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Malnutrition and frailty affect up to one-third of community-dwelling older adults in Australia and New Zealand (ANZ), burdening individuals, health systems and the economy. As these conditions are often under-recognised and untreated in the community, there is an urgent need for healthcare professionals (HCPs) from all disciplines to be able to identify and manage malnutrition and frailty in this setting. This paper describes the systematic and iterative process by which a practical guide for identifying and managing malnutrition and frailty in the community, tailored to the ANZ context, was developed. The development of the guide was underpinned by the Knowledge-to-Action Framework and included the following research activities: (1) a comprehensive literature review; (2) a survey of ANZ dietitians' current practices and perceptions around malnutrition and frailty; (3) interviews with ANZ dietitians; and (4) a multidisciplinary expert panel. This resulted in the development of a guide tailored to the ANZ context that provides recommendations around how to identify and manage malnutrition and frailty in the community. It is now freely available online and can be used by all HCPs across several settings. The approach used to develop this guide might be applicable to other conditions or settings, and our description of the process might be informative to others who are developing such tools to guide practice in their healthcare environment. Malnutrition and frailty are common in Australian and New Zealand communities, burdening individuals, health systems and the economy. This paper describes the process by which an evidence-informed guide for identifying and managing these conditions in the community was developed. The guide is now freely available online and can be used by all healthcare professionals across several settings, and our description of the process might be informative to others who are developing such tools to guide practice in their healthcare environment. [ABSTRACT FROM AUTHOR]

This perspective paper provides industry leaders, researchers and policy developers strategic approaches to ensure that the welfare of dairy cattle is protected at the same time as the industry increases its resilience to climate change. Farm systems and practices will evolve in response to the direct impacts of climate change and/or from responses to climate change, such as mitigation strategies to reduce dairy's greenhouse-gas (GHG) emissions. The five domains framework (nutrition, physical environment, health, behaviour, mental state) was used to assess the potential impacts on animal welfare and strategies to minimise these impacts are outlined. Given that the future climate cannot be certain these approaches can be applied under a range of emissions pathways to (1) ensure that the effects of GHG mitigations on animal welfare are considered during their development, (2) engage with end users and the public to ensure solutions to the effects of climate change and weather variability are accepted by consumers and communities, (3) identify and measure the areas where improved animal health can contribute to reducing GHG emissions from dairy production, (4) ensure those supporting farmers to develop and manage their farm systems understand what constitutes a good quality of life for dairy cattle, (5) ensure effective surveillance of animal disease and monitoring of welfare outcomes and farm-system performance in response to climate change and GHG mitigations. Overall, these strategies require a multidisciplinary co-development approach to ensure that the welfare of dairy cattle is protected at the same time as the industry increases its resilience to the wider impacts of a changing climate. [ABSTRACT FROM AUTHOR]

Background: Early career medical professionals experience stress and burnout at higher levels than the wider community. Burnout can arise with competing demands of life and career, which is evident in early career development, where family planning can coincide with specialty training. General practice may be seen as a family friendly career option; however, few studies examine the experience of general practice trainees with stress and burnout and the impact that parenting has on their experience. This study aims to explore the experience of stress and burnout in general practice registrars and the exacerbating and protective factors, with a focus on the experiences of two groups of registrars, those that have children, and those that do not. Methods: A qualitative study was conducted with 14 participants, who were interviewed with questions exploring experiences of stress and burnout. Participants were grouped into those with children and those without children. The transcripts were thematically analysed. Results: Themes were identified as those that contributed to stress and burnout (such as time, financial concerns and isolation) and those factors that reduced stress and burnout (such as support from others and being respected and valued within the workplace). Parenting was identified as both a factor that could contribute to and reduce stress and burnout. Conclusions: Stress and burnout are important foci for future research and policy to ensure the sustainability of general practice. System based and individual focused policies, including individualising training to support parenting, are required to ensure that registrars are supported through their training years and beyond. General practice needs to work to increase recruitment of doctors, reduce early career burnout and to retain GPs in the long term. Early career medical professionals experience stress and burnout at higher levels than the wider community. General practice may have traditionally been seen as a family friendly career option, however, unfortunately it may be no longer. This paper examines the experience of GP trainees with stress and burnout and the impact that parenting has on their experience and looks at solutions to improve conditions for early to mid career GPs, and hopefully make general practice more attractive for future doctors. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the suitability and acceptability of virtual training post accreditation visits conducted online for medical specialist training in ophthalmology in Australia and New Zealand. Methods: A two-phase study (pilot and implementation) was conducted. In the pilot phase, an open-ended observation proforma was used by the authors to independently record their observations, which were later compared and discussed until consensus was achieved. All participants were asked to complete an online survey. A document analysis of accreditation documents was conducted. Observation data were broken down into themes and triangulated with online survey and document analysis results. In the implementation phase, the inspections were observed by one of the authors (SK) and the observation notes were discussed with other authors to obtain a contextual and consensual view. A document analysis of all accreditation-related documentation was undertaken. The documents included in the document analysis were planning and scheduling records, interview and inspection notes, training post inspection fact and document notices and accreditation reports. Finally, a post-inspection focus group of all inspectors was conducted. Results: The accreditation interviews adequately addressed all relevant issues with high levels of robustness and reliability. Participants found it more difficult to discuss complex issues virtually compared with onsite visits. The virtual accreditation reports were not any different to what would be expected if a face-to-face accreditation visit had been conducted; however, it was not possible using the virtual inspection to determine the appropriateness of facilities and clinic layout to support and facilitate trainee learning and supervision. Conclusions: Virtual accreditation of training posts in medical specialist training is viable in limited circumstances where there are no known complex training post-related issues and the site has not made substantial changes to clinic and theatre layout, equipment and facilities since the previous accreditation. What is known about the topic? All medical specialist colleges in Australia and New Zealand accredit the sites where training is delivered, usually by conducting periodic face‐to‐face visits. What does this paper add? This paper provides evidence that in limited circumstances, it is possible to accredit training posts virtually. What are the implications for practitioners? This paper provides an outline of issues to consider when planning virtual accreditation of training posts in medical specialist education. [ABSTRACT FROM AUTHOR]

Background: Non-traumatic lower limb amputation rates are rising worldwide, resulting in increased hospitalisations and use of rehabilitation services. This study aimed to identify key comorbidities associated with prolonged length of stay or decreased functional gain for episodes receiving inpatient rehabilitation following non-traumatic lower limb amputation. Methods: Prospectively collected data submitted to the Australasian Rehabilitation Outcomes Centre were analysed. The cohort comprised episodes for patients (aged ≥18 years) discharged from inpatient rehabilitation between 1 July 2013 and 30 June 2018 following a non-traumatic lower limb amputation. Results: The cohort included 5074 episodes with an average age of 66.3 years and the majority being male (71.7%). Comorbidities affecting the ability to participate in rehabilitation were reported for 65.4% of episodes, most commonly diabetes mellitus (50.3%), cardiac disease (33.5%), and respiratory disease (10.1%). These comorbidities were associated with a prolonged length of stay and reduced functional improvement. Conclusion: This study showed comorbidities contribute to prolonged length of stay and poorer functional outcomes among those undergoing inpatient rehabilitation following non-traumatic lower limb amputation. Future research should focus on strategies to address these comorbidities to help improve patient outcomes and reduce healthcare costs. What is known about the topic? It is known that the presence of comorbidities contributes to lower limb amputation; however, the effect that comorbidities have on inpatient rehabilitation outcomes is not well reported. What does this paper add? This study identified five comorbidities (diabetes mellitus, cardiac disease, respiratory disease, renal failure with dialysis, and mental health problems) associated with prolonged length of stay and decreased functional outcomes following inpatient rehabilitation for non-traumatic lower limb amputation. What are the implications for practitioners? Our findings suggest practitioners should focus on strategies to address these comorbidities to help improve functional outcomes, reduce length of stay, and reduce healthcare costs. [ABSTRACT FROM AUTHOR]

Objective: Despite needs, people with advanced non-malignant respiratory disease are infrequently referred to palliative care services. Integrated models of palliative care and respiratory service delivery have been advocated to address this inequity of access. This study mapped current ambulatory palliative care service provision for patients with advanced non-malignant respiratory disease in Australia and New Zealand. Methods: An online survey was distributed to the palliative care physician membership of the Australian and New Zealand Society of Palliative Medicine. Information was sought regarding access to specific breathlessness and integrated respiratory and palliative care services, and their operation. Data were described using descriptive statistics. Results: In all, 133 respondents (93 from Australia, 40 from New Zealand; representing 55 Australian and 26 New Zealand discrete sites) with complete data were available for analysis. More than half the respondents reported seeing patients with advanced non-malignant respiratory disease frequently (56/97; 58%), and 18 of 81 services (22%) reported having breathlessness or integrated respiratory and palliative care services caring for this patient group. Such services were mostly staffed by respiratory and palliative care doctors and nurses and based in the clinic environment, with limited support available outside this setting. Of the 63 respondents without existing breathlessness or integrated services, 49 (78%) expressed interest in their establishment, with limited resources cited as the most common barrier. Conclusions: There is limited availability of integrated respiratory and palliative care or specialised breathlessness services in Australia and New Zealand despite widespread support by palliative care physicians. This study provides a snapshot to inform strategic service development. What is known about the topic?: People with advanced respiratory disease have very significant morbidity with complex needs equivalent to, and in many cases more intense than, people with end-stage lung cancer; they also have significant mortality. Yet, these people frequently do not access palliative care services. The establishment of integrated respiratory and palliative care services has been advocated as an effective means to overcome the barriers to palliative care access. Such services have demonstrated improved patient and family-reported outcomes, as well as service-level improvements. What does this paper add?: This paper maps the availability of integrated respiratory palliative care services in Australia and New Zealand. We reveal that although most palliative care physicians report seeing patients with advanced respiratory disease in practice, just one-fifth of services report having an integrated service approach. There was high interest and enthusiasm for such services (78%), but resources limited their establishment. What are the implications for practitioners?: Palliative care services recognise the needs of patients with advanced respiratory disease and the benefits of integrated respiratory and palliative care services to address these needs, but scarcity of resources limits the ability to respond accordingly. This study provides a snapshot of current service level to inform strategic development. [ABSTRACT FROM AUTHOR]

Objective: The climate crisis necessitates urgent decarbonisation. The health sector must address its large carbon footprint. In the present study, we sought healthcare thought leaders' views about a future environmentally sustainable health system. Methods: The present study was a qualitative exploratory study consisting of semistructured, in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the US and New Zealand. Audio recordings of the interviews were transcribed and analysed by matrix display and thematic analysis. Results: Overall, healthcare thought leaders believe that to reduce the carbon footprint of healthcare we need to look beyond traditional 'green' initiatives towards a more fundamental and longer-term redesign. Five main themes and one 'key enabler' (information communication technology) were identified. In this paper we draw on other relevant findings, but chiefly focus on the fifth theme about reshaping the role of healthcare within society and using the size and influence of the health sector to leverage wider health, environmental and societal benefits. Conclusions: These ideas represent potentially low-carbon models of care. The next step would be to pilot and measure the outcomes (health, environmental, financial) of these models. What is known about the topic?: The health sector needs to reduce its large carbon footprint. Traditional 'green' initiatives, such as recycling and improving energy efficiency, are insufficient to achieve the scale of decarbonisation required. What does this paper add?: Healthcare thought leaders surveyed in the present study suggested that we also consider other, non-traditional ways to achieve environmental sustainability. In this paper we discuss their ideas about adopting an anticipatory approach to healthcare using predictive analytics, and using the size and influence of the health sector to effect wider health and environmental benefits. What are the implications for practitioners?: Achieving an environmentally sustainable healthcare system is likely to require broad and fundamental (i.e. transformational) change to the current service model. Health practitioners throughout the sector must be closely engaged in this process. [ABSTRACT FROM AUTHOR]

The aphid Aploneura lentisci is widespread in Australia and New Zealand, living all year round on roots of its secondary grass hosts. The fungal endophyte (Epichloë festucae var. lolii), strain AR37 in Lolium perenne is known to greatly reduce populations and was a likely reason for the superior growth and persistence of this association previously observed in the field. Aphid populations were quantified in a field trial near Ballarat, comparing yields of perennial ryegrass infected with eight different endophyte strains and an endophyte-free (Nil) control in a common ryegrass background (Grasslands Samson (G. Samson)). AR37 and another endophyte strain, AR5, had significantly fewer aphids than all other endophytes. These differences were significantly related to yield increases taken before and after sampling that persisted until the end of the trial. In a pot trial comparing commercially available ryegrass-endophyte combinations with equivalent Nil controls, aphid numbers were lower on G. Samson AR37 and Banquet II with AR5 (Endo®5) than on all other cultivar-endophyte combinations. Compared with Nil controls, the common toxic strain in G. Samson, and two strains in Trojan also reduced aphid numbers. The AR5 endophyte produces the alkaloid ergovaline but high concentrations of this in roots of potted plants could not account for differences in root aphid numbers. Root concentrations of epoxyjanthitrems, the only known alkaloids produced by AR37, were low and unlikely to be the cause of resistance to A. lentisci. An aphid, Aploneura lentisci , that feeds on grass roots is widespread in pastures in New Zealand and Australia. This paper reports data confirming that perennial ryegrass infected with a strain of Epichloë fungal endophyte, AR37, is highly resistant to this aphid and shows that another endophyte strain, AR5, gives the same level of control. Suppression of high aphid populations by these endophytes in the field at Ballarat resulted in a 37% increase in pasture production over endophyte-free ryegrass over a 5-month period. [ABSTRACT FROM AUTHOR]

Australia needs a new shared vision that the current trajectory of loss of natural heritage on its offshore islands is not acceptable and needs to change. This Special Issue brings together seven papers from leaders and practitioners with experience in offshore islands across the Australian and New Zealand context. The fundamentals for each paper are to suggest potential solutions or scenarios to move forward with island policy, and management. [ABSTRACT FROM AUTHOR]

Objectives: HealthPathways, pioneered in Canterbury, New Zealand, in 2008, is a web-based tool designed to promote health care integration and patient management in primary care and to reduce fragmentation in the delivery of health services. This cross-sectional study evaluated the utilisation and perceptions of this tool among health professionals in Australia and New Zealand. Methods: A cross-sectional survey was administered online through Research Electronic Data Capture (REDCap) to general practitioners (GPs), practice nurses and managers, nurse practitioners, specialist and community nurses, hospital clinicians, nurses, managers, and allied health professionals between April and September 2018. The frequency of HealthPathways use in the previous month was modelled as an ordered response using an ordered logistic regression model after adjusting for the possible effects of sex, age, years in clinical practice, location and time spent in practice. Results: Health professionals perceived HealthPathways to be useful in primary care management and referral, as well as in the prereferral treatment of patients. GPs in New Zealand, New South Wales and Victoria were 73%, 47% and 27% more likely to have used HealthPathways ≥10 times in the previous month respectively. Conclusion: The results suggest that HealthPathways is having a positive effect on healthcare systems in New Zealand and Australia. However, differences in uptake suggests the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. What is known about the topic?: Early evaluations suggest that HealthPathways is a useful tool for health professionals, although uptake and utilisation may be limited. However, there is no comparative evidence regarding uptake and implementation of the tool. What does the paper add?: This study is among the first to provide a comparative narrative of the literature assessing the implementation and uptake of HealthPathways across Australia and New Zealand. It is also among the first to compare the perceptions of allied health professionals in the use of HealthPathways across Australia and New Zealand. What are the implications for practitioners?: The results of this study suggest the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. [ABSTRACT FROM AUTHOR]

The anadromous Geotria australis , one of only three lamprey species representing the early agnathan (jawless) stage of vertebrate evolution in Australia and New Zealand, is declining in abundance. Its adults were caught soon after they had entered rivers on their non-trophic upstream migration and maintained in laboratory tanks for 13–15 months through to spawning. As adult G. australis are susceptible to haemorrhagic septicaemia, they were treated prophylactically and maintained in 3-m3 aquaria supplied with a flow-through charcoal filtration system and UV steriliser. Air temperature and the light : dark regime were constantly adjusted to parallel those in the environment. Males developed the very large suctorial disc and gular pouch characteristic of maturity and both sexes matured at the same time as in the wild. While males frequently showed aggressive behaviour towards each other, the same male and female mated on several occasions. The male coiled around the female and, with his urogenital papilla close to the female's cloaca, twisted and vibrated, leading to egg release. These eggs formed coagulated clusters as in the wild, with many progressing through to the eight-cell stage. Remarkably, numerous G. australis were still alive 95–392 days after the end of the short spawning period, and one male after a further 119 days. Postspawning survival would be facilitated inter alia by extensive proteolysis, reflected in a shortening of the body. The data in this paper emphasise that G. australis is a highly atypical lamprey and provides invaluable information for conserving this declining species. The lamprey Geotria australis , when provided with appropriate conditions, can be maintained in laboratory tanks for many months from the commencement of the upstream migration through to spawning. Successful maintenance requires, however, the provision of conditions that overcome the potential for this species to succumb to haemorrhagic septicaemia. Spawning, which occurs at the same time as in their natural environment, is described. The prolonged period during which G. australis survive after spawning parallels that recorded for this species in its riverine environment and is unique among lampreys. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore whether a relationship exists between the number of disasters a jurisdiction has experienced and the presence of disaster-specific pharmacy legislation. Methods: Pharmacy legislation specific to disasters was reviewed for five countries: Australia, Canada, UK, US and New Zealand. A binary logistic regression test using a generalised estimating equation was used to examine the association between the number of disasters experienced by a state, province, territory or country and whether they had disaster-specific pharmacy legislation. Results: Three of six models were statistically significant, suggesting that the odds of a jurisdiction having disaster-specific pharmacy legislation increased as the number of disasters increased for the period 2007–17 and 2013–17. There was an association between the everyday emergency supply legislation and the presence of the extended disaster-specific emergency supply legislation AH19093_IE1.gif. Conclusions: It is evident from this review that there are inconsistencies as to the level of assistance pharmacists can provide during times of crisis depending on their jurisdiction and location of practice. It is not a question of whether pharmacists have the skills and capabilities to assist, but rather what legislative barriers are preventing them from being able to contribute further to the disaster healthcare team. What is known about the topic?: The contributing factors to disaster-specific pharmacy legislation has not previously been explored in Australia. It can be postulated that the number of disasters experienced by a jurisdiction increases the likelihood of governments introducing disaster-specific pharmacy legislation based on other countries. What does this paper add?: This study compared five countries and their pharmacy legislation specific to disasters. It identified that as the number of disasters increases, the odds of a jurisdiction having disaster-specific emergency supply or disaster relocation or mobile pharmacy legislation increases. However, this is likely to be only one of many factors affecting the political decisions of when and what legislation is passed in relation to pharmacists' roles in disasters. What are the implications for practitioners?: Pharmacists are well situated in the community to be of assistance during disasters. However, their ability to help patients with chronic disease management or providing necessary vaccinations in disasters is limited by the legislation in their jurisdiction. Releasing pharmacists' full potential in disasters could alleviate the burden of low-acuity patients on other healthcare services. This could subsequently free up other healthcare professionals to treat high-acuity patients and emergencies. [ABSTRACT FROM AUTHOR]

Objective: This study reports on the characteristics of individuals conducting health service research (HSR) in Australia and New Zealand, the perceived accessibility of resources for HSR, the self-reported impact of HSR projects and perceived barriers to conducting HSR. Methods: A sampling frame was compiled from funding announcements, trial registers and HSR organisation membership. Listed researchers were invited to complete online surveys. Close-ended survey items were analysed using basic descriptive statistics. Goodness of fit tests determined potential associations between researcher affiliation and access to resources for HSR. Open-ended survey items were analysed using thematic analysis. Results: In all, 424 researchers participated in the study (22% response rate). Respondents held roles as health service researchers (76%), educators (34%) and health professionals (19%). Most were employed by a university (64%), and 57% held a permanent contract. Although 63% reported network support for HSR, smaller proportions reported executive (48%) or financial (26%) support. The least accessible resources were economists (52%), consumers (49%) and practice change experts (34%); researchers affiliated with health services were less likely to report access to statisticians (P < 0.001), economists (P < 0.001), librarians (P = 0.02) and practice change experts (P = 0.02) than university-affiliated researchers. Common impacts included conference presentations (94%), publication of peer-reviewed articles (87%) and health professional benefits (77%). Qualitative data emphasised barriers such as embedding research culture within services and engaging with policy makers. Conclusions: The data highlight opportunities to sustain the HSR community through dedicated funding, improved access to methodological expertise and greater engagement with end-users. What is known about the topic?: HSR faces several challenges, such as inequitable funding allocation and difficulties in quantifying the effects of HSR on changing health policy or practice. What does this paper add?: Despite a vibrant and experienced HSR community, this study highlights some key barriers to realising a greater effect on the health and well-being of Australian and New Zealand communities through HSR. These barriers include limited financial resources, methodological expertise, organisational support and opportunities to engage with potential collaborators. What are the implications for practitioners?: Funding is required to develop HSR infrastructure, support collaboration between health services and universities and combine knowledge of the system with research experience and expertise. Formal training programs for health service staff and researchers, from short courses to PhD programs, will support broader interest and involvement in HSR. [ABSTRACT FROM AUTHOR]

Dairy feeding systems in Australia and New Zealand have seen an increase in the use of mixed rations to manage variability in climate and market conditions and enable a certain degree of resilience in the operating environment. In this review, resilience was defined as the ability of the farm system to respond to challenges, optimise productivity and profitability for a given set of circumstances, and persist over time. Specific attributes of a dairy system that contribute to resilience were considered as flexibility, consistency, adaptation, sustainability and profitability. A flexible forage base that uses water efficient forage species provides a consistent supply of nutrients from home-grown forages across the year and is a key driver of resilience. Consistent milk production from purchased concentrates adds value to the forage base and will ensure that the system is profitable in the long term. Appropriate investment in infrastructure and careful management of debt has a positive impact on technical and financial efficiency and improves overall economic performance and resilience of the system. Nutrients, feed wastage, cow comfort and welfare were also identified as key areas to focus on for improved sustainability. Future research investigating the interaction between forages and concentrates, and the subsequent milk production response will be important for the future resilience of mixed ration systems. Adaptive management at a tactical and strategic level across several technical areas will further underpin the resilience of a mixed ration dairy system, and minimise the impact of climate and price variability. This will have flow on benefits to animal welfare and resource sustainability, which will have a positive impact of the public perception of these systems within the Australian and New Zealand dairy industries. The use of mixed ration feeding systems in Australia and New Zealand has increased in the past decade in response to variable climate and market conditions and to enable dairy businesses to be more resilient. This paper reviews the attributes contributing to resilience, namely flexibility, consistency, adaptation, sustainability and profitability with a particular focus on the forage base, milk production responses, the production : cost base and resource management. Potential areas for future work to maintain the resilience of mixed ration systems are also considered. [ABSTRACT FROM AUTHOR]

The Australasian dairy industry is facing the dual challenges of increasing productivity, while also reducing its emissions of the greenhouse gases (GHG) methane and nitrous oxide. Following the COP21 Paris Agreement, all sectors of the economy will be expected to contribute to GHG abatement. Enteric methane is the major source of GHG emissions from dairy production systems (>70%), followed by nitrous oxide (13%) and methane (12%) from animal waste, with nitrogen (N)-fertiliser use contributing ~3.5% of total on-farm non-carbon dioxide equivalent (non-CO2e) emissions. Research on reducing methane emissions from dairy cattle has focussed on feeding dietary supplements (e.g. tannins, dietary oils and wheat), rumen modification (e.g. vaccine, inhibitors), breeding and animal management. Research on reducing nitrous oxide emissions has focussed on improving N fertiliser efficiency and reducing urinary N loss. Profitable options for significant abatement on farm are still limited, with the industry focusing instead on improving production efficiency, while reducing emission intensity (t CO2e/t product). Absolute emission reduction will become an imperative as the world moves towards carbon neutrality by 2050 and, thus, a priority for research. However, even with implementation of best-practice abatement, it is likely that some residual emissions will remain in the foreseeable future. The soil organic carbon content of dairy soils under well fertilised, high-rainfall or irrigated permanent pastures are already high, therefore limiting the potential for further soil carbon sequestration as an offset against these residual emissions. The Australasian dairy industry will, therefore, also need to consider how these residual emissions will be offset through carbon sequestration mainly in trees and, to a more limited extent, increasing soil organic carbon. The Australasian dairy industry is facing the challenge of increasing productivity while also reducing greenhouse gas (GHG) emissions. This paper reviews the most promising technologies, concluding that substantial GHG abatement is possible, but the industry will need to consider further offsets in trees to achieve carbon-neutral dairy farming in Australia and New Zealand. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact and cost associated with mental illness. Methods: A rapid review of the literature from Australia, New Zealand, UK and Canada was undertaken. The review included literature pertaining to the cost-of-illness and impact of mental illness as well as any modelling studies. Included studies were categorised according to impact on education, labour force engagement, earlier retirement or welfare dependency. The well-accepted Drummond 10-point economic appraisal checklist was used to assess the quality of the studies. Results: A total of 45 methodologically diverse studies were included. The studies highlight the significant burden mental illness places on all facets of society, including individuals, families, workplaces and the wider economy. Mental illness results in a greater chance of leaving school early, a lower probability of gaining full-time employment and a reduced quality of life. Research from Canada suggests that the total economic costs associated with mental illness will increase six-fold over the next 30 years with costs likely to exceed A$2.8 trillion (based on 2015 Australian dollars). Conclusions: Mental illness is associated with a high economic burden. Further research is required to develop a better understanding of the trajectory and burden of mental illness so that resources can be directed towards cost-effective interventions. What is known about the topic?: Although mental illness continues to be one of the leading contributors to the burden of disease, there is limited information on the economic impact that mental illness imposes on individuals, families, workplaces and the wider economy. What does this paper add?: This review provides a summary of the economic impact and cost of mental illness. The included literature highlights the significant burden mental illness places on individuals, families, workplaces, society and the economy in general. The review identified several areas for improvement. For example, only limited information is available on the impact of attention deficit hyperactivity disorder, anxiety, cognitive function, conduct disorder, eating disorder and psychological distress. There was also a dearth of evidence on the intangible elements of pain and suffering of people and their families with depressive disorders. More research is required to better understand the full extent of the impact of mental illness and strategies that may be implemented to minimise this harm. What are the implications for practitioners?: Knowing the current and future impact of mental illness highlights the imperative to develop an effective policy response. [ABSTRACT FROM AUTHOR]

This paper reviews current challenges in the Australian extension environment and provides a case for developing an adaptive extension platform for the dairy sector in Australia and New Zealand, to support evolving dairy farm systems. The variation in the public-sector engagement in extension, the diversity and number of extension providers and a relatively uncoordinated approach to define new extension roles, functions and professional requirements are current challenges for dairy extension across Australia. In the dairy sector, these challenges coincide with increasing demand for a responsive research, development, extension and education system in supporting the rapid evolution in dairy farming systems. Addressing these challenges is not an issue for extension alone; however, the required level of integration among research, development, extension and education in an environment where needs are changing and resources are scarce demands an engaged dairy-science profession. Drawing on international extension and agricultural innovation-system literature and earlier empirical research, the following three areas for development are proposed: (1) a professional development strategy that incorporates (i) an understanding of the new professional situations extension works within, (ii) leadership in cross-industry and cross-sector coordination concerning the nature of the changing client in research, development, extension and education system and (iii) clear priorities for extension; (2) a professional development plan that incorporates a workplace-learning approach; and (3) for extension specialists to be engaged in defining research priorities, the agenda for change and suitable pathways for change alongside other professional groups, including farming. This development agenda will, however, require an adaptive extension platform to advance these areas on behalf of farmers and public stakeholders. New thinking about the role of extension in supporting evolving dairy farm systems is required. This paper identifies significant changes and challenges impacting on the development of extension strategies in Australia and New Zealand. With increasing demand for a responsive research, development, extension and education system and declining resources, there is an imperative for dairy scientists to be active partners in addressing the challenges. [ABSTRACT FROM AUTHOR]

Changes in the farm operating and policy environments and a need to remain profitable under a cost-price squeeze have contributed to dairy systems in Australia and New Zealand becoming more intensive and complex in recent decades. Farm systems in both countries are now diverse, varying from being based predominantly on pasture with little purchased supplements, to those dependent on high levels of feed supplements and even having zero grazing. Dairy farm performance (defined in this paper as production or technical performance), return (return on assets or profit) and risk (variation in economic performance over time), and intensity of dairy systems was examined using farm survey data, case studies and existing published studies. The level of single technical performance measures, such as milk production, feed conversion efficiency and pasture consumption, prevailing in a business are not guides to the operating profit and return on assets of a business. In addition, when survey data of farm performance was grouped by return on assets, few farms were in the top 25% in successive years. Farms that performed consistently well were characterised by good, but not extreme, technical performance in a range of key areas, which translated to favourable business return (return on asset and profit). The knowledge and skills of farm managers are critical, and means that many different dairy systems can perform well physically and financially and successfully meet farmer goals. The relation between risk and the intensity of dairy systems was also investigated. Options that intensified systems generally resulted in higher net wealth for the farm owner, but almost always at increased risk. The best system for any farmer to operate is one which best meets their multifaceted preferences and goals, regardless of system type. A need to remain profitable under fluctuating operating and climatic conditions has increased the intensity of dairy systems in Australia and New Zealand. This paper examined if farm technical performance, profit and risk were related to farm system intensity and complexity. Single technical performance measures were poor guides of profit, with profitable businesses being more about the skills of the farm operator, and less about the system being run. [ABSTRACT FROM AUTHOR]

G. L. McClymont developed a unique paradigm in which to consider the challenges that confront agriculture and it is based on an understanding of the interrelationships of plants, animals, soils and water within an economic and social framework. The major changes in our environment are the consequence of rapid population growth and the need to increase world food supplies. Within this context, this paper provides an overview of the link between agriculture, especially animal production and population health and how mycotoxins, fungal secondary metabolites, can perturb this link. Examples from New Zealand and Australian animal agriculture are described. The underlying premise of this paper is that agriculture is a major determinant of human health through the supply of food derived from both plant and animal sources. In other words, nutrition is the conduit between agriculture and human health. Against this backdrop the potential role of mycotoxins in determining food and feed supplies is discussed. Globally, mycotoxins have significant human and animal health, economic and international trade implications. [ABSTRACT FROM AUTHOR]

Family circumstances in infancy are persistent and powerful determinants of children's physical and mental health, influencing inequalities that trace from childhood through to adulthood. While the social factors that perpetuate patterns of inequality are more complex than can be addressed through single interventions, child and family health (CFH) services represent crucial sites where trajectories of inequality can be disrupted. In particular, approaches that foster opportunities for practitioner-parent engagement that challenge traditional hierarchical health care practice, such as the Family Partnership Model (FPM), are recommended as ways of addressing disadvantage. Little is known about how practitioners implement models of working in partnership with families and, consequently, there is a gap in understanding how best to develop and sustain these new CFH practices. This paper reports a research project that investigated the experiences of 25 health professionals working within a FPM framework with vulnerable families. Through discussion of four key themes - redefining expertise, changing practices, establishing new relationships with parents and the complexities of partnership practice - the paper offers first-hand accounts of reframing practices that recognise the needs, skills and expertise of parents and thus contribute to empowerment of families. [ABSTRACT FROM AUTHOR]

This paper assesses what health workforce 'sustainability' might mean for Australia and New Zealand, given the policy direction set out in the World Health Organization draft code on international recruitment of health workers. The governments in both countries have in the past made policy statements about the desirability of health workforce 'selfsufficiency', but OEC data show that both have a high level of dependence on internationally recruited health professionals relative to most other OEC countries. The paper argues that if a target of 'self-sufficiency' or sustainability were to be based on meeting health workforce requirements from home based training, both Australia and New Zealand fall far short of this measure, and continue to be active recruiters. The paper stresses that there is no common agreed definition of what health workforce 'self-sufficiency', or 'sustainability' is in practice, and that without an agreed definition it will be difficult for policy-makers to move the debate on to reaching agreement and possibly setting measurable targets or timelines for achievement. The paper concludes that any policy decisions related to health workforce sustainability will also have to taken in the context of a wider community debate on what is required of a health system and how is it to be funded. [ABSTRACT FROM AUTHOR]

The concept of commissioning is starting to gain traction in the Australian health system. Primary Care Networks began operations in July 2015 with a remit around commissioning health services. Despite the centrality of this concept, we know relatively little about commissioning in Australia. Other systems have experimented with it for some time, and this paper reviews the evidence and lessons inherent within the international literature. The study defines commissioning, and explores experiences of others who have adopted commissioning approaches and the evidence concerning the outcomes of these experiments. Commissioning is a difficult topic in many senses and its application to a complex area such as health reform can make it even more challenging. Ultimately, this evidence suggests that commissioning is more than simply a technical or operational process, but one that is value-based and relational. This is not to downplay the technical aspects, which in many jurisdictions have resulted in explicit and evidenced-based approaches to planning and priority setting. However, if new commissioning organisations, such as Primary Health Networks, are to have an impact, they need to balance the operational and relational elements of commissioning. [ABSTRACT FROM AUTHOR]

The Medical Schools Outcomes Database (MSOD) is an ongoing longitudinal tracking project of medical students from all medical schools in Australia and New Zealand. It was established in 2005 to track the career trajectories of medical students and will directly help develop models of workforce flow, particularly with respect to rural and remote shortages. This paper briefly outlines the MSOD project and reports on key methodological factors in tracking medical students. Finally, the potential impact of the MSOD on understanding changes in rural practice intentions is illustrated using data from the 2005 pilot cohort (n = 112). Rural placements were associated with a shift towards rural practice intentions, while those who intended to practice rurally at both the start and end of medical school tended to be older and interested in a generalist career. Continuing work will track these and future students as they progress through the workforce, as well as exploring issues such as the career trajectories of international fee-paying students, workforce succession planning, and the evaluation of medical education initiatives. [ABSTRACT FROM AUTHOR]

The Australian government has announced major reforms with the move to a primary maternity care model. The direction of the reforms remains contentious; with the Australian Medical Association warning that the introduction of non-medically led services will compromise current high standards in maternity services and threaten the safety of mothers and babies. The purpose of this paper is to conduct a critical review of the literature to determine whether there is convincing evidence to support the safety of non-medically led models of primary maternity care. Twenty-two non-randomised international studies were included representing midwifery-led care, birth centre care and home birth. Comparative outcome measurements included: perinatal mortality; perinatal morbidity; rates of medical intervention in labour; and antenatal and intrapartum referral and transfer rates. Findings support those of the three Cochrane reviews, that there is sufficient international evidence to support the conclusion of no difference in outcomes associated with low risk women in midwifery-led, birth centre and home birth models compared with standard hospital or obstetric care. These findings are limited to services involving qualified midwives working within rigorous exclusion, assessment and referral guidelines, limiting the number of urgent intrapartum transfers that come with increased risk of perinatal mortality. What is known about the topic? Systematic reviews of maternal and perinatal outcomes associated with midwifery-led care when compared to conventional intrapartum hospital care concluded that these non-medically led models of care are associated with several benefits for low risk women and their babies with no identified adverse effects. What does this paper add? The finding of no difference in outcomes associated with midwifery-led, birth centre and home birth compared with standard hospital or obstetric care is limited to international studies involving women in the care of qualified midwives working within rigorous guidelines for practice involving inter-professionally agreed exclusion, assessment and referral criteria. What are the implications for practitioners? Midwives caring for women in non-medically led models are urged to be vigilant to the need for early detection and prompt action in the event of unforseen complications to avoid an over emphasis on normality. This decreases the likelihood of urgent intrapartum transfers that come with an increased risk of perinatal mortality. [ABSTRACT FROM AUTHOR]