AIMS The objective of this study was to investigate farmers' perception of lameness in comparison to the estimated prevalence of lameness in NSW pasture-based dairies to evaluate farmers' perceptions and approaches to detection, treatment and prevention of lameness. METHODS Across-sectional study was conducted on 62 pasture-based dairy farms across NSW, Australia. The prevalence of lameness in these farms was estimated using locomotion scoring (1-4 scale). A survey was also conducted, using a questionnaire and face-to-face interview, to explore farmers' perceived prevalence of lameness and approaches to treatment and prevention. RESULTS The prevalence of lameness estimated by farmers was 3.7 times less (mean 5%; range 0% to 26%) than that determined by locomotion scoring (mean 19.1%; range 5.0%-44.5%). Approaches to treatment included antimicrobial therapy, hoof inspection with or without application of wooden blocks. In 28% of the farms, the lame cows were managed by farmers or farm staff with no official training in treatment of lame cows. The mean interval from detection of lameness to examination of the affected hoof was almost 55 hours (range 2-720 hours).  https://www.selleckchem.com/products/sb297006.html  A very low percentage of farms kept lameness records or implemented lameness preventive strategies such as footbaths and prophylactic foot trimming. CONCLUSIONS Farmers and farm managers were found to underestimate the prevalence of lameness which could be due to the low level of awareness and can contribute to subsequent lack of implementation of prophylactic procedures and preventive management strategies for lameness. These findings accentuate the need to improve farmers' ability to detect lame cows and to emphasise the importance of recording in order to facilitate the management of lameness in dairy herds. © 2020 Australian Veterinary Association.BACKGROUND Gestational diabetes (GDM) is one of the commonest pregnancy complications and is placing an increasing burden on diabetes and obstetric resources. AIMS To describe different antenatal models of care that have developed to address the increasing proportion of pregnancies complicated by GDM. MATERIALS AND METHODS Narrative review with thematic analysis from 15 volunteer antenatal diabetes in pregnancy services from Australia and New Zealand identified through a national diabetes organisation. Main outcomes were approaches to patient education, medical nutrition therapy (MNT), ongoing management and escalation of therapy for women with GDM. RESULTS All clinics provided at least one group education and one MNT session within 1-2 weeks of GDM diagnosis. Women from culturally and linguistically diverse communities usually required 11 education. Ongoing management of women with GDM was through either all women being seen in the GDM clinic, a step-up approach (ongoing management by the primary antenatal team with diabetes team referral if self-blood glucose monitoring (SBGM) or insulin therapy dosage criteria are reached) or step-down approach (ongoing management by the diabetes team with step-down to the primary antenatal team if SBGM criteria are reached). Telehealth was used to reduce the burden of clinic attendance, particularly in rural areas. CONCLUSIONS Increasing numbers, earlier diagnoses, the need to provide care to women in rural, remote areas, and cultural/language differences, have generated a range of different antenatal models of care, allowed better workload accommodation and probably reduced costs. Randomised controlled trials of different models of care, with associated health economic analyses, are urgently needed. © 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.Green tea is widely consumed as a beverage and/or dietary supplement worldwide, resulting in the difficulty to avoid the comedication with ticagrelor for acute coronary syndrome (ACS) patients receiving antiplatelet therapy. This study was designed to investigate the effect of the most abundant content in green tea, tea polyphenols on the oral and intravenous pharmacokinetics of ticagrelor in rats and its in vitro metabolism. Rats were orally treated with either saline or tea polyphenol extracts (TPEs) dissolved in saline once daily for 6 consecutive days. On day 6, after the last dose of saline or TPE, ticagrelor was given to the rats orally or intravenously. Plasma samples were collected for pharmacokinetic analysis. Human liver and intestinal microsomes were then used to investigate the inhibition by TPE, as well as its major constituents on the metabolism of ticagrelor to its two metabolites, AR-C124910XX and AR-C133913XX. Apparent kinetic constants and inhibition potency (IC50 ) for each metabolic pathway of each compound were estimated. Oral study indicated that exposure of ticagrelor and AR-C124910XX was significantly decreased after TPE administration, while no significant differences were observed in pharmacokinetic parameters after intravenous administration of ticagrelor. TPE effectively inhibited the metabolism of ticagrelor in vitro, with epigallocatechin-3-gallate as the major constituent responsible for the observed inhibitory effects in human liver microsomes and intestinal microsomes (IC50 = 4.23 ± 0.18 µM). Caution should be taken for ACS patients receiving ticagrelor therapy with daily drinking of green tea. PRACTICAL APPLICATION Potential interactions between tea polyphenols and ticagrelor were revealed for the first time. Results can provide suggestions for clinicians to optimize the dosing of ticagrelor while they are in the face of ACS patients receiving ticagrelor therapy, who also take green tea or its related products in their daily life. © 2020 Institute of Food Technologists®.BACKGROUND/OBJECTIVES A patient-directed, online program (PREPARE for Your Care [PREPARE]; prepareforyourcare.org) has been shown to increase advance care planning (ACP) documentation. However, the mechanisms underlying PREPARE are unknown. Our objectives were to compare the efficacy of PREPARE plus an easy-to-read advance directive (AD) vs an AD alone to increase active patient participation in ACP discussions during clinic visits and to examine effects of active patient participation on ACP documentation. DESIGN Audio recordings of postintervention primary care visits from two randomized trials (2013-2016). SETTING Seven primary care clinics at a veterans affair and safety-net hospital in San Francisco, CA. PARTICIPANTS English- and Spanish-speaking adults, aged 55 years and older, with two or more chronic/serious conditions. INTERVENTION PREPARE plus an easy-to-read AD or an AD alone. MEASUREMENTS The primary outcome was the number of active patient participation utterances about ACP (eg, asking questions, stating preferences) measured by the validated Active Patient Participation Coding Scheme.