New South Wales (NSW) Health is committed to enhancing child health and development during the first 2000 days (conception to 5 years)(1). However, in Australia current child health behaviours indicate the need for further improvements. For example, discretionary foods (contributing high amounts of saturated fat, energy, added sodium and sugar) account for approximately 30% of total energy intakes in 2–3 years olds including the consumption of sugar sweetened beverages (SSB)(2). There remains a need to provide all parents raising children with direct and sustained support from birth to maximise health behaviours during this important life stage. Healthy Beginnings for HNEKids (HB4HNEKids) is an innovative text messaging program designed to be integrated into the usual care provided by Child and Family Health Nursing (CFHN) services. The messages were co-designed with key stakeholders to provide age-and-stage relevant preventive health information to parents/carers during the first 2000 days. HB4HNEKids has been piloted within five diverse CFHN services within the Hunter New England (HNE) local health district of NSW, reaching over 6000 families since its launch. However, the efficacy of the program on child health behaviours has not yet been explored. The aim of this study is to explore if families that received the HB4HNEKids program report reduced frequency of child discretionary food intake and a lower prevalence of SSB exposure, compared to families who did not receive the program. A cross-sectional survey of mothers 12–14 months post-partum was conducted between August 2023 and July 2024 including participants that received HB4HNEKids and a concurrent non-randomised comparison group, located in HNE. Mothers were asked to report on the frequency of child discretionary food intake per week, and whether their child had ever received SSB (including sweetened water, cordial, fruit drink, and soft-drinks). We conducted linear regression and logistic regression analyses to explore differences between the intervention and comparison participants. A total of 283 participants completed the survey, including 104 (37%) participants that had received the HB4HNEKids program. In infants aged 12–14 months, the frequency of discretionary food intake was approximately 1 serve per week and was unchanged based on if the family had received the HB4HNEKids program or not. Despite a 6-point prevalence difference in SSB exposure reported between groups (HB4HNEKids: 19.42% vs Comparison: 26.26%), this difference was not statistically significant (OR: 0.68 (95% CI: 0.37, 1.23), p = 0.2). Australian infant feeding guidelines suggest that the consumption of nutrient poor discretionary foods and sugar sweetened beverages should be avoided or limited(3). The HB4HNEKids program demonstrates some promise for improving infant feeding behaviours, however a larger effectiveness trial is required to ensure the evaluation is adequately powered.

We present the first systematic inventory of surge-type glaciers for the whole of Greenland compiled from published datasets and multitemporal satellite images and digital elevation models. The inventory allows us to define the spatial and climatic distribution of surge-type glaciers and to analyse the timing of surges from 1985 to 2019. We identified 274 surge-type glaciers, an increase of 37% compared to previous work. Mapping surge-type glacier distribution by temperature and precipitation variables derived from ERA5-Land reanalysis data shows that the west and east clusters occur in well-defined climatic envelopes. Analysis of the timing of surge active phases during the periods ~1985 to 2000 (T1) and ~2000 to 2019 (T2) suggests that overall surge activity is similar in T1 and T2, but there appears to be a reduction in surging in the west cluster in T2. Our climate analysis shows a coincident increase in mean annual and mean winter air temperature between T1 and T2. We suggest that as glaciers thin under current warming, some surge-type glaciers in the west cluster may be being prevented from surging due to (1) their inability to build-up sufficient mass and (2) a switch from a polythermal to a largely cold-based thermal regime.

Background: Meningiomas are the most common intracranial tumor, graded from 1 (benign) to 3 (malignant). The aim of this study was to identify clinical features associated with overall survival (OS), progression-free survival (PFS) and functional status for malignant meningiomas. Methods: Demographic, clinical and histopathological data from grade 3 intracranial meningioma cases were identified in the clinical databases from seven sites in North America and Europe from 1991-2022. Summary statistics and Kaplan-Meier OS and PFS curves were generated. Results: We identified 108 patients, with a median age 65 years (IQR: 52, 72) and 53.7% were female. Median OS was 109 months (95% CIs: 88, 227), and 5-year OS rate was 65% (95% CIs: 56, 76). Median PFS was 38 months (95% CIs: 24, 56) and 5-year PFS rate was 37% (95% CIs: 28, 49). OS and PFS were significantly lower in patients aged ≥65 years. Median preoperative KPS score was 80 (IQR: 70, 90), postoperatively KPS was 90 (IQR: 70, 98) and 1-year follow-up KPS was 70 (IQR: 50, 80). Conclusions: This study provides robust survival, recurrence and functional data for grade 3 meningiomas in North America and Europe over a 30-year period.

Frontal ablation, the combination of submarine melting and iceberg calving, changes the geometry of a glacier's terminus, influencing glacier dynamics, the fate of upwelling plumes and the distribution of submarine meltwater input into the ocean. Directly observing frontal ablation and terminus morphology below the waterline is difficult, however, limiting our understanding of these coupled ice–ocean processes. To investigate the evolution of a tidewater glacier's submarine terminus, we combine 3-D multibeam point clouds of the subsurface ice face at LeConte Glacier, Alaska, with concurrent observations of environmental conditions during three field campaigns between 2016 and 2018. We observe terminus morphology that was predominately overcut (52% in August 2016, 63% in May 2017 and 74% in September 2018), accompanied by high multibeam sonar-derived melt rates (4.84 m d−1 in 2016, 1.13 m d−1 in 2017 and 1.85 m d−1 in 2018). We find that periods of high subglacial discharge lead to localized undercut discharge outlets, but adjacent to these outlets the terminus maintains significantly overcut geometry, with an ice ramp that protrudes 75 m into the fjord in 2017 and 125 m in 2018. Our data challenge the assumption that tidewater glacier termini are largely undercut during periods of high submarine melting.

Severely depressed pigs exhibit differences in a number of important parameters that may affect gas euthanasia, including decreased respiration rate and tidal volume. Hence, the objectives of this study were to assess the efficacy and animal welfare implications of gas euthanasia of suckling pigs with varied disease severity (severely depressed [DP] vs other [OT]). A 2 × 2 factorial design was utilised with two gas types (carbon dioxide [CO2]; argon [Ar]) and two flow rates (G = gradual, 35% box volume exchange per min [BVE min−1]; P = prefill + 20% BVE min−1). Sixty-two pigs were enrolled and tested as DP/OT pairs in each gas treatment combination. Pigs identified for euthanasia were assigned a subjective depression score (0 = normal to 3 = severely depressed). Pigs scored 3 and ≤ 1 were categorised as DP and OT, respectively. Significantly lower respiration, rectal temperature, pulse and weight were observed for the DP pigs relative to OT. Pigs were assessed for behavioural indicators of efficacy and welfare. No differences were observed between DP and OT when using P-CO2 or G-CO2. However in P-Ar, DP had greater latency to loss of consciousness relative to OT (212 [± 22] vs 77 [± 22] s), decreased latency to last limb movement (511 [± 72] vs 816 [± 72] s), greater duration of open-mouth breathing (151 [± 21] vs 69 [± 21] s), decreased duration ataxia (101 [± 42] vs 188 [± 42] s) and decreased righting response (27 [± 11] vs 63 [± 11] s). The G-Ar treatment was removed due to ethical concerns associated with prolonged induction. In conclusion, depression score did not affect pig responses to euthanasia with CO2 gas, but did affect responses to Ar. Furthermore, Ar was associated with a prolonged euthanasia process, including frequencies and durations of distress behaviours.

While unobscured and radio-quiet active galactic nuclei are regularly being found at redshifts $z > 6$ , their obscured and radio-loud counterparts remain elusive. We build upon our successful pilot study, presenting a new sample of low-frequency-selected candidate high-redshift radio galaxies (HzRGs) over a sky area 20 times larger. We have refined our selection technique, in which we select sources with curved radio spectra between 72–231 MHz from the GaLactic and Extragalactic All-sky Murchison Widefield Array (GLEAM) survey. In combination with the requirements that our GLEAM-selected HzRG candidates have compact radio morphologies and be undetected in near-infrared $K_{\rm s}$ -band imaging from the Visible and Infrared Survey Telescope for Astronomy Kilo-degree Infrared Galaxy (VIKING) survey, we find 51 new candidate HzRGs over a sky area of approximately $1200\ \mathrm{deg}^2$ . Our sample also includes two sources from the pilot study: the second-most distant radio galaxy currently known, at $z=5.55$ , with another source potentially at $z \sim 8$ . We present our refined selection technique and analyse the properties of the sample. We model the broadband radio spectra between 74 MHz and 9 GHz by supplementing the GLEAM data with both publicly available data and new observations from the Australia Telescope Compact Array at 5.5 and 9 GHz. In addition, deep $K_{\rm s}$ -band imaging from the High-Acuity Widefield K-band Imager (HAWK-I) on the Very Large Telescope and from the Southern Herschel Astrophysical Terahertz Large Area Survey Regions $K_{\rm s}$ -band Survey (SHARKS) is presented for five sources. We discuss the prospects of finding very distant radio galaxies in our sample, potentially within the epoch of reionisation at $z \gtrsim 6.5$ .

Background: Concern around perceived neurocognitive decline is increasing, leading to increased number of referrals and anxiety for patients. We aimed to explore the likelihood of the “worried well” experiencing neurocognitive decline. Methods: 166 “worried well” patients who attended the Rural and Remote Memory Clinic between 2004 and 2019 were included. Mini Mental Status Examination, Center for Epidemiologic Studies Depression Scale, and Functional Assessment Questionnaire scores were measured and compared at initial assessment and at 1-year follow-up. MMSE scores over time were assessed with a mean follow-up of 2.95 years (SD 2.87). Results: There was no statistically significant difference in MMSE, CESD, or FAQ scores between clinic day and one-year follow-up, and no consistent pattern of MMSE score over time. Of the 166 patients with SCI on initial assessment, nine were eventually given a neurological diagnosis. Conclusions: There is no pattern of neurologic decline observed in the “worried well”. Though the likelihood of a patient with SCI developing a neurological diagnosis is reassuringly low, (9/166), it is not irrelevant. This, along with the benefits of early diagnosis and treatment for dementia, leads us to believe that patients with SCI should still be seen in follow-up at least at the one-year mark.

Through laboratory experiments and numerical simulations, we examine the evolution of buoyant plumes as they are influenced by background rotation in a uniform density ambient fluid. The source Rossby number is sufficiently large that rotation does not directly affect the plume at early times. However, on a time scale of the order of half a rotation period, the plume becomes deflected from the vertical axis. For some experiments and simulations, the deflection persists and the flow precesses about the vertical axis. In other cases, shortly after being deflected, the plume laminarizes near the source to form a near-vertical columnar vortex, which we refer to as a ‘tornado’. Tornado formation occurs in some experiments and not in others even if the source and background rotation parameters are identical. However, their formation is more likely if the plumes are ‘lazy’. Simulations reveal that this is a consequence of the competing dynamics that occurs on comparable time scales. As a consequence of entrainment, vertical vorticity builds up within the plume reducing the Rossby number and suppressing vertical motion at distances progressively closer to the source. Meanwhile, the swirl (the ratio of the azimuthal to vertical flow) around the vicinity of the source increases, which tends to suppress three-dimensional turbulence in the near-source flow. Although the former process ultimately acts to deflect the plume off axis, in some instances, the swirl around the source succeeds in laminarizing the flow, resulting in tornado formation.

Introduction: Patients with chronic non-cancer pain (CNCP) and opioid-use disorders make up a category of patients who present a challenge to emergency department (ED) providers and healthcare administrators. Their conditions predispose them to frequent ED utilization. This problem has been compounded by a worsening opioid epidemic that has rendered clinicians apprehensive about how they approach pain care. A systematic review has not yet been performed to inform the management of CNCP patients in the ED. As such, the purpose of this project was to identify and describe the effectiveness of interventions to reduce ED visits for high-utilizers with CNCP. Methods: Included participants were high-utilizers presenting with CNCP. All study designs were eligible for inclusion if they examined an intervention aimed at reducing ED utilization. The outcomes of interest were the number of ED visits as well as the amount and type of opioids prescribed in the ED and after discharge. We searched Medline, EMBASE, CINAHL, CENTRAL, SCOPUS, Web of Science, and the grey literature from inception to June 16, 2018. Two independent investigators assessed articles for inclusion following PRISMA guidelines. Risk of bias will be assessed using the Cochrane ROBINS-I and RoB 2 tools for non-randomized and randomized trials, respectively. Results: Following review, 14 of the 5,018 identified articles were included for analysis. These articles assessed a total of 1,670 patients from both urban and rural settings. Interventions included pain protocols or policies (n = 5), individualized care plans (n = 5), ED care coordination (n = 2), a chronic pain management pathway (n = 1), and a behavioural health intervention (n = 1). Intervention effects trended towards the reduction of both ED visits and opioid prescriptions. The meta-analysis is in progress. Conclusion: Preliminary results suggest that interventions aimed at high-utilizers with CNCP can reduce ED visits and ED opioid prescription. ED opioid-restriction policies that sought to disincentivize drug-related ED visits were most successful, especially when accompanied by an electronic medical record (EMR) alert to ensure consistent application of the policy by all clinicians and administrators involved in the care of these patients. This review was limited by inconsistencies in the definition of ‘high-utilizer’ and by the lack of high-powered randomized studies.

Temporal and spatial scarcity of water in semi-arid and seasonal ecosystems often leads to changes in movements and behaviour of large vertebrates, and in the neotropics this dynamic is poorly understood due to logistical and methodological limitations. Here we used camera trapping to elucidate variation in patterns of seasonal use of waterholes and pathways by 10 large-mammal and four large-bird species in the dry forest of north-western Costa Rica. From 2011 to 2015, we deployed trail cameras at 50 locations, including waterholes and three types of pathway (roads, human trails and animal paths). We used Generalized Linear Models to evaluate the effect of location and seasonality on the rates at which independent photographs were taken. We found interacting effects of location and seasonality for the capuchin monkey (Cebus capucinus), the tiger heron (Trigrisoma mexicanum), the white-tailed deer (Odocoileus virginianus) and the tapir (Tapirus bairdii) suggesting that these species were the most influenced by waterholes during the dry season. Comparison of waterhole sites and specific types of pathways (roads, animal paths and human trails) showed that location influenced photo-capture rates of almost all species, suggesting a useful insight to avoid and account for bias in camera trap studies. Furthering our ecological understanding of seasonal water regimes and large vertebrates’ behaviours allow for better understanding of the consequences of climate change on them.

Corundum xenocrysts from alkaline basalt fields differ in characteristics and hence lithospheric origins. Trace element, fluid/melt inclusion and oxygen isotope studies on two eastern Australian corundum deposits are compared to consider their origins. Sapphires from Weldborough, NE Tasmania, are magmatic (high-Ga, av. 200 ppm) and dominated by Fe (av. 3300 ppm) and variable Ti (av. 400 ppm) as chromophores. They contain Cl, Fe, Ga, Ti and CO2-rich fluid inclusions and give δ18O values (5.1–6.2‰) of mantle range. Geochronology on companion zircons suggests several sources (from 290 Ma to 47 Ma) were disrupted by basaltic melts (47 ± 0.6 Ma). Gem corundums from Barrington, New South Wales, also include magmatic sapphires (Ga av. 170 ppm; δ18O (4.6–5.8‰), but with more Fe (av. 9000 ppm) and less Ti (av. 300 ppm) as chromophores. Zircon dating suggests that gem formation preceded and was overlapped by Cenozoic basaltic melt generation (59–4 Ma). In contrast, a metamorphic sapphire-ruby suite (low-Ga, av. 30 ppm) here incorporates greater Cr into the chromophores (up to 2250 ppm). Fluid inclusions are CO2-poor, but melt inclusions suggest some alkaline melt interaction. The δ18O values (5.1–6.2‰) overlap magmatic sapphire values. Interactions at contact zones (T = 780–940°C) between earlier Permian ultramafic bodies and later alkaline fluid activity may explain the formation of rubies.

Introduction: The Ottawa SAH Rule was developed to identify patients at high-risk for subarachnoid hemorrhage (SAH) who require investigations and the 6-Hour CT Rule found that computed tomography (CT) was 100% sensitive for SAH 6 hours of headache onset. Together, they form the Ottawa SAH Strategy. Our objectives were to assess: 1) Safety of the Ottawa SAH Strategy and its 2) Impact on: a) CTs, b) LPs, c) ED length of stay, and d) CT angiography (CTA). Methods: We conducted a multicentre prospective before/after study at 6 tertiary-care EDs January 2010 to December 2016 (implementation July 2013). Consecutive alert, neurologically intact adults with a headache peaking within one hour were included. SAH was defined by subarachnoid blood on head CT (radiologists final report); xanthochromia in the cerebrospinal fluid (CSF); >1x106/L red blood cells in the final tube of CSF with an aneurysm on CTA. Results: We enrolled 3,669 patients, 1,743 before and 1,926 after implementation, including 185 with SAH. The investigation rate before implementation was 89.0% (range 82.9 to 95.6%) versus 88.4% (range 85.2 to 92.3%) after implementation. The proportion who had CT remained stable (88.0% versus 87.4%; p=0.60), while the proportion who had LP decreased from 38.9% to 25.9% (p<0.001), and the proportion investigated with CTA increased from 18.8% to 21.6% (p=0.036). The additional testing rate (i.e. LP or CTA) diminishedfrom 50.1% to 40.8% (p<0.001). The proportion admitted declined from 9.8% to 7.3% (p=0.008), while the mean length of ED stay was stable (6.2 +/− 4.0 to 6.4 +/− 4.1 hours; p=0.45). For the 1,201 patients with CT 6 hours, there was an absolute decrease in additional testing (i.e. LP or CTA) of 15.0% (46.6% versus 31.6%; p<0.001). The sensitivity of the Ottawa SAH Rule was 100% (95%CI: 98-100%), and the 6-Hour CT Rule was 95.3% (95%CI: 88.9-98.3) for SAH. Five patients with early CT had SAH with CT reported as normal: 2 unruptured aneuryms on CTA and presumed traumatic LP (determined by treating neurosurgeon); 1 missed by the radiologist on the initial interpretation; 1 dural vein fistula (i.e. non-aneuyrsmal); and 1 profoundly anemic (Hgb 63g/L). Conclusion: The Ottawa SAH Strategy is highly sensitive and can be used routinely when SAH is being considered in alert and neurologically intact headache patients. Its implementation was associated with a decrease in LPs and admissions to hospital.