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Urine patches from grazing ruminants contain high concentrations of nitrogen (N) and are the main source of N leaching from grazed pastoral farming systems. While there have been various options identified to substantially reduce N leaching, in general these practices increase the cost of production or reduce production per hectare. In New Zealand, multi‐species pastures were evaluated as a cheaper option that would potentially retain productivity. Early research showed these pastures had lower urinary N excretion from grazing animals and increased plant N uptake, compared with standard New Zealand perennial ryegrass/white clover (PR‐WC) pastures. Further research highlighted the beneficial attributes of the pasture herb narrow‐leaved plantain (Plantago lanceolata; PL), specifically: reduced urine N concentration, reduced urine N excretion, and reduced rate of soil nitrification. Significant reductions (14%–89%) in N leaching were found from cow urine applied to lysimeters with pastures including PL, compared with PR‐WC pasture. Paddock‐scale measurements confirmed the effects of PL, with 20%–60% lower N leaching when PL comprised 30%–40% of the dry matter (DM) of PL‐PR‐WC grazed pastures. There were no negative effects on milk production and composition when feeding PL to dairy cows, but small positive effects on fatty acid profiles. However, weed and pest management, palatability and persistence remain challenging in pastures containing PL on commercial farms. Management options need to be clarified to ensure successful establishment and maintenance of PL. Additionally, the cultivar differences in secondary compounds and their impact on nitrification rate and N leaching need to be better understood. [ABSTRACT FROM AUTHOR]

Communicating non-urgent, urgent and frank emergency requests for assistance between anaesthetists in theatre often requires a 'go-between' - frequently a non-anaesthetic healthcare professional - to transmit information. We compared the currently recommended situation, background, assessment, recommendation (SBAR) tool with a newly devised Traffic Lights tool ('red alert', 'amber assist' and 'green query') in a simulation study to assess communication quality using 12 validated clinical scenarios of varying urgency. Compared to SBAR, Traffic Lights was used more consistently ('very clear' or 'clear' Traffic Lights 94% vs SBAR 69%); transferred information better (two or three pieces of information correctly transferred Traffic Lights 85%, SBAR 44%; and was judged to lead to greater clarity (all p < 0.0001). Message delivery time was significantly reduced (Traffic Lights 20.5 s vs SBAR 45.5 s, median (95% CI) difference 25 (19-30) s, p < 0.001). Users rated the Traffic Lights system as significantly more useful than SBAR, with 96% of participants preferring the Traffic Lights tool. Results were independent of go-between training. We recommend the adoption of this communication tool as standard practice for anaesthetic teams. [ABSTRACT FROM AUTHOR]

Background Although there is evidence that minimal surveillance is compatible with an optimal outcome in women after early stage breast cancer, little is known of the surveillance that these women receive. Aims To describe the intended clinical follow up and patterns of use of imaging modalities in low-risk breast cancer survivors who are at least 5 years from diagnosis. Methods Participants in the Bupa Health Foundation Health and Wellbeing After Breast Cancer Study with stage 1 invasive breast cancer at diagnosis, who had survived free of recurrence or new primary breast cancer for at least 5 years, provided information for this analysis. Results The most common choice of physician follow up was with one doctor only (54%). Within this group, the most frequent choice was a general practitioner ( GP) (63%) followed by medical oncologist (23%). Thirty-five per cent of women said that they intended to consult two doctors and within this group, the most common combination was a GP and a medical oncologist (45%). This was despite two out of three women reporting being advised that there was no need to consult a medical oncologist. Over 90% of women reported having a mammogram with, or without, breast ultrasound in the previous 12 months. There was a low rate of use of other imaging tests in the absence of clear indications. Conclusions Minimising unnecessary medical consultations by women with breast cancer at low risk of recurrence 5 years from diagnosis will require education about the benefits of a minimal surveillance strategy. [ABSTRACT FROM AUTHOR]

Background Recently, the dual-energy X-ray absorptiometry ( DXA) diagnostic cut-off ( T-score) for Australian Pharmaceutical Benefits Scheme ( PBS) supported primary fracture prevention therapy with alendronate for older women (>70 years) has been changed from −3.0 to −2.5. Aim To examine the impact of the expanded criteria for PBS-supported fracture prevention therapy in older women on case finding and cost. Methods One thousand, nine hundred and eighty-three women, median age 76 years, not previously known to have low bone mineral density by DXA or a vertebral fracture underwent DXA scanning and a thoracolumbar X-ray. A woman was considered eligible for fracture prevention therapy if she had a T-score ≤−2.5 at the femoral neck and/or the lumbar vertebrae (two to four) or at least one vertebral fracture of ≥20% deformity. Results Seven hundred and forty-six women (37.6%) met the new criteria as a case for PBS-subsidised fracture prevention therapy. Four hundred and thirty-one (21.7%) had a T-score ≤−2.5 on DXA compared with 10.6% ( n = 210) with a T-score ≤−3.0. Four hundred and eighty-three (24.4%) had at least one vertebral fracture. Only 8.5% ( n = 168) had both a T-score ≤−2.5 and a prevalent vertebral fracture. The cost per case found by DXA equated to $460 compared with $398 for screening by thoracolumbar X-ray. Conclusions The use of either DXA or X-ray will identify approximately two-thirds of women aged 70 years and over who would be eligible for fracture prevention. The use of X-ray would identify a marginally larger number of women and at lower financial cost but involve substantially greater radiation exposure. [ABSTRACT FROM AUTHOR]

1. Floodplain environments are increasingly subject to enhancement and restoration, with the purpose of increasing their biodiversity and returning them to a more ‘natural’ state. Defining such a state based solely upon neoecological data is problematic and has led several authors to suggest the use of a palaeoecological approach. 2. Fossil Coleopteran assemblages recovered from multiple palaeochannel fills in south-west England were used to investigate past floodplain and channel characteristics during the mid- to late-Holocene. Ordination of coleopteran data was performed using Detrended Correspondence Analysis (DCA) and produced clear and discrete clustering. This clustering pattern is related to the nature of the environment in which assemblages were deposited and hence channel configuration and dynamics. 3. The DCA clustering pattern is strongly related to measures of ecological evenness, and a strong relationship between these indices and the composition of the water beetle assemblage within samples was revealed. Repeating the ordination with presence–absence data results in a similar pattern of clustering, implying that assemblage composition is crucial in determining cluster placement. 4. As assemblage composition is primarily a function of floodplain topography and hence disturbance regime, we attempt to relate these data to the Intermediate Disturbance Hypothesis (IDH). A significant positive correlation was found between ecological diversity (Shannon's H′) and Axis 1 of all ordinations in predominantly aquatic assemblages. [ABSTRACT FROM AUTHOR]

Abstract Background: The parenteral administration of oestradiol acutely protects against exercise-induced myocardial ischaemia in women, but whether this effect is sex ­specific is not known. Aims: The effects of acutely administered conjugated equine oestrogen on exercise-induced myocardial ischaemia in men with established coronary heart disease were investigated in a randomized, placebo-­controlled, double-blind cross-over trial. Methods: Twenty men, aged 62 ± 11.6 years, with reproducible exercise-induced myocardial ischaemia were treated with either intravenous conjugated equine oestrogen (25 mg) or saline prior to undergoing an exercise stress test. Primary end-points were total exercise time and time to 1 mm ST-segment depression. Results: All participants completed the protocol. Total exercise time exceeded the baseline value in 17 of the 20 men following saline, and in 17 of the 20 men following oestrogen pretreatment. Time to 1 mm ST-segment depression exceeded the baseline value in 14 of the 19 men following saline, and following oestrogen administration, exceeded baseline in 13 of the 19 men. There was no significant difference between the two treatments in either time to 1 mm ST-segment depression or total exercise time. A period effect was apparent for total exercise time (P = 0.05) but not for time to ST-segment depression. Conclusion: Acute parenteral oestrogen therapy did not increase total exercise time or time to the onset of electrocardiographic changes of ischaemia in men with chronic stable coronary artery disease. These findings contrast the favourable effects of oestrogen in women in comparable studies and indicate a sex specificity for the acute cardiovascular effects of oestrogen. (Intern Med J 2003; 33: 221-224). [ABSTRACT FROM AUTHOR]

A response from the authors of the article, "The 'go-between' study: a simulation study comparing the 'Traffic Lights' and 'SBAR' tools as a means of communication between anaesthetic staff," in the 2016 issue of the journal is presented.

SUMMARY Most patients presenting with malignant mesothelioma of the pleura (MMP) are only suitable for palliative treatment. Radiotherapy has not been shown to improve survival in patients with this disease, but is of use in the palliation of symptoms. In this retrospective review of 111 patients with MMP referred to the Peter MacCallum Cancer Institute, the palliative effect of radiotherapy was analysed. More than half of the patients whose response could be assessed had some symptomatic relief from the radiotherapy treatment. No dose-response relationship could be found. [ABSTRACT FROM AUTHOR]

Five primiparous and five multiparous cows were used to determine if mammary cisternal storage of milk during a 24 h period of milk accumulation limited milk secretion. In addition, we investigated if there is a parity effect for the capacity of the mammary cisternal compartment to hold a 24 h accumulation of milk secretion, and studied the movement of milk from the alveolar compartment into the cisternal compartment. All cows were fitted with catheters in all teats in order to collect cisternal and alveolar milk fractions separately. For a 24 h period of milk accumulation, the milk was drained once (after 24 h) from one side of the udder (OD), and continuously from the other side of the udder (CD). There was no significant parity effect for cisternal, alveolar and total milk volumes at 24 h. Therefore, data from primi- and multiparous cows were pooled for subsequent analyses. Cisternal milk volume from CD glands was higher than that from OD glands (P < 0.01), indicating that cisternal storage of milk in the mammary gland may be limiting to milk secretion during 24 h milking intervals. Alveolar volumes did not differ between OD and CD, but, as a result of the higher cisternal milk volume, total milk volume was highest in the CD glands (P = 0.05). Movement of milk from the alveolar into the cisternal compartment was intermittent. Moreover, analyses of the slopes of individual milk accumulation profiles of the first 6 h of accumulation revealed that the cisternal compartment starts filling immediately following milking, although the rate of filling is relatively low until 7-8 h postmilking.

Human synthetic parathyroid hormone-related protein (PTHrP) increased mammary blood flow (MBF) following close-arterial infusion via the external pudic artery in goats during mid-lactation. MBF increased 74 +/- 8% within 30 min of the start of continuous infusion of PTHrP compared with 10 +/- 3% in controls. MBF decreased by 90 min, however, and was not different from control values for the remainder of the infusion. The increase in plasma concentrations of calcium and decrease in phosphate during PTHrP suggests that this was not due to altered activity of PTHrP, but may relate to downregulation of response or production of counter-regulatory vasoconstrictive agents within the gland. This problem was alleviated when PTHrP was infused in a pulsatile fashion. An average 14-40% increase in MBF was achieved over 6 h, but this did not alter the rate of milk secretion, suggesting that mammary hyperaemia is not sufficient by itself to increase milk yield in the normally lactating goat. MBF increased in a dose-dependent fashion, although the lowest dose used to give a detectable response was approximately 40-fold higher than the concentration normally present in the mammary venous circulation. Thus, endogenous PTHrP may not be an important regulator of MBF during lactation in the goat.