Queensland Government

<h3>Importance</h3> Liver cancer is among the leading causes of cancer deaths globally. The most common causes for liver cancer include hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and alcohol use. <h3>Objective</h3> To report results of the Global Burden of Disease (GBD) 2015 study on primary liver cancer incidence, mortality, and disability-adjusted life-years (DALYs) for 195 countries or territories from 1990 to 2015, and present global, regional, and national estimates on the burden of liver cancer attributable to HBV, HCV, alcohol, and an “other” group that encompasses residual causes. <h3>Design, Settings, and Participants</h3> Mortality was estimated using vital registration and cancer registry data in an ensemble modeling approach. Single-cause mortality estimates were adjusted for all-cause mortality. Incidence was derived from mortality estimates and the mortality-to-incidence ratio. Through a systematic literature review, data on the proportions of liver cancer due to HBV, HCV, alcohol, and other causes were identified. Years of life lost were calculated by multiplying each death by a standard life expectancy. Prevalence was estimated using mortality-to-incidence ratio as surrogate for survival. Total prevalence was divided into 4 sequelae that were multiplied by disability weights to derive years lived with disability (YLDs). DALYs were the sum of years of life lost and YLDs. <h3>Main Outcomes and Measures</h3> Liver cancer mortality, incidence, YLDs, years of life lost, DALYs by etiology, age, sex, country, and year. <h3>Results</h3> There were 854 000 incident cases of liver cancer and 810 000 deaths globally in 2015, contributing to 20 578 000 DALYs. Cases of incident liver cancer increased by 75% between 1990 and 2015, of which 47% can be explained by changing population age structures, 35% by population growth, and −8% to changing age-specific incidence rates. The male-to-female ratio for age-standardized liver cancer mortality was 2.8. Globally, HBV accounted for 265 000 liver cancer deaths (33%), alcohol for 245 000 (30%), HCV for 167 000 (21%), and other causes for 133 000 (16%) deaths, with substantial variation between countries in the underlying etiologies. <h3>Conclusions and Relevance</h3> Liver cancer is among the leading causes of cancer deaths in many countries. Causes of liver cancer differ widely among populations. Our results show that most cases of liver cancer can be prevented through vaccination, antiviral treatment, safe blood transfusion and injection practices, as well as interventions to reduce excessive alcohol use. In line with the Sustainable Development Goals, the identification and elimination of risk factors for liver cancer will be required to achieve a sustained reduction in liver cancer burden. The GBD study can be used to guide these prevention efforts.

The biodiversity-productivity relationship (BPR) is foundational to our understanding of the global extinction crisis and its impacts on ecosystem functioning. Understanding BPR is critical for the accurate valuation and effective conservation of biodiversity. Using ground-sourced data from 777,126 permanent plots, spanning 44 countries and most terrestrial biomes, we reveal a globally consistent positive concave-down BPR, showing that continued biodiversity loss would result in an accelerating decline in forest productivity worldwide. The value of biodiversity in maintaining commercial forest productivity alone-US$166 billion to 490 billion per year according to our estimation-is more than twice what it would cost to implement effective global conservation. This highlights the need for a worldwide reassessment of biodiversity values, forest management strategies, and conservation priorities.

Haemodialysis (HD) is the commonest form of kidney replacement therapy in the world, accounting for approximately 69% of all kidney replacement therapy and 89% of all dialysis. Over the last six decades since the inception of HD, dialysis technology and patient access to the therapy have advanced considerably, particularly in high-income countries. However, HD availability, accessibility, cost and outcomes vary widely across the world and, overall, the rates of impaired quality of life, morbidity and mortality are high. Cardiovascular disease affects more than two-thirds of people receiving HD, is the major cause of morbidity and accounts for almost 50% of mortality. In addition, patients on HD have high symptom loads and are often under considerable financial strain. Despite the many advances in HD technology and delivery systems that have been achieved since the treatment was first developed, poor outcomes among patients receiving HD remain a major public health concern. Understanding the epidemiology of HD outcomes, why they might vary across different populations and how they might be improved is therefore crucial, although this goal is hampered by the considerable heterogeneity in the monitoring and reporting of these outcomes across settings. This Review examines the epidemiology of haemodialysis outcomes — clinical, patient-reported and surrogate outcomes — across world regions and populations, including vulnerable individuals. The authors also discuss the current status of monitoring and reporting of haemodialysis outcomes and potential strategies for improvement.

Abstract Drought events are increasing globally, and reports of consequent forest mortality are widespread. However, due to a lack of a quantitative global synthesis, it is still not clear whether drought‐induced mortality rates differ among global biomes and whether functional traits influence the risk of drought‐induced mortality. To address these uncertainties, we performed a global meta‐analysis of 58 studies of drought‐induced forest mortality. Mortality rates were modelled as a function of drought, temperature, biomes, phylogenetic and functional groups and functional traits. We identified a consistent global‐scale response, where mortality increased with drought severity [log mortality (trees trees −1 year −1 ) increased 0.46 (95% CI = 0.2–0.7) with one SPEI unit drought intensity]. We found no significant differences in the magnitude of the response depending on forest biomes or between angiosperms and gymnosperms or evergreen and deciduous tree species. Functional traits explained some of the variation in drought responses between species (i.e. increased from 30 to 37% when wood density and specific leaf area were included). Tree species with denser wood and lower specific leaf area showed lower mortality responses. Our results illustrate the value of functional traits for understanding patterns of drought‐induced tree mortality and suggest that mortality could become increasingly widespread in the future.

Abstract Urbanization is a major cause of loss of coastal wetlands. Urbanization also exerts significant influences on the structure and function of coastal wetlands, mainly through modifying the hydrological and sedimentation regimes, and the dynamics of nutrients and chemical pollutants. Natural coastal wetlands are characterized by a hydrological regime comprising concentrated flow to estuarine and coastal areas during flood events, and diffused discharge into groundwater and waterways during the non‐flood periods. Urbanization, through increasing the amount of impervious areas in the catchment, results in a replacement of this regime by concentrating rain run‐off. Quality of run‐off is also modified in urban areas, as loadings of sediment, nutrients and pollutants are increased in urban areas. While the effects of such modifications on the biota and the physical environment have been relatively well studied, there is to date little information on their impact at the ecosystem level. Methodological issues, such as a lack of sufficient replication at the whole‐habitat level, the lack of suitable indices of urbanization and tools for assessing hydrological connectivity, have to be overcome to allow the effects of urbanization to be assessed at the ecosystem level. A functional model is presented to demonstrate the impact of urbanization on coastal wetland structure and function.

Ongoing climate change poses significant threats to plant function and distribution. Increased temperatures and altered precipitation regimes amplify drought frequency and intensity, elevating plant stress and mortality. Large-scale forest mortality events will have far-reaching impacts on carbon and hydrological cycling, biodiversity, and ecosystem services. However, biogeographical theory and global vegetation models poorly represent recent forest die-off patterns. Furthermore, as trees are sessile and long-lived, their responses to climate extremes are substantially dependent on historical factors. We show that periods of favourable climatic and management conditions that facilitate abundant tree growth can lead to structural overshoot of aboveground tree biomass due to a subsequent temporal mismatch between water demand and availability. When environmental favourability declines, increases in water and temperature stress that are protracted, rapid, or both, drive a gradient of tree structural responses that can modify forest self-thinning relationships. Responses ranging from premature leaf senescence and partial canopy dieback to whole-tree mortality reduce canopy leaf area during the stress period and for a lagged recovery window thereafter. Such temporal mismatches of water requirements from availability can occur at local to regional scales throughout a species geographical range. As climate change projections predict large future fluctuations in both wet and dry conditions, we expect forests to become increasingly structurally mismatched to water availability and thus overbuilt during more stressful episodes. By accounting for the historical context of biomass development, our approach can explain previously problematic aspects of large-scale forest mortality, such as why it can occur throughout the range of a species and yet still be locally highly variable, and why some events seem readily attributable to an ongoing drought while others do not. This refined understanding can facilitate better projections of structural overshoot responses, enabling improved prediction of changes in forest distribution and function from regional to global scales.

Climate is predicted to change over the 21st century. However, little is known about how climate change can affect soil phosphorus (P) cycle and availability in global terrestrial ecosystems, where P is a key limiting nutrient. With a global database of Hedley P fractions and key-associated physiochemical properties of 760 (seminatural) natural soils compiled from 96 published studies, this study evaluated how climate pattern affected soil P cycle and availability in global terrestrial ecosystems. Overall, soil available P, indexed by Hedley labile inorganic P fraction, significantly decreased with increasing mean annual temperature (MAT) and precipitation (MAP). Hypothesis-oriented path model analysis suggests that MAT negatively affected soil available P mainly by decreasing soil organic P and primary mineral P and increasing soil sand content. MAP negatively affected soil available P both directly and indirectly through decreasing soil primary mineral P; however, these negative effects were offset by the positive effects of MAP on soil organic P and fine soil particles, resulting in a relatively minor total MAP effect on soil available P. As aridity degree was mainly determined by MAP, aridity also had a relatively minor total effect on soil available P. These global patterns generally hold true irrespective of soil depth (≤10 cm or >10 cm) or site aridity index (≤1.0 or >1.0), and were also true for the low-sand (≤50%) soils. In contrast, available P of the high-sand (>50%) soils was positively affected by MAT and aridity and negatively affected by MAP. Our results suggest that temperature and precipitation have contrasting effects on soil P availability and can interact with soil particle size to control soil P availability.

BACKGROUND: Engaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication. OBJECTIVE: The aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research. METHODS: A systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed). RESULTS: The systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients' privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes. CONCLUSIONS: While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.

In the montane rain forests of eastern Australia at least 14 species of endemic, stream‐dwelling frogs have disappeared or declined sharply (by more than 90%) during the past 15 years. We review available information on these declines and present eight lines of evidence that collectively suggest that a rapidly spreading, epidemic disease is the most likely responsible agent. The extreme virulence of the putative frog patbogen suggests it is likely exotic to Australian rain forests. We propose that exotic pathogens may be responsible for some recent declines of amphibian populations on other continents and that the intercontinental spread of such pathogens is greatly facilitated by human activities such as the thriving international trade in aquarium fish. Our hypothesis may help explain why some amphibian populations in seemingly pristine environments have mysteriously declined.

Ion-specific standards are needed to protect biodiversity

1 The relative roles of climate and management for driving changes in woody cover in savannas over the past century are the subject of active debate. Perspectives arising from short-term, small-scale, local experiments are rarely tested over larger scales and longer time frames. 2 Regression analysis and aerial photography were used to assess the relative importance of land-use history (fire and grazing), rainfall and initial woody cover (woody cover at the beginning of a sample period relative to the range of woody cover expressed within a land type) in accounting for rates of change in overstorey and understorey cover between the 1940s and 1990s in central Queensland, Australia. Analyses included 279 site-period combinations representing five semi-arid eucalypt savanna land-types within a 125 755 km2 region. 3 Fire and grazing variables provided no explanatory power. In general, relative rainfall (rainfall for a given period standardized against mean annual rainfall) was positively related and initial woody cover negatively related to rates of change in both the overstorey and the understorey. The interaction between rainfall and initial woody cover was significant, reflecting the fact that increases in cover coincided with low initial cover when rainfall is higher than average, whereas decreases in cover typically occurred with high initial cover, regardless of rainfall. 4 On average, overstorey and understorey cover increased over the second half of the 20th century. This pattern is consistent with the first half of the 20th century having more intense droughts and being drier overall than the relatively wet second half. 5 The findings highlight the primary importance of interactions between rainfall fluctuations and density dependence as determinants of large-scale, long-term woody plant cover dynamics in savannas subject to large rainfall excess and deficit over multiyear time-scales.

Purpose How knowledge management theories and frameworks are applied in the public sector is not well understood due to little evidence being published in the literature. This paper aims to identify core issues and challenges that governments face in delivering effective public policy, particularly challenges presented by increasing community expectations, and to highlight the importance of developing public policy via knowledge‐based partnerships with its stakeholders. Design/methodology/approach Arguments draw on relevant theory in knowledge management and related fields as well as from public sector experiences. Findings The main discussion examines some issues, challenges and opportunities in public policy developments and proposes some practical models to assist governments develop and capitalize on more effective knowledge‐based stakeholder partnerships. Practical implications This paper suggests that some existing process frameworks can provide a good starting‐point to capturing knowledge about stakeholders, highlighting how stakeholders interact with policy development processes. The reviewed literature and ideas proposed herein classify stakeholders from a number of different perspectives and attempt to provide some practical assistance to governments in developing more effective and strategically guided stakeholder policy partnerships, including more effective use of resources and improved knowledge transfer. Such frameworks need to be viewed as being dynamic and stakeholder classifications need to be monitored continually. Originality/value This paper highlights the need for more effective government and stakeholder partnerships to develop better public policy, including providing governments with cost‐effective avenues to knowledge and expertise, and facilitating greater public accountability. Several processes are suggeted that can facilitate more transparent and effective two‐way knowledge transfers between public organizations and stakeholders, which are fundamental for establishing successful partnerships.

Abstract The U.S. Climate Variability and Predictability (CLIVAR) working group on drought recently initiated a series of global climate model simulations forced with idealized SST anomaly patterns, designed to address a number of uncertainties regarding the impact of SST forcing and the role of land–atmosphere feedbacks on regional drought. The runs were carried out with five different atmospheric general circulation models (AGCMs) and one coupled atmosphere–ocean model in which the model was continuously nudged to the imposed SST forcing. This paper provides an overview of the experiments and some initial results focusing on the responses to the leading patterns of annual mean SST variability consisting of a Pacific El Niño–Southern Oscillation (ENSO)-like pattern, a pattern that resembles the Atlantic multidecadal oscillation (AMO), and a global trend pattern. One of the key findings is that all of the AGCMs produce broadly similar (though different in detail) precipitation responses to the Pacific forcing pattern, with a cold Pacific leading to reduced precipitation and a warm Pacific leading to enhanced precipitation over most of the United States. While the response to the Atlantic pattern is less robust, there is general agreement among the models that the largest precipitation response over the United States tends to occur when the two oceans have anomalies of opposite signs. Further highlights of the response over the United States to the Pacific forcing include precipitation signal-to-noise ratios that peak in spring, and surface temperature signal-to-noise ratios that are both lower and show less agreement among the models than those found for the precipitation response. The response to the positive SST trend forcing pattern is an overall surface warming over the world’s land areas, with substantial regional variations that are in part reproduced in runs forced with a globally uniform SST trend forcing. The precipitation response to the trend forcing is weak in all of the models. It is hoped that these early results, as well as those reported in the other contributions to this special issue on drought, will serve to stimulate further analysis of these simulations, as well as suggest new research on the physical mechanisms contributing to hydroclimatic variability and change throughout the world.

Abstract Plot-scale measurements have been the foundation for forest surveys and reporting for over 200 years. Through recent integration with airborne and satellite remote sensing, manual measurements of vegetation structure at the plot scale are now the basis for landscape, continental and international mapping of our forest resources. The use of terrestrial laser scanning (TLS) for plot-scale measurement was first demonstrated over a decade ago, with the intimation that these instruments could replace manual measurement methods. This has not yet been the case, despite the unparalleled structural information that TLS can capture. For TLS to reach its full potential, these instruments cannot be viewed as a logical progression of existing plot-based measurement. TLS must be viewed as a disruptive technology that requires a rethink of vegetation surveys and their application across a wide range of disciplines. We review the development of TLS as a plot-scale measurement tool, including the evolution of both instrument hardware and key data processing methodologies. We highlight two broad data modelling approaches of gap probability and geometrical modelling and the basic theory that underpins these. Finally, we discuss the future prospects for increasing the utilisation of TLS for plot-scale forest assessment and forest monitoring.

Abstract Increasing densities of woody plants in savannas has been attributed to both elevated atmospheric CO 2 and reduced burning with grazing management, such that the biome could represent a substantial carbon sink. However, we show that extreme droughts (less than two‐thirds expected rainfall over 3 years) occur in the drier half of the savanna biome and can cause substantial tree death. An Australian case study reveals that a net increase in tree cover over five decades of above‐average rainfall was offset by sudden tree death during drought. The relationship between woody cover change and rainfall is moderated by competition with growth being facilitated by low woody cover and drought‐induced death more likely as the woody component of savanna increases. The results are not supportive of a sustained increase in the woody component of xeric savannas resulting from CO 2 fertilization or land management. Extensive tree death in savanna regions will become a stark consequence of climate change if predictions of increasing severity and frequency of drought are realized.

Abstract Seagrass meadows are declining globally at an unprecedented rate, yet these valuable ecosystem service providers remain marginalized within many conservation agendas. In the Indo‐Pacific, this is principally because marine conservation priorities do not recognize the economic and ecological value of the goods and services that seagrasses provide. Dependency on coastal marine resources in the Indo‐Pacific for daily protein needs is high relative to other regions and has been found in some places to be up to 100%. Habitat loss therefore may have negative consequences for food security in the region. Whether seagrass resources comprise an important contribution to this dependency remains largely untested. Here, we assemble information sources from throughout the Indo‐Pacific region that discuss shallow water fisheries, and examine the role of seagrass meadows in supporting production, both directly, and indirectly through process of habitat connectivity (e.g., nursery function and foraging areas). We find information to support the premise that seagrass meadows are important for fisheries production. They are important fishery areas, and they support the productivity and biodiversity of coral reefs. We argue the value of a different paradigm to the current consensus on marine conservation priorities within the Indo‐Pacific that places seagrass conservation as a priority.

Climate change poses complex challenges and addressing these requires increasing integration across policy domains. This research developed a framework to assess policy integration between the tourism and climate change domains by examining coverage, scope, materiality and alignment. A database of 101 policy documents was compiled, representing 61 countries over 17 years. Only 37 documents covered the tourism-climate nexus substantially, suggesting climate change has not yet become a priority for tourism policy makers. Considering that tourism makes considerable contributions to and is substantially impacted by climate change, the observed gaps in tourism policy need to be addressed. The paper concludes with some minimum expectations for policy integration, including examples of good practice, and suggests that more effort is required to achieve climate change policy integration in tourism.

The purpose of this study was to develop statistical models that estimate the influence of training load on training injury and physical fitness in collision sport athletes. The incidence of training injuries was studied in 183 rugby league players over two competitive seasons. Participants were assessed for height, body mass, skinfold thickness, vertical jump, 10-m, 20-m and 40-m sprint time, agility, and estimated maximal aerobic power in the off-season, pre-season, mid-season, and end-season. Training load and injury data were summarised into pre-season, early-competition, and late-competition training phases. Individual training load, fitness, and injury data were modelled using a logistic regression model with a binomial distribution and logit link function, while team training load and injury data were modelled using a linear regression model. While physical fitness improved with training, there was no association (P=0.16-0.99) between training load and changes in physical fitness during any of the training phases. However, increases in training load during the early-competition training phase decreased (P= 0.04) agility performance. A relationship (P= 0.01-0.04) was observed between the log of training load and odds of injury during each training phase, resulting in a 1.50 - 2.85 increase in the odds of injury for each arbitrary unit increase in training load. Furthermore, during the pre-season training phase there was a relationship (P= 0.01) between training load and injury incidence within the training load range of 155 and 590 arbitrary units. During the early and late-competition training phases, increases in training load of 175-620 arbitrary units and 145-410 arbitrary units, respectively, resulted in no further increase in injury incidence. These findings demonstrate that increases in training load, particularly during the pre-season training phase, increase the odds of injury in collision sport athletes. However, while increases in training load from 175 to 620 arbitrary units during the early-competition training phase result in no further increase in injury incidence, marked reductions in agility performances can occur. These findings suggest that reductions in training load during the early-competition training phase can reduce the odds of injury without compromising agility performances in collision sport athletes.

Green turtles Chelonia mydas are endangered, long-lived marine reptiles that display an ontogenetic shift in diet and habitat use during development. During their early life stage, juvenile green turtles in the southwestern Pacific inhabit the pelagic zone where they feed omnivorously on neustonic material. At approximately 44 cm curved carapace length they recruit to inshore foraging habitats where they become primarily herbivorous. In this study we investigate the change in stable isotope (δ13C and δ15N) composition of green turtle epidermal tissue throughout their life history to examine this ontogenetic shift in diet and habitat as it occurs in a southwestern Pacific green turtle population. Turtles that had recently recruited to foraging grounds in Moreton Bay, Australia had significantly higher δ15N isotopic signatures when compared with all other life history groups examined and significantly lower δ13C when compared with all age classes other than pelagic juveniles. Adult and large immature turtles had similar isotopic signatures and were both significantly enriched in 13C when compared with hatchlings and small immature turtles. These results support previous observations that suggest pelagic juveniles are foraging in a different habitat and at a higher trophic level than turtles captured in the neritic environment. This is the first study to capture the entire life history of green turtles in terms of foraging ecology and supports the ontogenetic shift previously observed in traditional diet and behavioral studies of green turtles.

Highly productive tropical seagrasses often live adjacent to or among coral reefs and utilize large amounts of inorganic carbon. In this study, the effect of seagrass productivity on seawater carbonate chemistry and coral calcification was modelled on the basis of an analysis of published data.&#13;\nPublished data (11 studies, 64 records) reveal that seagrass meadows in the Indo-Pacific have an 83% chance of being net autotrophic, resulting in an average net sink of 155 gC m The&#13;\ncapacities for seagrass productivity were analysed using an empirical model to examine the effect on seawater carbonate chemistry. Our analyses indicate that increases in pH of up to 0.38 units, and �arag increases of 2.9 are possible in the presence of seagrass meadows (compared to their absence) with the precise values of these increases dependent on water residence time (tidal flushing) and water depth. In shallow water reef environments, Scleractinian coral calcification downstream of seagrass has the potential to be �18% greater than in an environment without seagrass. If this potential benefit to reef calcifiers is supported by further study it offers a potential tool in marine park management at a local scale. The applicability of this will depend upon local physical conditions as well as the spatial configuration of habitats, and the factors that influence their productivity. This novel study suggests that, in addition to their importance to fisheries, sediment stabilization and primary production, seagrass meadows may enhance coral reef resilience to future ocean acidification.