The National Mental Health Policy: Implications for Public Psychiatric Services in Australia

The Health Ministers of all Australian States, Territories and the Commonwealth endorsed National Mental Health Policy in April 1992 [1]. This Policy is intended to set clear direction for the future development of mental health services within Australia. The Policy recognises the high prevalence of mental health problems and mental disorders in the Australian community and the impact of these on consumers, carers, families and society as whole. It also clearly accepts the need to address the problems confronting the promotion of mental health and the provision of mental health services

Inducement prizes and innovation

We examine the effect of prizes on innovation using data on awards for technological development offered by the Royal Agricultural Society of England at annual competitions between 1839 and 1939. We find large effects of the prizes on competitive entry and we also detect an impact of the prizes on the quality of contemporaneous patents, especially when prize categories were set by a strict rotation scheme, thereby mitigating the potentially confounding effect that they targeted only “hot” technology sectors. Prizes encouraged competition and medals were more important than monetary awards. The boost to innovation we observe cannot be explained by the re-direction of existing inventive activity

Integrating management of marine activities in Australia

Integrated management (IM) has been widely proposed, but difficult to achieve in practice, and there remains the need for evaluation of examples that illustrate the practical issues that contribute to IM success or failure. This paper synthesises experiences of academics and practitioners involved in seven Australian case studies in which there have been attempts to integrate or take a broader, holistic perspective of management. The evaluative framework of Stephenson et al. (2019a) was used as a lens to explore, through workshops and a questionnaire survey, the nine key features and five anticipated stages of IM in the Gladstone Harbour Project, the Great Barrier Reef, the Northern Prawn fishery and regional development, the South-East Queensland Healthy Waterways Partnership, the Australian Oceans Policy, the New South Wales Marine Estate reforms, and progress toward Integrated Management in the Spencer Gulf. Workshops involving experts with direct experience of the case studies revealed that most of the key features (recognition of the need; a shared vision for IM; appropriate legal and policy frameworks; effective process for appropriate stakeholder participation; comprehensive suite of objectives (ecological, social, cultural, economic and institutional); consideration of trade-offs and cumulative effects of multiple activities; flexibility to adapt to changing conditions; process for ongoing review, evaluation and refinement; and effective resourcing) were seen as important in all case studies. However, there are only a few examples where key features of IM were implemented ‘fully’. A subsequent questionnaire of participants using ‘best-worst’ scaling indicated that an appropriate legal and institutional framework is considered to have most influence on IM outcomes, and therefore is the most important of the key features. This is followed in salience by effective stakeholder participation, effective resourcing, capacity and tools, and recognition of the need for IM. Key features may change in relative importance at different stages in the trajectory of IM

Benthic metabolism as an indicator of stream ecosystem health

We tested direct and indirect measures of benthic metabolism as indicators of stream ecosystem health across a known agricultural land-use disturbance gradient in southeast Queensland, Australia. Gross primary production (GPP) and respiration (R-24) in benthic chambers in cobble and sediment habitats, algal biomass (as chlorophyll a) from cobbles and sediment cores, algal biomass accrual on artificial substrates and stable carbon isotope ratios of aquatic plants and benthic sediments were measured at 53 stream sites, ranging from undisturbed subtropical rainforest to catchments where improved pasture and intensive cropping are major land-uses. Rates of benthic GPP and R-24 varied by more than two orders of magnitude across the study gradient. Generalised linear regression modelling explained 80% or more of the variation in these two indicators when sediment and cobble substrate dominated sites were considered separately, and both catchment and reach scale descriptors of the disturbance gradient were important in explaining this variation. Model fits were poor for net daily benthic metabolism (NDM) and production to respiration ratio (P/R). Algal biomass accrual on artificial substrate and stable carbon isotope ratios of aquatic plants and benthic sediment were the best of the indirect indicators, with regression model R-2 values of 50% or greater. Model fits were poor for algal biomass on natural substrates for cobble sites and all sites. None of these indirect measures of benthic metabolism was a good surrogate for measured GPP. Direct measures of benthic metabolism, GPP and R-24, and several indirect measures were good indicators of stream ecosystem health and are recommended in assessing process-related responses to riparian and catchment land use change and the success of ecosystem rehabilitation actions

Extending thrombolysis to 4·5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data

Background: Stroke thrombolysis with alteplase is currently recommended 0–4·5 h after stroke onset. We aimed to determine whether perfusion imaging can identify patients with salvageable brain tissue with symptoms 4·5 h or more from stroke onset or with symptoms on waking who might benefit from thrombolysis. Methods: In this systematic review and meta-analysis of individual patient data, we searched PubMed for randomised trials published in English between Jan 1, 2006, and March 1, 2019. We also reviewed the reference list of a previous systematic review of thrombolysis and searched ClinicalTrials.gov for interventional studies of ischaemic stroke. Studies of alteplase versus placebo in patients (aged ≥18 years) with ischaemic stroke treated more than 4·5 h after onset, or with wake-up stroke, who were imaged with perfusion-diffusion MRI or CT perfusion were eligible for inclusion. The primary outcome was excellent functional outcome (modified Rankin Scale [mRS] score 0–1) at 3 months, adjusted for baseline age and clinical severity. Safety outcomes were death and symptomatic intracerebral haemorrhage. We calculated odds ratios, adjusted for baseline age and National Institutes of Health Stroke Scale score, using mixed-effects logistic regression models. This study is registered with PROSPERO, number CRD42019128036. Findings: We identified three trials that met eligibility criteria: EXTEND, ECASS4-EXTEND, and EPITHET. Of the 414 patients included in the three trials, 213 (51%) were assigned to receive alteplase and 201 (49%) were assigned to receive placebo. Overall, 211 patients in the alteplase group and 199 patients in the placebo group had mRS assessment data at 3 months and thus were included in the analysis of the primary outcome. 76 (36%) of 211 patients in the alteplase group and 58 (29%) of 199 patients in the placebo group had achieved excellent functional outcome at 3 months (adjusted odds ratio [OR] 1·86, 95% CI 1·15–2·99, p=0·011). Symptomatic intracerebral haemorrhage was more common in the alteplase group than the placebo group (ten [5%] of 213 patients vs one [<1%] of 201 patients in the placebo group; adjusted OR 9·7, 95% CI 1·23–76·55, p=0·031). 29 (14%) of 213 patients in the alteplase group and 18 (9%) of 201 patients in the placebo group died (adjusted OR 1·55, 0·81–2·96, p=0·66). Interpretation: Patients with ischaemic stroke 4·5–9 h from stroke onset or wake-up stroke with salvageable brain tissue who were treated with alteplase achieved better functional outcomes than did patients given placebo. The rate of symptomatic intracerebral haemorrhage was higher with alteplase, but this increase did not negate the overall net benefit of thrombolysis