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Despite the importance of writing skills to school and life success, there is scant research into the enabling and constraining conditions that shape elementary students' views about their writing practices. This paper examines students' views about writing through the lens of reflexivity theory. Applying an explanatory sequential model of mixed-method design, it first describes the development of a self-report questionnaire to investigate the views of 570 elementary students about themselves as writers. Second, it draws on semi-structured interviews with 46 students across Years 3 to 6. The results show that the majority of students see themselves as autonomous and meta-reflexive writers. In addition, results indicate time, teacher pedagogy and the place to practice writing as contextual conditions experienced by learners and place an emphasis on the personal conditions such as students' lack of confidence, persistence and ideas. We discuss implications for further practice in elementary schools.

The typical process for assessing inter-rater reliability is facilitated by training raters within a research team. Lacking is an understanding if inter-rater reliability scores "between" research teams demonstrate adequate reliability. This study examined inter-rater reliability between 16 researchers who assessed fundamental motor skills using the Test of Gross Motor Development-3rd edition. Total score agreement (ICC = 0.363) and locomotor subscale agreement (ICC = 0.383) were "very poor," while ball skills subscale agreement (ICC = 0.478) was "poor." Consistencies of total (ICC = 0.757), locomotor (ICC = 0.730), and ball skills (ICC = 0.746) scores were "fair." Component percentage agreement ranged from 40.5% to 96.2%. These data suggest that there are significant differences in how different research groups evaluate fundamental motor skills based on the subjective nature of scoring. Consistency and agreement among users need to be addressed in motor development research to allow for direct comparisons across studies that use process-oriented measures.

The professional experience of school counsellors in training in Australia is subject to different supervisor-supervisee relationships and school settings. The current study explored the first-year New South Wales school counsellor in training professional experience via an adapted qualitative content and framework analysis approach. Participants were students undertaking their first professional experience as part of the Master of Teaching (School Counselling) at the University of Sydney. The most common descriptive reflections explored professional psychological learning, followed by system- and process-related knowledge of the school setting. Emergent themes highlighted that professional experience prepared students for the role, which varied based on supervisor and school setting, and helped the students form professional identities via observing rich ethical and professional practice. Future professional experiences may be enriched with explicit reflections, peer-to-peer learning and support to foster working supervisor-supervisee relationships.

This article analyzes the People's Republic of China's elite-making higher education policies that began in the early 1990s, notably with the 211 Project and then 985 Project, which led to the formation of the C9 League, a group of nine leading institution's dubbed China's "Ivy League." This elite grouping is compared with other Chinese universities in terms of global rankings from 2003 to 2015 to ascertain the separation by these top tiered institutions. Furthermore, the C9 League will be compared with other global elite coalitions in the United States, Canada, Australia, and the United Kingdom over the same period. University rankings, despite considerable criticism, have provided the Chinese leadership with key benchmarks for their vision of world-class higher education. This article finds that the C9 League has made some separation from other Chinese universities and has also caught up with its Western peers (notably passing Canada's U15) in terms of international rankings.

Purpose: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic condition with a constellation of symptoms presenting as severe and profound fatigue of ≥ 6 months not relieved by rest. ME/CFS affects health-related quality of life (HRQoL), which can be measured using multi-attribute health state utility (HSU) instruments. The aims of this study were to quantify HSUs for people living with ME/CFS, and to identify an instrument that is preferentially sensitive for ME/CFS. Methods: Cross-sectional national survey of people with ME/CFS using the AQoL-8D and EQ-5D-5L. Additional questions from the AQoL-8D were used as 'bolt-ons' to the EQ-5D-5L (i.e., EQ-5D-5L-Psychosocial). Disability and fatigue severity were assessed using the De Paul Symptom Questionnaire-Short Form (DSQ-SF). HSUs were generated using Australian tariffs. Mean HSUs were stratified for sociodemographic and clinical factors. Bland–Altman plots were used to compare the three HSU instruments. Results: For the 198 participants, mean HSUs (95% confidence intervals) were EQ-5D-5L: 0.46 (0.42–0.50); AQoL-8D: 0.43 (0.41–0.45); EQ-5D-5L-Psychosocial: 0.44 (0.42–0.46). HSUs were substantially lower than population norms: EQ-5D-5L: 0.89; AQoL-8D: 0.77. As disability and fatigue severity increased, HSUs decreased in all three instruments. Bland–Altman plots revealed interchangeability between the AQoL-8D and EQ-5D-5LPsychosocial. Floor and ceiling effects of 13.5% and 2.5% respectively were observed for the EQ-5D-5L instrument only. Conclusions: ME/CFS has a profound impact on HRQoL. The AQoL-8D and EQ-5D-5L-Psychosocial can be used interchangeably: the latter represents a reduced participant burden. [ABSTRACT FROM AUTHOR]

Objective. This study aimed to estimate costs of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to patients, government and Australian society. Methods. Australian ME/ CFS patients and their carers were recruited using convenience sampling. Patients completed an online retrospective cost diary, providing ME/CFS-related direct medical, non-medical and indirect costs. Informal care costs were collected directly from carers. Data from the Pharmaceutical Benefits Scheme and Medicare Benefits Schedule were linked to participant survey data. Annual per patient and total societal costs were estimated, broken down by category and presented in 2021 AUD. Factors associated with higher costs were investigated using generalised linear models. Results. One hundred and seventy five patients (mean age 49 years s.d. 14, 79.4% female) completed the cost diary. Estimated total annual societal costs of ME/CFS in Australia ranged between $1.38 and $10.09 billion, with average annual total costs of $63 400/patient. Three-quarters of these costs were due to indirect costs ($46 731). Disability severity was the key factor associated with higher costs, particularly for indirect costs (being 2.27-fold higher for severe disability than no/mild disability). Conclusions. ME/CFS poses a significant economic burden in Australia, owing mainly to high indirect and informal care costs. [ABSTRACT FROM AUTHOR]

Headwater streams are critical to the integrity of the stream network, yet they are being rapidly degraded, channelized, or lost through land-cover and land-use change, particularly in urbanizing areas. We refined the definition of a headwater stream, reviewed the headwater stream ecosystem literature using examples from southeastern Australia and globally, and identified 4 critical knowledge gaps that are hampering the management of these unique systems: 1) inadequate high-resolution mapping and, thus, low-accuracy estimates of headwater stream locations and extents within catchments; 2) insufficient characterization of headwater stream typologies across varying geological, topographical, climatic, and anthropogenic conditions; 3) incomplete quantification of headwater stream structure, function, and ecosystem services across varying scales; and 4) limited understanding of the effects of urbanization on headwater streams against a backdrop of climate change. We propose a series of research questions to address these gaps and, finally, hypothesize and discuss the most effective ways to protect headwater streams in urbanizing environments given our current state of understanding. Of particular importance are the need to 1) shift perceptions of these systems as dry, insignificant depressions in the landscape; 2) manage both the headwater stream catchment and the channel; and 3) prioritize protection of the natural flow regime. [ABSTRACT FROM AUTHOR]

Purpose: Commercially available microtechnology devices containing accelerometers, gyroscopes, magnetometers, and global positioning technology have been widely used to quantify the demands of rugby union. This study investigated whether data derived from wearable microsensors can be used to develop an algorithm that automatically detects scrum events in rugby union training and match play. Methods: Data were collected from 30 elite rugby players wearing a Catapult OptimEye S5 (Catapult Sports, Melbourne, Australia) microtechnology device during a series of competitive matches (n = 46) and training sessions (n = 51). A total of 97 files were required to "train" an algorithm to automatically detect scrum events using random forest machine learning. A further 310 files from training (n = 167) and match-play (n = 143) sessions were used to validate the algorithm's performance. Results: Across all positions (front row, second row, and back row), the algorithm demonstrated good sensitivity (91%) and specificity (91%) for training and match-play events when the confidence level of the random forest was set to 50%. Generally, the algorithm had better accuracy for match-play events (93.6%) than for training events (87.6%). Conclusions: The scrum algorithm was able to accurately detect scrum events for front-row, second-row, and back-row positions. However, for optimal results, practitioners are advised to use the recommended confidence level for each position to limit false positives. Scrum algorithm detection was better with scrums involving ≥5 players and is therefore unlikely to be suitable for scrums involving 3 players (eg, rugby sevens). Additional contact- and collision-detection algorithms are required to fully quantify rugby union demands. [ABSTRACT FROM AUTHOR]

To provide evidence-based guidance specific to allied health and nursing practice for the assessment and management of individuals with Duchenne muscular dystrophy (DMD). Thirteen key focus areas were identified in consultation with health professionals and consumer advocacy groups. A series of systematic literature reviews were conducted to identify assessment and management strategies for each key focus area. A consensus process using modified Delphi methodology, including an Australia-New Zealand expert consensus meeting, was conducted. Recommendations underwent consultative review with key groups before being finalised and prepared for dissemination. This clinical practice guideline (CPG) generated 19 evidence-based recommendations, 117 consensus-based recommendations and five research recommendations across the 13 focus areas to inform allied health assessment and management of individuals with DMD. The resulting recommendations can be used in conjunction with existing medical CPGs to improve, standardise and advocate for allied health and rehabilitation care in DMD. The process used here may be useful for the development of CPGs in other rare diseases. Implementation-ready evidence-based statements to guide clinical care of individuals with DMD are provided with the potential to improve participation, function in the community and quality of life. A model for developing best practice statements for other rare neurological diseases is described. Allied health and nursing health professionals should focus research efforts to generate quality evidence to support rehabilitation practice. [ABSTRACT FROM AUTHOR]

Methane availability in freshwaters is usually associated with spatial-temporal variation in methanogenesis. Unusually, however, natural gas macro-seeps occur along the Condamine River in eastern Australia which elevate ambient water-column methane concentrations more than 3,000 times. We quantified the spatial-temporal variation in methane oxidation rates and the total microbial and methanotroph community composition (through the amplification and sequencing of 16S rRNA and particulate methane monooxygenase (pmoA) genes), and the factors mediating this variation, in reaches with and without macro-seeps. Sediment methane oxidation rates were, on average, 29 times greater, and the abundance of methanotrophs significantly higher, in the vicinity of methane macro-seeps compared to non-seep sites. Methylocystis was the most abundant methanotroph group at all sites, but type Ib methanotrophs showed the steepest increase in abundance at seep sites. pmo A gene analysis identified these as clade 501, while 16S rRNA gene analysis identified these as the closely related genus Methylocaldum. Sediment methane oxidation rates and the relative abundance and composition of benthic microbial communities were primarily influenced by methane availability which was in turn related to variation in river discharge. Methane-derived carbon may be an important energy source for the aquatic food webs in reaches affected by natural gas macro-seeps. [ABSTRACT FROM AUTHOR]

Increasing the area sown to Ornithopus spp. (serradella) can reduce overall fertiliser requirements in Australian permanent pastures owing to their greater nutrient-acquisition efficiency than that of more widely used pasture legumes such as Trifolium spp. However, uncertainty regarding waterlogging tolerance of Ornithopus spp. may restrict their adoption in the high-rainfall zone of southern Australia. The waterlogging tolerance of cultivars and accessions of three species of Ornithopus (O. compressus , O. sativus and O. pinnatus) was determined by comparing root and shoot growth of plants in deoxygenated, stagnant agar nutrient solution (simulated waterlogging) with growth in aerated nutrient solution. The responses were benchmarked against the known waterlogging-tolerant pasture legume Trifolium michelianum. All Ornithopus cultivars were highly impacted by the deoxygenated stagnant treatment, including those of the anecdotally waterlogging-tolerant O. pinnatus. The 14-day stagnant treatment reduced root dry mass by 32–62% and relative growth rate (RGR) of roots by 36–73%. At the same time, root porosity increased from 1.4% to 8.8%. Following a 14-day recovery period, during which plants were returned to aerated nutrient solution, Ornithopus spp. failed to increase their shoot RGR (particularly for O. sativus cultivars); however, root RGR returned to that of the aerated controls. The stagnant conditions inhibited transport of potassium (K+) to the shoots in all species, as evidenced by lower shoot tissue K+ concentrations, with O. compressus and O. sativus most adversely affected (45% and 48% of the tissue concentration of aerated control plants). We conclude that the suggested area for Ornithopus spp. adaptation should not preclude areas of high rainfall because they have root adaptations that would assist them in coping with transient water excess; however, soil types and surface profiles conducive to long-term waterlogging should be avoided to negate significant productivity losses. The use of pasture legumes with greater nutrient-acquisition efficiency will reduce variable farm costs associated with fertiliser inputs and help to minimise environmental implications from fertiliser overuse. Ornithopus spp. have high nutrient-acquisition efficiency, but uncertainty regarding their waterlogging tolerance is limiting their adoption in high-rainfall environments. We found that these species cannot tolerate prolonged periods of waterlogging, but they have root adaptations to assist with transient waterlogging. [ABSTRACT FROM AUTHOR]

Benthic algae are a major source of carbon supporting aquatic food webs in northern Australia, but little is known about the factors that regulate algal production. We surveyed benthic algal biomass in mainstem habitats of an unregulated sandy tropical river (the Fitzroy River) during a base-flow period. We used predictive models to reveal the physical and chemical parameters controlling algal biomass in mainstem habitats. We found that water velocity was an important driver—algal biomass was lower at higher water velocities. Subsurface flow was also influential—algal biomass increased in locations where groundwater upwelling occurred, as evident by a positive relationship between algal biomass and elevated radon and ammonium concentrations. In this sand-bed river, it is likely that high water velocity destabilises the sandy substrate reducing the establishment of algal biofilms. However, where water velocity is low enough for algal establishment, groundwater upwelling likely promotes algal growth by delivering limiting resources and/or creating stable conditions that promote algal production. The importance of surface and subsurface-flow conditions to benthic algal biomass means that any modification to the Fitzroy River catchment that alters dry-season longitudinal flows (via river regulation) or groundwater levels (via groundwater extraction) may directly influence river algal production. [ABSTRACT FROM AUTHOR]

Groundwater aquifers around the world are experiencing stress due to the composite influence of climate change and excessive groundwater withdrawal. Despite this influence, there is still insufficient knowledge on climate-groundwater interaction dynamics in complex aquifers like Australia's Great Artesian Basin. This understanding can inform improved management, which can in turn, increase resilience of groundwater system to on-going groundwater withdrawal and climate change. The main aim of this research was to assess the impacts of climatic change on groundwater storage (GWS) changes over the Great Artesian Basin (GAB) using a range of multi-scale indicators, including Gravity Recovery and Climate Experiment (GRACE)-derived groundwater observations and standardized precipitation evapotranspiration indices (SPEI). Rotated principal component analysis (rPCA) was used to identify climatic hotspots (where GWS variation is particularly sensitive or vulnerable to the impacts of climate change), and correlation analyses were used to assess the relationship between these hotspots and changes in groundwater over space and time. The localized spatial pattern via rPCA was uncovered in the GAB's southeastern region, where annual variations in GWS exhibited conspicuous peaks in 2002, 2014, and 2015. Another finding was that the southeast region of the GAB experienced higher GWS variations as compared to other sub-basins during 2007–2008, which resulted in low groundwater recharge. These findings underscore the variations in GWS within the GAB, emphasizing its responsiveness to climatic variations (e.g., rainfall contributes to recharge of groundwater system and drought intensifies water extraction and restricts discharge). Moreover, this study found a substantial negative correlation (r = −0.7), between SPEI at 12-month scale and GWS variation in the southern GAB region. This relationship highlights the vulnerability of groundwater storage in the southern GAB region to prolonged drought conditions. Furthermore, this study identified positive correlations (r = 0.4 to 0.8), between key climate indices such as the El Niño-Southern Oscillation (ENSO), Pacific Decadal Oscillation (PDO) with GWS anomalies in the southeast and northern GAB regions. These correlations underscore the pivotal roles played by ENSO and PDO in shaping GWS variations in these areas, highlighting the need to incorporate an understanding of these climatic processes into water resource management strategies. This consideration is crucial for ensuring sustainable water management practices that can adapt to the influence of these climate phenomena. These findings provide essential insights into the dynamics of groundwater in the face of changing environmental conditions, with implications for sustainable water management. • Hotspots of groundwater-climate interactions assessed in Great Artesian Basin. • Climate teleconnections drive changes in groundwater in the Great Artesian Basin. • Groundwater changes are sensitive to extreme climatic events (droughts and floods). • ENSO and PDO are key drivers of groundwater fluxes in the Great Artesian Basin. [ABSTRACT FROM AUTHOR]

The SARS-CoV2 pandemic led to drastic social restrictions globally. Early data suggest that women in science have been more adversely affected by these lockdowns than men, with relatively fewer scientific articles authored by women. However, these observations test broad populations with many potential causes of disparity. Australia presents a natural experimental condition where several states of similar demographics and disease impact had differing approaches in their social isolation strategies. The state of Victoria experienced 280 days of lockdowns from 2020 to 2021, whereas the comparable state of New South Wales experienced 107 days, most of these in 2021, and other states even fewer restrictions. To assess how the gender balance changed in Australian biomedical publishing with the lockdowns, we created a custom workflow to analyse PubMed data from more than 120,000 published articles submitted in 2019–2021 from Australian authors. Broadly, Australian women have been incredibly resilient to the challenges faced by the lockdowns. There was an increase in the number of published articles submitted in 2020 that was equally due to women as men, including from Victoria. On the other hand, articles specifically addressing COVID-19 were significantly less likely to be authored by women than those on other topics, a finding not likely due to particular gender imbalance in virology or viral epidemiology, since publications on HIV followed similar patterns to previous years. By 2021, this imbalance had reversed, with more COVID-19-related papers authored by women than men. These data suggest women from Victoria were less able to rapidly transition to new research early in the pandemic but had accommodated to the new conditions by 2021. This work indicates we need strategies to support women in science as the pandemic continues and to continue to monitor the situation for its impact on vulnerable groups. • We analyzed PubMed data from >120,000 articles from Australian authors. • COVID-19 pandemic lockdown severity had no gender-specific effect. • Women authored fewer COVID-19 articles than expected in 2020. • Women's publishing of COVID-19 work normalized in 2021. • Women were less able to rapidly transition to new research in the COVID pandemic. [ABSTRACT FROM AUTHOR]

Background Guidelines for the management of acute coronary syndromes ( ACS) advocate for maintaining adequate long-term glycaemic control in diabetic patients. Glycosylated haemoglobin ( HbA1c) measurement is commonly used to monitor long-term glycaemic control in diabetes. Aims To evaluate the frequency and clinical predictors of in-hospital HbA1c measurement in diabetic patients presenting with ACS and the relationship between HbA1c assessment and mortality following discharge. Methods This registry-based cohort study included 1743 diabetic patients from 33 representative hospitals across Australia with a final diagnosis of ACS. Independent predictors of HbA1c assessment were evaluated using a multivariable logistic generalised estimating equations analysis. The association between HbA1c assessment and mortality following discharge was evaluated using Cox proportional hazard analysis. Results Seven hundred and fourteen (41%) patients had HbA1c assessment during admission. Frequency of assessment varied markedly between hospitals (7.7-87.6%). HbA1c assessment was significantly more frequent in hospitals with catheterisation laboratories. Frequency of assessment was not associated with location of hospital (rural vs urban) or hospital capacity. Independent clinical predictors of HbA1c assessment across participating hospitals were younger age, ST-Elevation Myocardial Infarction, cardiac catheterisation and coronary artery bypass surgery during admission. HbA1c assessment was associated with higher rates of coronary catheterisation, revascularisation and receipt of evidence-based medicines but not with mortality during 6 months following discharge (hazard ratio, 0.48; 95% confidence interval, 0.19-1.18). Conclusion Frequency of HbA1c assessment varies markedly between hospitals, and most diabetic patients admitted for ACS in Australia do not receive assessment of pre-admission glycaemic control. HbA1c assessment was associated with better evidence driven medical care. [ABSTRACT FROM AUTHOR]

• Water level in isolated pools connected to groundwater recedes at a constant rate. • The recession rates vary considerably amongst cease-to-flow periods within one stream. • The recession rates are significantly different between nearby streams. • This study provides new knowledge of water level recession in hyporheic flow phase. Persistent surface water pools within non-perennial streams provide critical refuges for freshwater species by facilitating their survival during extended dry periods. However, our understanding of how pool water levels recede is limited, hindering our ability to quantify and predict aquatic refuge persistence. We characterise variations in water-level recession rates based on one year of water-level measurements in five non-perennial streams. Most of the observations show that the water level recedes at a constant rate after streamflow ceases in our study streams, a rate often significantly higher than that during low-flow periods. However, water-level recession rates varied considerably amongst cease-to-flow periods within pools in the same non-perennial stream and between nearby streams. The constancy of water-level recession during a cease-to-flow period is applicable to other non-perennial streams, but a detailed understanding of the factors influencing recession rates is needed for prediction in ungauged streams and identifying persistent aquatic refuges across river networks. [ABSTRACT FROM AUTHOR]

This case explores the complex multi-layered governance structure in the international Olympic sport of gymnastics, describing in detail the governance structures and operations of each layer – the International Olympic Committee (IOC), Fédération Internationale de Gymnastique (FIG), which is the international federation for gymnastics, and the national governing bodies (NGB) of gymnastics in the United States and Australia, USA Gymnastics and Gymnastics Australia. While both NGBs highlighted in this case are deemed to be successful on an international level, the case reveals many subtle differences between the two, which can be discussed in both governance and organizational behavior contexts. Finally, the timely issue of age fraud in gymnastics and the response from each level of governance are presented and provide an opportunity for further in-depth discussion. [ABSTRACT FROM AUTHOR]

Dorycnium hirsutum and D. rectum are perennial legumes which may have potential for use as pastures for the control of groundwater recharge in southern Australia. Little is known about the quality of the forage of Dorycnium species for grazing livestock or how these species respond to cutting. The effect of cutting height on plant survival, production of dry matter (DM), the proportion of leaf, edible stem (approximately <5 mm diameter) and woody stem in the DM and the nutritive value of the edible components was investigated. Biomass above five cutting-height treatments (uncut, ground level, 5–8 cm, 10–15 cm and 15–30 cm above ground level) was removed at 8-week intervals from plots of D. hirsutum and D. rectum from September 2002 to July 2003. In both species, plants subjected to lower cutting height treatments produced less DM above the height of the cut than those cut at higher heights. DM production declined over time in all treatments. Plants cut to ground level failed to regrow after the second harvest in D. hirsutum and the fourth harvest in D. rectum. Thus, these Dorycnium species were susceptible to high severity defoliations at 8-week intervals. Negligible inedible woody stem was present in regrowth of both species after 8 weeks but D. hirsutum regrowth had a higher proportion of leaf (0·72) than D. rectum (0·56). Plants left uncut accumulated a large proportion of inedible woody stem in the DM (0·69 in both species) by July 2003, particularly at the base of the plant. Edible DM from regrowth of D. hirsutum and D. rectum had crude protein (CP) concentrations of 120 and 150 g kg−1 DM; dry matter digestibility (DMD) values of 0·45 and 0·58; organic matter digestibility (OMD) values of 0·50 and 0·64; neutral-detergent fibre (NDF) concentrations of 370 and 290 g kg−1 DM; and acid-detergent fibre (ADF) concentrations of 260 and 210 g kg−1 DM, respectively. Medicago sativa, grown under similar conditions, had higher digestibility values (0·63 DMD and 0·66 OMD) and similar CP concentrations to D. rectum (140 g kg−1 DM), but higher concentrations of NDF and ADF (410 and 290 g kg−1 DM). Leaf material from both Dorycnium species had a higher nutritive value than edible stems, with DMD and OMD values of leaf of D. rectum being 0·68 and 0·74 respectively. Uncut plants had a much lower nutritive value of edible DM than the regrowth from cut treatments; older material was also of a lower nutritive value. The relatively low nutritive value of even the young regrowth of Dorycnium species suggests that forage quality is a major limitation to its use. Forage of Dorycnium species could be used during periods when other sources of forage are in short supply but infrequent grazing it is likely to produce forage of a low nutritive value. [ABSTRACT FROM AUTHOR]

The article discusses the medical concerns associated with the competitive video game contests known as esports. Topics discussed include the physical mental exhaustion associated with esports, similarities between esports and traditional sports, and findings on a joint survey conducted by Bond University and the Interactive Games and Entertainment Association on video game habits of children in Australia.

Focuses on the resurgence of rheumatic heart disease among Australian children during the 1990s. Factors attributing to the decline in the incidence of rheumatic fever since World War II; Conditions that have possibly caused the persisting high rates of rheumatic heart disease in Australian Aboriginals; Characterization of the disease condition.

• Gravity Recovery and Climate Experiment (GRACE) data is used as to assess groundwater storage (GWS) variation. • Spring wetlands' hydrological properties are well-explained by GRACE. • GRACE-derived GWS variation is used to assess water driven changes in vegetation. • Vegetation and soil moisture are important predictors of changes in GWS. The Great Artesian Basin (GAB) is one of the world's largest actively recharging aquifers. Groundwater discharges from the GAB sustain numerous spring wetlands, which have great ecological, scientific, and socio-economic significance. However, groundwater extraction and variation over time have had an impact on the quantity and area of spring wetlands with a 38% decline in extent since 1900. A major barrier to understanding variability in surface–groundwater interactions in spring wetlands of the GAB is the lack of observational data across critical spatial and temporal scales. Satellite observations have the ability to overcome this barrier and allow the evaluation of spring wetland responses to groundwater storage (GWS) variation. We investigated how GWS, and its associated drivers such as evapotranspiration (ET), soil moisture storage (SMS), and rainfall, in the GAB, influence the extent of surface water at five spring supergroups (Eulo, Barcaldine, Flinders, Springsure, and Springvale). We used satellite observations (2002–2017) to assess ET, SMS, rainfall, the normalized difference vegetation index (NDVI) and the modified normalized difference water index (mNDWI) for observing surface–groundwater interactions. NDVI responded positively to the GWS variation over the GAB and varies from sub-basin to sub- basin, with higher correlations in the Carpentaria sub-basin and some parts of Central and Western Eromanga. GWS variations was correlated with ET, SMS, rainfall, NDVI, mNDWI and surface water level (SWL). After a strong La Niña began in 2010, we uncovered relatively higher linear relationships between different components (ET, SMS, rainfall, NDVI, mNDWI, and SWL) and GWS variation (R2 > 0.50) than before the La Niña (R2 < 0.50), with the Flinders spring supergroup being the exception. NDVI and SMS are found to be the most significant predictor variables among ET, rainfall, SWL, and mNDWI components to influence GWS. This study provides improved understanding of surface-ground water interaction in spring wetlands and the influence of different hydrological components on variation in spring wetland extent in the GAB region. [ABSTRACT FROM AUTHOR]

• We synthesise interdisciplinary knowledge about Australian non-perennial rivers. • Current research strengths include salinity, dryland ecology, droughts, and floods. • Lessons are relevant globally and four high-level research challenges are identified. Non-perennial rivers are valuable water resources that support millions of humans globally, as well as unique riparian ecosystems. In Australia, the Earth's driest inhabited continent, over 70% of rivers are non-perennial due to a combination of ancient landscape, dry climates, highly variable rainfall regimes, and human interventions that have altered riverine environments. Here, we review Australian non-perennial river research incorporating geomorphology, hydrology, biogeochemistry, ecology, and Indigenous knowledges. The dominant research themes in Australia were drought, floods, salinity, dryland ecology, and water management. Future research will likely follow these themes but must address emerging threats to river systems due to climate change and other anthropogenic impacts. Four high level opportunities for future research are identified, namely: (1) integrating Indigenous and western scientific knowledge; (2) quantifying climate change impacts on hydrological and biological function; (3) clarifying the meaning and measurement of "restoration" of non-perennial systems; and (4) understanding the role of groundwater. These challenges will require inter- and multi-disciplinary efforts supported by technological advances. The evolving body of knowledge about Australian rivers provides a foundation for comparison with other dryland areas globally where recognition of the importance of non-perennial rivers is expanding. [ABSTRACT FROM AUTHOR]

With a growing population and changing climate, there is an urgent need to increase global agricultural yields, while minimizing environmental impacts and land use. A component of this "sustainable intensification" process is the shift from synthetic fertilizer to nitrogen-fixing legumes. Subterranean clover (Trifolium subterraneum L.) is the world's most widely grown annual pasture legume and in Australia its widespread adoption over the past century has led to increases in soil fertility and productivity, enabling greater animal production and crop yields. Subterranean clover is an unusual plant, burying its seed to protect it from grazing animals, which complicates efforts to harvest the seed from below the soil surface. The challenge of harvesting this seed has driven innovative farmers and inventors in Australia to develop specialized machinery and techniques, turning Australia into the largest subterranean clover seed producer in the world. In this chapter we review literature, patents, primary sources, personal interviews, and family histories to collate this story, deliver an integrated history of subterranean clover seed harvesting and make recommendations for the future of the industry. The history of this unique, farmer-led industry provides a number of lessons for the development of successful agricultural systems and the factors that influence agricultural innovation. We analyze these lessons from the past in order to provide insights for sustainable intensification in the future. [ABSTRACT FROM AUTHOR]

Context: Dual-purpose wheat (Triticum aestivum L.) and canola (Brassica napus L.) crops have been extensively researched for grazing in Australian farming systems, with a focus on grazing by sheep. In some regions, dual-purpose crops have been grazed by cattle, but there have been reports of animal health problems. Aims: This paper sought to collate all known experiments conducted throughout Australia of cattle grazing dual-purpose crops, in order to evaluate grazing management options for cattle on dual-purpose crops that result in high growth rates and good animal health outcomes. Methods: There were six experiments. In Expts 1–3, cattle were grazed on wheat crops with and without available mineral supplementation of NaCl and MgO in a 1:1 ratio. In Expt 3, lime was also added to the mineral mix. In Expts 4 and 5, dual-purpose crops were grazed in combination with annual pastures to determine whether strategic use of dual-purpose crops could increase whole farm livestock productivity. In Expt 6, cattle were introduced to dual-purpose canola with different periods of adaptation (0, 4 and 7 days). Liveweight gain was monitored regularly to assess differences between adaptation treatments. Key results: Liveweight gain was increased by 0–27% when cattle grazing high quality, dual-purpose wheat were provided with mineral supplement. Cattle had an initial lag in growth rate when introduced to dual-purpose canola for grazing and this was not affected by the adaptation strategy used. Cattle that experienced a shorter adaptation period achieved higher weight gains more quickly. After the lag phase, average daily gain (ADG) was ≥2 kg/head.day, with an ADG over the entire grazing period for all treatments of 1.75 kg/head.day. The effect on the farm system was determined by extending the length of the grazing period on the dual-purpose crops. Grazing periods of shorter duration did not increase overall liveweight gains compared with grazing only pasture, whereas extending the period of dual-purpose crop grazing resulted in increased cattle weights. Conclusions: Cattle benefit from the addition of mineral supplements when grazing a dual-purpose wheat crop, with a response similar to that previously demonstrated in sheep. Cattle can safely graze dual-purpose canola and achieve high ADG. Inclusion of dual-purpose crops can improve overall cattle performance in the farming system. Implications: The potential area for production of dual-purpose crops within the Australian mixed farming zone is large and there may be insufficient livestock numbers within the zone to utilise the potential forage production. Cattle from other regions could be introduced during autumn and winter to realise this large forage potential during a period that is commonly a feed deficit on grazing-only properties. Estimates suggest that up to two million young cattle could be supported for 60 days, increasing liveweight by 90 kg/head. Beef cattle grazing dual-purpose crops on mixed farms can achieve high liveweight gains during periods of pasture deficit. Use of dual-purpose crops for beef production offers significant opportunity for the southern Australian beef industry. Growth rates of young cattle can be improved by appropriate mineral supplementation and livestock management. [ABSTRACT FROM AUTHOR]

Abstract Dual-purpose (DP) cereals provide an opportunity to graze vegetative crops in autumn and winter when pasture forage levels are low, and then harvested for grain after the exclusion of stock. The dual use provides significant increases in mixed farm returns and the area of DP crops is expanding from traditional areas in south-eastern Australia. DP crops have particular potential in the 9 M ha high rainfall zones (HRZ, >500–600 mm annual rainfall) where the crop growing season is longer, increasing the potential grazing period and the capacity to recover high grain yield. To capitalise on this potential, management packages that combine the most suitable varieties and sowing times to maximise forage and grain production are required. We conducted six experiments across the south-eastern, north-eastern and south-western regions of Australia’s HRZ to assess potential forage and grain production of DP cereal species (wheat, barley and triticale) and phenology types. In the south-eastern HRZ, slow winter cultivars out-performed spring types due the increased forage production in the ‘safe’ grazing period (stem elongation, DC30) providing up to 2600 DSE.days/ha and 7.5 t/ha grain yield from a mid-March sowing. Early-sown spring cultivars provided a shorter period of ‘safe’ grazing as the lack of vernalisation requirement hastened development and reduced grain yield potential. In the south-western HRZ, early sowing opportunities (March) are rare and the season much shorter. The best results were achieved with mid-April sowing of barley and longer season spring and facultative wheat, providing 640 DSE.days/ha and grain yields of 3.0 t/ha and 3.4 t/ha, respectively. In the north-eastern HRZ, grain recovery was more sensitive to grazing, however 2000 DSE.days/ha and 6.5 t/ha grain yield were achieved with winter cereals sown in early April. Grazing in the safe phenological window had no effect on grain yield in the south-west region, but reduced yield of some cultivars in the eastern regions. The reduction in grain yield of early-sown winter wheat cultivars due to grazing (17–28%) was greatest when yield potential was high (>6.8 t/ha). Overall, the experiments confirm the predicted potential for dual-purpose production of cereals across the Australian HRZ region provided appropriate cultivar and sowing dates are combined with careful grazing management. Further work is required to refine grazing management to reduce reductions in grain yield in well-managed DP crops grazed prior to stem elongation. [ABSTRACT FROM AUTHOR]

Background and Aim: The rising incidence of hepatocellular carcinoma (HCC) in Australia is related to increasing rates of metabolic-associated fatty liver disease (MAFLD). This study aimed to prospectively characterize the metabolic profile, lifestyle, biometric features, and response to treatment of HCC patients in an Australian population., Method: Multicenter prospective cohort analysis of newly diagnosed HCC patients at six multidisciplinary team meetings over a 2-year period., Results: Three hundred and thirteen (313) newly diagnosed HCC patients with MAFLD (n = 77), MAFLD plus other liver disease (n = 57) (the "mixed" group), and non-MAFLD (n = 179) were included in the study. Alcohol-associated liver disease (ALD) (43%) and MAFLD (43%) were the most common underlying liver diseases. MAFLD-HCC patients were older (73 years vs 67 years vs 63 years), more likely to be female (40% vs 14% vs 20%), less likely to have cirrhosis (69% vs 88% vs 85%), showed higher ECOG, and were less likely to be identified by screening (29% vs 53% vs 45%). Metabolic syndrome was more prevalent in the MAFLD and mixed groups. The severity of underlying liver disease and HCC characteristics were the same across groups. While the MAFLD population self-reported more sedentary lifestyles, reported dietary patterns were no different across the groups. Dyslipidemia was associated with tumor size, and those taking statins had a lower recurrence rate., Conclusion: Equal to ALD, MAFLD is now the most common underlying liver disease seen in HCC patients in Australia. Future HCC prevention screening and treatment strategies need to take this important group of patients into consideration., (© 2024 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Objective This study aimed to estimate costs of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to patients, government and Australian society. Methods Australian ME/CFS patients and their carers were recruited using convenience sampling. Patients completed an online retrospective cost diary, providing ME/CFS-related direct medical, non-medical and indirect costs. Informal care costs were collected directly from carers. Data from the Pharmaceutical Benefits Scheme and Medicare Benefits Schedule were linked to participant survey data. Annual per patient and total societal costs were estimated, broken down by category and presented in 2021 AUD. Factors associated with higher costs were investigated using generalised linear models. Results One hundred and seventy five patients (mean age 49 years s.d. 14, 79.4% female) completed the cost diary. Estimated total annual societal costs of ME/CFS in Australia ranged between $1.38 and $10.09 billion, with average annual total costs of $63 400/patient. Three-quarters of these costs were due to indirect costs ($46 731). Disability severity was the key factor associated with higher costs, particularly for indirect costs (being 2.27-fold higher for severe disability than no/mild disability). Conclusions ME/CFS poses a significant economic burden in Australia, owing mainly to high indirect and informal care costs.

Objective: To identify the level of training of Australian psychiatrists in Attention Deficit Hyperactivity Disorder (ADHD), and to compare the number of psychiatrists specialising in ADHD versus other psychiatric conditions on the basis of the prevalence of conditions, by interrogating the RANZCP 'Find a Psychiatrist' database., Conclusion: Fewer psychiatrists listed in the RANZCP database specialise in ADHD than in many other psychiatric conditions. Given that 5% of the Australian population suffers from ADHD, the condition can have significant adverse outcomes and is a common comorbidity with other psychiatric conditions, the RANZCP Training Program would be improved by requiring an in-depth knowledge of ADHD. Further training in ADHD would assist many practising psychiatrists., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In this study, we examined the relationships between extremes of low temperatures and chickpea yield in 12 field experiments conducted at six sites in the subtropical environment of southeast Queensland (SEQ) from 2014 to 2019. Three commercial chickpea cultivars, PBA-Boundary, PBA-HatTrick and PBA-Seamer, were grown in all the experiments. Cultivars PBA-Pistol, PBA-Monarch and Kyabra were also included in three of these experiments conducted in 2015. In these experiments, the crop experienced a total of 8 to 41 frosts (minimum temperature <  = 0 °C), 2 to 41 pre-flowering frosts, 2 to 19 frosts during the critical period, 0 to 13 frosts and 2 to 71 low-temperature days (< = 15 °C) after flowering. The mean yield, which varied from 1 to 3 t/ha, was negatively related to post-flowering frosts (r =  - 0.74, p < 0.01) and low-temperature days (r =  - 0.76, p < 0.01), and positively related to pre-flowering frosts (r = 0.67, p < 0.05). Each post-flowering frost was associated with a 5% decrease and a low-temperature day with a 1% decrease in yield. The cultivar × site interaction was significant only in the three experiments with six commercial cultivars. This interaction was most likely due to an increase in the sensitivity range with additional cultivars, as indicated by frost damage scores and their relationships with yield. The results imply that extreme low-temperature events after flowering could negatively impact chickpea yield in SEQ and similar subtropical environments. Overcoming these effects through management and breeding should increase and stabilise chickpea yield., (© 2022. Crown.)

Introduction: Hepatocellular carcinoma (HCC) is a serious complication of chronic liver disease. Lenvatinib is an oral multikinase inhibitor registered to treat advanced HCC. This study evaluates the real-world experience with lenvatinib in Australia., Methods: We conducted a retrospective cohort study of patients treated with lenvatinib for advanced HCC between July 2018 and November 2020 at 11 Australian tertiary care hospitals. Baseline demographic data, tumor characteristics, lenvatinib dosing, adverse events (AEs) and clinical outcomes were collected. Overall survival (OS) was the primary outcome. Progression free survival (PFS) and AEs were secondary outcomes., Results: A total of 155 patients were included and were predominantly male (90.7%) with a median age of 65 years (interquartile range [IQR]: 59-75). The main causes of chronic liver disease were hepatitis C infection (40.0%) and alcohol-related liver disease (34.2). Median OS and PFS were 7.7 (95% confidence interval [CI]: 5.8-14.0) and 5.3 months (95% CI: 2.8-9.2) respectively. Multivariate predictors of mortality were the need for dose reduction due to AEs (Hazard ratio [HR] 0.41, p < 0.01), new or worsening hypertension (HR 0.42, p < 0.01), diarrhoea (HR 0.47, p = 0.04) and more advanced BCLC stage (HR 2.50, p = 0.04). Multivariable predictors of disease progression were higher Child-Pugh score (HR 1.25, p = 0.04), the need for a dose reduction (HR 0.45, p < 0.01) and age (HR 0.96, p < 0.001). AEs occurred in 83.9% of patients with most being mild (71.6%)., Conclusions: Lenvatinib remains safe and effective in real-world use. Treatment emergent diarrhoea and hypertension, and the need for dose reduction appear to predict better OS., (© 2022. The Author(s).)

An estimated 18% of people living with chronic hepatitis B (CHB) in Australia were born in China. While guideline-based care, including regular clinical monitoring and timely treatment, prevent CHB-related cirrhosis, cancer and deaths, over three-quarters of people with CHB do not receive guideline-based care in Australia. This qualitative study aimed to identify enablers to engagement in CHB clinical management among ethnic Chinese people attending specialist care. Participants self-identified as of Chinese ethnicity and who attended specialist care for CHB clinical management were interviewed in Melbourne in 2019 (n = 30). Semi-structured interviews covered experiences of diagnosis and engagement in clinical management services, and advice for people living with CHB. Interviews were recorded with consent; data were transcribed verbatim and thematically analysed. Receiving clear information about the availability of treatment and/or the necessity of long-term clinical management were the main enablers for participants to engage in CHB clinical management. Additional enablers identified to maintain regular clinical monitoring included understanding CHB increases risks of cirrhosis and liver cancer, using viral load indicators to visualize disease status in patient-doctor communication; expectations from family, peer group and medical professionals; use of a patient recall system; availability of interpreters or multilingual doctors; and largely subsidized healthcare services. In conclusion, to support people attending clinical management for CHB, a holistic response from community, healthcare providers and the public health sector is required. There are needs for public health programmes directed to communicate (i) CHB-related complications; (ii) availability of effective and cheap treatment; and that (iii) long-term engagement with clinical management and its benefits., (© 2021 John Wiley & Sons Ltd.)

Objective: To determine whether the availability of invasive coronary angiography at the hospital of presentation influences catheterisation rates for patients with acute coronary syndrome (ACS), and whether presenting to a catheterisation-capable hospital is associated with better outcomes for patients with ACS., Design, Setting: Retrospective cohort study; analysis of Cooperative National Registry of Acute Coronary Events (CONCORDANCE) data., Setting, Participants: Adults admitted with ACS to 43 Australian hospitals (including 31 catheterisation-capable hospitals), February 2009 - October 2018., Main Outcome Measures: Major adverse cardiovascular events (myocardial infarction, stroke, congestive heart failure, cardiogenic shock, cardiovascular death) and all-cause deaths in hospital and by six and 12- or 24-month follow-up., Results: The proportion of women among the 5637 patients who presented to catheterisation-capable hospitals was smaller than for the 2608 patients who presented to hospitals without catheterisation facilities (28% v 33%); the proportion of patients diagnosed with ST elevation myocardial infarction was larger (32% v 20%). The proportions of patients who underwent catheterisation (81% v 70%) or percutaneous coronary intervention (49% v 35%) were larger for those who presented to catheterisation-capable hospitals. The baseline characteristics of patients who underwent catheterisation were similar for both presentation hospital categories, as were rates of major adverse cardiovascular events and all-cause death in hospital and by 6- and 12- or 24-month follow-up., Conclusions: Although a larger proportion of patients who presented to catheterisation-capable hospitals underwent catheterisation, patients with similar characteristics were selected for the procedure, independent of the hospital of presentation. Major outcomes for patients were also similar, suggesting equitable management of patients with ACS across Australia., (© 2021 AMPCo Pty Ltd.)

Objective: To examine the effectiveness of twice-daily moisturizer application for patients admitted to an acute care setting on reducing the incidence of skin tear (ST) injuries., Design, Setting, and Participants: This prospective, nonrandomized, case-control study identified an experimental and control ward equivalent in demography and patient acuity in a large hospital in regional Victoria, Australia. Patients 70 years or older admitted to the wards were invited to participate., Intervention: Twice-daily application of a commercially available skin and body lotion to the arms and legs of participants., Main Outcome Measures: The incidence of ST in the experimental and control settings in the pre-, intra-, and posttrial periods., Main Results: Although a decrease in ST incidence was observed over the study period (n = 128), this decrease was not significant pre- (median = 2.16, n = 73), intra- (median = 2.16, n = 73), or postintervention (median = 2.16, n = 69; χ[2, 152] = 0.502, P = .778). Similarly, there was no significant difference between wards (median = 9.86 [n = 152] vs median = 13.14 [n = 177]; U = 42.50, z = -1.198, r = 0.358, P = .231)., Conclusions: The moisturizer in this study did not have a direct influence on the frequency of STs in the study population, although the data would suggest an intermittent reduction in ST incidence. The authors postulate that this was correlated with behavior change effects from the study., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Survival rates for lymphoma are highest amongst hematological malignancies. In 2019, it was estimated that over 6400 Australians were diagnosed with lymphoma, a group of hematological malignancies with a high 5-year survival rate of ~ 76%. There is an increased focus on the promotion of wellness in survivorship and active approaches to reducing morbidity related to treatment; however, current models of follow-up care heavily rely on hospital-based specialist-led care. Maximizing the potential of general practitioners (GPs) in the ongoing management of cancer is consistent with the national health reform principles and the Cancer Council Australia's Optimal Care Pathways. GPs are well positioned to provide guideline-based follow-up care and are more likely to address comorbidities and psychosocial issues and promote healthy lifestyle behaviors. This study aims to test the feasibility of the GOSPEL I intervention for implementing an integrated, shared care model in which cancer center specialists and community-based GPs collaborate to provide survivorship care for patients with lymphoma., Methods: We describe a protocol for a phase II, randomized controlled trial with two parallel arms and a 1:1 allocation. Sixty patients with Hodgkin's and non-Hodgkin's lymphoma will be randomized to usual specialist-led follow-up care (as determined by the treating hematologists) or a shared follow-up care intervention (i.e., GOSPEL I). GOSPEL I is a nurse-enabled, pre-specified shared care pathway with follow-up responsibilities shared between cancer center specialists (i.e., hematologists and specialist cancer nurses) and GPs. Outcome measures assess feasibility as well as a range of patient-reported outcomes including health-related quality of life as measured by the Functional Assessment of Cancer Therapy-Lymphoma, patient experience of care, symptom distress, comorbidity burden, dietary intake, physical activity behaviors, financial distress/interference, and satisfaction of care. Safety indicators including hospital admission and unscheduled lymphoma clinic visits as well as process outcomes such as intervention fidelity and economic indicators will be analyzed., Discussion: This trial is designed to explore the feasibility and acceptability of a new model of shared care for lymphoma survivors. Patient-reported outcomes as well as potential barriers to implementation will be analyzed to inform a larger definitive clinical trial testing the effects and implementation of a shared care model on health-related quality of life of lymphoma survivors., Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12620000594921 . Registered on 22 May 2020.

Background: Due to advances in early detection and cancer treatment, 5-year relative survival rates for early breast cancer surpass 90% in developed nations. There is increasing focus on promotion of wellness in survivorship and active approaches to reducing morbidity related to treatment; however, current models of follow-up care are heavily reliant on hospital-based specialist-led care. This study aims to test the feasibility of the EMINENT intervention for implementing an integrated, shared-care model involving both cancer centre specialists and community-based general practitioners for early breast cancer post-treatment follow-up., Methods: We describe a protocol for a phase II, randomised controlled trial with two parallel arms and 1:1 allocation. A total of 60 patients with early-stage breast cancer will be randomised to usual, specialist-led, follow-up care (as determined by the treating surgeons, medical oncologists, and radiation oncologists) or shared follow-up care intervention (i.e. EMINENT). EMINENT is a nurse-enabled, pre-specified shared-care pathway with follow-up responsibilities divided between cancer centre specialists (i.e. surgeons and oncologists) and general practitioners. The primary outcome is health-related quality of life as measured by the Functional Assessment of Cancer Therapy-Breast Cancer. Secondary outcomes include patient experience, acceptance, and satisfaction of care; dietary, physical activity, and sedentary behaviours; financial toxicity; adherence; health resource utilisation; and adverse events., Discussion: The trial is designed to identify the barriers to implementing a shared-care model for breast cancer survivors following treatment. Results of this study will inform a definitive trial testing the effects of shared-care model on health-related quality of life of breast cancer survivors, as well as its ability to alleviate the growing demands on the healthcare system., Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12619001594112 . Registered on 19 November 2019.

The novel coronavirus (COVID-19) has rapidly impacted all of our lives following its escalation to pandemic status on 11 March 2020. Government guidelines and restrictions implemented to mitigate the risk of COVID-19 community transmission have forced radiation therapy departments to promptly adjust to the significant impact on our ability to deliver best clinical care. The inherent nature of our tri-partied professions relies heavily on multidisciplinary teamwork and patient-clinician interactions. Teamwork and patient interaction are critical to the role of a radiation therapist. The aim of this paper is to describe the experience of the Peter MacCallum Cancer Centre's (Peter Mac) radiation therapy services during the preliminary stages of the COVID-19 pandemic in minimising risk to patients, staff and our clinical service. Four critical areas were identified in developing risk mitigation strategies across our service: (a) Workforce planning, (b) Workforce communication, (c) Patient safety and wellbeing, and (d) Staff safety and wellbeing. Each of these initiatives had a focus on continuum of clinical care, whilst minimising risk of cross infection for our radiation therapy workforce and patients alike. Initiatives included, but were not limited to, establishing COVID-Eclipse clinical protocols, remote access to local applications, implementation of Microsoft Teams, personal protective equipment (PPE) guidelines and virtual 'Division of Radiation Oncology' briefing/updates. The COVID-19 pandemic has dictated change in conventional radiation therapy practice. It is hoped that by sharing our experiences, the radiation therapy profession will continue to learn, adapt and navigate this period together, to ensure optimal outcomes for ourselves and our patients., (© 2020 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Active surveillance of invasive group A Streptococcus (iGAS) disease indicates that its incidence in the US general population is low, but limited studies show rates for American Indians and Alaska Natives (AI/AN) are severalfold higher. Major disparities in rates of iGAS exist between Indigenous and non-Indigenous populations of Australia, New Zealand, and Canada, but much less is understood about iGAS among AI/AN in the United States. Although complex host-pathogen interactions influence the rates of iGAS, including strain variation and virulence, the number and type of concurrent conditions, and socioeconomic status, the relative contribution of each remains unclear. We highlight the poor correlation between the substantial effect of iGAS among Indigenous persons in industrialized countries and the current understanding of factors that influence iGAS disease in these populations. Prospective, large-scale, population-based studies of iGAS are needed that include AI/AN as a necessary first step to understanding the effects of iGAS.

Objective: To quantify the economic and health-related quality of life (HRQoL) burden incurred by households with a child affected by spinal muscular atrophy (SMA)., Methods: Hospital records, insurance claims, and detailed resource use questionnaires completed by caregivers were used to capture the direct and indirect costs to households of 40 children affected by SMA I, II, and III in Australia between 2016 and 2017. Prevalence costing methods were used and reported in 2017 US dollar (USD) purchasing power parity (PPP). The HRQoL for patients and primary caregivers was quantified with the youth version of the EQ-5D and CareQoL multiattribute utility instruments and Australian utility weights., Results: The average total annual cost of SMA per household was $143,705 USD PPP for all SMA types (SMA I $229,346, SMA II $150,909, SMA III $94,948). Direct costs accounted for 56% of total costs. The average total indirect health care costs for all SMA types were $63,145 per annum and were highest in families affected by SMA II. Loss of income and unpaid informal care made up 24.2% and 19.8% respectively, of annual SMA costs. Three of 4 (78%) caregivers stated that they experienced financial problems because of care tasks. The loss in HRQoL of children affected by SMA and caregivers was substantial, with average caregiver and patient scores of 0.708 and 0.115, respectively (reference range 0 = death and 1 = full health)., Conclusion: Our results demonstrate the substantial and far-ranging economic and quality of life burden on households and society of SMA and are essential to fully understanding the health benefits and cost-effectiveness associated with emerging disease-modifying therapies for SMA., (© 2020 American Academy of Neurology.)

Background: Repeat transarterial chemoembolisation (rTACE) is often required for hepatocellular carcinoma (HCC) to achieve disease control, however, current practice guidelines regarding treatment allocation vary significantly. This study aims to identify key factors associated with patient survival following rTACE to facilitate treatment allocation and prognostic discussion., Method: Patients with HCC undergoing rTACE at six Australian tertiary centers from 2009 to 2014 were included. Variables encompassing clinical, tumour, treatment type and response factors were analysed against the primary outcome of overall survival. Univariate analysis and multivariate Cox regression modelling were used to identify factors pre- and post-TACE therapy significantly associated with survival., Results: Total of 292 consecutive patients underwent rTACE with mainly Child Pugh A cirrhosis (61%) and BCLC stage A (57%) disease. Median overall survival (OS) was 30 months (IQR 15.2-50.2) from initial TACE. On multivariate analysis greater tumour number (p = 0.02), higher serum bilirubin (p = 0.007) post initial TACE, and hepatic decompensation (p = 0.001) post second TACE were associated with reduced survival. Patients with serum AFP ≥ 200 ng/ml following initial TACE had lower survival (p = 0.001), compared to patients with serum AFP level that remained < 200 ng/ml post-initial TACE, with an overall survival of 19.4 months versus 34.7 months (p = 0.0001) respectively., Conclusion: Serum AFP level following initial treatment in patients undergoing repeat TACE for HCC is a simple and useful clinical prognostic marker. Moreover, it has the potential to facilitate appropriate patient selection for rTACE particularly when used in conjunction with baseline tumour burden and severity of hepatic dysfunction post-initial TACE.

Background: There is extensive evidence on the relationship between receiving a cancer diagnosis and labour market outcomes. However, there is limited evidence on the relationship between a cancer diagnosis and non-labour market outcomes such as household work, passive leisure and physical leisure. Furthermore, most current research focuses on time allocation at a given time point, ignoring both the life course perspective and long term effects., Methods: Using data from the Australian Longitudinal Study on Women's Health (ALSWH), we observe time allocation for 91 women diagnosed with breast cancer and 486 women diagnosed with skin cancer, and 2711 women living without cancer. Our analysis is unique in combining sequence analysis and multivariate multinomial logit modelling. Using sequence analysis, we first analyse life-courses post a cancer diagnosis for paid work, household work, passive leisure and physical leisure from 2004 to 2016. Using multivariate multinomial logit modelling, we test whether a cancer diagnosis influences such life-courses. We consider the robustness of results to cancer severity and change in time allocation before and after a cancer diagnosis., Results: We identify three clusters for paid work and two clusters for household work, passive leisure and physical leisure. Neither a breast cancer nor skin cancer diagnosis has a significant effect on the pathways of time allocation. Such results are robust to severity of diagnosis with 'cured' and 'non-cured' breast cancer, and skin cancer treated with and without 'chemotherapy or radiotherapy'. Women post a breast cancer diagnosis are less likely to maintain their pre-cancer's time use on paid work, household work and passive leisure; however, such effects are not significant., Conclusion: Being diagnosed with breast cancer or skin cancer has no significant long-term effect on the pathways of time allocation. Future work should explore the relationship between time allocation and wellbeing and the preference for time allocation., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: The low diagnosis rate and poor access to clinical care among people with CHB is a major barrier to reducing HBV-related morbidity and mortality in Australia. One explanation for this is a lack of disease-specific knowledge among people living with CHB. Health literacy has been shown to be important for maximising engagement with medical care and adherence to recommended management. The 'teach-back' communication strategy has been shown to improve patient understanding in other clinical areas. This study aims to assess disease-specific knowledge; and evaluate the efficacy of the teach-back strategy for improving HBV knowledge, compared to a standard medical consultation., Method: A randomized pilot study was conducted between February and June 2017. Participants were recruited from the liver clinic at an inner-city tertiary hospital. English-speaking patients aged ≥18 years and diagnosed with CHB were eligible for the study. Participants were randomised to a control group (medical specialist appointment) and intervention group (teach-back). Knowledge was assessed at baseline, immediately post-intervention and at one month using a validated questionnaire. Participants in the intervention group received a one-on-one teach-back session about CHB. The main outcome measure was a combined knowledge score of the domains assessed - transmission, natural history, epidemiology and prevention and clinical management., Results: Seventy participants were recruited (control n = 32, teach-back n = 38). Mean baseline knowledge score was 19.1 out of 23 with 55 (79%) participants scoring ≥17.3 (defined as high knowledge) (7). Sub-analysis of CHB knowledge domains identified focal deficits concerning transmission and whether HBV is curable. Knowledge scores were found to be positively associated with English proficiency and antiviral treatment experience (p < 0.05). Teach-back was associated with a significant increase in CHB knowledge at early recall (22.5 vs 18.7, p < 0.001) and at 1-month follow-up (21.9 vs 18.7, p < 0.001); there was no improvement in CHB knowledge associated with standard clinical consultant (early recall: 19.6 vs 19.4, p = 0.49, one-month follow-up: 19.5 vs 19.4, p = 0.94)., Conclusion: In a tertiary hospital liver clinic population, baseline knowledge about CHB was good, but there were focal deficits concerning transmission and potential for cure. Teach-back was associated with improvement in CHB knowledge and it is a simple communication tool suitable for incorporation into a standard medical consultation.

Understanding the movement behaviour of marine megafauna within and between habitats is valuable for informing conservation management, particularly for threatened species. Stable isotope analyses of soft-tissues have been used to understand these parameters in sea turtles, usually relying on concurrent satellite telemetry at high cost. Barnacles that grow on sea turtles have been shown to offer a source of isotopic history that reflects the temperature and salinity of the water in which the host animal has been. We used a novel method that combines barnacle growth rates and stable isotope analysis of barnacle shells (δ 18 O and δ 13 C) as predictors of home area for foraging sea turtles. We showed high success rates in assigning turtles to foraging areas in Queensland, Australia, based on isotope ratios from the shells of the barnacles that were attached to them (86-94% when areas were separated by >400 km). This method could be used to understand foraging distribution, migration distances and the habitat use of nesting turtles throughout the world, benefiting conservation and management of these threatened species and may be applied to other taxa that carry hitchhiking barnacles through oceans or estuaries.

Felis catus gammaherpesvirus 1 (FcaGHV1), recently discovered in the USA, was detected in domestic cats in Australia (11.4%, 95% confidence interval 5.9-19.1, n=110) and Singapore (9.6%, 95% confidence interval 5.9-14.6, n=176) using qPCR. FcaGHV1 qPCR positive cats were 2.8 times more likely to be sick than healthy. Risk factors for FcaGHV1 detection included being male, increasing age and coinfection with pathogenic retroviruses, feline immunodeficiency virus (FIV) or feline leukaemia virus. FcaGHV1 DNA was detected in multiple tissues from infected cats with consistently high virus loads in the small intestine. FcaGHV1 viral load was significantly higher in FIV-infected cats compared with matched controls, mimicking increased Epstein-Barr virus loads in human immunodeficiency virus-infected humans. FcaGHV1 is endemic in distant geographic regions and is associated with being sick and with coinfections. Horizontal transmission of FcaGHV1 is supported, with biting being a plausible route. A pathogenic role for FcaGHV1 in domestic cats is supported., (Copyright © 2014 Elsevier Inc. All rights reserved.)