Sydney Area Research Articles

Highly inhomogeneous interactions between background climate and urban warming across typical local climate zones in heatwave and non-heatwave days

Abstract Urban heat island (UHI) in conjunction with heatwave (HW) leads to exacerbation of thermal stress in urban areas. Prior research on UHI and HW has predominantly concentrated on examining the thermal conditions at the surface and near-surface, with few investigations extending to the radiative and dynamical interactions of UHI and HW, particularly with a focus on the inhomogeneities across local climate zones (LCZs). Here, we analyse the temperature disparity between HW and non-HW conditions across LCZs in the Sydney area by quantifying the contributions of individual radiative and dynamical processes using the coupled surface-atmosphere climate feedback-response analysis method (CFRAM). Three moist HW events in 2017, 2019, and 2020 are simulated using the Weather Research and Forecasting (WRF) model coupled with the single-layer urban canopy model (SLUCM). It is found that the maximum surface and 900 hPa temperature difference between HW and non-HW days may reach up to 10 K, with the increased net solar radiation during HWs being comparable to the typical level of anthropogenic heat flux in urban areas. It is also found that the reduction of clouds, the presence of vapour, and the increase of sensible heat contribute to the warming effect to various degrees, with the contribution of clouds being the most dominant. Conversely, the generation of dry convection and the increase of latent heat flux lead to cooling effects, with the latter being more dominant and capable of causing up to 10 K surface temperature difference between LCZ1 (compact high-rise) and LCZ9 (sparsely built). The differences in the contributions of climate feedback processes across different LCZs become more evident during more severe and humid HWs. These findings underscore the necessity of implementing LCZ-tailored heat mitigation strategies.

Identifying common conditions of pregnancy for women, including women from culturally and linguistically diverse backgrounds, at an Australian hospital: A survey

ProblemResearch that explores the prevalence and range of treatments sought for common conditions of pregnancy is limited, particularly for culturally and linguistically diverse (CALD) women. BackgroundDuring pregnancy, physical and psychological conditions affect participation in the home, workplace, and community. However, treatment options may be limited, particularly for CALD women. AimTo establish the prevalence of physical and psychological conditions experienced during pregnancy, and ascertain treatments options sought by women attending a hospital in a multicultural area of Sydney (Australia), including medical, allied health and complementary medicines. MethodsA cross-sectional survey of pregnant women attending an outpatient antenatal clinic (July-December 2019). The survey was conducted in the most common language groups, English, Arabic and traditional Chinese (inclusive of Cantonese and Mandarin). Univariate and bivariate analysis was conducted. FindingsA total of 154 women participated. CALD women most frequently reported lower-back pain (41.5 %), constipation (34 %), nausea (28 %), and anxiety (7.5 %) . English-speaking women reported lower-back pain (43.5 %), difficulty sleeping (37 %), severe tiredness (35 %), and anxiety (15.8 %), and were more likely to seek treatment (p < 0.01). Practitioners most consulted were massage therapists, physiotherapists, community nurses and counsellors. Doctors were least consulted overall. ConclusionsPregnant women most commonly reported lower-back pain, however conditions were reported and treated less frequently by CALD women, including psychological conditions. It is vital that women can access hospital-based treatment for common physical and psychological conditions of pregnancy. The implication for clinicians is to establish routine asking, adequate care provision and referral to culturally safe and appropriate services.

Bus arrival and departure time updates in the Greater Sydney Area

Public Transport Authorities generate large quantities of data as part of their daily operations, including vehicle positions, arrival times, and dynamic routing options. This information is essential feedback into the system for planning routes and timetables, modelling passenger demand growth and evaluating operational performance. The General Transit Feed Specification (GTFS) is a data format that allows public transport data to be consumed by a wide variety of software applications. There are barriers to widespread consumption of GTFS data related to location-specific data extensions, non-human-readable formats and error cleaning. This paper describes a flexible dataset of actual bus arrivals and departure times created with a pipeline for GTFS realtime feeds designed to address these challenges. The paper describes the pipeline, verifies the quality of the data and presents an output of 25 months of actual bus arrival and departure times for Sydney, Australia. We conclude by discussing relevance to researchers and practitioners of the pipeline outputs in general and the sample data specifically.

Edgy Conservatives? The Late-Twentieth Century Rise of the Mortgage Belt in Australian Electoral Politics

The expansion of home ownership in Australia in the second half of the twentieth century was accompanied by a new vernacular geography – the mortgage belt. From the 1970s, such belts around major cities were frequently said to be crucial to federal and state elections. This article examines where political commentary located mortgage belt areas in Sydney and Melbourne and finds that it encompassed a diverse range of places often, but not always, on their urban edges. Their residents were believed to be particularly sensitive about interest rates but also other risks. While the politics of outer suburbia has often been posited as conservative, it is argued that such areas were electorally nuanced and reflected longstanding contingency in Australia around expectations of government that stands in contrast to conservatism elsewhere. These areas also highlight the continuing significance of popular access to property ownership as a theme of Australian political history.

A survey investigating owner perceptions and management of firework-associated fear in dogs in the Greater Sydney area.

To investigate the prevalence of firework-associated fear in dogs in Sydney, owner perception of their dog's response to fireworks, perceived efficacy of interventions to manage fearful behaviours and the frequency of dog owners seeking professional advice for these behaviours. Dog owners in the Greater Sydney area were invited to complete an anonymous online survey. From 387 valid responses, 44.4% (171 of 385) reported their dogs were fearful of fireworks. The most common fear-related behaviour was seeking an owner or caretaker (120 of 161, 74.5%). Most owners responded by bringing their dog inside or trying to comfort or reassure their dog. Only 22.5% of owners sought professional advice for their dog's fear of fireworks, but of these, 65.5% considered that advice to be effective. Source and breed group were significantly associated with fear of fireworks (P = 0.011, P = 0.036 respectively). Fear of fireworks was also significantly associated with fear of thunder (P < 0.0001), gunshots (P < 0.0001) and vehicles (P = 0.0009). Fear of fireworks and other loud noises negatively impacts canine welfare, yet only a small percentage of owners sought professional advice. There is scope for veterinarians to educate owners and raise awareness about the identification and management of noise-associated fear and reduce the risk of escalation of fearful behaviours.

Translation and cross-cultural adaptation of Osteoporosis Knowledge Assessment Tool (OKAT) for Chinese populations in Australia

SummaryThe increased prevalence of osteoporosis among Chinese-speaking communities in Australia deemed it necessary to have a culturally appropriate tool for assessing knowledge. This study describes the cultural adaption of the validated Osteoporosis Knowledge Assessment Tool (OKAT). The adapted tool is readable and understandable for diverse Chinese-speaking communities.PurposeWith an expected increasing prevalence of osteoporosis among Chinese-speaking communities in Australia, a cross-culturally adapted questionnaire is necessary to assess knowledge levels among the group. We aimed to cross-culturally adapt the Osteoporosis Knowledge Assessment Tool (OKAT) questionnaire for Chinese-speaking populations in Australia.MethodsCross-cultural adaptation guidelines were employed to culturally adapt the OKAT to simplified Chinese. This involved translation, revision, retroversion, and expert discussion before finalizing the Chinese version of OKAT. The participants were recruited through convenience sampling from a cohort of Chinese-speaking populations who attended a bone health promotion program. The adapted questionnaire was piloted with Chinese-speaking communities in the Greater Western Sydney area for face and content validity. The adapted questionnaire was compared with the original version for response agreement using Cohen’s kappa goodness of fit. The face validity of the adapted tool was analysed through a binary scale rating for readability and understandability.ResultsThe cross-culturally adapted version of OKAT has a 71.8% total response agreement with the original version of OKAT. The cross-culturally adapted OKAT yielded higher total scores than the translated version. The cross-culturally adapted tool had a good face and content validity.ConclusionThe cross-culturally adapted version of OKAT improves the overall readability and understandability of the questionnaire among Chinese-speaking populations in Australia.

COVID-19 lockdown impacts on eating patterns and lifestyle behaviours of residents of Western Sydney: Fact not Fiction

Lockdown measures imposed in Australia to slow the transmission of COVID-19 protected most Australians from the virus(1). In some areas in NSW, specifically Western Sydney areas, more stringent lockdown regulations were implemented from July to September 2021, referred to as local governmental areas (LGAs) of concern(2). Preliminary evidence showed that people’s lifestyle such as dietary and physical activity behaviours and mental health during lockdown were altered from before lockdown(3). However, intermediate and longer-term impacts on nutrition and physical health are unclear, especially in LGAs of concern. We aimed to examine the impacts of the lockdown on nutritional behaviour of residents of Western Sydney. Mixed methods were employed including quantitative surveys such as ASA-24 and qualitative focus groups, using R software for quantitative analysis. Data was collected from 523 survey participants in addition to 42 focus group participants. The sample was representative of age, gender, county of birth and area of residence. Sixty-two percent reported decreases in their physical activity level post-lockdown compared with pre-lockdown, and 15% reported increases in their physical activity level post-lockdown compared with pre-lockdown. Sixty-nine percent reported increases in their physical activity levels post-lockdown compared with during the lockdown, and 12% reported decreases. Self-reported weight increased in 50% of the participants post-lockdown compared with pre-lockdown and decreased in 13% of the participants. Forty percent self-reported a decrease in their body weight post-lockdown compared with during the lockdown while 16% self-reported an increase in their body weight post-lockdown compared with during the lockdown. Food security status was reported as much worse in seven percent of the participants post-lockdown compared with pre-lockdown while being unvaried in 93% of the participants. Food security status remained unvaried post-lockdown compared with during the lockdown in 93% of the participants but much better in six percent. Eating habits were self-reported as much worse by 52% of the participants post-lockdown compared with pre-lockdown and much better by nine percent. Forty-eight percent of the participants self-reported their eating habits as much better post-lockdown compared with during the lockdown and 10% as much worse. COVID-19 lockdown negatively impacted eating behaviours, physical activity and body weight of Western Sydney residents with minimal impacts on food security. Further analyses are required to examine the associations between eating patterns, physical activity, body weight and food security and age, gender, country of birth and area of residence of participants. These findings can later be used to draft policies that can be put in practice in case of future pandemics in Australia, or in the case of other common natural disasters, such as bushfires and floods.

Epidemiology, Clinical Signs, and Risk Factors Associated with Theileriosis in Australian Cattle (2006-2022).

For over a decade, bovine anaemia caused by Theileria orientalis Ikeda has been a significant disease in the Australian cattle industry. In this study, we conducted a spatial and temporal analysis of theileriosis in Australia using historic data from submissions to the New South Wales Department of Primary Industries (NSW DPI) from 2006 to 2022, where herd history, clinical signs, and PCR results were available. Since the first detections of bovine theileriosis in the Sydney area in 2006, the disease spread north- and southward and is now endemic to the southeast coast of Australia, closely mirroring the distribution of the principal vector Haemaphysalis longicornis. Across all years, the prevalence of the Ikeda genotype was 88%, while the prevalence of the benign Chitose and Buffeli genotypes was 55% and 38%, respectively. The majority of submissions were from beef cattle in coastal NSW, with anaemia, fever, jaundice, abortion, and lethargy the most frequently reported clinical signs. Transportation was identified as the major risk factor for disease. Until 2015, the majority of cases were reported in adult cattle, while in later years, calves made up the majority of cases, most likely due to the widespread acquisition of immunity in adults. Calves were significantly more likely to present with diarrhoea, lethargy, and anaemia, and to suffer mortality, while adults were significantly more likely to present with jaundice. Instances of abortion were observed to be significantly associated with beef cattle. The relationship between the level of parasitaemia and anaemia revealed a strong negative correlation for all animals examined.

Simplified excavation-induced lateral displacement assessment in Sydney area

Excavations change the stress state of the in-situ ground. The altered stress state causes lateral and vertical displacement in the buildings and structures adjacent to the excavation. In areas like the Sydney region, tectonic locked-in horizontal stresses at shallow depth exceed the vertical stress and the high in-situ horizontal stresses cause possibility of excavation-induced displacement in good quality rocks (e.g., Hawkesbury Sandstone Class I, II, and III). This paper estimates the magnitude and shape of the excavation-induced displacement trough along the excavation edge in Hawkesbury Sandstone. A parametric study was undertaken using three-dimensional finite element analysis to estimate the maximum lateral excavation-induced displacement as well as the lateral displacement trough as a function of the ground type, excavation depth and width, and principal in-situ stress orientation. The results were verified by comparing with monitoring results published for Sydney Sandstone.

A triple whammy: how urban heat, housing unaffordability and disadvantage affect urban spatial resilience

Climate change generates multiple negative impacts for cities, such as the urban heat island effect. Social stresses, including social disadvantage and housing unaffordability, compound the poor living conditions of urban residents and make our cities less resilient. This paper considers a climate event (urban heat) and social stresses (housing affordability and urban disadvantage) to explore urban resilience in Sydney. We draw on a framework for building urban climate resilience, incorporating facets of urban resilience, social stresses that amplify crises, and solutions that strengthen individuals and communities with coping abilities to withstand climate events. The study diverges from aggregate city-level analyses that hide small-area differences in climate impacts and vulnerability. The findings reveal the spatiality of these natural and social impacts, identifying 11 critical areas in Sydney impacted by the highest levels of urban heat and urban disadvantage, and two critical areas impacted by the highest levels of urban heat and housing unaffordability. We highlight the importance of context-based approaches and place-based policies to address climate risks and social vulnerabilities on the path toward creating more resilient cities.

Detection of tick-borne bacterial DNA (Rickettsia sp.) in reptile ticks Amblyomma moreliae from New South Wales, Australia

Ticks are major arthropod vectors of disease, transmitting tick-borne pathogens during blood meal episodes. Rickettsia spp. and Borrelia spp. are two tick-borne pathogens of zoonotic concern previously identified in DNA isolates from the tick genera Amblyomma and Bothriocroton associated with reptilian hosts in Australia. Some reports suggest that these reptile ticks bite and attach to humans via accidental parasitism and transmit disease, with the tick Bothriocroton hydrosauri known to transmit Rickettsia honei or Flinders Island Spotted Fever Rickettsia to humans. This descriptive study aims to identify the ticks collected from wild reptiles submitted to veterinary clinics and captured by snake rescuers from New South Wales (NSW), Australia, and detect the presence of tick-borne bacterial DNA using quantitative polymerase chain reaction (qPCR) to detect Rickettsia spp. and Bartonella spp. and conventional nested-PCR to detect Borrelia spp. Morphological identification revealed ticks removed from one eastern blue-tongued lizard (Tiliqua scincoides scincoides) from North-Eastern NSW (Lismore), one eastern blue-tongued lizard from the Greater Sydney area (Canley Heights), one diamond python (Morelia spilota spilota) from the Greater Sydney area (Woronora Heights) and one red-bellied black snake (Pseudechis porphyriacus) from the Greater Sydney Area (Cronulla) in New South Wales were Amblyomma moreliae. No ticks were positive for Bartonella spp. and Borrelia spp. DNA using real-time PCR targeting ssrA gene and nested PCR targeting Borrelia-specific 16S rRNA gene, respectively. Real-time PCR targeting gltA, ompA, ompB and 17kDa gene of Rickettsia spp. revealed 14 out of 16 ticks were positive. The undescribed Rickettsia sp. DNA was identical to that previously recovered from reptile ticks in Australia and closely related to Rickettsia tamurae and Rickettsia monacensis, both of which are aetiologic pathogens of the Spotted Fever Group Rickettsiosis (SFGR). These results accentuate the ongoing need for increased study efforts to understand zoonotic potential of bacteria from reptile ticks and the tick-reptile-human relationship.

A simple agent-based model for planning for bicycling: Simulation of bicyclists' movements in urban environments

Bicycling can improve the sustainability and liveability of cities, many of which desperately require better active transport infrastructure. Urban and transport planners need to examine how improvements in infrastructure change bicyclists' behaviour. With this knowledge, investment in bicycling networks can be more efficient and encourage the use of bicycling for transportation. This study developed a simple Agent-Based Model (ABM) to simulate bicyclists' movements in response to the built environment and road network characteristics in the City of Penrith, in the Greater Sydney Area, Australia. In this case study, the GAMA platform was used to build the ABM and Strava and Riderlog data were used to calibrate and validate the model. The model outputs give insights into bicyclist movements through the road network. The incorporated built environment characteristics include the type of bicycling infrastructure, tree canopy, slope, land use mix, and vehicle traffic. These choice factors also allowed the computation of rider levels of comfort and safety on each trip. Potential refinements of the model include additional bicycling behaviour factors (such as aesthetic preferences), and bicyclists' interactions with each other and other modes of transport.

The gendered violence of injecting-related stigma among relatively affluent, suburban women who inject drugs.

In honouring the legacy of Jude Byrne's life-long advocacy for women and mothers who use drugs, this paper presents a case study of a group of women about whom we know little about and hear even less from: women who inject drugs in relatively affluent suburbs. Based on a 2020 qualitative study of people who inject drugs in an affluent area of Sydney known as 'The Beaches', we use in-depth interview data to thematically explore the lived experiences of gendered stigma among women who inject drugs. Even when women occupy the 'ideal' social position in terms of class (middle-class) and race (White) they remain subject to harmful forms of gendered stigma related to injecting drug use. Participants had internalised negative attitudes around injection drug use as a form of failed femininity and, despite being part of 'good' families and neighbourhoods, participants experienced forced child removal. Taking the lead from feminist intersectionality scholarship, our data illustrate how stigma and discrimination act as a form of structural violence against women who inject drugs in affluent communities. While the social relations of gender provide some degree of protection by 'performing proximity to Whiteness', gendered stigma and violence persist.

Assessing the combined effects of local climate and mounting configuration on the electrical and thermal performance of photovoltaic systems. Application to the greater Sydney area

Extremely high urban temperatures adversely affect photovoltaic (PV) system performance. Accurate PV cell temperature assessment relies on local weather conditions, exacerbated by urban overheating, often overlooked by inadequate temperature models and non-local data. This study investigates the electrical and thermal PV performance, considering mounting configurations and local conditions. Data from ten weather stations in Greater Sydney (NSW) during 2016–2017, including a hot summer, are used. The Sandia model is used to predict cell temperatures and power output for four mounting configurations, from open rack to building-integrated (BIPV). A PV thermal model is implemented to analyse daytime convection, crucial for understanding PV impact on local climate. Results show peak cell temperatures of 60 °C (open rack) to over 90 °C (BIPV), causing up to 50% power loss and 11% reduction in monthly performance ratio. Local climate variations impact PV energy output up to 6%, with mounting configuration effects up to 11%. Daytime convective flux averages 150–180 W/m2, peaking at 700 W/m2. Convective release varies up to 22% based on local climate, generally higher for open rack than close roof mounts, with potential reversals under low wind speed conditions. These findings can improve the knowledge of PV performances in urban areas facing extreme temperatures.

Creating a dataset of historic roads in Sydney from scanned maps

This study creates a historic dataset of road opening dates in Sydney. A method was developed for map digitization to extract spatial data from historic maps and place them in a collective vector layer. The method includes extensive georeferencing of the maps, as well as editing and cleaning the maps through raster and vector analysis. Preferred methods for map digitization used in the project were identified. For a considerable area of Sydney, in which approximately 52000 road links were included, almost half of the links were identified with an open date by the start of the twentieth century. A further half of these links were confined to opening within a thirty-year period. The project has established a strong foundation for a historic road dataset for Sydney. It has also outlined methods and procedures that can be followed to progress the dataset further.

The inheritance and repetition of colonial practices of dispossession

State processes of land dispossession rely on multiple modes of power such as domination, legitimisation, pacification, and deceit to achieve their aims. This article analyses how governments in Australia have drawn on these varied forms to redevelop inner city areas in Sydney which are important to Indigenous communities. It analyses three redevelopment practices that targeted the suburbs of Redfern and Waterloo between 2005 and 2019. First, domineering planning structures used to marginalise Indigenous housing in Redfern. Second, racist tropes that have worked to legitimise this authoritarian approach and the resulting dispossession. Third, community consultations, that attempted to placate residents impacted by redevelopment, with culturally inclusive participation, but that maintained a deceitful silence on the question of colonisation. The article shows how authoritarian state planning, racialised legitimisation, and colonial pacification and deceit wielded in Redfern and Waterloo, are directly inherited from and/or reproduce historic colonial nation and city building agendas. On this basis, the article claims that settler colonialism can be understood as a self-perpetuating process, where practices of dispossession, developed at a given time, can set precedent for and be reworked into later programmes of land dispossession.

Variation in pre-nasal raising of TRAP in Australian English

Phonetically raised and fronted realizations of pre-nasal TRAP are increasingly common in Australian English with previous research suggesting that greater raising may be associated with speakers from monolingual English-speaking backgrounds. Here, we present the results of an acoustic examination of pre-nasal TRAP raising (which we refer to as HAND) in a corpus of speech recordings from 183 adolescent speakers (aged 15–18) from five areas of Sydney that differ according to levels of linguistic diversity and the major heritage languages spoken (English-only, Arabic, Chinese, Indian, and Vietnamese). We extracted 1971 items containing the HAND vowel, along with 1807 items of pre-obstruent TRAP and 540 items of pre-obstruent DRESS. We calculated the degree of raising in HAND relative to pre-obstruent TRAP and DRESS through Euclidean Distance. The results show increased HAND raising in female speakers, although less raising is seen in the area with the highest proportion of Vietnamese language background speakers. Among male speakers the greatest incidence of raising is seen in the area with the lowest level of linguistic diversity (i.e., highest level of English-speaking background). These results suggest that HAND raising is associated with English-speaking backgrounds, but also that this is a change led by females.

Redeveloping the compact city: the challenges of strata collective sales

PurposeHigh-density development requires large land parcels, but fragmented land ownership can impede redevelopment. While earlier compact city development in Sydney occurred on large-scale brownfield sites, redeveloping and re-amalgamating older strata-titled properties is now integral to further densification. The purpose of this study is to examine collective sales activity in one Sydney suburb where multiple strata-titled redevelopments and re-amalgamations have been attempted. The authors explore how owners navigate the process of selling collectively, focusing on their experience of legislation introduced to facilitate this process, the Strata Schemes Development Act 2015 [New South Wales (NSW)].Design/methodology/approachBy reviewing sales listings, development applications and media coverage, and interviewing owners, lawyers and estate agents, the authors map out collective sale activity in a case study area in Sydney’s northwest.FindingsStrata collective sales are slow and difficult to complete, even when planning and market drivers align. Owners find the Strata Scheme Development Act 2015 (NSW) difficult to navigate and it has not prevented strategic blocking attempts by competing developers. The long timelines required to organise collective sales can result in failure if the market shifts in the interim. Nonetheless, owners remain interested in selling collectively.Originality/valueThis case study is important for understanding the barriers to redevelopment to achieve a more compact city. It highlights lessons for other jurisdictions considering similar legislative changes. It also suggests that legislative change alone is insufficient to resolve the planning challenges created by hyper-fragmentation of land through strata-title development.

Improving Medication Safety in Cancer Services for Ethnic Minority Consumers: Protocol for a Pilot Feasibility and Acceptability Study of a Co-Designed Consumer Engagement Intervention.

People from ethnic minorities are often exposed to unsafe care contributing to poorer health care outcomes. Medication safety is a high-risk area requiring intervention to improve care outcomes. Using an adapted, experience-based co-design process with cancer service staff and patients from ethnic minorities, a medication communication tool was created: Making it Meaningful (MiM). We aim to test whether the MiM tool is feasible and acceptable for use with ethnic minority consumers in cancer services in Australia. A single site, controlled before and after this pilot study, will be used. Patients from Mandarin- and Russian-speaking backgrounds are eligible for inclusion. In total, 40 patients from these cultural backgrounds will be recruited and stratified by language to the intervention and control groups, with 20 participants in the intervention and 20 in the control group. Further, 4 health practitioners will be recruited and trained to use the MiM. Clinicians providing care for patients in the intervention will use the MiM during their usual appointment while providing medication communication using standard care processes for the control group. Telephone surveys will be conducted with participants at 3 time points, T1 before the intervention, T2 1 week post intervention, and T3 1 month post intervention, to assess knowledge and self-efficacy in medication management, perceived usability, and acceptability of the MiM. Qualitative interviews with clinicians who have used the MiM will be conducted 1 month postintervention to explore their perceptions of MiM feasibility and acceptability. Ethical approval for this research has been provided by the South Eastern Sydney Area Health Human Research Ethics Committee (HRECXXX). Bilingual field-workers, 1 Mandarin-speaking and 1 Russian-speaking, are contacting eligible patients to enroll. It is anticipated that recruitment will be completed by October 2023, with data collection completed by December 2023. Using experience-based co-design, we identified communication about medication, particularly between appointments, as a key issue impacting the safety of care for patients from ethnic minorities accessing cancer services. Increasing consumer engagement in medication management was identified as a strategy to reduce medication safety problems in cancer care; the MiM strategy was developed to address this issue. It is anticipated that by using the MiM, patient knowledge about prescribed medications and confidence in medication management will increase. Evidence from the pilot study will be used to inform a full-scale trial of the MiM tool with a range of ethnic minority communities accessing cancer services. A full-scale trial will seek to determine whether the MiM intervention is effective in knowledge and confidence about medication management, but also whether this improves patient outcomes in cancer care. Australian New Zealand Clinical Trials ACTRN12622001260718p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384658&isReview=true. DERR1-10.2196/49902.

Causes of hypercapnic respiratory failure: a population-based case-control study

ObjectiveThere are no population-based data on the relative importance of specific causes of hypercapnic respiratory failure (HRF). We sought to quantify the associations between hospitalisation with HRF and potential antecedent causes including chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and congestive cardiac failure. We used data on the prevalence of these conditions to estimate the population attributable fraction for each cause.MethodsA case–control study was conducted among residents aged ≥ 40 years from the Liverpool local government area in Sydney, Australia. Cases were identified from hospital records based on PaCO2 > 45 mmHg. Controls were randomly selected from the study population using a cluster sampling design. We collected self-reported data on medication use and performed spirometry, limited-channel sleep studies, venous sampling for N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and sniff nasal inspiratory pressure (SNIP) measurements. Logistic regression analyses were performed using directed acyclic graphs to identify covariates.ResultsWe recruited 42 cases and 105 controls. HRF was strongly associated with post-bronchodilator airflow obstruction, elevated NT-proBNP levels, reduced SNIP measurements and self-reported opioid medication use. There were no differences in the apnoea-hypopnea index or oxygen desaturation index between groups. COPD had the highest population attributable fraction (42%, 95% confidence interval 18% to 59%).ConclusionsCOPD, congestive cardiac failure, and self-reported use of opioid medications, but not obstructive sleep apnea, are important causes of HRF among adults over 40 years old. No single cause accounts for the majority of cases based on the population attributable fraction.