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Changes in the farm operating and policy environments and a need to remain profitable under a cost-price squeeze have contributed to dairy systems in Australia and New Zealand becoming more intensive and complex in recent decades. Farm systems in both countries are now diverse, varying from being based predominantly on pasture with little purchased supplements, to those dependent on high levels of feed supplements and even having zero grazing. Dairy farm performance (defined in this paper as production or technical performance), return (return on assets or profit) and risk (variation in economic performance over time), and intensity of dairy systems was examined using farm survey data, case studies and existing published studies. The level of single technical performance measures, such as milk production, feed conversion efficiency and pasture consumption, prevailing in a business are not guides to the operating profit and return on assets of a business. In addition, when survey data of farm performance was grouped by return on assets, few farms were in the top 25% in successive years. Farms that performed consistently well were characterised by good, but not extreme, technical performance in a range of key areas, which translated to favourable business return (return on asset and profit). The knowledge and skills of farm managers are critical, and means that many different dairy systems can perform well physically and financially and successfully meet farmer goals. The relation between risk and the intensity of dairy systems was also investigated. Options that intensified systems generally resulted in higher net wealth for the farm owner, but almost always at increased risk. The best system for any farmer to operate is one which best meets their multifaceted preferences and goals, regardless of system type. A need to remain profitable under fluctuating operating and climatic conditions has increased the intensity of dairy systems in Australia and New Zealand. This paper examined if farm technical performance, profit and risk were related to farm system intensity and complexity. Single technical performance measures were poor guides of profit, with profitable businesses being more about the skills of the farm operator, and less about the system being run. [ABSTRACT FROM AUTHOR]

Dairy feeding systems in Australia and New Zealand have seen an increase in the use of mixed rations to manage variability in climate and market conditions and enable a certain degree of resilience in the operating environment. In this review, resilience was defined as the ability of the farm system to respond to challenges, optimise productivity and profitability for a given set of circumstances, and persist over time. Specific attributes of a dairy system that contribute to resilience were considered as flexibility, consistency, adaptation, sustainability and profitability. A flexible forage base that uses water efficient forage species provides a consistent supply of nutrients from home-grown forages across the year and is a key driver of resilience. Consistent milk production from purchased concentrates adds value to the forage base and will ensure that the system is profitable in the long term. Appropriate investment in infrastructure and careful management of debt has a positive impact on technical and financial efficiency and improves overall economic performance and resilience of the system. Nutrients, feed wastage, cow comfort and welfare were also identified as key areas to focus on for improved sustainability. Future research investigating the interaction between forages and concentrates, and the subsequent milk production response will be important for the future resilience of mixed ration systems. Adaptive management at a tactical and strategic level across several technical areas will further underpin the resilience of a mixed ration dairy system, and minimise the impact of climate and price variability. This will have flow on benefits to animal welfare and resource sustainability, which will have a positive impact of the public perception of these systems within the Australian and New Zealand dairy industries. The use of mixed ration feeding systems in Australia and New Zealand has increased in the past decade in response to variable climate and market conditions and to enable dairy businesses to be more resilient. This paper reviews the attributes contributing to resilience, namely flexibility, consistency, adaptation, sustainability and profitability with a particular focus on the forage base, milk production responses, the production : cost base and resource management. Potential areas for future work to maintain the resilience of mixed ration systems are also considered. [ABSTRACT FROM AUTHOR]

There is a growing diversity and complexity of dairy farming systems in Australia. Feeding systems based on the provision of mixed rations to dairy cows grazing perennial pastures (termed partial mixed rations or PMR systems) have emerged and present the dairy industry with opportunities for improved production and feed efficiency, but also with significant challenges. Early research results are beginning to define the situations in which PMR systems are profitable and the mechanisms responsible for the improved milk responses. This review focuses on the role of PMR feeding systems in temperate dairying regions of Australia, highlights initial research findings, and identifies some of the gaps in current knowledge that warrant further research. The key findings were that, when very low allowances of pasture are offered to cows, milk production responses were driven mostly by increases in dry matter (DM) intake, and there appeared to be a minimal contribution to increased energy supply from improved whole tract DM digestibility. Differences in milk responses became apparent when >10 kg of total supplement DM was consumed (0.75:0.25 concentrate to forage) as PMR. There was a consistent maintenance of milk fat concentration when increasing amounts of concentrates were consumed as PMR, in contrast with supplements consumed in the dairy. There was also a consistent finding that replacing some wheat in the PMR with canola meal resulted in cows consuming more grazed pasture despite the limitations of very low pasture allowances (10-15 kg DM/cow.day, expressed to ground level). This was accompanied by further increases in energy-corrected milk yield. The potential to improve DM intake was further highlighted when pasture allowance was increased, with intake increasing from 3.6% to 4.5% of liveweight (from 20 to 25 kg DM/day for a 550-kg cow). There was also an indication that ~50% of the milk production benefit from PMR can be captured by providing the concentrate supplement as a grain mix in the dairy. There did not appear to be negative impacts of PMR systems on the social and grazing behaviour or health of cows. Feeding systems based on the provision of partial mixed rations (PMR) to grazing dairy cows present the dairy industry with opportunities for improved production and feed efficiency, but also with significant challenges. Early research results are beginning to define the situations in which PMR systems are profitable and the mechanisms responsible for the improved milk responses. This review focuses on the role of PMR in temperate dairying regions of Australia, highlights initial research findings, and identifies some of the gaps in knowledge that warrant further research. [ABSTRACT FROM AUTHOR]

Background: Long specialist outpatient waiting lists are a source of clinical risk. Triage assignment is based on subjective assessment of referrals and fails to account for dynamic changes in disease status while patients await clinical review., Aims: To pilot an innovative triage method using a trifold approach to conduct noninvasive assessment of fibrosis and to determine the feasibility of reflex hepatitis C virus (HCV) polymerase chain reaction (PCR) testing., Methods: A total of 1006 patients awaiting an initial liver clinic appointment at a tertiary Australian hospital were sent a short message service (SMS) requesting a blood test be completed. The first 60 patients received an SMS only, and the subsequent 946 patients also received a phone call from a Liver Care Guide (LCG), a nonclinician employed to increase patient engagement. Liver fibrosis assessment through noninvasive testing was performed using an aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 (FIB4) score. Patients with an APRI ≥1, FIB4 ≥3.25 or positive HCV PCR were retriaged to Category 1., Results: Four hundred ninety (49%) patients completed testing and 40 (4%) were triaged to Category 1. Subanalyses demonstrated increased response rates with LCG input (P = 0.012). Retriaged patients had been on the waitlist for a median of 216 days, exceeding initial category recommendations., Conclusion: This study successfully implemented a semiautomated strategy that prioritises patients with probable advanced liver disease or active HCV, demonstrating enhanced patient engagement with LCG support. It highlights the burden of patients referred for specialist care and the need for innovative strategies for monitoring and objective risk stratification., (© 2024 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.)

Background: Through the introduction of tumor agnostic therapies, people with metastatic cancer and their treating physicians are facing new treatment choices that have differing side effect and efficacy profiles from conventional chemotherapy., Objective: The present study undertakes a scoping review of research into the experiences of people with advanced or metastatic cancer across various solid tumor types with the goal of developing a tumor-agnostic conceptual model., Design: Automated queries on three internet search engines were performed to identify qualitative interview studies that focused on people with metastatic cancer. No limits were imposed for dates nor location of studies., Results: Of the 173 hits generated from the searches, 25 peer-reviewed papers were selected for the review with dates that ranged from 2007 to 2022. All papers originated from the USA, Europe, Australia, or Japan. Three major themes emerged that formed the basis for the tumor-agnostic conceptual model: symptoms, loss of autonomy, and adaptation/coping., Conclusions: The explication of the interplay between the physical and emotional symptoms experienced by those with advanced and metastatic cancer using a multi-tumor approach provides the potential to make generalizations about the needs of this population. An opportunity exists to potentially address these needs through matching patient needs and preferences with the characteristics of novel therapeutics., Implications for Cancer Survivors: In the era of tumor agnostic therapies, the elicitation of patient preferences across the spectrum of anatomical origins has the potential to enhance shared decision making in the setting of metastatic disease., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: Optimal child passenger protection requires use of a restraint designed for the age/size of the child (appropriate use) that is used in the way the manufacturer intended (correct use).This study aimed to determine child restraint practices approximately 10 years after introduction of legislation requiring correct use of age-appropriate restraints for all children aged up to 7 years., Methods: A stratified cluster sample was constructed to collect observational data from children aged 0-12 years across the Greater Sydney region of New South Wales (NSW). Methods replicated those used in a similar 2008 study. Population weighted estimates for restraint practices were generated, and logistic regression used to examine associations between restraint type, and child age with correct use accounting for the complex sample., Results: Almost all children were appropriately restrained (99.3%, 95% CI 98.4% to 100%). However, less than half were correctly restrained (no error=27.3%, 95% CI 10.8% to 43.8%, no serious error=43.8%, 95% CI 35.0% to 52.7%). For any error, the odds of error decreased by 39% per year of age (OR 0.61, 95% CI 0.46 to 0.81) and for serious error by 25% per year (OR 0.75, 95% CI 0.60 to 0.93)., Conclusion: The findings demonstrate high levels of appropriate restraint use among children across metropolitan Sydney approximately 10 years after introduction of legislation requiring age-appropriate restraint use until age 7, however, errors in the way restraints remain common., Implications for Public Health: Given the negative impact incorrect use has on crash protection, continuing high rates of incorrect use may reduce effectiveness of legislative change on injury reduction., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Calcium channel blockers (CCB), a commonly prescribed antihypertensive (AHT) medicine, may be associated with increased risk of breast cancer. The proposed study aims to examine whether long-term CCB use is associated with the development of breast cancer and to characterise the dose-response nature of any identified association, to inform future hypertension management., Methods and Analysis: The study will use data from 2 of Australia's largest cohort studies; the Australian Longitudinal Study on Women's Health, and the 45 and Up Study, combined with the Rotterdam Study. Eligible women will be those with diagnosed hypertension, no history of breast cancer and no prior CCB use at start of follow-up (2004-2009). Cumulative dose-duration exposure to CCB and other AHT medicines will be captured at the earliest date of: the outcome (a diagnosis of invasive breast cancer); a competing risk event (eg, bilateral mastectomy without a diagnosis of breast cancer, death prior to any diagnosis of breast cancer) or end of follow-up (censoring event). Fine and Gray competing risks regression will be used to assess the association between CCB use and development of breast cancer using a generalised propensity score to adjust for baseline covariates. Time-varying covariates related to interaction with health services will also be included in the model. Data will be harmonised across cohorts to achieve identical protocols and a two-step random effects individual patient-level meta-analysis will be used., Ethics and Dissemination: Ethical approval was obtained from the following Human research Ethics Committees: Curtin University (ref No. HRE2022-0335), NSW Population and Health Services Research Ethics Committee (2022/ETH01392/2022.31), ACT Research Ethics and Governance Office approval under National Mutual Acceptance for multijurisdictional data linkage research (2022.STE.00208). Results of the proposed study will be published in high-impact journals and presented at key scientific meetings., Trial Registration Number: NCT05972785., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

In this single cohort study, we investigated associations between the concentrations of a suite of serum biomarkers measured in the first 30 d of lactation and subsequent reproductive performance measured as mating start date to conception intervals, in pasture-based Holstein cows. A secondary objective was to examine associations between biomarker concentrations and 305-d milk yield to assess whether any positive associations between biomarker concentration and reproductive performance were explained by reduced milk production. The data used had been collected as part of an ongoing project from 2017 to 2020 to compile a data set from a large population of lactating dairy cows. Biomarkers measured were those associated with energy balance (β-hydroxybutyrate [BHB] and nonesterified fatty acids [NEFA]), protein nutritional status (urea and albumin), immune status (globulin, albumin to globulin ratio and haptoglobin), and macromineral status (calcium and magnesium). Associations between biomarker concentrations and mating start date to conception interval were investigated using Cox proportional hazard models, using between 634 and 1,121 lactations (varying by biomarker) from 632 to 1,103 cows and 11 to 17 mating periods from 10 to 13 herds. Based on hazard ratio (HR) estimates and associated 95% confidence intervals (CI), hazard of conception on any particular day of the herds' mating periods was positively associated with the concentrations of albumin (HR = 1.09; 95% CI: 1.05-1.12), albumin to globulin ratio (HR = 2.82; 95% CI: 1.66-4.79), calcium (HR = 2.01; 95% CI: 1.18-3.43), and magnesium (HR = 2.17; 95% CI: 1.01-4.66), and negatively associated with globulin concentration (HR = 0.98; 95% CI: 0.97 to 1.00). There was also some evidence that NEFA concentration was negatively associated (HR = 0.76; 95% CI: 0.57 to 1.01), and urea concentration positively associated (HR = 1.05; 95% CI: 0.99 to 1.11), with reproductive performance, but no evidence that BHB and haptoglobin concentrations were associated with reproductive performance. Except for NEFA, presence and direction of the associations between the biomarker and milk yield were not discordant with that for reproductive performance. Also, except for NEFA, we found no substantial evidence of nonlinear relationships between biomarker concentration and either reproductive performance or milk yield. Correlations between biomarker concentrations were generally weak, indicating that multibiomarker panels may collectively predict reproductive performance better than any single biomarker. We noted substantial variation in the concentrations of all biomarkers within, and for some biomarkers, between herd-year groups. Collectively, these results indicate that there may be scope to improve biomarker concentrations through nutritional, management, and genetic interventions, and by association, reproductive performance and milk yield may also improve., (© 2024, The Authors. Published by Elsevier Inc. and Fass Inc. on behalf of the American Dairy Science Association®. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).)

Objective: To examine the use of CT, emergency department (ED)-presentation and hospitalisation and in 12 months before and after a diagnosis of cancer., Design: Population-based retrospective cohort study., Setting: West Australian linked administrative records at individual level., Participants: 104 009 adults newly diagnosed with cancer in 2004-2014., Main Outcome Measures: CT use, ED presentations, hospitalisations., Results: As compared with the rates in the 12th month before diagnosis, the rate of CT scans started to increase from 2 months before diagnosis with an increase in both ED presentations and hospitalisation from 1 month before the diagnosis. These rates peaked in the month of diagnosis for CT scans (477 (95% CI 471 to 482) per 1000 patients), and for hospitalisations (910 (95% CI 902 to 919) per 1000 patients), and the month prior to diagnosis for ED (181 (95% CI 178 to 184) per 1000 patients) then rapidly reduced after diagnosis but remained high for the next 12 months. While the patterns of the health services used were similar between 2004 and 2014, the rate of the health services used during after diagnosis was higher in 2014 versus 2004 except for CT use in patients with lymphohaematopoietic cancer with a significant reduction., Conclusion: Our results showed an increase in demand for health services from 2 months before diagnosis of cancer. Increasing use of health services during and post cancer diagnosis may warrant further investigation to identify factors driving this change., Competing Interests: Competing interests: The institutions of RM, NTH, PO, DY, CW, MKB and DM received grant funding from the National Medical Research Council of Australia for investigator-initiated research. The funding agreement ensured author independence in designing the study, interpreting the data, writing and publishing the report., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)

A cross sectional nationally representative survey of 33,110 school-going children in Singapore aged between 9 and 20 years was carried out to obtain, for the first time, baseline information on smoking among the school-going population in Singapore. The survey was carried out among students attending vocational institutes and public sector schools in Singapore in 1987. The overall smoking prevalence was found to be 2% (3% among boys and 0.2% among girls). Ex-smokers comprised 2% of respondents whilst those who had only experimented with smoking made up 9% of the respondents. Analyses of the data showed that cigarette smoking was more prevalent among Malays, among boys, among older children, and among the less academically inclined. On average, boys smoked a median of 20 cigarettes a week and girls, 12 cigarettes a week. On an international basis, the smoking prevalence among the school-going population in Singapore is significantly lower than that of developed countries like Australia, England and Wales and neighbouring countries such as Malaysia.