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This paper presents a method to analyze and improve the set of equations constituting a rainfall‐runoff model structure based on a combination of a data assimilation algorithm and polynomial updates to the state equations. The method, which we have called "Data Assimilation Informed model Structure Improvement" (DAISI) is generic, modular, and demonstrated with an application to the GR2M model and 201 catchments in South‐East Australia. Our results show that the updated model generated with DAISI generally performed better for all metrics considered included Kling‐Gupta Efficiency, NSE on log transform flow and flow duration curve bias. In addition, the elasticity of modeled runoff to rainfall is higher in the updated model, which suggests that the structural changes could have a significant impact on climate change simulations. Finally, the DAISI diagnostic identified a reduced number of update configurations in the GR2M structure with distinct regional patterns in three sub‐regions of the modeling domain (Western Victoria, central region, and Northern New South Wales). These configurations correspond to specific polynomials of the state variables that could be used to improve equations in a revised model. Several potential improvements of DAISI are proposed including the use of additional observed variables such as actual evapotranspiration to better constrain internal model fluxes. Plain Language Summary: This paper presents a data‐driven method to improve rainfall‐runoff models used to generate future water resources scenario in climate change studies. The method, which we have called "Data Assimilation Informed model Structure Improvement" (DAISI) is generic, modular, and demonstrated with an application to monthly streamflow simulations over a large data set of catchments in South‐East Australia. Our results show that DAISI improves model performance for a wide range of metrics and increases the sensitivity of the model to climate inputs, which is critical in climate change scenarios. Finally, the improvements identified by DAISI take a simple mathematical form with distinct regional patterns in three sub‐regions of the study domain (Western Victoria, central region, and Northern New South Wales). Several improvements of DAISI are discussed including the inclusion of additional observed variables such as evapotranspiration to better constrain model simulations. Key Points: Data Assimilation Informed model Structure Improvement method diagnoses hydrological model structures by combining data assimilation with a polynomial update of state equationsThe method was applied to the GR2M rainfall‐runoff model with significantly improved streamflow simulations in 201 Australian catchmentsThe method identified updates to state equations with marked regional characteristics that could guide future improvement of GR2M [ABSTRACT FROM AUTHOR]

Indigenous young people around the world suffer poorer mental health outcomes than their non-Indigenous peers. Currently, how culture matters for health, what cultural practices are used in community to support health and well-being, and how culture is passed on in Aboriginal contemporary life in southeast Australia--the region most affected by settler-colonisation--is not well understood. This paper presents findings from yarns with a representative sample of 44 Indigenous participants working in the field of health and well-being that explored how culture interleaves with health and well-being. It uses grounded theory as the overarching methodology with community participation in all aspects of the project. Participants were nominated through snowball sampling and screened by a governing board of Elders. They included men and women of varied ages with half residing in urban areas and half in rural Victoria, Australia. They had declared affiliations to 31 traditional tribal groups. The yarns were held over Zoom videoconferencing between an Indigenous research assistant who was part of the community, and each participant. Each yarn was recorded, transcribed, coded and analysed by a multi-perspectival team. Culture was viewed as central to individual and communal life and passed on through relationships with people and Country itself. Community members used a wide variety of cultural practices to aid and maintain health and wellbeing in profound ways. Myriad extant obstacles to health and well-being were also described, from experiences of disconnection through to barriers for accessing services. These findings have the potential to shape future holistic care and policy. [ABSTRACT FROM AUTHOR]

Background: Organisational health literacy is a promising area of research that enables a focus on how systems and services can be designed in ways that are responsive to populations with varying states and levels of health literacy, knowledge, and practices, including African refugees. The challenge is how organisations and professionals do this in practice, and research in this area is in its early stages. This qualitative study examined barriers to implementing health literacy responsive care practices in primary health care settings in Australia. It also offered suggestions to potentially address the barriers to improving organisational health literacy. Methods: Refugees (n = 19), primary health care professionals (n = 14), and other key stakeholders (n = 19) were recruited through convenience and snowball strategies from three states in Australia: New South Wales, Victoria, and Queensland. All but one participant was interviewed face-to-face via Zoom. Semi-structured interview guides were used to guide the conversations. Transcriptions from audio recordings were analysed using directed content analysis. Results: Thirteen themes were extracted from the data. Themes were organised into the following categories: structural and systemic, organisational context, individual professional level, individual patient level, and socio-community level. Major structural and system-level factors affecting organisational health literacy included rigid systems and structures and limited time. Key organisation-level factors included inflexible organisational processes and policies, institutionalised othering, discrimination and racism, and lack of interpreters. Individual professional factors were poor communication with patients and cultural knowledge gaps. Linguistic issues and service mistrust were key individual patient-level factors. Socio-community factors included limited community engagement. Participants identified potential solutions to help services navigate out of the barriers and improve their response to health literacy. Conclusion: The findings suggest that mainstream services and organisations could improve timely and appropriate health care access and utilisation for refugees through strategies such as designing services and health literacy programs with refugee communities, promoting health literacy champions in the workforce, integrating health literacy and culturally responsive care plans and strategies into organisational priorities. [ABSTRACT FROM AUTHOR]

Simple Summary: Free-roaming cats in urban areas are a source of nuisance complaints. In Australia, legislation relating to requirements that cat owners microchip and contain their cats on their property has been largely ineffective in reducing the number of free-roaming cats, because most are strays with no owner. Cats causing nuisance complaints are typically trapped and impounded, but only 7% of cats entering local government facilities are reclaimed by owners, with the remaining either rehomed or euthanized. Many healthy cats are euthanized, negatively impacting the staff involved. In 2013, the city of Banyule in Victoria funded and implemented a free program for cat sterilization, microchipping, and registration. The program was largely targeted at low-socioeconomic suburbs with the highest cat-related complaints and microtargeted at "hot-spots". Free transport of cats was offered to community members if needed. Stray cats fed by community members enrolled in the program became owned. Over 8 years, 33.0 cats/1000 residents were sterilized in the three target suburbs (average 4.1 cats/1000 per year). Key findings were city-wide decreases in impoundments by 66%, euthanasia by 82%, and cat-related calls by 36% over 8 years, with savings to council of AU $440,660 for an outlay of AU $77,490. In most states of Australia, local governments (councils) are responsible for the enforcement of legislation relating to domestic cats. Traditional methods used for cat management based on trap–adopt or euthanize programs have been ineffective, with cat-related calls and cat impoundments continuing to increase, resulting in many healthy cats being euthanized. This has detrimental effects on the mental health of animal management officers, staff in shelters and council facilities, and cat caregivers. The city of Banyule, Victoria, implemented a free cat sterilization, microchipping, and registration (licensing) program in 2013/14. Initially, it was targeted at three low-socioeconomic suburbs with the highest cat-related calls and intake, and was microtargeted at call locations. An average of 4.1 cats/1000 residents per year were sterilized over eight years. The program included stray cats being fed by caregivers, provided they took ownership. The program was later expanded city-wide. Over eight years, city-wide cat intake decreased by 66%, euthanasia by 82%, and cats reclaimed by owners increased from 6% of intake (2012/13) to 16% (2020/21). Cat-related calls decreased in the target area by 51%, and city-wide by 36%. The council realized cost savings of AU $440,660 associated with reduced costs for cat-related calls to council (AU $137,170) and charges from the contracted welfare agency (AU $303,490), for an outlay of AU $77,490 for sterilization costs. Instead of the traditional management of urban cats, proactive management based on targeted sterilization should be utilized by government and animal welfare agencies in Australia and internationally. These types of programs are effective at reducing cat intake and euthanasia and are cost-effective. [ABSTRACT FROM AUTHOR]

Prior to its introduction in Australia, many people opposed euthanasia—or voluntary assisted dying as it is known—because of its potentially detrimental impact on grief and bereavement outcomes for family members and carers. We examine the novel experiences of grief and bereavement of VAD for family members and carers who were going through, had gone through, or were contemplating VAD, juxtaposing the international literature on grief and bereavement. As such, 42 semistructured interviews with family members and carers were undertaken in the state of Victoria, which was the first jurisdiction to legislate in favour of VAD. Interviews explored many themes around end‐of‐life decision‐making in order to ascertain the ways in which VAD helped or hindered grief and bereavement processes. A thematic analysis of the interview data was undertaken using QSR NVivo software. Four key themes were identified: values and meaning‐making, expression of a continuing bond, anticipatory grief, and the burden of care associated with supporting loved ones going through VAD. These themes were juxtaposed with the key literature on grief and bereavement to demonstrate how VAD presents novel challenges for carers. We argue that while VAD deaths share similar characteristics to other deaths; in some respects, grief and bereavement outcomes for family members and carers are unique. For family members and carers helping a loved one go through VAD, they were able to derive a sense of meaning from fulfilling their wishes and striving for them to have a "good death"; they were able to maintain a bond with them through advocacy of VAD and unique rituals; and they were able to plan and prepare effectively by knowing the exact time of death. Family members and carers also noted that VAD presents some significant challenges for grief and bereavement, especially in terms of the impact of VAD on familial relationships and burdens associated with moral predicaments. Nonetheless, VAD was generally viewed positively by family members and carers, who expressed gratitude for mitigating their loved one's suffering. [ABSTRACT FROM AUTHOR]

Simple Summary: Jumps racing is a form of Thoroughbred horse racing that involves hurdles and steeples and typically longer distances and heavier weights compared with flat racing, which does not incorporate obstacles. The continuation of jumps racing remains contentious due to the higher risk of fatalities, falls and injuries for horses, compared with flat racing. In Australia, jumps racing is carried out only in the state of Victoria after a legislated ban on jumps racing in South Australia in 2022. Jumps races account for only 1.8% of Thoroughbred horse races in Victoria. This study compared the incidence of fatalities, falls and injuries in horses participating in hurdle and steeplechase races with those participating in flat races at the same race meets, for all jumps races in the 2022 and 2023 Thoroughbred horse jumps racing seasons in Victoria, Australia. Overall, horse fatalities, falls and injuries occurred at higher rates in jumps races compared with flat races during the study period. Jumps racing is a form of Thoroughbred horse racing that involves hurdles and steeples and typically longer distances, and heavier weights compared with flat racing, which does not incorporate obstacles. In Australia, jumps racing is carried out only in Victoria, one of eight states and territories. The continuation of jumps racing is contentious due to the higher risk of fatalities, falls and injuries for horses, compared with flat racing. While measures have been introduced by the industry to improve the safety of riders and horses, the rates of fatalities, falls and injuries in horses participating in jumps races have not been collectively reported in Australia since the 2012 to 2014 race seasons. Although information on individual horse fatalities, falls and injuries is published by Racing Victoria in Stewards' Reports, the data are not aggregated, and so cannot readily be used to assess trends or evaluate the efficacy of safety measures introduced by the industry. The aim of this study was to determine the fatality, fall and injury rates for horses participating in hurdle and steeplechase races in Victoria in the 2022 and 2023 Thoroughbred horse jumps racing seasons compared with horses participating in flat races at the same race meets. Data on horse fatalities, falls and injuries were extracted from the published Racing Victoria race results and Stewards' Reports for the jumps races (n = 150) and corresponding flat races (n = 157) held at the 38 jumps race meets in Victoria in 2022 and 2023. Overall, horse fatalities, falls and injuries occurred at higher rates in jumps races compared with flat races during the study period. The rate of horse fatalities in jumps races was 3.3 per 1000 starts, with no fatalities in flat races. The rate of horse falls in hurdle races was 24 per 1000 starts and 41.6 per 1000 starts in steeplechase races, comparable with rates previously reported in the 2012 to 2014 seasons. There were no falls in flat races. Horse injuries occurred at a rate of 68.9 per 1000 starts in jumps races compared with 18.8 per 1000 starts in flat races. In hurdle and steeplechase races, veterinary clearance being required following horse injury was 5.4 times (OR 5.4, 95% CI 2.8–10.2) and 7.2 times (OR 7.2, 95% CI 3.3–15.6) more likely, respectively, compared with flat races. The risk of trauma was 4 times more likely in hurdle and steeplechase races (OR 4.8, 95% CI 1.7–13.3 and OR 4.1, 95% CI 1.2–13.4, respectively) and the risk of lameness was increased by 2.5 times in hurdles (OR 2.5, 95% CI 1.2–5.2) and 5.1 times in steeplechase races (OR 5.1, 95% CI 2.3–11.5), compared with flat races. These findings support concerns about the welfare of horses involved in jumps racing and of the need for further safety measures to reduce these risks. [ABSTRACT FROM AUTHOR]

Introduction: Effective primary healthcare services have been identified by the World Health Organization as the most equitable approach to enhancing universal healthcare. Robust models of mentoring for registered nurses (RNs) transitioning to primary healthcare roles have yet to be described in the Australian context. A robust mentoring model can support RNs to fulfill their potential, bridging the gap between theory and practice. In 2015, the peak body for nurses in primary health care (PHC) began developing a transition to practice program, including embedded mentoring to support newly graduated and more experienced registered and enrolled nurses. This quality improvement study reports the experiences and perspectives of nurses participating as mentors in two separate offerings of the program delivered between 2019 and 2021. Method: A two-phase concurrent mixed methods evaluation utilized data from pre- and post online surveys and post program meetings. Quantitative items underwent descriptive analyses. Thematic analysis of free-text responses and comments was conducted independently by two researchers. Mentors voluntarily provided self-report data and were informed that data is routinely collected to support continuous quality improvement processes for all programs. An Information Sheet informed mentors of data usage, confidentiality, and options to withdraw without penalty from the program at any time. Results: Seventy-nine mentors were recruited to support two groups of nurses (N = 111). Mentor self-rated overall satisfaction with program participation was 86.67% (very or extremely satisfied). Mentors described being "witness to mentee growth," "having facilitated access to learning" and receiving "unexpected benefits" including personal and professional growth and enhanced enthusiasm for their role in PHC. Conclusion: The embedded mentoring reported in this article combined a focus on skills acquisition and professional identity with the provision of a range of resources and support activities. Sustainable mentoring programs will be an important mechanism for supporting the expanding roles required of nurses working in primary health. [ABSTRACT FROM AUTHOR]

Background: Studying in a foreign country can be accompanied by challenges, including difficulty understanding the curriculum, culture shock, and a new language. These additional challenges place international students at risk and predispose them to developing mental health problems compared to domestic student., Aims: This study explores psychological well-being and help-seeking behaviours of international nursing students who commenced their program onshore or in a remote learning capacity., Materials & Methods: This paper reports the findings of the mixed-methods study. Research was conducted among international students enrolled in the Bachelor of Nursing programs across multiple campuses at two Victorian universities in 2022. Data was collected using a survey questionnaire with open-response questions and incorporated a validated Student Stress Survey., Results: Findings indicated that international students require support financially and to settle in Australia upon arrival. Participants highlighted that they require additional support to keep up with academic workloads and require further academic support tailored for international students. There was no patient or public contribution in the design, conduct, analysis or preparation of this manuscript., Discussion & Conclusion: Participants highlighted that they require additional support to keep up with academic workloads and require further academic support tailored for international students. There was no patient or public contribution in the design, conduct, analysis or preparation of this manuscript., (© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.)

Background: There is a lack of understanding regarding the impact of telehealth on clinical delivery and the feasibility of sustained implementation by health services. The COVID-19 pandemic provided an ideal opportunity to identify factors related to the implementation of telehealth. This study assessed factors that influenced telehealth implementation during COVID-19 in the Western region of Victoria, Australia, from the perspectives of practice managers and general practitioners (GPs)., Methods: Employing a qualitative approach, we conducted semi-structured interviews with 14 GPs and 11 practice managers across metropolitan and rural settings in the Western region of Victoria, Australia. Interviews were conducted between December 2021 to June 2022, which included periods during and beyond the peak of the COVID-19 pandemic. Themes were synthesised using the Consolidated Framework for Implementation Research, which comprised five domains: innovation, inner setting, outer setting, individuals and implementation process. An additional domain related to billing and finances was added., Results: The innovation domain revealed that telehealth was identified by both stakeholder groups as a critical tool for improving healthcare access for vulnerable patients. GPs highlighted the role of telehealth in follow-up care and the need for extended telephone consultation services. For the implementation process, both stakeholder groups identified a shift in attitudes among GPs from reluctance to acceptance of telehealth. In terms of outer setting, constant changes in regulations posed challenges to administrative staff. Practice managers faced difficulties in acquiring information on changes, but those with robust professional networks were well supported. Initial loss of incentive funding and government-imposed billing methods posed hurdles for clinics. Both stakeholder groups highlighted the need for education around videoconference and a standardised telehealth platform., Conclusion: Evolving telehealth regulations during the emergence of COVID-19 posed financial, operational and administrative challenges to primary care clinics. To ensure sustainability, policymakers should improve stakeholder communication, set interoperability standards, and ensure sustainable funding for telehealth., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: A knowledge gap exists regarding longitudinal assessment of personal radio-frequency electromagnetic field (RF-EMF) exposures globally. It is unclear how the change in telecommunication technology over the years translates to change in RF-EMF exposure. This study aims to evaluate longitudinal trends of micro-environmental personal RF-EMF exposures in Australia., Methods: The study utilised baseline (2015-16) and follow-up (2022) data on personal RF-EMF exposure (88 MHz-6 GHz) measured across 18 micro-environments in Melbourne. Simultaneous quantile regression analysis was conducted to compare exposure data distribution percentiles, particularly median (P 50 ), upper extreme value (P 99 ) and overall exposure trends. RF-EMF exposures were compared across six exposure source types: mobile downlink, mobile uplink, broadcast, 5G-New Radio, Others and Total (of the aforementioned sources). Frequency-specific exposures measured at baseline and follow-up were compared. Total exposure across different groups of micro-environment types were also compared., Results: For all micro-environmental data, total (median and P 99 ) exposure levels did not significantly change at follow-up. Overall exposure trend of total exposure increased at follow-up. Mobile downlink contributed the highest exposure among all sources showing an increase in median exposure and overall exposure trend. Of seven micro-environment types, five of them showed total exposure levels (median and P 99 ) and overall exposure trend increased at follow-up., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)