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Background: Hospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge.Methods: This randomised, controlled, single-blind trial enrolled children aged <2 years hospitalised for severe LRTI to 'intervention' or 'control'. Intervention was three monthly community clinics treating wet cough with prolonged antibiotics referring non-responders. All other health issues were addressed, and health resilience behaviours were encouraged, with referrals for housing or smoking concerns. Controls followed the usual pathway of parent-initiated healthcare access. After 24 months, all children were assessed by a paediatrician blinded to randomisation for primary outcomes of wet cough, abnormal examination (crackles or clubbing) or chest X-ray Brasfield score ≤22.Findings: 400 children (203 intervention, 197 control) were enrolled in 2011-2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe.Interpretation: We have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years.Trial Registration Number: ACTRN12610001095055. [ABSTRACT FROM AUTHOR]

Background: Rhesus disease of a newborn baby results from the entrance of anti-D antibodies of the rhesus factor D (RhD)-negative mother into the RhD positive foetal bloodstream. This transfer might cause stillbirths, neonatal deaths, or severe hyperbilirubinemia, which can develop into irreversible brain damage. In current practice, anti-D immunoglobulin is administered to RhD-negative women within 72 h after the delivery of RhD-positive newborn babies. During the antepartum period, it is given in events associated with placental trauma or disruption of the feto-maternal interface. This review was conducted to analyse the cost-effectiveness of the introduction of worldwide guidelines for the administration of anti-D immunoglobulin at 28 weeks to all RhD negative mothers with RhD-positive spouses in Palestine.Methods: This was a cost-effective analysis and a literature review of the international guidelines about RhD alloimmunisation prophylaxis. The US, Australian, Canadian, UK, and WHO guidelines were reviewed. A cost-effective analysis was done, and the primary outcomes were the number needed to treat and the overall cost of the treatment. Estimations were done for the cost of prevention to every case.Findings: All reviewed guidelines recommend that the administration of anti-D immunoglobulin is given routinely to all RhD-negative non-sensitised women at 28 weeks gestation, when the fetal blood type is unknown or the father is known to be RhD-positive. This practice is cost-effective, hence the implementation of the new guideline will cost approximately US$700 000 in Palestine ($400 000 in the West Bank and $300 000 in the Gaza Strip). The implementation of this guideline will prevent 148 cases (85 in the West Bank and 63 in the Gaza Strip) from further RhD alloimmunisation. The net cost of prevention of every case is approximately $4750.Interpretation: Routine administration of anti-D immunoglobulin to all RhD-negative non-sensitised women at 28 weeks gestation, when the spouses are RhD-positive, is cost-effective. An implementation programme for RhD alloimmunisation prophylaxis will be of great value.Funding: None. [ABSTRACT FROM AUTHOR]

Background: As fire regimes continue to evolve in response to climate change, understanding how fire characteristics have responded to changes in the recent past is vital to inform predictions of future fire events. Aims and methods: Using Fourier Transform Infrared (FTIR) spectroscopy, we assessed how fire intensity has changed in two fire-prone landscapes in south-eastern Australia: (1) the Blue Mountains; and (2) Namadgi National Park during the past 3000 years. Key results: Higher aromatic/aliphatic ratios suggest increased high-intensity fire frequency in sediments at the surface of both cores. Increases in the frequency of extreme drought periods, coupled with the change in vegetation and anthropogenic ignitions following colonisation, could have increased the frequency of high-intensity fires in the past ~200 years. Conclusions: FTIR spectroscopy can be used in sediment deposits to infer that the frequency of high-intensity fire events has increased in the past 200 years compared to the previous ~3000 years. Implications: These results are important for understanding how past fire regimes have responded to climate, people and vegetation shifts in the past ~3000 years and can be used to inform models for future predictions and management strategies. Fourier Transform Infrared (FTIR) spectroscopy was applied to sediment deposits in southeastern Australia. The aromatic/aliphatic ratio was used as a proxy for high-intensity fires. The increased frequency of high-intensity fire events could result from interactions between climate, people, and vegetation. The existing fire record was extended by centuries to millennia. [ABSTRACT FROM AUTHOR]

A deep learning model designed for time series predictions, the long short-term memory (LSTM) architecture, is regularly producing reliable results in local and regional rainfall–runoff applications around the world. Recent large-sample hydrology studies in North America and Europe have shown the LSTM model to successfully match conceptual model performance at a daily time step over hundreds of catchments. Here we investigate how these models perform in producing monthly runoff predictions in the relatively dry and variable conditions of the Australian continent. The monthly time step matches historic data availability and is also important for future water resources planning; however, it provides significantly smaller training datasets than daily time series. In this study, a continental-scale comparison of monthly deep learning (LSTM) predictions to conceptual rainfall–runoff (WAPABA model) predictions is performed on almost 500 catchments across Australia with performance results aggregated over a variety of catchment sizes, flow conditions, and hydrological record lengths. The study period covers a wet phase followed by a prolonged drought, introducing challenges for making predictions outside of known conditions – challenges that will intensify as climate change progresses. The results show that LSTM models matched or exceeded WAPABA prediction performance for more than two-thirds of the study catchments, the largest performance gains of LSTM versus WAPABA occurred in large catchments, the LSTMs struggled less to generalise than the WAPABA models (e.g. making predictions under new conditions), and catchments with few training observations due to the monthly time step did not demonstrate a clear benefit with either WAPABA or LSTM. [ABSTRACT FROM AUTHOR]

Event-based rainfall-runoff models are practical tools commonly used to predict catchments' response to a rainfall event. However, one of the main concerns is that the characteristics of rain events are neglected in the model development. This paper develops a novel event-based rainfall-runoff equation to incorporate rainfall characteristics into account. The performance of the new equation is evaluated based on the root mean square error, Nash–Sutcliffe efficiency coefficient, and per cent bias for 13,339 rainfall-runoff events between 2005 and 2020 over 23 catchments across New Zealand and Australia with oceanic, mediterranean, tropical, subtropical, and semiarid climates. Compared to the previous event-based models, the new equation shows an improvement in runoff estimation in almost all case studies. Furthermore, considering the new equation is simple, efficient, and takes the rain event duration into account, the new equation has the potential to become a robust alternative method to the conventional curve number method in hydrological engineering projects. [ABSTRACT FROM AUTHOR]

The aims of this study were to assess the cross-cultural invariance of athletes' self-reports of mental toughness and to introduce and illustrate the application of approximate measurement invariance using Bayesian estimation for sport and exercise psychology scholars. Athletes from Australia (n = 353, Mage = 19.13, SD = 3.27, men = 161), China (n = 254, Mage = 17.82, SD = 2.28, men = 138), and Malaysia (n = 341, Mage = 19.13, SD = 3.27, men = 200) provided a cross-sectional snapshot of their mental toughness. The cross-cultural invariance of the mental toughness inventory in terms of (a) the factor structure (configural invariance), (b) factor loadings (metric invariance), and (c) item intercepts (scalar invariance) was tested using an approximate measurement framework with Bayesian estimation. Results indicated that approximate metric and scalar invariance was established. From a methodological standpoint, this study demonstrated the usefulness and flexibility of Bayesian estimation for single-sample and multigroup analyses of measurement instruments. Substantively, the current findings suggest that the measurement of mental toughness requires cultural adjustments to better capture the contextually salient (emic) aspects of this concept. [ABSTRACT FROM AUTHOR]

Australia experiences some of the world's most variable rainfall. Previous studies have mostly focused on understanding rainfall variability in terms of frequency and intensity. However, understanding the timing of when extreme rainfall occurs is crucial for seasonal prediction, although it largely remains unexplored. Here we investigate the timing of extreme rainfall in Australia and the spatial variability of this timing. This study examines how some of the large‐scale drivers, such as the El Niño–Southern Oscillation (ENSO) and the Interdecadal Pacific Oscillation (IPO), determine the timing and interannual variability of the timing of extreme rainfall in Australia. Our results show that there is a clear spatial north–south delineation in the season when extreme rainfall occurs in Australia, shown by a contour diagonally extending roughly from 21°S in the west of Australia to 33°S in the east. North of this contour, extreme rainfall usually occurs in austral summer, with the smallest interannual variability in the timing of extreme rainfall in this region. In the south, extreme rainfall usually occurs in autumn/winter months; however, the timing is highly variable. In southeast Australia (SEA), extreme rainfall can fall at any time of the year, which makes seasonal prediction extremely challenging for this region. Both observation and reanalysis data show that the area where extreme rainfall occurs in summer extends further south during negative IPO years. We also find that IPO and ENSO phases, and the interaction between them, play significant roles in both determining the timing of extreme rainfall and constraining the interannual variability, especially in SEA. We focus on SEA for further analysis as this region shows the greatest shift in seasonality of extremes in response to large‐scale variability. We conclude that studying the relationship between rainfall and large‐scale drivers is important for verification and improvement of the seasonal prediction of extreme rainfall. [ABSTRACT FROM AUTHOR]

Determining mean transit times in headwater catchments is critical for understanding catchment functioning and understanding their responses to changes in landuse or climate. Determining whether mean transit times (MTTs) correlate with drainage density, slope angle, area, or land cover permits a better understanding of the controls on water flow through catchments and allows first‐order predictions of MTTs in other catchments to be made. This study assesses whether there are identifiable controls on MTTs determined using 3H in headwater catchments of southeast Australia. Despite MTTs at baseflow varying from a few years to >100 years, it was difficult to predict MTTs using single or groups of readily‐measured catchment attributes. The lack of readily‐identifiable correlations hampers the prediction of MTTs in adjacent catchments even where these have similar geology, land use, and topography. The long MTTs of the Australian headwater catchments are probably in part due to the catchments having high storage volumes in deeply‐weathered regolith, combined with low recharge rates due to high evapotranspiration. However, the difficulty in estimating storage volumes at the catchment scale hampers the use of this parameter to estimate MTTs. The runoff coefficient (the fraction of rainfall exported via the stream) is probably also controlled by evapotranspiration and recharge rates. Correlations between the runoff coefficient and MTTs in individual catchments allow predictions of MTTs in nearby catchments to be made. MTTs are shorter in high rainfall periods as the catchments wet up and shallow water stores are mobilized. Despite the contribution of younger water, the major ion geochemistry in individual catchments commonly does not correlate with MTTs, probably reflecting heterogeneous reactions and varying degrees of evapotranspiration. Documenting MTTs in catchments with high storage volumes and/or low recharge rates elsewhere is important for understanding MTTs in diverse environments. [ABSTRACT FROM AUTHOR]

The main objective of this study is to investigate how brightness temperature observations from satellite microwave sensors may help to reduce errors and uncertainties in soil moisture and evapotranspiration simulations with a large-scale conceptual hydro-meteorological model. In addition, this study aims to investigate whether such a conceptual modelling framework, relying on parameter calibration, can reach the performance level of more complex physically based models for soil moisture simulations at a large scale. We use the ERA-Interim publicly available forcing data set and couple the Community Microwave Emission Modelling (CMEM) platform radiative transfer model with a hydro-meteorological model to enable, therefore, soil moisture, evapotranspiration and brightness temperature simulations over the Murray–Darling basin in Australia. The hydro-meteorological model is configured using recent developments in the SUPERFLEX framework, which enables tailoring the model structure to the specific needs of the application and to data availability and computational requirements. The hydrological model is first calibrated using only a sample of the Soil Moisture and Ocean Salinity (SMOS) brightness temperature observations (2010–2011). Next, SMOS brightness temperature observations are sequentially assimilated into the coupled SUPERFLEX–CMEM model (2010–2015). For this experiment, a local ensemble transform Kalman filter is used. Our empirical results show that the SUPERFLEX–CMEM modelling chain is capable of predicting soil moisture at a performance level similar to that obtained for the same study area and with a quasi-identical experimental set-up using the Community Land Model (CLM). This shows that a simple model, when calibrated using globally and freely available Earth observation data, can yield performance levels similar to those of a physically based (uncalibrated) model. The correlation between simulated and in situ observed soil moisture ranges from 0.62 to 0.72 for the surface and root zone soil moisture. The assimilation of SMOS brightness temperature observations into the SUPERFLEX–CMEM modelling chain improves the correlation between predicted and in situ observed surface and root zone soil moisture by 0.03 on average, showing improvements similar to those obtained using the CLM land surface model. Moreover, at the same time the assimilation improves the correlation between predicted and in situ observed monthly evapotranspiration by 0.02 on average. [ABSTRACT FROM AUTHOR]

Rivers provide crucial ecosystem services in water-stressed drylands. Australian dryland rivers are geomorphologically diverse, ranging from through-going, single channels to discontinuous, multi-channelled systems, yet we have limited understanding of their sensitivity to future hydroclimatic changes. Here, we characterise for the first time the geomorphology of 29 dryland rivers with catchments across a humid to arid gradient covering >1,800,000 km2 of continental eastern and central Australia. Statistical separation of five specific dominantly alluvial river types and quantification of their present-day catchment hydroclimates enables identification of potential thresholds of change. Projected aridity increases across eastern Australia by 2070 (RCP4.5) will result in ~80% of the dryland rivers crossing a threshold from one type to another, manifesting in major geomorphological changes. Dramatic cases will see currently through-going rivers (e.g. Murrumbidgee, Macintyre) experience step changes towards greater discontinuity, characterised by pronounced downstream declines in channel size and local termination. Expanding our approach to include other river styles (e.g. mixed bedrock-alluvial) would allow similar analyses of dryland rivers globally where hydroclimate is an important driver of change. Early identification of dryland river responses to future hydroclimatic change has far-reaching implications for the ~2 billion people that live in drylands and rely on riverine ecosystem services. [ABSTRACT FROM AUTHOR]

Documenting the processes that control the variations in stream geochemistry at different streamflows is important for being able to use chemical tracers to understand catchment functioning. The concentrations of most solutes, including reactive cations (e.g., Na, Ca, K, and Mg) and anions that are primarily derived from precipitation (Cl and Br), in five headwater streams from southeast Australia vary little with streamflow and are close to being chemostatic. By contrast, NO3 and SO4 concentrations are higher at high streamflows. There is also a systematic increase of 3H activities from as low as 1.1 to as high as 2.6 TU with increasing streamflow. The changes in geochemistry cannot be explained solely by increased mineral dissolution at high streamflows or enhanced baseflow driven by hydraulic loading. They are best explained by an increased baseflow input augmented by water mobilized from shallower stores as the catchments wet up. The mean transit times of the water sustaining streamflow varies from 35 to 70 years at low streamflows to <7 years at high streamflows. The use of a range of geochemical tracers, including radioactive isotopes, allows the different possible causes of chemostatic behaviour to be assessed and improves our understanding of catchment functioning. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Marrow granulomas have been commonly associated with mycobacterial infections, prompting extensive investigations in some cases where they are found, but in the setting of changing infectious epidemiology, there is a lack of recent data to guide the search for probable causes. Methods: A retrospective case series examining the clinical and pathological findings in all cases where marrow granulomas were reported over a 10‐year period at The Canberra Hospital, Australia. Results: Of the 6062 marrow biopsies performed, 73 (1.2%) from 66 individuals had confirmed granulomas. Some patients had multiple potential causes found. B‐cell non‐Hodgkin Lymphoma, sarcoidosis and autoimmune disease were the most frequently observed causes. Infections were less common in this cohort than in the previous series, with no tuberculosis seen. The presence of granulomas in the marrow did not signify the presence of active malignancy in the marrow. There were no associations with any specific morphological characteristics of the granulomas and the presumed causes. Conclusion: Marrow granulomas are seen in a variety conditions. Neither their presence nor their morphological features are a guide to further investigations, which should be determined by the clinical presentation as appropriate. [ABSTRACT FROM AUTHOR]

Peatlands are a distinctive and important component of many upland regions that commonly contain distinctive flora and fauna which are different from those of adjacent forests and grasslands. Peatlands also represent a significant long-term store of organic carbon. While their environmental importance has long since been recognised, water transit times within peatlands are not well understood. This study uses tritium (³H) to estimate the mean transit times of water from peatlands and from adjacent gullies that contain eucalypt forests in the Victorian Alps (Australia). The ³H activities of the peatland water range from 2.7 to 3.3 tritium units (TUs), which overlap the measured (2.9 to 3.0 TU) and expected (2.8 to 3.2 TU) average ³H activities of rainfall in this region. Even accounting for seasonal recharge by rainfall with higher ³H activities, the mean transit times of the peatland waters are < 6.5 years and may be less than 2 years. Water from adjacent eucalypt forest streams has ³H activities of 1.6 to 2.1 TU, implying much longer mean transit times of 5 to 29 years. Cation = Cl and Si = Cl ratios are higher in the eucalypt forest streams than the peatland waters and both of these water stores have higher cation = Cl and Si = Cl ratios than rainfall. The major ion geochemistry reflects the degree of silicate weathering in these catchments that is controlled by both transit times and aquifer lithology. The short transit times imply that, unlike the eucalypt forests, the peatlands do not represent a long-lived store of water for the local river systems. Additionally, the peatlands are susceptible to drying out during drought, which renders them vulnerable to damage by the periodic bushfires that occur in this region. [ABSTRACT FROM AUTHOR]

Headwater streams contribute a significant proportion of the total flow to many river systems, especially during summer low-flow periods. However, despite their importance, the time taken for water to travel through headwater catchments and into the streams (the transit time) is poorly understood. Here, ³H activities of stream water are used to define transit times of water contributing to streams from the upper reaches of the Ovens River in south-east Australia at varying flow conditions. ³H activities of the stream water varied from 1.63 to 2.45 TU, which are below the average ³H activity of modern local rainfall (2.85 to 2.99 TU). The highest ³H activities were recorded following higher winter flows and the lowest ³H activities were recorded at summer low-flow conditions. Variations of major ion concentrations and ³H activities with streamflow imply that different stores of water from within the catchment (e.g. from the soil or regolith) are mobilised during rainfall events rather than there being simple dilution of an older groundwater component by event water. Mean transit times calculated using an exponential-piston flow model range from 4 to 30 years and are higher at summer low-flow conditions. Mean transit times calculated using other flow models (e.g. exponential flow or dispersion) are similar. There are broad correlations between ³H activities and the percentage of rainfall exported from each catchment and between ³H activities and Na and Cl concentrations that allow first-order estimates of mean transit times in adjacent catchments or at different times in these catchments to be made. Water from the upper Ovens River has similar mean transit times to the headwater streams implying there is no significant input of old water from the alluvial gravels. The observation that the water contributing to the headwater streams in the Ovens catchment has a mean transit time of years to decades implies that these streams are buffered against rainfall variations on timescales of a few years. However, impacts of any changes to land use in these catchments may take years to decades to manifest themselves in changes to streamflow or water quality. [ABSTRACT FROM AUTHOR]

The dramatic decline in the quality of coral reef cover of the Great Barrier Reef (GBR) over recent decades has resulted in targeted research to better understand the dynamics of sedimentary sources within river systems of Northeastern Australia. European land-use practices are thought to have increased sediment yields to the GBR lagoon by 5–10 times, yet there is a poor understanding of the pre-1850 sediment dynamics. This study presents the first detailed alluvial chronology of the spatial and temporal responses of fluvial systems in the Wet Tropics of Northeastern Australia over the late Holocene. Valley fill sequences of the Daintree River, one of the least disturbed catchments draining to the GBR lagoon, are examined to investigate the significance of floodplain dynamics in sedimentary process. An optically stimulated luminescence chronology combined with a detailed sedimentary analysis suggests that floodplain stripping is a major, and hitherto unrecognised, source of sediment. Furthermore, rates of floodplain accretion are far greater than has been previously estimated from sediment modelling for wet tropical catchments. Spatial analysis of the topographical relationships between floodplain morphological units suggests that a total of 178,516 ton/ha of sediment has been stripped from three small confined floodplain reaches between 1038 ± 215 and 99 ± 10 years. Evidence suggests that these erosion events are followed by phases of rapid accretion with an average depositional rate of 3.87 ± 0.92 cm/yr between 572 ± 74 and 51 ± 12 years across the study area. The floodplain appears to be in a constant state of disequilibrium, experiencing spatially discontinuous phases of erosion and aggradation resulting in much higher volumes of sediment being redistributed within the catchment than previously considered. The unpredictable nature of these regimes and the shear volume of sediment mobilised poses significant challenges in managing sediment sources to the GBR lagoon. [ABSTRACT FROM AUTHOR]

Acidic groundwater generated from pyrite oxidation in acid sulfate (AS) soil is a major geoenvironmental problem in Australia. This study aims to evaluate recycled concrete as a reactive material in permeable reactive barriers (PRBs) for the remediation of acidic groundwater in low-lying AS soil floodplains. Laboratory experiments were systematically conducted to investigate the acid neutralization behavior of recycled concrete and its potential to remove dissolved Al and Fe. The results confirmed that recycled concrete could effectively treat acidic groundwater from an AS soil terrain, resulting in near neutral effluent over a long period with complete removal of Al and Fe. The major mechanisms involved in neutralizing acidic groundwater are thought to be the precipitation of Al and Fe as oxides, oxyhydroxides, and hydroxides. However, the accumulation of secondary minerals could decrease the reactivity of the recycled concrete. For example, chemical armoring could decrease the neutralizing capacity of recycled concrete by up to 50% compared with the theoretical acid neutralization capacity of this material. The results reported here also show that the neutralization capacity and reactive efficiency of recycled concrete are dependent on the initial pH value and also the concentration of Al and Fe in acidic groundwater. [ABSTRACT FROM AUTHOR]

Contaminated groundwater resulting from pyrite oxidation of acid sulfate soils (ASSs) is a major environmental problem in coastal Australia. A column test was carried out for an extended period with recycled concrete to study the efficiency of the reactive materials for neutralizing acidic groundwater. Results show that the actual acid neutralization capacity of the recycled concrete could decrease to less than 50% of the theoretical value due to armoring effects. Nevertheless, the performance is good as a spot treatment in ASS Terrain using a near-zero cost waste product. Based on the test results and site characterization, a permeable reactive barrier (PRB) with recycled concrete was designed and installed in ASS terrain on the Shoalhaven River floodplain, southeastern, Australia in October 2006. The performance of the PRB was studied over two and half years to assess the potential of recycled concrete (1) to neutralize the groundwater acidity and (2) to remove the dissolved heavy metals such as iron and aluminum from in situ acidic groundwater. To date, performance monitoring of the PRB shows that recycled concrete can successfully improve the pH of groundwater from acidic to mildly alkaline. In addition, it successfully removes groundwater iron and aluminum. Results reported here also reveal a slow decrease in the performance of the PRB due to armoring effects probably caused by precipitation of iron and aluminum on the surface of the reactive recycled concrete materials. [ABSTRACT FROM AUTHOR]

We conducted a cost-benefit analysis of the contrasting phenologies of two evergreen and two deciduous species of the savannas of north Australia. Stomatal conductance, rates of light-saturated assimilation (Amax) and dark respiration were measured for six leaves from each of five or six trees. These leaves were then analyzed for total nitrogen, ether-soluble lipids, ash content, and heat of combustion. Construction and maintenance costs, nitrogen-use efficiencies and instantaneous transpiration efficiencies were then calculated from these data.Evergreen species had significantly lower specific leaf area, leaf nitrogen and leaf ash content than deciduous species. Evergreen species also had significantly higher heat of combustion and lipid content of crude extracts than deciduous species. Light-saturated assimilation rates were higher in evergreen species on a leaf area basis, but were higher in deciduous species on a leaf dry weight basis. In both evergreen and deciduous species, Amax and total Kjeldahl nitrogen were linearly related. Similarly, nitrogen-use efficiency did not differ among species. Leaf construction costs were significantly higher for evergreen species than for deciduous species, but maintenance costs did not differ among species. Evergreen species had a higher cost:benefit ratio than deciduous species but because of their longer-lived leaves, the payback interval was longer in evergreen species than in deciduous species. These results support the hypotheses that: (1) longer-lived leaves are more expensive to construct than shorter-lived leaves, and (2) there is a higher investment of nitrogen into short-lived leaves to support a higher Amax over a shorter payback interval. We conclude that deciduous and evergreen species partition resources both temporally and spatially, thereby reducing interspecies competition. [ABSTRACT FROM AUTHOR]

Windows account for a significant proportion of the total energy lost in buildings. The interaction of window type, Window-to-Wall Ratio (WWR) scheduled and window placement height influence natural lighting and heat transfer through windows. This is a pressing issue for nontropical regions considering their high emissions and distinct climatic characteristics. A limitation exists in the adoption of common simulation-based optimisation approaches in the literature, which are hardly accessible to practitioners. This article develops a numerical-based window design optimisation model using a common Building Information Modelling (BIM) platform adopted throughout the industry, focusing on nontropical regions of Australia. Three objective functions are proposed; the first objective is to maximise the available daylight, and the other two emphasize undesirable heat transfer through windows in summer and winter. The developed model is tested on a case study located in Sydney, Australia, and a set of Pareto-optimum solutions is obtained. Through the use of the proposed model, energy savings of up to 8.57% are achieved. [ABSTRACT FROM AUTHOR]

Background: Shift work is characterised by displaced sleep opportunities and associated sleep disturbance. Shift workers often report sleepiness and other wake time symptoms associated with poor sleep. However, clinical sleep disorders are also prevalent in shift workers. Although prevalence rates are similar or higher in shift workers compared with the general population, help seeking in shift workers with sleep disorders is low., Objective: This article aims to provide general practitioners with a contemporary overview of the prevalence rates for sleep disorders in shift workers, to clarify the existing evidence relating to mental and physical health consequences of sleep disorders in shift workers and to highlight the need to consider undiagnosed sleep disorders before attributing sleep-related symptoms solely to work schedules., Discussion: Symptoms of sleep loss associated with shift work overlap with symptoms experienced by individuals living with sleep disorders. Although >40% of middle-aged Australians live with a sleep disorder that requires investigation and management, symptoms in shift workers are often attributed to the work schedule and, as a result, might not be investigated for appropriate diagnosis and treatment. We argue that screening for sleep disorders in shift workers with sleep complaints should be a priority.

Background: Healthy sleep is vital for optimal child development, yet over 30% of Australian parents report having children with disrupted sleep affecting all family members. These sleep difficulties might co-exist with sleep breathing disorders, contributing to morbidity and reduced quality of life., Objective: This article aims to provide general practitioners (GPs) with an evidence-based, biopsychosocial approach to managing common sleep problems in infants and preschool-aged children., Discussion: Strategies and techniques are outlined to aid GPs in promoting healthy sleep during infancy, educating parents on typical sleep patterns and supporting families in managing problematic sleep patterns in toddlers. Emphasis is placed on a tailored approach to developing a healthy sleep environment to meet the child's needs and parental values. Valuable resources and indications for specialist consultation are included.

Background: Insomnia and obstructive sleep apnoea are the two most common sleep disorders and frequently co-exist. Patients with comorbid insomnia and sleep apnoea experience worse daytime function, mental health and physical health than patients with either disorder alone. General practitioners may face unique challenges in the assessment and management of this prevalent and debilitating condition., Objective: This article aims to provide an overview of the prevalence, consequences, assessment and management of patients with comorbid insomnia and sleep apnoea in Australian general practice., Discussion: Patients with either insomnia or sleep apnoea should be assessed for both conditions. Treatments for both disorders should be offered to patients with both conditions. The recommended treatment for insomnia is cognitive behavioural therapy, whereas the recommended first-line treatment for moderate and severe obstructive sleep apnoea is lifestyle/weight management advice (where relevant) and continuous positive airway pressure therapy.

Background: Chronic insomnia is a prevalent and debilitating disorder managed in Australian general practice. The most effective and recommended first-line treatment for insomnia is cognitive behavioural therapy. This treatment has been translated to a condensed brief behavioural therapy for insomnia (BBTi), which is suitable for delivery in the general practice setting. There is evidence that BBTi improves insomnia, daytime functioning and quality of life, with effects persisting far beyond treatment cessation. BBTi appears to be a cost-effective treatment that is superior to sedative-hypnotic management., Objective: The aim of this article is to present a step-by-step approach for Australian general practitioners to administer BBTi., Discussion: BBTi is an effective treatment for insomnia that may be administered in the Australian general practice setting. General practitioners may choose to use existing funding support to administer BBTi to treat chronic insomnia according to guideline recommendations.

Effective cardiovascular disease (CVD) prevention relies on timely identification and intervention for individuals at risk. Conventional formula-based techniques have been demonstrated to over- or under-predict the risk of CVD in the Australian population. This study assessed the ability of machine learning models to predict CVD mortality risk in the Australian population and compare performance with the well-established Framingham model. Data is drawn from three Australian cohort studies: the North West Adelaide Health Study (NWAHS), the Australian Diabetes, Obesity, and Lifestyle study, and the Melbourne Collaborative Cohort Study (MCCS). Four machine learning models for predicting 15-year CVD mortality risk were developed and compared to the 2008 Framingham model. Machine learning models performed significantly better compared to the Framingham model when applied to the three Australian cohorts. Machine learning based models improved prediction by 2.7% to 5.2% across three Australian cohorts. In an aggregated cohort, machine learning models improved prediction by up to 5.1% (area-under-curve (AUC) 0.852, 95% CI 0.837-0.867). Net reclassification improvement (NRI) was up to 26% with machine learning models. Machine learning based models also showed improved performance when stratified by sex and diabetes status. Results suggest a potential for improving CVD risk prediction in the Australian population using machine learning models.

Background: Atrial fibrillation (AF) management guidelines recommend screening for symptoms of sleep-disordered breathing (SDB). We aimed to assess the role of self-reported daytime sleepiness in detection of patients with SDB and AF., Methods: A total of 442 consecutive ambulatory patients with AF who were considered candidates for rhythm control and underwent polysomnography comprised the study population. The utility of daytime sleepiness (quantified by the Epworth Sleepiness Scale [ESS]) to predict any (apnea-hypopnea index [AHI] ≥ 5), moderate-to-severe (AHI ≥ 15), and severe (AHI ≥ 30) SDB on polysomnography was tested., Results: Mean age was 60 ± 11 years and 69% patients were men. SDB was present in two-thirds of the population with 33% having moderate-to-severe SDB. Daytime sleepiness was low (median ESS = 8/24) and the ESS poorly predicted SDB, regardless of the degree of SDB tested (area under the curve: 0.48-0.56). Excessive daytime sleepiness (ESS ≥ 11) was present in 11.9% of the SDB population and had a negative predictive value of 43.1% and a positive predictive value of 67.5% to detect moderate-to-severe SDB. Male gender (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 1.4-3.8, P = 0.001), obesity (OR: 3.5, 95% CI: 2.3-5.5, P < 0.001), diabetes (OR: 2.3, 95% CI: 1.2-4.4, P = 0.08), and stroke (OR: 4.6, 95% CI: 1.7-12.3, P = 0.002) were independently associated with an increased likelihood of moderate-to-severe SDB., Conclusions: In an ambulatory AF population, SDB was common but most patients reported low daytime sleepiness levels. Clinical features, rather than daytime sleepiness, were predictive of patients with moderate-to-severe SDB. Lack of excessive daytime sleepiness should not preclude patients from being investigated for the potential presence of concomitant SDB., (Copyright © 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)