Source: The Conversation (Au and NZ) – By Chris Hall, Associate Professor of Immunology, University of Auckland, Waipapa Taumata Rau

Ever found yourself out of sync with normal sleep patterns after late nights or working a night shift? It could be you’re experiencing what scientists call social jet lag.

The term describes the misalignment between our internal body clock (circadian rhythm) and our social schedule.

Social jet lag associated with irregular sleep patterns and inconsistent exposure to daylight is increasingly common, and has been linked with a weakened immune system.

Disruption of our circadian rhythms through shift work, for example, has been shown to have a negative impact on our ability to fight infections.

These observations reinforce the idea that maintaining a robust circadian rhythm through regular exposure to daylight supports a healthy immune system.

But how does the immune system know when it’s daytime? That is precisely what our research, published today in Science Immunology, has uncovered. Our findings could eventually deliver benefits for the treatment of inflammatory conditions.

First responders to infection

Circadian rhythms are a fundamental feature of all life on Earth. Believed to have evolved some 2.5 billion years ago, they enable organisms to adapt to challenges associated with the 24-hour solar day.

At the molecular level, these circadian rhythms are orchestrated through a genetically encoded multi-component time keeper called a circadian clock. Almost all cells are known to have the components for a circadian clock. But how they function within different cell types to regulate their behaviour is very poorly understood.

In the laboratory, we use zebrafish – small freshwater fish commonly sold in pet stores – as a model organism to understand our immune response to bacterial infection.

We use larval zebrafish because their genetic makeup and immune system are similar to ours. Also, they have transparent bodies, making it easy to observe biological processes under the microscope.

We focus on an immune cell called a “neutrophil”, a type of white blood cell. We’re interested in these cells because they specialise in killing bacteria, are first responders to infection, and are the most abundant immune cell in our bodies.

Because they are very short-lived cells, neutrophils isolated from human blood are notoriously difficult to work with experimentally. However, with transparent larval zebrafish, we can film them to directly observe how these cells function, within a completely intact animal.

Cells can tell if it’s daytime

Our initial studies showed the strength of immune response to bacterial infection peaked during the day, when the animals are active.

We think this represents an evolutionary response that provides both humans and zebrafish a survival advantage. Because diurnal animals such as humans and zebrafish are most active during daylight hours, they are more likely to encounter bacterial infections.

This work made us curious to know how this enhanced immune response was being synchronised with daylight. By making movies of neutrophils killing bacteria at different times of the day, we discovered they killed bacteria more efficiently during the daytime than at night.

We then genetically edited neutrophils to turn off their circadian clocks by carefully removing specific clock components. This is an approach similar to removing important cogs from an analogue clock so it doesn’t tick anymore.

This led to the discovery that these important immune cells possess an internal light-regulated circadian clock that alerts the cells to daytime (similar to an alarm clock). This boosts their ability to kill bacteria.

Our next challenge is to understand exactly how light is detected by neutrophils, and whether human neutrophils also rely on this internal timing mechanism to regulate their antibacterial activity.

We’re also curious to see if this killing mechanism is restricted to certain types of bacteria, such as those we’re more likely to encounter during the day. Or is it a more general response to all infectious threats (including viral infections)?

This research unlocks the potential for developing drugs that target the neutrophil circadian clock to regulate the cells’ activity. Given neutrophils are the first and most abundant immune cells to be recruited to sites of inflammation, the discovery has very broad implications for many inflammatory conditions.

The research described here was led by PhD candidates Lucia Du and Pramuk Keerthisinghe, and was a collaboration between the Hall laboratory and the Chronobiology Research Group, led by Guy Warman and James Cheeseman, at the University of Auckland’s Faculty of Medical and Health Sciences.

Chris Hall receives funding from the Marsden Fund.

– ref. Daylight can boost the immune system’s ability to fight infections – new study – https://theconversation.com/daylight-can-boost-the-immune-systems-ability-to-fight-infections-new-study-257224

Source: The Conversation (Au and NZ) – By Michelle Grattan, Professorial Fellow, University of Canberra

The Coalition is being glued together again, after a Liberal Party meeting on Friday gave the go ahead for Liberal leader Sussan Ley to negotiate with Nationals leader David Littleproud on the fine print of a settlement on policy.

The Liberal party room agreed to accept broadly the Nationals’ four policy demands, with the two leaders to deal with the details.

A new agreement between the parties is expected within days.

The rapprochement followed days of chaos after the Nationals on Tuesday walked out of the Coalition.

The turmoil has done significant damage to Littleproud, who has received widespread criticism of his handling of the relationship, including from within his own party. The crisis has raised questions about whether he will survive in his position in the longer term.

The Liberal meeting had before it four policies that the Nationals insisted should be kept, and not be caught up in the Liberals’ planned review of all policies.

The four were:

• removing the moratorium on nuclear energy, with a review of the remaining elements of the nuclear policy

• a $20 billion Regional Australia Future Fund, including a $1 billion annual budget allocation until the fund matured

• court-ordered divestiture powers in relation to major supermarkets and “big box” retailers

• and Universal Service Obligation reforms to boost mobile phone and internet services for regional Australians.

The Nationals’ demand on nuclear drops the core of the policy the opposition took to the election, which was for the government to fund a string of nuclear power plants.

The Liberals are divided over nuclear energy, with some wanting any policy on it scrapped.

Probably the most difficult of the Nationals’ policy points for the Liberals is the divestiture power, which was controversial within the Liberals when it was adopted last term as opposition policy.

A number of Liberals are particularly opposed to extending it to “big box” retailers.

There was also some concern among Liberals about the fiscal arrangements around the regional fund – whether it should be off budget or on budget.

While Liberals resent the Nationals’ behaviour, they were also aware of the political problems presented by a Coalition split and were anxious to get the two parties together again.

In a provocative tweet the Nationals Matt Canavan said: “Well done David Littleproud! Liberals back down on all requests.”

“Great win for the Nationals.”

Canavan ran against Littleproud for the leadership after the election.

Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. View from The Hill: Coalition is being glued together again after crisis week – https://theconversation.com/view-from-the-hill-coalition-is-being-glued-together-again-after-crisis-week-257332

Source: The Conversation (Au and NZ) – By Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, Monash University

This week, Australia’s Therapeutic Goods Administration (TGA) approved a drug called donanemab for people in the early stages of Alzheimer’s disease.

Donanemab has previously been approved in a number of other countries, including the United States.

So what is donanemab, and who will be able to access it in Australia?

How does donanemab work?

There are more than 100 different causes of dementia, but Alzheimer’s disease alone accounts for about 70% of these, making it the most common form of dementia.

The disease is believed to be caused by the accumulation in the brain of two abnormal proteins, amyloid and tau. The first is thought to be particularly important, and the “amyloid hypothesis” – which suggests amyloid is the key cause of Alzheimer’s disease – has driven research for many years.

Donanemab is a “monoclonal antibody” treatment. Antibodies are proteins the immune system produces that bind to harmful foreign “invaders” in the body, or targets. A monoclonal antibody has one specific target. In the case of donanemab it’s the amyloid protein. Donanemab binds to amyloid protein deposits (plaques) in the brain and allows our bodies to remove them.

Donanemab is given monthly, via intravenous infusion.

What does the evidence say?

Australia’s approval of donanemab comes as a result of a clinical trial involving 1,736 people published in 2023.

This trial showed donanemab resulted in a significant slowing of disease progression in a group of patients who had either early Alzheimer’s disease, or mild cognitive impairment with signs of Alzheimer’s pathology. Before entering the trial, all patients had the presence of amyloid protein detected via PET scanning.

Participants were randomised, and half received donanemab, while the other half received a placebo, over 18 months.

For those who received the active drug, their Alzheimer’s disease progressed 35% more slowly over 18 months compared to those who were given the placebo. The researchers ascertained this using the Integrated Alzheimer’s Disease Rating Scale, which measures cognition and function.

Those who received donanemab also demonstrated large reductions in the levels of amyloid in the brain (as measured by PET scans). The majority, by the end of the trial, were considered to be below the threshold that would normally indicate the presence of Alzheimer’s disease.

These results certainly seem to vindicate the amyloid hypothesis, which had been called into question by the results of multiple failed previous studies. They represent a major advance in our understanding of the disease.

That said, patients in the study did not improve in terms of cognition or function. They continued to decline, albeit at a significantly slower rate than those who were not treated.

The actual clinical significance has been a topic of debate. Some experts have questioned whether the meaningfulness of this result to the patient is worth the potential risks.

Is the drug safe?

Some 24% of trial participants receiving the drug experienced brain swelling. The rates rose to 40.6% in those possessing two copies of a gene called ApoE4.

Although three-quarters of people who developed brain swelling experienced no symptoms from this, there were three deaths in the treatment group during the study related to donanemab, likely a result of brain swelling.

These risks require regular monitoring with MRI scans while the drug is being given.

Some 26.8% of those who received donanemab also experienced small bleeds into the brain (microhaemorrhages) compared to 12.5% of those taking the placebo.

Cost is a barrier

Reports indicate donanemab could cost anywhere between A$40,000 and $80,000 each year in Australia. This puts it beyond the reach of many who might benefit from it.

Eli Lilly, the manufacturer of donanemab, has made an application for the drug to be listed on the Pharmaceutical Benefits Scheme, with a decision pending perhaps within a couple of months. While this would make the drug substantially more affordable for patients, it will represent a large cost to taxpayers.

The cost of the drug is in addition to costs associated with the monitoring required to ensure its safety and efficacy (such as doctor visits, MRIs and PET scans).

Who will be able to access it?

This drug is only of benefit for people with early Alzheimer’s-type dementia, so not everybody with Alzheimer’s disease will get access to it.

Almost 80% of people who were screened to participate in the trial were found unsuitable to proceed.

The terms of the TGA approval specify potential patients will first need to be found to have specific levels of amyloid protein in their brains. This would be ascertained either by PET scanning or by lumbar puncture sampling of spinal fluid.

Also, patients with two copies of the ApoE4 gene have been ruled unsuitable to receive the drug. The TGA has judged the risk/benefit profile for this group to be unfavourable. This genetic profile accounts for only 2% of the general population, but 15% of people with Alzheimer’s disease.

Improving diagnosis and tempering expectations

It’s estimated more than 400,000 Australians have dementia. But only 13% of people with dementia currently receive a diagnosis within a year of developing symptoms.

Given those with very early disease stand to benefit most from this treatment, we need to expand our dementia diagnostic services significantly.

Finally, expectations need to be tempered about what this drug can reasonably achieve. It’s important to be mindful this is not a cure.

Steve Macfarlane was an investigator on the donanemab trial, but received no direct compensation from Eli Lily for being so. Separately, has done consultancy work for Eli Lilly, for which he’s received payments.

– ref. The TGA has approved donanemab for Alzheimer’s disease. How does this drug work and who will be able to access it? – https://theconversation.com/the-tga-has-approved-donanemab-for-alzheimers-disease-how-does-this-drug-work-and-who-will-be-able-to-access-it-257321

Source: The Conversation (Au and NZ) – By Lauren Breen, Professor of Psychology, Curtin University

Grieving the death of a parent is often considered a natural part of life. But there are added layers of complexity when you had a difficult or estranged relationship.

This week former tennis star Jelena Dokic confirmed the death of her father and former coach Damir, whose verbal, physical and emotional abuse she revealed in 2009 and further detailed in her 2017 autobiography. They had been estranged for a decade.

In a social media post on Thursday, Dokic wrote about her “conflicting and complex emotions and feelings” around his death:

no matter how how hard, difficult and in the last 10 years even non existent [sic] our relationship and communication was, it is never easy losing a parent […] The loss of an estranged parent comes with a difficult and complicated grief.

Dokic’s news is a reminder that, when a parent dies, not all of us get to grieve a stable, warm and comforting relationship.

As in her case, a strained relationship might even be marked by maltreatment or abuse. Relinquishing contact can sometimes be the best, albeit difficult, choice.

When the parent dies, the loss can feel surprisingly complex. We may be grieving both the literal death of the parent and the figurative death, of what should have been – what we wished for and desired.

Death can spark more than sadness

Grief is not a single emotion. Usually, it involves a combination of many. Common feelings can include sadness, guilt, anger and even relief.

In sharing her social media post, Dokic has said among conflicting emotions she’s chosen to “focus on a good memory”.

Grief can reach beyond feelings. It can disrupt eating and sleeping habits and impair memory and concentration.

Deaths can also affect relationships.

For example, when grieving, someone might receive a lot of social support from family, friends and colleagues. But for others, the support they’d like might not be forthcoming. The lack of support is yet another loss and is linked to worse physical and mental health.

Family members may also react in different ways. It might be jarring or alienating if your sibling responds differently, for example by sharing fond memories of a parent you found harsh and distant.

A death can also affect your financial standing. A grieving person may be burdened with outstanding bills and funeral payments. Or the impact can be positive, via windfalls from insurance and inheritance.

What if I don’t feel sad?

With grief, it’s OK to feel how you feel. You might think you’re grieving the “wrong” way, but it can be helpful to remember there are no strict rules about how to grieve “right”.

Be gentle on yourself. And give other family members, who may have had a different relationship with the parent and therefore grieve differently, the same courtesy.

It’s also OK to feel conflicted about going to the funeral.

In this case, take the time to think through the pros and cons of attending. It might be helpful in processing your grief and in receiving support. Or you might feel that attending would be too difficult or emotionally unsafe for you.

If you choose to attend, it can help to go with someone who can support you through it.

In an estranged relationship, the adult child might not even find out about the death of the parent for many weeks or months afterwards. This means there is no option of attending the funeral or other mourning rituals. Consider making your own rituals to help process the loss and grief.

What if I do feel sad – but still hurt?

It can be really confusing to feel sad about the death of a parent with whom we had a difficult, strained or violent relationship.

Identifying where these conflicting thoughts and feelings come from can help.

You might need to acknowledge and grieve the loss of your parent, the loss of the parent-child relationship you deserved, and even the loss of hoped-for apologies and reconnections.

In many cases, it is a combination of these losses that can make the grief more challenging.

It may also be difficult to get the social support you need from family, friends and colleagues.

These potential helpers might be unaware of the difficulties you experienced in the relationship, or incorrectly believe troubled relationships are easier to grieve.

It can feel like a taboo to speak ill of the dead, but it might be helpful to be clear about the relationship and your needs so that people can support you better.

In fact, grieving the death of people with whom we have challenging, conflicting or even abusive relationships can lead to more grief than the death of those with whom we shared a warm, loving and more straightforward relationship.

If the loss is particularly difficult and your grief doesn’t change and subside over time, seek support from your general practitioner. They might be able to recommend a psychologist or counsellor with expertise in grief.

Alternatively, you can find certified bereavement practitioners who have specialised training in grief support online or seek telephone support from Griefline on 1300 845 745.

Lauren Breen receives funding from Healthway and has previously received funding from Wellcome Trust, Australian Research Council, Department of Health (Western Australia), Silver Chain, iCare Dust Diseases Board (New South Wales), and Cancer Council (Western Australia). She is on the board of Lionheart Camp for Kids, is a member of Grief Australia, and a Fellow of the Australian Psychological Society.

– ref. The death of Jelena Dokic’s father reveals the ‘difficult and complicated grief’ of losing an estranged parent – https://theconversation.com/the-death-of-jelena-dokics-father-reveals-the-difficult-and-complicated-grief-of-losing-an-estranged-parent-257324

Source: The Conversation (Au and NZ) – By Ellie Ong, Research Fellow, ARC Centre of Excellence for 21st Century Weather, Monash University

A little-known ocean current surrounds Antarctica, shielding it from warm water further north. But our new research shows Antarctica’s melting ice is disrupting this current, putting the continent’s last line of defence at risk.

We found meltwater from Antarctica is speeding up the current, known as the Antarctic Slope Current. And it’s set to become even faster by mid-century.

A faster current could be more unstable. This means eddies of warm water could eat away at Antarctica’s ice, posing a major concern for the stability of the Earth’s climate system.

Faster ice-melt means faster sea-level rise. Humanity must act now to preserve this natural phenomena that helps Antarctica’s ice shelves remain intact.

Melting of Antarctic ice has global consequences

Antarctica is melting as the world warms. This causes sea levels to rise. Even just a few centimetres of sea-level rise can double the chance of flooding in vulnerable coastal regions.

Previous research has shown meltwater is also slowing the global network of deep ocean currents. These currents transport water, heat and nutrients around the planet, so a global slow-down has huge ramifications.

It’s therefore crucial to reduce further loss of Antarctic ice, to stabilise our global climate system.

The Antarctic Slope Current moves ocean water westward over the continental slope, close to the coast. It acts as a barrier, preventing warm waters from further north from reaching the ice.

In this way, the current provides an important line of defence keeping warmer water at bay. It doesn’t stop Antarctica from melting, because warming air temperatures still cause this. But it slows the process.

However, our research shows this defence is under threat.

What we did

We wanted to find out how the Antarctic Slope Current will respond to changes in wind, heat, and meltwater as the climate changes. We did this using high-resolution ocean-sea ice models.

The meltwater makes the ocean around Antarctica less salty. This makes the waters closer to the coast less dense, changing the structure of the Antarctic Slope Current and speeding it up.

The models predicted a 14% increase in the speed of the current over the past 25 years and a 49% increase over the next 25 years.

But meltwater from Antarctic ice has another effect too. We found the added water also slows down the movement of dense, salty coastal water in “waterfalls” running off the Antarctic coast that feeds into the global overturning current network.

When these waterfalls of dense water slow down, warmer waters are able to flow closer to the Antarctic continent.

Together, these changes compound and cause the Antarctic Slope Current to speed up even more.

A complex story

It might be assumed the changes we modelled would be a good thing for Antarctica. That’s because the stronger the Antarctic Slope Current, the stronger the barrier between Antarctica and the warm waters to the north.

But there’s more to the story. When ocean currents flow faster, they become more turbulent –generating vigorous eddies or whirlpools.

You can see this effect if you rapidly run your hand through a bathtub of water. Watch for the dynamic, circular whirlpools in your hand’s wake.

Ocean eddies are also becoming more vigorous under climate change.

Around Antarctica, whirlpools or eddies can move large amounts of warm water towards the poles. This can make melting worse.

So although a stronger current might be expected to act as a better shield for Antarctica, the extra eddies in its wake can have the opposing effect. These eddies can amplify the transport of heat towards Antarctica, increasing melting.

Why this matters

No matter how uncertain Antarctica’s future may be, one thing is clear: this frozen frontier is crucial to the stability of our global climate.

The Antarctic Slope Current was once a steadfast guardian of the icy continent. But now the current is being transformed by the very ice it protects.

Humanity must act fast to preserve the current, by cutting carbon emissions. When it comes to Antarctica, this action isn’t optional — it’s the only way to hold the line.

Ellie Ong receives funding from the Australian Research Council and an Australian Government Research and Training Program Scholarship.

Edward Doddridge receives funding from the Australian Research Council.

Matthew England receives funding from the Australian Research Council.

Navid Constantinou receives funding from the Australian Research Council.

– ref. Antarctica has its own ‘shield’ against warm water – but this could now be under threat – https://theconversation.com/antarctica-has-its-own-shield-against-warm-water-but-this-could-now-be-under-threat-255738

Source: The Conversation (Au and NZ) – By Lauren Breen, Professor of Psychology, Curtin University

Grieving the death of a parent is often considered a natural part of life. But there are added layers of complexity when you had a difficult or estranged relationship.

This week former tennis star Jelena Dokic confirmed the death of her father and former coach Damir, whose verbal, physical and emotional abuse she revealed in 2009 and further detailed in her 2017 autobiography. They had been estranged for a decade.

In a social media post on Thursday, Dokic wrote about her “conflicting and complex emotions and feelings” around his death:

no matter how how hard, difficult and in the last 10 years even non existent [sic] our relationship and communication was, it is never easy losing a parent […] The loss of an estranged parent comes with a difficult and complicated grief.

Dokic’s news is a reminder that, when a parent dies, not all of us get to grieve a stable, warm and comforting relationship.

As in her case, a strained relationship might even be marked by maltreatment or abuse. Relinquishing contact can sometimes be the best, albeit difficult, choice.

When the parent dies, the loss can feel surprisingly complex. We may be grieving both the literal death of the parent and the figurative death, of what should have been – what we wished for and desired.

Death can spark more than sadness

Grief is not a single emotion. Usually, it involves a combination of many. Common feelings can include sadness, guilt, anger and even relief.

In sharing her social media post, Dokic has said among conflicting emotions she’s chosen to “focus on a good memory”.

Grief can reach beyond feelings. It can disrupt eating and sleeping habits and impair memory and concentration.

Deaths can also affect relationships.

For example, when grieving, someone might receive a lot of social support from family, friends and colleagues. But for others, the support they’d like might not be forthcoming. The lack of support is yet another loss and is linked to worse physical and mental health.

Family members may also react in different ways. It might be jarring or alienating if your sibling responds differently, for example by sharing fond memories of a parent you found harsh and distant.

A death can also affect your financial standing. A grieving person may be burdened with outstanding bills and funeral payments. Or the impact can be positive, via windfalls from insurance and inheritance.

What if I don’t feel sad?

With grief, it’s OK to feel how you feel. You might think you’re grieving the “wrong” way, but it can be helpful to remember there are no strict rules about how to grieve “right”.

Be gentle on yourself. And give other family members, who may have had a different relationship with the parent and therefore grieve differently, the same courtesy.

It’s also OK to feel conflicted about going to the funeral.

In this case, take the time to think through the pros and cons of attending. It might be helpful in processing your grief and in receiving support. Or you might feel that attending would be too difficult or emotionally unsafe for you.

If you choose to attend, it can help to go with someone who can support you through it.

In an estranged relationship, the adult child might not even find out about the death of the parent for many weeks or months afterwards. This means there is no option of attending the funeral or other mourning rituals. Consider making your own rituals to help process the loss and grief.

What if I do feel sad – but still hurt?

It can be really confusing to feel sad about the death of a parent with whom we had a difficult, strained or violent relationship.

Identifying where these conflicting thoughts and feelings come from can help.

You might need to acknowledge and grieve the loss of your parent, the loss of the parent-child relationship you deserved, and even the loss of hoped-for apologies and reconnections.

In many cases, it is a combination of these losses that can make the grief more challenging.

It may also be difficult to get the social support you need from family, friends and colleagues.

These potential helpers might be unaware of the difficulties you experienced in the relationship, or incorrectly believe troubled relationships are easier to grieve.

It can feel like a taboo to speak ill of the dead, but it might be helpful to be clear about the relationship and your needs so that people can support you better.

In fact, grieving the death of people with whom we have challenging, conflicting or even abusive relationships can lead to more grief than the death of those with whom we shared a warm, loving and more straightforward relationship.

If the loss is particularly difficult and your grief doesn’t change and subside over time, seek support from your general practitioner. They might be able to recommend a psychologist or counsellor with expertise in grief.

Alternatively, you can find certified bereavement practitioners who have specialised training in grief support online or seek telephone support from Griefline on 1300 845 745.

Lauren Breen receives funding from Healthway and has previously received funding from Wellcome Trust, Australian Research Council, Department of Health (Western Australia), Silver Chain, iCare Dust Diseases Board (New South Wales), and Cancer Council (Western Australia). She is on the board of Lionheart Camp for Kids, is a member of Grief Australia, and a Fellow of the Australian Psychological Society.

– ref. The death of Jelena Dokic’s father reveals the ‘complex and difficult grief’ of losing an estranged parent – https://theconversation.com/the-death-of-jelena-dokics-father-reveals-the-complex-and-difficult-grief-of-losing-an-estranged-parent-257324

Source: The Conversation (Au and NZ) – By Samuel Cornell, PhD Candidate in Public Health & Community Medicine, School of Population Health, UNSW Sydney

Almost 700 rescues had been carried out in New South Wales by Friday morning as
record-breaking rainfall pounds the state. Tragically, four people have died in floodwaters.

Amid the chaos, videos posted on social media show people deliberately entering or standing above swollen rivers and flooded roads. It is a pattern of dangerous behaviour that occurs frequently during natural disasters in Australia.

Filming unsafe acts for social media is not just risky for participants. It may inspire copycat behaviour, and, if things go wrong, can endanger the lives of rescuers. It’s a public health problem which requires new remedies.

Selfies in floods: a risky business

During a flood, water can be deceiving. Just 15cm of water can knock an adult off their feet or cause a car to lose traction and float. Submerged debris and contaminated water add to the dangers.

Emergency services routinely warn the public not to enter floodwaters – on foot or in vehicles. But many people ignore the warnings, including those out to create social media content.

In a startling example posted on Tiktok during the current floods, a young man stands on a mossy log which has fallen over a flooded river. The video, accompanied by dramatic music, shows swirling floodwaters surging beneath him. One wrong step, and the man could easily have drowned.

In other examples posted on Tiktok in recent days, a woman wades through murky floodwaters, and a person films as the car they are travelling in drives down a flooded road.

Similar behaviour was observed during floods in Townsville earlier this year. Residents filmed themselves diving and wading into floodwaters, and towing each other on inflatable rafts.

And during ex-Tropical Cyclone Alfred, social media was filled with images of people in Queensland surfing dangerous swells and wading in rough surf.

A worrying trend

Our research explores the links between social media and adverse health outcomes.

Selfie-related injury has become a public health concern. People are increasingly venturing off-trail, seeking out attractive but hazardous locations such as cliff edges and coastal rock platforms.

These behaviours can lead to injury and death. They can also put emergency services personnel in harm’s way. In 2021, for example, a woman fell into a swollen river on Canberra’s outskirts while trying to take a selfie with friends, prompting a police official to warn:

There is no photo or social media post that is worth risking your life to get. Any water rescue puts the lives of not only of yourself but those of emergency services personnel at risk.

Getting to grips with the problem

How should the problem be tackled? Previous research by others has recommended “no-selfie zones”, barriers, and signs as ways to prevent selfie incidents. But our research suggests these measures may not be enough.

The phenomenon of selfie-related incidents requires a public health approach. This entails addressing the behaviour through prevention, education, and other interventions such as via social media platforms.

In the latest floods, unsafe behaviour has occurred despite a series of official flood, weather and other warnings. Residents also continue to drive into floodwaters, despite repeated pleas from authorities.

Official warnings compete with – and can lose out to – more emotionally compelling, visually rich content. If the public sees other people behaving recklessly and apparently unharmed, then even clear, fact-based warnings can be ignored.

This is especially true in communities experiencing “alert-fatigue” after having gone through disasters before.

Sometimes, vague terminology in warnings means the messages don’t necessarily cut through. We’ve seen this before in relation to surf safety. Technical phrases such as “hazardous swell” don’t change behaviour if people don’t understand what they mean.

For warnings to work, they need to be clear and provide instruction – stating what the danger actually is, and what to explicitly do, or not do.

For social media users, that might mean spelling out not to go into floodwaters to capture content for social media.

We’ve also previously called on social media companies to be held more accountable for the dangerous content they publish – by flagging risky content and supporting in-app safety messaging, especially at high-risk locations or during extreme weather events.

What to do right now

If you’re in or near a flood zone, follow guidance from emergency services to keep yourself and your loved ones safe.

When it comes to using social media in an emergency:

• stay entirely out of floodwaters, even for a quick photo

• think before you post. Your safety is more important than your content. No post is worth risking your life

• avoid glamourising risk. Sharing risky photos or videos can influence others to do the same, potentially with worse outcomes

• follow official advice. Floodwaters are unpredictable. Warnings are issued for a reason

• use your platform for good. Share verified information, support affected communities and help amplify safety messages.

As extreme weather becomes more frequent in Australia under climate change, so too will the urge to document them. But we risk turning disasters into digital spectacles – at the expense of our lives and that of rescuers.

Samuel Cornell receives funding from Meta Platforms, Inc. His research is supported by a University of New South Wales Sydney, University Postgraduate Award. His research is supported by Royal Life Saving Society – Australia to aid in the prevention of drowning. Research at Royal Life Saving Society – Australia is supported by the Australian government. He has been affiliated with Surf Life Saving Australia and Surf Life Saving NSW in a paid and voluntary capacity.

Amy Peden receives funding from the National Health and Medical Research Council, Meta Platforms, and NSW National Parks and Wildlife Service. She holds an honorary affiliation with Royal Life Saving Society – Australia.

– ref. Disaster or digital spectacle? The dangers of using floods to create social media content – https://theconversation.com/disaster-or-digital-spectacle-the-dangers-of-using-floods-to-create-social-media-content-257350

Source: The Conversation (Au and NZ) – By Michelle Ward, Lecturer, School of Environment and Science, Griffith University

More and more Australian species are being listed as critically endangered – the final stage before extinction in the wild. Hundreds of species of plants and animals are now at this point.

For a species to be critically endangered, it is on death’s door. Its numbers must have shrunk alarmingly and its outlook is bleak. Why? One common reason is habitat loss. If we convert bushland or swamps into farmland or suburbs, we reduce how much space species have to survive.

Our new research examines how much habitat is left for 305 of Australia’s critically endangered species – more than 70% of the total. Alarmingly, we found almost half the remaining habitat is outside the protected area estate. That means the last remaining areas where these species are clinging on could very easily be cleared.

The good news? We now know exactly which areas most need to be safeguarded. If we protected an extra 0.5% of Australia’s land mass, we could slash the risk to hundreds of species approaching the point of no return. This is a relatively small amount compared to the 22.5% of Australia that already has some form of protection. The Australian government has committed to increasing this to 30% by 2030.

What did we do?

Australia now has 426 critically endangered species, including plants, fish, frogs, reptiles, mammals, birds and other animals. We focused on 305 of these species – those clinging to life in six or fewer isolated patches of habitat across Australia.

We then worked with 18 scientists whose expertise covers these 305 species to refine the maps of habitat for species to ensure we used the most accurate and current data available.

Once we had these maps, we compared them to maps of Australia’s network of protected areas. When we found unprotected habitat, we assessed whether it might be appealing for clearing and conversion into farmland.

When we put this data together, we found something startling – and encouraging. Our work found approximately 85,000 square kilometres of habitat (about 1% of Australia’s land area) urgently needs protection and management to halt extinction for these 305 species.

Alarmingly, half of this vital habitat currently lies outside existing protected areas, with 39 species having none of their remaining habitat in the protected area estate. Habitat in protected areas is safer, but not completely safe. Fuel reduction burns, invasive species and even harvesting can affect species inside protected areas.

Consider the Margaret River burrowing crayfish (Engaewa pseudoreducta), Lyon’s grassland striped skink (Austroablepharus barrylyoni) and the Rosewood keeled snail (Ordtrachia septentrionalis). Each of these critically endangered species survives in one or two tiny patches of habitat outside the protected area estate. They could be wiped out by something as simple as a highway expansion or a new suburban development.

Some remaining habitat is especially precious, as it could support several critically endangered species at once. These include areas west of Atherton in Queensland as well as areas around Tumbarumba in New South Wales and Campbell Town in Tasmania.

Other hotspots include Lord Howe Island, Macquarie Island, Christmas Island, Norfolk Island and its neighbour Phillip Island. Many critically endangered species with small ranges survive here, including Suter’s striped glass-snail, Christmas Island spleenwort and the Lord Howe Island phasmid (giant stick insect). While most of these islands are well protected, their conservation programs need to be well funded to deal with ongoing threats.

The last of them

When a species goes extinct, we lose an entire set of genes, traits, behaviours and history. Despite recent headlines, extinction is forever.

In 2022, the Australian government pledged to bring an end to extinction of the continent’s unique species.

This is easier said than done – extinctions are continuing, especially among invertebrates.

Our maps show the last known areas where these 305 species are holding on. If nothing is done, some of these areas of habitat will likely be converted to farming or grazing land. The most logical thing to do is to preserve and manage this habitat as quickly as possible.

The challenge is ownership. At present, much of this habitat occurs on private land (about 17,000 km²) or in state forests (about 7,000 km²) which often does not stop activities that cause habitat destruction, such as native forest logging. Other areas are under different forms of tenure which often lack stringent conservation measures.

Protecting species on private lands requires careful negotiation and incentives for landholders. The government doesn’t have to buy the land – it just has to find ways to conserve it. Australia now has many good examples of conservation on private land.

Agricultural potential poses another challenge. More than half (55%) of the habitat we identified has a clear overlap with lands suitable for farming or grazing. These preferred areas are usually flat and on fertile soils.

Conversion of habitat to farms or paddocks is a major reason why Australia is still one of the top land-clearing nations. In just one year, 6,800 km² of woody vegetation was cleared in Queensland – largely to make way for agriculture.

What can we do?

Our research gives policymakers detailed, geographically specific and actionable information on vital areas of habitat remaining for more than 70% of Australia’s critically endangered species.

These maps can help shape decisions on land management, expansion of protected areas and where biodiversity stewardship programs should be prioritised.

Policymakers must find effective incentives for landowners to preserve species on their land and rigorously enforce regulations to prevent illegal clearing.

Australia stands at a crossroads. The action (or inaction) of decision makers will change the fate of hundreds of critically endangered species. We know where these species are just holding on. The question is whether we can get to them in time.

Michelle Ward has received funding from various sources including the Australian Research Council, the Queensland Department of Environment and Science, WWF Australia, and the federal government’s National Environmental Science Program, and has advised both state and federal government on conservation policy.

James Watson has received funding from the Australian Research Council, National Environmental Science Program, South Australia’s Department of Environment and Water, Queensland’s Department of Environment, Science and Innovation as well as from Bush Heritage Australia, Queensland Conservation Council, Australian Conservation Foundation, The Wilderness Society and Birdlife Australia. He serves on the scientific committee of BirdLife Australia and has a long-term scientific relationship with Bush Heritage Australia and Wildlife Conservation Society. He serves on the Queensland government’s Land Restoration Fund’s Investment Panel as the Deputy Chair.

– ref. Half the remaining habitat of Australia’s most at-risk species is outside protected areas – https://theconversation.com/half-the-remaining-habitat-of-australias-most-at-risk-species-is-outside-protected-areas-256818

Source: The Conversation (Au and NZ) – By Christopher Yorke, Lecturer in sport management, Western Sydney University

Created in Australia, “Run It Straight” is a new, ultra-violent combat sport.

Across a 20×4 metre grassed “battlefield,” players charge at full speed toward one another.

Alternating between carrying the ball (ball runner) and defending (tackler), victory is awarded via knockout (a competitor cannot continue), or a judge’s decision based on an athlete’s dominance during the collisions.

Despite neuroscientists issuing grave warnings about the brutal sport’s risks, Run It Straight’s viral popularity, including endorsement among high profile athletes, is accelerating.

A growing scene

This month, Melbourne hosted the inaugural “RUNIT Championship League” event.

Footage showed some participants convulsing after their collisions as the winner celebrated, surrounded by children.

Drawing hundreds of spectators and millions of online views, the full-speed collision challenge is already turning its violence and social media footprint into commercial success abroad, securing interest in the United States.

The sport held some events in New Zealand this week, but one was was halted by Auckland Council due to safety concerns and failure to secure necessary permits.

A history of sport and violence

In ancient times, symbolic cultural displays of power and physical dominance featured in combat sports such as wrestling, boxing, pankration (a mixed martial art combining boxing and wrestling) and even armoured foot races.

This brutal entertainment is reflected in contemporary collision sports such as the National Rugby League (NRL) and Australian Football League (AFL).

In recent decades however, the danger of concussion has resulted in most contact sports changing rules and regulations to protect athletes from head injuries.

Various measures have been implemented to mitigate, eliminate and treat head trauma.

The Australian government is exerting influence and committing material resources to support athletes living with brain issues such as chronic traumatic encephalopathy (CTE).

Read more:
When does the love of the game outweigh the cost? ABC’s Plum brings rugby league’s concussion crisis to the fore

Considering this multi-pronged effort to make contact sports safer, the violence of Run It Straight is jarring.

Why are these new sports so popular?

With its origins as a social media challenge, Run It Straight is perfect content for short-form social media platforms: an entire competition can be distilled into a 30-second highlight.

Run It Straight’s accessible and minimalist format is also attractive to fans compared to many collision sports that have complex rules and strategies. This can be a barrier to interest, engagement and commercial returns.

Run It Straight and other emerging, violent sports such as Power Slap (a fight sport where contestants slap each other so hard they can be knocked unconscious) are simplistic and brutal.

But athletes in most traditional collision sports use their physical ability and skill to evade contact. Similarly, boxing is not just about strikes to the head, it is punch evasion, physical fitness and point scoring.

But the visual spectacle and shock of two people running toward one another for an inevitable collision is a form of violence that appeals to an increasing number of sport fans.

The risks involved

Run It Straight is a new sport, and to our knowledge there is no empirical peer-reviewed research focusing on it.

But many neurologists have expressed concerns about its total disregard for scientific evidence showing repeated head trauma damages brain health.

With Run it Straight appearing to lack the medical resources and infrastructure of professional sports organisations, and with the competition’s expressed intent to have participants collide at high speed, the risk of significant injury is high.

Power Slap, though, has been the subject of empirical research. A 2024 study reported many of the sport’s combatants showed visible signs of concussion (motor incoordination, slowness to get up and blank and vacant looks during bouts).

An opportunity for ‘traditional’ sports?

The rise of Run It Straight and Power Slap creates a unique opportunity for the governing bodies of contact codes such as AFL, NRL and rugby union to highlight what sets them apart.

Key to this is athlete safety. For years, governing bodies in these codes have invested time and resources to implement concussion management protocols at professional and community levels.

Currently, the tournament-based format for individual adult participants allows Run It Straight to operate without the broader governance responsibilities of football codes.

However, it is because of those governance responsibilities that the football codes can amplify their athlete wellbeing credentials to reassure participants and parents who may be nervous about concussion risks.

Second, the football codes are organised team sports played with multiple players on a team, facilitating skill acquisition, teamwork, mental wellbeing and physical fitness. While there appears to be a degree of camaraderie during Run It Straight events, it is evidently a one-on-one competition.

Ultimately, the rise and evident popularity of Run It Straight and Power Slap provides a stark reminder there will always be a section of society that is drawn to high-risk behaviours.

In turn, the football codes should look to highlight the value of balance and their athlete wellbeing credentials.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. Head knocks and ultra-violence: viral games Run It Straight and Power Slap put sports safety back centuries – https://theconversation.com/head-knocks-and-ultra-violence-viral-games-run-it-straight-and-power-slap-put-sports-safety-back-centuries-256473

Source: The Conversation (Au and NZ) – By Jennifer Curtin, Professor of Politics and Policy, University of Auckland, Waipapa Taumata Rau

In 1936, when the National Party was created through a merger of the United and Reform parties, there was a recognition among the power brokers that attracting women’s votes was crucial.

National’s women’s organisations were integral to mobilising support. Throughout the 1940s, the party’s publicity material promised the women of New Zealand a happy family life. This was a consistent approach over the next 20 years, and National was rewarded with the women’s vote.

Intermittent research on gender differences in vote choice between 1963 and 1993 indicate women made up between 45% and 51% of National’s support compared to 36% and 43% of Labour’s support.

After 1996, this trend became less consistent. The New Zealand Election Study indicates a decreasing share of the women’s vote going to National, and fluctuations in vote choice among both women and men.

Given the advent of proportional representation, some volatility may be expected. But there are also some constants. There is evidence women are more likely than men to support government spending on social policy, and they are significantly less likely than men to vote for National’s coalition partners NZ First and ACT.

Now, with Budget 2025 – in particular its reliance on funds that would otherwise have gone towards settling pay equity claims – National’s historical success at attracting the women’s vote may be under threat.

Growth before pay equity

The budget represents a ruthless determination to deliver economic growth, including through its centrepiece “Investment Boost” tax breaks for businesses investing in productive assets.

There is additional funding for health, defence, education and disability services, and the establishment of a social investment fund, and the budget left national superannuation untouched (for the remainder of this coalition government’s term, at least).

It focused instead on KiwiSaver. Contributions from employers and employees will increase from 3% to 4%, while the government contribution will be halved for those earning under NZ$180,000 and cancelled for those earning over this amount.

In summary, the new operational spend comes to $6.7 billion while savings, reprioritised spending and revenue-raising initiatives totalled $5.3 billion. As a result, the government has produced the lowest operational allowance in a decade ($1.3 billion) and promised $4 billion in new capital expenditure.

But it was the radical restructuring and cancellation of pay equity for a range of undervalued female-dominated occupations that funded this budget. Almost half of the $12 billion recouped will be spent on the business tax incentives.

The government expects the initiative will increase GDP and wages by 1% to 1.5% over the next 20 years. But given the gender-segregated structure of New Zealand’s labour market, it may take some time for women to benefit from the Investment Boost.

The gender gap and economic growth

Applying a systematic and evidence-based gender analysis as part of the budget preparation process would have revealed more inclusive ways of delivering economic growth.

For example, OECD modelling demonstrates the historical importance of increases in women’s labour market participation for economic growth, but notes that persistent gender gaps remain in productive capcity and hours of employment.

Closing these gaps could potentially add a 0.1 percentage point of additional economic growth per year, culminating in a 3.9% boost to GDP in the next 35 years.

Moreover, increasing women’s labour force participation may be a valuable mechanism to limit declines in the size of the labour force, given the rapidly ageing population.

Such an outcome would require increased government investment in childcare and early childhood education for under twos, ideally for more than 20 hours per week.

This would be a significant investment, given OECD data shows the net cost of childcare in New Zealand is as much as 38% of a two-earner couple’s average earnings (after accounting for government subsidies or benefits). This is considerably more expensive than most OECD member states.

Potential cost to National

Income and spending averages often mask more extreme impacts for different groups of women and men. For example, traditional economic models value labour used in the production of goods and services in the “market economy” but exclude the production of goods and services for their own use.

For wāhine Māori, non-market work includes care for whānau, community and land, as well as upholding the mana of the marae, and the intergenerational transfer of knowledge.

Finally, implementing pay equity, recognising the economic value of the unpaid care economy, and providing increased financial support for childcare, would also contribute to closing the gender pension gap.

Westpac data shows men have an average KiwiSaver balance 16% higher than women’s, most likely attributable to gender wage gaps and parenting career breaks.

Therefore the reduction in government contributions to KiwiSaver, and National’s desire to lift the retirement age, matter more to women because statistically they have a longer retirement to fund.

Budget 2025 came at a cost to many women in New Zealand, and it may yet come at a cost for National.

The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. NZ Budget 2025: funding growth at the expense of pay equity for women could cost National in the long run – https://theconversation.com/nz-budget-2025-funding-growth-at-the-expense-of-pay-equity-for-women-could-cost-national-in-the-long-run-257225

Source: The Conversation (Au and NZ) – By Milad Haghani, Associate Professor & Principal Fellow in Urban Risk & Resilience, The University of Melbourne

At least ten people died in fatal crashes earlier this month in a single 48-hour period on Victorian roads. It was the latest tragic demonstration of the mounting road trauma in Australia.

In the decade up to 2020, the national road toll was gradually declining, albeit with some fluctuations. But the trend has since reversed, with fatalities rising steadily year after year.

According to the latest official data, 1,296 people died on Australian roads in the year to April. 108 lives were lost last month alone, almost 15% more than the average for April over the previous five years.

While our population has increased by about 6% over this five-year period, our road deaths have gone up by 18.5%.

Road fatalities rarely follow evenly distributed averages. They sometimes spike, as they have in Victoria. And while we must never lose sight of the fact that these are people, and not just data, there is value in interrogating clusters when they occur.

Victoria breakdown

In the 12 months to May 20 this year, 118 lives were lost on Victorian roads, up 8.3% on the previous year and well above the five-year average of 100 annual deaths.

The sharpest increases by transport mode have been among pedestrians (up 24%), one of the most vulnerable road-user groups. And a new threat has emerged with the first publicly reported case in Australia of a pedestrian dying after being struck by an electric bike.

At least one pattern stands out from the recent cluster: five of the eight crashes occurred outside metropolitan Melbourne. This reflects the longstanding reality that fatal collisions remain disproportionately common in regional and remote areas. Over the 12 months, country road deaths have risen by 11%, compared to a 2% increase in metropolitan Melbourne.

Another striking detail is the gender distribution. Male deaths are up 22% on the previous period and now comprise nearly 80% of all fatalities. In contrast, female deaths have declined by 33%.

Another trend that stands out is the rising toll among older road users. In the last 12 months, 40 people aged 60 and over have died on Victorian roads – a 25% increase on the previous period.

4 National trends

The national road fatality data tells us some of these trends are not exclusive to Victoria. They reflect what is happening across the country.

1. Vulnerable road users: Nationally, pedestrians and motorcyclists have experienced sustained increases in lives lost for at least four years in a row. The share of pedestrians in total road deaths has risen from 11% in 2021 to 14% in the latest period. Despite the growing number, motorcyclist fatalities have remained relatively stable at about 20% of all deaths.

2. Gender disparity: Men continue to be disproportionately represented in the national road toll, accounting for approximately 75% of all road deaths in Australia.

3. Older age groups: In the 12 months to April 2025, deaths among individuals aged 75 and over increased by nearly 19% to 185.

4. Regional and remote areas: in the 12 months to April 2024, there were roughly 818 deaths on country roads, compared to 400 in metropolitan areas.

What do the trends tell us?

There are several key points in the data.

First, the persistent over-representation of men in fatalities remains a defining feature of the road toll. This gender imbalance is not specific to Australia.

But put simply, we still know very little about what’s driving this pattern. Known behavioural and physiological sex-based differences don’t fully explain the scale of the disparity.

The rise in fatalities among older Australians does not appear to be particularly abnormal when tracked with demographic changes. From 2020 to 2024, the number of Australians aged 75 and over increased by nearly 31%. In comparison, fatalities in this age group rose by around 25% over the same period. This suggests that the relative risk for older Australians has not necessarily increased.

As for rural and regional areas, approximately two-thirds of road deaths occur in these areas, while only one-third of Australians reside there. Despite years of acknowledgment, this urban–rural divide in road safety remains wide and unresolved.

SUVs a menace?

While vehicles have become safer for their occupants, they have become more dangerous for other road users, especially pedestrians.

One contributing factor could be the fast growing dominance of SUVs and light trucks in Australia.

A recent international review that pooled the findings of 24 studies found SUVs were associated with significantly higher fatality rates in crashes involving vulnerable road users, compared to smaller cars. The effect was particularly pronounced for children.

The dangers are not limited to pedestrians. In two-vehicle collisions, increasing the striking vehicle’s weight by around 450 kilograms raises the probability of a fatality in the other vehicle by 40–50%.

New targets

Australian governments have adopted a Vision Zero goal of no road deaths or serious injuries by 2050.

The complete elimination of fatalities should remain our moral benchmark. But the current data suggests intermediate targets are urgently needed.

A more achievable near-term priority may be to first reverse the rising national toll by focusing on where the greatest preventable harms persist: vulnerable road users, especially pedestrians, males and non-urban roads.

Milad Haghani receives funding from The Australian Government.

Iman Taheri Sarteshnizi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Australian roads are getting deadlier – pedestrians and males are among those at greater risk – https://theconversation.com/australian-roads-are-getting-deadlier-pedestrians-and-males-are-among-those-at-greater-risk-256994

Source: The Conversation (Au and NZ) – By Emma Rowe, Associate Professor in Education, Deakin University

Earlier this week, The Sydney Morning Herald reported one of Sydney’s top public high schools had more than 2,000 students for the first time, thanks to the booming population in the area.

This follows similar reports of other “super-sized” schools in Victoria, Western Australia and Queensland.

Parents may be wondering if a school’s size will impact their child’s opportunities or experience. What does the research say?

A controversial subject

Policy-makers have been concerned about school sizes for decades. This largely relates to declining enrolments in some areas and growing demand in others. For example, in Victoria during the Kennett government in the 1990s, some schools were merged into “super schools”.

Super schools are attractive to policy-makers due to their ability to pool resources. However, anecdotally, parents have tended to oppose mergers on the basis that big schools detract from the community feel and personal relationships.

There is no national data on average school size, although you can check individual school sizes on the MySchool website.

Education authorities consider a school to be “small” if it has fewer than 300 students for primary school and fewer than 700 for high school.

What does the research say?

Australian-based research tends to support larger schools, on the basis they provide more curriculum choices. In a 2014 study published in the Journal of Education Policy, the authors wrote:

large schools have more resources and are therefore better placed to offer a large range of curriculum, often including both academic and vocational subjects.

A 2023 study similarly argued:

smaller schools are generally less able to offer a wide range and diversity of curricular offerings compared to larger schools.

Small schools can be beneficial

But other education advocates argue small schools better facilitate participatory democratic environments for young people, improve discipline and sense of community.

A 2009 review of 57 studies (the majority from the United States) published after 1990 recommended high schools do not have more than 1,000 students.

The review said smaller schools can offer a community-like feel for students and are more likely to have smaller class sizes. A smaller school may be particularly advantageous for neurodiverse students if there are lower levels of noise and movement.

A US-based study from 1991 found schools with less than 400 students lead to better student participation, attendance and satisfaction with school:

The two primary arguments for large schools, cost savings and curriculum enhancement, pale in comparison with the positive schooling outcomes […] achieved by small schools.

But context matters

In 2000, the Gates Foundation had a “big idea” to break up large high schools and turn them into “small learning communities” of 400 or fewer students.

The foundation believed the initiative would lift graduation rates and student achievement, especially among minority students, because of the close relationships between students and teachers.

But by 2008, the foundation conceded it had not worked – there had been no “dramatic improvements” in the number of students who leave high school adequately prepared for further study.

But it’s not really about size

So the research offers a mixed picture – this strongly suggests the size of a school on its own is not the most important factor.

We also need to look at factors such as class size. Research shows smaller class sizes and lower teacher to student ratios are beneficial for student outcomes.

Smaller class sizes and lower teacher to student ratios can lead to more one-on-one attention, improved relationships and lower noise levels in a classroom.

Some studies have categorised “small classes” as between 13-17 students and larger classes as between 22-25 students.

Teaching quality may also be improved with a smaller class size, as the teacher has more time to tailor their instruction to individual students.

Importantly, the size of a school overall does not necessarily determine class sizes. A large school or a small school can still have large class sizes, and still struggle for quality one-on-one time.

Similarly, a large school can still offer a strong sense of community and positive relationships between teachers and peers, depending on the way the school is organised (for example, a “school-within-a-school” or specific learning group within the school).

If a small school is not well-resourced or does not have enough teachers, it may struggle to provide a positive, happy learning environment.

The point is the school size on its own is not necessarily a positive or negative. What matters is what else is going on inside that school and whether it has the funding and resources to offer smaller class sizes, specialised teachers and access to a wide variety of subjects.

Emma Rowe receives funding from the Australian Research Council.

– ref. There is a growing number of ‘super-sized’ schools. Does the number of students matter? – https://theconversation.com/there-is-a-growing-number-of-super-sized-schools-does-the-number-of-students-matter-257012

Source: The Conversation (Au and NZ) – By Garritt C. Van Dyk, Senior Lecturer in History, University of Waikato

Oysters and escargot are recognised as luxury foods around the world – but they were once valued by the lower classes as cheap sources of protein.

Less adventurous eaters today see snails as a garden pest, and are quick to point out that freshly shucked oysters are not only raw but also alive when they are eaten.

How did these unusual ingredients become items of conspicuous consumption?

From garden snail to gastronomy

Eating what many consider to be a slimy nuisance seems almost counter-intuitive, but consuming land snails has an ancient history, dating to the Palaeolithic period, some 30,000 years ago in eastern Spain.

Ancient Romans also dined on snails, and spread their eating habits across their empire into Europe.

Lower and middle class Romans ate snails from their gardens, while elite consumers ate specially farmed snails, fed spices, honey and milk.

Pliny the Elder (AD 24–79) described how snails were raised in ponds and given wine to fatten them up.

The first French recipe for snails appears in 1390, in Le Ménagier de Paris (The Good Wife’s Guide), but not in other cookbooks from the period.

In 1530, a French treatise on frogs, snails, turtles and artichokes considered all these foods bizarre, but surprisingly popular. Some of the appeal had to do with avoiding meat on “lean” days. Snails were classified as fish by the Catholic Church, and could even be eaten during Lent.

For the next 200 years, snails only appeared in Parisian cookbooks with an apology for including such a disgusting ingredient. This reflected the taste of upper-class urbanites, but snails were still eaten in the eastern provinces.

An 1811 cookbook from Metz, in the Alsace region in northeastern France, describes raising snails like the Romans, and a special platter, l’escargotière, for serving them. The trend did not travel to Paris until after 1814.

French diplomat Charles-Maurice de Talleyrand-Périgord (1754–1838) hosted a dinner for Russian Tsar Alexander I, after he marched into Paris following the allied forces’ defeat of Napoleon in 1814.

The chef catering the meal was the father of French cuisine Marie-Antoine Carême, a native of Burgundy, spiritual home of the now famous escargots de Bourgogne.

Carême served the Tsar what would become a classic recipe, prepared with garlic, parsley and butter. Allegedly, the Tsar raved about the “new” dish, and snails became wildly popular. A recipe for Burgundy snails first appeared in a French culinary dictionary published in 1825.

It is ironic that it took the approval of a foreign emperor, who had just conquered Napoleon, to restore luxury status to escargot, a food that became a symbol of French cuisine.

Snails remain popular today in France, with consumption peaking during the Christmas holidays, but May 24 is National Escargot Day in France.

Oysters: the original fast food

Oysters are another ancient food, as seen in fossils dating to the Triassic Era, 200 million years ago. Evidence of fossilised oysters are found on every major land mass, and there is evidence of Indigenous oyster fisheries in North America and Australia that dates to the Holocene period, about 12,000 years ago.

There are references in classical Greek texts to what are probably oysters, by authors like Aristotle and Homer. Oyster shells found at Troy confirm they were a favoured food. Traditionally served as a first course at banquets in Ancient Greece, they were often cooked, sometimes with exotic spices.

Pliny the Elder refers to oysters as a Roman delicacy. He recorded methods of the pioneer of Roman oyster farming, Sergius Orata, who brought the best specimens from across the Empire to sell to elite customers.

Medieval coastal dwellers gathered oysters at low tide, while wealthy inland consumers would have paid a premium for shellfish, a perishable luxury, transported to their castles.

French nobles in 1390 preferred cooked oysters, roasted over coals or poached in broths, perhaps as a measure to prevent food poisoning. As late as the 17th century, authors cautioned:

But if they be eaten raw, they require good wine […] to aid digestion.

By the 18th century, small oysters were a popular pub snack, and larger ones were added as meat to the stew pot. That century, it is believed as many as 100,000 oysters were eaten each day in Edinburgh and the shells from the tavern in the basement filled in gaps in the brickwork at Gladstone’s Land in Edinburgh’s Royal Mile.

Scottish oyster farms in the Firth of Forth, an inlet of the North Sea, produced 30 million oysters in 1790, but continual over-harvesting took its toll.

By 1883 only 6,000 oysters were landed, and the population was declared extinct in 1957.

As wild oyster stocks dwindled, large oyster farms developed in cities like New York in the 19th century. Initially successful, they were polluted, and infected by typhoid from sewage. An outbreak in 1924 killed 150 people, the deadliest food poisoning in United States history.

Far from the overabundance of oysters we once had, over-fishing, pollution, and invasive species all threaten oyster populations worldwide today. Due to this scarcity of wild oysters and the resources required to safely farm environmentally sustainable oysters, they are now a premium product.

Next on the menu

Scarcity made oysters a luxury, and a Tsar’s approval elevated snails to gourmet status. Could insects become the next status food?

Ancient Romans ate beetles and grasshoppers, and cultures around the world consume insects, but not (yet) as luxury products.

Maybe the right influencer can make honey-roasted locust the next species to jump from paddock to plate.

Garritt C. Van Dyk has received funding from the Getty Research Institute.

– ref. From peasant fodder to posh fare: how snails and oysters became luxury foods – https://theconversation.com/from-peasant-fodder-to-posh-fare-how-snails-and-oysters-became-luxury-foods-254299

Source: The Conversation (Au and NZ) – By Michelle Grattan, Professorial Fellow, University of Canberra

Remember that cliche about the Nationals tail wagging the Liberal dog? That tail wagged very vigorously this week, and smashed a lot of crockery, as it sought to bring Liberal leader Sussan Ley to heel.

In a gesture of overreach, the Nationals split the Coalition on Tuesday, after Ley refused to accept their demand that four policies to which they were committed be immediately endorsed by the Liberals.

Ley had said the Liberal Party had all policies on the table and would review them systematically, and she would not pre-empt that. The new Liberal leader was also concerned Nationals’ leader David Littleproud had not explicitly agreed to her insistence the Nationals observe shadow cabinet solidarity – that frontbenchers could not go out freelancing on issues.

Ley won praise from Liberals and commentators for standing firm against the Nationals’ unilateralism.

But elders and MPs from both parties, knowing how dysfunctional the consequences of the split would be, were appalled at the break. It emerged that the National Party itself had been divided about this course, which would cost frontbenchers pay and probably lose Senate seats at the next election.

As Barnaby Joyce, who warned against the break, said subsequently, “Even from the start, people wanted to re-form as quickly as possible. […] Blind Freddy can see it was going to be chaotic.”

By late Wednesday Littleproud was taking a lot of heat for rushing something that could have been handled more judiciously. Littleproud tried to blame Ley for imposing a fast timetable, despite the fact her mother died last weekend.

If disaster was to be avoided, and the break repaired, Littleproud or Ley or both would have to give ground.

By Thursday morning time was fast running out. Ley was preparing to announce her all-Liberal shadow ministry; Littleproud was readying to put out a list of Nationals spokespeople for various policy areas. Once these teams were in place, it would be hard to retreat on the split. People would be locked into positions and there would be less appetite in either party to do so.

Amid these preparations, however, compromise was emerging.

Littleproud said on radio that he had accepted as “more than reasonable” Ley’s requirement for shadow cabinet solidarity.

One reason Ley was anxious to get a firm agreement on this was the prospect of a debate coming about the commitment to net zero emissions by 2050, as well as about the 2035 target, when the government announces it. Ley would not want the Nationals, if they were in a coalition, to be able to contradict opposition policy or try to set it ahead of the shadow cabinet.

At a Thursday press conference Littleproud said the solidarity issue arose from the Nationals’ action over the Voice in the last term. He and his party had reached a position ahead of the Liberals. “That actually hurt in some small way the relationship that I had with Peter [Dutton] and I lost trust and I had to rebuild that.”

Ley said she welcomed the solidity commitment “as a foundation to resolve other ,atters”, and agreed to take to a Liberal party meeting the four policies the Nationals wanted endorsed, These are commitments to nuclear energy, divestiture powers for supermarkets that do the wrong thing, a $20 billion regional future fund, and upgraded regional communications services.

The commitment on nuclear the Nationals want is not to the specific election policy, which was for a string of government-funded nuclear power stations. The Nationals are talking about something more general.

In her concession to the Nationals, Ley is essentially asking her party to carve out these priority policy areas from the Liberals’ general policy review. This can be seen as a big thing (the Liberals being dictated to by the minor party) or a small thing (making an exception for the greater good of keeping a coalition).

If the Liberals want to re-establish the Coalition, these policies will not be too hard for them to endorse.

Liberals are divided over nuclear but most could accept at least keeping it in the policy tool box, in a generalised form, such as a commitment to lift the moratorium.

But some Liberals will resent being forced to bow to Nationals’ wishes. And some, especially those with eyes on winning back city seats, have been relishing the prospect of being free of the constraint of the ties binding them to the noisy Nationals.

Thursday’s pause to determine whether the two parties can come together again was a major step. But there are likely to be difficult times ahead.

Having agreed to take the Nationals’ policies to her party room, Ley has now to smooth them through. That will take some private wrangling ahead of the general meeting, when that occurs next week.

Assuming the party room agrees and the Coalition is re-glued, the two leaders have to work out a shadow ministry, in terms of respective numbers and key positions.

Given the long-standing poor personal relationship between Littleproud and Ley, in a re-formed Coalition there would be ongoing suspicion and tension between the two of them. Angus Taylor, only narrowly defeated by Ley for the leadership and probably preferred by Littleproud, will be watching for opportunity.

The Nationals could be expected to push the envelope on policy issues, including net zero – which Joyce on Thursday said should be on the table – and the detail of divestiture. Moderates among the Liberals would have even less regard for their country cousins than usual.

Critics of Littleproud say he has been damaged by the way he has handled the week. They point out he keeps declaring it’s his party room that’s driving decisions, when he should have exercised stronger leadership and better judgement.

Depending on the outcome, it will take a while to determine whether this episode strengthens or undermines Ley’s leadership. But she could hardly have had a more bruising start.

Michelle Grattan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Grattan on Friday: if Ley and Littleproud find a way to cohabit, it will be a tense household – https://theconversation.com/grattan-on-friday-if-ley-and-littleproud-find-a-way-to-cohabit-it-will-be-a-tense-household-256457

Source: The Conversation (Au and NZ) – By Piet Filet, Adjunct Industry Fellow, Australian Rivers Institute, Griffith University

Heavy rain continues to fall across the Hunter and Mid North Coast of New South Wales. Rivers are bursting their banks and spreading over floodplains, leaving many areas on flood watch. And now, this emergency is heading south.

The unfolding disaster shows just how vulnerable rural catchments and regional communities are to extreme rainfall. It comes just a few months after extensive flooding hit western Queensland.

The flooding issues for rural and regional Australia are quite distinct from city areas, where populations are concentrated and urban runoff is the main danger. So what can Australia’s regional and rural communities learn from this extreme weather event?

Highly exposed communities

NSW’s Mid North Coast comprises farmland and bushland, with steep hilly country at the back of river catchments and more urban settlements closer to the coast.

Residents are spread across rural properties and lifestyle bushland blocks as well as local villages and bigger towns. Taree is home to about 17,000 people. About 50,000 people live in Port Macquarie and 36,500 live elsewhere in the Port Macquarie-Hastings local government area.

The population also swells with regular weekend and holiday visitors coming to enjoy coastal, river and mountain settings.

With people and communities spread right across these catchments, they can be left highly exposed when heavy rain falls. Flooding is likely, roads and rail are often cut off and life is turned upside down.

Short catchments in coastal areas fill rapidly

The nature of the landscape – including the geography, the size of the rivers and the shape of the catchment area – largely determines the flood hazard.

The catchments of the Mid North Coast feature short, east-flowing streams and rivers up against the Great Dividing Range. Some ranges are just 20–30 kilometres from the coast. Others are no further than 100–150km from the coast.

When heavy rain hits this steep bushland country, runoff water is quickly concentrated in streams. When these streams join with other creeks and waterways, the concentrated flows overwhelm the natural storage volumes of these waterways. So the water rises and breaks the banks, flowing out across the adjacent floodplains.

Prior rainfall along the east coast, over the past two to three months, means less moisture can soak into the soil and runoff increases. As a consequence:

• houses, community facilities and business are inundated

• river and creek crossings are being cut, low lying roads on floodplains flooded and railway lines threatened

• local water supply and sewerage treatment plants – often in low lying parts of the landscape – are at risk

• livestock and household pets, horses and other animals are at risk

• wildlife in bushland and waterways are being displaced

• local wetlands are being overwhelmed

• estuaries are being flooded and in some cases, slugs of sediment and nutrients are being washed downstream and out into coastal waters.

Other rural and regional communities face similar impacts during floods. As the magnitude of this event becomes clear, it is a timely warning for other communities to plan for future floods in their catchments.

The human dimension

As the flooding unfolds, the safety of people and their property is a high priority. Many people have been displaced, leaving their homes for safer locations. Others have been stranded by rising floodwaters.

Many will be feeling stress, fear and uncertainty. This will affect their mental health and wellbeing, and that of their families and local communities. So psychological support is needed both now and after the disaster.

Local and state government agency staff, non-government organisations and volunteers will be active at emergency response and recovery centres to support and guide affected people through this difficult time.

It’s vital that staff and volunteers are prepared and trained in mental health first aid.

Flood preparedness planning must also consider a mix of communication support networks for both the emergency response phase and the recovery phase. And there are opportunities to establish permanent community hubs for building resilience post floods, fires, cyclones and heatwaves.

Preparing for a new chapter

After the 2011 floods in southeast Queensland, I helped set up a national network of professionals striving to develop better ways to design, implement and sustain flood solutions for more resilient communities. This involves not the immediate emergency response, but the 10-50 year plans needed to help communities reduce the harm of flooding and adapt to climate-related risks.

Long-term flood-risk planning includes options on flood mitigation, such as dykes and levees. It also involves multiple approaches to adaptation, such as household flood resilience. This might mean raising houses off the ground, or relocating residents away from high-risk areas.

The approach, which started in collaboration with Brisbane City Council, is now being used in Queensland and New South Wales, and has been supported by the federal government.

In impacted cities, authorities and communities have committed to prioritising new ways to adapt and minimise the impacts from flood waters. Similarly in rural and regional areas, measures to reduce flood impacts – at both the landscape and household scale – must become more common, to ensure community resilience.

Piet Filet is affiliated with Flood Community of Practice

– ref. The deluge in NSW sounds a warning to rural and regional communities elsewhere – https://theconversation.com/the-deluge-in-nsw-sounds-a-warning-to-rural-and-regional-communities-elsewhere-256814

Source: The Conversation (Au and NZ) – By Mitchell Sarkies, Senior Lecturer, Horizon Fellow and NHMRC Emerging Leadership Fellow at the Sydney School of Health Sciences, University of Sydney

Floodwaters have engulfed large parts of New South Wales, with at least one person dead and almost 50,000 evacuated after days of heavy rainfall in a “one-in-500-year” flood event. The scale of the disaster is still unfolding and affected communities will be recovering for some time to come.

One question worth asking is: how ready are our hospitals to cope when disaster strikes?

A growing body of research, including our own, has looked at how hospitals might contend with disasters like floods, bushfires, heatwaves, cyclones or even mass injury events such as a stadium collapse. The answer? There’s room for improvement.

Australia is already prone to natural disasters, which are expected to become more frequent and severe as the climate changes.

Research around the world shows hospital administrators can better plan for how they’d cope if a disaster or terrorist attack wiped out their hospital’s capacity to function normally.

When flood strikes, large parts of the hospital stop working

In March 2022, rapidly rising floodwaters on Australia’s east coast posed an imminent threat to Ballina Hospital, on the NSW far north coast.

With a few hours’ notice, staff safely evacuated the whole hospital to a nearby high school. This included 55 patients, essential equipment, supplies and medications.

Our study documented this remarkable achievement via seven interviews with doctors and nurses integral to the evacuation.

Several key themes emerged:

• communication was disrupted: there was no mobile phone reception. Field hospital staff requested a satellite phone, but it was sent without any battery charge or a charging device
• staff shortages: flooded roads prevented doctors and nurses from reaching the hospital. However, they could get to the high school field hospital, which still had road access
• managing volunteers was tricky: community support was praised. However, there were so many volunteers, security was called to ensure volunteers didn’t get into spaces that would compromise the patient confidentiality, privacy and safety
• patient tracking was a challenge: it was hard to keep track of vulnerable evacuated patients with cognitive decline or behavioural impairment
• transport had to be improvised: cars, buses and taxis were used to transport equipment, medication and supplies
• triage for patient transfers and discharging was crucial: health professionals prioritised less critical patients first, as they often make up the majority. By swiftly addressing their needs, staff could then concentrate on the smaller group of patients requiring intensive care.

Some workers, dealing with their own personal losses during the evacuation, had to be sent home. One staff member told us:

There were a couple of nursing staff who also lived within the flood risk area, and they had children at home, so we needed to let them go home.

Another said:

We did end up with almost too many people wanting to help, which is lovely, but it becomes a problem because we don’t need this many people.

A third staff member said:

Everybody was accounted for. We had a list of patients at one end and then when they got there, they put a new list of who was there and who was coming; that was all written on a big whiteboard.

Disaster simulation: when a semi-trailer crash causes a stadium collapse

Natural disasters aren’t the only kind of catastrophe for which hospitals must prepare.

Our research has also looked at how hospitals might contend with a human-made disaster such as a mass casualty or injury event.

Our team studied a mass casualty simulation exercise at one of Australia’s largest public hospitals.

More than 200 hospital staff participated in the three‐hour long exercise, which simulated a semi‐trailer crashing into a stadium grandstand. Some 120 “patients” were taken to the hospital with crush, burn, smoke inhalation and other injuries.

In the simulation, clinicians had to adapt quickly. New patients were continuously coming via the ambulance ramp and private cars.

Participants had to make rapid collective decisions on treatment and transfers based on patient conditions and severity.

During the exercise, additional random disruptive scenarios were introduced to test the clinicians’ ongoing responses. This included the city mayor repeatedly calling the Hospital Emergency Operations Centre for updates.

Some key challenges included:

• some of the hypothetical patients died from a lack of critical care equipment
• an overwhelming number of minor injuries had to be managed
• clinicians were uncertain about how many casualties were en route to the hospital and how many beds to make available for them
• a shortage of orderlies to accompany transfers from the emergency department to surgical theatres or for scans
• difficulties in keeping track of patients and bed allocations.

We also observed hospital staff adapting to the situation. This included:

• paediatricians treating adult patients with minor injuries
• staff fast‐tracking triage
• staff manually ventilating patients using a specialised resuscitation balloon when mechanical ventilation equipment was unavailable
• running scans and imaging in batches instead of individually, due to the limited number of orderlies.

A growing body of research

Research shows that despite many hospitals having excellent, longstanding hospital disaster management plans, things can still go wrong. After the Fukushima nuclear accident in Japan, nearly half of evacuated stroke and renal failure patients died in vehicles or on arrival to another hospital.

Learning from hospital responses to disasters can help hospitals prepare for the future.

Overall, our research shows many Australian hospitals have excellent disaster preparedness planning. However, some areas require improvement well before disaster strikes. Adapting on-the-fly as your hospital is inundated with floodwater or struck by another disaster means things have been left too late.

Faran Naru is the recipient of a Macquarie University Research Excellence Scholarship (20203593). He works for the Australian government’s National Emergency Management Agency. This article reflects his work as a researcher, not the views of his employer.

Janet Long, Jeffrey Braithwaite, Kate Churruca, and Mitchell Sarkies do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

– ref. Floods, fires and even terrorist attacks: how ready are our hospitals to cope when disaster strikes? – https://theconversation.com/floods-fires-and-even-terrorist-attacks-how-ready-are-our-hospitals-to-cope-when-disaster-strikes-257318

Source: The Conversation (Au and NZ) – By Simon Vella, Postdoctoral Research Fellow, Institute for Musculoskeletal Health, University of Sydney

Around 4 million Australians experience back problems and people are increasingly calling ambulances and presenting to emergency departments to manage back pain.

Yet most of these cases of back pain don’t require emergency care. Back pain is a symptom rather than a disease. When symptoms last more than 12 weeks it is referred to as chronic back pain. The most common form of back pain is non-specific back pain – this term is given when no tissue or structure can be identified as the cause.

Non-specific back pain usually best managed in primary care, by GPs and allied health professionals.

Once people with non-serious back pain contact emergency health services, they are more likely to receive care that isn’t recommended and is considered low-value and, sometimes, harmful.

This may include unnecessary laboratory investigations, such as blood tests, and imaging, such as x-rays, CT scans or MRIs. One-third of imaging requests for back pain in emergency departments aren’t clinically warranted and are judged as inappropriate.

However, in some instances it is recommended that people with back pain contact an ambulance or present to the emergency department. This includes when back pain is a result of trauma, when people live alone without access to carers, when people have other complex presentations, and when people show signs of potentially serious conditions.

Unnecessary hospital admissions are costly to the health system and can cause patients harm. Almost one in four (24%) of those admitted to hospital for back pain acquire infections or experience falls.

Medications prescribed in hospital can also have negative consequences for the patient. Nearly one in ten patients with back pain are still taking opioids after discharge, with risk of dependency and overdose. One in three patients continue to use opioids one month after their emergency department visit.

Read more:
Opioids don’t relieve acute low back or neck pain – and can result in worse pain, new study finds

The influx of back pain presentations to emergency health services also has ramifications for emergency department overcrowding and ambulance ramping. This means other ambulance patients cannot enter the emergency department and results in longer waiting times.

Why is this happening?

In primary health care, the management of back pain is well established in clinical practice guidelines. But emergency health services don’t have guidelines specific to low back pain. This is likely due to the lack of evidence from these settings (though the evidence-base has increased over the past five years).

The lack of specific guidance means there is a high likelihood of people both missing out on the right care and receiving the wrong care.

A key challenge for emergency clinicians is discriminating between patients with back pain that require emergency care from those who do not.

One Australian study found 38% of patients in the emergency department who were initially diagnosed with non-serious back pain were later found to have a specific pathology, such as an infection, during hospital admission. In cases such as these, further diagnostic investigation and emergency care is necessary.

But nearly half of ambulance and emergency department patients without serious pathology receive unnecessary care. Our recent study found 81% of people who presented to ambulance service with non-traumatic back pain were transferred to the emergency department.

Once in the emergency department, 46% of ambulance patients received opioids, 59% received imaging and 50% were admitted. However, it’s unclear what proportion actually required emergency department care.

Clinicians are required to make quick decisions about patient care. For paramedics, limited scope of medications and access to community health services, particularly outside of business hours, ultimately leaves them with no other option but to transport the patient to hospital.

Emergency department clinicians have to manage people with complex presentations and multiple conditions and address patient expectations about opioids and imaging. This can influence their decisions about care.

How can emergency back pain care be improved?

A key area for improvement is reducing the use of opioids. An New South Wales trial reduced opioid use for back pain in emergency departments by 43% by introducing a new model of care. The model involved clinician education, implementation of non-opioid provisions such as heat packs, and timely referrals to outpatient services such as specialist back clinics.

This approach will now be scaled up to include 44 emergency departments across NSW. If successful, it could be rolled out across the country.

Virtual hospitals have also been implemented to reduce in-person presentations to emergency departments for back pain, which often means people with back pain can receive care while remaining in their home. However, the effectiveness and safety of this new service has not yet been established, though research is underway.

The Australian government has promised to open more Urgent Care Clinics, where people with urgent but not life-threatening complaints can be managed by a doctor, nurse, or in some cases, a physiotherapist. The service allows people with back pain to still receive in-person care while diverting them away from the emergency department. But while they seem like a good idea, we have little or no evidence on their value.

To reduce the burden that back pain places on emergency health services, changes need to be made across all health system-levels. But these changes must be backed by reliable research evidence.

Better information for patients and clinicians

The general public needs to be aware when and where to seek appropriate care for back pain. This can be achieved through successful health promotion initiatives.

For clinicians, specific guidelines for back pain need to be developed and implemented into ambulance and hospital emergency departments to improve decision-making and reduce unnecessary care escalation. Policymakers, health service managers and stakeholders need to revise current policy to align with the most recent evidence.

Additionally, easy-to-access referral pathways need to be developed between emergency health and community health services to keep people with non-serious back pain out of hospital, to reduce their risk of receiving unnecessary and costly care.

Simon Vella receives grant funding from HCF Research Foundation, Health Service Research Grant Scheme and the Australian Chiropractors Education Research Foundation. Simon is a board member of Chiropractic Australia Research Foundation.

Christopher Maher has a research fellowship from National Health and Medical Research Council, grants from National Health and Medical Research Council, Medical Research Future Fund, New South Wales Health, Ramsay Hospital Research Foundation, HCF Research Foundation, ArthritisAustralia, Australian Rheumatology Association, Royal Prince Alfred Hospital, and Sao Paulo Research Foundation.

Gustavo Machado has an investigator grant from the National Health and Medical Research Council. He also holds research grants from the National Health and Medical Research Council, Medical Research Future Fund, and HCF Research Foundation.

– ref. Too many people with back pain call ambulances or visit the ED. Here’s why that’s a problem – https://theconversation.com/too-many-people-with-back-pain-call-ambulances-or-visit-the-ed-heres-why-thats-a-problem-255776

Source: The Conversation (Au and NZ) – By Erin Smith, Associate Professor and Discipline Lead (Paramedicine), La Trobe University

As unprecedented flooding inundates towns and leaves residents stranded in parts of New South Wales, local first responders have rescued hundreds of people from floodwaters and rooftops.

Volunteering Australia estimates more than 400,000 people volunteer as first responders around the nation. Around half of those volunteer in fire services and around 25,000 in state and territory emergency services. Thousands of additional “invisible” first responders help informally and spontaneously to support their communities before and after a disaster.

In a situation such as the current flooding in NSW, local first responders, many of whom are volunteers, face a difficult dilemma. How do they prioritise their commitment to their communities and the safety of the public while also protecting their own families and homes?

It’s a dilemma one of us (Cameron) knows too well. Cameron is a registered paramedic and volunteer firefighter, and responded to the Black Saturday bushfires in Victoria in 2009. He’s well aware of the challenge first responders have to juggle – helping others while also ensuring their loved ones are safe.

It’s a juggle

During a disaster, first responders and their families may be at risk due to extreme weather and rising floodwaters, damaged infrastructure, and other dangers. First responders may need to evacuate homes, coordinate emergency services, and navigate dangerous conditions while trying to ensure their own family’s safety.

In rapidly evolving emergencies, they may also be faced with the choice to abandon their emergency work to prioritise their family’s safety, potentially placing their first responder colleagues at risk.

Even now, 16 years after the Black Saturday bushfires devastated parts of Victoria, Jessica Ciccosillo, a first responder with St John Ambulance Australia, still feels like she abandoned her community when it needed her the most. She told us:

I had a baby at home, and my husband was also volunteering during the disaster. We couldn’t both respond at the same time, so I stayed home with the baby. I also wanted to protect our animals and property. But the desire to help was so strong, and it was so hard to make the decision to stay at home and prioritise our own family.

It’s a moral dilemma

Finding the balance between helping others while their own families are at risk can create a moral dilemma for first responders, forcing them to make difficult decisions about where to focus their efforts.

These moral dilemmas can arise from conflicting values (such as having to follow organisational policies or directives that conflict with our personal beliefs), the need to make difficult decisions under pressure, or witnessing events that challenge their sense of what is right and wrong.

Moral dilemmas about who to priortise during an emergency situation can lead to a sense of moral injury, when people can feel guilty, ashamed and distressed about the choices they have made.

Families can suffer too

First responder work can significantly impact family members. Long and unpredictable hours can interfere with family activities and undermine their sense of support. Added to this is the constant fear for their loved one’s safety. When emergencies occur, these fears can be heightened.

Families may even experience vicarious trauma, where they absorb the stress and trauma of their loved one’s work, leading to their own mental health challenges.

First responders want to talk to someone who ‘gets it’

When we asked local first responders what would be most helpful for supporting their wellbeing, the message was clear: they want to talk about what they have experienced with someone who “gets it”.

Sharing their experience with supportive colleagues and peers offers a different kind of support for many responders who may not have benefited from, or want to use, more traditional counselling programs.

Emergency services organisations can also promote wellbeing by creating supportive cultures and strong leadership that focus on building mental-health literacy. Programs that address the needs of the whole family, rather than just the individual responder, can foster resilience.

For local first responders currently helping flood-affected communities in NSW, focusing on making small, short-term decisions can help them feel less overwhelmed and allow them to better manage their mental health.

There’s support

If you are a first responder and need support now, resources include:

• The National Emergency Worker Support Service, which offers free, confidential, and evidence-based mental health support, including 12 free sessions with trauma-informed clinicians

• Fortem Australia provides mental health support, including clinical support and wellbeing activities, for first responders and their families

• Beyond Blue offers the Police and Emergency Services Program to promote mental health and reduce suicide risk among police and emergency service personnel, including their families

• Phoenix Australia offers information, support and treatment options related to trauma for first responders, including the Responder Assist program

• The Code 9 Foundation provides support for first responders living with post-traumatic stress disorder, depression, anxiety and other mental health conditions resulting from their service to the community.

For families of first responders:

• This guide from the Emergency Services Foundation is intended to help families of emergency service workers, especially families of volunteers. It was developed with input from partners, children and other relatives who have experience living with an emergency service worker.

If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.

Cameron Anderson is a registered paramedic and volunteer firefighter.

Erin Smith does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. In a flood, first responders balance helping others while their own families are at risk. It’s an impossible choice – https://theconversation.com/in-a-flood-first-responders-balance-helping-others-while-their-own-families-are-at-risk-its-an-impossible-choice-257313