The strategy dynamics of collective systems: Underlying hindrances beyond two-actor coordination.

Engineering systems, characterized by their high technical complexity and societal intricacies, require a strategic design approach to navigate multifaceted challenges. Understanding the circumstances that affect strategic action in these systems is crucial for managing complex real-world challenges. These challenges go beyond localized coordination issues and encompass intricate dynamics, requiring a deep understanding of the underlying structures impacting strategic behaviors, the interactions between subsystems, and the conflicting needs and expectations of diverse actors. Traditional optimization and game-theoretic approaches to guide individual and collective decisions need adaptation to capture the complexities of these design ecosystems, particularly in the face of increasing numbers of decision-makers and various interconnections between them. This paper presents a framework for studying strategic decision-making processes in collective systems. It tackles the combinatorial complexity and interdependencies inherent in large-scale systems by representing strategic decision-making processes as binary normal-form games, then dissects and reinterprets them in terms of multiple compact games characterized by two real-numbered structural factors and classifies them across four strategy dynamical domains associated with different stability conditions. We provide a mathematical characterization and visual representation of emergent strategy dynamics in games with three or more actors intended to facilitate its implementation by researchers and practitioners and elicit new perspectives on design and management for optimizing systems-of-systems performance. We conclude this paper with a discussion of the opportunities and challenges of adopting this framework within and beyond the context of engineering systems.

Trends and projections of cause-specific premature mortality in Australia to 2044: a statistical modelling study.

Background: Long-term projections of premature mortality (defined as deaths age <75 years) help to inform decisions about public health priorities. This study aimed to project premature mortality rates in Australia to 2044, and to estimate numbers of deaths and potential years of life lost (PYLL) due to premature mortality overall and for 59 causes. Methods: We examined the past trends in premature mortality rates using Australian mortality data by sex, 5-year age group and 5-year calendar period up to 2019. Cigarette smoking exposure data (1945-2019) were included to project lung cancer mortality. Age-period-cohort or generalised linear models were developed and validated for each cause to project premature mortality rates to 2044. Findings: Over the 25-year period from 1990-1994 to 2015-2019, there was a 44.4% decrease in the overall age-standardised premature mortality rate. This decline is expected to continue, from 162.4 deaths/100,000 population in 2015-2019 to 141.7/100,000 in 2040-2044 (12.7% decrease). Despite declining rates, total numbers of premature deaths are projected to increase by 22.8%, rising from 272,815 deaths in 2015-2019 to 334,894 deaths in 2040-2044. This is expected to result in 1.58 million premature deaths over the 25-year period 2020-2044, accounting for 24.5 million PYLL. Of the high-level cause categories, cancer is projected to remain the most common cause of premature death in Australia by 2044, followed by cardiovascular disease, external causes (including injury, poisoning, and suicide), and respiratory diseases. Interpretation: Despite continuously declining overall premature mortality rates, the total number of premature deaths in Australia is projected to remain substantial, and cancer will continue to be the leading cause. These projections can inform the targeting of public health efforts and can serve as benchmarks against which to measure the impact of future interventions. They emphasise the ongoing importance of accelerating the prevention, early detection, and treatment of key health conditions. Funding: No funding was provided for this study.

The Arctic Plant Aboveground Biomass Synthesis Dataset.

Plant biomass is a fundamental ecosystem attribute that is sensitive to rapid climatic changes occurring in the Arctic. Nevertheless, measuring plant biomass in the Arctic is logistically challenging and resource intensive. Lack of accessible field data hinders efforts to understand the amount, composition, distribution, and changes in plant biomass in these northern ecosystems. Here, we present The Arctic plant aboveground biomass synthesis dataset, which includes field measurements of lichen, bryophyte, herb, shrub, and/or tree aboveground biomass (g m-2) on 2,327 sample plots from 636 field sites in seven countries. We created the synthesis dataset by assembling and harmonizing 32 individual datasets. Aboveground biomass was primarily quantified by harvesting sample plots during mid- to late-summer, though tree and often tall shrub biomass were quantified using surveys and allometric models. Each biomass measurement is associated with metadata including sample date, location, method, data source, and other information. This unique dataset can be leveraged to monitor, map, and model plant biomass across the rapidly warming Arctic.

Parent's awareness of, and influence on, their 14-17-year-old child's vaping and smoking behaviours; an analysis of 3242 parent-child pairs in Australia.

BACKGROUND: Vaping by young people in Australia is a rapidly emerging public health issue. Evidence shows that parental behaviours and attitudes can play a key role in influencing adolescent behaviours. Considering the health harms of vaping and evidence that it can be a gateway to tobacco smoking for never-smokers, it is important to understand whether parents' smoking and vaping behaviours influence their teenage children's smoking and vaping behaviours. METHODS: Online cross-sectional surveys as part of the Generation Vape study, conducted in Australia in 2021/2022, were used to assess parents' influence on, and awareness of, one of their 14-17-year-old child's vaping and smoking behaviours. Participants were 3242 parents and 3242 14-17-year-old teenage children. RESULTS: The risk of vaping and smoking uptake among 14-17-year-old teenagers was 42% (p = 0.003) and 97% (p < 0.001) higher, respectively, if their parent was an ever-vaper. The risk of vaping and smoking uptake among teenagers was 81% (p < 0.001) and 159% (p < 0.001) higher, respectively, if their parent was an ever-smoker. Parents of teenagers who have not vaped were considerably better at correctly predicting this (97% correct) than parents of teenagers who have vaped (70% correct). Compared to parents, teenagers tended to have less agreement with statements suggesting vaping is unsafe or harmful, and more agreement with statements suggesting vaping is relatively safe. CONCLUSIONS: Parental smoking and vaping behaviours are associated with those of their children. Hence, it is important that both tobacco and vaping control policies and interventions are designed to influence behaviours of all demographics, consistent with the evidence.

Benefits and harms of prostate specific antigen testing according to Australian guidelines.

Guidelines for prostate specific antigen (PSA) testing in Australia recommend that men at average risk of prostate cancer who have been informed of the benefits and harms, and who decide to undergo regular testing, should be offered testing every 2 years from 50 to 69 years. This study aimed to estimate the benefits and harms of regular testing in this context. We constructed Policy1-Prostate, a discrete event microsimulation platform of the natural history of prostate cancer and prostate cancer survival, and PSA testing patterns and subsequent management in Australia. The model was calibrated to pre-PSA (before 1985) prostate cancer incidence and mortality and validated against incidence and mortality trends from 1985 to 2011 and international trials. The model predictions were concordant with trials and Australian observed incidence and mortality data from 1985 to 2011. Out of 1000 men who choose to test according to the guidelines, 36 [21-41] men will die from prostate cancer and 126 [119-133] men will be diagnosed with prostate cancer, compared with 50 [47-54] and 94 [90-98] men who do not test, respectively. During the 20 years of active PSA testing, 32.3% [25.6%-38.8%] of all PSA-test detected cancers are overdiagnosed cases that is, 30 [21-42] out of 94 [83-107] PSA-test detected cancers. Australian men choosing to test with PSA every two years from 50 to 69 will reduce their risk of ever dying from prostate cancer and incur a risk of overdiagnosis: for every man who avoids dying from prostate cancer, two will be overdiagnosed with prostate cancer between 50 and 69 years of age. Australian men, with health professionals, can use these results to inform decision-making about PSA testing.

Pain and its interference with daily living in relation to cancer: a comparative population-based study of 16,053 cancer survivors and 106,345 people without cancer.

BACKGROUND: Pain is a common, debilitating, and feared symptom, including among cancer survivors. However, large-scale population-based evidence on pain and its impact in cancer survivors is limited. We quantified the prevalence of pain in community-dwelling people with and without cancer, and its relation to physical functioning, psychological distress, and quality of life (QoL). METHODS: Questionnaire data from participants in the 45 and Up Study (Wave 2, n = 122,398, 2012-2015, mean age = 60.8 years), an Australian population-based cohort study, were linked to cancer registration data to ascertain prior cancer diagnoses. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for bodily pain and pain sufficient to interfere with daily activities (high-impact pain) in people with versus without cancer, for 13 cancer types, overall and according to clinical, personal, and health characteristics. The relation of high-impact pain to physical and mental health outcomes was quantified in people with and without cancer. RESULTS: Overall, 34.9% (5,436/15,570) of cancer survivors and 31.3% (32,471/103,604) of participants without cancer reported bodily pain (PR = 1.07 [95% CI = 1.05-1.10]), and 15.9% (2,468/15,550) versus 13.1% (13,573/103,623), respectively, reported high-impact pain (PR = 1.13 [1.09-1.18]). Pain was greater with more recent cancer diagnosis, more advanced disease, and recent cancer treatment. High-impact pain varied by cancer type; compared to cancer-free participants, PRs were: 2.23 (1.71-2.90) for multiple myeloma; 1.87 (1.53-2.29) for lung cancer; 1.06 (0.98-1.16) for breast cancer; 1.05 (0.94-1.17) for colorectal cancer; 1.04 (0.96-1.13) for prostate cancer; and 1.02 (0.92-1.12) for melanoma. Regardless of cancer diagnosis, high-impact pain was strongly related to impaired physical functioning, psychological distress, and reduced QoL. CONCLUSIONS: Pain is common, interfering with daily life in around one-in-eight older community-dwelling participants. Pain was elevated overall in cancer survivors, particularly for certain cancer types, around diagnosis and treatment, and with advanced disease. However, pain was comparable to population levels for many common cancers, including breast, prostate and colorectal cancer, and melanoma.

Plant traits poorly predict winner and loser shrub species in a warming tundra biome.

Climate change is leading to species redistributions. In the tundra biome, shrubs are generally expanding, but not all tundra shrub species will benefit from warming. Winner and loser species, and the characteristics that may determine success or failure, have not yet been fully identified. Here, we investigate whether past abundance changes, current range sizes and projected range shifts derived from species distribution models are related to plant trait values and intraspecific trait variation. We combined 17,921 trait records with observed past and modelled future distributions from 62 tundra shrub species across three continents. We found that species with greater variation in seed mass and specific leaf area had larger projected range shifts, and projected winner species had greater seed mass values. However, trait values and variation were not consistently related to current and projected ranges, nor to past abundance change. Overall, our findings indicate that abundance change and range shifts will not lead to directional modifications in shrub trait composition, since winner and loser species share relatively similar trait spaces.

Fifty-year forecasts of daily smoking prevalence: can Australia reach 5% by 2030?

OBJECTIVE: To compare 50-year forecasts of Australian tobacco smoking rates in relation to trends in smoking initiation and cessation and in relation to a national target of ≤5% adult daily prevalence by 2030. METHODS: A compartmental model of Australian population daily smoking, calibrated to the observed smoking status of 229 523 participants aged 20-99 years in 26 surveys (1962-2016) by age, sex and birth year (1910-1996), estimated smoking prevalence to 2066 using Australian Bureau of Statistics 50-year population predictions. Prevalence forecasts were compared across scenarios in which smoking initiation and cessation trends from 2017 were continued, kept constant or reversed. RESULTS: At the end of the observation period in 2016, model-estimated daily smoking prevalence was 13.7% (90% equal-tailed interval (EI) 13.4%-14.0%). When smoking initiation and cessation rates were held constant, daily smoking prevalence reached 5.2% (90% EI 4.9%-5.5%) after 50 years, in 2066. When initiation and cessation rates continued their trajectory downwards and upwards, respectively, daily smoking prevalence reached 5% by 2039 (90% EI 2037-2041). The greatest progress towards the 5% goal came from eliminating initiation among younger cohorts, with the target met by 2037 (90% EI 2036-2038) in the most optimistic scenario. Conversely, if initiation and cessation rates reversed to 2007 levels, estimated prevalence was 9.1% (90% EI 8.8%-9.4%) in 2066. CONCLUSION: A 5% adult daily smoking prevalence target cannot be achieved by the year 2030 based on current trends. Urgent investment in concerted strategies that prevent smoking initiation and facilitate cessation is necessary to achieve 5% prevalence by 2030.

A modelled evaluation of the impact of COVID-19 on breast, bowel, and cervical cancer screening programmes in Australia.

Australia introduced COVID-19 infection prevention and control measures in early 2020. To help prepare health services, the Australian Government Department of Health commissioned a modelled evaluation of the impact of disruptions to population breast, bowel, and cervical cancer screening programmes on cancer outcomes and cancer services. We used the Policy1 modelling platforms to predict outcomes for potential disruptions to cancer screening participation, covering periods of 3, 6, 9, and 12 mo. We estimated missed screens, clinical outcomes (cancer incidence, tumour staging), and various diagnostic service impacts. We found that a 12-mo screening disruption would reduce breast cancer diagnoses (9.3% population-level reduction over 2020-2021) and colorectal cancer (up to 12.1% reduction over 2020-21), and increase cervical cancer diagnoses (up to 3.6% over 2020-2022), with upstaging expected for these cancer types (2, 1.4, and 6.8% for breast, cervical, and colorectal cancers, respectively). Findings for 6-12-mo disruption scenarios illustrate that maintaining screening participation is critical to preventing an increase in the burden of cancer at a population level. We provide programme-specific insights into which outcomes are expected to change, when changes are likely to become apparent, and likely downstream impacts. This evaluation provided evidence to guide decision-making for screening programmes and emphasises the ongoing benefits of maintaining screening in the face of potential future disruptions.

The 'hot zone policy' for colorectal cancer screening presents unique risks and opportunities for rural Australia.

OBJECTIVE: Colorectal cancer has geographic inequities in Australia, with higher mortality rates and lower participation in the National Bowel Cancer Screening Program (NBCSP) in remote and rural areas. The at-home kit is temperature-sensitive, necessitating a 'hot zone policy' (HZP); kits are not sent when an area's average monthly temperature is above 30°C. Australians in HZP areas are susceptible to potential screening disruptions but may benefit from well-timed interventions to improve participation. This study describes the demographics of HZP areas and estimates the impacts of potential screening changes. METHODS: The number of individuals in HZP areas was estimated, as well as correlations with remoteness, socio-economic and Indigenous status. The potential impacts of screening changes were estimated. RESULTS: Over a million eligible Australians live in HZP areas, which are more likely to be remote/rural, have lower socio-economic status and higher Indigenous populations. Predictive modelling estimates that any 3-month screening disruption would increase CRC mortality rates up to 4.1 times more in HZP areas vs unaffected areas, while targeted intervention could decrease mortality rates 3.4 times more in HZP areas. CONCLUSION: People living in affected areas would be negatively impacted by any NBCSP disruption, compounding existing inequities. However, well-timed health promotion could have a stronger impact.

Improving colonoscopy prioritisation and promoting the National Bowel Cancer Screening Program: keys to reducing bowel cancer burden.

Australia's National Bowel Cancer Screening Program (NBCSP) has the potential to prevent almost 84 000 bowel cancer deaths if 60% program participation rates could be reached and maintained over the next two decades. Immunochemical faecal occult blood test (iFOBT) is used as an initial screening tool. Participants who test positive are referred for colonoscopy for diagnostic assessment. Concerns about colonoscopy capacity and lengthy wait times between positive iFOBT and colonoscopy have hampered efforts to promote the program. However, a separate research paper published in this issue of PHRP shows that only an estimated 10-14% of Medicare-funded colonoscopies (almost 75% of all colonoscopies) in Australia are generated by the NBCSP. Inappropriate use of colonoscopy as a primary screening tool and failure to prioritise NBCSP participants may be the main reasons for long colonoscopy wait times associated with the program. Promoting clinical practice guidelines, and the Direct Access Colonoscopy initiative for priority patients, are key to reducing colonoscopy wait times and proactive promotion of the NBCSP.

Cryptogam plant community stability: Warming weakens influences of species richness but enhances effects of evenness.

Community stability is a fundamental factor sustaining ecosystem functioning and is affected by species richness and species evenness. The Arctic is warming more rapidly than other biomes, and cryptogam plant species (specifically lichens and bryophytes in this study) are major contributors to tundra biodiversity and productivity. However, to our knowledge, the impacts of warming on cryptogam community stability and the underlying mechanisms have not been investigated. We conducted a 13-year summer warming experiment in mesic birch hummock tundra vegetation near Daring Lake in the continental interior of low Arctic Canada and recorded patterns of cryptogam species abundance in several different growing seasons. Warming decreased the stability of total community abundance, had no effects on species richness, but increased species evenness and species synchrony. Structural equation model analyses indicated that higher species richness was the principal factor associated with the stronger community abundance stability in the control plots and that this effect was driven primarily by a negative correlation with species synchrony. By contrast, higher species evenness was the principal factor associated with the weakened community abundance stability in the warming plots, and this effect was driven primarily by a positive correlation with species synchrony. Our study suggests that climate warming could reduce cryptogam plant community stability in low Arctic tundra and, therefore, decrease important ecosystem services, including carbon storage and food availability to caribou in northern regions.

Colonoscopies in Australia - how much does the National Bowel Cancer Screening Program contribute to colonoscopy use?

Objectives and importance of study: Colorectal cancer (CRC) is Australia's fourth most commonly diagnosed cancer. CRC screening is an effective intervention to reduce this burden. The National Bowel Cancer Screening Program (NBCSP) provides 2-yearly immunochemical faecal occult blood tests (iFOBTs) to Australians aged 50-74 years; a diagnostic colonoscopy is conducted after a positive iFOBT. Clinical guidelines inform colonoscopy usage, and appropriate use of these guidelines is vital to investigate gastrointestinal symptoms, detect bowel abnormalities and CRC, and remove precancerous polyps. Colonoscopy services are under strain, with limited formal strategies to prioritise patients. There are concerns among practitioners and patient advocates that the NBCSP generates additional colonoscopy requests and increases wait times, worsening patient outcomes and prolonging distress. In this research study, we estimate and project colonoscopy use in Australia from 2001 to 2030 and determine the impact of the NBCSP by examining model-estimated NBCSP colonoscopy demand. METHODS: Colonoscopy use in Australia was compiled using Medicare Benefits Schedule (MBS) claims for colonoscopies from 2001 to 2019. From these data, projections were made from 2020 to 2030. Policy1-Bowel, a microsimulation model, was used to estimate NBCSP-related colonoscopy demand from screening follow-up and colonoscopic surveillance from 2006 to 2030. RESULTS: MBS-funded colonoscopy use increased from 284 676 in 2001 to 663 213 in 2019. Annual use is projected to be more than 780 000 by 2030. Of these, 10-14% are projected to be generated by the NBCSP. Per-capita MBS-funded colonoscopy utilisation increased 0.2% annually over 2015-2019, a slowing of growth compared to previous trends. CONCLUSION: The NBCSP accounts for a modest fraction of colonoscopy use in Australia, and a better understanding of colonoscopy use not associated with the NBCSP is needed. Promoting adherence to guideline-recommended iFOBT and colonoscopy use could ease pressure on services and improve outcomes.

Capacity of the 45 and Up Study to mobilise evidence-based improvements in cancer control: lung cancer case study.

OBJECTIVE: Over the 15 years since the 45 and Up Study (the Study) was established, researchers have harnessed its capacity for enabling rigorous, comprehensive investigation of cancer causes, care, and outcomes. For the first time in Australia, the entire cancer-control continuum could be investigated by linking questionnaire data with cancer registry notifications, hospital records, outpatient medical services and prescription medications at scale. Here, we use lung cancer as a case study to demonstrate the Study's potential to improve cancer control. METHOD: Narrative description. RESULTS: Between 2006-2013, approximately 1200 participants in the Study cohort who had no prior history of cancer were diagnosed with lung cancer, allowing the generation of novel, policy- and practice-relevant evidence for tobacco control, screening, and systems of care. The Study produced evidence on the continuing impact of smoking, including that 'light smoking' (1-5 cigarettes/day) is associated with nine times the risk of lung cancer compared to never-smoking; and that 54% of lung cancers could be avoided long-term if all Australians who smoked were to quit. The Study was used to validate a lung cancer screening risk prediction tool, correctly identifying 70% of the participants with a history of smoking who developed lung cancer within a 6-year period as 'high-risk'. Potential inequities in lung cancer care were identified using the Study cohort, including suboptimal levels of radiotherapy utilisation, below benchmark levels of systemic therapy for patients with metastatic disease, and high numbers of emergency department presentations prior to diagnosis. Participants with lung cancer reported poorer quality of life than those with almost any other cancer type, and about 50% reported severe physical functioning limitations. The Study also provided the infrastructure for the first comprehensive report on lung cancer health system costs. LESSONS LEARNT: As a statewide, population-based cohort, the Study provides reliable estimates of cancer risk, health services utilisation, and person-centred outcomes that can inform policy and practice decision making; and has provided the backbone for localising policy-relevant insights from international experience. We have found that the direct involvement of clinicians and policy makers in research design, and engagement with community networks, can yield tractable, policy-relevant, and ultimately impactful scientific insights.

An ecological study of obesity-related cancer incidence trends in Australia from 1983 to 2017.

Background: Overweight and obesity is a growing public health issue as it contributes to the future burden of obesity-related diseases, including cancer, especially in high-income countries. In Australia, 4.3% of all cancers diagnosed in 2013 were attributable to overweight and obesity. Our aim was to examine Australian age-specific incidence trends over the last 35 years for obesity-related cancers based on expert review (colorectal, liver, gallbladder, pancreas, breast in postmenopausal women, uterine, ovary, kidney, thyroid, and multiple myeloma) individually and pooled. Methods: Australian incidence data for 10 obesity-related cancers among people aged 25-84 years, diagnosed from 1983 to 2017, were obtained from the Australian Cancer Database. We used age-period-cohort modelling and joinpoint analysis to assess trends, estimating incidence rate ratios (IRR) by birth-cohort for each individual cancer and pooled, and the annual percentage change. The analyses were also conducted for non-obesity-related cancers over the same period. Findings: The total number of cancers where some proportion is obesity-related, diagnosed from 1983-2017, was 1,005,933. This grouping was 34.7% of cancers diagnosed. The IRR of obesity-related cancers increased from 0.77 (95% CI 0.73, 0.81) for the 1903 birth-cohort to 2.95 (95% CI 2.58, 3.38) for the recent 1988 cohort relative to the 1943 cohort. The IRRs of non-obesity related cancers were stable with non-significant decreases in younger cohorts. These trends were broadly similar across sex and age groups. Interpretation: The incidence of obesity-related cancers in Australia has increased by birth-cohort across all age-groups, which should be monitored. Obesity, a public health epidemic, needs to be addressed through increased awareness, policy support and evidence-based interventions. Funding: This research received no specific funding.

Vaping product access and use among 14-17-year-olds in New South Wales: a cross-sectional study.

OBJECTIVES: We assessed access to vaping products and types of products used and the factors associated with vaping and smoking among young people in the state of New South Wales (NSW), Australia. METHODS: A cross-sectional survey was conducted with a sample of 721 young people aged 14 to 17 years from NSW recruited through online panels. Poisson regression with robust variance was used to estimate relative risks of ever-vaping and ever-smoking. RESULTS: Almost one-third of the sample (32%, n=233) reported being an ever-vaper, of which more than half (54%) had never smoked prior to starting vaping. Ever-vaping was independently associated with age and being Aboriginal or Torres Strait Islander, and ever-smoking was independently associated with being male. Ever-smokers were seven times more likely to be ever-vapers than those who had never smoked, and ever-vapers were 18 times more likely to be ever-smokers than those who had never vaped. Among ever-vapers who reported which type of device they were using, 86% reported the use of disposable products. "Flavourings and taste" was rated as the most important characteristic of vapes. More than half of ever-vapers reported getting the last vape they used from their friends (55%, n=130). More than half of ever-vapers had used a vape that they knew contained nicotine (53%, n=123). CONCLUSIONS: Vaping was the strongest risk factor for smoking, and vice versa, suggesting there is not a straightforward, unidirectional relationship between vaping and smoking in young people. Young people appear to be readily accessing nicotine vaping products, which are often disposable and flavoured, through both social and commercial channels. IMPLICATIONS FOR PUBLIC HEALTH: Stronger enforcement of federal and state policies designed to protect young people from vaping products is urgently needed.

Whole genome sequencing of mesorhizobia isolated from northern Canada.

Rhizobia are soil-dwelling bacteria that can form N2-fixing symbioses with legume plant species (Fabaceae). These bacteria are globally distributed; however, few studies have examined the genomics of rhizobia that live in cold environments. Here, we isolated and characterized three rhizobial strains from legume nodules collected at a pair of distant low Arctic tundra and boreal forest sites in northern Canada. Phylogenetic and average nucleotide identity measurements suggested that the three strains are members of the genus Mesorhizobium, and that each strain represents a novel genospecies. Intriguingly, whereas most mesorhizobia contain the classical determinants of nodulation and nitrogen fixation on their chromosome, whole genome sequencing revealed that all three strains carry these genes on large symbiotic megaplasmids of ∼750 to ∼1000 kb. Phylogenetic and sequence analyses of the common nodulation genes revealed highly conserved alleles amongst these northern mesorhizobia, leading us to propose that they belong to a novel symbiovar that we termed symbiovar oxytropis. Interestingly, these nod gene alleles are uncommon in mesorhizobia isolated from similar plant hosts in other climatic regions, suggesting potential functional adaptive differences.

Cancer incidence and mortality in Australia from 2020 to 2044 and an exploratory analysis of the potential effect of treatment delays during the COVID-19 pandemic: a statistical modelling study.

BACKGROUND: Long-term projections of cancer incidence and mortality estimate the future burden of cancer in a population, and can be of great use in informing the planning of health services and the management of resources. We aimed to estimate incidence and mortality rates and numbers of new cases and deaths up until 2044 for all cancers combined and for 21 individual cancer types in Australia. We also illustrate the potential effect of treatment delays due to the COVID-19 pandemic on future colorectal cancer mortality rates. METHODS: In this statistical modelling study, cancer incidence and mortality rates in Australia from 2020 to 2044 were projected based on data up to 2017 and 2019, respectively. Cigarette smoking exposure (1945-2019), participation rates in the breast cancer screening programme (1996-2019), and prostate-specific antigen testing rates (1994-2020) were included where relevant. The baseline projection model using an age-period-cohort model or generalised linear model for each cancer type was selected based on model fit statistics and validation with pre-COVID-19 observed data. To assess the impact of treatment delays during the COVID-19 pandemic on colorectal cancer mortality, we obtained data on incidence, survival, prevalence, and cancer treatment for colorectal cancer from different authorities. The relative risks of death due to system-caused treatment delays were derived from a published systematic review. Numbers of excess colorectal cancer deaths were estimated using the relative risk of death per week of treatment delay and different durations of delay under a number of hypothetical scenarios. FINDINGS: Projections indicate that in the absence of the COVID-19 pandemic effects, the age-standardised incidence rate for all cancers combined for males would decline over 2020-44, and for females the incidence rate would be relatively stable in Australia. The mortality rates for all cancers combined for both males and females are expected to continuously decline during 2020-44. The total number of new cases are projected to increase by 47·4% (95% uncertainty interval [UI] 35·2-61·3) for males, from 380 306 in 2015-19 to 560 744 (95% UI 514 244-613 356) in 2040-44, and by 54·4% (95% UI 40·2-70·5) for females, from 313 263 in 2015-19 to 483 527 (95% UI 439 069-534 090) in 2040-44. The number of cancer deaths are projected to increase by 36·4% (95% UI 15·3-63·9) for males, from 132 440 in 2015-19 to 180 663 (95% UI 152 719-217 126) in 2040-44, and by 36·6% (95% UI 15·8-64·1) for females, from 102 103 in 2015-19 to 139 482 (95% UI 118 186-167 527) in 2040-44, due to population ageing and growth. The example COVID-19 pandemic scenario of a 6-month health-care system disruption with 16-week treatment delays for colorectal cancer patients could result in 460 (95% UI 338-595) additional deaths and 437 (95% UI 314-570) deaths occurring earlier than expected in 2020-44. INTERPRETATION: These projections can inform health service planning for cancer care and treatment in Australia. Despite the continuous decline in cancer mortality rates, and the decline or plateau in incidence rates, our projections suggest an overall 51% increase in the number of new cancer cases and a 36% increase in the number of cancer deaths over the 25-year projection period. This means that continued efforts to increase screening uptake and to control risk factors, including smoking exposure, obesity, physical inactivity, alcohol use, and infections, must remain public health priorities. FUNDING: Partly funded by Cancer Council Australia.

Projections of smoking-related cancer mortality in Australia to 2044.

BACKGROUND: While many high-income countries including Australia have successfully implemented a range of tobacco control policies, smoking remains the leading preventable cause of cancer death in Australia. We have projected Australian mortality rates for cancer types, which have been shown to have an established relationship with cigarette smoking and estimated numbers of cancer deaths attributable to smoking to 2044. METHODS: Cancer types were grouped according to the proportion of cases currently caused by smoking: 8%-30% and >30%. For each group, an age-period- cohort model or generalised linear model with cigarette smoking exposure as a covariate was selected based on the model fit statistics and validation using observed data. The smoking-attributable fraction (SAF) was calculated for each smoking-related cancer using Australian smoking prevalence data and published relative risks. RESULTS: Despite the decreasing mortality rates projected for the period 2015-2019 to 2040-2044 for both men and women, the overall number of smoking-related cancer deaths is estimated to increase by 28.7% for men and 35.8% for women: from 138 707 (77 839 men and 60 868 women) in 2015-2019 to 182 819 (100 153 men and 82 666 women) in 2040-2044. Over the period 2020-2044, there will be 254 583 cancer deaths (173 943 men and 80 640 women) directly attributable to smoking, with lung, larynx, oesophagus and oral (comprising lip, oral cavity and pharynx) cancers having the largest SAFs. INTERPRETATION: Cigarette smoking will cause over 250 000 cancer deaths in Australia from 2020 to 2044. Continued efforts in tobacco control remain a public health priority, even in countries where smoking prevalence has substantially declined.