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The article focuses on the evolution of Together Home, a Housing First program funded by the New South Wales (NSW) Government. Topics include providing access to culturally appropriate health and wellbeing services; building connections to family, community, and culture, supporting daily living and self-management skills; and offering positive structured activities like education and employment.

The Australian disability workforce has grown, and there is compelling evidence that peer work has a number of valuable impacts. Despite these apparent opportunities, there continue to be high levels of unemployment among people with disability and failure to draw on the assets of people with disability in Australian workplaces. To understand these ostensible missed opportunities, this study examined the ways in which lived experience was described as an asset in disability workforce recruitment. Advertisements for positions in New South Wales, Australia, that referred to lived experience or peer work and disability were collected over a 3‐month period. Through a process of content analysis, we found that there were more employment opportunities for people with lived experience of mental illness than for other types of disability. Community engagement was a key function, and peer workers were described as complementary to professionals. Recruitment processes for lived experience jobs were not necessarily accessible. We recommend systemic reforms to facilitate recognition of lived experience as a valuable criterion for disability sector employment and to harness the benefits of a disability peer workforce.

This article explains the principles of Gillick competence, including how to involve young people and those with parental responsibility in decisions about medical treatment

This is undoubtedly the most uncertain time that many of us have faced in our careers, or in fact our lives, but alongside this uncertainty, I truly believe, comes plenty [...]

Concomitant administration of COVID-19 and influenza vaccines could reduce burden on health-care systems. We aimed to assess the safety of concomitant administration of ChAdOx1 or BNT162b2 plus an age-appropriate influenza vaccine.

Temporal aspects of child and adolescent time allocation in diverse cultural settings have been difficult to model using conventional statistical techniques. A new statistical approach, Egocentric Relational Event Modelling (EREM), allows for the simultaneous modelling of activity frequency, duration, and sequencing. Here, EREM is applied to a focal follow dataset of Congolese BaYaka forager child and adolescent play and work activities. Results show that, as children age, they engage in less frequent and extended play bouts and more frequent and extended work bouts. Bout frequency and duration were a more sensitive measure for early sex differences than overall time allocation. Sequential patterns of work and play suggest that these activities have short-term energetic trade-offs. This article demonstrates that EREM can reveal stable and variable patterns in child development.

The article discusses need for frontline organizations to develop alternative approaches to keep women and children safe and sheltered in New South Wales. Topics discussed included research by University of Newcastle Human Research Ethics Committee, it mentions that women who had a lived experience of homelessness reported a range of issues and the outcomes of the research reviewed that people experiencing homelessness respond to interest and care.

Most hospitals do not provide services to meet recommendations in the Pain After Surgery report of 1990, according to a national acute pain survey undertaken in 1994. Post-operative pain control is often unsatisfactory in spite of the introduction of more efficient techniques in managing pain. A national acute pain directory should be created listing those hospitals with acute pain services.

Australian child protection systems are being challenged to find more effective ways of responding to the needs of children and families. This article describes legal processes that govern children’s removal from their families and queries whether we are doing enough to prioritise children’s relationships with their families. The court’s capacity to review the decisions of state welfare authorities and evaluate risks of children being removed is considered with reference to research with stakeholders and a recent case in the NSW Children’s Court. The authors argue that reforms which emphasise family inclusion and address power differentials could provide better outcomes for children.

Globally, Indigenous people have lower-health status compared to non-Indigenous people due to unequal access to health care. Barriers or enablers to accessing maternal health services by Indigenous women are not well researched. This review aims to determine accessibility and utilisation of maternal primary healthcare services among Indigenous women in lower- and middle-income countries. We conducted a systematic integrative review of published and grey literature published between 2000 and 2017. Studies on maternal healthcare service utilisation by Indigenous women in lower- and middle-income countries were included. From 3092 articles identified, 10 met the eligibility criteria. The most prominent barrier to accessing maternal primary healthcare services was the top-down nature of intervention programmes, which made programmes culturally unfriendly for Indigenous women. Distance, cost, transport, accommodation, language barriers and lack of knowledge about existing services also impacted access. Findings provided insights into understanding the gaps in existing policies for Indigenous women and their access to maternal health services. Results suggested that efforts be made to ensure appropriate programmes for Indigenous women’s maternal health right.

The article presents the author's views about cultivating hope towards the future development in earth and environmental sciences. It highlights the struggle of the societies to come to terms with the nature and dealing with the threat and loss due to natural disasters. It also cites the healing process in the gap between hope and the reality of life.

A student teacher recounts the challenges and advantages of starting a PGCE course in secondary education at the age of 48.

This competency framework was developed by a working group of endocrine specialist nurses with the support of the Society for Endocrinology to enhance the clinical care that adults with an endocrine disorder receive. Nurses should be able to demonstrate that they are functioning at an optimal level in order for patients to receive appropriate care. By formulating a competency framework from which an adult endocrine nurse specialist can work, it is envisaged that their development as professional practitioners can be enhanced. This is the second edition of the Competency Framework for Adult Endocrine Nursing. It introduces four new competencies on benign adrenal tumours, hypo- and hyperparathyroidism, osteoporosis and polycystic ovary syndrome. The authors and the Society for Endocrinology welcome constructive feedback on the document, both nationally and internationally, in anticipation that further developments and ideas can be incorporated into future versions.

This paper examines the challenges and opportunities for integrating peer support in mental health. After reviewing the contemporary literature, it considers how the findings of a recent qualitative case study, which examined the perspectives of mental health service users (n =  11) on service-user participation and evidence-based practice, might inform the introduction of a peer support program into a mental health service provided by a large Australian non-government organisation. While there is little empirical evidence demonstrating the effectiveness of peer support, the study revealed that service users valued the expertise of their peers and offered guidance for translating evidence into service models.

The article presents the ways that environmental activists have changed the world and how people can do it too. It mentions that imagining a better world is an inspirational vision that have always helped humankind cope with life's difficulties and disappointments. Moreover, harnessing people power is a successful social movement as it had strong support from ordinary people willing to protest on the streets.

The article discusses sustainability literacy and environmental education. It notes on the importance of environmental education and states that it helps in building up an ecologically literate society that understands the principles of ecological systems. It provides six strategies for the enhancement of the ecological literacy of learning society which include creating learning communities, embracing diversity and learning from experience.

Large antral follicles grow in waves in the ewe, and each wave is triggered by a peak in serum concentrations of FSH. The existence of follicular dominance in the ewe is unclear. The objective of experiment 1 was to determine if an endogenously driven follicular wave could emerge during the growth phase of a wave induced by injection of ovine FSH (oFSH). Cyclic ewes (n = 7) were given oFSH (two injections of 0.5 μg/kg; s.c.; 8 h apart) on 2 separate days equally spaced in the interval between the first two endogenously driven follicular waves of an estrous cycle. Injection of oFSH induced two follicular waves in the interval between the first two endogenously driven waves of the cycle. The second endogenously driven wave of the estrous cycle emerged in the midgrowth phase of a follicular wave induced by injection of oFSH and its day of emergence, and growth pattern did not differ from that of the equivalent wave in control ewes (emerging 5.4 ± 0.2 and 4.8 ± 0.5 days after ovulation, respectively; P> 0.05). Experiment 2 was designed to determine if emergence of follicular waves could be induced on a daily basis. Six anestrus ewes were given oFSH (two injections of 0.35 μg/kg; s.c.; 8 h apart) on each of 4 days, starting 24 h after the expected time of an endogenously driven FSH peak. Each injection of oFSH resulted in a discrete peak in serum FSH concentrations and the emergence of a new follicular wave. The present findings provide evidence for the lack of follicular dominance in the ewe.

In a previous study, 10-day estradiol implant treatment truncated the FSH peaks that precede follicular waves in sheep, but subsequent ovine FSH (oFSH) injection reinitiated wave emergence. The present study's objectives were to examine the effects of a 20-day estradiol and progesterone treatment on FSH peaks, follicle waves, and responsiveness to oFSH injection. Also, different estradiol doses were given to see whether a model that differentially suppressed FSH peaks, LH pulses, or basal gonadotropin secretion could be produced in order to study effects of these changes on follicular dynamics. Mean estradiol concentrations were 11.8 ± 0.4 pg/ml, FSH peaks were truncated, wave emergence was halted, and the number of small follicles (2–3 mm in diameter) was reduced (P< 0.05) in cyclic ewes given estradiol and progesterone implants (experiment 1). On Day 15 of treatment, oFSH injection failed to induce wave emergence. With three different estradiol implant sizes (experiment 2), estradiol concentrations were 5.2, 19.0, 27.5, and 34.8 (±4.6) pg/ml in control and treated ewes, respectively. All estradiol treatments truncated FSH peaks, except those that created the highest estradiol concentrations. Experiment 2-treated ewes had significantly reduced mean and basal FSH concentrations and LH pulse amplitude and frequency. We concluded that 20-day estradiol treatment truncated FSH peaks, blocking wave emergence, and reduced the small-follicle pool, rendering the ovary unresponsive to oFSH injection in terms of wave emergence. Varying the steroid treatment created differential FSH peak regulation compared with other gonadotropin secretory parameters. This provides a useful model for future studies of the endocrine regulation of ovine antral follicular dynamics.

Follicle waves are preceded by follicle-stimulating hormone (FSH) peaks in ewes. The purpose of the present study was to see whether estradiol implant treatment would block FSH peaks to create a model in which the effect of the timing and mode of FSH peaks could be studied by ovine FSH (oFSH) injection. In Experiment 1, 10 ewes received estradiol-17beta implants on Day 4 after ovulation (Day 0, day of ovulation); five ewes received large implants, and five ewes received small implants. Five control ewes received empty implants. In Experiment 2, 12 ewes received large implants on Day 4. On Day 9, six ewes received oFSH twice, 8 h apart (0.5 μg/kg; s.c.). Implants were left in place for 10 days in both experiments. In both studies, ovarian ultrasonography and blood sampling was done daily. In Experiment 1, estradiol concentrations were significantly higher in ewes with large implants (10.4 ± 0.7 pg/ml) compared with controls (3.9 ± 0.7 pg/ml) and ewes with small implants (5.4 ± 0.7 pg/ml; P< 0.001). A significant reduction was found in mean FSH peak concentration (31%; P< 0.05) and FSH peak amplitude (45%; P< 0.05) in ewes with large implants compared with controls. Mean and basal FSH concentrations were unaffected by the large implants. The large implants halted follicle-wave emergence between Day 0 and 8 after implant insertion. The small follicle pool (2–3 mm in diameter) was unaffected by the large implants. When oFSH was injected into ewes with large implants, a follicle wave emerged 1.5 ± 0.5 days after injection; however, in ewes given saline alone, a follicle wave emerged 4.8 ± 0.8 days after injection (P< 0.01). We concluded that truncation of FSH peaks by estradiol implants prevented follicle-wave emergence, but injection of physiologic concentrations of oFSH reinitiated follicle-wave emergence.

Objective: Early diagnosis and effective treatment of paediatric Cushing’s disease (CD) is necessary to minimise associated morbidity. Accepted first-line treatment is selective transsphenoidal microadenomectomy (TSS), which can be technically difficult, and cure rates vary considerably between centres. In our paediatric CD patient group we have assessed the possible factors which may influence cure by TSS.Subjects and methods: From 1983–2004, 27 paediatric patients (16 males, 11 females; mean age±s.d., 13.1±3.2 yr; range, 6.4–17.8 yr) with CD were managed in our centre and underwent TSS. Sixteen patients (59%), seven males and nine females (mean age±s.d., 14.2±2.5 yr; range, 8.2–17.8 yr), were cured (post-operative serum cortisol < 50 nM). Eleven patients, nine males and two females (mean age±s.d., 11.5±3.6 yr; range, 6.4–17.8 yr) had post-operative cortisol levels above 50 nM (2–20 days), with mean serum cortisol levels at 09:00 h of 537 nM (range 269–900 nM) indicating a lack of cure. These 11 patients received external beam pituitary radiotherapy (RT). One patient with a pituitary macroadenoma had a post-operative cortisol level of < 50 nM but 0.8 yr later showed an elevated cortisol and residual disease.Results: The patients cured by TSS alone were significantly older than those not cured (P= 0.038; Student’s ttest). All patients had CT/MRI pituitary imaging: 14 were reported to have microadenomas and one macroadenoma, while 12 were reported as normal. Bilateral simultaneous inferior petrosal sinus sampling (BSIPSS) with i.v. corticotropin-releasing hormone (CRH) administration was introduced as a pre-operative investigation in 1986 and was performed in 21 patients (78%), on BSIPSS, 16 (76%) had evidence suggesting pituitary adrenocorticotropic hormone (ACTH) secretion (central to peripheral (IPS:P) ACTH ratio after CRH of ≥ 3.0) and 16 (76%) showed lateralisation of ACTH secretion (IPSG of ≥ 1.4). There was concordance between the BSIPSS finding and the position of the microadenoma at surgery in 17/21 (81%) patients. Of the 16 patients showing lateralisation of ACTH secretion, 12 (75%) were cured by TSS. Of the four without lateralisation of ACTH, suggesting a midline lesion, 3 (75%) were cured by TSS. Post-operative pituitary hormone deficiencies in the patients cured by TSS were: pan-hypopituitarism 1/16, isolated growth hormone deficiency (GHD) (peak GH on glucagon/ITT < 1–17.9 mU/l) 9/16 and diabetes insipidus 3/16.Conclusion: Over a 21-year period selective adenomectomy by TSS cured 59% of all paediatric CD patients, with higher age favouring cure. Introduction of BSIPSS resulted in the demonstration of a high rate of lateralisation of ACTH secretion consistent with the surgical identification of the adenoma, and therefore appears likely to have contributed to the higher surgical cure rate.

Interleukin-4 (IL-4) has potent anti-inflammatory properties on monocytes and suppresses lipopolysaccharide (LPS)-induced tumor necrosis factor-α (TNF-α) and IL-1β production. Culture with interferon (IFN-γ) alters human monocyte responses to IL-4 by multiple mechanisms. As previously published, IFN-γ reduced IL-4-activated signal transducer and activator of transcription-6 (STAT-6). This correlated with an inability of IL-4 to suppress LPS-induced TNF-α but not IL-1β production. A second mechanism, apparent some 48 h after exposure to IFN-γ, involved a significant suppression of IL-4 receptor (IL-4R) expression at the cell surface, and this correlated with the loss of additional functional responses to IL-4, including IL-4-induced suppression of LPS-induced IL-1β production. This study identified a further role of IFN-γ on IL-4 responses, including reduced IL-4R surface expression by human monocytes. Increased release of soluble γc from IFN-γ-treated monocytes provides an additional mechanism by which IFN-γ may control the functional activity of IL-4. This study characterizes further the opposing effects of the type 1 and type 2 cytokine regulatory systems.

The anti-inflammatory effects of IL-4 on activated monocytes differ from those on monocyte-derived macrophages (MDMac). While IL-4 suppresses LPS-induced IL-1β, IL-12, IL-10 and TNFα production by monocytes, IL-4 suppresses only IL-1β and IL-12 production by MDMac. The U937 and Mono Mac 6 cell lines have similar cytokine responses to IL-4 as monocytes and MDMac, respectively. The IL-4Rα and IL-2Rγ (γc) chains are well-characterized components of the IL-4 receptor. Cross-linking studies with 1251-IL-4 revealed that for monocytes and U937 cells, the binding of IL-4 to the receptor components was approximately 1:1 for IL-4Rα: γc. In contrast, for MDMac and Mono Mac 6 cells that have a relative reduction in γc surface expression, the binding of IL-4 to IL-4Rα:γc was approximately 3:1. Furthermore, IL-4 induced IL-4Rα chain phosphorylation more rapidly in MDMac and Mono Mac 6 cells than in monocytes and U937 cells. This study identifies a correlation between altered 1251-IL-4 cross-linking to IL-4Rα: γc, IL-4-induced signaling and regulation of pro-inflammatory cytokine production by IL-4.

The article explains the necessity for borrowers to explore mortgage options in Great Britain. It mentions the failure of borrowers to take advantage of the competitive mortgage market when buying a new home or refinancing loans. Also cited is the importance of seeking advice from a professional mortgage adviser in finding the appropriate product option. It describes the impact of the COVID-19 pandemic on mortgage lending.

Abscess formation has been viewed as a host defense strategy to contain the spread of infection. However, abscesses are also serious and life‐threatening manifestations of persisting microbial infection. The initiation of abscess formation, both clinically and experimentally, involves the release of bacteria and an abscess‐potentiating agent (e.g., fecal fiber or an analog) into a sterile site, with host defense mechanisms being unable to eliminate the infecting organisms. Abscess formation is aided by a combination of factors that share a common feature: impairment of phagocytic killing and hence clearance of microorganisms. These include bacterial virulence factors (e.g., capsule formation, succinic acid production); complement activation by the abscess potentiating agent; fibrin deposition; and microbial sequestration within abscess neutrophils. Recruitment of cells into the peritoneal cavity follows mast cell activation in the pathogenesis of infection: histamine and tumor necrosis factor αcan be detected in the peritoneal cavity within minutes of challenge with an abscess‐inducing mixture. However, the role of mast cells in host defense is made less clear by the finding of diminished abscess formation (but no mortality or increased morbidity) in mast‐cell‐depleted mice. This may indicate that mast cell products have a role in not only the initiation of an inflammatory response but also the promotion of fibrin deposition and abscess formation. J. Leukoc.Biol.66: 583–587; 1999.

The primary IL-13 receptor complex on human monocytes is believed to be a heterodimer comprised of the IL-4Rα chain and the IL-2Rγ chain (γc)-like molecule, IL-13Rα1. mRNA levels for IL-13Rα1, but not IL-4Rα, were markedly decreased in in vitro monocyte-derived macrophages (MDMac), and with increasing time of monocytes in culture correlated with the loss of IL-13 regulation of lipopolysaccharide-induced TNF-α production. Analysis of cell lines Daudi and THP-1 that differentially express γc and IL-13Rα1 showed that IL-13 can activate STAT6 in IL-13Rα1-positive THP-1 cells but not in γc-positive, IL-13Rα1-negative Daudi cells. IL-13 activation of STAT6 was reduced in MDMac which was associated with diminished IL-13-induced expression of CD23 and MHC class II. However, with reduced IL-13Rα1 expression and low nuclear STAT6 activity, some IL-13-induced responses were unaltered in magnitude in MDMac. In the absence of functional IL-13Rα1 and γc, IL-13 must signal through an alternative receptor complex on MDMac. Experiments with a blocking antibody to IL-4Rα showed that this chain remains an essential component of the IL-13 receptor complex on MDMac.

Estate management fees for freehold properties seems fair in principle. Estate management fees are becoming an escalating problem for homeowners and mortgage lenders, but recent statements suggest progress is being made in the right direction. It would be far better if developers were to give prospective purchasers full and transparent explanations around the current and future costs of estate management fees upfront - before they commit themselves to the development. [Extracted from the article]

If you were to take every statement made this year about technology "disrupting" the mortgage market at face value, you might believe that 2020 will see widespread transformation across the industry. Looking to 2020, there are of course some areas within the mortgage sector - the application process for example - where lenders feel technology could have an mmediately tangible impact. That could reduce lender approval time from weeks to minutes, increase the ability for lenders to lend and improve customer satisfaction and trust. [Extracted from the article]

Presents a panel discussion regarding the reasons why women should deal with environmental issues in Canada. Ability of the oppression of men in history to link women and environment strongly; Impact of understanding the equality of man and environment on the sense of responsibility of people; Impact of the notion of sustainable development on the protection of environment.

Developing digital understanding within the intermediary mortgage sector is critical to future-proofing the industry. According to research recently commissioned by IMLA, which was based on interviews with lenders, the data and technology required to realise a digital-first vision already exists at many lenders. It was clear through discussions with lenders for our report that a few have their eyes on digitalisation as an opportunity to reshape their entire mortgage value chain. [Extracted from the article]

Tech firms are already exploiting markets where they can add real consumer value - lenders cited Apple's credit card as one example - and the mortgage market is not exempt from this threat. However, lenders must avoid incorporating digital solutions for the benefit of one customer segment at the risk of isolating or losing another. Digitalisation should ultimately focus on enhancing lenders' current offerings to create more efficient, customer engagement-focused processes while cutting costs at the same time. [Extracted from the article]

Several letters to the editor are presented in response to articles in previous issues including the survey where to live other than in Great Britain, climate change and social networking.

The article discusses the importance of knowing exactly when a woman's ovulation occurs in order to maximize her chances of conception. Topics discussed include the luteal phase in menstrual cycle, the ways of predicting and detecting ovulation, and information on OvuSense, a real-time fertility monitor app and sensor that predicts ovulation.

ObjectiveIn an attempt to address the findings of the CQC report ‘A different ending – addressing inequalities in end of life care’ we explored staff perceptions of end of life care in the Care of the Elderly (COTE) wards of an acute hospital trust.MethodWe conducted focus groups with health care professionals (HCPs) (nurses, junior doctors and allied health professionals) working on two COTE wards in November 2016. We used vignettes describing a frail elderly person and a person with dementia to aid discussion. During the focus groups, the facilitators wrote copious notes which were then analysed to produce a summary of participants’ views, supported by verbatim quotes.ResultsWe spoke to 31 HCPs. Key themes identified were: patients try to discuss their imminent death but are prevented from doing so by staff and families; whilst HCPs recognise reduced oral intake as a symptom of approaching death, this is not well explained to families, leading to conflict and distress; care is directed by senior medics and other staff do not always feel able to challenge interventions they deem inappropriate.ConclusionsHCPs can recognise patients with frailty or dementia approaching the end of their lives, but feel unable to discuss this with the patients or their families. Early discussions around goals of care may reduce their feeling that ‘patients are done to’. They would welcome learning about better communication skills with these patients and considered this as important as learning life support skills. No funding was obtained for this study.

ObjectiveIn an attempt to address the findings of the CQC report ‘A different ending – addressing inequalities in end of life care’, we interviewed family members of patients on Care of the Elderly wards in our trust. Our aim was to ascertain their views about hearing prognostic information.MethodWe interviewed family members who had told ward staff they were happy to speak to us. We used vignettes to aid discussion and explained we did not know the details of any ward patients. We wrote copious notes which were then analysed to produce a summary of participants’ views, supported by verbatim quotes.ResultsWe spoke to 9 relatives (three wives, three siblings, two sons and one son-in-law) and one patient. Key themes identified were: families welcome prognostic information since it allows them to feel prepared and prioritise their time – some would feel relieved to hear that time could be short; relatives have strong feelings about the appropriateness of medical treatments and do not always hope for active treatment, but are mostly guided by medical staff; given the choice relatives would wish the patient to be given the opportunity to receive end of life care at home.ConclusionsRelatives (and one patient) told us they would welcome a pro active approach to the recognition of a patient approaching the end of life. They would also wish information regarding prognosis to be shared with the GP, even if it was not information the patients themselves wished to have. No funding was obtained for this study.

Several letters to the editor are presented in response to articles in previous issues such as "Days of Hope and False Dawns," by Geoffrey Lean, the 50th anniversary edition of the journal, and the inconsistency of the subsidies and tax concessions for fossil fuel.

Letters to the editor are presented in response to articles published in previous issues including a preview of the Academy Awards, "Soaps: How Long Will They Last?" and an article on authors.

The short story "A Tale of Two Toxicities," by Kate Davies is presented.

The article presents a response to Paul Hawken's paper "To Remake the World," which focused on the new progressive movement. It outlines the four goals or aspirations that unite much of the new social movement. It describes the approach to leadership in the new movement. It addresses the need for social movements to have internal organization.