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Includes Supplementary Material, Naval Special Warfare (NSW), in accordance with strategic level guidance issued over the last few years, is shifting its focus from the counter-terrorism missions of the last two decades to preparing to respond to threats posed by developed nation-states such as China and Russia. It will be important to identify and fill any critical gaps in operational capability that would prevent NSW from achieving anticipated objectives against said adversaries. One particularly valuable—yet underutilized—asset that should be leveraged to accomplish this goal is the personnel that NSW sends to Naval Postgraduate School (NPS) as students. They are in a unique position to conduct in-depth analysis to better understand, characterize, and identify solutions to current and anticipated real-world operational problems. Establishing official and sustainable mechanisms for coordination between NSW and its students at NPS is a task of principal importance for ensuring that both organizations are maximizing the school’s utility. This capstone project provides deliverables intended to enact and codify mechanisms for coordination between NSW, NPS, and the National Security Innovation Base., Senior Chief Petty Officer, United States Navy, Approved for public release. Distribution is unlimited.

Naval Special Warfare (NSW) operators are required to dive into cold waters for a prolonged time to infiltrate demanding environments. While underwater vehicles give the opportunity for longer infiltration ranges and deeper dives, the diving suit, which protects the diver from hypothermia, becomes the most essential diving equipment for the success of the mission. Although the first wetsuit was made in the 1950s, there has been no significant advancement in the neoprene material until recently, and the shrinking neoprene air pockets under depth pressure decrease the thermal insulation of the wetsuit and affect the diver’s buoyancy. To overcome this downside, the K-Suit Mk.4 prototype was created to give NSW operators an alternate diving wetsuit option with superior ergonomics, depth-independent thermal insulation and buoyancy, and possible sound protection. This wetsuit has a base layer of 3mm neoprene and two layers of composite materials. The first composite layer is composed of 8mm-thick glass microspheres mixed with a polymer and the second is thinner and forms solid ceramic beads coupled with the same polymer. Six experimental dives were carried out to gather temperature and pressure data. The data were analyzed, and the result is the K-Suit has the ability to outperform the traditional 7mm diving wetsuit specifications that NSW typically uses., ONR, Plotarhis, Hellenic Navy, Approved for public release. Distribution is unlimited.

Naval Special Warfare (NSW) operators are not currently manned, trained, or equipped to effectively survive or execute High Arctic mission sets. The dynamic rate of environmental change and the adversarial exploitation of the Arctic regions have disadvantaged the United States and its allies. This capstone intends to reduce inherent survival risks an NSW operator would incur associated with extreme “cold” and increase the duration an NSW operator can remain on station in the High Arctic. The end state is to provide NSW with research and a Course of Action (COA) that leads to prototype production, orchestrated through the Defense Innovation Unit (DIU), enabling NSW operators to rapidly respond to crisis/conflict in all Arctic regions., Lieutenant, United States Navy, Approved for public release. Distribution is unlimited.

The NSW EDRS sample comprises a sentinel sample of people who regularly use ecstasy and other illicit stimulants recruited via social media, advertisement on websites and via word-of-mouth in Sydney, NSW. The results are not representative of all people who use illicit drugs, nor of use in the general population. Data were collected in 2020 from May-June, subsequent to COVID-19 restrictions on travel and gatherings in Australia. Interviews were also delivered via phone/videoconference rather than face-to-face. This should be factored into all comparisons of data from the 2020 sample relative to previous years.

BackgroundThe relationship between serious mental conditions such as psychosis and criminal offending has gained increasing attention over time, particularly towards better management of prisoners with mental illness in the justice system. The extent to which psychosis contributes to offending is likely to vary across different practices of health and legal consideration.This thesis aims to examine the association between psychosis and offending in New South Wales (NSW), Australia. It also examines other aspects of this relationship, including the first diagnosis in prison and subsequent engagement in community treatments and post-release mortality of prisoners with and without a diagnosis of psychosis.MethodA retrospective study involving a population-level data-linkage using health and justice data collections pertaining to the most populous state in Australia, and the jurisdiction with the largest number of offenders (including prisoners) was conducted. Multivariate logistic regression was used to examine the relationship between psychosis and offending, and factors associated with a first diagnosis of psychosis. Cox regression model was used to examine the association between the setting of the first diagnosis (prison/community) and subsequent engagement with community mental health care services, and to determine the risk of mortality among prisoners with psychosis.Results Individuals with a diagnosis of psychosis were five times as likely to offend than those without a diagnosis of psychosis;Individuals who were diagnosed for the first time with psychosis inside the prison were diagnosed sooner (79.1% within three months of incarceration);Individuals with a first diagnosis of psychosis inside prisons were three times as likely not to receive mental health care services post-release compared to those who were diagnosed for the first time in hospitals; Prisoners with prior diagnoses of psychosis were twice as likely to die post-release than prisoners without a d

The World Health Organisation (WHO) recognises providing access to sterile needles and syringes to be a ‘fundamental component of any comprehensive and effective public health program’ to reduce the transmission of HIV amongst people who inject drugs (PWID). Similarly, Australia’s national and jurisdictional blood borne virus (BBV) strategies highlight promoting the use of and ensuring access to sterile needles and syringes as a primary intervention in retaining the virtual elimination of HIV amongst PWID and reducing hepatitis B and C transmission. These strategies aim to guide Australia’s response to meeting its commitments in reducing BBVs amongst priority populations. While Australia routinely exceeds the UNAIDS definition of high syringe coverage, receptive needle sharing practices continue to occur and is reported to be associated with sub-populations within the PWID community, such as women and younger people. Increased access to sterile needles is emphasized for these subpopulations. Internationally, the introduction of COVID-19 restrictions resulted in a drastic reduction in the distribution of sterile needles. In New South Wales (NSW), COVID-19 restrictions forced services providing needle and syringe programs (NSP) to adapt their modes of operation to comply with restrictions and protect the wellbeing of their staff, volunteers, and service users. Changes to services included reduced opening hours, limiting the number of staff and clients allowed in physical spaces to maintain social distancing requirements, and implementing contact tracing systems. While NSP services rapidly implemented strategies to ensure they continued to provide essential harm reduction services and information to their clients, there were concerns that changes to services and disruptions to supply chains could result in reduced NSP coverage.

In 1987, the Department of the Navy enacted the Special Warfare Technician/SEAL chief warrant officer designator to support the Naval Special Warfare SEAL Teams’ officer community. In general, the U.S. Navy recognizes the chief warrant officer program’s value; however, amid Naval Special Warfare’s Force Optimization plan, the SEAL chief warrant officer’s value proposition is unclear. This study aims to answer the question: How should Naval Special Warfare select and employ their SEAL chief warrant officers in order to best contribute to the improvement of Naval Special Warfare’s organizational effectiveness? This thesis provides recommendations from the analysis of qualitative and quantitative data that examines and compares the selection requirements and employment utilization of U.S. Navy SEAL chief warrant officers and Army Special Forces warrant officers. The results of the study reveal that SEAL chief warrant officers are not tactically employed; are too diverse across the Naval Special Warfare spectrum; are not optimally utilized as newly commissioned chief warrant officers; may not be remaining at the same command for repeated tours; and face qualification selection requirements that are too broad. This research offers a framework and mechanism for coherent action among the stakeholders that will increase the value proposition of the Special Warfare Technician and, consequently, improve Naval Special Warfare’s organizational effectiveness., Outstanding Thesis, Lieutenant Commander, United States Navy, Chief Warrant Officer Three, United States Army, Approved for public release. distribution is unlimited

In recent years, Naval Special Warfare has been plagued with a seemingly constant stream of highly publicized ethical violations involving mostly active-duty SEALs. The last decade has also seen an exponential increase in former SEALs who have engaged in self-aggrandizing behavior and the commodification of the “SEAL brand.” In particular, the highly publicized cases of ethical misconduct among active SEALs have raised questions about the efficacy of ethics, culture, and leadership in NSW. In response, many outside observers have provided answers to this purported “problem with SEALs.” This thesis claims that these hypotheses are false and that the problem has been misidentified and misattributed. Instead, I claim that SEALs do not have an ethics problem but suffer from a perception of an ethics problem. This perception finds its origin in (a) strategically purposed media narratives that spread far and wide due to constantly advancing information technology; (b) the politically hyper-polarized nature of American society and the mass media; and (c) five salient events involving NSW and the SEAL counterculture. In the final analysis, it is my primary claim that this perception fundamentally derives from—and would not have been possible without—the self-promoting actions of the SEAL minority counterculture. The men who have been so keen to bastardize the sanctity of the SEAL Ethos, selfishly choosing fame, wealth, and influence in place of the warrior ethic—in place of virtue., Naval Special Warfare Command, Outstanding Thesis, Lieutenant, United States Navy, Approved for public release. Distribution is unlimited.

Every year, the SEAL Officer Community Management (OCM) receives approximately 300 applications from candidates who want to attend Basic Underwater Demolition/SEAL (BUD/S) training to become Navy SEAL Officers. The applications include multiple data elements such as university attendance, grade point average (GPA) and physical fitness test scores. From this data, the SEAL OCM selects approximately 80% of the candidates to participate in SEAL Officer Assessment and Selection (SOAS). At SOAS, the candidates are assessed by the cadre at Naval Special Warfare (NSW) Basic Training Command (BTC), who provide evaluation data and recommendations to the SEAL OCM for candidate selection to BUD/S. In total, the process of assessing, selecting and training candidates to become SEAL Officers is resource-intensive, incurring a financial cost to the Navy, manning challenges for NSW and the time and energy of the candidates themselves. Removing candidates who have a low probability of success at BUD/S early in the process reduces the costs and allows them to be reassigned within the Navy to a community more appropriate to their abilities. This thesis aims to analyze data collected on the candidates to train statistical models capable of predicting a candidate's probability of success in the first phase of BUD/S and inform data collection to capture information on candidates for future data analysis., Outstanding Thesis, Lieutenant, United States Navy, Approved for public release. Distribution is unlimited.

Background: Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. Methods: Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for individual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region. Results: Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91–0.96) and obesity (OR 0.91, CI 0.88–0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4–1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%. Conclusion: The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and individual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region.

Background: Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. Methods: Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for individual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region. Results: Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91–0.96) and obesity (OR 0.91, CI 0.88–0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4–1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%. Conclusion: The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and individual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region.

Background: Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. Methods: Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for individual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region. Results: Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91–0.96) and obesity (OR 0.91, CI 0.88–0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4–1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%. Conclusion: The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and individual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region.

The Palliative Care Outcomes Collaboration (PCOC) is a national program that aims to improve the quality and outcomes of palliative care in Australia. This is achieved via a standardised clinical language that supports a national data collection. This report provides a high level profile of 6,150 patients who received palliative care in NSW and ACT during July to December 2019 and had their pain, symptom, family / carer and psychological / spiritual issues assessed as part of routine clinical care.

The Palliative Care Outcomes Collaboration (PCOC) is a national program that aims to improve the quality and outcomes of palliative care in Australia. This is achieved via a standardised clinical language that supports a national data collection. This report provides a high level profile of 6,150 patients who received palliative care in NSW and ACT during July to December 2019 and had their pain, symptom, family / carer and psychological / spiritual issues assessed as part of routine clinical care.

Background: Access to primary care is important for the identification, control and management of cardiometabolic risk factors (CMRFs). This study investigated whether differences in geographic access to primary care explained area-level variation in CMRFs. Methods: Multilevel logistic regression models were used to derive the association between area-level access to primary care and seven discrete CMRFs after adjusting for individual and area-level co-variates. Two-step floating catchment area method was used to calculate the geographic access to primary care for the small areas within the study region. Results: Geographic access to primary care was inversely associated with low high density lipoprotein (OR 0.94, CI 0.91–0.96) and obesity (OR 0.91, CI 0.88–0.93), after adjusting for age, sex and area-level disadvantage. The intra-cluster correlation coefficient (ICCs) of all the fully adjusted models ranged between 0.4–1.8%, indicating low general contextual effects of the areas on CMRF distribution. The area-level variation in CMRFs explained by primary care access was ≤10.5%. Conclusion: The findings of the study support proportionate universal interventions for the prevention and control of CMRFs, rather than any area specific interventions based on their primary care access, as the contextual influence of areas on all the analysed CMRFs were found to be minimal. The findings also call for future research that includes other aspects of primary care access, such as road-network access, financial affordability and individual-level acceptance of the services in order to gain an overall picture of the area-level contributing role of primary care on CMRFs in the study region.

Introduction Metabolic risk factors for cardiovascular disease (CVD) warrant significant public health concern globally. This study aims to utilise the regional database of a major laboratory network to describe the geographic distribution pattern of eight different cardiometabolic risk factors (CMRFs), which in turn can potentially generate hypotheses for future research into locality specific preventive approaches. Method A cross-sectional design utilising de-identified laboratory data on eight CMRFs including fasting blood sugar level (FBSL); glycated haemoglobin (HbA1c); total cholesterol (TC); high density lipoprotein (HDL); albumin creatinine ratio (ACR); estimated glomerular filtration rate (eGFR); body mass index (BMI); and diabetes mellitus (DM) status was used to undertake descriptive and spatial analyses. CMRF test results were dichotomised into 'higher risk' and 'lower risk' values based on existing risk definitions. Australian Census Statistical Area Level 1 (SA1) were used as the geographic units of analysis, and an Empirical Bayes (EB) approach was used to smooth rates at SA1 level. Choropleth maps demonstrating the distribution of CMRFs rates at SA1 level were produced. Spatial clustering of CMRFs was assessed using Global Moran's I test and Local Indicators of Spatial Autocorrelation (LISA). Results A total of 1,132,016 test data derived from 256,525 individuals revealed significant geographic variation in the distribution of 'higher risk' CMRF findings. The populated eastern seaboard of the study region demonstrated the highest rates of CMRFs. Global Moran's I values were significant and positive at SA1 level for all CMRFs. The highest spatial autocorrelation strength was found among obesity rates (0.328), and the lowest for albuminuria (0.028). LISA tests identified significant High-High (HH) and Low-Low (LL) spatial clusters of CMRFs, with LL predominantly in the less populated northern, central and southern regions of the study area. Conclusion

Introduction Metabolic risk factors for cardiovascular disease (CVD) warrant significant public health concern globally. This study aims to utilise the regional database of a major laboratory network to describe the geographic distribution pattern of eight different cardiometabolic risk factors (CMRFs), which in turn can potentially generate hypotheses for future research into locality specific preventive approaches. Method A cross-sectional design utilising de-identified laboratory data on eight CMRFs including fasting blood sugar level (FBSL); glycated haemoglobin (HbA1c); total cholesterol (TC); high density lipoprotein (HDL); albumin creatinine ratio (ACR); estimated glomerular filtration rate (eGFR); body mass index (BMI); and diabetes mellitus (DM) status was used to undertake descriptive and spatial analyses. CMRF test results were dichotomised into 'higher risk' and 'lower risk' values based on existing risk definitions. Australian Census Statistical Area Level 1 (SA1) were used as the geographic units of analysis, and an Empirical Bayes (EB) approach was used to smooth rates at SA1 level. Choropleth maps demonstrating the distribution of CMRFs rates at SA1 level were produced. Spatial clustering of CMRFs was assessed using Global Moran's I test and Local Indicators of Spatial Autocorrelation (LISA). Results A total of 1,132,016 test data derived from 256,525 individuals revealed significant geographic variation in the distribution of 'higher risk' CMRF findings. The populated eastern seaboard of the study region demonstrated the highest rates of CMRFs. Global Moran's I values were significant and positive at SA1 level for all CMRFs. The highest spatial autocorrelation strength was found among obesity rates (0.328), and the lowest for albuminuria (0.028). LISA tests identified significant High-High (HH) and Low-Low (LL) spatial clusters of CMRFs, with LL predominantly in the less populated northern, central and southern regions of the study area. Conclusion

Objective To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. Methods A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi‐level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short‐stay admission (≤24 h), >24 h admissions, unplanned ED re‐attendances within 7 days and ‘left at own risk’ (including ‘did not wait for assessment’). Results Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24; P < 0.001) and access block decreased (OR = 0.41 and 0.22; P < 0.001), but not in ACT (OR = 1.28; P > 0.05). ED presentations increased over time before and after NEAT introduction with a significant increase above the projected trend in NSW after NEAT (mean ratio = 1.07). Short‐stay admissions increased in QLD (OR = 2.60), ACT (OR = 1.68) and NSW (OR = 1.35). Unplanned ED re‐attendances did not change significantly. Those who left at their own risk decreased significantly in NSW and QLD (OR = 0.38 and 0.67). Conclusion ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time‐based measures. Significant increases in short‐stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re‐attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.

Objective To evaluate the impact of the Australian National Emergency Access Target (NEAT) policy introduced in 2012 on ED performance. Methods A longitudinal cohort study of NEAT implementation using linked data, for 12 EDs across New South Wales (NSW), Australian Capital Territory (ACT) and Queensland (QLD) between 2008 and 2013. Segmented regression in a multi‐level model was used to analyse ED performance over time before and after NEAT introduction. The main outcomes measures were ED length of stay ≤4 h, access block, number of ED presentations, short‐stay admission (≤24 h), >24 h admissions, unplanned ED re‐attendances within 7 days and ‘left at own risk’ (including ‘did not wait for assessment’). Results Two years after NEAT introduction, ED length of stay ≤4 h increased in NSW and QLD (odds ratio [OR] = 2.48 and 3.24; P < 0.001) and access block decreased (OR = 0.41 and 0.22; P < 0.001), but not in ACT (OR = 1.28; P > 0.05). ED presentations increased over time before and after NEAT introduction with a significant increase above the projected trend in NSW after NEAT (mean ratio = 1.07). Short‐stay admissions increased in QLD (OR = 2.60), ACT (OR = 1.68) and NSW (OR = 1.35). Unplanned ED re‐attendances did not change significantly. Those who left at their own risk decreased significantly in NSW and QLD (OR = 0.38 and 0.67). Conclusion ED presentations continued to increase over time in all jurisdictions. NSW and QLD, but not ACT, showed significant improvements in time‐based measures. Significant increases in short‐stay admissions suggest a strategic change in ED process associated with NEAT implementation. Rates of unplanned ED re‐attendances and those leaving at their own risk showed no evidence for adverse effects from NEAT.

Based on historical lessons learned from irregular warfare case studies, and internal organizational analysis, this thesis seeks to provide Marine Special Operations Command (MARSOC) with specific implementable recommendations based on Edward Luttwak’s concept of relational maneuver. Luttwak defines relational maneuver as a style of warfare that requires a deep understanding of the threat and its operational environment to identify vulnerabilities, adapt, and exploit those weaknesses to destroy the enemy as a system. Luttwak argues that irregular warfare requires effective implementation of relational maneuver to achieve operational and strategic success. The U.S. military’s experiences in Iraq and Afghanistan from 2009 through 2016 have revealed insufficient use of relational maneuver, favoring, instead, employment of attrition warfare, which focuses on optimizing internal organizational efficiency without understanding, or adapting to, the threat or the operational environment. Through this research, the authors seek to influence MARSOC’s organizational strategy to more effectively wage irregular warfare. The final recommendations provide a possible path to MARSOC for overcoming institutional challenges inhibiting the employment of relational maneuver in irregular warfare., MARSOC, http://archive.org/details/relationalmaneuv1094561304, Outstanding Thesis, Major, United States Marine Corps, Lieutenant, United States Navy, Approved for public release; distribution is unlimited.

The Palliative Care Outcomes Collaboration (PCOC) is a national program that aims to improve the quality and outcomes of palliative care in Australia. This is achieved via a standardised clinical language that supports a national data collection. This report provides a high level profile of 5,873 patients who received palliative care in NSW and ACT during January to June 2019 and had their pain, symptom, family / carer and psychological / spiritual issues assessed as part of routine clinical care.

The Palliative Care Outcomes Collaboration (PCOC) is a national program that aims to improve the quality and outcomes of palliative care in Australia. This is achieved via a standardised clinical language that supports a national data collection. This report provides a high level profile of 5,588 patients who received palliative care in NSW and ACT during July to December 2018 and had their pain, symptom, family / carer and psychological / spiritual issues assessed as part of routine clinical care.

The purpose of these guidelines is to provide a resource to assist organisations, communities and individuals to work together to prevent unintentional injury to Aboriginal children in New South Wales in a way that reflects the values, attitudes and priorities of Aboriginal people.

The Australian palliative care sector is a world leader in using routine clinical assessment information to guide patient centred care and measure patient and family outcomes. Providers of palliative care are commended for their commitment to excellence in delivering evidence-based, patient-centred care by using the routine Palliative Care Outcomes Collaboration (PCOC) assessment framework and contributing patient data toward national outcome measurement and benchmarking. PCOC acknowledges the dedication and willingness of clinicians to improve the care of patients, their families and caregivers. The information collected is not just data - it represents the real-life outcomes of over 40,000 Australians who die an expected death every year. While the focus of this report is on the most recent information relating to January to June 2019, results over the last three years are also presented to highlight achievements and improvement in outcomes. The most recent information corresponds to 24,562 patients, having 31,826 episodes of care and 73,209 palliative care phases from 138 services who provide palliative care in hospital / hospice or in the person's home.

The Australian palliative care sector is a world leader in using routine clinical assessment information to guide patient centred care and measure patient and family outcomes. Providers of palliative care are commended for their commitment to excellence in delivering evidence-based, patient-centred care by using the routine Palliative Care Outcomes Collaboration (PCOC) assessment framework and contributing patient data toward national outcome measurement and benchmarking. PCOC acknowledges the dedication and willingness of clinicians to improve the care of patients, their families and caregivers. The information collected is not just data - it represents the real-life outcomes of over 40,000 Australians who die an expected death every year. While the focus of this report is on the most recent information relating to July to December 2018, results over the last three years are also presented to highlight achievements and improvement in outcomes. The most recent information corresponds to 23,333 patients, having 29,931 episodes of care and 70,135 palliative care phases from 127 services who provide palliative care in hospital / hospice or in the person's home.

The purpose of these guidelines is to provide a resource to assist organisations, communities and individuals to work together to prevent unintentional injury to Aboriginal children in New South Wales in a way that reflects the values, attitudes and priorities of Aboriginal people.

The Australian palliative care sector is a world leader in using routine clinical assessment information to guide patient centred care and measure patient and family outcomes. Providers of palliative care are commended for their commitment to excellence in delivering evidence-based, patient-centred care by using the routine Palliative Care Outcomes Collaboration (PCOC) assessment framework and contributing patient data toward national outcome measurement and benchmarking. PCOC acknowledges the dedication and willingness of clinicians to improve the care of patients, their families and caregivers. The information collected is not just data - it represents the real-life outcomes of over 40,000 Australians who die an expected death every year. While the focus of this report is on the most recent information relating to January to June 2019, results over the last three years are also presented to highlight achievements and improvement in outcomes. The most recent information corresponds to 24,562 patients, having 31,826 episodes of care and 73,209 palliative care phases from 138 services who provide palliative care in hospital / hospice or in the person's home.

The Palliative Care Outcomes Collaboration (PCOC) is a national program that aims to improve the quality and outcomes of palliative care in Australia. This is achieved via a standardised clinical language that supports a national data collection. This report provides a high level profile of 5,588 patients who received palliative care in NSW and ACT during July to December 2018 and had their pain, symptom, family / carer and psychological / spiritual issues assessed as part of routine clinical care.

The Australian palliative care sector is a world leader in using routine clinical assessment information to guide patient centred care and measure patient and family outcomes. Providers of palliative care are commended for their commitment to excellence in delivering evidence-based, patient-centred care by using the routine Palliative Care Outcomes Collaboration (PCOC) assessment framework and contributing patient data toward national outcome measurement and benchmarking. PCOC acknowledges the dedication and willingness of clinicians to improve the care of patients, their families and caregivers. The information collected is not just data - it represents the real-life outcomes of over 40,000 Australians who die an expected death every year. While the focus of this report is on the most recent information relating to July to December 2018, results over the last three years are also presented to highlight achievements and improvement in outcomes. The most recent information corresponds to 23,333 patients, having 29,931 episodes of care and 70,135 palliative care phases from 127 services who provide palliative care in hospital / hospice or in the person's home.

The Palliative Care Outcomes Collaboration (PCOC) is a national program that aims to improve the quality and outcomes of palliative care in Australia. This is achieved via a standardised clinical language that supports a national data collection. This report provides a high level profile of 5,873 patients who received palliative care in NSW and ACT during January to June 2019 and had their pain, symptom, family / carer and psychological / spiritual issues assessed as part of routine clinical care.

Introduction Metabolic risk factors for cardiovascular disease (CVD) warrant significant public health concern globally. This study aims to utilise the regional database of a major laboratory network to describe the geographic distribution pattern of eight different cardiometabolic risk factors (CMRFs), which in turn can potentially generate hypotheses for future research into locality specific preventive approaches. Method A cross-sectional design utilising de-identified laboratory data on eight CMRFs including fasting blood sugar level (FBSL); glycated haemoglobin (HbA1c); total cholesterol (TC); high density lipoprotein (HDL); albumin creatinine ratio (ACR); estimated glomerular filtration rate (eGFR); body mass index (BMI); and diabetes mellitus (DM) status was used to undertake descriptive and spatial analyses. CMRF test results were dichotomised into 'higher risk' and 'lower risk' values based on existing risk definitions. Australian Census Statistical Area Level 1 (SA1) were used as the geographic units of analysis, and an Empirical Bayes (EB) approach was used to smooth rates at SA1 level. Choropleth maps demonstrating the distribution of CMRFs rates at SA1 level were produced. Spatial clustering of CMRFs was assessed using Global Moran's I test and Local Indicators of Spatial Autocorrelation (LISA). Results A total of 1,132,016 test data derived from 256,525 individuals revealed significant geographic variation in the distribution of 'higher risk' CMRF findings. The populated eastern seaboard of the study region demonstrated the highest rates of CMRFs. Global Moran's I values were significant and positive at SA1 level for all CMRFs. The highest spatial autocorrelation strength was found among obesity rates (0.328), and the lowest for albuminuria (0.028). LISA tests identified significant High-High (HH) and Low-Low (LL) spatial clusters of CMRFs, with LL predominantly in the less populated northern, central and southern regions of the study area. Conclusion

Introduction Metabolic risk factors for cardiovascular disease (CVD) warrant significant public health concern globally. This study aims to utilise the regional database of a major laboratory network to describe the geographic distribution pattern of eight different cardiometabolic risk factors (CMRFs), which in turn can potentially generate hypotheses for future research into locality specific preventive approaches. Method A cross-sectional design utilising de-identified laboratory data on eight CMRFs including fasting blood sugar level (FBSL); glycated haemoglobin (HbA1c); total cholesterol (TC); high density lipoprotein (HDL); albumin creatinine ratio (ACR); estimated glomerular filtration rate (eGFR); body mass index (BMI); and diabetes mellitus (DM) status was used to undertake descriptive and spatial analyses. CMRF test results were dichotomised into 'higher risk' and 'lower risk' values based on existing risk definitions. Australian Census Statistical Area Level 1 (SA1) were used as the geographic units of analysis, and an Empirical Bayes (EB) approach was used to smooth rates at SA1 level. Choropleth maps demonstrating the distribution of CMRFs rates at SA1 level were produced. Spatial clustering of CMRFs was assessed using Global Moran's I test and Local Indicators of Spatial Autocorrelation (LISA). Results A total of 1,132,016 test data derived from 256,525 individuals revealed significant geographic variation in the distribution of 'higher risk' CMRF findings. The populated eastern seaboard of the study region demonstrated the highest rates of CMRFs. Global Moran's I values were significant and positive at SA1 level for all CMRFs. The highest spatial autocorrelation strength was found among obesity rates (0.328), and the lowest for albuminuria (0.028). LISA tests identified significant High-High (HH) and Low-Low (LL) spatial clusters of CMRFs, with LL predominantly in the less populated northern, central and southern regions of the study area. Conclusion

This thesis traces the development of adult literacy provision in NSW over its 40 year history, with particular focus on the discursive tensions between policy and practice. A major and overriding theme has been the move away from a philosophy of humanist education and a socio-cultural view of literacy, towards an economically driven, human capital view of literacy. The study analyses the changing socio-economic background to the development of the field of adult literacy (later called adult basic education) and the ways in which resulting public and policy discourses have impacted the field. In the foundation years, the public discourse of liberal humanism was reflected in the professional discourse. From the early 1990s however, a tension began to emerge as the public and policy discourse moved increasingly towards an instrumentalist, human capital view. The study illuminates the increasing discursive tensions between policy and practice and between the public and professional discourses that have sought to shape the field. Discourse theory, with its focus on power relations, as developed for example by Foucault (1972), and elaborated by Gee (2015) and Fairclough (2015), informs the analysis of the ways in which these discursive struggles have defined and redefined the field over the period discussed. Building on this understanding of discourse, the main conceptual resource employed is that of Actor Network Theory (ANT) (Callon 1986; Latour 2005). It is chosen as a useful lens through which to view the multiplicity of ‘actors’ both human and non-human, that have interacted in a non-linear and fluid fashion to influence the direction of the field. The study uses a number of the concepts described by ANT theorists to illuminate the ways in which some assemblages of actors came to exert power and advance a dominant discourse of literacy, whilst the influence of others declined. A number of past and present practitioners were interviewed in order to capture the teache

This thesis traces the development of adult literacy provision in NSW over its 40 year history, with particular focus on the discursive tensions between policy and practice. A major and overriding theme has been the move away from a philosophy of humanist education and a socio-cultural view of literacy, towards an economically driven, human capital view of literacy. The study analyses the changing socio-economic background to the development of the field of adult literacy (later called adult basic education) and the ways in which resulting public and policy discourses have impacted the field. In the foundation years, the public discourse of liberal humanism was reflected in the professional discourse. From the early 1990s however, a tension began to emerge as the public and policy discourse moved increasingly towards an instrumentalist, human capital view. The study illuminates the increasing discursive tensions between policy and practice and between the public and professional discourses that have sought to shape the field. Discourse theory, with its focus on power relations, as developed for example by Foucault (1972), and elaborated by Gee (2015) and Fairclough (2015), informs the analysis of the ways in which these discursive struggles have defined and redefined the field over the period discussed. Building on this understanding of discourse, the main conceptual resource employed is that of Actor Network Theory (ANT) (Callon 1986; Latour 2005). It is chosen as a useful lens through which to view the multiplicity of ‘actors’ both human and non-human, that have interacted in a non-linear and fluid fashion to influence the direction of the field. The study uses a number of the concepts described by ANT theorists to illuminate the ways in which some assemblages of actors came to exert power and advance a dominant discourse of literacy, whilst the influence of others declined. A number of past and present practitioners were interviewed in order to capture the teache

In 1966, Peter Loveday and Allan Martin published their book Parliament Factions and Parties: The First Thirty Years of Responsible Government in New South Wales, 1856-1889. They aimed to show how factions operated within the New South Wales Parliament during the colonial period of responsible government between 1856 and 1889. While Loveday and Martin’s work was challenged briefly at the time, that challenge was short-lived. It has since become the foundational theory regarding how colonial politics worked, and most political histories written since that time use the term ‘faction’ as a short-hand description for proto-party organisation that carries connotations of disapproval and disappointment.

In 1966, Peter Loveday and Allan Martin published their book Parliament Factions and Parties: The First Thirty Years of Responsible Government in New South Wales, 1856-1889. They aimed to show how factions operated within the New South Wales Parliament during the colonial period of responsible government between 1856 and 1889. While Loveday and Martin’s work was challenged briefly at the time, that challenge was short-lived. It has since become the foundational theory regarding how colonial politics worked, and most political histories written since that time use the term ‘faction’ as a short-hand description for proto-party organisation that carries connotations of disapproval and disappointment. However, Loveday and Martin’s ideas are unhelpful when it comes to understanding how independent politicians behaved. John Lucas, who had a reputation as a fierce independent, did not fit their model. Using the first full parliament in which Lucas served – the Fourth (1860-1864) – this research initially aimed to determine how the behaviour of independents differed from that of their fellow politicians who were members of factions. Using a combination of prosopography, statistical analysis, and case studies, this thesis explores the ideals and practical demonstrations of political independence and the social construct of the nineteenth century gentleman to show that they are intimately linked. This research shows that factions very likely did not exist during the Fourth Parliament, and uncovered more complex ideas regarding independence and the nineteenth century politician. Instead of the factions that Loveday and Martin saw, this research proposes an alternative hypothesis – that the Fourth Parliament was comprised of politicians who considered themselves to be independent.

Objective: Low rates of driver licensing have been linked to increased risk of transport‐related injury, and reduced access to health services, employment and educational opportunities in the Aboriginal population. This paper reports on how barriers to obtaining a driver licence are being addressed in four Aboriginal communities in New South Wales and South Australia. Methods: Qualitative data were collected over a four‐month period in 2013. Interviews with Aboriginal and non‐Aboriginal stakeholders (n=31) and 11 focus groups with Aboriginal participants (n=46) were analysed thematically using a framework approach. Results: Factors facilitating licensing included: family support, professional lessons, alternative testing and programs that assist with literacy, fines management, financial assistance and access to a supervising driver. Stakeholders recommended raising awareness of existing services and funding community‐based service provision to promote access to licensing. Discussion: Facilitating licence participation requires systemic change and long‐term investment to ensure interagency collaboration, service use and sustainability of relevant programs, including job search agencies. Implications for public health: The disadvantage faced by Aboriginal people in driver licensing is a fundamental barrier to participation and a social determinant of health. Understanding the factors that promote licensing is crucial to improving access for under‐serviced populations; recommendations provide pragmatic solutions to address licensing disadvantage.