Journal articles on the topic 'Pediatric nursing Victoria Melbourne'

Background: Nurses played a critical role in providing care for patients throughout the COVID-19 pandemic. Aim: This study aimed to explore perspectives of Australian palliative care nurses regarding the impact of COVID-19 on the provision of care for patients with advanced illness, or at the end of life. Methods: The authors conducted a survey of palliative care nurses in ward- and consultation-based roles at a metropolitan health service in Victoria, Australia. Findings: A total of 24 out of 39 nurses completed the survey. Responses included strong themes of fear of COVID-19 and sadness about separating dying patients from their families. Conclusion: Delivery of palliative care changed at an individual and service level. Importantly, there were strong themes of adapting to change and ‘soldiering on’ with the core business of palliative care.

Background Invasive group A streptococcal disease (IGAS) carries significant morbidity and mortality in children. Fluctuations in disease incidence are well documented. However, the modulating factors that contribute to these changes remain unclear. Prospective monitoring of IGAS cases in Victoria, Australia, showed an increased number of cases in 2017, coinciding with a peak of influenza illness. Methods Children identified to have IGAS are prospectively monitored in Melbourne through a disease surveillance network. Data on their presentation, investigations, and clinical course are collected. An increased number of cases identified between June 1, 2017, and October 31, 2017, have been retrospectively analyzed. Results We identified 22 cases of pediatric IGAS during the study period. Increased case detection occurred during a period of increased influenza disease. Of 11 children in our cohort who underwent respiratory viral testing, 4 were confirmed to have concurrent respiratory tract illnesses, and 2 were confirmed to have influenza.

The care of people living with HIV/AIDS in the home and community can be complex and challenging, requiring high levels of knowledge, skill, preparedness and, importantly, the ability to engage with people belonging to marginalised groups. In 2003, the Royal District Nursing Service (RDNS) HIV/AIDS Team in Victoria, Australia, developed the new role of HIV Resource Nurse at two RDNS centres in Melbourne serving high numbers of people living with HIV/AIDS. Drawing from two case studies and interviews with two HIV Resource Nurses from one of the centres, this paper describes this practice innovation. Benefits (including a positive impact on client engagement with services, client care, relationships with other health care workers and job satisfaction) are outlined, along with challenges in the implementation and evolution of the role. Strategies to sustain and develop the HIV Resource Nurse role are proposed.

Over the past decade, several Australian universities have offered a double degree in nursing and paramedicine. Mainstream employment models that facilitate integrated graduate practice in both nursing and paramedicine are currently lacking. The aim of the present study was to detail the development of the Interprofessional Graduate Program (IPG), the industrial and professional issues that required solutions, outcomes from the first pilot IPG group and future directions. The IPG was an 18-month program during which participants rotated between graduate nursing experience in emergency nursing at Northern Health, Melbourne, Australia and graduate paramedic experience with Ambulance Victoria. The first IPG with 10 participants ran from January 2011 to August 2012. A survey completed by nine of the 10 participants in March 2014 showed that all nine participants nominated Ambulance Victoria as their main employer and five participants were working casual shifts in nursing. Alternative graduate programs that span two health disciplines are feasible but hampered by rigid industrial relations structures and professional ideologies. Despite a ‘purpose built’ graduate program that spanned two disciplines, traditional organisational structures still hamper double-degree graduates using all of skills to full capacity, and force the selection of one dominant profession. What is known about the topic? There are no employment models that facilitate integrated graduate practice in both nursing and paramedicine. The lack of innovative employment models for double-degree graduates means that current graduate program structures force double-degree graduates to practice in one discipline, negating the intent of a double degree. What does this paper add? This is the first time that a graduate program specifically designed for double-degree graduates with qualifications as Registered Nurses and Paramedics has been developed, delivered and evaluated. This paper confirms that graduate programs spanning two health disciplines are feasible. What are the implications for practitioners? Even with a graduate program specifically designed to span nursing and paramedicine, traditional organisational structures still hamper double-degree graduates using all their skills to full capacity, and force the selection of one dominant profession.

Background Responsibilities of critical care nurses for management of mechanical ventilation may differ among countries. Organizational interventions, including weaning protocols, may have a variable impact in settings that differ in nursing autonomy and interdisciplinary collaboration. Objective To characterize the role of Australian critical care nurses in the management of mechanical ventilation. Methods A 3-month, prospective cohort study was performed. All clinical decisions related to mechanical ventilation in a 24-bed, combined medical-surgical adult intensive care unit at the Royal Melbourne Hospital, a university-affiliated teaching hospital in Melbourne, Victoria, Australia, were determined. Results Of 474 patients admitted during the 81-day study period, 319 (67%) received mechanical ventilation. Death occurred in 12.5% (40/319) of patients. Median durations of mechanical ventilation and intensive care stay were 0.9 and 1.9 days, respectively. A total of 3986 ventilation and weaning decisions (defined as any adjustment to ventilator settings, including mode change; rate or pressure support adjustment; and titration of tidal volume, positive end-expiratory pressure, or fraction of inspired oxygen) were made. Of these, 2538 decisions (64%) were made by nurses alone, 693 (17%) by medical staff, and 755 (19%) by nurses and staff in collaboration. Decisions made exclusively by nurses were less common for patients with predominantly respiratory disease or multiple organ dysfunction than for other patients. Conclusions In this unit, critical care nurses have high levels of responsibility for, and autonomy in, the management of mechanical ventilation and weaning. Revalidation of protocols for ventilation practices in other clinical contexts may be needed.

ObjectiveThe aim of this study was to identify the challenges anticipated by clinical staff in two Melbourne health services in relation to the legalisation of voluntary assisted dying in Victoria, Australia. MethodsA qualitative approach was used to investigate perceived challenges for clinicians. Data were collected after the law had passed but before the start date for voluntary assisted dying in Victoria. This work is part of a larger mixed-methods anonymous online survey about Victorian clinicians’ views on voluntary assisted dying. Five open-ended questions were included in order to gather text data from a large number of clinicians in diverse roles. Participants included medical, nursing and allied health staff from two services, one a metropolitan tertiary referral health service (Service 1) and the other a major metropolitan health service (Service 2). The data were analysed thematically using qualitative description. ResultsIn all, 1086 staff provided responses to one or more qualitative questions: 774 from Service 1 and 312 from Service 2. Clinicians anticipated a range of challenges, which included burdens for staff, such as emotional toll, workload and increased conflict with colleagues, patients and families. Challenges regarding organisational culture, the logistics of delivering voluntary assisted dying under the specific Victorian law and how voluntary assisted dying would fit within the hospital’s overall work were also raised. ConclusionsThe legalisation of voluntary assisted dying is anticipated to create a range of challenges for all types of clinicians in the hospital setting. Clinicians identified challenges both at the individual and system levels. What is known about the topic?Voluntary assisted dying became legal in Victoria on 19 June 2019 under the Voluntary Assisted Dying Act 2017. However there has been little Victorian data to inform implementation. What does this paper add?Victorian hospital clinicians anticipate challenges at the individual and system levels, and across all clinical disciplines. These challenges include increased conflict, emotional burden and workload. Clinicians report concerns about organisational culture, the logistics of delivering voluntary assisted dying under the specific Victorian law and effects on hospitals’ overall work. What are the implications for practitioners?Careful attention to the breadth of staff affected, alongside appropriate resourcing, will be needed to support clinicians in the context of this legislative change.

Aim. Receiving professional help early can reduce long-term harms associated with substance use. However, little is known about the factors that influence help-seeking for substance use problems during early-mid adolescence, prior to the emergence of disorder. Given that beliefs regarding help-seeking are likely to develop early, understanding adolescent views of help-seeking during this period is likely to provide important information for prevention and intervention efforts. The current study identifies perceptions that would facilitate or prevent adolescents from seeking support for substance use problems from formal and informal help sources. Method. Thirty-four 12- to 16-year-olds from two schools in Melbourne, Victoria, Australia, were recruited. A qualitative interpretative design was used, incorporating semistructured, audio-recorded interviews. Results. Three overlapping themes that reflected barriers or enablers to help-seeking were identified: approachability, confidentiality and trustworthiness, and expertise. Help-seeking was facilitated when adolescents believed that the help source would be supportive and understanding, would keep information confidential, and had expertise in the alcohol and drug field. Conversely, adolescents were reluctant to seek help from sources they believed would be judgmental, lacked expertise, or would inform their parents. Conclusions. These findings highlight perceptions that may influence help-seeking for alcohol and drug problems during adolescence. Further research is needed to determine if help-seeking can be facilitated by improving parents’ and peers’ knowledge and promoting health professionals’ expertise in working with young people’s alcohol and drug issues.

Abstract Background Electronic medical task management systems (ETMs) have been adopted in health care institutions to improve health care provider communication. ETMs allow for the requesting and resolution of nonurgent tasks between clinicians of all craft groups. Visibility, ability to provide close-loop feedback, and a digital trail of all decisions and responsible clinicians are key features of ETMs. An embedded ETM within an integrated electronic health record (EHR) was introduced to the Royal Children's Hospital Melbourne on April 30, 2016. The ETM is used hospital-wide for nonurgent tasks 24 hours a day. It facilitates communication of nonurgent tasks between clinical staff, with an associated designated timeframe in which the task needs to be completed (2, 4, and 8 hours). Objective This study aims to examine the usage of the ETM at our institution since its inception. Methods ETM usage data from the first 3 years of use (April 2016 to April 2019) were extracted from the EHR. Data collected included age of patient, date and time of task request, ward, unit, type of task, urgency of task, requestor role, and time to completion. Results A total of 136,481 tasks were placed via the ETM in the study period. There were approximately 125 tasks placed each day (24-hour period). The most common time of task placement was around 6:00 p.m. Task placement peaked at approximately 8 a.m., 2 p.m., and 9 p.m.—consistent with nursing shift change times. In total, 63.16% of tasks were placed outside business hours, indicating predominant usage for after-hours task communication. The ETM was most highly utilized by surgical units. The majority of tasks were ordered by nurses for medical staff to complete (97.01%). A significant proportion (98.79%) of tasks was marked as complete on the ETM, indicating closed-loop feedback after tasks were requested. Conclusion An ETM function embedded in our EHR has been highly utilized in our institution since its introduction. It has multiple benefits for the clinician in the form of efficiencies in workflow and improvement in communication and also workflow management. By allowing collection, tracking, audit, and prioritization of tasks, it also provides a stream of actionable data for quality-improvement activities.

Objective: To determine the frequency, nature and consequence of adverse events sustained by children admitted to a combined general and cardiac paediatric intensive care unit (PICU). Design: Retrospective analysis of data collected between January 1st 2008 and December 31st 2017 from PICU. Setting: The Royal Children’s Hospital, a paediatric tertiary referral centre in Melbourne, Victoria, Australia. The PICU has thirty beds. Results: During the study period, PICU received 15208 admissions, of which 73% sustained at least one adverse event with a frequency of 67 adverse events per 100 PICU-days and 3 per admission. One adverse event was sustained for every 35 hours of care. The risk of an adverse event was highest in children less than a month of age, or if mechanically ventilated, a high Pediatric Index of Mortality (PIM2) score, longer PICU length of stay, had a pre-existing disability or a high risk adjustment for congenital heart surgery (RACHS) score. Those patients who sustained an adverse event, as compared to those who did not, were mechanically ventilated for longer (80 hrs Vs. 7 hrs, p=<0.001), had a longer PICU length of stay (131 hrs Vs. 35 hrs, p=<0.001), had a longer hospital length of stay (484 hrs Vs. 206 hrs, p=<0.001) and had a higher mortality rate (3% vs. 0.1%, p=<0.001). Conclusion: Whilst admission to PICU is an essential aspect of care for many patients, the risk of adverse events is high and is associated with significant clinical consequences. Monitoring of adverse events as part of quality improvement enables targeted intervention to improve patient safety.

Objective: Virtual reality (VR), a novel and highly immersive technology, offers promise in addressing potential psychological impacts of cancer treatments and hospitalization. The primary aim of this study was to examine multiple key user perspectives on the acceptability and feasibility of an Immersive VR therapeutic intervention for use with hospitalized patients with cancer. Secondary aims were to identify issues and opportunities related to the adoption and clinical implementation of VR in pediatric oncology settings. Method: The study was conducted at The Royal Children’s Hospital (RCH), Melbourne, Australia. Thirty multidisciplinary oncology health care professionals participated in an initial test of VR intervention usability (Stage 1). Ninety oncology inpatients (7-19 years) and their parent caregivers participated in a pilot randomized controlled study to examine the effectiveness of an Immersive VR therapeutic intervention (Stage 2). This mixed methods study reports Stages 1 and 2 quantitative and qualitative data related to VR feasibility and acceptability. Results: Results indicate favorable perceptions from health care professionals with respect to ease of use and usefulness of VR, and had positive intentions to use it in the future. Parent caregivers reported high acceptability of VR for their hospitalized child. Patients reported high satisfaction of the VR intervention within minimal adverse effects. Barriers and facilitators to VR use with seriously ill children and specific recommendations for content development were elicited. Conclusion: This study shows that there are several potential clinical uses for Immersive VR intervention, beyond medical procedural distraction, to support psychological adjustment to hospitalization and patient quality of life.

The aims of the present study were to understand enablers to participation in postgraduate education for primary care nurses (PCNs), and to explore how postgraduate education has advanced their nursing practice. Cross-sectional questionnaires were mailed out in April 2012 to current and past students undertaking postgraduate studies in primary care nursing at The University of Melbourne, Victoria, Australia. Questionnaires were returned by 100 out of 243 nurses (response rate 41%). Ninety-one per cent (91/100) of the respondents were first registered as nurses in Australia. Fifty-seven per cent were hospital trained and 43% were university educated to attain their initial nurse qualification. The respondents reported opportunities to expand scope of practice (99%; 97/98), improve clinical practice (98%; 97/99), increase work satisfaction (93%; 91/98) and increase practice autonomy (92%; 89/97) as factors that most influenced participation in postgraduate education in primary care nursing. Major enablers for postgraduate studies were scholarship access (75%; 71/95) and access to distance education (74%; 72/98). Many respondents reported an increased scope of practice (98%; 95/97) and increased job satisfaction (71%; 70/98) as an education outcome. Only 29% (28/97) cited an increase in pay-rate as an outcome. Of the 73 PCNs currently working in general practice, many anticipated an increase in time spent on the preparation of chronic disease management plans (63%; 45/72), multidisciplinary care plans (56%; 40/72) and adult health checks (56%; 40/72) in the preceding 12 months. Recommendations emerging from findings include: (1) increased access to scholarships for nurses undertaking postgraduate education in primary care nursing is imperative; (2) alternative modes of course delivery need to be embedded in primary care nursing education; (3) the development of Australian primary care policy, including policy on funding models, needs to more accurately reflect the educational level of PCNs, PCN role expansion and the extent of interprofessional collaboration that is evident from research undertaken to date. Nurses with postgraduate education have the potential to increase their scope of practice, take on a greater teaching role and provide more preventive and chronic disease services in primary care. Policies aimed at increasing access to education for nurses working in primary care would strengthen the primary care nursing profession, and enhance the delivery of primary health care services in Australia.

TO THE EDITOR: Goddard et al, authors of ?People with an intellectual disability in the discourse of chronic and complex conditions: an invisible group??1 are to be congratulated for raising discussion about one of the most vulnerable groups in Australia with respect to their receipt of optimal health care. The authors conclude that ?developing interventions and strategies to increase the knowledge of health care workers . . . caring for people with intellectual disabilities will likely improve the health care needs of this population and their families?. In relation to this identified need for health professional education and training in the care of people with intellectual disabilities, we would like to draw the attention of your readers to some work undertaken by the Centre for Developmental Disability Health Victoria (CDDHV) to address this issue. The CDDHV works to improve the health and health care of people with developmental disabilities through a range of educational, research and clinical activities. In recent years there has been an increasing awareness of the need for health professional education in this area. Moreover, as people with disabilities often have chronic and complex health and social issues, focusing on their health care provides a platform for interprofessional education and a springboard for understanding the essential importance and value of interprofessional practice. Recently, the CDDHV has taken a lead role in developing a teaching and learning resource that focuses both on the health care of people with disabilities and on the importance and value of interprofessional practice. This resource promotes and facilitates interprofessional learning, and develops understanding of the health and health care issues experienced by people with disabilities and those who support them. ?Health and disability: partnerships in action? is a new video-based teaching and learning package, produced through an interprofessional collaboration between health professionals from medicine, nursing, occupational therapy, physiotherapy, paramedic practice, health science, social work, speech pathology, dietetics and dentistry. Those living with a disability are the experts on their own experience and so their direct involvement in and contribution to the education of health care professionals is essential. The collaboration between those featured in the video stories and health professionals has led to the development of a powerful resource that facilitates students and practitioners developing insights into the health and health care issues encountered by people with developmental disabilities. We also believe that through improving their understanding of, and health provision to, people with disabilities and those who support them, health professionals will acquire valuable attitudes, knowledge and skills applicable to many other patients in their practice population. Jane M Tracy Education Director Centre for Developmental Disability Health Victoria Melbourne, VIC

Background Children with autism spectrum disorder (ASD) frequently demonstrate aggression and externalizing behaviors in the acute care hospital environment. Pediatric acute care nursing staff are often not trained in managing aggression and, in particular, lack confidence in preventing and managing externalizing behaviors in children with ASD. High-fidelity simulation exercises will be used in this study to provide deliberate practice for acute care pediatric nursing staff in the management of aggressive and externalizing behaviors. Objective The purpose of this study is to conduct a pilot and feasibility cluster randomized controlled trial (RCT) to evaluate the effectiveness of simulation-based education for staff in managing aggression and externalizing behaviors of children with ASD in the hospital setting. Methods This study has a mixed design, with between-group and within-participant comparisons to explore the acceptability and feasibility of delivering a large-scale cluster RCT. The trial process, including recruitment, completion rates, contamination, and completion of outcome measures, will be assessed and reported as percentages. This study will assess the acceptability of the simulation-based training format for two scenarios involving an adolescent with autism, with or without intellectual disability, who displays aggressive and externalizing behaviors and the resulting change in confidence in managing clinical aggression. Two pediatric wards of similar size and patient complexity will be selected to participate in the study; they will be randomized to receive either simulation-based education plus web-based educational materials or the web-based educational materials only. Change in confidence will be assessed using pre- and posttraining surveys for bedside nursing staff exposed to the training and the control group who will receive the web-based training materials. Knowledge retention 3 months posttraining, as well as continued confidence and exposure to clinical aggression, will be assessed via surveys. Changes in confidence and competence will be compared statistically with the chi-square test using before-and-after data to compare the proportion of those who have high confidence between the two arms at baseline and at follow-up. The simulation-based education will be recorded with trained assessors reviewing participants’ abilities to de-escalate aggressive behaviors using a validated tool. This data will be analyzed using mean values and SDs to understand the variation in performance of individuals who undertake the training. Data from each participating ward will be collected during each shift for the duration of the study to assess the number of aggressive incidents and successful de-escalation for patients with ASD. Total change in Code Grey activations will also be assessed, with both datasets analyzed using descriptive statistics. Results This study gained ethical approval from The Royal Children's Hospital Melbourne Human Research Ethics Committee (HREC) on November 1, 2019 (HREC reference number: 56684). Data collection was completed in February 2020. Data analysis is due to commence with results anticipated by August 2020. Conclusions We hypothesize that this study is feasible to be conducted as a cluster RCT and that simulation-based training will be acceptable for acute care pediatric nurses. We anticipate that the intervention ward will have increased confidence in managing clinical aggression in children with ASD immediately and up to 3 months posttraining. Trial Registration Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000139976; http://www.ANZCTR.org.au/ACTRN12620000139976.aspx International Registered Report Identifier (IRRID) DERR1-10.2196/18105

Abstract Sleep disturbances in women with and without polycystic ovary syndrome (PCOS) and their association with lifestyle factors (diet, physical activity and sitting time) Bennett C1, Mansfield DR2, Mo L2, Hodge A3, Joham A4, 5, Cain SW6, Blumfield M1, Teede H4, 5, Moran LJ4 1. Be Active Sleep and Eat (BASE) Facility, Department of Nutrition and Dietetics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 2. Monash Lung and Sleep, Monash Health, Clayton, Victoria 3. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria 4. Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria 5. Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria 6. Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria Sleep disturbances are a risk factor for poorer lifestyle behaviours. While PCOS is associated with a higher prevalence of sleep disturbances, the relationship between sleep and lifestyle behaviours is unknown in PCOS. Self-reported data from the Australian Longitudinal Study on Women’s Health young cohort (31–36 years, n=6067, n=464 PCOS, n=5603 non-PCOS) were collected on PCOS, anthropometry, physical activity, sedentary behaviour, diet (74-item validated food frequency questionnaire) and sleeping behaviour (sleep quantity and adverse sleep symptoms). Multivariate regression models controlled for sleeping behaviour, BMI, age, marital status, education, income and area of residence. Women with PCOS reported greater adverse sleep symptoms, higher energy intake, diet quality (dietary guidelines index (DGI)), fibre intake and sedentary time and lower glycaemic index, compared to women without PCOS. This was not maintained for energy intake and sedentary behaviour on adjustment for confounders. For diet quality, there was an interaction between PCOS and sleep disturbances. Only for women with fewer sleep disturbances (~8 hours sleep/no adverse sleep symptoms) was PCOS associated with better diet quality (DGI higher by 3.14±0.86, p&lt;0.001), with no differences in diet quality for women with poorer sleep. Lifestyle behaviours in women with PCOS appear to be influenced by sleep quality and quantity. Nothing to disclose: CB, DM, LM, AH, AJ, SC, MB, HT, LM

Pressure injuries (PIs) substantively impact quality of care during hospital stays, although only when they are severe or acquired as a result of the hospital stay are they reported as quality indicators. Globally, researchers have repeatedly highlighted the need to invest more in quality improvement, risk assessment, prevention, early detection, and care for PI to avoid the higher costs associated with treatment of PI. Coders' perspectives on quality assurance of the clinical coded PI data have never been investigated. This study aimed to explore challenges that hospital coders face in accurately coding and reporting PI data and subsequently, explore reasons why data sources may vary in their reporting of PI data. This article is based upon data collected as part of a multi-phase collaborative project to build capacity for optimizing PI prevention across Monash Partners health services. We have conducted 16 semi-structured phone interviews with clinical coders recruited from four participating health services located in Melbourne, Australia. One of the main findings was that hospital coders often lacked vital information in clinicians' records needed to code PI and report quality indicators accurately and highlighted the need for quality improvement processes for PI clinical documentation. Nursing documentation improvement is a vital component of the complex capacity building programs on PI prevention in acute care services and is relied on by coders. Coders reported the benefit of inter-professional collaborative workshops, where nurses and coders shared their perspectives. Collaborative workshops had the potential to improve coders' knowledge of PI classification and clinicians' understanding of what information should be included when documenting PI in the medical notes. Our findings identified three methods of quality assurance were important to coders to ensure accuracy of PI reporting: (1) training prior to initiation of coding activity and (2) continued education, and (3) audit and feedback communication about how to handle specific complex cases and complex documentation. From a behavioral perspective, most of the coders reported confidence in their own abilities and were open to changes in coding standards. Transitioning from paper-based to electronic records highlighted the need to improve training of both clinicians and coders.

Introduction: Stroke is a leading cause of perinatal brain injury and cerebral palsy. Current therapeutic efforts focus on optimizing developmental curves but the biological processes dictating these outcomes are poorly understood. Alterations in myelination are recognized as a major determinant of outcome in preterm brain injury but are unexplored in perinatal stroke (PS). Hypothesis: Ipsilesional delays in myelination occur in children with PS and are associated with poor developmental outcome. Methods: Participants were identified through the Alberta Perinatal Stroke Project, a population-based research cohort. Inclusion criteria were: 1) MRI-confirmed, unilateral arterial PS, 2) T1-weighted MRI >6mo, 3) absence of other neurological disorders, 4) neurological outcome (Pediatric Stroke Outcome Measure, PSOM), and 5) motor assessments (Assisting Hand Assessment, AHA; Melbourne Assessment). FreeSurfer software measured hemispheric asymmetry in myelination intensity. A second method using ImageJ validated the detection of myelination asymmetry. Overall PSOM scores were classified as poor (>1) or not. Repeated measures ANOVA compared perilesional, ipsilesional remote, and contralesional homologous regions. Myelination ratios for stroke cases were compared to typically developing controls (t-test), PSOM scores (t-test), and motor assessments (Pearson’s correlation). Results: Nineteen arterial stroke cases (mean age: 13.73±4.0yo) and 27 controls (mean age: 12.52±3.7yo) were studied. Stroke cases showed a greater degree of asymmetry with lower myelination in the lesioned hemisphere, compared to controls (p<0.001). Myelination in perilesional regions was decreased compared to ipsilesional remote (p<0.001) and contralesional homologous areas (p<0.001). Ipsilesional remote regions were decreased compared to homologous regions on the contralesional hemisphere (p=0.009). Contralesional myelination was also less than controls (p<0.001). Myelination ratios were not associated with PSOM, AHA, or Melbourne scores (p=0.144, 0.218, 0.366 respectively). Conclusion: Myelination of uninjured brain in the lesioned hemisphere is altered in children with PS. Further study is required to determine clinical significance.

Introduction: Stroke utilizes a large portion of hospital resources. Little is known about the frequency of contacts with hospitals prior to first-ever stroke and potentially missed opportunities for stroke prevention. In addition, re-admissions may indicate failed secondary prevention. Hypothesis: Many patients have had a presentation or admission to hospital in the year prior to a first-ever stroke event. Methods: Data from the prospective, national Australian Stroke Clinical Registry (AuSCR) obtained between 15 June 2009 and 31 December 2010 from a large hospital in Melbourne, Victoria (Australia) were linked to the Victorian government emergency department (ED) and hospital discharge datasets for a 3 year ‘look-back’ period and any re-presentation up until February 2011 using stepwise deterministic linkage methods. Descriptive statistics are presented. Results: Matched linkage to ED (731/788) and hospital discharge (736/788) datasets was achieved in 93% of AuSCR registrants, of whom 513 were first-ever strokes (51% male, average age 74 [±16] years, 82% ischemic). Prior to the first-ever stroke, 221 (47%) registrants had ED presentations and 283 had a hospital admission on average 2.9 months before stroke. The mean number of ED presentations within 3 years of AuSCR registration for a first-ever event was 2.1 (SD 1.6); and 48/466 (10%) occurred in the month prior to stroke. Among first-ever stroke registrants, 200 were re-admitted on average within 5 months following discharge; 3.5% for recurrent stroke/TIA. Conclusion: Contact with hospitals was common (~50%) before first stroke, raising opportunities to screen and intervene in people at risk of stroke. As one in 5 hospital re-admissions is for recurrent stroke, a closer monitoring of secondary prevention measures in the early post-discharge period may be warranted.

Introduction: Multiple data collections can be a burden for clinicians. In 2009, the Australian Stroke Clinical Registry (AuSCR) was established by non-government and research organizations to provide quality of care data unavailable for acute stroke admissions. We show here the reliability of linking complimentary registry data with routinely collected hospital discharge data submitted to governmental bodies. Hypothesis: A high quality linkage with a > 90% rate is possible, but requires multiple personal identifiers common to each dataset. Methods: AuSCR identifying variables included date of birth (DoB), Medicare number, first name, surname, postcode, gender, hospital record number, hospital name and admission date. The Victorian Department of Health emergency department (ED) and hospital discharge linked dataset has most of these, with first name truncated to the first 3 digits, but no surname. Common data elements of AuSCR patients registered at a large hospital in Melbourne, Victoria (Australia) between 15 June 2009 and 31 December 2010 were submitted to undergo stepwise deterministic linkage. Results: The Victorian AuSCR sample had 818 records from 788 individuals. Three steps with 1) Medicare number, postcode, gender and DoB (80% matched); 2) hospital number/admit date; and 3) ED number/visit date were required to link AuSCR data with the ED and hospital discharge data. These led to an overall high quality linkage of >99% (782/788) of AuSCR patients, including 731/788 for ED records and 736/788 for hospital records. Conclusion: Multiple personal identifiers from registries are required to achieve reliable linkage to routinely collected hospital data. Benefits of these linked data include the ability to investigate a broader range of research questions than with a single dataset. Characters with spaces= 1941 (limit is 1950)

Objectives: To investigate correlations between infarct topography on acute diffusion weighted MRI, using voxel-based lesion-symptom mapping (VLSM), and later development of cerebral palsy (CP) and neurological impairments, in neonatal arterial ischaemic stroke (AIS). Methods: Newborns were recruited from prospective Australian and Swiss pediatric stroke registries. CP diagnosis was based on clinical examination. Language or cognitive-behavioural impairments were assessed using the Pediatric Stroke Outcome Measure dichotomized to good (0-0.5) or poor (≥1), at ≥18 months of age. Infarcts were manually segmented using axial DWI images, and coregistered to the Melbourne Children’s Regional Infant Brain 2.0 atlas. All lesions were projected to the left hemisphere to obtain binary union masks. VLSM was conducted using MATLAB SPM12 toolbox. A generalised linear model was used to correlate the lesion mask with outcomes. Voxel-wise t test statistics were calculated, and corrected for multiple comparisons using family-wise error rate (FWE). Results: 85 newborns (55 male) met inclusion criteria. Infarct lateralization was left hemisphere in 62%, right in 8% and bilateral in 29%. At median age 2.1 years (IQR1.9-2.6), 34% developed CP and 42% had neurological impairments. 54 ROIs were correlated with CP (t>4.33; FWE <0.05); the 12 highest correlated ROIs were the superior corona radiata, putamen, anterior corona radiata, insula, thalamus, external capsule, pars triangularis, caudate, lateral orbitofrontal cortex, superior temporal cortex, pars opercularis and precentral cortex. (Figure) No significant correlations were found for poor language or cognitive-behavioural outcomes. Conclusions: Cerebral palsy following neonatal AIS correlates predominantly with regions of acute infarction directly involved in motor control, or in functionally connected regions. Brain regions associated with language or cognitive-behavioural impairment are less clear.

BACKGROUND: The Pediatric Stroke Outcome Measure (PSOM), a 10 point scale based on 5 domains, is one of the few measures of outcome in pediatric stroke. The PSOM has been used to estimate global deficit for studies of stroke outcome and post-stroke quality of life, but its sensitivity to cognitive and functional impairments has received little attention. To address this question, we examined the ability of the PSOM to predict cognitive functioning and behavior after childhood stroke. METHODS: Children ages 6-15 years who had neonatal or childhood onset arterial ischemic stroke were identified by chart review at the Nationwide Children’s Hospital (Columbus, OH, USA) and Royal Children’s Hospital (Melbourne, Australia). Subjects were included if they could complete the test battery. Age- and gender-matched children who had asthma were selected as controls. Stroke cases were assessed with the PSOM and had an MRI brain scan after the acute phase of stroke. Cases and controls underwent functional assessments at least 1 year after the incident stroke. The battery of tests and ratings included the Child Behavior Checklist, Adaptive Behavior Assessment System, Child and Adolescent Scales of Participation, the Wechsler Abbreviated Scales of Intelligence (WASI), and the WISC-4 Processing Speed Index. Infarct volumes were measured by manual segmentation. RESULTS: The sample included 36 children with perinatal or childhood stroke, and 15 controls. Median age at assessment was 8.7 yrs (IQR 6.9-11.9) and median time after presentation was 5.1 yrs (IQR 2.8-7.4). The total PSOM was significantly and inversely related to all measures of cognitive functioning (p range for WISC and WASI 0.001-0.048), multiple measures of adaptive behavior (p range for ABAS scales 0.000-0.031), and all measures of social participation (p range for CASP scales 0.000-0.007). The cognitive/behavioral (C/B) scale of the PSOM was significantly and inversely related to all measures of social participation (p values for CASP 0.000) and multiple measures of adaptive behavior (p range for ABAS scales 0.001-0.057), and positively related to multiple measures of behavior problems (p range for CBCL scales 0.001-0.037). Conclusions: The total PSOM can predict multiple areas of intellectual impairment, and also predicts impairment in adaptive behavior and social participation. In addition the C/B scale can predict behavior problems. The C/B scale depends upon parental report and the clinician's impression, so it is noteworthy that abnormalities on this four-point scale can suggest impairments in a broad range of domains. In addition to a quantitative measure of stroke outcome, the PSOM can serve as a useful screening tool for the identification of intellectual or functional deficits that warrant further investigation for appropriate intervention.

Abstract Background The emergency department has been a major focus for the implementation of Australia’s national electronic health record, known as My Health Record. However, the association between use of My Health Record in the emergency department setting and patient care is largely unknown. The aim of this study was to explore the perspectives of emergency department clinicians regarding My Health Record use frequency, the benefits of My Health Record use (with a focus on patient care) and the barriers to use. Methods All 393 nursing, pharmacy, physician and allied health staff employed within the emergency department at a tertiary metropolitan public hospital in Melbourne were invited to participate in a web-based survey, between 1 May 2021 and 1 December 2021, during the height of the Delta and Omicron Covid-19 outbreaks in Victoria, Australia. Results Overall, the survey response rate was 18% (70/393). Approximately half of the sample indicated My Health Record use in the emergency department (n = 39, 56%, confidence interval [CI] 43–68%). The results showed that users typically only engaged with My Health Record less than once per shift (n = 15, 39%, CI 23–55%). Just over half (n = 19/39, 54%, CI 32–65%) of all participants who use My Health Record agreed they could remember a time when My Health Record had been critical to the care of a patient. Overall, clinicians indicated the biggest barrier preventing their use of My Health Record is that they forget to utilise the system. Conclusion The results suggest that My Health Record has not been adopted as routine practice in the emergency department, by the majority of participants. Close to half of self-identified users of My Health Record do not associate use as being critical to patient care. Instead, My Health Record may only be used in scenarios that clinicians perceive will yield the greatest benefit—which clinicians in this paper suggest is patients with chronic and complex conditions. Further research that explores the predictors to use and consumers most likely to benefit from use is recommended—and strategies to socialise this knowledge and educate clinicians is desperately required.

BACKGROUND: Stroke can affect children with long-term impairment of intellectual ability and increased risk of attention deficits and psychiatric disorders. Although limited studies in the literature suggest that stroke can chronically impair functional behavior and social adaptation, these functional outcomes have received little attention. We performed a pilot case-control study to examine the hypothesis that pediatric stroke impairs adaptive behavior, and we addressed the secondary hypotheses that stroke volume and location predict impaired functional behavior. METHODS: Children ages 6-15 years who had neonatal or childhood onset arterial ischemic stroke were identified by chart review at the Nationwide Children’s (Columbus, OH, USA) and Royal Children’s Hospital (Melbourne, Australia). Subjects were included if they could complete the test battery. Age- and gender-matched children who had asthma were selected as controls. Stroke cases were assessed with the Pediatric Stroke Outcome Measure and had an MRI brain scan after the acute phase of stroke. Cases and controls underwent functional assessments at least one year after the incident stroke. The battery of tests and ratings included the Wechsler Abbreviated Scales of Intelligence, WISC-IV Processing Speed Index, Child Behavior Checklist, Adaptive Behavior Assessment System, and Child & Adolescent Scale of Participation. Infarct volumes were measured by manual segmentation. RESULTS: The sample included 10 children with perinatal stroke, 26 with acquired childhood stroke, and 15 controls. Median age at assessment was 8.7 yrs (IQR 6.9-11.9) and median time after presentation was 5.1 yrs (IQR 2.8-7.4). The median PSOM for stroke cases was 1 (range 0-8.0) and for controls was 0 (range 0-1). Stroke was significantly associated with lower levels of multiple daily living skills (p range 0.001-0.025), functional academics (p=0.048), and self-care (p=0.020), as well as a trend toward impaired school participation (p=0.064), but was not associated with impaired intellectual functioning or behavioral adjustment. Larger Infarcts showed a trend association with higher PSOM total scores (p=0.091). Infarcts that involved both cortex and subcortical parenchyma were associated with poorer daily living skills (p range 0.005-0.052) and a trend toward impaired home community participation (p=0.079). Age of stroke onset was not associated with impairments. Conclusions: Stroke causes deficits that may not be appreciated by standard IQ screening or report of overt behavior disorders. These deficits can affect daily living skills and result in impaired adaptive behavior. Strokes involving both cortex and subcortex, as a proxy for more extensive strokes, may be particularly associated with impaired adaptive behavior. These results are “best case” estimates because our study excluded mentally retarded or grossly impaired children.

IntroductionFilmed during a 1955 family trip from Perth to the Gulf of Carpentaria, Keith Adams’s Northern Safari showed to packed houses across Australia, and in some overseas locations, across three decades. Essentially a home movie, initially accompanied by live commentary and subsequently by a homemade sound track, it tapped into audiences’ sense of Australia’s north as a place of adventure. In the film Adams interacts with the animals of northern Australia (often by killing them), and while by 1971 the violence apparent in the film was attracting criticism in letters to newspapers, the film remained popular through to the mid-1980s, and was later shown on television in Australia and the United States (Cowan 2; Adams, Crocodile Safari Man 261). A DVD is at present available for purchase from the website of the same name (Northern Safari). Adams and his supporters credited the film’s success to the rugged and adventurous landscape of northern Australia (Northeast vii), characterised by dangerous animals, including venomous spiders, sharks and crocodiles (see Adams, “Aussie”; “Crocodile”). The notion of Australia’s north as a place of rugged adventure was not born with Adams’s film, and that film was certainly not the last production to exploit the region and its wildlife as a source of excitement. Rather, Northern Safari belongs to a long list of adventure narratives whose hunting exploits have helped define the north of Australian as a distinct region and contrast it with the temperate south where most Australians make their lives.This article explores the connection between adventure in Australia’s north and the large animals of the region. Adams’s film capitalised on popular interest in natural history, but his film is only one link in a chain of representations of the Australian north as a place of dangerous and charismatic megafauna. While over time interest shifted from being largely concentrated on the presence of buffalo in the Northern Territory to a fascination with the saltwater crocodiles found more widely in northern Australia that interest in dangerous prey animals is significant to Australia’s northern imaginary.The Northern Safari before AdamsNorthern Australia gained a reputation for rugged, masculine adventure long before the arrival there of Adams and his cameras. That reputation was closely associated with the animals of the north, and it is generally the dangerous species that have inspired popular accounts of the region. Linda Thompson has recognised that before the release of the film Crocodile Dundee in 1986 crocodiles “received significant and sensational (although sporadic) media attention across Australia—attention that created associations of danger, mystery, and abnormality” (118). While Thompson went on to argue that in the wake of Crocodile Dundee the saltwater crocodile became a widely recognised symbol of Australia (for both Australians and non-Australians) it is perhaps more pertinent to consider the place of animals in creating a notion of the Australian north.Adams’s extended and international success (he showed his film profitably in the United States, Canada, England, Germany, South Africa, Rhodesia, and New Zealand as well as throughout Australia) suggests that the landscape and wildlife of northern Australia holds a fascination for a wide audience (Adams, Crocodile Safari Man 169-261). Certainly northern Australia, and its wild beasts, had established a reputation for adventure earlier, particularly in the periods following the world wars. Perhaps crocodiles were not the most significant of the north’s charismatic megafauna in the first half of the twentieth century, but their presence was a source of excitement well before the 1980s, and they were not the only animals in the north to attract attention: the Northern Territory’s buffalo had long acted as a drawcard for adventure seekers.Carl Warburton’s popular book Buffaloes was typical in linking Australians’ experiences of war with the Australian north and the pursuit of adventure, generally in the form of dangerous big game. War and hunting have long been linked as both are expressions of masculine valour in physically dangerous circumstances (Brennan “Imperial” 44-46). That link is made very clear in Warbuton’s account when he begins it on the beach at Gallipoli as he and his comrades discuss their plans for the future. After Warburton announces his determination not to return from war to work in a bank, he and a friend determine that they will go to either Brazil or the Northern Territory to seek adventure (2). Back in Sydney, a coin flip determines their “compass was set for the unknown north” (5).As the title of his book suggests, the game pursued by Warburton and his mate were buffaloes, as buffalo hides were fetching high prices when he set out for the north. In his writing Warburton was keen to establish his reputation as an adventurer and his descriptions of the dangers of buffalo hunting used the animals to establish the adventurous credentials of northern Australia. Warburton noted of the buffalo that: “Alone of all wild animals he will attack unprovoked, and in single combat is more than a match for a tiger. It is the pleasant pastime of some Indian princes to stage such combats for the entertainment of their guests” (62-63). Thereby, he linked Arnhem Land to India, a place that had long held a reputation as a site of adventurous hunting for the rulers of the British Empire (Brennan “Africa” 399). Later Warburton reinforced those credentials by noting: “there is no more dangerous animal in the world than a wounded buffalo bull” (126). While buffalo might have provided the headline act, crocodiles also featured in the interwar northern imaginary. Warburton recorded: “I had always determined to have a crack at the crocodiles for the sport of it.” He duly set about sating this desire (222-3).Buffalo had been hunted commercially in the Northern Territory since 1886 and Warburton was not the first to publicise the adventurous hunting available in northern Australia (Clinch 21-23). He had been drawn north after reading “of the exploits of two crack buffalo shooters, Fred Smith and Paddy Cahill” (Warburton 6). Such accounts of buffalo, and also of crocodiles, were common newspaper fodder in the first half of the twentieth century. Even earlier, explorers’ accounts had drawn attention to the animal excitement of northern Australia. For example, John Lort Stokes had noted ‘alligators’ as one of the many interesting animals inhabiting the region (418). Thus, from the nineteenth century Australia’s north had popularly linked together remoteness, adventure, and large animals; it was unsurprising that Warburton in turn acted as inspiration to later adventure-hunters in northern Australia. In 1954 he was mentioned in a newspaper story about two English migrants who had come to Australia to shoot crocodiles on Cape York with “their ambitions fed by the books of men such as Ion Idriess, Carl Warburton, Frank Clune and others” (Gay 15).The Development of Northern ‘Adventure’ TourismNot all who sought adventure in northern Australia were as independent as Adams. Cynthia Nolan’s account of travel through outback Australia in the late 1940s noted the increasing tourist infrastructure available, particularly in her account of Alice Springs (27-28, 45). She also recorded the significance of big game in the lure of the north. At the start of her journey she met a man seeking his fortune crocodile shooting (16), later encountered buffalo shooters (82), and recorded the locals’ hilarity while recounting a visit by a city-based big game hunter who arrived with an elephant gun. According to her informants: “No, he didn’t shoot any buffaloes, but he had his picture taken posing behind every animal that dropped. He’d arrange himself in a crouch, gun at the ready, and take self-exposure shots of himself and trophy” (85-86). Earlier, organised tours of the Northern Territory included buffalo shooter camps in their itineraries (when access was available), making clear the continuing significance of dangerous game to the northern imaginary (Cole, Hell 207). Even as Adams was pursuing his independent path north, tourist infrastructure was bringing the northern Australian safari experience within reach for those with little experience but sufficient funds to secure the provision of equipment, vehicles and expert advice. The Australian Crocodile Shooters’ Club, founded in 1950, predated Northern Safari, but it tapped into the same interest in the potential of northern Australia to offer adventure. It clearly associated that adventure with big game hunting and the club’s success depended on its marketing of the adventurous north to Australia’s urban population (Brennan “Africa” 403-06). Similarly, the safari camps which developed in the Northern Territory, starting with Nourlangie in 1959, promoted the adventure available in Australia’s north to those who sought to visit without necessarily roughing it. The degree of luxury that was on offer initially is questionable, but the notion of Australia’s north as a big game hunting destination supported the development of an Australian safari industry (Berzins 177-80, Brennan “Africa” 407-09). Safari entrepreneur Allan Stewart has eagerly testified to the broad appeal of the safari experience in 1960s Australia, claiming his clientele included accountants, barristers, barmaids, brokers, bankers, salesmen, journalists, actors, students, nursing sisters, doctors, clergymen, soldiers, pilots, yachtsmen, racing drivers, company directors, housewives, precocious children, air hostesses, policemen and jockeys (18).Later Additions to the Imaginary of the Northern SafariAdams’s film was made in 1955, and its subject of adventurous travel and hunting in northern Australia was taken up by a number of books during the 1960s as publishers kept the link between large game and the adventurous north alive. New Zealand author Barry Crump contributed a fictionalised account of his time hunting crocodiles in northern Australia in Gulf, first published in 1964. Crump displayed his trademark humour throughout his book, and made a running joke of the ‘best professional crocodile-shooters’ that he encountered in pubs throughout northern Australia (28-29). Certainly, the possibility of adventure and the chance to make a living as a professional hunter lured men to the north. Among those who came was Australian journalist Keith Willey who in 1966 published an account of his time crocodile hunting. Willey promoted the north as a site of adventure and rugged masculinity. On the very first page of his book he established his credentials by advising that “Hunting crocodiles is a hard trade; hard, dirty and dangerous; but mostly hard” (1). Although Willey’s book reveals that he did not make his fortune crocodile hunting he evidently revelled in its adventurous mystique and his book was sufficiently successful to be republished by Rigby in 1977. The association between the Australian north, the hunting of large animals, and adventure continued to thrive.These 1960s crocodile publications represent a period when crocodile hunting replaced buffalo hunting as a commercial enterprise in northern Australia. In the immediate post-war period crocodile skins increased in value as traditional sources became unreliable, and interest in professional hunting increased. As had been the case with Warburton, the north promised adventure to men unwilling to return to domesticity after their experiences of war (Brennan, “Crocodile” 1). This part of the northern imaginary was directly discussed by another crocodile hunting author. Gunther Bahnemann spent some time crocodile hunting in Australia before moving his operation north to poach crocodiles in Dutch New Guinea. Bahnemann had participated in the Second World War and in his book he was clear about his unwillingness to settle for a humdrum life, instead choosing crocodile hunting for his profession. As he described it: “We risked our lives to make quick money, but not easy money; yet I believe that the allure of adventure was the main motive of our expedition. It seems so now, when I think back to it” (8).In the tradition of Adams, Malcolm Douglas released his documentary film Across the Top in 1968, which was subsequently serialised for television. From around this time, television was becoming an increasingly popular medium and means of reinforcing the connection between the Australian outback and adventure. The animals of northern Australia played a role in setting the region apart from the rest of the continent. The 1970s and 1980s saw a boom in programs that presented the outback, including the north, as a source of interest and national pride. In this period Harry Butler presented In the Wild, while the Leyland brothers (Mike and Mal) created their iconic and highly popular Ask the Leyland Brothers (and similar productions) which ran to over 150 episodes between 1976 and 1980. In the cinema, Alby Mangels’s series of World Safari movies included Australia in his wide-ranging adventures. While these documentaries of outback Australia traded on the same sense of adventure and fascination with Australia’s wildlife that had promoted Northern Safari, the element of big game hunting was muted.That link was reforged in the 1980s and 1990s. Crocodile Dundee was an extremely successful movie and it again placed interactions with charismatic megafauna at the heart of the northern Australian experience (Thompson 124). The success of the film reinvigorated depictions of northern Australia as a place to encounter dangerous beasts. Capitalising on the film’s success Crump’s book was republished as Crocodile Country in 1990, and Tom Cole’s memoirs of his time in northern Australia, including his work buffalo shooting and crocodile hunting, were first published in 1986, 1988, and 1992 (and reprinted multiple times). However, Steve Irwin is probably the best known of northern Australia’s ‘crocodile hunters’, despite his Australia Zoo lying outside the crocodile’s natural range, and despite being a conservationist opposed to killing crocodiles. Irwin’s chosen moniker is ironic, given his often-stated love for the species and his commitment to preserving crocodile lives through relocating (when necessary, to captivity) rather than killing problem animals. He first appeared on Australian television in 1996, and continued to appear regularly until his death in 2006.Tourism Australia used both Hogan and Irwin for promotional purposes. While Thompson argues that at this time the significance of the crocodile was broadened to encompass Australia more generally, the examples of crocodile marketing that she lists relate to the Northern Territory, with a brief mention of Far North Queensland and the crocodile remained a signifier of northern adventure (Thompson 125-27). The depiction of Irwin as a ‘crocodile hunter’ despite his commitment to saving crocodile lives marked a larger shift that had already begun within the safari. While the title ‘safari’ retained its popularity in the late twentieth century it had come to be applied generally to organised adventurous travel with a view to seeing and capturing images of animals, rather than exclusively identifying hunting expeditions.ConclusionThe extraordinary success of Adams’s film was based on a widespread understanding of northern Australia as a type of adventure playground, populated by fascinating dangerous beasts. That imaginary was exploited but not created by Adams. It had been in existence since the nineteenth century, was particularly evident during the buffalo and crocodile hunting bubbles after the world wars, and boomed again with the popularity of the fictional Mick Dundee and the real Steve Irwin, for both of whom interacting with the charismatic megafauna of the north was central to their characters. The excitement surrounding large game still influences visions of northern Australia. At present there is no particularly striking northern bushman media personage, but the large animals of the north still regularly provoke discussion. The north’s safari camps continue to do business, trading on the availability of large game (particularly buffalo, banteng, pigs, and samba) and northern Australia’s crocodiles have established themselves as a significant source of interest among international big game hunters. Australia’s politicians regularly debate the possibility of legalising a limited crocodile safari in Australia, based on the culling of problem animals, and that debate highlights a continuing sense of Australia’s north as a place apart from the more settled, civilised south of the continent.ReferencesAdams, Keith. ’Aussie Bites.’ Australian Screen 2017. <https://aso.gov.au/titles/documentaries/northern-safari/clip2/>.———. ‘Crocodile Hunting.’ Australian Screen 2017. <https://aso.gov.au/titles/documentaries/northern-safari/clip3/>.———. Crocodile Safari Man: My Tasmanian Childhood in the Great Depression & 50 Years of Desert Safari to the Gulf of Carpentaria 1949-1999. Rockhampton: Central Queensland University Press, 2000.Bahnemann, Gunther. New Guinea Crocodile Poacher. 2nd ed. London: The Adventurers Club, 1965.Berzins, Baiba. Australia’s Northern Secret: Tourism in the Northern Territory, 1920s to 1980s. Sydney: Baiba Berzins, 2007.Brennan, Claire. "’An Africa on Your Own Front Door Step’: The Development of an Australian Safari.” Journal of Australian Studies 39.3 (2015): 396-410.———. “Crocodile Hunting.” Queensland Historical Atlas (2013): 1-3.———. "Imperial Game: A History of Hunting, Society, Exotic Species and the Environment in New Zealand and Victoria 1840-1901." Dissertation. Melbourne: University of Melbourne, 2005.Clinch, M.A. “Home on the Range: The Role of the Buffalo in the Northern Territory, 1824–1920.” Northern Perspective 11.2 (1988): 16-27.Cole, Tom. Crocodiles and Other Characters. Chippendale, NSW: Sun Australia, 1992.———. Hell West and Crooked. Sydney: Angus and Robertson, 1990.———. Riding the Wildman Plains: The Letters and Diaries of Tom Cole 1923-1943. Sydney: Pan Macmillan, 1992.———. Spears & Smoke Signals: Exciting True Tales by a Buffalo & Croc Shooter. Casuarina, NT: Adventure Pub., 1986.Cowan, Adam. Letter. “A Feeling of Disgust.” Canberra Times 12 Mar. 1971: 2.Crocodile Dundee. Dir. Peter Faiman. Paramount Pictures, 1986.Crump, Barry. Gulf. Wellington: A.H. & A.W. Reed, 1964.Gay, Edward. “Adventure. Tally-ho after Cape York Crocodiles.” The World’s News (Sydney), 27 Feb. 1954: 15.Nolan, Cynthia. Outback. London: Methuen & Co, 1962.Northeast, Brian. Preface. Crocodile Safari Man: My Tasmanian Childhood in the Great Depression & 50 Years of Desert Safari to the Gulf of Carpentaria 1949-1999. By Keith Adams. Rockhampton: Central Queensland University Press, 2000. vi-viii.Northern Safari. Dir. Keith Adams. Keith Adams, 1956.Northern Safari. n.d. <http://northernsafari.com/>.Stewart, Allan. The Green Eyes Are Buffaloes. Melbourne: Lansdown, 1969.Stokes, John Lort. Discoveries in Australia: With an Account of the Coasts and Rivers Explored and Surveyed during the Voyage of H.M.S. Beagle in the Years 1837-38-39-40-41-42-43. By Command of the Lords Commissioners of the Admiralty, Also a Narrative of Captain Owen Stanley's Visits to the Islands in the Arafura Sea. London: T. and W. Boone, 1846.Thompson, Linda. “’You Call That a Knife?’ The Crocodile as a Symbol of Australia”. New Voices, New Visions: Challenging Australian Identities and Legacies. Eds. Catriona Elder and Keith Moore. Newcastle upon Tyne, UK: Cambridge Scholars, 2012: 118-134.Warburton, Carl. Buffaloes: Adventure and Discovery in Arnhem Land. Sydney: Angus & Robertson Ltd, 1934.Willey, Keith. Crocodile Hunt. Brisbane: Jacaranda Press, 1966.

There have been a number of Australian memoirs written by adoptees over the last twenty years—Robert Dessaix’s A Mother’s Disgrace, Suzanne Chick’s Searching for Charmian, Tom Frame’s Binding Ties:An Experience of Adoption and Reunion in Australia, for example—as well as international adoptee narratives by Betty Jean Lifton, Florence Fisher, and A. M. Homes amongst others. These works form a component of the small but growing field of adoption life writing that includes works by “all members of the adoption triad” (Hipchen and Deans 163): adoptive parents, birthparents, and adoptees. As the broad genre of memoir becomes more theorised and mapped, many sub-genres are emerging (Brien). My own adoptee story (which I am currently composing) could be a further sub-categorisation of the adoptee memoir, that of “late discovery adoptees” (Perl and Markham), those who are either told, or find out, about their adoption in adulthood. When this is part of a life story, secrets and silences are prominent, and digging into these requires using whatever resources can be found. These include cookbooks, recipes written by hand, and the scraps of paper shoved between pages. There are two cookbooks from my adoptive mother’s belongings that I have kept. One of them is titled Miss Tuxford’s Modern Cookery for the Middle Classes: Hints on Modern Gas Stove Cooking, and this was published around 1937 in England. It’s difficult to date this book exactly, as there is no date in my copy, but one of the advertisements (for Bird’s Custard, I think; the page is partly obscured by an Orange Nut Loaf recipe from a Willow baking pan that has been glued onto the page) is headed with a date range of 1837 to 1937. It has that smell of long ago that lingers strongly even now, out of the protective custody of my mother’s storage. Or should I say, out of the range of my adoptive father’s garbage dump zeal. He loved throwing things away, but these were often things that I saw as valuable, or at least of sentimental value, worth keeping for the memories they evoked. Maybe my father didn’t want to remember. My mother was brimming with memories, I discovered after her death, but she did not reveal them during her life. At least, not to me, making objects like these cookbooks precious in my reconstruction of the lives I know so little about, as well as in the grieving process (Gibson).Miss Tuxford (“Diplomée Board of Education, Gold Medallist, etc”) produced numerous editions of her book. My mother’s is now fragile, loose at the spine and browned with age. There are occasional stains showing that the bread and cakes section got the most use, with the pages for main meals of meat and vegetables relatively clean. The author divided her recipes into the main chapters of Soups (lentil, kidney, sheep’s head broth), Sauces (white, espagnol, mushroom), Fish (“It is important that all fish is fresh when cooked” (23)), Meats (roasted, boiled, stuffed; roast rabbit, boiled turkey, scotch collop), Vegetables (creamed beetroot, economical salad dressing, potatoes baked in their skins), Puddings and Sweets (suet pastry, Yorkshire pudding, chocolate tarts, ginger cream), Bread and Cakes (household bread, raspberry sandwich cake, sultana scones, peanut fancies), Icings and Fillings, Invalid Cookery (beef tea, nourishing lemonade, Virol pudding), Jams, Sweetmeats and Pickles (red currant jelly, piccalilli) and Miscellaneous Dishes including Meatless Recipes (cheese omelette, mock white fish, mock duck, mock goose, vegetarian mincemeat). At the back, Miss Tuxford includes sections on gas cooking hints, “specimen household dinners” (206), and household hints. There is then a “Table of Foods in Season” (208–10) taking the reader through the months and the various meats and vegetables available at those times. There is a useful index and finally an advertisement for an oven cleaner on the last page (which is glued to the back cover). There are food and cookery advertisements throughout the book, but my favourite is the one inside the front cover, for Hartley’s jam, featuring two photographs of a little boy. The first shows him looking serious, and slightly anxious, the second wide-eyed and smiling, eager for his jam. The text tells mothers that “there’s nothing like plenty of bread and Hartley’s for a growing boy” (inside front cover). I love the simple appeal to making your little boy happy that is contained within this tiny narrative. Did my mother and father eat this jam when they were small? By 1937, my mother was twenty-one, not yet married, living with her mother in Weston-super-Mare. She was learning secretarial skills—I have her certificate of proficiency in Pitman’s shorthand—and I think she and my father had met by then. Perhaps she thought about when she would be giving her own children Hartley’s jam, or something else prepared from Miss Tuxford’s recipes, like the Christmas puddings, shortbread, or chocolate cake. She would not have imagined that no children would arrive, that twenty-five years of marriage would pass before she held her own baby, and this would be one who was born to another woman. In the one other cookbook I have kept, there are several recipes cut out from newspapers, and a few typed or handwritten recipes hidden within the pages. This is The Main Cookery Book, in its August 1944 reprint, which was written and compiled by Marguerite K. Gompertz and the “Staff of the Main Research Kitchen”. My mother wrote her name and the date she obtained the cookbook (31 January 1945) on the first blank page. She had been married just over five years, and my father may, or may not, have still been in the Royal Air Force. I have only a sketchy knowledge of my adoptive parents. My mother was born in Newent, Gloucestershire, and my father in Bromley, Kent; they were both born during the first world war. My father served as a navigator in the Royal Air Force in the second world war in the 1940s, received head and psychological injuries and was invalided out before the war ended. He spent some time in rehabilitation, there being letters from him to my mother detailing his stay in one hospital in the 1950s. Their life seemed to become less and less secure as the years passed, more chaotic, restless, and unsettled. By the time I came into their lives, they were both nearly fifty, and moving from place to place. Perhaps this is one reason why I have no memory of my mother cooking. I cannot picture her consulting these cookbooks, or anything more modern, or even cutting out the recipes from newspapers and magazines, because I do not remember seeing her do it. She did not talk to me about cooking, we didn’t cook together, and I do not remember her teaching me anything about food or its preparation. This is a gap in my memory that is puzzling. There is evidence—the books and additional paper recipes and stains on the pages—that my mother was involved in the world of the kitchen. This suggests she handled meats, vegetables, and flours, kneaded, chopped, mashed, baked, and boiled all manners of foods. But I cannot remember her doing any of it. I think the cooking must have been a part of her life before me, when she lived in England, her home country, which she loved, and when she still had hope that children would come. It must have then been apparent that her husband was going to need support and care after the war, and I can imagine she came to realise that any dreams she had would need rearranging.What I do remember is that our meals were prepared by my father, and contained no spices, onions, or garlic because he suffered frequently from indigestion and said these ingredients made it worse. He was a big-chested man with small hips who worried he was too heavy and so put himself on diets every other week. For my father, dieting meant not eating anything, which tended to lead to binges on chocolate or cheese or whatever he could grab easily from the fridge.Meals at night followed a pattern. On Sundays we ate roast chicken with vegetables as a treat, then finished it over the next days as a cold accompaniment with salad. Other meals would feature fish fingers, mince, ham, or a cold luncheon meat with either salad or boiled vegetables. Sometimes we would have a tin of peaches in juice or ice cream, or both. No cookbooks were consulted to prepare these meals.What was my mother doing while my father cooked? She must have been in the kitchen too, probably contributing, but I don’t see her there. By the time we came back to Australia permanently in 1974, my father’s working life had come to an end, and he took over the household cookery for something to do, as well as sewing his own clothes, and repairing his own car. He once hoisted the engine out of a Morris Minor with the help of a young mechanic, a rope, and the branch of a poinciana tree. I have three rugs that he wove before I was born, and he made furniture as well. My mother also sewed, and made my school uniforms and other clothes as well as her own skirts and blouses, jackets and pants. Unfortunately, she was fond of crimplene, which came in bright primary colours and smelled of petrol, but didn’t require ironing and dried quickly on the washing line. It didn’t exactly hang on your body, but rather took it over, imposing itself with its shapelessness. The handwritten recipe for salad cream shown on the pink paper is not in my mother’s hand but my father’s. Her correction can be seen to the word “gelatine” at the bottom; she has replaced it with “c’flour” which I assume means cornflour. This recipe actually makes me a liar, because it shows my father writing about using pepper, paprika, and tumeric to make a food item, when I have already said he used no spices. When I knew him, and ate his food, he didn’t. But he had another life for forty-seven years before my birth, and these recipes with their stains and scribbles help me to begin making a picture of both his life, and my mother’s. So much of them is a complete mystery to me, but these scraps of belongings help me inch along in my thinking about them, who they were, and what they meant to me (Turkle).The Main Cookery Book has a similar structure to Miss Tuxford’s, with some variations, like the chapter titled Réchauffés, which deals with dishes using already cooked foodstuffs that only then require reheating, and a chapter on home-made wines. There are also notes at the end of the book on topics such as gas ovens and methods of cooking (boiling, steaming, simmering, and so on). What really interests me about this book are the clippings inserted by my mother, although the printed pages themselves seem relatively clean and uncooked upon. There is a recipe for pickles and chutneys torn from a newspaper, and when I look on the other side I find a context: a note about Charlie Chaplin and the House of Representatives’s Un-American Activities Committee starting its investigations into the influence of Communists on Hollywood. I wonder if my parents talked about these events, or if they went to see Charlie Chaplin’s films. My mother’s diaries from the 1940s include her references to movies—Shirley Temple in Kiss and Tell, Bing Crosby in Road to Utopia—as well as day to day activities and visits to, and from, family and friends, her sinus infections and colds, getting “shock[ed] from paraffin lamp”, food rationing. If my father kept diaries during his earlier years, nothing of them survives. I remember his determined shredding of documents after my mother’s death, and his fear of discovery, that his life’s secrets would be revealed. He did not tell me I had been adopted until I was twenty-three, and rarely spoke of it afterwards. My mother never mentioned it. I look at the recipe for lemon curd. Did my mother ever make this? Did she use margarine instead of butter? We used margarine on sandwiches, as butter was too hard to spread. Once again, I turn over this clipping to read the news, and find no date but an announcement of an exhibition of work by Marc Chagall at the Tate Gallery, the funeral of Sir Geoffrey Fison (who I discover from The Peerage website died in 1948, unmarried, a Baronet and decorated soldier), and a memorial service for Dr. Duncan Campbell Scott, the Canadian poet and prose writer, during which the Poet Laureate of the time, John Masefield, gave the address. And there was also a note about the latest wills, including that of a reverend who left an estate valued at over £50 000. My maternal adoptive grandmother, who lived in Weston-super-Mare across the road from the beach, and with whom we stayed for several months in 1974, left most of her worldly belongings to my mother and nothing to her son. He seems to have been cut out from her life after she separated from her husband, and her children’s father, sometime in the 1920s. Apparently, my uncle followed his father out to Australia, and his mother never forgave him, refusing to have anything more to do with her son for the rest of her life, not even to see her grandchildren. When I knew her in that brief period in 1974, she was already approaching eighty and showing signs of dementia. But I do remember dancing the Charleston with her in the kitchen, and her helping me bathe my ragdoll Pollyanna in a tub in the garden. The only food I remember at her stone house was afternoon tea with lots of different, exotic cakes, particularly one called Neopolitan, with swirls of red and brown through the moist sponge. My grandmother had a long narrow garden filled with flowers and a greenhouse with tomatoes; she loved that garden, and spent a lot of time nurturing it.My father and his mother-in-law were not each other’s favourite person, and this coloured my mother’s relationship with her, too. We were poor for many years, and the only reason we were able to go to England was because of the generosity of my grandmother, who paid for our airfares. I think my father searched for work while we were there, but whether he was successful or not I do not know. We returned to Australia and I went into grade four at the end of 1974, an outsider of sorts, and bemused by the syllabus, because I had moved around so much. I went to eight different primary schools and two high schools, eventually obtaining a scholarship to a private girls’ school for the last four years. My father was intent on me becoming a doctor, and so my life was largely study, which is another reason why I took little notice of what went on in the kitchen and what appeared on the dining table. I would come home from school and my parents would start meal preparation almost straight away, so we sat down to dinner at about four o’clock during the week, and I started the night’s study at five. I usually worked through until about ten, and then read a novel for a little while before sleep. Every parcel of time was accounted for, and nothing was wasted. This schedule continued throughout those four years of high school, with my father berating me if I didn’t do well at an exam, but also being proud when I did. In grades eight, nine, and ten, I studied home economics, and remember being offered a zucchini to taste because I had never seen one before. I also remember making Greek biscuits of some sort for an exam, and the sieve giving out while I was sifting a large quantity of flour. We learned to cook simple meals of meats and vegetables, and to prepare a full breakfast. We also baked cakes but, when my sponges remained flat, I realised that my strengths might lay elsewhere. This probably also contributed to my lack of interest in cooking. Domestic pursuits were not encouraged at home, although my mother did teach me to sew and knit, resulting in skewed attempts at a shirt dress and a white blouse, and a wildly coloured knitted shoulder bag that I actually liked but which embarrassed my father. There were no such lessons in cakemaking or biscuit baking or any of the recipes from Miss Tuxford. By this time, my mother bought such treats from the supermarket.This other life, this previous life of my parents, a life far away in time and place, was completely unknown to me before my mother’s death. I saw little of them after the revelation of my adoption, not because of this knowledge I then had, but because of my father’s controlling behaviour. I discovered that the rest of my adoptive family, who I hardly knew apart from my maternal grandmother, had always known. It would have been difficult, after all, for my parents to keep such a secret from them. Because of this life of constant moving, my estrangement from my family, and our lack of friends and connections with other people, there was a gap in my experience. As a child, I only knew one grandmother, and only for a relatively brief period of time. I have no grandfatherly memories, and none either of aunts and uncles, only a few fleeting images of a cousin here and there. It was difficult to form friendships as a child when we were only in a place for a limited time. We were always moving on, and left everything behind, to start again in a new suburb, state, country. Continuity and stability were not our trademarks, for reasons that are only slowly making themselves known to me: my father’s mental health problems, his difficult personality, our lack of money, the need to keep my adoption secret.What was that need? From where did it spring? My father always seemed to be a secretive person, an intensely private man, one who had things to hide, and seemed to suffer many mistakes and mishaps and misfortune. At the end, after my mother’s death, we spent two years with each other as he became frailer and moved into a nursing home. It was a truce formed out of necessity, as there was no one else to care for him, so thoroughly had he alienated his family; he had no friends, certainly not in Australia, and only the doctor and helping professionals to talk to most days. My father’s brother John had died some years before, and the whereabouts of his other sibling Gordon were unknown. I discovered that he had died three years previously. Nieces had not heard from my father for decades. My mother’s niece revealed that my mother and she had never met. There is a letter from my mother’s father in the 1960s, probably just before he died, remarking that he would like a photograph of her as they hadn’t seen each other for forty years. None of this was talked about when my mother was alive. It was as if I was somehow separate from their stories, from their history, that it was not suitable for my ears, or that once I came into their lives they wanted to make a new life altogether. At that time, all of their past was stored away. Even my very origins, my tiny past life, were unspoken, and made into a secret. The trouble with secrets, however, is that they hang around, peek out of boxes, lurk in the corners of sentences, and threaten to be revealed by the questions of puzzled strangers, or mistakenly released by knowledgeable relatives. Adoptee memoirs like mine seek to go into those hidden storage boxes and the corners and pages of sources like these seemingly innocent old cookbooks, in the quest to bring these secrets to light. Like Miss Tuxford’s cookbook, with its stains and smudges, or the Main Cookery Book with its pages full of clippings, the revelation of such secrets threaten to tell stories that contradict the official version. ReferencesBrien, Donna Lee. “Pathways into an ‘Elaborate Ecosystem’: Ways of Categorising the Food Memoir”. TEXT (October 2011). 12 Jun. 2013 ‹http://www.textjournal.com.au/oct11/brien.htm›.Chick, Suzanne. Searching for Charmian. Sydney: Picador, 1995.Dessaix, Robert. A Mother’s Disgrace. Sydney: Angus & Robertson, 1994.Fisher, Florence. The Search for Anna Fisher. New York: Arthur Fields, 1973.Frame, Tom. Binding Ties: An Experience of Adoption and Reunion in Australia. Alexandria: Hale & Iremonger, 1999.Gibson, Margaret. Objects of the Dead: Mourning and Memory in Everyday Life. 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