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Urbanization replaces natural shorelines with built infrastructure, seriously impacting species living on these "new" shores. Understanding the ecology of developed shorelines and reducing the consequences of urban development to fauna and flora cannot advance by simply documenting changes to diversity. It needs a robust experimental programme to develop ways in which biodiversity can be sustained in urbanized environments. There have, however, been few such experiments despite wholesale changes to shorelines in urbanized areas. Seawalls--the most extensive artificial infrastructure--are generally featureless, vertical habitats that support reduced levels of local biodiversity. Here, a mimic of an important habitat on natural rocky shores (rock-pools) was experimentally added to a seawall and its impact on diversity assessed. The mimics created shaded vertical substratum and pools that retained water during low tide. These novel habitats increased diversity of foliose algae and sessile and mobile animals, especially higher on the shore. Many species that are generally confined to lowshore levels, expanded their distribution over a greater tidal range. In fact, there were more species in the constructed pools than in natural pools of similar size on nearby shores. There was less effect on the abundances of mobile animals, which may be due to the limited time available for recruitment, or because these structures did not provide appropriate habitat. With increasing anthropogenic intrusion into natural areas and concomitant loss of species, it is essential to learn how to build urban infrastructure that can maintain or enhance biodiversity while meeting societal and engineering criteria. Success requires melding engineering skills and ecological understanding. This paper demonstrates one cost-effective way of addressing this important issue for urban infrastructure affecting nearshore habitats.

Objective Only one third of clinically eligible patients attend a cardiac rehabilitation ( CR) program. Few studies have looked at participation in rural cardiac patients. This paper examines the risk profile and participation in CR of rural and urban residents with cardiac disease who enrolled in a telephone coaching program. Design, setting and participants Comparison of baseline characteristics of 173 urban and 140 rural Australians referred to CR, and who enrolled in a telephone-based coaching program. Main outcome measures Sociodemographic characteristics, health behaviours and participation in CR programs. Results Rural residents were more likely to enrol in a telephone coaching secondary prevention program (44.7% versus 25.5%, P < 0.001) than urban residents. For those enrolling in the telephone-based program, rural participants were more likely to be obese (42.0% rural versus 28.8% urban, P = 0.02), to rate their health as fair or poor (45% versus 24.3%, P < 0.001) and less likely to be sufficiently physically active (35.3% versus 53.2%, P = 0.002), or follow a special diet for their heart (40.0% versus 56.6%, P = 0.003) compared with urban participants. Those who attended a CR program were more likely to be from an urban location and live closer to a CR program. Conclusions Rural participants in this study had poorer health profiles and attendance at outpatient CR compared with urban participants. This poses challenges for the provision of secondary prevention programs for rural cardiac patients and highlights opportunities to trial innovative delivery models, such as telephone-based programs, to reach people that would otherwise not have access. [ABSTRACT FROM AUTHOR]

The concept and definition of pastoral care in aged care remains ambiguous. This paper reports on the defining characteristics and meaning of pastoral care from the perspective of older recipients, their family members and pastoral care workers. Using a qualitative descriptive approach semistructured in-depth interviews were conducted with 18 pastoral care workers and 11 older people. Transcribed data were analysed using NVivo software and coded for emerging themes. The defining characteristics of pastoral care that emerged from analysis of transcribed interviews were: a trusting relationship, spiritual support, emotional support and practical support. Findings also portray the role of the pastoral care worker as spiritual guide, confidante, and emotional and practical supporter acting within a trusting relationship. Future studies should confirm these results by exploring the perceptions of experts in the field of pastoral care. [ABSTRACT FROM AUTHOR]

If this is the case, restoration and conservation of these threatened oyster reefs may enhance ontogenetic movement opportunities for the species by providing key juvenile habitats, which could further aid in the long-term stability and protection of blue groper populations. Conservation, demography, life history, recruitment, charismatic megafauna, estuarine ecosystem, intertidal reef, temperate reef, threatened species This observation of an iconic and threatened species using threatened oyster reefs as a juvenile habitat is significant, not only because it enhances our understanding of I A. viridis i and their ontogenetic movement, but because of the opportunity that this presents for the engagement and funding of ongoing and future oyster reef restoration projects. Keywords: charismatic megafauna; conservation; demography; estuarine ecosystem; intertidal reef; life history; recruitment; temperate reef; threatened species EN charismatic megafauna conservation demography estuarine ecosystem intertidal reef life history recruitment temperate reef threatened species 1 5 5 12/05/22 20221201 NES 221201 Understanding the life cycle and the demography of individual species is critical for the management of threatened populations and integral to understanding the ecology of various ecosystems and habitats (Kimirei et al., [11]; Perez & Munch, [15]). [Extracted from the article]

The peri-urban interface (PUI) exhibits characteristic qualities of both urban and rural regions, and this complexity has meant that risk assessments and long-term planning for PUI are lagging, despite these areas representing new developing settlement frontiers. This study aims to address this knowledge gap by modifying an existing approach to quantify and assess flood risk. The risk triangle framework was used to map exposure, vulnerability and biophysical variables; however, in a novel application, the risk triangle framework was adapted by presuming that there is a variation in the degree of exposure, vulnerability and biophysical variables. Within Australia and globally, PUIs are often coastal, and flood risk associated with rainfall and coastal inundation poses considerable risk to communities in the PUI; these risks will be further exacerbated should projections of increasing frequency of extreme rainfall events and accelerating sea-level rise eventuate. An indicator-based approach using the risk triangle framework that maps flood hazard, exposure and vulnerability was used to integrate the biophysical and socio-economic flooding risk for communities in PUI of the St Georges Basin and Sussex Inlet catchments of south-eastern Australia. Integrating the flood risk triangle with future scenarios of demographic and climate change, and considering factors that contribute to PUI flood risk, facilitated the identification of planning strategies that would reduce the future rate of increase in flood risk. These planning strategies are useful for natural resource managers and land use planners across Australia and globally, who are tasked with balancing socio-economic prosperity for a changing population, whilst maintaining and enhancing ecosystem services and values. The indicator-based approach used in this study provides a cost-effective first-pass risk assessment and is a valuable tool for decision makers planning for flood risk across PUIs in NSW and globally. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to assist clinicians evaluating refugee children for latent tuberculosis infection (LTBI) by comparing paired tuberculin skin test (TST) and Quantiferon Gold In-Tube (QGIT) test results with clinical management decisions and follow-up data in a large cohort of newly arrived refugee children.Methods: This was a retrospective analysis of all refugee children (<15 years of age) evaluated for LTBI with both TST and interferon-γ release assay between 2007 and 2010 in the Illawarra-Shoalhaven region of New South Wales, Australia. Demographics, country of origin, bacille Calmette-Guerin (BCG) vaccination status, chest X-ray results, TST and QGIT test results, clinical management and outcome on long-term follow-up were assessed.Results: Of 272 children evaluated, complete results were available for 212 (78%). The vast majority (207; 98%) were from Africa or Southeast Asia. Overall, 33 (16%) children were treated for LTBI; 13 (39%) had concordant TST and QGIT results and 20 (61%) discordant results. Of 63 (30%) TST-positive (≥10 mm) children, 46 (73%) were QGIT assay-negative, 44 (70%) had a BCG scar, 3 (5%) were younger than 2 years and 6 (10%) were treated for LTBI. Of 32 QGIT assay-positive children, 15 (47%) were TST negative, 31 (97%) had a BCG scar, all were older than 2 years and 14 (44%) were treated for LTBI.Conclusions: Discordant TST and QGIT results were found in a high percentage of refugee children. QGIT is convenient and more specific than TST to diagnose LTBI in BCG-vaccinated children, although a careful tuberculosis exposure history and clinical assessment to rule out active disease remain important. [ABSTRACT FROM AUTHOR]

Objective This study aimed to describe demographic and socio-economic characteristics and to assess baseline health status and care needs among Japanese residents aged 60 years and over living in New South Wales, Australia. Methods A postal questionnaire was used to survey older community-dwelling Japanese residents recruited from a number of different sources. Results Eighty-two residents responded to the questionnaire (mean age: 70.5 years, range 60-85), and 56 (68.3%) were female. The respondents appeared to be socio-economically comfortable. While 63.4% of respondents noticed reduced strength and balance, and 45% had at least one chronic medical condition, the majority did not require help with personal care or domestic chores. However, there were respondents who were considered at risk of subsequent development of major mobility limitations. Conclusion Overall, the respondents in this study demonstrated good function. There may be a role for interventional programs aimed at maintaining functional independence. [ABSTRACT FROM AUTHOR]

Objective: To investigate differences in the characteristics of burn injuries leading to hospitalisation of Indigenous Australian and non-Indigenous children in New South Wales.Design, setting: Population-based cohort analysis of linked hospital and mortality data for 2000-2014.Participants: 35 749 Indigenous and 1 088 938 non-Indigenous children aged 0-13 years.Main Outcome Measures: The external cause of the injury, its anatomic location, total body surface area affected (%TBSA), burn depth, length of hospital stay (LOS).Results: 4246 non-Indigenous and 323 Indigenous children were hospitalised for a first burn injury during 2000-2014. A higher proportion of Indigenous than non-Indigenous children were admitted with burns affecting more than 10% TBSA (17% v 12%) and a lower proportion of Indigenous children than of non-Indigenous children were treated at a hospital with a paediatric tertiary referral burn unit (40% v 50%; P < 0.001). The mean LOS during the index admission was almost 3 days longer for Indigenous children than for non-Indigenous children (6.1 days [95% CI, 4.8-7.4 days] v 3.4 days [95% CI, 3.2-3.7 days]; P < 0.001); the difference in LOS was still statistically significant after adjusting for characteristics of the burn and residential location.Conclusion: The proportion of Indigenous children with burns who presented with burn injuries affecting more than 10% TBSA was greater than for non-Indigenous children. Their mean LOS was also longer; the difference remained statistically significant after adjusting for characteristics of the burn and of residential location. [ABSTRACT FROM AUTHOR]

Objective: To prospectively compare the actual weights of Australian children in an ethnically diverse metropolitan setting with the predicted weights using the Paediatric Advanced Weight Prediction in the Emergency Room (PAWPER) tape, Broselow tape, Mercy system and calculated weights using the updated Advanced Paediatric Life Support (APLS), Luscombe and Owens and Best Guess formulae.Methods: A prospective, cross-sectional, observational, blinded, convenience study conducted at the Children's Hospital at Westmead Paediatric Emergency Department in Sydney, Australia. Comparisons were made using Bland-Altman plots, mean difference, limits of agreement and estimated weight within 10% and 20% of actual weight.Results: 199 patients were enrolled in the study with a mean actual weight of 27.2 kg (SD 17.2). Length-based tools, with or without body habitus adjustment, performed better than age-based formulae. When measuring estimated weight within 10% of actual weight, PAWPER performed best with 73%, followed by Mercy (69%), PAWPER with no adjustment (62%), Broselow (60%), Best Guess (47%), Luscombe and Owens (41%) and revised APLS (40%). Mean difference was similar across all methods ranging from 0.4 kg (0.0, 0.9) for Mercy to -2.2 kg (-3.5, -0.9) for revised APLS. Limits of agreement were narrower for the length-based tools (-5.9, 6.8 Mercy; -8.3, 5.6 Broselow; -9.0, 7.1 PAWPER adjusted; -12.1, 9.2 PAWPER unadjusted) than the age-based formulae (-18.6, 17.4 Best Guess; -19.4, 15.1 revised APLS, -21.8, 17.7 Luscombe and Owens).Conclusion: In an ethnically diverse population, length-based methods with or without body habitus modification are superior to age-based methods for predicting actual body weight. Body habitus modifications increase the accuracy and precision slightly. [ABSTRACT FROM AUTHOR]

Background: The New South Wales Health (NSW Health) Chronic Disease Management Program (CDMP) delivers interventions to adults at risk of hospitalisation for five target chronic conditions that respond well to ambulatory care: diabetes, hypertension, chronic obstructive pulmonary disease, congestive heart failure, and coronary artery disease. The intervention consists of two main components: (1) care coordination across sectors (acute, ambulatory, and community care from both public and private sectors) and clinical specialties, facilitated by program care coordinators, and (2) health coaching including management of lifestyle risk factors and medications and self-management. These components were broadly prescribed by the head office of NSW Health, which funded the program, and were implemented by regional health services (local health districts) in ways that best suited their own history, environment, workforce, and patient need. We used a propensity-matched cohort study to evaluate health service utilisation after enrolment in the CDMP.Methods and Findings: The evaluation cohort included 41,303 CDMP participants enrolled between 1 January 2011 and 31 December 2013 who experienced at least one hospital admission or emergency department (ED) presentation for a target condition in the 12 mo preceding enrolment. Potential controls were selected from patients not enrolled in the CDMP but experiencing at least one hospital admission or ED presentation over the same period. Each CDMP patient in the evaluation cohort was matched to one control using 1:1 propensity score matching. The primary outcome was avoidable hospitalisations. Secondary outcomes included avoidable readmissions, avoidable bed days, unplanned hospitalisations, unplanned readmissions, unplanned bed days, ED presentations, and all-cause death. The primary analysis consisted of 30,057 CDMP participants and 30,057 matched controls with a median follow-up of 15 mo. Of those, 25,638 (85.3%) and 25,597 (85.2%) were alive by the end of follow-up in the CDMP and control groups, respectively. Baseline characteristics (including history of health service utilisation) were well balanced between the matched groups. In both groups, utilisation peaked just before the time of enrolment/matching, declined sharply immediately following enrolment, and then continued to decrease more gradually; however, after enrolment, avoidable and unplanned health service utilisation remained higher for CDMP participants compared to controls. The adjusted yearly rate of avoidable hospital admissions was 0.57 (95% CI 0.52 to 0.62) in the CDMP group versus 0.33 (95% CI 0.31 to 0.37) in the control group (adjusted rate ratio 1.70, 95% CI 1.62 to 1.79, p < 0.001). Significant increases in service utilisation were also observed for unplanned hospitalisations (1.42, 95% CI 1.37 to 1.47, p < 0.001) and ED presentations (1.37, 95% CI 1.32 to 1.42, p < 0.001) as well as avoidable (2.00, 95% CI 1.80 to 2.22, p < 0.001) and unplanned (1.51, 95% CI 1.40 to 1.62, p < 0.001) readmissions and avoidable (1.70, 95% CI 1.59 to 1.82, p < 0.001) and unplanned (1.43, 95% CI 1.36 to 1.49, p < 0.001) bed days. No evidence of a difference was seen for all-cause death (adjusted risk ratio 0.96, 95% CI 0.96 to 1.01, p = 0.10) or non-avoidable hospitalisations (all hospitalisations minus avoidable hospitalisations; adjusted rate ratio 1.03, 95% CI 0.97 to 1.10, p = 0.26). Despite the robustness of these results to sensitivity analyses, in the absence of a randomised control group, one cannot exclude the possibility of residual or unmeasured confounding that was not controlled for by the matching process and multivariable analyses.Conclusions: Participation in the CDMP was associated with an increase in avoidable hospital admissions compared to matched controls but no difference in the rate of other types of hospitalisation or death. A possible explanation is that the program identified conditions that required participants to be hospitalised. Service utilisation decreased sharply following its peak for both groups. This finding reflects the natural tendency for high-risk patients to show reductions in use following intense phases of service utilisation and highlights that, despite the additional complexity, a carefully selected control group is essential when assessing the effectiveness of interventions on hospital use. [ABSTRACT FROM AUTHOR]

Objective: Determine the acceptability and epidemiological impact of increases in HIV testing in gay men in New South Wales (NSW), Australia– particularly pertinent when considering treatment as prevention and the need to reduce undiagnosed infections. Methods: We conducted an online survey and focus groups to assess whether increases in HIV testing would be acceptable to gay men in NSW. In parallel, we assessed the potential impact of increases in testing coverage and/or frequency using an individual-based model of HIV transmission. Results: If sexual practices and the rate of initiating HIV treatment are unchanged then increasing HIV testing reduces infections. Increasing testing frequency has the largest impact, with a 13.8% reduction in HIV infections over 10 years if the ∼55–75% of men who test at least once per year increased their testing frequency to four times per year. If testing levels decrease from current levels then we expect an increase in HIV infections with a sharply rising trend over time. Increasing HIV testing would be acceptable if testing was more convenient. However, only ∼25% of men surveyed were ‘very likely’ to increase their level of HIV testing. Men delayed or avoided testing due to the slowness in obtaining results and if they believed they had not put themselves at risk. Conclusions: An increase in HIV testing alone is unlikely to reduce HIV incidence substantially in NSW gay men– however, the relatively high testing levels need to continue to prevent an increase in HIV infections. In jurisdictions with lower levels of HIV testing, increases in testing coverage and frequency are likely to have a larger impact. Successful treatment as prevention interventions will require increases in testing rates; such increases would be acceptable to gay men in NSW but only if more convenient testing and rapid communication of results were available. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to describe the current demography of rural dietetic private practice and to determine the drivers and barriers for further development. Design: A sequential explanatory mixed methods approach was used. Document searches and semistructured in‐depth individual interviews were used to collect quantitative and qualitative data. Setting: Six rural case study sites of dietetic service delivery in rural northern New South Wales. Participants: Forty key informants including past and present dietitians, dietetic managers and health service managers were recruited, of these a subset of 15 interviews included discussion or comments about private practice in rural areas. Main outcomes measures: Themes identified from the interview transcripts, Medicare enhanced primary care consultation data and public/private dietetic staffing levels from document searches. Results: Private practice staffing ranged between 0% and 26% of the dietetic workforce across the six sites in 2006. Themes relating to the drivers and barriers for private practice were identified: financial factors, job satisfaction, opportunities for private practice and establishing private practice. Conclusions: There is an opportunity for growth of private practice to meet the gap in public dietetic services in rural areas. [ABSTRACT FROM AUTHOR]

To examine the factor structure and internal consistency of the Chronic Disease Compliance Instrument-Diabetes in an Australian sample of adolescents with diabetes, to modify the instrument and re-examine factor structure and internal consistency of subsequent scales and to examine the relationship between compliance behaviour and theoretically relevant explanatory factors. Compliance is a key challenge for adolescents with a chronic disease; however, valid and reliable self-report measures of compliance behaviour and explanatory factors for diabetes remain elusive, particularly applied in an Australian setting. Correlational design. Participants were 133 adolescents (12-17 years) diagnosed with diabetes and receiving treatment at several health care settings in New South Wales. Participants voluntarily completed the self-report instrument while waiting to see their Physician/Clinical Nurse Consultant/Diabetes Educator. On logical modification of the instrument based on exploratory factor analysis and thorough review of item content, the instrument was shown to have sufficient factor structure and internal consistency. Further, eight of the 11 explanatory factor scales were significantly related to compliance behaviour (accounting for 31% of variance). The present study represents the first application of an established instrument to measure compliance to diabetes treatment among adolescents in an Australian sample and demonstrates that the instrument has sufficient factor structure and internal consistency in this setting. Findings provide a list of relevant factors for explaining compliance, which may be employed to guide the development of initiatives to increase the level of compliance to treatment among Australian adolescents with diabetes. The Chronic Disease Compliance Instrument-Diabetes is a tool that can help nurses with their clinical practice by allowing for more efficient identification of adolescent compliance to diabetes treatment, which may be used in conjunction with HbA1c values already employed. [ABSTRACT FROM AUTHOR]

Attrition from undergraduate nursing programs continues to warrant investigation particularly in the climate of nursing shortages and fiscal reflection on academic institutional programs. This three-year study used a prospective longitudinal survey design to determine entry characteristics of students, attrition, progression and completion in an undergraduate program. Students were surveyed in the first three weeks of commencing their program and gave permission for academic grades to be collected during their six session, three year Bachelor of Nursing program. Of the 740 students enrolled 48% (357 students) were surveyed and 352 students (99%) gave consent for their grades to be collected. One-third of the student cohort graduated in the expected three-year timeframe, one-third had dropped out and one-third was still completing their studies. A higher Grade Point Average and being a native English speaker were most predictive of students completing their course in the minimum expected timeframe. [ABSTRACT FROM AUTHOR]

This study reports patient satisfaction with the nursing care on a neurosurgical critical care unit. A modified version of the Ludwig-Beymer Patient Satisfaction Questionnaire (PSQ-7) was used, and included structured items and semi-structured interview questions. Data were collected from 149 patients. Participants rated their satisfaction as high (Mean = 25.14; SD = 2.96). The distribution of scores was skewed and every item demonstrated a ceiling effect. Principal com-ponent analysis yielded a one-component solution which explained 48% of the variance. NVivo® was used to match PSQ-7 scores with qualitative data. Participants' comments were categorised as positive, negative or 'yes, but'. Just over half the patients made positive comments and 29% of patients in the low group made negative comments. Three categories: 'communication', 'nursing care delivery' and 'the hospital environment' emerged from the qualitative data. A mixed method approach enables researchers to move beyond the ceiling effect of quantitative measures of patient satisfaction and to gain a more mean-ingful explanation of patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective To explore the association between daily patient numbers, sociodemographic, clinical and system characteristics and walkout rates of patients from New South Wales (NSW) public hospital ED (without seeing a medical officer). Methods This was a secondary analysis of the NSW Emergency Department Data Collection, between 1 January 1999 and 31 December 2001, with a total of 4 356 323 ED attendances. Bivariate and multiple logistic regression analyses were performed to explore the relationship of walkout from ED and explanatory variables. Results About 5.7% of the patients attending in NSW public hospital ED left without seeing a doctor. The results from bivariate and multivariate analyses revealed that walkout rates significantly varied by sociodemographic and clinical characteristics of the patients. Patient groups that more likely to walk out were those aged 15–44 years, from a non-English-speaking background, Aboriginal, with lower socioeconomic status, with no private health insurance coverage and longer waiting times for triage. Patient volume in the ED showed a significant positive association with walkout rates. Conclusions After adjusting for triage category (urgency of presentation) and triage time, patients from lower socioeconomic backgrounds and those without private health insurance coverage were more likely to leave ED without treatment. These results have important implications for Health Services. Future strategies aimed at minimizing walkouts from public hospital ED should prioritize and target factors identified in the present study. [ABSTRACT FROM AUTHOR]

This research provided background for surveys and interviews in later stages of a 3 part project. It aimed to identify, from secondary research, sociodemographic characteristics which tend to support registered clubs and their machine gaming activities in the Sydney Statistical Division. Using multiple methods including Pearson's Product Moment correlation, Principal Components factor analysis, and stepwise regression, the study profiled Sydney populations which spend highly on gaming machines. The most important sociodemographic predictors of Sydney statistical local areas where per capita gaming machine expenditure is high are large proportions of the adult resident population who were born in Malta, Greece, Lebanon, China, Italy, Vietnam, Yugoslavia, India or the Philippines; have no vocational or tertiary qualifications; or are unemployed. [ABSTRACT FROM AUTHOR]

International Journal of Paediatric Dentistry 2012; 22: 302-309 Background. Early Childhood Caries is a significant public health issue worldwide. Although much is known about the aetiology of dental caries, there is limited evidence on the understanding of caregivers on readily available early childhood oral health education materials. Aim. The purpose of this study was to record how parents cope with dental health education materials for preschool children commonly available in New South Wales, Australia. Design. This qualitative study was nested within a large cohort study in South Western Sydney. English-speaking mothers ( n = 24) with young children were approached for a face-to-face, semi-structured interview at their homes. Two dental leaflets designed by NSW Health to give advice on monitoring young children's oral health were sent to mothers prior to the interview. Interviews were recorded and subsequently transcribed verbatim. Transcripts were analysed by interview debriefing and a thematic coding. Results. Mothers generally reported that the leaflets were easy to read but noted that the information pertaining to bottle feeding was confusing. Furthermore, they were unable to understand terms such as 'fluoride' and 'fissure sealants'. Early childhood nutrition and infant teething were inadequately addressed, and mothers preferred pictorial presentations to improve their understanding of oral health. Conclusions. Producers of health education leaflets should keep the messages simple and straightforward, avoid the use of medical jargon, and use pictorial aids to improve communication with parents. [ABSTRACT FROM AUTHOR]