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Patients with high model for end‐stage liver disease (MELD) scores waiting for liver transplantation in Australia and New Zealand (ANZ) have had limited access to deceased donor livers and therefore binational sharing of livers, for patients with a MELD score ≥35 was introduced in February 2016. Waiting list mortality, post‐transplant outcomes and intention‐to‐treat survival were compared between patients whose MELD score reached 35 on the waiting list between October 2013 and April 2015 (Pre‐Share 35 group, n = 23) and patients who were Share 35 listed between February 2016 and May 2022 (Share 35 group, n = 112). There was significantly reduced waiting list mortality in share 35 listed patients in comparison to the pre‐Share 35 group (11.7% vs. 52.2%, OR.120 95% CI.044–.328, P <.001). Post‐transplant patient and graft survival were not significantly different between the groups (5‐year patient survival 82% vs. 84%, P =.991, 5‐year graft survival 82% vs. 76%, P =.543). Intention‐to‐treat survival was superior in the Share 35 group (HR.302, 95% CI.149–.614, P <.001). Introduction of Share 35 in ANZ resulted in a 78% risk reduction in waiting list mortality, equivalent post‐transplant survival and an improvement in intention‐to‐treat survival. [ABSTRACT FROM AUTHOR]

Transformative urban development is urgent to achieve future sustainable development and wellbeing. Transformation can benefit from shared and cumulative learning on strategies to guide urban development across local to national scales, while also reflecting the complex emergent nature of urban systems, and the need for context-specific and place-based solutions. The article addresses this challenge, drawing on extensive transdisciplinary engagement and National Strategy co-development processes for Australia. This includes generation of two frameworks as boundary objects to assist such transdisciplinary strategy development. An 'enabling urban systems transformation' framework comprises four generic overarching transformation enablers and a set of necessary underpinning urban capacities. This also built cumulatively on other sustainability and urban transformation studies. A complementary 'knowledge for urban systems transformation' framework comprises key knowledge themes that can support an integrated systems approach to mission-focused urban transformations, such as decarbonising cities. The article provides insights on the transdisciplinary processes, urban systems frameworks, and scoping of key strategies that may help those developing transformation strategies from local to national scales. Science highlights • Transdisciplinary national urban strategy development is used to distil generic frameworks and strategy scopes with potential international application. • The frameworks also build on other published framings to support convergent, cumulative and transdisciplinary urban science. • The 'enabling transformations' and 'urban knowledge' frameworks include the perspective of those developing sustainable urban systems strategies. • The enabling framework also informs 'National Urban Policy' and 'Knowledge and Innovation Hub' strategies, and prevailing power imbalances. • The knowledge framework can help frame urban challenges, missions and knowledge programs. Policy and practice recommendations • An urban 'transformation imperative' and 'strategic response' can be co-developed from local to national scales. • Local initiative is crucial to drive urban strategies, but sustained national leadership with coherent policy across sectors and scales is also key. • Diversity in engagement participation and processes generates whole-of-urban-systems and local-to-national perspectives. • Urban solutions are context-specific but generic frameworks can help collaborative issue framing and responses. • Collaborative issue framing informed by generic frameworks can bring broader perspectives to context-specific and contested policy and practice issues. [ABSTRACT FROM AUTHOR]

Simple Summary: Liver transplantation (LT) is considered the only curative therapeutic option for early, unresectable, and unablatable hepatocellular carcinoma (HCC), particularly in the setting of chronic liver disease. The criteria for selecting patients for LT for HCC have evolved since the description of the Milan Criteria by Professor Mazzaferro. In Australia and New Zealand (ANZ), the choice of criteria has expanded over the last 24 years from the Milan to the University of California San Francisco (UCSF) criteria and, more recently, to Metroticket 2.0 (MT2). This study analysed the overall and HCC-related deaths following LT in ANZ through the last 24 years to clarify the impact of the expansion of these criteria. Our data confirm that overall survival following LT for HCC has significantly improved over time despite expanding criteria from Milan to UCSF. Patients fulfilling the MT2 criteria have a survival comparable to the UCSF cohort. Thus, the expansion of criteria to MT2 is justifiable. Background: Expansion in liver transplantation (LT) criteria for HCC from Milan to UCSF has not adversely impacted overall survival, prompting further expansion towards Metroticket 2.0 (MT2). In this study, we compared patient survival post-transplant before and after 2007 and long-term outcomes for LT within Milan versus UCSF criteria (to determine the true benefit of the expansion of criteria) and retrospectively validated the MT2 criteria. Methods: Retrospective analysis of ANZLITR (including all patients transplanted for HCC since July 1997). The entire cohort was divided based on criteria used at the time of listing, namely, Milan era (1997–2006) and the UCSF era (2007–July 2015). Results: The overall 5- and 10-year cumulative survival rates for the entire cohort of 691 patients were 78% and 69%, respectively. Patients transplanted in UCSF era had significantly higher 5- and 10-year survival rates than in the Milan era (80% vs. 73% and 72% vs. 65%, respectively; p = 0.016). In the UCSF era, the 5-year survival rate for patients transplanted within Milan criteria was significantly better than those transplanted outside Milan but within UCSF criteria (83% vs. 73%; p < 0.024). Patients transplanted within the MT2 criteria had a significantly better 5- and 10-year survival rate as compared to those outside the criteria (81% vs. 64% and 73% vs. 50%, respectively; p = 0.001). Conclusion: Overall survival following LT for HCC has significantly improved over time despite expanding criteria from Milan to UCSF. Patients fulfilling the MT2 criteria have a survival comparable to the UCSF cohort. Thus, expansion of criteria to MT2 is justifiable. [ABSTRACT FROM AUTHOR]

The article focuses on the reflections of doctor Mark Duncan-Smith, the President of the AMA (WA), as his presidency comes to an end. He discusses the challenges faced by the medical system in Western Australia, the outcomes achieved during his tenure, and his advocacy efforts on various topics including healthcare resources, budget increases, emergency department access, culture and safety improvements, doctors in training, infrastructure, COVID-19 protocols, and more.

The article discusses the normality of the "Situation Normal, All Fouled Up" (SNAFU) in the healthcare system under the McGowan Government in Western Australia. It mentions that poor metrics are tolerated and insufficient action is taken to tackle problems like ramping, surgery cancellations, and hospital fatalities. It questions the responsibility of the Health Minister and the resolve of the Premier and Cabinet to improve healthcare resources.

The article focuses on the AMA (WA)'s history of public health advocacy and highlights the impact of the anti-smoking movement BUGA UP, which involved doctors taking a stand against cigarette advertising, leading to societal awareness of the dangers of smoking and subsequent government regulations. It also acknowledges the current efforts of the AMA (WA) in raising awareness about the public health dangers of vaping and applauds the previous contributions.

The article explores that authors surprising and disappointing momet to learn the McGowan Government has planned to expand the community pharmacy vaccination program. It discuses the topics a 2021 WA Government report,The Pharmacy Guild The Pharmacy Guild represents community pharmacy owners who form the minority of pharmacists in Australia, and this State. The bottom line Why are pharmacists so interested in vaccines?.

By 2031 the population of NSW is expected to increase by 2 million. Almost 80% of growth will occur within the Sydney metropolitan area. This will place increased pressure on our transport infrastructure as customer demands for an effective and integrated transport system in and around Sydney grows. The context for our unprecedented program of infrastructure build is clearly set. So too, is the imperative to develop our asset base responsibly to ensure we establish and maintain a legacy network that can serve the City and the State for generations to come - ensuring Sydney continues to be a great place to live, work and do business. The imperative to work smarter, to learn and to harness and deploy the knowledge and experience gained across the globe to our projects and our assets is set. The Asset Standards Authority was created as part of the reform of the metropolitan rail system and has evolved to become a primary assurance vehicle providing technical and governance expertise and advice across Transport for NSW (TfNSW) as well as providing linkages to and access for industry. With a clear focus on ‘whole of life’ multi-mode transport infrastructure, the asset standards authority has led an unprecedented program of engagement centred on competency and capability development across the supply chain. In concert with this, the authority has developed focused relationships with global academia and R&D entities - providing the ‘asset-owners’ perspective and drawing on the considerable intellect that the relationship offers. The paper will describe the early evolution of the ASA's role as an enabler of asset-focused concepts and knowledge, innovation and R&D as part of a broader Industry Engagement task. It will draw on our experiences to date including industry acceptance and readiness and provide insight into our future direction geared towards incorporating the ‘knowledge business’ as BAU. [ABSTRACT FROM AUTHOR]

The author explains the necessity for permanent contracts for hospital doctors in Australia. Topics discussed include the efforts of the Australian Medical Association (AMA) to promote permanency such as negotiations with Western Australia (WA) Health and conciliation in the Western Australia Industrial Relations Commission, role of permanency in the job security of physicians, and tendency of doctors not to express their opinion on quality and safety due to lack of job security.

The article explores the The mood was understandably buoyant when most public health measures were removed on 29 April, especially at pubs, clubs, restaurants and stadia.

Objective: There is increasing interest in the use of administrative data for surveillance and research in Australia. The purpose of the present study was to evaluate the usefulness of such data for the surveillance of mood and anxiety disorder using databases from the following Canadian provinces: British Columbia, Ontario, Quebec and Nova Scotia. Method: A population-based record-linkage analysis was done using data from physician billings and hospital discharge abstracts, and community-based clinics using a case definition of ICD-9 diagnoses of 296.0–296.9, 311.0, and 300.0–300.9. Results: The prevalence of treated mood and/or anxiety disorder was similar in Nova Scotia, British Columbia, and Ontario at approximately 10%. The prevalence for Quebec was slightly lower at 8%. Findings from the provinces showed consistency across age and sex despite variations in data coding. Women tended to show a higher prevalence overall of mood and anxiety disorder than men. There was considerably more variation, however, when treated anxiety (300.0–300.9) and mood disorders (296.0–296.9, 311.0) were considered separately. Prevalence increased steadily to middle age, declining in the 50s and 60s, and then increased after 70 years of age. Conclusions: Administrative data can provide a useful, reliable and economical source of information for the surveillance of treated mood and/or anxiety disorder. Due to the lack of specificity, however, in the diagnoses and data capture, it may be difficult to conduct surveillance of mood and anxiety disorders as separate entities. These findings may have implications for the surveillance of mood and anxiety disorders in Australia with the development of a national network for the extraction, linkage and analysis of administrative data. [ABSTRACT FROM AUTHOR]

The article explores the incorporation of ecological and evolutionary processes into conservation planning assessments in Australia. It discusses how biodiversity is generated by a number of ecological and evolutionary processes. It focuses on the novel incorporation of processes with traditional framework of a comprehensive sample of biodiversity to identify spatial priorities. It is stated that priority areas that considered ecological and evolutionary processes were more connected along vegetated waterways.

Abstract: In this paper we show how ideas from a longstanding but little recognised literature on adaptive governance can be used to rethink the way science supports Australian drought policy. We compare and contrast alternative ways of using science to support policy in order to critique traditional commentary on Australian drought policy. We find that criticism from narrow disciplinary and institutional perspectives has provided few practical options for policy makers managing these complex and interacting goals. In contrast, ideas from a longstanding but little recognised literature on adaptive governance have potential to create innovative policy options for addressing the multiple interacting goals of Australian drought policy. From an adaptive governance perspective, the deep concern held by Australian society for rural communities affected by drought can be viewed as a common property resource that can be sustainably managed by governments in cooperation with rural communities. Managing drought assistance as a common property resource can be facilitated through nested and polycentric systems of governance similar to those that have already evolved in other arenas of natural resource management in Australia, such as Landcare groups and Catchment Management Authorities. Essential to delivering these options is the creation of flexible, regionally distributed scientific support for drought policy capable of integrating local knowledge and informing the livelihood outcomes of critical importance to governments and rural communities. [Copyright &y& Elsevier]

Many rangelands around the globe are degraded because of mismatches between the goals and actions of managers operating at different spatial scales. In this paper, we focus on identifying, interpreting, and correcting cross-scale mismatches in rangeland management by building on an existing four-step resilience analysis procedure. Resilience analysis is an evaluation of the capacity of a system to persist in the face of disturbances. We provide three examples of cross-scale resilience analysis using a rangeland system located in northern Australia. The system was summarized in a diagram showing key interactions between three attributes (water quality, regional biodiversity, and beef quality), which can be used to indicate the degree of resilience of the system, and other components that affect these attributes at different scales. The strengths of cross-scale interactions were rated as strong or weak, and the likely causes of mismatches in strength were interpreted. Possible actions to correct cross-scale mismatches were suggested and evaluated. We found this four-step, cross-scale resilience analysis procedure very helpful because it reduced a complex problem down to manageable parts without losing sight of the larger-scale whole. To build rangeland resilience, many such cross-scale mismatches in management will need to be corrected, especially as the global use of rangelands increases over the coming decades. [ABSTRACT FROM AUTHOR]

Pastoral managers in savannas face difficult decisions about trading off short-term use of grass biomass for animal production against its longer term use as fuel to manage tree–grass balances with fire. This study develops a model to represent the interactions between seasonal variability, fire behaviour, tree response, pasture growth and condition, grazing utilisation and animal productivity in a grazed savanna ecosystem. It successfully integrates simplified versions of several existing models, results of local research and expert knowledge to permit economic evaluation of tradeoffs given various fire treatments. The modelling framework also enabled the effects of wildfire events to be simulated and allowed fire and livestock management costs and revenue to be quantified. Applied to one site and climate sequence, the initial results assuming constant stocking rates show the importance of burning for the long-term maintenance of productivity, and suggest that some level of late dry season fire is needed for this. Net present values of applying different fire regimes over different time horizons emphasise the factors that pastoralists must take into account in making decisions about preferred fire regimes. [ABSTRACT FROM AUTHOR]

Climate change is threatening water security in water-scarce regions across the world, challenging water management policy in terms of how best to adapt. Transformative new approaches have been proposed, but management policies remain largely the same in many instances, and there are claims that good current management practice is well adapted. This paper takes the case of the Murray–Darling Basin, Australia, where management policies are highly sophisticated and have been through a recent transformation in order to critically review how well adapted the basin's management is to climate change. This paper synthesizes published data, recent literature, and water plans in order to evaluate the outcomes of water management policy. It identifies several limitations and inequities that could emerge in the context of climate change and, through synthesis of the broader climate adaptation literature, proposes solutions that can be implemented when basin management is formally reviewed in 2026. [ABSTRACT FROM AUTHOR]

Studies the spread of mistletoes in fragmented Australian woodlands. Interaction between landscape pattern and components of the dispersal strategy of the mistletoe Amyema preissii; Parameters to characterize seed dispersal; Analysis pertaining to factorial design on landscape type and dispersal parameters.

ABSTRACTThis study aimed to describe the establishment of a new University Department of Rural Health (UDRH) in South Australia and to report early achievements. In May 1997, the UDRH was established, key staff were recruited, infrastructure was developed and in April 1998 a Joint University Committee on Rural and Remote Health was formed. By mid-1999, 14 full-time equivalent staff were employed in Whyalla and Adelaide. Early achievements include: review of undergraduate rural placements; increased rural clinical placements by 1000 student-weeks; partnership with the Dental School resulting in training opportunities and falling public dental waiting lists; multidisciplinary teaching practices in four rural sites; priority public health projects established; competitive research grants won; and a capital grant to strengthen Aboriginal health services infrastructure secured. These early achievements demonstrate UDRH potential to have a real impact on health worker education, service delivery, and public health status in rural and remote areas. This strong foundation must now be built on. [ABSTRACT FROM AUTHOR]

Abstract: Tension between dominant urban political and economic centres and associated rural communities continues despite various programs to decentralisation. This phenomenon is often explained in terms of a core-periphery political economy. To generate complementary explanatory hypotheses from a social perspective, we examine the impacts of rural–urban community interactions on the development of social norms such as the strength of mutual cooperation. We explore this using deliberately abstracted models of the “Iterated Prisoners’ Dilemma” to represent intra- and inter-community interactions, in regionalised and centralised interaction arrangements. We have considered changes in mutual cooperation as an indicator of social capital dynamics. In our model, increasing interaction of rural communities with urban centres increases “non-cooperative” behaviour of members of the small rural communities. Moreover, as the strength of centralisation (the proportion of interaction between each rural community and the urban centre as compared with the interaction among rural communities) increases, cooperative behaviour among the members of smaller rural communities and mutual cooperation with individuals of larger urban centre decreases. Our hypothesis is that interaction with urban centres disrupts norms used in resolving local social dilemmas. If so, this partly explains the dissatisfaction expressed in rural–urban relations, which may be a fundamental emergent property of particular settlement patterns. Understanding these relationships could guide better policies to facilitate rural–urban interactions in the worldwide trend towards regionalism. [Copyright &y& Elsevier]

Abstract: As in all parts of the globe, rapid climate change in Australia will have significant negative impacts on biodiversity. It also will interact with pre-existing stressors such as native vegetation clearing, altered natural disturbance regimes and invasive species – all of which already have major negative effects on biota in Australia. Strategies to reduce climate change impacts on Australian biodiversity include a mixture of mitigation and adaptation actions (sensu) such as: (1) significantly reducing greenhouse gas emissions, (2) ensuring bio-diverse carbon capture, (3) better tackling pre-existing stressors on biodiversity, (4) better preparing for the effects of major natural disturbances, (5) significantly improving off-reserve conservation efforts including fostering appropriate connectivity, and (6) enhancing the existing reserve system by making it more comprehensive, adequate and representative. The first strategy above demands a global response otherwise major mitigation attempts in Australia that are not paralleled elsewhere around the world will have little effect on climate change and, in turn, contribute little to enhanced biodiversity conservation. Strategies 2–6 demand multi-scaled responses, particularly at a regional level, given the major regional differences in direct climate change impacts and their interactions with pre-existing regional stressors. Well developed multi-scaled conservation plans to implement these strategies currently do not exist, nor do appropriate institutional arrangements and capacities. Institutional reforms are urgently needed in Australia to develop the land management, monitoring and regional response capabilities required to conserve biodiversity on a continent already significantly modified. [Copyright &y& Elsevier]

Background: The International Study Group for Liver Surgery (ISGLS) definition of post hepatectomy liver failure (PHLF) was developed to be consistent, widely applicable, and to include severity stratification. This international multicentre collaborative study aimed to prospectively validate the ISGLS definition of PHLF., Methods: 11 HPB centres from 7 countries developed a standardised reporting form. Prospectively acquired anonymised data on liver resections performed between 01 July 2010 and 30 June 2011 was collected. A multivariate analysis was undertaken of clinically important variables., Results: Of the 949 patients included, 86 (9%) met PHLF requirements. On multivariate analyses, age ≥70 years, pre-operative chemotherapy, steatosis, resection of >3 segments, vascular reconstruction and intraoperative blood loss >300 ml significantly increased the risk of PHLF. Receiver operator curve (ROC) analysis of INR and serum bilirubin relationship with PHLF demonstrated post-operative day 3 and 5 INR performed equally in predicting PHLF, and day 5 bilirubin was the strongest predictor of PHLF. Combining ISGLS grades B and C groups resulted in a high sensitivity for predicting mortality compared to the 50-50 rule and Peak bilirubin >7 mg/dl., Conclusions: The ISGLS definition performed well in this prospective validation study, and may be the optimal definition for PHLF in future research to allow for comparability of data., (Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.)

Background: The International Study Group for Liver Surgery (ISGLS) proposed a definition for bile leak after liver surgery. A multicentre international prospective study was designed to evaluate this definition., Methods: Data collected prospectively from 949 consecutive patients on specific datasheets from 11 international centres were collated centrally., Results: Bile leak occurred in 69 (7.3%) of patients, with 31 (3.3%), 32 (3.4%) and 6 (0.6%) classified as grade A, B and C, respectively. The grading system of severity correlated with the Dindo complication classification system (P < 0.001). Hospital length of stay was increased when bile leak occurred, from a median of 7 to 15 days (P < 0.001), as was intensive care stay (P < 0.001), and both correlated with increased severity grading of bile leak (P < 0.001). 96% of bile leaks occurred in patients with intra-operative drains. Drain placement did not prevent subsequent intervention in the bile leak group with a 5-15 times greater risk of intervention required in this group (P < 0.001)., Conclusion: The ISGLS definition of bile leak after liver surgery appears robust and intra-operative drain usage did not prevent the need for subsequent drain placement., (© 2014 International Hepato-Pancreato-Biliary Association.)