The Making of a Health Profession:How Chinese Medicine Became a Nationally Registered Allied Health Profession in Australia

In 2012, traditional Chinese medicine(TCM) practitioners in Australia became nationally-registered allied health professionals in three categories: acupuncturist, Chinese herbal medicine practitioner, and Chinese herbal medicine dispenser. Australia was the first Western country to introduce national registration for Chinese medicine, followed by Portugal and, recently, New Zealand. The practice of TCM in Australia can be traced back to the beginning of Chinese immigration to Australia during the Victorian Gold Rush which began in the 1850s. The process which led to national registration commenced in the early 1970s with the establishment of the first acupuncture courses. Decades of gradual development of courses from unaccredited part-time diplomas to accredited bachelor degrees, and the development, by the profession, of national consensus on educational standards were essential elements in the process which led to registration. Professional associations, such as the Australian Acupuncture and Chinese Medicine Association Ltd.(AACMA), also developed a framework of professional selfregulation, including Codes of Ethics, Codes of Conduct, ongoing professional development requirements and Infection Control Guidelines, and provided leadership in the development of the profession. After decades of tribalism and division within the TCM profession, the National Academic Standards Committee brought almost all stakeholders together to reach a consensus on the Australian Guidelines for Traditional Chinese Medicine Education which were published by AACMA in 2001. Professional associations also collaborated on joint submissions to the government in support of registration, which was introduced first in the state of Victoria in 2000, and subsequently became national in 2012. Despite national registration, some barriers still remain, and professional associations continue to lobby the federal government for inclusion in Medicare, chronic disease management scheme, and Veterans Affairs.

Molecular Phylogeny, Species Delimitation and Taxonomic Revision of the Australian Spider Wasp Genus Heterodontonyx Haupt, 1935 (Hymenoptera: Pompilidae)

Heterodontonyx (Pompilidae: Pepsinae) is an understudied genus with Australasiandistribution and most species are endemic to Australia. There have recently been sometaxonomic changes involving the genera Heterodontonyx and Cryptocheilus based on molecular and morphological evidence, however, phylogenetic relationships within Heterodontonyx, species delimitation and formal revision have not been conducted. Here, we construct a Maximum Likelihood phylogeny estimate of Heterodontonyx based on ITS1, 5.8S, ITS2 region of 30 samples representing seven Heterodontonyx morphospecies. bPTP species delimitation approach was employed and ultimately the taxonomic revision of the genus was carried out. Phylogenetic analyses strongly support the monophyly of Heterodontonyx and the species delimitation method recognizes eight species among which one new species is identified.

Thornthwaite moisture index and depth of suction change under current and future climate‒An Australian study

Climate change is one of the major global challenges and it can have a significant influence on the behaviour and resilience of geotechnical structures.The changes in moisture content in soil lead to effective stress changes and can be accompanied by significant volume changes in reactive/expansive soils.The volume change leads to ground movement and can exert additional stresses on structures founded on or within a shallow depth of such soils.Climate change is likely to amplify the ground movement potential and the associated problems are likely to worsen.The effect of atmospheric boundary interaction on soil behaviour has often been correlated to Thornthwaite moisture index(TMI).In this study,the long-term weather data and anticipated future projections for various emission scenarios were used to generate a series of TMI maps for Australia.The changes in TMI were then correlated to the depth of suction change(H s),an important input in ground movement calculation.Under all climate scenarios considered,reductions in TMI and increases in H s values were observed.A hypothetical design scenario of a footing on expansive soil under current and future climate is discussed.It is observed that a design that might be considered adequate under the current climate scenario,may fail under future scenarios and accommodations should be made in the design for such events.

A Case Study in Complex Concrete Construction in Australia:A Hybrid Approach of Hand and Machine

This paper describes and provides a critique of the design and implementation of the“scoops”-a set of bespoke multifunctioning architectural free-form elements that are a highlight of the new Soheil Abedian School of Architecture at Bond University,Australia,by the office of Sir Peter Cook and Gavin Robotham,CRAB(Cook Robotham Architecture Bureau,London).The development includes the transfer of analogue design processes into digital 3d modeling,which is then analyzed and rationalized via an exchange with consultants and procurement contractors.The complexity of the concrete works necessitated the use of digital fabrication to make their implementation affordable and within time constraints,with said complexity creating a variety of challenges for many aspects of the entire delivery team.The 3d model played a critical role in communicating intent and accuracy at all stages.The use of site-based craftsmanship combined with computer aided design and fabrication overlapped to realize the project.

The quality of older adults'involvement in clinical communication with general practitioners:evidence from rural towns in Australia

Objective:A study was conducted about the putative links of older rural Australians'health knowledge and preparation with their quality of involvement in patient-general practitioner(GP)communication during health intake visits.Methods:It was a cross-sectional study between January 2021 and April 2022.The 32-item quality of involvement in communication scale was designed and incorporated into the SurveyGizmo software.This online survey was administered by sending an email request to the Renmark Rotary Club,which actively promoted this study across five rural towns in South Australia.121 participants completed the surveys.Mean-sum scores were calculated based on the questionnaire responses to evaluate outcomes,specifically initiation of information,active participation,and emotional expression.We employed different methods including t-tests,ANOVA,and leaner regressions to analyse data.Results:The demographic profile of participants characterised by a female predominance(58.7%,71/121),a majority falling within the 65-<70 age bracket(47.1%,57/121),and a high level of educational attainment(58.7%had completed high school or higher,71/121).Additionally,35%of the participants predominantly spoke a language other than English at home.Regarding the initiation of information with GPs,the mean sum-score was(20.5+3.7),indicating a marginally above-average level of engagement.Contrarily,the active participation was suboptimal,as suggested by a mean sum score of(35.9±6.3).Furthermore,the emotional expression was relatively low,with a mean score of(13.9±1.8).Substantial variations were discerned in the quality of patient-GP communication,contingent upon factors such as educational background,language spoken at home,health literacy,and preparatory measures for clinical visits.Participants who predominantly spoke a language other than English at home demonstrated significantly lower levels of information initiation with their GPs(P<0.o01).Higher educational attainment was positively correlated with increased active participation(P<0.001).Enhanced health literacy and thorough visit preparation were significantly associated with increased levels of active participation(P<0.001).Conclusion:Meaningful engagement through recognition,empowerment,and support(health literacy programs)for older rural adults is suggested for improving their quality of involvement in communication with GPs.

A systems perspective on national prioritisation of sustainable development goals:Insights from Australia

Achieving the Sustainable Development Goals(SDGs)requires effective national initiatives and resource allo-cation.Yet,the simultaneous attainment of all goals is hindered by constraints such as limited budgets and resources,varied national priorities,and the intricate nature of the goals.As we approach 2030 and beyond,an urgent need for an effective,data-driven prioritisation system exists to optimise what can be accomplished.A considerable knowledge gap persists in identifying the priority areas that demand concentrated attention and how their improvement would propel overall sustainability goals.To bridge this gap,our study presents a priori-tisation approach that identifies significant SDG indicators based on urgency and impact,utilising Benchmarking,Bivariate,and Network analysis.Furthermore,we introduce an innovative Impact Index(IMIN)to assess an indi-cator’s extensive effect on the SDG network.This system carries significant international relevance by establishing a robust framework to identify key,potent,and interconnected indicators.It supports decision-makers worldwide in comprehending their nation’s SDG performance and promotes efficient resource allocation.In the specific con-text of Australia,our analysis spotlights several impactful,yet underperforming SDG indicators.These include the protection of Freshwater,Terrestrial,and Mountain Key Biodiversity Areas(KBAs),the share of renewable energy and energy intensity level of primary energy,targeted research and development,gender equality in national parliaments,and carbon-efficient manufacturing,amongst others.

Social relationship satisfaction and accumulation of chronic conditions and multimorbidity:a national cohort of Australian women

Background Social relationships are associated with mortality and chronic conditions.However,little is known about the effects of social relationship satisfaction on multiple chronic conditions(multimorbidity).Aims To examine whether social relationship satisfaction is associated with the accumulation of multimorbidity.Methods Data from 7694 Australian women who were free from 11 chronic conditions at 45–50 years of age in 1996 were analysed.Five types of social relationship satisfaction(partner,family members,friends,work and social activities)were measured approximately every 3 years and scored from 0(very dissatisfied)to 3(very satisfied).Scores from each relationship type were summed to provide an overall satisfaction score(range:≤5–15).The outcome of interest was the accumulation of multimorbidity in 11 chronic conditions.Results Over a 20-year period,4484(58.3%)women reported multimorbidities.Overall,the level of social relationship satisfaction had a dose–response relationship with the accumulation of multimorbidities.Compared with women reporting the highest satisfaction(score 15),women with the lowest satisfaction(score≤5)had the highest odds of accumulating multimorbidity(odds ratio(OR)=2.35,95%confidence interval(CI):1.94 to 2.83)in the adjusted model.Similar results were observed for each social relationship type.Other risk factors,such as socioeconomic,behavioural and menopausal status,together explained 22.72%of the association.Conclusions Social relationship satisfaction is associated with the accumulation of multimorbidity,and the relationship is only partly explained by socioeconomic,behavioural and reproductive factors.Social connections(eg,satisfaction with social relationships)should be considered a public health priority in chronic disease prevention and intervention.

High-resolution coupling of stratigraphic'sweet-spot'lithofacies and petrophysical properties:A multiscale study of Ordovician Goldwyer Formation,Western Australia

The identification of stratigraphic'sweet-spot'interval is significant in oil and gas formation evaluation.However,formation evaluation in macroscopic-scale merely provides low resolution and limited infor-mation,thus may lead to uncertainties in resource estimation.To accurately identify the'sweet-spot'intervals amongst heterogeneous lithofacies,we conducted a very high-resolution and quantitative analysis from in-situ macroscopic scale to laboratory microscopic scale on the Goldwyer formation of Canning Basin,Western Australia.The comprehensive advanced well logging and slim-compact micro imager(SCMI)technologies were synthetically applied in couple with the laboratory nanoscaled ex-periments.The results unveiled an extraordinarily large lithofacies heterogeneity between different rock intervals,with distinguished features shown in Goldwyer Ⅰ,Ⅱ,and Ⅲ members.The most favorable lithofacies is recognized as the laminated argillaceous thermally-matured organic matter(OM)-rich mudstone,which is widely developed in Goldwyer Ⅲ as the major attributor to'sweet-spot'intervals.Goldwyer Ⅱ is exclusively characterized by thick mudstone intervals(94.4%),interbedded with thin calcareous mudstones(5.5%),corresponding to a depositional environment of low-energy distal section of the outer ramp settings.Microscopically,the most favorable lithofacies in'sweet-spot'intervals develop numerous OM-/mineral nanopores for hydrocarbon storage.Illite-rich lithofacies develops abundant inter-particle pores from 2 to 17 nm that mainly contribute to pore volume for free gas storage capacity.OM-rich lithofacies with higher maturity have OM-pores with good connectivity,bearing large specific surface area that is beneficial for adsorbed gas capacity.

Creating Prep to Play PRO for women playing elite Australian football:A how-to guide for developing injury-prevention programs

Background:Developing context-specific,evidence-informed,and implementable injury-prevention programs is challenging.Women playing in the elite Australian Football League for Women are at high risk of serious knee injuries,and no specific injury-prevention program exists.The objective of the study was to describe the collaborative process used to create a context-specific injury-prevention program.Methods:A previously used intervention-development process was modified to incorporate a partnership with the sport’s governing organization and focus on engaging program implementers.The Reach Effectiveness Adoption Implementation and Maintenance(RE-AIM)Sports Setting Matrix guided program development and implementation strategies.Results:The 7-step process,aligned with the RE-AIM Sports Setting Matrix,was applied to develop the injury-prevention program and was titled Prep to Play PRO.The steps were:(Step 1)gaining organizational support and establishing a project partnership;(Step 2)using research evidence and clinical experience;(Step 3)consulting content and context experts;(Step 4)engaging the organization,experts,program implementers,and end-users to concreate the intervention and develop implementation strategies;(Step 5)testing the intervention acceptability and feasibility;(Step 6)evaluating the intervention and implementation strategies against theory;and(Step 7)obtaining feedback from early implementers and end-users.Conclusion:Engaging critical stakeholders at multiple ecological levels(organization,team,and athlete)throughout program development and implementation planning support real-world use.The processes and activities described can guide future sports injury-prevention program development and implementation.

The relationship between chronic PTSD,cortical volumetry and white matter microstructure among Australian combat veterans

Background:Posttraumatic stress disorder(PTSD)has been associated with volumetric and white matter microstructural changes among general and veteran populations.However,regions implicated have greatly varied and often conflict between studies,potentially due to confounding comorbidities within samples.This study compared grey matter volume and white matter microstructure among Australian combat veterans with and without a lifetime diagnosis of PTSD,in a homogenous sample assessed for known confounding comorbidities.Methods:Sixty-eight male trauma-exposed veterans(16 PTSD-diagnosed;mean age 69 years)completed a battery of psychometric assessments and underwent magnetic resonance and diffusion tensor imaging.Analyses included tractbased spatial statistics,voxel-wise analyses,diffusion connectome-based group-wise analysis,and volumetric analysis.Results:Significantly smaller grey matter volumes were observed in the left prefrontal cortex(P=0.026),bilateral middle frontal gyrus(P=0.021),and left anterior insula(P=0.048)in the PTSD group compared to controls.Significant negative correlations were found between PTSD symptom severity and fractional anisotropy values in the left corticospinal tract(R^(2)=0.34,P=0.024)and left inferior cerebellar peduncle(R^(2)=0.62,P=0.016).No connectome-based differences in white matter properties were observed.Conclusions:Findings from this study reinforce reports of white matter alterations,as indicated by reduced fractional anisotropy values,in relation to PTSD symptom severity,as well as patterns of reduced volume in the prefrontal cortex.These results contribute to the developing profile of neuroanatomical differences uniquely attributable to veterans who suffer from chronic PTSD.

Effects of site productivity on individual tree maximum basal area growth rates of Eucalyptus pilularis in subtropical Australia

Inventory data were available from 96 plots of even-aged,monoculture,tall-open forests of Eucalyptus pilularis Smith,aged 2-63 years,growing in sub-tropical regions along the east coast of Australia.A model was developed relating the maximum possible stem basal area growth rate of individual trees to their stem basal area.For any tree size,this maximum increased as site productivity increased.However,the size at which this maximum occurred decreased as productivity increased.Much research has shown that,at any stand age,trees of a particular stem basal area are taller on more productive sites than on less productive ones.Taller trees incur greater respiratory costs to ensure maintenance of the photo synthetic capacity of their canopies;this reduces their growth rates.It was concluded that trees with larger basal areas will have the maximum possible growth rate on a less productive site,whilst trees with smaller basal areas will have the maximum possible on a more productive site.The model developed may constitute the first stage of a complete individual tree growth model system to predict wood yields from these forests.

Clinical outcomes for men with positive surgical margins after radical prostatectomy—results from the South Australian Prostate Cancer Clinical Outcomes Collaborative community-based registry

Objective Positive surgical margins(PSMs)after radical prostatectomy(RP)indicate failure of surgery to completely clear cancer.PSMs confer an increased risk of biochemical recurrence(BCR),but how more robust outcomes are affected is unclear.This study investigated factors associated with PSMs following RP and determined their impact on clinical outcomes(BCR,second treatment[radiotherapy and/or androgen deprivation therapy],and prostate cancer-specific mortality[PCSM]).Methods The study cohort included men diagnosed with prostate cancer(pT2-3b/N0/M0)between January 1998 and June 2016 who underwent RP from the South Australian Prostate Cancer Clinical Outcomes Collaborative database.Factors associated with risk of PSMs were identified using Poisson regression.The impact of PSMs on clinical outcomes(BCR,second treatment,and PCSM)was assessed using competing risk regression.Results Of the 2827 eligible participants,28%had PSMs—10%apical,6%bladder neck,17%posterolateral,and 5%at multiple locations.Median follow-up was 9.6 years with 81 deaths from prostate cancer recorded.Likelihood of PSM increased with higher pathological grade and pathological tumor stage,and greater tumour volume,but decreased with increasing surgeon volume(odds ratio[OR]:0.93;95%confidence interval[CI]:0.88-0.98,per 100 previous prostatectomies).PSMs were associated with increased risk of BCR(adjusted sub-distribution hazard ratio[sHR]2.5;95%CI 2.1-3.1)and second treatment(sHR 2.9;95%CI 2.4-3.5).Risk of BCR was increased similarly for each PSM location,but was higher for multiple margin sites.We found no association between PSMs and PCSM.Conclusion Our findings support previous research suggesting that PSMs are not independently associated with PCSM despite strong association with BCR.Reducing PSM rates remains an important objective,given the higher likelihood of secondary treatment with associated comorbidities.

Detection,management,and prevention of diabetes-related foot disease in the Australian context

Diabetes-related foot disease(DFD)is a widely feared complication among people who live with diabetes.In Australia and globally,rates of disability,cardiovascular disease,lower extremity amputation,and mortality are significantly increased in patients with DFD.In order to understand and prevent these outcomes,we analyse the common pathogenetic processes of neuropathy,arterial disease,and infection.The review then summarises important management considerations through the interdisciplinary lens.Using Australian and international guidelines,we offer a stepwise,evidence-based practical approach to the care of patients with DFD.

Clinical utilities and end-user experience of pharmacogenomics:39 mo of clinical implementation experience in an Australian hospital setting

BACKGROUND Pharmacogenomics(PG)testing is under-utilised in Australia.Our research provides Australia-specific data on the perspectives of patients who have had PG testing and those of the clinicians involved in their care,with the aim to inform wider adoption of PG into routine clinical practice.AIM To investigate the frequency of actionable drug gene interactions and assess the perceived utility of PG among patients and clinicians.METHODS We conducted a retrospective audit of PG undertaken by 100 patients at an Australian public hospital genetics service from 2018 to 2021.Via electronic surveys we compared and contrasted the experience,understanding and usage of results between these patients and their clinicians.RESULTS Of 100 patients who had PG,84% were taking prescription medications,of which 67% were taking medications with actionable drug-gene interactions.Twenty-five out of 81 invited patients and 17 out of 89 invited clinicians completed the surveys.Sixty-eight percent of patients understood their PG results and 48% had medications changed following testing.Paired patient-clinician surveys showed patient-perceived utility and experience was positive,contrasting their clinicians’hesitancy on PG adoption who identified insufficient education/training,lack of clinical support,test turnaround time and cost as barriers to adoption.CONCLUSION Our dichotomous findings between the perspectives of our patient and clinician cohorts suggest the uptake of PG is likely to be driven by patients and clinicians need to be prepared to provide information and guidance to their patients.

Relationships among the Monsoon-like Southwest Australian Circulation,the Southern Annular Mode, and Winter Rainfall over Southwest Western Australia

This study examines the relationships among the monsoon-like southwest Australian circulation （SWAC）, the South- ern Annular Mode （SAM）, and southwest Western Australia winter rainfall （SWR）, based on observed rainfall, reanalysis datasets, and the results of numerical modeling. By decomposing the SWAC into two components using a linear model, i.e. the component related to SAM （RSAM） and the component unrelated to SAM （SWACI＊）, we find it is the SWACI＊ that shows a significant influence on SWR. Similarly, it is the component of SAM associated with SWAC that exhibits an impact on SWR, whereas the component unrelated to SAM. A similar result is obtained in terms of the circulation associated with SWAC and the SAM. These facts suggest the SAM plays an indirect role in influencing SWR, and raise the possibility that SWAC acts as a bridge between the SAM and SWR, by which the SAM passes its influences onto SWR. This is due to the fact that the variations of SWAC are closely linked to the thermal contrast between land and sea across the southern Indian Ocean and southwest Australia. By contrast, the SAM does not significantly relate to this thermal structure, particularly for the component unrelated to SWAC. The variations of surface sea temperature over the southern Indian Ocean contribute to the favored rainfall circulation patterns. This finding is supported by the numerical modeling results. The strong coupling between SWAC and SWR may be instrumental for understanding the interactions between SWR and the southern Indian Ocean, and provides another perspective in examining the variations in SWR.

Australian tertiary care outcomes of entecavir monotherapy in treatment naive patients with chronic hepatitis B

AIM:To evaluate the long-term treatment outcomes of entecavir monotherapy in treatment naive patients in an Australian tertiary care setting. METHODS:A retrospective analysis of treatment naive patients receiving entecavir monotherapy through Westmead Hospital was performed.Patients were excluded if they had received previous treatment with another nucleoside or nucleotide analogue,were pregnant or less than 18 years old. RESULTS:Out of 336 patients,163 patients fulfilled the selection criteria.Range of follow up was 3-46 mo (mean 26 mo).134 patients(82.2%)had pre-treatment biopsies,with 26 patients(16.0%)demonstrating F3-4 fibrosis.In total,153 patients(93.9%)achieved at least Partial Virological Suppression(PVS),with 134 patients (82.2%)achieving complete virological suppression. The cumulative CVS and PVS rates at 36 mo were 82.1%and 96.4%,respectively.3 patients(1.8%)failed to achieve PVS,while 5 patients(3.0%)developed virological rebound.128 patients(78.5%)maintained CVS throughout follow up.Predictors of CVS included lower baseline DNA level(P=0.001),hepatitis B virus e antigen negative status(P=0.001)and increasing age at treatment(log rank 0.001).No significant adverse effects were reported necessitating cessation of entecavir. CONCLUSION:Entecavir monotherapy is efficacious and safe in an Australian tertiary care setting.Resistance and rebound rates are very low.This is similar to data from controlled and uncontrolled trials around the world.

Towards a Large-Scale Hydrogen Industry for Australia

1.Introduction As nations around the world seek to reduce carbon dioxide emissions in order to mitigate climate change risks,there has been a resurgence of interest in the use of hydrogen as a zero-emissions energy carrier.Hydrogen can be produced from diverse feedstocks via a range of low-emissions pathways and has broad potential in the process of decarbonization across the energy,transport,and industrial sectors.With an abundance of both renewable and fossil fuel energy resources,a comparatively low national energy demand and excellent existing regional resource trading links,Australia is well positioned to pursue industrial-scale hydrogen production for both domestic and export purposes[1,2].In this paper,we present an overview of the progress at the government,industry,and research levels currently undertaken to enable a large-scale hydrogen industry for Australia.

Plant conservation in Australia:Current directions and future challenges

Australia is a large, old and flat island continent that became isolated following the breakup of the Gondwanan super continent. After more than 40-50 M years of independent evolution, approx. 600,000-700,000 species now call Australia home. More than 21,000 of these species are plants, with at least84% of these being endemic. Plant taxa are protected, conserved and managed under a range of legislation at the State-and Territory-level as well as Federally for matters of national significance. This can create issues of misalignment among threatened species lists but generally there is co-operation among conservation agencies to reduce misalignments and to manage species irrespective of jurisdictional borders. Despite significant investment in programs designed to assist the recovery of Australian biodiversity, threatened plants in particular appear to be continuing to decline. This can be attributed to a range of factors including major threatening processes associated with habitat loss and invasive species,lack of public awareness of the cultural and socio-economic value of plant conservation, and our relatively poor understanding of basic species taxonomy and biology, especially for those species that have specific interactions with pollinators, symbionts and herbivores. A recent shift in Federally-based conservation programs has been to identify 30 key plant species for recovery through the setting of measurable targets, improving the support provided to recovery teams and encouraging industry,business and philanthropy to support conservation actions.

Tracking the Cretaceous transcontinental Ceduna River through Australia:The hafnium isotope record of detrital zircons from offshore southern Australia

The middle-upper Cretaceous Ceduna River system traversed continental Australia from the NE coast to the centre of the southern coast. At its mouth, it formed a vast delta system that is similar in scale to the Niger delta of West Africa. The delta system is composed of two main lobes that represent different phases of delta construction. A recent hypothesis has challenged the traditional idea that both lobes of the delta were derived from a transcontinental river system by suggesting that the upper lobe （Santonian -Maastrichtian） is instead derived from a restricted catchment within southern Australia. Hf isotopic data presented here fingerprint the original source of the upper delta lobe zircons to NE Australia, with data comparing well with similar U-Pb and Lu-Hf isotopic data from the Lachlan Orogen, the New England Orogen, the eastern Musgraves Province and the northern Flinders Ranges. These data do not preclude a model where the lobe is derived from recycled Eromanga Basin sediments during a phase of late Cretaceous inland Australian uplift, but when coupled with reconnaissance low-temperature thermochronometry from the region of the Ceduna River course indicating widespread Triassic-Jurassic exhumation, and comparisons with detrital zircon data from the Winton Formation upstream of any proposed uplift, we suggest that both lobes of the Ceduna Delta are likely to be derived from a transcontinental Ceduna River.

Epidemiology and outcomes of acute liver failure in Australia

BACKGROUND Acute liver failure (ALF) is a life-threatening syndrome with varying aetiologies requiring complex care and multidisciplinary management. Its changing incidence, aetiology and outcomes over the last 16 years in the Australian context remain uncertain. AIM To describe the changing incidence, aetiology and outcomes of ALF in South Eastern Australia. METHODS The database of the Victorian Liver Transplant Unit was interrogated to identify all cases of ALF in adults (> 16 years) in adults hospitalised between January 2002 and December 2017. Overall, 169 patients meeting criteria for ALF were identified. Demographics, aetiology of ALF, rates of transplantation and outcomes were collected for all patients. Transplant free survival and overall survival (OS) were assessed based on survival to discharge from hospital. Results were compared to data from a historical cohort from the same unit from 1988- 2001. RESULTS Paracetamol was the most common aetiology of acute liver failure, accounting for 50% of cases, with an increased incidence compared with the historical cohort (P = 0.046). Viral hepatitis and non-paracetamol drug or toxin induced liver injury accounted for 15% and 10% of cases respectively. Transplant free survival (TFS) improved significantly compared to the historical cohort (52% vs 38%, P = 0.032). TFS was highest in paracetamol toxicity with spontaneous recovery in 72% of cases compared to 31% of non-paracetamol ALF (P < 0.001). Fifty-nine patients were waitlisted for emergency liver transplantation. Nine of these died while waiting for an organ to become available. Forty-two patients (25%) underwent emergency liver transplantation with a 1, 3 and 5 year survival of 81%, 78% and 72% respectively. CONCLUSION Paracetamol toxicity is the most common aetiology of ALF in South-Eastern Australia with a rising incidence over 30 years. TFS has improved, however it remains low in non-paracetamol ALF.