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Over the past three years, the Atlas of Living Australia (ALA), a data infrastructure in its own right and the Australian node of the Global Biodiversity Information Facility (GBIF), has been both enjoying both rapid growth (now with over 50 employees covering a broad project portfolio), and maturing as an organisation with formal processes in place for strategy and workplan development, project management and planning. Having recently upgraded our core infrastructure to align with GBIF and now sharing a code base for our data ingestion pipelines, we have been working on extending the occurrence data model with a focus on ecological survey sites and events and will continue to participate in the development of GBIF's diversified data model. We have been developing a framework with our jurisdictional agencies for managing restricted data, which will see us develop our Sensitive Data Service to handle a broader range of data sensitivity scenarios than the current system, which obfuscates by species rules only, whereas there are requirements to manage sensitivity at the levels of dataset, provider or location. We have begun a cross-agency project for aggregating genomic data for Australian species from multiple platforms, and a new technical roadmap will guide us as we redevelop and modernise our suite of web services and applications. This presentation will give a very brief overview of our current major project work, relating it to our stated strategies to deliver trusted data and robust services, partner for impact, and support decision making.

Currently, genomics data for living species are stored in public and private repositories online. These repositories remain largely disconnected and only partially findable. The Australian Reference Genome Atlas (ARGA) Project is solving the problem of genomics data obscurity by creating an online platform where life sciences researchers can comprehensively and confidently search for data for taxa relevant to Australian research. At its most basic, ARGA is a tool for aggregating and indexing publicly available genomics (and genetics) data. We aim to improve the experience of discovering and accessing this data by building search functionality, based on features such as phenotypic traits and predicted and observed species distributions, and supporting data packaging and transfer to analysis environments. ARGA will index GenBank (National Institutes of Health (NIH), USA), the European Nucleotide Archive (EMBL-ENA), the database of Bioplatforms Australia, and selected DNA repositories in Australian faunal collections and herbaria. We will integrate these records with the occurrence records and taxonomic framework of the Atlas of Living Australia (ALA) to enrich the data and make it searchable using taxonomy, location, ecological characteristics and selected phenotypic data. The chief aims and outputs for the project are to: create a system to enable contextual metadata about a species to be used as a pointer to a variety of genomic data associated with that species; add functionality to that system to enable additional contextual information groupings, and community curation of these created groupings; create a user-facing web-accessible interface for the system; and devise a mechanism that allows the researchers searching the multiple genomic repositories, via ARGA, to select files for subsequent analysis and export them to other cloud-based analysis infrastructure. create a system to enable contextual metadata about a species to be used as a pointer to a variety of genomic data associated with that species; add functionality to that system to enable additional contextual information groupings, and community curation of these created groupings; create a user-facing web-accessible interface for the system; and devise a mechanism that allows the researchers searching the multiple genomic repositories, via ARGA, to select files for subsequent analysis and export them to other cloud-based analysis infrastructure. Our approach to ARGA incorporates: ingesting species metadata from multiple sequence repositories into a consistent data format using Darwin Core Archive (DwC-A); processing metadata using the Pipelines system developed by the Global Biodiversity Information Facility (GBIF), and as implemented in the ALA and other Living Atlases. indexing metadata using a Solr search engine; and providing a front-end web interface for users to find, select and export sequence files to a number of cloud-based analysis platforms. ingesting species metadata from multiple sequence repositories into a consistent data format using Darwin Core Archive (DwC-A); processing metadata using the Pipelines system developed by the Global Biodiversity Information Facility (GBIF), and as implemented in the ALA and other Living Atlases. indexing metadata using a Solr search engine; and providing a front-end web interface for users to find, select and export sequence files to a number of cloud-based analysis platforms. Here we will present an overview of the ARGA infrastructure and demonstrate an early prototype of the platform. We will show how ARGA can be used to interrogate DNA sequence records for taxa relevant to Australian research questions, realising a vision where genomics-based solutions to biological questions in conservation, ecology, agriculture and biosecurity can be manifested.

Synthesizing trait observations and knowledge across the Tree of Life remains a grand challenge for biodiversity science. Species traits are widely used in ecological and evolutionary science, and new data and methods have proliferated rapidly. Yet accessing and integrating disparate data sources remains a considerable challenge, slowing progress toward a global synthesis to integrate trait data across organisms. Trait science needs a vision for achieving global integration across all organisms. Here, we outline how the adoption of key Open Science principles—open data, open source and open methods—is transforming trait science, increasing transparency, democratizing access and accelerating global synthesis. To enhance widespread adoption of these principles, we introduce the Open Traits Network (OTN), a global, decentralized community welcoming all researchers and institutions pursuing the collaborative goal of standardizing and integrating trait data across organisms. We demonstrate how adherence to Open Science principles is key to the OTN community and outline five activities that can accelerate the synthesis of trait data across the Tree of Life, thereby facilitating rapid advances to address scientific inquiries and environmental issues. Lessons learned along the path to a global synthesis of trait data will provide a framework for addressing similarly complex data science and informatics challenges.

The Atlas of Living Australia (ALA) is an Australian Government supported collaborative partnership of organisations that have stewardship of Australian biodiversity data. The ALA (www.ala.org.au) provides research infrastructure that enables delivery of biodiversity information to over 45,000 unique users in research, industry and government per annum. It delivers impact and enables research excellence in fields such as biodiversity, environmental management, ecology and genetic sciences. Integrated and consistent infrastructure and processes are fundamental to increasing value of collections and associated data. The Atlas of Living Australia has a mature industry engagement program that provides data standardisation, quality and analytical services to decision makers in all tiers of Australian government (local, state and federal). This program is built on formal partnerships between data providers (collection institutions) and analytical services (such as Virtual Laboratories and Research and Science Clouds www.ecocloud.org.au). The provision of high quality, authoritative data is critical to utilisation and uptake of these services and sector sustainability. This presentation will showcase data service and analytical methods for decision makers within the Australian context. It will also explore how international efforts such as DiSSCo assist in data stewardship, cultural change and system enhancement.

Synthesising trait observations and knowledge across the Tree of Life remains a grand challenge for biodiversity science. Despite the well-recognised importance of traits for addressing ecological and evolutionary questions, trait-based approaches still struggle with several basic data requirements to deliver openly accessible, reproducible, and transparent science. Here, we introduce the Open Traits Network (OTN) – a decentralised alliance of international researchers and institutions focused on collaborative integration and standardisation of the exponentially increasing availability of trait data across all organisms. The OTN embraces the use of Open Science principles in trait research, particularly open data, open source, and open methodology protocols and workflows, to accelerate the synthesis of trait data across the Tree of Life. Increased efforts at all levels – from individual scientists, research networks, scientific societies, funding agencies, to publishers – are necessary to fully exploit the opportunities offered by Open Science in trait research. Democratising access to data, tools and resources will facilitate rapid advances in the biological sciences and our ability to address pressing environmental and societal demands.

© 2018 IEEE. In part-based categorization context, the ability to learn representative feature from quantitative tiny object parts is of similar importance as to exactly localize the parts. We propose a new deep net structure for fine-grained categorization that follows the taxonomy workflow, which makes it interpretable and understandable for humans. By training customized sub-nets on each manually annotated parts, we increased the state-of-the-art part-based classification accuracy for general fine-grained CUB-200-2011 dataset by 2.1%. Our study shows the proposed method can produce more activation to discriminate detail part difference while maintaining high computing performance by applying a set of strategies to optimize the deep net structure.

Effective management of our natural world under current and future conditions requires efficient, collaborative and complementary planning and decision-making processes with clear lines of accountability. While there has been significant progress in establishing national databases for the management of species observation data, these only represent samples of a species' total distribution. The need and challenge therefore is to model these point-based observation data to obtain estimates or projections of the total range and distribution of the species. Such Species Distribution Models (SDMs), also known as Environmental Niche Models (ENMs), and the geographic data (or “maps”) they generate, provide vital information needed by governments at all levels to meet various policy and statutory responsibilities and obligations. SDMs quantify the response of species occurrence to environmental conditions described by variables such as climate, substrate, productivity and vegetation. The outcomes of an SDM can be used to identify locations and regions with potentially suitable environmental conditions for a species, as well as assess how species may respond to projected future climate changes or habitat loss. While SDMs are widely used in many decision- and policy-making programs, investment in species distribution information has been fragmented and limited. In Australia, three different government departments joined forces with the Atlas of Living Australia and the Biodiversity and Climate Change Virtual Laboratory to develop a standard framework for modelling threatened species distributions for use in policy and environmental decision-making. The pilot program that will be conducted throughout 2019 includes three complementary pillars: An expert panel with both researchers and government practitioners who will review current SDM practices used in government and develop a set of best-practice methods. A technology program that includes the development of a new modelling platform that implements the best-practice methods for transparent and reproducible SDMs for decision making as established by the expert panel. Additionally, there will be an online portal for publishing ecological model outputs in a searchable catalogue to enhance cross-jurisdiction collaborations. Establishment of a training and skill development program to upskill decision makers using the new tools and methodology in practice. An expert panel with both researchers and government practitioners who will review current SDM practices used in government and develop a set of best-practice methods. A technology program that includes the development of a new modelling platform that implements the best-practice methods for transparent and reproducible SDMs for decision making as established by the expert panel. Additionally, there will be an online portal for publishing ecological model outputs in a searchable catalogue to enhance cross-jurisdiction collaborations. Establishment of a training and skill development program to upskill decision makers using the new tools and methodology in practice. This presentation will showcase the outcomes of this program and highlight how digital infrastructure can enhance decision making. In this case specifically, the collaboration across government departments ensures a) a consistent approach across jurisdictions, b) an increase in model quality, thereby leading to a decrease in unnecessary survey or consultation efforts, c) an increase in suitability, robustness and reproducibility of SDMs, and d) increased advocacy and coordination in national programs and resources.

Advances in computing power and infrastructure, increases in the number and size of ecological and environmental datasets, and the number and type of data collection methods, are revolutionizing the field of Ecology. To integrate these advances, virtual laboratories offer a unique tool to facilitate, expedite, and accelerate research into the impacts of climate change on biodiversity. We introduce the uniquely cloud-based Biodiversity and Climate Change Virtual Laboratory (BCCVL), which provides access to numerous species distribution modelling tools; a large and growing collection of biological, climate, and other environmental datasets; and a variety of experiment types to conduct research into the impact of climate change on biodiversity.Users can upload and share datasets, potentially increasing collaboration, cross-fertilisation of ideas, and innovation among the user community. Feedback confirms that the BCCVL's goals of lowering the technical requirements for species distribution modelling, and reducing time spent on such research, are being met. BCCVL facilitates and expedites modelling of climate change's impact on biodiversity.BCCVL integrates numerous species distribution modelling tools and myriad datasets.BCCVL negates the need for advanced programming and modelling expertise.BCCVL allows for increases in productivity and complexity of experimental design.BCCVL facilitates the sharing of data promoting transparency in the research process.

In the version of this Perspective originally published, the first author of reference 39 was incorrectly listed as W. Cornwell and the publication year was incorrect. The reference should have read as follows: “Flores-Moreno, H. et al. fungaltraits aka funfun: a dynamic functional trait database for the world's fungi (GitHub, 2019); https://doi.org/10.5281/zenodo.1216257”. This has now been corrected.

This research identifies the psychosocial needs of HIV-positive women attending two of the newly established Community Care Centres in Kerala, as recounted by the health care practitioners of those services. Findings include the complex and devastating impacts of the stigma associated with HIV/AIDS on women's lives, including their avoidance of health care due to fear of disclosure and the denial of their children's access to education. The report suggests that further research into the linkages between the different stakeholders, to fully exploit the successful strategies employed by each to combat the stigma, may well be beneficial in addressing one of the most damaging and pervasive challenges of the disease.

Enterprise Architecture thinking and techniques, like disciplined project management, translate well into the eScience domain - both in decomposing the problem to be solved and maintaining an optimal solution path. This holds true across the many perspectives that constitute eScience: discipline leaders, governments, institutions, research groups and investigators. We apply this thinking to the emerging EcoCloud which is representative of the complex, national, multi-stakeholder and collaborative e-science infrastructure projects currently being implemented within Australia.

McGrathAims This study set out to explore the attitudes toward a “Patient Stories” DVD as a psychosocial support initiative for patients diagnosed with a hematological malignancy. Design A qualitative research design was employed through a series of open-ended interviews and one focus group. Participants Participants were purposively sampled from a database of patients maintained by the Leukaemia Foundation of Queensland. In total, there were 50 participants (n = 26 male, n = 24 female), which represented the following major hematological diagnostic groups: multiple myeloma (n = 15), lymphoma (n = 14), leukemia (n = 17), and other (n = 4). Of the overall cohort, 11 participants had undergone a bone marrow transplant, and 15 had undergone a stem cell transplant (allogeneic and autologous transplants). Results and Conclusion Most participants believed that a “Patient Stories” DVD would be a beneficial and effective way for nurses delivering psychosocial support to hematology patients. Such benefits included a sense of normalization from hearing similar stories and providing convenient support that did not require travel or potentially uncomfortable social situations. However, some participants did not show interest in the idea for reasons such as already having a local support system and not wanting to watch potentially frightening stories. McGrath

Background: This article presents a subset of findings on the experience of bone marrow aspiration and biopsy (BMAB) from an Australian hematology survivorship study.Objective: The aim of the larger research was to document and explore issues associated with the experience of survivorship for hematology patients supported by Leukaemia Foundation of Queensland. The experience with BMABs was one of the issues explored. Interventions/Methods: The qualitative study involved in-depth interviews with 50 individuals with a diagnosis of a hematologic malignancy from a range of locations throughout Queensland, Australia. The interviews were transcribed verbatim, coded, and then analyzed thematically. Results: The findings demonstrate that, for many of the hematology patients in the study, BMABs were a painful experience. The findings indicate that a major contributing factor to the pain and discomfort is the lack of effective procedural care. Conclusions: The findings emphasized the importance of the provision of choice with regard to anesthesia or sedation as part of the procedural care for BMABs. Implications for Practice: The insights provide urgency to the call for further research to improve clinical practice and procedural care in relation to BMABs. The strong recommendation from the study is that procedural pain in relation to BMABs for hematology patients be managed from the initial procedure as the consequences of a traumatic experience can be far reaching, particularly in light of the need for repeated BMABs over the treatment trajectory. As specialist nurses are now increasingly taking responsibility for carrying out such procedures, the findings have implications for the nursing profession.

There is an increasing international movement of physicians, with substantial numbers of International Medical Graduates (IMGs) now seeking jobs outside the countries in which they were educated. For IMGs there are potential elements of crisis and loss associated with this transition. This article presents findings from Australian-based research which explores the IMGs' experience during entry to their chosen country and posits the need for a designated liaison officer to help support the transition. The research was based on thirty open-ended, qualitative interviews which were coded and thematically analyzed. The findings document factors associated with the decision to leave their country of origin, psycho-social aspects of stress experienced upon arrival in Australia, and the participants' perspective on the suggestion for the appointment of a hospital-based liaison officer to assist IMGs during the transition process.

This paper presents a sub-set of findings from the first interview (T1) of an Australian longitudinal study that documents the living donor's experience with renal transplant. There has been limited Australian research on this topic to date. A qualitative methodological approach was used, involving open-ended interviews with prospective living kidney donors (n = 20) from the Renal Transplantation Unit at the Princess Alexandra Hospital in Brisbane, Queensland, Australia. The interviews were analysed using qualitative research methods of coding and thematic analysis. A significant majority of participants reported that the decision to become a living kidney donor was a positive, easy and spontaneous decision. It was driven by their natural instincts and they offered to be a donor at the earlier opportunity, rather than waiting to be asked. The offer was based on their desire to relieve the recipient's suffering and possible death associated with dialysis and kidney failure. While concerns associat...

The use of the word 'survivor' is now widely accepted in academic and clinical oncology culture. However, despite such prevalence, there is limited research exploring the meaning of the term survivor for the very individuals to which the term is applied. The article provides insights on the term survivor from a sub-set of findings taken from a Queensland study exploring the experience of survivorship for individuals diagnosed with a haematological malignancy.The qualitative study involved in-depth interviews with 50 individuals diagnosed with a haematological malignancy. The interviews were transcribed verbatim, coded and then analysed thematically.The results indicated that the majority of participants actively disliked the term and did not embrace the notion of survivor in their post-diagnosis identity. Only a small number actively embraced the term.The word survivor had a multiplicity of meanings depending on the individual interpretation of the term. RELEVANCE OF MANUSCRIPT TO INFORM RESEARCH, POLICIES AND/OR PROGRAMMES: The clear message from the research is that the term survivor needs to be used with care and sensitivity. The strong recommendation is that caution should be used when applying the term to individuals diagnosed with a haematological malignancy. The naming of support groups and newsletters should be sensitive to the wide range of meanings that individuals bring to this term. Indeed, the findings indicate that many do not identify with the term and require a more appropriate language to respond to their supportive care needs.

Patients diagnosed with haematological malignancies require specialist treatments provided by major metropolitan hospitals. Those living outside the cities where the specialist care is located have to relocate for this specialist treatment. The findings presented in this article are from a program of research that documents the psychosocial impact of relocation on patients and their families. Prior Australian-based research conducted as part of the program indicates that the process of relocation exacerbates the stress of treatment and creates significant practical, emotional, social, and financial disruption to the families involved. The Australian findings provided the basis for a recent comparative study conducted by the program that explores the experience of relocation for haematology from the perspective of patients and their carers in New Zealand. The findings from the comparative study indicate that whilst there is evidence of similar psycho-social distress associated with relocation, there are a number of factors specific to living in New Zealand that ameliorate the impact, including smaller distances, strong community connections, and the participants' personal determination to retain the focus on living.

To date, the research on relocation has been conducted in countries such as Australia where there are vast distances that need to be travelled by regional, rural and remote patients to access specialist metropolitan treatment. This research considers the issue of relocation for specialist treatment in a New Zealand context.The exploration of the experience of relocation from the consumers' perspective was conducted through an iterative, qualitative research methodology using open-ended interviews conducted by speaker-phone at the time and location of each participant's choice.The three factors that underpin the phenomenon of 'travel-based' accommodation in New Zealand are the strong desire to return home, the small geographical distances that make this possible for many and the strong determination to endure hardship associated with travel when distances are long.Any understanding of relocation for specialist treatment needs to be informed by two concepts: 'travel-based' relocation and 'accommodation-based' relocation. RELEVANCE OF MANUSCRIPT TO INFORM RESEARCH, POLICIES AND/OR PROGRAMS: The focus needs to be on providing supportive travel arrangements where possible. In New Zealand, as elsewhere, cancer supportive care organisations are increasingly providing volunteers to assist with travel. Such practical volunteer assistance is important, as is financial support through government subsidies to cover the cost of such travel. The insights from the study affirm the importance of health professionals who are supportive and creative in their efforts to assist people to return home. Supportive clinical care such as addressing issues in relation to nausea and pain management for those travelling must also be considered.

This article presents the findings of a cross-cultural research project that explored similarities and differences between palliative care service provision in Kerala, India and South-East Queensland, Australia, to inform a process of mutual learning for service development. Three major points of difference that can inform this process of mutual learning were identified: 1) an understanding of the significance of honesty in information-giving to the patient, 2) recognition of the importance of palliative care specialists providing education to mainstream health professionals, and 3) appreciation of the need for palliative care to be cognizant of the socio-economic impact of dying-especially for families experiencing poverty-by embracing strategies for financial and material support. The findings highlight the effectiveness of a cross-cultural collaboration between health professionals and researchers in South-East Queensland, Australia and Kerala, India.

Although Aboriginal Australians experience morbidity and mortality rates far greater than that of the wider Australian population, to date, their access to culturally appropriate palliative care services has remained unexplored. This article provides findings from an Australian National Health and Medical Research funded study that documents the availability of palliative care services to Aboriginal peoples of the Northern Territory, Australia. The data were collected through a series of open-ended, qualitative interviews with a cross section of Aboriginal peoples and health professionals conducted during a 2-year period. The findings provide an overview of the palliative care services that are presently available and reflect a serious lack of local, culturally appropriate palliative care services. This research shows the similarities in the struggles and difficulties faced by Australian Aboriginals and Indigenous peoples worldwide. The hope is that the suggestions put forward for improvement will one day be useful for the world's Indigenous peoples.

Recent haematology clinical guidelines recommend that palliative care specialists should have central roles in haemato-oncology teams. However, the available research evidence indicates there are presently significant obstacles to the integration of palliative care in haematology. The following discussion presents findings from an Australian study designed to address the problems associated with lack of referral of haematology patients to the palliative system through the development of a best-practice model for end-of-life care for these diagnostic groups. The preliminary step in the development of such a model is to document the factors that denote the special characteristics of the end-of-life stage of haematological conditions and their treatments. This article presents the list of special considerations from a nursing perspective, including issues associated with the high-tech nature of treatments, the speed of change to a terminal event, the need for blood products and possibility of catastrophic bleeds, the therapeutic optimism based on a myriad of treatment options and the clinical indices of the terminal trajectory. The nursing insights provide an important foundation for building a practical, patient-centred model for terminal care in haematology.

Purpose/Objectives: To present a model for end-of-life care in adult hematology that has been developed from nursing insights. Data Sources: Insights obtained from 25 nursing interviews during a two-year, qualitative, Australian National Health and Medical Research Council research study. Data Synthesis: The nursing insights indicate that an understanding of end-of-life care in hematology needs to be set in a trilogy of overlapping models (labeled functional, evolving, and refractory) that address the complexity of issues associated with professional and hospital culture. Conclusions: The authors have used the findings of their national research study to develop a useful, working model to assist with the integration of palliative care into adult hematology. Implications for Nursing: The model develops a new language for understanding and fostering the integration of palliative care and hematology.

In recent years the literature on bioethics has begun to pose the sociological challenge of how to explore organisational processes that facilitate a systemic response to ethical concerns. The present discussion seeks to make a contribution to this important new direction in ethical research by presenting findings from an Australian pilot study. The research was initiated by the Clinical Ethics Committee of Redland Hospital at Bayside Health Service District in Queensland, Australia, and explores health professionals’ understanding of the nature of ethics and their experience with ethical decision-making within an acute medical ward. This study focuses on the actual experience, understanding and attitudes of clinical professionals in a general medical ward. In particular, the discussion explores the specific findings from the study concerned with how a multi-disciplinary team of health professionals define and operationalise the notion of ethics in an acute ward hospital setting. The key issue reported is that health professionals are not only able to clearly articulate notions of ethics, but that the notions expressed by a multi-disciplinary diversity of participants share a common definitional concept of ethics as patient-centred care. The central finding is that all professional groups indicated that there is a guiding principle to address their ethical sense of the ‘good’ or the ‘ought’ and that is to act in a way that furthered the interests of patients and their families. The findings affirm the importance of a sociological perspective as a productive new direction in bioethical research.

There is now extensive consumer research to indicate that patients with haematological malignancies are not receiving appropriate or timely referrals to the palliative system. This paper begins to explore the issue from the professional perspective by presenting findings from haematology nurses on their experience with terminal care. The nursing insights have been gathered through open-ended interviews with a national sample of nurses with extensive experience in haematology in both public and private hospitals throughout Australia. The findings resonate with the previous consumer research in that all the acute care nurses affirmed that it is their belief, based on their professional experience, that patients from these diagnostic groups typically die in the acute ward dealing with escalating technology and invasive treatments. For some, the statements could be qualified by the satisfaction that they worked in a haematology unit, aware of the death-denying issues, trying to address the problem. Others, caught in a 'refractory' subculture (i.e. a subculture with a negative perception of palliative care), outlined the factors driving the lack of integration for their specific hospital. The focus of the discussion of findings is on the latter.

It is now common in health care for a diverse range of professions and disciplines to work together in regular and close contact. Thus, there are now calls in the literature for research that documents insights on the ethical dimension of multidisciplinary relationships. Recent Australian research has responded to this call by examining how a multidisciplinary team of health professionals define and operationalize the notion of ethics in an acute ward hospital setting. This article provides findings from the research study that indicate that, although there is a shared conceptualization of ethics as "patient-centered care," there can be times of conflict and tension in determining what is best for the patient. The discussion begins to build an understanding of how a multidisciplinary mix of health professionals responds to ethical conflict and tension. The authors' hope and expectation is that, by keeping the research focus on what health professionals in a multidisciplinary team (MDT) actually do, rather...

Issues associated with speech and language have been noted in the international literature as an important aspect of the process of integration for Australian International Medical Graduates (IMGs). This paper makes a contribution through the presentation of a sub-set of findings on the factors associated with speech and language practices for IMGs, taken from a qualitative study which examined the IMGs’ experience of integration into the Australian healthcare system. A purposive sample of 30 IMGs were interviewed via telephone. Participants were asked to share their experience with communicating in English with patients and other health professionals in the context of the Australian healthcare system. The taped interviews were transcribed verbatim and then coded and thematically analysed. The findings indicate that the months following the point of entry into a medical position are a critical time for the majority of IMGs in terms of difficulties with communicating in English. A range of suggestions to improve speech and language skills for IMGs is provided. The findings emphasize the importance of speech and language skills and the serious implications of this issue for the clinical practice of IMGs.

Introduction: There has been no research exploring the financial impact on the live renal donor in terms of testing, hospitalisation and surgery for kidney removal (known as nephrectomy). The only mention of financial issues in relation to live renal transplantation is the recipients' concerns in relation to monetary payment for the gift of a kidney and the recipients' desire to pay for the costs associated with the nephrectomy. The discussion in this article posits a new direction in live renal donor research; that of understanding the financial impact of live renal donation on the donor to inform health policy and supportive care service delivery. The findings have specific relevance for live renal donors living in rural and remote locations of Australia. Methods: The findings are presented from the first interview (time 1: T1) of a set of four times (time 1 to time 4: T1-T4) from a longitudinal study that explored the experience of live renal donors who were undergoing kidney removal (nephrectomy) at the Renal Transplantation Unit at the Princess Alexandra Hospital, Brisbane, Australia. A qualitative methodological approach was used that involved semi-structured interviews with prospective living kidney donors (n=20). The resulting data were analysed using the qualitative research methods of coding and thematic analysis. Results: The findings indicate that live renal donors in non-metropolitan areas report significant financial concerns in relation to testing, hospitalisation and surgery for nephrectomy. These include the fact that bulk billing (no cost to the patient for practitioner's service) is not always available, that individuals have to pay up-front and that free testing at local public hospitals is not available in some areas. In addition, non-metropolitan donors have to fund the extra cost of travel and accommodation when relocating for the nephrectomy to the specialist metropolitan hospital. Conclusion: Live renal transplantation is an important new direction in medical care that has excellent long-term results for individuals diagnosed with end-stage renal disease. An essential element of the transplantation procedure is the voluntary donation of a healthy kidney by the live renal donor. Such an altruistic gift, which has no personal health benefit for the donor, is to be applauded and supported. The present research demonstrates that for some donors, particularly those living outside the metropolitan area, the gift may also include a range of financial costs to the donor. There is no prior research available on the financial impact of live renal donation for individuals living in non-metropolitan areas. Thus, this article is a seminal work in the area. The findings affirm 'rural disadvantage' by demonstrating that it is the live renal donors in non-metropolitan areas who are reporting financial concerns in relation to testing, hospitalisation and surgery for nephrectomy. It is the hope and expectation that the reporting on these costs will encourage further work in this area and the findings will be used for health policy and service delivery considerations.

Despite the personal and economic importance of the issue of returning to work after cancer treatment, there are major limitations in the research literature on the topic. Indeed, in relation to the focus of the present article, the experience of return to work for Australian haematology patients, there is little research available. The return-to-work findings are a sub-set from a study examining survivorship issues conducted through in-depth, qualitative interviews with a state-wide sample (n = 50) of individuals who were at least 1 year post-treatment for haematological malignancy. There were three groups identified in relation to employment: (1) those who were retired and work was not an issue, (2) those who had successfully re-entered the workforce and (3) those who wanted to work but were finding the process of return-to-work difficult. It is the third group that is the major focus for this paper. The clear indications are that group 3 requires assistance with return-to-work and were vulnerable to a range of psychosocial distress caused by inability to return to employment. Supportive care strategies to assist return to employment are provided. Relevance of manuscript to inform research, policies and/or programs Current improvements in cancer treatments have not only increased the number of cancer survivors but also peoples’ ability to work during and following treatment. Maximising opportunities for cancer patients to return to work is a significant concern not only for individuals and employers but also economically for society. The findings reported in this article explored the individual story of a range of individuals with haematological malignancies in relation to their desire and efforts to return to work. Importantly, the findings not only provide insights on the work re-entry challenges faced by such individuals but also posit supportive care service delivery solutions to assist those who are vulnerable and frustrated in their efforts to find employment.

The increasing global mobility of physicians and severe physician shortages of many countries has led to an increasing reliance on International Medical Graduates (IMGs) by countries including Australia and Canada.A web-based comparison of licensing policies for IMGs in Australia and Canada to inform and improve policies in each country.The research involved identification of relevant government and medical regulatory bodies' official websites documenting information on the licensing process for IMGs from each respective country; in-depth examination and comparison of the licensing processes outlined on these sites; and compilation of a comprehensive list of similarities and differences.While difficult entry requirements are imposed in Canada, once full registration is achieved IMGs have the same membership rights as Canadian medical graduates and their separate status (nominally) ends. In Australia, IMGs are allowed relatively easy access to temporary or conditional licenses, especially in designated underserviced areas or areas of need in order to fulfil resource demands. However IMGs are predominantly restricted to practise in limited and less prestigious positions within the medical hierarchy.The Canadian process for recertifying IMGs can be characterized as being based on the integration/assimilation of IMGs with domestically trained doctors. In contrast, Australia has pursued a different strategy of parallelism of its IMGs.The findings provide insights into how each country balances national licensing requirements with physician shortages in a globalized environment in order to provide healthcare for its citizens.

Spousal bereavement is documented as a highly stressful event. This article presents findings from research that explored bereavement survivors' perspectives on what support factors were most helpful to them.A qualitative telephone survey was conducted with caregiver spouses of Cittamani Hospice Service clients who died during 2005 and 2006.Partner loss results in significant grief; the initial period is most intense but the grieving continues over a long period. Factors identified as assisting bereaved spouses include: hospice bereavement assistance provided before, during and following the bereavement; having a support network, including both informal support networks and formal support from general practitioners; and keeping active and busy.General practitioners play an important role in bereavement care. Key factors assisting bereavement survivors include appropriate referral to palliative care, maintaining a supportive informal network and keeping busy.

This article presents the findings from a pilot study conducted as a first step in understanding the myriad psychological and psychiatric sequelae stemming from the use of steroids for hematology patients. Descriptions of the side effects experienced by 10 hematology patients undergoing steroid treatment are documented and discussed. Steroid usage can have a range of physical and emotional side effects on patients, including hematology patients. The insights are a serious reminder to all who care for hematology patients that the psychological and psychiatric side effects of steroids need to be taken seriously.

With regards to end-of-life care, there is scant published research that looks specifically at the provision of palliative care services for Indigenous people. In addition, for Indigenous people in the rural and remote areas there is only limited literature that focuses on the problems associated with geography. To address the hiatus in the literature on Aboriginal, rural and remote palliative care, the following article provides findings from a two-year research project, funded by Australia's National Health and Medical Research Council (NH&MRC), which developed an innovative model for Indigenous palliative care. The data was collected through a qualitative methodology (descriptive phenomenology) which involved open-ended in-depth interviews, audio-recorded, transcribed verbatim and thematically analysed. The sub-set of findings from the study presented in this paper examine issues in relation to the many practical obstacles in relation to palliative care service provision to Indigenous people in the rural and remote areas. The findings are a testament to the ingenuity and dedication of those who provide end-of-life care for Aboriginal peoples in rural and remote locations. The information about the many obstacles associated with equipment, power, transport, distance and telephone access provide important insights to inform the development of health policy planning and funding. The topic is specifically relevant to nurses as further findings from the study indicate that clinic and community nurses are key health professionals providing care to Indigenous people in the rural and remote areas.

As a follow-up to a recent study which highlighted the existence of medical dominance in multi-disciplinary team (MDT) meetings, this paper presents research findings from an Australian study which shows that medico-centrism is a key cause of tension within MDTs. The findings are from a 1-year qualitative study in a regional hospital that explored the ethical decision-making of health professionals within an acute care medical unit. This exploration was conducted through an iterative, phenomenological, qualitative research methodology that consisted of open-ended interviews with a multi-disciplinary representation of health professionals and a sample of consumers for whom they care. The paper situates the notion of nursing advocacy within the context of medico-centrism and examines how the nursing profession interfaces with other disciplines. The findings indicate that the professional framework of nursing includes the language of advocacy, whilst the framework of doctors centres around the medical decision-making process. All professional groups made reference to the MDT as the modus operandi for patient-centred care. All participants noted that time and familiarity with patients and their families is essential for patient-centred care and this could be achieved through MDT collaboration. However, doctors who have scant time to spend with patients saw it as their responsibility to direct the decisions of the MDT and viewed the MDT as adding confusion to the decision-making process. Nurses reported that the limited amount of time spent by doctors in patient consultation translated into the need for advocacy. Professional and clinical confidence and experience are noted as necessary to successfully engage in the process of advocacy. The findings of this article indicate that the adoption of an advocacy role by nurses represents an important means through which MDT operation can be enhanced, medico-centrism limited and patient-centred care improved.

Although the incidence of cancer in Indigenous peoples is similar to its incidence in the overall Australian population, Indigenous peoples are less likely to access early detection and medical interventions resulting in higher mortality and morbidity rates. To explore and address this discrepancy, the National Health and Medical Research Council funded a research study to examine Indigenous peoples' views of cancer and cancer treatments with an end goal of developing an innovative model of Indigenous Palliative Care. Seventy-two participants were interviewed from four geographical areas within the Northern Territory (Australia) including patients, caregivers, Indigenous and non-Indigenous health care workers, and interpreters. Indigenous peoples' views of cancer have to be examined within a historical, socio-political, and cultural context. There is no Indigenous word for cancer and the Western biomedical language that semantically constructs the notion of cancer is not widely understood. Additionally, for many Indigenous people, the aetiology of cancer is embedded in beliefs about the spiritual world of curses and payback from perceived misdeeds. The paper advocates for cross-cultural education initiatives, stressing the importance of a two way education strategy incorporating a process whereby medical and nursing personnel would improve their understanding of Indigenous peoples' view of cancer and Indigenous peoples would learn more about prevention and treatment of cancer from a biomedical perspective.

Whilst access to respite care has been found to represent an important source of support for terminally ill patients and their families, the availability of these services to Indigenous Australians has to date remained undocumented. This potential need for respite in Indigenous communities was explored as part of a National Health and Medical Research Council (NH&MRC) funded study designed to develop an innovative model for Indigenous palliative care. The data needed for model development were collected through a series of open-ended, qualitative interviews conducted with a cross-section of consumers and health professionals within the Northern Territory, Australia. The findings reflected a serious need for Indigenous respite services, coupled with a severe deficiency in the present availability of these services, especially within rural and regional areas. This lack of local respite services was documented to be negatively impacting upon the ability of carers to fulfil their caring duties and was found placing undue physical, emotional and economic stress upon carers, patients and their families. Furthermore, the lack of access to local respite services documented was found to be forcing rural and regional patients to relocate to metropolitan areas away from the family, community and land to which strong ties are held. The lack of Indigenous respite services was also found to obstruct patients’ and carers’ wishes for death to occur in the local community, rather than in far away cities. Significant obstacles were found to be hindering the provision of respite care to Indigenous Australians, namely beliefs about families looking after their own, resource restrictions, limited staff availability in local areas, as well as problems associated with hostel use in metropolitan areas. The conclusions drawn from this study suggest the importance of tackling the obstacles preventing local respite services being established in areas close to where patients and carers live.

Introduction: Understanding the impact of culture on medical communication is particularly important for international medical graduates (IMGs) who enter health systems from different cultures of origin. This article presents data on IMGs' perception of the impact of cultural factors on IMG doctor−patient communication during their integration into the Australian health system. Methods: The methodology used was a descriptive qualitative methodology, using iterative, open-ended, in-depth interviews with a sample of 30 IMGs employed at a hospital in Brisbane, Queensland, Australia. Results: According to subjects' comments, understanding patient-centered communication is a major challenge faced by IMGs during integration in the Australian health system. They perceive that this difficulty is associated with the major shift from the culture of their country of origin (described as paternalistic doctor-dominated communication system; standard practice to talk to the family and not the patient) to the very different health care culture of Australia (perceived to be more educated and informed consumers that demand high levels of information and discussion). The findings detail IMGs' experience with learning about patient-centered communication at the point of arrival, during integration and practice. Subjects' perceived the need to provide education on patient-centered communication for IMGs integrating into the Australian health system. Conclusion: There is a significant need for IMGs to be educated in cultural issues including doctor−patient communication practices in Australia.

Objective. In Australia, 25% of international medical graduates (IMGs) make up the medical workforce. Concern is expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs’ education. Although there is literature alluding to difficulties IMGs face with undertaking the Australian Medical Council (AMC) examination, there is little research detailing this experience. We therefore explored IMGs’ reflections on facilitators and barriers in undertaking the AMC examination. Methods. After ethics approval, in-depth telephone interviews were conducted with 30 IMGs selected from a hospital in Queensland. Data were coded and analysed using thematic analysis principles. Results. Two facilitating themes were identified: ability to sit for the first part of the examination in country of origin; and having access to resources such as bridging courses and study groups. Three themes represented barriers: not understanding procedural steps; financial issues; and lack of information on examination content and standards. Conclusion. The themes provide new insights and add depth to existing literature that can be used to improve procedural processes and education for IMGs towards successful outcomes in the AMC examination. What is known about the topic? There is concern expressed in the literature about the lack of awareness and knowledge of issues that impinge on IMGs education. The Australian work that is available only depicts educational experience of fellowships or education and training strategies after IMGs have passed their AMC examination. What does this paper add? The findings indicate that the process of sitting for the AMC examination is perceived as one of the major difficulties associated with entering and integrating into the Australian health system. The findings indicate a range of practical, financial and resource problems faced by IMGs attempting to sit for the AMC examination. What are the implications for practitioners? The detailed accounts from IMGs about their experience with undertaking the AMC examination will provide up-skilling program coordinators with the information they need to better assist IMGs to prepare for the examination. The provision of appropriate medical training and educational support will contribute to more effective integration of IMGs into the healthcare system.

Objective. This paper presents the findings of research which explored how International Medical Graduates (IMGs) understand and integrate with the allied health system in relation to multidisciplinary care. Methods. An open-ended, exploratory qualitative design comprised of thirty (n = 30) open-ended, in-depth interviews with IMGs employed in a public hospital in Queensland, Australia. Results. Many IMGs have no experience with allied health support in their country of origin. Multidisciplinary collaboration is a new concept for IMGs integrating into the Australia healthcare system. Learning about the allied health system, including how to work effectively within the context of the multidisciplinary team, is an important topic that needs to be addressed as a matter of priority. Conclusions. There is a strong need to focus on improving strategies for integrating IMGs into the allied health system. In particular, IMGs require information to help them understand the roles and referral processes associated with interfacing with the allied health system. What is known about the topic? To date, there is no research available on the important topic of how IMGs understand and integrate with the allied health system in relation to multidisciplinary care in the Australian healthcare system. What does this paper add? The present findings make an important contribution to the literature by highlighting the need to focus on integrating IMGs into the allied health system. The findings presented in this paper indicate that, for the range of reasons summarised the IMGs’ understanding of the allied health system is limited. What are the implications for practitioners? The IMGs in this study called for assistance in understanding the allied health system, a process they considered difficult to do on their own. The strong recommendation is that it is most appropriate for allied health professionals in the hospital to take such leadership, and such efforts will be met by a readiness to learn on the part of the IMGs.

To date, there is scant research literature that explores the provision of end-of-life care to Aboriginal peoples in Australia. In particular, there is a lack of published research available on issues at the interface of Aboriginal languages and English during palliative care. The complexity and importance of the issue for palliative care provision, however, is demonstrated by the fact that in Australia, Aboriginality is itself a very broad category, containing many distinct language groups and subcultures. Thus, although to date there is some mention of the problems associated with language in the literature, there is scant research on the topic of the provision of palliative care to Aboriginal peoples in remote areas. The following findings from a recent two-year National Health and Medical Research Council (NHMRC) study are provided to address this hiatus. The findings provide insights on the impact of language difference on palliative care practice for Aboriginal peoples in the Northern Territory of Australia.

The following discussion presents findings from a National Health and Medical Research Council (NHMRC) study that documents the importance to Indigenous people of including the network of extended family and community in health care communication. In particular the discussion explores the data relating to the importance of communicating through family meetings with Aboriginal people during end-of-life care. The data was collected through a series of open-ended, qualitative interviews (n=72) conducted with a cross-section of members of the Aboriginal community and health professionals within the Northern Territory, Australia. Acknowledging Aboriginal peoples' relationship rules and communicating through family meetings are practices that demonstrate respect for Indigenous cultural processes of information sharing. Anger on the part of Aboriginal people about lack of information can be the outcome when such processes are ignored or not understood. Respecting the need to "share the story" broadly with appropriate people in the extended family and community network through family meetings is noted as vitally important in health care, especially during the dying trajectory. The discussion explores the practical issues associated with, the different reasons for, and the positive outcomes from, incorporating family meetings for Indigenous people along the illness trajectory.