts; Family and Society; Scopus; and Web of Science. A total of 128 articles were identified in the databases (33 found by hand searching). The title and abstract of these were read, and 102 were removed because they were not primary research articles relating to LSVRO-type injuries. Twenty-six articles were assessed against the inclusion (reporting population level incidence rates) and exclusion criteria, 19 of which were excluded, leaving a total of five articles for inclusion in the review. Findings: Five studies were identified that met the inclusion criteria. The incidence rate in nonfatal LSVRO events varied in the range of 7.09 to 14.79 per 100,000 and from 0.63 to 3.2 per 100,000 in fatal events. Discussion: Using International Classification of Diseases codes for classifying fatal or nonfatal LSVRO incidents is problematic as there is no specific code for LSVRO. The current body of research is void of a comprehensive secular population data analysis. Only with an improved spectrum of incidence rates will appropriate evaluation of this problem be possible, and this will inform nursing prevention interventions. The effect of LSVRO incidents is clearly understudied. More research is required to address incidence rates in relation to culture, environment, risk factors, car design, and injury characteristics. Conclusions: Thevlack of nursing research or policy around this area of injury, most often to children, indicates a field of inquiry and policy development that needs attention.

Themes in landscape architecture publishing: Past trends, future needs

Many scholars acknowledge the need for rigorous research in landscape architecture to improve practice and teaching, and several recent studies have explored research trends in the discipline. This study continues this exploration by reviewing the articles published in the three prominent English- language landscape architecture journals: Landscape Journal, Landscape Review, and the Journal of Landscape Architecture. Specifically, this study analyzes the abstracts from 441 research articles to determine specific themes and publishing trends over 31 years (1982–2013). Findings indicate that “history” is by far the most prominent research theme, followed by “social and cultural processes and issues” and “aesthetics.” Several themes—such as “sustainability and green infrastructure,” “participation and collaboration,” and “research methods and methodologies”—have become more prominent in recent years. However, topics of current social and political concern—such as “climate change,” “active living,” “energy,” and “health”—are not yet prominent themes in the research literature, and could be key areas for future contribution. With the exception of a few themes, findings also suggest a moderate degree of alignment between research and practice. The article concludes with recommendations for future areas of research that will better position landscape architecture as a research- oriented profession with broad social relevance.

Solid fuel block as an alternate fuel for cooking and barbecuing: Preliminary result

A large part of the rural people of developing countries use traditional biomass stoves to meet their cooking and heating energy demands. These stoves possess very low thermal efficiency; besides, most of them cannot handle agricultural wastes. Thus, there is a need to develop an alternate cooking contrivance which is simple, efficient and can handle a range of biomass including agricultural wastes. In this reported work, a highly densified solid fuel block using a range of low cost agro residues has been developed to meet the cooking and heating needs. A strategy was adopted to determine the best suitable raw materials, which was optimized in terms of cost and performance. Several experiments were conducted using solid fuel block which was manufactured using various raw materials in different proportions; it was found that fuel block composed of 40% biomass, 40% charcoal powder, 15% binder and 5% oxidizer fulfilled the requirement. Based on this finding, fuel blocks of two different configurations viz. cylindrical shape with single and multi-holes (3, 6, 9 and 13) were constructed and its performance was evaluated. For instance, the 13 hole solid fuel block met the requirement of domestic cooking; the mean thermal power was 1.6 kWth with a burn time of 1.5 h. Furthermore, the maximum thermal efficiency recorded for this particular design was 58%. Whereas, the power level of single hole solid fuel block was found to be lower but adequate for barbecue cooking application.

Coronary calcium scoring: Calcium location needs to be integrated!

Coronary calcium scoring (CCS) has been a topic of great interest lately. In a large population-based study comprising 6,722 patients, Detrano et al. (1) have effectively shown that CCS can be a strong predictor of incident coronary heart disease among different racial groups. Henneman et al. (2) have, however, reported that CCS does not reliably exclude the presence of (significant) atherosclerosis. This topic is quite controversial as there is significant evidence from Detrano's work that higher CCS is associated with an increased risk of acute coronary events. We think that the location of calcium within the coronary arteries should also be considered. Li et al. (3,4) have shown that the position of the calcium in the plaque is a better determinant of plaque vulnerability than the total calcium load. Using a biomechanical model, predicted maximum stress was found to increase by 47.5% when calcium deposits were located in the thin fibrous cap. The presence of calcium deposits in the lipid core or remote from the fibrous cap resulted in no increase in maximum stress. It was also noted that the presence of calcification within the lipid core may even stabilize the plaque. Integration of calcium location in CCS will, therefore, enable better assessment of severity of atherosclerosis and prediction of future cardiovascular events.

Basic Needs and Much More With One Kilowatt Per Capita

Conventional thinkin g holds that increased energy consumption is a prerequisite for economic and social development. This belief, together With the prospect of dwindling global petroleum supplies and the high costs of expanding energy supply generally, lead many to believe that it is not feasible to improve living standards substantially in the developing countries. But by shifting to high-quality energy carriers and by exploiting cost-effective opportunities for more efficient energy use, it would be possible to satisfy basic human needs and to provide considerable further improvements in living standards without significantly increasing per-capita energy use above the present level.

Community Pharmacies and the Needs of Mobile EU Citizens - A study on Finns living in Spain

Migration within the European Union (EU) has increased since the Union was established. Community pharmacies provide open access to health care services and can be the first, most frequently used or even the only contact with a nation s health care system among mobile community residents. In some of the mass-migration areas in Southern Europe, most of the customers may represent mobile citizens of foreign background. This has not always been taken into consideration in the development of community pharmacy services. Mobile patients have been on the EU's health policy agenda, but they have seldom been mentioned in the context of community pharmacies. In most of the EU member states, governments control the specific legislation concerning community pharmacies and there is no harmonised pharmaceutical policy or consistent minimal standards for community pharmacy services in the EU. The aim of this study was to understand medication use, the role of community pharmacies and the symptom mitigation process of mobile community residents. Finns living in Spain were used as an example to examine how community pharmacies in a EU member state meet the needs of mobile community residents. The data were collected by a survey in 2002 (response rate 53%, n= 533) and by five focus group discussions in 2006 (n=30). A large number (70%) of the respondents had moved to Spain for health reasons and suffered from chronic morbidity. Community pharmacies had an important role in the healthcare of mobile community residents and the respondents were mostly satisfied with these services. However, several medication safety risks related to community pharmacy practices were identified: 1) Availability of prescription medicines without prescription (e.g., antibiotics, sleeping pills, Viagra®, asthma medications, cardiovascular medicines, psoriasis medicines and analgesics); 2) Irrational use of medicines (e.g., 41% of antibiotic users had bought their antibiotics without a prescription, and the most common reasons for antibiotic self-medication were symptomatic common colds and sore throats); 3) Language barriers between patients and pharmacy professionals; 4) Lack of medication counselling; 5) Unqualified pharmacy personnel providing pharmacotherapy. A fifth of the respondents reported experiencing problems during pharmacy visits in Spain, and the lack of a common language was the source of most of these problems. The findings of this study indicate that regulations and their enforcement can play a crucial role in actually assuring the rational and safe use of medicines. These results can be used in the development of pharmaceutical and healthcare policies in the EU. It is important to define consistent minimum standards for community pharmacy services in the EU. Then, the increasing number of mobile community residents could access safe and high quality health care services, including community pharmacy services, in every member state within the EU.

Studies of Phosphazenes. Part 13.' Thermal Rearrangement Reactions of Some Met hoxycyclo phosp hazenes

The methoxycyclophosphazenes [NP(OMe),], (n = 3-6) rearrange on heating to give oxocyclophosphazanes, [N(Me)PO(OMe)],. Isomeric products are formed when n = 4-6. The lH, ,lP, and 13C n.m.r. data for the starting materials and the products are presented. The ethoxy- and n-propoxy-derivatives N,P,( OR)* do not undergo the above rearrangement. The geminal derivatives N,P,R,(OMe), (R = Ph or NHBut) on heating yield both fully and partially rearranged products, namely dioxophosphaz-1 -enes and oxophosphazadienes, as shown by 270- MHz lH n.m.r. spectroscopy. The non-geminal derivative N,P,( NMe,),(OMe), gives only the fully rearranged product N,Me,P,(NMe,),O,(OMe), whose structure has been established from its lH and 31P n.m.r. spectra.

Climate information needs of Gascoyne-Murchison pastoralists: a representative study of the Western Australian grazing industry

The Gascoyne-Murchison region of Western Australia experiences an arid to semi-arid climate with a highly variable temporal and spatial rainfall distribution. The region has around 39.2 million hectares available for pastoral lease and supports predominantly catle and sheep grazing leases. In recent years a number of climate forecasting systems have been available offering rainfall probabilities with different lead times and a forecast period; however, the extent to which these systems are capable of fulfilling the requirements of the local pastoralists is still ambiguous. Issues can range from ensuring forecasts are issued with sufficient lead time to enable key planning or decisions to be revoked or altered, to ensuring forecast language is simple and clear, to negate possible misunderstandings in interpretation. A climate research project sought to provide an objective method to determine which available forecasting systems had the greatest forecasting skill at times of the year relevant to local property management. To aid this climate research project, the study reported here was undertaken with an overall objective of exploring local pastoralists' climate information needs. We also explored how well they understand common climate forecast terms such as 'mean', median' and 'probability', and how they interpret and apply forecast information to decisions. A stratified, proportional random sampling was used for the purpose of deriving the representative sample based on rainfall-enterprise combinations. In order to provide more time for decision-making than existing operational forecasts that are issued with zero lead time, pastoralists requested that forecasts be issued for May-July and January-March with lead times counting down from 4 to 0 months. We found forecasts of between 20 and 50 mm break-of-season or follow-up rainfall were likely to influence decisions. Eighty percent of pastoralists demonstrated in a test question that they had a poor technical understanding of how to interpret the standard wording of a probabilistic median rainfall forecast. this is worthy of further research to investigate whether inappropriate management decisions are being made because the forecasts are being misunderstood. We found more than half the respondents regularly access and use weather and climate forecasts or outlook information from a range of sources and almost three-quarters considered climate information or tools useful, with preferred methods for accessing this information by email, faxback service, internet and the Department of Agriculture Western Australia's Pastoral Memo. Despite differences in enterprise types and rainfall seasonality across the region we found seasonal climate forecasting needs were relatively consistent. It became clear that providing basic training and working with pastoralists to help them understand regional climatic drivers, climate terminology and jargon, and the best ways to apply the forecasts to enhance decision-making are important to improve their use of information. Consideration could also be given to engaging a range of producers to write the climate forecasts themselves in the language they use and understand, in consultation with the scientists who prepare the forecasts.

Developing African mahogany (Khaya senegalensis) germplasm and its management for a sustainable forest plantation industry in northern Australia: Progress and needs.

The demonstrated wide adaptability, substantial yield potential and proven timber quality of African mahogany (Khaya senegalensis) from plantings of the late 1960s and early 1970s in northern Australia have led to a resurgence of interest in this high-value species. New plantations or trials have been established in several regions since the early 1990s -in four regions in north Queensland, two in the Northern Territory and one in Western Australia. Overall, more than 1500 ha had been planted by early 2007, and the national annual planting from 2007-2008 as currently planned will exceed 2400 ha. Proceedings of two workshops have summarised information available on the species in northern Australia, and suggested research and development (R&D) needs and directions. After an unsustained first phase of domestication of K. senegalensis in the late 1960s to the early 1970s, a second phase began in northern Australia in 2001 focused on conservation and tree improvement that is expected to provide improved planting stock by 2010. Work on other aspects of domestication is also described in this paper: the current estate and plans for extension; site suitability, soils and nutrition; silviculture and management; productivity; pests and diseases; and log and wood properties of a sample of superior trees from two mature plantations of unselected material near Darwin. Some constraints on sustainable plantation development in all these fields are identified and R&D needs proposed. A sustained R&D effort will require a strategic coordinated approach, cooperative implementation and extra funding. Large gains in plantation profitability can be expected to flow from such inputs.

Standardising bull breeding soundness evaluations and reporting in Australia

There is substantial variation in bull breeding soundness evaluation procedures and reports in Australia; the situation is compounded by difficulties in interpretation and the validity of many reports. In an effort to overcome this, the scientific literature was reviewed [Fordyce G. In: Fordyce G, editor. Bull fertility: selection and management in Australia. Eight Mile Plains, Australia: Australian Cattle Vets; 2002] and the needs of stakeholders were considered in preparing a manual, Evaluating and Reporting Bull Fertility [Entwistle KW, Fordyce G. Evaluating and reporting bull fertility. Eight Mile Plains, Australia: Australian Cattle Vets; 2003.] that outlined standards for assessing and reporting bull breeding soundness. A new recording and reporting system, called Bull Reporter, is based on standards from this manual and groups bull fertility traits into five summary categories: Scrotum, Physical, Crush-side Semen, Sperm Morphology, and Serving. The client will generally select which categories they wish to have included in the evaluation to suit their specific purposes. While there is adequate room for comments, the veterinarian is not required to make an overall judgment of whether the bull has normal capacity to sire calves under natural mating management, but ensures the standards for each selected category are met. Professional, standardised, easy-to-read reports are produced either electronically [Entwistle KW, Fordyce G. Evaluating and reporting bull fertility. Eight Mile Plains, Australia: Australian Cattle Vets; 2003.] or manually. A bull owner or their agent signs the certificate to affirm that bulls have not undergone procedures to rectify faults which may have otherwise caused them to fail the standards. An accreditation system for assessing sperm morphology was established because of its demonstrated relationship with pregnancy rates and because of the difficulties in achieving consistent and accurate assessments among laboratories. It is considered that Bull Reporter is applicable to beef and dairy bulls across all levels of management, genotypes and environments throughout Australia, with substantial potential for application elsewhere in the world.

Australia needs an innovation ‘skunkworks’

Malcolm Turnbull has been heralded as the new “innovation PM”. Expectations are high that he must now translate his rhetoric around agility, disruption, entrepreneurship into concrete economic policies...

On a Novel Concept of Continuing Education

A continuing education program PROFICIENCE is described, which is the collaborative effort of 14 Professional Institutions in Bangalore and the Indian Institute of Science, to give full-term rigorous courses of topical interest. The novel aspect is that the professional institutions are coming together to evolve the academic needs that are met by the Indian Institute of Science. More than 4000 participants have benefited since its inception in August 1980.

Building better information products by assessing the information needs of growers of subtropical strawberries in Queensland

Timely access to effective technical information is a key ingredient of profitable strawberry production. Through the Better Berries Program, a joint RD&E initiative of government and industry, a number of information products and services have been provided in recent years to Australia's subtropical strawberry industry, centred in southern Queensland. However, there is a lack of knowledge of how well these are meeting the information needs of growers, both in content and delivery. To better understand grower information use and needs, a stratified sample of 25 growers was interviewed on-farm during the 2004 season. Growers were asked about how they currently accessed information, what they thought of a range of information products and ideas on show, and what advice they would provide for information development in the future. Results indicated that information sought by growers and the style in which it is best presented, varied considerably with grower experience, but little with farm size. New growers had a wide range of needs while the needs of experienced growers were focused mainly on problem identification and new production development. Interestingly, the overwhelming majority across all sectors still preferred paper-based information products despite their extensive use of computers for business purposes. The findings were used to develop a strategy for an improved range of technical information products and services that are more accessible, easier to use, more timely, and more relevant to the needs of growers.

Analysing industry needs to fine tune IPM project activities

As a first step to better targeting the activities of a project for improving management of western flower thrips, Frankliniella occidentialis, (WFT) in field grown vegetable crops, we surveyed growers, consultants and other agribusiness personnel in two regions of Queensland. Using face-to-face interviews, we collected data on key pests and measures used to manage them, the importance of WFT and associated viral diseases, sources of pest management information and additional skills and knowledge needed by growers and industry. Responses were similar in the two regions. While capsicum growers in one northern Queensland district had suffered serious losses from WFT damage in 2002, in general the pest was not seen as a major problem. In cucurbit crops, the silverleaf whitefly (Bemisia tabaci biotype B) was considered the most difficult insect pest to manage. Pest control tactics were largely based on pesticides although many respondents mentioned non-chemical methods such as good farm hygiene practices, control of weed hosts and regular crop monitoring, particularly when prompted. Respondents wanted to know more about pest identification, biology and damage, spray application and the best use of insecticides. Natural enemies were mentioned infrequently. Keeping up to date with available pesticide options, availability of new chemicals and options for a district-wide approach to managing pests emerged as key issues. Growers identified agricultural distributors, consultants, Queensland Department of Primary Industries staff, other growers and their own experience as important sources of information. Field days, workshops and seminars did not rank highly. Busy vegetable growers wanted these activities to be short and relevant, and preferred to be contacted by post and facsimile rather than email. In response to these results, we are focusing on three core, interrelated project extension strategies: (i) short workshops, seminars and farm walks to provide opportunities for discussion, training and information sharing with growers and their agribusiness advisors; (ii) communication via newsletters and information leaflets; (iii) support for commercialisation of services.