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Background and aim: Unplanned cardiac readmissions in patients with percutaneous intervention (PCI) is very common and is seen as a quality indicator of in-hospital care. Most studies have reported on the 30-day cardiac readmission rates, with very limited information being available on 1-year readmission rates and their association with mortality. The aim of this study was to investigate the impact of biological sex at 1-year post-PCI on unplanned cardiac readmissions. Methods and results: Patients enrolled into the GenesisCare Cardiovascular Outcomes Registry (GCOR-PCI) from December 2008 to December 2020 were included in the study. A total of 13,996 patients completed 12 months of follow-up and were assessed for unplanned cardiac readmissions. All patients with unplanned cardiac readmissions in the first year of post-PCI were followed in year 2 (post-PCI) for survival status. The rate of unplanned cardiac readmissions was 10.1%. Women had a 29% higher risk of unplanned cardiac readmission (HR 1.29, 95% CI 1.11 to 1.48; p = 0.001), and female sex was identified as an independent predictor of unplanned cardiac readmissions. Any unplanned cardiac readmission in the first year was associated with a 2.5-fold higher risk of mortality (HR 2.50, 95% CI 1.67 to 3.75; p < 0.001), which was similar for men and women. Conclusion: Unplanned cardiac readmissions in the first year post-PCI was strongly associated with increased all-cause mortality. Whilst the incidence of all-cause mortality was similar between women and men, a higher incidence of unplanned cardiac readmissions was observed for women, suggesting distinct predictors of unplanned cardiac readmissions exist between women and men. [ABSTRACT FROM AUTHOR]

Google Scholar OpenURL Placeholder Text WorldCat 28 Smit B, Harding CT, Hockey PAR, McKechnie AE (2013) Adaptive thermoregulation during summer in two populations of an arid-zone passerine. Google Scholar OpenURL Placeholder Text WorldCat 22 Noakes MJ, Wolf BO, McKechnie AE (2016) Seasonal and geographical variation in heat tolerance and evaporative cooling capacity in a passerine bird. Google Scholar Crossref Search ADS PubMed WorldCat 21 Noakes MJ, McKechnie AE (2019) Reaction norms for heat tolerance and evaporative cooling capacity do not vary across a climatic gradient in a passerine bird. [Extracted from the article]

Intense heat waves are occurring more frequently, with concomitant increases in the risk of catastrophic avian mortality events via lethal dehydration or hyperthermia. We quantified the risks of lethal hyperthermia and dehydration for 10 Australian arid-zone avifauna species during the 21st century, by synthesizing thermal physiology data on evaporative water losses and heat tolerance limits. We evaluated risks of lethal hyperthermia or exceedance of dehydration tolerance limits in the absence of drinking during the hottest part of the day under recent climatic conditions, compared to those predicted for the end of this century across Australia. Increases in mortality risk via lethal dehydration and hyperthermia vary among the species modelled here but will generally increase greatly, particularly in smaller species (~10–42 g) and those inhabiting the far western parts of the continent. By 2100 CE, zebra finches' potential exposure to acute lethal dehydration risk will reach ~ 100 d y−1 in the far northwest of Australia and will exceed 20 d y−1 over > 50% of this species' current range. Risks of dehydration and hyperthermia will remain much lower for large non-passerines such as crested pigeons. Risks of lethal hyperthermia will also increase substantially for smaller species, particularly if they are forced to visit exposed water sources at very high air temperatures to avoid dehydration. An analysis of atlas data for zebra finches suggests that population declines associated with very hot conditions are already occurring in the hottest areas. Our findings suggest that the likelihood of persistence within current species ranges, and the potential for range shifts, will become increasingly constrained by temperature and access to drinking water. Our model adds to an increasing body of literature suggesting that arid environments globally will experience considerable losses of avifauna and biodiversity under unmitigated climate change scenarios. [ABSTRACT FROM AUTHOR]

The number of males entering higher education via an enabling pathway is slowly increasing; yet, males still battle with the anti-intellectual attitude that is prevalent in regional areas of Australia. Previous research undertaken by the authors began exploring the factors that inhibited or enhanced the male experience within an enabling course. This paper expands upon this research with a deeper focus on the male experience through personalised accounts derived from individual interviews. Using qualitative methodology and narrative inquiry, the findings provide a deeper understanding of the issues that males of different ages face when creating a new identity as a university student. This paper shares insights into what motivated the male students to enter university via an enabling pathway; the actual personal experiences both positive and negative during this time; and the effect that this commitment to study had on them personally and the people around them. The lens of transformative theory underpins this research through exploring frames of reference that align with the students' experiences. Portraiture prose shares the individual stories which are analysed and the key findings extrapolated. [ABSTRACT FROM AUTHOR]

Context Longitudinal integrated clerkships ( LICs) represent a model of the structural redesign of clinical education that is growing in the USA, Canada, Australia and South Africa. By contrast with time-limited traditional block rotations, medical students in LICs provide comprehensive care of patients and populations in continuing learning relationships over time and across disciplines and venues. The evidence base for LICs reveals transformational professional and workforce outcomes derived from a number of small institution-specific studies. Objectives This study is the first from an international collaborative formed to study the processes and outcomes of LICs across multiple institutions in different countries. It aims to establish a baseline reference typology to inform further research in this field. Methods Data on all LIC and LIC-like programmes known to the members of the international Consortium of Longitudinal Integrated Clerkships were collected using a survey tool developed through a Delphi process and subsequently analysed. Data were collected from 54 programmes, 44 medical schools, seven countries and over 15 000 student-years of LIC-like curricula. Results Wide variation in programme length, student numbers, health care settings and principal supervision was found. Three distinct typological programme clusters were identified and named according to programme length and discipline coverage: Comprehensive LICs; Blended LICs, and LIC-like Amalgamative Clerkships. Two major approaches emerged in terms of the sizes of communities and types of clinical supervision. These referred to programmes based in smaller communities with mainly family physicians or general practitioners as clinical supervisors, and those in more urban settings in which subspecialists were more prevalent. Conclusions Three distinct LIC clusters are classified. These provide a foundational reference point for future studies on the processes and outcomes of LICs. The study also exemplifies a collaborative approach to medical education research that focuses on typology rather than on individual programme or context. [ABSTRACT FROM AUTHOR]

Background: The WHO End TB Strategy requires drug susceptibility testing and treatment of all people with tuberculosis, but second-line diagnostic testing with line-probe assays needs to be done in experienced laboratories with advanced infrastructure. Fewer than half of people with drug-resistant tuberculosis receive appropriate treatment. We assessed the diagnostic accuracy of the rapid Xpert MTB/XDR automated molecular assay (Cepheid, Sunnyvale, CA, USA) to overcome these limitations.Methods: We did a prospective study involving individuals presenting with pulmonary tuberculosis symptoms and at least one risk factor for drug resistance in four sites in India (New Delhi and Mumbai), Moldova, and South Africa between July 31, 2019, and March 21, 2020. The Xpert MTB/XDR assay was used as a reflex test to detect resistance to isoniazid, fluoroquinolones, ethionamide, amikacin, kanamycin, and capreomycin in adults with positive results for Mycobacterium tuberculosis complex on Xpert MTB/RIF or Ultra (Cepheid). Diagnostic performance was assessed against a composite reference standard of phenotypic drug-susceptibility testing and whole-genome sequencing. This study is registered with ClinicalTrials.gov, number NCT03728725.Findings: Of 710 participants, 611 (86%) had results from both Xpert MTB/XDR and the reference standard for any drug and were included in analysis. Sensitivity for Xpert MTB/XDR detection of resistance was 94% (460 of 488, 95% CI 92-96) for isoniazid, 94% (222 of 235, 90-96%) for fluoroquinolones, 54% (178 of 328, 50-61) for ethionamide, 73% (60 of 82, 62-81) for amikacin, 86% (181 of 210, 81-91) for kanamycin, and 61% (53 of 87, 49-70) for capreomycin. Specificity was 98-100% for all drugs. Performance was equivalent to that of line-probe assays. The non-determinate rate of Xpert MTB/XDR (ie, invalid M tuberculosis complex detection) was 2·96%.Interpretation: The Xpert MTB/XDR assay showed high diagnostic accuracy and met WHO's minimum target product profile criteria for a next-generation drug susceptibility test. The assay has the potential to diagnose drug-resistant tuberculosis rapidly and accurately and enable optimum treatment.Funding: German Federal Ministry of Education and Research through KfW, Dutch Ministry of Foreign Affairs, and Australian Department of Foreign Affairs and Trade. [ABSTRACT FROM AUTHOR]

Background: Implantable Cardiac Monitors (ICMs) are used for long-term monitoring of arrhythmias. BIOMONITOR III is a novel ICM with a miniaturized profile, long sensing vector due to a flexible antenna, simplified implantation with a dedicated insertion tool for pocket formation and ICM placement in a single step, and daily automatic Home Monitoring (HM) function., Methods: In 47 patients undergoing BIOMONITOR III insertion for any ICM indication, 16 investigators at 10 Australian sites assessed handling characteristics of the insertion tool, R-wave amplitudes, noise burden, P-wave visibility, and HM transmission success. Patients were followed for 1 month., Results: All 47 attempted insertions were successful. Median time from skin incision to removal of the insertion tool after ICM insertion was 39 s (IQR 19-65) and to wound closure and cleaning was 4.7 min (IQR 3.5-7.8). All aspects of the insertion tool were rated as "good" or "excellent" in ≥97.9% and "fair" in ≤2.1% of patients, except for "force needed for tunnelling" (91.5% good/excellent, 8.5% fair). Based on HM data, R-waves in the first month were stable at 0.70 ± 0.37 mV. Median noise burden (disabling automatic rhythm evaluation) was 0.19% (IQR 0.00-0.93), equivalent to 2.7 min (IQR 0.0-13.4) per day. In HM-transmitted ECG strips with regular sinus rhythm, P-waves were visible in 89 ± 24% of heart cycles. Patient-individual automatic Home Monitoring transmission success was 98.0% ± 5.5%., Conclusions: The novel ICM performed well in all aspects studied, including fast insertion, reliable R-wave sensing, good P-wave visibility, and highly successful HM transmissions., Competing Interests: Declaration of competing interest JM, RW, UM, PG, RP, TL, AC, PI and SP have received honoraria and/or non-financial support from Biotronik in the context of this study. JS is a full-time employee of Biotronik. PG, DHL and UW has received honoraria from Biotronik outside the context of this study., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)