Patterns of service utilisation within Australian hepatology clinics: High prevalence of advanced liver disease

Accepted Article Abstract Background: Liver diseases in Australia are estimated to affect 6 million people with a societal cost of $51 billion annually. Information about utilization of specialist hepatology care is critical in informing policy makers about the requirements for delivery of hepatology-related health care. Aims: This study examined etiology and severity of liver disease seen in a tertiary hospital hepatology clinic, as well as resource utilisation patterns. Methods: A longitudinal cohort study included consecutive patients booked in hepatology outpatient clinics during a 3 month period. Subsequent outpatient appointments for these patients over the following 12 months were then recorded. Results: During the initial 3 month period 1471 appointments were scheduled with a hepatologist, 1136 of which were attended. 21% of patients were “new cases”. Hepatitis B (HBV) was the most common disease etiology for new cases (37%). Advanced disease at presentation varied between etiology, with HBV (5%), Hepatitis C (HCV) (31%), non-alcoholic fatty liver disease (NAFLD) (46%) and alcoholic liver disease (ALD) (72%). Most patients (83%) attended multiple hepatology appointments, and a range of referrals patterns for procedures, investigations and other specialty assessments were observed. Conclusions: There is a high prevalence of HBV in new case referrals. Patients with HCV, NAFLD and ALD have a high prevalence of advanced liver disease at referral, requiring ongoing surveillance for development of decompensated liver disease and liver cancer. These findings that describe patterns of health service utilisation among patients with liver disease provide useful information for planning sustainable health service provision for this clinical population

More equal than others?: Meeting the professional development needs of rural primary and secondary science teachers

It is often assumed that teachers in rural and remote schools are at a disadvantage when it comes to accessing professional development. But is there sufficient evidence to support this assumption? This paper reports findings from two national surveys comparing the professional development priorities of primary and secondary science teachers from metropolitan, provincial and remote schools. The research found that while teachers' unmet needs for some PD opportunities increased significantly with school remoteness, this was not the case for all opportunities. In teasing out the different PD priorities of primary and secondary science teachers, the paper provides evidence to help education authorities and professional organisations address the specific needs of teachers in different locations.

Online identification guides for Australian smut fungi (Ustilaginomycotina) and rust fungi (Pucciniales)

Interactive identification keys for Australian smut fungi (Ustilaginomycotina and Pucciniomycotina, Microbotryales) and rust fungi (Pucciniomycotina, Pucciniales) are available online at http://collections.daff.qld.gov.au. The keys were built using Lucid software, and facilitate the identification of all known Australian smut fungi (317 species in 37 genera) and 100 rust fungi (from approximately 360 species in 37 genera). The smut and rust keys are illustrated with over 1,600 and 570 images respectively. The keys are designed to assist a wide range of end-users including mycologists, plant health diagnosticians, biosecurity scientists, plant pathologists, and university students. The keys are dynamic and will be regularly updated to include taxonomic changes and incorporate new detections, taxa, distributions and images. Researchers working with Australian smut and rust fungi are encouraged to participate in the on-going development and improvement of these keys.

School policies on bullying and cyberbullying: Perspectives across three Australian states

Background Despite decades of research, bullying in all its forms is still a significant problem within schools in Australia, as it is internationally. Anti-bullying policies and guidelines are thought to be one strategy as part of a whole school approach to reduce bullying. However, although Australian schools are required to have these policies, their effectiveness is not clear. As policies and guidelines about bullying and cyberbullying are developed within education departments, this paper explores the perspectives of those who are involved in their construction. Purpose This study examined the perspectives of professionals involved in policy construction, across three different Australian states. The aim was to determine how their relative jurisdictions define bullying and cyberbullying, the processes for developing policy, the bullying prevention and intervention recommendations given to schools and the content considered essential in current policies. Sample Eleven key stakeholders from three Australian states with similar education systems were invited to participate. The sample selection criteria included professionals with experience and training in education, cyber-safety and the responsibility to contribute to or make decisions which inform policy in this area for schools in their state. Design and methods Participants were interviewed about the definitions of bullying they used in their state policy frameworks; the extent to which cyberbullying was included; and the content they considered essential for schools to include in anti-bullying policies. Data were collected through in-depth, semi-structured interviews and analysed thematically. Findings Seven themes were identified in the data: - (1) Definition of bullying and cyberbullying; - (2) Existence of a policy template; - (3) Policy location; - (4) Adding cyberbullying; - (5) Distinguishing between bullying and cyberbullying; - (6) Effective policy, and; - (7) Policy as a prevention or intervention tool. The results were similar both across state boundaries and also across different disciplines. Conclusion Analysis of the data suggested that, across the themes, there was some lack of information about bullying and cyberbullying. This limitation could affect the subsequent development, dissemination and sustainability of school anti-bullying policies, which have implications for the translation of research to inform better student outcomes.

A design approach to innovation in the Australian energy industry

Electricity businesses across Australia are facing many market disruptions, such as the increasing demand from the rapid uptake of domestic air conditioners and the contrasting problematic generation from solar power connections to the grid. In this context, the opportunity to proactively leverage forthcoming technological advances in battery storage and electric vehicles to address the steeply rising cost of electricity supply has emerged. This research explores a design approach to support a business to navigate such disruptions in the current market.This study examines a design-led approach to innovation conducted over a ten month action research study within a large, risk-averse firm in the Australian energy sector. This article presents results describing a current foresight gap within the business; the response of the business to using design-led innovation to address this issue; and the tools, approaches and processes used. The business responses indicate their perception of the value of qualitative customer engagement as a path to addressing, and potentially benefiting from, disruptive innovation. It is anticipated that these results will further business model development within the company, and assist in leveraging disruptive innovations for this industry participant, thus limiting future increases in the cost of electricity supply for customers in Australia.

Boosting the productivity and profitability of northern Australian beef enterprises: Exploring innovation options using simulation modelling and systems analysis

The financial health of beef cattle enterprises in northern Australia has declined markedly over the last decade due to an escalation in production and marketing costs and a real decline in beef prices. Historically, gains in animal productivity have offset the effect of declining terms of trade on farm incomes. This raises the question of whether future productivity improvements can remain a key path for lifting enterprise profitability sufficient to ensure that the industry remains economically viable over the longer term. The key objective of this study was to assess the production and financial implications for north Australian beef enterprises of a range of technology interventions (development scenarios), including genetic gain in cattle, nutrient supplementation, and alteration of the feed base through introduced pastures and forage crops, across a variety of natural environments. To achieve this objective a beef systems model was developed that is capable of simulating livestock production at the enterprise level, including reproduction, growth and mortality, based on energy and protein supply from natural C4 pastures that are subject to high inter-annual climate variability. Comparisons between simulation outputs and enterprise performance data in three case study regions suggested that the simulation model (the Northern Australia Beef Systems Analyser) can adequately represent the performance beef cattle enterprises in northern Australia. Testing of a range of development scenarios suggested that the application of individual technologies can substantially lift productivity and profitability, especially where the entire feedbase was altered through legume augmentation. The simultaneous implementation of multiple technologies that provide benefits to different aspects of animal productivity resulted in the greatest increases in cattle productivity and enterprise profitability, with projected weaning rates increasing by 25%, liveweight gain by 40% and net profit by 150% above current baseline levels, although gains of this magnitude might not necessarily be realised in practice. While there were slight increases in total methane output from these development scenarios, the methane emissions per kg of beef produced were reduced by 20% in scenarios with higher productivity gain. Combinations of technologies or innovative practices applied in a systematic and integrated fashion thus offer scope for providing the productivity and profitability gains necessary to maintain viable beef enterprises in northern Australia into the future.

Flying-foxes in the Australian urban environment - community attitudes and opinions

The urban presence of flying-foxes (pteropid bats) in eastern Australia has increased in the last 20 years, putatively reflecting broader landscape change. The influx of large numbers often precipitates community angst, typically stemming from concerns about loss of social amenity, economic loss or negative health impacts from recently emerged bat-mediated zoonotic diseases such as Hendra virus and Australian bat lyssavirus. Local authorities and state wildlife authorities are increasingly asked to approve the dispersal or modification of flying-fox roosts to address expressed concerns, yet the scale of this concern within the community, and the veracity of the basis for concern are often unclear. We conducted an on-line survey to capture community attitudes and opinions on flying-foxes in the urban environment to inform management policy and decision-making. Analysis focused on awareness, concerns, and management options, and primarily compared responses from communities where flying-fox management was and was not topical at the time of the survey. While a majority of respondents indicated a moderate to high level of knowledge of both flying-foxes and Hendra virus, a substantial minority mistakenly believed that flying-foxes pose a direct infection risk to humans, suggesting miscommunication or misinformation, and the need for additional risk communication strategies. Secondly, a minority of community members indicated they were directly impacted by urban roosts, most plausibly those living in close proximity to the roost, suggesting that targeted management options are warranted. Thirdly, neither dispersal nor culling was seen as an appropriate management strategy by the majority of respondents, including those from postcodes where flying-fox management was topical. These findings usefully inform community debate and policy development and demonstrate the value of social analysis in defining the issues and options in this complex human - wildlife interaction. The mobile nature of flying-foxes underlines the need for a management strategy at a regional or larger scale, and independent of state borders.

Whiteness scholarship in early childhood education

This paper explores how whiteness scholarship can support deep engagement with both historical and contemporary forms of whiteness and racism in early childhood education. To this point, the uptake of whiteness scholarship in the field of early childhood has focused predominantly on autobiographical narratives. These narratives recount white educators’ stories of ‘becoming aware’ or ‘unmasking’ their whiteness. In colonising contexts including Australia, New Zealand and Canada, understanding how whiteness operates in different ways and what this means for educational research and practice, can support researchers and educators to identify and describe more fully the impacts of subtle forms of racism in their everyday practices. In this paper, whiteness is explored in a broader sense as: a form of property; an organising principle for institutional behaviours and practices; and as a fluid identity or subject position. These three intersecting elements of whiteness are drawn on to analyse data from a doctoral study about embedding Aboriginal and Torres Strait Islander perspectives in early childhood education curricula in two Australian urban childcare settings. Analysis is focused on how whiteness operated within the research site and research processes, along with the actions, inaction and talk of two educators engaged in embedding work. Findings show that both the researcher and educators reinforced, rather than reduced the impacts of whiteness and racism, despite the best of intentions.

Frost trends and their estimated impact on yield in the Australian wheatbelt

Radiant spring frosts occurring during reproductive developmental stages can result in catastrophic yield loss for wheat producers. To better understand the spatial and temporal variability of frost, the occurrence and impact of frost events on rain-fed wheat production was estimated across the Australian wheatbelt for 1957–2013 using a 0.05 ° gridded weather data set. Simulated yield outcomes at 60 key locations were compared with those for virtual genotypes with different levels of frost tolerance. Over the last six decades, more frost events, later last frost day, and a significant increase in frost impact on yield were found in certain regions of the Australian wheatbelt, in particular in the South-East and West. Increasing trends in frost-related yield losses were simulated in regions where no significant trend of frost occurrence was observed, due to higher mean temperatures accelerating crop development and causing sensitive post-heading stages to occur earlier, during the frost risk period. Simulations indicated that with frost-tolerant lines the mean national yield could be improved by up to 20 through (i) reduced frost damage (~10 improvement) and (ii) the ability to use earlier sowing dates (adding a further 10 improvement). In the simulations, genotypes with an improved frost tolerance to temperatures 1 °C lower than the current 0 °C reference provided substantial benefit in most cropping regions, while greater tolerance (to 3 °C lower temperatures) brought further benefits in the East. The results indicate that breeding for improved reproductive frost tolerance should remain a priority for the Australian wheat industry, despite warming climates.

The Use of Australian Honey in Moist Wound Management

This project has investigated the correlation between antimicrobial activity and the non-peroxide activity of particular Leptospermum-derived honeys. Initial investigations tested the efficacy of these honeys against one particular bacteria (Staphylococcus aureus), while later studies assessed the effect of this honey on a range of food pathogens, animal pathogens (e.g. in mastitis) and human pathogens (e.g. golden Staph). Using honeys sourced from around Australia and screened against several reference microorganisms, the anti-microbial potency of one particular Australian honey (from Leptospermum polygalifolium) was shown to be comparable to NZ Manuka honey (from L.scoparium). The results of this screening of active honeys against pathogenic bacteria has supported the registration of honey by Capilano Honey Limited as a “Drug” with the Therapeutic Goods Administration based on its antimicrobial activity.

Scoping study to inform the development of the new national nutrition policy for Australia

This comprehensive report (748 pages) scopes a new nutrition policy for Australia (RFT 028/1213) Australian Department of Health and Ageing. Optimum nutrition is fundamental to good health. It is essential for the normal growth and physical and cognitive development of infants and children, contributes significantly to quality of life, wellbeing and workforce productivity, enhances resistance to infection and reduces the risk of obesity, chronic disease and premature death (AIHW 2012; NHMRC 2013). This scoping study reviews the current literature to identify: - key population health issues related to diet and nutrition within the Australian population; and - where gaps in current policy are evident. The scoping study reviews the literature on past and present national and international nutrition policies, strategies (policy actions), interventions and evaluations. The study analyses the evidence from the literature review and formulates recommendations regarding the key elements of effective nutrition policies including scope, guiding principles, format, key inclusions (content), development processes, governance, implementation, timelines, monitoring and surveillance, evaluation and review to guide the development of a new comprehensive National Nutrition Policy for Australia.

The professional development, resource and support needs of rural and urban ICT teachers

This paper presents findings from the SiMERR National Survey concerning the need priorities of secondary ICT teachers for professional development, resources and student learning experiences. The findings - drawn from a survey of 237 secondary ICT teachers across Australia - provide an opportunity to compare the needs of teachers working in metropolitan, provincial and remote schools. The study found that vacant ICT positions are difficult to fill ond that the novel on dynamic nature of ICT requires teachers to have more extensive opportunities for on-the-job training, collegial collaboration and mentoring than is the case for teachers of more traditional subjects like science and mathematics. The study also found that ICT teachers are commonly required to manage and maintain ICT resources and to assist other staff to use ICT resources, while being allocated insufficient time in which to do these additional activities. The implications of these and other findings are discussed along with recommendations to help address the needs of ICT teachers in different parts of Australia.

Digital revolution or digital divide: Will rural teachers get a piece of the professional development pie?

In order to sustain the rural education community, access to high quality professional development opportunities must become a priority. Teachers in rural areas face many challenges in order to access professional learning equitable to their city counterparts. In the current climate, the Federal government of Australia is committed to initiatives that support the use of ICT in education. These include initiatives such as the Digital Education Revolution, including the National Broadband Network. This "revolution" includes the committal of $2.2 billion funding over six years from 2008 - 2013 which purports to bring substantial and meaningful change to teaching and learning in Australian schools. Of this funding, the Prime Minister (former Minister for Education), Julia Gillard, has committed $40 million of the total budget to ICT related professional development for teachers. But how will rural teachers ensure they get a piece of the PD pie? Access to professional learning is critical and isolation from colleagues, professional associations and support structures can affect the retention of teachers and in turn affect the sustainability of rural communities. This research paper describes the findings of the first phase of a study that investigates access to professional learning from rural and remote areas of Western Australia, the efficiencies of this approach including teacher perceptions and possible opportunities for improvement through the application of technologies. A survey instrument was administered and the results from104 principals and teachers within the Remote Teaching Service and the Country Teaching Program of the Department of Education and Training (WA) are discussed. Qualitative data was collected by semi-structured interviews and emailed questionnaires. Phase One findings highlight the principals and teachers? perceptions of their access to professional development opportunities, professional learning communities and their use of information and communication technologies (ICT) to bridge the gap

Making decisions about antibiotic use in the Australian primary healthcare sector

Background Australia has one of the highest rates of antibiotic use amongst OECD countries. Data from the Australian primary healthcare sector suggests unnecessary antibiotics were prescribed for self-resolving conditions. We need to better understand what drives general practitioners (GPs) to prescribe antibiotics, consumers to seek antibiotics, and pharmacists to fill repeat antibiotic prescriptions. It is also not clear how these individuals trade-off between the possible benefits that antibiotics may provide in the immediate/short term, against the longer term societal risk of antimicrobial resistance. This project investigates what factors drive decisions to use antibiotics for GPs, pharmacists and consumers, and how these individuals discount the future. Methods Factors will be gleaned from published literature and from semi-structured interviews, to inform the development of Discrete Choice Experiments (DCEs). Three DCEs will be constructed – one for each group of interest – to allow investigation of which factors are more important in influencing (a) GPs to prescribe antibiotics, (b) consumers to seek antibiotics, and (c) pharmacists to fill legally valid but old or repeat prescriptions of antibiotics. Regression analysis will be conducted to understand the relative importance of these factors. A Time Trade Off exercise will be developed to investigate how these individuals discount the future. Results Findings from the DCEs will provide an insight into which factors are more important in driving decision making in antibiotic use for GPs, pharmacists and consumers. Findings from the Time Trade Off exercise will show what individuals are willing to trade for preserving the miracle of antibiotics. Conclusion Research findings will contribute to existing national programs to bring about a reduction in inappropriate use of antibiotic in Australia. Specifically, influencing how key messages and public health campaigns are crafted, and clinical education and empowerment of GPs and pharmacists to play a more responsive role as stewards of antibiotic use in the community.

Measuring the impact of burn scarring on health-related quality of life: Development and preliminary content validation of the Brisbane Burn Scar Impact Profile (BBSIP) for children and adults

INTRODUCTION No burn-scar specific, health-related quality of life (HRQOL) measure exists. This study aimed to develop a patient-reported, evaluative HRQOL measure to assess the impact of burn scarring in children and adults. METHOD Semi-structured interviews, content validation surveys, and cognitive interviews were used to develop and test content validity of a new measure - the Brisbane Burn Scar Impact Profile (BBSIP). RESULTS Participants comprised Australian adults (n=23) and children (n=19) with burn scarring; caregivers of children with burn scarring (n=28); and international scar management experts (n=14). Items distinct from other burn scar measures emerged. Four versions of the BBSIP were developed; one for children aged 8-18 years, one for adults, one for caregivers (as proxies for children aged less than 8-years), and one for caregivers of children aged 8-18 years. Preliminary content validity of the BBSIP was supported. Final items covered physical and sensory symptoms; emotional reactions; impact on social functioning and daily activities; impact of treatment; and environmental factors. CONCLUSION The BBSIP was developed to assess burn-scar specific HRQOL and will be available at http://www.coolburns.com.au under a creative commons license. Further testing is underway.