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Multi-morbidity due to diabetes and chronic kidney disease (CKD) remains challenging for current health-systems, which focus on single diseases. As a first step toward health-care improvement, we explored the perspectives of patients and their carers on factors influencing the health-care of those with co-morbid diabetes and CKD. In this qualitative study participants with co-morbid diabetes and CKD were purposively recruited using maximal variation sampling from 4 major tertiary health-services from 2 of Australia's largest cities. Separate focus groups were conducted for patients with CKD stages 3, 4 and 5. Findings were triangulated with semi-structured interviews of carers of patients. Discussions were transcribed verbatim and thematically analysed. Twelve focus groups with 58 participants and 8 semi-structured interviews of carers were conducted. Factors influencing health-care of co-morbid diabetes and CKD grouped into patient and health service level factors. Key patient level factors identified were patient self-management, socio-economic situation, and adverse experiences related to co-morbid diabetes and CKD and its treatment. Key health service level factors were prevention and awareness of co-morbid diabetes and CKD, poor continuity and coordination of care, patient and carer empowerment, access and poor recognition of psychological co-morbidity. Health-service level factors varied according to CKD stage with poor continuity and coordination of care and patient and carer empowerment emphasized by participants with CKD stage 4 and 5, and access and poor recognition of psychological co-morbidity emphasised by participants with CKD stage 5 and carers. According to patients and their carers the health-care of co-morbid diabetes and CKD may be improved via a preventive, patient-centred health-care model which promotes self-management and that has good access, continuity and coordination of care and identifies and manages psychological morbidity.

Background: The majority of Australians with end-stage kidney disease undertake their dialysis treatment in a hospital or satellite centre. Dialysis patients are committed to having a repeating, high-frequency program and a potentially lifelong dependency on transport to survive. Existing knowledge about dialysis transport in Australia indicates a fragmented system that often does not meet the needs of those on dialysis. Methods: Between May 2014 and July 2014, nurse managers at each of the 200 dialysis units in Australia with more than five dialysis-dependent patients were invited to complete an online survey of patient transport issues. The survey contained seven questions examining multiple aspects of patient transport and two open-ended questions to record qualitative experiences in patient transport. Results: The national response rate was 50% (100 surveys). State-based transport arrangements were found to operate on an ad hoc basis, with 77% of units reporting inadequate transport access. Assisted transport was used for 1.7 journeys (one-way) per person per week (excluding family support). High-use transport sources were community-based transport (44%) ambulance services (39%) and subsidised taxis (28%). On average, 12% of patients experience unresolved transport difficulties in the long term. Parking cost $10-$15 each treatment for 10% of units but was free at the majority of units. Conclusions: This survey has confirmed that the Australian dialysis transport system is inconsistent, uses expensive transport sources, and is inadequate for regular and routine dialysis attendance. The system requires systematic recognition and streamlining with the potential to save costs and to improve the quality of life for those on dialysis.

Background Chronic obstructive pulmonary disease (COPD) includes chronic bronchitis and emphysema and is characterized by persistent airflow limitation. It is caused by long-term exposure to harmful particles or gases, leading to significant breathing difficulties and substantially impacting quality of life. Understanding the complexity and socioeconomic burden of COPD is vital for improving patient outcomes and addressing broader implications. This study assesses the self-reported physical activity levels of COPD patients in the United States using the 2021 Behavioral Risk Factor Surveillance System (BRFSS) data, exploring the impact of demographic, socioeconomic, and healthcare access variables. Methodology The 2021 BRFSS data were analysed, focusing on 34,061 individuals diagnosed with COPD, emphysema, or chronic bronchitis. Fisher's exact test and the chi-square test were used to examine associations between self-reported physical activity levels and demographic (age, gender, race), socioeconomic (education, employment, income), and healthcare access (last routine check-up) variables, with 95% confidence intervals. Results Of the 435,780 BRFSS participants, 7.8% reported having COPD. Among these, 55% engaged in physical activity compared to 77.4% of non-COPD individuals. Physical activity levels were significantly lower among COPD patients (p < 0.001), with notable variations across age groups, genders, races, education levels, employment statuses, income categories, and time since the last routine check-up. Conclusions The findings reveal a significant disparity in physical activity between COPD patients and non-COPD individuals. These findings highlight the need for targeted interventions to improve physical activity among COPD patients to enhance their health outcomes and quality of life.

In this study of 263 heart, kidney, liver, and pancreas transplant patients, BK virus (BKV) and JC virus (JCV) DNAemia were observed most commonly in kidney and/or pancreas transplant patients (26%), although they were also observed, to a lesser extent, in heart (7%) and liver (4%) transplant patients. The majority of episodes of polyomavirus DNAemia were subclinical, although, in some cases, BKV DNAemia was associated with kidney rejection, and JCV DNAemia was accompanied by nonspecific symptoms. Hence, BKV and JCV DNAemia are not uncommon during the first year after kidney, heart, liver, and pancreas transplantation, and they could be associated with certain clinical syndromes in transplant patients

The International Federation of Kidney Foundations surveyed its members on chronic kidney disease ‘prevention’ programs in their regions and countries in 2005 and 2007. A profile was developed, representing 28 countries (56% response). Some form of screening activity was reported in 24 of the 28 countries (85.7%). Two countries (7%) had, or anticipated development of, legislated national screening. Programs were conducted by kidney foundations or research groups, and were variously population based, focused on high risk groups or opportunistic. Tests in 63% of responding programs included weight, height, blood pressure, blood glucose, dipstick urinalysis and serum creatinine. Several programs used the USA's Kidney Early Evaluation Program's and International Society of Nephrology's templates. World Kidney Day activities contributed significantly. Stated needs were for more government recognition, firm policies and approaches, and critically, resources. Repeat responders reported progress in 2007, particularly in government interest and education delivery. Despite difficulties, programs are developing in many regions. Most need more resources and some members need substantial and sustained assistance.

The Open Championship, one of the largest remaining jewels in the BBC's sporting crown, is courting satellite television. The Royal and Ancient, which runs the Open, has approached BSkyB through an intermediary and is discussing a deal worth pounds 25m over five years. The BBC is paying less than pounds 1m a year. The event is synonymous with the BBC but the television contract expires after the 125th Open at Royal Lytham in July. The Open is not one of the \"listed\" events - the Olympic Games, the World Cup, Test cricket, Wimbledon, the Grand National, the Derby, the FA Cup final and the Scottish FA Cup final - prevented by current legislation from being broadcast on pay-TV. The success of the Open, which makes a profit of pounds 3-4m a year, makes the R and A financially self-sufficient but it needs more to develop the game at grass roots. Through an intermediary, TWI, the television arm of Mark McCormack's International Management Group, it is testing the water with subscription television.

Driven by the proliferation of augmented reality (AR) technologies, many firms are pursuing a strategy of service augmentation to enhance customers’ online service experiences. Drawing on situated cognition theory, the authors show that AR-based service augmentation enhances customer value perceptions by simultaneously providing simulated physical control and environmental embedding. The resulting authentic situated experience, manifested in a feeling of spatial presence, functions as a mediator and also predicts customer decision comfort. Furthermore, the effect of spatial presence on utilitarian value perceptions is greater for customers who are disposed toward verbal rather than visual information processing, and the positive effect on decision comfort is attenuated by customers’ privacy concerns.

Ocean warming is driving species poleward, causing a ‘tropicalization’ of temperate ecosystems around the world. Increasing abundances of tropical herbivores on temperate reefs could accelerate declines in habitat-forming seaweeds with devastating consequences for these important marine ecosystems. Here we document an expansion of rabbitfish ( Siganus fuscescens ), a tropical herbivore, on temperate reefs in Western Australia following a marine heatwave and demonstrate their impact on local kelp forests ( Ecklonia radiata ). Before the heatwave there were no rabbitfish and low rates of kelp herbivory but after the heatwave rabbitfish were common at most reefs and consumption of kelp was high. Herbivory increased 30-fold and kelp abundance decreased by 70% at reefs where rabbitfish had established. In contrast, where rabbitfish were absent, kelp abundance and herbivory did not change. Video-analysis confirmed that rabbitfish were the main consumers of kelp, followed by silver drummers ( Kyphosus sydneyanus ), a temperate herbivore. These results represent a likely indirect effect of the heatwave beyond its acute impacts, and they provide evidence that range-shifting tropical herbivores can contribute to declines in habitat-forming seaweeds within a few years of their establishment.

The timing and duration of the coldest period in the last glacial stage, often referred to as the last glacial maximum (LGM), has been observed to vary spatially and temporally. In Australia, this period is characterised by colder, and in some places more arid, climates than today. We applied Monte-Carlo change point analysis to all available continuous proxy records covering this period, primarily pollen records, from across Australia (n = 37) to assess this change. We find a significant change point occurred (within uncertainty) at 28.6 ± 2.8 ka in 25 records. We interpret this change as a shift to cooler climates, associated with a widespread decline in biological productivity. An additional change point occurred at 17.7 ± 2.2 ka in 24 records. We interpret this change as a shift towards warmer climates, associated with increased biological productivity. We broadly characterise the period between 28.6 (± 2.8) – 17.7 (± 2.2) ka as an extended period of maximum cooling, with low productivity vegetation that may have occurred as a combined response to reduced temperatures, lower moisture availability and atmospheric CO2. These results have implications for how the spatial and temporal coherence of climate change, in this case during the LGM, can be best interrogated and interpreted.

Cardiorespiratory fitness is a strong predictor of cardiovascular (CV) disease and all-cause mortality, with increases in cardiorespiratory fitness associated with corresponding decreases in CV disease risk. The effects of exercise upon the myocardium and vascular system are dependent upon the frequency, intensity and duration of the exercise itself. Following a prolonged period (≥6 months) of regular intensive exercise in previously untrained individuals, resting and submaximal exercising heart rates are typically 5–20 beats lower, with an increase in stroke volume of ∼20% and enhanced myocardial contractility. Structurally, all four heart chambers increase in volume with mild increases in wall thickness, resulting in greater cardiac mass due to increased myocardial cell size. With this in mind, the present paper aims to review the basic science behind the CV benefits of exercise. Attention will be paid to understanding (1) the relationship between exercise and cardiac remodelling; (2) the cardiac cellular and molecular adaptations in response to exercise, including the examination of molecular mechanisms of physiological cardiac growth and applying these mechanisms to identify new therapeutic targets to prevent or reverse pathological remodelling and heart failure; and (3) vascular adaptations in response to exercise. Finally, this review will briefly examine how to optimise the CV benefits of exercise by considering how much and how intense exercise should be.