Shift workers in Australia constitute approximately 16% of the workforce, with nearly half working a rotating shift pattern(1). Whilst poor dietary habits of shift workers have been extensively reported, along with increased risk of metabolic health conditions such as obesity, cardiovascular disease and diabetes compared to non-shift workers(2,3,4), studies on shift working populations rarely control for individual and lifestyle factors that might influence dietary profiles. While rotating shift work schedules have been linked with higher energy intake than daytime schedules(5), little is known about the impact of different night shift schedules (e.g., fixed night vs rotating schedules) on the diets of shift workers, including differences in 24-hour energy intake and nutrient composition. This observational study investigated the dietary habits of night shift workers with overweight/obesity and compared the impact of rotating and fixed night shift schedules on dietary profiles. The hypothesis was posited, that shift workers’ diets overall would deviate from national nutrition recommendations, and those working rotating shift schedules compared with fixed night schedules would have higher energy consumption. Participants were from the Shifting Weight using Intermittent Fasting in night shift workers (SWIFt) trial, a randomised controlled weight loss trial, and provided 7-day food diaries upon enrolment. Mean energy intakes (EI) and the percentage of EI from macronutrients, fibre, saturated fat, added sugar, alcohol, and the amount of sodium were evaluated against Australian adult recommendations. Total group and subgroup analysis of fixed night vs rotating schedules’ dietary profiles were conducted, including assessment of plausible and non-plausible energy intake reporters. Hierarchical regression analysis were conducted on nutrient intakes, controlling for individual and lifestyle factors of age, gender, BMI, physical activity, shift work exposure, occupation and work schedule. Overall, night shift workers (n = 245) had diets characterised by high fat/saturated fat/sodium content and low carbohydrate/fibre intake compared to nutrition recommendations, regardless of shift schedule type. Rotating shift workers (n = 121) had a higher mean 24-hour EI than fixed night workers (n = 122) (9329 ± 2915 kJ vs 8025 ± 2383 kJ, p < 0.001), with differences remaining when only plausible EI reporters were included (n = 130) (10968 ± 2411 kJ vs 9307 ± 2070 kJ, p < 0.001). These findings highlight poor dietary choices among this population of shift workers, and higher energy intakes of rotating shift workers, which may contribute to poor metabolic health outcomes often associated with working nightshift.

Approximately 15% of Australia’s workforce are shift workers, who are at greater risk for obesity and related conditions, such as type 2 diabetes and cardiovascular disease.(1,2,3) While current guidelines for obesity management prioritise diet-induced weight loss as a treatment option, there are limited weight-loss studies involving night shift workers and no current exploration of the factors associated with engagement in weight-loss interventions. The Shifting Weight using Intermittent Fasting in night shift workers (SWIFt) study was a randomised controlled trial that compared three, 24-week weight-loss interventions: continuous energy restriction (CER), and 500-calorie intermittent fasting (IF) for 2-days per week; either during the day (IF:2D), or the night shift (IF:2N). This current study provided a convergent, mixed methods, experimental design to: 1) explore the relationship between participant characteristics, dietary intervention group and time to drop out for the SWIFt study (quantitative); and 2) understand why some participants are more likely to drop out of the intervention (qualitative). Participant characteristics included age, gender, ethnicity, occupation, shift schedule, number of night shifts per four weeks, number of years in shift work, weight at baseline, weight change at four weeks, and quality of life at baseline. A Cox regression model was used to specify time to drop out from the intervention as the dependent variable and purposive selection was used to determine predictors for the model. Semi-structured interviews at baseline and 24-weeks were conducted and audio diaries every two weeks were collected from participants using a maximum variation sampling approach, and analysed using the five steps of framework analysis.(4) A total of 250 participants were randomised to the study between October 2019 and February 2022. Two participants were excluded from analysis due to retrospective ineligibility. Twenty-nine percent (n = 71) of participants dropped out of the study over the 24-week intervention. Greater weight at baseline, fewer years working shift work, lower weight change at four weeks, and women compared to men were associated with a significant increased rate of drop out from the study (p < 0.05). Forty-seven interviews from 33 participants were conducted and 18 participants completed audio diaries. Lack of time, fatigue and emotional eating were barriers more frequently reported by women. Participants with a higher weight at baseline more frequently reported fatigue and emotional eating barriers, and limited guidance on non-fasting days as a barrier for the IF interventions. This study provides important considerations for refining shift-worker weight-loss interventions for future implementation in order to increase engagement and mitigate the adverse health risks experienced by this essential workforce.

In recent decades there has been an increased interest in the Mediterranean diet’s (MedDiet) protective capacity against age-related diseases. The MedDiet is comprised of wholefoods, with moderate to high dietary fat and a kilojoule intake of approximately 9,300kJ(1). The Mediterranean Diet Adherence Screener (MEDAS) has allowed for rapid assessment of MedDiet adherence across intervention and cohort studies globally(2). However, well-established reductions in older adults’ energy requirements often present a barrier to full MedDiet adherence(3,4). We sought to create an energy-adjusted MEDAS (E-MEDAS) for use in populations with reduced energy requirements, with a secondary analysis to determine that the strength of the relationship between E-MEDAS adherence and cardiometabolic biomarkers is not diminished through energy-adjustment. Baseline data from independently living, 60–90 year old participants enrolled in the MedWalk clinical trial were used. Estimated energy requirements (EER) were calculated for all participants (n = 161) using gender and age specific Schofield Equations, multiplied by a physical activity level (PAL) we derived from a novel method to calculate PAL’s from Actigraph and IPAQ-E data. Three distinct energy categories of E-MEDAS criteria were identified, with evenly reduced cutoff criteria across all food components. Participants with a completed MEDAS (n = 157) had their MedDiet adherence re-scored according to the reduced criteria cutoffs. Spearman’s rank correlation coefficient analyses, with 95% confidence intervals constructed by accelerated bias-corrected bootstrapping, were used to determine the strength and direction of association between both MEDAS and E-MEDAS adherence scores and 8 cardiometabolic biomarkers. The newly calculated E-MEDAS categories included Category 3 (corresponding to the original MEDAS) with a range of 9100–10500kJ (n = 30), Category 2 with a range of 7700–9100kJ (n = 81) and Category 1 with a range of 6300–7700kJ (n = 44). There was a significant (p < 0.05) weak negative correlation between the re-scored E-MEDAS and 5 cardiometabolic biomarkers; BMI (rs = −0.228, BCa 95% CI [−0.388, −0.074]), WHR (rs = −0.189, BCa 95% CI [−0.352, −0.027]), LDL (rs = −0.174, BCa 95% CI [−0.347, 0.009]), Total:HDL Ratio (rs = −0.288, BCa 95% CI [−0.429, −0.127]), Trigs (rs = −0.235, BCa 95% CI [−0.373, −0.079]. In contrast, the original MEDAS score resulted in a significant (p < 0.05) weak negative correlation in only 3 cardiometabolic biomarkers; WHR (rs = −0.167, BCa 95% CI [−0.317, −0.011]), Total:HDL Ratio (rs = −0.205, BCa 95% CI [−0.354, −0.049], and Trigs (rs = −0.217, BCa 95% CI [−0.360, −0.054]). Ultimately, we have successfully developed two categories of E-MEDAS, using a novel calculation of PALs, for use in individuals with reduced EERs. E-MEDAS scores showed a modest increase in the strength of relationship with five cardiometabolic biomarkers, indicating that reducing serves of individual components, while maintaining the overall dietary pattern does not negate the protective capacity of a MedDiet.

Significant progress has been made in understanding planetary core dynamics using numerical models of rotating convection (RC) in spherical shell geometry. However, the behaviour of forces in these models within various dynamic regimes of RC remains largely unknown. Directional anisotropy, scale dependence and the role of dynamically irrelevant gradient contributions in incompressible flows complicate the representation of dynamical balances in spherical shell RC. In this study, we systematically compare integrated and scale-dependent representations of mean and fluctuation forces and curled forces (which contain no gradient contributions) separately for the three components ($\hat {r},\hat {\theta },\hat {\phi }$). The analysis is performed with simulations in a range of convective supercriticality $Ra_T/Ra_T^{c}=1.2{-}297$ where $Ra_T$ and $Ra^{c}_T$ are the Rayleigh and critical Rayleigh numbers, respectively and Ekman number $E=10^{-3}{-}10^{-6}$, with fixed Prandtl number $Pr=1$, along with no-slip and fixed flux boundaries. We have excluded regions from each boundary of the spherical shell, with a thickness equivalent to ten velocity boundary layers, which provides a consistent representation of the bulk dynamics between the volume-averaged force and curled force balance in the parameter space studied. Radial, azimuthal and co-latitudinal components exhibit distinct force and curled force balances. The total magnitudes of the mean forces and mean curled forces exhibit a primary thermal wind balance; the corresponding fluctuating forces are in a quasi-geostrophic primary balance, while the fluctuating curled forces transition from a Viscous–Archimedean–Coriolis balance to an Inertia–Viscous–Archimedean–Coriolis balance with increasing $Ra_T/Ra_T^{c}$. The curled force balances are more weakly scale-dependent compared to the forces, and do not show clear cross-over length scales. The fluctuating force and curled force balances are broadly consistent with three regimes of RC (weakly nonlinear, rapidly rotating and weakly rotating), but do not exhibit sharp changes with $Ra_{T}/Ra_{T}^{c}$, which inhibits the identification of precise regime boundaries from these balances.

This paper contributes to an increasingly critical assessment of a policy framing of ‘financial resilience’ that focuses on individual responsibility and financial capability. Using a participatory research and design process, we construct a ground-up understanding of financial resilience that acknowledges not only an individual’s actions, but the contextual environment in which they are situated, and how those relate to one another. We inductively identify four inter-connected dimensions of relational financial resilience: infrastructure (housing, health, and childcare), financial and economic factors (income, expenses, and financial services and strategies), social factors (motivation and community and family), and the institutional environment (policy and local community groups, support and advice services). Consequently, we recommend that social policies conceptualise financial resilience in relational terms, as a cross-cutting policy priority, rather than being solely a facet of individual financial capability.

Large stratovolcanoes in the Cascade Range have high equilibrium-line altitudes that support glaciers whose Holocene and latest Pleistocene advances are amenable to dating. Glacier advances produced datable stratigraphic sequences in lateral moraines, which complement dating of end moraines. New mapping of glacial deposits on Mount Rainier using LIDAR and field observations supports a single latest Pleistocene or early Holocene advance. Rainier R tephra overlies deposits from this advance and could be as old as >11.6 ka; the advance could be of Younger Dryas age. Radiocarbon ages on wood interbedded between tills in the lateral moraines of Nisqually, Carbon, and Emmons glaciers and the South Tahoma glacier forefield suggest glacier advances between 200 and 550 CE, correlative with the First Millennium Advance in western Canada, and during the Little Ice Age (LIA) beginning as early as 1300 CE.

These results resolve previous contradictory interpretations of Mount Rainier's glacial history and indicate that the original proposal of a single pre-Neoglacial cirque advance is correct, in contrast to a later interpretation of two advances of pre- and post-Younger Dryas age, respectively. Meanwhile, the occurrence of the pre-LIA Burroughs Mountain Advance, interpreted in previous work as occurring 3–2.5 ka, is questionable based on inherently ambiguous interpretations of tephra distribution.

Pregnancy is a time of increased vulnerability to psychopathology, yet limited work has investigated the extent to which variation in psychopathology during pregnancy is shared and unshared across syndromes and symptoms. Understanding the structure of psychopathology during pregnancy, including associations with childhood experiences, may elucidate risk and resilience factors that are transdiagnostic and/or specific to particular psychopathology phenotypes. Participants were 292 pregnant individuals assessed using multiple measures of psychopathology. Confirmatory factor analyses found evidence for a structure of psychopathology consistent with the Hierarchical Taxonomy of Psychopathology (HiTOP). A common transdiagnostic factor accounted for most variation in psychopathology, and both adverse and benevolent childhood experiences (ACEs and BCEs) were associated with this transdiagnostic factor. Furthermore, pregnancy-specific anxiety symptoms most closely reflected the dimension of Fear, which may suggest shared variation with manifestations of fear that are not pregnancy-specific. ACEs and BCEs also linked to specific prenatal psychopathology involving thought problems, detachment, and internalizing, externalizing, antagonistic, and antisocial behavior. These findings extend the dimensional and hierarchical HiTOP model to pregnant individuals and show how maternal childhood risk and resilience factors relate to common and specific forms of psychopathology during pregnancy as a period of enhanced vulnerability.

The inclusion of students with autism spectrum disorder (ASD) is increasing, but there have been no longitudinal studies of included students in Australia. Interview data reported in this study concern primary school children with ASD enrolled in mainstream classes in South Australia and New South Wales, Australia. In order to examine perceived facilitators and barriers to inclusion, parents, teachers, and principals were asked to comment on the facilitators and barriers to inclusion relevant to each child. Data are reported about 60 students, comprising a total of 305 parent interviews, 208 teacher interviews, and 227 principal interviews collected at 6-monthly intervals over 3.5 years. The most commonly mentioned facilitator was teacher practices. The most commonly mentioned barrier was intrinsic student factors. Other factors not directly controllable by school staff, such as resource limitations, were also commonly identified by principals and teachers. Parents were more likely to mention school- or teacher-related barriers. Many of the current findings were consistent with previous studies but some differences were noted, including limited reporting of sensory issues and bullying as barriers. There was little change in the pattern of facilitators and barriers identified by respondents over time. A number of implications for practice and directions for future research are discussed.

Introduction: CAEP recently developed the acute atrial fibrillation (AF) and flutter (AFL) [AAFF] Best Practices Checklist to promote optimal care and guidance on cardioversion and rapid discharge of patients with AAFF. We sought to assess the impact of implementing the Checklist into large Canadian EDs. Methods: We conducted a pragmatic stepped-wedge cluster randomized trial in 11 large Canadian ED sites in five provinces, over 14 months. All hospitals started in the control period (usual care), and then crossed over to the intervention period in random sequence, one hospital per month. We enrolled consecutive, stable patients presenting with AAFF, where symptoms required ED management. Our intervention was informed by qualitative stakeholder interviews to identify perceived barriers and enablers for rapid discharge of AAFF patients. The many interventions included local champions, presentation of the Checklist to physicians in group sessions, an online training module, a smartphone app, and targeted audit and feedback. The primary outcome was length of stay in ED in minutes from time of arrival to time of disposition, and this was analyzed at the individual patient-level using linear mixed effects regression accounting for the stepped-wedge design. We estimated a sample size of 800 patients. Results: We enrolled 844 patients with none lost to follow-up. Those in the control (N = 316) and intervention periods (N = 528) were similar for all characteristics including mean age (61.2 vs 64.2 yrs), duration of AAFF (8.1 vs 7.7 hrs), AF (88.6% vs 82.9%), AFL (11.4% vs 17.1%), and mean initial heart rate (119.6 vs 119.9 bpm). Median lengths of stay for the control and intervention periods respectively were 413.0 vs. 354.0 minutes (P < 0.001). Comparing control to intervention, there was an increase in: use of antiarrhythmic drugs (37.4% vs 47.4%; P < 0.01), electrical cardioversion (45.1% vs 56.8%; P < 0.01), and discharge in sinus rhythm (75.3% vs. 86.7%; P < 0.001). There was a decrease in ED consultations to cardiology and medicine (49.7% vs 41.1%; P < 0.01), but a small but insignificant increase in anticoagulant prescriptions (39.6% vs 46.5%; P = 0.21). Conclusion: This multicenter implementation of the CAEP Best Practices Checklist led to a significant decrease in ED length of stay along with more ED cardioversions, fewer ED consultations, and more discharges in sinus rhythm. Widespread and rigorous adoption of the CAEP Checklist should lead to improved care of AAFF patients in all Canadian EDs.

Keven & Akins (K&A) propose that neonatal “imitation” is a function of newborns' spontaneous oral stereotypies and should be viewed within the context of normal aerodigestive development. Their proposal is in line with the result of our recent large longitudinal study that found no compelling evidence for neonatal imitation. Together, these works prompt reconsideration of the developmental origin of genuine imitation.