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The globally widespread adoption of Artificial Light at Night (ALAN) began in the mid-20th century. Yet, it is only in the last decade that a renewed research focus has emerged into its impacts on ecological and biological processes in the marine environment that are guided by natural intensities, moon phase, natural light and dark cycles and daily light spectra alterations. The field has diversified rapidly from one restricted to impacts on a handful of vertebrates, to one in which impacts have been quantified across a broad array of marine and coastal habitats and species. Here, we review the current understanding of ALAN impacts in diverse marine ecosystems. The review presents the current state of knowledge across key marine and coastal ecosystems (sandy and rocky shores, coral reefs and pelagic) and taxa (birds and sea turtles), introducing how ALAN can mask seabird and sea turtle navigation, cause changes in animals predation patterns and failure of coral spawning synchronization, as well as inhibition of zooplankton Diel Vertical Migration. Mitigation measures are recommended, however, while strategies for mitigation were easily identified, barriers to implementation are poorly understood. Finally, we point out knowledge gaps that if addressed would aid in the prediction and mitigation of ALAN impacts in the marine realm.

Coastlines globally are increasingly being illuminated with Artificial Light At Night (ALAN) from various urban infrastructures such as houses, offices, piers, roads, ports and dockyards. Artificial sky glow can now be detected above 22% of the world’s coasts nightly and will dramatically increase as coastal human populations more than double by the year 2060. One of the clearest demonstrations that we have entered another epoch, the urbanocene, is the prevalence of ALAN visible from space.Photobiological life history adaptations to the moon and sun are near ubiquitous in the surface ocean (0-200m), such that cycles and gradients of light intensity and spectra are major structuring factors in marine ecosystems. The potential for ALAN to reshape the ecology of coastal habitats by interfering with natural light cycles and the biological processes they inform is increasingly recognized and is an emergent focus for research.In this paper we derive a methodology to quantify and map the depths to which biologically relevant ALAN penetrates in the marine environment. We use two satellite derived global datasets to achieve this: an artificial night sky brightness world atlas (Falchi et al., 2016) and an in-water Inherent Optical Property (Lee et al., 2002) dataset derived from ESA’s Ocean Colour Climate Change Initiative (OC-CCI https://www.oceancolour.org/). These primary datasets are both used in conjunction with in-situ derived measurements and radiative transfer modelling in order to quantify the critical depth (Zc) to which biologically relevant ALAN penetrates throughout the global ocean’s estuarine, coastal and near shore regions, in particular the area defined by an individual country’s Exclusive Economic Zone.

Atmospheric forcing applied as ocean model boundary conditions can have a critical impact on the quality of ocean forecasts. This paper assesses the sensitivity of an eddy-resolving (1.5 km resolution) regional ocean model of the North-West European shelf (NWS) to atmospheric forcing resolution and air-sea coupling. The analysis is focused on a month-long simulation experiment for July 2014 and evaluation of simulated sea surface temperature (SST) in a shallow near-coastal region to the south-west of the UK (Celtic Sea and western English Channel). Observations above and below the sea surface at the L4 ocean buoy from the Western Channel Observatory are used to evaluate ocean and atmosphere model data. The impacts of differences in the atmospheric forcing are illustrated by comparing results from an ocean model run in forcing mode using operational global-scale numerical weather prediction (NWP) data with a run forced by a convective scale regional atmosphere model. The value of dynamically representing feedbacks between the atmosphere and ocean state is assessed through use of these model components within a fully coupled ocean-wave-atmosphere system. Simulated SST show considerable sensitivity to atmospheric forcing and to the impact of model coupling in near-coastal areas. A warm ocean bias relative to in-situ observations in the simulation forced by global-scale NWP (0.7 K mean difference, warmer relative to all observations in the model domain) is shown to be reduced (to 0.4 K) through use of the 1.5 km resolution atmosphere forcing. When simulated in coupled mode, this bias is further reduced by 0.2 K. Results demonstrate much greater variability of both surface energy balance terms and near-surface winds in the higher resolution atmosphere model data, as might be expected. Assessment of the surface energy balance and wind forcing over the ocean is challenging due to a scarcity of observations. It can however be demonstrated that the wind speed over the ocean simulated by the high resolution atmosphere agreed with the limited number of observations less well than the global-scale NWP data. Further partially-coupled experiments are discussed to better understand why the degraded wind forcing does not detrimentally impact on SST results.

Background: Advances in surgical techniques and anaesthetic practise have facilitated a significant change in the way surgery is currently delivered. In particular, short stay surgery including ambulatory surgery has become the norm for the majority of surgical conditions. However, the planning of surgical services has not always kept pace with nor capitalised on these clinical advances. Like many major urban centres in Australia, the Greater Sydney region is changing, in terms of population growth and configuration of clinical and operational networks. In conjunction with NSW Department of Health, the ministerially appointed Surgical Services Taskforce was tasked with determining the shape and direction of surgery in Greater Sydney over the next 5 to 10 years. Methods: Over 400 clinicians either attended hospitals forums or were contacted by the Surgery Futures project team. Results: From the consultations, three models of service delivery were strongly advocated. These were the development of high volume short stay surgery centres, the establishment of specialty centres and the expansion of the streaming of planned and emergency surgery. Conclusion: These three major recommendations will require a significant reorganisation of surgical services in NSW. However, they are also relevant to surgical services planning elsewhere in Australia. It is imperative that these recommendations are incorporated into long term surgical planning in order to improve the efficiency and sustainability of surgical service delivery.

Bioethics is a marginalised participant in Australian policy development While it is involved in some policy arenas it is almost absent or not being heard in others. Bioethics needs to raise its profile and reposition itself to shape the policy development agenda rather than respond to it In order to be a mainstream component at all levels of the health system, bioethics needs to work through education, skilling, active participation and value adding to the political and policy development process. There is also a role for the Australian Bioethics Association in this process.

Advances in surgical techniques and anaesthetic practise have facilitated a significant change in the way surgery is currently delivered. In particular, short stay surgery including ambulatory surgery has become the norm for the majority of surgical conditions. However, the planning of surgical services has not always kept pace with nor capitalised on these clinical advances. Like many major urban centres in Australia, the Greater Sydney region is changing, in terms of population growth and configuration of clinical and operational networks. In conjunction with NSW Department of Health, the ministerially appointed Surgical Services Taskforce was tasked with determining the shape and direction of surgery in Greater Sydney over the next 5 to 10 years.Over 400 clinicians either attended hospitals forums or were contacted by the Surgery Futures project team.From the consultations, three models of service delivery were strongly advocated. These were the development of high volume short stay surgery centres, the establishment of specialty centres and the expansion of the streaming of planned and emergency surgery.These three major recommendations will require a significant reorganisation of surgical services in NSW. However, they are also relevant to surgical services planning elsewhere in Australia. It is imperative that these recommendations are incorporated into long term surgical planning in order to improve the efficiency and sustainability of surgical service delivery.

Safe and high quality health care is an objective that everybody supports.With so much written about it and everybody committed to it, why are we still struggling to achieve it? The successful acceptance and adoption of casemix provides some clues as to the answer. This paper examines the factors that assisted casemix and the obstacles to achieving progress with safety and quality. It concludes that both the health industry and community's tolerance of risk in health is too high. The lessons from the casemix story can be applied to advance the safety and quality agenda. A good place to start is a determined campaign focussing on improving safety.

Australian Health Review sought the following replies to the commentary Why a traditional health outcomes approach will fail in health care and a possible solution by Lesia Gale.

OBJECTIVE To explore the factors associated with waiting times for surgery in public hospitals. SETTING Three major acute care public hospitals in one Area Health Service. PARTICIPANTS 691 adult patients entered onto the computerised booking list between 16 and 22 November 1994, and then between 16 January and 12 February 1995, were interviewed prospectively and followed up over a minimum of 18 months. Data were obtained from the Area Health Service's computerised booking system and patient self-report. RESULTS Relevant surgical specialty, urgency rating, employment status and health insurance status were significantly associated with waiting time. Age, hospital, sex, country of birth, education, marital status and holding a Health Care Card were not significantly associated with waiting time. Self-reported health status (as measured by the SF-36) was not associated with waiting time for surgery. CONCLUSIONS Waiting time for surgery was not simply determined by how urgently patients need surgery, but also by the type of surgery needed and patient's employment and health insurance status. The extent of disability experienced by patients, as measured by the SF-36, was not reflected in waiting times for surgery.