Evaluation of a pilot online education program to develop midwives' knowledge, skill and confidence in perinatal mental health in rural South Australia.

One in five women will experience perinatal anxiety and/or depression. In South Australia, a rural health service identified a high proportion of women with risk of perinatal mental health challenges and sought additional education for midwives. In response, a six-week facilitated, online perinatal mental health education program (e-PMHEP) was piloted. AIM: The aim of this study was to evaluate the effectiveness of the (e-PMHEP) for rural midwives, nurses and Aboriginal maternal infant care practitioners. METHOD: Program evaluation incorporated a validated online pre/post survey to assess self-reported knowledge, skill and confidence regarding perinatal mental healthcare. Additional questions sought feedback on satisfaction and feasibility. FINDINGS: Sixteen participants from rural South Australia engaged in the project from June to August 2022. Twelve participants completed the online pre/post survey. The overall pre/post knowledge scores were statistically significant (t = 2.73, 8df, p = 0.025) with improvement from the pre to post-test. Pre/post data also showed a measurable increase in confidence and skills. All respondents agreed that the content addressed their learning needs and would recommend this program to other practitioners. DISCUSSION: The e-PMHEP appeared beneficial in developing knowledge, skills and confidence regarding perinatal mental healthcare in rural midwives and practitioners. Only a third of practitioners routinely developed a mental health care plan with women. Key strengths of the program included the accessible content, and the combination of an experienced mental health clinician and a facilitator with lived experience. CONCLUSION: Providing an accessible, facilitated online perinatal mental health education program could be beneficial for rural midwives.

'There is no other option': Exploring health care providers' experiences implementing regional multisite midwifery model of care in South Australia.

INTRODUCTION: In the past 30 years, 60% of South Australia's rural maternity units have closed. Evidence demonstrates midwifery models of care offer regional Australia sustainable birthing services. Five birthing sites within the York and Northern Region of South Australia, designed in collaboration with key stakeholders, offered a new all-risk midwifery continuity of care model (MMoC). All pregnant women in the region were allocated to a known midwife once pregnancy was confirmed. In July 2019, the pilot program was implemented and an evaluation undertaken. OBJECTIVE: The study aimed to evaluate the effectiveness, acceptability, and sustainability of the new midwifery model of care from the perspective of health care providers. DESIGN: The evaluation utilised a mixed methods design using focus groups and surveys to explore experiences of health care providers impacted by the implementation of the MMoC. This paper reports on midwives, doctors and nurses experiences at different time points, to gain insight into the model of care from the care providers impacted by the change to services. FINDINGS: The first round of focus groups included 14 midwives, 6 hospital nurses/midwives and 5 doctors with the overarching theme that the 'MMoC was working well.' The second round of focus groups were undertaken across the five sites with 10 midwives, 9 hospital nurses/midwives and 5 doctors. The overarching theme captured all participants commitment to the MMoC, with agreement that 'there is no other option - it has to work'. DISCUSSION: All participants reported positive outcomes and a strong commitment to navigate the changes required to implement the new model of care. Collaboration and communication was expressed as key elements for success. Specific challenges and complexities were evident including a need to clarify expectations and the workload for midwives, and for nurses who were accustomed to having midwives 24 hours a day in hospitals. CONCLUSION: This innovative model responds to challenges in providing rural maternity care and offers a sustainable model for maternity services and workforce. There is an overwhelming commitment and consensus that there is 'no other option-it has to work'.

The role of hyperbaric oxygen in osteoradionecrosis-a prophylactic insight.

BACKGROUND: Osteoradionecrosis (ORN) is an uncommon and debilitating consequence of head and neck radiotherapy and hyperbaric oxygen therapy (HBOT) has been advocated for prophylaxis prior to performing dentoalveolar procedures. The aim of this study was to evaluate a prophylactic HBOT protocol and describe the outcomes of susceptible individuals. METHODS: A retrospective audit of adults who attended the Oral and Maxillofacial Surgery department at the Royal Adelaide Hospital (South Australia) who received dental extractions with a history of radiotherapy to the jaws from 2008 to 2020. Data including demographic information and outcomes of osteoradionecrosis and delayed healing was recorded. RESULTS: A total of 121 individuals were eligible for case note review; 68.6% of individuals were male and 55.4% were aged over 67 years. Osteoradionecrosis occurred in 9.1% of individuals and delayed healing for 3.3%; fifteen individuals (12.4%) were unable to complete the HBOT protocol. The individuals who were diagnosed with ORN had a significant association with age (P = 0.006) and binary analysis showed alcohol consumption to be a significant predictor. CONCLUSIONS: Prophylactic HBOT protocol had a lower proportion of individuals diagnosed with ORN and those who were diagnosed were more likely to be younger males and have current alcohol consumption.

An Aboriginal-led consortium approach to chronic disease action for health equity and holistic wellbeing.

ISSUE ADDRESSED: The Wellbeing Economy, which places human and ecological wellbeing at the centre of policy making, aligns with holistic Aboriginal and Torres Strait Islander conceptualisations of health and wellbeing. In order to address chronic diseases in South Australian Aboriginal and Torres Strait Islander populations, the South Australian Aboriginal Chronic Disease Consortium (Consortium) is fostering action in ways that align both with the Wellbeing Economy and with Health in All Policies (HiAP) approaches. METHODS: In June 2017, the Consortium was established as a collaborative partnership between government and non-government organisations, researchers, Aboriginal organisations and communities to lead the effective implementation of three state-wide chronic disease plans. A coordinating centre was funded to support and progress the work of the Consortium. RESULTS: During its first 5 years, the Consortium has developed a foundation for sustained system reform through partnering with stakeholders, leading projects and initiatives, advocating for key priorities, leveraging existing infrastructure and funding, supporting services, and coordinating delivery of priority actions using innovative approaches. CONCLUSIONS: Through the Consortium governance structure, Aboriginal and Torres Strait Islander community members, policy actors, service providers and researchers oversee, drive, influence and support the implementation of priority action initiatives. Sustained funding, competing priorities of partner organisations and project evaluation are constant challenges. SO WHAT?: A consortium approach provides direction and shared priorities, which foster collaboration across and between organisations, service providers and the Aboriginal community. Aligning with HiAP approaches and the Wellbeing Economy, it harnesses knowledge, networks and partnerships that support project implementation and reduce duplication.

Barriers and Facilitators to Hepatitis C Virus (HCV) Treatment for Aboriginal and Torres Strait Islander Peoples in Rural South Australia: A Service Providers' Perspective.

This study explored the barriers and facilitators to hepatitis C virus (HCV) treatment for Aboriginal and Torres Strait Islander peoples in rural South Australia as viewed from a healthcare provider perspective in the era of direct acting antivirals (DAAs). Phase 1 was a qualitative systematic review examining the barriers and enablers to diagnosis and treatment amongst Indigenous peoples living with HCV worldwide. Phase 2 was a qualitative descriptive study with healthcare workers from six de-identified rural and regional Aboriginal Community-Controlled Health Services in South Australia. The results from both methods were integrated at the analysis phase to understand how HCV treatment could be improved for rural Aboriginal and Torres Strait Islander peoples. Five main themes emerged: the importance of HCV education, recognizing competing social and cultural demands, the impact of holistic care delivery and client experience, the effect of internal barriers, and overlapping stigma, discrimination, and shame determine how Indigenous peoples navigate the healthcare system and their decision to engage in HCV care. Continued efforts to facilitate the uptake of DAA medications by Aboriginal and Torres Strait peoples in rural areas should utilize a multifaceted approach incorporating education to community and cultural awareness to reduce stigma and discrimination.

Understanding experiences of Aboriginal and/or Torres Strait Islander patients at the emergency departments in Australia.

OBJECTIVES: The present study describes the experiences of Aboriginal and/or Torres Strait Islander patients and the factors that shaped their experiences of ED visits in regional settings. METHODS: This is a qualitative descriptive study. We conducted semi-structured in-depth interviews with Aboriginal and/or Torres Strait Islander patients who used the ED services at three hospitals in New South Wales, Northern Territory and South Australia. We coded the collected data and analysed them using a thematic analysis technique. RESULTS: A total of 33 Aboriginal and/or Torres Strait Islander patients participated. Analyses of their experiences revealed four themes, which included: (i) patients' waiting times in ED; (ii) cultural determinants of health; (iii) treatment services; and (iv) safety, security and privacy. CONCLUSIONS: A holistic approach and a robust hospital commitment to address cultural needs while considering overall health, social and emotional wellbeing, will enhance Aboriginal and/or Torres Strait Islander patients' satisfaction for ED visits.

Agency in change: Learning experiences of international midwifery students in South Australia.

PROBLEM: While literature reports broadly on the experiences of international students of health professions in higher education, the experience of students undertaking an undergraduate midwifery program outside their country of origin has not previously been reported. BACKGROUND: Midwifery studies incorporate distinct clinical practice and discipline-specific therapeutic relationships which can challenge students familiar with the health system, so it is necessary to understand their impact on the learning needs of international students, who contribute to the diversity of our workforce. AIM: To explore learning experiences of international students of an undergraduate midwifery program to identify their perceptions and personal strategies which impacted their participation in the program. METHODS: A qualitative descriptive study, with a purposive sample of nine current international students and recent graduates of a midwifery program at a South Australian university. Participants attended a focus group or individual phone interview to explore their learning experiences, and data were thematically analysed. FINDINGS: Five themes and sub-themes were identified, built around a core concept of the international midwifery student experience as agency in change: language and culture, teaching and learning, isolation and integration, services and support, and motivation and resilience. Studying abroad was associated with personal and professional growth. Continuity of care for women presented challenges and produced learnings unique to this cohort. CONCLUSION: Tailored support, such as specialized clinical facilitation and organized peer networking, is required for international midwifery students in Australia. Additionally, effective approaches to facilitate bilingualism to support language concordant care are needed.

Evaluation of a regional midwifery caseload model of care integrated across five birthing sites in South Australia: Women's experiences and birth outcomes.

INTRODUCTION: The ongoing closure of regional maternity services in Australia has significant consequences for women and communities. In South Australia, a regional midwifery model of care servicing five birthing sites was piloted with the aim of bringing sustainable birthing services to the area. An independent evaluation was undertaken. This paper reports on women's experiences and birth outcomes. AIM: To evaluate the effectiveness, acceptability, continuity of care and birth outcomes of women utilising the new midwifery model of care. METHOD: An anonymous questionnaire incorporating validated surveys and key questions from the Quality Maternal and Newborn Care (QMNC) Framework was used to assess care across the antenatal, intrapartum and postnatal period. Selected key labour and birth outcome indicators as reported by the sites to government perinatal data collections were included. FINDINGS: The response rate was 52.6% (205/390). Women were overwhelmingly positive about the care they received during pregnancy, birth and the postnatal period. About half of women had caseload midwives as their main antenatal care provider; the other half experienced shared care with local general practitioners and caseload midwives. Most women (81.4%) had a known midwife at their birth. Women averaged 4 post-natal home visits with their midwife and 77.5% were breastfeeding at 6-8 weeks. Ninety-five percent of women would seek this model again and recommend it to a friend. Maternity indicators demonstrated a lower induction rate compared to state averages, a high primiparous normal birth rate (73.8%) and good clinical outcomes. CONCLUSION: This innovative model of care was embraced by women in regional SA and labour and birth outcomes were good as compared with state-wide indicators.

Association between grass, tree and weed pollen and asthma health outcomes in Adelaide, South Australia: a time series regression analysis.

OBJECTIVES: We aim to establish daily risk estimates of the relationships between grass, tree and weed pollen and asthma health outcomes. DESIGN: Time series regression analysis of exposure and health outcomes using interaction by month to determine risk estimates all year round. SETTING: Metropolitan Adelaide, South Australia. PARTICIPANTS: Health outcomes for asthma are based on 15 years of hospital admissions, 13 years emergency presentations and ambulance callouts. In adults (≥18 years), there were 10 381 hospitalisations, 26 098 emergency department (ED) presentations and 11 799 ambulance callouts and in children (0-17 years), 22 114, 39 813 and 3774, respectively. OUTCOME MEASURES: The cumulative effect of 7 day lags was calculated as the sum of the coefficients and reported as incidence rate ratio (IRR) related to an increase in 10 grains of pollen/m3. RESULTS: In relation to grass pollen, children and adults were disparate in their timing of health effects. Asthma outcomes in children were positively related to grass pollen in May, and for adults in October. Positive associations with weed pollen in children was seen from February to May across all health outcomes. For adults, weed pollen-related health outcomes were restricted to February. Adults were not affected by tree pollen, while children's asthma morbidity was associated with tree pollen in August and September. In children, IRRs ranged from 1.14 (95% CI 1.06 to 1.21) for ED presentations for tree pollen in August to 1.98 (95% CI 1.06 to 3.72) for weed pollen in February. In adults, IRRs ranged from 1.28 (95% CI 1.01 to 1.62) for weed pollen in February to 1.31 (95% CI 1.08 to 1.57) for grass pollen in October. CONCLUSION: Monthly risk assessment indicated that most pollen-related asthma health outcomes in children occur in the colder part of the year, while adults are affected in the warm season. The findings indicate a need for year-round pollen monitoring and related health campaigns to provide effective public health prevention.

Pollen Exposure and Cardiopulmonary Health Impacts in Adelaide, South Australia.

(1) Background: Limited research has suggested that cardiopulmonary health outcomes should be considered in relation to pollen exposure. This study sets out to test the relationship between pollen types (grasses, trees, weeds) and cardiovascular, lower respiratory and COPD health outcomes using 15 years (2003-2017) of data gathered in Adelaide, South Australia; (2) Methods: A time-series analysis by months was conducted using cardiopulmonary data from hospital admissions, emergency presentations and ambulance callouts in relation to daily pollen concentrations in children (0-17) for lower respiratory outcomes and for adults (18+). Incidence rate ratios (IRR) were calculated over lags from 0 to 7 days; (3) Results: IRR increases in cardiovascular outcomes in March, May, and October were related to grass pollen, while increases in July, November, and December were related to tree pollen. IRRs ranged from IRR 1.05 (95% confidence interval (CI) 1.00-1.10) to 1.25 (95% CI 1.12-1.40). COPD increases related to grass pollen occurred only in May. Pollen-related increases were observed for lower respiratory outcomes in adults and in children; (4) Conclusion: Notable increases in pollen-related associations with cardiopulmonary outcomes were not restricted to any one season. Prevention measures for pollen-related health effects should be widened to consider cardiopulmonary outcomes.

A holistic reverse logistics planning framework for end-of-life PV panel collection system design.

Photovoltaic (PV) technologies are critical for sustainable energy supply, climate change mitigation, and energy security with lower environmental impact compared to other generation alternatives. Despite the environmental benefits of PV technologies, one of these major downsides is the growing concern over the environmental impact due to risks associated with improper waste handling and disposal of decommissioned PV panels. As a result, there are strong incentives for PV panel recycling to recover valuable resources and mitigate risks caused by hazardous substances. This study proposes a reverse logistical planning framework for collecting end-of-life PV panels, which aims to support the integration of existing recycling technologies and collection schemes using a holistic approach for ensuring feasibility and reducing environmental impact. The framework reviews current recycling methodologies for PV waste and the state of PV markets, including PV uptake, waste stream forecast, collection and logistic strategies. Additionally, South Australia is used as the context of analysis for a case study where the framework is applied to identify the potential strategies for handling and collection of end-of-life PV panels based on current PV uptake and waste stream forecast. As a result, capital, transportation and operation costs can be reduced, contributing to lower overall recycling cost for the PV waste treatment and a more efficient reverse logistic system.

Geospatial analysis of Helicobacter pylori infection in South Australia: Should location influence eradication therapy?

BACKGROUND AND AIM: Rates of antimicrobial-resistant Helicobacter pylori infection are rising globally; however, geospatial location and its interaction with risk factors for infection have not been closely examined. METHODS: Gastric biopsy specimens were collected to detect H. pylori infection at multiple centers in Adelaide, South Australia, between 1998 and 2017. The geospatial distribution of antibiotic-resistant H. pylori in the Greater Adelaide region was plotted using choropleth maps. Moran's I was used to assess geospatial correlation, and multivariate linear regression (MLR) was used to examine associations between migration status, socioeconomic status, age, gender, and rates of H. pylori positivity and antibiotic resistance. Geographically weighted regression (GWR) was used to determine the extent to which the associations varied according to geospatial location. RESULTS: Of 20 108 biopsies across 136 postcodes within the Greater Adelaide region, 1901 (9.45%) were H. pylori positive. Of these, 797 (41.9%) displayed clarithromycin, tetracycline, metronidazole, or amoxicillin resistance. In MLR, migration status was associated with the rate of H. pylori positivity (ß = 3.85% per 10% increase in a postcode's migrant population; P < 0.001). H. pylori positivity and resistance to any antibiotic were geospatially clustered (Moran's I = 0.571 and 0.280, respectively; P < 0.001 for both). In GWR, there was significant geospatial variation in the strength of the migrant association for both H. pylori positivity and antibiotic resistance. CONCLUSION: Our study demonstrates the heterogeneous geospatial distribution of H. pylori positivity and antibiotic resistance, as well as its interaction with migrant status. Geographic location and migrant status are important factors to consider for H. pylori eradication therapy.

Child-, Family-, and Community-Level Facilitators for Promoting Oral Health Practices among Indigenous Children.

Despite the preventive nature of oral diseases and their significance for general wellbeing, poor oral health is highly prevalent and has unfavourable ramifications for children around the world. Indigenous children in Australia experience disproportionate rates of early childhood caries compared to their non-Indigenous counterparts. Therefore, this paper aims to collate parental experiences and generate an understanding of facilitators for Indigenous childhood oral health. This project aggregated stories from parents of Indigenous children across South Australia who were participants in an early childhood caries-prevention trial. This paper explores facilitators for establishing oral health and nutrition behaviours for Indigenous children under the age of three through reflexive thematic analysis. Fisher-Owens' conceptual model for influences on children's oral health is utilised as a framework for thematic findings. Child-level facilitators include oral hygiene routines and regular water consumption. Family-level facilitators include familial ties, importance of knowledge, and positive oral health beliefs. Community-level facilitators include generational teaching, helpful community resources, and holistic health care. Recommendations from findings include the following: exploration of Indigenous health workers and elder participation in oral health initiatives; inclusion of Indigenous community representatives in mainstream oral health discussions; and incorporation of child-level, family-level, and community-level facilitators to increase support for efficacious oral health programs.

"Context, content, and system" supporting digital health hub (DHH)-enabled models of care (MoCs) for fragility hip fractures: perspectives of diverse multidisciplinary stakeholders in South Australia from qualitative in-depth interviews.

Combining thematic analysis and a human-computer persuasive systems framework suggests that hip fracture recovery among older people can be enhanced through person-centered digital health hub models of care focused on behavior change education and integrated care. The findings intend to guide settings involving comorbid conditions and low- and middle-income countries in developing innovative digital health solutions. PURPOSE: The purpose of this study was to understand stakeholders' perspectives on the development of a digital health-enabled model of care for fragility hip fractures and to map out factors that could influence the design and implementation of such a model. METHODS: Qualitative in-depth interviews were conducted with stakeholders from various clinical disciplines, allied health, and computer science. A hybrid process involving thematic analysis of the raw data using inductive coding was the first step. In the second step, the tenets of a theoretical framework (health behavior change supporting systems) were deductively applied to the thematic constructs generated as part of the first step of the analysis. RESULTS: In total, 24 in-depth interviews were conducted with stakeholders. We identified 18 thematic constructs presented under the categories of context, content, and system. Context covered patient characteristics such as frailty, digital literacy, and patient or carer participation, whereas healthcare delivery aspects included the structure and culture of existing practice and the need for innovative holistic models of care. Content outlines the active ingredients and approach in developing a digital health hub, and it highlights the importance of targeted education and behavior change. The system is a complicated matrix crossing different aspects of healthcare and offering a value proposition design through personalization across modes of content delivery. This must foster trust, ensure adequate financing, and support ownership and privacy by establishing appropriate mechanisms for embedding change. CONCLUSION: The findings from this study provide insights around potential factors related to patients, community support, and healthcare delivery influencing the design and next-stage implementation of a digital health hub model of care for fragility hip fractures.

The characterisation and provenance of crude oils stranded on the South Australian coastline. Part II: Potential parent petroleum systems.

In 2014-2016 more than 600 specimens of semi-solid crude oil were recovered from 30 ocean beaches along the coastline of South Australia, as part of the recently completed Great Australian Bight Research Program. All are believed to be products of submarine oil seepage. Their source-specific biomarker signatures provide the basis for their assignment to sixteen oil families, some previously unrecognised. Two of these families (asphaltite and asphaltic tar) likely originated from Cretaceous marine source rocks in the offshore Bight Basin. The others comprise waxy oils of lacustrine, fluvio-deltaic and marine source affinity. Their biomarker characteristics do not match those of any Australian crude oil. However, they are strikingly similar to those of oils found in Cenozoic and Mesozoic basins throughout the Indonesian Archipelago and elsewhere in Southeast Asia.

Holistic approach supporting mental wellbeing of people in enforced quarantine in South Australia during the COVID-19 pandemic.

OBJECTIVES: To report the experience of quarantine for international arrivals to South Australia requiring quarantine in a medi-hotel setting during the COVID-19 pandemic and to describe the range of evidence-based support services to mitigate the mental health impacts of quarantine. METHODS: A range of services targeted at physical and mental wellbeing were provided. Data from 533 adult respondents out of 721 passengers were included. The Kessler 10 was used to measure psychological distress at two time points. RESULTS: About 7.1% of respondents reported psychological distress at time one, reduced to 2.4% at time two. There was no significant difference in psychological distress by gender at either time point. The mean K10 score at time one was 13.6 (standard deviation=5.2) and the mean score at time two was 11.5 (standard deviation=3.1), with a significant reduction in mean scores (p<0.001) between the two time points. CONCLUSIONS: The level of psychological stress in repatriated Australians was low at arrival and improved further at the time of release from quarantine. Implications for public health: A collaborative multi-sector approach to provide support services for individuals in quarantine can mitigate risks to mental wellbeing.

COVID-19, individual wellbeing and multi-dimensional poverty in the state of South Australia.

Research efforts in the initial months of the COVID-19 pandemic focused on the actual and potential impacts on societies, economies, sectors, and governments. Less attention was paid to the experiences of individuals and less still to the impact of COVID-19 on an individual's wellbeing. This research addresses this gap by utilising a holistic wellbeing framework to examine the impact of COVID-19 on the overall wellbeing of individuals in the Australian state of South Australia through an online survey. The research framework for the survey comprises six dimensions: psychological and emotional health, physical health, living standards, family and community vitality, governance, and ecological diversity and resilience. The results show that most respondents (71%) were able to maintain overall wellbeing during the pandemic. However, more than a half of the respondents could not maintain wellbeing in psychological and emotional health. Further examination of the drivers of inability to maintain overall wellbeing reveals that low-income individuals, younger respondents (aged 18-24) and women suffer disproportionate hardships. Defining poverty in terms of multi-dimensional deprivations in wellbeing enables a nuanced analysis of the unequal impacts of COVID-19 mitigation policies that can be used to improve policymaking.

Health-related quality of life and work impairment in idiopathic inflammatory myopathies in South Australia.

AIM: The idiopathic inflammatory myopathies (IIM) are rare autoimmune diseases that are usually chronic and often present with skeletal muscle inflammation and weakness. We sought to examine the impact of IIM in a cohort of 50 South Australian patients on health-related quality of life (HRQOL) and work productivity (WP). We uniquely categorized patients across gender, IIM subtypes, employment status, and also whether there was extramuscular involvement from IIM. METHODS: Multiple modalities were used, as recommended by the International Myositis Assessment and Clinical Studies Group (IMACS), to assess the impact of IIM, including manual muscle strength testing (MMT-8), the Physician and Patient Global Activity Assessments (PHGAA, PTGAA), Myositis Disease Activity Assessment Tool (MDAAT), and serum creatinine kinase (CK) levels. The impacts of IIM on HRQOL and WP were analyzed using the Medical Outcomes Study 36-items Short Form (SF-36) and Work Productivity and Activity Impairment (WPAI) questionnaires, respectively. RESULTS: We found significantly lower HRQOL outcome scores in most of the SF-36 domains when compared to the most recent population norms (P ≤ .01). Physical health was predominantly affected with relative preservation of emotional health. There were also significant associations between MMT-8, PHGAA and PTGAA scores and HRQOL and WP. CONCLUSIONS: Our findings highlight the significant impact of IIM on HRQOL and WP in a well-characterized cohort of patients with IIM within Australia, and therefore the importance of a holistic approach to the management of these patients.

Measuring organizational readiness for implementing change (ORIC) in a new midwifery model of care in rural South Australia.

BACKGROUND: The sustainability of Australian rural maternity services is under threat due to current workforce shortages. In July 2019, a new midwifery caseload model of care was implemented in rural South Australia to provide midwifery continuity of care and promote a sustainable workforce in the area. The model is unique as it brings together five birthing sites connecting midwives, doctors, nurses and community teams. A critical precursor to successful implementation requires those working in the model be ready to adopt to the change. We surveyed clinicians at the five sites transitioning to the new model of care in order to assess their organizational readiness to implement change. METHODS: A descriptive study assessing readiness for change was measured using the Organizational Readiness for Implementing Change scale (ORIC). The 12 item Likert scale measures a participant's commitment to change and change efficacy. All clinicians working within the model of care (midwives, nurses and doctors) were invited to complete an e-survey. RESULTS: Overall, 55% (56/102) of clinicians participating in the model responded. The mean ORIC score was 41.5 (range 12-60) suggesting collectively, midwives, nurses and doctors began the new model of care with a sense of readiness for change. Participants were most likely to agree on the change efficacy statements, "People who work here feel confident that the organization can get people invested in implementing this change and the change commitment statements "People who work here are determined to implement this change", "People who work here want to implement this change", and "People who work here are committed to implementing this change. CONCLUSION: Results of the ORIC survey indicate that clinicians transitioning to the new model of care were willing to embrace change and commit to the new model. The process of organizational change in health care settings is challenging and a continuous process. If readiness for change is high, organizational members invest more in the change effort and exhibit greater persistence to overcome barriers and setbacks. This is the first reported use of the instrument amongst midwives and nurses in Australia and should be considered for use in other national and international clinical implementation studies.

The natural hydrocarbon loading of the South Australian coastline.

Crude oil released from natural offshore seeps may strand in coastal environments. Understanding the different types of oil which accumulate on a given coastline, in addition to their spatial distribution and abundance, may be used to establish an environmental baseline for natural "background" petroleum contamination. Here we summarise the hydrocarbon loading of thirty beaches on Australia's southern margin based on three annual surveys in 2014-2016. Comparison with the results of surveys conducted in 1990 and 1991 reveals a marked reduction in hydrocarbon loading. Furthermore, modern samples of the most commonly encountered oil, attributed to a lacustrine petroleum system in the Indonesian Archipelago, are significantly more degraded than those of prior studies. We attribute this reduction in hydrocarbon loading to prolonged oil production in Southeast Asia, which in turn results in reduced reservoir pressures and the eventual cessation of formerly active offshore seepage.