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Introduction: This discussion paper investigates workforce shortage of Australian sonographers through identifying educational responses to the shortage. Method: An ethnographic content analysis of insights into the sonographer workforce provided in the Australian Government Department of Employment occupational reports (2007‐2016) and current education models across providers of prequalification sonographer education and data correlation with Australian Sonographer Accreditation Registry, education provider correspondence, and website information were conducted. Results: Industry‐identified shortage factors related to prequalification education including sonographer quantity and suitability, education model and location, student admission, and skill and attribute training. Educational changes related to these factors were identified. Queensland demonstrated the greatest increase in sonographer (166%) and student (1000%) numbers (2007‐2016). Population‐weighted binomial ratios identified South Australia with the highest number of sonographers and students per head of population (2016). In 2016, sonographers graduated from the UG+1 Postgraduate Model (74.6%), Direct Entry Postgraduate Model (18%), and UG+1 Postgraduate Model with mandatory simulated skill training (7.4%). Discussion Sonographer and student supply increased, indicating growth in clinical training capacity (2007‐2016). Increased sonographer demand meant workforce shortage was relatively static. Educational response involved change to education models with characteristics related to shortage factors. Research into these education models may identify strategies to further increase clinical training capacity. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods: This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results: Supervisee's work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions: High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision. What is known about the topic?: There is mounting evidence on the benefits of clinical supervision to health professionals, organisations and patients. Clinical supervision enhances recruitment and retention of the health workforce. However, there are still gaps regarding the factors that contribute to high-quality clinical supervision, especially for rural and remote health professionals. What does this paper add?: This study, the first of its kind, recruited rural and remote health professionals from seven allied health disciplines across two Australian states. It investigated the factors that influence high-quality clinical supervision in this under-resourced group. This paper outlines specific factors that contribute to clinical supervision quality for rural and remote allied health professionals. What are the implications for practitioners?: Effective and high-quality clinical supervision of the rural and remote allied health workforce can enhance recruitment and retention in those areas. Healthcare organisations can facilitate effective clinical supervision delivery by using the evidence gathered in this study in clinical supervision policy, training and practice. [ABSTRACT FROM AUTHOR]

This paper outlines the current Australian policy environment for delivering affordable housing in urban renewal contexts. An increasing shift towards infill development, coupled with a decreasing provision of government-owned social housing, is placing severe pressure on housing affordability. The cumulative effect is to create the need for governments to intervene on urban renewal projects to ensure that affordable housing options are delivered as a part of any new development. Three different approaches to planning for affordable housing in three states are examined: the former Urban Land Development Authority in Queensland, the 15% inclusionary zoning requirement in South Australia and the Affordable Rental Housing State Environmental Planning Policy in New South Wales. Despite significant differences between these approaches, a number of potential roles emerge for government to support delivery of affordable housing by market and not-for-profit housing providers, without adversely affecting development viability. These roles are as theland facilitator, educator, risk taker, subsidiser and long-term planner. Given that one aim of current policy directions is to reduce the role of government in delivering housing and urban growth, the paper concludes by considering the extent to which the approaches across the three states studied can be considered successful. [ABSTRACT FROM PUBLISHER]

Background: Head injuries in children are a common and potentially devastating presentation. The CareTrack Kids (CTK) study assessed care of Australian children aged 0–15 years, in 2012 and 2013, to evaluate the proportion in line with guideline-based indicators for 17 common conditions. Overall adherence to guideline-based recommended practice occurred 59.8% of care encounters (95% CI: 57.5–62.0), and 78.3% (95% CI: 75.1–81.2) for head injury. This paper presents results for head injury, at indicator level. Methods: A modified version of the RAND-UCLA method of indicator development was used. Indicators, measurable components of a standard or guideline, were developed from international and national guidelines relating to head injury in children and were ratified by clinical experts using a Delphi process. Paediatric nurses extracted data from medical records from general practitioners (GPs), emergency departments (EDs) and inpatient wards in Queensland, New South Wales and South Australia, for children under 15 years receiving care in 2012–13. Our purpose was to estimate the percentage adherent for each indicator. Results: The medical records of 629 children with head injury were examined. Fifty-one percent of children were under 5 years old, with more males (61%) than females. Thirty-eight indicators were assessed. Avoidance of nasotracheal airways (100%; 95% CI: 99.4–100) or nasogastric tubes (99.7%; 95% CI: 98.5–100) for children with a head injury had the highest adherence. Indicators relating to primary and secondary assessment of head injuries were mostly adhered to. However, adherence to other indicators was poor (e.g., documentation of the past history of children (e.g., presence or absence of seizures) before the injury; 29.9% (95% CI: 24.5–35.7)), and for others was difficult to estimate with confidence due to small sample sizes (e.g., Children with a head injury who were intubated had PaO2above 80mm Hg; 56.0% (95% CI: 28.6–80.9)). Indicators guiding clinical decision making regarding the need for CT scan had insufficient data to justify reporting. Conclusion: This study highlights that management of head injury in children mostly follows guidelines, but also flags some specific areas of inconsistency. Individual sites are encouraged to use these results to guide investigation of local practices and inform quality improvement endeavours. [ABSTRACT FROM AUTHOR]

Fellows of the Australasian College for Emergency Medicine and members of the Australasian Society for Emergency Medicine are invited to forward to the journal, details of their publications which have appeared in journals other than Emergency Medicine during the period September–October 2003. Commentary on these papers will appear in the April 2004 issue of the journal. Copies of the papers are to be forwarded by mail or fax to journal headquarters (17 Grattan Street, Carlton, Victoria 3053, Australia; fax: +61 3 9663 8013) by 15 November 2003. The next call will be for papers published in the period November–December 2003. [ABSTRACT FROM AUTHOR]

Aim Facilities in retirement villages form a supportive environment for older residents. The purpose of this paper is to investigate the provision of these facilities in retirement villages, which are regarded as a viable accommodation option for the increasing ageing population in Australia. Methods A content analysis of facilities in 124 retirement villages operated by 22 developers in Queensland and South Australia was conducted. Results The most widely provided facilities are community centres, libraries, barbeque facilities, hairdressers/salons and billiards/snooker/pool tables. Commercial operators provide more facilities than not-for-profit organisations, and larger retirement villages normally have more facilities due to the economies of scale involved. Conclusions The results of the study provide a useful reference for providing facilities within retirement villages that may support the quality lifestyles of older residents. [ABSTRACT FROM AUTHOR]

Meat/meat alternatives (M/MA) are key sources of Fe, Zn and protein, but intake tends to be low in young children. Australian recommendations state that Fe-rich foods, including M/MA, should be the first complementary foods offered to infants. The present paper reports M/MA consumption of Australian infants and toddlers, compares intake with guidelines, and suggests strategies to enhance adherence to those guidelines. Mother–infant dyads recruited as part of the NOURISH and South Australian Infants Dietary Intake studies provided 3 d of intake data at three time points: Time 1 (T1) (n 482, mean age 5·5 (sd 1·1) months), Time 2 (T2) (n 600, mean age 14·0 (sd 1·2) months) and Time 3 (T3) (n 533, mean age 24 (sd 0·7) months). Of 170 infants consuming solids and aged greater than 6 months at T1, 50 (29 %) consumed beef, lamb, veal (BLV) or pork on at least one of 3 d. Commercial infant foods containing BLV or poultry were the most common form of M/MA consumed at T1, whilst by T2 BLV mixed dishes (including pasta bolognaise) became more popular and remained so at T3. The processed M/MA increased in popularity over time, led by pork (including ham). The present study shows that M/MA are not being eaten by Australian infants or toddlers regularly enough; or in adequate quantities to meet recommendations; and that the form in which these foods are eaten can lead to smaller M/MA serve sizes and greater Na intake. Parents should be encouraged to offer M/MA in a recognisable form, as one of the first complementary foods, in order to increase acceptance at a later age. [ABSTRACT FROM PUBLISHER]

This article explores forms of public administration and public policy associated with the governance of mining regions in Australia, many of which experienced unprecedented levels of resource-based development during the country's most recent mining boom. Drawing on data from a two-year investigation into the governance challenges associated with the resources boom, the authors document the different approaches adopted by State government authorities to deliver public infrastructure and services to mining-affected regions. This paper introduces a typology that classifies State government action by the extent to which it enables, influences, or harnesses private sector action to deliver public services. Analysis reveals that a range of environmental variables affect the prevailing governance model. Adopting a contingency approach, it is argued that governance arrangements should be viewed as dynamic, with State governments engaging in different approaches to policy implementation in response to location-specific environmental factors. • Individual state governments respond differently to demands for infrastructure and services in mining communities. • State government approaches are categorized according to whether they enable, influence, or harness private sector action to deliver public services. • Western Australia, Queensland and South Australia during the mining boom are characterised as enabling state, influencing state or minimal state. • The paths followed by each state were contingent on critical external influences. [ABSTRACT FROM AUTHOR]

Children placed in out-of-home care are a particularly disadvantaged group in society, who have often been exposed to trauma and socioeconomic disadvantage. As a result, they experience poorer health outcomes than children in the general population, especially mental health outcomes. One health outcome that has yet to be researched thoroughly is overweight and obesity of children placed in out-of-home care. Hence, the overall goal of this paper was to review the extant literature over the last decade on weight-related issues for children in out-of-home care, with particular emphasis on overweight and obesity. The findings of the review revealed that there is a lack of rigorous Australian research in relation to prevalence rates of overweight and obesity in children in out-of-home care; there is a lack of strategies or interventions designed specifically to combat overweight and obesity in children in out-of-home care; and one of the major limitations of Australian research to date is the use of self-report measures to assess the weight status of children in out-of-home care. It was concluded that prevention and intervention strategies are needed that target children as they enter out-of-home care. [ABSTRACT FROM PUBLISHER]

The Tully Alliance Project delivered a 15.5 km National Highway realignment of the Bruce Highway across the combined Tully and Murray Rivers flood plain in north Queensland. This flood plain is located in one of the wettest regions in Australia, with an annual average rainfall throughout the catchment in excess of 4 m. In this area, the previous Bruce Highway could be inundated several times a year for extended periods and this had a significant impact on the movement of freight, tourists and local residents. There were long stretches of the highway that were cut regularly by floodwaters. As well as the low flood immunity, there were safety concerns with the highway formation across the floodplain being essentially a two-lane embankment with no shoulder or stopping lanes. While a high standard of flood immunity was desirable and needed to meet the Department of Main Roads flood immunity standards, the large flood flows experienced on this floodplain meant that a compromise was required. The main reason for this was the high cost associated with the required upgrading works. In addition, raising the highway significantly would cause severe impacts on flood levels for properties located on the flood plain, which was considered unacceptable. Adopted design criteria for the project were therefore related to the time of closure and the minimizing impacts on surrounding land. This paper details the hydraulic analysis undertaken throughout the various phases of the project, and discusses the critical role that hydraulic modelling played in the development of the final vertical and horizontal alignment of the upgraded highway. In addition it discusses the role the community and other stakeholder's played in validating the results of the hydraulic model, and how the flood model was able to assist the community in understanding and accepting the impacts of the proposed upgrade. The final outcomes of the hydraulic investigation are presented, including how the upgraded highway performs against the adopted design criteria. [ABSTRACT FROM AUTHOR]

As the basic guarantee for the reliability and economic operations of state grid corporations, power load prediction plays a vital role in power system management. To achieve the highest possible prediction accuracy, many scholars have been committed to building reliable load forecasting models. However, most studies ignore the necessity and importance of data preprocessing strategies, which may lead to poor prediction performance. Thus, to overcome the limitations in previous studies and further strengthen prediction performance, a novel short-term power load prediction system, VMD-BEGA-LSTM (VLG), integrating a data pretreatment strategy, advanced optimization technique, and deep learning structure, is developed in this paper. The prediction capability of the new system is evaluated through simulation experiments that employ the real power data of Queensland, New South Wales, and South Australia. The experimental results indicate that the developed system is significantly better than other comparative systems and shows excellent application potential. [ABSTRACT FROM AUTHOR]

Eyrean Grasswrens Amytornis goyderi have generally been considered habitat specialists associated with Sandhill Canegrass Zygochloa paradoxa on the dunes of inland Australian deserts in the Lake Eyre Basin. Following above-average rainfall in 2020-2022 and an associated vegetation response in the Strzelecki Desert, Eyrean Grasswrens were observed at 39 locations south-east of their known distribution, with sites up to 11 km inside New South Wales, well beyond the extent of previous easterly records on the New South Wales-South Australia border. Further, two sites were north of the New South Wales-Queensland border, confirming the species 380 km south of previous Queensland records. Nine sites were within feral-free exclosures at the Wild Deserts project site in Sturt National Park, New South Wales. Repeated observations between May 2021 and August 2022 suggest persistence for at least 16 months in ephemeral vegetation on sand dunes supporting no Sandhill Canegrass. Two instances of breeding were recorded, with juvenile birds and feeding by an adult male observed. We explore possible drivers for this apparent range expansion and future scenarios around persistence inside landscape-scale exclosures, within which theorised threats from feral predators and overabundant herbivores are absent, presenting an opportunity to assess the relevancy of these drivers on the ecology of Eyrean Grasswrens. [ABSTRACT FROM AUTHOR]

Lunatic asylums formed part of the civic infrastructure that was constructed out of British colonists invading and subsequently colonising unceded, Indigenous Australian lands during the eighteenth and nineteenth century. This historical narrative examined nineteenth century primary and secondary sources including, patient lists, medical files, and government correspondence, to provide insight into the experiences of Indigenous Australians admitted to Australia's earliest lunatic asylums. Awareness that lunatic asylums formed part of the structure imposed during colonisation, provides nurses and other health professionals with greater historical literacy regarding the impact of colonial lunatic asylums on Indigenous Australians. Such impacts continue to be experienced through transgenerational trauma and emphasise the importance of culturally safe mental health services. [ABSTRACT FROM AUTHOR]

By being able to communicate the speed limit to drivers using speed sign recognition cameras, Intelligent Speed Assist (ISA) is expected to bring significant road safety gains through increased speed compliance. In the absence of complete digital speed maps and due to limited cellular connectivity throughout Australia, this study estimated the forgone savings of ISA in the event that speed signs are solely relied upon for optimal advisory ISA function. First, speed-related fatalities and serious injuries (FSI) in the Australian states of Victoria, South Australia, and Queensland (2013–2018) were identified, and published effectiveness estimates of ISA were applied to determine the potential benefits of ISA. Subsequently, taking into account speed sign presence across the three states, the forgone savings of ISA were estimated as FSI that would not be prevented due to absent speed signage. Annually, 27–35% of speed-related FSI in each state are unlikely to be prevented by ISA because speed sign infrastructure is absent, equating to economic losses of between AUD 62 and 153 million. Despite a number of assumptions being made regarding ISA fitment and driver acceptance of the technology, conservative estimates suggest that the benefits of speed signs placed consistently across road classes and remoteness levels would far outweigh the costs expected from the absence of speed signs. The development and utilisation of a methodology for estimating the foregone benefits of ISA due to suboptimal road infrastructure constitutes a novel contribution to research. This work provides a means of identifying where infrastructure investments should be targeted to capitalise on benefits offered by advanced driver assist technologies. [ABSTRACT FROM AUTHOR]

Most Australian state and territory governments have healthy food provisioning policies targeting availability of unhealthy food at the retail level, and sustainability policies promoting a life-cycle approach to procurement. However, it remains unclear if health and sustainability are important considerations in awarding contracts, and whether these high-level policies are implemented into supplier contracts. A political economy analysis framework has been developed to prospectively identify and explain barriers and enablers to policy implementation. Using food procurement in Queensland and South Australia as case studies, the political economy analysis seeks to understand the structural and contextual factors, bargaining processes, stakeholders, and incentives and ideas surrounding food procurement. It involves a desktop and content analysis of existing policies and food contracts, and key informant interviews with government and industry stakeholders. Participants will be targeted across different departments (e.g. health, environment, treasury) and in varying roles from policy design, contract management and food service, and industry suppliers in different food and drink categories (e.g. meat, packaged foods, beverages, fruit & vegetables). Participants will be recruited using purposive sampling. Thematic analysis of interview transcripts will be undertaken, informed by the political economy analysis framework. The study will identify current food procurement policy implementation barriers and enablers, including why high-level policies aren't embedded into contracts, mechanisms for achieving policy coherence and future opportunities for addressing barriers and incorporating socio-economic, public health and environmental considerations into purchasing practices. Ultimately, the study will achieve impact by informing a whole of government approach to health and the environment by elevating the priority of health and sustainability in procurement (short term), increasing the availability of healthy and sustainable foods (medium term), and improving health and environmental outcomes (long term). To our knowledge this is the first political economy analysis of food procurement in Australia. [ABSTRACT FROM AUTHOR]

Objectives: To examine the relationship between structural characteristics of Australian residential aged care facilities (RACFs) and breaches of the aged care quality standards., Methods: Facility-level analysis of audits, sanctions and non-compliance notices of all accredited Australian RACFs between 2015/16 and 2018/19. Structural factors of interest included RACF size, remoteness, ownership type and jurisdiction. Two government data sources were joined. Each outcome was analysed to calculate time trends, unadjusted rates and relative risks., Results: Non-compliance notices were imposed on 369 RACFs (13%) and 83 sanctions on 75 RACFs (3%). Compared with New South Wales (NSW), non-compliance notices were less likely in Victoria, Queensland and the Northern Territory (NT), more likely in South Australia (SA), and comparable in Western Australia (WA), Tasmania and the Australian Capital Territory (ACT). RACFs with more than 100 beds and RACFs located in remote and outer regional areas (vs. major cities) also increased the likelihood of non-compliance notices. Compared with NSW, sanctions were less likely in Victoria, Queensland, NT and WA and comparable in SA, Tasmania and ACT. Additionally, the likelihood of sanctions was higher for RACFs with more than 40 beds. For both non-compliance notices and sanctions, no significant relationship was found with RACF ownership type., Conclusions: We partially confirmed other Australian findings about the relationship between RACF structural characteristics and regulatory sanctions and reported new findings about non-compliance notices. Routine and standardised public reporting of RACF performance is needed to build trust that Australia's latest aged care reforms have led to sustained quality improvements., (© 2023 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc’.)

The desert rat-kangaroo or 'ngudlukanta' (Caloprymnus campestris) was once sparsely distributed in the Lake Eyre Basin of north-eastern South Australia and adjacent parts of Queensland, but has not been collected since the 1930s. However, numerous reported sightings, including some recent, provide some hope that it may still be extant. In 2018 and 2019, we searched for evidence of this species at sites where it had been collected in the 1930s, and at places where people have since reported seeing an animal that fits its description. Our survey, which analysed data from more than 6000 camera trap nights, 536 predator scats and 226 km of spotlight transects, was the most extensive field-based search ever undertaken for this animal; but we found no evidence for its continued existence. However, our work did detect other threatened species including a range extension for the kowari (Dasyuroides byrnei), thereby demonstrating the value of surveys like this one. Because of the vastness and inaccessibility of much of the terrain comprising the supposed distribution of C. campestris , we do not see our null result as definitive for this poorly surveyed animal; we instead hope that it provides a starting point for future surveys aimed at resolving its status. The desert rat-kangaroo or 'ngudlukanta' once occurred in north-eastern South Australia and adjacent parts of Queensland but is now presumed extinct. However, spurred on by some recent sightings we searched for the animal throughout its former distribution using camera trapping, spotlighting, and predator scat analysis. Although we found no evidence during our survey for its continued existence, we did detect other threatened species in this poorly-surveyed region of arid Australia. [ABSTRACT FROM AUTHOR]

Objective. To analyse Medicare expenditure by State/Territory, remoteness, and Indigenous demography to assess funding equality in meeting the health needs of remote Indigenous populations in the Northern Territory. Methods. Analytic descriptions of Medicare online reports on services and benefits by key demographic variables linked with Australian Bureau of Statistics data on remoteness and Indigenous population proportion. The Northern Territory Indigenous and non-Indigenous populations were compared with the Australian average between the 2010/2011 and 2019/2020 fiscal years in terms of standardised rates of Medicare services and benefits. These were further analysed using ordinary least squares, simultaneous equations and multilevel models. Results. In per capita terms, the Northern Territory receives around 30% less Medicare funds than the national average, even when additional Commonwealth funding for Aboriginal medical services is included. This funding shortfall amounts to approximately AU$80 million annually across both the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. The multilevel models indicate that providing healthcare for an Aboriginal and Torres Strait Islander person in a remote area involves a Medicare shortfall of AU$531-- AU$1041 less Medicare Benefits Schedule benefits per annum compared with a non-Indigenous person in an urban area. Indigenous population proportion, together with remoteness, explained 51% of the funding variation. An age--sex based capitation funding model would correct about 87% of the Northern Territory primary care funding inequality. Conclusions. The current Medicare funding scheme systematically disadvantages the Northern Territory. A needs-based funding model is required that does not penalise the Northern Territory population based on the remote primary health care service model. [ABSTRACT FROM AUTHOR]

Aim: The aim of this scoping review was to determine the extent of off-patent prescription medicine use beyond registered indications in various Australian clinical settings. Method: The review followed the Joanna Briggs Institute approach and reported using PRISMA Extension for Scoping Reviews. Online databases were used to identify published literature about off-patent registered prescription medicines used for off-label indications in Australian public hospital, community and primary healthcare settings. In addition, empirical data from the Queensland and the South Australian state-wide medicine formularies were screened for the same medication/off-label indication dyads identified in the literature, and other locally approved uses. Results: Overall, fourteen studies were included, conducted in public hospitals (n = 11), palliative care units (n = 2) and the community setting (n = 1). There were 213 reports extracted from the literature describing off-patent registered prescription medicines used for off-label indications, representing 128 unique medication/off-label indication dyads and 32 different medicines. Of these, just five medication/off-label indication dyads were approved for use on both the Queensland and South Australian state-wide medicine formularies, with 12 others only approved for use in Queensland and 16 others only approved for use in South Australia. Further examination of these state-wide formularies demonstrated that the use of off-patent registered prescription medicines beyond registered indications is more extensive than has been reported to date in the literature. There were 28 additional medication/off-label indication dyads approved on the Queensland state-wide medicine formulary and 14 such examples approved for use in South Australia. Of these, just two medication/off-label indication dyads were approved for use on both formularies. Conclusion: The extent to which off-patent registered prescription medicines have been repurposed in clinical settings for off-label indications in Australia is greater than previously reported in the literature. Usage and funded availability of certain medication/off-label indication dyads, varies across Australia. These results further expose the two tiered system of medicines regulation in Australia, and its impact on equity of access to medicines. Further research is required to support policy change to encourage submission of registration updates for off-patent prescription medicines. [ABSTRACT FROM AUTHOR]

Background: Nurses have limited time outside of work for continuing professional development. Consequently, strategies need to be explored to enable them to better maintain their competence. This article describes recent research investigating if nursing behaviours in the use of mobile technologies could be leveraged to better facilitate mobile learning. It addresses a gap in the existing literature around how nurses resource their own professional development and learning in the absence of appropriate learning resources in the workplace. Methods: The research employed a classic grounded theory methodology which was conducted with 27 registered nurses from Public and Private Hospitals in Queensland and external postgraduate nursing students from Victoria, South Australia and the Northern Territory enrolled at the University of Southern Queensland. Results: The Theory of Economising Learning describes how nurses maintain competence with limited resources. Unfavourable staffing levels and a fast-paced workplace mean that nurses rarely prioritise their professional learning while at work. Instead, it requires the nurse to contribute personal resources including time and money. Though the research revealed nurses were unconcerned about using mobile technologies, they were concerned about maintaining competence with limited resources. To counter this, nurses economised their learning by balancing personal resources against their motivation to maintain competence. The process of economising learning begins and ends with the development of the nurse's personal curriculum in response to what they identify as being the most significant knowledge deficits at work that jeopardise their competence. A learning opportunity that addresses the knowledge deficit is sought. Nurses balance the opportunity to address the deficit against the cost of personal resources, to decide if they will engage with the opportunity and update their personal curriculum accordingly. Conclusions: It is suggested that workplaces need to create reasonable expectations within nurses to address knowledge deficits and provide the resources, including time, to allow them to do so without personal cost. It is also necessary for workplaces to moderate the flow of learning opportunities so as not to overwhelm and demotivate the nurses. Currently, nurses use several strategies to optimise their learning using mobile technologies which could be leveraged in the workplace. [ABSTRACT FROM AUTHOR]

Background: Behavioural medicine is characterised by findings for the effectiveness and efficacy of complex behaviour change interventions. Comparatively, scant attention has been paid to key intervention components or mechanisms of action. Evaluating relationships between process variables (fidelity) and intervention effects is central to addressing this imbalance. Accordingly, in the current study, we sought to explore the magnitude and direction of effect between fidelity predictors (dietitian adherence and competence) and intervention effects (patient nutritional status) during the intervention phase of a real-world, stepped-wedge evaluation of 'EAT: Eating As Treatment'.Methods: The EAT clinical trial was conducted within five major Australian hospitals located in Queensland, Western Australia, Victoria and South Australia between 2013 and 2016. EAT is a dietitian-delivered health behaviour change intervention designed to reduce malnutrition in head and neck cancer (HNC) patients undergoing radiotherapy. Dietitian adherence and competence ratings were derived from a 20% random sample of audio-recorded dietetic consultations (n=194) conducted after dietitians (n=18) were trained in EAT. Sessions were coded by trained, independent, coders using a study checklist, the Behaviour Change Counselling Index (BECCI) and items from the Cognitive Therapy Scale-Revised (CTS-R). Patient nutritional status was measured using the Patient-Generated Subjective Global Assessment (PGSGA).Results: Dietitian adherence to a written nutrition plan (β=7.62, 95% CI=0.65 to 14.58, p=0.032), dietitian adherence to behaviour change counselling (β=0.69, 95% CI =0.02 to 1.38, p=0.045) and competence in delivering behaviour change counselling (β=3.50, 95% CI =0.47 to 6.53, p=0.024) were significant predictors of patient nutritional status. Dietitian adherence and competence ratings were higher during consultations with intervention patients at greater risk of malnutrition.Conclusions: This study contributes new insights into the relationship between fidelity and treatment outcome by demonstrating that dietitian adherence and competence is greater when working with more challenging patients. This is likely central to the demonstrated success of the EAT intervention in reducing malnutrition and highlights the importance of ensuring that providers are adequately equipped to flexibly integrate intervention elements according to patient need.Trial Registration: This study is a process analysis of a stepped-wedge randomised controlled trial prospectively registered on the Australian New Zealand Clinical Trials Registry ( ACTRN12613000320752 ; Date of registration 21/03/2013). [ABSTRACT FROM AUTHOR]

Background: There is limited best- practice evidence to address behavioral and psychiatric symptoms for those with dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, 'Harmony in the Bush', based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia.Methods: A quasi-experimental (nonrandomized, pre-post) intervention study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focused on the theory of the Progressively Lowered Stress Threshold principles and delivery of person-centered care plan with integrated music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff's caregiving stress, using Caregivers Stress Inventory. This study adheres to the CONSORT guidelines.Results: Mean age of residents with dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was similar reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency.Conclusions: The Harmony in the Bush model is effective in reducing agitation among dementia residents with significant reduction in staff stress levels in nursing homes in rural Australia.Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458. [ABSTRACT FROM AUTHOR]

In Australia, the deep-water (bathyal and abyssal) benthic invertebrate fauna is poorly known in comparison with that of shallow (subtidal and shelf ) habitats. Benthic fauna from the deep eastern Australian margin was sampled systematically for the first time during 2017 RV 'Investigator' voyage 'Sampling the Abyss'. Box core, Brenke sledge, and beam trawl samples were collected at one-degree intervals from Tasmania, 42°S, to southern Queensland, 24°S, from 900 to 4800 m depth. Annelids collected were identified by taxonomic experts on individual families around the world. A complete list of all identified species is presented, accompanied with brief morphological diagnoses, taxonomic remarks, and colour images. A total of more than 6000 annelid specimens consisting of 50 families (47 Polychaeta, one Echiura, two Sipuncula) and 214 species were recovered. Twenty-seven species were given valid names, 45 were assigned the qualifier cf., 87 the qualifier sp., and 55 species were considered new to science. Geographical ranges of 16 morphospecies extended along the eastern Australian margin to the Great Australian Bight, South Australia; however, these ranges need to be confirmed with genetic data. This work providing critical baseline biodiversity data on an important group of benthic invertebrates from a virtually unknown region of the world's ocean will act as a springboard for future taxonomic and biogeographic studies in the area. [ABSTRACT FROM AUTHOR]

Objectives: To examine trends in ED presentations with a mental health diagnosis (MHdx) in Australia by jurisdiction and by sex, between 2004–05 and 2016–17. Methods: Data were captured in the National Non‐Admitted Patient Emergency Department Care Database. Outcomes were the proportion of ED presentations with a principal diagnosis of ICD‐10‐AM F00‐F99 (MHdx), and the rate of all ED and MHdx presentations per 10 000 population. Results: Between 2004–05 and 2016–17, MHdx presentations experienced compounding annual growth of 5.9% nationally, and increased from 3.3% to 3.7% of all ED presentations with a diagnosis. Most growth occurred between 2010–11 and 2015–16. Northern Territory (NT) had the highest level of MHdx presentations per 10 000 population, more than double the Australian average. The proportion of MHdx presentations was highest in South Australia (SA) in most years, and the average annual proportion of MHdx presentations was statistically significantly higher than the national average in SA, Queensland (QLD) and Western Australia (WA). The proportion of MHdx presentations increased in each jurisdiction, with significant increases for Victoria, QLD, WA, Australian Capital Territory and NT. Males experienced greater numbers and rates of all ED and MHdx presentations, while the proportion of MHdx presentations was 8% higher for females. Conclusions: The proportion of ED presentations for MH conditions, narrowly defined, has increased in all Australian jurisdictions between 2004–05 and 2016–17, but particularly since 2010–11. Differences between jurisdictions indicate jurisdictional specific issues. However, significant or upward trend of MHdx presentations across all jurisdictions indicates generic issues necessitating concern and policy development at a national level. [ABSTRACT FROM AUTHOR]

Quality of dementia care improves with a personalized approach to aged care, and knowledge of the disease process and unique care needs of residents with dementia. A personalized model of care can have a significant impact on the overall organizational culture in aged care homes. However, the dimensions of personalized aged care relating to dementia often remain under-managed. We aim to explore the factors that shape the dimensions of personalized dementia care in rural nursing homes using qualitative data of a mixed-method 'Harmony in the Bush' dementia study. The study participants included clinical managers, registered nurses, enrolled nurses and care workers from five rural aged care homes in Queensland and South Australia. One hundred and four staff participated in 65 semi-structured interviews and 20 focus groups at three phases: post-intervention, one-month follow-up and three-months follow-up. A multidimensional model of nursing home care quality developed by Rantz et al. (1998) was used in data coding and analysis of the factors. Three key themes including seven dimensions emerged from the findings: resident and family [resident and family centeredness, and assessment and care planning]; staff [staff education and training, staff-resident interaction and work-life balance]; and organization [leadership and organizational culture, and physical environment and safety]. A lack of consideration of family members views by management and staff, together with poorly integrated, holistic care plan, limited resources and absence of ongoing education for staff, resulted in an ineffective implementation of personalized dementia care. Understanding the dimensions and associated factors may assist in interpreting the multidimensional aspects of personalized approach in dementia care. Staff training on person-centered approach, assessment and plan, and building relationships among and between staff and residents are essential to improve the quality of care residents receive. [ABSTRACT FROM AUTHOR]

Background: Infections caused by antibiotic resistant pathogens are increasing, with antibiotic overuse a key contributing factor.Objective: The CareTrack Kids (CTK) team assessed the care of children in Australia aged 0-15 years in 2012 and 2013 to determine the proportion of care in line with clinical practice guidelines (CPGs) for 17 common conditions. This study analyses indicators relating to paediatric antibiotic overuse to identify those which should be prioritised by antimicrobial stewardship and clinical improvement programs.Method: A systematic search was undertaken for national and international CPGs relevant to 17 target conditions for Australian paediatric care in 2012-2013. Recommendations were screened and ratified by reviewers. The sampling frame comprised three states containing 60% of the Australian paediatric population (South Australia, New South Wales and Queensland). Multi-stage cluster sampling was used to select general practices, specialist paediatric practices, emergency departments and hospital inpatient services, and medical records within these. Medical records were reviewed by experienced paediatric nurses, trained to assess eligibility for indicator assessment and compliance with indicators. Adherence rates were estimated.Results: Ten antibiotic overuse indicators were identified; three for tonsillitis and one each for seven other conditions. A total of 2621 children were assessed. Estimated adherence for indicators ranged from 13.8 to 99.5% while the overall estimate of compliance was 61.9% (95% CI: 47.8-74.7). Conditions with high levels of appropriate avoidance of antibiotics were gastroenteritis and atopic eczema without signs of infection, bronchiolitis and croup. Indicators with less than 50% adherence were asthma exacerbation in children aged > 2 years (47.1%; 95% CI: 33.4-61.1), sore throat with no other signs of tonsillitis (40.9%; 95% CI: 16.9, 68.6), acute otitis media in children aged > 12 months who were mildly unwell (13.8%; 95% CI: 5.1, 28.0), and sore throat and associated cough in children aged < 4 years (14.3%; 95% CI: 9.9, 19.7).Conclusion: The results of this study identify four candidate indicators (two for tonsillitis, one for otitis media and one for asthma) for monitoring by antibiotic stewardship and clinical improvement programs in ambulatory and hospital paediatric care, and intervention if needed. [ABSTRACT FROM AUTHOR]

In Australia, the community heritage sector – galleries, libraries, archives, museums and historical societies managed by volunteers – plays a significant role in recording and preserving the diversity of Australia's cultural heritage. However, these community heritage organisations face uncertain futures. This article offers four examples of heritage organisations located in New South Wales, Queensland and South Australia which have struggled with organisational sustainability arising from various financial, human, physical, skills, and expertise challenges. We assess some of the common problems threatening the longevity of community heritage organisations and what action is needed to safeguard this sector into the future. [ABSTRACT FROM AUTHOR]

Background: Fever in childhood is a common acute presentation requiring clinical triage to identify the few children who have serious underlying infection. Clinical practice guidelines (CPGs) have been developed to assist clinicians with this task. This study aimed to assess the proportion of care provided in accordance with CPG recommendations for the management of fever in Australian children.Methods: Clinical recommendations were extracted from five CPGs and formulated into 47 clinical indicators for use in auditing adherence. Indicators were categorised by phase of care: assessment, diagnosis and treatment. Patient records from children aged 0 to 15 years were sampled from general practices (GP), emergency departments (ED) and hospital admissions in randomly-selected health districts in Queensland, New South Wales and South Australia during 2012 and 2013. Paediatric nurses, trained to assess eligibility for indicator assessment and adherence, reviewed eligible medical records. Adherence was estimated by individual indicator, phase of care, age-group and setting.Results: The field team conducted 14,879 eligible indicator assessments for 708 visits by 550 children with fever in 58 GP, 34 ED and 28 hospital inpatient settings. For the 33 indicators with sufficient data, adherence ranged from 14.7 to 98.1%. Estimated adherence with assessment-related indicators was 51.3% (95% CI: 48.1-54.6), 77.5% (95% CI: 65.3-87.1) for diagnostic-related indicators and 72.7% (95% CI: 65.3-79.3) for treatment-related indicators. Adherence for children < 3 months of age was 73.4% (95% CI: 58.0-85.8) and 64.7% (95% CI: 57.0-71.9) for children 3-11 months of age, both significantly higher than for children aged 4-15 years (53.5%; 95% CI: 50.0-56.9). The proportion of adherent care for children attending an ED was 77.5% (95% CI: 74.2-80.6) and 76.7% (95% CI: 71.7-81.3) for children admitted to hospital, both significantly higher than for children attending a GP (40.3%; 95% CI: 34.6-46.1).Conclusions: This study reports a wide range of adherence by clinicians to 47 indicators of best practice for the management of febrile children, sampled from urban and rural regions containing 60% of the Australian paediatric population. Documented adherence was lowest for indicators related to patient assessment, for care provided in GP settings, and for children aged 4-15 years. [ABSTRACT FROM AUTHOR]

The fossil record provides important information about changes in species diversity, distribution, habitat and abundance through time. As we understand more about these changes, it becomes possible to envisage a wider range of options for translocations in a world where sustainability of habitats is under increasing threat. The Critically Endangered alpine/subalpine mountain pygmy-possum, Burramys parvus (Marsupialia, Burramyidae), is threatened by global heating. Using conventional strategies, there would be no viable pathway for stopping this iconic marsupial from becoming extinct. The fossil record, however, has inspired an innovative strategy for saving this species. This lineage has been represented over 25 Myr by a series of species always inhabiting lowland, wet forest palaeocommunities. These fossil deposits have been found in what is now the Tirari Desert, South Australia (24 Ma), savannah woodlands of the Riversleigh World Heritage Area, Queensland (approx. 24–15 Ma) and savannah grasslands of Hamilton, Victoria (approx. 4 Ma). This palaeoecological record has led to the proposal overviewed here to construct a lowland breeding facility with the goal of monitoring the outcome of introducing this possum back into the pre-Quaternary core habitat for the lineage. If this project succeeds, similar approaches could be considered for other climate-change-threatened Australian species such as the southern corroboree frog (Pseudophryne corroboree) and the western swamp tortoise (Pseudemydura umbrina). This article is part of a discussion meeting issue 'The past is a foreign country: how much can the fossil record actually inform conservation?' [ABSTRACT FROM AUTHOR]

Background: Inappropriate utilization of prescription opioids and benzodiazepines is a public health problem. This study examined and compared user-types and trends in dispensing of these medicines, and identified associated factors related to the duration of dispensing in Australia. Methods: A random 10% sample of unit-record data of opioids and benzodiazepines dispensed nationally during 2013–2016 was analyzed. Users were categorized into four types: single-quarter (i.e., three months), medium-episodic (dispensed 2–6 quarters), long-episodic (dispensed 7–11 quarters), chronic (dispensed 12–16 quarters). Dispensing quantity was computed in defined daily dose (DDD). Generalized multilevel ordinal models were developed to examine the factors associated with the duration of dispensing. Results: There were similarities in terms of trends of dispensing of opioids and benzodiazepines in Australia. Overall, more people were dispensed opioids than benzodiazepines. Around 52% of opioids users and 46% of benzodiazepines users were dispensed these medicines for a single quarter. However, chronic users were dispensed 60% of opioids and 50% of benzodiazepines in DDD/1000 people/day, respectively. On average, 16.6 DDD/1000 people/day of opioids and 14.2 DDD/1000 people/day of benzodiazepines were dispensed in Australia during the study period. Tasmania was dispensed the highest quantity (in DDD/1000 people/day) of these medicines, followed by South Australia and Queensland. Women compared to men, and clients of age-group 20–44, 45–64 and 65+ compared to age-group 0–19, were significantly more likely to have dispensed opioids/benzodiazepine for a relatively long duration. Clients with a history of dispensing of one of these two medicines were significantly more likely to have dispensed the other for a relatively long period. Conclusions: There were similarities in patterns of dispensing of opioids and benzodiazepines in terms of user characteristics and structural variables. Consistent use of real-time drug monitoring program and tailored intervention are recommended. [ABSTRACT FROM AUTHOR]

The advance of renal replacement therapy options for people with end-stage kidney disease has given rise to the development of specialist renal nurses including the renal transplant coordinator. The renal transplant coordinator role requires a high level of specialist knowledge in renal and transplantation nursing plus a commitment to following through with people in the long term. To find out just what renal transplant coordinators in Australia do, an interview was conducted with renal transplant coordinators from each Australian state and territory. Their stories relate to transplanting units; referring centres; and, adult, paediatric, statewide and national renal services. They demonstrate the diversity that exists within the role of the renal transplant coordinator. [ABSTRACT FROM AUTHOR]

Aim: The benefits of Transition Care Programs (TCPs) for patients with cognitive impairment are not well established. This study aimed to investigate the impact of TCP on patients according to their cognitive status. Methods: In this prospective cohort study, 351 patients were comprehensively assessed at TCP admission using the interRAI Home Care instrument and divided into two groups based on scores on the Cognitive Performance Scale. Results: Of 346 patients assessed for cognition, 242 (69.9%) were considered cognitively intact, and 104 (30.1%) were classified as cognitively impaired (Cognitive Performance Scale ⩾ 2). There were no significant differences in TCP outcomes between the two groups, including community living at six months (P = 0.1), hospital readmission rates (P = 0.6), or achievement of TCP goals (P = 0.3). Conclusions: Cognitively intact and cognitively impaired patients have similar outcomes post-TCP. Older patients should not be refused Transition Care based on the presence of cognitive impairment. [ABSTRACT FROM AUTHOR]

Background Advance care planning is regarded as integral to better patient outcomes, yet little is known about the prevalence of advance directives ( AD) in Australia. Aim To determine the prevalence of AD in the Australian population. Methods A national telephone survey about estate and advance planning. Sample was stratified by age (18-45 and >45 years) and quota sampling occurred based on population size in each state and territory. Results Fourteen per cent of the Australian population has an AD. There is state variation with people from South Australia and Queensland more likely to have an AD than people from other states. Will making and particularly completion of a financial enduring power of attorney are associated with higher rates of AD completion. Standard demographic variables were of limited use in predicting whether a person would have an AD. Conclusions Despite efforts to improve uptake of advance care planning (including AD), barriers remain. One likely trigger for completing an AD and advance care planning is undertaking a wider future planning process (e.g. making a will or financial enduring power of attorney). This presents opportunities to increase advance care planning, but steps are needed to ensure that planning, which occurs outside the health system, is sufficiently informed and supported by health information so that it is useful in the clinical setting. Variations by state could also suggest that redesign of regulatory frameworks (such as a user-friendly and well-publicised form backed by statute) may help improve uptake of AD. [ABSTRACT FROM AUTHOR]

Background/aim The reliable evaluation of occupational therapy students completing practice education placements along with provision of appropriate feedback is critical for both students and for universities from a quality assurance perspective. This study describes the development of a comment bank for use with an online version of the Student Practice Evaluation Form-Revised Edition ( SPEF-R Online) and investigates its reliability. Methods A preliminary bank of 109 individual comments (based on previous students' placement performance) was developed via five stages. These comments reflected all 11 SPEF-R domains. A purpose-designed online survey was used to examine the reliability of the comment bank. A total of 37 practice educators returned surveys, 31 of which were fully completed. Participants were asked to rate each individual comment using the five-point SPEF-R rating scale. Results One hundred and two of 109 comments demonstrated satisfactory agreement with their respective default ratings that were determined by the development team. At each domain level, the intra-class correlation coefficients (ranging between 0.86 and 0.96) also demonstrated good to excellent inter-rater reliability. There were only seven items that required rewording prior to inclusion in the final SPEF-R Online comment bank. Conclusion The development of the SPEF-R Online comment bank offers a source of reliable comments (consistent with the SPEF-R rating scale across different domains) and aims to assist practice educators in providing reliable and timely feedback to students in a user-friendly manner. [ABSTRACT FROM AUTHOR]

Energy consumption data is being used for improving the energy efficiency and minimizing the cost. However, obtaining energy consumption data has two major challenges: (i) data collection is very expensive, time-consuming, and (ii) security and privacy concern of the users which can be revealed from the actual data. In this research, we have addressed these challenges by using generative adversarial networks for generating energy consumption profile. We have successfully generated synthetic data which is similar to the real energy consumption data. On the basis of the recent research conducted on TimeGAN, we have implemented a framework for synthetic energy consumption data generation that could be useful in research, data analysis and create business solutions. The framework is implemented using the real-world energy dataset, consisting of energy consumption data of the year 2020 for the Australian states of Victoria, New South Wales, South Australia, Queensland and Tasmania. The results of implementation is evaluated using various performance measures and the results are showcased using visualizations along with Principal Component Analysis (PCA) and t-distributed stochastic neighbor embedding (TSNE) plots. Overall, experimental results show that Synthetic data generated using the proposed implementation possess very similar characteristics to the real dataset with high comparison accuracy. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore issues and challenges associated with nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory from the perspectives of senior nurses. Background Nurses play an important part in managing sedation because the prescription is usually given verbally directly from the cardiologist who is performing the procedure and typically, an anaesthetist is not present. Design A qualitative exploratory design was employed. Methods Semi-structured interviews with 23 nurses from 16 cardiac catheterisation laboratories across four states in Australia and also New Zealand were conducted. Data analysis followed the guide developed by Braun and Clark to identify the main themes. Results Major themes emerged from analysis regarding the lack of access to anaesthetists, the limitations of sedative medications, the barriers to effective patient monitoring and the impact that the increasing complexity of procedures has on patients' sedation requirements. Conclusions The most critical issue identified in this study is that current guidelines, which are meant to apply regardless of the clinical setting, are not practical for the cardiac catheterisation laboratory due to a lack of access to anaesthetists. Furthermore, this study has demonstrated that nurses hold concerns about the legitimacy of their practice in situations when they are required to perform tasks outside of clinical practice guidelines. To address nurses' concerns, it is proposed that new guidelines could be developed, which address the unique circumstances in which sedation is used in the cardiac catheterisation laboratory. Relevance to clinical practice Nurses need to possess advanced knowledge and skills in monitoring for the adverse effects of sedation. Several challenges impact on nurses' ability to monitor patients during procedural sedation and analgesia. Preprocedural patient education about what to expect from sedation is essential. [ABSTRACT FROM AUTHOR]

Large scale forest plantations in the Murray-Darling Basin are a possible carbon sequestration mechanism which may be adopted in response to the introduction of a carbon price. However, increased tree plantation will be associated with reduced inflows to river systems because of increased transpiration, interception and evaporation. This could have significant implications for regions vulnerable to drought. This study examines the interaction between carbon pricing, water pricing, and agricultural land use in the Murray-Darling Basin and its impact on water flow under current and climate change settings. [ABSTRACT FROM AUTHOR]

The abundance and activity of the prothrombin activator (pseutarin C) within the venom of the Eastern brown snake (Pseudonaja textilis textilis) is the primary determinant of its coagulation potency. Textilinin-1, also in this venom, is a plasmin inhibitor which is thought to exert its toxic effects through the slowing of fibrinolysis. The aim of this report is to determine if there are differences in the potency of the venom from Eastern brown snakes collected from South Australia (SA) compared to those from Queensland (QLD). A concentration of 0.4 μg/ml venom protein from six QLD specimens clotted citrated plasma in an average time of 21.4 ± 3.3 s compared to 68.7 ± 2.4 s for the same amount of SA venom (averaged for six individuals). The more potent procoagulant activity of the QLD venom was measured between 0.4 and 94 μg/ml venom protein in plasma. The anti-plasmin activity of textilinin was also greater in the venom of the snakes collected from QLD, causing full inhibition of plasmin at approximately 1.88 μg/ml of venom protein compared to approximately 7.5 μg/ml for the SA venoms. It is concluded that geographic differentiation of the Eastern brown snakes results in significant differences venom potency. [ABSTRACT FROM AUTHOR]

Two new species, Catasphactes truncatus sp. nov. from Western Australia and South Australia and C. pallidus sp. nov . from southeastern Queensland are described, and a key for the separation of these species from other known species of the genus Catasphactes Stål is given, along with a redescription of the two previously known species, C. pyrrhopterus Stål and C. coprias (Stål). [ABSTRACT FROM AUTHOR]

Background: Variable and poor care quality are important causes of preventable patient harm. Many patients receive less than recommended care, but the extent of the problem remains largely unknown. The CareTrack Kids (CTK) research programme sought to address this evidence gap by developing a set of indicators to measure the quality of care for common paediatric conditions. In this study, we focus on one clinical area, 'preventive care' for pre-school aged children. Our objectives were two-fold: (i) develop and validate preventive care quality indicators and (ii) apply them in general medical practice to measure adherence.Methods: Clinical experts (n = 6) developed indicator questions (IQs) from clinical practice guideline (CPG) recommendations using a multi-stage modified Delphi process, which were pilot tested in general practice. The medical records of Australian children (n = 976) from general practices (n = 80) in Queensland, New South Wales and South Australia identified as having a consultation for one of 17 CTK conditions of interest were retrospectively reviewed by trained paediatric nurses. Statistical analyses were performed to estimate percentage compliance and its 95% confidence intervals.Results: IQs (n = 43) and eight care 'bundles' were developed and validated. Care was delivered in line with the IQs in 43.3% of eligible healthcare encounters (95% CI 30.5-56.7). The bundles of care with the highest compliance were 'immunisation' (80.1%, 95% CI 65.7-90.4), 'anthropometric measurements' (52.7%, 95% CI 35.6-69.4) and 'nutrition assessments' (38.5%, 95% CI 24.3-54.3), and lowest for 'visual assessment' (17.9%, 95% CI 8.2-31.9), 'musculoskeletal examinations' (24.4%, 95% CI 13.1-39.1) and 'cardiovascular examinations' (30.9%, 95% CI 12.3-55.5).Conclusions: This study is the first known attempt to develop specific preventive care quality indicators and measure their delivery to Australian children in general practice. Our findings that preventive care is not reliably delivered to all Australian children and that there is substantial variation in adherence with the IQs provide a starting point for clinicians, researchers and policy makers when considering how the gap between recommended and actual care may be narrowed. The findings may also help inform the development of specific improvement interventions, incentives and national standards. [ABSTRACT FROM AUTHOR]

Tobacco smoking leads to one in five deaths of Aboriginal Australians and accounts for 17% of the reversible health gap. One in two Aboriginal women are reported to smoke during pregnancy, with no effective strategies currently available for health practitioners to utilise for supporting Aboriginal women. Aboriginal community participation in primary health research is crucial to implementing ethical research, with a clear benefit to the people and communities involved. However, currently there is little evidence on how Aboriginal programs and interventions are being developed in partnership with Aboriginal people and communities. 'Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy' aims to address the prevalence of smoking during pregnancy by enhancing health providers' training in offering evidence-based smoking cessation care to Aboriginal mothers during pregnancy. This paper outlines the participatory research approach adopted for the developmental phase of the 'ICAN QUIT in Pregnancy' project developed in partnership with two Aboriginal Community-Controlled Health Services in NSW, and negotiation processes undertaken to implement a pilot intervention across NSW, SA and Qld.

To date, universal, school-based interventions have produced limited success in the long-term prevention of depression in young people. This paper examines whether family relationship support moderates the outcomes of a universal, school-based preventive intervention for depression in adolescents. It reports a secondary analysis of data from the beyondblue schools research initiative. Twenty-five matched pairs of secondary schools were randomly assigned to an intervention or control condition (N = 5633 Grade 8 students). The multi-component, school-based intervention was implemented over a 3-year period, with 2 years of follow-up in Grades 11 and 12. For those available at follow-up, small but significantly greater reductions in depressive and anxiety symptoms and improvements in emotional wellbeing were found over time for the intervention group compared to the control among those who experienced low family relationship support in Grade 8. For those who did not experience low family relationship support in Grade 8, no significant effects of the invention were found over the control condition. This pattern of results was also found for the intent-to-treat sample for measures of depression and anxiety. Previous research may have overlooked important moderating variables that influence the outcome of universal approaches to the prevention of depression. The findings raise issues of the relative costs and benefits of universal versus targeted approaches to the prevention of depression.

Background: Community-based palliative care services face challenges in meeting the needs of terminally ill clients who live alone without a primary caregiver. Yet, there is a dearth of literature on the perceptions of health service providers (HSPs) regarding the care needs and possible management options to assist this growing group to remain at home., Objective: This paper investigated the support needs of people living alone with a terminal illness from a service provider perspective., Design: In depth semi-structured interviews were conducted with nine HSPs from community based services in three Australian states., Results: Four main themes emerged: care challenges, differences in care provision, appropriate approaches to care and essentials for an effective service such as 24 h care, cost-free provision of personal alarm systems, supported and coordinated housekeeping services, funded respite care and financial care packages. HSPs expressed a respect for the autonomy and independence of the clients, yet felt pressured to ensure that safe and attentive care was possible. HSPs recognised the central importance of maintaining the independence and autonomy of palliative care clients living alone., Conclusions: This study is the first in-depth account of what HSPs perceive they need to effectively look after home alone dying clients. The study provided directions to inform service planning for this growing and challenging population group regarding adequate and timely services that will lead to more complying with the clients' wishes, more care being delivered at home, a reduction in hospitalisations, a better quality of life and a capacity to die at home.

Since first being implemented more than 30 years ago, problem-based learning has become an increasingly popular approach to education. More and more dental schools in the United States and internationally are implementing some aspect of PBL into their curriculum. This paper will define PBL, describe how it is implemented within various institutions and discuss the potential for using PBL as the basis for collaboration among institutions.

The poor state of Aboriginal and Torres Strait Islander health has been documented in many ways, most obviously by comparing the relatively higher age-specific mortality and morbidity rates. This paper demonstrates the use of acute hospital separation data as a way to identify potential deficiencies in providing appropriate primary health care services for Aboriginal and Torres Strait Islander populations. It does so by using 'ambulatory sensitive conditions': those conditions (and procedures) for which high-quality appropriate primary health services deliverable under ideal circumstances are though to potentially reduce or eliminate the need for hospitalisation. Potential or realised access to primary care is not analysed directly using primary health service data. In this study, 1993-94 acute hospital separation data from NSW, Queensland, South Australia, Western Australia and the Northern Territory were used to calculate separation rates and odds ratios for Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander populations. Age-specific acute hospital separation rates for ambulatory sensitive conditions were 1.7 to 11 times higher for the Aboriginal and Torres Strait Islander populations studied. This supports clinical contentions that much Aboriginal and Torres Strait Islander morbidity and mortality is preventable and that further consideration is needed to service delivery reform at all levels in the health system and the distribution of funding.