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Objective: This study aimed to describe and compare the proportion of patients classified as an emergency department (ED) mental health presentation under different definitions, including the Australian Institute of Health and Welfare (AIHW) definition. Methods: This retrospective cohort study enrolled all patients that presented to the EDs of a multi-centre Victorian health service between 1 January 2020 and 30 June 2023. Varying definitions of a mental health presentation were applied to each ED attendance, applying the current AIHW definition (using selected diagnosis codes), broader diagnosis-based coding, the presenting complaint recorded at triage and whether the patient was seen by or referred to the emergency psychiatric service (EPS). The proportion of all ED presentations meeting each definition and any overlap between definitions were calculated. The agreement between each definition and the AIHW definition was evaluated using Kappa's coefficient. Results: There were 813,078 presentations to ED of which 34,248 (4.2%) met the AIHW definition for a mental health presentation. Throughout the study, 45,376 (5.6%) patients were seen and/or referred to EPS, and 36,160 (4.4%) patients were allocated a mental health presenting complaint by triage staff. There was moderate interrater agreement between these definitions, with a kappa statistic (95% confidence interval) between the AIHW definition and a mental health presenting complaint recorded at triage of 0.58 (0.58–0.59) and between the AIHW definition and review by EPS of 0.58 (0.57–0.58). Conclusions: The AIHW definition is a conservative measure of ED mental health presentations and may underestimate emergency psychiatry workload in Australian EDs. What is known about this topic? It is unknown whether the Australian Institute of Health and Welfare (AIHW) definition of an emergency department (ED) mental health presentation definition accurately reflects ED mental health workload. What does this paper add? The AIHW definition appears to underestimate the clinical workload related to ED mental health presentations. There is moderate agreement between the AIHW definition and mental health presentations classified according to complaint recorded at triage, or whether the patient is reviewed by psychiatry services. What are the implications for practitioners? Accurate measurement of emergency psychiatry workload should not rely on the AIHW definition alone. [ABSTRACT FROM AUTHOR]

Objectives: This study explored the familiarity, perceptions and confidence of Australian radiology clinicians involved in reading screening mammograms, regarding artificial intelligence (AI) applications in breast cancer detection. Methods: Sixty-five radiologists, breast physicians and radiology trainees participated in an online survey that consisted of 23 multiple choice questions asking about their experience and familiarity with AI products. Furthermore, the survey asked about their confidence in using AI outputs and their preference for AI modes applied in a breast screening context. Participants' responses to questions were compared using Pearson's χ 2 test. Bonferroni-adjusted significance tests were used for pairwise comparisons. Results: Fifty-five percent of respondents had experience with AI in their workplaces, with automatic density measurement powered by machine learning being the most familiar AI product (69.4%). The top AI outputs with the highest ranks of perceived confidence were 'Displaying suspicious areas on mammograms with the percentage of cancer possibility' (67.8%) and 'Automatic mammogram classification (normal, benign, cancer, uncertain)' (64.6%). Radiology and breast physicians preferred using AI as second-reader mode (75.4% saying 'somewhat happy' to 'extremely happy') over triage (47.7%), pre-screening and first-reader modes (both with 26.2%) (P < 0.001). Conclusion: The majority of screen readers expressed increased confidence in utilising AI for highlighting suspicious areas on mammograms and for automatically classifying mammograms. They considered AI as an optimal second-reader mode being the most ideal use in a screening program. The findings provide valuable insights into the familiarities and expectations of radiologists and breast clinicians for the AI products that can enhance the effectiveness of the breast cancer screening programs, benefitting both healthcare professionals and patients alike. What is known about the topic? Artificial intelligence (AI) holds promise in providing computer-aided detection in health care, however, current research suggests that standalone AI applications in clinical practice fall short of matching the accuracy of a single radiologist. What does this paper add? The study showed a significant preference among clinicians for using AI as a supplementary tool, serving as a second-reader. Such an integrated approach, where AI aids in flagging suspicious areas on mammograms or offers automatic classification, reflects the ideal cooperation between breast screening readers and AI systems. What are the implications for practitioners? These insights shed light on clinicians' familiarity with and expectations of AI tools that can boost the effectiveness of breast screening programs. [ABSTRACT FROM AUTHOR]

Objectives: Integrated respiratory and palliative care services for people with advanced lung disease provide disease-orientated care until the end of life, alongside symptom management and discussions about future care. This study aimed to explore patient, caregiver and general practitioner perspectives of an integrated respiratory and palliative care service, to understand which components of the service were considered valued and effective. Methods: We approached patients, caregivers and general practitioners, to participate in semi-structured phone interviews. A grounded theory approach guided data collection and qualitative analysis. Results: Between July and December 2019, 10 patients, eight caregivers and five general practitioners completed interviews. The overarching theme was that of valuing integrated care – the provision of disease-orientated care along with palliative care. Four other major themes emerged: Valuing communication and engagement between patient, caregiver and healthcare professionals – who spoke of 'growing this plan together'; the delivery of person-centred care – where physicians 'actually listen and you are not treated like a number'; the reality of action plan use in serious illness – while many found plans 'certainly' do help, others described when they were simply 'too ill to do the action plan'; and finally, divergent preferences for discussions about future care – while some patients felt this subject was 'better left alone', caregivers consistently reported their preference was to 'make a plan.' Conclusion: Consumer perspectives highlight the service was valued for delivering personalised care with high communication standards. Similar services should appreciate the usefulness and limitations of action plan use in advanced lung disease, and be sensitive to potential diverging preferences of the patient and caregiver when discussing future care. What is known about the topic? Integrated respiratory and palliative care services for people with advanced lung disease may improve quality of life and decrease acute healthcare utilisation and cost. What does this paper add? This paper adds to our understanding of patients', caregivers' and general practitioners' perspectives of this integrated care model. Participants highly valued this integrated service for providing person-centred care. Participants outlined both the effectiveness and limitations of action plan use in advanced lung disease, and of diverging preferences between patients and caregivers for discussions about future care. What are the implications for practitioners? The integration of disease-orientated care along with the provision of palliative care is highly valued from a consumer perspective. [ABSTRACT FROM AUTHOR]

Alcohol and other drug (AoD) use is an important health and community issue and may be positively affected by collaborative care programs between specialist AoD services and general practice. This paper describes the feasibility, model of care and patient outcomes of a pilot general practice and specialist AoD (GP-AoD) collaborative care program, in Sydney, Australia, based on usual care data, the minimum data set, service utilisation information and the Australian Treatment Outcome Profile (ATOP), a patient-reported outcome measure. There were 367 referrals to the collaborative care program. GPs referred 210 patients, whereas the AoD service referred 157 patients. Most GP referrals (91.9%) were for AoD problems, whereas nearly half the AoD service referrals were for other issues. The primary drugs of concern in the GP group were either opioids or non-opioids (mostly alcohol). The AoD service-referred patients were primarily using opioids. An ATOP was completed for 152 patients. At the time of referral, those in the GP-referred non-opioid group were significantly less likely to be abstinent, used their primary drug of concern more days and were more likely to be employed (all P < 0.001). A second ATOP was completed for 93 patients. These data showed a significant improvement in the number of days the primary drug of concern was used (P = 0.026) and trends towards abstinence, improved quality of life and physical and psychological well-being for patients in the program. There are few studies of GP-AoD collaborative care programs and nothing in the Australian context. This study suggests that GP-AoD collaborative care programs in Australia are feasible and improve drug use. Alcohol and other drug use is common in Australia and causes serious health and well-being issues. Collaborative care between GPs and specialist alcohol and other drug services may improve this. This is the first Australian study to address collaborative care between GPs and alcohol and other drug services. The study shows that collaborative care is feasible in the Australian setting and suggests that it could help people who use alcohol and other drugs to access care and improve their health and well-being outcomes. [ABSTRACT FROM AUTHOR]

Background Rising demand for sexual health services requires publicly funded service providers to ensure they are seeing members of priority populations. Sydney Sexual Health Centre in New South Wales, Australia developed an innovative online triage tool called 'Am I OK?' to support this goal. Methods This paper outlines the findings of a review that examined the use of the triage tool using retrospective cross-sectional analysis of 2017 data. Results The tool has achieved its purpose in ensuring that non-priority populations are referred to other services, consequently saving a significant amount (approximately 6months equivalent) of phone triage nurse time. Conclusion More work may need to be done to ensure that the tool is not creating a barrier for priority populations wishing to access the service. [ABSTRACT FROM AUTHOR]

Context: Forested wetlands occurring on fluvial sediments are among the most threatened ecosystems in south-east Australia. The first quantitative diagnosis of forested wetland types in NSW was completed in 2005. Since then, there has been a three-fold increase in survey data on coastal floodplains, vegetation classification systems have been developed in New South Wales, Queensland and Victoria, and methods for the assessment of ecosystem conservation risks have been adopted by the International Union for the Conservation of Nature (IUCN). Aims: To ensure an evidence base that can support conservation decisions and national conservation assessments, there is a need to review and update the classification of forested wetlands and integrate classification schemes across jurisdictions. Methods: We evaluated the efficacy of a multi-stage clustering strategy, applied to data from different sources with largely unknown methodological idiosyncrasies, to retrieve ecologically meaningful clusters. We assessed the veracity and robustness of the 2005 classification of forest wetlands as a framework for national risk assessments over an expanded range. Key results: We derived a quantitative, cross-jurisdictional classification of forested wetlands based on a synthesis of 5173 plot samples drawn from three states and identified the status of our units in relation to IUCN's Global Ecosystem Typology. Conclusions: Our analyses support the retention of the five legacy types which are the basis for threatened ecosystem listings under the NSW Biodiversity Conservation Act 2016 and Commonwealth Environment Protection and Biodiversity Conservation Act 1999. Implications: Our results will support revised assessments of current listings and facilitate their integration at state, national and global scales. This paper presents a revised broad-scale classification of forested wetlands occurring on floodplains in temperate subtropical south-east Australia and identifies relationships with vegetation types of finer thematic scale described in sub-regional classifications in Queensland, Victoria and New South Wales. Patterns in the distribution of forested wetland types are described using statistical models. [ABSTRACT FROM AUTHOR]

While conducting phylogenetic analyses of sequence-capture data of Australian members of Asteraceae tribe Astereae, we found that Elachanthus pusillus F.Muell., Isoetopsis graminifolia Turcz. and Kippistia suaedifolia F.Muell. formed a clade with Minuria. We, therefore, conducted an analysis focused on this clade, but with replicate samples of the three smaller genera, and confirmed our results. Kippistia had been synonymised under Minuria between 1876 and 1980, when it was reinstated. Elachanthus and Isoetopsis had not previously been suggested to be part of Minuria , and, indeed, Isoetopsis had been considered so morphologically divergent that even its tribal affiliations were long controversial. However, on closer examination, Elachanthus and Isoetopsis are strikingly similar to Minuria , especially in cypsela and pappus morphology. The evolution of both genera from a common ancestor in Minuria appears plausible in the light of their overall similarity to annual species of that genus such as M. annua , their multiple uniform rows of herbaceous phyllaries with scarious margins, a pappus of scales v. the tendency of Minuria to form pappi with scale-like bases, female outer and male inner florets, and a cypsela indumentum shared with some species of Minuria. We propose the following three new combinations under Minuria : M. pusilla , M. glabra and M. graminifolia. We conducted a phylogenetic analysis of Minuria and related genera and found that Elachanthus , Isoetopsis , and Kippistia phylogenetically nested in Minuria. Before 1980, Kippistia had long been considered part of Minuria. Morphological examination showed many similarities between Eleachanthus , Isoetopsis , and annual species of Minuria. We publish new combinations for four species, synonymising the three smaller genera. (Image credit: Alexander Schmidt-Lebuhn.) This article belongs to the collection Genomics for Australian Plants. [ABSTRACT FROM AUTHOR]

Introduction. Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim. We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods. Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-toface semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results. All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. 'Competitive business model and lack of collaboration' - participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. '(Un)professional behaviour' - participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. 'Lack of support and mentoring' - the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion. This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to assess and compare the psychological wellbeing of Australian hospital clinical staff at three timepoints during the coronavirus disease 2019 (COVID-19) pandemic. Methods. An anonymous, online, cross-sectional survey was conducted at three timepoints during the COVID-19 pandemic (T1: May–June 2020; T2: October–December 2020; T3: November 2021–January 2022). The surveys were completed by nurses, midwives, doctors and allied health staff employed at a large metropolitan tertiary health service located in Melbourne, Australia. The Depression, Anxiety and Stress Scale (DASS-21) assessed respondents’ psychological wellbeing in the past week. General linear models were used to measure the effects of survey timepoint on DASS-21 subscale scores, adjusting for selected sociodemographic and health characteristics. Results. A total of 1470 hospital clinical staff completed at least one survey (T1: 668 (14.7%), T2: 358 (7.9%) and T3: 444 (9.8%)). Respondents’ sociodemographic characteristics were similar across the three timepoints and within professional discipline groups. Respondents’ psychological wellbeing was worse at T3 compared to the earlier survey timepoints. Adjusting for respondent characteristics, depression, anxiety and stress scores were significantly higher for respondents of the third survey compared to the first (P < 0.001). Conclusions. There was a significant and persistent negative impact on the psychological wellbeing of hospital clinical staff in Australia across waves of the COVID-19 pandemic. Hospital clinical staff would benefit from ongoing and continued wellbeing support during and after pandemic waves. [ABSTRACT FROM AUTHOR]

Cool temperatures can limit productivity of temperate grazing systems as poor pasture growth rates in winter create feed shortages for livestock. Ornithopus spp. (serradella) are broadly adapted annual pasture legumes that produce high-quality forage in soil types considered marginal for other temperate legume species. However, serradella establishment is perceived to be difficult in cool-season environments. We used survival analysis to compare germination rate and seedling emergence for two serradella species (yellow serradella and French serradella) against three reference species (Medicago sativa, M. polymorpha and Trifolium subterraneum) in four temperature treatments (10/5, 15/10, 20/15 and 25/20°C; max/min). We also compared shoot relative growth rate and photosynthetic rate at 15/10°C (cool) and 23/18°C (warm). Cool temperatures (10/5, 15/10°C) did not slow germination rates for serradella relative to the reference species, but warm temperatures (20/15, 25/20°C) delayed emergence and reduced post-emergent shoot growth rates. Once established, Ornithopus spp. had similar mean photosynthetic rates and stomatal conductance at cool temperatures to the reference species.We conclude that, contrary to common perception, cool temperatures did not adversely influence germination, emergence, or early growth of Ornithopus spp. relative to the reference species. [ABSTRACT FROM AUTHOR]

Objective. This study investigated whether the provision of financial assistance to patients living in regional New South Wales influenced patients' decisions to participate in a cancer clinical trial (cancer treatment or supportive care) and resulted in improved psychosocial outcomes. Methods. Administrative data were collected from participants, including demographics, travel distances and the value of financial support provided. Qualitative interviews were then conducted with a subset of consenting patients who received financial assistance for a clinical trial. Results. Sixty-four patients with cancer received financial support for a clinical trial, 27 (42%) of whom were interviewed. Participants whose distance to a trial site was over 400 km received almost three times as much financial support (M = A$3194.20, s.d. = A$1597.60) as participants whose distance to a trial site was between 50 and 100 km (M = A$1116.29, s.d. = $A1311.23). Half of participants indicated that receiving financial assistance influenced their decision to participate in a clinical trial, and most indicated the support alleviated the financial burden of clinical trial participation. Conclusions. The provision of financial assistance to patients living in regional areas may reduce inequities in cancer clinical trial participation and improve psychosocial outcomes. [ABSTRACT FROM AUTHOR]

Background: Almost one in four women in Australia experience an unintended pregnancy during their lifetime; of these, approximately 30% currently end in abortion. Although early medical abortion (EMA) up to 9 weeks gestation is becoming more widely available in Australia, it is still not commonly offered in primary care. The aim of this study was to investigate the barriers and facilitators to the provision of EMA in primary care. Methods: A sample of 150 general practitioners (GPs) and 150 registered nurses (RNs) working in Australia responded to a best–worst scaling survey designed to answer the following question: what are the most important facilitators and barriers to the provision of EMA in primary care? Results: GPs believe that the lack of clinical guidelines, the amount of information provision and counselling required, and the fact that women who are not their patients may not return for follow-up are the most important barriers. For RNs, these three barriers, together with the stigma of being known as being involved in the provision of EMA, are the most important barriers. The formation of a community of practice to support the provision of EMA was identified by both professions as the most important facilitator. Conclusions: Having access to a community of practice, enhanced training and reducing stigma will encourage the provision of EMA. Although clinical guidelines are available, they need to be effectively disseminated, implemented and endorsed by peak bodies. Primary care practices should consider using task sharing and developing patient resources to facilitate the provision of information and counselling. Although available, early medical abortion is not commonly offered in general practice. When asked, GPs and RNs reported that lack of clinical guidelines, the need to provide information and counselling, and follow-up issues were important barriers to the provision of early medical abortion, whereas having access to a community of practice was the most important facilitator. Guidelines are available, but require dissemination and implementation. Task sharing and appropriate remuneration will encourage more GPs to offer early medical abortion, so it is seen as an essential service. [ABSTRACT FROM AUTHOR]

Background. The Camp Fire burned through communities in Butte County, California, on 8 November 2018. The fire destroyed over 18 000 structures and caused 85 fatalities, mostly within the first 12 h of the incident. Aims. A post-fire case study was conducted to learn from the devastating incident. Methods. The case study was supported by detailed first-hand accounts from 157 first responders, photos and videos, first responder radio logs, and other field data. Subsequent analysis and data integration yielded a timeline reconstruction of the first 24 h of the entire event, as well as additional observations of the fire behaviour. Key results. A total of 23 life-threatening entrapment and burnover events were identified, in which fire trapped or overtook people and compromised escape routes. Conclusions. Seventeen burnovers directly impacted evacuating civilians, 12 of which occurred on major evacuation roadways. These events affected the safety of hundreds of evacuating civilians and dozens of first responders. Implications. Fast-moving fires may require last-minute large-scale evacuations, such as the Camp Fire. The risk of similar types of events is high, particularly in intermix communities where the presence of wildland vegetation along evacuation routes, likely amplified by local topography and wind, can result in significant entrapments or burnovers. [ABSTRACT FROM AUTHOR]

Background: In July 2018, participants at a Waiben (Thursday Island) conference declared that it was time for a locally driven research agenda for the Torres Strait and Queensland Northern Peninsula Area. For decades, they felt exploited by outside researchers. They identified a lack of respect and consultation, with few benefits for their people. Methods: In response, the Australian Institute of Tropical Health and Medicine (Waiben Campus‐Ngulaigau Mudh) invited a consultative group of elders and senior health providers to develop a research program based on local cultural and health needs. The aim was to promote research skills through a learn-by-doing approach. Four workshops were conducted over 2019. Key financial and in-kind support was provided by the Australian Institute of Tropical Health and Medicine, Hot North, and Queensland Health's Torres and Cape Hospital and Health Service. Results: The first workshop attracted 24 people; none had previous research experience. The workshop format evolved over 2019, mainly guided by the participants. Overall, feedback was positive, and participant research proposals remain in various stages of development. Conclusions: Although suspended during the COVID-19 pandemic, this is a long-term investment in community-driven research that seeks to translate health benefits to the people. This model may apply to other communities, especially in rural and remote Australia. Warning: This article contains the names and/or images of deceased Aboriginal and Torres Strait Islander peoples. Research had a bad name in the Torres Strait. People felt exploited by outside researchers over decades with few benefits for the people. A consultative group of elders and senior health providers developed a research agenda focused on local cultural and health needs, based on a learn-by-doing approach. Participants created their research proposals during four workshops. The program was interrupted by COVID-19 restrictions but should resume in 2022. The model may apply to other Australian rural and remote communities. [ABSTRACT FROM AUTHOR]

Pyrolysate gas mixtures are multivariate and relative in nature. Statistical techniques applied to these data generally ignore their relative nature. Published data for permanent gases (CO, CO2, H2, CH4) and tars produced by pyrolysing 15 wildland fuels were reanalysed using compositional data analysis techniques. Mass and mole fractions were compositionally equivalent. Plant species, moisture status and heating mode effects on compositional balances formed from subsets of pyrolysates were tested. Plant species affected the amount of phenol, primary and secondary/tertiary tars relative to permanent gases and relative amounts of single- and multi-ring compounds. Plant moisture status affected the amount of CO relative to other permanent gases, of H2 to CH4 and tars to phenol. Heating mode and rate strongly influenced pyrolysate composition. Slow heating produced more primary tars relative to multi-ring tars than fast heating convective and combined radiant and convective heating modes. Slow heating produced relatively more compounds with fewer rings and fast heating produced relatively more multi-ring compounds. Compositional data analysis is a well-developed statistical methodology, providing models and methods equivalent to traditional ones, that accounts for the special constraining features of relative data. Future analysis of the compositional data related to wildland fire using compositional techniques is recommended. Compositional data techniques were applied to show that heating mode, plant species and moisture status affected the composition of pyrolysis products in an improved and statistically rigorous analysis. These methods should be used for other compositional data related to wildland fire. [ABSTRACT FROM AUTHOR]

Therapeutic day rehabilitation (TDR) is a non-residential intensive structured program designed for individuals recovering from substance misuse. A weekly afternoon of therapeutic gardening was a new incentive initiated in a TDR program at one Australian community health service, designed to give participants the opportunity to spend time outdoors connecting with nature and each other. The aim of this study was to explore perceptions of participants enrolled in this program by employing a convergent parallel mixed-method design using qualitative individual, semi-structured interviews (n = 14) and longitudinal quantitative quality of life (QOL) data at three different intervals (n = 17). The analysis of the quantitative data showed that there was a statistically significant increase in the participants' QOL scores in three of four domains (physical health, psychological, social relationships) when comparing baseline and post completion of the TDR. These observed changes were maintained at the 4-week follow up. The key findings from the semi-structured interviews include positive effects for participants on social connectivity, structure and achievement, understanding of recovery and relaxation from contact with nature. This study shows that a combination of TDR and therapeutic gardening can improve participants' physical health, psychological health and social relationships. Incorporating therapeutic gardening within therapeutic day rehabilitation is an appropriate program design for individuals recovering from substance abuse. This research has demonstrated positive outcomes with this combination, improving participants' physical health, psychological health, and social relationships. In addition, it has helped participants to build social connections, a better understanding of recovery and a sense of achievement on completion of the program. [ABSTRACT FROM AUTHOR]