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OBJECTIVES: To examine out-of-pocket costs incurred by patients for radiation oncology services and their variation by geographic location. DESIGN: Analysis of patient-level Medical Benefits Schedule (MBS) claims data linked with data from the Sax Institute 45 and Up Study. SETTING, PARTICIPANTS: People who received Medicare-subsidised radiation oncology services in New South Wales, 2006-2017. MAIN OUTCOME MEASURE: Mean out-of-pocket costs for an episode of radiation oncology (during 90 days from start of radiotherapy planning service), by geographic location (postcode-based), overall and after excluding episodes with no out-of-pocket costs (fully bulk-billed). RESULTS: During 2006-2017, 12 724 people received 15 506 episodes of radiation oncology care in 25 postcode-defined geographic areas. The proportion of episodes for which the out-of-pocket cost was less than $1 increased from 39% in 2006 to 76% in 2017; the proportion for which out-of-pocket costs exceeded $500 declined from 43% in 2006 to 10% in 2014, before increasing to 17% in 2017. For care episodes with non-zero out-of-pocket costs, the mean amount rose from around $1186 to $1611 per episode of care during 2006-2017. The proportion of radiation oncology episodes bulk-billed exceeded 90% in nine areas; in seven areas, all with exclusively private care provision of radiation oncology, it was 21% or smaller. Within geographic areas, out-of-pocket costs for individual care episodes varied widely; in ten areas with lower bulk-billing rates, the interquartile range for costs ranged from $240 to $1857. CONCLUSION: Out-of-pocket costs are an important determinant of access to care. Although radiotherapy costs for most people are moderate, some face very high costs, and these vary markedly by location. It is important to ensure that radiation oncology services remain affordable for all people who need treatment.

BACKGROUND/AIMS: The use and costs of health care rise substantially in the months prior to death, and although the use of palliative care services may be expected to lead to less costly care, the evidence is mixed. We analysed the costs of care over the last year of life and the extent to which these are associated with the use and duration of specialist palliative care (SPC) for decedents who died from cancer or another life-limiting illness. METHODS: The decedents were participants in a cohort study of older residents of the state of New South Wales, Australia. Using linked survey and administrative health data from 2007 to 2016, two cohorts were identified: n = 10,535 where the cause of death was cancer; and n = 11,179 where the cause of death was another life-limiting illness. Costs of various types were analysed with separate risk-adjusted linear regression models for the last 1, 3, 6, 9 and 12 months before death and for both cohorts. SPC was categorised according to time to death from first contact with the service as 1-7 days, 7-30 days, 30-180 days and more than 180 days. RESULTS: SPC use was higher among the cancer cohort (30.0%) relative to the non-cancer cohort (4.8%). The mean costs over the final year of life were AU$55,037 (SD 45,059) for the cancer cohort and AU$35,318 (SD 41,948) for the non-cancer cohort. Earlier use of SPC was associated with higher costs over the last year of life but lower costs in the last 1 and 3 months for both cohorts. Initiating SPC use more than 180 days before death was associated with a mean difference relative to the no SPC group of AU$15,590 (95% CI 10,617 to 20,562) and AU$13,739 (95% CI 733 to 26,746) over the last year of life for those dying from cancer and another illness, respectively. The same differences over the last month of life were - AU$2810 (95% CI - 3945 to - 1676) and - AU$4345 (95% CI - 6625 to - 2066). Admitted hospital care was the major driver of costs, with longer SPC associated with lower rate

OBJECTIVE: Skin cancer is Australia's most common and costly cancer. We examined the frequency of Australian general practice consultations for skin cancer-related conditions, by patient and general practitioner (GP) characteristics and by time period. DESIGN: Nationally representative, cross-sectional survey of general practice clinical activity. SETTING, PARTICIPANTS: Patients aged 15 years or older having a skin cancer-related condition managed by GPs in the Bettering the Evaluation And Care of Health study between April 2000 and March 2016. PRIMARY OUTCOME MEASURES: Proportions and rates per 1000 encounters. RESULTS: In this period, 15 678 GPs recorded 1 370 826 patient encounters, of which skin cancer-related conditions were managed 65 411 times (rate of 47.72 per 1000 encounters, 95% CI 46.41 to 49.02). Across the whole period, 'skin conditions' managed were solar keratosis (29.87%), keratinocyte cancer (24.85%), other skin lesion (12.93%), nevi (10.98%), skin check (10.37%), benign skin neoplasm (8.76%) and melanoma (2.42%). Over time, management rates increased for keratinocyte cancers, skin checks, skin lesions, benign skin neoplasms and melanoma; but remained stable for solar keratoses and nevi. Skin cancer-related encounter rates were higher for patients aged 65-89 years, male, living in Queensland or in regional or remote areas, with lower area-based socioeconomic status, of English-speaking background, Veteran card holders and non-healthcare card holders; and for GPs who were aged 35-44 years or male. CONCLUSION: These findings show the spectrum and burden of skin cancer-related conditions managed in general practice in Australia, which can guide GP education, policy and interventions to optimise skin cancer prevention and management.

Discoidin domain receptor 1 (DDR1) is a tyrosine kinase receptor expressed in epithelial cells from different tissues in which collagen binding activates pleiotropic functions. In the brain, DDR1 is mainly expressed in oligodendrocytes (OLs), the function of which is unclear. Whether collagen can activate DDR1 in OLs has not been studied. Here, we assessed the expression of DDR1 during in vitro OL differentiation, including collagen IV incubation, and the capability of collagen IV to induce DDR1 phosphorylation. Experiments were performed using two in vitro models of OL differentiation: OLs derived from adult rat neural stem cells (NSCs) and the HOG16 human oligodendroglial cell line. Immunocytofluorescence, western blotting, and ELISA were performed to analyze these questions. The differentiation of OLs from NSCs was addressed using oligodendrocyte transcription factor 2 (Olig2) and myelin basic protein (MBP). In HOG16 OLs, collagen IV induced DDR1 phosphorylation through slow and sustained kinetics. In NSC-derived OLs, DDR1 was found in a high proportion of differentiating cells (MBP+/Olig2+), but its protein expression was decreased in later stages. The addition of collagen IV did not change the number of DDR1+/MBP+ cells but did accelerate OL branching. Here, we provide the first demonstration that collagen IV mediates the phosphorylation of DDR1 in HOG16 cells and that the in vitro co-expression of DDR1 and MBP is associated with accelerated branching during the differentiation of primary OLs.

Schizophrenia (SCZ) is a complex disorder that typically arises in late adolescence or early adulthood. Age at onset (AAO) of SCZ is associated with long-term outcomes of the disease. We explored the genetic architecture of AAO with a genome-wide association study (GWAS), heritability, polygenic risk score (PRS), and copy number variant (CNV) analyses in 4 740 subjects of European ancestry. Although no genome-wide significant locus was identified, SNP-based heritability of AAO was estimated to be between 17 and 21%, indicating a moderate contribution of common variants. We also performed cross-trait PRS analyses with a set of mental disorders and identified a negative association between AAO and common variants for SCZ, childhood maltreatment and attention-deficit/hyperactivity disorder. We also investigated the role of copy number variants (CNVs) in AAO and found an association with the length and number of deletions (P-value = 0.03), whereas the presence of CNVs previously reported in SCZ was not associated with earlier onset. To our knowledge, this is the largest GWAS of AAO of SCZ to date in individuals from European ancestry, and the first study to determine the involvement of common variants in the heritability of AAO. Finally, we evidenced the role played by higher SCZ load in determining AAO but discarded the role of pathogenic CNVs. Altogether, these results shed light on the genetic architecture of AAO, which needs to be confirmed with larger studies.© 2023. The Author(s).

Culverts allow roads to safely traverse small streams or drainage ditches, and their proper design is critical to ensure a safe and reliable transportation network. A correct modelization of these hydraulic structures becomes crucial in the assessment of flood footprints or discharge peak estimation in a risk evaluation plan. The question of how to include culverts comes up frequently when assembling a hydraulic model that requires the presence of as many singular elements as possible. In this work, three different culvert integrations with the surface domain are studied and compared in the context of a 2D shallow water (SW) model. All of them are based on the Federal Highway Administration (FHWA) formulation for the culvert discharge estimation but differ in complexity and in the interaction with the numerical model for surface flow, some of them as internal boundary conditions. Several steady and unsteady validation test cases are presented and the numerical results are compared with the predictions from HEC-RAS 1D and HY-8 software. The culvert area, shape and their sensitivity to the 2D computational mesh is also analyzed.

In this work, a novel 2D depth-integrated numerical model for highly sediment-laden shallow flows over non-uniform erodible beds is presented, including variable density and exchange between the bed layer and the water–sediment mixture flow. The system of equations is formed by the 2D conservation equations for the mass and momentum of the mixture, the mass conservation equation for the different sediment size-classes transported in the flow and the bed evolution equation. The depth-averaged mixture density varies according to the volumetric concentration of the different sediment size-classes that can be incorporated from the bed to the flow and transported as suspended materials. The rheological behaviour of the flow is directly controlled by the properties of the mixture. A new x-split augmented Roe (xA-Roe) scheme is derived to solve the coupled flow and suspended solid-phase equations in both structured and unstructured meshes. The numerical scheme is defined to properly include density variations and momentum source terms, retaining a well-balanced flux formulation in steady states and the correct treatment of the wet–dry fronts. The numerical scheme is assessed with steady and transient cases involving highly sediment-laden flows, demonstrating its accuracy, stability and robustness in the presence of complex bed topography, wetting–drying fronts and rapid morphological changes.

The two-layer problem is defined as the coexistence of two immiscible fluids, separated by an interface surface. Under the shallow-flow hypothesis, 1D models are based on a four equations system accounting for the mass and momentum conservation in each fluid layer. Mathematically, the system of conservation laws modelling 1D two-layer flows has the important drawback of loss of hyperbolicity, causing that numerical schemes based on the eigenvalues of the Jacobian become unstable. In this work, well-balanced FORCE scheme is proposed for 1D two-layer shallow flows. The FORCE scheme combines the first-order Lax–Friedrichs flux and the second-order Lax–Wendroff flux. The scheme is supplemented with a hydrostatic reconstruction procedure in order to ensure the well-balanced behaviour of the model for steady flows even under wet–dry conditions. Additionally, a method to obtain high-accuracy numerical solutions for two-layer steady flows including friction dissipation is proposed to design reference benchmark tests for model validation. The enhanced FORCE scheme is faced to lake-at-rest benchmarking tests and steady flow cases including friction, demonstrating its well-balanced character. Furthermore, the numerical results obtained for highly unsteady two-layer dambreaks are used to analyse the robustness and accuracy of the model under a wide range of flow conditions.

An important feature of the two-layer shallow flow model is that the resulting system of equations cannot be expressed in conservation-law form. Here, the HLLS and ARoe solvers, derived initially for systems of conservation laws, are reformulated and applied to the two-layer shallow flows in a great variety of problems. Their resulting extension and combination allows us to overcome the loss of the hyperbolic character, ensuring energy or exactly balanced property, guarantees positivity of the solution, and provides a correct drying/wetting advance front without requiring tuning parameters. As a result, in those cases where the rich description of internal and external waves cannot be provided by the ARoe solver, HLLS is applied. Variable density is considered in each layer as a result of a bulk density driven by the mixture of different constituents. A wide variety of test cases is presented confirming the properties of this combination, including exactly balanced scenarios in subcritical and subcritical-transcritical scenarios, dam-break problems over bed variations and wet/dry fronts, non-hyperbolic conditions, transcritical exchange flow with loss of hyperbolicity. Despite the complexity of the test cases presented here, accurate and stable simulations are guaranteed, ensuring positivity of the solution without decreasing the time step.

Steady shallow flows past an open channel lateral cavity can induce the excitation of an eigenmode of a gravity standing wave inside the cavity, called seiche, which may be coupled with the shedding of vortices at the opening of the cavity. The presence of the seiche is of fundamental interest as it enhances the mass exchange between the main channel and the cavity. Measurements of the time evolution of the water surface are not often found in the literature for this type of flows. In this work, an experimental and numerical study of a shallow flow past a channel lateral cavity is carried out. The main novelty is the use of a pioneering non-intrusive experimental technique to measure the water surface at the channel-cavity region. This optical technique offers high resolution 2D data in time and space of the water surface evolution, allowing to determine the relevant features of the seiche oscillation. Such data are supplemented with Particle Image Velocimetry measurements. Furthermore, the experiments are numerically reproduced using a high-resolution depth-averaged URANS shallow water model, under the assumption that shallow water turbulence is mainly horizontal. The experimental and numerical results are analyzed in the frequency domain. High-resolution two-dimensional amplitude oscillation maps of the seiche phenomenon, as well as velocity fields, are presented. The high quality of the experimental data reported in this work makes this data set a suitable benchmark for numerical simulation models in order to evaluate their performance in the resolution of turbulent resonant shallow flows.

Nowadays, the great power of modern computers allows to develop computational models able to deal with simulations of several coupled phenomena over detailed complex topography. An efficient and properly calibrated computational model represents a useful tool to provide insight into the catchment dynamics at hydrological and geomorphological levels. In addition, it allows to develop detailed risk management and conservation plans. In this work, we present a coupled surface-groundwater distributed flow model with hydrological (rainfall and infiltration) and geomorphological (suspended and bed load sediment transport) components. The coupled model is applied to well characterized experimental catchments that are used as realistic test cases. The calibration of the water flow model response to rainfall is performed by means of the fitting to experimental outlet hydrographs of the results supplied by a coupled formulation of 2D Shallow Water Equations and 2D Darcy’s law for saturated porous media connected via suitable infiltration laws. The calibration of a suspended and bed load model is also addressed by means of the fitting to experimental outlet sedigraphs. The numerical results show a good agreement between numerical and observed hydrographs and sedigraphs, significantly improving previous published simulations. Additionally, the need to repeat the simulations in the calibration processes is no longer an unapproachable problem.

Background: Smoking cessation after a cancer diagnosis reduces risk of hospital readmission, improves recovery and reduces the risk of death. evidence-based policies recommend hospital admission is an ideal time to deliver smoking cessation interventions. However, hospital-based interventions are not well implemented. Implementation strategies are the techniques used to embed a new model of care into practice. Sharing knowledge about implementation strategies that have been applied in smoking cessation interventions in hospital-based settings is needed. Aim(s): This presentation will detail a comprehensive index of implementation strategies that have been applied to embed smoking cessation interventions into health services, as identified in a systematic review. Methods : We searched CINAHL Complete, Embase, MEDLINE Complete and PsycInfo using concepts smoking cessation, hospitals and implementation from 2010 to 2020, including all study designs. Data were extracted on study characteristics and implementation strategies, assessed according to four defined managerial functions: planning, organising, leading, monitoring. Results : A total of 14,287 original records were identified and screened, resulting in 63 included papers from 56 studies. Forty-two different implementation strategies were identified. Seventeen of these were categorised under Planning, including stakeholder consultation/engagement (n = 14 studies;25%), executive/senior leadership buy-in (n = 10;18%) and piloting (n = 10;18%). Twenty-one studies (38%) had no planning activities. Organising encompassed 10 strategies, the most common being certification of staff (n = 7, 13%), though most studies had no organisation implementation strategies (n = 31;55%). All studies used a Leading implementation strategy, most commonly training (54 studies;96%), and audit was the most common for Monitoring (n = 29 studies;52%). Results indicate multi-strategic approaches are recommended. Conclusions and Implications

Smoking cessation reduces the risk of death, improves recovery, and reduces the risk of hospital readmission. Evidence and policy support hospital admission as an ideal time to deliver smoking-cessation interventions. However, this is not well implemented in practice. In this systematic review, the authors summarize the literature on smoking-cessation implementation strategies and evaluate their success to guide the implementation of best-practice smoking interventions into hospital settings. The CINAHL Complete, Embase, MEDLINE Complete, and PsycInfo databases were searched using terms associated with the following topics: smoking cessation, hospitals, and implementation. In total, 14,287 original records were identified and screened, resulting in 63 eligible articles from 56 studies. Data were extracted on the study characteristics, implementation strategies, and implementation outcomes. Implementation outcomes were guided by Proctor and colleagues' framework and included acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, and sustainability. The findings demonstrate that studies predominantly focused on the training of staff to achieve implementation. Brief implementation approaches using a small number of implementation strategies were less successful and poorly sustained compared with well resourced and multicomponent approaches. Although brief implementation approaches may be viewed as advantageous because they are less resource-intensive, their capacity to change practice in a sustained way lacks evidence. Attempts to change clinician behavior or introduce new models of care are challenging in a short time frame, and implementation efforts should be designed for long-term success. There is a need to embrace strategic, well planned implementation approaches to embed smoking-cessation interventions into hospitals and to reap and sustain the benefits for people who smoke.

BACKGROUND: Long-term projections of cancer incidence and mortality estimate the future burden of cancer in a population, and can be of great use in informing the planning of health services and the management of resources. We aimed to estimate incidence and mortality rates and numbers of new cases and deaths up until 2044 for all cancers combined and for 21 individual cancer types in Australia. We also illustrate the potential effect of treatment delays due to the COVID-19 pandemic on future colorectal cancer mortality rates. METHODS: In this statistical modelling study, cancer incidence and mortality rates in Australia from 2020 to 2044 were projected based on data up to 2017 and 2019, respectively. Cigarette smoking exposure (1945-2019), participation rates in the breast cancer screening programme (1996-2019), and prostate-specific antigen testing rates (1994-2020) were included where relevant. The baseline projection model using an age-period-cohort model or generalised linear model for each cancer type was selected based on model fit statistics and validation with pre-COVID-19 observed data. To assess the impact of treatment delays during the COVID-19 pandemic on colorectal cancer mortality, we obtained data on incidence, survival, prevalence, and cancer treatment for colorectal cancer from different authorities. The relative risks of death due to system-caused treatment delays were derived from a published systematic review. Numbers of excess colorectal cancer deaths were estimated using the relative risk of death per week of treatment delay and different durations of delay under a number of hypothetical scenarios. FINDINGS: Projections indicate that in the absence of the COVID-19 pandemic effects, the age-standardised incidence rate for all cancers combined for males would decline over 2020-44, and for females the incidence rate would be relatively stable in Australia. The mortality rates for all cancers combined for both males and females are expected to con

OBJECTIVE: To better serve women with gynaecological cancers, we need a sound understanding of their health, wellbeing and needs. This study sought to explore these issues in a sample of Australian women before commencing curative radiotherapy. METHODS: We undertook a secondary analysis of baseline data from a supportive care trial (n = 311). Descriptive statistics were used to summarise responses to measures of wellbeing, general psychological distress, symptom distress, sexual function and vaginal changes, and supportive care needs. Pre-specified regression models were used to examine sources of variation in wellbeing and sexual function. RESULTS: Women reported lower emotional, functional and physical wellbeing than population norms (all p < 0.001). The prevalence of general psychological distress was 31% (95% CI 26-36%). Distress caused by physical symptoms was typically low. Health system and information needs comprised eight of the top ten moderate-to-high supportive care needs. Most women reported no change in interest for physical contact or sex compared to pre-diagnosis, but some sexually active women (16-24%) reported smaller vaginal size, increased dryness, and more pain on intercourse. General psychological distress was a robust marker of poorer wellbeing and sexual function. CONCLUSIONS: Before radiotherapy, a substantial minority of women with gynaecological cancers experience general psychological distress, reduced wellbeing and moderate-to-high health system and information needs. A model of comprehensive care incorporating assessment of unmet needs, general psychological distress, and sexual issues is recommended. Healthcare providers may require training to elicit and respond to a constellation of interrelated issues and access relevant services for women requiring additional support.