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Objective: It is widely understood that a key means of improving health systems and patient outcomes is through research – accessing, understanding, generating and applying research evidence-based practice. To promote more targeted and strategic research in Allied Health practice, this study sought to establish the principles, areas and priorities for clinical research as perceived by Allied Health leaders in the South Australian public health system. Methods: The study used a mixed-methods design (full, sequential and equal model). Participants were recruited from the South Australian Department of Health and Wellbeing employment lists for Allied Health senior leaders. Consenting participants attended face-to-face focus groups; after an overview presentation, they discussed the principles for Allied Health research, followed by areas and priorities for research. Summaries of the responses were themed descriptively and circulated electronically so participants could confirm the research areas and ascribe priority ratings, clinical populations and services. Results: A total of 28 people attended the stakeholder forum (5 online); 20 responded to the second-round electronic summary. Nine principles of research action were agreed. Fourteen research areas were identified and prioritised. There was a relatively consistent prioritisation of measuring Allied Health value, Allied Health workforce, hospital avoidance and closing the gap for Aboriginal and Torres Strait Islander peoples health outcomes – whether the individuals were thinking about their own service or the state as a whole. Conclusions: Allied Health leadership identified key principles and priorities for research to improve service delivery and patient outcomes. These priorities should generate further discussion and interest for novice and experienced researchers and leaders and can be used to inform granting and project plans. What is known about the topic? Allied Health are well equipped to engage in research but have limited capacity. What does this paper add? We have identified key priorities and principles to inform Allied Health research activity. What are the implications for practitioners? Practitioners, funders and other stakeholders can develop these identified principles and priorities to direct research time and resources for the most impact on health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To explore general practitioners' perspectives on the discharge summaries they receive about their patients who have been discharged from hospital. Methods: A survey of general practitioners in the catchment of a major metropolitan South Australian health service consisting of three teaching hospitals was undertaken. Surveys were disseminated electronically and via hardcopy mailout to general practitioners. The 36-question survey focused on five constructs of discharge summaries: accessibility, length and clarity, format, transparency, and medicines content. Results: A total of 150 general practitioners responded (response rate, 27.6%). Respondents were vocationally registered (96%), predominately from metropolitan practices (90.2%), and 65.8% were female. Overwhelmingly, 86.7% of general practitioners stated that the optimal time for receipt of discharge summaries was <48 h post-discharge, and 96.6% considered that late arrival of discharge summaries adversely impacts patient care. The ideal length of discharge summaries was reported as <4 pages by 64% of respondents. A large proportion of respondents (84.6%) would like to be notified when their patients are admitted and discharged from hospital, and 82.7% were supportive of patients receiving their own copy of the discharge summary. A total of 76.7% general practitioners reported that they had detected omissions or discrepancies in the discharge summaries. Provision of rationale for medication changes was viewed as important by 86.7%, however, only 29.3% reported that it is always or often communicated. Conclusions: General practitioners supported timely receipt, concise length of discharge summary and format refinement to improve the utility and communication of this important clinical handover from hospital to community care. What is known about the topic? Discharge summaries are an important handover document when transitioning care from hospital to general practice. Delays, omissions and inaccuracies in discharge summaries can contribute to adverse patient outcomes. What does this paper add? This paper provides contemporary perspectives of general practitioners about discharge summaries and scope for improvements. What are the implications for practitioners? General practitioners value receiving discharge summaries that are timely, follow a format, provide clear details for ongoing care, and are an appropriate length. [ABSTRACT FROM AUTHOR]

Golden everlasting paper daisies in the genus Xerochrysum Tzvelev are iconic Australian native plants grown worldwide. The X. bracteatum species complex has been regarded as taxonomically confusing and in need of revision for over 60 years. We applied morphological and molecular analyses to delimit species, detect common ancestry among populations, and identify putative hybrids in the genus Xerochrysum (Asteraceae: Gnaphalieae). Multiple lines of evidence provided strong support for the recognition of new taxa. Here we describe the following 11 new species: X. andrewiae T.L.Collins & J.J.Bruhl, X. berarngutta T.L.Collins & I.Telford, X. copelandii J.J.Bruhl & I.Telford, X. frutescens J.J.Bruhl & I.Telford, X. gudang T.L.Collins & J.J.Bruhl, X. hispidum T.L.Collins & I.Telford, X. macsweeneyorum T.L.Collins, X. murapan T.L.Collins & I.Telford, X. neoanglicum J.J.Bruhl & I.Telford, X. strictum T.L.Collins, and X. wilsonii T.L.Collins, reinstate Helichrysum banksii A.Cunn. ex DC. (as X. banksii (A.Cunn. ex DC.) T.L.Collins & I.Telford), lectotypify X. banksii and X. papillosum (Labill.) R.J.Bayer, and recircumscribe X. bicolor (Lindl.) R.J.Bayer to include X. halmaturorum Paul G.Wilson and some populations of X. bracteatum sens. lat. from mainland South Australia and Victoria. We also provide revised descriptions of all taxa in the genus, their conservation status, a dichotomous key, tables distinguishing closely related taxa and distribution maps. Golden everlasting paper daisies in the genus Xerochrysum are iconic Australian native plants grown worldwide, but have been in need of revision for over 60 years. We use multiple lines of evidence to delimit species, detect common ancestry among populations and identify putative hybrids. We describe 11 new species, provide revised descriptions, conservation status, a dichotomous key, tables distinguishing closely related taxa, and distribution maps. [ABSTRACT FROM AUTHOR]

Objective: This study assessed the impact of the COVID-19 pandemic on emergency departments (EDs) in South Australia, measured by changes in the number and casemix of patients in the system over time. Methods: Data from the South Australia Emergency Department Dashboard, updated every 30 min, were analysed for the period 4 October–21 December 2020. The Dashboard reports live counts of the number and type of patients in each of the six adult metropolitan public EDs in Adelaide, South Australia. Results: There was a significant difference in the mean daily average occupied ED capacity before and during two distinct increases in COVID-19 cases in South Australia. An increase in COVID-19 cases coincided with a decrease in patients in EDs (Pearson's r = –0.93 and –0.67; P < 0.001 for both). Presentations in Australasian Triage Scale (ATS) Categories 2–5 decreased during these periods, whereas ATS Category 1 stayed constant. Mental health patients continued to present to the ED, despite the overall drop in ED presentations. Conclusions: During the two periods of COVID-19 case growth in South Australia, there was a significant drop in the number of patients presenting to the major public EDs and a change in the casemix of patients over time. What is known about the topic?: EDs in Australia often operate at or over capacity, with frequent reports of ambulance ramping, access block and long waiting times. There have been reports internationally of significant declines in ED presentations throughout the COVID-19 pandemic. What does this paper add?: This paper uses a novel publicly available data source that is available in real time to contribute a new perspective from South Australia, which has experienced two distinct periods of strict restrictions and lockdown. The research showed that the number of mental health presentations remained consistently high, despite a significant overall decline in ED occupancy. What are the implications for practitioners?: This study demonstrates that South Australians are accessing emergency medical treatment differently in response to the COVID-19 pandemic. In the context of an overall decline in presentation numbers, the number of mental health-related presentations has not changed significantly, suggesting that this trend should be closely monitored. The findings corroborate the national concern that unwell people have avoided accessing emergency medical care during the pandemic, leading to worse outcomes and increased need for healthcare resources at a later date. It will be important to monitor and quickly detect further changes in ED usage using real-time data as the pandemic evolves, as well as in any future significant health crises. [ABSTRACT FROM AUTHOR]

This paper describes opportunistic observations of the response of wombats to rainfall. Within a few minutes after heavy showers of rain wombats congregated to drink at an area of exposed calcrete (limestone) where water had accumulated. The wombats interacted socially much more than is typical for wombats. This event demonstrates a level of understanding of their environment and of the availability of a transient resource that has not been documented previously. This paper describes opportunistic observations of the response of wombats to rainfall. Within a few minutes of heavy rain wombats congregated to drink at an area of exposed calcrete (limestone) where water had accumulated, interacting socially much more than is typical for wombats. This event demonstrates a level of understanding of their environment and of the availability of a transient resource that has not been documented previously. [ABSTRACT FROM AUTHOR]

Objective: To describe patterns of use of the available Government-subsidised mental health services among people living in Australian residential aged care facilities. Methods: A retrospective population-based trend analysis was conducted, including all non-Indigenous people living in an Australian facility between 2012 and 2017. Adjusted incidence proportions and trends were estimated for four groups of mental health services. Results: The use of Medicare-subsidised mental health services was very low overall. The proportion of residents who accessed primary care mental health services increased from 1.3% in 2012/2013 to 2.4% in 2016/2017, while psychiatry service use increased from 1.9 to 2.3%. Claims for clinical psychology increased from 0.18 to 0.26%, and claims for a registered psychologist, occupational therapist or social worker rose from 0.45 to 1.2%. People with dementia were less likely than people without dementia to access all services aside from psychiatry services. Conclusions: Less than 3% of residents accessed funding subsidies for mental health services and people with dementia experienced pronounced barriers to service access. Mental health care is a pillar of the publicly-funded health system in Australia, and low use of these services among aged care residents indicates a need for organisational and policy changes to improve access. What is known about the topic? People living in residential aged care facilities report very high rates of mental health conditions, including depression and anxiety. What does this paper add? We demonstrate very low use (<3%) of Government-funded mental health services among people living in residential aged care facilities in Australia, with only small increases in use over time. What are the implications for practitioners? Practitioners should routinely assess the mental health needs of people living in residential aged care and refer for in-reach mental health services where needed, noting that facility staff are usually not trained for this role. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods: This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results: Supervisee's work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions: High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision. What is known about the topic?: There is mounting evidence on the benefits of clinical supervision to health professionals, organisations and patients. Clinical supervision enhances recruitment and retention of the health workforce. However, there are still gaps regarding the factors that contribute to high-quality clinical supervision, especially for rural and remote health professionals. What does this paper add?: This study, the first of its kind, recruited rural and remote health professionals from seven allied health disciplines across two Australian states. It investigated the factors that influence high-quality clinical supervision in this under-resourced group. This paper outlines specific factors that contribute to clinical supervision quality for rural and remote allied health professionals. What are the implications for practitioners?: Effective and high-quality clinical supervision of the rural and remote allied health workforce can enhance recruitment and retention in those areas. Healthcare organisations can facilitate effective clinical supervision delivery by using the evidence gathered in this study in clinical supervision policy, training and practice. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate whether increasing costs of delivering care have driven real growth in acute public hospital expenditure in South Australia (SA) and what has contributed to these real cost increases. Methods: Using published time-series data, we decomposed inflation-adjusted growth in per capita total acute public hospital recurrent expenditure into its major utilisation and cost components to evaluate their relative contribution over the 12 years to 2017–18. Results: Real per capita total acute public hospital recurrent expenditure grew by AU$667 (45.2%) over the 12-year period; of this, 86.0% was from real growth in input costs per weighted activity unit, with real growth in the average salaries of hospital staff accounting for AU$247 or 37.0%. Hospital utilisation rates contributed a minor 14.0%. Conclusion: Over the 12 years to 2017–18, real growth in average clinical salaries was a more important driver of real growth in per capita total acute public hospital expenditure than rates of hospital utilisation. This would be facilitated by improvements in the scope, accuracy, quality and consistency of published national hospital data. What is known about the topic?: Public hospital expenditure is one of the largest and fastest growing areas of government expenditure in Australia. Policy narratives often centre around demand pressures from an increasingly older, overweight, and chronically ill population. Comparatively little attention has been paid to the influence of increases in real input costs within the Australian context. What does this paper add?: Real salary growth has been a major driver of acute public hospital recurrent expenditure growth in SA, whereas hospital utilisation rates have played a minor role. What are the implications for practitioners?: A clearer understanding of the main drivers of acute public hospital expenditure growth and the resulting benefits to population health is needed to guide the efficient and sustainable use of scarce healthcare resources. [ABSTRACT FROM AUTHOR]

Objective: The aims of the present study were to establish rates of resuscitation order documentation of patients aged ≥65 years from both psychogeriatric and general medical units and to compare patients on predictors of resuscitation status, particularly examining the effect of depression. Methods: A retrospective case note audit of psychogeriatric (n = 162) and general medical (n = 135) unit admissions within a tertiary teaching hospital was performed. Multivariate logistic regression was used to determine significant clinical and demographic predictors of resuscitation status. Results: Resuscitation orders were documented in more psychogeriatric (94.4%) than general medical (48.1%) files. Depression did not significantly predict resuscitation status in either group. Having undergone competency assessment significantly predicted resuscitation status for the total sample and separately for psychogeriatric and medical patients. Older age (overall sample), poorer prognosis (overall sample), living in residential care (overall sample and medical group) and self-consenting to resuscitation status (overall sample and medical group) significantly predicted resuscitation status. Conclusions: Resuscitation orders were more frequently documented on the psychogeriatric unit. Further prospective analysis is needed of how resuscitation orders are made before depression is discounted as a predictor of end-of-life decision-making. What is known about the topic?: Despite increased community, media and research attention to end-of-life decision-making, resuscitation preferences of older patients are often poorly documented. Existing research into patient clinical and demographic factors that influence end-of-life decision-making have largely focused on general medical rather than psychogeriatric settings. There is a need to investigate rates of resuscitation documentation in psychogeriatric and general medical units and specific factors associated with having a 'do not attempt resuscitation' order in place, particularly the effect of current depression on decision-making. What does this paper add?: Resuscitation orders were more frequently documented on the psychogeriatric than medical unit. Depression was not a significant predictor of resuscitation status in either group of patients. Although having undergone a competency assessment, older age and poorer prognosis predicted not being for resuscitation for the total sample, living in residential care and self-consenting to resuscitation status predicted not being for resuscitation for the overall sample and the medical group specifically. What are the implications for practitioners?: This paper suggests that the need for clinicians to ensure documentation of preferences is a focus of day-to-day work with older patients. Clinicians should consider patient competency in end-of-life decision-making and how factors associated with depression, such as helplessness, may be more closely related to resuscitation decision-making in older patients. [ABSTRACT FROM AUTHOR]

Objective: Arguments to fund obesity prevention have often focused on the growing hospital costs of associated diseases. However, the relative contribution of overweight and obesity to public hospital expenditure growth is not well understood. This paper examines the effect of overweight and obesity on acute public hospital in-patient expenditure in South Australia over time compared with other expenditure drivers. Methods: Annual inflation-adjusted acute public admitted expenditure attributable to a high body mass index was estimated for 2007–08 and 2011–12 and compared with other expenditure drivers. Results: Expenditure attributable to overweight and obesity increased by A$45 million, from 4.7% to 5.4% of total acute public in-patient expenditure. This increase accounted for 7.8% of the A$583 million total expenditure growth, whereas the largest component of total growth (62.4%) was a real increase in the average cost per separation. Conclusions: The relatively minor contribution of overweight and obesity to expenditure growth over the time period examined invites reflection on arguments to boost preventive spending that centre upon reducing hospital costs. These arguments may inadvertently detract attention from the considerable health and social burdens of overweight and obesity and from unrelated sources of expenditure growth that reduce opportunities for state governments to fund obesity prevention programs despite their comparative benefits to population health. What is known about the topic?: Stand-alone estimates suggest that overweight and obesity are placing a considerable financial burden on the Australian public healthcare system. What does this paper add?: Our findings challenge common perceptions about the relative importance of overweight and obesity in the context of rising public in-patient expenditure in Australia. What are the implications for practitioners?: Consistent serial estimates of overweight- and obesity-attributable expenditure enable its tracking and comparison with other potentially controllable expenditure drivers that may also warrant attention. Explicit consideration of population health trade-offs in expenditure-related decisions, including in enterprise bargaining, would enhance transparency in priority setting. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the experience of patients with chronic diseases regarding access to and utilisation of multidisciplinary care during COVID-19 in South Australia. Methods: Telephone interviews were conducted with 30 patients with chronic conditions attending nine general practices in metropolitan Adelaide. Supplementary data were obtained from the Medicare Benefit Schedule (MBS) to compare health services activity data provided by different health professionals before and after COVID-19 (from January 2019 to June 2020). Results: There was variation in access to different health services by patients with chronic conditions during COVID-19. The introduction of telehealth facilitated continuity of general practitioner (GP) services, with a high level of satisfaction among patients. Changes in medicines regulation, including the home delivery of medications, enabled timely access to medications for patients. The use of telehealth was less common for specialist and particularly allied health services. Dental check-ups that are important for the management of some chronic conditions were disrupted the most during COVID-19. Conclusion: The findings of this study suggest that the policy measures introduced in Australia provided an opportunity to maintain multidisciplinary care for patients with chronic diseases during COVID-19. GPs, as core members of the primary healthcare team, as well as pharmacy and pathology services, were highly accessible. Telehealth was less accessed for chronic care services provided by specialists and allied health professionals. What is known about the topic?: Access to multidisciplinary care is critical to ensure continuity and quality of care for patients with chronic health conditions. Evidence suggests disruptions in health services can occur during pandemics. To continue access to routine care, the Australian Government introduced several policy initiatives during COVID-19 to enhance access to multidisciplinary care. What does this paper add?: Telehealth policy was particularly effective in facilitating patients' access to general practice services during COVID-19 particularly those services that did not need physical examinations. This policy complemented changes in medicines regulations that enabled timely and convenient access to medications for patients with chronic conditions. Allied health services, as important elements of multidisciplinary care, were more likely to be disrupted during COVID-19. What are the implications for practitioners?: Continuation of telehealth services is likely to enhance access to general practice services. The acceptability and use of telehealth for allied health services may require more flexibility, and training for both practitioners and patients. [ABSTRACT FROM AUTHOR]

The National Bowel Cancer Screening Program (NBCSP) offers population-based screening for colorectal cancer (CRC) across Australia. The aims of this paper were to highlight the inequities in CRC screening in South Australia (SA) and the system-related barriers and enablers to CRC screening from the perspective of participants identified as having inequitable participation. First, de-identified data for the SA population of the NBCSP were statistically analysed and then mapped. Second, 117 in-depth interviews were conducted with culturally and linguistically diverse (CALD) groups, Indigenous and Anglo-Saxon Australians. Participation rates in the NBCSP were geographically and statistically significantly different (P<0.0001) on the basis of gender (higher for women), age (higher for older people) and socioeconomic status (higher for more affluent people). The main system-related barriers were the lack of awareness of CRC or CRC screening within these groups, the problems with language due to most of the information being in English and the lack of recommendation by a doctor. This study revealed that inequity exists in the NBCSP participation in SA, and we identified both barriers and facilitators to CRC screening that require action at the level of both policy and practice. There is a large role in primary health care of both recommending CRC screening and facilitating equitable participation. [ABSTRACT FROM AUTHOR]

The Murray Darling Basin Plan (Murray Darling Basin Authority 2012) represents the largest investment by government in an Australian environmental management challenge and remains highly conflicted owing to the contested allocation of diminishing water resources. Central to the decision to reallocate consumptive water to environmental purposes in this Plan was the case made to maintain the freshwater character of two lakes at the terminus of the Murray Darling Basin, in South Australia. This freshwater state was identified as the natural condition on the basis of selected anecdotal evidence and was enshrined in the site's listing under the Ramsar Convention. The commitment to the freshwater state was challenged under drought when sea water was seen as a means of averting acidification when low river flows risked the exposure of sulfidic sediments. Independent evidence from water quality indicators (diatoms) preserved in lake sediment records, however, attested to an estuarine, albeit variable, condition before the commissioning of near-mouth barrages in 1940. This interpretation for a naturally estuarine history, published after peer review, was overlooked in a report to the South Australian government, which argued, without the provision of new evidence from the lakes, that they were fresh for their entire history. This revised interpretation is widely cited in the scientific literature, government reports and online discussion and underpins a watering strategy aimed at a freshwater future for the Lower Lakes. The allocation of large volumes of fresh water to achieve this condition presents significant difficulties owing to the highly contested nature of water use across the Basin. In this paper I show that the interpretation for an estuarine history of Lake Alexandrina presented in a doctoral thesis (Fluin 2002) and subsequently published in the journal Hydrobiologia (Fluin et al. 2007) was reinterpreted in an unpublished report to a state government (Fluin et al. 2009) without the provision of new evidence or a critique to discount the findings of the original paper. This new interpretation argues that the lake has been predominantly fresh for 7000 years and this revised finding has been widely cited in the literature and online discussions and used by governments to advocate for a freshwater future for the Lower Lakes. [ABSTRACT FROM AUTHOR]

Objective: Risk factors and clinical outcomes of non-index hospital readmissions (readmissions to a hospital different from the previous admission) have not been studied in Australia. The present study compared characteristics and clinical outcomes between index and non-index hospital readmissions in the Australian healthcare setting. Methods: This retrospective cohort study included medical admissions from 2012 to 2016 across all major public hospitals in South Australia. Readmissions within 30 day to all public hospitals were captured using electronic health information system. In-hospital mortality and readmission length of hospital stay (LOS) were compared, along with 30-day mortality and subsequent readmissions among patients readmitted to index or non-index hospitals. Results: Of 114 105 index admissions, there were 20 539 (18.0%) readmissions. Of these, 17 519 (85.3%) were index readmissions and 3020 (14.7%) were non-index readmissions. Compared with index readmissions, patients in the non-index readmissions group had a lower Charlson comorbidity index, shorter LOS and fewer complications during the index admission and were more likely to be readmitted with a different diagnosis to the index admission. No difference in in-hospital mortality was observed, but readmission LOS was shorter and 30-day mortality was higher among patients with non-index readmissions. Conclusion: A substantial proportion of patients experienced non-index hospital readmissions. Non-index hospital readmitted patients had no immediate adverse outcomes, but experienced worse 30-day outcomes. What is known about the topic?: A significant proportion of unplanned hospital readmissions occur to non-index hospitals. North American studies suggest that non-index hospital readmissions are associated with worse outcomes for patients due to discontinuity of care, medical reconciliation and delayed treatment. Limited studies have determined factors associated with non-index hospital readmissions in Australia, but whether such readmissions lead to adverse clinical outcomes is unknown. What does this paper add?: In the Australian healthcare setting, 14.7% of patients were readmitted to non-index hospitals. Compared with index hospital readmissions, patients admitted to non-index hospitals had a lower Charlson comorbidity index, a shorter index LOS and fewer complications during the index admission. At the time of readmission there was no differences in discharge summary completion rates between the two groups. Unlike other studies, the present study found no immediate adverse outcomes for patients readmitted to non-index hospitals, but 30-day outcomes were worse than for patients who had an index hospital readmission. What are the implications for practitioners?: Non-index hospital readmissions may not be totally preventable due to factors such as ambulance diversions stemming from emergency department overcrowding and prolonged emergency department waiting times. Patients should be advised to re-present to hospital in case they experience recurrence or relapse of a medical condition, and preferably should be readmitted to the same hospital to prevent discontinuity of care. [ABSTRACT FROM AUTHOR]

The term 'Aboriginal' in this text has been used when referring to Aboriginal peoples living on the Anangu Pitjantjatjara Yankunytjatjara (APY) Lands. The term 'Aboriginal and Torres Strait Islander' has been used when referring to the broader community. Background: This project investigated how cultural immersion in remote Aboriginal communities influenced medical students' career intentions. Methodology: An academic GP registrar (AB) interviewed 15 medical students who participated in the Adelaide Medical Students' Society Anangu Pitjantjatjara Yankunytjatjara (APY) Exchange. This program was coordinated by medical student volunteers in collaboration with the Ngaanyatjarra Pitjantjatjara Yankunytjatjara Women's Council (NPYWC). The following questions were specifically addressed: 'How does being a guest in a remote Aboriginal community influence medical students' attitudes towards Aboriginal and Torres Strait Islander health care?' and 'Does exposure to Aboriginal communities increase medical students' willingness to pursue careers in Aboriginal and Torres Strait Islander health, rural and remote medicine and/or general practice?'. Results: Interest in Aboriginal and Torres Strait Islander health care increased from 73% of participants pre-trip to 100% post-trip, in rural and remote medicine from 40% to 100%, and in general practice from 33% to 67%. The experience also challenged pre-conceptions and increased understanding of the bio-psycho-socio-spiritual aspects of Aboriginal health. Conclusion: Being a guest in remote Aboriginal communities enhanced students' personal and professional motivation to work in Aboriginal and Torres Strait Islander health, remote health and general practice. There is limited evidence regarding the most effective ways to engage medical students in rural and remote health care, particularly in settings with a large Aboriginal and Torres Strait Islander population. This project found that immersion trips positively influenced career intentions of medical students towards working in Aboriginal and Torres Strait Islander health care, rural and remote health and general practice. The findings suggest that investment in such experiences could significantly change workforce engagement in these under-resourced areas of health care. [ABSTRACT FROM AUTHOR]

Clinical commissioning was introduced in South Australia in 2012 to support implementation of the South Australian Health Care Plan and to achieve the desired transformation and efficiency gains required for a sustainable health system. This paper describes how the South Australian Commissioning Model was established and the process of developing the necessary culture, governance arrangements and performance management structures. Commissioning has played a key role in improving appropriateness and quality of clinical practice, resulting in reduced hospital inpatient growth and average length of stay. Despite early successes, there remain many challenges that need to be faced before value can be demonstrated consistently across the whole system. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to compare the health status of South Australians with recent experience of caring for an adult with chronic disease with non-carers drawn from the same population. Methods: Data were collected via the South Australian Health Omnibus, an annual population-based, cross-sectional survey. Respondents were asked whether they had provided care or support in the last 5 years to someone with cancer, heart disease, respiratory disease, mental illness, neurological disease or dementia. Health status was measured using the Short Form-12 version 1 (SF-12) physical and mental component scale summary scores (PCS and MCS respectively), with poor health status defined as ≥0.5 standard deviation below the normative mean. Logistic regression explored characteristics associated with poor health status. Results: Of 3033 respondents analysed, 987 (32.5%) reported caring experience. Poor PCS and MCS were associated with carer status, lower-than-degree-level education, employment status other than employed and annual household income less than A$60 000. Being Australian born was a protective factor for PCS, whereas factors protective for MCS were being married or in a de facto relationship and age ≥65 years. Conclusions: Providing care or support in the last 5 years is independently associated with poorer health status, but not with the magnitude found in studies of current carers. Future research should explore health status recovery after completion of the caring role, and investigate whether relationships between health and socioeconomic status differ for carers versus non-carers. What is known about the topic?: Population-based survey studies in Australia and overseas have consistently found that informal carers have worse health status than non-carers. What does this paper add?: Including recent as well as current carers in a population-based sample was associated with less effect on health status compared with studies focused on current carers only. This finding is consistent with the possibility that health status recovers during the 5 years after caring. What are the implications for practitioners?: Support for Australian carers is warranted to ensure their continuing contributions to society and return to productivity after their caring role is completed. [ABSTRACT FROM AUTHOR]

Flinders Medical Centre was experiencing issues with timely discharge and knowing the potential discharges and in-patient bed capacity for the next day. This case study describes the application of 'visual management' theory to discharge processes. The solutions developed were 'patient journey boards' and 'discharge traffic lights'. The implementation of these visual management systems has enabled the hospital to improve its discharge processes. What is known about the topic? Communication is critical to the delivery of safe patient care. There is little in the literature on the use of visual management principles and techniques in healthcare. What does the paper add? This paper provides a brief overview of visual management principles and gives two case study examples showing the development and implementation of visual management systems in an acute hospital setting to promote safe and efficient patient care. What are the implications for practitioners? Practitioners can learn visual management principles and how these have been applied to an acute healthcare context. [ABSTRACT FROM AUTHOR]

This paper examines how pregnant women living in South Australia use information and communication technologies (ICTs), principally Internet and mobile phones, to access pregnancy-related information. It draws on 35 semistructured interviews conducted as part of the 'Health-e Baby' project, a qualitative study designed to assess the information needs and ICT preferences of pregnant women cared for at a South Australian metropolitan teaching hospital. Our research shows that although ICTs offer exciting possibilities for health promotion and the potential for new forms of communication, networking and connection, we cannot assume the effectiveness of communicating through such channels, despite near universal levels of ICT access. In turn, this highlights that if e-mediated health promotion is to be effective, health promoters and practitioners need to better understand ICT access, usage and content preferences of their clients. [ABSTRACT FROM AUTHOR]

The online provision of health information and services has been viewed as having the potential to inform and empower health consumers and, ultimately, to promote better health. The Internet can be an innovative tool to deliver services to 'hard-to-reach' population groups, including geographically isolated populations. However, the online platform raises questions regarding the equitable distribution of health services. In this paper we examine a case study of a website that aims to promote health by fostering social connectedness. The website provides information to connect people to locally based community events across Australia. We draw on evaluation findings to examine the socioeconomic and geographical distribution of website usage.Adescriptive analysis of web usage statistics revealed a gradient whereby more information is listed and viewed about events in affluent socioeconomic areas. Furthermore, the analysis showed that a greater proportion of information listed and viewed related to urban areas. These results are consistent with broader gradients of Internet access and usage. Drawing on these findings, we identify implications for online health promotion across different population groups, particularly for interventions that do not incorporate an explicit equity focus. [ABSTRACT FROM AUTHOR]

Objective To compare the costs of inpatient (usual care) with outpatient (intervention) care for cervical priming for induction of labour in women with healthy, low-risk pregnancies who are being induced for prolonged pregnancies or for social reasons. Methods Data from a randomised controlled trial at two hospitals in South Australia were matched with hospital financial data. A cost analysis comparing women randomised to inpatient care with those randomised to outpatient care was performed, with an additional analysis focusing on those who received the intervention. Results Overall, 48% of women randomised into the trial did not receive the intervention. Women randomised to outpatient care had an overall cost saving of $319 per woman (95% CI -$104 to $742) as compared with women randomised to usual care. When restricted to women who actually received the intervention, in-hospital cost savings of $433 (95% CI -$282 to $1148) were demonstrated in the outpatient group. However, these savings were partially offset by the cost of an outpatient priming clinic, reducing the overall cost savings to $156 per woman. Conclusions Overall cost savings were not statistically significant in women who were randomised to or received the intervention. However, the trend in cost savings favoured outpatient priming. What is known about the topic? Induction of labour is a common obstetric intervention. For women with low-risk, prolonged pregnancies who require cervical priming there has been increased interest in whether this period of waiting for the cervix to 'ripen' can be achieved at home. Outpatient priming has been reported to reduce hospital costs and improve maternal satisfaction. However, few studies have actually examined the cost of outpatient priming for induction of labour. What does this paper add? This is the first paper in Australia to both assess the full cost of outpatient cervical priming and to compare it with usual (inpatient) care. This is the first costing paper from a randomised controlled trial directly comparing inpatient and outpatient priming with prostaglandin E[sub 2]. What are the implications for practitioners? For women with prolonged, low-risk pregnancies, a program of outpatient cervical priming can potentially reduce in-hospital costs and free up labour ward beds by avoiding an additional overnight hospitalisation. [ABSTRACT FROM AUTHOR]

Background: To effectively reduce future wildfire risk, several management strategies must be evaluated under plausible future scenarios, requiring models that provide estimates of how likely wildfires are to spread to community assets (wildfire likelihood) in a computationally efficient manner. Approaches to quantifying wildfire likelihood using fire simulation models cannot practically achieve this because they are too computationally expensive. Aim: This study aimed to develop an approach for quantifying wildfire likelihood that is both computationally efficient and able to consider contagious and directionally specific fire behaviour properties across multiple spatial 'neighbourhood' scales. Methods: A novel, computationally efficient index for quantifying wildfire likelihood is proposed. This index is evaluated against historical and simulated data on a case study in South Australia. Key results: The neighbourhood index explains historical burnt areas and closely replicates patterns in burn probability calculated using landscape fire simulation (ρ = 0.83), while requiring 99.7% less computational time than the simulation-based model. Conclusions: The neighbourhood index represents patterns in wildfire likelihood similar to those represented in burn probability, with a much-reduced computational time. Implications: By using the index alongside existing approaches, managers can better explore problems involving many evaluations of wildfire likelihood, thereby improving planning processes and reducing future wildfire risks. Wildfire likelihood is quantified in a computationally efficient manner using a multi-scale 'neighbourhood index'. This is achieved by aggregating fire behaviour properties across multiple neighbourhood scales. The index is much more computationally efficient than alternative approaches and considers contagious and directionally specific fire behaviour properties across multiple spatial 'neighbourhood' scales. This article belongs to the Collection Fire & Climate. [ABSTRACT FROM AUTHOR]

Objective. To estimate the risk of functional decline after discharge for older people presenting to, and discharged from, a large emergency department (ED) of a tertiary hospital. Methods. The cohort was generated by consecutive sampling of non-Indigenous males and females aged 65 years or over or Aboriginal and Torres Strait Islander males and females aged 45 years or more, without diagnosed dementia, who were living independently in the community before presenting at ED and who were not admitted to hospital as an inpatient after presenting to ED. The hospital assessment risk profile (HARP) was administered to all eligible participants. Sociodemographic information was collected. Results. Approximately 40 patients per day over two 14-week data collection periods were potentially eligible for inclusion in the study. In total, 597 (17.6% of individuals who presented to ED) were eligible, agreed to participate and continued to be eligible on discharge from ED. Their HARP scores suggested that ~52% were at-risk of functional decline (14.1% high risk, 38.5% intermediate risk). Conclusions. Elderly patients present to and are discharged from ED every day. The routinely administered HARP instrument scores suggested that approximately half these individuals were at-risk of functional decline in one large hospital ED. Given this instrument's moderate diagnostic accuracy, the true figure may be higher. We suggest that all over-65 year olds presenting at ED without being admitted as an inpatient should be considered for routine screening for potential downstream functional decline, and for intervention if indicated. What is known about the topic? Older individuals often present to ED in lieu of consulting a general medical practitioner, and are not admitted to a hospital bed. Patient demographics, functional and mental capacity and reasons for presentation may be flags for functional decline in the coming months. These could be used by ED staff to implement targeted assessment and intervention. What does this paper add? This paper highlights the high percentage of older individuals who, at time of ED presentation, are at-risk of downstream functional decline. What are the implications for practitioners? Older people who are discharged from ED without a hospital admission may 'slip through the net', as an ED presentation presents a limited window of opportunity for ED staff to undertake targeted assessment, and intervention, to address the potential for downstream functional decline. The busy nature of ED, resource implications and the range of presenting conditions of older people may preclude this. This research suggests a reality that a large percentage of older people who present at ED but do not require a subsequent hospital admission have the potential for functional decline after discharge. Addressing this, in terms of specific screening processes and interventions, requires a rethink of hospital and community resources, and relationships. [ABSTRACT FROM AUTHOR]

Equity in resource allocation is central to the tenet of social justice in health care. The management of surgical waiting lists is of critical importance to clinicians, patients and regulators. In most hospital environments, the basic process has remained unchanged for decades. Patients are assigned to one of three urgency-related categories. Clinicians consequently administer three competing patient pools. The basis by which patients are selected for treatment may be difficult to define. The specific clinical circumstances of each patient are often unreported and may be unknown to those administering the list. Waiting list bias is also recognised. This may reflect clinician advocacy, pressure to meet category timeframe restrictions or perceived training requirements. In this environment, it is difficult to demonstrate propriety in care. We report the implementation of a pilot program to redesign waiting list management within a South Australian public hospital unit. This allows assemblage of patients into a single list. Overall priority is determined by balancing clinical acuity and waiting time. The determination of acuity takes into account both the primary category and the specific characteristics of each patient that are relevant to their intended procedure. Uniquely, the process is applicable to lists containing patients with dissimilar conditions. This paper reviews the limitations of current approaches in meeting reasonable community expectations. The principles and social justification underpinning this reform are introduced. Finally, the benefits offered by the program are discussed and interim results are reported. What is known about this topic? Current models for the management of hospital waiting lists have remained largely unchanged for several decades. Typically patients are allocated to urgent, semi-urgent and non-urgent categories of care. No methodology exists to systematically integrate these groups, or to account for specific patient factors. In this void, propriety in management is difficult to establish or defend. What does this paper add? A program is reported that unifies all categories of patients into a single prioritised waiting list. The order of patients is dynamic, and transparently reflects waiting time, category assignment and relevant individual patient factors. Uniquely, the program is applicable to lists containing patients with diverse clinical conditions. What are the implications for clinicians? Adoption of new technology is essential if reasonable community expectations in waiting list management are to be met. The current program provides unambiguous, defensible prioritisation of all patients awaiting care. The present reliance on individual managers is reduced, and the unique circumstances of each patient are recognised. We believe this approach affords significant benefit to patients, practitioners and regulators. [ABSTRACT FROM AUTHOR]

This paper outlines the background and progress to date of a project to improve the coordination of care for Aboriginal people with mental health and/or alcohol and other drug problems living in the Eyre Peninsula region of South Australia. The project responds to recommendations from previous research by this team in this area, and has been running since 2004. Working with a wide range of health and human service providers, we explored issues that improve or hinder coordination of care and identified useful strategies. Some of these have already been implemented through the project: e.g. interagency cross-disciplinary training in response to shared needs, and lobbying for afterhours telephone help. Other strategies are still in progress: e.g. implementing a uniform triage and referral system and improving information sharing within Port Lincoln Aboriginal Health Service. The paper reflects on our experience of conducting Aboriginal health service research using a participatory action oriented approach, and discusses the challenges in providing effective and well coordinated rural and remote mental health/alcohol and other drug care in the context of complex health and social needs of Aboriginal people. [ABSTRACT FROM AUTHOR]

Type 2 diabetes mellitus (T2DM) is a progressive chronic disease that requires significant self-surveillance and adherence to the treatment protocols for successful management and future health. There is a growing body of evidence suggesting that diabetes education is beneficial for patient outcomes. However, there is some debate about how best to deliver diabetes education, whether individually or in groups. Although several studies have investigated the role of group education in improving the management of T2DM, few studies have examined this issue from the client's perspective. It is here that this study makes a contribution to understanding diabetes management. Drawing on systematic observation of group education sessions provided by diabetic resource nurses and in-depth interviews with clients, this paper describes the experiences, perspectives and significance of these sessions to clients. Our results suggest that group education sessions were seen as valuable to the clients for: the opportunity they provided to meet others living with diabetes; to improve motivation for managing the disease; and to enhance knowledge of diabetes, its management and long-term implications. In short, this study demonstrates that the clients value group education sessions for the social contact, increasing knowledge about the disease for self-management and support they provide; factors recognised as important to maintaining health. In addition, group education sessions appear to be a cost-effective method for diabetes self-management that funders need to consider. [ABSTRACT FROM AUTHOR]

This paper presents the findings from a qualitative study, which sought to investigate the barriers and enablers to implementation of a continuous quality improvement (CQI) program by health-care professionals in Aboriginal primary health-care services in South Australia. Eighteen semi-structured interviews across 11 participating services were conducted alongside CQI implementation activities. Multiple barriers exist, from staff perspectives, which can be categorised according to different levels of the primary health-care system. At the macro level, barriers related to resource constraints (workforce issues) and access to project support (CQI coordinator). At the meso level, barriers related to senior level management and leadership for quality improvement and the level of organisational readiness. At the micro level, knowledge and attitudes of staff (such as resistance to change; lack of awareness of CQI) and lack of team tenure were cited as the main barriers to implementation. Staff identified that successful and sustained implementation of CQI requires both organisational systems and individual behaviour change. Improvements through continuing regional level collaborations and using a systems approach to develop an integrated regional level CQI framework, which includes building organisational and clinic team CQI capacity at the health centre level, are recommended. Ideally, this should be supported at the broader national level with dedicated funding. [ABSTRACT FROM AUTHOR]

The leopard seal Hydrurga leptonyx is one of five phocid species with a circumpolar distribution in the Southern Ocean. They do not breed on the Australian coast. We document records of 14 leopard seals (two collected specimens, 12 live sightings) in South Australia (SA) between November 2017 and November 2022, from Fowlers Bay to the mouth of the River Murray. We used records from the SA Museum, reports from coastal officers of SA Department for Environment and Water, and information from the public. All 14 seals were juvenile and most were in fair/thin body condition. Two collected specimens and two sighted animals showed evidence of blunt trauma. Stomachs contained fish remains and feathers, and one contained 21 semi-digested smooth toadfish Tetractenos glaber, a species which contains the toxin tetrodo-toxin. Necropsies on two specimens involved gross, histopathological, and diagnostic assessment of pathogens, organs, and skin lesions. All records were between June and December, similar to the seasonal distribution reported previously in southern Australia. The 14 records over 5 years to 2022 averaged 2.8 per year, higher than during a previous study in SA that ran over three decades to October 2009 at 1.2 per year. [ABSTRACT FROM AUTHOR]

Objectives. The aims of the present study were to: (1) identify trends in bariatric surgery in South Australia (SA) from 2001 to 2013; and (2) compare public and private hospitals, and so discuss the implications of these trends as they relate to equity in access to bariatric procedures and public system healthcare expenditure. Methods. An analysis of retrospective data of all bariatric procedures in public and private hospitals in SA was conducted using all SA public and private hospital administrative records between 2001 and 2013. Results. Of all procedures conducted in SA, 22.6% were revisions or reversals. The number of revisions or reversals conducted in SA has increased at a rate higher than weight loss procedures (6.4- vs 3.8-fold increase). An increasing proportion of public surgeries are revisions or reversals of weight loss procedures that occurred outside of the SA public system (interstate or in the private system). Conclusion. Further investigation is necessary to identify the pathways patients navigate to access bariatric surgery, the utilisation of public services following private procedures and why rates of revisions or reversals of bariatric procedures are increasing in SA. What is known about the topic? Rates of bariatric surgery are increasing internationally as a treatment for obesity. What does this paper add? Trends in bariatric procedures in SA have not been published. We have identified that: (1) rates of bariatric revisions or reversals in SA far surpass the rate at which bariatric weight loss procedures are increasing; (2) rates of revisions or reversals are increasing in public hospitals; and (3) an increasing number of the revision or reversal procedures in public hospitals are for weight loss procedures that have occurred outside the public system. What are the implications for practitioners? The data have implications for practitioners caring for patients interested in undergoing bariatric surgery for the treatment of obesity. The data suggest that rates of revisions or reversals are increasing in public hospitals, which suggests that further information is needed regarding the effectiveness of weight loss procedures and the implications of revision or reversal increases on waiting times for patients seeking weight loss treatment in a system with limited resources. [ABSTRACT FROM AUTHOR]

Objective: Risk factors and clinical outcomes of non-index hospital readmissions (readmissions to a hospital different from the previous admission) have not been studied in Australia. The present study compared characteristics and clinical outcomes between index and non-index hospital readmissions in the Australian healthcare setting. Methods: This retrospective cohort study included medical admissions from 2012 to 2016 across all major public hospitals in South Australia. Readmissions within 30 day to all public hospitals were captured using electronic health information system. In-hospital mortality and readmission length of hospital stay (LOS) were compared, along with 30-day mortality and subsequent readmissions among patients readmitted to index or non-index hospitals. Results: Of 114 105 index admissions, there were 20 539 (18.0%) readmissions. Of these, 17 519 (85.3%) were index readmissions and 3020 (14.7%) were non-index readmissions. Compared with index readmissions, patients in the non-index readmissions group had a lower Charlson comorbidity index, shorter LOS and fewer complications during the index admission and were more likely to be readmitted with a different diagnosis to the index admission. No difference in in-hospital mortality was observed, but readmission LOS was shorter and 30-day mortality was higher among patients with non-index readmissions. Conclusion: A substantial proportion of patients experienced non-index hospital readmissions. Non-index hospital readmitted patients had no immediate adverse outcomes, but experienced worse 30-day outcomes. What is known about the topic?: A significant proportion of unplanned hospital readmissions occur to non-index hospitals. North American studies suggest that non-index hospital readmissions are associated with worse outcomes for patients due to discontinuity of care, medical reconciliation and delayed treatment. Limited studies have determined factors associated with non-index hospital readmissions in Australia, but whether such readmissions lead to adverse clinical outcomes is unknown. What does this paper add?: In the Australian healthcare setting, 14.7% of patients were readmitted to non-index hospitals. Compared with index hospital readmissions, patients admitted to non-index hospitals had a lower Charlson comorbidity index, a shorter index LOS and fewer complications during the index admission. At the time of readmission there was no differences in discharge summary completion rates between the two groups. Unlike other studies, the present study found no immediate adverse outcomes for patients readmitted to non-index hospitals, but 30-day outcomes were worse than for patients who had an index hospital readmission. What are the implications for practitioners?: Non-index hospital readmissions may not be totally preventable due to factors such as ambulance diversions stemming from emergency department overcrowding and prolonged emergency department waiting times. Patients should be advised to re-present to hospital in case they experience recurrence or relapse of a medical condition, and preferably should be readmitted to the same hospital to prevent discontinuity of care. [ABSTRACT FROM AUTHOR]

Objectives To describe the burden of bone and joint problems (BJP) in a defined regional population, and to identify characteristics and service-usage patterns. Methods In 2010, a health census of adults aged ≥15 years was conducted in Port Lincoln, South Australia. A follow-up computer-assisted telephone interview provided more specific information about those with BJP. Results Overall, 3350 people (42%) reported current BJP. General practitioners (GP) were the most commonly used provider (85%). People with BJP were also 85% more likely to visit chiropractors, twice as likely to visit physiotherapists and 34% more likely to visit Accident and Emergency or GP out of hours (compared with the rest of the population). Among the phenotypes, those with BJP with co-morbidities were more likely to visit GP, had a significantly higher mean pain score and higher levels of depression or anxiety compared with those with BJP only. Those with BJP only were more likely to visit physiotherapists. Conclusions GP were significant providers for those with co-morbidities, the group who also reported higher levels of pain and mental distress. GP have a central role in effectively managing this phenotype within the BJP population including linking allied health professionals with general practice to manage BJP more efficiently. What is known about the topic? As a highly prevalent group of conditions that are likely to impact on health-related quality of life and are a common cause of severe long-term disability, musculoskeletal conditions place a significant burden on individuals and the health system. However, far less is known about access and usage of musculoskeletal-related health services and programs in Australia. What does this paper add? As a result of analysing the characteristics of the overall BJP population, as well as phenotypes within it, a greater understanding of patterns of health service interactions, care pathways and opportunities for targeted improvements in delivery of care may be identified. The results emphasise that participants with BJP utilised the services of a narrow range of providers, which may have workforce implications for these sectors. The funding models for physiotherapists and chiropractors in Australia involve a mix of private and fees for service, which limits access to those who have private health insurance or can pay directly for these services. What are the implications for practitioners? These analyses indicate the importance of linking allied health professionals with general practice to manage BJP more efficiently. Alternative and appropriate care pathways need to be more strongly developed and identified for effective management of these conditions rather than relying on a traditional range of practitioners. Alternatively, greater ease of access to allied health practitioners may enable more effective treatment and improved quality of life for those with BJP. There is an urgent need to develop an effective population-based model of integrated care for BJP within regional Australia. [ABSTRACT FROM AUTHOR]

Common dolphins are subject to large-scale fishing activity and tourism operations in SouthAustralia; however, there is a paucity of data on this species. Understanding the behaviour of a population can contribute greatly to our knowledge of a species and how to manage potential population-level threats. This paper describes the behaviour of short-beaked common dolphins (Delphinus delphis) in Australian waters for the first time. Data were collected from 109 independent dolphin groups during boat-based surveys conducted in Gulf St Vincent, South Australia, between September 2005 and May 2008. Activity budgets were used to assess behaviour of common dolphins in relation to diel patterns, season, water depth, sea surface temperature (SST), group size and composition. Foraging (33.9%) and resting (2.8%) were the most and least frequently observed behaviours, respectively. Travelling (33.0%), socialising (20.2%) and milling (10.1%) accounted for the remainder of the activity budget. Diurnal differences were detected, with foraging (59.5%) and socialising (31.8%) groups most frequently observed from 10.00 to 11.59 hours. Behaviour did not vary seasonally or with water depth, SST, group size or composition. Behaviour varied significantly between single- and multispecies aggregations. Foraging was more frequent in multispecies aggregations, as 78.4% of all foraging behaviour observed for common dolphins occurred in the presence of other species. Multispecies aggregations were most frequently observed with flesh-footed shearwaters (Puffinus carneipes), which were present during 29.4% of common dolphin encounters. Behaviour varied significantly during aggregations with shearwaters, as 62.2% of foraging groups occurred in the presence of shearwaters. Resting, milling or socialising was rarely observed in the presence of any other species, indicating that the primary mechanism for aggregations is likely prey-related. [ABSTRACT FROM AUTHOR]

South Australia's Strategic Plan includes a target to improve the population's healthy life expectancy. A common question among health policy and service planners is: 'How do health programs and services in the community relate to healthy life expectancy?' In response, this paper outlines an effectiveness and equity framework (EEF) for evaluating health interventions in applied settings. Using the example of coronary heart disease (CHD) management in general practice in South Australia, the EEF: (1) applies an internally consistent approach to accounting for population healthy life expectancy at state and smaller geographic levels; (2) estimates average population health gains from health programs, and gains across different socioeconomic subgroups within the community; (3) conducts economic evaluation by equating health gains against health system costs in population subgroups; (4) summarises relevant information about candidate intervention programs within a multi-criteria performance matrix for presentation to decision makers; (5) reassesses outcomes (and processes) following the implementation of a program and iteratively adds to the relevant knowledge and evidence base. The EEF offers a practical approach to selecting and evaluating intervention programs. The challenge is to develop system culture and data capture methods clearly focussed on linking health system activities to population health outcomes. [ABSTRACT FROM AUTHOR]

The ‘Regional Combinations' project and its biophysical outcomes have been described in several other papers in this special edition. The information provided in these papers allows an evaluation of the most profitable beef cattle production systems across different environments in southern Australia. In this paper, the focus is on the New South Wales experimental site where the trial animals were finished in a feedlot. The data identified liveweight gain as the biggest driver of profitability of production. Between growth treatments, there was a large difference in the gross margins before feedlot entry between the ‘fast' and ‘slow' treatments favouring the fast-grown animals, even after accounting for the higher cost of producing pasture capable of sustaining faster growth. However, the slow growth treatments consistently outperformed the fast growth treatments in the feedlot. In terms of breeds, the European breed types consistently outperformed the Wagyu breeds. There were no time-of-calving experiments in New South Wales. [ABSTRACT FROM AUTHOR]

The ‘Regional Combinations' project and its biophysical outcomes, and the subsequent identification of the most profitable beef cattle production systems across different environments in southern Australia, have been described in several other papers in this special edition. In this paper, the economic calculations reported for each of the individual beef enterprises representative of the various state sites are aggregated up to the level of the Australian cattle and beef industry and then projected forward over several years into the future. To do this, an existing model of the world beef market is used. The analyses suggest that both the fast-growth-rate technology and the time-of-calving technology have the potential to generate significant economic benefits for the southern Australia cattle and beef industries. The cumulative present values of each technology are around $70 million over a 15-year time horizon at a 7% real discount rate. [ABSTRACT FROM AUTHOR]

Promoting men's health in primary care settings such as general practice is now common, but what might primary health care for men's health look like in community health settings? This paper reports on case studies of diverse community-based health and wellbeing services for men in South Australia. The programs selected as case studies include Aboriginal men, gay men and homosexually active men, men from culturally and linguistically diverse backgrounds, older men, middle-aged men, fathers, young men, as well as services that focus on childhood sexual abuse and violence intervention. The case studies share the following main features—they have a social view of health, use a primary health care approach with an emphasis on prevention, address issues of access and equity, use social justice principles, and work across a number of sectors. These features were integrated into a socially just primary health care framework for men's health in community health settings. Socially just primary health care can address health inequities within men's health that are related to, among other things, class, race, ethnicity and sexuality. Socially just primary health care services can work collaboratively with women's health on common concerns such as violence intervention and childhood sexual abuse. Moreover, socially just primary health care services reflect local concerns, where health professionals work with men rather than acting as outside experts. [ABSTRACT FROM AUTHOR]

Context: Bromus diandrus Roth is a serious weed of cereal-based cropping systems in South Australia. Its adaptation to local climate and production systems, prolific seed production and evolution of herbicide resistance have made this weed difficult to manage. Aims: Studies were undertaken to determine genetic variation in seed dormancy within B. diandrus populations and its association with genes involved with gibberellic acid and abscisic acid synthesis. Methodology: Seeds from five B. diandrus populations were sampled during 2017 from commercial fields and planted during 2018 in pots. Protracted seedling emergence in these populations allowed selection of low and high dormancy cohorts. Seeds produced by these cohorts from each population were evaluated for variation in seed dormancy in the following year. The process of cohort selection and seed dormancy evaluation was repeated. The mechanism regulating seed dormancy was investigated in 2020 by assessing seeds of low and high dormancy cohorts concurrently for dormancy and for expression of ABA1 and GA20ox genes, using quantitative real-time PCR. Results: There was at least a two-fold difference in seed dormancy among populations collected from different farms. Low and high dormancy cohorts within each population maintained consistent differences in seed dormancy in both years of assessment, suggesting genetic control over this trait. Differences in seed dormancy between low and high dormancy cohorts were significantly correlated with ABA1 and GA20ox gene expression. Conclusions: Large differences in seed dormancy exist between individuals in B. diandrus populations. The study has provided evidence of genetic variation for seed dormancy within B. diandrus populations, which was associated with ABA1 and GA20ox gene expression. Implications: Presence of genetic variation for seed dormancy could play an important role in adaptation to escape pre-sowing weed-control tactics, meaning that B. diandrus could become an even greater problem in field crops grown in this region. Bromus diandrus is a serious weed of cereal crops in South Australia and is responsible for significant yield decline in wheat. Seed dormancy of different B. diandrus populations analysed for 3 years revealed genetic variation, and genes responsible for the control of seed dormancy were identified. The findings improve understanding of the genes involved in regulating seed dormancy, their expression over time, and how loss of dormancy is associated with changes in the gene expression. [ABSTRACT FROM AUTHOR]

Background: Chronic hepatitis B is a significant public health issue; however, there is limited understanding of the engagement in primary health care of Aboriginal people living with chronic hepatitis B (CHB). Methods: To better understand the management of CHB, diagnostic reports and case note audits were conducted in six South Australian Aboriginal community controlled health services. The audits covered the initial assessment, CHB monitoring, and hepatocellular carcinoma screening. The initial assessment was reviewed by auditing client clinical records for the first 12 months from the date of diagnosis, whereas CHB monitoring and hepatocellular carcinoma screening were determined by auditing a 12-month sample period (January to December 2019). Associations with CHB monitoring were determined using a Chi-squared test and Fisher's exact test P -values, as appropriate. Results: There were 50 current clients with a diagnosis of CHB at the time of the audit (January 2020). Testing was incomplete for the initial assessment, CHB monitoring and hepatocellular carcinoma screening. There were significant associations between the increased likelihood of accessing monitoring and the number of times a person attended an Aboriginal community controlled health service, accessing care in a more remote region, having a documented recall and having a GP management plan containing CHB. Conclusion: Through providing evidence of significant associations between having a recall set and GP management plans with increased uptake of disease monitoring, this study has highlighted areas for improvement in clinical management. This study explores the management of chronic hepatitis B in six South Australian Aboriginal community controlled health services. This study has found clients received incomplete testing across the initial assessment, chronic hepatitis B monitoring and hepatocellular carcinoma screening. Through providing evidence of significant associations between having a recall set and GP management plans with increased uptake of disease monitoring, this study has highlighted areas for improvement in clinical management. [ABSTRACT FROM AUTHOR]

Background: The Community Health Program of the 1970s was an attempt to introduce a national community health model. However, although community-based health care is an important element of the health systems of all Australian states and territories, the definition of what constitutes a 'community health service' in Australia today is not clear. Methods: A search of government websites failed to provide information about the types and characteristics of services that would be included in the term. Therefore, semi-structured interviews were conducted with 13 key informants in roles with responsibility for primary and community health services from health departments in all Australian states and territories. Questions explored their understanding of community health services as they operated in their jurisdiction. The study adopted a blended inductive and deductive orientation within a qualitative descriptive method. Results: There was little consistency in the way community health services were described across jurisdictions. The defining attributes of a 'community health centre' described by an international peak body did not apply to services in the majority of jurisdictions in Australia. Victoria was more aligned with the description than other jurisdictions, with organisations defined through legislation and a separate funding stream to support aspects of service delivery. Conclusions: Those designing and implementing national health system programs and reforms need to be aware that terms, such as 'community health', do not mean the same thing across jurisdictions; attempts to create consistency have to recognise differences that will affect new initiatives, as well as the spread of successful policies and programs from one jurisdiction to another. Without a consistent description, it is difficult to explore the current role of community-based health care across Australia in improving access to health care. 'Community health' is an important element of Australian health systems and recognised as such in national policy. Interviews with 13 key informants in roles with responsibility for primary and community health services from health departments in Australian states/ territories found little uniformity in the way community health was described. Inconsistencies in the use of the term 'community health' and the complexity of the multi-jurisdictional context need to be acknowledged when considering the design and implementation of national health system programs and reforms. [ABSTRACT FROM AUTHOR]

Many animal species 'play dead' or feign death (in some cases called tonic immobility) as a defence strategy against predators, including some ants, although triggers and durations are poorly understood. We repeatedly observed such death-feigning behaviour in Polyrhachis femorata ants that occupied pygmy-possum nest boxes deployed on Kangaroo Island following the 2019–2020 bushfires that burnt half of the island. Most of the 759 bat and pygmy-possum boxes (901 cavities) were on burnt ground. In 3312 box cavity checks on 13 diverse properties during monitoring visits, 28 of 40 P. femorata records (first for South Australia) occurred in unburnt Critically Endangered Narrow-Leaf Mallee Woodland community, seven in adjacent mallee community containing narrow-leaf mallee, three in cup gum unburnt habitat, and two in one box on burnt ground. Fire may have affected the abundance and re-establishment of the species. Polyrhachis femorata engages in a surprising defensive immobility strategy in boxes, since it is not only undertaken by individuals facing a potential predator, but also by entire colonies. The death-feigning behaviours were complemented by plugging box entrances. Nest boxes may be used to study this mysterious behaviour in this poorly known species, although frequent observation could lead to nest abandonment by the ant. The ant Polyrhachis femorata , a first record for South Australia, feigned death individually and in colonies in wooden nest boxes made for pygmy-possums. The ant was most common in unburnt Critically Endangered Narrow-Leaf Mallee Woodland community on Kangaroo Island. Death feigning is likely to deter potential predators and could be studied with nest boxes placed on trees. Photograph by Sophie Petit. [ABSTRACT FROM AUTHOR]

The desert rat-kangaroo or 'ngudlukanta' (Caloprymnus campestris) was once sparsely distributed in the Lake Eyre Basin of north-eastern South Australia and adjacent parts of Queensland, but has not been collected since the 1930s. However, numerous reported sightings, including some recent, provide some hope that it may still be extant. In 2018 and 2019, we searched for evidence of this species at sites where it had been collected in the 1930s, and at places where people have since reported seeing an animal that fits its description. Our survey, which analysed data from more than 6000 camera trap nights, 536 predator scats and 226 km of spotlight transects, was the most extensive field-based search ever undertaken for this animal; but we found no evidence for its continued existence. However, our work did detect other threatened species including a range extension for the kowari (Dasyuroides byrnei), thereby demonstrating the value of surveys like this one. Because of the vastness and inaccessibility of much of the terrain comprising the supposed distribution of C. campestris , we do not see our null result as definitive for this poorly surveyed animal; we instead hope that it provides a starting point for future surveys aimed at resolving its status. The desert rat-kangaroo or 'ngudlukanta' once occurred in north-eastern South Australia and adjacent parts of Queensland but is now presumed extinct. However, spurred on by some recent sightings we searched for the animal throughout its former distribution using camera trapping, spotlighting, and predator scat analysis. Although we found no evidence during our survey for its continued existence, we did detect other threatened species in this poorly-surveyed region of arid Australia. [ABSTRACT FROM AUTHOR]

Remnant natural populations of greater bilbies (Macrotis lagotis) are confined to the Australian arid zone where bilbies construct and shelter in multiple burrows within their home range. We investigated burrow use behaviour of bilbies in a translocated population in temperate southern Australia to determine if behaviour differed in this climatic zone. Over a 12 month period, 43 adult bilbies at Venus Bay Conservation Park were spool-and-line tracked to 118 burrows. Active burrow density was 0.55 per ha, and bilbies at the site used multiple burrows (up to 13 for males and 8 for females) and regularly moved between diurnal burrows. Male bilbies had significantly larger burrow ranges (10.2 ± 5.8 ha, MCP100, mean ± s.d.) than females (2.6 ± 1.8 ha), and were similar in size to those recorded in an arid zone population. Males' burrow ranges tended to overlap with the burrow range of multiple other males and females. The density of burrows in the current study suggests that bilby burrows were likely to have been a common landscape feature within the southern parts of the species range prior to their local extinction. Further research is needed to determine the impact of the loss of bilby burrows from southern Australia on other burrow commensal species. We describe burrow use behaviour in greater bilbies exposed to a temperate climate for the first time using a translocated population in southern South Australia. Bilbies in our study used multiple burrows within their home range, regularly moved between diurnal burrows and male bilbies had larger burrow ranges with more overlap than did females. Burrow density was 2.75–5.0 times the density of bilbies at the site, indicating that burrows were likely a common landscape feature in areas where bilbies were once in high density. Photograph by Karleah Berris. [ABSTRACT FROM AUTHOR]

Objective. To analyse Medicare expenditure by State/Territory, remoteness, and Indigenous demography to assess funding equality in meeting the health needs of remote Indigenous populations in the Northern Territory. Methods. Analytic descriptions of Medicare online reports on services and benefits by key demographic variables linked with Australian Bureau of Statistics data on remoteness and Indigenous population proportion. The Northern Territory Indigenous and non-Indigenous populations were compared with the Australian average between the 2010/2011 and 2019/2020 fiscal years in terms of standardised rates of Medicare services and benefits. These were further analysed using ordinary least squares, simultaneous equations and multilevel models. Results. In per capita terms, the Northern Territory receives around 30% less Medicare funds than the national average, even when additional Commonwealth funding for Aboriginal medical services is included. This funding shortfall amounts to approximately AU$80 million annually across both the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme. The multilevel models indicate that providing healthcare for an Aboriginal and Torres Strait Islander person in a remote area involves a Medicare shortfall of AU$531-- AU$1041 less Medicare Benefits Schedule benefits per annum compared with a non-Indigenous person in an urban area. Indigenous population proportion, together with remoteness, explained 51% of the funding variation. An age--sex based capitation funding model would correct about 87% of the Northern Territory primary care funding inequality. Conclusions. The current Medicare funding scheme systematically disadvantages the Northern Territory. A needs-based funding model is required that does not penalise the Northern Territory population based on the remote primary health care service model. [ABSTRACT FROM AUTHOR]

Objectives. This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. Methods. The study concentrated on three diverse Aboriginal communities in South Australia; the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for individual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the individual and group levels. Results. Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. Conclusions. The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs. What is known about the topic? Chronic condition management and self-management programs have been available to Aboriginal people in a range of forms for some time. We know that some groups of patients are keen to engage with care planning and self-management protocols and we have anecdotal evidence of this engagement leading to improved quality of life and health outcomes for Aboriginal people. What does this paper add? This paper provides early evidence of sustained improvement over time for a cohort of Aboriginal people who are learning to deal with a range of chronic illnesses through accessing structured systems of support and care. What are the implications for practitioners? This longitudinal evidence of improved outcomes for Aboriginal people is encouraging and should lead on to more definitive studies of outcomes accruing for people engaged in structured systems of care. Not only does this finding have implications for the overall management of chronic illness in Aboriginal communities, but it points the way to how health services might best invest their resources and efforts to improve the health status of people with chronic conditions and, in the process, close the gap between the life expectancy of Aboriginal people and that of other community groups in Australia. [ABSTRACT FROM AUTHOR]

Objectives. Despite the incidence of joint replacements in Australia, there is a paucity of information regarding how patients progress from their referral to their surgery. The aim of this study was to describe a patient pathway from referral to receipt of total hip replacement (THR) or total knee replacement (TKR) surgery in South Australian public hospitals. Methods. Patient perspectives of the pathway to THR and TKR surgery were obtained via a postal survey (n = 450) and hospital employee perspectives were attained via semi-structured interviews (n = 19). Survey data were analysed using descriptive statistics and interview data were analysed thematically. Results. A typical patient pathway to THR and TKR surgery can be divided into two distinct phases; referral-to-initial appointment (9-24 months), and initial appointment-to-surgery (12-15 months). This gives an overall waiting period between 2 and 3 years for THR or TKR surgery. Conclusions. Waiting times for THR and TKR surgery reported in this study were longer than other reports in the literature. Current Australian health policy does not consider the first (and longest) phase of the patient pathway. Excluding this initial phase could be generating an erroneous perception of the patient pathway to THR or TKR surgery, possibly leading to poorly considered health reforms. What is known about the topic? Meeting the demand for elective surgery services in public hospitals is an ongoing challenge for governments and health systems alike. The persistent mismatch between supply and demand has resulted in the development of waiting lists for elective total hip replacement (THR) and total knee (TKR) replacement surgery in Australia. Current state-level health policies such as the Policy Framework and Associated Procedural Guidelines for Elective Surgery Services in South Australia or the Elective Surgery Access Policy in Victoria, outline a generic pathway consisting of a few linear steps that occur immediately before receipt of surgery, without consideration of the early stages of the journey. Aside from these types of policies, we were unable to identify any published literature outlining the patient journey from referral to receipt of THR or TKR surgery. As such, our understanding of the issue is inadequate due the paucity of existing research evidence. What does this paper add? Our current understanding of the patient journey to THR and TKR surgery is limited to the perspective of the policy-makers, whose focus is the organisation of waiting lists and the systematic progression of an individual through the elective surgery system. This perspective reinforces the assumption that it is a simple, linear process and may lead to erroneous judgements regarding the impact that the patient pathway has on an individual and the time it takes to progress along that pathway. This study presents the patient pathway from the perspective of individuals working within the systems responsible for delivering THR and TKR surgery and from patients who have received a joint replacement in a South Australian public hospital. As such, this paper provides new insight into the length, impact and features of the entire patient journey, rather than a snap-shot of the final stages. What are the implications for practitioners? This study is the first step towards better understanding of the patient pathway to joint replacement surgery in Australian public hospitals. Greater understanding of the complete pathway and identification of areas of congestion within the pathway, as evidenced by longer waiting periods, offers insight into areas with the potential for effective reforms. Should the patient pathway be significantly altered, the experience of practitioners responsible for the interim and postoperative management of patients undergoing THR and TKR surgery will also be changed. Additionally, practitioners currently frustrated by the long delays experienced by their patients who are in need of elective surgery in Australian public hospitals, could have that frustration abated by system improvements that reduce the length and complexity of the pathway to joint replacement surgery. [ABSTRACT FROM AUTHOR]

Objective. To present research findings on access to, and use of, digital information and communication technologies (ICTs) by Australians from lower income and disadvantaged backgrounds to determine implications for equitable consumer access to digitally-mediated health services and information. Methods. Focus groups were held in 2008-09 with 80 residents from lower income and disadvantaged backgrounds in South Australia, predominantly of working- and family-formation age (25 to 55 years). Qualitative analysis was conducted on a-priori and emergent themes to describe dominant categories. Results. Access to, and use of, computers, the Internet and mobile phones varied considerably in extent, frequency and quality within and across groups due to differences in abilities, resources and life experience. Barriers and facilitators included English literacy (including for native speakers), technological literacy, education, income, housing situation, social connection, health status, employment status, and trust. Many people gained ICT skills by trial and error or help from friends, and only a few from formal programs, resulting in varied skills. Conclusion. The considerable variation in ICT access and use within lower income and disadvantaged groups must be acknowledged and accommodated by health initiatives and services when delivering digitally-mediated consumer-provider interaction, online health information, or online self-management of health conditions. If services require consumers to participate in a digitally-mediated communication exchange, then we suggest they might support skills and technology acquisition, or provide non-ICT alternatives, in order to avoid exacerbating health inequities. 1. What is known about the topic? Government and health provider use of digitally-mediated information and communication is rapidly increasing. However, national data show that ICT access is distributed unevenly across Australia's population. Furthermore, this distribution mirrors the health gradient. There is little qualitative data on the extent to which, and ways in which, ICTs are used within lower income and disadvantaged groups - those with greater health need. 2. What does this paper add? This paper augments the scant literature to describe ICT access and use in a range of lower income and disadvantaged groups. It indicates barriers and facilitators, and highlights the need for formal supports to level up the whole population to have the skills, confidence and resources to use and benefit from ICT-mediated communication. 3. What are the implications for practitioners? As health services and governments increase the level of digitally-mediated information and communication connection with consumers/patients, it is important to understand and find ways to address differential consumer access to and use of ICTs, so that equity of access to services and information is promoted. This is particularly important as lower income and disadvantaged groups are likely to have both poorer health and lower ICT use. [ABSTRACT FROM AUTHOR]

The article explores issues relating to access to physical and mental health care for people with mental health problems in light of Australia's endorsement in 2008 of the Convention of the Rights of Persons with Disabilities, which established the right to health and to health care. Under the program, interviews were conducted with 10 key stakeholders with legal, policy, clinical and advocacy roles within South Australia and at a national and international level.

The short-beaked echidna is the most widely distributed endemic Australian mammal, and echidnas from different geographic areas differ so much in appearance that they have been assigned to several subspecies. In this paper, we present data obtained from free-ranging echidnas in southern Tasmania, and compare this with studies from other parts of Australia. In Tasmania mating occurs between early June and mid-September, and throughout Australia the normal breeding season lies within these limits. In echidnas from the more easterly parts of Australia reproduction closely follows hibernation, with Tasmanian echidnas showing a significant overlap between hibernation and reproduction. There is intense competition between males, and female echidnas from Tasmania show multiple matings. There are significant differences between echidnas from different areas of Australia in the use of nursery burrows and maternal care. One of the most dramatic differences is in duration of lactation: echidnas from Kangaroo Island wean the young at 204–210 days, but in Tasmania weaning occurs at 139–152 days, even though the masses of the young at weaning are comparable. [ABSTRACT FROM AUTHOR]

Throughout their Australia-wide distribution, short-beaked echidnas breed during the winter months, i.e. June through early September. Actual duration of the female reproductive cycle, from attracting males and mating until weaning the young, can vary from 7 to 9 months depending on geographic location. Much of this variation is due to length of courtship and age of weaning the young. This paper presents data about the behaviour of free-ranging female echidnas on Kangaroo Island from egg laying through to weaning and compares it with findings from other areas. On Kangaroo Island, behaviour of lactating echidnas falls into two distinct phases: (1) while carrying the young in the pouch; and (2) after the young is placed in a nursery burrow. Females significantly increased both the number of hours active each day as well as the size of area utilised after the young was in the nursery. Although types of nursery burrows are similar throughout Australia, duration of use and frequency visited varies between geographic locations. A major difference is that Kangaroo Island echidnas are often active while carrying either the egg or the young in the pouch and echidnas in other regions remain in a burrow for extended periods. [ABSTRACT FROM AUTHOR]

Nicotiana is found predominantly in the Americas and Australia, but also has representatives in Africa and the Pacific Islands. All native Australian Nicotiana species belong to section Suaveolentes. The number of species in this section is uncertain and subject to revision. An example of this uncertainty is the taxonomic status of a South Australian Nicotiana accession colloquially termed 'Corunna'. Here, we report sequences for nuclear and plastid markers for N. sp. Corunna (D.E.Symon 17088) and accessions of two other Australian species, N. burbidgeae and N. benthamiana. Phylogenetic comparison of these sequences with those of other members of Nicotiana places all three taxa in N. section Suaveolentes and shows that 'Corunna' represents a distinct phylogenetic lineage in a well supported clade along with N. goodspeedii , N. maritima , N. amplexicaulis and N. suaveolentes. Phenetic analysis of floral characters also supports recognition of N. sp. Corunna (D.E.Symon 17088) as a distinct species, which we describe here as Nicotiana paulineana Newbigin & P.M.Waterh., sp. nov. The enlarged molecular dataset described here contributes to a better understanding of taxonomic relationships within the section. We have used sequence and morphological characteristics to identify a new species of plant, exclusive to Australia, that was collected by the late David Symon from a region around Port Augusta, South Australia. It is named Nicotiana paulineana in honour of Prof. Pauline Ladiges (retired), a highly respected botanist at The University of Melbourne. [ABSTRACT FROM AUTHOR]