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Background: Economic evaluations are less commonly applied to implementation interventions compared to clinical interventions. The efficacy of an implementation strategy to improve adherence to screening guidelines among first-degree relatives of people with colorectal cancer was recently evaluated in a randomized-controlled trial. Using these trial data, we examined the costs and cost-effectiveness of the intervention from societal and health care funder perspectives. Method: In this prospective, trial-based evaluation, mean costs, and outcomes were calculated. The primary outcome of the trial was the proportion of participants who had screening tests in the year following the intervention commensurate with their risk category. Quality-adjusted life years were included as secondary outcomes. Intervention costs were determined from trial records. Standard Australian unit costs for 2016/2017 were applied. Cost-effectiveness was assessed using the net benefit framework. Nonparametric bootstrapping was used to calculate uncertainty intervals (UIs) around the costs and the incremental net monetary benefit statistic. Results: Compared with usual care, mean health sector costs were $17 (95% UI [$14, $24]) higher for those receiving the intervention. The incremental cost-effectiveness ratio for the primary trial outcome was calculated to be $258 (95% UI [$184, $441]) per additional person appropriately screened. The significant difference in adherence to screening guidelines between the usual care and intervention groups did not translate into a mean quality-adjusted life year difference. Discussion: Providing information on both the costs and outcomes of implementation interventions is important to inform public health care investment decisions. Challenges in the application of cost-utility analysis hampered the interpretation of results and potentially underestimated the value of the intervention. Further research in the form of a modeled extrapolation of the intermediate increased adherence effect and distributional cost-effectiveness to include equity requirements is warranted.

Health promotion is conceived as a unifying concept for improving the health of populations. This means addressing the socio-cultural, economic and commercial causes of ill-health, which are necessarily informed by past policies and socio-cultural contexts. However, historical scholarship has rarely figured in health promotion practice or scholarship. This gap resides in the determinants of health, and notably in the analyses of tobacco control and skin cancer prevention, two long-running campaigns that have shaped modern health promotion in Australia. Both highlight a need for understanding the profound impact of history on the present and the value of learning from past successes and failures. Doing so requires integrating historical analyses into existing health promotion scholarship. To achieve this aim, we present a new 'public health humanities' methodology. This novel interdisciplinary framework is conceived as a spectrum in which historical studies integrate with existing health promotion disciplines to solve complex health problems. We draw on the many calls for more interdisciplinarity in health promotion and derive this methodology from proposals in the medical humanities and cognate fields that have wrestled with combining history and present-focused disciplines. Using tobacco control and skin cancer prevention as case studies, we demonstrate how public health humanities uses interdisciplinary teams and shared research questions to generate valuable new knowledge unavailable with traditional methods. Furthermore, we show how it creates evaluation criteria to consider the powerful impact of issues like colonialism on current inequities that hinder health promotion strategies, and from which lessons may be derived for the future. [ABSTRACT FROM AUTHOR]

Since Joseph Nye introduced the concept of "Soft power" in his 1991 book, "Bound to Lead: The Changing Nature of American Power", analysts have discussed states' efforts to exercise their influence by attracting and co-opting rather than coercing or using force. This paper will examine enrolments trends in Indonesian language in Australian universities, in the context of Indonesia's public diplomacy and Australian government educational policy. Enrolment data and trend analysis updates the 2012 National Report on "Indonesian in Australian Universities: Strategies for a Stronger Future". Then, using statistics provided by a recent Newspoll commissioned by the Australian Department of Foreign Affairs and Trade, the article explores Australian attitudes to Indonesia in the context of Indonesia's limited linguistic "soft power". It concludes that the fluctuations in Indonesian language learning in Australia and Australian attitudes to Indonesia generally appear more influenced by Australian government policy than any conscious efforts by Indonesia to exercise "soft power". It concludes that it is to the advantage of both countries that Indonesian language learning be better promoted and supported.

For many women, the only alternative to breast reconstruction following a mastectomy is to use external prostheses, which need replacing regularly at a cost of up to $395 per prosthesis. Commonwealth and state governments across Australia have responded to this need by providing subsidies to assist in the purchase of breast prostheses. However, current arrangements have been highly variable and sometimes difficult to access. As part of a larger review of breast prosthesis services in Victoria, Australia, the aim of this research was to evaluate client satisfaction among Victorian women who accessed funds through the State Government's Aids and Equipment Program, compare the responses of the program service providers with the experiences of clients accessing funding, and identify opportunities to improve service provision.

It can be expected that the power systems of the future will be significantly different from today’s, especially due to increasing renewable energy sources (RESs), storage systems, and price-responsive users leading to large uncertainty and complexity. The operation of these future grids (FGs) at levels of renewable energy approaching 100% will require all the usual stability analysis along with new issues in a much more complex situation than has been encountered in the past. In fact, how close we can get to this desired level will likely be dependent on the assessed stability limits. Therefore, in this study, we use a novel scenario-sensitivity-contingency based framework to evaluate the system stability along possible evolution pathways towards high renewable FGs. As a case study, we carry out our studies based on proposed future scenarios and sensitivities for the Australian FG. Using a simulation platform that encompasses market simulation, load flow calculation and stability assessment altogether, the impact of grid strength, level of prosumers, and utility storage on the stability of the FG is studied and quantified indices for long term stability have been devised. The results of this study enable us to address the underlying stability issues of the FGs. [ABSTRACT FROM AUTHOR]

Objective: Supportive care is recognised as an integral component of cancer care. To comprehensively improve supportive care and to inform policy, it is essential to examine consumer's views of health services. This study aimed to develop and test a patient‐centred approach by measuring consumer perspectives on the importance of aspects of supportive care to determine what patients consider highest quality or 'optimal' care. Methods: A cross‐sectional survey was conducted in oncology outpatient clinics. Eligible patients were invited to complete the optimal care survey on an iPad. The survey consisted of 69 items assessing 14 care domains across five phases of the care trajectory. Results: A total of 359 participants completed the survey. Items in the 'preparation for treatment' and 'follow‐up and end‐of‐life care' phases were endorsed as very important/essential to optimal care by most participants (79–97% and 80–100%, respectively). Items in the 'preparation for first appointment' (48–84%), 'first appointment' (51–97%) and 'receiving treatment' (32–93%) phases showed greater variation in endorsement. Conclusion: This study provides a patient‐centred tool for quantifying optimal supportive care for people with cancer across the treatment trajectory. This tool could be used by healthcare providers to evaluate existing care quality, develop policies and guide clinical service improvements. [ABSTRACT FROM AUTHOR]

Background: Limited data Exists ? on the Australian epidemiology of renal trauma, with very few studies published in the literature. The authors aim to detail the trends of renal trauma in the coastal city of the Gold Coast. Methods: Retrospective data collection yielded 81 patients who sustained renal trauma from our 3‐year period. Data included information on demographics, mechanism, American Association for the Surgery of Trauma (AAST) grade, presence of haematuria, associated injuries, management, and complications. Results: Male patients accounted for 83% (n = 67) of cases, and the average age of all injuries was 36 years. Low‐grade AAST Grade I–III injuries comprised of 76% (n = 62) of injuries, AAST Grade IV contributed to 20% (n = 16) and 4% (n = 3) of injuries were AAST Grade V. The most common mechanism of injury was road accidents accounting for 35% (n = 28) followed by fall‐related injuries (26%, n = 21). Other mechanisms included sport‐related (13.5%, n = 11), non‐motorized bicycle injuries (8.5%, n = 7), alleged assault (8.5%, n = 7), pedestrian injuries (5%, n = 4) and horse‐related injuries (2%, n = 2). Ninety‐six percent (n = 78) of kidney injuries were managed conservatively. Of the patients requiring intervention, all were AAST Grade V kidney injuries. Conclusion: Males accounted for the majority of renal trauma cases, similar to the 3:1 ratio of male‐to‐female injuries found in other studies. In line with other studies, renal trauma reviewed on the Gold Coast also revealed road trauma as the leading cause, closely followed by falls. The majority of high‐grade renal trauma was managed conservatively. Renal trauma trends from a Gold Coast trauma centre, including mechanisms of injury, American Association for the Surgery of Trauma (AAST) grades of injury, associated injuries, management and complications. Unique mechanisms in the authors' institution included Australian Rules Football‐ and Surf‐related renal trauma. Outcomes supported that the majority of haemodynamically stable high‐grade renal trauma can be successfully managed conservatively. [ABSTRACT FROM AUTHOR]

Abstract: In 2006 Australia introduced graphic health warnings (GHW) on cigarette packets, depicting a range of tobacco-related pathology. This intervention, controlling the appearance of a consumer product, was designed to raise consumers’ awareness of the harms of tobacco use, motivate quitting, and discourage uptake of smoking. This study applies the reasoned action approach to assess the relevance of GHW-related beliefs and attitudes to smokers’ behavioural intentions and smoking behaviour. A sample of 587 smokers was recruited through a random representative population survey in 2005, prior to the introduction of new warnings. A subset of 158 was followed up a year later. The results show that GHW-related beliefs and attitudes were predictive of intention to quit smoking. Intentions to quit were, in turn, predictive of quitting behaviour as measured in the follow up stage. New GHW warnings, smokers are presumed to have been exposed to, were also associated with changes in beliefs over time. [Copyright &y& Elsevier]

Background: In the year 2006, Australia introduced graphic cigarette packet warnings. Previous warnings were text only. New warnings include one of 14 pictures, many depicting tobacco-related pathology. Methods: This study monitored the roll-out of the health policy initiative using multiple methodologies. Print media coverage of new pack warnings was observed over 3 years. Story content was coded as positive (supportive of pack warnings), neutral or negative. An observational study of small random sample of metropolitan stores (n = 16) over 7 months measured the pace of the roll-out in shops. Once new packs were readily available in stores, smokers (n = 152) were intercepted in city streets and asked about their reactions. Results: Of the 67 media stories, 85% were positive or neutral about the new warnings and 15% were negative. Supportive content presented health benefits. Unsupportive content presented industry arguments. After the legislative change, it took 2 months before any new packs appeared in stores. After 6 months, the majority carried them. Newest images had highest recall among smokers. About 60% said new warnings detracted from the look of their brand. About 51% felt the increased risk of dying from smoking-related illness. About 38% felt motivated to quit. Conclusion: Plans by government to introduce graphic warnings were delayed up to 2 years, apparently by heavy industry lobbying. Actual widespread appearance in shops occurred several months after the implementation date. While media coverage of the new warnings reported the industry arguments against them, the balance of coverage was overwhelmingly positive. Smokers’ initial reactions were in line with tobacco control objectives. [ABSTRACT FROM PUBLISHER]

Australia has an evolving national cancer control agenda. In this paper, we review the history and development of cancer control policies in Australia up to the end of 2005, and discuss the principal publications produced by both government and non-government groups which have given rise to cancer control recommendations, goals and targets. These cancer control plans have arisen in response to the impact of cancer on the Australian community and in recognition of the health gains that can be made through effective cancer control. They have been developed either in the context of a broader framework of health policy or as specific endeavours in regard to cancer. The specific recommendations and strategies proposed have focused on reducing the impact of cancer in the Australian population. Most commonly, recommendations, goals, and targets within the cancer control plans have addressed points along the continuum of care, specific cancers, and frameworks and processes. The strength of these reports is their comprehensive approach in identifying priority cancers and areas where specific developments should impact on morbidity and mortality. In the future, cancer control plans should be better supported by economic evaluations, and greater financial support for implementation and regular assessment is needed to identify progress on cancer outcomes. The more recent national and State cancer control plans include the development of frameworks to foster a coordinated and cohesive approach to the delivery of cancer care. These plans represent important reforms in cancer care in Australia, and have the potential to reduce the impact of cancer on the community and improve health outcomes. [ABSTRACT FROM AUTHOR]

Aims To incorporate a psychosocial model of tobacco smoking into a behavior genetic design to examine genetic and environmental influences on variation in smoking involvement. Design Longitudinal twin study. Setting and participants Twins initially aged between 13 and 18 years and registered with the Australian Twin Registry were surveyed three times between 1988 and 1996. A total of 414 pairs of identical and same-sex fraternal twin pairs participated in all three surveys, aged between 20 and 25 at wave 3. Biometric modelling estimated the influence of genetic and environmental factors in determining variation in smoking at each wave, both before and after adjusting for perceived smoking behaviours of peers and parents. Measurements Twins answered a questionnaire on their own smoking status and reported on the use of tobacco by parents and friends as they perceived it, at each survey wave. Findings At all three surveys, current smokers were more likely to have parents who smoked and to have smokers among their peers. Genes and environmental factors, both common and unique, contributed to variation in smoking behaviours. However, after controlling for the smoking behaviours of peers and parents, the role of genes in determining variation in smoking involvement was reduced by 100% at wave 1 and by 30% at wave 2. Friends' smoking reduced the magnitude of the common environment variance by 11%, 30% and 40% at waves 1, 2 and 3, respectively. Parents' smoking behaviours explained part of the common environment. Biometric modelling of the covariation between smoking involvement and peer smoking suggested that genes might influence smoking involvement at wave 1 by influencing choice of peers. Conclusion Environmental factors play the greatest role in determining variation in tobacco smoking among adolescents and young adults. Among adolescents, genes may influence variation in smoking behaviours indirectly by influencing choice of peers. However, genes seem to have a... [ABSTRACT FROM AUTHOR]

Objective: This study was initiated to estimate the prevalence of alcohol use among Australian secondary students in 1999 and to examine changes in that prevalence over a 15-year period between 1984 and 1999. Method: A randomly selected representative sample of approximately 400 secondary schools across Australia participated in the study. At each school, up to 80 randomly selected students completed a pencil-and-paper questionnaire anonymously. Results: The use of alcohol by secondary students was widespread in 1999. By the age of 15, 44% of boys and 36% of girls had consumed alcohol in the week before the survey. Among 1.6 and 17 year olds, about 50% had consumed alcohol in this time period. Of 16 and 17 year olds who had consumed alcohol in the past week, around 35% had drunk at hazardous levels. Long-term trends in alcohol use showed declines during the late 1980s but increases through the 1990s. While the proportion of hazardous drinkers among 12-15 year olds had not changed throughout the 1990s, the proportion among 16 and 17 year olds had increased over the period of the survey. The proportion of current drinkers buying the last alcoholic drink consumed had decreased since 1987, although there was no change between 1996 and 1999 among 16 and 17 year olds. Conclusions: Alcohol is widely used by secondary students in Australia, and significant proportions of the student population drink at hazardous levels. [ABSTRACT FROM AUTHOR]

This research estimates the prevalence of alcohol use among Australian secondary students in 1996 and examines trends in alcohol prevalence over a 12-year period. A national randomly selected representative sample of 434 secondary schools participated in the 1996 study. Eghty students were selected randomly from each school and completed a questionnaire anonymously. Current drinking (drinking alcohol in the week before the survey) increased with age from 17% of boys and 10% of girls aged 12 to 56% of boys and 50% of girls aged 17. Comparisons with data collected by similar surveys in 1984, 1987, 1990 and 1993 showed that while fewer 12-15-year-olds were current drinkers in 1996 than in 1984 or 1987, the 1996 proportion was no different from the 1993 proportion. In 1996, there were more hazardous drinkers among male current drinkers aged 12-15 than in any other survey period. Among 16-and 17-year-olds, there were more current drinkers in 1996 than in 1993 or 1990, and more male and female current drinkers were drinking at hazardous levels in 1996 than in 1987 and 1990. Extrapolating from the 1996 findings, nearly 424000 students aged 12-17 years were current drinkers. [ABSTRACT FROM AUTHOR]

Australia introduced new health warnings and contents labelling on cigarettes and other tobacco products from January 1995. The changes were based on recommendations emerging from research commissioned for that purpose. The research demonstrated the need for changes, that changes could increase the noticeability of the warnings and contribute to an increase in relevant knowledge, and that the changes were acceptable to the public. The tobacco industry fought the changes and some modifications resulted, but new stronger warnings with elaborations on the back of the pack, an information number to call and elaborated contents labelling have been implemented. [ABSTRACT FROM AUTHOR]

A community antismoking campaign began in Sydney, Australia in 1983, and in Melbourne in 1984. These campaigns purchased prime-time television advertising spots to set the community agenda. An intense effort was made to ensure that Antismoking activities were maximized at the school, organizational, and community level. Smoking prevalences in both cities from 1981 were fitted with a statistical model to identify any underlying trend, to assess any immediate impact, and to assess the longer term effect of continuing to conduct such campaigns, i.e. to identify any change in the underlying trend. During the years before the antismoking campaigns, there was no observable trend in smoking prevalence in either city. At the beginning of the campaigns, there was an immediate drop of more than two percentage points in male and female smoking prevalence in both cities. Thereafter, a decline of about 1.5 percentage points per year was observed among males. No post campaign trend was observed in smoking prevalence for women in either city. These data support conducting coordinated community campaigns to reduce current smoking prevalence. (Am J Public Health 1990; 80:565-569.) [ABSTRACT FROM AUTHOR]

The article presents information on the factors related to continued breast self-examination (BSE) practice. The factors were determined using BSE training sessions between February 1985 and September 1987 in Victoria, Australia. Breast self-examination (BSE) is an effective method of detecting breast cancer in the early stages. It is particularly effective if women have been personally trained in BSE techniques and their examinations are regular and systematic. The aim of this study is to evaluate the effectiveness of a comprehensive BSE teaching program, called Mammacheck.

The article presents information on the development of Mammacheck breast self-examination (BSE) training program by the Anti-Cancer Council of Victoria, Australia. The program is delivered on a large scale throughout Victoria by a network of health educators. This report describes the experience of teaching BSE to the first 6,000 participants. Breast cancer is the most commonly occurring internal cancer in Australian women, with one in 15 women expected to develop breast cancer in her lifetime. BSE is one precaution women can take against breast cancer.

The article reports on a strategy that was developed to increase participation in screening mammography. 668 randomly selected women were interviewed from the target population of an Australian pilot screening mammography program. The aims of the study were to use cross-sectional data to determine factors which predicted women's intentions regarding attendance at the Program. Some of the variables that entered the final regression model are the intensity of thought about getting breast cancer; a belief that early detection is extremely desirable and that screening mammograms are accurate; having had a Pap test within the last 2 years; and a feeling of personal susceptibility to breast cancer.

Approaches in both the primary prevention and early detection areas to control the incidence and mortality of skin cancer have been examined in terms of a model for skin cancer control. Population-based approaches are thought to be appropriate in public health terms because it is possible for individuals to reduce their exposure to sunburn (and subsequently, their risk of skin cancer), by individual sun protection behavioural change. A number of preventative intervention studies have identified specific methods for achieving such change. The success of Australian efforts in changing behaviours and reducing sunburn is also described, along with the need to equip doctors and patients with the knowledge and skills required for the early detection of skin cancer. Approaches that promote screening with acceptable sensitivity along with reasonable specificity are important when considering the costs and effectiveness of population-based programmes. [ABSTRACT FROM AUTHOR]

Carbon pricing is often discussed as a means by which to reduce power sector emissions, but typically faces opposition on the grounds that such schemes will increase wholesale electricity prices and have adverse impacts on the wider economy. Consequently, there is renewed focus on emissions pricing initiatives that have muted price impacts, with a Refunded Emissions Payments Scheme one such example. Under this mechanism, collected emissions payments are refunded to generators in proportion to energy output, with the net effect of the scheme resulting in each generator being subject to a net liability per MWh that is proportional to the difference between it's own emissions intensity and the average emissions intensity of energy produced by regulated plant. A limitation of the scheme is the average emissions intensity of energy produced by regulated plant is only known after energy has been delivered, therefore there is some uncertainty with respect to each generator's short-run marginal cost at the time of production. The presented framework addresses this issue by developing adaptive recalibration strategies that seek to make these net liabilities explicit. A rule-based updating strategy is developed, along with a highly generalisable model predictive control framework for updating scheme parameters. A case study using an agent-based framework is used to evaluate these mechanisms in the context of Australia's National Electricity Market, and demonstrates how a policymaker could use such an approach to transparently update scheme parameters, and also accomplish auxiliary economic objectives. • Emissions payments refunded using model predictive control. • Net liabilities faced by generators are made explicit at the time of generation. • Emissions intensity baseline adjusted to manage net accrued scheme revenue. • Lookahead horizon impacts net accrued scheme revenue and baseline variability. • Minimal impact on wholesale electricity prices under a 40 $/tCO 2 emissions price. [ABSTRACT FROM AUTHOR]

In 2016, 2017 and 2018, elevated levels of the species Alexandrium pacificum were detected within a blue mussel (Mytilus galloprovincialis) aquaculture area at Twofold Bay on the south coast of New South Wales, Australia. In 2016, the bloom persisted for at least eight weeks and maximum cell concentrations of 89,000 cells L−1 of A. pacificum were reported. The identity of A. pacificum was confirmed using molecular genetic tools (qPCR and amplicon sequencing) and complemented by light and scanning electron microscopy of cultured strains. Maximum reported concentrations of paralytic shellfish toxins (PSTs) in mussel tissue was 7.2 mg/kg PST STX equivalent. Elevated cell concentrations of A. pacificum were reported along the adjacent coastal shelf areas, and positive PST results were reported from nearby oyster producing estuaries during 2016. This is the first record of PSTs above the regulatory limit (0.8 mg/kg) in commercial aquaculture in New South Wales since the establishment of routine biotoxin monitoring in 2005. The intensity and duration of the 2016 A. pacificum bloom were unusual given the relatively low abundances of A. pacificum in estuarine and coastal waters of the region found in the prior 10 years. [ABSTRACT FROM AUTHOR]

Abstract: A sample of staff working in the Australian Public Service (n = 2113) were surveyed two to four weeks before a mandated total ban on workplace smoking was introduced, and again five to six months later. Among the 391 smokers on whom complete data were available, the workplace smoking bans were associated with reduced rates of smoking, particularly among heavier smokers where the reduction in consumption was over 25 percent. [ABSTRACT FROM AUTHOR]

Background: In the present paper we describe the presentation andmanagement of ductal carcinoma in situ (DCIS) of the breast inwomen in Australia in 1995. This representative, national data setprovides a historical comparator for studies examining DCIS managementthat follow. Methods: Surgeons identified by population-based cancer registriesas having treated a new diagnosis of DCIS between 1 April and 30September 1995 completed a questionnaire on the presentation andmanagement of each case. Results: Two hundred and five surgeons supplied treatment detailson 418 DCIS tumours in 415 women. Half of all tumours were detectedat BreastScreen clinics and a further 25% were detectedat other mammography centres. Twenty-six percent of tumours werepalpable at presentation, 33% were multifocal and 55% werehigh grade (including comedocarcinoma). Breast conserving therapy(BCT) rather than mastectomy was utilized in 260 (62%)of cases. Tumours that were of low grade, small in size and not multifocalwere more likely to be treated by BCT. Surgeons seeing six or moreDCIS cases in the 6-month period were more likely to utilize BCT.Of the conservatively treated cases, 22% were referredfor a radiation oncology consultation. The most common reasons fortreating DCIS with mastectomy were that the tumour was too extensiveor multifocal (63%), it extended to margins of the specimen(42%), or patient concerns about recurrence (34%). Conclusions: In 1995 the majority of DCIS was treated with breastconserving surgery alone. Surgeons treating more DCIS cases weremore likely to perform conservative surgery than surgeons treatingonly one DCIS case in the study period. [ABSTRACT FROM AUTHOR]

Objective To determine the impact of tobacco control policies and mass media campaigns on smoking prevalence in Australian adults. Methods Data for calculating the average monthly prevalence of smoking between January 2001 and June 2011 were obtained via structured interviews of randomly sampled adults aged 18 years or older from Australia’s five largest capital cities (monthly mean number of adults interviewed: 2375). The influence on smoking prevalence was estimated for increased tobacco taxes; strengthened smoke-free laws; increased monthly population exposure to televised tobacco control mass media campaigns and pharmaceutical company advertising for nicotine replacement therapy (NRT), using gross ratings points; monthly sales of NRT, bupropion and varenicline; and introduction of graphic health warnings on cigarette packs. Autoregressive integrated moving average (ARIMA) models were used to examine the influence of these interventions on smoking prevalence. Findings The mean smoking prevalence for the study period was 19.9% (standard deviation: 2.0%), with a drop from 23.6% (in January 2001) to 17.3% (in June 2011). The best-fitting model showed that stronger smoke-free laws, tobacco price increases and greater exposure to mass media campaigns independently explained 76% of the decrease in smoking prevalence from February 2002 to June 2011. Conclusion Increased tobacco taxation, more comprehensive smoke-free laws and increased investment in mass media campaigns played a substantial role in reducing smoking prevalence among Australian adults between 2001 and 2011. [ABSTRACT FROM AUTHOR]

• A framework for aggregating large-scale prosumers in electricity markets is proposed. • The proposed bi-level framework is linearized by duality theory and big-M method. • Cases studies based on 120,000 prosumers from Australia are conducted. • Increasing prosumers enlarges the gap between strategic and non-strategic bidding. Increased penetration of distributed energy resources is unleashing the flexibility of large-scale prosumers in deregulated markets. To explore prosumers' potential market revenues, some existing studies have focused on the strategic bidding of prosumers aggregation. A majority of those studies assume the price-taker role of the aggregator while a few studies assume the price-maker role of the aggregator. However, it remains an open question as to how the increasing number of prosumers influences the profit of a strategic aggregator. Therefore, we conduct a numerical analysis in this paper to quantify the profits of aggregating large-scale prosumers. A stochastic bi-level optimization model is proposed to depict the strategic behavior of prosumers aggregation bidding in joint energy and regulation markets. This bi-level model is transformed into a mixed-integer linear programming model by employing the Karush-Kuhn-Tucker conditions based on strong duality theory. Case studies based on 120,000 prosumers from Australia demonstrate that the strategic bidding behavior of an aggregator can lead to a 7.5% decrease in operation costs, and increasing the number of prosumers will lead to a larger gap between non-strategic and strategic behavior. [ABSTRACT FROM AUTHOR]

Introduction: Knee osteoarthritis (OA) is the most prevalent arthritis type and a leading cause of chronic mobility disability. While pain medications provide only symptomatic pain relief; growing evidence suggests pentosan polysulfate sodium (PPS) is chondroprotective and could have anti-inflammatory effects in knee OA. This study aims to explore the efficacy and safety of oral PPS in symptomatic knee OA with dyslipidaemia., Methods and Analysis: MaRVeL is a phase II, single-centre, parallel, superiority trial which will be conducted at Royal North Shore Hospital, Sydney, Australia. 92 participants (46 per arm) aged 40 and over with painful knee OA and mild to moderate structural change on X-ray (Kellgren and Lawrence grade 2 or 3) will be recruited from the community and randomly allocated to receive two cycles of either oral PPS or placebo for 5 weeks starting at baseline and week 11. Primary outcome will be the 16-week change in overall average knee pain severity measured using an 11-point Numeric Rating Scale. Main secondary outcomes include change in knee pain, patient global assessment, physical function, quality of life and other structural changes. A biostatistician blinded to allocation groups will perform the statistical analysis according to the intention-to-treat principle., Ethics and Dissemination: The protocol has been approved by the NSLHD Human Research Ethics Committee (HREC) (2021/ETH00315). All participants will provide written informed consent online. Study results will be disseminated through conferences, social media and academic publications., Trial Registration Numbers: Australian New Zealand Clinical Trial Registry (ACTRN12621000654853); U1111-1265-3750., Competing Interests: Competing interests: DJH is supported by an NHMRC Practitioner Fellowship and provides consulting advice for Haleon, Novartis, TLC Bio, Tissuegene, Lilly and Pfizer., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study explored associations between exposure to other people's gambling and the prevalence of gambling in the last month, engagement in hard gambling activities (defined as those which occur more frequently, with a quicker determination of outcomes, and/or high payout ratios), and the prevalence of at risk and problem gambling, among a large sample of Australian adolescent school students., Method: In 2017, 6,377 students from Victoria and Queensland answered gambling questions as part of the cross-sectional triennial Australian Secondary Students' Alcohol and Drug Survey. Students reported on gambling behaviors (gambling in the last month, types of gambling activities), were assessed for problem gambling using the Diagnostic Statistical Manual IV adapted for Juveniles (DSM-IV-[MR]-J), and reported whether people they knew (parents, siblings, other relatives, best friend, or someone else) had gambled in the last month. Logistic regressions explored the relationship between other people's gambling and student gambling behaviors in the last month., Results: Approximately, one in five students reported that someone from their household gambled in the last month. Overall, 6% of students reported they had gambled, and 4% gambled on a hard gambling activity, in the previous month; 10% were classified as potentially at risk or problem gamblers. Having a parent, sibling, best friend, another relative, or someone else who gambled in the last month were each significantly associated with the three gambling outcomes., Conclusions: There is a need to address the modeling of gambling behaviors by young people's friends, family, and others, in order to reduce gambling behaviors and problem gambling among Australian adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Youth gambling is associated with a range of harms. This study aimed to examine, among Australian adolescents, the prevalence of gambling (ever, in the last month, at-risk and problem), the most frequent gambling types and modalities, and to explore the student characteristics associated with gambling in the last month and with at-risk or problem gambling. Students aged 12-17 years from Victoria and Queensland answered gambling questions as part of the Australian Secondary School Alcohol and Drug (ASSAD) Survey in 2017. The ASSAD also included a series of questions about smoking, alcohol and other drug use, and mental health. A total of 6377 students from 93 schools were included in analysis. The prevalence of ever gambling and gambling in the last month was 31% and 6% respectively. Of students who had gambled in the last month, 34% were classified as at-risk and 15% were classified as problem gamblers. The most frequent types of gambling in the last month were horse or dog race and sports betting. Students who gambled in the last month did so most frequently via a parent or guardian purchasing or playing for them, at home or at a friends' house, and online or using an app. Regression analysis indicated that male gender, having money available to spend on self, alcohol consumption in the last seven days, the number of types of advertisements seen in the last month, and the number of peer or family members who gambled in the last month, were significantly associated with the likelihood of students gambling in the last month. Male gender, some age categories, and exposure to more types of gambling advertising were also significant predictors of being classified as an at-risk or problem gambler. This large study of youth gambling provides data on gambling behaviours and related variables from a large sample of Australian secondary school students. Student characteristics, including male gender and exposure to more types of gambling advertising, were associated with an increased likelihood of gambling in the last month and of being classified as an at-risk or problem gambler. Further implications of the study findings are discussed., (© 2022. The Author(s).)

Purpose: To examine variations in anxiety and longitudinal associations between unmet supportive care needs and elevated anxiety in young women (< 50 years) within 13 months of their breast cancer diagnosis., Methods: Two hundred and nine women recruited through Victorian Cancer Registry completed questionnaires at study entry (T1) (average 7 months post-diagnosis) then 3 (T2) and 6 months later (T3). Women completed the Hospital Anxiety and Depression Scale (HADS) and Supportive Care Needs Survey-Breast Cancer (SCNS-Breast) at each time point. Primary outcome was anxiety with six domains of SCNS-Breast (physical daily living, information, psychological, health system information, peer support, patient care and miscellaneous needs) the key predictors. Generalised estimating equations examined longitudinal associations., Results: Over the 6 months, the proportion of young women with elevated anxiety decreased (T1, 41% to T3, 35%; p = .06) as did the proportion with any moderate or high unmet needs (T1, 88%; T3, 74%; p < .01). While psychological needs and peer needs were positively associated with anxiety levels in multivariable cross-sectional analyses, in multivariable longitudinal analysis, only informational needs were associated with higher levels of anxiety (p < .001) with this association holding after adjusting for baseline anxiety levels., Conclusions: While reducing over time, a third of young women treated for breast cancer enter early survivorship with elevated anxiety and unmet supportive care needs., Implications for Cancer Survivors: As informational needs were positively associated with future levels of anxiety, addressing needs in this domain may decrease the risk of anxiety in younger women with breast cancer.

Background: Although food allergy has probably risen over recent decades, recent reports suggest that the prevalence of food sensitization in the general population has not changed. However, this has not been analyzed in infants at high risk of food allergy., Objective: The objective of this study was to compare the prevalence of food sensitization in high-risk infants from 2 cohorts recruited 15 years apart in the same region., Methods: This study includes 620 high-risk infants with a family history of allergy (Melbourne Atopy Cohort Study [MACS]) born 1990-1994, and a subgroup of high-risk infants from the population-based HealthNuts study (n = 3,661/5,276), born 2006-2010. Both studies undertook skin prick tests (SPT) to peanut, egg, and milk at age 12 months. A logistic regression model generated adjusted prevalences to account for differences in sampling frame. SPT ≥ 95% positive predictive values (PPVs) for food allergy were used as proxies for food allergy., Results: The adjusted prevalence of sensitization in MACS was similar to the observed prevalence of sensitization in the high-risk subgroup of HealthNuts: 7.9% (95% confidence interval 6.8-8.9) and 7.9% (7.0-8.8) respectively for peanut, 15.0% (13.4-16.6) and 14.5% (13.4-15.7) respectively for egg, and 2.4% (1.6-3.1) and 2.6% (2.0-3.4) respectively for cow's milk. The prevalence of SPT ≥ 95% PPVs was similar between the 2 studies., Conclusions: The prevalence of food sensitization among high-risk infants has remained stable in Australia since the 1990s, despite the reported increase in food-related anaphylaxis in the same period. This discrepancy could be due to increased food allergy in the low-risk population, increased conversion of food sensitization to allergy, or increased number of high-risk infants. Alternatively, increased awareness or severity of reactions may have led to an apparent increase in food allergy., (Copyright © 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Rationale: Better characterization of childhood wheeze phenotypes using newer statistical methods provides a basis for addressing the heterogeneity of childhood asthma. Outcomes of these phenotypes beyond childhood are unknown., Objectives: To determine if adolescent respiratory symptoms, lung function, and changes in lung function over adolescence differ by childhood wheeze phenotypes defined through latent class analysis., Methods: A prospective birth cohort (Melbourne Atopy Cohort Study) followed 620 high allergy-risk children, recording respiratory symptoms and spirometry at 12 and 18 years. Regression analyses identified relationships between wheeze phenotypes (never/infrequent, early transient, early persistent, intermediate onset, and late onset) and lung function, change in lung function (12-18 yr), respiratory symptoms, and asthma. The baseline classification was never/infrequent wheeze., Measurements and Main Results: Deficits in expected growth of lung function, measured by change in prebronchodilator FEV1 between 12 and 18 years, were found for early persistent (reduced 290 ml; 95% confidence interval [CI], 82-498), intermediate-onset (reduced 210 ml; 95% CI, 62-359), and late-onset wheeze (reduced 255 ml; 95% CI, 69-442). Intermediate-onset wheezers had persistent FEV1 deficit after bronchodilator at 18 years (reduced 198 ml; 46,350). Current asthma risk was increased for all phenotypes except early transient, which was also not associated with lung function deficits at 12 or 18 years., Conclusions: Persistent wheeze phenotypes in childhood were associated with reduced growth in prebronchodilator FEV1 over adolescence. Intermediate-onset wheezers showed irreversible airflow limitation by 18 years. Conversely, early transient wheeze was a benign condition with no sequelae for respiratory health by age 18.

Background: Although systematic use of the Perinatal Society of Australia and New Zealand internationally endorsed Clinical Practice Guideline for Perinatal Mortality (PSANZ-CPG) improves health outcomes, implementation is inadequate. Its complexity is a feature known to be associated with non-compliance. Interactive education is effective as a guideline implementation strategy, but lacks an agreed definition. SCORPIO is an educational framework containing interactive and didactic teaching, but has not previously been used to implement guidelines. Our aim was to transform the PSANZ-CPG into an education workshop to develop quality standardised interactive education acceptable to participants for learning skills in collaborative interprofessional care., Methods: The workshop was developed using the construct of an educational framework (SCORPIO), the PSANZ-CPG, a transformation process and tutor training. After a pilot workshop with key target and stakeholder groups, modifications were made to this and subsequent workshops based on multisource written observations from interprofessional participants, tutors and an independent educator. This participatory action research process was used to monitor acceptability and educational standards. Standardised interactive education was defined as the attainment of content and teaching standards. Quantitative analysis of positive expressed as a percentage of total feedback was used to derive a total quality score., Results: Eight workshops were held with 181 participants and 15 different tutors. Five versions resulted from the action research methodology. Thematic analysis of multisource observations identified eight recurring education themes or quality domains used for standardisation. The two content domains were curriculum and alignment with the guideline and the six teaching domains; overload, timing, didacticism, relevance, reproducibility and participant engagement. Engagement was the most challenging theme to resolve. Tutors identified all themes for revision whilst participants identified a number of teaching but no content themes. From version 1 to 5, a significant increasing trend in total quality score was obtained; participants: 55%, p=0.0001; educator: 42%, p=0.0004; tutor peers: 57%, p=0.0001., Conclusions: Complex clinical guidelines can be developed into a workshop acceptable to interprofessional participants. Eight quality domains provide a framework to standardise interactive teaching for complex clinical guidelines. Tutor peer review is important for content validity. This methodology may be useful for other guideline implementation.

Objective: The objective was to assess the effectiveness of a volunteer-delivered tailored telephone-based intervention in reducing prevalence of unmet supportive care needs, elevated levels of anxiety and depression among people with colorectal cancer over a 9-month period., Methods: There were 653 participants who completed the baseline questionnaire and were randomised to usual care (n = 341) or intervention (n = 306). Three follow-up questionnaires were completed at 3-monthly intervals (response rates: 93%, 87%, 82%, respectively). All four questionnaires contained the Supportive Care Needs Survey (SCNS), Hospital Anxiety and Depression Scale (HADS) and checklists for colorectal cancer symptoms and use of support services. The intervention consisted of trained volunteers providing emotional support, service referral and information and was delivered after completion of each of the first three questionnaires. Primary outcomes were prevalence of moderate to high SCNS needs and elevated levels (scores of 8+) of HADS anxiety and depression., Results: Over the study period, SCNS needs decreased similarly for both groups, and prevalence of elevated depression did not change for either group. There was a greater reduction in the prevalence of elevated anxiety in the intervention than usual care group (p < 0.01), with the intervention group decrease mainly occurring between baseline and the first follow-up survey (p < 0.01). However, the prevalence of elevated anxiety was similar between the two groups at each follow-up point., Conclusions: The intervention had no effect on supportive care needs or depression, although it may be associated with a greater reduction in anxiety. Future research should test the intervention with patients closer to diagnosis., (Copyright © 2011 John Wiley & Sons, Ltd.)

Background: Reducing childhood exposure to ultraviolet radiation is important to minimize lifetime skin cancer risk., Objectives: We sought to describe the prevalence of children's sun-related behaviors and associated parental and other factors., Methods: In weekly cross-sectional telephone interviews during summer, 1140 parents/guardians of children aged 0 to 11 years were recruited. Parents provided proxy reports for one of their children. Key questions related to weekend sun protection and sunburn, parent's sun-related attitudes, and demographic characteristics. Potential predictors of children's sun protection and sunburn were analyzed adjusting for covariates including weather conditions on the previous weekend., Results: On summer weekends, 73% of children spent longer than 15 minutes outdoors in peak ultraviolet radiation periods. Of these, 64% were protected by a hat and 58% by sun-protection factor 15 or higher sunscreen, 32% stayed under shade, and 18% wore three-quarter or long-sleeved tops. Overall, 8% of children had sunburn. Parental attitudes were typically supportive of children's sun protection. Parental use of hats (odds ratio [OR] 3.1; 95% confidence interval [CI] 1.6-6.2), shade (OR 9.6; 95% CI 4.4-20.8), sunscreen (OR 12.6; 95% CI 5.2-30.4), longer leg cover (OR 10.3; 95% CI 4.4-24.0), and two or more protective behaviors (OR 5.7; 95% CI 2.8-11.9) increased the odds of their children practicing these behaviors, as did some parental attitudes., Limitations: We relied on cross-sectional parent reports., Conclusion: Although children's sun protection was favorable, there was room for improvement. Health promotion to improve sun-protection practices in adults may benefit children's sun-safe behaviors., (Copyright © 2011 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Identification of children at risk of developing asthma provides a window of opportunity for risk-reducing interventions. Allergen sensitization might identify high-risk children., Objective: We sought to determine whether skin prick tests (SPTs) to individual allergens up to age 2 years predict wheeze at age 12 years., Methods: In a birth cohort of 620 children oversampled for familial allergy, sensitization was assessed by using SPTs (monosensitized, polysensitized, or either) to 6 allergens at ages 6, 12, and 24 months. Wheeze and eczema were recorded 18 times during the first 2 years. Current wheeze was recorded at age 12 years. Adjusted associations were evaluated by multiple logistic regression., Results: A positive SPT to house dust mite (HDM) at age 1 or 2 years predicted wheeze at age 12 years (adjusted odds ratio: 1 year, 3.31 [95% CI 1.59-6.91]; 2 years, 6.37 [95% CI, 3.48-11.66]). Among wheezy 1-year-olds, those who were HDM sensitized had a 75% (95% CI, 51% to 91%) probability of wheeze at age 12 years compared with a 36% (95% CI, 23% to 50%) probability among those not sensitized. Among eczematous 1-year-olds, those who were HDM sensitized had a 67% (95% CI, 45% to 84%) probability of wheeze at age 12 years compared with a 35% (95% CI, 25% to 45%) probability among those not sensitized. Among 1-year-old children with both eczema and wheeze, the probability of wheeze at age 12 years was 64% (95% CI, 35% to 87%) if HDM sensitized and 50% (95% CI, 26% to 74%) if not., Conclusion: HDM sensitization at age 1 or 2 years in wheezing and eczematous children at increased familial allergy risk predicts asthma and may inform management of these high-risk groups., (Copyright © 2011 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.)

The role of early childhood infections and immunisation in the development of allergic diseases remains controversial. To examine these associations, six hundred and twenty infants with first-degree relatives with allergic diseases were recruited into the Melbourne Atopy Cohort Study. Information on risk factors and outcomes was collected by interviewer administered questionnaire and was based on parental report and/or a physician's diagnosis. Risk factors examined included early childhood infections (including gastroenteritis, otitis media and lower respiratory tract infections) and immunisations in the first 2 yr of life. Outcomes were current asthma, allergic rhinitis and eczema at 6 yr of age. Univariate and multivariate regression analysis were used to estimate relative risk (RR) and assess confounding. By 6 yr, 79% of the original cohort remained in the study. Those with at least three episodes of gastroenteritis showed an increased risk (crude RR 2.36, 95%CI 1.41 3.95; adjusted RR 2.03 95%CI 1.50 2.75) for the later development of asthma at age 6. Of the scheduled immunisations, Sabin immunisation in the second year had a reduced risk of asthma at 6 yr (crude RR 0.60, 95%CI 0.37 0.98; adjusted RR 0.63 95%CI 0.39 1.02). Combined diphtheria and tetanus (CDT) immunisation in the first year had an increased risk of asthma at 6 yr (RR 1.76, 95%CI 1.11 2.78; adjusted RR 1.88 95%CI 1.28 2.77). Recurrent gastroenteritis in early childhood is associated with a later risk of asthma. This may reflect a cause and effect relationship, or exposure to common risk factors. In contrast, Sabin immunisation in the second year is associated with a decreased risk of asthma in later childhood. CDT immunisation in the first year may be a risk factor for asthma, but the need for CDT immunisation may also be a marker of increased risk of asthma in later childhood., (© 2010 John Wiley & Sons A/S.)