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An alternative to an “all or none” approach to contact precautions for patients with MRSA carriage may be a “risk-tailored” approach – using gloves and gowns only for certain high-risk activities, locations, or roles.
Methods:
We distributed a discrete choice experiment to healthcare personnel (HCPs) in three cities. Respondents were presented with eight choice sets, each consisting of two hypothetical policy options for glove and gown use to prevent MRSA transmission. In each comparison, respondents selected their preferred option. Using mixed logit modeling we calculated utility derived from each policy component, probability of uptake for the most favored policies, and heterogeneity in preferences based on HCP role.
Results:
In total, 326 HCPs completed the survey. 237 (54%) respondents reported wearing gloves and gowns ‘all the time’ when required. Respondents’ preferred policy with the highest utility score was to use gloves and gown for all HCPs roles (utility, 0.17; 95% CI, 0.12 to 0.23), in high-risk settings (utility, 0.12; 95% CI 0.07–0.18), when touching the patient (utility, 0.11; 95% CI 0.06–0.17). Sixty-three percent (95% CI 60–66) would support a risk-tailored approach over an approach where contact precautions are used by all HCPs in all settings and for all activities. Support varied by HCP role (p < 0.02), with the strongest probability of support from physicians and advanced practice providers (77%, 95% CI 72%–82%) and the least support from environmental services personnel (45%, 95% CI 37%–53%).
Conclusions:
This discrete choice survey demonstrates that most HCPs prefer a risk-tailored approach to contact precautions when caring for patients with MRSA.
The success of clinical research studies depends on effective recruitment and retention of study participants, yet only a small fraction of patients engage in research studies, even in academic health systems. Increasing awareness of research opportunities and facilitating connections with clinical research study teams would help to improve the success of research programs. In this Special Communications, we describe the creation and evolution of and tools used for the My Research Partners Concierge Service (MRPcs) of an academic health system. The MRPcs provides a centralized point of contact or hub for patients and community members, as well as clinical research organizations and academic partners, who have research-related questions or interests. The MRPcs helps to connect the users of the service with relevant research study teams, personnel, or resources to facilitate their engagement in a clinical research program. Our experience with the MRPcs informs our recommendation that peer institutions organize similar research service hubs for their clinical research programs to help increase awareness of and participation in clinical research by the public and to help increase the success of research programs at fulfilling their ultimate goal of improving the health of their population.
We present a new radio detection from the Australian Square Kilometre Array Pathfinder Evolutionary Map of the Universe (EMU) survey associated with the Reflection Nebula (RN) VdB-80. The radio detection is determined to be a previously unidentified Hii region, now named Lagotis. The RN is located towards Monoceros, centred in the molecular cloud feature known as the ‘Crossbones’. The 944 MHz EMU image shows a roughly semicircular Hii region with an integrated flux density of 30.2$\pm$0.3 mJy. The Hii region is also seen at 1.4 GHz by NRAO VLA Sky Survey (NVSS), yielding an estimated spectral index of 0.65$\pm$0.51, consistent with thermal radio emission. Gaia Data Release 3 (DR3) and Two Micron All Sky Survey (2MASS) data give a distance to the stars associated with the Hii region of $\sim$960 pc. This implies a size of 0.76$\times$0.68($\pm$0.09) pc for the Hii region. We derive an Hii region electron density of the bright radio feature to be 26 cm$^{-3}$, requiring a Lyman-alpha photon flux of $10^{45.6}$ s$^{-1}$, which is consistent with the expected Lyman flux of HD 46060, the B2 ii type star which is the likely ionising star of the region. The derived distance to this region implies that the Crossbones feature is a superposition of two filamentary clouds, with Lagotis embedded in the far cloud.
The aim of this paper is to characterise the internal structures and ice-flow history of representative valley glaciers in Svalbard and infer from them dynamic changes over centennial timescales. Three polythermal and one cold valley glacier are investigated using field- and laboratory-based techniques and remote sensing. Structures along flow-unit boundaries indicate that ice-flow configuration in three of the glaciers has remained stable spanning the residence time of the ice. Deformation of a flow-unit boundary in the fourth reveals an ice-flow instability, albeit one that has been maintained since its most recent advance. Macro-crystallographic, sedimentological and isotopic analyses indicate that basal ice is elevated to the glacier surface, as shown by entrained sediments and enrichment in heavy isotopes. In narrow zones of enhanced cumulative strain, new ice facies are generated through dynamic recrystallisation. The surface density of longitudinal foliation is shown to represent the relative magnitude of cumulative strain. Geometric similarities between flow-unit boundaries in Svalbard valley glaciers and larger scale longitudinal surface structures in ice sheets suggest that deformation mechanisms are common to both.
We present new Australia Telescope Compact Array (ATCA) radio observations towards N 49, one of the brightest extragalactic supernova remnants (SNRs) located in the Large Magellanic Cloud (LMC). Our new and archival ATCA radio observations were analysed along with Chandra X-ray data. These observations show a prominent ‘bullet’ shaped feature beyond the southwestern boundary of the SNR. Both X-ray morphology and radio polarisation analysis support a physical connection of this feature to the SNR. The ‘bullet’ feature’s apparent velocity is estimated at $\sim$1 300 km s$^{-1}$, based on its distance ($\sim$10 pc) from the remnant’s geometric centre and estimated age ($\sim$7 600 yr). we estimated the radio spectral index, $\alpha= -0.55 \pm 0.03$ which is typical of middle-age SNRs. Polarisation maps created for N 49 show low to moderate levels of mean fractional polarisation estimated at 7$\pm$1% and 10$\pm$1% for 5.5 and 9 GHz, respectively. These values are noticeably larger than found in previous studies. Moreover, the mean value for the Faraday rotation of SNR N 49 from combining CABB data is 212$\pm$65 rad m$^{-2}$ and the maximum value of RM is 591$\pm$103 rad m$^{-2}$.
Accounting for 53% of U.S. peanuts (Arachis hypogaea L.), Georgia is the top peanut-producing state, with approximately 1.42 billion kg produced in 2023. Peanut producers often use the acetolactate synthase (ALS) imidazolinone herbicide imazapic, but reduced yellow nutsedge (Cyperus esculentus L.) control was reported in Georgia peanuts after 4 yr of continuous imazapic use. This study aimed to determine the level of resistance (LD50, I50, and GR50) and potential cross-resistance for the suspected resistant population and to identify the associated genetic mutations conferring resistance. A susceptible biotype was treated with 0, 0.0088, 0.0175, 0.035, 0.07, 0.14, 0.28, and 0.56 kg ai ha−1, and a resistant biotype was sprayed with 0, 0.07, 0.14, 0.28, 0.56, 1.13, 2.26, and 4.5 kg ai ha−1 of imazapic. To determine whether the suspected resistant biotype was cross-resistant to halosulfuron-methyl, an ALS herbicide used to control Cyperus spp., both biotypes were treated with 0, 0.0117, 0.0233, 0.0466, 0.0933, 0.187, 0.373, and 0.746 g ai ha−1 of halosulfuron-methyl. Plants were rated for injury at 7, 14, and 28 d after treatment (DAT), and aboveground biomass was harvested at 28 DAT. For imazapic, LD50 was 0.041 and 1.503 kg ai ha−1 and the GR50 was estimated to be 0.0128 and 1.853 kg ha−1 for Sus and Res biotypes, respectively, indicating 36- and 145-fold increase in resistance of the Res biotype for I50 and GR50, respectively. Both biotypes responded similarly to applications of halosulfuron-methyl, with biomass reduction at rates greater than 0.023 kg ai ha−1. Transcriptome profiles revealed a mutation in the target-site gene of the resistant biotype causing an amino acid substitution from alanine to valine at position 205 (Ala-205-Val). Growers should continue to rotate chemistries and implement integrated weed management approaches for control of C. esculentus, as the use of imazapic over consecutive years has led to resistance in C. esculentus.
As TeV gamma-ray astronomy progresses into the era of the Cherenkov Telescope Array (CTA), instantaneously following up on gamma-ray transients is becoming more important than ever. To this end, a worldwide network of Imaging Atmospheric Cherenkov Telescopes has been proposed. Australia is ideally suited to provide coverage of part of the Southern Hemisphere sky inaccessible to H.E.S.S. in Namibia and the upcoming CTA-South in Chile. This study assesses the sources detectable by a small, transient-focused array in Australia based on CTA telescope designs. The TeV emission of extragalactic sources (including the majority of gamma-ray transients) can suffer significant absorption by the extragalactic background light. As such, we explored the improvements possible by implementing stereoscopic and topological triggers, as well as lowered image cleaning thresholds, to access lower energies. We modelled flaring gamma-ray sources based on past measurements from the satellite-based gamma-ray telescope Fermi-LAT. We estimate that an array of four Medium-Sized Telescopes (MSTs) would detect $\sim$24 active galactic nucleus flares >5$\sigma$ per year, up to a redshift of $z\approx1.5$. Two MSTs achieved $\sim$80–90% of the detections of four MSTs. The modelled Galactic transients were detectable within the observation time of one night, 11 of the 21 modelled gamma-ray bursts were detectable, as were $\sim$10% of unidentified transients. An array of MST-class telescopes would thus be a valuable complementary telescope array for transient TeV gamma-ray astronomy.
It is well established that there is a substantial genetic component to eating disorders (EDs). Polygenic risk scores (PRSs) can be used to quantify cumulative genetic risk for a trait at an individual level. Recent studies suggest PRSs for anorexia nervosa (AN) may also predict risk for other disordered eating behaviors, but no study has examined if PRS for AN can predict disordered eating as a global continuous measure. This study aimed to investigate whether PRS for AN predicted overall levels of disordered eating, or specific lifetime disordered eating behaviors, in an Australian adolescent female population.
Methods
PRSs were calculated based on summary statistics from the largest Psychiatric Genomics Consortium AN genome-wide association study to date. Analyses were performed using genome-wide complex trait analysis to test the associations between AN PRS and disordered eating global scores, avoidance of eating, objective bulimic episodes, self-induced vomiting, and driven exercise in a sample of Australian adolescent female twins recruited from the Australian Twin Registry (N = 383).
Results
After applying the false-discovery rate correction, the AN PRS was significantly associated with all disordered eating outcomes.
Conclusions
Findings suggest shared genetic etiology across disordered eating presentations and provide insight into the utility of AN PRS for predicting disordered eating behaviors in the general population. In the future, PRSs for EDs may have clinical utility in early disordered eating risk identification, prevention, and intervention.
We present deep near-infrared $K_\textrm{s}$-band imaging for 35 of the 53 sources from the high-redshift ($z \gt 2$) radio galaxy candidate sample defined in Broderick et al. (2022, PASA, 39, e061). These images were obtained using the High-Acuity Widefield K-band Imager (HAWK-I) on the Very Large Telescope. Host galaxies are detected for 27 of the sources, with $K_\textrm{s} \approx 21.6$–23.0 mag (2$^{\prime\prime}$ diameter apertures; AB). The remaining eight targets are not detected to a median $3\unicode{x03C3}$ depth of $K_\textrm{s} \approx 23.3$ mag (2$^{\prime\prime}$ diameter apertures). We examine the radio and near-infrared flux densities of the 35 sources, comparing them to the known $z \gt 3$ powerful radio galaxies with 500-MHz radio luminosities $L_{500\,\textrm{MHz}} \gt 10^{27}$ W Hz$^{-1}$. By plotting 150-MHz flux density versus $K_\textrm{s}$-band flux density, we find that, similar to the sources from the literature, these new targets have large radio to near-infrared flux density ratios, but extending the distribution to fainter flux densities. Five of the eight HAWK-I deep non-detections have a median $3\unicode{x03C3}$ lower limit of $K_\textrm{s} \gtrsim 23.8$ mag (1$.\!^{\prime\prime}$5 diameter apertures); these five targets, along with a further source from Broderick et al. (2022, PASA, 39, e061) with a deep non-detection ($K_\textrm{s} \gtrsim 23.7$ mag; $3\unicode{x03C3}$; 2$^{\prime\prime}$ diameter aperture) in the Southern H-ATLAS Regions $K_\textrm{s}$-band Survey, are considered candidates to be ultra-high-redshift ($z \gt 5$) radio galaxies. The extreme radio to near-infrared flux density ratios ($\gt 10^5$) for these six sources are comparable to TN J0924$-$2201, GLEAM J0856$+$0223 and TGSS J1530$+$1049, the three known powerful radio galaxies at $z \gt 5$. For a selection of galaxy templates with different stellar masses, we show that $z \gtrsim 4.2$ is a plausible scenario for our ultra-high-redshift candidates if the stellar mass $M_\textrm{*} \gtrsim 10^{10.5}$ M$_\odot$. In general, the 35 targets studied have properties consistent with the previously known class of infrared-faint radio sources. We also discuss the prospects for finding more UHzRG candidates from wide and deep near-infrared surveys.
Our aim was to explore the experiences of individuals receiving emergency department (ED) care for acute headaches.
Background:
Patients with headache exacerbations commonly present to EDs. This study explored the experiences of adult patients during the exacerbation period, specifically using photovoice.
Methods:
Recruited from two urban EDs in Alberta, Canada, participants with primary headaches took photographs over 3–4 weeks and subsequently completed a 60–90 minute, one-on-one, in-person photo-elicitation interview. Interviews were audio recorded, transcribed and thematically analyzed alongside photographs.
Results:
Eight participants (six women) completed the study. The average age was 42 years (standard deviation: 16). Five themes emerged: (1) the struggle for legitimacy in light of the invisibility of their condition; (2) the importance of hope, hopelessness and fear in the day-to-day life of participants; (3) the importance of agency and becoming “your own advocate”; (4) the struggle to be and be seen as themselves despite the encroachment of their headaches; and (5) the realities of “good” and “bad” care in the ED. Participants highlighted examples of good care, specifically when they felt seen and believed. Additionally, some expressed the acute care space itself being a beacon of hope in the midst of their crisis. Others felt dismissed because providers “know it’s not life or death.”
Conclusions:
This study highlighted the substantial emotional impact that primary headaches have on the lives of participants, particularly during times of exacerbation and while seeking acute care. This provides insight for acute care settings and practitioners on how to effectively engage with this population.
We aimed to determine whether automated identification of antibiotic targeting suspected urinary tract infection (UTI) shortened the time to antimicrobial stewardship (AS) intervention.
Design:
Retrospective before-and-after study.
Setting:
Tertiary and quaternary care academic medical center.
Patients:
Emergency department (ED) or admitted adult patients meeting best practice alert (BPA) criteria during pre- and post-BPA periods.
Methods:
We developed a BPA to alert AS pharmacists of potential ASB triggered by the following criteria: ED or admitted status, antibiotic order with genitourinary indication, and a preceding urinalysis with ≤ 10 WBC/hpf. We evaluated the median time from antibiotic order to AS intervention and overall percent of UTI-related interventions among patients in pre-BPA (01/2020–12/2020) and post-BPA (04/15/2021–04/30/2022) periods.
Results:
774 antibiotic orders met inclusion criteria: 355 in the pre- and 419 in the post-BPA group. 43 (35 UTI-related) pre-BPA and 117 (94 UTI-related) post-BPA interventions were documented. The median time to intervention was 28 hours (IQR 18–65) in the pre-BPA group compared to 16 hours (IQR 2–34) in the post-BPA group (P < 0.01). Despite absent pyuria, there were six cases with gram-negative bacteremia presumably from a urinary source.
Conclusions:
Automated identification of antibiotics targeting UTI without pyuria on urinalysis reduced the time to stewardship intervention and increased the rate of UTI-specific interventions. Clinical decision support aided in the efficiency of AS review and syndrome-targeted impact, but cases still required AS clinical review.
The figure of Anthony Comstock may seem like an odd historical relic: a repressed, puritanical, anti-sex reformer from a bygone past. And yet, because his namesake act has been revived as a potential strategy for limiting access to reproductive healthcare, Comstock is no joke. Today, some Americans see the Comstock Act, passed by Congress in 1873, as a pathway to banning abortion and other reproductive care, effectively jettisoning any need for new Supreme Court abortion rulings or congressional legislation. As scholars of the Gilded Age and Progressive Era, we are uniquely situated to intervene in this dialogue and ensure that contemporary conversations are grounded in historical context. We present this forum not as an exhaustive account of the Comstock Act and its architect, but as aopportunity to highlight the context in which this law, which holds so much potential relevance for our present, was created, enacted, enforced, and challenged. We hope this forum will stimulate further scholarly and public conversations around the nation’s long history of regulating reproductive rights and how that history became entangled with other social anxieties.
Diagnostic criteria for major depressive disorder allow for heterogeneous symptom profiles but genetic analysis of major depressive symptoms has the potential to identify clinical and etiological subtypes. There are several challenges to integrating symptom data from genetically informative cohorts, such as sample size differences between clinical and community cohorts and various patterns of missing data.
Methods
We conducted genome-wide association studies of major depressive symptoms in three cohorts that were enriched for participants with a diagnosis of depression (Psychiatric Genomics Consortium, Australian Genetics of Depression Study, Generation Scotland) and three community cohorts who were not recruited on the basis of diagnosis (Avon Longitudinal Study of Parents and Children, Estonian Biobank, and UK Biobank). We fit a series of confirmatory factor models with factors that accounted for how symptom data was sampled and then compared alternative models with different symptom factors.
Results
The best fitting model had a distinct factor for Appetite/Weight symptoms and an additional measurement factor that accounted for the skip-structure in community cohorts (use of Depression and Anhedonia as gating symptoms).
Conclusion
The results show the importance of assessing the directionality of symptoms (such as hypersomnia versus insomnia) and of accounting for study and measurement design when meta-analyzing genetic association data.
Encompassing global cooling, the spread of grasslands, and biogeographic interchanges, the Hemphillian North American Land Mammal Age is an important interval for understanding the factors driving ecological and evolutionary change through time. McKay Reservoir near Pendleton, Oregon is a natural laboratory for analyses of these factors. It is remarkable for its small vertebrate fauna including rodents, bats, turtles, and lagomorphs, but also for its larger mammal fossils like camelids, rhinocerotids, canids, and felids. Despite the importance of the site, few revisions to its faunal list have been published since its original description. We expand on this description by identifying taxa not previously known from McKay Reservoir based on specimens collected during fieldwork and through reidentification of previously collected fossils. Newly identified taxa include the borophagine canid Borophagus secundus (Matthew and Cook, 1909), the camelids Megatylopus Matthew and Cook, 1909 and Pleiolama Webb and Meachen, 2004, a dromomerycid, and the equids Cormohipparion Skinner and MacFadden, 1977 and Pseudhipparion Ameghino, 1904. Specimens previously assigned to Neohipparion Gidley, 1903 and Hipparion de Christol, 1832 lack the features necessary to diagnose these genera, which are therefore removed from the site's faunal list. The presence of Borophagus secundus, Cormohipparion, and Pseudhipparion is especially important, because each occurrence represents a major geographic range extension. This refined understanding of the fauna lays the foundation for future studies of taphonomy, taxonomy, functional morphology, and paleoecology—potentially at the population, community, or ecosystem levels—at this paleobiologically significant Miocene locality.
We report the discovery of a bow-shock pulsar wind nebula (PWN), named Potoroo, and the detection of a young pulsar J1638$-$4713 that powers the nebula. We present a radio continuum study of the PWN based on 20-cm observations obtained from the Australian Square Kilometre Array Pathfinder (ASKAP) and MeerKAT. PSR J1638$-$4713 was identified using Parkes radio telescope observations at frequencies above 3 GHz. The pulsar has the second-highest dispersion measure of all known radio pulsars (1 553 pc cm$^{-3}$), a spin period of 65.74 ms and a spin-down luminosity of $\dot{E}=6.1\times10^{36}$ erg s$^{-1}$. The PWN has a cometary morphology and one of the greatest projected lengths among all the observed pulsar radio tails, measuring over 21 pc for an assumed distance of 10 kpc. The remarkably long tail and atypically steep radio spectral index are attributed to the interplay of a supernova reverse shock and the PWN. The originating supernova remnant is not known so far. We estimated the pulsar kick velocity to be in the range of 1 000–2 000 km s$^{-1}$ for ages between 23 and 10 kyr. The X-ray counterpart found in Chandra data, CXOU J163802.6$-$471358, shows the same tail morphology as the radio source but is shorter by a factor of 10. The peak of the X-ray emission is offset from the peak of the radio total intensity (Stokes $\rm I$) emission by approximately 4.7$^{\prime\prime}$, but coincides well with circularly polarised (Stokes $\rm V$) emission. No infrared counterpart was found.
Clinical outcomes of repetitive transcranial magnetic stimulation (rTMS) for treatment of treatment-resistant depression (TRD) vary widely and there is no mood rating scale that is standard for assessing rTMS outcome. It remains unclear whether TMS is as efficacious in older adults with late-life depression (LLD) compared to younger adults with major depressive disorder (MDD). This study examined the effect of age on outcomes of rTMS treatment of adults with TRD. Self-report and observer mood ratings were measured weekly in 687 subjects ages 16–100 years undergoing rTMS treatment using the Inventory of Depressive Symptomatology 30-item Self-Report (IDS-SR), Patient Health Questionnaire 9-item (PHQ), Profile of Mood States 30-item, and Hamilton Depression Rating Scale 17-item (HDRS). All rating scales detected significant improvement with treatment; response and remission rates varied by scale but not by age (response/remission ≥ 60: 38%–57%/25%–33%; <60: 32%–49%/18%–25%). Proportional hazards models showed early improvement predicted later improvement across ages, though early improvements in PHQ and HDRS were more predictive of remission in those < 60 years (relative to those ≥ 60) and greater baseline IDS burden was more predictive of non-remission in those ≥ 60 years (relative to those < 60). These results indicate there is no significant effect of age on treatment outcomes in rTMS for TRD, though rating instruments may differ in assessment of symptom burden between younger and older adults during treatment.
This study describes the illness burden in the first year of life for children with single-ventricle heart disease, using the metric of days alive and out of hospital to characterize morbidity and mortality.
Methods:
This is a retrospective single-centre study of single-ventricle patients born between 2005 and 2021 who had their initial operation performed at our institution. Patient demographics, anatomical details, and hospitalizations were extracted from our institutional single-ventricle database. Days alive and out of hospital were calculated by subtracting the number of days hospitalized from number of days alive during the first year of life. A multivariable linear regression with stepwise variable selection was used to determine independent risk factors associated with fewer days alive and out of hospital.
Results:
In total, 437 patients were included. Overall median number of days alive and out of hospital in the first year of life for single-ventricle patients was 278 days (interquartile range 157–319 days). In a multivariable analysis, low birth weight (<2.5kg) (b = −37.55, p = 0.01), presence of a dominant right ventricle (b = −31.05, p = 0.01), moderate-severe dominant atrioventricular valve regurgitation at birth (b = −37.65, p < 0.05), index hybrid Norwood operation (b = −138.73, p < 0.01), or index heart transplant (b = −158.41, p < 0.01) were all independently associated with fewer days alive and out of hospital.
Conclusions:
Children with single-ventricle heart defects have significant illness burden in the first year of life. Identifying risk factors associated with fewer days alive and out of hospital may aid in counselling families regarding expectations and patient prognosis.
Biodiversity monitoring programmes should be designed with sufficient statistical power to detect population change. Here we evaluated the statistical power of monitoring to detect declines in the occupancy of forest birds on Christmas Island, Australia. We fitted zero-inflated binomial models to 3 years of repeat detection data (2011, 2013 and 2015) to estimate single-visit detection probabilities for four species of concern: the Christmas Island imperial pigeon Ducula whartoni, Christmas Island white-eye Zosterops natalis, Christmas Island thrush Turdus poliocephalus erythropleurus and Christmas Island emerald dove Chalcophaps indica natalis. We combined detection probabilities with maps of occupancy to simulate data collected over the next 10 years for alternative monitoring designs and for different declines in occupancy (10–50%). Specifically, we explored how the number of sites (60, 128, 300, 500), the interval between surveys (1–5 years), the number of repeat visits (2–4 visits) and the location of sites influenced power. Power was high (> 80%) for the imperial pigeon, white-eye and thrush for most scenarios, except for when only 60 sites were surveyed or a 10% decline in occupancy was simulated over 10 years. For the emerald dove, which is the rarest of the four species and has a patchy distribution, power was low in almost all scenarios tested. Prioritizing monitoring towards core habitat for this species only slightly improved power to detect declines. Our study demonstrates how data collected during the early stages of monitoring can be analysed in simulation tools to fine-tune future survey design decisions.