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Background: Effective and scalable prevention approaches are urgently needed to address the rapidly increasing rates of e-cigarette use among adolescents. School-based eHealth interventions can be an efficient, effective, and economical approach, yet there are none targeting e-cigarettes within Australia. This paper describes the protocol of the OurFutures Vaping Trial which aims to evaluate the efficacy and cost-effectiveness of the first school-based eHealth intervention targeting e-cigarettes in Australia. Methods: A two-arm cluster randomised controlled trial will be conducted among Year 7 and 8 students (aged 12–14 years) in 42 secondary schools across New South Wales, Western Australia and Queensland, Australia. Using stratified block randomisation, schools will be assigned to either the OurFutures Vaping Program intervention group or an active control group (health education as usual). The intervention consists of four web-based cartoon lessons and accompanying activities delivered during health education over a four-week period. Whilst primarily focused on e-cigarette use, the program simultaneously addresses tobacco cigarette use. Students will complete online self-report surveys at baseline, post-intervention, 6-, 12-, 24-, and 36-months after baseline. The primary outcome is the uptake of e-cigarette use at 12-month follow-up. Secondary outcomes include the uptake of tobacco smoking, frequency/quantity of e-cigarettes use and tobacco smoking, intentions to use e-cigarettes/tobacco cigarettes, knowledge about e-cigarettes/tobacco cigarettes, motives and attitudes relating to e-cigarettes, self-efficacy to resist peer pressure and refuse e-cigarettes, mental health, quality of life, and resource utilisation. Generalized mixed effects regression will investigate whether receiving the intervention reduces the likelihood of primary and secondary outcomes. Cost-effectiveness and the effect on primary and secondary outcomes will also be examined over the longer-term. Discussion: If effective, the intervention will be readily accessible to schools via the OurFutures platform and has the potential to make substantial health and economic impact. Without such intervention, young Australians will be the first generation to use nicotine at higher rates than previous generations, thereby undoing decades of effective tobacco control. Trial registration: The trial has been prospectively registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12623000022662; date registered: 10/01/2023). [ABSTRACT FROM AUTHOR]

This paper reports on changes in the social‐emotional well‐being of 6‐ to 12‐year‐old children tested before the COVID‐19 pandemic and during 2020 and 2021. Well‐being was assessed using a video game that empowers children to report their own well‐being, including school attachment, social and emotional well‐being, behavioural conformity and family support. We compared well‐being over time for two groups of children in government schools in Queensland, Western Australia and Tasmania. The treatment group of 580 children were tested in 2019 (Time 1) and a second time in mid‐late 2020 and early 2021 (Time 2). The comparison group of 841 children were tested twice before the pandemic. Results showed that children in the treatment group reported significantly lower family support at Time 2 than those in the comparison group. This reduction in perceived family support was stronger for girls. In addition, children in the treatment group who reported lower levels of family support at Time 1 reported a steeper decline in family support by Time 2. Finally, boys in the treatment group reported significantly better behavioural conformity and emotional well‐being relative to girls over time. Results highlight the varied impacts of the pandemic lockdowns and the need to provide continued support to vulnerable families. [ABSTRACT FROM AUTHOR]

There has been significant investment by police agencies in the use of body-worn cameras (BWCs). Preliminary evidence suggests that when used in the context of domestic and family violence, BWC footage may strengthen evidential cases and prosecutions. There is, however, a paucity of research examining the merits of and risks posed by the use of BWC footage in DFV incidents and legal proceedings. Notably absent in much of the literature are the views and experiences of police officers who, as initial owners of BWC footage, are likely to affect how it is produced and interpreted. This paper presents findings from the first Australian study to examine how police officers, as users and operators of BWC technology, perceive the use of BWC footage in DFV-related civil and criminal legal proceedings in two Australian state jurisdictions: Western Australia and Queensland. While broadly supportive of BWC technology, police respondents, especially those from specialised DFV units, identified various benefits and limitations to using BWC footage in the context of DFV, including that BWCs have the potential to capture DFV upon police call-outs, but can be limiting insofar as they do not show ongoing patterns of violence. Our findings highlight the importance of exercising domain-specific, rather than a 'one size fits all' approach when it comes to understanding the benefits and limitations of BWC technology. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [ABSTRACT FROM AUTHOR]

Voluntary assisted dying laws have now been enacted in all six Australian States with reform being considered in the remaining two. While there is an emerging body of literature examining various aspects of regulation, there has been scant consideration of what these reforms mean for First Nations peoples, and to what extent their experiences have been considered in the process of developing legislation. This article provides a critical analysis of how Indigenous perspectives both contributed to, and were engaged with, during the law reform processes in Victoria and Western Australia, the first two States to grapple with this topic. Findings reveal the sophistication in how Indigenous organisations and individuals engaged with this issue and highlight the critical importance of not universalising Indigenous perspectives. Significantly, there was much greater engagement with Indigenous views in Western Australia than in Victoria. We conclude by considering how Indigenous voices can meaningfully influence Australian law reform processes. [ABSTRACT FROM AUTHOR]

Introduction: Despite a decline in unintended teenage pregnancy in Australia, rates remain higher amongst justice-involved adolescent girls, who are more likely to be from disadvantaged socio-economic backgrounds, have histories of abuse, substance use and/or mental health issues. Furthermore, exposure to the criminal justice system may alter access to education and employment and opportunities, potentially resulting in distinct risk-factor profiles. We examine factors associated with unintended pregnancy, non-contraceptive use and Long-Acting Reversible Contraception (LARC) in a sample of sexually active, justice-involved adolescent girls from Western Australia and Queensland. Methods: Data from the Mental Health, Sexual Health and Reproductive Health of Young People in Contact with the Criminal Justice System (MeH-JOSH) Study was analysed on 118 sexually active adolescent girls. Participants were aged between 14 and 17 years, purposefully sampled based on justice-system involvement and completed an anonymous telephone survey. We constructed two multivariate models taking reproductive outcomes as the dependent variables. Results: Over one quarter (26%, 30/118) reported a past unintended pregnancy, 54 did not use any contraception at their last sexual encounter, and 17 reported LARC use. Following adjustments in the multivariate analysis, lifetime ecstasy use was associated with both unintended pregnancy (aOR 3.795, p = 0.022) and non-contraception use (aOR 4.562, p = 0.004). A history of physical abuse was also associated with both any contraception (aOR 3.024, p = 0.041) and LARC use (aOR 4.892, p = 0.050). Identifying as Aboriginal & Torres Strait Islander, education/employment status and geographic location appeared to have no association. Conclusion: Our findings suggest that justice-involved adolescent girls have distinct risk factors associated with unplanned pregnancy and contraception use compared to the general population, but more research is required to understand the mechanisms and contexts underlying these risk factors. How exposure to physical violence may encourage contraception and LARC use, in particular, warrants further attention as does the association with ecstasy use. [ABSTRACT FROM AUTHOR]

This article explores forms of public administration and public policy associated with the governance of mining regions in Australia, many of which experienced unprecedented levels of resource-based development during the country's most recent mining boom. Drawing on data from a two-year investigation into the governance challenges associated with the resources boom, the authors document the different approaches adopted by State government authorities to deliver public infrastructure and services to mining-affected regions. This paper introduces a typology that classifies State government action by the extent to which it enables, influences, or harnesses private sector action to deliver public services. Analysis reveals that a range of environmental variables affect the prevailing governance model. Adopting a contingency approach, it is argued that governance arrangements should be viewed as dynamic, with State governments engaging in different approaches to policy implementation in response to location-specific environmental factors. • Individual state governments respond differently to demands for infrastructure and services in mining communities. • State government approaches are categorized according to whether they enable, influence, or harness private sector action to deliver public services. • Western Australia, Queensland and South Australia during the mining boom are characterised as enabling state, influencing state or minimal state. • The paths followed by each state were contingent on critical external influences. [ABSTRACT FROM AUTHOR]

The absence of legal criteria to support the responsible closure of large-scale mines is a significant global issue. Mine closure regulation primarily focuses on the physical aspects of mining, with limited attention paid to social aspects of mine closure. This paper examines the extent to which regulatory instruments across three major Australian mining jurisdictions – New South Wales, Queensland and Western Australia – include provisions that require proponents to consider the social aspects of mine closure. We found that regulatory frameworks broadly cover social aspects, but often without explicit text in legislation or policy guidelines. We also found that regulators rely on front-end approval processes to account for and mitigate the social impacts of mining and that, following approval, regulators rely on stakeholder engagement, rather than also requiring evidence-based analysis and impact management. In the absence of restrictive regulatory elements in the latter stages of the project life cycle, we conclude that mining companies are relatively unhindered, free to enter into indefinite care and maintenance mode, or divest their assets. The current approach allows the costs of mine closure to sit 'outside' the life of mine planning processes. [ABSTRACT FROM AUTHOR]

The velvet-leaf hibiscus, Hibiscus krichauffianus F.Muell. (Malvaceae subfamily Malvoideae), is predominantly associated with sand dunes in the Australian arid zone but the name is presently also applied to plants occurring in different habitats on the southern edge of the range, and in disjunct locations in Western Australia and eastern Queensland. We investigated the morphological and environmental variation within H. krichauffianus throughout the geographic range. As a result, we have identified two new species, H. verecundus McLay & Albr. and H. calcareus McLay & Albr.; coined a phrase name, H. sp. Belele (D.W.Goodall 3417) for a putative new taxon; and recircumscribed H. krichauffianus. We also assessed material collected when the protologue of H. krichauffianus was published in the late 1850s and selected a lectotype from the original material identified. The velvet-leaf hibiscus, Hibiscus krichauffianus. Our investigation of the Australian arid zone specialist Hibiscus krichauffianus resulted in the discovery of two new species, H. verecundus and H. calcareus , both of which are described here. We also recircumscribe and lectotypify H. krichauffianus, and raise a phrase name entity. Distribution maps, figures, a table of morphological differences and a key are provided to identify these species. (Image credit: Dave Albrecht.) [ABSTRACT FROM AUTHOR]

The genus Erythrophleum Afzel ex R.Br. is revised for Australia and three species are recognised, all previously included in E. chlorostachys (F.Muell.) Baill. Erythrophleum arenarium R.L.Barrett & M.D.Barrett is described as a new species to accommodate populations from desert sands of the Great Sandy Desert and Dampier Botanical Districts in north-western Australia, parapatric to the remaining species. Erythrophleum pubescens R.L.Barrett & M.D.Barrett is described as a new species spanning tropical Australia, and is sympatric with E. chlorostachys sensu stricto in the Northern Territory and adjacent areas of Western Australia and Queensland. Morphological examination has shown these three taxa to be consistently distinct across their respective ranges. Analyses of the nuclear ribosomal ITS1 region recovered three well-supported clades corresponding to the three morphologically defined species, and ITS1 has utility as a marker to separate sterile specimens. Erythrophleum pubescens is widespread in the Australian Monsoon Tropics, from the coast of Western Australia, near Derby, to Cape York Peninsula in northern Queensland. Erythrophleum chlorostachys is also widespread, from the eastern Kimberley Region, in Western Australia, to the Gulf of Carpentaria, in northern Queensland. A lectotype is chosen for Laboucheria chlorostachya F.Muell. Full descriptions, illustrations of key features and identification keys are provided for the three Australian species. A summary of the significant utilisation of Erythrophleum species is presented. [ABSTRACT FROM AUTHOR]

Background: Lifetime trajectories of mental ill-health are often established during adolescence. Effective interventions to prevent the emergence of mental health problems are needed. In the current study we assessed the efficacy of the cognitive behavioural therapy (CBT)-informed Climate Schools universal eHealth preventive mental health programme, relative to a control. We also explored whether the intervention had differential effects on students with varying degrees of social connectedness. Method: We evaluated the efficacy of the Climate Schools mental health programme (19 participating schools; average age at baseline was 13.6) v. a control group (18 participating schools; average age at baseline was 13.5) which formed part of a large cluster randomised controlled trial in Australian schools. Measures of internalising problems, depression and anxiety were collected at baseline, immediately following the intervention and at 6-, 12- and 18-months post intervention. Immediately following the intervention, 2539 students provided data on at least one outcome of interest (2065 students at 18 months post intervention). Results: Compared to controls, we found evidence that the standalone mental health intervention improved knowledge of mental health, however there was no evidence that the intervention improved other mental health outcomes, relative to a control. Student's social connectedness did not influence intervention outcomes. Conclusion: These results are consistent with recent findings that universal school-based, CBT-informed, preventive interventions for mental health have limited efficacy in improving symptoms of anxiety and depression when delivered alone. We highlight the potential for combined intervention approaches, and more targeted interventions, to better improve mental health outcomes. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to assess student nurses’ knowledge of and attitudes towards pressure injury prevention evidence-based guidelines. Background Pressure injuries are a substantial problem in many healthcare settings causing major harm to patients, and generating major economic costs for health service providers. Nurses have a crucial role in the prevention of pressure injuries across all health care settings. Design A multi-centered, cross-sectional study was conducted using a paper-based questionnaire with undergraduate nursing students enrolled in seven universities with campuses across five Australian states (Queensland, New South Wales, Western Australia, Victoria and Tasmania). Methods Data were collected from nursing students using two validated instruments (Pressure Ulcer Knowledge Assessment Instrument and Attitude Toward Pressure Ulcer Prevention Instrument), to measure students’ pressure injury prevention knowledge and attitudes. Results Students reported relatively low pressure injury prevention knowledge scores (51%), and high attitude scores (78%). Critical issues in this study were nursing students’ lack of knowledge about preventative strategies to reduce the amount and duration of pressure/shear, and lower confidence in their capability to prevent pressure injury. Level of education and exposure to working in a greater number of different clinical units were significantly related to pressure injury prevention knowledge and attitude scores. Conclusion The study findings highlight the need to implement a comprehensive approach to increasing Australian nursing students’ pressure injury prevention and management knowledge, as well as ensuring that these students have adequate experiences in clinical units, with a high focus on pressure injury prevention to raise their personal capability. [ABSTRACT FROM AUTHOR]

A particular historical travelling religious complex in northern Western Australia, usually known as Kurangara, has been the subject of anthropological attention since the late 1930s. Overlooked in all the literature is a similar account assigned to 1912–1918, in the distant Channel Country of southwest Queensland. This is in Alice Duncan‐Kemp's last book, published in 1968. My examination shows that a good deal of Duncan‐Kemp's account repeated parts of a 1954 popular magazine about Kurangara in the Pilbara. In other respects Duncan‐Kemp may have drawn on her own childhood experiences, but in the absence of corroboration her account has to be considered unreliable. [ABSTRACT FROM AUTHOR]

Objective: Estimate impact of socioeconomic factors and remoteness from tertiary hospital on incidence/duration of Australian mental health admissions. Methods: Retrospective analysis of incidence/duration of public mental health unit admissions (2018–19). Covariates included Indigenous population, potentially preventable hospitalisations (PPH) and socioeconomic disadvantage. Results: Regional distance from hospital was correlated with socioeconomic disadvantage (ρ : p < 0.01). Population identifying as Aboriginal or Torres Strait Islander was associated with distance from hospital, socioeconomic disadvantage and PPH (ρ : p < 0.01). Bed days per capita was explained (R 2adj: 0.48) by distance and socioeconomic disadvantage (p < 0.0001). A 1% increase in distance from hospital was associated with a 0.37% decrease in per capita bed days. Admission rate per capita across Queensland and WA was explained (R 2adj: 0.36) by distance, education/occupation and state (p < 0.05). Across Queensland and WA a 1% increase in distance from hospital was associated with a 0.05% decreased incidence of admission. Conclusions: Rural Australians face high mental illness burden, socioeconomic disadvantage and limited service provision. Overcoming the additional disadvantages of reduced likelihood of admission to and reduced time in hospital with increasing distance from hospital will require increased outreach proportional to remoteness. [ABSTRACT FROM AUTHOR]

Lunatic asylums formed part of the civic infrastructure that was constructed out of British colonists invading and subsequently colonising unceded, Indigenous Australian lands during the eighteenth and nineteenth century. This historical narrative examined nineteenth century primary and secondary sources including, patient lists, medical files, and government correspondence, to provide insight into the experiences of Indigenous Australians admitted to Australia's earliest lunatic asylums. Awareness that lunatic asylums formed part of the structure imposed during colonisation, provides nurses and other health professionals with greater historical literacy regarding the impact of colonial lunatic asylums on Indigenous Australians. Such impacts continue to be experienced through transgenerational trauma and emphasise the importance of culturally safe mental health services. [ABSTRACT FROM AUTHOR]

Early in the twentieth century, Australian women’s claims for juror eligibility (that is, jury franchise) were debated and fiercely opposed in state parliaments more often than is realised. Bills and motions lapsed and failed, leaving parliamentary debate littered with claims that women lacked capacity and emotional regulation and revelations that parliamentarians fretted over the so-called wrong women becoming jurors. However, these thin reasons do not explain why Queensland enacted formal gender equality late yet was the first state to permit women into jury rooms. Nor do they explain why formal gender equality in jury franchise in Australia was out of kilter with parliamentary suffrage; nor why Western Australia, which legislated women’s right to vote and debated women’s jury franchise early, rejected women’s jury participation early and often. This article responds to these questions by mapping this trail of inchoate lawmaking, missed opportunities and hard-fought battles during the first four decades of Australia’s slow and uneven acceptance of women jurors. [ABSTRACT FROM AUTHOR]

Lethal infectious disease epidemics have historically occurred in military, refugee and mining camps where crowded conditions promote the spread of enteric, respiratory and insect‐borne infections. The early history of gold mines around Palmer River, Queensland in the 1870s, Kalgoorlie, Western Australia in the 1890s and Papua on the island of New Guinea in the 1910s are recounted specifically as it relates to infectious disease deaths. Despite large diagnostic gaps, it is likely that malaria was the predominant problem in Palmer River, typhoid in Kalgoorlie and bacillary dysentery in Papua. Nearly two‐thirds of all recorded deaths in the Palmer River district from 1873 to 1883 were due to infections, predominately 'fevers'. Typhoid fever likely killed >2000 Australians in the early phases of the Western Australian goldfields in the 1890s. Severe dysentery outbreaks killed up to a majority of the local workforce in the Lakekema goldfields of Papua resulting in the colonial authorities stopping mining activity in the second decade of the 20th century. In the absence of public health measures and specific chemotherapy, large mortality rates in miners reflected the over‐riding economic drivers of gold miners and their lack of any understanding of microbial disease and its interruption by public health measures. Similar infectious disease epidemics are likely to reoccur when large numbers of impoverished miners use low‐technology methods to work alluvial gold deposits in conflict areas as has been seen in modern Africa. [ABSTRACT FROM AUTHOR]

Fathers in families raising children with disabilities are under-researched. Fathers' perspectives can be better accommodated in childhood disability services that operate on a family-centred paradigm if their perspectives are understood. This study aimed to investigate the perspectives of fathers on caring and family life, work, and health. A mixed-methods design with an online questionnaire included open-ended questions and three instruments: Depression Anxiety Stress Scales (DASS); Health Promoting Activities Scale (HPAS-M); Fathers of Children with Developmental Challenges (FCDC) Scale. Fathers (n = 33) reported high depressive (58%), anxiety (37%), and stress symptoms (61%). Fathers reported low participation in health-promoting activity with less than weekly: planning health activities (58%); solo physical activity (26%); social activity (3%); time relaxing (16%). Sixty-four percent worked full-time, although work was reported to be challenged by family responsibilities. Fathers described directly caring for their children although service interactions were low and delegated to mothers. Fathers in this study reported stress, mental health issues, and low participation in healthy activity. Fathers experienced challenges related to career progression and job choices due to family responsibilities. Providing individualised and responsive support to fathers of a child with a disability would better support the family unit. Fathers of children with a disability in this study experienced high mental health symptoms. Fathers were involved with their child's care at home but had low service interactions suggesting that service providers need to discover new ways to better engage fathers. Fathers experienced challenges to participation in paid work secondary to care responsibilities for their child with a disability and resulting needs of their family. Services that better support fathers are important to promote better health and wellbeing and support families. [ABSTRACT FROM AUTHOR]

The International Panel on Climate Change (IPCC) projects a global temperature rise of 4.3 ± 0.7 °C by 2100 and an extinction of 8.5% in one out of every six species. Australia's aquatic ecosystem is no exception; habitat loss, fragmentation, and loss of biodiversity are being experienced. As the center for Nymphaea species distribution, it presents the culturally, ecologically, and scientifically important genus as the best candidate for habitat suitability assessment in climate change, whose habitat suitability is presumed to decline. The models were run according to the maximum entropy (MaxEnt) method, using one general circulation model (GCM). Projections were made for the current, past, and future in medium (4.5) and high (8.5) representative concentration pathways. Significantly, bio2 and bio15 were highly preferred among the species. Less distribution was noted in West Australia compared to the north, east, and south of the continent, while north of the continent in Western Australia, Northern Territory, and Queensland indicate more habitat contractions compared to the east and southeast of Queensland and New South Wales, although it receives high precipitation. Generally, the species respond variably to both temperature and precipitation variables which is a key species response factor for planners and decision makers in species habitat and biodiversity conservation. [ABSTRACT FROM AUTHOR]

Callistemon viminalis, often known as the stream bottlebrush, is a tropical plant in the Myrtaceae family and is renowned for its ability to grow rapidly in riparian zones. It is exclusively found in New South Wales, Queensland, and Western Australia. The roots of this species are entangled, which helps stabilize the soil, which reduces the danger of erosion. This plant has antibacterial, antifungal, antioxidant, and other pharmacological and insecticidal abilities that are also related to other medicinal properties. This research investigates the benefits, applications, and features of several extracts obtained from components of C. viminalis (branches, flowers, fruits, bark, and leaves). Bioactive compounds were characterized in detail by noting their chemical structures. The use of C. viminalis in folk medicine was fully supported by the results. Collecting and compounding plant materials, including processing, drying, and grinding, and then doing research to screen pharmaceutical effects, are all part of making the cure. Rats had their wound healing ability tested using a method known as in vitro experimentation. This method relies on excision wounds. The capacity of the extracted substance to close wounds when applied as an ointment was shown to be greater than in the control. The epithelization time in the standard and treated groups was significantly shorter than in the basic ointment base treatment group. The group treated with 5% w/w extract ointment had greater traction intensity than the control group (1.96 gm/mm2), with a significant difference of (1.12) gm/mm2. The tensile strength of the (3.86) gm/mm2 of the 5% w/w treated group. A substantial increase in tensile strength was seen on the tenth day for both the extract level and the normal medicine. [ABSTRACT FROM AUTHOR]

Objective. To analyse Medicare expenditure by State/Territory, remoteness, and Indigenous demography to assess funding equality in meeting the health needs of remote Indigenous populations in the Northern Territory. Methods. Analytic descriptions of Medicare online reports on services and benefits by key demographic variables linked with Australian Bureau of Statistics data on remoteness and Indigenous population proportion. The Northern Territory Indigenous and non-Indigenous populations were compared with the Australian average between the 2010/2011 and 2019/2020 fiscal years in terms of standardised rates of Medicare services and benefits. These were further analysed using ordinary least squares, simultaneous equations and multilevel models. Results. In per capita terms, the Northern Territory receives around 30% less Medicare funds than the national average, even when additional Commonwealth funding for Aboriginal medical services is included. This funding shortfall amounts to approximately AU$80 million annually across both the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. The multilevel models indicate that providing healthcare for an Aboriginal and Torres Strait Islander person in a remote area involves a Medicare shortfall of AU$531-- AU$1041 less Medicare Benefits Schedule benefits per annum compared with a non-Indigenous person in an urban area. Indigenous population proportion, together with remoteness, explained 51% of the funding variation. An age--sex based capitation funding model would correct about 87% of the Northern Territory primary care funding inequality. Conclusions. The current Medicare funding scheme systematically disadvantages the Northern Territory. A needs-based funding model is required that does not penalise the Northern Territory population based on the remote primary health care service model. [ABSTRACT FROM AUTHOR]

Background: Sea snakes are venomous snakes found in the warm parts of the Indo-Pacific, including around Australia. Most sea snake envenoming causes myotoxicity, but previous Australian case reports describe neurotoxicity. We aimed to describe the epidemiology and clinical presentation of Australian sea snake envenoming and the effectiveness of antivenom. Methods: Patients were recruited to the Australian Snakebite Project (ASP), an Australia-wide prospective observational study recruiting all patients with suspected or confirmed snakebite >2 years. Information about demographics, bite circumstances, species involved, clinical and laboratory features of envenoming, and treatment is collected and entered into a purpose-built database. Results: Between January 2002 and August 2020, 13 patients with suspected sea snake bite were recruited to ASP, 11 were male; median age was 30 years. Bites occurred in Queensland and Western Australia. All patients were in or around, coastal waters at the time of bite. The species involved was identified in two cases (both Hydrophis zweifeli). Local effects occurred in 9 patients: pain (5), swelling (5), bleeding (2), bruising (1). Envenoming occurred in eight patients and was characterised by non-specific systemic features (6) and myotoxicity (2). Myotoxicity was severe (peak CK 28200 and 48100 U/L) and rapid in onset (time to peak CK 13.5 and 15.1 h) in these two patients. Non-specific systemic features included nausea (6), headache (6), abdominal pain (3), and diaphoresis (2). Leukocytosis, neutrophilia, and lymphopenia occurred in both patients with myotoxicity and was evident on the first blood test. No patients developed neurotoxicity or coagulopathy. Early Seqirus antivenom therapy was associated with a lower peak creatine kinase. Conclusion: While relatively rare, sea snake envenoming is associated with significant morbidity and risk of mortality. Early antivenom appears to have a role in preventing severe myotoxicity and should be a goal of therapy. [ABSTRACT FROM AUTHOR]

Applications of complex networks-based concepts in hydrology are gaining momentum at the current time. One of the most critical limitations in such studies is the use of linear correlation between the nodes (e.g. rainfall stations) for some assumed threshold levels to identify possible relationships/links. In this regard, entropy theory can be useful to better identify the information flow between the nodes. This study demonstrates the concept of transfer entropy for the directed–weighted complex network to study rainfall dynamics, especially to establish the statistically significant information flow between the nodes. The methodology is applied to a rainfall network of 218 stations across Australia, and total monthly rainfall data observed over the period 1981–2006 are analysed. The nature of the network is studied by determining the in-clustering, out-clustering, and cyclic-clustering coefficients. The highest number of in-clustering values are obtained for the northern parts of Northern Territory and Queensland in addition to the eastern parts of Queensland and New South Wales. Further, the highest number of out-clustering values are also obtained for the northern parts of Northern Territory and Queensland. It can be concluded that while the stations in the northern parts of Australia affect other stations, they are also influenced by others in a reciprocal relationship as shown by the high cyclic-clustering values for these regions. The stations in Western Australia and Victoria have relatively lower in- and out-clustering values, indicating that these stations have lower tendency to make a cluster with other stations. However, while the stations in Western Australia have the lowest clustering coefficients, they have also the highest out-strength values among the stations. These stations constitute a low number of triangles (or groups) with other stations but are significantly influential over other stations, especially located in Victoria (in the southeast). Therefore, the proposed methodology can be useful for determining the tendencies of the nodes in a network to make a cluster with strong or weak relationships with other nodes. [ABSTRACT FROM AUTHOR]

Background: The burden of disease attributable to alcohol and other drug (AOD) use in young people is considerable. Prevention can be effective, yet few programs have demonstrated replicable effects. This study aimed to replicate research behind Climate Schools: Alcohol and Cannabis course among a large cohort of adolescents. Methods: Seventy-one secondary schools across three States participated in a cluster-randomised controlled trial. Year 8 students received either the web-based Climate Schools: Alcohol and Cannabis course (Climate, n = 3236), or health education as usual (Control, n = 3150). Outcomes were measured via self-report and reported here for baseline, 6- and 12-months for alcohol and cannabis knowledge, alcohol, cannabis use and alcohol-related harms. Results: Compared to Controls, students in the Climate group showed greater increases in alcohol- [standardised mean difference (SMD) 0.51, p < 0.001] and cannabis-related knowledge (SMD 0.49, p < 0.001), less increases in the odds of drinking a full standard drink[(odds ratio (OR) 0.62, p = 0.014], and heavy episodic drinking (OR 0.49, p = 0.022). There was no evidence for differences in change over time in the odds of cannabis use (OR 0.57, p = 0.22) or alcohol harms (OR 0.73, p = 0.17). Conclusions: The current study provides support for the effectiveness of the web-based Climate Schools: Alcohol and Cannabis course in increasing knowledge and reducing the uptake of alcohol. It represents one of the first trials of a web-based AOD prevention program to replicate alcohol effects in a large and diverse sample of students. Future research and/or adaptation of the program may be warranted with respect to prevention of cannabis use and alcohol harms. [ABSTRACT FROM AUTHOR]

The sponge genus Sollasella has three named species, two from eastern Australia, (Queensland and New South Wales) and one from the western Arabian Sea. Using a combination of morphological and molecular data, we describe three new species from northern Western Australia. We sequenced Cytochrome Oxidase I and two different fragments of 28S to reconstruct genealogical relationships among species in the genus. Sollasella suttonorum sp. nov. is closest morphologically to the two previously known Australian species: S. digitata Lendenfeld, 1888 and S. moretonensis van Soest, Hooper, Beglinger and Erpenbeck 2006. However, S. ananas sp. nov., and S. maraca sp. nov. show a novel clubbed or oval (rather than digitate or lobed) morphology. These two species contain a unique spicule type (anatriaene-like) not previously reported in the Axinellida. As a consequence of this study the species diversity of Sollasella is doubled to six species, with all species confined to the Indian and Pacific oceans. [ABSTRACT FROM AUTHOR]

We have little knowledge of differences in end‐of‐life care between home settings and residential aged care facilities (RACFs) where people spend most of their last year of life. This study aimed to compare end‐of‐life care between home settings and RACFs from the perspective of Australian general practitioners (GPs). A descriptive study was conducted with 62 GPs from Western Australia, Queensland and Victoria. Participants were asked to provide reports on end‐of‐life care of decedents in their practice using a validated clinic‐based data collection process developed by our team between September 2018 and August 2019. Of the 213 reported expected deaths, 66.2% mainly lived at home in the last year of life. People living at home were more likely to die at a younger age (median 77 vs. 88, p < 0.001), to be male (51.1% vs. 33.3%, p = 0.01) and to die of cancer (53.9% vs. 4.2%, p < 0.001) compared to those in RACFs. There were no significant differences between the two patient groups for seven out of the eight assessed symptoms, except nausea. GPs' perceived roles in caring for patients and levels of their involvement in provision of common palliative care services were comparable between the two groups. The usual accommodation setting was most frequently considered the preferred place of death in both groups. However, more home residents ended up dying in hospital compared to RACF residents. There were significantly higher frequencies of end‐of‐life discussions (ORs ranged 5.46–9.82 for all topic comparisons) with GPs associated with people living at home versus RACFs. One opportunity for improved care is through promoting greater involvement of GPs in end‐of‐life discussions with RACF residents and staff. In general, more Australians could potentially remain at home until death if provided with greater access to essential specialist palliative care services and supportive services in home settings. [ABSTRACT FROM AUTHOR]

Reducing the damage caused by feral cats (Felis catus) to wildlife, livestock and human health is a key objective for many land managers and human health agencies globally. The lack of safe and efficacious lethal control tools in many regions, however, makes the control of feral cats and their impacts challenging. We performed a baiting trial in central Queensland to measure the efficacy and safety of Eradicat®, a feral cat bait currently approved for use only in the state of Western Australia, as a potential tool for the broadscale control of feral cats in eastern Australian environments. We used camera traps, cat-borne GPS collars and chemical residue analysis to monitor mortality and changes in feral cat populations following baiting. We also used camera traps and bird count surveys to monitor the response of key at-risk non-target species, specifically wild dogs (Canis familiaris), common brush-tailed possums (Trichosurus vulpecula) and 10 bird species at risk of consuming baits. Feral cat abundance reduced significantly (29–40%) following baiting, with reductions observed across 83% of the site. There were no significant changes in wild dog, possum or potentially bait-consuming bird populations following baiting. Our findings suggest that Eradicat® could potentially be a safe and efficacious tool for the landscape control of feral cats at some sites in eastern Australia. Future research is required to test the safety and efficacy of Eradicat® at other sites in eastern Australia, as suites of non-target species will vary among sites in different environments. [ABSTRACT FROM AUTHOR]

The fatal shark bite of a scuba diver off the coast of Esperance in Western Australia in January 2020, followed in recent months by a further four fatalities in New South Wales and Queensland, has once again sparked debate about government policies to protect humans from potentially dangerous marine life. This debate is not new; during 2010–13 Western Australia experienced an unusually high level of human fatalities from shark bites. These events precipitated the introduction of the Western Australian Shark Hazard Mitigation Drum Line Program, a controversial and costly pre-emptive state government initiative that cost approximately $13.6 million for shark repellent responses, and the implementation of a Shark Response Unit. This research utilises official documents obtained under the Freedom of Information Act 1989 (Cth), together with interviews with relevant stakeholders, media reports, and public submissions to critically examine the political antecedents of a costly and flawed shark hazard mitigation program. It also provides lessons for how governments construct problems and manage marine environments and protected species. It concludes, utilising the theory of claims-making, that shark bite increases in Western Australia was a media constructed social problem, used to convince the government that a catch-and-kill policy of an internationally protected species was necessary to avert a perceived economic downturn in tourism revenue and to appease an invented public outcry. [ABSTRACT FROM AUTHOR]

Background: Behavioural medicine is characterised by findings for the effectiveness and efficacy of complex behaviour change interventions. Comparatively, scant attention has been paid to key intervention components or mechanisms of action. Evaluating relationships between process variables (fidelity) and intervention effects is central to addressing this imbalance. Accordingly, in the current study, we sought to explore the magnitude and direction of effect between fidelity predictors (dietitian adherence and competence) and intervention effects (patient nutritional status) during the intervention phase of a real-world, stepped-wedge evaluation of 'EAT: Eating As Treatment'.Methods: The EAT clinical trial was conducted within five major Australian hospitals located in Queensland, Western Australia, Victoria and South Australia between 2013 and 2016. EAT is a dietitian-delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. Dietitian adherence and competence ratings were derived from a 20% random sample of audio-recorded dietetic consultations (n=194) conducted after dietitians (n=18) were trained in EAT. Sessions were coded by trained, independent, coders using a study checklist, the Behaviour Change Counselling Index (BECCI) and items from the Cognitive Therapy Scale-Revised (CTS-R). Patient nutritional status was measured using the Patient-Generated Subjective Global Assessment (PGSGA).Results: Dietitian adherence to a written nutrition plan (β=7.62, 95% CI=0.65 to 14.58, p=0.032), dietitian adherence to behaviour change counselling (β=0.69, 95% CI =0.02 to 1.38, p=0.045) and competence in delivering behaviour change counselling (β=3.50, 95% CI =0.47 to 6.53, p=0.024) were significant predictors of patient nutritional status. Dietitian adherence and competence ratings were higher during consultations with intervention patients at greater risk of malnutrition.Conclusions: This study contributes new insights into the relationship between fidelity and treatment outcome by demonstrating that dietitian adherence and competence is greater when working with more challenging patients. This is likely central to the demonstrated success of the EAT intervention in reducing malnutrition and highlights the importance of ensuring that providers are adequately equipped to flexibly integrate intervention elements according to patient need.Trial Registration: This study is a process analysis of a stepped-wedge randomised controlled trial prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12613000320752 ; Date of registration 21/03/2013). [ABSTRACT FROM AUTHOR]

The Chestnut-backed Button-quail Turnix castanotus is widely distributed in monsoonal tropical woodland but previously known only from the Northern Territory and Western Australia. Here we provide the first verified record in Queensland. We observed at least eight birds during October and November 2020 at Westmoreland Station, which is located in far north-western Queensland. These observations represent a significant (~215 km) easterly range extension and are the first confirmed records of this species for Queensland. Chestnut-backed Button-quail had gone undetected in Queensland likely owing to the difficulty in locating and identifying button-quail generally and the low number of birdwatchers in the region. A potential record made by W.R. McLennan in 1910 may represent a previously unreported record of this species in Queensland. Here we describe our observations in 2020 and the habitat where the species was recorded. [ABSTRACT FROM AUTHOR]

Objective: Private practice psychiatry in Australia was largely office-based until the Commonwealth Government introduced new psychiatrist Medicare Benefits Schedule (MBS) telehealth items in response to the first wave of the COVID-19 pandemic. We investigate the uptake of (1) video and telephone telehealth consultations in April–May 2020, and (2) the overall changing rates of consultation, i.e. total telehealth and in-person consultations across the larger states of Australia. Method: MBS item service data were extracted for COVID-19 psychiatrist video- and telephone-telehealth item numbers and compared with a baseline of the 2018−2019-financial-year monthly average of in-person consultations for New South Wales, Queensland, Victoria, and Western Australia. Results: Total psychiatry consultations (telehealth and in-person) rose during the first wave of the pandemic by 10%−20% compared to the previous year. The majority of private practice was conducted by telehealth in April but was lower in May as new COVID-19 case rates fell. Most telehealth provision was by telephone for short consultations of ⩽15−30 min. Video consultations increased from April into May. Conclusions: For large states, there has been a rapid adoption of the MBS telehealth psychiatrist items, followed by a trend back to face-to-face as COVID-19 new case rates reduced. There was an overall increased consultation rate (in-person plus telehealth) for April−May 2020. [ABSTRACT FROM AUTHOR]

Objectives: To examine trends in ED presentations with a mental health diagnosis (MHdx) in Australia by jurisdiction and by sex, between 2004–05 and 2016–17. Methods: Data were captured in the National Non‐Admitted Patient Emergency Department Care Database. Outcomes were the proportion of ED presentations with a principal diagnosis of ICD‐10‐AM F00‐F99 (MHdx), and the rate of all ED and MHdx presentations per 10 000 population. Results: Between 2004–05 and 2016–17, MHdx presentations experienced compounding annual growth of 5.9% nationally, and increased from 3.3% to 3.7% of all ED presentations with a diagnosis. Most growth occurred between 2010–11 and 2015–16. Northern Territory (NT) had the highest level of MHdx presentations per 10 000 population, more than double the Australian average. The proportion of MHdx presentations was highest in South Australia (SA) in most years, and the average annual proportion of MHdx presentations was statistically significantly higher than the national average in SA, Queensland (QLD) and Western Australia (WA). The proportion of MHdx presentations increased in each jurisdiction, with significant increases for Victoria, QLD, WA, Australian Capital Territory and NT. Males experienced greater numbers and rates of all ED and MHdx presentations, while the proportion of MHdx presentations was 8% higher for females. Conclusions: The proportion of ED presentations for MH conditions, narrowly defined, has increased in all Australian jurisdictions between 2004–05 and 2016–17, but particularly since 2010–11. Differences between jurisdictions indicate jurisdictional specific issues. However, significant or upward trend of MHdx presentations across all jurisdictions indicates generic issues necessitating concern and policy development at a national level. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 40–50% of people with multiple sclerosis (MS) have dysarthria impacting confidence in communication. This study explored how people with MS experienced a novel therapeutic approach combining dysarthria therapy with poetry in a group format. Method: Participants were recruited through MSWA (formerly known as the Multiple Sclerosis Society of Western Australia), a leading service provider for people living with all neurological conditions in Western Australia. They attended eight weekly sessions led by a speech pathologist and a professional poet. The study was co-designed and qualitative, using observational field notes recorded during sessions and semi-structured in-depth interviews with participants after programme completion. The results from an informal, unstandardised rating scale of communication confidence, along with standardised voice and speech measures, were used to facilitate discussion about confidence in the interviews. Result: Nine participants with MS completed the group programme. Analysis of the qualitative data revealed participants' positive views regarding the pairing of speech pathology and poetry. Thematic analysis identified four core themes: living with MS and its "series of griefs"; belonging to a group – "meeting with a purpose"; the power of poetry; and poetry as a medium for speech pathology. Conclusion: Poetry in combination with dysarthria therapy represents a novel, interprofessional approach for improving communication confidence in individuals with MS. [ABSTRACT FROM AUTHOR]

Data from this article are derived from responses to questionnaires provided by 232 frontline workers and team leaders from a range of organizations across four Australian states who participated in The Invisible Practices Project: Engaging With Fathers Who Use Violence. This project was designed to explore the practices of workers who see perpetrators of domestic violence outside the relative safety of group-work programs. Thematic analysis was employed to examine the research question: What is the organizational context that contributes to, or constrains, the practices of frontline workers intervening with fathers who use violence? This article reports the ways that agencies increase the visibility of, and practices with, fathers who use violence. Increasing the visibility of fathers who use violence is posited as a crucial driver of policy and practice reform aligned with feminist goals of eliminating sexist institutional practices. It is argued that such practices render fathers who use violence invisible, reinforce patriarchal views of family roles and responsibilities, intensify the scrutiny on the mothering of women survivors, and compound the impact of domestic violence. This article documents emerging practices that seek to redress practices that support patriarchal views of family roles and responsibilities and has implications for understanding the capacity of social workers and other professionals to intervene with fathers who use violence. [ABSTRACT FROM AUTHOR]

The advance of renal replacement therapy options for people with end-stage kidney disease has given rise to the development of specialist renal nurses including the renal transplant coordinator. The renal transplant coordinator role requires a high level of specialist knowledge in renal and transplantation nursing plus a commitment to following through with people in the long term. To find out just what renal transplant coordinators in Australia do, an interview was conducted with renal transplant coordinators from each Australian state and territory. Their stories relate to transplanting units; referring centres; and, adult, paediatric, statewide and national renal services. They demonstrate the diversity that exists within the role of the renal transplant coordinator. [ABSTRACT FROM AUTHOR]

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Until recently, the only descriptions of Night Parrot Pezoporus occidentalis vocalisations were anecdotal reports from observers in the late 19th and early 20th centuries. The 2013 discovery of an extant population of Night Parrots in western Queensland led to the first contemporary descriptions, and further calls were described following the 2017 discovery of Night Parrots at a site in central Western Australia. Ongoing field studies have shown that the species has a complex repertoire and, although there are some similarities in vocalisations between sites, there is much spatial and temporal variation. It is likely that call recognition will be the primary means of detection for this cryptic species, underscoring the importance of cataloguing vocalisations across the species’ range. Accordingly, we describe all known vocalisations from the three sites where Night Parrots are known to occur. [ABSTRACT FROM AUTHOR]

Non-resident work practices, which involve prolonged separations from family, long-distance commuting between home and remote work sites and long work hours across compressed rosters, are now commonplace in Australia. This study examined the impact of these work arrangements, often termed Fly-In/Fly-Out (FIFO), on children and families, and to identify family-related and employment-related factors that influence child and family outcomes. Anonymous online surveys containing measures of family and couple relationship quality, child behavioral and emotional adjustment, parenting and personal adjustment were completed by 232 partners of FIFO workers, 46 FIFO workers, and a comparison group of community parents ( N = 294 mothers, N = 36 fathers). There were no differences between FIFO partners and community parents on family or couple relationship quality, parenting competence and child behavioral or emotional difficulties. FIFO partners reported higher levels of personal emotional problems and greater usage of harsh discipline practices than community mothers, while FIFO workers reported greater work to family conflict and alcohol use than community fathers. Regression analyses on the FIFO partners sample indicated that child and family functioning were best predicted by family factors, including harsh parenting and parental emotional adjustment. Implications of the findings for the design and provision of family-based support for FIFO families are discussed. [ABSTRACT FROM AUTHOR]

The lava tubes at Undara became internationally recognised in the late 1980s, when 24 species of terrestrial cave-adapted invertebrates (troglobionts) were recorded from Bayliss Cave, making it one of the 20 richest known cave communities in the world at the time. Over the last decades, several of the Undara species have been taxonomically described and a great deal of research has been undertaken in other parts of Australia, which has revealed additional subterranean hotspots. It is therefore timely to update the list of Undara cave fauna, and to evaluate the Undara cave system in relation to other subterranean hotspots in Australia. The updated species list was compiled from the published literature and museum databases. Minimally, 78 species of arthropods have been recorded from 17 lava tube caves in the Undara Basalt. Sixteen species have been taxonomically described; 30 identified to genus and/or morpho-species; and 32 remain unidentified to species or genus level. Thirty troglobionts and one stygobiont species were recorded. Seven caves harboured obligate subterranean species; Bayliss Cave harboured the most obligate subterranean species: 23 troglobionts and one stygobiont. All these caves contained deep zone environments with high humidity, of which three also contained 'bad air' (CO2). The unique combination of geomorphic structure and environmental parameters (high humidity) and multiple energy sources (tree roots, bats and guano, organic material wash-in) are the main factors responsible for Bayliss Cave's extraordinary local richness. Further research is needed to investigate CO2 as a factor influencing troglobiont richness and distribution in 'bad air' caves. Undara remains the richest subterranean hotspot in humid tropical Australia; however, significantly richer subterranean assemblages are found in arid and semi-arid calcrete aquifers, karst and iron-ore terrains, mostly in Western Australia. [ABSTRACT FROM AUTHOR]

Ovine congenital progressive muscular dystrophy (OCPMD) was first described in Merino sheep flocks in Queensland and Western Australia in the 1960s and 1970s. The most prominent feature of the disease is a distinctive gait with stiffness of the hind limbs that can be seen as early as 3 weeks after birth. The disease is progressive. Histopathological examination had revealed dystrophic changes specifically in type I (slow) myofibres, while electron microscopy had demonstrated abundant nemaline bodies. Therefore, it was never certain whether the disease was a dystrophy or a congenital myopathy with dystrophic features. In this study, we performed whole genome sequencing of OCPMD sheep and identified a single base deletion at the splice donor site (+ 1) of intron 13 in the type I myofibre-specific TNNT1 gene (KT218690 c.614 + 1delG). All affected sheep were homozygous for this variant. Examination of TNNT1 splicing by RT-PCR showed intron retention and premature termination, which disrupts the highly conserved 14 amino acid C-terminus. The variant did not reduce TNNT1 protein levels or affect its localization but impaired its ability to modulate muscle contraction in response to Ca2+ levels. Identification of the causative variant in TNNT1 finally clarifies that the OCPMD sheep is in fact a large animal model of TNNT1 congenital myopathy. This model could now be used for testing molecular or gene therapies. [ABSTRACT FROM AUTHOR]

Background: In a number of countries, frameworks have been developed to improve self-management support (SMS) in order to reduce the impact of chronic disease. The frameworks potentially provide direction for system-wide change in the provision of SMS by healthcare systems. Although policy formulation sets a foundation for health service reform, little is currently known about the processes which underpin SMS framework development as well as the respective implementation and evaluation plans.Methods: The aim of this study was to conduct a cross-country comparative document analysis of frameworks on SMS for chronic diseases in member countries of the Organisation for Economic Cooperation and Development. SMS frameworks were sourced through a systematic grey literature search and compared through document analysis using the Health Policy Triangle framework focusing on policy context, contents, actors involved and processes of development, implementation and evaluation.Results: Eight framework documents published from 2008 to 2017 were included for analysis from: Scotland, Wales, Ireland, Manitoba, Queensland, Western Australia, Tasmania and the Northern Territory. The number of chronic diseases identified for SMS varied across the frameworks. A notable gap was a lack of focus on multimorbidity. Common courses of action across countries included the provision of self-management programmes for individuals with chronic disease and education to health professionals, though different approaches were proposed. The 'actors' involved in policy formulation were inconsistent across countries and it was only clear from two frameworks that individuals with chronic disease were directly involved. Half of the frameworks had SMS implementation plans with timelines. Although all frameworks referred to the need for evaluation of SMS implementation, few provided a detailed plan.Conclusions: Differences across frameworks may have implications for their success including: the extent to which people with chronic disease are involved in policy making; the courses of action taken to enhance SMS; and planned implementation processes including governance and infrastructure. Further research is needed to examine how differences in frameworks have affected implementation and to identify the critical success factors in SMS policy implementation. [ABSTRACT FROM AUTHOR]

Background: Achieving quality improvement in primary care is a challenge worldwide, with substantial gaps between best practice and actual practice. Within the context of Australia, Aboriginal and Torres Strait Primary Health Care (PHC) services have great variation across settings, structures and context. Research has highlighted how these contextual differences can critically influence the success of Quality Improvement (QI) interventions and outcomes. Less understood is the interaction between local context and other factors, which may impact the implementation of QI interventions. This paper aims to explore the strengths and challenges in QI for Aboriginal and Torres Strait Islander PHC services and their priorities for improvement., Methods: A multiple case study design was adopted, working with eight Aboriginal and Torres Strait Islander PHC services in Northern Territory, Queensland and Western Australia. Data were collected via a health service survey, semi-structured interviews with health service staff and service users and researcher observations, to explore QI and perceptions of care quality at the service level. Data reported here were analysed using an iterative thematic technique, within-case and across-case., Results: A total of 135 interviews were conducted with health service staff, service users and community members. Participants emphasised the centrality of resilient community, committed workforce and valued Aboriginal and Torres Strait Islander team members in delivering care. A shared purpose around improving the health of community was a significant driver. Key challenges included staff turnover and shortages, a complex and overwhelming acute and chronic care workload, building relationships and trust between health services and the community. Service-suggested priority areas for improvement were categorised into five themes: i) cultural safety (community driving health and planning for culturally safe services); ii) community engagement (through clinical activities in the community); iii) shared ownership and a team approach around QI; iv) strengthening systems and consistent ways of doing things in the health service; and v) strengthening local workforce (and resources for a culturally safe workforce)., Conclusions: These findings advance understandings of relational, community and cultural factors which are identified priorities for the delivery of quality care in Aboriginal and Torres Strait Islander PHC services across varied contexts.

Objective This study examined strategic human resource management (SHRM) activities in two case hospitals relative to their approach to greenfield site success. Methods A comparative case study analysis approach was used, with documents sourced from public, open-access sites. The theoretical framework of crisis management theory's (CMT) proactive management and open communication channels was used to examine the documents, which were annual reports addressing both hospitals' first year of performance, union publications and transcripts of relevant parliamentary inquiries. Results The hospital that effectively used CMT in its first 12 months was demonstratively more 'successful' than the hospital that reported to not have effectively used CMT. 'Success' in this project was articulated as the hospital's ability to consolidate operations, without ongoing negative media attention, after 12 months. Conclusion This study provided an identification of how the use of CMT in a hospital's greenfield stage can increase the hospital's chances of 'success'. What is known about the topic? Journal and media articles illustrated a gap in greenfield human resource management (HRM) regarding successful consolidation, especially the healthcare context. Although manufacturing firms are addressed in academic literature in a greenfield context, there is a lack of knowledge concerning successful greenfield HRM in a healthcare context. What does this paper add? This study is among the first to identify the role of CMT in successful greenfield site establishment by identifying its presence in management activities. What are the implications for practitioners? The findings of this study suggest a potential link between the implementation of CMT and greenfield site success. This could allow future greenfield healthcare sites to operate with less cost and risk. The lack of stakeholder participation in the present study limits the applicability of its findings. However, archival document analysis provides a strong foundation for future studies.

Background: The Four-Hour Rule or National Emergency Access Target policy (4HR/NEAT) was implemented by Australian State and Federal Governments between 2009 and 2014 to address increased demand, overcrowding and access block (boarding) in Emergency Departments (EDs). This qualitative study aimed to assess the impact of 4HR/NEAT on ED staff attitudes and perceptions. This article is part of a series of manuscripts reporting the results of this project., Methods: The methodology has been published in this journal. As discussed in the methods paper, we interviewed 119 participants from 16 EDs across New South Wales (NSW), Queensland (QLD), Western Australia (WA) and the Australian Capital Territory (ACT), in 2015-2016. Interviews were recorded, transcribed, imported to NVivo 11 and analysed using content and thematic analysis., Results: Three key themes emerged: Stress and morale, Intergroup dynamics, and Interaction with patients. These provided insight into the psycho-social dimensions and organisational structure of EDs at the individual, peer-to-peer, inter-departmental, and staff-patient levels., Conclusion: Findings provide information on the social interactions associated with the introduction of the 4HR/NEAT policy and the intended and unintended consequences of its implementation across Australia. These themes allowed us to develop several hypotheses about the driving forces behind the social impact of this policy on ED staff and will allow for development of interventions that are rooted in the rich context of the staff's experiences.