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The evolution and current operation of the National Library of Australia are described. Included is information on the library's collections (book, film, and pictorial), union catalogs, bibliographical services, publications, technical processes, and special services. Comments on Australian interests and activities in foreign countries are also provided. (DGC)

Both antiretroviral treatment interruption (TI) and cessation have been strongly discouraged since 2006. We describe the incidence, duration, and risk factors for TI and loss-to-follow-up (LTFU) rates across 13 countries. All 4689 adults (76% men) in two large HIV cohorts in Australia and Asia commencing combination antiretroviral therapy (ART) to March 2010 were included. TI was defined by ART cessation >30 days, then recommencement, and loss to follow-up (LTFU) by no visit since 31 March 2009 and no record of death. Survival analysis and Poisson regression methods were used. With median follow-up of 4.4 years [interquartile range (IQR):2.1-6.5], TI incidence was 6.7 per 100 person years (PY) (95% CI:6.1-7.3) pre-2006, falling to 2.0 (95% CI:1.7-2.2) from 2006 ( p<0.01). LTFU incidence was 3.5 per 100 PY (95% CI:3.1-3.9) pre-2006, and 4.1 (95% CI:3.5-4.9) from 2006 ( p=0.22). TIs accounted for 6.4% of potential time on ART pre-2006 and 1.2% from 2006 ( p<0.01), and LTFU 4.7% of potential time on ART pre-2006 and 6.6% from 2006 ( p<0.01). Median TI duration was 163 (IQR: 75-391) days pre-2006 and 118 (IQR: 67-270) days from 2006 ( p<0.01). Independent risk factors for the first TI were: Australia HIV Observational Database participation; ART initiation pre-2006; ART regimens including stavudine and didanosine; three nucleoside analogue reverse transcriptase inhibitors; ≥7 pills per day; and ART with food restrictions (fasting or with food). In conclusion, since 2006, 7.8% of patients had significant time off treatment, which has the potential to compromise any 'test and treat' policy as during the interruption viral load will rebound and increase the risk of transmission. [ABSTRACT FROM AUTHOR]

Existing assessments might have underappreciated ozone-related health impacts worldwide. Here our study assesses current global ozone pollution using the high-resolution (0.05°) estimation from a geo-ensemble learning model, with key focuses on population exposure and all-cause mortality burden. Our model demonstrates strong performance, achieving a mean bias of less than -1.5 parts per billion against in-situ measurements. We estimate that 66.2% of the global population is exposed to excess ozone for short term (> 30 days per year), and 94.2% suffers from long-term exposure. Furthermore, severe ozone exposure levels are observed in Cropland areas, particularly over Asia. Importantly, the all-cause ozone-attributable deaths significantly surpass previous recognition from specific diseases worldwide. Notably, mid-latitude Asia (30°N) and the western United States show high mortality burden, contributing substantially to global ozone-attributable deaths. Our study highlights current significant global ozone-related health risks and may benefit the ozone-exposed population in the future., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: There is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty., Methods: Secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0-2 (non-frail), 3-6 (frail) and 7-14 (most-frail). Data were analyzed using descriptive statistics., Results: Overall, 17.4 % (n = 1010) residents used ≥1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %)., Conclusions: One in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm., Competing Interests: Declaration of competing interest A.J.C. has received grant or consulting funds from the Medical Research Future Fund, Dementia Australia Research Foundation and the Pharmaceutical Society of Australia. All these funds were paid to the administering University. A.J.C. is also a national board director for the Pharmaceutical Society of Australia. S.H. belongs to an endowed chair funded by donations from Hakue technology, PROUMED, Japan Bio Products, Towa Pharmaceutical, Yellow Eight and Sugi Holdings and received research funding from SOMPO Care Inc. outside of this work. N.M.V. has received grant or consulting funds from UCB Biopharma, Nestlé and Vegenat. R.V. was previously on the board of Resthaven and the board governance committee. Visvanathan is co-founder and chair of the clinical advisory group for a wearable sensor technology start-up HealthVibes.ai. J.S.B. has received grant or consulting funds from the NHMRC, Medical Research Future Fund, Victorian Government Department of Health and Human Services, Dementia Australia Research Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, Australian Commission on Safety and Quality in Health Care, Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies Programme, Amgen, and several aged care provider organizations. All these funds were paid to the administering University. All other authors have no conflicts of interest to declare., (Copyright © 2024. Published by Elsevier B.V.)

Tobacco use among people with mental illness is one of the contributing risk factors for premature morbidity and mortality. Two in three people with mental illness are current smokers with deteriorating physical health and quality of life. This review outlines the prevalence and predictors of tobacco use among people with mental illness in Asia. Twenty-five cross-sectional studies were selected from the exhaustive search of databases. Ten countries emerged based on the number of studies conducted within Asia among people diagnosed with mental illness and tobacco use, namely, India (8), China (7), Pakistan (2), Singapore (2), Sri Lanka (01), Japan (01), Jordan (01), Malaysia (01), Korea (01), and Taiwan (01). The prevalence of tobacco use was in the range of 3.6% to 89.4%, with the measure of precision at 95% confidence. The highest and lowest prevalence was reported in China, followed by India. Being male, separated, lower education, unemployed, lack of family support, a psychotic diagnosis, lack of knowledge, motivation, and a coping mechanism were predictors of tobacco use. This review emphasized the extent and predictors of tobacco use among this vulnerable group that need to be reflected while initiating and implementing cessation strategies by healthcare providers., Competing Interests: Declarations. Conflict of interest: The authors have no competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s).)

Globally, health care workers (HCWs) are at a high risk of occupational exposure to needlestick injuries (NSIs). Needlestick injuries not only are associated with an increased risk of infections caused by bloodborne pathogens but are also a primary source of emotional distress and job burnout for HCWs and patients. Insulin injection-related NSIs are common among HCWs working in hospitals in the Asia-Pacific (APAC) region and impose a significant burden. Insulin pen needles have a high risk of transmitting infections (at both the patient-end and cartridge end of the sharp) after use. Recapping a needle after administering an insulin injection poses a major risk to HCWs. Currently, several safety-engineered needle devices (SENDs) are available with active or passive safety mechanisms. Passive insulin safety pen needles with dual-ended protection and automatic recapping capabilities have resulted in a significant drop in accidental punctures to HCWs while administering insulin to patients with diabetes. In this article, we have reviewed the burden and common causes of NSIs with insulin injections among HCWs in the APAC region. We have discussed current approaches to address the issues associated with NSIs and the benefits of introducing SENDs in health care settings, including long-term care facilities, nursing homes, and home care settings where patients may require assisted insulin injections. This review also summarizes key strategies/recommendations to prevent NSIs in HCWs and patients with diabetes in the APAC region., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Shailendra Bajpai and Kevin Friedman are employees and stockholders of BD/embecta (formerly BD Diabetes Care), manufacturer of a range of safety-engineered devices. No other potential conflict of interest relevant to this article was reported by the rest of the authors.

Context: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) was introduced as a new entity replacing the diagnosis of noninvasive encapsulated follicular variant of papillary thyroid carcinoma (PTC). Significant variability in the incidence of NIFTP diagnosed in different world regions has been reported., Objective: To investigate the rate of adoption of NIFTP, change in practice patterns, and uniformity in applying diagnostic criteria among pathologists practicing in different regions., Methods: Two surveys distributed to pathologists of the International Endocrine Pathology Discussion Group with multiple-choice questions on NIFTP adoption into pathology practice and whole slide images of 5 tumors to collect information on nuclear score and diagnosis. Forty-eight endocrine pathologists, including 24 from North America, 8 from Europe, and 16 from Asia/Oceania completed the first survey and 38 the second survey., Results: A 94% adoption rate of NIFTP by the pathologists was found. Yet, the frequency of rendering NIFTP diagnosis was significantly higher in North America than in other regions (P = .009). While the highest concordance was found in diagnosing lesions with mildly or well-developed PTC-like nuclei, there was significant variability in nuclear scoring and diagnosing NIFTP for tumors with moderate nuclear changes (nuclear score 2) (case 2, P < .05). Pathologists practicing in North America and Europe showed a tendency for lower thresholds for PTC-like nuclei and NIFTP than those practicing in Asia/Oceania., Conclusion: Despite a high adoption rate of NIFTP across geographic regions, NIFTP is diagnosed more often by pathologists in North America. Significant differences remain in diagnosing intermediate PTC-like nuclei and respectively NIFTP, with more conservative nuclear scoring in Asia/Oceania, which may explain the geographic differences in NIFTP incidence., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Increasing numbers of people with HIV have received prolonged antiretroviral therapy (ART). We assessed long-term immunological and survival outcomes among people with HIV from Asia (TREAT Asia HIV Observational Database) and Australia (Australian HIV Observational Database)., Methods: People with HIV receiving ART for ≥10 years were included. Factors associated with CD4 counts in years 11-15 of ART were analyzed using repeated measures linear regression. Survival after 10 years was analyzed using competing risk regression., Results: There were 7139 people included: 4867 (68%) from the TREAT Asia HIV Observational Database and 2272 (32%) from the Australian HIV Observational Database. Higher CD4 levels after 10 years were observed if the nadir CD4 in the first decade was higher (CD4 (cells/µL) 101-200: difference = 35, 95% CI: 18 to 51; >200: difference = 125, 95% CI: 107 to 142) compared with ≤50. The same patterns were observed in those who achieved CD4 ≥500 cells/µL, which subsequently decreased to <500 (difference = 225, 95% confidence interval [CI]: 213 to 236), or in those who achieved and maintained CD4 ≥500 cells/µL (difference = 402, 95% CI: 384 to 420), compared with always <500 in the previous decade. Previous protease inhibitor (PI)-based regimen (difference=-17, 95% CI -33 to -1) compared with no PI, and previous treatment interruptions (TI) of 14 days to 3 months and >6 months were associated with lower CD4 counts after 10 years (difference = -38, 95% CI -62 to -15 and difference=-44, 95% CI -61 to -27, respectively) compared with no TI. The mortality rate was 1.04 per 100 person-years. Virological failure was associated with subsequent mortality (subhazard ratio = 1.34, 95% CI: 1.04 to 1.71)., Conclusions: Sustaining high CD4 levels and minimizing TI has far-reaching benefits well beyond the first decade of ART., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

COVID-19 (hereafter COVID) induced lockdown provided a unique opportunity to evaluate the effects of human activities on coastal ecosystems. This study quantified the seasonal variations in concentrations of nine metals (Al, Cr, Cd, Co, Cu, Fe, Mn, Ni, and Pb) in surface water and sediment samples of the largest brackish water lagoon in Asia (i.e., Chilika Lagoon), comparing pre-and post-COVID scenarios. The COVID lockdown resulted in a wide variation in metals concentrations, with surface water showing 1 to 8.6-fold reduction in metals such as Al, Cr, Cu, Fe, Mn, and Pb, while sediment displayed a more modest reduction of 1 to 1.3-fold. Metals like Cd, Co and Ni were below detection limit in post-COVID water samples with a slight decrease (1-fold) in the sediments. COVID lockdown did not show any significant correlation with metal concentrations in water or sediment. This study provides baseline data for metal contamination in the surface water and sediment of the Chilika Lagoon., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Generalized pustular psoriasis (GPP) is a rare, chronic, heterogeneous, and potentially life-threatening disease characterized by primary, sterile, and macroscopically visible pustules with or without systemic symptoms. There are ethnic differences in the genetic mutations associated with GPP that might affect the clinical manifestations and treatment responses. Currently, there is limited evidence from the patient population in the Asia-Pacific (APAC) region, resulting in a general paucity of information on the effective management of patients with GPP in this region. This modified Delphi panel study aimed to identify current evidence and gain advanced insights to facilitate the development of a regionally tailored APAC consensus on the management of GPP. A systematic literature review (SLR) was conducted to identify published literature and develop consensus statements on (i) definition and clinical course, (ii) diagnosis of GPP, (iii) treatment outcomes, goals, and monitoring measures, and (iv) optimal management strategies and clinical practices. Statements were rated by a panel of dermatologists in two rounds, with the threshold for consensus at ≥80% agreement. Twenty experts from the APAC region reached consensus on 106 statements that were developed based on the SLR and experts' collective expertise. The experts agreed that GPP is a rare, severe, and potentially life-threatening condition that is distinct from plaque psoriasis. This consensus emphasized the importance of a tailored treatment strategy taking into account the GPP flare severity and each patient's unique clinical circumstances. The experts reached consensus on the severity classification of GPP flares and recommended first-line and maintenance treatment options for adult GPP, childhood GPP, and GPP in pregnancy. These consensus outcomes have been synthesized into treatment algorithms to guide dermatologists in the APAC region in their clinical decision-making processes., (© 2024 The Author(s). The Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Japanese Dermatological Association.)

Objectives: To evaluate changes in the age at menarche in Asian populations., Study Design: Retrospective cohort study., Methods: We included 548,830 women from six countries in Asia. The data were sourced from 20 cohorts participating in the Asia Cohort Consortium (ACC) and two additional cohort studies: Japan Multi-institutional Collaborative Cohorts (J-MICC), and Japan Nurse Health Study (JNHS) with data on age at menarche. Joinpoint regression was used to evaluate changes in age at menarche by birth year and by country., Results: The study includes data from cohorts in six Asian countries namely, China, Iran, Japan, Korea, Malaysia and Singapore. Birth cohorts ranged from 1873 to 1995. The mean age of menarche was 14.0 years with a standard deviation (SD) of 1.4 years, ranged from 12.6 to 15.5 years. Over 100 years age at menarche showed an overall decrease in all six countries. China showed a mixed pattern of decrease, increase, and subsequent decrease from 1926 to 1960. Iran and Malaysia experienced a sharp decline between about 1985 and 1990, with APC values of -4.48 and -1.24, respectively, while Japan, South Korea, and Singapore exhibited a nearly linear decline since the 1980s, notably with an APC of -3.41 in Singapore from 1993 to 1995., Conclusions: Overall, we observed a declining age at menarche, while the pace of the change differed by country. Additional long-term observation is needed to examine the contributing factors of differences in trend across Asian countries. The study could serve as a tool to strengthen global health campaigns., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: Mental disorders remain the most significant contributor to years lived with disability in South Asia, yet governmental health expenditure on mental health in South Asia remains very low with limited strategic policy development. To strengthen the case for action it is important to better understand the profound economic costs associated with poor mental health., Methods: We conducted a systematic review on the costs of all mental disorders, as well as intentional self-harm and suicide, in the World Bank South Asia Region. Ten global and South Asian databases as well as grey literature sources were searched., Results: 72 studies were identified, including 38 meeting high quality criteria for good reporting of costs. Of these, 27 covered India, five Pakistan, four Nepal and three Bangladesh and Sri Lanka. Most studies focused on depressive disorders (15), psychoses (14) and harmful alcohol use (7); knowledge of economic impacts for other conditions was limited. Profound economic impacts within and beyond health care systems were found. In 15 of 18 studies which included productivity losses to individuals and/or carers, these costs more than outweighed costs of health care., Conclusion: Mental disorders represent a considerable economic burden, but existing estimates are conservative as they do not consider long-term impacts or the full range of conditions. Modelling studies could be employed covering longer time periods and more conditions. Clear distinctions should be reported between out-of-pocket and health system costs, as well as between mental health service-specific and physical health-related costs., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: CCA has a poor prognosis. Different anatomical subtypes are characterized by distinct clinical features, surgical options, and prognoses, which can potentially impact survival outcomes following radical resection. In addition to the malignancy of CCA itself, clinical staging and treatment methods are the main factors that can affect survival. This study aims to update a more reliable prediction model for the prognosis of CCA based on different anatomical locations., Methods: A total of 1172 CCA patients (305 iCCA, 467 pCCA, and 400 dCCA) who underwent surgical resection between 2015 and 2022 were included in the analysis. The covariates included in the analysis were age, sex, tumor diameter, differentiation grade, T stage, N stage, M stage, neural invasion, cancer thrombus, history of hepatitis B or biliary calculi, and receipt of adjuvant chemotherapy. The data were randomly divided into training (80 %) and validation cohort (20 %)., Results: We developed a nomogram of the sensitive model and calculated concordance indices of different constructed prognostic survival models. Meanwhile, we validated the effectiveness of the nomogram model and compared it with the TNM system through decision curve analysis (DCA) and internal cohort validation. The nomogram model had a better net benefit than the TNM system at any given threshold for iCCA, pCCA, and dCCA, regardless of their location., Conclusions: We have updated the prognostic model for OS in CCA patients who underwent radical resection according to the different tumor locations. This model can effectively predict OS and has the potential to facilitate individual clinical decision-making., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Globally, nearly half of deaths from cirrhosis and chronic liver diseases (CLD) and three-quarters of deaths from hepatocellular carcinoma (HCC) occur in the Asia-Pacific region. Chronic hepatitis B is responsible for the vast majority of liver-related deaths in the region. Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common form of CLD, affecting an estimated 30% of the adult population. Compared with people of European descent, people from the Asia-Pacific region carry more genetic variants associated with MASLD and its progression. Alcohol is a fast-growing cause of CLD and HCC in Asia as a result of the rising per-capita consumption of alcohol. Drug-induced liver injury is under-recognized and probably has a high prevalence in this region. The epidemiological and outcome data of acute-on-chronic liver failure are heterogeneous, and non-unified definitions across regions contribute to this heterogeneity. CLDs are severely underdiagnosed, and effective treatments and vaccinations are underutilized. In this Review, we highlight trends in the burden of CLD and HCC in the Asia-Pacific region and discuss the rapidly changing aetiologies of liver disease. We examine the multiple gaps in the care cascade and propose mitigating strategies and future directions., Competing Interests: Competing interests: L.-Y.M. served on the advisory board for Gilead Sciences and Roche Diagnostics. K.C.Y. was a speaker for Gilead and AbbVie, and received a grant supported by the Educate, Test, Treat! Programme, which was funded in part by Gilead Sciences Inc. R.L. has served as an advisory board member for Gilead Sciences, speaker for GenieBiome, and owns equity in Pfizer. J.C.-T.L. served as a speaker for Gilead Sciences, and served on an advisory board committee for Gilead Sciences and Boehringer Ingelheim. Y.C.H. has received research grants from Gilead Sciences, served on advisory committees for Gilead Sciences and Sysmex, and received lecture fees from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Merck Sharp & Dohme and Novartis. D.Q.H. has served on the advisory board for Gilead Sciences and Roche Diagnostics. The other authors have no competing interests to declare., (© 2024. Springer Nature Limited.)

Population expansions and contractions out of and into Africa since the early Pleistocene have influenced the course of human evolution. While local- and regional-scale investigations have provided insights into the drivers of Eurasian hominin dispersals, a continental-scale and integrated study of hominin-environmental interactions across Palearctic Eurasia has been lacking. Here, we report high-resolution (up to ∼5-10 kyr sample interval) carbon isotope time series of loess deposits in Central Asia and northwest China, a region dominated by westerly winds, providing unique paleoecological and paleoclimatic records for over ~3.6 Ma. These data, combined with further syntheses of Pleistocene paleontological and archaeological records and spatio-temporal distributions of Eurasian eolian deposits and river terraces, demonstrate a pronounced transformation of landscapes around the Mid-Pleistocene Climate Transition. Increased climate amplitude and aridity fluctuations over this period led to the widespread formation of more open habitats, river terraces, and desert-loess landscapes, pushing hominins to range more widely and find solutions to increasingly challenging environments. Mid-Pleistocene climatic and ecological transitions, and the formation of modern desert and loess landscapes and river networks, emerge as critical events during the dispersal of early hominins in Palearctic Eurasia., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

The Asia Allergy Birth Cohort (A2BC) network consolidates data from multiple independently established birth cohorts across Asia to enhance research on host-environment interactions in allergic diseases. These cohorts, established at different times with various methodologies, are reliable data sources. Our aim is to introduce the content, variables, and outcomes of these cohorts while highlighting their differences, laying the groundwork for future collaborative research. The A2BC network includes 10 cohort studies on allergic diseases from six Asian countries. Enrollment criteria, study aims, and an initial inventory were discussed and confirmed through five business meetings. A common database was developed to assess the study characteristics of these observational cohorts on allergic diseases, though harmonization efforts are retrospective. Five studies collected data on specific immunoglobulin E responses to various inhalant and food allergens, while six cohorts conducted skin prick tests. Lung function measurements were included in some studies, but without standardized procedures across cohorts. Asthma and allergic rhinitis were primarily assessed using questionnaires or doctor diagnoses, while assessments of eczema and food allergies varied across studies. The A2BC network also examines early-life environmental factors such as delivery mode, antibiotic usage, diet, and air pollutants, although these exposures were measured differently across the cohorts. Despite differences in the origins, methods, and objectives of each cohort, pooling data and conducting joint analyses offer valuable insights into the relationship between environmental exposures and allergic disease outcomes in Asian children. This approach can serve as a foundation for future collaborative research., (© 2024 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

Purpose of Review: Health data sciences can help mitigate high burden of cardiovascular disease (CVD) management in South Asia by increasing availability and affordability of healthcare services. This review explores the current landscape, challenges, and strategies for leveraging digital health technologies to improve CVD outcomes in the region., Recent Findings: Several South Asian countries are implementing national digital health strategies that aim to provide unique health account numbers for patients, creating longitudinal digital health records while others aim to digitize healthcare services and improve health outcomes. Significant challenges impede progress, including lack of interoperability, inadequate training of healthcare workers, cultural barriers, and data privacy concerns. Leveraging digital health for CVD management involves using big data for early detection, employing artificial intelligence for diagnostics, and integrating multiomics data for health insights. Addressing these challenges through policy frameworks, capacity building, and international cooperation is crucial for improving CVD outcomes in region., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

HCV RNA test determines current active infection and is a requirement prior to initiating HCV treatment. We investigated trends and factors associated with post-diagnosis HCV RNA testing rates prior to HCV treatment, and risk factors for first positive HCV RNA among people living with HIV (PLHIV) with HCV in the Asia-Pacific region. PLHIV with positive HCV antibody and in follow-up after 2010 were included. Patients were considered HCV-antibody positive if they ever tested positive for HCV antibody (HCVAb). Repeated measures Poisson regression model was used to analyse factors associated with post-diagnosis HCV RNA testing rates from positive HCVAb test. Factors associated with time to first positive HCV RNA from positive HCVAb test were analysed using Cox regression model. There were 767 HCVAb positive participants included (87% from LMICs) of whom 11% had HCV RNA tests. With 163 HCV RNA tests post positive HCVAb test, the overall testing rate was 5.05 per 100 person-years. Factors associated with increased testing rates included later calendar years of follow-up, HIV viral load ≥1000 copies/mL and higher income countries. Later calendar years of follow-up, ALT >5 times its upper limit of normal, and higher income countries were associated with shorter time to first positive HCV RNA test. Testing patterns indicated that uptake was predominantly in high income countries possibly due to different strategies used to determine testing in LMICs. Expanding access to HCV RNA, such as through lower-cost point of care assays, will be required to achieve elimination of HCV as a public health issue., (© 2024 John Wiley & Sons Ltd.)

Barramundi aquaculture is at risk of severe disease outbreaks and massive production losses. Here we used bioinformatics to screen 84 farmed barramundi transcriptomes to identify novel viruses that could threaten barramundi aquaculture and to establish a barramundi aquaculture virome. We discovered five novel viruses: latid herpesvirus 1 (LatHV-1) from the Alloherpesviridae family, barramundi parvovirus 1 (BParV1) from the Parvoviridae family, barramundi calicivirus 1 (BCaV1) from the Caliciviridae family, and barramundi associated picorna-like virus 1 and 2 (BPicV1 and BPicV2) from the Picornaviridae family. LatHV-1, BCaV1, and BParV1 are closely related to pathogenic viruses found in other fish species that can cause mass mortality in farms. To aid in future viral surveillance, we also designed and successfully tested an RT-PCR assay for the detection of BCaV1. Overall, we discovered a range of pathogenic viruses in barramundi aquaculture, paving the way for developing effective detection methods to assist early outbreak management., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To determine country/region-specific mortality (in-hospital, 30-day and 1-year) following hip fracture across the Asia Pacific region., Methods: Five databases MEDLINE, PUBMED, EMBASE, Web of Science and the Cochrane Library were searched to identify studies that reported mortality following hospitalisation for low-trauma hip fracture in adults aged ≥50 years with data from 2010 to 30 September 2021. There were no restrictions on study design or language. Pooled mortality estimates for countries/regions with ≥2 studies were calculated using random-effects models., Results: In total 244 studies were included in the meta-analysis. 123 studies (1,382,810 patients, 13 countries/regions) reported in-hospital mortality which ranged from 1.4 % in Japan [95 %CI 1.2-1.7], Singapore [95 %CI 1.0-1.6], China [95 %CI 0.8-2.3] and Hong Kong SAR [95 %CI 0.8-2.6] to 5.5 % [95 %CI 4.1-7.2] in New Zealand. 92 studies (628,450 patients, 13 countries/regions) reported 30-day mortality which ranged from 1.2 % in Japan [95 %CI 0.9-1.5] and Thailand [95 %CI 0.7-2.0] to 7.4 % [95 %CI 7.0-7.8] in Australia. 142 studies (1,139,752 patients, 14 countries/regions) reported 1-year mortality which ranged from 10.8 % [95 %CI 9.6-12.1] in Singapore to 23.3 % [95 %CI 22.3-24.5] in Australia and 23.8 % in New Zealand., Conclusion: There is substantial variation in mortality across the Asia Pacific region. Short-term mortality rates in Asian countries, notably Japan and Singapore, are up to four-fold lower than for Australia and New Zealand. This difference, although less marked, is sustained at 1-year with a two-fold lower mortality rate in Asia. This meta-analysis is the first to delineate these differences, further studies are required to understand the reasons for this variation., Competing Interests: Declaration of competing interest Lara Harvey, Narelle Payne, Azriel Tan, Jing Zhang, Yong Chang Lai, Morag Taylor, Elizabeth Armstrong, Catherine McVeigh, Anna Stefanie Mikolaizak, Rismah Hairu, Taylor Scott, Madeleine Bishop, and Jacqueline Close declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

China hosts around 68,000 international medical students (IMSs) primarily from lower income countries in Africa and Asia, who have the potential to contribute to international medical services. Understanding how these IMSs make career decisions can help better address the issue of global medical workforce shortage. However, such research is limited. Our study aims to explore the career decision-making process of China-educated IMSs, the challenges they experienced and the strategies they employed.In this exploratory qualitative study, we conducted semi-structured interviews with IMSs educated in China in 2022 using purposeful sampling. Twenty virtual one-on-one interviews were conducted, and data were analysed through directed qualitative content analysis. Cognitive Information Processing (CIP) theory was applied as the guiding framework for organising and analysing the data.The career decision-making process of the participants generally followed the stages of decision-making cycle in CIP theory, with a combination of urgent migration decisions and specialisation considerations adding layers of complexity to their career trajectories. Identified challenges encompassed lack of knowledge about oneself and career options, lack of decision-making skills, concerns of contextual complexities that limited the career decision-making process, low motivation and negative thoughts. Specific challenges due to their role as IMSs arose, which were related to career information access, self-capability evaluation, degree accreditation, employment competitiveness and mental states. Participants' proposed strategies were categorised into personal and institutional aspects, providing insights into addressing these challenges.This study substantiates and expands the application of the CIP theory within the sphere of the particular cultural and educational context of IMSs educated in China. It highlights the significance of integrating migration decision-making into career guidance for IMSs, and contributes to the literature by proposing an evidence-based tiered career intervention programme for IMSs., (© 2024. The Author(s).)

Diabetes is prevalent, and it imposes a substantial public health burden globally and in the Asia-Pacific (APAC) region. The cornerstone for optimizing diabetes management and treatment outcomes is glucose monitoring, the techniques of which have evolved from self-monitoring of blood glucose (SMBG) to glycated hemoglobin (HbA1c), and to continuous glucose monitoring (CGM). Contextual differences with Western populations and limited regionally generated clinical evidence warrant regional standards of diabetes care, including glucose monitoring in APAC. Hence, the APAC Diabetes Care Advisory Board convened to gather insights into clinician-reported CGM utilization for optimized glucose monitoring and diabetes management in the region. We discuss the findings from a pre-meeting survey and an expert panel meeting regarding glucose monitoring patterns and influencing factors, patient profiles for CGM initiation and continuation, CGM benefits, and CGM optimization challenges and potential solutions in APAC. While CGM is becoming the new standard of care and a useful adjunct to HbA1c and SMBG globally, glucose monitoring type, timing, and frequency should be individualized according to local and patient-specific contexts. The results of this APAC survey guide methods for the formulation of future APAC-specific consensus guidelines for the application of CGM in people living with diabetes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: ST is a paid member of APAC diabetes care advisory board and the Chair of the Abbott Diabetes Care Australian National Advisory Board for FreeStyle Libre Flash Glucose Monitoring; receives project-specific research funding from Abbott Diabetes Care for clinical studies of FreeStyle Libre Flash Glucose Monitoring; and is an Australian National Board member of the AstraZeneca Advisory Board, the Sanofi-Aventis Australian Advisory Board, and Australian Nevro Advisory Board. SL is a paid international advisory board member for Novo Nordisk, AstraZeneca, and Sanofi; has received honoraria for lectures from Novo Nordisk, Sanofi, Boehringer Ingelheim, AstraZeneca, and MSD; and has received research funding from MSD, Astellas, Daiichi Sankyo, and CKD. S-HY, LC, and YB have no conflicts of interest to declare. AK has received honoraria for consultancy or speakership from Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Kyowa Kirin, Merck Serono, Nestle, Novo Nordisk, Pfizer, and Sanofi. EY is a paid member of the APAC Abbott Advisory Board and has received speaker honoraria from Abbott, Medtronic, Novo Nordisk, and Boehringer Ingelheim. SPC has received honoraria as speaker and as a member of advisory boards from AstraZeneca, Boehringer Ingelheim, Merck, Novo Nordisk, Servier, Sanofi-Aventis, ZP Therapeutics; and is a paid member of APAC Abbott Diabetes Care Advisory Board. JR is a paid member of the APAC Abbott Advisory Board and has received speaker honoraria from Abbott, Sanofi, Novo Nordisk, Eli Lilly, Merck, MSD, Novartis, and Boehringer Ingelheim. VM has received honoraria, speaker support, and research grants from Abbott, MSD, Novo Nordisk, and Lifescan and has received speaker fees from Roche Diabetes Care, Medtronic, USV, Dr. Reddy’s Laboratories, Novo Nordisk, Sanofi-Aventis, and several Indian pharmaceutical companies. NC is a paid member of the Abbott Diabetes Care Australian National Advisory Board for FreeStyle Libre Flash Glucose Monitoring and has received research support from Boehringer Ingelheim, AstraZeneca, Novartis, Sanofi, Novo Nordisk, and Ypsomed. MM is a paid member of the APAC diabetes care advisory board and sits on the Abbott Diabetes Care Australian National Advisory Board for FreeStyle Libre Flash Glucose Monitoring; and receives lecture fees from Abbott Diabetes Care. LJ has received consulting and lecture fees from Eli Lilly, Novo Nordisk, Merck, Bayer, Sanofi-Aventis, Roche, MSD, Medtronic, AstraZeneca, Boehringer Ingelheim, and Abbott.

Objective: To assess changes in key measures of kidney care using data reported in 2019 and 2023., Design: Cross sectional survey in 148 countries., Setting: Surveys from International Society of Nephrology Global Kidney Health Atlas between 2019 and 2023 that included participants from countries in Africa (n=36), Eastern and Central Europe (n=16), Latin America (n=18), the Middle East (n=11), Newly Independent States and Russia (n=10), North America and the Caribbean (n=8), North and East Asia (n=6), Oceania and South East Asia (n=15), South Asia (n=7), and Western Europe (n=21)., Participants: Countries that participated in both surveys (2019 and 2023)., Main Outcome Measures: Comparison of 2019 and 2023 data for availability of kidney replacement treatment services, access, health financing, workforce, registries, and policies for kidney care. Data for countries that participated in both surveys (2019 and 2023) were included in our analysis. Country data were aggregated by International Society of Nephrology regions and World Bank income levels. Proportionate changes in the status of these measures across both periods were reported., Results: Data for 148 countries that participated in both surveys were available for analysis. The proportions of countries that provided public funding (free at point of delivery) increased from 27% in 2019 to 28% in 2023 for haemodialysis, 23% to 28% for peritoneal dialysis, and 31% to 36% for kidney transplantation services. Centres for these treatments increased from 4.4 per million population (pmp) to 4.8 pmp (P<0.001) for haemodialysis, 1.4 pmp to 1.6 pmp for peritoneal dialysis, and 0.43 pmp to 0.46 pmp for kidney transplantation services. Overall, access to haemodialysis and peritoneal dialysis improved, however, access to kidney transplantation decreased from 30 pmp to 29 pmp. The global median prevalence of nephrologists increased from 9.5 pmp to 12.4 pmp (P<0.001). Changes in the availability of kidney registries and in national policies and strategies for kidney care were variable across regions and country income levels. The reporting of specific barriers to optimal kidney care by countries increased from 55% to 59% for geographical factors, 58% to 68% (P=0.043) for availability of nephrologists, and 46% to 52% for political factors., Conclusions: Important changes in key areas of kidney care delivery were noted across both periods globally. These changes effected the availability of, and access to, kidney transplantation services. Countries and regions need to enact enabling strategies for preserving access to kidney care services, particularly kidney transplantation., Competing Interests: Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: funding support for this project from the International Society of Nephrology (grant RES0033080 to the University of Alberta); ST reports fellowship grants from the International Society of Nephrology-Salmasi Family and the Kidney Foundation of Thailand, outside the submitted work. SA reports personal fees from The International Society of Nephrology, outside the submitted work. SD reports personal fees from The International Society of Nephrology, outside the submitted work. JD reports personal fees from The International Society of Nephrology, outside the submitted work. VJ reports personal fees from GSK, Astra Zeneca, Baxter Healthcare, Visterra, Biocryst, Chinook, Vera, and Bayer, paid to his institution, outside the submitted work. VAL reports royalties from Elsevier, consulting fees from the World Health Organization, travel support from the European Renal Association and International Society of Nephrology, and leadership role in Advocacy Working Group of the International Society of Nephrology, outside the submitted work. MN reports grants and personal fees from KyowaKirin, Boehringer Ingelheim, Chugai, Daiichi Sankyo, Torii, Japan Tobacco, Mitsubishi Tanabe, grants from Takeda and Bayer, and personal fees from Astellas, Akebia, AstraZeneca, and GSK, outside the submitted work. AKB reports other (consultancy and honoraria) from AMGEN Incorporated and Otsuka, other (consultancy) from Bayer and GSK, and grants from Canadian Institute of Health Research and Heart and Stroke Foundation of Canada, outside the submitted work; he is also Associate Editor of the Canadian Journal of Kidney Health and Disease and Co-chair of the ISN-Global Kidney Health Atlas. DWJ reports consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care, consultancy fees from Astra Zeneca, Bayer, and AWAK, speaker’s honoraria from ONO and Boehringer Ingelheim & Lilly, and travel sponsorships from ONO and Amgen, outside the submitted work. He is also a current recipient of an Australian National Health and Medical Research Council Leadership Investigator Grant, outside the submitted work. All other authors have nothing to declare., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Among ST-elevation myocardial infarction (STEMI) patients, those with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have higher 30-day mortality than those with SMuRFs. Differences in coronary lesion characteristics remain unclear., Methods: Data from STEMI patients aged ≤60 years from the Asia Pacific Evaluation of Cardiovascular Therapies Network (Australia, Hong Kong, Malaysia, Singapore, and Vietnam) was retrospectively analysed. Exclusion criteria included incomplete SMuRF data, prior myocardial infarction, or prior coronary revascularisation. Lesion type was defined using the American College of Cardiology criteria. Major adverse cardiovascular events (MACE) were defined as peri-procedural myocardial infarction, emergency coronary artery bypass surgery, cerebrovascular event, or mortality. Multiple logistic regressions were used., Results: Of 4404 patients, 767 (17.4%) were SMuRFless. SMuRFless patients were more frequently younger (median age 51 vs. 53 years; p < 0.001), female (22.6% vs. 15.5%; p < 0.001), thrombolysed (20.1% vs. 12.5%; p < 0.001), and in cardiogenic shock (11.2% vs. 8.6%; p = 0.020). SMuRFless patients had significantly higher in-hospital MACE (7.2% vs. 4.3%; adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.24-4.08; p = 0.008) but 1-year mortality was not significantly different (3.6% vs. 5.7%, aOR 0.58; 95% CI 0.06-6.12; p = 0.549). Compared with patients with SMuRFs (4918 lesions), the SMuRFless (940 lesions) had fewer type B2/C lesions (60.8% vs. 65.6%; p = 0.020) and fewer lesions ≥20 mm (51.1% vs. 57.1%; p = 0.002) but more procedural complications (5.1% vs. 2.7%; p < 0.001)., Conclusions: Among young STEMI patients, the SMuRFless have shorter and less complex lesions, but worse procedural and short-term MACE outcomes., (© 2024 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC.)

Objective: To understand current practices and challenges for collecting author feedback for English-language, industry-sponsored publications in Asia-Pacific (APAC), and the implications for adherence to international publication guidelines., Methods: A cross-sectional, internet-based survey of industry ('internal') authors (17 questions) and publication professionals (18 questions) supporting publications in APAC, conducted between November 18 and December 4, 2022., Results: Overall, 142 survey responses were received, of which 94 (66%) were complete and included in the analysis (33 internal authors, 61 publication professionals). Almost half (45%) of internal authors preferred a non-English language for providing feedback on publications, and most (70%) would use this language whenever possible. Internal authors favored written (91%) versus spoken (73%) English, and email was the preferred mode of communication. Publication professionals said they have observed qualitative differences when authors provide feedback in a preferred non-English language versus English. Many agreed that authors tend to provide more substantive or critical feedback when they can respond in their preferred non-English language. Internal authors had low self-assessed familiarity with key publication guidelines, while most publication professionals had a moderate or high self-assessed familiarity. The main barriers to application of publication guidelines, as rated by publication professionals, were that external authors in APAC are not familiar with global publication guidelines and do not always provide feedback/responses in writing., Conclusion: It is important to consider the diverse language, cultural, and communication preferences of individuals involved in English-language publication development in APAC, and to ensure that authors are aware of current publication guidelines and best practices.

Competing Interests: SMT holds a NHMRC Investigator Grant helped cover time spent on this commentary; lead two paid consultancies for AHSPR in 2020 conducting literature reviews on the intersection of evolving COVID 19 responses and primary health care; and is an unpaid member of the Board of Directors of Health Systems Global. RG is Director of Research at the Family Health Centers at NYU Langone (FHC). The views expressed in this Comment are hers alone and do not necessarily reflect those of the FHC. All other authors declare no competing interests.

In the south Asian region, delivering non-communicable disease (NCD) prevention and control services through existing primary health-care (PHC) facilities is urgently required yet currently challenging. As the first point of contact with the health-care system, PHC offers an ideal window for prevention and continuity of care over the life course, yet the implementation of PHC to address NCDs is insufficient. This review considers evidence from five south Asian countries to derive policy-relevant recommendations for designing integrated PHC systems that include NCD care. Findings reveal high political commitment but poor multisectoral engagement and health systems preparedness for tackling chronic diseases at the PHC level. There is a shortage of skilled human resources, requisite infrastructure, essential NCD medicines and technologies, and dedicated financing. Although innovations supporting integrated interventions exist, such as innovations focusing on community-centric approaches, scaling up remains problematic. To deliver NCD services sustainably, governments must aim for increased financing and a redesign of PHC service., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC 4.0 license. Published by Elsevier Ltd.. All rights reserved.)