Impact of COVID-19 on the stroke rehabilitation pathway: multidisciplinary team reflections on a patient and carer journey from acute to community stroke services.

A 62-year old man attended accident and emergency in June 2020 with dense right sided weakness, aphasia and confusion. Investigations revealed a left middle cerebral artery infarct, and he was admitted under the stroke team for ongoing inpatient rehabilitation. He was discharged home in September 2020 and received community stroke rehabilitation from physiotherapy, nursing, occupational therapy and speech and language therapy. He is now working towards a graded discharge from the Community Stroke and Neuro Rehab Team, after achieving his rehabilitation goals. In this case, the multidisciplinary team adopted different ways of working to accommodate the patients' priorities while also negotiating the COVID-19 pandemic. This included taking a transdisciplinary approach to rehabilitation and considering alternative supported self-management strategies. This case highlighted several learning points, particularly the potential benefits of shared goal setting for patients with communication difficulties and transdisciplinary approaches to community stroke rehabilitation.

Biophysical and anthropogenic influences on the status of Tonga's coral reefs and reef fish fishery.

Despite increasing threats to Tonga's coral reefs from stressors that are both local (e.g. overfishing and pollution) and global (e.g. climate change), there is yet to be a systematic assessment of the status of the country's coral reef ecosystem and reef fish fishery stocks. Here, we provide a national ecological assessment of Tonga's coral reefs and reef fish fishery using ecological survey data from 375 sites throughout Tonga's three main island groups (Ha'apai, Tongatapu and Vava'u), represented by seven key metrics of reef health and fish resource status. Boosted regression tree analysis was used to assess and describe the relative importance of 11 socio-environmental variables associated with these key metrics of reef condition. Mean live coral cover across Tonga was 18%, and showed a strong increase from north to south correlated with declining sea surface temperature, as well as with increasing distance from each provincial capital. Tongatapu, the southernmost island group, had 2.5 times greater coral cover than the northernmost group, Vava'u (24.9% and 10.4% respectively). Reef fish species richness and density were comparable throughout Tongatapu and the middle island group, Ha'apai (~35 species/transect and ~2500 fish/km2), but were significantly lower in Vava'u (~24 species/transect and ~1700 fish/km2). Spatial patterns in the reef fish assemblage were primarily influenced by habitat-associated variables (slope, structural complexity, and hard coral cover). The biomass of target reef fish was greatest in Ha'apai (~820 kg/ha) and lowest in Vava'u (~340 kg/ha), and was negatively associated with higher human influence and fishing activity. Overall mean reef fish biomass values suggest that Tonga's reef fish fishery can be classified as moderately to heavily exploited, with 64% of sites having less than 500 kg/ha. This study provides critical baseline ecological information for Tonga's coral reefs that will: (1) facilitate ongoing management and research; and (2) enable accurate reporting on conservation targets locally and internationally.

Sociodemographic and behavioral correlates of insufficient sleep in Australian adults.

OBJECTIVES: Insufficient sleep is being increasingly recognized as a public health issue. There is a need to identify correlates of insufficient sleep to guide future preventative health interventions. This study aims to determine the sociodemographic and behavioral correlates of frequent perceived insufficient sleep in the Australian population. DESIGN: Pooled analyses of two cross-sectional, self-report national telephone surveys were conducted in 2015 (July-August) and 2016 (June-August). SETTING: Adults living in Australia. PARTICIPANTS: Data from participants (age 18 years and over) of both surveys were pooled for analysis (2015 n = 1041; 2016 n = 1170), with 2211 participants being included in the current study. MEASUREMENTS: Participants self-reported their age, gender, education and employment level, language spoken at home, urbanization, chronic disease, and height and weight to calculate BMI. Self-reported physical activity, sitting time, smoking, and consumption of fruit, vegetables, fast food, alcohol and frequency of perceived insufficient sleep were also assessed. Binary logistic regression analysis examined the relationship between insufficient sleep (≥14 days out of 30), sociodemographic and behavioral variables. RESULTS: The overall prevalence of insufficient sleep was 24%. Female gender, obesity, >8 h/d sitting time, smoking, and frequent consumption of fast food were positively associated with frequent insufficient sleep (P < .05). Higher levels of physical activity and being aged 51 years or older were negatively associated with frequent insufficient sleep (P < .05). CONCLUSIONS: The sociodemographic and behavioral characteristics associated with frequent perceived insufficient sleep can be used to guide the development of future interventions to reduce sleep insufficiency.

Composition and temporal stability of turf sediments on inner-shelf coral reefs.

Elevated sediment loads within the epilithic algal matrix (EAM) of coral reefs can increase coral mortality and inhibit herbivory. Yet the composition, distribution and temporal variability of EAM sediment loads are poorly known, especially on inshore reefs. This study quantified EAM sediment loads (including organic particulates) and algal length across the reef profile of two bays at Orpheus Island (inner-shelf Great Barrier Reef) over a six month period. We examined the total sediment mass, organic load, carbonate and silicate content, and the particle sizes of EAM sediments. Throughout the study period, all EAM sediment variables exhibited marked variation among reef zones. However, EAM sediment loads and algal length were consistent between bays and over time, despite major seasonal variation in climate including a severe tropical cyclone. This study provides a comprehensive description of EAM sediments on inshore reefs and highlights the exceptional temporal stability of EAM sediments on coral reefs.