Search

OBJECTIVES: During a precommissioning inspection of a new biocontainment centre, radiographers noted structural features of quarantine rooms that could compromise staff and patient safety and the X-ray image quality, even after significant modifications had been made to an earlier radiography protocol. The aim of this study was to explore the safety and effectiveness of the modified protocol, in the new space, and identify improvements, if required. DESIGN: A qualitative study using in situ simulation and video-reflexive methods. SETTING: A newly built biocontainment centre, prior to its commissioning in 2021, in a large, tertiary hospital in Sydney, Australia. PARTICIPANTS: Five radiographers, and a nurse and a physician from the biocontainment centre, consented to participate. All completed the study. INTERVENTIONS: Two simulated mobile X-ray examinations were conducted in the unit prior to its commissioning; simulations were videoed. Participants and other stakeholders analysed video footage, collaboratively, and sessions were audio recorded, transcribed and analysed thematically. Problems and potential solutions identified were collated and communicated to the hospital executive, for endorsement and actioning, if possible. RESULTS: Four themes were identified from the data: infection exposure risks, occupational health and exposure risks, communication and X-ray image quality. Facilitated group reviews of video footage identified several important issues, across these four areas of risk, which had not been identified previously. CONCLUSIONS: In situ simulation is used, increasingly, to evaluate and improve healthcare practices. This study confirmed the added value of video-reflexive methods, which provided experienced participants with a richer view of a familiar protocol, in a new setting. Video footage can be examined immediately, or later if required, by a broader group of stakeholders, with diverse experience or expertise. Using video reflexivity, clinicians

It is common for aspects of the COVID-19 response-and other public health initiatives before it-to be described as polarised. Public health decisions emerge from an interplay of facts, norms and preferred courses of action. What counts as 'evidence' is diverse and contestable, and disagreements over how it should be interpreted are often the product of differing choices between competing values. We propose a definition of polarisation for the context of public health expertise that acknowledges and accounts for epistemic and social values as part of evidence generation and its application to public health practice. The 'polarised' label should be used judiciously because the descriptor risks generating or exacerbating the problem by oversimplifying complex issues and positions and creating groups that seem dichotomous. 'Independence' as a one-size-fits-all answer to expert polarisation is insufficient; this solution is premised on a scientistic account of the role of evidence in decision making and does not make room for the value difference that is at the heart of both polarisation and evidence-based decision making.

The emergence of SARS-CoV-2 and the subsequent COVID-19 pandemic has resulted in significant global impact. However, COVID-19 is just one of several high-impact infectious diseases that emerged from wildlife and are linked to the human relationship with nature. The rate of emergence of new zoonoses (diseases of animal origin) is increasing, driven by human-induced environmental changes that threaten biodiversity on a global scale. This increase is directly linked to environmental drivers including biodiversity loss, climate change and unsustainable resource extraction. Australia is a biodiversity hotspot and is subject to sustained and significant environmental change, increasing the risk of it being a location for pandemic origin. Moreover, the global integration of markets means that consumption trends in Australia contributes to the risk of disease spill-over in our regional neighbours in Asia-Pacific, and beyond. Despite the clear causal link between anthropogenic pressures on the environment and increasing pandemic risks, Australia’s response to the COVID-19 pandemic, like most of the world, has centred largely on public health strategies, with a clear focus on reactive management. Yet, the span of expertise and evidence relevant to the governance of pandemic risk management is much wider than public health and epidemiology. It involves animal/wildlife health, biosecurity, conservation sciences, social sciences, behavioural psychology, law, policy and economic analyses to name just a few. The authors are a team of multidisciplinary practitioners and researchers who have worked together to analyse, synthesise, and harmonise the links between pandemic risk management approaches and issues in different disciplines to provide a holistic overview of current practice, and conclude the need for reform in Australia. We discuss the adoption of a comprehensive and interdisciplinary ‘One Health’ approach to pandemic risk management in Australia. A key goal of the One Heal

The emergence of SARS-CoV-2 and the subsequent COVID-19 pandemic has resulted in significant global impact. However, COVID-19 is just one of several high-impact infectious diseases that emerged from wildlife and are linked to the human relationship with nature. The rate of emergence of new zoonoses (diseases of animal origin) is increasing, driven by human-induced environmental changes that threaten biodiversity on a global scale. This increase is directly linked to environmental drivers including biodiversity loss, climate change and unsustainable resource extraction. Australia is a biodiversity hotspot and is subject to sustained and significant environmental change, increasing the risk of it being a location for pandemic origin. Moreover, the global integration of markets means that consumption trends in Australia contributes to the risk of disease spill-over in our regional neighbours in Asia-Pacific, and beyond. Despite the clear causal link between anthropogenic pressures on the environment and increasing pandemic risks, Australia's response to the COVID-19 pandemic, like most of the world, has centred largely on public health strategies, with a clear focus on reactive management. Yet, the span of expertise and evidence relevant to the governance of pandemic risk management is much wider than public health and epidemiology. It involves animal/wildlife health, biosecurity, conservation sciences, social sciences, behavioural psychology, law, policy and economic analyses to name just a few.The authors are a team of multidisciplinary practitioners and researchers who have worked together to analyse, synthesise, and harmonise the links between pandemic risk management approaches and issues in different disciplines to provide a holistic overview of current practice, and conclude the need for reform in Australia. We discuss the adoption of a comprehensive and interdisciplinary 'One Health' approach to pandemic risk management in Australia. A key goal of the One Healt

OBJECTIVES: General practitioners (GPs) and their staff have been at the frontline of the SARS-CoV-2 pandemic in Australia. However, their experiences of responding to and managing the risks of viral transmission within their facilities are poorly described. The aim of this study was to describe the experiences, and infection prevention and control (IPC) strategies adopted by general practices, including enablers of and challenges to implementation, to contribute to our understanding of the pandemic response in this critical sector. DESIGN: Semistructured interviews were conducted in person, by telephone or online video conferencing software, between November 2020 and August 2021. PARTICIPANTS: Twenty general practice personnel working in New South Wales, Australia, including nine GPs, one general practice registrar, four registered nurses, one nurse practitioner, two practice managers and two receptionists. RESULTS: Participants described implementing wide-ranging repertoires of IPC strategies-including telehealth, screening of patients and staff, altered clinic layouts and portable outdoor shelters, in addition to appropriate use of personal protective equipment (PPE)-to manage the demands of the SARS-CoV-2 pandemic. Strategies were proactive, influenced by the varied contexts of different practices and the needs and preferences of individual GPs as well as responsive to local, state and national requirements, which changed frequently as the pandemic evolved. CONCLUSIONS: Using the 'hierarchy of controls' as a framework for analysis, we found that the different strategies adopted in general practice often functioned in concert with one another. Most strategies, particularly administrative and PPE controls, were subjected to human variability and so were less reliable from a human factors perspective. However, our findings highlight the creativity, resilience and resourcefulness of general practice staff in developing, implementing and adapting their IPC strategies

From the adoption of mask-wearing in public settings to the omnipresence of hand-sanitising, the SARS-CoV-2 pandemic has brought unprecedented cultural attention to infection prevention and control (IPC) in everyday life. At the same time, the pandemic threat has enlivened and unsettled hospital IPC processes, fracturing confidence, demanding new forms of evidence, and ultimately involving a rapid reassembling of what constitutes safe care. Here, drawing on semi-structured interviews with 63 frontline healthcare workers from two states in Australia, interviewed between September 2020 and March 2021, we illuminate some of the affective dimensions of IPC at a time of rapid change and evolving uncertainty. We track how a collective sense of risk and safety is relationally produced, redefining attitudes and practices around infective risk, and transforming accepted paradigms of care and self-protection. Drawing on Puig de la Bellacasa's formulation, we propose the notion of IPC as a multidimensional matter of care. Highlighting the complex negotiation of space and time in relation to infection control and care illustrates a series of paradoxes, the understanding of which helps illuminate not only how IPC works, in practice, but also what it means to those working on the frontline of the pandemic.

Vaccination plays an important role in pandemic planning and response. The possibility of developing an effective vaccine for a novel pandemic virus is not assured. However, as we have seen with SARS-CoV-2 vaccine development, with sufficient resources and global focus, successful outcomes can be achieved in a relatively short period. However even when vaccine is available it will initially be scarce. When one becomes available, how should it be distributed? In this paper we explicate how ethical thinking that is carefully attuned to context is essential to decisions about how we should conduct vaccination in a pandemic where demand exceeds supply. We focus on two key issues. First, setting the aims for a pandemic vaccination programme. Second, thinking about the means of delivering a chosen aim. We outline how pandemic vaccine distribution strategies can be implemented with distinct aims, e.g. protecting groups at greater risk of harm, saving the most lives, or ensuring societal benefit. Each aim will result in a focus on a different priority population and each strategy will have a different benefit-harm profile. Once we have decided our aim, we still have choices to make about delivery. We may achieve at least some ends via direct or indirect strategies. Such policy decisions are not merely technical, but necessarily involve ethics. One important general issue is that such planning decisions about distribution will always be made under conditions of uncertainty about vaccine safety and effectiveness. However, planning how to distribute vaccine for SARS-CoV-2 is even harder because we understand relatively little about the virus, transmission, and its immunological impact in the short and long term.

BACKGROUND: Pandemic planning has historically been oriented to respond to an influenza virus, with vaccination strategy being a key focus. As the current COVID-19 pandemic plays out, the Australian government is closely monitoring progress towards development of SARS-CoV2 vaccines as a definitive intervention. However, as in any pandemic, initial supply will likely be exceeded by demand due to limited manufacturing output. METHODS: We convened community juries in three Australian locations in 2019 to assess public acceptability and perceived legitimacy of influenza pandemic vaccination distribution strategies. Preparatory work included literature reviews on pandemic vaccine allocation strategies and on vaccine allocation ethics, and simulation modelling studies. We assumed vaccine would be provided to predefined priority groups. Jurors were then asked to recommend one of two strategies for distributing remaining early doses of vaccine: directly vaccinate people at higher risk of adverse outcomes from influenza; or indirectly protect the general population by vaccinating primary school students, who are most likely to spread infection. RESULTS: Thirty-four participants of diverse backgrounds and ages were recruited through random digit dialling and topic-blinded social media advertising. Juries heard evidence and arguments supporting different vaccine distribution strategies, and questioned expert presenters. All three community juries supported prioritising school children for influenza vaccination (aiming for indirect protection), one by 10-2 majority and two by consensus. Justifications included that indirect protection benefits more people and is likely to be more publicly acceptable. CONCLUSIONS: In the context of an influenza pandemic, informed citizens were not opposed to prioritising groups at higher risks of adverse outcomes, but if resources and epidemiological conditions allow, achieving population benefits should be a strategic priority. These insights m

BACKGROUND: The SARS-CoV-2 pandemic has critically challenged healthcare systems globally. Examining the experiences of healthcare workers (HCWs) is important for optimising ongoing and future pandemic responses. OBJECTIVES: In-depth exploration of Australian HCWs' experiences of the SARS-CoV-2 pandemic, with a focus on reported stressors vis-à-vis protective factors. METHODS: Individual interviews were performed with 63 HCWs in Australia. A range of professional streams and operational staff were included. Thematic analysis was performed. RESULTS: Thematic analysis identified stressors centred on paucity of, or changing, evidence, leading to absence of, or mistrust in, guidelines; unprecedented alterations to the autonomy and sense of control of clinicians; and, deficiencies in communication and support. Key protective factors included: the development of clear guidance from respected clinical leaders or recognised clinical bodies, interpersonal support, and strong teamwork, leadership, and a sense of organisational preparedness. CONCLUSIONS: This study provides insights into the key organisational sources of emotional stress for HCWs within pandemic responses and describes experiences of protective factors. HCWs experiencing unprecedented uncertainty, fear, and rapid change, rely on clear communication, strong leadership, guidelines endorsed by recognised expert groups or individuals, and have increased reliance on interpersonal support. Structured strategies for leadership and communication at team, service group and organisational levels, provision of psychological support, and consideration of the potential negative effects of centralising control, would assist in ameliorating the extreme pressures of working within a pandemic environment.

The COVID-19 pandemic continues to highlight both global interconnectedness and schisms across place, context and peoples. While countries such as Australia have securitised their borders in response to the global spread of disease, flows of information and collective affect continue to permeate these boundaries. Drawing on interviews with Australian healthcare workers, we examine how their experiences of the pandemic are shaped by affect and evidence 'traveling' across time and space. Our analysis points to the limitations of global health crisis responses that focus solely on material risk and spatial separation. Institutional responses must, we suggest, also consider the affective and discursive dimensions of health-related risk environments.

BACKGROUND: The SARS-CoV-2 pandemic has challenged health systems globally. A key controversy has been how to protect healthcare workers (HCWs) using personal protective equipment (PPE). METHODS: Interviews were performed with 63 HCWs across two states in Australia to explore their experiences of PPE during the SARS-CoV-2 pandemic. Thematic analysis was performed. RESULTS: Four themes were identified with respect to HCWs' experience of pandemic PPE: 1. Risk, fear and uncertainty: HCWs experienced considerable fear and heightened personal and professional risk, reporting anxiety about the adequacy of PPE and the resultant risk to themselves and their families. 2. Evidence and the ambiguities of evolving guidelines: forms of evidence, its interpretation, and the perception of rapidly changing guidelines heightened distress amongst HCWs. 3. Trust and care: Access to PPE signified organisational support and care, and restrictions on PPE use were considered a breach of trust. 4. Non-compliant practice in the context of social upheaval: despite communication of evidence-based guidelines, an environment of mistrust, personal risk, and organisational uncertainty resulted in variable compliance. CONCLUSION: PPE preferences and usage offer a material signifier of the broader, evolving pandemic context, reflecting HCWs' fear, mistrust, sense of inequity and social solidarity (or breakdown). PPE therefore represents the affective (emotional) demands of professional care, as well as a technical challenge of infection prevention and control. If rationing of PPE is necessary, policymakers need to take account of how HCWs will perceive restrictions or conflicting recommendations and build trust through effective communication (including of uncertainty).

Tuberculosis (TB) is the leading infectious cause of human mortality and is responsible for nearly 2 million deaths every year. It is often regarded as a 'silent killer' because it predominantly affects the poor and marginalized, and disease outbreaks occur in 'slow motion' compared to Ebola or coronavirus 2 (COVID-19). In low incidence countries, TB is predominantly an imported disease and TB control in migrants is pivotal for countries to progress towards TB elimination in accordance with the World Health Organisations (WHO's) End TB strategy. This review provides a brief overview of the different screening approaches and surveillance processes that are in place in low TB incidence countries. It also includes a detailed discussion of the ethical issues related to TB screening of migrants in these settings and the different interests that need to be balanced. Given recognition that a holistic approach that recognizes and respects basic human rights is required to end TB, the review considers the complexities that require consideration in low-incidence countries that are aiming for TB elimination.

This article introduces the online One Welfare learning and teaching portal (OWP) and describes its development, use, importance and relevance to animal welfare and ethics (AWE) stakeholders. As animal welfare issues increase in importance, veterinarians must be trained to lead the science that underpins AWE discourses. The OWP is a collection of resources designed to engage and challenge veterinary science students as they become advocates for animals. It was developed collaboratively by all eight veterinary schools in Australia and New Zealand, and funded by the Australian Government Office for Learning and Teaching. Surveys to investigate the attitudes of students and educators to AWE issues in six context-specific themes based on the Australian Animal Welfare Strategy (AAWS) (companion animals; animals used in research and teaching; livestock/production animals; animals used for sport, recreation or display; animals in the wild and aquatic animals) were administered through all participating schools. Students assigned more importance to Day One competence in knowledge of welfare concepts than did educators for the following groups: production animals, companion animals, animals in the wild, aquatic animals, animals used in research and teaching, and animals used for sport, recreation or display (all p < 0.01). Agreement between educators and students was closer regarding the importance of Day One competence for euthanasia for all six context-specific themes (p < 0.01–0.03). Students assigned more importance than educators to social, economic and cultural drivers of welfare outcomes in production animals (p < 0.01); slaughter and preslaughter inspections in production animals (p < 0.01); animal abuse and hoarding in companion animals (p < 0.01); shelter medicine in companion animals (p < 0.01); disaster preparedness in wildlife animals (p < 0.01); pain and distress caused by fishing in aquatic animals (p < 0.01); conscientious objection related to animals held fo

The welfare of aquatic animals is receiving increasing attention around the world, and this should be reflected in the veterinary curricular. Veterinary students in Australia and New Zealand ranked the importance of five pre-selected topics on aquatic animal welfare and ethical issues for newly qualified veterinarians in an online survey. They ranked aquatic animals’ health and welfare issues, husbandry techniques of farmed fish, and the use of antibiotics as being of high importance for their first day in practice, with pain and distress associated with angling and trawling practices (fishing) and euthanasia ranking moderate to high. Females assigned more importance to fishing, health and welfare issues, and husbandry techniques of farmed fish than did males. Students in the early stages of study assigned more importance to fishing than did senior students. To the authors’ knowledge, this is the first study to investigate what importance veterinary students place on their competence regarding aquatic animal welfare and ethics. Gaining an understanding of how veterinary students prioritize these issues, and if this differs based on gender and stage of study, will help veterinary educators to better prepare graduates to address concerns surrounding the welfare of aquatic animals. This could be achieved by careful consideration of course content and where in the curriculum this material is taught, as well as reiterating key messages in the senior years and addressing changing student attitudes as they progress through the course.

ObjectivesAs governments attempt to navigate a path out of COVID-19 restrictions, robust evidence is essential to inform requirements for public acceptance of technologically enhanced communicable disease surveillance systems. We examined the value of core surveillance system attributes to the Australian public, before and during the early stages of the current pandemic.DesignA discrete choice experiment was conducted in Australia with a representative group of respondents, before and after the WHO declared COVID-19 a Public Health Emergency of International Concern. We identified and investigated the relative importance of seven attributes associated with technologically enhanced disease surveillance: respect for personal autonomy; privacy/confidentiality; data certainty/confidence; data security; infectious disease mortality prevention; infectious disease morbidity prevention; and attribution of (causal) responsibility. Specifically, we explored how the onset of the COVID-19 outbreak influenced participant responses.Setting and participants2008 Australians (general public) completed the experiment: 793 before COVID-19 outbreak onset (mean age 45.9 years, 50.2% male) and 1215 after onset (mean age 47.2 years, 49% male).ResultsAll seven attributes significantly influenced respondents’ preferences for communicable disease surveillance systems. After onset, participants demonstrated greater preference for a surveillance system that could prevent a higher number of illnesses and deaths, and were less concerned about their personal autonomy. However, they also increased their preference for a system with high data security.ConclusionsPublic acceptance of technology-based communica

BACKGROUND: Tuberculosis (TB) elimination strategies in Australia require a focus on groups who are at highest risk of TB infection, such as immigrants from high-burden settings. Understanding attitudes to different strategies for latent TB infection (LTBI) screening and treatment is an important element of justifiable elimination strategies. METHOD: Two community panels were conducted in Melbourne with members of the Vietnamese (n = 11), Sudanese and South Sudanese communities (n = 9). Panellists were provided with expert information about LTBI and different screening and health communication strategies, then deliberated on how best to pursue TB elimination in Australia. FINDINGS: Both panels unanimously preferred LTBI screening to occur pre-migration rather than in Australia. Participants were concerned that post-migration screening would reach fewer migrants, noted that conducting LTBI screening in Australia could stigmatize participants and that poor awareness of LTBI would hamper participation. If targeted screening was to occur in Australia, the Vietnamese panel preferred 'place-based' communication strategies, whereas the Sudanese and South Sudanese panel emphasized that community leaders should lead communication strategies to minimize stigma. Both groups emphasized the importance of maintaining community trust in Australian health service providers, and the need to ensure targeting did not undermine this trust. CONCLUSION: Pre-migration screening was preferred. If post-migration screening is necessary, the potential for stigma should be reduced, benefit and risk profile clearly explained and culturally appropriate communication strategies employed. Cultural attitudes to health providers, personal health management and broader social vulnerabilities of targeted groups need to be considered in the design of screening programs.

This article introduces the online One Welfare learning and teaching portal (OWP) and describes its development, use, importance and relevance to animal welfare and ethics (AWE) stakeholders. As animal welfare issues increase in importance, veterinarians must be trained to lead the science that underpins AWE discourses. The OWP is a collection of resources designed to engage and challenge veterinary science students as they become advocates for animals. It was developed collaboratively by all eight veterinary schools in Australia and New Zealand, and funded by the Australian Government Office for Learning and Teaching. Surveys to investigate the attitudes of students and educators to AWE issues in six context-specific themes based on the Australian Animal Welfare Strategy (AAWS) (companion animals; animals used in research and teaching; livestock/production animals; animals used for sport, recreation or display; animals in the wild and aquatic animals) were administered through all participating schools. Students assigned more importance to Day One competence in knowledge of welfare concepts than did educators for the following groups: production animals, companion animals, animals in the wild, aquatic animals, animals used in research and teaching, and animals used for sport, recreation or display (all p < 0.01). Agreement between educators and students was closer regarding the importance of Day One competence for euthanasia for all six context-specific themes (p < 0.01 - 0.03). Students assigned more importance than educators to social, economic and cultural drivers of welfare outcomes in production animals (p < 0.01); slaughter and preslaughter inspections in production animals (p < 0.01); animal abuse and hoarding in companion animals (p < 0.01); shelter medicine in companion animals (p < 0.01); disaster preparedness in wildlife animals (p < 0.01); pain and distress caused by fishing in aquatic animals (p < 0.01); conscientious objection related to animals held

The aim of this research was to determine what veterinary students in Australia and New Zealand consider important for animal welfare and ethics (AWE) competence when dealing with wildlife, and to determine how these priorities correlate with gender and stage of study. These students were asked to state their gender and stage of veterinary education and to rank the importance of six AWE topics: (1) "disaster preparedness," (2) "veterinarians' duties to wild animals," (3) "methods and justification for wild animal use" (e.g., harvesting/ hunting, wildlife parks), (4) "tensions between animal-welfare concerns and environmental concerns," (5) "the nature and status of semiowned animals," and (6) "euthanasia," pertaining to wildlife for competence on the first day after their graduation. Data were then analyzed. Of 3,320 students invited to participate, 556 responded to questions about animals in the wild. The AWE topic ranked as the most important was "veterinarians' duties to wild animals,"” followed by "euthanasia." Senior students ranked "euthanasia" as the most important topic. The rankings of "methods and justification for wild animal use" and "tension between animal welfare and environmental concerns" were significantly less important for students in the later years of study than for those in early years. Male respondents ranked "euthanasia" as more important than female respondents did, especially in later years of study. Senior veterinary students ranked "euthanasia" as the most important AWE topic for day one competency.

Animals used for sport, recreation and display are highly visible and can divide community attitudes. The study of animal welfare and ethics (AWE) as part of veterinary education is important because it is the responsibility of veterinarians to use their scientific knowledge and skills to promote animal welfare in the context of community expectations. To explore the attitudes of veterinary students in Australia and New Zealand to AWE, a survey of the current cohort was undertaken. The survey aimed to reveal how veterinary students in Australia and New Zealand rate the importance of five selected AWE topics for Day One Competences in animals used in sport, recreation and display and to establish how veterinary students’ priorities were associated with gender and stage of study. The response rate (n = 851) across the seven schools was just over 25%. Results indicated little variation on ratings for topics. The topics were ranked in the following order (most to least important): Pushing of animals to their physiologic/behavioral limits; ownership/responsibility; euthanasia; educating the public; and behavior, selection, and training for sport and recreation displays. In contrast to related studies, ratings were not associated with stage of study and there were few differences associated with gender. More females rated the pushing of animals to physiologic/behavioral limits as extremely important than did males ( p < .001). The role of veterinarians in advocating for and educating the public about the welfare of animals used in sport, recreation and display merits further discussion.

STUDY QUESTION: Does an informed group of citizens endorse the clinical use of mitochondrial donation in a country where this is not currently permitted? SUMMARY ANSWER: After hearing balanced expert evidence and having opportunity for deliberation, a majority (11/14) of participants in a citizens' jury believed that children should be able to be born using mitochondrial donation. WHAT IS KNOWN ALREADY: Research suggests that patients, oocyte donors and health professionals support mitochondrial donation to prevent transmission of mitochondrial disease. Less is known about public acceptability of this novel reproductive technology, especially from evidence using deliberative methods. STUDY DESIGN, SIZE, DURATION: This study comprised a citizens' jury, an established method for determining the views of a well-informed group of community members. The jury had 14 participants, and ran over one and a half days in 2017. PARTICIPANTS/MATERIALS, SETTING, METHODS: Jurors were members of the public with no experience of mitochondrial disease. They heard and engaged with relevant evidence and were asked to answer the question: 'Should Australia allow children to be born following mitochondrial donation?' MAIN RESULTS AND THE ROLE OF CHANCE: Eleven jurors decided that Australia should allow children to be born following mitochondrial donation; 7 of whom added conditions such as the need to limit who can access the intervention. Three jurors decided that children should not (or not yet) be born using this intervention. All jurors were particularly interested in the reliability of evidence, licensing/regulatory mechanisms and the rights of children to access information about their oocyte donors. LIMITATIONS, REASONS FOR CAUTION: Jurors' views were well informed and reflected critical deliberation and discussion, but are not intended to be representative of the whole population. WIDER IMPLICATIONS OF THE FINDINGS: When presented with high quality evidence, combined with opportun

© 2019 Norris et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The affiliation for the first, eighth, and ninth authors is incorrect. Jacqueline M. Norris, Dale Dominey-Howes, and Michael P. Ward are not affiliated with #8 but with #7: Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia.

© 2019 Norris et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Antimicrobial resistance (AMR) is a global crisis with impacts on the future health and welfare of humans and animals. Determining key factors that influence veterinarians’ antimicrobial prescribing behaviours can bridge the gap between prescribing guidelines and clinical usage. Veterinarians practicing in Australia were surveyed on their frequency in prescribing different antibiotics; factors influencing their antibiotic prescribing behaviours; and their perceptions of current drivers of AMR. Antibiotics were prescribed in a third of consultations with key differences in the frequency of use of specific antibiotics by small companion animal (SCA), equine and livestock veterinarians, which broadly aligned with antibiotic registration restrictions in Australia. SCA veterinarians reported prescribing broad-spectrum antibiotics of higher importance to human health more frequently than livestock veterinarians. Factors that were reported as ‘strong’ or ‘moderate’ barriers to appropriate antibiotic prescribing were the 1) cost of culture and susceptibility testing and 2) lack of access to rapid and affordable diagnostic tests. Fear of losing clients, colleague pressure, and lack of their own understanding about antibiotics were considered to be ‘no’ or ‘somewhat’ of a barrier to appropriate prescribing by respondents. SCA veterinarians placed greater importance on the contribution of antibiotic use in livestock to AMR, than antibiotic use in companion animals. Despite reporting use of fewer, mostly narrow spectrum antibiotics of lower importance to human and animal health, livestock veterinarians were generally more aware of their potential contribution to AMR. This study provides insights into the similarities and diff

Veterinarians are in a strong position of social influence on animal-related issues. Hence, veterinary schools have an opportunity to raise animal health and welfare standards by improving veterinary students’ animal welfare and ethics (AWE) education, including that related to animals used for scientific purposes. A survey of 818 students in the early, mid, and senior stages of their courses at all eight veterinary schools across Australia and New Zealand was undertaken on their first day of practice (or Day One Competences) to explore how veterinary students viewed the importance of their competence in the management of welfare and ethical decision-making relating to animals kept for scientific purposes. From highest to lowest, the rankings they assigned were: Animal Ethics Committee (AEC) Procedures or Requirements; 3Rs (Replacement, Refinement and Reduction); Humane Endpoints; Euthanasia; “What Is a Research Animal?”; and Conscientious Objections. Female students rated Conscientious Objections, Humane Endpoints, and Euthanasia significantly higher than male students did across the three stages of study. The score patterns for these three variates showed a trend for the male students to be more likely to score these topics as extremely important as they advanced through the course, but female students’ scores tended to decline slightly or stay relatively stable. No gender differences emerged for the three variates: 3Rs (Replacement, Refinement and Reduction); AEC Procedures or Requirements; and “What Is a Research Animal?”. This study demonstrates that understandings of the regulatory and normative frameworks are considered most important in animal welfare and ethics competence in veterinary students. To the authors’ knowledge, this is the first study to investigate what importance veterinary students place on their competence regarding animals kept for scientific purposes.

Veterinarians are in a strong position of social influence on animal-related issues. Hence, veterinary schools have an opportunity to raise animal health and welfare standards by improving veterinary students' animal welfare and ethics (AWE) education, including that related to animals used for scientific purposes. A survey of 851 students in the early, mid, and senior stages of their courses at all eight veterinary schools across Australia and New Zealand was undertaken on their first day of practice (or Day One Competences) to explore how veterinary students viewed the importance of their competence in the management of welfare and ethical decision-making relating to animals kept for scientific purposes. From highest to lowest, the rankings they assigned were: Animal Ethics Committee (AEC) Procedures or Requirements; 3Rs (Replacement, Refinement and Reduction); Humane Endpoints; Euthanasia; "What Is a Research Animal?"; and Conscientious Objections. Female students rated Conscientious Objections, Humane Endpoints, and Euthanasia significantly higher than male students did across the three stages of study. The score patterns for these three variates showed a trend for the male students to be more likely to score these topics as extremely important as they advanced through the course, but female students' scores tended to decline slightly or stay relatively stable. No gender differences emerged for the three variates: 3Rs (Replacement, Refinement and Reduction); AEC Procedures or Requirements; and "What Is a Research Animal?". This study demonstrates that understandings of the regulatory and normative frameworks are considered most important in animal welfare and ethics competence in veterinary students. To the authors' knowledge, this is the first study to investigate what importance veterinary students place on their competence regarding animals kept for scientific purposes.

OBJECTIVE: To elicit informed views from Australian women aged 70-74 regarding the acceptability of ceasing to invite women their age to participate in government-funded mammography screening (BreastScreen). DESIGN: Two community juries held in 2017. SETTING: Greater Sydney, a metropolis of 4.5 million people in New South Wales, Australia. PARTICIPANTS: 34 women aged 70-74 with no personal history of breast cancer, recruited by random digit dialling and previously randomly recruited list-based samples. MAIN OUTCOMES AND MEASURES: Jury verdict and rationale in response to structured questions. We transcribed audio-recorded jury proceedings and identified central reasons for the jury's decision. RESULTS: The women's average age was 71.5 years. Participants were of diverse sociocultural backgrounds, with the sample designed to include women of lower levels of educational attainment. Both juries concluded by majority verdict (16-2 and 10-6) that BreastScreen should continue to send invitations and promote screening to their age group. Reasons given for the majority position include: (1) sending the invitations shows that society still cares about older women, empowers them to access preventive health services and recognises increasing and varied life expectancy; (2) screening provides women with information that enables choice and (3) if experts cannot agree, the conservative approach is to maintain the status quo until the evidence is clear. Reasons for the minority position were the potential for harms through overdiagnosis and misallocation of scarce health resources. CONCLUSIONS: Preventive programmes such as mammography screening are likely to have significant symbolic value once they are socially embedded. Arguments for programme de-implementation emphasising declining benefit because of limited life expectancy and the risks of overdiagnosis seem unlikely to resonate with healthy older women. In situations where there is no consensus among experts on the value of

The importance of animal welfare and ethics (AWE) within the veterinary education should reflect community concerns and expectations about AWE, and the professional demands of veterinary accreditation on the first day of practice (or 'Day One' competences). Currently, much interest and debate surrounds the treatment of production animals, particularly around live export. To explore the attitudes to AWE of veterinary students in Australia and New Zealand, a survey was undertaken to (i) understand what students consider important AWE topics for initial production animal competence; and (ii) ascertain how these priorities correlated with gender, area of intended practice and stage-of-study. The results from 575 veterinary students showed that all students ranked strategies to address painful husbandry procedures as the most important issues on their first day in production animal practice. Additionally, it was found that the importance students assigned to an understanding of human⁻animal interactions declined as they progressed through the veterinary course. In contrast, the importance of an understanding of euthanasia issues for production animals increased for male students as they progressed through the course, and remained consistently high in females. Females also gave higher ranking to the importance of understanding production animal stress associated with transport, and ranked strategies to address painful husbandry procedures more important than did males. These findings should help the development of AWE teaching resources that address students' attitudes and competence and that can be delivered when students are most receptive.

The importance of animal welfare and ethics (AWE) within the veterinary education should reflect community concerns and expectations about AWE, and the professional demands of veterinary accreditation on the first day of practice (or ‘Day One’ competences). Currently, much interest and debate surrounds the treatment of production animals, particularly around live export. To explore the attitudes to AWE of veterinary students in Australia and New Zealand, a survey was undertaken to (i) understand what students consider important AWE topics for initial production animal competence; and (ii) ascertain how these priorities correlated with gender, area of intended practice and stage-of-study. The results from 575 veterinary students showed that all students ranked strategies to address painful husbandry procedures as the most important issues on their first day in production animal practice. Additionally, it was found that the importance students assigned to an understanding of human–animal interactions declined as they progressed through the veterinary course. In contrast, the importance of an understanding of euthanasia issues for production animals increased for male students as they progressed through the course, and remained consistently high in females. Females also gave higher ranking to the importance of understanding production animal stress associated with transport, and ranked strategies to address painful husbandry procedures more important than did males. These findings should help the development of AWE teaching resources that address students’ attitudes and competence and that can be delivered when students are most receptive.

© 2018 Article author(s). Objectives To explore and compare the knowledge, attitudes and experiences of doctors, dentists and veterinarians (as prescribers) in relation to antibiotic use and antibiotic resistance (AbR), and to consider the implications of these for policy-making that support a One Health approach. Design A cross-sectional survey conducted online. Setting Doctors, dentists and veterinarians practising in primary, secondary or tertiary care in Australia. Participants 547 doctors, 380 dentists and 403 veterinarians completed the survey. Main outcome measures Prescribers' knowledge, attitudes and perceptions of AbR, the extent to which a range of factors are perceived as barriers to appropriate prescribing practices, and perceived helpfulness of potential strategies to improve antibiotic prescribing in practice. Results There was substantial agreement across prescriber groups that action on AbR is required by multiple sectors and stakeholders. However, prescribers externalised responsibility to some extent by seeing the roles of others as more important than their own in relation to AbR. There were common and context-specific barriers to optimal prescribing across the prescriber groups. Prescriber groups generally perceived restrictive policies as unhelpful to supporting appropriate prescribing in their practice. Conclusions The results have implications for implementing a One Health approach that involves doctors, dentists and veterinarians as key players to tackling the crisis of AbR. The findings are that (1) prescribers understand and are likely receptive to a One Health policy approach to AbR, (2) policy development should be sensitive to barriers that are specific to individual prescriber groups and (3) the development and introduction of interventions that might be perceived as reducing prescriber autonomy will need to be carefully designed and implemented.

Objective: To determine what veterinary students in Australia and New Zealand consider important competences in companion animal welfare and ethics (AWE) required on their first day of practice, and to explore how their priorities relate to gender and stage of study. Methods: Undergraduate students at all veterinary schools in Australia and New Zealand were sent an online survey. A subset of questions required participants to rank the importance of preselected AWE topics pertaining to companion animals. Data were analysed to determine differences in the way students of different gender or academic stage prioritised each of these AWE topics. Results: Of 3220 currently enrolled students, 851 participated in the survey: 79% were female, 17% male, 4% unspecified. Ranking of the AWE topics, from highest to lowest importance, was: neutering, companion animal husbandry, euthanasia, behaviour and training, animal breeding, over-servicing in relation to animal needs and cosmetic surgery. Female students consistently ranked competency in AWE issues surrounding neutering more highly than male students (P = 0.006). Students in senior years of study ranked the importance of competency in animal abuse/hoarding (P = 0.048), shelter medicine (P = 0.012) and animal breeding (P = 0.002) less highly than those in junior years. Conclusions: Australasian veterinary students placed more importance on competency in AWE issues associated with clinical practice (such as neutering and euthanasia) than on professional behaviours (such as over-servicing and animal breeding). However, we consider that emphasis should still be placed on developing graduate competency in the latter categories to reflect growing societal concerns about companion animal over-supply and inappropriate professional conduct.

The study of animal welfare and ethics (AWE) as part of veterinary education is important due to increasing community concerns and expectations about this topic, global pressures regarding food security, and the requirements of veterinary accreditation, especially with respect to Day One Competences. To address several key questions regarding the attitudes to AWE of veterinary students in Australia and New Zealand (NZ), the authors surveyed the 2014 cohort of these students. The survey aimed (1) to reveal what AWE topics veterinary students in Australia and NZ consider important as Day One Competences, and (2) to ascertain how these priorities align with existing research on how concern for AWE relates to gender and stage of study. Students identified triage and professional ethics as the most important Day One Competences in AWE. Students ranked an understanding of triage as increasingly important as they progressed through their program. Professional ethics was rated more important by early and mid-stage students than by senior students. Understanding the development of animal welfare science and perspectives on animal welfare were rated as being of little importance to veterinary graduates as Day One Competences, and an understanding of “why animal welfare matters” declined as the students progressed through the program. Combined, these findings suggest that veterinary students consider it more important to have the necessary practical skills and knowledge to function as a veterinarian on their first day in practice

Historically, the veterinary profession has understood animal welfare primarily in terms of animal health and productivity, with less recognition of animals' feelings and mental state. Veterinary students' career preferences and attitudes to animal welfare have been the focus of several international studies. As part of a survey in Australia and New Zealand, this study reports on whether veterinary students prioritize animal welfare topics or professional conduct on the first day of practice, and examines links between students' career preferences and their institution, gender, and year of study. The questionnaire was designed to explore the importance that students assign to topics in animal welfare and ethics. Of the 3,320 students invited to participate in the online survey, a total of 851 students participated, representing a response rate of 25.5%. Students' preferences increased for companion-animal practice and decreased for production-animal practice as they progressed through their studies. Females ranked the importance of animal welfare topics higher than males, but the perceived importance declined for both genders in their senior years. In line with previous studies, this report highlighted two concerns: (1) the importance assigned to animal welfare declined as students progressed through their studies, and (2) males placed less importance overall on animal welfare than females. Given that veterinarians have a strong social influence on animal issues, there is an opportunity, through enhanced education in animal welfare, to improve student concern for animal welfare and in turn improve animal care and policy-making by future veterinarians.

The need for undergraduate teaching of Animal Welfare and Ethics (AWE) in Australian and New Zealand veterinary courses reflects increasing community concerns and expectations about AWE, global pressures regarding food security and sustainability, the demands of veterinary accreditation, and fears that, unless students encounter AWE as part of their formal education, as veterinarians they will be relatively unaware of the discipline of animal welfare science. To address this need we are developing online resources to ensure Australian and New Zealand veterinary graduates have the knowledge, and the research, communication and critical reasoning skills, to fulfill the AWE role demanded of them by contemporary society. To prioritize development of these resources we assembled leaders in the field of AWE education from the eight veterinary schools in Australia and New Zealand and used modified deliberative polling. This paper describes the role of the poll in developing the first shared online curriculum resource for veterinary undergraduate learning and teaching in AWE in Australia and New Zealand. The learning and teaching strategies that ranked highest in the exercise were: scenario-based learning, a quality of animal life assessment tool, the so-called ‘Human Continuum’ discussion platform, and a negotiated curriculum.

The need for undergraduate teaching of Animal Welfare and Ethics (AWE) in Australian and New Zealand veterinary courses reflects increasing community concerns and expectations about AWE; global pressures regarding food security and sustainability; the demands of veterinary accreditation; and fears that, unless students encounter AWE as part of their formal education, as veterinarians they will be relatively unaware of the discipline of animal welfare science. To address this need we are developing online resources to ensure Australian and New Zealand veterinary graduates have the knowledge, and the research, communication and critical reasoning skills, to fulfill the AWE role demanded of them by contemporary society. To prioritize development of these resources we assembled leaders in the field of AWE education from the eight veterinary schools in Australia and New Zealand and used modified deliberative polling. This paper describes the role of the poll in developing the first shared online curriculum resource for veterinary undergraduate learning and teaching in AWE in Australia and New Zealand. The learning and teaching strategies that ranked highest in the exercise were: scenario-based learning; a quality of animal life assessment tool; the so-called 'Human Continuum' discussion platform; and a negotiated curriculum.