Southern Cross University

Aim Our aim was to identify multimorbidity clusters and, in particular, to examine their contribution to well-being outcomes among the oldest old in Germany. Methods Data were taken from the large nationally representative D80+ study including community-dwelling and institutionalized individuals aged 80 years and over residing in Germany(n=8,773). The mean age was 85.6 years (SD: 4.1). Based on 21 chronic conditions, latent class analysis was carried out to explore multimorbidity (≥2 chronic conditions) clusters. Widely used tools were applied to quantify well-being outcomes. Results Approximately nine out of ten people aged 80 and over living in Germany were multimorbid. Four multimorbidity clusters were identified: relatively healthy class (30.2%), musculoskeletal class (44.8%), mental illness class (8.6%), and high morbidity class (16.4%). Being part of the mental disorders cluster was consistently linked to reduced well-being (in terms of low life satisfaction, high loneliness and lower odds of meaning in life), followed by membership in the high morbidity cluster. Conclusions Four multimorbidity clusters were detected among the oldest old in Germany. Particularly belonging to the mental disorders cluster is consistently associated with low well-being, followed by belonging to the high morbidity cluster. This stresses the need for efforts to target such vulnerable groups, pending future longitudinal research.

Aim Variation in community composition along environmental gradients provides crucial information for identifying zones where species turnover is rapid and to ascertain whether compositional changes occur gradually or rather abruptly. We examined changes in bird community composition along three bioclimatic transects in Australia to test whether drivers of species turnover are consistent, rather than spatially contingent, across biologically contrasting ecosystems. We also detected potential transition zones associated with environmental thresholds and determined whether certain abiotic conditions promote a higher rate of community compositional turnover. Location Mainland Australia. Taxon Terrestrial birds. Methods We applied multivariate community analysis, generalised dissimilarity modelling (GDM) and threshold indicator taxa analysis (TITAN). Results We observed that environmental variables are better predictors of community composition than spatial distance, which indicates that species sorting, rather than dispersal, plays a key role in structuring Australian avian communities. Annual precipitation constitutes a key driver of species turnover regardless of the analysed transect. The most humid landscapes and those with a higher tree canopy show lower spatial heterogeneity in community composition compared to those with less benign environmental conditions (e.g., dryer environments). TITAN detected significant transition points and supported the results obtained using GDM, which suggests that bird composition change along the gradients is not monotonic. Main Conclusions Our results suggest that avian beta diversity increases with increasing environmental harshness, presumably through changes in the relative importance of stochastic versus deterministic processes. The obtained findings show that open forests and woodlands are extremely important ecosystems on this continent and deserve special attention in terms of conservation due to their vulnerability to global change. Lastly, this study exemplifies the value of combining community‐ and taxon‐based analyses to identify and interpret community thresholds, which can serve to pinpoint targets for preserving biodiversity.

Discovering new antibiotics and increasing the efficacy of existing antibiotics are priorities to address antimicrobial resistance. Antimicrobial proteins and peptides (AMPPs) are considered among the most promising antibiotic alternatives and complementary therapies. Here, we build upon previous work investigating the antibacterial activity of a semi-purified hemolymph protein extract (HPE) of the Australian oyster Saccostrea glomerata. HPE showed antimicrobial-biofilm inhibitory activity toward laboratory and clinical strains of Streptococcus pneumoniae and Streptococcus pyogenes at 4.4 and 24.1 μg/mL total protein, respectively. In combination assays, the effectiveness of conventional antibiotics (ampicillin, gentamicin, trimethoprim and ciprofloxacin) was improved between 2 to 32-fold in the presence of HPE (1–12 μg/mL) against a range of clinically important bacteria including Streptococcus spp., Pseudomonas aeruginosa, Moraxella catarrhalis, Klebsiella pneumoniae and Staphylococcus aureus. Effective HPE concentrations are comparable to AMPPs currently approved for use or in clinical trials pipelines. Proteomics analysis of HPE identified a number of proteins including abundant known AMPPs. It was non-toxic to A549 human lung cells up to 205 μg/mL, demonstrating safety well above effective concentrations. Activity was retained with storage at -80°C and ambient laboratory temperature (~24°C), but declined after treatment at either 37°C or 60°C (1 h). This study is in agreement with growing evidence that AMPPs show specificity and a high capacity for synergism with antibiotics. The discovery of HPE provides great opportunities for both pharmaceutical and aquaculture industry development.

Background: Inpatient mortality is a critical outcome measure for healthcare services. Improving patient outcomes and ensuring high-quality healthcare outcomes requires an understanding of the factors that contribute to inpatient mortality. Aim: This study aimed to investigate the impact of safety culture, quality of care, missed care, and nurse staffing on inpatient mortality rates and nurse-reported inpatient death frequency. Methods: A cross-sectional survey and an administrative dataset on inpatient mortality were used in this study. A web-based survey was conducted among nurses from 34 units in five acute public hospitals. Inpatient mortality data between 2018 and 2021 were collected from participating units. The study variables were analyzed using generalized linear models. Results: Safety culture scores were less than positive in all hospitals, and most nurses reported missed care during their last shift. However, nursing units that had strong subscale scores for teamwork climate, safety climate, and safety behavior had lower incidence rates of inpatient mortality and fewer nurse-reported inpatient deaths in their units. Conclusion: The study’s findings highlight the importance of teamwork climate, safety climate, and safety behaviors on safety culture and the role nurses play in reducing inpatient mortality rates and lowering nurse-reported inpatient death frequency.

Several legal acts mandate that management agencies regularly assess biological populations. For species with distinct markings, these assessments can be conducted noninvasively via capture‐recapture and photographic identification (photo‐ID), which involves processing considerable quantities of photographic data. To ease this burden, agencies increasingly rely on automated identification (ID) algorithms. Identification algorithms present agencies with an opportunity—reducing the cost of population assessments—and a challenge—propagating misidentifications into abundance estimates at a large scale. We explored several strategies for generating capture histories with an ID algorithm, evaluating trade‐offs between labor costs and estimation error in a hypothetical population assessment. To that end, we conducted a simulation study informed by 39 photo‐ID datasets representing 24 cetacean species. We fed the results into a custom optimization tool to discern the optimal strategy for each dataset. Our strategies included choosing between truly and partially automated photo‐ID and, in the case of the latter, choosing the number of suggested matches to inspect. True automation was optimal for datasets for which the algorithm identified individuals well. As identification performance declined, the optimization recommended that users inspect more suggested matches from the ID algorithm, particularly for small datasets. False negatives (i.e., individual was resighted but erroneously marked as a first capture) strongly predicted estimation error. A 2% increase in the false negative rate translated to a 5% increase in the relative bias in abundance estimates. Our framework can be used to estimate expected error of the abundance estimate, project labor effort, and find the optimal strategy for a dataset and algorithm. We recommend estimating a strategy's false negative rate before implementing the strategy in a population assessment. Our framework provides organizations with insights into the conservation benefits and consequences of automation as conservation enters a new era of artificial intelligence for population assessments.

As climate change and biodiversity loss continue to devastate the planet and human mental health impacts more than a billion people across the globe, the human–nature relationship has become even more vital for human and planetary health (Brymer et al., Citation2019, Citation2024; Fletcher et al., Citation2024). This special issue supports the need for an interdisciplinary and intersectional approach to deepen our understanding of how human–nature interactions benefit human health and wellbeing (Ghosh & Dutta, Citation2024; Seymour, Citation2016). We envisaged critical discussions of health and wellbeing beyond the traditional focus on formalised and structured sport and exercise, and the narrow biomedical model. We hoped submissions would illuminate alternative ways of engaging with adventure, outdoor learning and experiential education occurring in natural environments that would positively influence health and wellbeing. We anticipated that this focus would bring forth critical analyses and reflections on how capitalist societal systems, industrialisation, modernity, urbanisation, unsustainable consumption together with globalisation and commodification of nature for human exploitation are at odds with a sustainable relationship with nature ideal for healthy planet and people (Mago et al., Citation2024). We are delighted that in this special issue, researchers and practitioners from diverse disciplines and geographical locations have shared comparative and interdisciplinary critical discussions, lived experience, intervention-focused approaches, policy-oriented examinations, and empirical studies that would extend the intersectional lens into our understandings of the roles outdoors and adventure play in enhancing human and planetary wellbeing (Loureiro et al., Citation2021; Zwart & Ewert, Citation2022). We sincerely thank the authors of these 18 articles for sharing their valuable works and the reviewers of their manuscripts for providing further insights into respective research areas with their expertise and experience. The articles reflect multiple paradigms from a range of fields, representing multidimensional perspectives on ‘outdoor learning’ and ‘adventure,’ ‘outdoor education,’ and interactions with nature through activity, participation and experience. What is perceived as formalised outdoor learning and or education in the Western-centric approach can also be understood asexperiential education that ancient wisdom cultures practised over many generations. The traditional one-size-fits all approach to outdoor adventure activity design that focuses on tasks and performance outcomes in one context can, in another, be simple informal nature-based activities resulting in a wider reach and more collective benefits. For example, migrants’ walks in outdoor urban recreational spaces, community nature-journalling and nature play. At another level, nature-based activities are perceived and experienced as therapeutic, empowering and forming a sense of identity, especially for adolescents and at-risk youth. Outdoor residentials and nature-based activity focused programs bring changes to individual and community wellbeing. Early life experiences of nature are significantly impactful for personal wellbeing, extending into the later years of life for older adults. As with local traditional ecological knowledge systems, Indigenous Knowledges embedding place-based relationality are profoundly meaningful in deepening human–nature relationships in post-colonial societies. In these varying contexts and approaches, all populations may feel and experience unique personalised meanings, results and insights that can be more-than-human and fulfilling at individual and collective levels (Sharma-Brymer, Citation2022a). Justifiably, these articles offer new narratives of human–nature relationships in a broad diversity-focused, stimulating and considered critical dialogic space. Articles in this special issue seem naturally to fit within several themes: 1) Therapeutic interventions and diversities in nature-based experiences, 2) Outdoor learning and wellbeing, 3) Outdoor adventure education and wellbeing, 4) Nature-based interactions across the lifespan, 5) Theoretical/conceptual models, 6) Immigrants, nature-based experiences and community connectedness and 7) Nature’s influence on authentic leadership style. In the following paragraphs, we present short summaries.

Key message Cannabis trichome development progresses in distinct phases that underpin the dynamic biosynthesis of cannabinoids and terpenes. Abstract This study investigates the molecular mechanisms underlying cannabinoid and terpenoid biosynthesis in glandular trichomes of Cannabis sativa (CsGTs) throughout their development. Female Cannabis sativa c. Hindu Kush were cultivated under controlled conditions, and trichome development was analysed from week 3 to week 8 of the flowering period. We employed light microscopy, quantitative metabolomics and proteomics to analyse morphological changes in trichome secretory cell development, and temporal changes in metabolite accumulation and protein abundance. Our findings identified three distinct developmental phases: pre-secretory (T3), secretory (T6), and post-secretory (T8), the first time the three phases of trichome development have been identified and investigated in CsGTs. The pre-secretory phase was characterized by smaller secretory cells, limited metabolite accumulation and elevated levels of proteins involved in protein biosynthesis and cellular development. The secretory phase exhibited the highest biosynthetic activity, marked by larger secretory cells, increased plastidal activity, central carbon metabolism, and significant accumulation of cannabinoids and terpenoids. The post-secretory phase showed a decrease in secretory cell size, reduced metabolic activity, and a decrease in the abundance of primary and secondary metabolism enzymes, although THCA continued to accumulate. Key enzymes showed dynamic changes correlating with the stages of trichome development. This study provides a comprehensive understanding of the molecular mechanisms regulating cannabinoid and terpenoid biosynthesis in CsGTs, offering insights for enhancing the production of these valuable compounds through targeted breeding and biotechnological approaches.

This article considers the geographies of literacy learning by analysing maps that children drew about their experiences. The maps were created during a mapping-and-talking session with the researchers. Sociomaterial ways of thinking were used to foreground the relationships between people, texts, tools, technologies and spaces, in which literacy actions and practices occur. Four cases are outlined and analysed using the material, connected, and textual dimensions of literacy learning. Place-use and place-behaviour highlighted the material dimension; cognitive, social, and participatory activity focused on the connected dimension; and visual and linguistic activity addressed the textual dimension. Connections were found between the human, material, textual and spatial elements of children’s maps, signalling that quality literacy learning is a networked experience. Children’s maps indicated that literacy learning occurs outside the boundaries of the school environment, with rich home-based writing evident in children’s homes with their families, and that literacy learning is still predominantly a print-based activity.

Background Sexual well‐being significantly impacts the overall quality of life for individuals with and without intellectual disabilities. Notably, parents play a pivotal role in influencing their children's sexual development, and their attitudes towards this topic are shaped by Chinese sociocultural values. Methods This study employed Interpretative phenomenological analysis to explore the experiences and attitudes of five individuals with intellectual disabilities and seven parents/caregivers regarding the sexual needs of their adult offspring with intellectual disabilities. Results The findings revealed participants' experiences and concerns, often navigating the challenges posed by traditional Chinese cultural restrictions through responses characterised as ‘Silent’ (avoidance of discussion) and ‘Weep’ (deep‐seated psycho‐emotional burden). Conclusions This research emphasises the importance of a pluralistic society and advocates for promoting sexual autonomy among individuals with intellectual disabilities. The findings have implications for future practises and highlight the need for a more inclusive and compassionate approach to their sexual well‐being.

Coastal ecosystems play a major role in marine carbon budgets, but substantial uncertainties remain in the sources and fluxes of coastal carbon dioxide (CO 2 ). Here, we assess when, where, and how submarine groundwater discharge (SGD) releases CO 2 to shallow coastal ecosystems. Time-series observations of dissolved CO 2 and radon ( ²²² Rn, a natural groundwater tracer) across 40 coastal systems from 14 countries revealed large SGD-derived CO 2 fluxes. The mean groundwater partial pressure of CO 2 was 35 times higher than surface seawater. The mean SGD-derived CO 2 flux was 148 ± 226 millimoles per square meter per day (mmol m ⁻² day ⁻¹ ), resulting in a mean water-air CO 2 flux of 80 ± 133 mmol m ⁻² day ⁻¹ . Tidal rather than diel cycles drove CO 2 enrichment in most ecosystems. Tidally driven SGD was the primary CO 2 source in mangroves, salt marshes, tidal flats, estuaries, and canals. Overall, we expand current knowledge of marine carbon cycles by demonstrating SGD as an important source of CO 2 that requires inclusion in coastal carbon budgets.

Grandparents have a long history of assuming caregiving responsibilities, particularly in Indigenous communities, where the concepts of “kin” and “care” are expansive. In Australia, there has been a rise in grandparents becoming custodial carers for their grandchildren who cannot live with their parents, biological or otherwise. Placement with relatives or family friends is known as kinship care, with most of these families headed by grandparents raising grandchildren. Children being raised by kin are widely considered the preferred option compared to nonrelative institutional or foster care, as kinship care provides a connection to family, community, and culture and fosters a sense of belonging and identity, while also offering the potential for stable living arrangements. This paper reports on an Australian study involving 428 grandparent carers sharing their experiences of caring for their grandchildren as survey respondents, with nine of those carers participating in an individual in-depth interview. Findings suggest that the pleasure of watching their grandchildren grow was a privilege for many. Alongside this privilege, many experienced multiple and complex levels of stress, distress and trauma, exacerbated by a service system that did not appear to want to hear or understand. Implications for policy, practice and further research are highlighted.

The Australian Credentialled Diabetes Educator (CDE) registered trademark signifies quality care and education to those with diabetes. A review of the Australian Diabetes Educators Association (ADEA) CDE pathway was undertaken to ensure the quality of the CDE credential. The purpose of this study was to examine perceptions of the diabetes education workforce on the current pathway for educating and qualifying CDEs for practice. Stakeholders (e.g. CDEs, students, supervisors, course coordinators) were invited via the ADEA email, e-newsletter and Facebook to complete a 34-item online survey exploring their perceptions of the pathway, focusing on the requisite graduate certificate and subsequent credentialling requirements. Most (80%) of the 319 respondents were CDEs, 15% were CDEs in training and 12% were supervisors or employers. Half of participants (46%) indicated that graduate certificate course alumni were somewhat or very unprepared to take on the role of a diabetes educator (DE) prior to undertaking credentialling to become a CDE. Seventy-one percent of participants indicated more, and a greater variety, of clinical experiences are necessary within the course. Participants recommended formal assessment of competence within the clinical setting. Fifty-four percent of participants disagreed or were unsure that the subsequent credentialling pathway equips CDEs well for practice, indicating it is too onerous, and supported a more streamlined pathway. Findings highlight the need for education and skills-based training beyond the graduate certificate, and assessment of competence in conducting core diabetes skills to better equip CDEs for their role. Supplementary Information The online version contains supplementary material available at 10.1186/s12909-024-06620-7.

First Nations women in Australia diagnosed with type 2 diabetes, co-designed and attended a programmed shared medical appointment that included continuous glucose monitors and culturally responsive food appreciation activities over 8 weekly sessions to improve glycaemic control. The project was a single site, longitudinal change from baseline, mixed methods, feasibility study using HbA1c as the primary outcome measure. Secondary outcome measures included, weight, metabolic health-related blood panels, CGM, Blood Glucose Levels (BGL) time-in-range percentage, Patient Activation Measure (PAM) and Problem Areas In Diabetes (PAID) tools and client satisfaction survey and semi focussed interviews. Forty participants commenced and twenty-five participants completed the program (62,5%). Of the completing participants the mean HbA1c had an absolute reduction of 0.7 percentage points ( from baseline to program completion, P = .013). Eighteen (75%) reduced HbA1c and maintained some reduction for 12 months. Seven (28%) achieved remission, HbA1c <6.4% (46 mmol/l) maintained for 12 months. There were statistically significant improvements in weight, systolic blood pressure, liver enzymes, BGL time-in-range, PAM and PAID scores. It is feasible to use programmed shared medical appointments incorporating CGM aiming to improve glycaemic control and other metabolic measures of health among First Nations women in Australia. Trial Registration: The project was registered with the Australian and New Zealand Clinical Trial Registry ACTRN12622000650796. The trial web page = https://www.anzctr.org.au/ACTRN12622000650796.aspx .

Terrestrial dissolved inorganic carbon (DIC) and total alkalinity (TAlk) loads have contrasting effects on the pH and carbonate chemistry of the coastal ocean. While TAlk can buffer against ocean acidification, elevated exports of free CO2 can further exacerbate ocean acidification. In this study, we quantify terrestrial DIC and TAlk loads from rivers and mangrove floodplains across six bioregions and varying flow conditions to assess their impact on the buffering capacity of the Great Barrier Reef (GBR) lagoon in Australia. For a mid‐flow year, median terrestrial DIC and TAlk loads ranged from 0.72 to 0.89 Tg C yr⁻¹ and 0.26 to 1.03 Tg C yr⁻¹, respectively. We find that mangrove‐dominated terrestrial inputs only have a small influence on the whole GBR but contribute 12.5% (range: 1.9%–45.7%) of the DIC and 18.7% (range: 2.8%–68.2%) of the TAlk inner shelf inventory. Depending on the approach used to estimate TAlk loads, mangroves have a potential short‐term buffering effect on near‐shore coastal waters due to higher TAlk loads. However, long‐term mangrove TAlk production via pyrite formation complicates this interpretation, highlighting the need for ongoing monitoring to understand the complex interplay between terrestrial inputs and their effect on the GBR carbonate chemistry.