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Background Current processes collecting cancer stage data in population-based cancer registries (PBCRs) lack standardisation, resulting in difficulty utilising diverse data sources and incomplete, low-quality data. Implementing a cancer staging tiered framework aims to improve stage collection and facilitate inter-PBCR benchmarking. Objective Demonstrate the application of a cancer staging tiered framework in the Western Australian Cancer Staging Project to establish a standardised method for collecting cancer stage at diagnosis data in PBCRs. Methods The tiered framework, developed in collaboration with a Project Advisory Group and applied to breast, colorectal, and melanoma cancers, provides business rules – procedures for stage collection. Tier 1 represents the highest staging level, involving complete American Joint Committee on Cancer (AJCC) tumour–node–metastasis (TNM) data collection and other critical staging information. Tier 2 (registry-derived stage) relies on supplementary data, including hospital admission data, to make assumptions based on data availability. Tier 3 (pathology stage) solely uses pathology reports. Findings The tiered framework promotes flexible utilisation of staging data, recognising various levels of data completeness. Tier 1 is suitable for all purposes, including clinical and epidemiological applications. Tiers 2 and 3 are recommended for epidemiological analysis alone. Lower tiers provide valuable insights into disease patterns, risk factors, and overall disease burden for public health planning and policy decisions. Capture of staging at each tier depends on data availability, with potential shifts to higher tiers as new data sources are acquired. Conclusions The tiered framework offers a dynamic approach for PBCRs to record stage at diagnosis, promoting consistency in population-level staging data and enabling practical use for benchmarking across jurisdictions, public health planning, policy development, epidemiological analyses, and assessing cancer outcomes. Evolution with staging classifications and data variable changes will futureproof the tiered framework. Its adaptability fosters continuous refinement of data collection processes and encourages improvements in data quality.

The Southern Ocean plays a critical role in regulating global climate as a major sink for atmospheric carbon dioxide (CO2), and in global ocean biogeochemistry by supplying nutrients to the global thermocline, thereby influencing global primary production and carbon export. Biogeochemical processes within the Southern Ocean regulate regional primary production and biological carbon uptake, primarily through iron supply, and support ecosystem functioning over a range of spatial and temporal scales. Here we assimilate existing knowledge and present new data to examine the biogeochemical cycles of iron, carbon and major nutrients, their key drivers and their responses to, and roles in, contemporary climate and environmental change. Projected increases in iron supply, coupled with increases in light availability to phytoplankton through increased near-surface stratification and longer ice-free periods, are very likely to increase primary production and carbon export around Antarctica. Biological carbon uptake is likely to increase for the Southern Ocean as a whole, whilst there is greater uncertainty around projections of primary production in the Sub-Antarctic and basin-wide changes in phytoplankton species composition, as well as their biogeochemical consequences. Phytoplankton, zooplankton, higher trophic level organisms and microbial communities are strongly influenced by Southern Ocean biogeochemistry, in particular through nutrient supply and ocean acidification. In turn, these organisms exert important controls on biogeochemistry through carbon storage and export, nutrient recycling and redistribution, and benthic-pelagic coupling. The key processes described in this paper are summarised in the graphical abstract. Climate-mediated changes in Southern Ocean biogeochemistry over the coming decades are very likely to impact primary production, sea-air CO2 exchange and ecosystem functioning within and beyond this vast and critically important ocean region.

The production and removal of ammonium (NH4+) are essential upper-ocean nitrogen cycle pathways, yet in the Southern Ocean where NH4+ has been observed to accumulate in surface waters, its mixed-layer cycling remains poorly understood. For surface seawater samples collected between Cape Town and the Marginal Ice Zone in winter 2017, we found that NH4+ concentrations were 5-fold higher than is typical for summer and lower north than south of the Subantarctic Front (0.01–0.26 µM versus 0.19–0.70 µM). Our observations confirm that NH4+ accumulates in the Southern Ocean's winter mixed layer, particularly in polar waters. NH4+ assimilation rates were highest near the Polar Front (12.9 ± 0.4 nM d−1) and in the Subantarctic Zone (10.0 ± 1.5 nM d−1), decreasing towards the Marginal Ice Zone (3.0 ± 0.8 nM d−1) despite the high ambient NH4+ concentrations in these southernmost waters, likely due to the low temperatures and limited light availability. By contrast, rates of NH4+ oxidation were higher south than north of the Polar Front (16.0 ± 0.8 versus 11.1 ± 0.5 nM d−1), perhaps due to the lower-light and higher-iron conditions characteristic of polar waters. NH4+ concentrations were also measured along five transects of the Southern Ocean (Subtropical Zone to Marginal Ice Zone) spanning the 2018/19 annual cycle. These measurements reveal that mixed-layer NH4+ accumulation south of the Subantarctic Front derives from sustained heterotrophic NH4+ production in late summer through winter that, in net, outpaces NH4+ removal by temperature-, light-, and iron-limited microorganisms. Our observations thus imply that the Southern Ocean becomes a biological source of CO2 to the atmosphere in autumn and winter not only because nitrate drawdown is weak but also because the ambient conditions favour net heterotrophy and NH4+ accumulation.

Improving patient-centered outcomes is a core aim of value-based healthcare (VBHC). Integrating patient-reported outcome and experience measures (PROMs/PREMs) into clinical quality registries may provide insight into health-related quality of life (HRQL) and variation in care. We piloted PROMs/PREMs collection in an Australian Lung Cancer Registry to evaluate associations between HRQL, clinical outcomes and treatment value. Individuals newly diagnosed with lung cancer across five metropolitan health services were invited to complete electronic PROMs (EORTC QLQ-C30 and QLQ-LC29) and PREMs at baseline and follow-up. Preference-based utilities (QLU-C10D) and quality-adjusted life-years (QALYs) were derived and linked with registry clinical data. Stage-specific Australian health system cost estimates for guideline concordant treatment (GCT) provided context for value-based reporting. Multivariable regression examined associations between HRQL and clinical variables. Baseline PROMs/PREMs were completed by 241/490 (49%) participants. HRQL was associated with cancer stage, ECOG performance status ≥ 2, comorbidities, weight loss, and receipt of GCT (p = 0.041). HRQL remained stable among ongoing respondents over time. Estimated health system costs increased with advancing stage, while earlier stage disease was associated with better HRQL and survival. A registry-level VBHC dashboard integrating HRQL, patient experience, clinical quality indicators and cost context was developed to support health service performance review. PROMs/PREMs linked with clinical and cost data provided meaningful insight into patient-centered outcomes and drivers of value in lung cancer care. This VBHC framework highlights the importance of early diagnosis and access to evidence-based treatment and offers a scalable approach to support patient-centered quality improvement at the health system level.

IntroductionLung cancer is the leading cause of cancer mortality, comprising the largest national cancer disease burden in Australia and New Zealand. Regional reports identify substantial evidence-practice gaps, unwarranted variation from best practice, and variation in processes and outcomes of care between treating centres. The Australia and New Zealand Lung Cancer Registry (ANZLCR) will be developed as a Clinical Quality Registry to monitor the safety, quality and effectiveness of lung cancer care in Australia and New Zealand.Methods and analysisPatient participants will include all adults >18 years of age with a new diagnosis of non-small-cell lung cancer (NSCLC), SCLC, thymoma or mesothelioma. The ANZLCR will register confirmed diagnoses using opt-out consent. Data will address key patient, disease, management processes and outcomes reported as clinical quality indicators. Electronic data collection facilitated by local data collectors and local, state and federal data linkage will enhance completeness and accuracy. Data will be stored and maintained in a secure web-based data platform overseen by registry management. Central governance with binational representation from consumers, patients and carers, governance, administration, health department, health policy bodies, university research and healthcare workers will provide project oversight.Ethics and disseminationThe ANZLCR has received national ethics approval under the National Mutual Acceptance scheme. Data will be routinely reported to participating sites describing performance against measures of agreed best practice and nationally to stakeholders including federal, state and territory departments of health. Local, regional and (bi)national benchmarks, augmented with online dashboard indicator reporting will enable local targeting of quality improvement efforts.

Objective: Implement a revised daily audit tool to promote delirium screening, mobility, and adequate nutrition to reduce patient falls, fall rate, falls with injury, and fall with injury rate at an academic medical center.Methods: Of nine medical-surgical units at an academic medical center, five medical-surgical units (intervention group) implemented a revision of a currently utilized daily audit tool, whereas four control units did not implement the intervention. The tool was utilized to audit completion of nursing interventions of delirium screening, mobilization of the patient, and improving nutrition intake.Results: Statistical testing using a paired samples t-test resulted in a range of P-values from .259 to .418 for all measures including totals falls (p=.259), fall rate (p=.321), total falls with injury (p=.328), and fall with injury rate (p=.418). Since P>.05, findings suggest lack of significance with the reduction of falls pre-intervention versus post-intervention. Statistical testing comparing post-intervention results for intervention units versus control units using an independent samples test resulted in P-values ranging from .377 to .720 for all measures including total falls (p=.720), fall rate (p=.602), falls with injury (p=.377), and falls with injury rate (p=.295). Since P>.05, statistical findings suggest the effects of the daily audit tool cannot be assumed to be correlated with a fall decrease from any measure.Conclusion: Although total falls and fall rates increased in frequency, falls with injury and fall with injury rates decreased in all sample units, pre-intervention versus post-intervention. The daily audit tool intervention results do not suggest a correlation to a decrease in falls; however, it is recommended to extend the project timeframe and increase the sample size for further analysis.

The Weddell Sea represents a point of origin in the Southern Ocean where globally important water masses form. Biological activities in Weddell Sea surface waters thus affect large-scale ocean biogeochemistry. During January–February 2019, we measured net primary production (NPP), nitrogen (nitrate, ammonium, urea) uptake, and nitrification in the western Weddell Sea at the Antarctic Peninsula (AP) and Larsen C Ice Shelf (LCIS), in the southwestern Weddell Gyre (WG), and at Fimbul Ice Shelf (FIS) in the south-eastern Weddell Sea. The highest average rates of NPP and greatest nutrient drawdown occurred at LCIS. Here, the phytoplankton community was dominated by colonial Phaeocystis antarctica, with diatoms increasing in abundance later in the season as sea ice melted. At the other stations, NPP was variable, and diatoms known to enhance carbon export (e.g. Thalassiosira spp.) were dominant. Euphotic zone nitrification was always below detection, such that nitrate uptake could be used as a proxy for carbon export potential, which was highest in absolute terms at LCIS and the AP. Surprisingly, the highest f ratios occurred near FIS rather than LCIS (average of 0.73±0.09 versus 0.47±0.08). We attribute this unexpected result to partial ammonium inhibition of nitrate uptake at LCIS (where ammonium concentrations were 0.6±0.4 µM, versus 0.05±0.1 µM at FIS), with elevated ammonium resulting from increased heterotrophy following the accumulation of nitrate-fuelled phytoplankton biomass in early summer. Across the Weddell Sea, carbon export appears to be controlled by a combination of physical, chemical, and biological factors, with the highest potential export flux occurring at the ice shelves and lowest in the central WG.

Fil: Cavan, Emma Louise. Imperial College London; Reino Unido

After reading the story about \"throwaway marriages,\" I sat back and reflected upon my own childhood. As a child whose parents had continuous sexual misdemeanours, I asked myself if I would have been better off if my parents had stayed together or if they had divorced.