Search

Editorial

Editorial

Tress et al. (2014) gave Pacific Conservation Biology readers a clear overview of preparing a paper for publication in a peer- reviewed journal…

Tress et al. (2014) gave Pacific Conservation Biology readers a clear overview of preparing a paper for publication in a peer- reviewed journal…

Purpose This study examines a paper hand-held record and shared electronic health record in an Australian tertiary hospital health care maternity setting and the role that both types of records play in facilitating integrated care among health care providers. Theory and methods A qualitative research design was used where five focus groups were conducted in two phases with 69 hospital health care providers. Thirty-two interviews were also carried out with general practitioners. Transcripts were analysed using qualitative content analysis. Results Three key themes were identified: 1. Selective use of records; 2. Communication of care; 3. Negativity about the use of records. Conclusions This study demonstrates that health care providers do not effectively share information using either a paper hand-held record or a shared electronic health record. Considering a national commitment to e-health innovation, a multi-professional input, organisational support and continuing education are identified as crucial to realising the potential of a maternity shared electronic health record to facilitate integrated care.

The paper hand-held record (PHR) has been used extensively in general practice (GP) shared care management of pregnant women, and recently, the first Mater Shared Electronic Health Record (MSEHR) was introduced. The aim of this qualitative study was to examine women’s experiences using the records and the contribution of the records to integrate care. At the 36-week antenatal visit in a maternity tertiary centre clinic, women were identified as a user of either the PHR or the MSEHR and organised into Phase 1 and Phase 2 studies respectively. Fifteen women were interviewed in Phase 1 and 12 women in Phase 2. Semi-structured interviews were used for data collection, and analysed using qualitative content analysis. Four main themes were identified: (1) purpose of the record; (2) perceptions of the record; (3) content of the record, and; (4) sharing the record. Findings indicate that the PHR is a well-liked maternity tool. The findings also indicate there is under-usage of the MSEHR due to health-care providers failing to follow up and discuss the option of using the electronic health record option or if a woman has completed the log-in process. This paper adds to an already favourable body of knowledge about the use of the PHR. It is recommended that continued implementation of the MSEHR be undertaken to facilitate its use.

The Australian Community Climate and Earth System Simulator (ACCESS) has contributed to the World Climate Research Programme’s Coupled Model Intercomparison Project Phase 6 (CMIP6) using two fully coupled model versions (ACCESS-CM2 and ACCESS-ESM1.5) and two ocean–sea-ice model versions (1° and 0.25° resolution versions of ACCESS-OM2). The fully coupled models differ primarily in the configuration and version of their atmosphere components (including the aerosol scheme), with smaller differences in their sea-ice and land model versions. Additionally, ACCESS-ESM1.5 includes biogeochemistry in the land and ocean components and can be run with an interactive carbon cycle. CMIP6 comprises core experiments and associated thematic Model Intercomparison Projects (MIPs). This paper provides an overview of the CMIP6 submission, including the methods used for the preparation of input forcing datasets and the post-processing of model output, along with a comprehensive list of experiments performed, detailing their initialisation, duration, ensemble number and computational cost. A small selection of model output is presented, focusing on idealised experiments and their variants at global scale. Differences in the climate simulation of the two coupled models are highlighted. ACCESS-CM2 produces a larger equilibrium climate sensitivity (4.7°C) than ACCESS-ESM1.5 (3.9°C), likely a result of updated atmospheric parameterisation in recent versions of the atmospheric component of ACCESS-CM2. The idealised experiments run with ACCESS-ESM1.5 show that land and ocean carbon fluxes respond to both changing atmospheric CO2 and to changing temperature. ACCESS data submitted to CMIP6 are available from the Earth System Grid Federation (https://doi.org/10.22033/ESGF/CMIP6.2281 and https://doi.org/10.22033/ESGF/CMIP6.2288). The information provided in this paper should facilitate easier use of these significant datasets by the broader climate community.

Australia needs a new shared vision that the current trajectory of loss of natural heritage on its offshore islands is not acceptable and needs to change. This Special Issue brings together seven papers from leaders and practitioners with experience in offshore islands across the Australian and New Zealand context. The fundamentals for each paper are to suggest potential solutions or scenarios to move forward with island policy, and management.

Objective This study investigated the short-term psychosocial effects of the COVID-19 pandemic on hospital clinical staff, specifically their self-reported concerns and perceived impact on their work and personal lives. Methods Nurses, midwives, doctors and allied health staff at a large metropolitan tertiary health service in Melbourne, Australia, completed an anonymous online cross-sectional survey between 15 May and 10 June 2020. The survey assessed respondents' COVID-19 contact status, concerns related to COVID-19 and other effects of COVID-19. Space was provided for free-text comments. Results Respondents were mostly concerned about contracting COVID-19, infecting family members and caring for patients with COVID-19. Concerns about accessing and using personal protective equipment, redeployment and their ability to provide high-quality patient care during the pandemic were also reported. Pregnant staff expressed uncertainty about the possible impact of COVID-19 on their pregnancy. Despite their concerns, few staff had considered resigning, and positive aspects of the pandemic were also described. Conclusion The COVID-19 pandemic has had a considerable impact on the work and personal lives of hospital clinical staff. Staff, particularly those who are pregnant, would benefit from targeted well-being and support initiatives that address their concerns and help them manage their work and personal lives. What is known about the topic? The COVID-19 pandemic is having an impact on healthcare workers' psychological well-being. Little is known about their COVID-19-related concerns and the perceived impact of the pandemic on their work and personal lives, particularly hospital clinical staff during the 'first wave' of the pandemic in Australia. What does this paper add? This paper contributes to a small but emerging evidence base about the impact of the COVID-19 pandemic on the work and personal lives of hospital clinical staff. Most staff were concerned about their own

Objective: The aim of this study was to quantify the direct and indirect costs of asthma and allergic rhinitis (AR) for 2018 in Tasmania. Methods: We used publicly available data, and Tasmanian-specific values where available, to estimate direct and indirect costs of both diseases. Direct costs included outcomes such as emergency department (ED) presentations, hospitalisations, general practice visits and medication use. Indirect costs included premature mortality and lost productivity. Results: Direct health impacts for both conditions combined included 1454 ED presentations, 682 hospitalisations, 72 446 general practice visits and 7122 specialist visits. Indirect health impacts included 13 deaths and between 483 000 and 2.8 million days of lost productivity. Total costs ranged between A126.5 million and A436.7 million for asthma and between A65.3 million and A259.7 million for AR. Per-person annual costs ranged between A1918 and A6617 for asthma and between A597 and A2374 for AR. Conclusions: The main financial burden due to asthma and AR was related to productivity losses from presenteeism and absenteeism. The magnitude of the economic impacts of AR and asthma warrants further analysis to produce a national-level assessment. Such analyses could identify cost-effective interventions that produce highest benefits for the management of these conditions in our community. What is known about the topic?: Allergic respiratory diseases, and particularly asthma and AR, pose a significant health burden, with effects including asthma-related hospital admissions, significant pharmaceutical expenditure and lost workforce and school education productivity. Australia, and particularly Tasmania, has a high prevalence of these conditions, but no recent studies have appraised or estimated their health impacts and costs. What does this paper add?: This paper proposes a unique and transparent costing model that allows the costs of these conditions to be estimated while accounting

Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of 'low-value' interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement; all have occurred within existing payment structures. In this paper we describe options for value-based payment reform and highlight two challenges critical for success: attributing financial risk fairly and organisational structures.What is known about the topic?'Fee for service' is the dominant payment method in Australia and creates incentives to increase service volume, rewarding inputs rather than improvements in longer-term health outcomes. There is increasing recognition that payment reform is needed to support the shift to value-based health care in Australia.What does this paper add?This paper describes the three main options for value-based payment reform: episode-based bundled payments chronic condition bundled payments and comprehensive capitation payments. Each involves some degree of funds pooling, and the shifting of risk from the funder to provider to stimulate the more efficient use of resources.What are the implications for practitioners?We conclude that local hospital authorities in the states, private health insurers and primary health networks could implement reform as payment holders, but that capacity development in coordination and risk adjustment will be required. Successful implementation of payment reform will also require investment in data collection and information technology to track patients' care and measure outcomes and costs.

Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of 'low-value' interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement; all have occurred within existing payment structures. In this paper we describe options for value-based payment reform and highlight two challenges critical for success: attributing financial risk fairly and organisational structures.What is known about the topic?'Fee for service' is the dominant payment method in Australia and creates incentives to increase service volume, rewarding inputs rather than improvements in longer-term health outcomes. There is increasing recognition that payment reform is needed to support the shift to value-based health care in Australia.What does this paper add?This paper describes the three main options for value-based payment reform: episode-based bundled payments chronic condition bundled payments and comprehensive capitation payments. Each involves some degree of funds pooling, and the shifting of risk from the funder to provider to stimulate the more efficient use of resources.What are the implications for practitioners?We conclude that local hospital authorities in the states, private health insurers and primary health networks could implement reform as payment holders, but that capacity development in coordination and risk adjustment will be required. Successful implementation of payment reform will also require investment in data collection and information technology to track patients' care and measure outcomes and costs.

Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of 'low-value' interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement; all have occurred within existing payment structures. In this paper we describe options for value-based payment reform and highlight two challenges critical for success: attributing financial risk fairly and organisational structures.What is known about the topic?'Fee for service' is the dominant payment method in Australia and creates incentives to increase service volume, rewarding inputs rather than improvements in longer-term health outcomes. There is increasing recognition that payment reform is needed to support the shift to value-based health care in Australia.What does this paper add?This paper describes the three main options for value-based payment reform: episode-based bundled payments chronic condition bundled payments and comprehensive capitation payments. Each involves some degree of funds pooling, and the shifting of risk from the funder to provider to stimulate the more efficient use of resources.What are the implications for practitioners?We conclude that local hospital authorities in the states, private health insurers and primary health networks could implement reform as payment holders, but that capacity development in coordination and risk adjustment will be required. Successful implementation of payment reform will also require investment in data collection and information technology to track patients' care and measure outcomes and costs.

ObjectiveTo compare the historical staffing patterns and organisational characteristics of Australian residential aged care facilities (RACFs) against the new minimum staffing standards recommended by the Royal Commission into Aged Care Quality and Safety (RCACQS).MethodRetrospective data analysis was used to compare the staffing levels and characteristics of 1705 RACFs (for 4 years, 2016-19) with the three new mandatory staffing requirements. De-identified datasets were provided by the RCACQS, obtained under its legal authority.ResultsOnly 3.8% of RACFs have staffing levels at or above all three requirements. Although many (79.7%) already meet the requirement to have a registered nurse (RN) on-site for morning and afternoon shifts, few have staffing levels above requirements for total direct care per resident per day (10.4%) or care provided by an RN per resident per day (11.1%). Historical levels of on-site RNs, total direct care, and RN care vary significantly across facilities of different size, location and provider scale.ConclusionThe new staffing standards, to be mandatory by 2023, prescribe minimum requirements significantly higher than existing levels, particularly in care per resident per day. Each of the three requirements will likely have a differential effect for different types of RACFs.What is known about the topic?International evidence suggests that introducing mandatory minimum staffing standards tends to increase the amount of care provided by staff in residential aged care facilities (RACFs). However, the impact of staffing standards is influenced by the stringency of the minimum threshold relative to existing staffing levels, the capacity of organisations to increase their staffing levels, and the specific way the regulation is formulated.What does this paper add?This paper explores the potential implications of the three national minimum staffing standards, to be in force by October 2023, specifying total direct care, care received by a registe

© 2020 Australian Academy of Science. David Paver Mellor (1903-80) was a physical inorganic chemist of significant influence in coordination chemistry and chemical education in Australia. He retired in 1970 after a brief appointment as dean of the Faculty of Science at the University of New South Wales, having been head of the School of Chemistry there for more than a decade. Mellor had been appointed to the staff of the University of Sydney in 1929 and was one of the first Australians to use X-ray diffraction techniques for the determination of crystal structures. In 1936 he applied for a year of leave to work with Linus Pauling at the California Institute of Technology, particularly to learn more about crystal structure analysis. On sabbatical leave he spent a period of one year across 1937-8 in California where he carried out work on X-ray diffraction in Linus Pauling's laboratory. Two 1939 articles in Zeitschrift für Kristallographie appeared under his sole authorship as contributions from the California Institute of Technology. Perhaps more significantly, he published a 1938 Journal of the American Chemical Society paper with Charles D. Coryell on the magnetic properties of manganese(II) and cobalt(II) dipyridine chlorides. Mellor returned to Australia fired with enthusiasm for magnetochemistry. He built a magnetic balance and published many papers on the magnetic properties of coordination compounds with collaborators and students. Australian coordination chemistry has a strong tradition in magnetochemistry and that tradition started with Mellor's work at the University of Sydney.

This is the first paper in a sequential pair devoted to the enzyme mutarotase (aldose 1-epimerase; EC 5.1.3.3). Here, the broader context of the physiological role of mutarotase, among those enzymes considered to be part of ‘metabolic structure’, is reviewed. We also summarise the current knowledge about the molecular mechanism and substrate specificity of the enzyme, which is considered in the context of the binding of fluorinated glucose analogues to the enzyme’s active site. This was done as a prelude to our experimental studies of the anomerisation of fluorinated sugars by mutarotase that are described in the following paper.

Objective This study gathered information from public hospital chief medical officers to better understand underlying mechanisms through which public reporting affects institutional behavioural change and decision making towards quality improvement. Methods This qualitative study used thematic analysis of 17 semistructured, in-depth interviews among a peak group of medical directors representing 26 health services in Victoria, Australia. Results The medical directors indicated a high level of in-principle support for public reporting of identifiable, individual clinician-level data. However, they also described varying conceptual understanding of what public reporting of performance data is. Overall, they considered public reporting of individual clinicians' performance data a means to improve health care quality, increase transparency and inform consumer healthcare decision making. Most identified caveats that would need to be met before such data should be publicly released, in particular the need to resolve issues around data quality and timeliness, context and interpretation and ethics. Acknowledgement of the public's right to access individual clinician-level data was at odds with some medical directors' belief that such reporting may diminish trust between clinicians and their employers, thus eroding rather than motivating quality improvement. Conclusions Public reporting of identifiable individual healthcare clinicians' performance data is an issue that merits robust research and debate given the effects such reporting may have on doctors and on hospital quality and safety. What is known about the topic? The public reporting of individual clinician-level data is a mechanism used in some countries, but not in Australia, for increasing health care transparency and quality. Clinician-level public reporting of doctors' performance attracts contention and debate in Australia. What does this paper add? This paper informs debate around the public reporting of indivi

Objective Medication adherence is a significant public health concern. Australian studies of statins show patients facing the highest copayments are the least likely to be adherent. This study examined whether the association identified between adherence and costs for statins also applies to a wider group of medications prescribed for Australian patients with chronic conditions. Methods Data from 267086 participants in the Sax Institute's 45 and Up Study linked to data from the Pharmaceutical Benefits Scheme (PBS) provided by the Department of Human Services were used. Patients using angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, glitazones and bisphosphonates were identified and classified according to concessional status and whether they had access to the PBS 'safety net'. Data were analysed using mainly descriptive methods to investigate the association of adherence with cost and other selected covariates. Results Across medications, the group facing the highest copayment was least adherent. Speaking a language other than English at home and facing high levels of psychological distress were also associated with lower levels of adherence. Conclusions As for statins, the main financial determinant of adherence is cost in the form of prescribed copayments, suggesting that this may apply across many medications. What is known about the topic? Previous studies have shown patients' concern about the costs of pharmaceuticals, and more detailed studies of statins show that the lowest adherence relates to patients facing the highest copayments. What does this paper add? This paper provides support for the contention that the results found for statins broadly apply across more medications used by people with chronic conditions. What are the implications for practitioners? Although practitioners cannot affect legislated copayments, they can consider the costs of options for medications for patients with chronic conditions, especially those gener

The purpose of this paper is to clarify the relationship between medical practitioners (MPs) and nurse practitioners (NPs) in general, and privately practising NPs (PPNPs) in particular, in relation to collaboration, control and supervision in Australia, as well as to explore the difficulties reported by PPNPs in establishing mandated collaborative arrangements with MPs in Australia. In order for the PPNPs to have access to the Medicare Benefit Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) in Australia, they are required, by law, to establish a collaborative arrangement with an MP or an entity that employs MPs. This paper begins by describing the history of and requirements for collaborative arrangements, then outlines the nature of successful collaboration and the reported difficulties. It goes on to address some of the commonly held misconceptions in order to allay medical concerns and enable less restrictive access to the MBS and PBS for PPNPs. This, in turn, would improve patient access to highly specialised and expert PPNP care. What is known about the topic?: NPs have been part of the Australian health workforce since 1998, but until 2009 their patients did not receive any reimbursement for care delivered by PPNPs. In 2009, the Federal government introduced limited access for PPNPs to the MBS and PBS, but only if they entered into a collaborative arrangement with either an MP or an entity that employs MPs. What does this paper add?: The introduction of collaborative arrangements between PPNPs and MPs seems, in some instances, to have created confusion and misunderstanding about the way in which these collaborative arrangements are to operate. This paper provides clarification of the relationship between MPs and NPs in general, and PPNPs in particular, in relation to collaboration, control and supervision. What are the implications for practitioners?: A clearer understanding of these issues will hopefully enable greater collegial generosity and imp

Objective: This study provides insights into the reported early impacts of the digital transformation of a large Australian hospital and healthcare service (HHS) by surveying staff perceptions of an integrated electronic medical record (ieMR). Methods: The information systems success model was used as a tool to evaluate perceptions of system quality, information quality, individual benefits and expected organisational benefits of the ieMR soon after its introduction at the HHS. A questionnaire was distributed to staff in all five hospitals in the HHS immediately after implementation. Overall staff perceptions were examined, in addition to how perceptions differed by site and profession. Results: Overall, staff held mildly positive early perceptions of system quality, information quality, individual benefits and expected organisational benefits. These views were largely consistent across sites. In terms of professions, allied health held more positive perceptions, followed by administrative and nursing professionals. Medical professionals held negative perceptions, but were neutral regarding their future expectations. Conclusion: On average, staff viewed the ieMR mildly positively immediately after implementation (despite significant changes to work practices), but differences exist across professional groups. What is known about the topic?: Hospitals globally are in the midst of a digital transformation. Yet, reported impacts are mixed and there have been few studies of the effects of comprehensive electronic medical record (EMR) implementations. What does this paper add?: This paper evaluates a comprehensive EMR immediately after go-live. We found positive early perceptions of system quality, information quality, individual benefits and expected organisational benefits. We also found that perceptions of medical professionals were largely negative, but they were neutral in terms of their future expectations. What are the implications for practitioners?: Health se

Objective Medication adherence is a significant public health concern. Australian studies of statins show patients facing the highest copayments are the least likely to be adherent. This study examined whether the association identified between adherence and costs for statins also applies to a wider group of medications prescribed for Australian patients with chronic conditions. Methods Data from 267086 participants in the Sax Institute's 45 and Up Study linked to data from the Pharmaceutical Benefits Scheme (PBS) provided by the Department of Human Services were used. Patients using angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, glitazones and bisphosphonates were identified and classified according to concessional status and whether they had access to the PBS 'safety net'. Data were analysed using mainly descriptive methods to investigate the association of adherence with cost and other selected covariates. Results Across medications, the group facing the highest copayment was least adherent. Speaking a language other than English at home and facing high levels of psychological distress were also associated with lower levels of adherence. Conclusions As for statins, the main financial determinant of adherence is cost in the form of prescribed copayments, suggesting that this may apply across many medications. What is known about the topic? Previous studies have shown patients' concern about the costs of pharmaceuticals, and more detailed studies of statins show that the lowest adherence relates to patients facing the highest copayments. What does this paper add? This paper provides support for the contention that the results found for statins broadly apply across more medications used by people with chronic conditions. What are the implications for practitioners? Although practitioners cannot affect legislated copayments, they can consider the costs of options for medications for patients with chronic conditions, especially those gener

© 2020 Australian Academy of Science. David Paver Mellor (1903-80) was a physical inorganic chemist of significant influence in coordination chemistry and chemical education in Australia. He retired in 1970 after a brief appointment as dean of the Faculty of Science at the University of New South Wales, having been head of the School of Chemistry there for more than a decade. Mellor had been appointed to the staff of the University of Sydney in 1929 and was one of the first Australians to use X-ray diffraction techniques for the determination of crystal structures. In 1936 he applied for a year of leave to work with Linus Pauling at the California Institute of Technology, particularly to learn more about crystal structure analysis. On sabbatical leave he spent a period of one year across 1937-8 in California where he carried out work on X-ray diffraction in Linus Pauling's laboratory. Two 1939 articles in Zeitschrift für Kristallographie appeared under his sole authorship as contributions from the California Institute of Technology. Perhaps more significantly, he published a 1938 Journal of the American Chemical Society paper with Charles D. Coryell on the magnetic properties of manganese(II) and cobalt(II) dipyridine chlorides. Mellor returned to Australia fired with enthusiasm for magnetochemistry. He built a magnetic balance and published many papers on the magnetic properties of coordination compounds with collaborators and students. Australian coordination chemistry has a strong tradition in magnetochemistry and that tradition started with Mellor's work at the University of Sydney.

The Rohingya community living in the City of Canterbury-Bankstown in Sydney have been identified as a priority population with complex health needs. As part of ongoing work, AU$10000 was provided to the community to address important, self-determined, health priorities through the Can Get Health in Canterbury program. Program staff worked with community members to support the planning and implementation of two community-led events: a soccer (football) tournament and a picnic day. This paper explores the potential for this funding model and the effect of the project on both the community and health services. Data were qualitatively analysed using a range of data sources within the project. These included, attendance sheets, meeting minutes, qualitative field notes, staff reflections and transcripts of focus group and individual discussions. This analysis identified that the project: (1) enabled community empowerment and collective control over funding decisions relating to their health; (2) supported social connection among the Australian Rohingya community; (3) built capacity in the community welfare organisation –Burmese Rohingya Community Australia; and (4) enabled reflective practice and learnings. This paper presents an innovative model for engaging with refugee communities. Although this project was a pilot in the Canterbury community, it provides knowledge and learnings on the engagement of refugee communities with the health system in Australia.

Voluntary assisted dying is a major social policy issue with significant implications for the health system, health and medical professionals and the wider community. Voluntary assisted dying is now lawful in Victoria in limited circumstances, and other states are likely to follow Victoria and legalise the practice. In the same way that we expect the making of health policy and the provision of health care to be evidence based, so too should we should expect evidence-based law making from our parliamentarians on this important topic. What is known about the topic? The importance of evidence when making health policy and providing evidence-based medical care is well accepted. Australian states are actively considering laws about voluntary assisted dying. What does this paper add? This paper argues that evidence-based law making by parliamentarians is needed as they deliberate proposed voluntary assisted dying laws. There has been limited recognition of the value of evidence-based approaches in the discipline of law. What are the implications for practitioners? A failure by parliaments to adequately consider evidence can lead to suboptimal law making. When this occurs about important health issues, such as voluntary assisted dying, it leads to problematic regulatory frameworks for patients, health professionals and health systems.

The global goat meat sector is advancing and contributes to long-term food security, especially in meeting the protein demands of the growing human population in developing countries. Spanning all countries, Australia, is the largest exporter of goat meat, although it has negligible consumption. However, Australia does potentially have a secure future as an innovative, profitable, and resilient world leader in goat production, provided some challenges are addressed. These challenges facing the goat meat sector require suitable strategies and interventions for better profitability and acceptance of goat meat consumed in Australia and as an export product. Limited research on goat meat quality and the lack of an adequate grading system for goat meat quality are two of the major issues that need attention from the industry and researchers. Some of the most critical areas that need further research to enable growth of the goat meat industry are the influence of genetics and age of animals on meat quality, standardisation of the ageing period of various goat meat cuts, cooking innovations, consumer acceptance and sensory analysis of goat meat (both farmed and rangeland goats). This paper reviews the status of the goat meat sector and identifies the opportunities for the goat meat sector, particularly in Australia. In addition, we highlight several key issues requiring further research and interventions to enhance the growth of the goat meat industry.

The Australian Commission for Safety and Quality in Health Care has created the National Safety and Quality Health Service standards that all hospitals must address in order to remain accredited. This case study details the first known digitisation of the 10 national quality and safety standards mandated in a quaternary integrated digital hospital. A team of clinical informaticians, information technology experts and clinicians was assembled. Data were chosen and the data were then extracted and validated and presented (often in near real time) in an easily consumable dashboard format with appropriate governance to allow clinicians and executives to monitor the quality and safety standards across the hospital. All 10 standards were defined and extracted contemporaneously from the digital hospital for every patient, every time. This is in stark contrast with traditional retrospective point prevalence surveys. This case study details the first known fully digital accreditation in a sophisticated integrated digital hospital. Digitisation of hospital quality and safety to produce real-time data is the future of clinical redesign to improve patient care. What is known about the topic?: Healthcare delivery is complex and the ability of healthcare providers to maintain consistent standards of quality and safety is variable. Traditionally, these standards have been assessed by intermittent retrospective point-prevalence survey activity. Sophisticated digital hospitals provide the opportunity to develop data and analytics that monitor quality and safety standards across every patient, every time in near real time. What does this paper add?: This paper describes a digital hospital which has created streaming analytics to monitor live performance of quality and safety standards. The necessary skills, leadership and governance for this process are outlined and the products described. What are the implications for practitioners?: Shifting from retrospective paper-based point

We highlight women's contributions to freshwater ecology by firstly considering the historical context and gender-based barriers faced by women attempting to gain an education and secure research jobs in science over the past 100+ years. The stories of four remarkable, pioneering women in freshwater ecology (Kathleen Carpenter, Ann Chapman, Rosemary Lowe-McConnell and Ruth Patrick) illustrate the impact of barriers, emphasise the significance of their contributions and provide inspiration for the challenges ahead. Women still face barriers to participation in science, and the second part of the paper focuses on a current form of discrimination, which is citation metrics used to measure the 'quality' or 'impact' of research. We show that arguments that citation metrics reflect research quality are logically flawed, and that women are directly disadvantaged by this practice. Women are also indirectly disadvantaged in ecology because they are more likely to carry out empirical than theoretical research, and publications are generated more slowly from empirical research. Surveys of citation patterns in ecology reveal also that women are less likely to be authors of review papers, which receive three times more citations than do original articles. Unless unfettered use of citation metrics is stopped, research will be damaged, and women will be prominent casualties.

Exploration geophysics and reservoir production strategies rely on a robust knowledge of reservoir petrophysical properties and their uncertainties. We have developed a new approach that not only quantifies uncertainties of petrophysical properties in a static scenario but also assesses their dynamic changes under tectonic, chemical and production loads. We address this challenge with a new Multi-scale and Multiphysics data assimilation approach integrating experiments, numerical simulations and rock physics theory.This paper focusses on data integration from molecular to laboratory scale to provide a solid physics foundation for the multiscaling approaches presented in companion papers for the larger scales.

Objective: Since legislative changes in 2010, certain health care services provided by privately practising nurse practitioners (PPNPs) in Australia have been eligible for reimbursement under the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS). The aim of the present study was to describe survey results relating to the care provided by PPNPs subsidised through the MBS and PBS. Methods: PPNPs in Australia were invited to complete an electronic survey exploring their practice activities. Quantitative data were analysed using descriptive statistics and 95% confidence intervals were calculated for percentages where relevant. Free text data were analysed using thematic analysis. Results: Seventy-three PPNPs completed the survey. The most common form of payment reported (34%; n = 25) was payment by direct fee for service (MBS rebate only, also known as bulk billing). Seventy-five per cent of participants (n = 55) identified that there were aspects of care delivery not adequately described and compensated by the current nurse practitioner (NP) MBS item numbers. 87.7% (n = 64) reported having a PBS prescriber authorisation number. Themes identified within the free text data that related to the constraints of the MBS and PBS included 'duplication of services' and 'level of reimbursement'. Conclusion: The findings of the present study suggest that PPNPs are providing subsidised care through the MBS and PBS. The PPNPs in the present study reported challenges with the current structure and breadth of the NP MBS and PBS items, which restrict them from providing complete episodes of patient care. What is known about the topic?: Since the introduction of legislative changes in 2010, services provided by PPNPs in Australia have been eligible for subsidisation through the MBS and PBS. What does this paper add?: This paper provide

The Ramsar Convention is the world’s most important international treaty governing wetland environments. Since the 1970s, the Convention has concerned itself with listing and protecting wetlands of international significance. In the last three decades, however, a focus has shifted from the identification of potential sites towards addressing adverse changes in their ‘ecological character’. One of the few mechanisms Ramsar has at its disposal for achieving this is the Montreux Record (MR). The MR, first established in 1990, is a kind of ‘in danger’ list for Ramsar sites which have undergone, are undergoing, or are likely undergoing, adverse ecological change. Unlike other in danger lists, for example, under the World Heritage Convention, the MR is entirely voluntary and not deployed as a disciplinary measure or reputational sanction. The empirical research presented in this paper reveals the declining use and importance of the MR. The paper provides an analysis of the composition and use of the MR from 1990-2018 and generates recommendations for how it might be used more effectively. The findings in this paper are significant given the rapid declines of many Ramsar sites around the world.

Objective Analytical techniques are being implemented with increasing frequency to improve the management of surgical departments and to ensure that decisions are well informed. Often these analytical techniques rely on the validity of underlying statistical assumptions, including those around choice of distribution when modelling uncertainty. The aim of the present study was to determine a set of suitable statistical distributions and provide recommendations to assist hospital planning staff, based on three full years of historical data. Methods Statistical analysis was performed to determine the most appropriate distributions and models in a variety of surgical contexts. Data from 2013 to 2015 were collected from the surgical department at a large Australian public hospital. Results A log-normal distribution approximation of the total duration of surgeries in an operating room is appropriate when considering probability of overtime. Surgical requests can be modelled as a Poisson process with rate dependent on urgency and day of the week. Individual cancellations could be modelled as Bernoulli trials, with the probability of patient-, staff- and resource-based cancellations provided herein. Conclusions The analysis presented herein can be used to ensure that assumptions surrounding planning and scheduling in the surgical department are valid. Understanding the stochasticity in the surgical department may result in the implementation of more realistic decision models. What is known about the topic? Many surgical departments rely on crude estimates and general intuition to predict surgical duration, surgical requests (both elective and non-elective) and cancellations. What does this paper add? This paper describes how statistical analysis can be performed to validate common assumptions surrounding surgical uncertainty. The paper also provides a set of recommended distributions and associated parameters that can be used t

The study aimed to explore Indigenous narrative accounts of healthcare access within qualitative research papers, to better understand Indigenous views on culturally safe healthcare and health communication represented in that literature. A systematic literature review of peer-reviewed academic qualitative studies identified 65 papers containing Indigenous respondents' views on accessing healthcare. Analysis included all Indigenous voice (primary quotations) and author findings describing healthcare access across these studies. Healthcare communication, or 'talk', emerged as a key theme. Indigenous clients valued talk within healthcare interactions it was essential to their experience of care, having the power to foster relationships of trust, strengthen engagement and produce positive outcomes. By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client's level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system.

The Voluntary Assisted Dying Act 2017 (Vic) will come into force in June 2019, becoming the first law in Australia in 20 years to permit voluntary assisted dying (VAD). This paper considers how other Australian states and territories are likely to respond to this development. It analyses three key factors that suggest that law reform is likely to occur in other parts of Australia: (1) the growing international trend to permit VAD; (2) social science evidence about how VAD regimes operate; and (3) changes to the local political environment. The paper argues that these three factors, coupled with the effect of Victoria changing its law, suggest that other VAD law reform is likely to occur in Australia. It also considers the different types of laws that may be adopted, including whether other states and territories will follow the very conservative Victorian approach or adopt more liberal models.

Objective: This paper examines the implementation and implications of four development and research initiatives, collectively titled the Curriculum Renewal Studies program (CRS), occurring over a 6-year period ending in 2015 and focusing on interprofessional education (IPE) within Australian pre-registration health professional education. Methods: The CRS was developed as an action-focused and participatory program of studies. This research and development program used a mixed-methods approach. Structured survey, interviews and extensive documentary analyses were supplemented by semi-structured interviews, focus groups, large group consultations and consensus building methods. Narrative accounts of participants' experiences and an approach to the future development of Australian IPE were developed. Results: Detailed accounts of existing Australian IPE curricula and educational activity were developed. These accounts were published and used in several settings to support curriculum and national workforce development. Reflective activities engaging with the findings facilitated the development of a national approach to the future development of Australian IPE-a national approach focused on coordinated and collective governance and development. Conclusion: This paper outlines the design of an innovative approach to national IPE governance and development. It explores how ideas drawn from sociocultural theories were used to guide the choice of methods and to enrich data analysis. Finally, the paper reflects on the implications of CRS findings for health professional education, workforce development and the future of Australian IPE. What is known about the topic?: IPE to enable the achievement of interprofessional and collaborative practice capabilities is widely accepted and promoted. However, many problems exist in embedding and sustaining IPE as a system-wide element of health professional education. How these implementation problems can be successfully addressed is a

Some research papers presented at the first international conference dedicated to creating a Global Artificial Photosynthesis (GAP) or Global Solar Fuels (GSF) project, Lord Howe Island, August 14 18, 2011, are discussed. Craig Hill of Emory University spoke of his research involving a polyoxometalate water oxidation catalyst capable of strongly binding multiple transition metal centers proximal to one another, facilitating multi-electron processes such as the 4-electron oxidation of H2O to O2. The paper by Johannes Messinger provided a case study on how discrete solar fuels projects are being established around the world. A paper by Joseph Hughes and Elmars Krausz from ANU evaluated the centrality of the relatively poorly understood role of multi-electron processes in the ultrafast kinetics, energy-trapping events, and catalytic four-electron water oxidation chemistry of Photosystem II (PSII).

Primary care settings are ideal for initiating advance care planning (ACP) conversations and assessing palliative and supportive care needs. However, time constraints and a lack of confidence to sensitively and efficiently initiate such discussions are noted barriers. The Advance Project implemented a national multicomponent training package to support Australian general practice nurses (GPNs) to work with GPs to initiate ACP and palliative care conversations in their practice. This paper reports on semistructured interviews conducted with 20 GPNs to explore barriers and facilitators to implementing the Advance Project model. Participants identified a range of factors that affected implementation, including lack of time, limited support from colleagues, lack of knowledge about systems and funding processes in general practice and a need for better alignment of the Advance Project resources and practices with general practice information management platforms. Barriers related to professional roles, particularly the lack of clarity and/or limitations in the scope of practice of GPNs, highlighted the importance of defining and supporting the roles that different primary health practice staff could play to support implementation of the model. The findings underline the need for complementary training in the Advance Project model for GPs and practice managers to enable a team-based approach to implementation.

Primary care settings are ideal for initiating advance care planning (ACP) conversations and assessing palliative and supportive care needs. However, time constraints and a lack of confidence to sensitively and efficiently initiate such discussions are noted barriers. The Advance Project implemented a national multicomponent training package to support Australian general practice nurses (GPNs) to work with GPs to initiate ACP and palliative care conversations in their practice. This paper reports on semistructured interviews conducted with 20 GPNs to explore barriers and facilitators to implementing the Advance Project model. Participants identified a range of factors that affected implementation, including lack of time, limited support from colleagues, lack of knowledge about systems and funding processes in general practice and a need for better alignment of the Advance Project resources and practices with general practice information management platforms. Barriers related to professional roles, particularly the lack of clarity and/or limitations in the scope of practice of GPNs, highlighted the importance of defining and supporting the roles that different primary health practice staff could play to support implementation of the model. The findings underline the need for complementary training in the Advance Project model for GPs and practice managers to enable a team-based approach to implementation.

Deer antlers are unique because they are cast and regenerate each year. They are the fastest-growing structure, reaching an astonishing growth rate of up to 2.75 cm/day in length and more than 20 cm2/day of skin. Surprisingly, no study so far has assessed the metabolic rate of the antler. High metabolic rate needs highly efficient (or large) mitochondria, and it involves a high creation or reactive oxygen species (ROS), origin of oxidative stress. The speed of creation of ROS and the oxidative stress are inversely related to ageing and many diseases such as cancer or age-related diseases. However, antler must have the most efficient anti-oxidant system, as it rarely shows any departure from a perfect growth. This paper examines recent studies showing surprising applications in medicine of growing-antler extracts, or the information regarding its physiology. A recent study (Wang et al. (2019), Science 364, eaav6335) has shown that antlers have evolved a speed of growth faster than cancer, based on high expression of proto-oncogenes. As a result, deer has evolved tumour-suppression genes to control the high risk of developing cancer. This may explain why several studies have found in vitro and in vivo anti-cancer effects of deer velvet-antler extract in human tumours, such as cell cultures and animal models of cancers such as brain cancer (glioblastoma), prostate cancer, and others. We will also discuss findings in the study of the cyclic osteoporosis of the deer, with unexpected similarities in their proteomics and gene expression with that of the human pathological osteoporosis. Last, we will examine potential applications based on having the highest metabolic rate. If the future studies establish the antler as the tissue having the fastest metabolism and the best antioxidant system, this may have implications for understanding how to fight oxidative stress, which, in turn, will have direct implications for aging and age-related diseases (and others, from cancer to

Primary care settings are ideal for initiating advance care planning (ACP) conversations and assessing palliative and supportive care needs. However, time constraints and a lack of confidence to sensitively and efficiently initiate such discussions are noted barriers. The Advance Project implemented a national multicomponent training package to support Australian general practice nurses (GPNs) to work with GPs to initiate ACP and palliative care conversations in their practice. This paper reports on semistructured interviews conducted with 20 GPNs to explore barriers and facilitators to implementing the Advance Project model. Participants identified a range of factors that affected implementation, including lack of time, limited support from colleagues, lack of knowledge about systems and funding processes in general practice and a need for better alignment of the Advance Project resources and practices with general practice information management platforms. Barriers related to professional roles, particularly the lack of clarity and/or limitations in the scope of practice of GPNs, highlighted the importance of defining and supporting the roles that different primary health practice staff could play to support implementation of the model. The findings underline the need for complementary training in the Advance Project model for GPs and practice managers to enable a team-based approach to implementation.

[Background]: Little is known about the interaction between predators and wildfires, in part because the large home range and scarcity of predators make their study difficult, and their response is strongly species-specific. [Aims]: In this paper, we study, for the first time, the effect of wildfire on the behaviour of Bonelli’s eagles (Aquila fasciata) simultaneously tracked by GPS/GSM dataloggers in four neighbouring territories. [Methods]: One territory was burnt in a wildfire and the other three were used for comparison. We computed the home-range area by comparing individual spatial and temporal behaviour before, during and after the fire event using kernel density estimators and movement parameters. [Key results]: Our results show an immediate negative effect during the first days of the wildfire for an individual inhabiting the burnt territory – the individual flew directly away from the burning area. However, after a few days, the individual recovered their usual behaviour. The three neighbouring pairs did not show significant differences in behavioural parameters before, during and after the wildfire. [Conclusions and implications]: Our results suggest that occasional wildfires do not affect the distribution and density of Bonelli’s eagles in the short or medium-term (two years after fire). This could be the result of adaptation by this species to the frequent and recurrent wildfires in the Mediterranean area.

Chronic disease identification and management is a significant issue in Australia, with general practice being the primary contact point for those at risk of, or living with, chronic disease. However, there is a well-described gap between guideline recommendations for chronic disease management and translation in the general practice setting. In 2018, a group of researchers, clinicians and software developers collaborated to develop a tool to support the identification and management of chronic disease in general practice, with the aim to create a platform that met the needs of general practice. The co-design process drew together core principles and expectations for the establishment of a technological platform, called Future Health Today (FHT), which would sit alongside the electronic medical record (EMR) management system within general practice. FHT used algorithms applied to EMR data to identify patients with, or at risk of, chronic disease and requiring review. Using chronic kidney disease as a clinical focus, the FHT prototype was piloted in a large, metropolitan general practice, and a large regional general practice. Based on user feedback, the prototype was further developed and improved. This paper provides a report on the key features and functionalities that participants identified and implemented in practice.

Bacterial vaginosis (BV), the most common cause of vaginal discharge in women of reproductive age, is associated with considerable reproductive and gynaecological sequelae and increases the risk of acquiring sexually transmissible infections including HIV. Although we understand the burden of BV in women of reproductive age, much less is known about the burden of BV in postmenopausal women. We undertook this systematic review and meta-analysis to estimate the prevalence of BV in postmenopausal women. The electronic databases PubMed, EMBASE, Web of Science, and The Cochrane Library were searched for English-language papers reporting on the prevalence of BV in postmenopausal women and published up until the end of July 2020. Search terms included: (prevalence OR survey OR proportion) AND 'bacterial vaginosis'. Meta-analysis was used to calculate pooled estimates of prevalence. We identified 2461 unique references and assessed 328 full-text articles for eligibility, with 13 studies included in the meta-analysis. The prevalence of BV ranged from 2.0 to 57.1%, with a summary estimate of 16.93% (95% CI: 8.5-27.4; I 2 =97.9). There was considerable heterogeneity between studies and quality varied considerably. Further research is needed to provide a better understanding of the condition in postmenopausal women and understand its effect on their lives.

This paper presents results from a review of methods of agricultural extension, including the evidence for the effectiveness of methods in supporting farm practice change, how they affect the change process, and the critical success factors involved. Agricultural scientists face challenges in aligning their research outputs to the change process on farm. These challenges are exacerbated by the funding environment for research, development, and extension (RD&E), the complexity of the adoption process and the privatisation and commercialisation of advisory and extension services. To assist scientists in navigating these challenges, a structured literature review of extension methods was conducted, examining the following: group-learning/peer-topeer; technology development; training; information provision; one-on-one advice/coaching; e-extension; co-innovation; best management practice; and social marketing. In addition, two case studies outlining the application of combinations of extension methods in the context of feeding system challenges in the Australian dairy industry, and their effects, are described. While the evidence across the studies reviewed was strongest for the effect on adoption of small group-learning and one to one consulting, it was combinations of methods that resulted in larger effects (for example, in practice change or profitability), which was credited to how they addressed the human and social dimensions of the adoption process. Case studies of adoption in the dairy sector found that scientists influenced adoption by collaborating with the private sector, being directly involved with on-farm trials and demonstrations, and supporting grouplearning approaches to help the adoption of past research. This role for scientists in adoption was enabled by investment in programs of RD&E rather than discreet research experiments, and research designs and methods that incorporated the social dimensions of adoption. This synthesis demonstrates the need for

The COVID-19 pandemic has challenged the mental health of communities worldwide, with the triple pressures of financial insecurity, lockdowns, and worry about the infection. Australia rapidly deployed resources to protect the mental wellbeing of the community through supplementing existing services, supporting at-risk groups, investing in social supports, embracing technology, and supporting the health workforce. This paper describes the Australian Government's investment in mental health during the COVID-19 pandemic in relation to the 10 priority areas identified in Australia's National Mental Health Pandemic Response Plan.

What is known about the topic? Avoidable adverse events are often being attributed to health workforce shortages associated with the coronavirus disease 2019 (COVID-19) pandemic and government funding cuts. What does this paper add? Health workforce shortages were predicted well before the COVID-19 pandemic. What are the implications for practitioners? Senior executives and leaders should unitedly take action to influence change in funding and models of care.

Background: Little is known about the interaction between predators and wildfires, in part because the large home range and scarcity of predators make their study difficult, and their response is strongly species-specific. Aims: In this paper, we study, for the first time, the effect of wildfire on the behaviour of Bonelli’s eagles (Aquila fasciata) simultaneously tracked by GPS/GSM dataloggers in four neighbouring territories. Methods: One territory was burnt in a wildfire and the other three were used for comparison. We computed the home-range area by comparing individual spatial and temporal behaviour before, during and after the fire event using kernel density estimators and movement parameters. Key results: Our results show an immediate negative effect during the first days of the wildfire for an individual inhabiting the burnt territory – the individual flew directly away from the burning area. However, after a few days, the individual recovered their usual behaviour. The three neighbouring pairs did not show significant differences in behavioural parameters before, during and after the wildfire. Conclusions and implications: Our results suggest that occasional wildfires do not affect the distribution and density of Bonelli’s eagles in the short or medium-term (two years after fire). This could be the result of adaptation by this species to the frequent and recurrent wildfires in the Mediterranean area.