India faces a critical challenge of drug-impaired driving, with over 1500 fatal intoxicated driving crashes reported by the National Crime Records Bureau in 2024. Pilot initiatives in Maharashtra and Kerala show promise but underline the need for a unified legal and technological enforcement framework. This study compares international best practices from the US, UK, and Australia, focusing on detection accuracy, legal admissibility, ethical safeguards, officer training, and public perception. Effective enforcement relies on validated oral fluid testing, rapid toxicology, blockchain-verified legal records, and interoperable cloud systems. The UK's statutory limits and officer training ensure legal clarity; Australia's zero-tolerance model maximises deterrence; the US, despite diverse technologies, faces inconsistency. India's system remains fragmented under the Narcotic Drugs and Psychotropic Substances (NDPS) Act and Motor Vehicles Act, weakened by unvalidated devices, unclear post-2019 laws, poor coordination, and inadequate Article 21 protections. The comparative analysis reveals that while India's current framework suffers from fragmented legal authority, unvalidated detection practices, and weak inter-agency coordination, the US, UK, and Australian models demonstrate complementary strengths in officer training, statutory clarity, technological validation, and institutional oversight—insights that directly inform the design of the proposed “Safe Drive India 1.0” framework. The study proposes a phased “Safe Drive India 1.0” pilot that integrates standardised oral fluid kits, AI-based behavioural impairment analysis with privacy safeguards, blockchain-based evidence management, and coordinated digital enforcement platforms. It emphasises constitutional compliance, procedural transparency, and oversight through a National Drug-Impaired Driving Observatory. This study aims to (i) comparatively examine roadside drug testing laws and enforcement practices in the US, the UK, and Australia; (ii) identify legal, institutional, and evidentiary gaps in India's existing framework governing drug-impaired driving; (iii) evaluate the feasibility of integrating behavioural detection technologies within constitutional and procedural safeguards; and (iv) propose a phased legal–technological–institutional reform model, titled “Safe Drive India 1.0,” tailored to the Indian context. Key contributions include a comparative framework, an integrated legal-technological-ethical model, and policy recommendations for reform, institutional strengthening, and rights-conscious enforcement. This roadmap supports India in developing scientifically validated, legally robust roadside drug testing systems that enhance public safety while upholding individual liberties within its federal structure. Safe Drive India 1.0: A Phased Framework for Roadside Drug TestingThis schematic outlines India's phased framework, drawing from US DRE programs, UK drug limits, and Australian zero-tolerance policies. It addresses challenges and technical and legal features, aiming for outcomes such as less impaired driving, greater judicial confidence, and increased public trust.Source: Author's own creation, based on synthesis of US National Highway Traffic Safety Administration (NHTSA) reports, UK Home Office protocols, Australian Transport Safety Bureau guidelines, and Indian legislative frameworks.

ABSTRACT Immigrants are overrepresented in Canada’s platform economy, yet platform work is not characterized as legitimate and sustainable within employment services shaped by New Public Management (NPM) and austerity policies. This focused ethnography interrogates limitations of NPM and uses a sociotechnical approach to analyse key informant interviews. Three themes are addressed: (1) Out of scope: the limits of current policy, (2) Systemic lags and the unknowns of platform work and (3) Reproducing racial and cultural inequalities in platform work. Findings show that narrow performance metrics, competitive funding and depoliticized environments marginalize platform workers, constrain innovation and suppress culturally responsive advocacy.

Urgent diagnostic imaging and consent: A comparative review of Australian law and policy.

The poor performance of the UK in reducing mortality compared to many other high-income countries following the 2008 financial crisis have been extensively studied, with particular attention to deaths of despair at working ages. However, longer-term trends in the differences in working-age mortality between the UK and peer countries have not been systematically investigated. We compared trends (1990-2019) in age-standardised mortality rates at age 25-49 years in the UK and its constituent parts (England and its 9 standard regions, Wales, Scotland, Northern Ireland) with those of 21 peer countries. Between 1990 and 2019 the UK went from having relatively low mortality rates at age 25-49 years compared to its peers to having one of the highest. This reflects both the better progress made by many other countries in reducing mortality rates as well as an absolute increase in the UK from 2013. Against the counter-factual that rates in the UK followed the median of the comparator countries (2001-2019) this resulted in 3.1million excess years of life lost. The divergence in mortality of the UK with its peers was apparent from 1990 and was observed for all constituent parts of the UK and English regions. External cause mortality accounted for much of the divergence in rates between 2001 and 2019 (69% women; 78% men), as did the overlapping categories of drug-related deaths (42%; 28%) and suicides (17%; 20%). Alcohol-related deaths made only a small contribution. The divergence in mortality rates at ages 25-49 years in the UK from peer countries was already apparent from 1990, pre-dating the austerity policies two decades later. Nevertheless, austerity may well have exacerbated this longer-term deterioration in the UKs position. The fact that all areas of the UK showed deterioration relative to peer countries indicates that this is a national problem.

ABSTRACT Marine climate interventions (mCIs) are ocean-based approaches to support climate change mitigation and/or adaptation. Carbon dioxide removal approaches focus on reducing atmospheric greenhouse gas concentrations through enhancing ocean carbon uptake and storage. Solar radiation management proposals aim to shade and cool vulnerable marine ecosystems. How research is progressed into these two types of mCIs over the coming decade will be critical to enable responsible research and deployment, ensuring that Australian scientists and policymakers can make informed decisions. We consider the technical, social, and governance challenges that must be overcome in the next decade and identify three strategic priorities: (1) intensify research into current and future mCIs; (2) enhance Australia’s monitoring, reporting, and verification capabilities; (3) enact targeted governance and engagement strategies, ensuring the inclusion of affected communities and First Nations in research decisions. These are prerequisites to determine whether, how, and at what scale mCIs may be deployed as part of Australian climate policy.

ABSTRACT Indigenous Librarianship represents a vital yet underdeveloped field in Australia, requiring urgent development as the Australian Library and Information Association (ALIA) formally recognises Indigenous contexts within its professional framework and government policy increasingly acknowledges Indigenous data rights as national priorities. Drawing on Burns, Doyle, Joseph, and Krebs’ (2009) foundational definition of Indigenous Librarianship as a field that unites library practice with Indigenous knowledge systems and methodologies, this paper sets an agenda for Indigenous Librarianship in Australia. Drawing on international Indigenous librarianship scholarship and Australian policy frameworks, we conducted thematic analysis of discussions from the ‘Libraries and their Intersection with Indigenous Knowledges’ dialogue session hosted by ALIA on 15 October 2024. Our findings identified two priority areas: Indigenous Librarianship and Leadership, and Indigenous representation in library collections, systems and services. We argue that establishing a strong foundation for Indigenous Librarianship in Australia requires structural change within institutions and meaningful partnership with Indigenous communities in advancing their aspirations for sovereignty over Indigenous cultural heritage. We propose two purposeful acts: collaborative research to define Indigenous Librarianship in the Australian context, and the establishment of recognised qualifications and career pathways to support Indigenous-led practice that advances self-determination while connecting to international Indigenous librarianship movements.

Poor oral health is a common, but overlooked, issue among people with serious mental ill-health who experience higher rates of dental caries and periodontal disease, leading to increased hospital admissions. Despite its preventability, oral health remains largely absent from Australian mental healthcare policy and service delivery. This two-phase study (1) systematically reviewed oral health integration within Australian oral and mental health policy and competitive funding mechanisms; and (2) qualitatively explored the experiences and prioritising of oral health care by individuals with serious mental ill-health, carers and healthcare professionals. Findings indicated that oral health is rarely prioritised in mental health policy and that it receives only 0.22% of health research funding. Eighteen participants, including health practitioners and individuals with lived experience, were interviewed. Participants described oral health as being largely ignored, personal experiences of inadequate care, financial and psychological barriers to care and systemic neglect. Recommendations for change were identified, including a need for trauma-informed, holistic approaches to care that address social determinants and promote oral health within mental health services. Poor oral health significantly, and negatively, impacts both quality of life and hospital admissions for people with serious mental ill-health, yet remains overlooked in mental health care. Holistic, interdisciplinary approaches - integrating oral health into psychiatric assessments, education and policy - are essential. Early intervention, public health messaging, trauma-informed training and personalised care may improve outcomes. Co-produced interventions and equitable access to services are critical to reducing oral health disparities and enhancing well-being for individuals living with serious mental ill-health.

Extensive critique of the evidence-based policy paradigm has led to new ways of considering the role of evidence; for example Katherine Smith suggests that "ideas" rather than evidence mediate "the relationship between research and policy". In this paper, we used Smith's typology on "ideas" to explore how this can be applied to a case of Australian policy making: a police diversion scheme for simple possession of drugs. We aimed to analyse the idea's journey into policy in one Australian jurisdiction (New South Wales) and assess its fit with the four different types of ideas outlined by Smith. Qualitative case study analysis using data from New South Wales, Australia, over the period 2018 to 2024. Multiple data sources were used: interviews with stakeholders (n = 26), documents [reports, non-governmental organization (NGO) advocacy documents], media and official reports of a Drug Summit. Each data source was searched for narration/text concerned with police diversion in addition to decriminalisation, extracted and analysed against Smith's typology. Features of 'institutionalised ideas' suggest that police diversion is not an institutionalised idea. It appears in this case to be a 'chameleonic idea' inasmuch as its characteristics change and are malleably deployed by different stakeholders with different interests. 'Flexian policy actors' (including police, government officials, advocates and researchers) are able to interpret, transform and shape the meaning of police diversion to suit their interests and commitments. Despite evidence synthesis and expert review recommending police diversion as a second-best option to decriminalisation, it was taken up into policy. We suggest this is because of its chameleonic nature, serving simultaneously at the hands of different policy actors as a roadblock to decriminalisation and as a Trojan horse for decriminalisation reform whilst also obscuring tensions between police diversion and decriminalisation. Applying Katherine Smith's typology of ideas to an Australian police diversion scheme for simple possession of drugs shows that the scheme is not an institutionalised idea but rather a chameleonic idea. Smith's typology of ideas adds another layer to policy process frameworks, enhancing analysis seeking to understand the uptake of ideas into policy.

Abstract Consumer law in Australia has traditionally relied on economic rationales centred on market failure and rational actor theory. However, the rise of behavioural economics has exposed the limitations of these assumptions while raising questions about meaningful autonomy and consumer vulnerability that economic frameworks alone cannot resolve. Human rights principles can meaningfully address these normative gaps by grounding consumer protection in dignity, autonomy, and material security. This article argues for integrating a rights-based approach into Australian consumer law and policy, drawing on Deena Hurwitz’s framework of human rights lawyering to transform relationships between consumers and the marketplace. The article examines how human rights intersect with consumer protection across three dimensions, with particular attention to the right to an adequate standard of living and the right to privacy. First, it explores how substantive protections can be enhanced by incorporating human rights principles into the regulation of key types of consumer transactions, such as essential services and housing. Second, it develops a rights-based approach to consumer remediation, showing how human rights principles inform the interpretation of harm, exercise of regulatory discretion, and design of remedies within Australia’s existing enforcement architecture, particularly for consumers experiencing structural disadvantage. Third, it advocates for transforming legal service delivery and policy development to prioritize dignity, participation, and empowerment. The analysis reveals an existing but underutilized relationship between human rights and Australian consumer law, with substantial scope for embedding rights considerations more fully within the legal framework. This approach not only strengthens consumer protection but also aligns with Australia’s international obligations, helping to ensure consumers experiencing vulnerability and marginalization have their rights respected, protected, and fulfilled.

Governments frequently adopt austerity policies when facing economic crises, yet their long-term consequences for population health remain incompletely understood. This paper examines the impact of large-scale fiscal austerity on infant mortality by exploiting the Troika-led economic adjustment program implemented in Greece beginning in 2010 as a quasi-experimental shock. Using the synthetic control method, we construct a counterfactual for Greece based on OECD and Union for the Mediterranean countries that did not experience austerity of comparable depth or duration. Relative to this counterfactual, Greece experienced a sharp and persistent increase in infant mortality following the onset of austerity. The divergence emerges immediately after 2010, remains statistically significant throughout the post-intervention period, and shows little evidence of full reversion prior to the COVID-19 pandemic. The estimated effect corresponds to an average 43 percent increase in the infant mortality rate. Mortality effects are larger for boys than for girls and are concentrated in the neonatal period. Accounting explicitly for the fertility decline, we estimate approximately 854 excess infant deaths cumulatively from 2010 to 2020. Extensive robustness checks support the findings. The results identify the total effect of austerity and highlight the importance of protecting early-life health during fiscal consolidation.

Reducing stigma and discrimination towards people with mental ill-health is a key priority in Australian mental health policy. Population-based surveys conducted in Australia between 2003 and 2011 showed some improvement in stigmatising attitudes, but also a deterioration in attitudes about dangerousness and unpredictability, particularly in relation to schizophrenia. This study aimed to investigate whether stigmatising attitudes have changed since the 2011 national survey. Two large, nationally representative samples of Australian adults were surveyed in 2011 (n=1967) and 2024 (n=1984). At each time point, participants were presented with vignettes of a person in the early stages of depression or schizophrenia and completed questionnaires about stigmatising attitudes towards the person in the vignette (Personal Stigma Scale) and willingness to interact with them (Social Distance Scale). Using weighted data, logistic regressions assessed change from 2011 to 2024 while controlling for sociodemographic characteristics. Results were considered significant at p<.01. There were significant reductions in endorsement of stigmatising attitudes towards depression and early schizophrenia. Notably, there were large reductions in beliefs about dangerousness (depression 22.5-4.8% and schizophrenia 37.1-18.1%). Conversely, the willingness to interact with a person with depression remained unchanged and had worsened for schizophrenia, with the odds of being unwilling to interact approximately doubling (11.0-26.9% unwilling to make friends and 18.8-33.2% unwilling to work closely with them). The data show mixed findings regarding change in stigma in the Australian population. Despite negative beliefs diminishing over time, this has not translated into greater willingness to interact with people with depression or schizophrenia. Key action is needed on understanding the barriers to interacting with people with mental health conditions and reducing perceptions of unpredictability, particularly for schizophrenia, which remains more highly stigmatised.

The long-term sustainability of Australian agriculture is fundamentally constrained by the capacity, condition, availability, and governance of soil resources. Australian soils are among the oldest and most weathered globally, highly heterogeneous, and often slow or effectively irreversible to recover once degraded. Traditional approaches centred on soil health, while valuable at paddock scale, are insufficient to address national-scale challenges related to spatial variability, data continuity, economic valuation, and policy integration. This paper examines soil security as a policy-relevant framework for supporting more sustainable Australian agriculture. Building on the dimensions of soil security (capacity, condition, capital, connectivity, and codification), we synthesise recent Australian case studies to show how soil security extends beyond soil health to integrate biophysical properties, digital soil infrastructure, socio-economic value, and governance mechanisms. Drawing on recent Australian case studies, this review identifies advances in digital soil mapping, national soil assessments, economic valuation of soil capital, stakeholder connectivity, and emerging policy frameworks, while also identifying persistent gaps in regulation, data standardisation, and institutional coordination. The paper argues that soil security can help operationalise 3-N agriculture—Net-Zero, Nature-Positive, and Nutrient-Balanced systems—by translating sustainability goals into spatially explicit, place-based decisions grounded in soil realities. By explicitly accounting for soil capacity limits, condition trajectories, capital value, information flows, and codified rules, soil security can support more realistic climate mitigation strategies, targeted nature-positive interventions, and durable nutrient security outcomes. We conclude that embedding soil security more explicitly within Australian agricultural research, policy, and governance would strengthen efforts to deliver productive, resilient, and socially legitimate food and fibre systems. Without soil security, sustainability frameworks may remain difficult to operationalise consistently; with soil security, they can be translated more effectively into measurable, place-based, and durable decisions.

To describe the outcomes of cannabis policy debates in Australia from 1967 to 2024. We searched popular media, public reports, parliamentary inquiries and policy documents on cannabis in Australia since the 1960s and examined peer reviewed papers, national survey data and police records of cannabis-related arrests. We describe three phases in the development of Australian cannabis policy: a prolonged debate (1970-1999) about whether state governments should remove criminal penalties for cannabis possession and use; a less prominent but overlapping debate (1994-2016) about whether Australia should legally permit the medical use of cannabis; and a renewed debate (1999-2023) about whether adults should be allowed to use cannabis for non-medical purposes and obtain it from a regulated legal market. The legalisation of medical cannabis in 2016, and the progressive liberalisation of its regulation, appear to have increased public support for adult cannabis legalisation in Australia and encouraged several so far unsuccessful attempts to pass legislation to do so. Criminal penalties for personal possession and use of cannabis have been removed in smaller states and territories of Australia, but the more populous states have diverted persons charged with cannabis use offences into education and treatment. The legalisation of medical cannabis use in 2016 appears to have increased public support for the legalisation of adult use, but there are major political obstacles to this policy change.

More older adults are living with an implantable cardioverter defibrillator (ICD). Deactivation rates for those approaching end-of-life are low, risking undue distress and an undignified death. This scoping review aimed to determine the availability and content of hospital guidance documents regarding ICD deactivation towards end-of-life. Guidelines' databases from two Australian states (Victoria and South Australia) were systematically searched between September 2022 to February 2023, to identify all documents that specified guidance for ICD deactivation at end-of-life. Relevant documents were analysed using a pre-specified data extraction tool. Following screening of 59,662 documents from 94 health services providing acute, aged or palliative care, 11 were included. Most were from public (10, 91%), metropolitan (eight, 73%) health services. Guidance on timing of ICD deactivation discussions was limited; only two (18%) documents advised discussion at time of insertion, one (9%) at generator change and six (55%) during advance care planning discussions. Recommended criteria for ICD deactivation varied: people with a terminal illness (two, 18%), with an active do not resuscitate order (five, 45%), receiving end-of-life care (11, 100%), or at the person's request (seven, 64%). Nine (82%) recommended consent dialogue that deactivation does not cause/hasten death (eight, 73%) or deactivate pacing (eight, 73%), aims to promote a peaceful death (eight, 73%) and that reactivation is possible (eight, 73%). There is a paucity of local health service guidance to support clinicians navigating ICD deactivation at end-of-life.

Young mothers aged 15-24 years face complex maternity health needs, including higher risks of mental health issues, barriers to consistent and non-judgmental care, and increased social isolation and stigma. This study aims to examine how the health care needs of young mothers are represented in Australian maternity policies. A qualitative content analysis. This qualitative content analysis used a Foucauldian approach to analyse seven Australian national and regional Tasmanian maternity and health care policy documents. Data was extracted and placed into predefined categories. The policy documents provided minimal evidence to guide and inform service provision for young mothers who live in regional, rural, and remote areas. The disconnect between global, national, and local policy relating to identified health issues and maternal health care for young mothers was evident. The paucity of specific documented maternal health strategies and service provision for young mothers within national, statewide and local policy is apparent. This has led to poor policy development and guidance for young mothers. Further policy developments targeting service provision and maternal health care for young mothers living in regional, rural and remote areas needs to be addressed.

This paper explores three scenarios for the future evolution of Sino-US ‘strategic competition’ and examines how these trajectories may affect the defense strategy adopted by Australia. It identifies three scenarios for Sino-US relations: the normalization of ‘strategic competition’; the retrenchment of the United States under the second Trump presidency coupled with Chinese resilience under Xi Jinping; and the simultaneous retrenchment of the United States and the stagnation and/or retrenchment of Chinese power. It argues that the first of these scenarios, while presenting significant risks, provides Australia with greater prospects of achieving its core security objectives than the latter two scenarios which confront Australia with the prospect of having its strategic dependency on the United States leveraged by a transactional White House or its economic prosperity undercut by a stagnating China.

Background: Low urgency presentations to emergency departments by those aged 15-24 years are high on the North Coast of Australia. Healthy North Coast Primary Health Network is implementing an initiative to improve access to primary health care and reduce emergency department presentations through an 24/7 nursing triage service that supports centralised bookings into general practice and community pharmacy. Approach: Following data analysis and validation, a series of codesign workshops were undertaken with consumers, GPs, allied health professionals, nurses, Local Health Districts (hospitals), Aboriginal Medical Services, national subject matter experts and digital triage providers, to understand issues and elicit potential solutions for new innovative approaches to support access to primary care. Codesign included ideas generation, consumer testing and an exploration of the feasibility of solutions. Two dominant themes emerged: technology enabled care and improved access to same day care. North Coast Health Connect was launched in late 2022 and is delivered by Amplar Health, the Pharmaceutical Society of Australia, 20 general practices and 20 community pharmacies. The service provides 24/7 digital nurse triage via phone and webchat and a centralised booking system into free general practice and community pharmacy appointments across 12 local government areas, comprising of half a million residents. The service offers a digital integrated distributed model of urgent care where free same day GP appointments can be secured for new patients. Elements of the service are the first of its kind in Australia to date. Results: 25,000 calls and webchats have been made, with 25% of callers diverted from emergency. Over 2,000 general practice and 150 pharmacy consultations have been booked through the centralised booking system. The George Institute for Global Health is independently evaluating the service over the three-year service delivery period. The theory of change continues to evolve. New initiatives are being added to the program as learnings are identified. The evaluators have noted how the program is evolving alongside rapid Australian primary health care policy change brought about due to increasing pressure on acute and primary health services. Implications: Although urgent care may be unplanned, it is highly predictable. North Coast Health Connect is enhancing primary health care access by enabling patients to receive digitally enabled triage wherever they are at their time of need. Empowering patients to identify and prioritise place-based solutions was critical to designing a service that met their needs. Digital triage connected to face to face services can improve access and integration in a fragmented and complex service environment. There is untapped capacity in general practice for same day care, even in locations where wait times are long. It is hoped that other referral points can be added to the service over time and integrated with other urgent care improvements occurring at national and state levels and with the national telephony service healthdirect.

ABSTRACT Student wellbeing has become a prominent focus of education policy globally. Yet despite significant investment and a proliferation of initiatives, indicators of youth wellbeing continue to decline. This raises questions about how wellbeing is conceptualised in policy and why current approaches fall short. This paper critically examines how student wellbeing has been conceptualised and operationalised in Australian national education policies over the past two decades, with particular attention to its convergence with equity agendas. Drawing on an interpretive analysis of 42 national-level documents, the study explores how wellbeing is constructed as a policy problem and positioned within broader social and political priorities. The analysis identifies a persistent tension between expansive definitions, which render wellbeing diffuse and ambiguous, and selective emphases, most notably on cultural wellbeing, that narrow its scope. We argue that wellbeing is a contested policy arena in which ambiguity functions strategically, enabling consensus while producing performative policies that privilege measurable outcomes and obscure structural determinants. Making these trade-offs visible is essential for developing more coherent, balanced and inclusive wellbeing policies.

This paper critically examines the governance of smart glasses in K-12 science education, using science classrooms as a case through which policy design challenges become visible. We position these wearable technologies not only as tools of pedagogical innovation but as governance challenges requiring regulatory attention. The vendors of smart glasses claim that their devices enhance real-time visualisation, support hands-free inquiry, and personalise activity. Yet, despite increased consumer availability and promotion by vendors, smart glasses are inconsistently specified in Australian school policy, unlike other high-stakes sectors such as transportation where wearable device categories are explicitly regulated. Drawing on a comparative analysis of policy associated with Australia’s K-12 mobile phones and the 2023 Victorian Road Rule Amendments “New Driver Distraction Road Rules”, this study proposes that science education requires similar anticipatory governance. Whereas the road safety framework classifies wearable technologies as potential sources of cognitive distraction and provides a stratified risk profile, device-specific restrictions, and enforcement mechanisms, we illustrate a stark contrast to the comparable provisions analysed in educational policy. This analysis identifies governance-relevant risk categories for staff, students, and schools that are not consistently addressed in the education policy texts examined, and that are difficult to standardise through discretionary, school-level interpretation alone. As such, this paper contributes to global conversations on educational justice, digital governance, and the ethical integration of emerging technologies in education.

Newborn screening (NBS) for spinal muscular atrophy (SMA) facilitates early diagnosis and treatment for affected individuals. However, fluid biomarkers that provide early insights into disease activity and outcomes in a neonatal cohort and those unable to access (due to reimbursement criteria) or deferring immediate treatment are lacking. This study evaluated neurofilament light chain (NfL) levels to provide insights into disease activity and outcomes in newborns and children with SMA. This study correlated pretreatment NfL levels in the serum and cerebrospinal fluid (CSF) in a cross-sectional cohort of individuals with SMA against clinical, neurophysiological, molecular genetic variables, and treatment characteristics. Longitudinal NfL levels were evaluated in individuals that did not immediately commence treatment (governed by Australian reimbursement policies) and in those treated with nusinersen monotherapy. Participants included 45 individuals with SMA (age range = 4 days to 42 years). Pretreatment serum NfL (sNfL) in 2 SMN2 copy neonates were significantly higher (2 SMN2, mean[SE] 680.9 [163.7]; ≥ 3 SMN2 146.9 [59.8] pg/ml, p = 0.01), correlating with increasing post-natal age (2 SMN2 r[12] = 0.75, p = 0.005). Combining sNfL and compound muscle action potential (CMAP) with pretreatment CHOP-INTEND in a regression model provided a stronger prediction of motor outcomes for neonates at 2 years (p = 0.02). Pretreatment sNfL in infants with ≥3 SMN2 copies who did not initiate immediate treatment increased despite motor function remaining stable. There is a malignant disease course with active denervation in children with 2 SMN2 copies within the neonatal period. sNfL gives early insights into underlying pathophysiology prior to a clinical phenotype and may expedite access to the initiation of treatment. ANN NEUROL 2026.