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The concept of coastal sediment compartments was first used in the 1960s in the United States. It has since been recognised as appropriate for defining sections of the Australian coast, but had not been uniformly adopted around the nation in the way that has underpinned management, as in other countries. In 2012, the Australian Government supported a project to better understand coastal sediment dynamics using the sediment compartment approach as a framework within which to consider future shoreline behaviour and the impacts of climate change, including rising sea level, changing wave climates and sediment budgets. This paper outlines the sediment compartment project and uses case studies to demonstrate its application. The project consisted of three steps. The first step involved delineation of a hierarchy of coastal sediment compartments following a nationally agreed set of criteria, integrating the onshore/offshore geologic framework with known patterns of sediment movement and those inferred from surface landforms. This identified more than 100 primary compartments bounded by major structural features such as headlands or changes of shoreline orientation. At a finer scale, approximately 350 secondary compartments were identified, many of which encompass smaller scale structural features that define tertiary scale compartments or cells. For verification of this sediment compartments approach to coastal planning and management, the second step of the study comprised case studies of contrasting compartments with different patterns of sediment supply, transport and deposition. The third step, involved embedding all secondary compartments around the continental coast into the Shoreline Explorer, within the CoastAdapt toolbox (National Climate Change Adaption Research Facility). Information regarding the sensitivity of shorelines to change was compiled at the compartment scale, based upon evidence such as substrate, sediment transport attributes and oceanographic forcing, including waves, tides and storm processes. Presentation of information through CoastAdapt within the compartments framework provides a resource to facilitate improved coastal planning and management over different implementation levels, from national strategy scale down to local policy scale. Case studies from several contrasting settings around the Australian coast demonstrated the potential and feasible application of the sediment compartment approach at different spatial and temporal scales. [ABSTRACT FROM AUTHOR]

Osteoporosis constitutes a major public health problem through its association with age-related fractures, most notably those of the proximal femur. Substantial geographic variation has been noted in the incidence of hip fracture throughout the world, and estimates of recent incidence trends have varied widely. Studies in the published literature have reported an increase, plateau, and decrease in age-adjusted incidence rates for hip fracture among both men and women. Accurate characterisation of these temporal trends is important in predicting the health care burden attributable to hip fracture in future decades. We therefore conducted a review of studies worldwide, addressing secular trends in the incidence of hip and other fractures. Studies in western populations, whether in North America, Europe or Oceania, have generally reported increases in hip fracture incidence through the second half of the last century, but those continuing to follow trends over the last two decades have found that rates stabilise with age-adjusted decreases being observed in certain centres. In contrast, some studies suggest that the rate is rising in Asia. This synthesis of temporal trends in the published literature will provide an important resource for preventing fractures. Understanding the reasons for the recent declines in rates of hip fracture may help understand ways to reduce rates of hip fracture worldwide. [ABSTRACT FROM AUTHOR]

This paper presents the results of a detailed survey into the reasons for the spate of mergers between Geography and Environment Studies that took place in Australian universities from 1989 to 1999. The results, from a 1998 survey, suggest that the development of a symbiotic relationship between the two areas of study is merely a veneer masking a complexity of underlying factors. These include financial reasons, internal university politics, staff changes and mobility, and only in some cases, a genuine academic rationale for a merger. The paper concludes that the superficial appearance of a symbiosis between Geography and Environment Studies generally masks an opportunistic pragmatism which is very site specific in its complexity. The result has been a series of departmental mergers which, although providing a firmer financial footing, raise questions about the academic implications for the development of both study areas as we move into the third millennium. [ABSTRACT FROM AUTHOR]

This paper identifies four triggers that underpinned the late 20th century reform of coastal management in Australia. These have operated across federal, state and local levels of government. The triggers are global environmental change, sustainable development, integrated resource management, and community awareness of management issues and participation in decision making. This reform has been driven by international and national forces. A number of inquiries into coastal management in Australia culminated in the production of a national coastal policy in 1995. This has led to fundamental changes in coastal management and to the recognition of the inevitability of changes in coastal systems. Federal policies and programs are being translated into action at the state and local government levels through a variety of funding mechanisms and programs. These involve capacity building, a memorandum of understanding between all levels of government, an enhanced role for state advisory or co-ordinating bodies, and an increased role for public participation. [ABSTRACT FROM AUTHOR]

The global concern about human-induced climatic change and its potential effect on sea-level has dominated the debate on coastal vulnerability, particularly since a common assessment methodology was developed by the Intergovernmental Panel on Climate Change in 1991. There have been numerous attempts to use or adapt this methodology but the focus has remained on sea-level rise as the single most important issue for coastal vulnerability. This paper presents a revised and more holistic coastal vulnerability assessment methodology which incorporates spatial and temporal scales relevant to the predicted impacts of climatic change and current human-induced hazards. Three studies in contrasting coastal environments of South Australia demonstrate that there are significant regional variations in sea-level response, human-induced hazards and local planning issues and that these may present a greater immediate threat than the possibility of sea-level rise. [ABSTRACT FROM AUTHOR]

Introduction: Maternity unit closures in rural and remote settings of Australia have left a substantial gap in services for pregnant women. In the absence of midwives, and when women are unable to attend a maternity facility, registered nurses (RNs) are required to fill the void. While maternity education can attempt to prepare RNs for such encounters, there is little documented to suggest it meets all their physical and psychological needs. The existing challenges for health professionals, practising a vast generalist scope of practice while living and working in a rural and remote location, have been well researched and documented. How nurses feel about the expectation that they work outside their scope of practice to provide maternity care in a rural and remote setting in Australia has not been asked until now. This study explores the perceptions and experiences of RNs who find themselves in this situation., Methods: The study utilised a hermeneutic phenomenological methodology to examine the experiences and perceptions of rural and remote nurses providing care for pregnant women. RNs working in rural and remote health facilities that had no maternity services were recruited by a purposive sampling method. Semistructured conversational interviews were recorded and transcribed verbatim. Data analysis was guided by van Manen's analytical approach., Results: Eight nurses participated, and from the data three themes, each with several subthemes, emerged: 'being-in-the-world of the rural and remote nurse' - described how participants viewed rural and remote nursing as an entity with unchangeable aspects that could not be considered in isolation; 'scope of practice - unprepared or underprepared' described how, despite their existing and extensive nursing skills, participants felt ill-equipped theoretically, practically and mentally to care for pregnant women; 'moral distress' - participants expanded their feelings of unpreparedness to include inadequacy, fear, and appropriateness of care delivery., Discussion: The realism of rural and remote nursing practice demonstrates that at some point in their career, rural and remote nurses will care for a labouring and/or pregnant woman at high risk for complications. Participants in this study appeared open and honest in their interviews, displaying pride at their extensive nursing skills and job satisfaction. However, they were unanimous in their discussions of what being a nurse and providing maternity care in a rural and remote setting meant to themselves and to pregnant women. They suggested care was fragmented and inadequate from a workforce that is inadequately prepared and stressed., Conclusion: This study has highlighted another concerning aspect of rural and remote midwifery care - the experiences and perceptions of eight nurses delivering care that has previously been overlooked. The united voice of the RNs in this study warrants a platform to speak from and deserves acknowledgement and attention from government and midwifery policy drivers. These nurses, and the women receiving their care, deserve more.

Introduction: In remote Australian hospitals there are no onsite paediatric intensive care units (PICUs), increasing the reliance on aeromedical retrieval to access tertiary care. Nasal high flow (NHF) therapy is an oxygen therapy used in tertiary hospitals to treat paediatric patients with respiratory conditions. In rural and remote Queensland, Australia, the use of NHF therapy is inconsistent and there are no guidelines on how this therapy should be implemented in practice. Therefore, three remote hospitals within the Torres Strait and Cape York commenced a project to improve consistent and equitable access to NHF therapy. Implementing NHF therapy in remote hospitals may improve health and social outcomes for children with acute respiratory distress. A clinical guideline for the use of NHF therapy in the three participating remote hospitals was published on 28 October 2021. This study aimed to develop a clinical guideline for the use of NHF therapy in three remote hospitals., Methods: A modified Delphi technique was used to develop the guideline. Remote medicine and nursing clinicians at the three study sites, retrieval experts, a receiving tertiary-based paediatrician, PICU specialists and NHF therapy experts made up the expert panel of participants. These experts participated in an iterative round table discussion to develop remote-specific guidelines for the use of NHF therapy. Prior to the meeting, panellists were provided with an executive summary of the current literature on NHF therapy implementation with key questions for consideration. Participants were able to add relevant issues ad hoc. A final guideline representing the panellists' recommendations was submitted to the Torres and Cape Health Service for ratification., Results: Remote-specific decisions on the following topics were produced: environment of care, nasogastric tube usage, timings of chest X-ray, automatic approvals to arrange courier services for pathology, medication use, staff training; staff ratios, observations regimes, both tertiary and local medical consultation frequency and the experience level of the medical officer required to attend to these consultations, location of the on-call medical officer, documentation, escalation of care considerations and disposition of the patient in relation to retrievals., Discussion: Decisions were made to mitigate two highly representative remote factors: delays in the workplace practices, such as time to arrange treatment locally and delays in retrievals; and burden of the lack of access to services, such as lack of access to trained staff, staffing levels on-shift, adequate oxygen and equipment/consumable supplies., Conclusion: The aim was to develop a clinical guideline that was contextualised to the remote hospital. This outcome was achieved by using a modified Delphi technique, with a panel of experts providing the decision-making for the guideline. Consistency and safety were addressed by reducing delays in workplace practices; examples were time to arrange treatment locally and mitigate delays in an unknown time to retrievals, access to trained staff, staffing levels, and communication between remote and tertiary teams.

Aim: To explore challenges and stressors experienced by rural and remote area nurses and identify any interventions that aided in decreasing stress and increasing job satisfaction., Background: Demand for a generalist nursing workforce in rural and remote locations exposes nurses to the same conditions as people residing there: higher mortality rates and higher incidence of chronic diseases and inadequacies in accessing health services., Design: Christmals and Gross's integrative review framework was used with specified inclusion and exclusion criteria. Four databases were searched with no date limits. Only Australian studies were searched as international scope of practice differences for nurses could have distorted findings., Findings: Eighteen studies identified three broad themes: access to education; isolation (geographical, professional and personal) and recognition of role., Discussion: Interlinked themes showed positives and negatives from differing viewpoints. Ambivalence to education stemmed from inadequate exposure to learning and was linked with geographical isolation. Isolation was found to be less of a challenge to nurses who had an existing emotional connection with the community., Conclusion: The themes identified were recurrent and interconnecting. The benefits of working in small rural and remote communities are being used as a driver for recruitment. These benefits include higher wages, providing a sense of belonging and allowing nurses to work to their full scope and develop generalist nursing skills. The geographical isolation generates challenges through inequality in access to education and professional support, working outside their scope of practice, safety and vulnerability that comes with living remotely and adapting to extreme weather conditions., Tweetable Abstract: What are the challenges and enablers of rural and remote working and living that influence job satisfaction for rural and remote area nurses in Australia?, Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Researchers from Australia, New Zealand, Canada and the United States collaborated to validate their foot and mouth disease models--AusSpread, InterSpread Plus and the North American Animal Disease Spread Model--in an effort to build confidence in their use as decision-support tools. The final stage of this project involved using the three models to simulate a number of disease outbreak scenarios, with data from the Republic of Ireland. The scenarios included an uncontrolled epidemic, and epidemics managed by combinations of stamping out and vaccination. The predicted numbers of infected premises, the duration of each epidemic, and the size of predicted outbreak areas were compared. Relative within-model between-scenario changes resulting from different control strategies or resource constraints in different scenarios were quantified and compared. Although there were differences between the models in absolute outcomes, between-scenario comparisons within each model were similar. In all three models, early use of ring vaccination resulted in the largest drop in number of infected premises compared with the standard stamping-out regimen. This consistency implies that the assumptions made by each of the three modelling teams were appropriate, which in turn serves to increase end-user confidence in predictions made by these models.

Aims: To describe results of a relative validation exercise using the three simulation models of foot-and-mouth disease (FMD) in use by the quadrilateral countries (QUADS; Australia, Canada, New Zealand, and United States of America; USA)., Methods: A hypothetical population of farms was constructed and, following the introduction of an FMD-like disease into a single farm, spread of disease was simulated using each of the three FMD simulation models used by the QUADS countries. A series of 11 scenarios was developed to systematically evaluate the key processes of disease transmission and control used by each of the three models. The predicted number of infected units and the size of predicted outbreak areas for each scenario and each model were compared using the Kruskal-Wallis test. Agreement among the three models in terms of geographical areas predicted to become infected were quantified using Fleiss' Kappa statistic., Results: Although there were statistically significant differences in model outputs in terms of the numbers of units predicted to become infected, the temporal onset of infection throughout the simulation period, and the spatial distribution of infected units, these differences were generally small and would have resulted in the same (or similar) management decisions being adopted in each case., Conclusions: Agreement among the three models in terms of the numbers of premises predicted to become infected, the temporal onset of infection throughout the simulation period, and the spatial distribution of infected premises provides evidence that each of the model developers are consistent in their approach to simulating the spread of disease throughout a population of susceptible individuals. This consistency implies that the assumptions taken by each development team are appropriate, which in turn serves to increase end-user confidence in model predictions., Clinical Relevance: Relative validation is one of a number of steps that can be undertaken to increase end-user confidence in predictions made by infectious disease models.

The experiences of nurses in war is prolifically described in the North American scholarly literature, and in the Australian nursing literature to a lesser extent. The literature describes the plights and achievements of nurses caring for soldiers and civilians often under the most undesirable of circumstances. A central focus of war time nursing is the resuscitation of critically wounded soldiers. This paper addresses the experiences of the Australian Army nurses who were involved in the triage and resuscitation of critically wounded allied and enemy soldiers in the Vietnam War between 1967 and 1971. As part of a research study to explore and analyse the nature of nursing work in the Vietnam War, seventeen Vietnam veteran nurses were interviewed about their experiences. This paper explores the progression of the triage department in the Australian military hospital in Vung Tau, and it highlights that the majority of the nurses who took part in this study were clinically unprepared, particularly as emergency nurses.

A retrospective analysis of 91 patients with endometrial carcinoma is presented with emphasis on important factors in relation to survival. Patients with Stage 1 carcinoma were treated with a standardized mode of preoperative radiation and extended abdominal hysterectomy. An 87.1% 5-year survival rate was obtained for patients with well differentiated lesions, with only 1 patient developing a vault metastasis. The assessment of residual tumour after intracavity radiotherapy proved reliable in predicting prognosis and should prove of benefit in directing additional therapy for endometrial carcinoma.