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BACKGROUND/OBJECTIVES: Vulval lichen sclerosus (VLS) is a chronic inflammatory skin condition predominantly affecting the anogenital region in women and children. To date, there is lack of agreement amongst experts on a severity scale to aid assessment, research and treatment stratification on VLS. Furthermore, literature on best practice for long-term management of VLS is lacking. The aim of this consensus is to provide broad guidelines on the short and long-term management of VLS. METHODS: An initial focus group of Australasian experts in vulval dermatology developed a draft consensus statement for the management of VLS. Based on the results of the draft statement, a consensus panel of 22 Australasian experts, comprised of the initial and additional members, participated in an anonymous four-stage eDelphi process. Round 1 involved generation and voting on statements from the draft consensus statement developed by the focus group. In Rounds 2, 3 & 4, panel members were presented formal feedback from previous rounds and asked to indicate their level of agreement. Consensus was reached if there was ≥70% agreement on the importance of an item in the 4 (agree) to 5 (strongly agree) range. RESULTS: The expert panel, with a total of 504 collective years of experience in the field of VLS, reached consensus on a core set of 51 management statements related to diagnosis, severity, initial and long-term management, follow-up, and complications of VLS. CONCLUSIONS: This study has identified a set of management statements for VLS that may be useful in clinical practice in the Australasian population.

Background: Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods: AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings: Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, p

Research Statement: This project aimed to examine changes in surf amenity over time at Blacksmiths Beach, NSW. As part of the study, possible causes of historical change to surfing conditions were assessed and potential options to improve surf amenity were developed. A literature review was undertaken to assess examples of NSW and international beaches where surf amenity has been changed or managed. Possible options to improve and manage future surf amenity were identified in the short, medium and long term.

Research Statement: This project aimed to develop a conceptual design for a new ocean pool at Port Macquarie, NSW. As part of the study, best practice guidelines for ocean pool design were developed following review of the performance of a range of existing ocean pools in NSW and South Africa. These guidelines were prepared through literature review, and interviews with ocean pool managers and users. Importantly, the recommended ocean pool geometry balances the need to achieve flushing to maintain good water quality while also providing reasonable safety from wave overtopping. Contemporary coastal engineering techniques were then used to assess the local coastal processes at a variety of potential locations for the new ocean pool, and a preferred location was identified through a multi criteria assessment.

Study region: Thirlmere Lakes National Park, New South Wales, Australia Study focus: Uncertainties in water balance calculations can arise from errors associated with each of the budget input terms: precipitation, evapotranspiration, and inflows/outflows. However, uncertainties associated with the accuracy of the surface storage calculation have seldom been the focus of previous water balance studies. Digital elevation models (DEMs) used in water balance studies typically rely on bathymetric/topographic surveys, with remote-sensing techniques including satellite imaging processing, Light-Detection-and-Ranging (LiDAR), and unmanned-aerial-vehicle photogrammetry. This study investigates the vertical errors in bathymetric DEMs obtained from various remote-sensing techniques and its implication on water balance estimates in an intermittent wetland under drying conditions with vegetation encroachment. New hydrological insights: When bathymetry data obtained from different remote-sensing survey methods were adopted to calculate the water balance of a lake, variations in the model-predicted levels were attributed to the poor quality of photogrammetric DEMs. To improve the photogrammetric data, a new ground-filtering approach is developed, which reduces vertical errors induced by vegetation interference. The correlation (R2) of the DEMs, as compared to ground-truthed elevations, was improved from 0.5 before ground filtering to 0.9 after ground filtering. Using the ground-filtered DEM in the water balance calculation, a 70 % improvement was achieved in the water balance residuals. As such, uncertainties in lake and wetland bathymetry should be assessed in future water balance studies.