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Background: Social support is a crucial factor influencing the sustainability of physical activity (PA). This proof-of-concept study presents the development of a Social Physical Activity Index for Area (SPAIFA) an indicator reflecting opportunities for individuals to actively participate as part of a group within which opportunities for social interaction can be developed. Methods: Six government councils in the state of New South Wales, Australia, were selected encompassing 174 suburbs. Using 2 search engines' map tools, we identified PA venues for each suburb (eg, park, studios, etc). To enumerate activities per suburb, we used (1) venue websites, (2) New South Wales Office of Sport website, (3) national websites of grassroots PA for nonorganized activity (eg, parkrun, meetup, etc), and (4) social media. The database was linked to the suburb demographic profile, the area disadvantage score, walkability and open space scores, and the proportion of insufficiently active residents. Spatial analysis techniques were used to identify SPAIFA clusters. Results: SPAIFA councils' average was 9.9 activities per 10,000 people (ranging from 6.6/10,000 to 16.2/10,000). SPAIFA-Old (ie, activities specific to older adults) varied significantly (ranging from 11.7/10,000 to 0.8/10,000 seniors). Disadvantaged areas and a high proportion of insufficiently active residents were associated with being classified as low SPAIFA (P <.01). Three clusters of low SPAIFA were identified, and 17 high-risk areas where low SPAIFA was compounded by poor environmental support. Conclusions: SPAIFA can be used by councils and policymakers as an indicator for monitoring and intervening in areas where natural and/or urban design is not conducive for PA. [ABSTRACT FROM AUTHOR]

Ageing in a non-native land brings numerous challenges that may complicate adaptation and health for older Latin American immigrants in Australia. While religiosity emerges as a protective factor for mental health, there is scarce research focused on exploring the multifaceted dimensions of religiosity in this population. As part of a broad Constructivist Grounded Theory study, the aim of this qualitative descriptive analysis was to explore and understand this population's religious practices and experiences, focusing on the impact on their mental health. Following ethical approval, 23 Spanish-speaking Latin American immigrants aged 60 and older living in Australia were interviewed. Data analysis was performed on a constant comparative basis and concurrent with data collection to understand the findings. Three key categories were identified: "Being involved in religious groups and communities," "Connecting with God," and "Changing how one lives one's faith." Regardless of their religious practices, all participants engaged in social activities that helped them integrate into their communities. Several barriers to religious practices were identified. The findings add to the field of religiosity as a protective factor in older Latin American immigrants' mental health. Future research should identify barriers to religious practices and targeted interventions. [ABSTRACT FROM AUTHOR]

Background: General practice training in outer metropolitan (OM) areas contributes to patients' access to care. Differences in clinical practice and training in rural versus urban areas have been established, but less is known about OM versus inner metropolitan (IM) differences – whether they offer a trainee learning experience of populations with distinct demographics and healthcare characteristics. This study sought to identify the characteristics and associations of general practice training in New South Wales and Australian Capital Territory OM areas, compared to IM and rural areas. Methods: Cross-sectional analyses of data (2016–2020) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours, were performed. Multinomial logistic regression assessed associations of rural/OM/IM practice location with registrar and practice factors, patient factors, consultation content factors and consultation action factors. Results: Overall, 1308 registrars provided data from 177,026 consultations. For several variables, there was a pattern in the differences of associations across rural/OM/IM areas. Experience of care of older patients and Aboriginal and/or Torres Strait Islander health were more likely in OM than IM areas. Care of patients from non-English speaking background was more likely in OM than in rural areas. Possible markers of healthcare access (specialist referrals, and pathology and imaging requests) were less likely in OM than in both IM and rural areas. Conclusions: OM areas are distinct (and educationally rich) clinical learning environments, with distinct demographic characteristics and seeming healthcare access limitations. This finding has implications for workforce support and health resource allocation. General practice in outer metropolitan regions is unique. In GP registrars' practice in these regions, fewer specialist, pathology and imaging referrals were generated, and care of older patients and Aboriginal and Torres Strait Islander patients was more likely than in inner metropolitan areas. Care of patients from non-English speaking backgrounds was more likely than in rural areas. A gradient (from inner metropolitan to outer metropolitan to rural regions) existed for many characteristics of registrars, practices, patients and clinical care. [ABSTRACT FROM AUTHOR]

Objective: To provide the first document map of sustainability and decarbonisation actions across the Australian healthcare sector, as reported in publicly available documents online, and to identify gaps in actions. Methods: Healthcare providers were identified across all state and territories. Structured Google searches between August and December 2022 were followed by document searches. Updates were undertaken, most recently in December 2023. Targeted documents included position statements, strategies, and reports. Key points from these documents pertaining to sustainability and/or decarbonisation were extracted and descriptively analysed. Results: A total of 294 documents were included, mostly focused on power generation, transport, building design, and circular procurement/waste pathways. In contrast, relatively few plans for decarbonisation of clinical care were identified (n = 42). National and two state governments (New South Wales, Western Australia) have established healthcare sustainability and decarbonisation units, and two further states have publicly committed to doing so (Queensland, Tasmania). However, these documents generally reported separate, siloed actions. While attempts were made to make this review comprehensive, some documents may have been missed or are only available inside an organisation, and new actions will continue to emerge. Conclusion: Broad sustainability plans have been developed by many healthcare providers; however, to achieve net zero, decarbonising of clinical practices is also needed, and this is where the least action is currently occurring. To decarbonise clinical care, the sector needs to come together in a more coordinated way. What is known about the topic? Little is known about what actions are occurring to make healthcare more sustainable and to reduce the carbon footprint of healthcare in Australia. What does this paper add? This paper provides a snapshot of publicly available documents from healthcare providers and professional organisations as they relate to healthcare sustainability and helps reveal the gaps and siloed nature of current actions. What are the implications for practitioners? This paper can help jurisdictions identify gaps or areas for improvement and may aid in targeted and coordinated interventions, especially as they relate to decarbonised clinical care. [ABSTRACT FROM AUTHOR]

Objective: Quad bikes are a leading cause of death and incident-related injury on farms, yet little is understood about rules used by farmers to ensure their safe operation. This study explored rules about quad bikes set by those who live or work on farms. Through the case of quad bikes, this study sought to understand how rules are determined and implemented at the farm level. Setting: A mix of farm types and locations in rural Australia including Queensland, South Australia, and New South Wales. Participants: Eight farmers were interviewed and recruited from information sheets at farmers' markets, through a local health organisation, and a media release. Design: Thematic analysis was used to transform data from eight semi-structured interviews with farmers in rural Australia. Results: Data were distilled into two themes – "Rule content" described the explicit rules farmers had set on their properties, while the theme "Underlying rule principles" explored the values and norms which underpinned the creation and implementation of these rules. Conclusions: Through the case of quad bike rules, this study illustrated how rules are determined and implemented at the farm level. Perceptions of risk were tied to farmers being experts in their own environment and therefore able to mitigate risk. In contrast to injury data, reckless use of quad bikes was perceived to cause incidents, and this was the basis of rules for adults and children. [ABSTRACT FROM AUTHOR]

Purpose: This article uses an Indigenous concept of family violence as a frame to interrogate interviews held with Indigenous LGBTIQSB + people in Australia. The article reorients family violence away from Western heteronormative framings and aims to contribute towards a new conversation about family violence. Methods: A qualitative thematic analysis was used to analyse 16 interviews with Indigenous LGBTIQSB + people in the state of New South Wales, Australia. This is one of a series of articles that provide preliminary findings from a research project into the social and emotional wellbeing of Indigenous LGBTIQSB + young people living in New South Wales. Results: The interviews highlight the complex impact family violence on Indigenous LGBTIQSB + youth. The article shows differences in reactions between family and community in urban settings with those experienced in rural settings highlighting intergenerational differences, with older family members such as grandparents, more likely to exhibit negative reactions and behaviours. These experiences are interconnected as many young people were living in urban areas while extended family often lived in rural or remote communities. Conclusions: The findings of this study demonstrate the intersectional nature of family violence highlighting the fact that Indigenous LGBTIQSB + young people are integral parts of extended kinship networks, families and communities and are deeply impacted by any acts of family violence. The study's findings also support current research into family and community violence for LGBTIQ + people that shows the differential behaviours and actions of rural and urban families as well as the different reactions between generations within families. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a prevalent neurodegenerative condition, ranking as the most common among movement disorders. People living with Parkinson's disease benefit from the specialised skills and expertise of a dedicated Parkinson's disease and movement disorders nurse specialist (PDMDNS) (Bramble, Carroll, & Rossiter, 2018). Access to a PD nurse embedded into the local health setting impacts the potential to avoid hospital admissions due to worsening of symptoms, improving quality of life through improved access to specialist services and reducing carer burden (Bramble et al. 2018) The World Health Organisation advocates for the tracking healthcare workforce demographics and distribution trends to ensure equity of health care services and robust economic planning to meet future needs (WHO 2016). This marks the fourth publication in an ongoing annual series examining the longitudinal trends of the PDMDNS workforce in Australia (Williams et al., 2021, 2023). [ABSTRACT FROM AUTHOR]

Pressure injuries are a significant problem for immobile patients in acute care and can have a profound impact on patients' health and well‐being, putting pressure on healthcare systems and strain on the healthcare economy. Nurses play a pivotal role in preventing pressure injuries. A study using multiple methods was conducted to explore pressure injury prevention practices in four inpatient units within a tertiary‐level Australian Hospital. Quantitative and qualitative methods were used to gather data across a 9‐month period. Observations, audits, surveys and interviews were used to collect data across five time points. Statistical analysis of the quantitative data was undertaken, and thematic analysis was used to analyse qualitative data. Data were integrated using a realist evaluation framework. Ethical approval for the study was granted. The quantitative results demonstrated significant reductions in pressure injury prevalence from 11.5% at commencement to 4.8% at completion of the study. Hospital‐acquired pressure injuries also reduced from 4.6% to 1.9%. These results were achieved even though nursing knowledge and attitudes did not increase during the study period. Three qualitative themes were identified: Making Nursing Care Visible, Understanding the 'Why' and Engagement is Key. This study demonstrates that pressure injuries can be prevented with improvements in nursing care processes. Nurses' knowledge and attitudes towards pressure injury prevention did not change throughout this study and further research is required on how nurses' knowledge and attitudes contribute towards pressure injury prevention practices. [ABSTRACT FROM AUTHOR]

Background: Primary health care is the first point of contact for patients from refugee backgrounds in the Australian health system. Sociocultural factors, including beliefs and value systems, are salient determinants of health literacy and access to primary health care services. Although African refugees in Australia have diverse sociocultural backgrounds, little is known about the influence of sociocultural factors on their experiences of accessing primary health care services. Guided by the theoretical framework of access to health care, this study examined from the perspective of African refugees how culturally and religiously conditioned, constructed and bound health beliefs, knowledge and practices influence their experiences of access to, acceptance and use of primary health care services and information in Australia. Methods: This exploratory, qualitative study involved 19 African refugees from nine countries living in New South Wales, Australia. Semi-structured interviews were conducted and recorded using Zoom software. The interviews were transcribed verbatim and analysed using a bottom-up thematic analytical approach for theme generation. Results: Four main themes were identified. The themes included: participants' experiences of services as inaccessible and monocultural and providing information in a culturally unsafe and insensitive manner; the impact of the clinical care environment; meeting expectations and needs; and overcoming access challenges and reclaiming power and autonomy through familiar means. The findings generally support four dimensions in the access to health care framework, including approachability, acceptability, availability and accommodation and appropriateness. Conclusion: African refugees experience significant social and cultural challenges in accessing primary health care services. These challenges could be due to a lack of literacy on the part of health services and their providers in servicing the needs of African refugees. This is an important finding that needs to be addressed by the Australian health care system and services. Enhancing organisational health literacy through evidence-informed strategies in primary health systems and services can help reduce disparities in health access and outcomes that may be exacerbated by cultural, linguistic and religious differences. [ABSTRACT FROM AUTHOR]

Background: Electronic medical records (EMRs) have been widely implemented in Australian hospitals. Their usability and design to support clinicians to effectively deliver and document care is essential, as is their impact on clinical workflow, safety and quality, communication, and collaboration across health systems. Perceptions of, and data about, usability of EMRs implemented in Australian hospitals are key to successful adoption. Objective: To explore perspectives of medical and nursing clinicians on EMR usability utilising free-text data collected in a survey. Method: Qualitative analysis of one free-text optional question included in a web-based survey. Respondents included medical and nursing/midwifery professionals in Australian hospitals (85 doctors and 27 nurses), who commented on the usability of the main EMR used. Results: Themes identified related to the status of EMR implementation, system design, human factors, safety and risk, system response time, and stability, alerts, and supporting the collaboration between healthcare sectors. Positive factors included ability to view information from any location; ease of medication documentation; and capacity to access diagnostic test results. Usability concerns included lack of intuitiveness; complexity; difficulties communicating with primary and other care sectors; and time taken to perform clinical tasks. Conclusion: If the benefits of EMRs are to be realised, there are good reasons to address the usability challenges identified by clinicians. Easy solutions that could improve the usability experience of hospital-based clinicians include resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors. Implications: These essential improvements to the usability of the EMR, which are the foundation of the digital health system, will enable hospital clinicians to deliver safer and more effective health care. [ABSTRACT FROM AUTHOR]

Young people in rural, regional, and remote communities experience high levels of mental distress. Health services in rural and remote communities are also poorer in quality. Hence, it is critical to understand how social work can help young people in these areas access mental health supports. This scoping review identifies what enables and hinders access to mental health services for young people in rural, regional, and remote areas of Australia and Canada. Twenty-two studies published between 2018 and 2022 were included and analyzed. Findings highlight the need for social workers to reduce peer-stigmatization of mental illness and foster community collaboration. [ABSTRACT FROM AUTHOR]

Background and aims: Australians spend more per capita on gambling than any other country in the world. Electronic gaming machines (EGM) expenditure accounts for almost 90% of this expenditure. No study to date has conducted a rigorous longitudinal analysis of the relationship between gambling expenditure and crime. This study aimed to estimate the short‐ and long‐run relationship between gambling expenditure and crime. Design: Longitudinal analysis using panel autoregressive distributed lag (ARDL) modelling. Setting and cases: Recorded property and violent crimes committed in New South Wales (NSW), Australia, between 28 December 2015 and 5 January 2020. Measurements Monthly gross EGM expenditure profit, broken down by Local Government Area (LGA). Monthly recorded rates of assault, break enter and steal (dwelling), break enter and steal (non‐dwelling), break enter and steal (total), motor vehicle theft, stealing from a motor vehicle, stealing from a retail store, stealing from the person, stealing (total) and fraud. Findings Each 10% increase in gambling expenditure in NSW is associated with annual: 7.4% increase in assaults, 10.5% increase in break and enter (dwelling) offences; 10.3% increase in break and enter (non‐dwelling) offences; 11% increase in motor vehicle theft offences; 8.2% increase in stealing from motor vehicle offences; and 7.4% increase in fraud offences. Conclusion: Electronic gaming expenditure appears to be positively associated with property and violent crime in New South Wales, Australia. [ABSTRACT FROM AUTHOR]

Aim: To describe the trends of hospitalisation for infections in people with diabetes and in the general population. Methods: People with diabetes were identified from the Australian National Diabetes Services Scheme linked to hospitalisation datasets from 2010/11 to 2018/19. Data on hospitalisations in the general population were obtained from the Australian Institute of Health and Welfare. Joinpoint regression software was used to calculate the annual percentage change (APC) of rates. Results: The rate of hospitalisation for total infections increased with an APC of 2.6% (95% CI: 1.5, 3.7) among people with type 1 diabetes, 3.6% (2.6, 4.6) among people with type 2 diabetes, and 2.5% (1.3, 3.9) in the general population. Increasing rates were observed for sepsis, influenza, kidney infections, osteomyelitis, cellulitis, and foot infections in all groups. The rate of hospitalisation for urinary tract infection declined among people with type 2 diabetes though it was stable in other groups. The rate of hospitalisation for respiratory tract infections was stable among people with type 1 diabetes but increased in other groups. The rate of hospitalisation for gastrointestinal infection was stable in all cohorts. Conclusion: Hospitalisation rates for infection have increased more rapidly over time in people with diabetes than in the general population. [ABSTRACT FROM AUTHOR]

Objectives: In overdose, gamma‐hydroxybutyrate (GHB) and its precursors can cause decreased levels of consciousness, coma and death. Here, we aim to describe reported exposure to GHB at four EDs in Sydney, New South Wales (NSW), Australia. Methods: We searched the ED databases of four Sydney metropolitan hospitals for presentations relating to GHB exposure between 2012 and 2021. We calculated annual number of presentations stratified by hospital, age, sex, mode of arrival and triage category. Results: A total of 3510 GHB‐related presentations to ED were recorded across the four hospitals. Data for all hospitals were only available from 2015 onwards and between 2015 and 2021; there was a 114% increase in annual presentations (from 228 to 487). Males represented 68.7% of all presentations and the median age was 31 years (range 16–74 years). There was an increase in the proportion of female presentations between 2012 and 2021 (from 27.9% to 37.9%) along with the severity of presentation over the same period, with the proportion of presentations with a triage category 1 increasing from 19.7% to 34.5%. Conclusions: Increases in recorded absolute number and severity of GHB‐related presentations to Sydney EDs are a major public health concern. There may also be shifts in the demographics of those with GHB‐related presentations. Renewed efforts are required to understand the drivers of these increases to optimally target harm reduction approaches. [ABSTRACT FROM AUTHOR]

This paper investigates the impact on Culturally and Linguistically Diverse (CALD) communities in Australia of government and community responses to the coronavirus pandemic of 2019 in the domains of education, employment, housing, social connectedness, and public health communication. Most of the examples are drawn from the state of New South Wales. In Australia, CALD refers to people from countries not classified as main English speaking. Most CALD communities reported in this article are from refugee backgrounds, are recently arrived migrants or do not use English in most of their communication. Inadequate, and in some instances, inappropriate or absent support, adversely impacts CALD communities. We used a multidisciplinary bricolage approach that draws on media, government, and community support publications and concluded that CALD communities experienced heightened pressures due to lower resource availability and poor communication. This led to disruption of support services, exposing gaps and vulnerability. The results reported here challenge Australian government, schools, community agencies, researchers to include proactively CALD community perspectives when planning and responding to such crises in future. Improving communication, pandemic response planning, addressing needs and ensuring participation are key considerations. [ABSTRACT FROM AUTHOR]

Aim: Oncology care provision by multidisciplinary teams (MDTs) is widely acknowledged as best practice. Formal team meetings, led by chairpersons, coordinate decisions on diagnosis, staging, treatment planning, and review. This study addresses a gap in meeting Chairs' perspectives on factors affecting functionality across the meeting cycle, from pre‐meeting patient list triage to post‐meeting dissemination of recommendations. Methods: Semi‐structured interviews were conducted in person with Chairs within two urban geographical regions in New South Wales, Australia as part of a larger project. Though the population of oncology MDT Chairs in Australia is small, the richness and depth of data from nine Chairs were considered to be valuable knowledge in support of extant literature on meeting functionality. An integrated deductive‐inductive approach was applied to data analysis. Results: Perceived facilitators, barriers, and ideals relating to pre‐meeting, in‐meeting, and post‐meeting functionality were identified across five pre‐determined analytic categories: the team; meeting infrastructure; meeting organization and logistics; patient‐centered clinical decision‐making, and; team governance. Key barriers included inadequate information technology, limited support staff, and lack of dedicated time for Chair duties. Corresponding facilitators included robust Information Technology infrastructure and support, provision of clinically knowledgeable MDT meeting coordinators, and formal employment recognition of Chairs' responsibilities and skill sets. Conclusion: Chairs across various tumor streams develop workarounds to overcome barriers and ensure quality meeting outcomes. With more robust support they could enhance value by sharing evidence, conducting audits, and engaging in research. The findings highlight the need for healthcare systems to support tumor stream clinical networks by allocating greater resources to prioritize multidisciplinary meetings and cancer care decision‐making. [ABSTRACT FROM AUTHOR]

Objective Setting Participants Design Results Conclusion To explore the experiences of clinician and management stakeholders involved in a rural/metropolitan collaborative mental health disaster response to the 2019–2020 Black Summer bushfires in the Snowy Valleys region of southern New South Wales (NSW), Australia.A mental health and drug health service in the Snowy Valleys region of rural NSW in collaboration with a mental health service from metropolitan Sydney, NSW.Mental health clinicians and managers from a rural health district (n = 6) and a metropolitan health district (n = 8) involved in a collaborative disaster response to the 2019–2020 Black Summer bushfire disaster in the Snowy Valleys region of southern NSW, Australia.An interpretive qualitative study design using semi‐structured individual interviews, with transcripts analysed using Reflexive Thematic Analysis.Thematic findings on participant experiences are presented under three organising constructs of before (stepping up and jumping right in), during (finding a rhythm of working together), and after (profound personal and professional impacts) the mental health disaster response.Participant experiences had shared and distinct components before, during and after the mental health disaster response, culminating in profound personal and professional impacts. Findings highlight positive aspects and challenges for clinicians participating in a rural/metropolitan collaborative mental health disaster response. The findings of this study contribute new knowledge about experiences of mental health clinicians participating in a disaster response after bushfires, from dual perspectives of members of a bushfire‐affected community and those responding from outside a bushfire‐affected community, which may inform ongoing planning of responses to disaster in Australia. [ABSTRACT FROM AUTHOR]

Precision in grazing management is highly dependent on accurate pasture monitoring. Typically, this is often overlooked because existing approaches are labour-intensive, need calibration, and are commonly perceived as inaccurate. Machine-learning processes harnessing big data, including remote sensing, can offer a new era of decision-support tools (DST) for pasture monitoring. Its application on-farm remains poor because of a lack of evidence about its accuracy. This study aimed at evaluating and quantifying the minimum data required to train a machine-learning satellite-based DST focusing on accurate pasture biomass prediction using this approach. Management data from 14 farms in New South Wales, Australia and measured pasture biomass throughout 12 consecutive months using a calibrated rising plate meter (RPM) as well as pasture biomass estimated using a DST based on high temporal/spatial resolution satellite images were available. Data were balanced according to farm and week of each month and randomly allocated for model evaluation (20%) and for progressive training (80%) as follows: 25% training subset (1W: week 1 in each month); 50% (2W: week 1 and 3); 75% (3W: week 1, 3, and 4); and 100% (4W: week 1 to 4). Pasture biomass estimates using the DST across all training datasets were evaluated against a calibrated rising plate meter (RPM) using mean-absolute error (MAE, kg DM/ha) among other statistics. Tukey's HSD test was used to determine the differences between MAE across all training datasets. Relative to the control (no training, MAE: 498 kg DM ha−1) 1W did not improve the prediction accuracy of the DST (P > 0.05). With the 2W training dataset, the MAE decreased to 342 kg DM ha−1 (P < 0.001), while for the other training datasets, MAE decreased marginally (P > 0.05). This study accounts for minimal training data for a machine-learning DST to monitor pastures from satellites with comparable accuracy to a calibrated RPM which is considered the 'gold standard' for pasture biomass monitoring. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is a major cause of health loss internationally, and in Australia. Most of that loss is inequitably concentrated among vulnerable or disadvantaged people and amenable to prevention and earlier detection. In response, best practice lung cancer care considers peoples' background, circumstances and care needs. Comprehensive, person level descriptions of demographic, health and discrete socio-economic disadvantage related factors are therefore required to inform best practice. We examine population wide correlations of demographic, health and socioeconomic characteristics with lung cancer diagnosis for use in cancer control programs, including screening. Methods: A study of 5,504,777 (89.9%) adults living in New South Wales and participating in Australia's Census in August 2016 with subsequent follow-up to the end of 2018. The Australian Bureau of Statistics' (ABS) person-level integrated data asset linked census records with the NSW population cancer registry which includes primary site. Our study compared census participants who did not experience cancer in the follow-up period with those diagnosed with lung cancer, (n = 6160 and ICD10 C33-34). Outcomes are expressed as the adjusted relative odds (aOR) of incident lung cancer among adults in the community and measured using multi-variable logistic regression models. Validated ABS methods informed categorisation of social and economic variables. Results: Multivariable comparison of those with lung cancer and those without a first cancer diagnosis (3276 lung cancers among 2,484,145 males; 2884 lung cancers among 2,944,148 females) showed associations with increasing age, varying ancestry, living alone (aOR = 1.30 95% CI 1.19–1.42 males; 1.24 95% CI 1.14–1.35 females), number of health conditions medicated, less than Year 12 education (aOR = 1.40 95% CI 1.30–1.51 males; 1.37 95% CI 1.27–1.48 females) and housing authority rental (aOR = 1.69 95% CI 1.48–1.94 males; 1.85 95% CI 1.63–2.11 females). Additional associations occurred among males with low income, disabilities before age 70, those unemployed and labouring occupations. As numbers of characteristics increased, so did the likelihood of lung cancer. Conclusion: We provided a population wide description of characteristics relevant to lung cancer diagnosis. Deeper knowledge of these characteristics inform continuing development of lung cancer programs in prevention (e.g. tobacco control) and detection (e.g. lung cancer screening), then help prioritise targeted delivery of those programs. [ABSTRACT FROM AUTHOR]

Over the past decade, escalating extreme weather events have significantly affected New South Wales (NSW), Australia, with unprecedented droughts and intense fires. Yet, the impact on water quality and purification processes remains insufficiently studied. This research focuses on the immediate changes in NSW's environmental water quality and issues in water purification unit operations following the 2019 bushfires. Water samples and maintenance records from affected catchments, intakes, purification units, and reservoirs were analysed. Compared to control samples, post-bushfire water exhibited high turbidity. Sediment and ash shock loads posed significant threats to aquatic ecosystems. Elevated turbidity, suspended sediments, pH, and alkalinity were major concerns for water purification. Raw water samples showed turbidity exceeding 195 NTU, with flocculation and sedimentation most impacted. Immediate measures included sediment traps, aeration, pre-chlorination, and inline monitoring. These findings inform strategies to mitigate bushfire impacts on water quality and optimise water purification in fire-prone regions. [ABSTRACT FROM AUTHOR]

Aiming at the problems of high stochasticity and volatility of power loads as well as the difficulty of accurate load forecasting, this paper proposes a power load forecasting method based on CEEMDAN (Completely Integrated Empirical Modal Decomposition) and TCN-LSTM (Temporal Convolutional Networks and Long-Short-Term Memory Networks). The method combines the decomposition of raw load data by CEEMDAN and the spatio-temporal modeling capability of TCN-LSTM model, aiming to improve the accuracy and stability of forecasting. First, the raw load data are decomposed into multiple linearly stable subsequences by CEEMDAN, and then the sample entropy is introduced to reorganize each subsequence. Then the reorganized sequences are used as inputs to the TCN-LSTM model to extract sequence features and perform training and prediction. The modeling prediction is carried out by selecting the electricity compliance data of New South Wales, Australia, and compared with the traditional prediction methods. The experimental results show that the algorithm proposed in this paper has higher accuracy and better prediction effect on load forecasting, which can provide a partial reference for electricity load forecasting methods. [ABSTRACT FROM AUTHOR]

Background: Anaemia during pregnancy is common worldwide. In Australia, approximately 17% of non-pregnant women of reproductive age have anaemia, increasing to a rate of 25% in pregnant women. This study sought to determine the rate of screening for anaemia in pregnancy in regional New South Wales, and to determine whether screening and treatment protocols followed the recommended guidelines. Methods: This retrospective study reviewed antenatal and postnatal (48 h) data of women (n = 150) who had a live birth at Bathurst Hospital between 01/01/2020 and 30/04/2020. Demographic data, risk factors for anaemia in pregnancy, antenatal bloods, treatments provided in trimesters one (T1), two (T2) and three (T3), and postpartum complications were recorded. These were compared to the Australian Red Cross Guidelines (ARCG) using descriptive statistics. Results: Of the women with screening data available (n = 103), they were mostly aged 20-35yrs (79.6%), 23.3% were obese, 97.1% were iron deficient, 17% were anaemic and only a few (5.3%) completed the full pregnancy screening as recommended by the ARCG while a majority completed only partial screenings specifically Hb levels in T1 (56.7%), T2 (44.7%) and T3 (36.6%). Compliance to oral iron was largely undocumented, but constipation was a common side effect among the women. IV iron was administered in 14.0% of women, approximately 1.75x higher than the recommended rate. Conclusions: This study provided useful information about compliance to screening and treatment guidelines for anaemia in pregnancy. We identified the need for improved documentation and communication between various health providers to ensure adequate antenatal care to prevent maternal complications during pregnancy. This will improve patient care and encourage further developments in maternal care, bridging the rural health gap. [ABSTRACT FROM AUTHOR]

Introduction: Population health management is increasingly being used to support place-based models of care. This case study provides an account of the use of the Population Health Management – Maturity Index (PHM-MI) tool to inform the future development of a neighbourhood model of care for older people in the Central Coast region of Australia. Description: The PHM-MI tool comprises a set of six evidence-informed elements known to be important in enabling PHM in practice. As part of a joint strategic needs assessment, 17 selected stakeholders from key regional organizations were invited to undertake the PHM-MI tool survey. Three follow-up workshops were held to interpret the results and determine priority actions. Discussion: The PHM-MI scores revealed that the overall maturity of the Central Coast to successfully deliver PHM was low across all six elements, findings that were corroborated through participant workshops. Systemic fragmentations, most pertinently of funding and regulation, incentivised silo-based working. The need to formalise and strengthen regional collaborations, enable data integration, find creative ways to use existing funding streams, and promote community engagement were highlighted as core priorities. Conclusion: Using the PHM-MI tool was enabled by it being embedded within a pre-existing regional strategic process. The results were used to inform future regional priorities. The PHM-MI tool has the potential for use across regional or national contexts. [ABSTRACT FROM AUTHOR]

Issue Addressed: People with a mental health condition are at risk of developing chronic physical disease due to smoking tobacco, inadequate nutrition, high alcohol consumption, low physical activity and poor sleep (SNAPS). Community managed organisations (CMOs) represent an opportune setting to support mental health consumers to improve their health behaviours through providing preventive care. Reporting of methods used to co‐develop implementation strategies to assist CMO staff to deliver preventive care for SNAPS are scarce yet warranted. Objectives: This study aims to: (1) describe a co‐development workshop involving CMO staff and researchers to identify preferred implementation support strategies to help staff routinely provide preventive care; (2) describe the strategies that emerged from the workshop; and (3) report staff ratings of the workshop on four co‐development principles. Methods: A three‐hour co‐development workshop was conducted on two occasions with staff of one CMO in New South Wales, Australia. Twenty staff participated in the workshops. Results: Participants generated and ranked a total of seven discrete implementation strategies within five categories (training, point of care prompts, guidelines, continuous quality improvement and consumer activation). Training for staff to have difficult conversations about behaviour change was ranked highest in both workshops. Participants rated the workshops positively across four co‐development principles. Conclusions: The co‐development workshop enabled implementation strategies to be developed within the context in which they were to be delivered and tested, potentially increasing their feasibility, acceptability, appropriateness and impact. So What?: Implementation strategies selected from the workshops will inform a pilot implementation support trial to assist CMO staff to provide preventive care to people with mental health conditions. [ABSTRACT FROM AUTHOR]

Aims: Oxycodone is the most commonly prescribed strong opioid in Australia. This study describes health service antecedents and sociodemographic factors associated with oxycodone initiation. Methods: Population‐based new user cohort study linking medicine dispensings, hospitalizations, emergency department visits, medical services and cancer notifications from New South Wales (NSW) for 2014–2018. New users had no dispensings of any opioid in the preceding year. We analysed health service use in the 5 days preceding initiation and proportion of people on treatment over 1 year and fitted an area‐based, multivariable initiation model with sociodemographic covariates. Results: Oxycodone accounted for 30% of opioid initiations. Annually, 3% of the NSW population initiated oxycodone, and 5–6% were prevalent users; the new user cohort comprised 830 963 people. Discharge from hospital (39.3%), therapeutic procedures (21.4%) and emergency department visits (19.7%) were common; a hospital admission for injury (6.0%) or a past‐year history of cancer (7.2%) were less common. At 1 year after initiation, 4.6% of people were using oxycodone. In the multivariable model, new use of oxycodone increased with age and was higher for people outside major cities, for example, an incidence rate ratio of 1.43 (95% confidence interval 1.36–1.51) for inner regional areas relative to major cities; there was no evidence of variation in rates of new use by social disadvantage. Conclusion: About half of new oxycodone use in NSW was preceded by a recent episode of hospital care or a therapeutic procedure. Higher rates of oxycodone initiation in rural and regional areas were not explained by sociodemographic factors. [ABSTRACT FROM AUTHOR]

This paper explores young people's understandings of gender and investigates their gender-based experiences in high schools in Australia. The discussion is based on qualitative research including focus groups and interviews with 47 recent high school leavers from diverse linguistic, socioeconomic, religious, ethnic, gender and sexuality backgrounds, who attended a broad range of high school types in New South Wales (NSW). We found that young people are critically engaging in gender issues and are often challenging binary gender and associated inequitable practices in schools and beyond. They are taking a leading role in educating adults about gender—that is, they are 'teaching up', as young people conceptualised it, to their families and teachers about gender, gender-related issues and doing gender differently in contemporary times. Their views on gender are often in contrast to those institutional views that currently prevail in NSW schools, which often still reflect stereotypes that perpetuate gender inequalities. [ABSTRACT FROM AUTHOR]

Understandings of gender diversity have increasingly recognised the rights and experiences of children and young people (Meyer & Pullen Sansfaçon, 2014, Smith et al., 2014). A small, but significant body of work focusses on the schooling experiences of gender diverse children/young people. The critical role parents play in supporting gender diverse children/young people is acknowledged (Davy & Cordoba, 2020; Riley et al., 2011), including their involvement in negotiating schooling. This research uses a qualitative research design to explore the schooling experiences of five parents with gender diverse children, attending primary or secondary schools in New South Wales, Australia. A feminist poststructuralist framework was used to analyse the complex factors that influenced school choice, and to explore the challenges or opportunities they had encountered during their child's schooling years. The participants in this study highlighted the qualities of schools they believed to be inclusive, which affirmed their own school choice. However, participants also reflected on their sense of rejection when their children were not accommodated at school, or when they had to find a new school. Negotiations around school choice were made easier with economic and social capital. These findings highlight the layered inequalities of the Australian educational marketplace. [ABSTRACT FROM AUTHOR]

Monitoring inundation in flow-dependent floodplain wetlands is important for understanding the outcomes of environmental water deliveries that aim to inundate different floodplain wetland vegetation types. The most effective way to monitor inundation across large landscapes is with remote sensing. Spectral water indices are often used to detect water in the landscape, but there are challenges in using them to map inundation within the complex vegetated floodplain wetlands. The current method used for monitoring inundation in the large floodplain wetlands that are targets for environmental water delivery in the New South Wales portion of the Murray–Darling Basin (MDB) in eastern Australia considers the complex mixing of water with vegetation and soil, but it is a time-consuming process focused on individual wetlands. In this study, we developed the automated inundation monitoring (AIM) method to enable an efficient process to map inundation in floodplain wetlands with a focus on the lower Lachlan floodplain utilising 25 Sentinel-2 image dates spanning from 2019 to 2023. A local adaptive thresholding (ATH) approach of a suite of spectral indices combined with best available DEM and a cropping layer were integrated into the AIM method. The resulting AIM maps were validated against high-resolution drone images, and vertical and oblique aerial images. Although instances of omission and commission errors were identified in dense vegetation and narrow creek lines, the AIM method showcased high mapping accuracy with overall accuracy of 0.8 measured. The AIM method could be adapted to other MDB wetlands that would further support the inundation monitoring across the basin. [ABSTRACT FROM AUTHOR]

A chance discovery early in 1980 led to a body of work on a virus and a rare species that lasted until the end of the decade. The discovery and characterisation of turnip yellow mosaic virus (TYMV-Cd) infecting one-fifth of the fragmented population of Cardamine robusta at Mt Kosciuszko, New South Wales, revealed a puzzle that remains unresolved. There is no clear explanation as to why there is a population of TYMV here in the Southern Hemisphere whose sequence has only diverged from Northern Hemisphere TYMV by a few percent. Adding to the mystery is the fact that TYMV-Cd only infects one of the rarest and geographically most restricted species in Australia, while it is surrounded by potential hosts known to be infected in the Northern Hemisphere. This article reviews research published on TYMV at Mt Kosciuszko during the 1980s and 1990s. While human agency cannot be ruled out, indications are that TYMV established without human intervention. The work is set in a historical context and highlights some of the changes around how plant virology is done. A chance discovery in alpine Australia in 1980 led to the discovery of a virus in a remote and rare species of plant. The virus has clear connections with a virus in the Northern Hemisphere. The way we study plant virology has changed over the intervening years but the mystery as to how the virus got there remains. Photograph by: PL Guy 2004. [ABSTRACT FROM AUTHOR]

Sugarcane is one of Australia's major agricultural industries, with approximately 95% of the crop being grown in Queensland and the remainder in northern New South Wales. In the last decade of the nineteenth century, cane growers in northern New South Wales started to see a new disease that resulted not only in the death of plants but also in difficulties in the extraction of sugar. Theories about the cause abounded, but investigations by the New South Wales vegetable pathologist Nathan Cobb revealed that the disease, previously unknown to the world, was caused by a microbe in the creamy 'gum' that could be commonly found in the vascular tissues of affected stalks. He named the organism Bacillus vascularum (now known as Xanthomonas axonopodis pv. vasculorum). For some time after, the disease was known as 'Cobb's gumming disease of sugarcane'. The Australian bacteriologist Robert Greig-Smith was not convinced that Cobb had conclusively demonstrated that B. vascularum was the culprit, mainly because he did not satisfy Koch's Postulates. However, the American bacteriologist Erwin Frink Smith came to Cobb's rescue when he proved beyond doubt that B. vascularum was to blame. The disease is now known simply as 'gumming disease of sugarcane'. At the start of the decade of 1890, sugarcane growers in southern Queensland and northern New South Wales began to notice a serious disease affecting their crops. American-born Nathan Cobb, who was the New South Wales Government Vegetable Pathologist, discovered that a bacterium, now known as Xanthomonas axonopodis pv. vasculorum , was the cause of the disease. Although others were not convinced that Cobb had conclusively proved that the bacterium was the causal agent, it was for many years known as 'Cobb's gumming disease of cane'. [ABSTRACT FROM AUTHOR]

Creative practice is frequently being deployed in research by cultural geographers. This article explores one such deployment, centering on a participatory community art exhibition titled 'Wheelability'. The exhibition was organized by non-disabled geographers for people who use powered mobility devices in the Northern Rivers region of New South Wales, Australia. The article illustrates the distinctive contribution art can make to disability mobility justice. It uses the personal stories and mobile creative expressions of one co-researcher and their carer to explore how engaging in creative activities provides opportunities to understand the emotional aspects of everyday mobility challenges and what emotions can do. Thinking through the emotional geographies of a mobile form of creative practice allows us to illustrate how dominant social norms are confirmed, ruptured, and reconfigured by the co-researcher. In conclusion, we discuss the implications of creative practices for conducting geographical research that promotes justice for individuals with mobility disabilities. [ABSTRACT FROM AUTHOR]

In Australia, transcatheter aortic valve implantation (TAVI) is only performed in a limited number of specialised metropolitan centres, many of which are private hospitals, making it likely that TAVI patients who require readmission will present to another (non-index) hospital. It is important to understand the impact of non-index readmission on patient outcomes and healthcare resource utilisation. We analysed linked hospital and death records for residents of New South Wales, Australia, aged ≥18 years, who had an emergency readmission within 90 days following a TAVI procedure in 2013–2022. Mixed-effect, multi-level logistic regression models were used to evaluate predictors of non-index readmission, and associations between non-index readmission and readmission length of stay, 90-day mortality, and 1-year mortality. Of 4,198 patients (mean age, 82.7 years; 40.6% female) discharged alive following TAVI, 933 (22.2%) were readmitted within 90 days of discharge. Over three-quarters (76.0%) of those readmitted returned to a non-index hospital, with no significant difference in readmission principal diagnosis between index hospital and non-index hospital readmissions. Among readmitted patients, independent predictors of non-index readmission included: residence in regional or remote areas, lower socio-economic status, having a pre-procedure transfer, and a private index hospital. Readmission length of stay (median, 4 days), 90-day mortality (adjusted odds ratio [OR] 1.04, 95% confidence interval [CI] 0.56–1.96) and 1-year mortality (adjusted OR 1.01, 95% CI 0.64–1.58) were similar between index and non-index readmissions. Non-index readmission following TAVI was highly prevalent but not associated with increased mortality or healthcare utilisation. Our results are reassuring for TAVI patients in regional and remote areas with limited access to return to index TAVI hospitals. [ABSTRACT FROM AUTHOR]

Aim: Sodium‐glucose cotransporter 2 inhibitors (SGLT2is) and glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) improve glycaemic control and cardio‐renal outcomes for people with type 2 diabetes (T2D). However, geographic and socio‐economic variation in use is not well understood. Methods: We identified 367 829 New South Wales residents aged ≥40 years who dispensed metformin in 2020 as a proxy for T2D. We estimated the prevalence of use of other glucose‐lowering medicines among people with T2D and the prevalence of SGLT2i and GLP‐1RA use among people using concomitant T2D therapy (i.e. metformin + another glucose‐lowering medicine). We measured the prevalence by small‐level geography, stratified by age group, and characterized by remoteness and socio‐economic status. Results: The prevalence of SGLT2i (29.7%) and GLP‐1RA (8.3%) use in people with T2D aged 40‐64 increased with geographic remoteness and in areas of greater socio‐economic disadvantage, similar to other glucose‐lowering medicines. The prevalence of SGLT2i (55.4%) and GLP‐1RA (15.4%) among people using concomitant T2D therapy varied across geographic areas, with lower SGLT2i use in more disadvantaged areas and localized areas of high GLP‐1RA use (2.5 times the median). Compared with people aged 40‐64 years, the prevalence of SGLT2i and GLP‐1RA use was lower in older age groups, but with similar patterns of variation across geographic areas. Conclusions: The prevalence of SGLT2i and GLP‐1RA use varied by geography, probably reflecting a combination of system‐ and prescriber‐level factors. Socio‐economic variation in GLP‐1RA use was overshadowed by localized patterns of prescribing. Continued monitoring of variation can help shape interventions to optimize use among people who would benefit the most. [ABSTRACT FROM AUTHOR]

Objective: To identify the size and distribution of the horse population in the Northern Rivers Region of NSW, including changes from 2007 to 2021, to better understand populations at risk of Hendra virus transmission. Methods: Census data from the 2007 Equine Influenza (EI) outbreak were compared with data collected annually by New South Wales Local Land Services (LLS) (2011–2021), and with field observations via road line transects (2021). Results: The horse populations reported to LLS in 2011 (3000 horses; 0.77 horses/km2) was 145% larger than that reported during the EI outbreak in 2007 (1225 horses; 0.32 horses/km2). This was inconsistent with the 6% increase in horses recorded from 2011 to 2020 within the longitudinal LLS dataset. Linear modelling suggested the true horse population of this region in 2007 was at least double that reported at the time. Distance sampling in 2021 estimated the region's population at 10,185 horses (3.89 per km2; 95% CI = 4854–21,372). Field sampling and modelling identified higher horse densities in rural cropland, with the percentage of conservation land, modified grazing, and rural residential land identified as the best predictors of horse densities. Conclusions: Data from the 2007 EI outbreak no longer correlates to the current horse population in size or distribution and was likely not a true representation at the time. Current LLS data also likely underestimates horse populations. Ongoing efforts to further quantify and map horse populations in Australia are important for estimating and managing the risk of equine zoonoses. [ABSTRACT FROM AUTHOR]

Social impact assessment as a concept and practice is generally framed as a process for delivering socially equitable outcomes, and in particular, a vehicle for improving the lives of society's most vulnerable and marginalised people. For example, the International Association for Impact Assessment 2015 guidance document makes the normative statement that projects should benefit local communities and be a 'force for positive social change and beneficial social development'. Yet most guidance provides little prescription for what this looks like in practice. More recently, the New South Wales 2021 guideline includes distributive equity as a principle for social impact assessment, but its application is yet to be tested. This article discusses key dimensions of equity concepts, drawing on international social impact assessment guidance documents, academic literature on equity, fairness and justice, and case studies in Australia. We elaborate process/procedural/participative and outcome/distributive dimensions of equity. We further argue that, to reflect the International Association for Impact Assessment position, social impact assessment needs to defend its normative purpose of advancing equity, rather than simply 'considering' equity impacts. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the collaborative practice between speech-language pathologists (SLPs) and teachers in two Australian states with different policies and legislations affecting SLP services in schools. Methods: Teachers from New South Wales (NSW) and Queensland (QLD) completed an online survey (N = 117). A mixed-method approach was used to analyse teachers' responses in the survey. Results: QLD teachers were significantly more likely to work with SLPs in multiple models of collaborative practice. NSW teachers were more than twice as likely to work with SLPs in the pull-out model as the single means of collaborative practice. While NSW and QLD teachers accessed SLP services differently, they perceived funding and lack of time to be influencing collaborative practices. A clear need was highlighted for SLPs and teachers to develop a greater depth of shared understanding for successful collaborative practices. Conclusion: This study provided preliminary insight into SLP-teacher collaborative practices in two Australian states with different policies and legislations affecting SLP services in schools. There is a need for evidence-based and student-centred guidelines to facilitate SLP-teacher collaborative practices in schools. [ABSTRACT FROM AUTHOR]

Zieria buxijugum , Z. formosa , and Z. parrisiae are three closely related, Critically Endangered species of questionable taxonomic validity that occur within six kilometres of each other on the south coast of New South Wales, Australia. We investigated genetic relationships and diversity of these species, along with two related but taxonomically distinct congeners, Z. granulata and Z. tuberculata , and a possible undescribed taxon, Z. aff. tuberculata. Double-digest restriction-site associated sequencing (ddRADseq) was used to generate anonymous genomic loci that were used for phylogenetic, network, and genetic structure analyses, and for estimating genetic diversity of the threatened species. Our results support the current taxonomic status of Z. buxijugum , Z. formosa , and Z. parrisiae , and suggest that Z. aff. tuberculata warrants recognition as a distinct species. We detected no evidence of inbreeding in the three Critically Endangered species, and found their genetic diversity to be similar to that of the more widespread species Z. granulata and Z. tuberculata. Comparison of plant material held in ex situ collections at the Australian National Botanic Gardens with wild plants highlighted several genotypes of the Critically Endangered species that are not represented in the ex situ collection, and we provide suggestions for the future inclusion of those unrepresented genotypes. [ABSTRACT FROM AUTHOR]

In Australia, the policy priorities and processes of government and national governing bodies of sport impact how community sport organizations operate. This study explored the views of community sport club (CSC) officials (n = 53) in the Illawarra region in New South Wales, where there is a disparity in impact compared with their better‐resourced urban counterparts concerning sustainability, policy, and advocacy matters. Participants were surveyed for their views about the typically top‐down policy processes, inter‐organizational relationships, and advocacy for community sport. CSC officials participated in an online survey to assess opinions on resource issues and policy processes. The findings demonstrated that community sport is challenging to sustain and that CSC officials have little influence on policy. The outcome points to an appetite for advocacy from CSC officials in policy creation. Further, the Advocacy Coalition Framework is proffered as a platform for evaluating the viability of advocacy within community sport. [ABSTRACT FROM AUTHOR]

Invasive species pose a significant threat to global biodiversity, prompting the need for novel management strategies. We investigated the effect of pond placement in preventing colonization by Gambusia holbrooki, an invasive fish impacting amphibians, including the threatened green and golden bell frog (Litoria aurea). Because Gambusia moves between aquatic systems during surface flow events, we aimed to determine whether constructing ponds on elevated plots devoid of fish was less likely to be colonized due to the absence of two‐way water connectivity with sources from below. Over eight consecutive years, we monitored Gambusia presence at 50 ponds within an industrialized area of Kooragang Island, New South Wales, Australia, home to one of the largest extant subpopulations of L. aurea. This included 24 constructed ponds, 19 of which were on elevated plots, along with 26 historic ponds already present prior to the study. None of the ponds constructed on elevated plots were ever colonized by Gambusia during the study period, while most (three out of five) constructed at lower elevation and historical ponds (25 out of 26) were. Our findings indicate that the elevated plots acted as plateau safe havens, with elevation difference rather than proximity to Gambusia sources the key driver preventing colonization. These plateaus are now functioning as some of the only Gambusia‐free breeding habitat for L. aurea in this area. This research highlights the role of landscape topography and intentional pond placement in safeguarding newly constructed wetlands from invasive fish, providing insights for wetland conservation and biodiversity protection. [ABSTRACT FROM AUTHOR]

The global trend in offsetting for no‐net‐loss (NNL) is increasing, focusing on protecting high‐condition habitats and restoring degraded ones. Australia's New South Wales (NSW) Biodiversity Offset Scheme (BOS) promotes active restoration (AR; reconstruction of missing ecosystem properties, AR) on offset sites. We examined (1) the adoption of AR under the BOS, and (2) practical constraints and attitudes toward AR. Records of management actions on 138 proposed offset sites revealed that AR was proposed for 19.3% (12,180 ha) of the total offset area (67,310 ha). For areas with a low‐moderate condition score (26,528 ha), AR was proposed for only 27.3% (7248 ha), despite these being the areas where it would be most likely to be necessary. A survey of 111 individuals involved in offsetting policy and restoration revealed that while 76% agreed AR was necessary for NNL, financial constraints were seen as a major barrier. A structural equation model indicated that positive attitudes toward AR rules and AR as a social imperative were strongly linked to agreement on the necessity of AR for NNL outcomes. Our results indicate that attitudes could influence the adoption of AR on offset sites, even in cases where policies are explicitly designed to provide financial incentives for AR, as exemplified in the context of NSW. [ABSTRACT FROM AUTHOR]