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ObjectivesTo explore the impact of a temporary cancellation of elective surgery in winter 2017 on trends in primary hip and knee replacement at a major National Health Service (NHS) Trust, and whether lessons can be learnt about efficient surgery provision.Design and settingObservational descriptive study using interrupted time series analysis of hospital records to explore trends in primary hip and knee replacement surgery at a major NHS Trust, as well as patient characteristics, 2016–2019.InterventionA temporary cancellation of elective services for 2 months in winter 2017.OutcomesNHS-funded hospital admissions for primary hip or knee replacement, length of stay and bed occupancy. Additionally, we explored the ratio of elective to emergency admissions at the Trust as a measure of elective capacity, and the ratio of public to private provision of NHS-funded hip and knee surgery.ResultsAfter winter 2017, there was a sustained reduction in the number of knee replacements, a decrease in the proportion of most deprived people having knee replacements and an increase in average age for knee replacement and comorbidity for both types of surgery. The ratio of public to private provision dropped after winter 2017, and elective capacity generally has reduced over time. There was clear seasonality in provision of elective surgery, with less complex patients admitted during winter.ConclusionsDeclining elective capacity and seasonality has a marked effect on the provision of joint replacement, despite efficiency improvements in hospital treatment. The Trust has outsourced less complex patients to independent providers, and/or treated them during winter when capacity is most limited. There is a need to explore whether these are strategies that could be used explicitly to maximise the use of limited elective capacity, provide benefit to patients and value for money for taxpayers.

Conventional viticultural practice in Australia and elsewhere involves removal of under‐vine vegetation using herbicides or cultivation. Concerns over the long‐term effects of herbicides on soil health, evolution of resistant weeds and possible impacts on human health motivate the search for alternative weed management options. Industry‐supported trials on commercial vineyards in four South Australian regions investigated standard practices of straw mulch and bare earth created with herbicides, compared to under‐vine cover crops, focusing on soil health attributes (soil carbon, soil microbiological processes, etc.) and grape yields in 2016 and 2017. Measured yields with the Control (herbicide) treatment were combined with published district grape prices and yields over the 12‐year (2006–2017) period, defining multivariate distributions of gross revenues ($/ha). Assuming all treatments produce grapes of equal quality and price as the Control, our results showed median per‐hectare gross margins greater than the Control in the Barossa district, lower than Control in Riverland, and mixed results in Langhorne Creek and Eden Valley. Multi‐year risk profiles, based on decadal whole‐farm (50 ha) cash flows for each treatment, were calculated using Monte Carlo analysis, based on historical yield and price distributions. These risk profiles showed the under‐vine treatments may result in major differences in long‐term vineyard financial viability.

Background and aims The literature demonstrates that hepatic steatosis reduces the tolerance of immunosuppression in people with inflammatory bowel disease. It also shows that elevated methylmercaptopurine may be responsible for thiopurine-induced hepatitis. This exploratory study investigates the relationship between hepatic steatosis, methylmercaptopurine and alanine transaminase.Methods We performed a retrospective review of patients started on azathioprine treatment at University Hospitals Bristol NHS Foundation Trust between 2014 and 2017. There were 600 patients in total. Ninety-one patients met our inclusion criteria which were at least one ultrasound scan commenting on the appearance of the liver, liver function tests at commencement of azathioprine and liver function tests and a methylmercaptopurine level between 6 and 8 weeks after starting treatment.Results Of 91 patients included in our study, 32 patients (32%) were identified as having radiological hepatic steatosis on ultrasound imaging and 59 patients had no evidence of steatosis. We found a positive association between methylmercaptopurine levels and change in alanine transaminase in patients with hepatic steatosis (P Conclusion We conclude that the higher levels of methylmercaptopurine may be a risk factor for hepatitis in patients with hepatic steatosis but not in those with a normal liver.

Purpose The aim of this paper is to determine whether health-related quality of life (HRQOL) at diagnosis of head and neck cancer (HNC) is associated with overall survival following treatment with curative intent after adjusting for other factors. Methods Data were collected from 5511 participants of the Head and Neck 5000 study (HN5000). HRQOL was measured using the EORTC QLQ-C30. Questionnaire and covariate data were available from 2171 participants diagnosed as follows: oral cavity (655), oropharynx HPV+ (723) and HPV− (277), and larynx (516). On average, participants were followed up 3.2 years (SD 1.2) after diagnosis. Data were adjusted for age, gender, co-morbidity, intended treatment, education level, income from benefits, smoking status and alcohol consumption. Results There was a clinically meaningful difference between Global HRQOL scores at diagnosis and survival in an unadjusted and adjusted model: [HR = 0.86, CI 0.82–0.89, p p Conclusion As survival is the main priority for most people diagnosed with cancer, pre-treatment HRQOL is an additional factor to be included in risk stratification and case-mix adjustments. There is merit in incorporating HRQOL into routine clinical care as this is a useful facet in patient-clinician decision making, prognostication and recovery.

ObjectivesTo identify risk factors associated with prolonged length of hospital stay and staying in hospital longer than medically necessary following primary knee replacement surgery.DesignRetrospective, longitudinal observational study.SettingElective knee replacement surgeries between 2016 and 2019 were identified using routinely collected data from an NHS Trust in England.ParticipantsThere were 2295 knee replacement patients with complete data included in analysis. The mean age was 68 (SD 11) and 60% were female.Outcome measuresWe assessed a binary length of stay outcome (>7 days), a continuous length of stay outcome (≤30 days) and a binary measure of whether patients remained in hospital when they were medically fit for discharge.ResultsThe mean length of stay was 5.0 days (SD 3.9), 15.4% of patients were in hospital for >7 days and 7.1% remained in hospital when they were medically fit for discharge. Longer length of stay was associated with older age (b=0.08, 95% CI 0.07 to 0.09), female sex (b=0.36, 95% CI 0.06 to 0.67), high deprivation (b=0.98, 95% CI 0.47 to 1.48) and more comorbidities (b=2.48, 95% CI 0.15 to 4.81). Remaining in hospital beyond being medically fit for discharge was associated with older age (OR=1.07, 95% CI 1.05 to 1.09), female sex (OR=1.71, 95% CI 1.19 to 2.47) and high deprivation (OR=2.27, 95% CI 1.27 to 4.06).ConclusionsThe regression models could be used to identify which patients are likely to occupy hospital beds for longer. This could be helpful in scheduling operations to aid hospital efficiency by planning these patients’ operations for when the hospital is less busy.

Introduction Previous research suggests that patient-reported outcomes plateau by one year after total knee replacement (TKR). Analysis of trajectories to date has predominately been based on changes in median/mean scores over the first post-operative year, rather than variability in trajectory patterns over the longer-term. The aim was to evaluate variability in long-term pain and function trajectories after TKR. Hypothesis There will be variability in long-term pain and function trajectories after TKR. Patients and methods In all, 266 patients undergoing a Triathlon® TKR because of osteoarthritis were recruited from one orthopaedic centre. Participants completed the WOMAC Pain and Function scales preoperatively and then at 3 months, 1 year, 2 years, 3 years, 5 years and 7 years post-operative. Longitudinal analyses evaluated patterns of clinically meaningful change. Results Most patients had an improvement in pain and function during the first year post-operative; improvement was greatest in the first 3 months. By 1-year post-operative, 8% of patients had no change or a worsening of pain and 21% for function. Thereafter, approximately 15% of patients improved and 15% worsened between each assessment time. For those patients who had no change in symptoms from pre-operative to 1-year post-operative, one third had further improvement between 1 and 2 years post-operative. Discussion This study identified clinically meaningful variability in long-term outcomes after TKR, which could be discussed with patients to ensure they have realistic expectations of their outcome. Further research is needed to evaluate determinants of this variability and whether patients who will do poorly can be identified early in their recovery pathway. Level of evidence IV, prospective cohort study.

BackgroundInfantile colic is a distressing condition characterised by excessive crying in the first few months of life. The aim of this research was to update the synthesis of evidence of complementary and alternative medicine (CAM) research literature on infantile colic and establish what evidence is currently available.MethodsMedline, Embase and AMED (via Ovid), Web of Science and Central via Cochrane library were searched from their inception to September 2018. Google Scholar and OpenGrey were searched for grey literature and PROSPERO for ongoing reviews. Published systematic reviews that included randomised controlled trials (RCTs) of infants aged up to 1 year, diagnosed with infantile colic using standard diagnostic criteria, were eligible. Reviews of RCTs that assessed the effectiveness of any individual CAM therapy were included. Three reviewers were involved in data extraction and quality assessment using the AMSTAR-2 scale and risk of bias using the ROBIS tool.ResultsSixteen systematic reviews were identified. Probiotics, fennel extract and spinal manipulation show promise to alleviate symptoms of colic, although some concerns remain. Acupuncture and soy are currently not recommended. The majority of the reviews were assessed as having high or unclear risk of bias and low confidence in the findings.ConclusionThere is clearly a need for larger and more methodologically sound RCTs to be conducted on the effectiveness of some CAM therapies for IC. Particular focus on probiotics in non-breastfed infants is pertinent.Systematic review registrationPROSPERO: CRD42018092966.

BackgroundPrevious data suggests that anti-OX40 mAb can elicit anti-tumor effects in mice through deletion of Tregs. However, OX40 also has powerful costimulatory effects on T cells which could evoke therapeutic responses. Human trials with anti-OX40 antibodies have shown that these entities are well tolerated but to date have delivered disappointing clinical responses, indicating that the rules for the optimal use of anti-human OX40 (hOX40) antibodies is not yet fully understood. Changes to timing and dosages may lead to improved outcomes; however, here we focus on addressing the role of agonism versus depleting activity in determining therapeutic outcomes. We investigated a novel panel of anti-hOX40 mAb to understand how these reagents and mechanisms may be optimized for therapeutic benefit.MethodsThis study examines the binding activity and in vitro activity of a panel of anti-hOX40 antibodies. They were further evaluated in several in vivo models to address how isotype and epitope determine mechanism of action and efficacy of anti-hOX40 mAb.ResultsBinding analysis revealed the antibodies to be high affinity, with epitopes spanning all four cysteine-rich domains of the OX40 extracellular domain. In vivo analysis showed that their activities relate directly to two key properties: (1) isotype—with mIgG1 mAb evoking receptor agonism and CD8+ T-cell expansion and mIgG2a mAb evoking deletion of Treg and (2) epitope—with membrane-proximal mAb delivering more powerful agonism. Intriguingly, both isotypes acted therapeutically in tumor models by engaging these different mechanisms.ConclusionThese findings highlight the significant impact of isotype and epitope on the modulation of anti-hOX40 mAb therapy, and indicate that CD8+ T-cell expansion or Treg depletion might be preferred according to the composition of different tumors. As many of the current clinical trials using OX40 antibodies are now using combination therapies, this understanding of how to manipulate therapeutic activity will be vital in directing new combinations that are more likely to improve efficacy and clinical outcomes.

ObjectiveDietary factors and physical activity may alter prostate cancer progression. We explored the feasibility of lifestyle interventions following radical prostatectomy for localised prostate cancer.DesignPatients were recruited into a presurgical observational cohort; following radical prostatectomy, they were offered randomisation into a 2×3 factorial randomised controlled trial (RCT).SettingA single National Health Service trust in the South West of England, UK.ParticipantsThose with localised prostate cancer and listed for radical prostatectomy were invited to participate.RandomisationRandom allocation was performed by the Bristol Randomised Trial Collaboration via an online system.InterventionsMen were randomised into both a modified nutrition group (either increased vegetable and fruit, and reduced dairy milk; or lycopene supplementation; or control) and a physical activity group (brisk walking or control) for 6 months.BlindingOnly the trial statistician was blind to allocations.Primary outcome measuresPrimary outcomes were measures of feasibility: randomisation rates and intervention adherence at 6 months. Collected at trial baseline, three and six months, with daily adherence reported throughout. Our intended adherence rate was 75% or above, the threshold for acceptable adherence was 90%.Results108 men entered the presurgical cohort, and 81 were randomised into the postsurgical RCT (randomisation rate: 93.1%) and 75 completed the trial. Of 25 men in the nutrition intervention, 10 (40.0%; 95% CI 23.4% to 59.3%) adhered to the fruit and vegetable recommendations and 18 (72.0%; 95% CI 52.4% to 85.7%) to reduced dairy intake. Adherence to lycopene (n=28), was 78.6% (95% CI 60.5% to 89.8%), while 21/39 adhered to the walking intervention (53.8%; 95% CI 38.6% to 68.4%). Most men were followed up at 6 months (75/81; 92.6%). Three ‘possibly related’ adverse events were indigestion, abdominal bloating and knee pain.ConclusionsInterventions were deemed feasible, with high randomisation rates and generally good adherence. A definitive RCT is proposed.Trial registration numberISRCTN 99048944.

The incorporation of cover crops in orchards and vineyards can increase soil organic carbon (OC) and improve nitrogen (N) availability. This study compared how three herbaceous under-vine cover crop assemblages affected OC and N pools in four edaphically distinct vineyard agroecosystems. Using physical fractionation and soil spectral analysis we: 1) compared effects of grass and legume mono- and poly-cultures on total, coarse (≥50 µm) and fine (

Background: Knee replacement (KR) surgery is one of the most common elective procedures in the UK. A large number of different KR implant brands are in use in the UK, which may contribute to variation in uptake and patient outcomes. Methods: A cohort of 722,178 primary KRs performed for osteoarthritis (with or without other indications) by 2675 consultant surgeons between 2008 and 2017 in England and Wales from the National Joint Registry was examined. We described the uptake of new (first use >2008) KR implant brands, and variation in uptake by consultant surgeons (primary objectives). We explored consultant-level/patient-level factors associated with use/receipt of new implant brands with multilevel logistic regression models (secondary objectives). Results: Sixty-five new KR implant brands were used in 22,134 KRs (3.1%) by 759 consultants (28.4%) between 2008 and 2017. Consultants used a median of 1 new brand (interquartile range = 1-2, max = 8) in 4.1% (interquartile range = 1.1%-12.3%) of their KRs. Younger patients ( Conclusion: A large number of new KR implant brands have been introduced in the National Joint Registry since 2008. A quarter of consultants have tried a new implant brand but have used them in only a small proportion of primary KRs in this period. Younger, healthier patients are more likely to receive new implant brands, and they are more likely to be used by surgeons who use many different implant brands.

BACKGROUND: The association between diet and head and neck cancer (HNC) survival is unclear.METHODS: Cox proportional hazard models measured the association between fruit, vegetable, and deep-fried food intake and HNC overall survival adjusting for clinical, social and lifestyle variables including smoking, alcohol, and HPV status.RESULTS: Fruit and vegetable intake and improved survival were associated in minimally adjusted analyses. Following adjustment for smoking and alcohol consumption (fully adjusted analyses), the association with survival disappeared for fruit (HR 0.91, 95% CI 0.67, 1.23; P for trend = .55) and attenuated for vegetables (HR 0.79, 95% CI 0.61, 1.03; P for trend = .04). We observed no association between survival and deep-fried food intake in minimally adjusted or fully adjusted analyses (HR 0.88 95% CI 0.72, 1.07; P for trend = .13).CONCLUSIONS: Vegetable intake and HNC survival are modestly associated. There is some confounding by tobacco and alcohol consumption.

With diminishing world reserves of phosphorus (P) deposits and rising fertilizer prices, it is important to find alternate sources of P for crops. The aim of this research was to evaluate the effect of four different composts C1 (animal manure and straw), C2 (garden waste), C3 (wood chips and bark), and C4 (kitchen waste) on soil P pools and P uptake by wheat on 14, 28, and 72 days after compost application. The composts were applied as a 2.5 cm thick layer on the soil surface. During sampling, only the soil underlying compost was sampled. Soil pH and total organic carbon were not affected by the amendments. Soil respiration was significantly higher in compost-amended soils compared with the unamended soil except with C4 on day 72. Addition of composts increased plant growth, and P uptake being highest on day 72 with C1 and C4. With little effect on available P concentration on day 14, there was a conversion of organic P into inorganic P in the compost treatments suggesting net mineralization of o...

Ectomycorrhizal (EM) fungi could form symbiosis with plant roots and participate in nutrient absorption; however, many EM species commonly found in forest soils, where phosphorus (P) concentration and availability are usually very low, particularly in tropical and subtropical areas, have not yet been investigated for their efficiencies to mobilize soil P. In this study, fungal growth, P absorption, efflux of protons and organic acids, and soil P depletion by four isolates of EM fungi isolated either from acidic or calcareous soils were compared in pure liquid culture using soil as a sole P source. Boletus sp. 7 (Bo 7), Lactarius deliciosus 3 (Ld 3), and Pisolithus tinctorius 715 (Pt 715) from acidic and P-deficient soils of southwestern China showed higher biomass and P concentration and accumulation than Cenococcum geophilum 4 (Cg 4) from a calcareous soil of Inner Mongolia, northern China, after 4 weeks of liquid culture. Oxalate, malate, succinate, acetate, and citrate concentrations in the culture solutions varied significantly with fungal species, and oxalate accounted for 51.5%–91.4% of the total organic acids. Organic acids, particularly oxalate, in the culture solutions may lead to the solubilization of iron-bound P (Fe-P), aluminum-bound P (Al-P), and occluded P (O-P) from soil phosphates. Fungal species also varied greatly in proton efflux, which decreased the culture solution pH and may dissolve calcium-bound P (Ca-P) in soil. This could be the reason for the increment of both inorganic P in the culture solutions and Olsen P in the soil when EM fungi were present. Total inorganic P, the sum of Al-P, Fe-P, O-P, and Ca-P, in the culture solutions was positively correlated with the total concentration of organic acids in the culture solutions (r = 0.918*, n = 5), but negatively with both the total inorganic P in soil (r = −0.970**, n = 5) and the culture solution pH (r = −0.830*, n = 5). These suggested variable efficiencies of EM fungal species to mobilize inorganic P fractions from soil, which could make EM trees to utilize inorganic P in the same way like EM fungi and adapt to the soils with various P concentrations and availabilities.

Improved understanding of the effect of compost application on soil properties is critical for optimizing the desired effects of compost application. However there are no studies on the effect of composts on soil properties within the first centimetres of the compost layer. In this microcosm study three composts from different feedstocks, namely C1 (from animal manures) and C2 and C3 (from the organic fraction and municipal solid waste) were applied as a layer which was separated from the soil by a mesh. Microcosms without compost served as controls. Microbial and chemical properties of the soil were determined at 0–5 and 5–10 mm distance from the mesh after 30 and 63 days. During the 63 day incubation, the total C, N and P and available N concentrations in the composts decreased whereas the available P concentration increased. The composts induced higher microbial biomass and activity, total organic C and available N and P concentrations up to 10 mm into the surrounding soil with greater effects after 30 than after 63 days. The increase in nutrient concentrations was generally greater in soil adjacent to the two finer-textured composts with the higher nutrient concentration (C1 and C3) than in the coarser-textured compost (C2) which had lower nutrient concentrations, however the differences in nutrient concentrations in the soil were small compared to those among the composts. The 0–5 and 5–10 mm layers did not differ in most of the measured properties except for greater soil respiration and N and P availability in the 0–5 mm layer. It is concluded that composts release nutrients into the surrounding soil over a period of 2 months which increase nutrient availability and microbial activity, with the zone of influence extending at least 10 mm from the compost-soil interface.

Little is known about the decomposition rates of shoot and root residues of perennial grasses. This knowledge is important to estimate the carbon sequestration potential of the grasses. An incubation experiment was carried out in a sandy clay loam with shoot and root residues of three native perennial grasses (Wallaby grass, Stipa sp. and Kangaroo grass) and the annual grass barley either separately or in mixtures of two residues. Respiration rate was measured over 18 days, and microbial C and available N were measured on days 0 and 18. Decomposition was lower for roots than for shoots and lower for residues of perennial grasses than for barley. Cumulative respiration was positively correlated with water-soluble C in the residues but not with residue C/N. In the mixtures, the measured cumulative respiration was higher than the expected value in five of the nine mixes usually where the differences in cumulative respiration between the individual residues were relatively small. Lower than expected cumulative respiration were found in two of the mixtures in which barley shoots (high cumulative respiration) were mixed with residues with low cumulative respiration. There was a negative correlation between the change in microbial biomass C concentration from day 0 to day 18 and cumulative respiration on day 18. In the amended soils, the available N concentration decreased from day 0 to day 18. It is concluded that the low decomposition rate of perennial grasses residues should favour C sequestration, but that mixing residues of similar decomposition rate may accelerate their decomposition.

The poor solubility of rock phosphate limits its usefulness for crop production, but it has been shown that combined application of rock phosphate with plant residues can increase its P availability compared to rock phosphate alone. To investigate if compost mulch has a similar effect as residues, the effect of two rock phosphates [Nutriphos Guano Powder (RPA) and Indian Potash Limited (RPB)] with or without two different composts C1 (from garden waste) and C2 (from wood chips and bark), on soil P pools and P uptake by wheat was evaluated in a 75-day glasshouse experiment in a loamy sand soil. The composts were applied as a 2.5-cm-thick layer on the soil surface and rock P was mixed in the soil at a rate of 0.250 g kg−1 soil (equivalent to 35 mg P kg−1 of RPA and 26 mg P kg−1 soil as RPB). Further treatments included an unamended soil and a soil amended with soluble P (KH2PO4) at a rate of 50 mg P kg−1 soil. Wheat was sown and harvested after 42 and 75 days. At sampling, the compost layer was removed and the underlying soil was sampled. Soil pH and total organic C concentration were not affected by the amendments. Soil respiration was significantly higher in soil amended with composts with or without rock P compared to unamended and inorganic fertiliser treatments. On day 75, addition of composts alone or with rock P increased plant growth and P uptake by 30–50 % compared to the unamended soil, which was greater increase than with soluble P. Compared with either rock P or compost applied alone, the combination of rock P with compost increased the concentration of NaHCO3-Pi and microbial P by about 30 %, suggesting that compost increased the mobilisation of rock P. The combination of compost and rock P also changed the concentrations of non-labile P pools compared to rock P alone indicating effects on P flux between the pools. This study showed that surface compost application can increase P mobilisation from rock P, but plant growth and P uptake were not increased compared to compost alone indicating that the composts supplied sufficient P to the plants.

This essay reads Cinema Documents of the Atrocities of the German-Fascist Invaders (1945) as visceral testimony for the Soviet prosecution’s evidence testifying to crimes against the civilian popul...

Although the beneficial effects of compost on soil properties are well known, there are few systematic studies comparing the effects of composts on soils of different textures. The aim of this pot study was to assess the effects of a single application as mulch of two types of composts derived from different feedstocks, namely C1 (from garden waste) and C2 (from agricultural residues and manures) on three soils with different clay contents (46%, 22% and 13%, hereafter referred to as S46, S22 and S13) in terms of their physical, chemical and biological properties as well as on plant growth and nutrient uptake. The composts were placed as 2.5-cm-thick mulch layer on the soil surface, and wheat plants were grown for 35 days and to grain filling (70 days). The composts reduced the soil pH by 0.3–0.7 units, slightly increased total organic C, but increased soil electrical conductivity compared to unamended soil. Soil respiration was significantly higher in S13 than S46 in all treatments after 5 weeks. At grain filling, soil respiration was higher in S13 than in the other two soils and higher with C2 than with C1 and in the non-amended soil. The addition of compost significantly increased soil cation exchange capacity (CEC) in S22 and S46, but not in S13 which also had the lowest CEC among the soils. C2 increased the available P concentration and macro-aggregate stability in all soils compared to C1 and the unamended soil. Compost addition increased available N in S46 and S22 compared to the unamended soil with a stronger effect by C1. Both composts increased wheat growth and shoot P concentrations with the effect of C2 being greater than that of C1. It is concluded that the effect of composts varies with soil type as well as compost type and that this interaction needs to be taken into account when composts are applied to improve specific soil properties.

Composts with different feedstocks may have differential effects on soil properties and plant growth which, may be further modulated by soil texture. In a 77-day pot experiment in the glasshouse, we investigated the effect of a single application as mulch of six types of composts derived from different starting feedstocks in two soils (13% and 46% clay, referred to as S13 and S46) on soil physical, chemical and biological properties, plant growth and nutrient uptake. Composts were placed as 2.5 cm thick mulch layer on the soil surface and wheat plants were grown and harvested at 42 days and at 77 days (grain filling). Composts differed in total and available N and P and particle size with C1, C3, C4 and C5 being fine-textured, whereas C2 and C6 were coarse-textured. Compost addition as mulch increased soil total organic C and EC, but had no effect on pH. In all treatments, cumulative soil respiration was higher in S13 than in S46 and was increased by compost addition with the greatest increase with C2 and C6. Compared to the unamended soil, most compost mulches (except C2) increased macroaggregate stability. Compost mulches significantly increased available P and N in both soils, except for C2. Compost mulches increased available N up to 6-fold in both soils with the strongest increase by C5. Most composts also increased wheat growth and shoot P and N concentrations with the greatest effect on plant N concentration by C5 and on plant P concentration by C4. However, C2 decreased shoot N and P concentrations compared to the unamended soil. Most compost mulches (except C2) increased mycorrhizal colonization by up to 50% compared to the unamended soil. Fine-textured compost mulches generally had a greater effect on soil properties and plant growth than coarse-textured composts. Despite distinct differences between the soils with respect to clay content, TOC and available P, the effect of the compost mulches on soil and plant properties was quite similar.

Indigenous cover crops have the potential to promote an increase in natural enemies providing fortuitous control of pest species and other ecosystem services. We test this idea in a vineyard in south eastern Australia, where reduced water availability because of drought coupled with increased temperatures has generated interest in sustainable alternatives to the exotic perennial cover crops commonly planted. Three endemic perennial cover crops, comprising the grasses Austrodanthonia richardsonii and Chloris truncata and a mix of two saltbushes (Atriplex semibaccata and Atriplex suberecta) were established as cover crops and compared with introduced oats (Avena sativa). Abundance of a range of predators and parasitoids was higher in vines with native cover crops compared with the oat control. In addition, predation levels of sentinel eggs of a common vineyard pest, light brown apple moth (Epiphyas postvittana), were increased in the native cover crops. However, the native cover crops also increased the abundance of some potential pest species. Native plants therefore have potential to increase abundance of beneficial invertebrates that assist in pest control, but need to be used carefully to ensure that they do not increase local pest problems.

Maintenance of available phosphorus (P) is a problem faced by both conventional and organic systems but it is exacerbated in the latter given that manufactured inorganic sources of P fertiliser are not permitted under the International Federation of Organic Agriculture Movements certification guidelines. The focus of this paper is a discussion of potential agronomic strategies to assist in sustainable management of the soil P resource in organic and low-input broadacre farming systems within the Australian rain-fed cereal–livestock belt. The paper considers three broad strategies for agronomic management of P in this context and draws on reported research from overseas and within Australia. An analysis of the current knowledge suggests that the option most likely to ensure that soluble P is not a limitation in the system is the importation of allowable inputs that contain P from off-farm, although for much of the Australian cereal–livestock belt the immediate issue may be access to economically viable sources. Research targeted at quantifying the economic and biological benefits to the whole-farm system associated with the adoption of these practices is required. Improving the P-use efficiency of the system by incorporating species into rotation or intercropping systems that are able to use P from less soluble sources has been a successful strategy in parts of the world with climate similar to much of the Australian cereal–sheep belt, and deserves further research effort in Australia. Agronomic management to maximise quantity and quality of pasture and crop plant residues undoubtedly builds labile soil organic matter and facilitates P cycling, but the strategy may be of limited benefit in low-rainfall areas that do not have the capacity to produce large biomass inputs. Evidence that organic or low-input systems naturally increase the numbers and diversity of soil organisms is sparse and published studies from Australian systems suggest that P nutrition is not enhanced. However, seed and soil microbial inoculants to facilitate improved P uptake have been developed and are currently being field tested in Australia. Progress in selection and breeding for cereal genotypes that are more P efficient and other plant genotypes that can use less labile P sources, is gaining momentum but still remains a long-term prospect, and may involve genetic modification which will not be acceptable for organic systems.

BACKGROUND: Head and neck cancer is an important cause of ill health. Survival appears to be improving but the reasons for this are unclear. They could include evolving aetiology, modifications in care, improvements in treatment or changes in lifestyle behaviour. Observational studies are required to explore survival trends and identify outcome predictors.METHODS: We are identifying people with a new diagnosis of head and neck cancer. We obtain consent that includes agreement to collect longitudinal data, store samples and record linkage. Prior to treatment we give participants three questionnaires on health and lifestyle, quality of life and sexual history. We collect blood and saliva samples, complete a clinical data capture form and request a formalin fixed tissue sample. At four and twelve months we complete further data capture forms and send participants further quality of life questionnaires.DISCUSSION: This large clinical cohort of people with head and neck cancer brings together clinical data, patient-reported outcomes and biological samples in a single co-ordinated resource for translational and prognostic research.