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Background: Critical care retrieval is a nascent field in South Africa. An increasing number of private and provincial emergency medical services are starting to invest in developing and setting up dedicated critical care retrieval services (CCRS). To date, there are no minimum standards or definitions on what constitutes a CCRS in the South African context. The aim of this paper is to describe the development of and propose a consensus definition of CCRS within the South African context. Methods: A literature search was performed to determine the key aspects of CCRS definitions elsewhere. An initial draft definition was circulated to the CCRS working group of the Emergency Care Society of South Africa (ECSSA) for commentary. Comments were collated, and a second round of commentary was undertaken. Finally, a consensus meeting was held through video-conferencing to finalise the definition presented herein. Thereafter, the definition was circulated to key role-players in emergency and critical care, both locally and internationally, for endorsement. The definition, as it is presented, has been endorsed by the ECSSA, the Southern African Society of Critical Care (SASCC), and the International Board for Specialty Certification (IBSC). Results: The proposed definition outlines five equally important aspects that should be demonstrable and interlinked to be denoted a CCRS. These five aspects are: specific patient populations, case selection, dedicated crew with additional training, dedicated equipment, and continuous quality management and training. Conclusion: Numerous questions remain unanswered regarding the best approach for CCRS development in South Africa and internationally. Defining what CCRS is in a South African context is a necessary departure point for further research endeavours to develop a core curriculum and practice standards.

An underlying tension exists between the fundamental elements of accountability, government decision-making, performance management, evidence-based policy and the measurement of results. This artic...

Quantitative field methods were used to refine eco-hydrogeological conceptual models of terrestrial groundwater dependent ecosystems (GDEs) in the Great Artesian Basin (GAB), Queensland, Australia. There are few studies which report on the effectiveness of published methods to ground truth the occurrence of assumed GDEs, particularly in areas subject to coal seam gas development. Using a combination of methods, a field investigation was completed at four sites in vegetation communities dominated by river red gum (Eucalyptus camaldulensis) in areas overlying the GAB. Multiple lines of evidence determined the predominant source of water utilised by large trees at each locality to assess if the terrestrial ecosystems were dependent on the presence of groundwater. Methods included soil coring to observe tree rooting depth and underlying hydrogeological conditions, matching of soil moisture with leaf water potential, and analysis of naturally occurring stable isotopes of hydrogen and oxygen found in tree xylem, soil moisture and groundwater. Results indicate that despite study locations being conceptually mapped as GDEs, trees located within at least three of the four assessed sites were predominantly utilising shallow sources of soil moisture located above the regional water-table aquifer. Also, rooting depths of targeted tree species were consistently much shallower (maximum depth 7.6 mbgl) than what is commonly reported in literature (12–22.6 mbgl). The findings highlight the importance of ground-truthing to refine the eco-hydrogeological conceptual models of GDEs using a combination of methods to create a holistic understanding of water sources for terrestrial vegetation communities in areas vulnerable to groundwater abstraction.

Background\ud \ud Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) has been reported in individual studies to significantly increase the rate of bystander CPR and survival from cardiac arrest.\ud \ud Methods \ud \ud We undertook a systematic review and meta-analysis to evaluate the impact of DA-CPR programs on key clinical outcomes following out-of-hospital cardiac arrest. We searched the PubMED, EMBASE, CINAHL, ERIC and Cochrane Central Register of Controlled Trials databases from inception until July 2018. Eligible studies compared systems with and without dispatcher-assisted CPR programs. Included studies were divided into three groups: comparison of outcomes in systems providing DA-CPR; comparison of cases where DA-CPR was provided to cases where bystander CPR was ongoing, and DA-CPR was not provided; and comparison of cases where DA-CPR was provided to cases where no bystander CPR was provided (patient level comparisons). The GRADE system was used to assess certainty of evidence at an outcome level. We used random-effects models to produce summary effect sizes across all outcomes.\ud \ud Results \ud \ud Of 5,531 citations screened, 33 studies were eligible for inclusion. All included studies were observational. Evidence certainty across all outcomes was assessed as low or very low. In system-level and patient-level comparisons, the provision of DA-CPR compared with no DA-CPR was consistently associated with improved outcome across all analyses. Comparison of DA-CPR to bystander CPR produced conflicting results. Findings were consistent across sensitivity analyses and the pediatric sub-group.\ud \ud Conclusion \ud \ud These results support the recommendation that dispatchers provide CPR instructions to callers for adults and children with suspected OHCA.\ud

Sudden out‐of‐hospital cardiac arrest is the third leading cause of death in industrialized nations. Many of these lives could be saved if bystander cardiopulmonary resuscitation rates were better. “All citizens of the world can save a life—CHECK—CALL—COMPRESS.” With these words, the International Liaison Committee on Resuscitation launched the 2019 global “World Restart a Heart” initiative to increase public awareness and improve the rates of bystander cardiopulmonary resuscitation and overall survival for millions of victims of cardiac arrest globally. All participating organizations were asked to train and to report the numbers of people trained and reached. Overall, social media impact and awareness reached up to 206 million people, and >5.4 million people were trained in cardiopulmonary resuscitation worldwide in 2019. Tool kits and information packs were circulated to 194 countries worldwide. Our simple and unified global message, “CHECK—CALL—COMPRESS,” will save hundreds of thousands of lives worldwide and will further enable many policy makers around the world to take immediate and sustainable action in this most important healthcare issue and initiative.

Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines. © 2018 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

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Recent policy shifts in health care have created opportunities for social workers to provide services in integrated primary care and behavioral health settings. However, traditionally prepared social workers may not have the skill set necessary to meet practice demands. This article describes a behavioral health workforce initiative that trains master’s of social work students for work in integrated primary care settings with children, adolescents, and transition-age youths. The training model includes field placements in integrated care settings, co-curricular seminars, and advanced clinical electives. This article identifies challenges of creating new field placements and developing new curricula to support students’ acquisition of knowledge and skills required in integrated care settings. Additionally, it presents data on changes in students’ knowledge and confidence.

This article uses longitudinal data to estimate the shortand medium-term economic effects of divorce in the USA, the UK, Switzerland, Korea, Germany and Australia during the first decade of the 21st century. Based on the data collected during the 2000s, in all of the countries studied, divorce had, on average, negative effects on the equivalised household incomes of women. However, the extent and duration of the negative effects of divorce differed markedly between countries. In all of the countries, the effects of divorce on the equivalised household income of men were smaller than for women. Although, using the available data, it is not possible to definitely explain the differences between countries, the analysis presented in this article has demonstrated that the average economic effects of divorce, particularly for women, are heavily influenced by the social security system, the labour market, family models and the family law system of each country. While the social security system and institutional arrangements such as child support and spousal maintenance do influence women's post-divorce economic outcomes, what is most important in explaining cross-country differences is women's labour market earnings and the extent to which re-partnering occurs.

The International Liaison Committee on Resuscitation has initiated a near-continuous review of cardiopulmonary resuscitation science that replaces the previous 5-year cyclic batch-and-queue approach process. This is the first of an annual series of International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations summary articles that will include the cardiopulmonary resuscitation science reviewed by the International Liaison Committee on Resuscitation in the previous year. The review this year includes 5 basic life support and 1 paediatric Consensuses on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Each of these includes a summary of the science and its quality based on Grading of Recommendations, Assessment, Development, and Evaluation criteria and treatment recommendations. Insights into the deliberations of the International Liaison Committee on Resuscitation task force members are provided in Values and Preferences sections. Finally, the task force members have pri-oritised and listed the top 3 knowledge gaps for each population, intervention, comparator, and outcome question. (C) 2017 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier B.V. All rights reserved.

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.

Burkholderia pseudomallei, a bacterium that lives in the soil of the tropics, causes the disease melioidosis. This retrospective study investigated the temporospatial epidemiology of the 49 laboratory-confirmed melioidosis cases in the Torres Straits Islands of tropical Australia between 1997 and 2017. An identifiable risk factor for the disease was present in 43/49 (88%) cases and in 35/36 (97%) cases with complete clinical data. The mean incidence of melioidosis varied across the region, from 0/100,000 persons/year in the Eastern Island Cluster to 116.1/100,000 persons/year in the Near Western Island Cluster. An environmental suitability score for the growth of B. pseudomallei-constructed using the rainfall, vegetation, and soil type on each island-correlated with disease incidence (Spearman's rho 0.51; P = 0.035). Melioidosis is an opportunistic disease that occurs in patients with specific risk factors, but its incidence is also strongly influenced by environmental factors that favor the growth of the causative organism.

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.

The past two decades have witnessed the application of new forms of conditionality to Australian social security policy. This paper argues that a distinctive feature has been the attempt to link receipt of government benefits to parental behaviour in order to address concerns about the welfare of children. With a view to providing a framework that can help to inform debates regarding the merits of these new forms of conditionality, this paper outlines the historical antecedents and philosophical framework of new conditionality. The paper also examines three pertinent Australian social security initiatives: the Maternity Immunisation Allowance, the Improving School Enrolment and Attendance through Welfare Reform Measure, and Compulsory Income Management. The paper concludes with some consideration of the potential pitfalls of new conditionality.

Key threatening processes to biodiversity include habitat loss and fragmentation, with populations restricted to small fragments of habitat being more prone to extinction. The mahogany glider (Petaurus gracilis) is endemic to sclerophyll woodland forests between Tully and Ingham in north Queensland and is one of Australia’s most endangered arboreal mammals due to these processes. The aim of this study was to identify the degree of habitat fragmentation of the remaining remnant vegetation of the mahogany glider, identify subpopulations within its distribution and identify key wildlife corridors for restoration to facilitate the movement of this species within and between subpopulations. Ten glider subpopulations, spread over 998 habitat fragments, were identified, of which only five subpopulations may currently be considered to be viable. To assist in providing habitat connectivity between and within the subpopulations, 55 corridors were identified for restoration that had an average length of 8.25 km. The average number of gaps greater than 30 m was 3.4 per corridor, with the average length of these gaps being 523 m. This study confirmed a high degree of habitat fragmentation across the distribution of the mahogany glider and highlighted the need to strengthen the remaining subpopulations by restoring habitat connectivity between the remaining habitat fragments.

Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines.

“All citizens of the world can save a life”. With these words, the International Liaison Committee on Resuscitation (ILCOR) is launching the first global initiative – World Restart a Heart (WRAH) – to increase public awareness and therefore the rates of bystander cardiopulmonary resuscitation (CPR) for victims of cardiac arrest. In most of the cases, it takes too long for the emergency services to arrive on scene after the victim's collapse. Thus, the most effective way to increase survival and favourable outcome in cardiac arrest by two- to fourfold is early CPR by lay bystanders and by “first responders”. Lay bystander resuscitation rates, however, differ significantly across the world, ranging from 5 to 80%. If all countries could have high lay bystander resuscitation rates, this would help to save hundreds of thousands of lives every year. In order to achieve this goal, all seven ILCOR councils have agreed to participate in WRAH 2018. Besides schoolchildren education in CPR (“KIDS SAVE LIVES”), many other initiatives have already been developed in different parts of the world. ILCOR is keen for the WRAH initiative to be as inclusive as possible, and that it should happen every year on 16 October or as close to that day as possible. Besides recommending CPR training for children and adults, it is hoped that a unified global message will enable our policy makers to take action to address the inequalities in patient survival around the world.

This paper situates the Henderson Poverty Inquiry in the context of other social security reviews occurring at the time and subsequently. Insights are drawn on the influence of these inquiries by exploring their characteristics, activities and findings and by reflecting on ensuing policy change. The analysis suggests that inquiries make diverse policy contributions across at least three dimensions: nature (inquiries contribute in different ways); extent (inquiries make different degrees of contribution); and temporality (some contribute in the short term; others exhibit a slow burn over many decades). With respect to the Henderson Poverty Inquiry, its contribution included influencing immediate policy change as well as providing an evidence base and strategic approach of value to subsequent policy development and inquiry activity. Its contribution was significant and enduring. This paper concludes by reflecting that wide-ranging social security inquiries have been very rare. Arguably, the last inquiry with breadth was the Henderson Poverty Inquiry. When considered in light of the extensive piecemeal reform of the social security system that has occurred over recent decades, this suggests a comprehensive and integrated review of social security policy in Australia is long overdue.

2017 marks the 25th anniversary of the International Liaison Committee on Resuscitation (ILCOR). ILCOR was formed in 1992 to create a forum for collaboration among principal resuscitation councils worldwide. Since then, ILCOR has established and distinguished itself for its pioneering vision and leadership in resuscitation science. By systematically assessing the evidence for resuscitation standards and guidelines and by identifying national and regional differences, ILCOR reached consensus on international resuscitation guidelines in 2000, and on international science and treatment recommendations in 2005, 2010 and 2015. However, local variation and contextualization of guidelines are evident by subtle differences in regional and national resuscitation guidelines. ILCORs efforts to date have enhanced international cooperation, and progressively more transparent and systematic collection and analysis of pertinent scientific evidence. Going forward, this sets the stage for ILCOR to pursue its vision to save more lives globally through resuscitation.

SUMMARY Social protection systems reflect each country's history, culture and social values, as well as its economic capacity. But, once first established, they can be very hard to redesign as expectations are locked in, and the scale of the systems makes major change a difficult and risky management challenge. This paper describes alternative designs of social security systems and how each addresses the two core objectives of poverty alleviation and income maintenance. Drawing on the ‘pillars’ typology or framework, the paper describes how different systems are being adjusted to meet changing demographic profiles and economic pressures. It focuses in particular on Australia, which has always emphasised ‘foundation pillar’ programmes aimed at poverty alleviation and has only recently given emphasis to income maintenance. In doing so, it has chosen a very different approach involving mandated contributions into mostly fully funded schemes where individuals rather than the government and future generations of taxpayers bear most of the risks. Australia has also restructured its schemes for public sector employees. What possible lessons are there for countries at the early stages of design and implementation of a social security system? Copyright © 2014 John Wiley & Sons, Ltd.

Divorce has become a key life-course risk that can have significant economic impacts. This article uses a new Australian data source that follows families over a 10-year period to estimate the impact of divorce on income and assets. There have been few longitudinal studies of the impact of divorce on assets and relatively few such studies of its impact on income. The article finds that divorce has a substantial negative impact upon the household income of women in the short term, but by 6 years after divorce income had largely recovered to what it would have been had they remained married. In contrast, men who divorce experience a substantially faster rate of increase in income post-divorce than had they remain married. The analysis of asset data reveals that while the gap between the value of assets of the divorced and non-divorced grows post-divorce, it appears that the growing disparity in assets largely reflects pre-divorce differences in assets. The results in this article clearly demonstrate the critical importance of using longitudinal data to estimate the economic and labour market consequences of divorce. While the economic effects of divorce on Australian women appear to be, on average, relatively short-run, the Australian social security system plays a crucial role in protecting the incomes of women post-divorce, particularly those with children.

SummaryMeeting all four natural criteria for United Nations World Heritage listing, the Wet Tropics World Heritage Area that covers 61% of the remaining vegetation of the bioregion conserves, on a biodiversity basis, habitats ‘containing threatened species of outstanding universal value from the point of view of science or conservation’. As discussed in an accompanying paper by the same authors, the Wet Tropics Bioregion faces a level of habitat change unprecedented in threat and scale and manifested in the transition of sclerophyll forests and woodlands to closed forest habitats, a change attributable to the absence of fire or reduction in its frequency.The implications of habitat change for certain threatened species and ecosystems present a challenge to conserving the ark of biodiversity the Wet Tropics represents. Evidence indicates that the dominant reason for these changes in vegetation patterns is the reduction in fire or its exclusion across a bioregion with the highest rainfall of the nation. It ...

SummaryThe vegetation and geology of the Wet Tropics Bioregion of North Queensland, covering 1 998 150 ha, were mapped at a scale of 1:50 000. The resulting geographic information system (GIS) data base provided an unprecedented opportunity to examine vegetation condition across the entire bioregion. Mapping used colour aerial photography at 1:25 000, informed by ground truthing. Vegetation type, nature of the understory and ground cover, degree and type of disturbance, and the presence of secondary vegetation were described by a coding system, with codes marked directly on the aerial photos.Analysis of these data has confirmed a picture, which emerged from ground truthing, of large areas of sclerophyll woodland and forest being invaded by a rainforest understory that prevents regeneration of the sclerophyll canopy. Fifty-three per cent of the native vegetation of the bioregion consists of non-rainforest vegetation types, dominated in both area and number by sclerophyll woodlands and forests. Seventeen pe...

In virtually all Organisation for Economic Co-operation and Development (OECD) countries the number of older people who have experienced divorce at some point in their lives will increase in coming decades. While there is an extensive literature that analyses the effects of divorce on wellbeing, there is relatively little research on the long-run effects of divorce in later life. This paper uses Australian data to estimate the long-run impacts of divorce on the wellbeing of older Australians. Dimensions of wellbeing examined are social interaction and connectedness, perceived social support, life satisfaction, and physical and mental health. The paper shows that divorce has a long-lasting, negative impact on wellbeing that persists into later life for both men and women. However, the negative effects of divorce on wellbeing are largely confined to those who do not re-partner. An important difference between men and women is that for women who are divorced and remain single, the negative effects of divorce are found for general health, vitality and mental health. Furthermore, these effects are reasonably large. For older men, there appear to be no long-term effects of divorce on physical or mental health. While there appears to be some effect of divorce on perceived social support for both older men and women, the effects of divorce on social support are less pervasive in later life than the effects of divorce on satisfaction with life and, for women, health.

Utstein-style guidelines contribute to improved public health internationally by providing a structured framework with which to compare emergency medical services systems. Advances in resuscitation science, new insights into important predictors of outcome from out-of-hospital cardiac arrest, and lessons learned from methodological research prompted this review and update of the 2004 Utstein guidelines. Representatives of the International Liaison Committee on Resuscitation developed an updated Utstein reporting framework iteratively by meeting face to face, by teleconference, and by Web survey during 2012 through 2014. Herein are recommendations for reporting out-of-hospital cardiac arrest. Data elements were grouped by system factors, dispatch/recognition, patient variables, resuscitation/postresuscitation processes, and outcomes. Elements were classified as core or supplemental using a modified Delphi process primarily based on respondents' assessment of the evidence-based importance of capturing those elements, tempered by the challenges to collect them. New or modified elements reflected consensus on the need to account for emergency medical services system factors, increasing availability of automated external defibrillators, data collection processes, epidemiology trends, increasing use of dispatcher-assisted cardiopulmonary resuscitation, emerging field treatments, postresuscitation care, prognostication tools, and trends in organ recovery. A standard reporting template is recommended to promote standardized reporting. This template facilitates reporting of the bystander-witnessed, shockable rhythm as a measure of emergency medical services system efficacy and all emergency medical services system-treated arrests as a measure of system effectiveness. Several additional important subgroups are identified that enable an estimate of the specific contribution of rhythm and bystander actions that are key determinants of outcome. (C) 2014 European Resuscitation Council and American Heart Association, Inc. Published by Elsevier Ireland Ltd. All rights reserved

Background: Experimental evidence suggests that substances able to interact with voltage-dependent Ca2+ channels (VDCCs) might be beneficial in glaucoma management. It was therefore of significance to show that β-adrenoceptor antagonists used in glaucoma directly interact with L-type VDCCs. In the present study, the affinity of several antiglaucoma drugs (betaxolol, carteolol, levobunolol, timolol, brimonidine, dorzolamide, latanoprost and pilocarpine) for these and other VDCCs was investigated using radioligand binding assays. Experiments were also carried out to assess the effect of antiglaucoma drugs on the NMDA-stimulated Ca2+ influx into isolated rat retinas. Methods: Competition radioligand binding studies to L-, N- and P/Q-type VDCCs were performed in rat cortical homogenates. The effects of antiglaucoma drugs on the NMDA-stimulated influx of 45Ca2+ were studied in isolated rat retinas. Results: Only β-adrenoceptor antagonists significantly interacted with radioligand binding to L-type VDCCs, with betaxolol displaying the highest potency. None of the antiglaucoma drugs tested showed any significant affinity for either N- or P/Q-type VDCCs. Only β-adrenoceptor antagonists attenuated the NMDA-stimulated 45Ca2+ influx into isolated rat retinas, with betaxolol exhibiting at least 10 times higher potency than timolol. Brimonidine, dorzolamide, latanoprost and pilocarpine did not elicit any significant effect on the NMDA-stimulated 45Ca2+ influx. Additional experiments strongly suggested that the effect of betaxolol on the NMDA-stimulated 45Ca2+ resulted from inhibition of L-type VDCCs. Conclusion: Of the antiglaucoma drugs investigated, betaxolol displays the greatest L-type VDCC-blocking activity and this may be of clinical relevance. Such a characteristic could account for some of its described ocular actions.

The paper outlines an approach to the assessment of policy options and program design. The core concepts of equity, effectiveness, employment, efficiency and economy are discussed. Real-world examples from Australian social policy are considered, including from areas such as retirement incomes; family allowances; dependency to work; disability support and health insurance. The delivery of social programs through the taxation system is also discussed. There clearly is no one template for turning policy principles into programs. Many processes and players may be involved and unpredictability is ever-present. Most governments are interested in achieving policy as well as political outcomes. They are also more constrained by economic and social realities than is often assumed. This imposes some order and logic on program development. From a policy adviser’s perspective, the key is ‘preparation meeting opportunity’. It is possible to insert rigour into the process if the issues have been anticipated, the research and analysis done, and the arguments assembled for ministers to consider.