Emergency Services Workforce 2030

Australia’s emergency management sector sits within an environment that is becoming ever more complex, dynamic and uncertain. This is due to factors like a growing population, changing climate, social and cultural change, and the impact of new technologies. At the same time, the nature of how we work, in both paid and voluntary ways, is also changing. Work is greatly influenced by changes in technology and lifestyle, and by increasing levels of interconnectivity and cross-boundary collaboration. In this dynamic context, planning for the sustainability, effectiveness and wellbeing of the future emergency management workforce takes on considerable importance. The workforces of Australia’s fire, emergency services and rural land management agencies (referred to in this report as emergency service organisations) are crucial to Australia’s emergency management capability. These workforces include career and volunteer members, they also include first responders as well as professional, technical, and administrative support staff and volunteers (hereafter referred to collectively as the emergency service workforce). This report provides a consolidated, overview picture of emerging workforce challenges and opportunities likely to face emergency service organisations over the coming decade. It is a first step in bringing together the wide range of research that can inform and strengthen strategic workforce planning in these organisations. The report presents a high-level summary of key trends and developments highlighted in research from beyond the emergency management sphere. It identifies potential implications of these trends and developments for the future emergency service workforce. It also highlights key Bushfire and Natural Hazards Cooperative Research Centre (CRC) affiliated research that can assist workforce planners to understand and respond to these implications. The bulk of the combined emergency service workforce are volunteers. According to the Productivity Commission, there were around 212,293 fire service volunteers and 23,897 state and territory emergency service volunteers across emergency service organisations in Australia in 2017-18 (Commonwealth of Australia, 2019). Volunteers therefore formed around 91% of the fire service workforce, and 97% of the state and territory emergency service workforce in that year. Furthermore, given the geographic size, changing risk profile, and demographic shifts in Australia, a heavy reliance on volunteers is likely to continue into the future. As such, volunteers and volunteering issues form a key component of the terrain covered in this report. While focusing on the emergency service workforce, this report is also based on recognition that the emergency services are part of a wider emergency management workforce that is also diverse and changing. The complete emergency management workforce extends far beyond the emergency services to include the volunteer and paid workforces of not-for-profits active in recovery, local governments, wider community sector and faith-based organisations, government departments, private businesses and more. Increasingly, under the influence of changing community expectations, and policy goals of community resilience, shared responsibility, and clear risk ownership (COAG, 2011; Commonwealth of Australia, 2018), ‘unaffiliated’ community members and groups are also recognised as a valuable part of the emergency management workforce (AIDR, 2017). Consequently, the future emergency management workforce is not going to be restricted to the affiliated volunteer and paid workforces of formal emergency service organisations. Therefore, this report considers the future emergency service workforce within the context of how it interacts with and forms a part of the wider emergency management workforce

Emergency Services Workforce 2030: Changing landscape literature review

The Changing Landscape Literature Review collates a high-level evidence base around seven major themes in the changing landscape (i.e., the external environment) that fire, emergency service, and rural land management agencies operate in, and which will shape workforce planning and capability requirements over the next decade. It is an output of the Workforce 2030 project and is one of two literature reviews that summarise the research base underpinning a high-level integrative report of emerging workforce challenges and opportunities, Emergency Services Workforce 2030. Workforce 2030 aimed to highlight major trends and developments likely to impact the future workforces of emergency service organisations, and their potential implications. The starting point for the project was a question: What can research from outside the sphere of emergency management add to our knowledge of wider trends and developments likely to shape the future emergency services workforce, and their implications? The seven themes included in the Changing Landscape Literature Review are: 1) demographic changes, 2) changing nature of work, 3) changes in volunteering, 4) physical technology, 5) digital technology, 6) shifting expectations, and changing risk. A second, accompanying literature review, the Changing Work Literature Review, focuses on another nine themes related to emergency service organisation’s internal workforce management approaches and working environments

Emergency Services Workforce 2030: Changing work literature review

The Changing Work Literature Review collates a high-level evidence base around nine major themes related to internal workforce management approaches and working environments of fire, emergency service, and rural land management agencies. It is an output of the Workforce 2030 project and is one of two literature reviews that summarise the research base underpinning a high-level integrative report of emerging workforce challenges and opportunities, Emergency Services Workforce 2030. Workforce 2030 aimed to highlight major trends and developments likely to impact the future workforces of emergency service organisations, and their potential implications. The starting point for the project was a question: What can research from outside the sphere of emergency management add to our knowledge of wider trends and developments likely to shape the future emergency services workforce, and their implications? The Changing Work Literature Review focuses on nine themes relevant to changes that have implications for emergency service organisation’s internal workforce management approaches and working environments: 1) Recruitment, assessment, and selection, 2) Socialisation and training, 3) Work design, 4) Diversity and inclusion, 5) Managing mental health and wellbeing, 6) Leadership, 7) Change management, 8) Managing an ageing workforce, and 9) Managing volunteer workforces

Effect of Prior Bilateral Oophorectomy on the Presentation of Breast Cancer in BRCA1 and BRCA2 Mutation Carriers

Purpose: To compare the presentation of invasive breast cancer in BRCA1 and BRCA2 mutation carriers with and without prior bilateral oophorectomy. Patients and methods: Women with a BRCA1 or BRCA2 mutation with the diagnosis of invasive breast cancer were identified from ten cancer genetics clinics. The medical history, medical treatment records and pathology reports for the breast cancers were reviewed. Information was abstracted from medical charts, including history (and date) of oophorectomy, date of breast cancer diagnosis, stage of disease, and pathologic characteristics of the breast cancer. Women with prior bilateral oophorectomy were matched by age, year of diagnosis, and mutation with one or more women who had two intact ovaries at the time of breast cancer diagnosis. Characteristics of the breast tumours were compared between the two groups

The top 10 research priorities in diabetes and pregnancy according to women, support networks and healthcare professionals.

Funder: Nuffield Department of Population Health, University of OxfordAIMS: To undertake a Priority Setting Partnership (PSP) to establish priorities for future research in diabetes and pregnancy, according to women with experience of pregnancy, and planning pregnancy, with any type of diabetes, their support networks and healthcare professionals. METHODS: The PSP used established James Lind Alliance (JLA) methodology working with women and their support networks and healthcare professionals UK-wide. Unanswered questions about the time before, during or after pregnancy with any type of diabetes were identified using an online survey and broad-level literature search. A second survey identified a shortlist of questions for final prioritisation at an online consensus development workshop. RESULTS: There were 466 responses (32% healthcare professionals) to the initial survey, with 1161 questions, which were aggregated into 60 unanswered questions. There were 614 responses (20% healthcare professionals) to the second survey and 18 questions shortlisted for ranking at the workshop. The top 10 questions were: diabetes technology, the best test for diabetes during pregnancy, diet and lifestyle interventions for diabetes management during pregnancy, emotional and well-being needs of women with diabetes pre- to post-pregnancy, safe full-term birth, post-natal care and support needs of women, diagnosis and management late in pregnancy, prevention of other types of diabetes in women with gestational diabetes, women's labour and birth experiences and choices and improving planning pregnancy. CONCLUSIONS: These research priorities provide guidance for research funders and researchers to target research in diabetes and pregnancy that will achieve greatest value and impact

Breast tumor copy number aberration phenotypes and genomic instability

BACKGROUND: Genomic DNA copy number aberrations are frequent in solid tumors, although the underlying causes of chromosomal instability in tumors remain obscure. Genes likely to have genomic instability phenotypes when mutated (e.g. those involved in mitosis, replication, repair, and telomeres) are rarely mutated in chromosomally unstable sporadic tumors, even though such mutations are associated with some heritable cancer prone syndromes. METHODS: We applied array comparative genomic hybridization (CGH) to the analysis of breast tumors. The variation in the levels of genomic instability amongst tumors prompted us to investigate whether alterations in processes/genes involved in maintenance and/or manipulation of the genome were associated with particular types of genomic instability. RESULTS: We discriminated three breast tumor subtypes based on genomic DNA copy number alterations. The subtypes varied with respect to level of genomic instability. We find that shorter telomeres and altered telomere related gene expression are associated with amplification, implicating telomere attrition as a promoter of this type of aberration in breast cancer. On the other hand, the numbers of chromosomal alterations, particularly low level changes, are associated with altered expression of genes in other functional classes (mitosis, cell cycle, DNA replication and repair). Further, although loss of function instability phenotypes have been demonstrated for many of the genes in model systems, we observed enhanced expression of most genes in tumors, indicating that over expression, rather than deficiency underlies instability. CONCLUSION: Many of the genes associated with higher frequency of copy number aberrations are direct targets of E2F, supporting the hypothesis that deregulation of the Rb pathway is a major contributor to chromosomal instability in breast tumors. These observations are consistent with failure to find mutations in sporadic tumors in genes that have roles in maintenance or manipulation of the genome

Ineffectiveness of light emitting diodes as underwater deterrents for Long-tailed Ducks Clangula hyemalis

Gillnet bycatch accounts for over 400,000 bird mortalities worldwide every year, affectinga wide variety of species, especially those birds that dive when foraging. Technologicalsolutions to improve gillnet visibility or deter birds from approaching nets, such as LEDlights, are essential for aiding diving birds to perceive nets as a hazard. Designing suchsolutions requires obtaining visual and behavioural ecology information from species toassess their ability to see the warning devices, and to examine their behavioural responsesto them. Seaducks, particularly Long-tailed DucksClangula hyemalis,have high bycatchmortality rates. We examined the visualfields of four Long-tailed Ducks to understandtheir three-dimensional view around the head. The visualfield characteristics of thisspecies indicate a reliance on visual guidance for foraging associated with their capture ofvaried, mobile prey in their generalist diet. We subsequently conducted dive tank trials totest the effectiveness of 12 different LED treatments as visual deterrents to the underwaterforaging behaviour of 8 Long-tailed Ducks. During each trial, ducks were offered foodrewards from a specific underwater location in a dive tank, having the choice of whether totake the food or not. At the same time, they were exposed to either one LED light or thecontrol (no light) to determine whether the presence of each light affected the foragingsuccess rate of dives compared to the control. Exposure of ducks to all 13 treatmentcombinations was randomised over the trial period. White lights with an increasingflashrate were shown to have a significant positive effect on foraging success, and likely acted asa visual attractant, rather than as a deterrent. No light treatment significantly reduced theforaging success of ducks. LED lights did not inhibit the feeding of Long-tailed Ducks. Suchlights may be ineffective as underwater visual deterrents when deployed on gillnets, whilewhiteflashing lights may make foraging sites more attractive to Long-tailed Ducks.©2020 The Authors. Published by Elsevier B.V. This is an open access article under the CCBY-NC-ND license

Quality of life after postmastectomy radiotherapy in patients with intermediate-risk breast cancer (SUPREMO): 2-year follow-up results of a randomised controlled trial

Background Postmastectomy radiotherapy in patients with four or more positive axillary nodes reduces breast cancer mortality, but its role in patients with one to three involved nodes is controversial. We assessed the effects of postmastectomy radiotherapy on quality of life (QOL) in women with intermediate-risk breast cancer. Methods SUPREMO is an open-label, international, parallel-group, randomised, controlled trial. Women aged 18 years or older with intermediate-risk breast cancer (defined as pT1–2N1; pT3N0; or pT2N0 if also grade III or with lymphovascular invasion) who had undergone mastectomy and, if node positive, axillary surgery, were randomly assigned (1:1) to receive chest wall radiotherapy (50 Gy in 25 fractions or a radiobiologically equivalent dose of 45 Gy in 20 fractions or 40 Gy in 15 fractions) or no radiotherapy. Randomisation was done with permuted blocks of varying block length, and stratified by centre, without masking of patients or investigators. The primary endpoint is 10-year overall survival. Here, we present 2-year results of QOL (a prespecified secondary endpoint). The QOL substudy, open to all UK patients, consists of questionnaires (European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23, Body Image Scale, Hospital Anxiety and Depression Scale [HADS], and EQ-5D-3L) completed before randomisation, and at 1, 2, 5, and 10 years. The prespecified primary outcomes within this QOL substudy were global QOL, fatigue, physical function, chest wall symptoms, shoulder and arm symptoms, body image, and anxiety and depression. Data were analysed by intention to treat, using repeated mixed-effects methods. This trial is registered with the ISRCTN registry, number ISRCTN61145589. Findings Between Aug 4, 2006, and April 29, 2013, 1688 patients were enrolled internationally and randomly assigned to receive chest wall radiotherapy (n=853) or not (n=835). 989 (79%) of 1258 patients from 111 UK centres consented to participate in the QOL substudy (487 in the radiotherapy group and 502 in the no radiotherapy group), of whom 947 (96%) returned the baseline questionnaires and were included in the analysis (radiotherapy, n=471; no radiotherapy, n=476). At up to 2 years, chest wall symptoms were worse in the radiotherapy group than in the no radiotherapy group (mean score 14·1 [SD 15·8] in the radiotherapy group vs 11·6 [14·6] in the no radiotherapy group; effect estimate 2·17, 95% CI 0·40–3·94; p=0·016); however, there was an improvement in both groups between years 1 and 2 (visit effect −1·34, 95% CI −2·36 to −0·31; p=0·010). No differences were seen between treatment groups in arm and shoulder symptoms, body image, fatigue, overall QOL, physical function, or anxiety or depression scores. Interpretation Postmastectomy radiotherapy led to more local (chest wall) symptoms up to 2 years postrandomisation compared with no radiotherapy, but the difference between groups was small. These data will inform shared decision making while we await survival (trial primary endpoint) results. Funding Medical Research Council, European Organisation for Research and Treatment of Cancer, Cancer Australia, Dutch Cancer Society, Trustees of Hong Kong and Shanghai Banking Corporation