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A 6‐month‐old male neutered Domestic Shorthair cat was assessed for a 24‐h history of anorexia, lethargy, depressed mentation, mild abdominal pain and persistent bradycardia. Abdominal ultrasound revealed marked thickening of the gastric wall, gastric distension, free abdominal fluid, distension and corrugation of the small intestine. Full‐thickness histopathological biopsy of the gastric wall demonstrated intralesional chitinous structures whose morphology (size and presence of obvious barbs) supports these structures being urticating hairs (setae). A processionary caterpillar is considered most likely as these are the most common urticating caterpillars in Australia. This is the first case of suspected severe gastroenteritis associated with the ingestion of caterpillar setae fragments in a cat. [ABSTRACT FROM AUTHOR]

Remarkable perturbations in the stratospheric abundances of chlorine species and ozone were observed over Southern Hemisphere mid-latitudes following the 2020 Australian wildfires 1,2 . These changes in atmospheric chemical composition suggest that wildfire aerosols affect stratospheric chlorine and ozone depletion chemistry. Here we propose that wildfire aerosol containing a mixture of oxidized organics and sulfate 3-7 increases hydrochloric acid solubility 8-11 and associated heterogeneous reaction rates, activating reactive chlorine species and enhancing ozone loss rates at relatively warm stratospheric temperatures. We test our hypothesis by comparing atmospheric observations to model simulations that include the proposed mechanism. Modelled changes in 2020 hydrochloric acid, chlorine nitrate and hypochlorous acid abundances are in good agreement with observations 1,2 . Our results indicate that wildfire aerosol chemistry, although not accounting for the record duration of the 2020 Antarctic ozone hole, does yield an increase in its area and a 3-5% depletion of southern mid-latitude total column ozone. These findings increase concern 2,12,13 that more frequent and intense wildfires could delay ozone recovery in a warming world., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

SignificanceLarge wildfires have been observed to inject smoke into the stratosphere, raising questions about their potential to affect the stratospheric ozone layer that protects life on Earth from biologically damaging ultraviolet radiation. Multiple observations of aerosol and NO 2 concentrations from three independent satellite instruments are used here together with model calculations to identify decreases in stratospheric NO 2 concentrations following major Australian 2019 through 2020 wildfires. The data confirm that important chemistry did occur on the smoke particle surfaces. The observed behavior in NO 2 with increasing particle concentrations is a marker for surface chemistry that contributes to midlatitude ozone depletion. The results indicate that increasing wildfire activity in a warming world may slow the recovery of the ozone layer.

Objectives: To assess physical activity (PA), mental health and well-being of adults in the United Kingdom (UK), Ireland, New Zealand and Australia during the initial stages of National governments' Coronavirus disease (COVID-19) containment responses., Design: Observational, cross-sectional., Methods: An online survey was disseminated to adults (n=8,425; 44.5±14.8y) residing in the UK, Ireland, New Zealand and Australia within the first 2-6 weeks of government-mandated COVID-19 restrictions. Main outcome measures included: Stages of Change scale for exercise behaviour change; International Physical Activity Questionnaire (short-form); World Health Organisation-5 Well-being Index; and the Depression Anxiety and Stress Scale-9., Results: Participants who reported a negative change in exercise behaviour from before initial COVID-19 restrictions to during the initial COVID-19 restrictions demonstrated poorer mental health and well-being compared to those demonstrating either a positive-or no change in their exercise behaviour (p<0.001). Whilst women reported more positive changes in exercise behaviour, young people (18-29y) reported more negative changes (both p<0.001). Individuals who had more positive exercise behaviours reported better mental health and well-being (p<0.001). Although there were no differences in PA between countries, individuals in New Zealand reported better mental health and well-being (p<0.001)., Conclusion: The initial COVID-19 restrictions have differentially impacted upon PA habits of individuals based upon their age and sex, and therefore have important implications for international policy and guideline recommendations. Public health interventions that encourage PA should target specific groups (e.g., men, young adults) who are most vulnerable to the negative effects of physical distancing and/or self-isolation., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Argentina and Australia endured among the most severe COVID-19 lockdowns globally. This study examined which artistic creative activities (ACAs) Argentinians in the Buenos Aries region used to support their mental health and wellbeing and compared these findings with existing data for Australians (primarily from Victoria) across a similar period. Adult Argentinians (N = 86) responded to an online survey regarding 27 listed ACAs, as well as ratings of anxiety, depression, and loneliness. While "watching films and television" was the most commonly reported ACA, it was not rated as effective in supporting mental health and wellbeing. Conversely, musical ACAs were ranked highest. We consider evidence from Australia, North America, and South America that musical ACAs (especially music listening) have been most effective at supporting mental health and wellbeing during the COVID-19 pandemic by way of avoidance-based emotion regulation. We also conclude from the data that Argentinians tended to place greater importance on music-based ACAs than Australians. [ABSTRACT FROM AUTHOR]

Background: The elderly is commonly susceptible to depression, the symptoms for which may overlap with natural aging or other illnesses, and therefore miss being captured by routine screening questionnaires. Passive sensing data have been promoted as a tool for depressive symptoms detection though there is still limited evidence on its usage in the elderly. Therefore, this study aims to review current knowledge on the use of passive sensing data via smartphones and smartwatches in depressive symptom screening for the elderly. Method: The search of literature was performed in PubMed, IEEE Xplore digital library, and PsycINFO. Literature investigating the use of passive sensing data to screen, monitor, and/or predict depressive symptoms in the elderly (aged 60 and above) via smartphones and/or wrist-worn wearables was included for initial screening. Studies in English from international journals published between January 2012 to September 2022 were included. The reviewed studies were further analyzed by a narrative analysis. Results: The majority of 21 included studies were conducted in Western countries with a few in Asia and Australia. Most studies adopted a cohort study design (n = 12), followed by cross-sectional design (n = 7) and a case-control design (n = 2). The most popular passive sensing data was related to sleep and physical activity using an actigraphy. Sleep characteristics, such as prolonged wakefulness after sleep onset, along with lower levels of physical activity, exhibited a significant association with depression. However, cohort studies expressed concerns regarding data quality stemming from incomplete follow-up and potential confounding effects. Conclusion: Passive sensing data, such as sleep, and physical activity parameters should be promoted for depressive symptoms detection. However, the validity, reliability, feasibility, and privacy concerns still need further exploration. [ABSTRACT FROM AUTHOR]

Sleep hygiene behaviours are recommendations given to both clinical and non-clinical populations with a focus on modifying behaviours to maximise sleep outcomes. However, methodological issues present in sleep hygiene research make it difficult to conclusively determine the impact of each behaviour. This study aimed to address these issues by adopting a two-week, repeated measures design which incorporated objective sleep measures and used linear mixed effect modelling to assess the daily association of a wide range of sleep hygiene behaviours on sleep in a non-clinical, university sample. Between-persons effects revealed that bedtime and frequency of daytime napping, alcohol use, and social media use were negatively related to sleep duration while waketime and frequency of too much water consumption were positively related to sleep duration. Within-person effects revealed that later than usual bedtime, earlier than usual waketime, no sunlight exposure, poor ventilation, having an unpleasant conversation before bed were negatively associated with sleep duration whereas using alcohol to deliberately help full asleep was positively related to sleep duration. In contrast, disproportionately more behaviours were not significantly related to either sleep outcome, only some of which could be explained by individual differences, which suggests that more research is needed to determine the conditions under which these behaviours affect sleep, if at all. [ABSTRACT FROM AUTHOR]

Purpose: This commentary aims to reveal how a steering committee has effectively responded to advancing accessibility to harm reduction resources, hepatitis C virus (HCV) policy and health strategies within adult prison settings in New South Wales (NSW)., Design/methodology/approach: By reviewing the audit approach taken by the of the Justice Health and Forensic Mental Health Network and Corrective Services New South Wales Harm Reduction Reference Group (JHFMHN/CSNSW HRRG), this commentary emphasizes the committee's success in identifying contemporary harm reduction issues that affect people in custodial settings. This commentary is a compilation of data gathered through the 2018 JHFMHN/CSNSW HRRG audit and corresponding program materials. Conclusions regarding the effectiveness of the working group's audit were drawn by critically appraising the JHFMHN/CSNSW HRRG's Final Audit Report (JHFMHN and CSNSW, 2018) with reference to current harm reduction literature., Findings: The HRRG has provided leadership, professional representation and strategic advice on the development, implementation, monitoring and evaluation of best practice harm reduction strategies in prison settings. The HRRG developed and maintained networks and information exchange between the state-wide HCV health network, corrections services and the NSW harm reduction sector at large. Public health partnerships and advocacy that involve all key players, such as the HRRG, will continue to be crucial to remove barriers to enhancing HCV harm reduction measures especially in NSW prison settings., Social Implications: Strategies such as primary prevention and treatment can mitigate the spread of HCV in the custodial system. This audit of access to harm reduction resources was conducted on behalf of the diverse group of professionals, scholars and stakeholders comprising the HRRG. This audit and other advocacy efforts of this committee can facilitate future access to quality healthcare and the necessary policies required to support a healthier prison population at large., Originality/value: Collaborating with health authorities, researchers and social service workers can enable prison health-care systems to be guided by wider health workforce programs and public health standards. This collaboration can reduce the professional isolation of custodial health-care staff and promote a balanced approach to harm reduction policies by ensuring an equitable focus on both health and security imperatives., (© Emerald Publishing Limited.)

Wildfires can have a significant impact on air quality in Australia during severe burning seasons, but incomplete knowledge of the injection heights of smoke plumes poses a challenge for quantifying smoke exposure. In this study, we use two approaches to quantify the fractions of fire emissions injected above the planetary boundary layer (PBL), and we further investigate the impact of plume injection fractions on daily mean surface concentrations of fine particulate matter (PM 2.5) from wildfire smoke in key cities over northern and southeastern Australia from 2009 to 2020. For the first method, we rely on climatological, monthly mean vertical profiles of smoke emissions from the Integrated Monitoring and Modelling System for wildland fires (IS4FIRES) together with assimilated PBL heights from NASA Modern-Era Retrospective Analysis for Research and Application (MERRA) version 2. For the second method, we develop a novel approach based on the Multi-angle Imaging SpectroRadiometer (MISR) observations and a random forest, machine learning model that allows us to directly predict the daily plume injection fractions above the PBL in each grid cell. We apply the resulting plume injection fractions quantified by the two methods to smoke PM 2.5 concentrations simulated by the Stochastic Time-Inverted Lagrangian Transport (STILT) model in target cities. We find that characterization of the plume injection heights greatly affects estimates of surface daily smoke PM 2.5 , especially during severe wildfire seasons, when intense heat from fires can loft smoke high in the troposphere. However, using climatological injection profiles cannot capture well the spatiotemporal variability in plume injection fractions, resulting in a 63 % underestimation of daily fire emission fluxes injected above the PBL in comparison with those fluxes derived from MISR injection fractions. Our random forest model successfully reproduces the daily injected fire emission fluxes against MISR observations (R2=0.88 , normalized mean bias = 10 %) and predicts that 27 % and 45 % of total fire emissions rise above the PBL in northern and southeastern Australia, respectively, from 2009 to 2020. Using the plume behavior predicted by the random forest method also leads to better model agreement with observed surface PM 2.5 in several key cities near the wildfire source regions, with smoke PM 2.5 accounting for 5 %–52 % of total PM 2.5 during fire seasons from 2009 to 2020. [ABSTRACT FROM AUTHOR]

Introduction: Men who receive androgen deprivation therapy (ADT) for prostate cancer (PCa) are a vulnerable falls population due to the side effects of treatment. The purpose of this paper is to determine the cost-effectiveness of exercise in preventing falls and fractures for this high-risk population in Australia., Methods: A decision analytic model was constructed to evaluate the cost utility of an exercise intervention compared to usual care from a health system perspective. The intervention comprised two 1-h sessions of supervised exercise per week over 1 year for men with non-metastatic PCa receiving curative radiation therapy and ADT. A Markov model simulated the transition between five health states: (1) at risk of falling; (2) at recurrent risk of falling; (3) fracture (minor or major); (4) non-fracture injury (minor or major); and (5) death. Model inputs including transition probabilities and utility scores were obtained from published meta-analyses, and costs were drawn from Australian data sources (e.g. Medical Benefits Schedule). The model time horizon was 3 years, and costs and effects were discounted at 5% annual rate. Costs and quality-adjusted life years (QALYs) were aggregated and compared between the intervention and control to calculate incremental net monetary benefit (iNMB). Uncertainty in the results was explored using deterministic and probabilistic sensitivity analyses (PSA)., Results: At a willingness-to-pay of AU$50,000 per QALY, the exercise intervention dominated, as it was less costly and more effective than usual care. The iNMB was $3010 per patient. The PSA showed a 58% probability the intervention was cost-effective., Conclusion: This is the first modelled economic evaluation of exercise for men with PCa. Our results suggest supervised exercise is cost-effective in reducing the risks of falls and fractures in this population., (© 2022. Crown.)

The few studies assessing the relationship between mental health and a multidimensional measure of sleep have been conducted in samples of almost exclusively women. In the present study, we therefore assessed associations of multidimensional sleep health with mental well-being in Australian adults. A cross-sectional, national online survey of sleep health was conducted in 2019 in 2,044 community dwelling adults aged 18-90 years. Composite scores of self-reported healthy sleep were based on Ru-SATED (R-SATED) dimensions of satisfaction, alertness, timing, efficiency and duration scored 0 (never/rarely), 1 (sometimes) or 2 (usually/always), and regularity (social jet lag) was scored 0 (≥1 hr) or 1 (<1 hr). Mental well-being was identified by a report of no problem on the EuroQol (European quality of life) five dimension five level scale (EQ-5D-5L) anxiety/depression scale, as well as absence of six chronic depressive symptoms. Ordinal logistic regression analyses determined associations of mental well-being with sleep dimensions, and total R-SATED (range 0-11) and SATED scores (0-10), adjusted for sociodemographic and health factors. In males and females, healthy categories of SATED dimensions (but not regularity) were associated with mental well-being. A 1 unit increase in the total SATED score (mean [SD] 6.6 [2.1]) was associated with less problems on the EQ-5D-5L (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.08-1.14) and fewer chronic depressive symptoms (OR 1.20, 95% CI 1.17-1.23). These estimates did not differ when the total R-SATED score was considered. Sleep health promotion focussing solely on traditional messaging around healthy sleep duration may limit mental health gains. Rather, a more holistic approach to public health messaging to improve sleep health literacy may be beneficial for mental well-being., (© 2021 European Sleep Research Society.)

Record-breaking wildfires ravaged south-eastern Australia during the fire season 2019–2020. The intensity of the fires reached its paroxysmal phase at the turn of the year 2019–2020, when large pyro-cumulonimbi developed. Pyro-convective activity injected biomass burning aerosols and gases in the upper-troposphere–lower-stratosphere (UTLS), producing a long-lasting perturbation to the atmospheric composition and the stratospheric aerosol layer. The large absorptivity of the biomass burning plume produced self-lofting of the plume and thus modified its vertical dynamics and horizontal dispersion. Another effect of the in-plume absorption was the generation of compact smoke-charged anticyclonic vortices which ascended up to 35 km altitude due to diabatic heating. We use observational and modelling description of this event to isolate the main vortex from the dominant Southern Hemispheric biomass burning aerosol plume. Entering this information into an offline radiative transfer model, and with hypotheses on the absorptivity and the angular scattering properties of the aerosol layer, we estimate the radiative heating rates (HRs) in the plume and the vortex. We found that the hemispheric-scale plume produced a HR of 0.08±0.05 K d -1 (from 0.01 to 0.15 K d -1 , depending on the assumption on the aerosol optical properties), as a monthly average value for February 2020, which is strongly dependent on the assumptions on the aerosol optical properties and therefore on the plume ageing. We also found in-vortex HRs as large as 15–20 K d -1 in the denser sections of the main vortex (8.4±6.1 K d -1 on average in the vortex). Our results suggest that radiatively heated ascending isolated vortices are likely dominated by small-sized strongly absorbing black carbon particles. The hemispheric-scale and in-vortex HR estimates are consistent with the observed ensemble self-lofting (a few kilometres in 4 months) and the main isolated vortex rise (∼ 20 km in 2 months). Our results also show evidence of the importance of longwave emission in the net HR of biomass burning plumes. [ABSTRACT FROM AUTHOR]

During the 2019/2020 Australian bushfire season, intense wildfires generated a rising plume with a record concentration of smoke in the lower stratosphere. Motivated by this event, we use the atmospheric wind reanalysis model ERA5 to characterize the three dimensional atmospheric transport in the general region of the plume following a dynamical system approach in the Lagrangian framework. Aided by the Finite Time Lyapunov Exponent tool (FTLE), we identify Lagrangian Coherent Structures (LCS) which simplify the three‐dimensional transport description. Different reduced FTLE formulations are compared to study the impact of the vertical velocity and the vertical shear on the movement of the plume. We then consider in detail some of the uncovered LCS that are directly relevant for the evolution of the plume, as well as other LCS that are less relevant for the plume but have interesting geometries, and we show the presence of 3D lobe dynamics at play. Also, we unveil the qualitatively different dynamical fates of the smoke parcels trajectories depending on the region in which they originated. One feature that had a pronounced influence on the evolution of the smoke plume is a synoptic‐scale anticyclone that was formed near the same time as, and close to the region of, intense wildfires. We analyze this anticyclone in detail, including its formation, the entrainment of the smoke plume, and how it maintained coherence for a long time. Transport paths obtained with the inclusion of the buoyancy effects are compared with those obtained considering only the reanalysis velocity. Plain Language Summary: In the course of the 2019/2020 bushfire season in Australia, there were wildfires that generated a dense plume with a record concentration of smoke in the lower stratosphere. Our study uses Lagrangian techniques to investigate the 3D atmospheric transport of the plume and identify key features of it temporal evolution, including Lagrangian Coherent Structures (LCS). We explore the impact of different factors on the plume movement and uncover fascinating 3D dynamics in the region. Our research also sheds light on the different fates of smoke parcels depending on their origin and the role played by a synoptic‐scale anticyclone in the smoke plume's evolution. We compare transport paths with and without buoyancy effects to gain a better understanding of the plume's behavior. Key Points: The impact of the vertical velocity and the vertical shear is described using different Finite Time Lyapunov Exponent (FTLE) formulationsCoherent regions where smoke parcels have qualitatively different fates are characterized with and without considering buoyancy effectsLagrangian Coherent Structures linked to the anticyclone, which affected the smoke plume's evolution, are analyzed in detail [ABSTRACT FROM AUTHOR]

Wildfires are important sources of atmospheric reactive nitrogen. The reactive nitrogen species partitioning generally depends on fire characteristics. One reactive nitrogen compound, nitrous acid (HONO), is a source of hydroxyl radicals and nitric oxide, which can impact the oxidizing capacity of the atmosphere and fire plume chemistry and composition. We study the Australian wildfire season of 2019–2020, known as Black Summer, where numerous large and intense wildfires burned throughout the continent. We use HONO and nitrogen dioxide (NO2) from the TROPOspheric Monitoring Instrument (TROPOMI) and fire radiative power (FRP) from the Visible Infrared Imaging Radiometer Suite to investigate HONO and NO2 relationships with fire characteristics. The ratio of HONO to NO2 increases linearly with FRP both in Australia and globally. Both Australian and global fire relationships depend strongly on land cover type. These relationships can be applied to emission inventories to improve wildfire emission representation in models. Plain Language Summary: During the southern hemisphere summer from 2019 to 2020, colloquially known as the Black Summer, multiple wildfires burned throughout Australia that caused widespread environmental, ecological, and property damage. The smoke and gases from the wildfires contributed to poor air quality and impacted stratospheric ozone chemistry. One gas that wildfires emit is nitrous acid, a nitrogen‐containing molecule that breaks down under sunlight to create reactive species. These reactive species undergo rapid chemical transformations that ultimately lead to the creation of pollutants, such as ozone and particulate matter. Nitrous acid is emitted alongside nitrogen dioxide from wildfire smoke, but the amounts emitted depend on fire characteristics. Multiple satellites were able to measure nitrous acid, nitrogen dioxide, and fire power during the Black Summer. By counting each smoke pixel and computing summary statistics, we found an increasing, linear relationship between the ratio of nitrous acid to nitrogen dioxide and fire power. Satellites can also characterize the type of ecosystem that is burning. With this information, we derived relationships over three ecosystem types, which can be extended globally. This relationship can be included in computer models that simulate the chemistry of the atmosphere and the impacts of wildfire emissions. Key Points: We report TROPOspheric Monitoring Instrument nitrous acid, nitrogen dioxide, and the ratio of nitrous acid to nitrogen dioxide during the Australian Black SummerMean nitrous‐acid‐to‐nitrogen‐dioxide ratio shows an increasing relationship with mean fire radiative power both in Australia and globallyThe relationship between nitrous‐acid‐to‐nitrogen‐dioxide ratio and fire radiative power is affected by vegetation type [ABSTRACT FROM AUTHOR]

Objectives: This paper presents an Australian model that formed part of the health technology assessment for public investment in siltuximab for the rare condition of idiopathic Multicentric Castleman Disease (iMCD) in Australia. Methods: Two literature reviews were conducted to identify the appropriate comparator and model structure. Survival gain based on available clinical trial data were modelled using an Excel-based model semi-Markov model including time-varying transition probabilities, an adjustment for trial crossover and long-term data. A 20-year horizon was taken, and an Australian healthcare system perspective was adopted, with both benefits and costs discounted at 5%. The model was informed with an inclusive stakeholder approach that included a review of the model by an independent economist, Australian clinical expert opinion and feedback from the Pharmaceutical Benefits Advisory Committee (PBAC). The price used in the economic evaluation reflects a confidential discounted price, which was agreed to with the PBAC. Results: An incremental cost-effectiveness ratio of A$84,935 per quality-adjusted life-year (QALY) gained was estimated. At a willingness-to-pay threshold of A$100,000 per QALY, siltuximab has a 72.1% probability of being cost-effective compared with placebo and best supportive care. Sensitivity analyses results were most sensitive to the length of interval between administrations (from 3- to 6-weekly) and crossover adjustments. Conclusion: Within a collaborative and inclusive stakeholder framework, the model submitted to the Australian PBAC found siltuximab to be cost-effective for the treatment of iMCD. [ABSTRACT FROM AUTHOR]

The incidence of pyro-cumulonimbus (pyroCb) caused by extreme wildfires has increased markedly in Australia over the last several decades. This increase can be associated with a dangerous escalation of wildfire risk and severe stratospheric pollution events. Atmospheric and fuel conditions are important influences on pyroCb occurrence, but the exact causal relationships are still not well understood. We used the Continuous Haines Index (C-Haines) to represent atmospheric instability and the Fuel Moisture Index (FMI) to represent fuel moisture to provide better insight into the effects of atmospheric and fuel conditions on pyroCb occurrence over southeast Australia. C-Haines and FMI were related to the probability of pyroCb occurrence by employing a logistic regression on data gathered between 1980 and 2020. Emphasis is placed on investigating the independent effects and combined effects of FMI and C-Haines, as well as assessing their potential to predict whether a pyroCb develops over a fire. The main findings of this study are: (1) high C-Haines and low FMI values are representative of favorable conditions for pyroCb occurrence, but C-Haines can offset the effect of FMI—the addition of C-Haines to the logistic model muted the significance of FMI; (2) among the components of C-Haines, air temperature lapse rate (CA) is a better predictor of pyroCb occurrence than the dryness component (CB); (3) there are important regional differences in the effect of C-Haines and FMI on pyroCb occurrence, as they have better predictive potential in New South Wales than in Victoria. [ABSTRACT FROM AUTHOR]

Background: The constraining prison culture is not, for the most part, conducive to the provision of palliative care for people in prison. Aim: This study aimed to explore patterns of palliative and end-of-life care provision for hospitalised prison patients. Design: A retrospective qualitative review of hospital medical records to explore the quality of end-of-life care provision for patients experiencing incarceration who died within hospital. Qualitative inductive analysis of record extracts of each patients final 3-months of life was undertaken. Setting/participants: An Australian metropolitan hospital responsible for providing secondary and tertiary health services for people experiencing incarceration. This study included a systematic sample of male patients experiencing incarceration who died in hospital between 2009 and 2019. Results: Medical record extracts of 15 male patients revealed two broad themes: (1) barriers to equitable access to palliative care for incarcerated hospitalised patients; and (2) factors that facilitated quality end-of-life care for patients and families. Barriers included: tensions between balancing risk and humanity; and limited agency over place and death. Conversely, early recognition of deterioration and anticipated dying provided patients and families opportunity to focus on end-of-life goals. Conclusions: Institutional influences of security and control challenged the provision of equitable end-of-life care for people experiencing incarceration. Further research is required to inform, and incorporate, best approaches to identifying patient wishes and advance planning into care within, or despite, the constrains of incarceration. Policy reform and a coordinated, best practice approach to the management of end-of-life care for people experiencing incarceration is needed. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survival is improving, making optimal management of long-term treatment-related adverse effects increasingly important. Exercise and a healthy diet are beneficial and regularly recommended in cancer survivorship guidelines; however, few cancer survivors meet these recommendations so there is a need to explore why. This study aimed to understand experiences receiving exercise and diet support among Australian breast and prostate cancer survivors during and following treatment, and to explore what support they would like to receive., Methods: Adults who completed active treatment for breast or prostate cancer were recruited via a private cancer care centre. Using a qualitative descriptive study design, participants attended in-person focus groups that were recorded, transcribed, then analysed using reflexive thematic analysis., Results: In total, 26 cancer survivors (15 breast, 11 prostate) participated in one of seven focus groups (4 breast, 3 prostate). Two themes were developed: 1) It was just brushed over, and 2) Wanting more. Theme 1 reports that exercise, and especially diet, were rarely discussed. If they were, it was often limited to general recommendations. Theme 2 shows that participants wanted more specific and personalised support, and information about how exercise and/or diet could benefit their cancer treatment., Conclusion: Despite strong interest in receiving personalised exercise and diet support, neither are routinely provided to Western Australian breast and prostate cancer survivors. If support was provided, there was inconsistency in the level and type of support provided. These findings identify important gaps in exercise and diet support provision to cancer survivors and will inform future strategies aiming to improve cancer survivorship care., (© 2024. The Author(s).)

Southern Australia's rainfall is highly variable and influenced by factors across scales from synoptic weather to large‐scale circulation and remote climate modes of variability. Anthropogenic climate change and natural variability modulate these factors and their interactions. However, studies often focus on changes in selected parts of the climate system with less emphasis on the system as a whole. As such, it is difficult to gain a complete understanding of how southern Australia's rainfall responds to broad‐scale changes in the climate system. We step through the existing literature on long‐term changes in synoptic‐to‐large‐scale atmospheric circulation and drivers of climate variability to form a more complete story of rainfall changes across southern Australia. This process reveals that the most robust change is the observed winter decline in rainfall as it is consistent with several changing climatic factors: decreasing rainfall from weather systems, strengthening subtropical ridge, poleward shifts in the Hadley Cell and the Southern Annular Mode, and increasing frequency of positive Indian Ocean Dipole events. In other seasons, particularly summer, changes in atmospheric circulation and drivers may not agree with observed rainfall changes, highlighting gaps in our knowledge of atmospheric dynamics and climate change processes. Future work should focus on research across temporal‐ and spatial‐scales, better understanding of jet interactions, the influence of stratospheric processes on the troposphere, and instances of contrasting trends in drivers and southern Australian rainfall changes. This article is categorized under:Paleoclimates and Current Trends > Modern Climate ChangePaleoclimates and Current Trends > Detection and AttributionAssessing Impacts of Climate Change > Observed Impacts of Climate Change [ABSTRACT FROM AUTHOR]

Background: While advances in healthcare mean people are living longer, increasing frailty is a potential consequence of this. The relationship between frailty among older surgical patients and hospital acquired adverse events has not been extensively explored. We sought to describe the relationship between increasing frailty among older surgical patients and the risk of hospital acquired adverse events. Methods: We included consecutive surgical admissions among patients aged 70 years or more across the SWSLHD between January 2010 and December 2020. This study used routinely collected ICD‐10‐AM data, obtained from the government maintained Admitted Patient Data Collection. The relationships between cumulative frailty deficit items and risk of hospital acquired adverse events were assessed using Poisson regression modelling. This study followed the RECORD/STROBE guidelines. Results: During the study period, 44,721 (57% women) older adults were admitted, and 41% (25,306) were planned surgical admissions. The risk of all adverse events increased with increasing number of frailty deficit items, the highest deficit items group (4–12 deficit items) compared with the lowest deficit items group (0 or 1 deficit item): falls adjusted rate ratio (adj RR) = 15.3, (95% confidence interval (CI) 12.1, 19.42); pressure injury adj RR = 21.3 (95% CI 12.53, 36.16); delirium adj RR = 40.9 (95% CI 31.21, 53.55); pneumonia adj RR = 16.5 (95% CI 12.74, 21.27); thromboembolism adj RR = 17.3 (95% CI 4.4, 11.92); and hospital mortality adj RR = 6.2 (95% CI 5.18, 7.37). Conclusion: The increase in number of cumulative frailty deficit items among older surgical patients was associated with a higher risk of adverse hospital events. The link offers an opportunity to clinical nursing professionals in the surgical setting, to develop and implement targeted models of care and ensure the best outcomes for frail older adults and their families. [ABSTRACT FROM AUTHOR]

Refugees can experience elevated levels of psychological distress upon resettlement, although disparate outcomes over time are expected. The current study modeled trajectories of changes in distress over a 5-year period among resettled refugees and sought to explicate post-settlement factors that influence distress over time. A large-scale sample of refugees resettled in Australia (2,399) was tracked over a 5-year period, completing measures of psychological distress at each wave and initial risk and protective factors immediately after resettlement. A latent class growth analysis conducted on distress found four unique classes characterized by (1) resilient levels of distress, (2) consistent clinical distress, (3) recovering levels of distress, and (4) deteriorating distress. Lower perceived discrimination and greater positive context of reception predicted membership to the resilient group and differentiated the recovering and deteriorating groups. Further, lower ingroup social support predicted membership to the clinically distressed group relative to all others. We conclude by echoing calls to strengthen community support for refugees and promote ingroup ties, particularly among those who are the most vulnerable. [ABSTRACT FROM AUTHOR]

Introduction: Understanding the attitudes, competency, and awareness of those supporting older people who have an acquired combined vision and hearing loss is an important endeavor for this population. It can help guide aged care policy makers, leaders, and managers in the allocation of resources and training. This Australian study investigated the awareness and perceptions of aged care workers on supporting older adults with acquired combined vision and hearing loss. Methods: Twenty-four participants who were employed in aged care services participated in semistructured interviews that were thematically analyzed. The interviews explored the participants' awareness of this disability, identification within their service, adaptation strategies, and their access to relevant information. Results: Several themes emerged, including lack of identification and recording of acquired combined vision and hearing loss in this population, lack of awareness of this disability, and lack of available information or training to support aged care workers within their care setting. Discussion: Aged care workers have little understanding of the prevalence of acquired combined vision and hearing loss in an older population. Care plans are key documents for individuals, which outline their needs and any sensory losses; however, this information is not well recorded. Aged care workers have little awareness of how to effectively support this population. When encountering an individual with an acquired combined vision and hearing loss, however, an aged care worker will develop strategies to support the individual. Individuals with this acquired dual-sensory loss, as well as dementia, pose a significant challenge to aged care workers, and dementia is often the primary focus of intervention. Implications for Practitioners: It appears that older individuals living in aged care settings who have acquired combined vision and hearing loss are not adequately identified, nor are aged care workers adequately trained to support individuals with this unique disability. [ABSTRACT FROM AUTHOR]

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Objective: The objective of this study was to investigate the association between chronic diseases and sleep difficulty in older women. Method: A total of 10,721 women from The Australian Longitudinal Study on Women’s Health, aged 70 to 75 years at baseline (1996), who answered sleep questionnaire data over 15 years follow-up, were surveyed. Longitudinal sleep difficulty class was regressed on baseline diseases. Results: Arthritis and heart disease were the strongest predictors of sleep difficulty; odds ratios for belonging to the greatest sleep difficulty class were 2.27 (95% confidence interval [CI] = [1.98, 2.61]) and 1.8 (95% CI [1.5, 2.16], respectively. Bronchitis/emphysema, osteoporosis, asthma, diabetes, and hypertension also predicted greater sleep difficulty. Conclusion: Older women diagnosed with the aforementioned significant diseases may also be at greater risk of sleep difficulty. These women may need counseling or treatment for their sleep difficulty, to prevent depression, cognitive function decline, falls, frailty, and increased mortality, as well as greater risk of nursing home placement, well known to be reinforced by sleep trouble, and the associated health care costs and societal impacts poor sleep quality has for older adults. [ABSTRACT FROM AUTHOR]

Background Injection drug use (IDU) following treatment for hepatitis C virus (HCV) infection may lead to reinfection, particularly if access to harm reduction services is suboptimal. This study assessed HCV reinfection risk following direct-acting antiviral therapy within Australian prisons that had opioid agonist therapy (OAT) programs but did not have needle and syringe programs (NSPs). Methods The Surveillance and Treatment of Prisoners With Hepatitis C (SToP-C) study enrolled people incarcerated in 4 prisons between 2014 and 2019. Participants treated for HCV were followed every 3–6 months to identify reinfection (confirmed by sequencing). Reinfection incidence and associated factors were evaluated. Results Among 388 participants receiving treatment, 161 had available posttreatment follow-up and were included in analysis (92% male; median age, 33 years; 67% IDU in prison; median follow-up 9 months). Among those with recent (in the past month) IDU (n = 71), 90% had receptive needle/syringe sharing. During 145 person-years (PY) of follow-up, 18 cases of reinfection were identified. Reinfection incidence was 12.5/100 PY (95% confidence interval [CI]: 7.9–19.8) overall, increasing to 28.7/100 PY (95% CI: 16.3–50.6) among those with recent IDU and needle/syringe sharing. In adjusted analysis, recent IDU with needle/syringe sharing was associated with increased reinfection risk (adjusted hazard ratio [aHR], 4.74 [95% CI: 1.33–16.80]; P =.016) and longer HCV testing interval with decreased risk (ie, chance of detection; aHR, 0.41 per each month increase [95% CI:.26–.64]; P  < .001). Conclusions A high rate of HCV reinfection was observed within prison. Posttreatment surveillance and retreatment are -essential to limit the impact of reinfection. High-coverage OAT and NSPs should be considered within prisons. Clinical Trials Registration NCT02064049 [ABSTRACT FROM AUTHOR]

Extreme events in the stratospheric polar vortex can lead to changes in the tropospheric circulation and impact the surface climate on a wide range of timescales. The austral stratospheric vortex shows its largest variability in spring, and a weakened polar vortex is associated with changes in the spring to summer surface climate, including hot and dry extremes in Australia. However, the robustness and extent of the connection between polar vortex strength and surface climate on interannual timescales remain unclear. We assess this relationship by using reanalysis data and time-slice simulations from two chemistry-climate models (CCMs), building on previous work that is mainly based on observations. The CCMs show a similar downward propagation of anomalies in the polar vortex strength to the reanalysis data: a weak polar vortex is on average followed by a negative tropospheric Southern Annular Mode (SAM) in spring to summer, while a strong polar vortex is on average followed by a positive SAM. The signature in the surface climate following polar vortex weakenings is characterized by high surface pressure and warm temperature anomalies over Antarctica, the region where surface signals are most robust across all model and observational datasets. However, the tropospheric SAM response in the two CCMs considered is inconsistent with observations. In one CCM, the SAM is more negative compared to the reanalysis after weak polar vortex events, whereas in the other CCM, it is less negative. In addition, neither model reproduces all the regional changes in midlatitudes, such as the warm and dry anomalies over Australia. We find that these inconsistencies are linked to model biases in the basic state, such as the latitude of the eddy-driven jet and the persistence of the SAM. These results are largely corroborated by models that participated in the Chemistry-Climate Model Initiative (CCMI). Furthermore, bootstrapping of the data reveals sizable uncertainty in the magnitude of the surface signals in both models and observations due to internal variability. Our results demonstrate that anomalies of the austral stratospheric vortex have significant impacts on surface climate, although the ability of models to capture regional effects across the Southern Hemisphere is limited by biases in their representation of the stratospheric and tropospheric circulation. [ABSTRACT FROM AUTHOR]

Australia experienced record‐breaking wildfires during 2019–2020, which emitted large amounts of carbonaceous aerosols (CAs) to the atmosphere. In this study, we explored the atmospheric dynamics and thermodynamic mechanism of the long‐range transport of CAs during November 2019–February 2020. The results indicate that the emitted CAs had a ternary advective spreading pattern across the Pacific Ocean in the Southern Hemisphere (SH), influenced mainly by the westerlies and anticyclonic systems. Upward vertical motion over the convergence zone and heat released from smoke pyro‐cumulonimbus clouds and strong light absorption of CAs provided strong vertical lift as the predominant injection pathway of the CAs into the stratosphere in the central Pacific Ocean in the SH. The abundant tropospheric CAs induced atmospheric heating (and potentially surface cooling), with increasing air temperature and decreasing of surface temperature. The anomalous thermal structure led to changes in atmospheric circulation, which weakened the upward vertical motion. Plain Language Summary: During the summer of 2019–2020, Australia suffered unprecedented wildfires. These wildfires emitted large amounts of pollutants into the free atmosphere. The pollutants are mainly composed of carbonaceous aerosols (CAs). Under the effects of meteorological conditions, the CAs experienced a long‐range spread expanding from the western Pacific Ocean to the eastern Pacific Ocean even arriving at the Atlantic Ocean. During the transportation, the CAs were accumulated over the central Pacific Ocean under the trapping effect of the anticyclone and then exhibited significant lift owing to upward motion over the convergence zone between westerlies and anticyclone and heat buoyancy released from smoke pyro‐cumulonimbus clouds and strong light absorption of CAs. As a response, the strong absorption of CAs resulted in the warming of the atmosphere and cooling of the surface, which enhanced atmospheric stratification and constrained the development of atmospheric instability. Thus, the upward vertical motion was weakened. Key Points: The westerlies and anticyclonic system dominated the advective spread of carbonaceous aerosols (CAs)The upward vertical motion, heat released from smoke pyro‐cumulonimbus clouds, and strong CAs light absorption contributed to CAs liftThe CAs caused warming of air temperature and cooling of surface temperature, which weakened the upward vertical motion [ABSTRACT FROM AUTHOR]

As a consequence of extreme heat and drought, record-breaking wildfires developed and ravaged south-eastern Australia during the fire season 2019–2020. The fire strength reached its paroxysmal phase at the turn of the year 2019–2020. During this phase, pyrocumulonimbus clouds (pyroCb) developed and injected biomass burning aerosols and gases into the upper troposphere and lower stratosphere (UTLS). The UTLS aerosol layer was massively perturbed by these fires, with aerosol extinction increased by a factor of 3 in the visible spectral range in the Southern Hemisphere, with respect to a background atmosphere, and stratospheric aerosol optical depth reaching values as large as 0.015 in February 2020. Using the best available description of this event by observations, we estimate the radiative forcing (RF) of such perturbations of the Southern Hemispheric aerosol layer. We use offline radiative transfer modelling driven by observed information of the aerosol extinction perturbation and its spectral variability obtained from limb satellite measurements. Based on hypotheses on the absorptivity and the angular scattering properties of the aerosol layer, the regional (at three latitude bands in the Southern Hemisphere) clear-sky TOA (top-of-atmosphere) RF is found varying from small positive values to relatively large negative values (up to -2.0 W m -2), and the regional clear-sky surface RF is found to be consistently negative and reaching large values (up to -4.5 W m -2). We argue that clear-sky positive values are unlikely for this event, if the ageing/mixing of the biomass burning plume is mirrored by the evolution of its optical properties. Our best estimate for the area-weighted global-equivalent clear-sky RF is -0.35±0.21 (TOA RF) and -0.94±0.26 W m -2 (surface RF), thus the strongest documented for a fire event and of comparable magnitude with the strongest volcanic eruptions of the post-Pinatubo era. The surplus of RF at the surface, with respect to TOA, is due to absorption within the plume that has contributed to the generation of ascending smoke vortices in the stratosphere. Highly reflective underlying surfaces, like clouds, can nevertheless swap negative to positive TOA RF, with global average RF as high as +1.0 W m -2 assuming highly absorbing particles. [ABSTRACT FROM AUTHOR]

The malnutrition-universal-screening-tool (MUST) is commonly used for screening malnutrition in hospitalised patients but its utility in the detection of frailty is unknown. This study determined the utility of MUST in detection of frailty in older hospitalised patients. This prospective-study enrolled 243 patients ⩾65 years in a tertiary-teaching hospital in Australia. Patients with a MUST score of ⩾1 were classified as at-risk of malnutrition. Frailty status was determined by the Edmonton-Frail-Scale (EFS) and patients with an EFS score of >8 were classified as frail. We validated the MUST against the EFS by plotting a receiver-operating-characteristic-curve (ROC) curve and area-under-the-curve (AUC) was determined. The mean (SD) age was 83.9 (6.5) years and 126 (51.8%) were females. The EFS determined 149 (61.3%) patients as frail, while 107 (44.1%) patients were at-risk of malnutrition according to the MUST. There was a positive linear but weak association between the MUST and the EFS scores (Pearson's correlation coefficient=.22, 95% CI.12–.36, p <.001). The sensitivity, specificity, positive and negative predictive value of MUST in the detection of frailty was 51%, 67%, 78.5% and 37%, respectively and the AUC was.59 (95% CI.53–.65, p <.001). The MUST is moderately sensitive in detection of frailty in older-hospitalised patients. [ABSTRACT FROM AUTHOR]

Aim: Cancer and its treatment produce significant acute and long‐term adverse effects in cancer survivors, resulting in a range of supportive cancer care needs across the disease trajectory. To enhance supportive cancer care in Australia, this study sought to understand and describe conventional services offered nationwide, specific to their structure (ownership, setting, duration), process (participants, delivery mode, referral pathways), and outcomes (evaluation). Methods: A survey canvassing 13 conventional supportive cancer care interventions was electronically distributed to 265 cancer organizations in all Australian states and territories over 2019 and 2020. Cancer organizations were invited to participate if they provided at least one cancer‐directed treatment (ie, surgery, radiation therapy, or systemic therapies); or clinical cancer care to adults, adolescents, or children; or conventional supportive care interventions to cancer survivors. Results: A response rate of 46% (n = 123/265) was achieved, with 72% of cancer organizations (n = 88) delivering at least one intervention. Most were provided as outpatient or inpatient services, with few at home (<13%) or via telehealth (<10%). Psychological therapy (90%), self‐care (82%), exercise (77%), healthy eating (69%), and lymphedema (69%) services were most common. Fatigue management (51%) and pelvic health (32%) were less common. Services offering massage, return‐to‐work, cognitive therapy, sleep hygiene, and leisure were underrepresented (<31%). Conclusion: Provision of conventional supportive cancer care services continues to evolve in Australia. Multiple areas of care require development of dedicated services to address supportive cancer care intervention shortfalls across the country. Online resources and telemedicine are currently underutilized modalities that are available for further development. [ABSTRACT FROM AUTHOR]

The latter months of 2020 and 2021 were marked by two of the largest Antarctic ozone holes on record. That such large ozone holes occurred despite ongoing ozone recovery raises questions about their origins and climate impacts. Here we provide novel evidence that supports the hypothesis that the ozone holes were influenced by two distinct and extraordinary events: the Australian wildfires of early 2020 and the eruption of La Soufriere in 2021. We further reveal that both ozone holes were associated with widespread changes in Southern Hemisphere climate that are consistent with the established climate impacts of Antarctic ozone depletion, including a strengthening of the polar stratospheric vortex, enhanced surface westerlies over the Southern Ocean, and surface temperature changes over Antarctica and Australia. The results thus provide suggestive evidence that injections of both wildfire smoke and volcanic emissions into the stratosphere can lead to hemispheric‐scale changes in surface climate. Plain Language Summary: The Antarctic ozone hole is characterized by dramatic decreases in stratospheric ozone during the austral spring months. The ozone hole is expected to recover over the next few decades in response to the phasing out of ozone‐depleting substances. However, the latter months of 2020 and 2021 were marked by two of the largest Antarctic ozone holes on record, which raises questions about their origins and climate impacts. Here we provide novel evidence that supports the hypothesis that the ozone holes were influenced by two extraordinary events: the Australian wildfires of early 2020 and the eruption of La Soufriere in 2021. We further reveal that both ozone holes were associated with changes in Southern Hemisphere surface climate consistent with the established climate impacts of Antarctic ozone depletion. Together, the results provide suggestive evidence that injections of both wildfire smoke and volcanic emissions into the stratosphere can lead to hemispheric‐scale changes in surface climate. Key Points: The large Antarctic ozone holes of 2020 and 2021 were accompanied by stratospheric burdens of wildfire and volcanic emissions, respectivelyBoth ozone holes were associated with pronounced changes in surface climate consistent with the impacts of Antarctic ozone depletionTogether, the linkages suggest that both wildfire smoke and volcanic emissions can lead to large‐scale changes in surface climate [ABSTRACT FROM AUTHOR]

Stratospheric injections of carbonaceous aerosols and combustion gases by extreme wildfires have become increasingly common. Recent "megafires," particularly large and intense fires, delivered particulate burdens to the lower stratosphere comparable to those of moderate volcanic eruptions. The 2017 Canadian megafire generated four large Pyrocumulonimbi (pyroCbs), injecting up to ≈0.3 Tg of smoke in the lower stratosphere. Even more extreme, the 2019/2020 Australian event produced a pyroCb activity resulting in stratospheric smoke intrusions of ≈1 Tg. To understand their contrasting behavior, we present global climate simulations of the atmospheric response to these events, applying smoke burdens informed by remote observations. Model outcomes, compared to satellite data of smoke transport, reproduce reasonably well the initial plume rise, at 0.2–0.3 km/day, attaining heights of ≈20 km in Canada and above 30 km in Australia. Global dispersal of the plume occurs within about 3 weeks in both cases, consistent with observations. Smoke removal timescales, ≈5 months for the Canadian megafire, agree with remote measurements. During the Australian megafire, observations indicate stratospheric injections three times as large, and models predict comparatively longer smoke lifetimes, ≈16 months. After the latter event, atmospheric optical depths and radiative cooling achieved values close to those measured following the Pinatubo eruption. Sensitivity tests of model assumptions indicate, in accord with prior studies, that smoke burden, injection heights, and black carbon content can determine plume evolution and possible climate impacts. An empirical relation between peak heights of stratospheric plumes and lifetimes is derived that can help assess megafire impacts on the stratosphere, climate and the Earth system. Key Points: Goddard Earth Observing System‐Version 5 and Community Earth System Model Version 1 predict similar removal timescales of stratospheric smoke injected by megafiresRemoval timescales of smoke with a 2% effective mass fraction of black carbon match observationsRemoval timescales and plume peak heights are sensitive to injection height, loading, and mixing state [ABSTRACT FROM AUTHOR]

Antarctic ozone has been regarded as a major driver of the Southern Hemisphere (SH) circulation change in the recent past. Here, we show that Antarctic ozone can also affect the subseasonal-to-seasonal (S2S) prediction during the SH spring. Its impact is quantified by conducting two reforecast experiments with the Global Seasonal Forecasting System 5 (GloSea5). Both reforecasts are initialized on September 1st of each year from 2004 to 2020 but with different stratospheric ozone: one with climatological ozone and the other with year-to-year varying ozone. The reforecast with climatological ozone, which is common in the operational S2S prediction, shows the skill re-emergence in October after a couple of weeks of no prediction skill in the troposphere. This skill re-emergence, mostly due to the stratosphere–troposphere dynamical coupling, becomes stronger in the reforecast with year-to-year varying ozone. The surface prediction skill also increases over Australia. This result suggests that a more realistic stratospheric ozone could lead to improved S2S prediction in the SH spring. [ABSTRACT FROM AUTHOR]

Background: Mental illness costs the world economy over US2.5 Bn each year, including premature mortality, morbidity, and productivity losses. Multisector approaches are required to address the systemic drivers of mental health and ensure adequate service provision. There is an important role for economics to support priority setting, identify best value investments and inform optimal implementation. Mental health can be defined as a complex dynamic system where decision makers are challenged to prospectively manage the system over time. This protocol describes the approach to equip eight system dynamics (SD) models across Australia to support priority setting and guide portfolio investment decisions, tailored to local implementation context. Methods: As part of a multidisciplinary team, three interlinked protocols are developed; (i) the participatory process to codesign the models with local stakeholders and identify interventions for implementation, (ii) the technical protocol to develop the SD models to simulate the dynamics of the local population, drivers of mental health, the service system and clinical outcomes, and (iii) the economic protocol to detail how the SD models will be equipped to undertake a suite of economic analysis, incorporating health and societal perspectives. Models will estimate the cost of mental illness, inclusive of service costs (health and other sectors, where necessary), quality-adjusted life years (QALYs) lost, productivity costs and carer costs. To assess the value of investing (disinvesting) in interventions, economic analysis will include return-on-investment, cost-utility, cost benefit, and budget impact to inform affordability. Economic metrics are expected to be dynamic, conditional upon changing population demographics, service system capacities and the mix of interventions when synergetic or antagonistic interactions. To support priority setting, a portfolio approach will identify best value combinations of interventions, relative to a defined budget(s). User friendly dashboards will guide decision makers to use the SD models to inform resource allocation and generate business cases for funding. Discussion: Equipping SD models to undertake economic analysis is intended to support local priority setting and help optimise implementation regarding the best value mix of investments, timing and scale. The objectives are to improve allocative efficiency, increase mental health and economic productivity. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of being an older nurse or midwife employed in the healthcare workplace. Design: A qualitative descriptive study. Method: Semi‐structured interviews were conducted with nurses and midwives who self‐identified as older workers. All Australian states were represented and given recruitment was undertaken nationally, most interviews were conducted via telephone. Data were collected between November 2018 and October 2019. Audio recordings were transcribed verbatim and then thematically analysed. Results: A total of 50 nurses and midwives were recruited, aged between 46 and 74 years. Three themes were identified. Ageing body: Being an older worker meant increased fatigue and physical changes affecting their ability to function at full capacity. Youth focus: For many, being an older worker was about being viewed as a poor‐quality worker, with limited access to education and promotional opportunities because of their age. Wise worker: For a small number of older nurses and midwives, it was about being valued and respected for their knowledge, experience and skills. Conclusion: Participants self‐identifying as older nurses or midwives represented a wide age range. Spanning across the age spectrum, many experienced fatigue, physical changes or loss of value to the workplace which often impacted on their working lives. The findings contributed to an understanding about what it is to be an older nurse or midwife in terms of how their contribution is regarded and valued by others in the workplace. Impact: This study highlighted there is a need for support of older nurses and midwives in managing age‐related fatigue and physical changes. It also suggests consideration of a wise‐worker model as a means to recognize the important contribution that older workers can offer. [ABSTRACT FROM AUTHOR]

This article addresses contemporary security challenges related to borders within Oceania, focusing on trans-Tasman relations. We address border security between Aotearoa New Zealand and Australia as a matter of an ascendant relationship, based on coordination and cooperation. By interrogating shared and divergent attributes between the nations, we are able to provide an overview of approaches towards regional threats. Behind these approaches are socio-political contexts, including drivers and authorities for cooperation as well as cultural and political identities. Importantly, the evolution of shared practices between the nations and a future scan of security in the region lead to important geopolitical considerations. [ABSTRACT FROM AUTHOR]

Almost 80 million people globally are forcibly displaced. A small number reach wealthy western countries and seek asylum. Over half are children. Wealthy reception countries have increasingly adopted restrictive reception practices including immigration detention. There is an expanding literature on the mental health impacts of immigration detention for adults, but less about children. This scoping review identified 22 studies of children detained by 6 countries (Australia, Canada, Hong Kong, Netherlands, the UK and the US) through searches of Medline, PsychINFO, Emcare, CINAHL and Scopus data bases for the period January 1992–May 2019. The results are presented thematically. There is quantitative data about the mental health of children and parents who are detained and qualitative evidence includes the words and drawings of detained children. The papers are predominantly small cross-sectional studies using mixed methodologies with convenience samples. Despite weaknesses in individual studies the review provides a rich and consistent picture of the experience and impact of immigration detention on children's wellbeing, parental mental health and parenting. Displaced children are exposed to peri-migration trauma and loss compounded by further adversity while held detained. There are high rates of distress, mental disorder, physical health and developmental problems in children aged from infancy to adolescence which persist after resettlement. Restrictive detention is a particularly adverse reception experience and children and parents should not be detained or separated for immigration purposes. The findings have implications for policy and practice. Clinicians and researchers have a role in advocacy for reception polices that support the wellbeing of accompanied and unaccompanied children who seek asylum. [ABSTRACT FROM AUTHOR]

Background Evaluating progress towards hepatitis C virus (HCV) elimination is critical. This study estimated prevalence of current HCV infection and HCV treatment uptake among people who inject drugs (PWID) in Australia. Methods The Enhancing Treatment of Hepatitis C in Opioid Substitution Settings Engage is an observational study of PWID attending drug treatment clinics and needle and syringe programs (NSPs). Participants completed a questionnaire including self-reported treatment history and underwent point-of-care HCV RNA testing (Xpert HCV Viral Load Fingerstick; Cepheid). Results Between May 2018 and September 2019, 1443 participants were enrolled (64% injected drugs in the last month, 74% receiving opioid agonist therapy [OAT]). HCV infection status was uninfected (28%), spontaneous clearance (16%), treatment-induced clearance (32%), and current infection (24%). Current HCV was more likely among people who were homeless (adjusted odds ratio, 1.47; 95% confidence interval, 1.00–2.16), incarcerated in the previous year (2.04; 1.38–3.02), and those injecting drugs daily or more (2.26; 1.43–2.42). Among those with previous chronic or current HCV, 66% (n = 520/788) reported HCV treatment. In adjusted analysis, HCV treatment was lower among females (.68;.48–.95), participants who were homeless (.59;.38–.96), and those injecting daily or more (.51;.31–.89). People aged ≥45 years (1.46; 1.06–2.01) and people receiving OAT (2.62; 1.52–4.51) were more likely to report HCV treatment. Conclusions Unrestricted direct-acting antiviral therapy access in Australia has yielded high treatment uptake among PWID attending drug treatment and NSPs, with a marked decline in HCV prevalence. To achieve elimination, PWID with greater marginalization may require additional support and tailored strategies to enhance treatment. [ABSTRACT FROM AUTHOR]

Mental health carers frequently report interpersonal difficulties in their caring relationship. This exploratory study aims to examine the interpersonal problems of mental health carers from the perspective of the interpersonal circumplex. A cross-sectional survey design was utilised with 147 participants. Mental health carers displayed higher mean interpersonal problems than a community sample, and descriptive proportions indicated 17.7% experienced interpersonal problems of significant difficulty. Shorter-term carers obtained higher scores on the Overly Accommodating domain, longer-term carers scored higher on the Vindictive/Self-centred domain. The care-receivers' mental health diagnosis was not associated with domains of interpersonal problems. Severity of mental health was associated with lower scores on the Overly Accommodating domain. There were no differences between being a parent or spouse carer. Results highlight the importance of understanding mental health carers' interpersonal profiles in order to guide treatment planning. [ABSTRACT FROM AUTHOR]

The hydroxyl radical (OH) is the primary atmospheric oxidant responsible for removing many important trace gases, including methane, from the atmosphere. Although robust relationships between OH drivers and modes of climate variability have been shown, the underlying mechanisms between OH and these climate modes, such as the El Niño–Southern Oscillation (ENSO), have not been thoroughly investigated. Here, we use a chemical transport model to perform a 38 year simulation of atmospheric chemistry, in conjunction with satellite observations, to understand the relationship between tropospheric OH and ENSO, Northern Hemispheric modes of variability, the Indian Ocean Dipole, and monsoons. Empirical orthogonal function (EOF) and regression analyses show that ENSO is the dominant mode of global OH variability in the tropospheric column and upper troposphere, responsible for approximately 30 % of the total variance in boreal winter. Reductions in OH due to El Niño are centered over the tropical Pacific and Australia and can be as high as 10 %–15 % in the tropospheric column. The relationship between ENSO and OH is driven by changes in nitrogen oxides in the upper troposphere and changes in water vapor and O1D in the lower troposphere. While the correlations between monsoons or other modes of variability and OH span smaller spatial scales than for ENSO, regional changes in OH can be significantly larger than those caused by ENSO. Similar relationships occur in multiple models that participated in the Chemistry–Climate Model Initiative (CCMI), suggesting that the dependence of OH interannual variability on these well-known modes of climate variability is robust. Finally, the spatial pattern and r2 values of correlation between ENSO and modeled OH drivers – such as carbon monoxide, water vapor, lightning, and, to a lesser extent, NO2 – closely agree with satellite observations. The ability of satellite products to capture the relationship between OH drivers and ENSO provides an avenue to an indirect OH observation strategy and new constraints on OH variability. [ABSTRACT FROM AUTHOR]

Research with 'good sleepers' is ubiquitous, yet there are no standardised criteria to identify a 'good sleeper'. The present study aimed to create and validate a questionnaire for identifying good sleepers for use in research studies known as the Good Sleeper Scale-15 items (GSS-15). Data were derived from a population-based survey of Australian adults (n = 2,044). A total of 23 items were chosen for possible inclusion. An exploratory factor analysis (EFA) was conducted on ~10% of the survey dataset (n = 191) for factor identification and item reduction. A confirmatory factor analysis (CFA) was conducted on the remaining data (n = 1,853) to test model fit. Receiver operating characteristic curves and correlations were conducted to derive cut-off scores and test associations with sleep, daytime functioning, health, and quality-of-life. The EFA identified six factors: 'Sleep Difficulties', 'Timing', 'Duration', 'Regularity', 'Adequacy', and 'Perceived Sleep Problem'. The CFA showed that model fit was high and comparable to other sleep instruments, χ 2 (63) = 378.22, p < 0.001, root mean square error of approximation = 0.05, with acceptable internal consistency (α = 0.76). Strong correlations were consistently found between GSS-15 global scores and outcomes, including 'a good night's sleep' (r = 0.7), 'feeling un-refreshed' (r = -0.59), and 'experienced sleepiness' (r = -0.51), p < 0.001. Cut-off scores were derived to categorise individuals likely to be a good sleeper (GSS-15 score ≥40) and those very likely to be a good sleeper (GSS-15 score ≥45). The GSS-15 is a freely available, robust questionnaire that will assist in identifying good sleepers for the purpose of sleep research. Future work will test relationships with other sleep measures in community and clinical samples., (© 2022 European Sleep Research Society.)

Objectives: Depression among older adults in long-term care remains a problem, despite the uptake of antidepressants and the development of intervention programs. A better understanding of the risk factors for depression is much needed. Guided by a systematic assessment of the evidence, this prospective observational cohort study sought to clarify existing evidence, identify modifiable risk factors and explore novel variables. Methods: Adults aged ≥65 (T1 n=147, T2 n= 81) were recruited from 15 long-term-care facilities in Melbourne, Australia. Cognitive impairment, functional impairment, pain, sleep disturbance, social support, and person-environment fit were investigated as risk factors. Outcomes were depressive symptoms and indicated Major Depressive Episode. Results: Generalized Estimating Equations (GEE) identified that changes in pain (b= 0.06, p<.05), sleep disturbance (b= 0.02, p<.001), social support (b= −0.02, p<.001) and person-environment fit (b= −0.02, p= <.01) were significantly associated with changes in depression score. Conclusions: Pain, sleep disturbance, social support, and person-environment fit are modifiable risk factors, making them strongly positioned to strategically inform prevention and intervention strategies. Clinical Implications: Individuals with clinically significant symptoms on these risk factors for depression should be selected for interventions that target these risk factors. For depressed individuals, psychotherapy should prioritize the potential role of these risk factors. Finally, these risk factors should be used as screening and monitoring variables: clinically significant changes in symptoms warrant investigation. [ABSTRACT FROM AUTHOR]

Purpose: Prostate cancer (PCa) is the most commonly diagnosed cancer in Australia, accounting for one quarter of all new cancer diagnoses for males. Androgen deprivation therapy (ADT) is the standard first-line therapy for metastatic PCa but is also used across much of the spectrum of disease. Unfortunately, debilitating adverse effects are a significant and largely unavoidable feature of ADT. A recent systematic review of adverse effects of ADT identified 19 sub-groups classified according to the Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0. The potential for multiple simultaneous adverse effects, their associated management and the impact of adverse effects on cancer outcomes and quality of life are important considerations in the treatment and supportive care of men with PCa. Exercise is increasingly being recognized as an efficacious strategy in managing these adverse effects.Methods: A rapid review was undertaken to examine the role of exercise in the management of the most commonly reported ADT adverse effects classified according to the CTCAE sub-groups. A systematic search was conducted in Medline, PsycINFO, Google Scholar and Google for the years 2010 to September 2019 to identify the benefits of exercise in managing the adverse effects of ADT for PCa.Results: There is strong evidence for exercise as medicine in addressing several of the adverse effects of PCa such as loss of muscle mass and strength, fatigue and declining physical function. Moderate level evidence for PCa exists for exercise-induced improvements in depression and anxiety, bone loss, and sexual dysfunction. While evidence of the effectiveness of exercise is lacking for many adverse effects of ADT for PCa, evidence in the cancer population as a whole or other clinical populations is strong, and many clinical guidelines recommend exercise as a fundamental part of their clinical management. With the exception of gynaecomastia and breast pain, there is increasing evidence (PCa, cancer or other clinical populations) to suggest that exercise has the potential to reduce and even prevent many of the adverse effects of ADT, thus improving survivorship outcomes for men with PCa.Conclusion: Exercise has the potential to reduce and even prevent many of the adverse effects of ADT, thus improving survivorship outcomes for men with PCa. The use of exercise for PCa management has the potential to translate into health and economic benefits in improved quality of life and fewer complications, resulting in savings to the health care system, enhanced productivity and reduced patient and carer burden. Exercise thus has the potential to improve quality of life for this population as well as generate significant cost savings. [ABSTRACT FROM AUTHOR]

Environmental context: Chlorofluorocarbons (CFCs) are potent greenhouse and stratospheric ozone depleting trace gases. Their atmospheric concentrations are in decline, thanks to global production and consumption controls imposed by the Montreal Protocol. In recent years, the rates of decline of CFC atmospheric concentrations, especially for CFC-11 (CCl3F), are not as large as anticipated under the Protocol, resulting in renewed efforts to estimate CFC consumption and/or emissions to possibly identify new or poorly quantified sources. Australian emissions of chlorofluorocarbons (CFCs) have been estimated from atmospheric CFC observations by both inverse modelling and interspecies correlation techniques, and from CFC production, import and consumption data compiled by industry and government. Australian and global CFC emissions show similar temporal behaviour, with emissions peaking in the late-1980s and then declining by ~10 % per year through to the present. Australian CFC emissions since 1978 account for less than 1 % of global emissions and therefore make a correspondingly small contribution to stratospheric ozone depletion. The current CFC emissions in Australia are likely from 'banks' of closed-cell foams, and refrigeration–air conditioning equipment now more than 20 years old. There is no evidence of renewed consumption or emissions of CFCs in Australia. The reduction in CFC emissions has made a significant contribution to reducing Australian greenhouse gas emissions. Environmental context. Chlorofluorocarbons (CFCs) are potent greenhouse and stratospheric ozone depleting trace gases. Their atmospheric concentrations are in decline, thanks to global production and consumption controls imposed by the Montreal Protocol. In recent years, the rates of decline of CFC atmospheric concentrations, especially for CFC-11 (CCl3F), are not as large as anticipated under the Protocol, resulting in renewed efforts to estimate CFC consumption and/or emissions to possibly identify new or poorly quantified sources. [ABSTRACT FROM AUTHOR]

Context: Muscle strength and performance are associated with fractures. However, the contribution of their rate of decline is unclear.Objective: To assess the independent contribution of the rate of decline in muscle strength and performance to fracture risk.Design, Setting, and Participants: Community-dwelling women (n = 811) and men (n = 440) aged 60 years or older from the prospective Dubbo Osteoporosis Epidemiology Study followed from 2000 to 2018 for incident fracture. Clinical data, appendicular lean mass/height2 (ht)2, bone mineral density, quadricep strength/ht (QS), timed get-up-and-go (TGUG), 5 times repeated sit-to-stand (5xSTS), and gait speed (GS) measured biennially. Rates of decline in muscle parameters were calculated using ordinary least squares regression and fracture risk was assessed using Cox's models.Main Outcome: Incident low-trauma fracture ascertained by x-ray report.Results: Apart from lean mass in women, all muscle parameters declined over time. Greater rates of decline in physical performance were associated with increased fracture risk in women (Hazard ratios [HRs] ranging from 2.1 (95% CI: 1.5-2.9) for GS to 2.7 (95% CI: 1.9-3.6) for 5xSTS, while in men only the decline in GS was associated with fracture risk (HR: 3.4 [95% CI: 1.8-6.3]). Baseline performance and strength were also associated with increased fracture risk in men (HRs ranging from 1.8 (95% CI: 1.1-3.0) for QS to 2.5 (95% CI: 1.5-4.1) for TGUG, but not in women.Conclusion: Rate of decline in physical performance in both genders, and baseline strength and performance in men, contributed independently to fracture risk. Sit-to-stand and GS were the tests most consistently associated with fractures. Further studies are required to determine whether muscle strength and/or performance improve the predictive accuracy of fracture prediction models. [ABSTRACT FROM AUTHOR]

Objective: To identify caregiving characteristics that are associated with financial stress in Australian carers of people with a chronic disease. Methods: Data were collected via the South Australian Health Omnibus, an annual population‐based, cross‐sectional survey. Individuals who provided care to someone with prevalent chronic conditions were asked about financial stress and caregiving characteristics. Results: Of 32.4% (988/3047) who were carers, 13.4% (132/988) experienced financial stress. Adjusting for age and household income, providing more than 20 hours of care per week (AOR = 2.39, 95% CI = 1.48‐3.86), transport assistance (AOR = 1.89, 95% CI = 1.15‐3.09) and assistance with household tasks (AOR = 1.92, 95% CI = 1.14‐3.26) and caring for a person with a mental illness (AOR = 2.01, 95% CI = 1.24‐3.28) were associated with a significant increase in odds of experiencing financial stress. Caring for a person with cancer (AOR = 0.49, 95% CI = 0.30‐0.81) or dementia (AOR = 0.40, 95% CI = 0.21‐0.76) was associated with decrease in odds. Conclusions: Financial stress was reported by more than 13% of carers, and factors other than household income were implicated. [ABSTRACT FROM AUTHOR]

Background: Frailty is an important predictive measure of mortality and rehospitalisation in people with heart failure. To date, there are no frailty instruments validated for use in people with heart failure. Aim: The aim of this study was to evaluate the convergent and discriminant validity of three versions of the frailty phenotype in those with heart failure. Methods: A single site, prospective cohort study was undertaken among individuals with a confirmed diagnosis of heart failure. Frailty was assessed concurrently using three versions of the frailty phenotype: the original frailty phenotype and two modified versions; the Survey of Health, Ageing and Retirement in Europe frailty instrument (SHARE-FI) and the St Vincent's frailty instrument. Convergent and discriminant validity were assessed by reporting the correlations between each version and related heart failure subconstructs, and by evaluating the ability of each version to discriminate between normal and abnormal scores of other physical and psychosocial scales specific to heart failure-related subconstructs. Results: The New York Heart Association classes were moderately correlated with the St Vincent's frailty instrument (r =0.47, P ⩽0.001), SHARE-FI (r =0.42, P ⩽0.001) and the frailty phenotype (r =0.42, P ⩽0.001). The SHARE-FI and the St Vincent's frailty instrument were both able to discriminate consistently between normal and abnormal scores in three out of five of the physical and psychosocial subconstructs that were assessed. The SHARE-FI was also able to discriminate between inpatients and outpatients who were classified as frail. Conclusions: Both the SHARE-FI and the St Vincent's frailty instrument displayed good convergent and discriminant validity. [ABSTRACT FROM AUTHOR]

Background People who inject drugs (PWID) are a priority for HIV prevention. This study aimed to determine perceptions, potential eligibility and willingness to use PrEP among PWID in Sydney.Methods: Clients completed a cross-sectional survey to collect data on demographics, perceived risk of HIV and willingness to use PrEP, which were then analysed.Results: Twelve (7%) of 172 HIV-negative participants were eligible for PrEP under current guidelines for injecting reasons, of whom three would also be eligible for sexual risk, leaving nine (5%) eligible for injecting reasons alone. Half had heard of PrEP and, of these, 65% would consider taking it. Most (88%) thought they would continue using needle syringe program services. A minority (8%) indicated they may be likely to share needles and syringes or be less concerned about injecting partners' HIV status (26%).Conclusions: Although PrEP will benefit a small proportion of PWID, this may equate to a significant number nationally. Policy development around PrEP incorporating affected populations will best support the community of people currently injecting to keep rates of HIV low. [ABSTRACT FROM AUTHOR]

Objective: To provide a qualitative examination of the service and support needs of children who have had a mild traumatic brain injury (mTBI), and their parents, in order to improve clinical services. Methods: Semi-structured interviews were conducted with 9 children (8-12 years; M = 10.6 years, SD = 0.8) and their parents (n = 9) 29-55 days (M = 34 days; SD = 9.3) after presenting to an Australian Paediatric Emergency Department (PED) for mTBI. Children's post-concussive symptoms (PCS) were additionally measured using the Post-Concussive Symptom Inventory (PCSI). Audio recordings were transcribed, and a thematic analysis was conducted. Results: Post-injury needs were reflected in four main themes: Communication; Family Burden; Continuity of Care; and Social and Community Support. These themes reflected children's and parents' needs for information, emotional/social/community support, and follow-up care. Both the children's and parents' needs, and the extent to which they were met, appeared to be related to the severity and duration of the child's PCS. Conclusions: Dedicated pediatric mTBI follow-up services that build on family's resources and meet their individual needs for information, emotional support, and referral may assist in optimizing post-injury outcomes. [ABSTRACT FROM AUTHOR]