Culture dose for kids: Impact of arts engagement on 9- 12 year-olds with anxiety

There is growing momentum to understand the value of the arts in mental health and wellbeing. Engagement with the arts can promote wellbeing by helping to build resilience, aid recovery and foster social connections. Aim(s): To co-develop, implement and evaluate the impact of Culture Dose for Kids (CDK), an arts engagement program, on young people's anxiety. Method(s): Mixed methods [surveys and interviews] were used to research an 8-week series of face-to-face arts engagement sessions conducted at the Art Gallery of New South Wales with anxious youth (9-12 years) and their parents/carers. Result(s): Findings indicate that the children's anxiety scores decreased over the eight-week program. Sustained high attendance rates throughout were another marker of its effectiveness and engagement, although a COVID outbreak affected several sessions. Qualitative data, from parent and children's interviews, offered greater insight and meaning into CDK's impact on the child and family. Not only did parents find CDK calming and stress-relieving for themselves ('a little gift of time'), but they said that they are using some strategies and topics from the sessions to connect more closely with their child and their child's issues. By engaging both parent and child in this inclusive, non-stigmatizing arts-based mental health intervention, a more holistic, family-centred, community approach to supporting wellbeing occurred. Conclusion(s): This study responds to the recent call to move beyond the formal mental health system to facilitate community-led initiatives and infrastructure to strengthen young people's overall mental health and well-being and their social connections and involvement with their community.

FEASIBILITY of LINKING UNIVERSAL WELL-CHILD HEALTHCARE and FINANCIAL COUNSELLING: FINDINGS from the AUSTRALIAN HEALTHIER WEALTHIER FAMILIES (HWF) PILOT RANDOMISED CONTROLLED TRIAL

Background: We pilot-tested the feasibility and short-term impacts of "Healthier Wealthier Families" (HWF), which seeks to reduce financial hardship by developing a referral pathway between universal child and family health (CFH) services and financial counselling. Method(s): Setting: CFH services in five sites (Victoria, New South Wales), coinciding with the COVID-19 pandemic. Participant(s): Caregivers of children aged 0-5 years. Eligible clients disclosed financial hardship using a study-designed screening tool. Design(s): Pilot randomised controlled trial (RCT). With mixed progress in Sites 1-3, we conducted an implementation evaluation and adapted the protocol to a simplified RCT (Site 4) and direct referral with pre-post evaluation (Site 5). Intervention(s): Financial counselling. The comparator was usual care. Measures: Feasibility was assessed via proportions of clients screened, enrolled, followed-up, and who accessed financial counselling. Impacts (quantitative surveys, qualitative interviews) included finances to 6 months post-enrolment. Result(s): 72%-100% of clients across sites answered the financial screen. In RCT sites (1-4), less than one-quarter enrolled. In Site 5, n = 44/64 (64%) clients were eligible and engaged with financial counselling. Common challenges facing these clients were utility debts (73%), obtaining government entitlements (43%) and material aid/emergency relief (27%). On average, their household income increased $250 per fortnight ($6504 annually), and families received average single payments of $784. Caregivers identified benefits including reduced stress, practical help, increased knowledge and empowerment. Conclusion(s): Financial hardship screening via CFH, and direct referral, were acceptable to caregivers. Individual randomisation was infeasible. Matching between populations and CFH practice is necessary to incorporate a HWF model of care.

IMPLEMENTATION INSIGHTS from SITE CHAMPIONS and STATE LEADS POST-ROLLOUT of the SAFER BABY BUNDLE

Background: National rollout of the Safer Baby Bundle (SBB) is recommended by the National Stillbirth Action and Implementation Plan for improving the standard of antenatal care at scale to reduce stillbirth. Progressive implementation over 2.5 years, commenced from mid-2019. This qualitative study aims to understand the process enablers and barriers influencing the effectiveness of SBB implementation. Method(s): Semi-structured interviews with SBB site leads/champions (17 maternity services) and state program leads across Queensland (QLD), Victoria (VIC) and New South Wales (NSW) were conducted post-implementation of SBB to explore local, regional, and state implementation strategies, processes and experiences. Normalization Process Theory was used as an analytic framework for thematic analysis to understand different approaches and contexts for SBB implementation. Result(s): 17 site leads (6 VIC, 5 NSW, 6 QLD) and 6 state program leads were interviewed from Sept to mid-Nov 2022. Findings indicate strong local leadership, shared regional and state-based learning opportunities, consistency of information and endorsement by clinical networks were key implementation supports. Barriers included limitations and inconsistencies across data and information systems, and constraints with protected time for training and improvement activities. High turnover and re-deployment of leads due to external factors (e.g., COVID, extreme weather events) disrupted timelines, impacting commitment and engagement with the initiative. Conclusion(s): Despite differences in resources, approaches, and timelines between sites and states for SBB implementation, similar key barriers and enablers were identified. An in-depth understanding of the factors underpinning successful implementation of the SBB will guide future activities to support sustainable change.

A simple framework for calibrating hydraulic flood inundation models using crowd-sourced water levels

Floods are the most commonly occurring natural disaster, with the Centre for Research on the Epidemiology of Disasters 2021 report on "The Non-COVID Year in Disasters" estimating economic losses worth over USD 51 million and more than 6000 fatalities in 2020. The hydrodynamic models which are used for flood forecasting need to be evaluated and constrained using observations of water depth and extent. While remotely sensed estimates of these variables have already facilitated model evaluation, citizen sensing is emerging as a popular technique to complement real-time flood observations. However, its value for hydraulic model evaluation has not yet been demonstrated. This paper tests the use of crowd-sourced flood observations to quantitatively assess model performance for the first time. The observation set used for performance assessment consists of 32 distributed high water marks and wrack marks provided by the Clarence Valley Council for the 2013 flood event, whose timings of acquisition were unknown. Assuming that these provide information on the peak flow, maximum simulated water levels were compared at observation locations, to calibrate the channel roughness for the hydraulic model LISFLOOD-FP. For each realization of the model, absolute and relative simulation errors were quantified through the root mean squared error (RMSE) and the mean percentage difference (MPD), respectively. Similar information was extracted from 11 hydrometric gauges along the Clarence River and used to constrain the roughness parameter. The calibrated parameter values were identical for both data types and a mean RMSE value of ~50 cm for peak flow simulation was obtained across all gauges. Results indicate that integrating uncertain flood observations from crowd-sourcing can indeed generate a useful dataset for hydraulic model calibration in ungauged catchments, despite the lack of associated timing information.

Implementation of a successful statewide fit testing program: Breaking down the challenges and barriers

Background: Since its emergence, millions of people have acquired and died from SARS-CoV-2 infections. A key controversy has been how to protect health workers (HWs) when there is ambiguous evidence on the adequacy of personal protective equipment and fit testing. Operationalizing these requirements was very challenging as fit testing had not been routine practice in New South Wales (NSW) Health. Furthermore, it is impractical to fit test 140,000 HWs in the middle of a pandemic. Method(s): A multidisciplinary Respiratory Protection Program (RPP) board was convened with representatives from work health and safety, workplace relations and clinical teams along with legal and union delegates with the aim of providing strategic advice and guidance on implementation, monitoring, and outcomes of RPP. Result(s): Local implementation was led by Infection Prevention and Control and by experienced nurses and work health and safety experts. The program included the more complex aspects of managing HWs who are unable to pass a fit test due to religious, cultural, or medical conditions. During 2021 NSW Health performed 234,499 fit tests on 84,685 HWs with overall, 98% of HWs (n=83210) achieving a fit test pass, demonstrating the success of the program. Conclusion(s): Fit testing is now well established and continues as new staff enter the workforce, new respirators become available as well as repeat testing for those many frontline HWs who were fit tested early in the pandemic. The RPP board is progressing with an evaluation of the program to determine its impact, effectiveness, and sustainability in coming years.Copyright © 2022

Federated networks in England and Australia cricket: a model of economic dependency and financial insecurity

PurposeThe purpose of this study is to critically examine the financial health and performance of the English and Australian cricket networks. This includes the county cricket clubs (CCC) and state and territory cricket associations (STCA) affiliated to the England and Wales Cricket Board (ECB) and Cricket Australia (CA) respectively, as well as the ECB and CA themselves. The authors apply resource dependency theory to understand if there are any financial dependencies within the networks of cricket in England and Australia.Design/methodology/approachThe data for this research was obtained from the financial statements of the ECB, the 18 affiliated CCCs, CA and the six affiliated STCAs. This sample covers the last 5 years of financial information (2014–2019) for all the organisations at the time of writing. Ratio analysis was conducted on all organisations within the sample to assess financial health and performance.FindingsBoth CCCs and STCAs show signs of poor financial health. There is a clear dependence on the financial support they receive from the ECB and CA respectively and this dependence appears more prominent in Australia. The ECB and CA have better financial health which ultimately allows them to financially support the CCCs and STCAs.Originality/valueThe ECB and CA are facing difficult financial decisions to remain financially secure themselves due to the impact of COVID-19 but also to support their affiliated clubs. The affiliated clubs do not generate sufficient revenues and must diversity their revenue streams if they are to become financially self-sustaining. This financial structure and distribution mechanism will be vital in safeguarding the future of some of England's and Australia's most important cricket organisations.

Initiating advance care planning in New South Wales general practices using a structured conversation guide

There is variation in ACP terminology and legislation of ACDs between different jurisdictions within Australia.4 General practice is the ideal setting for ACP discussions, and evidence supports patient preference for initiation of ACP while they are still healthy in the community.5-7 The Royal Australian College of General Practitioners (RACGP) recommends that general practitioners (GPs) discuss ACP as part of routine care for older patients during the annual 75 years and over health assessment.8 The COVID-19 pandemic highlighted the need for GPs to have these conversations, and there have been calls for ACP to be an integral part of pandemic health planning responses.9 Evaluating the prevalence of ACP conversations is difficult, with most studies focusing on the more tangible assessment of ACD completion. Some barriers to GPs initiating ACP include difficulties in defining the right moment to discuss the topic, a perceived lack of knowledge in the ACP process and concern regarding the potential time-consuming nature of ACP discussions.11'12 Strategies to increase initiation of ACP in general practice have focused on workshops and communication skills training for GPs and general practice nurses (GPNs), which are time and resource intensive.13-15 Some studies have shown that discussion guides and question prompt lists can improve the frequency of ACP discussions with patients, but these have been limited to palliative care settings.16-18 Most doctors believe it is their responsibility to initiate these discussions but struggle with timing.19 More evidence is needed to understand how to help GPs facilitate these conversations in a way that is acceptable and meaningful for older patients and their families. [...]it's the family that's really going to make the decision. [Female GP, FG 1.1] Some GPs preferred to focus on clinical decisions such as cardiopulmonary resuscitation (CPR) as the main subject of the conversation, while others preferred to broaden the discussion to general healthcare goals.

Koala conservation in South East Queensland: A grey literature review analysis

This grey literature review documents koala (Phascolarctos cinereus) conservation initiatives applied across 12 local government areas in South East Queensland, Australia. To overcome threats to koalas' survival, the grey literature indicates that local governments in this region focus on wildlife management solutions, wildlife signage, habitat restoration projects and koala awareness campaigns. Despite these measures, land clearing of koala habitat to cater for urban population growth combined with recent bushfires and floods have contributed to the decline of koalas in this region. Recommendations to enhance progress include greater usage of the grey literature in peer review work and further application of social marketing to encourage residents to uptake behaviors that can mitigate threats to koalas, including slowing down when driving in koala zones, participating in citizen science, and leashing dogs when walking in native bush areas. The need for collaborative efforts aimed at conserving the koala from potential extinction is indicated. This paper provides an approach that can be applied to track progress on coordinated efforts to conserve koalas.

Impact of lockdowns on paediatric asthma hospital presentations over three waves of COVID-19 pandemic

The impact of COVID-19 pandemic on paediatric asthma, the most common chronic condition of childhood, in Australia remains unknown. In a multicentre study, we examined the impact of COVID-19 on paediatric asthma in New South Wales Australia. Method(s): Time series analysis was performed to determine trends in asthma hospital presentations in children aged 2-17 years in pre-pandemic (Jan 2015-Dec 2019) and COVID-19 pandemic years (Jan 2020-August 2021) using emergency department and hospital admission datasets from two large tertiary paediatric hospitals. Result(s): In the pre-pandemic years there were in total 492,863 hospital presentations in children aged 2-17 years, of these 13,160 (2.67%) were due to asthma and in pandemic years there were 163,521 hospital presentations of which 3,364 (2.05%) were due to asthma. We observed a significant decrease in asthma hospital presentations during lockdown periods of COVID-19 pandemic including April (68.85%), May (69.46%) and December (49.00%) of 2020 and August 2021 (66.59%) compared to pre-pandemic predictions. The reduction in asthma hospital presentation in April-May of 2020 and August 2021 was observed across all the age-groups excluding children aged 2-5 years. Conclusion(s): While this decline may be associated with reduced exposure to outdoor environmental factors from restricted movement due to lockdowns, such an approach is not feasible or sustainable in the absence of an infectious disease outbreak. Therefore further research to determine the positive factors associated with this observed pattern will help develop strategies to build a resilient health system.

"Part of My Daily Life": The Importance of Public Libraries as Physical Spaces

The COVID-19 pandemic provided a unique opportunity to gauge how much, and why, people value visiting public libraries by asking them about the impact of the library closures. A questionnaire survey was administered to users of four library networks in New South Wales, Australia. About 19% of 1,295 respondents missed their library "a great deal," another 28% "quite a lot." Most commonly respondents missed browsing the shelves, taking children for visits, studying, reading, and socializing there. They also missed the quiet, relaxing, and friendly environment, and the resources provided. For many, the closures impacted their lives in a critical way. [ FROM AUTHOR] Copyright of Public Library Quarterly is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Update on influenza epidemiology and vaccines

COVID-19 pandemic mitigation measures, including travel restrictions, effectively limited global circulation of influenza viruses for much of 2020 and 2021. Travel bans and quarantine requirements were lifted on 1 November 2021 enabling recirculation of influenza. In Victoria, follow up of early influenza cases detected Dec-Feb revealed a history of travel or contact with a recent traveller. Cases were few during the Omicron epidemic in January-February. However, in late March, there was a sharp increase in cases, which in Victoria was associated with an outbreak in university residential colleges. Genomic sequencing supported a likely point-source outbreak that spread throughout the state and to other jurisdictions. In the Northern Territory and New South Wales circulation of A(H1N1)pdm09 preceded circulation of A(H3N2) and was associated with a high rate of paediatric hospitalisations. Both the A(H1N1)pdm09 and A(H3N2) viruses that circulated were well matched to the vaccine, but the early onset of the epidemic meant that many cases were infected prior to availability of vaccines in April. Nationally, circulation declined sharply in June-July coincident with another COVID-19 wave. Circulation of influenza may continue to be disrupted by SARS-CoV-2 epidemics until it establishes a seasonal pattern, which may impact seasonal influenza preparedness. Copyright © 2021

Implementation of a successful infection prevention and control governance structure and capacity building strategies during COVID-19 pandemic - A brief report.

An analysis of the Clinical Excellence Commissions response to COVID-19 prevention and protection measures identified the need to build on the existing governance process to achieve a more structured and methodical approach. The infection prevention and control measures and strategies implemented within health and nonhealth care, proved to be effective and sustainable with the ability to build additional clinician capacity even during an ongoing pandemic.

Enhancing healthy skin and wound prevention outcomes in the Intensive Care Unit -- changing practice...Wounds Australia Conference, 14-17 September 2022, Sydney, Australia

Objectives: The aim of the study was to explore the impact of a healthy skin and wound prevention programme by measuring nursing staff knowledge and patient wound prevalence in the Intensive Care Unit (ICU) pre and post intervention. A secondary aim was to identify the impact of the education and implementation program on pressure injury (PI), skin tear (ST) and incontinence associated dermatitis (IAD) prevalence and incidence rates in the ICU. Methods: A prospective quality improvement project based on the plan-study-do-act methodology included three phases: 1. Pre-Intervention Data Collection (December 2020) - Wound Prevalence Survey (full body skin inspection) & Staff Knowledge Quiz 2. Intervention Phase -- Staff Education, Evidence Based Protocol Implementation & Evidence based products available in units 3. Post-Intervention Data Collection - Wound Prevalence Survey (full body skin inspection) & Staff Knowledge Quiz Results: Pre-intervention data demonstrated two thirds of ICU patients had one or more wound. ICU Pressure Injury prevalence was 37.5%, IAD prevalence 12.5% and ST prevalence was 4%. ICU PI incidence reporting rate was 11%. Device Related PI rate was 56% of all PIs identified. Staff knowledge about wound prevention averaged 50%. Conclusions: As a result of the Covid-19 surge, post implementation data will be collected in May 2022 and the data will be presented as comparative outcomes.

Clinical outcomes of foot infections in persons with diabetes. Data from the LIV-DFI registry...Wounds Australia Conference, 14-17 September 2022, Sydney, Australia

Background: Foot infections in persons with diabetes is a significant detriment to the patient and accounts for approximately 27,600 hospital admissions every year in Australia. To our knowledge, there is scant data from large datasets reporting on clinical outcomes for foot infections in persons with diabetes (DFIs). Aim: The primary aim is to report the number of DFI episodes and their associated clinical outcomes. Methods: The South West Sydney Limb Preservation and Wound Research Academic unit established a clinical registry in Liverpool Hospital High Risk Foot Service in 2018. All data is entered prospectively into REDCap. Infection presentations to the High-Risk Foot Service are captured and entered in terms of an infection episode, hence one patient may have multiple episodes of infection. Data recorded on REDCap is extensive and includes broad demographic, laboratory and clinical data, in addition to all outcome data. In order to capture the increased activity of COVID-19 we plan to have a cut off period as of June 2022 for full data extraction and analysis. Results: We will report clinical outcomes of interest separately for skin and soft tissue DFI and Osteomyelitis, and stratify infections based on the PEDIS infection grade and severity. Outcome data will include the number of DFI episodes and their outcome;infection resolution, infection failure, % of episodes medically managed, the % of episodes requiring surgery [minor or major amputation, resection, and debridement], duration and type of antibiotic therapy, death. Conclusion: The full data set will be available by the conference presentation and currently includes >400 infection episodes and outcomes. To the best to our knowledge there is no single prospective database as large from > 4 years of collection, reporting on infection outcomes for those with diabetes and foot disease.

Pandemic within a pandemic: foot infection in persons with diabetes related foot ulcers and COVID-19...Wounds Australia Conference, 14-17 September 2022, Sydney, Australia

Background: SARS-COV-2 (COVID-19) pandemic was accompanied by public health orders placing restrictions on healthcare and social systems. Most out-patient based services and GP practices closed face-to-face appointments and transitioned to telehealth. Liverpool High Risk Foot Service (LHRFS) remained functionally open but utilised the Australian clinical triage guide for people with diabetes-related foot disease during COVID-19. Only patient's considered 'highly serious' or 'critical' (i.e. infections' or limb threatening condition) were seen face-to-face. Over this period we anecdotally recognised a significant increase in presentations for Diabetes foot Infections (DFIs). Methods: The South West Sydney Limb Preservation and Wound Research Academic unit established a clinical registry in 2018. All data is prospectively entered into REDCap including demographic, laboratory, outcome and clinical data. Infection presentations to the HRFS recorded in terms of an infection episode, hence one patient may have multiple events of infection. In order to capture the increased activity of COVID-19 we plan to collect from 2020 through June 2022. Pre-COVID data will be from 2018 to early 2020. Results: We will report the number of DFI events by month and year for 2018-2022 and analyse trends of COVID restrictions to determine if this affected the number and severity of DFI events. Conclusion: COVID-19 public health orders limited access to care. We will conclude if this affected people with foot ulcers accessing timely care and if this caused an increase in the number of infections.

Reshaping wound care: Evaluation of an artificial intelligence app amid the COVID-19 pandemic...Wounds Australia Conference, 14-17 September 2022, Sydney, Australia

Objectives: To evaluate the usability and effectiveness of a digital application for wound care from a clinician-and-patient user perspective. Methods: A quasi-experimental design was conducted in four settings in an Australian health service from July to December 2019 to October 2020. Owing to the coronavirus disease pandemic, the study paused in March 2020 but then restarted immediately after 3 weeks. Data were collected from patients in the standard group (n = 166, 243 wounds), and intervention group (n = 124, 184 wounds). Clinicians participated in a survey (n = 10) and focus group interviews (n = 13) and patients were interviewed (n = 4). Wound documentation data were analysed descriptively. Interviews were thematically analysed. Results: Positive evaluations identified improvements such as instantaneous objective wound assessment, shared wound plans, increased patient adherence and enhanced efficiency in providing virtual care. Compared to the standard group, wound documentation in the intervention group improved significantly (more than two items documented 24% versus 70%, p < .001). During the intervention, 101 out of 132 wounds improved (mean wound size reduction = 53.99 %). The travel-related fuel cost saved for a patient living in a rural area was on average $72.90. Conclusions: The digital application provided real-time wound data with an interface for communication between the patient and clinician and clinicians in a hospital, community, and outpatient setting in a variety of settings. The use of the application facilitated remote patient monitoring, and reduced patient travel time, while maintaining optimal wound care.

Protecting mental health in quarantine: Exploring lived experiences of healthcare in mandatory COVID-19 quarantine, New South Wales, Australia.

Objectives: In response to the COVID-19 pandemic, Australia implemented mandatory hotel quarantine for returned international travellers from March 2020-November 2021. Healthcare was rapidly transformed and scaled up to facilitate delivery of face-to-face and virtual healthcare within quarantine facilities. We sought to understand, from the patient perspective, what a virtual model of healthcare may need to be aware of to respond to, protect, and mitigate people's mental health within a 'public health protection' context of quarantine. Design: Qualitative study design using in-depth semi-structured interviews exploring experiences of the virtual model of healthcare in quarantine. Setting: Special Health Accommodation (SHA) quarantine facilities following Australian Federal and New South Wales (NSW) State quarantine policy, NSW, Australia. Participants: 25 returned international travellers aged 18 years or older of any COVID-19 status who quarantined within SHA between October 2020-March 2021. Results: Participants identified three broad areas of concern. Firstly, their potential to transmit COVID-19, that created anxiety for all participants. Secondly, the effects of losing personal freedoms in quarantine to protect the wider Australian community. Thirdly, many participants entered quarantine during intense biographical moments in their lives, compounding the stress of their experience. Participants felt lost within the 'faceless' quarantine administrative system they navigated prior to their actual arrival in Australia and during their mandated quarantine period. This cumulative experience compromised their expectations and experiences of person-centred care once in quarantine. Conclusions: Quarantine has been a critical public health measure for managing COVID-19 in Australia. The pandemic provides opportunities to learn from quarantine implementation. Participants struggled to separate healthcare provision from the broader quarantine systems and processes. Due to this confusion, blame was directed at healthcare providers for many, and in some cases all difficulties, including those encountered getting into and once within quarantine. Valuable lessons can be learnt from engaging with patients' perspectives to adapt and strengthen future quarantine to deliver responsive, person-centred healthcare.

Moving forward with the lessons learned during COVID-19 pandemic - an Australian multi-institutional Radiation Oncology Survey

Purpose: The COVID-19 pandemic has impacted the health industry including cancer care in unprecedented ways, leading to rapid adoption of strategies in radiation oncology departments to ensure safe delivery of treatments without compromising the quality of care (1,2). We aimed to evaluate the impact of the COVID-19 strategies on patients and staff across Queensland, New South Wales, and Victoria. Methods and Materials: A multidisciplinary team from Princess Alexandra Hospital developed a survey to address the impact of the pandemic strategies related to key areas including patient care, quality assurance (QA), staff education, research. Additionally, the survey examined the influence of flexible working arrangements on patient care and staff wellbeing. Result(s): 210 responses from seven institutions collected between November 2020 to April 2021, were analysed. Virtual solutions were adopted (79%, 165/201) for QA activities. Due to disruption in education programmes, respondents (38% 79/210) reported negative impact on junior staff. All institutions recommenced trials/research activities during the survey period. Strong support for ongoing incorporation of virtual platforms for QA (50.8%, 60/118), research (67.4%, 58/86) and education (81.4%, 171/210) purposes. Despite existing stress and burnout support (38.6% 81/210), burnout was captured in 44.8% (94/210) of the respondents. Continued flexible work through remote access was preferred by 86% (131/153). Interestingly, 38% (15/39) of the radiation oncologists reported improved work-life balance during the pandemic following the introduction of remote working (73%, 11/15). Conclusion(s): Despite the pandemic challenges, radiation oncology departments continued to deliver quality patient care. Our study confirms an ongoing challenge within the community related to burnout but also a suggests a potential solution with improved productivity and work-life balance with the introduction of remote working and virtual platforms.

Heterogeneity of the COVID-19 epidemic: what can we learn from it?

Objectives: The goal of this article is to evaluate and explain the heterogeneity of the Coronavirus disease 2019 (COVID-19) epidemic in Australia, to offer advice for stopping the current outbreak and preparing for a suitable response to epidemics in the future. Method(s): We conducted a review to analyze the epidemic and explain its variable manifestation across states in Australia. Most COVID-19 cases and deaths were in the states of Victoria and New South Wales due to differences in the governance of the epidemic and public health responses (quarantine and contact tracing) among states. Result(s): Countries could learn from Australia's overall successful response not only through good governance, effective community participation, adequate public health, adequate health system capacity and multisectoral actions but also from the heterogeneity of the epidemic among states. Conclusion(s): A successful response to epidemics in countries with a decentralized administration requires multilevel governance with alignment and harmonization of the response. Copyright © 2022 E-Century Publishing Corporation. All rights reserved.