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Within the typical 2–8 month (January to August inclusive) farming cycle for southern bluefin tuna, Thunnus maccoyii (Castelnau), in Spencer Gulf, South Australia, counts of a sea louse, Caligus chiastos Lin et Ho, 2003, were strongly statistically associated with both fish condition and severity of eye damage. During a trial examining the feasibility of maintaining T. maccoyii in farms for more than 1 year, including over the summer season when temperatures may exceed 24 °C, we collected additional epidemiological data on burdens of sea lice over a 17-month period (April 2005 to August 2006 inclusive), on a total of 200 T. maccoyii and 40 ‘control’ T. maccoyii farmed and harvested within 2006. In the first farming season, an epizootic of C. chiastos was characterized by a significant increase in prevalence from 0% to 55% in the first 6 weeks after transfer to farms from the wild, which was followed by a significant decline to zero over the next 12 weeks. A single specimen of a second species of Caligus was also detected within this 4.5-month period. In the second farming season, we recorded a third species of sea louse, C. amblygenitalis Tripathi, 1961. In March 2006, a second epizootic peak occurred, this time with mixed infections of C. chiastos and C. amblygenitalis, with a combined prevalence of 100%. The prevalence of both sea lice species then declined significantly over the second winter period (June to August inclusive). On all but one date that sea lice were detected, sea lice counts were significantly associated with the severity of gross eye damage. Because both peaks in infection occurred in summer months (December to February inclusive), we conclude that infections of sea lice pose a risk to the farming of T. maccoyii under certain summer conditions within Spencer Gulf. [ABSTRACT FROM AUTHOR]

Following the wave of COVID and the numerous protocols of INR -self-management for patients with LVAD, it has been demonstrated that patients can monitor and adjust their anticoagulation and achieve better time in therapeutic range (TTR) compared to standard monitoring and care by physicians. To achieve this goal, more INR tests are performed. Here we compare the TTR in self-management versus the standard treatment and the costs of these two strategies in a European context. Using a protocol established at St-Vincent Hospital in Australia, patients were offered to follow a training on anticoagulation and then manage their anti-vitamin K treatment independently (Auto-management). We then compared the TTR and the cost before and under this protocol. Costs are based on Swiss prices and converted into Dollars (1CHF=1.03US $). Test-strip cost $4.8 per unit, the lancet costs a few cents, and the INR machine (CoaguCheck) is available for $810. The combined cost of the blood test and its interpretation by a general physician (GP) is about $50. Since November 2021, 11 patients have been included in the protocol; these included no women, one patient with a HeartWare, and 10 with a HeartMate 3. The patients have been included in the protocol for a cumulative time of 80 months or a mean of 7.3 months per patient. One patient was transplanted, and none died. One patient had a haemorrhagic complication following colonoscopy under therapeutic INR (2.8), no patient suffered thrombosis, and no LVAD replacement was performed. We compare this group during the Standard Care (SC) and Auto-management (AM) period. During SC, the median TTR was 72% (IQR 63-78); during AM it increased to 90% (IQR 77-93). In SC, the INR control cost per day was $9.4 (IQR 6.6-13) on average, which decreased to $2.4 (IQR 1.9-2.6) per day in AM. INR monitoring occurred on average 5.9 (IQR 4.2-8.2) times per month in SC phase; while in AM patients measured their INR 13.1 (IQR 11.7-13.4) times per month. The cost of one day of INR within the therapeutic range was $13 under standard care, $5.0 in the first year on Auto-management. Despite being associated with more INR control, Self-management of anticoagulation by LVAD- patients are less expensive and results in a higher TTR. Self-management also promotes patient independence. It should be encouraged and expanded to other LVAD implant centres. [ABSTRACT FROM AUTHOR]

Purpose Stroke and ventricular assist device (VAD) pump thrombus are serious complications that have previously been thought to be related to surgical placement - namely VAD inflow cannula angle. Our aim with this study was to better elucidate the impact of post-operative HeartWare HVAD (left VAD) cannula inflow angle on stroke and thrombus rate within a single centre in Sydney, Australia. Methods Data were extracted retrospectively for all patients who underwent Heartware HVAD implantation from 2007-2017 with accessible on-site CT imaging. BiVAD patients were excluded. Angulation data was available for 95 patients. Post-implant inflow angle was measured between the middle of the inflow cannula relative to the middle of the sternum. All measurements were carried out in the axial plane on CT imaging. Data on Free Haemoglobin level was extracted at 3 intervals (3, 6, and 12-months post VAD implantation). Statistical analysis was carried out using IBM SPSS v25. Results Mean post-operative inflow cannula angle was 89 +/- 27 degrees vs 91 +/- 22 degrees for the non-stroke and stroke groups respectively, p=NS. Similarly, there was no difference in mean post-operative inflow cannula angle between those that formed pump thrombus (89 +/- 28 degrees) and those that did not (91 +/- 19 degrees), p=NS. Average 12-month post-implant Free Haemoglobin was higher in the group with pump thrombus than the group that did not form thrombus (9.1 +/- 9 vs 5.3 +/- 9), p=0.012. Conclusion There was no association between HVAD cannula inflow position and incidence of stroke or thrombus rates in this population. The previous finding of an interaction between inflow cannula angulation and pump thrombosis may be device specific. [ABSTRACT FROM AUTHOR]

Clinical trials of the HeartWare™ HVADTM System have demonstrated a low rate of post-implant severe right ventricular failure (RVF) requiring implantation of a right ventricular assist device (RVAD). In an analysis of the North American clinical trials of the HVAD System, including the ADVANCE BTT+CAP Trial (N=382), the ENDURANCE Trial (N=296), the ENDURANCE Supplemental Trial (N=308) and the Lateral Trial (N=144), RVADs were implanted in 2.7% of patients (31/1130) over 2 years of support. However, the overall percentage of patients in INTERMACS profile 1 at implant was only 4.2% and those with anticipated need for post-operative RVAD were excluded. We will present an analysis of severe RVF requiring an RVAD in the real-world post-approval study of the HVAD System when used in destination therapy patients (DT-PAS and Apogee International study). The objective of this analysis is to examine the rate of RVAD use in the prospective DT PAS study (n=212) and the Apogee International study (n=46). At the time of presentation, we will have 258 patients with follow-up data through at least 6 months of support. Data is currently being collected from 50 centers in the US, EMEA, and Australia. Descriptive data and severe RVF data will be presented, and a comparison, accounting for baseline differences, to the HVAD clinical trials will be performed. Baseline parameters of the 258 patients includes mean age 58.3 years, with 15.4% INTERMACS profile 1 and 44.6% with ischemic etiology. Preliminary data from 212 patients in the US DT PAS cohort (with 16.3% INTERMACS 1) reveals an incidence of RVAD use of 6.1% over a mean time on support of 5 months. Data collection and analysis is ongoing. Analyses of real-world use of the HVAD System reveals its increasing use in higher risk and more complex patients. Final data on RVAD use in 258 patients through 6 months will be available at the time of presentation. [ABSTRACT FROM AUTHOR]

Aims: To investigate whether 'low sugar' and related claims influence consumers' perceptions of the healthiness or other attributes of alcoholic drinks, promote greater consumption or impact diet and activity behaviour intentions., Method: N = 501 Australian women aged 18-35 viewed and rated six images of alcoholic drinks in a randomized online experiment with a 2 (claim: low sugar claim, no claim control) × 2 (drink type: cider, ready-to-drink spirits) between-subjects design., Results: Participants who viewed drinks with low sugar claims rated them as healthier, less harmful to health, lower in sugar and kilojoules, and more suitable for weight management and a healthy diet than participants who viewed identical drinks with no claim (P < 0.001-P = 0.002). Drinks with low sugar claims were also perceived as being lower in alcohol (P < 0.001) despite being of equivalent alcohol content. There were no significant differences in anticipated social approval associated with consumption or in hypothetical intended consumption of the drinks, but participants who viewed drinks with low sugar claims were less likely to indicate they would compensate for consumption of the drink by modifying food intake or physical activity (P = 0.01)., Conclusions: Low sugar and related claims on alcoholic drinks can generate a health halo: consumers generalise from a specific favourable attribute (low sugar) to misperceive other favourable health- and nutrition-related attributes, including lower alcohol content. Findings support calls to reconsider the permissibility of low sugar claims on alcoholic drinks as they may mislead consumers., (© The Author(s) 2022. Medical Council on Alcohol and Oxford University Press. All rights reserved.)

Background: Aboriginal Australians are known to suffer high levels of acquired brain injury (stroke and traumatic brain injury) yet experience significant barriers in accessing rehabilitation services. The aim of the Healing Right Way trial is to evaluate a culturally secure intervention for Aboriginal people with newly acquired brain injury to improve their rehabilitation experience and quality of life. Following publication of the trial protocol, this paper outlines the statistical analysis plan prior to locking the database.  METHODS: The trial involves a stepped wedge design with four steps over 3 years. Participants were 108 adult Aboriginal Australians admitted to one of eight hospitals (four rural, four urban) in Western Australia within 6 weeks of onset of a new stroke or traumatic brain injury who consented to follow-up for 26 weeks. All hospital sites started in a control phase, with the intervention assigned to pairs of sites (one metropolitan, one rural) every 26 weeks until all sites received the intervention. The two-component intervention involves training in culturally safe care for hospital sites and enhanced support provided to participants by Aboriginal Brain Injury Coordinators during their hospital stay and after discharge. The primary outcome is quality of life as measured by the Euro QOL-5D-3L VAS. A mixed effects linear regression model will be used to assess the between-group difference at 26 weeks post-injury. The model will control for injury type and severity, age at recruitment and time since commencement of the trial, as fixed effects. Recruitment site and participant will be included as random effects. Secondary outcomes include measurements of function, independence, anxiety and depression, carer strain, allied health occasions of service received and hospital compliance with minimum processes of care based on clinical guidelines and best practice models of care., Discussion: The trial will provide the first data surrounding the effectiveness of an intervention package for Aboriginal people with brain injury and inform future planning of rehabilitation services for this population. The statistical analysis plan outlines the analyses to be undertaken., Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618000139279. Registered 30 January, 2018., (© 2022. The Author(s).)

Background: Cardiac amyloidosis has a very poor prognosis, but it is the nature of the involved precursor protein that ultimately dictates treatment and survival., Aim: Definitively characterise the amyloid subtype by mass spectrometry (MS) in an Australian cohort of patients with cardiac amyloidosis., Methods: We report the clinical characteristics and survival of 47 cardiac amyloid patients across two Australian centres including 39 patients evaluated for definitive amyloid subtype utilising laser microdissection and tandem mass spectrometry., Results: A quarter (n = 12) of patients were classified as wild-type transthyretin amyloidosis (ATTRwt), 33 patients as light or heavy chain amyloidosis (AL or AH) and two as hereditary mutant transthyretin amyloidosis. Greater left ventricular hypertrophy (interventricular septum 22 vs 15 mm; P = 0.005) and history of cardiac arrhythmia (75% vs 31%; P = 0.016) were significantly associated with ATTRwt patients compared with AL/AH patients. AL patients demonstrated significantly shorter median survival compared with ATTRwt patients (3.5 vs 37 months; P = 0.007). New York Heart Association class III-IV symptoms or plasma cells ≥10% at diagnosis, were the only independent predictors of worse survival in AL patients on multivariate analysis., Conclusions: AL amyloidosis accounted for 68% of our cohort of patients with cardiac amyloidosis while ATTR accounted for 26%. In the era of novel therapies for both AL amyloid and ATTR, identification of the correct amyloid subtype is essential in making therapeutic decisions and providing accurate prognostic information to patients. Laser microdissection and tandem mass spectrometry plays an important role in identifying amyloid subtype, particularly in complex cases., (© 2020 Royal Australasian College of Physicians.)

Introduction: Despite higher incidence of brain injury among Aboriginal compared with non-Aboriginal Australians, suboptimal engagement exists between rehabilitation services and Aboriginal brain injury survivors. Aboriginal patients often feel culturally insecure in hospital and navigation of services post discharge is complex. Health professionals report feeling ill-equipped working with Aboriginal patients. This study will test the impact of a research-informed culturally secure intervention model for Aboriginal people with brain injury. METHODS AND ANALYSIS: Design: Stepped wedge cluster randomised control trial design; intervention sequentially introduced at four pairs of healthcare sites across Western Australia at 26-week intervals. Recruitment: Aboriginal participants aged ≥18 years within 4 weeks of an acute stroke or traumatic brain injury. Intervention: (1) Cultural security training for hospital staff and (2) local, trial-specific, Aboriginal Brain Injury Coordinators supporting participants. Primary outcome : Quality-of-life using EuroQOL-5D-3L (European Quality of Life scale, five dimensions, three severity levels) Visual Analogue Scale score at 26 weeks post injury. Recruitment of 312 participants is estimated to detect a difference of 15 points with 80% power at the 5% significance level. A linear mixed model will be used to assess the between-condition difference. Secondary outcome measures : Modified Rankin Scale, Functional Independence Measure, Modified Caregiver Strain Index, Hospital Anxiety and Depression Scale at 12 and 26 weeks post injury, rehabilitation occasions of service received, hospital compliance with minimum care processes by 26 weeks post injury, acceptability of Intervention Package, feasibility of Aboriginal Brain Injury Coordinator role. Evaluations : An economic evaluation will determine the potential cost-effectiveness of the intervention. Process evaluation will document fidelity to study processes and capture changing contexts including barriers to intervention implementation and acceptability/feasibility of the intervention through participant questionnaires at 12 and 26 weeks., Ethics and Dissemination: The study has approvals from Aboriginal, university and health services human research ethics committees. Findings will be disseminated through stakeholder reports, participant workshops, peer-reviewed journal articles and conference papers., Trial Registration Number: ACTRN12618000139279., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Aboriginal people have high rates of stroke and traumatic brain injury (TBI), often with residual, chronic communication deficits and multiple co-morbidities. This study examined general practitioners' (GPs') perceptions of their communication with Aboriginal patients with acquired communication disorders (ACD) after brain injury. Effective communication underpins good care but no previous research has explored this specific context., Methods: A qualitative descriptive approach was employed using interviews and focus groups with 23 GPs from metropolitan Perth and five regional sites in Western Australia. Data were analysed thematically., Results: GPs reported low visibility of Aboriginal patients with ACD in their practices, minimal training on neurogenic ACD, and difficulty distinguishing ACD from cultural-linguistic factors. They had few communication resources, and depended on families and Aboriginal Health Workers to assist in interactions. They rarely used formal interpreting services or referred to speech pathology. They reported communication (dis)ability having low priority in consultations., Conclusion: GPs report difficulty recognising ACD and their lack of prioritising assessment and treatment of communication ability after brain injury potentially compounds the disadvantage and disempowerment experienced by many Aboriginal people., Practice Implications: GPs require further communication and cultural training. Improved access to speech pathology and formal interpreting services would be beneficial., (Copyright © 2019 Elsevier B.V. All rights reserved.)

New health technologies often yield health benefits, but often at a high cost. In Australia, the processes for public reimbursement of high-cost pharmaceuticals and medical devices are different, potentially resulting in inequity in support for new therapies. We explore how reimbursement is different for medical devices compared with pharmaceuticals, including whether higher cost-effectiveness thresholds are accepted for pharmaceuticals. A literature review identified the challenges of economic evaluations for medical devices compared with pharmaceuticals. We used the ventricular assist device as a case study to highlight specific features of medical device funding in Australia. We used existing guidelines to evaluate whether ventricular assist devices would fulfil the requirements for the "Life-Saving Drugs Program", which is usually reserved for expensive life-extending pharmaceutical treatments of serious and rare medical conditions. The challenges in conducting economic evaluations of medical devices include limited data to support effectiveness, device-operator interaction (surgical experience) and incremental innovations (miniaturisation). However, whilst high-cost pharmaceuticals may be funded by a single source (federal government), the funding of high-cost devices is complex and may be funded via a combination of federal, state and private health insurance. Based on the Life-Saving Drugs Program criteria, we found that ventricular assist devices could be funded by a similar mechanism to that which funds high-cost life-extending pharmaceuticals. This article highlights the complexities of medical device reimbursement. Whilst differences in available evidence affect the evaluation process, differences in funding methods contribute to inequitable reimbursement decisions between medical devices and pharmaceuticals.

Background: Transplantation of hearts retrieved from donation after circulatory death (DCD) donors is an evolving clinical practice., Objectives: The purpose of this study is to provide an update on the authors' Australian clinical program and discuss lessons learned since performing the world's first series of distantly procured DCD heart transplants., Methods: The authors report their experience of 23 DCD heart transplants from 45 DCD donor referrals since 2014. Donor details were collected using electronic donor records (Donate Life, Australia) and all recipient details were collected from clinical notes and electronic databases at St. Vincent's Hospital., Results: Hearts were retrieved from 33 of 45 DCD donors. A total of 12 donors did not progress to circulatory arrest within the pre-specified timeframe. Eight hearts failed to meet viability criteria during normothermic machine perfusion, and 2 hearts were declined due to machine malfunction. A total of 23 hearts were transplanted between July 2014 and April 2018. All recipients had successful implantation, with mechanical circulatory support utilized in 9 cases. One case requiring extracorporeal membrane oxygenation subsequently died on the sixth post-operative day, representing a mortality of 4.4% over 4 years with a total follow-up period of 15,500 days for the entire cohort. All surviving recipients had normal cardiac function on echocardiogram and no evidence of acute rejection on discharge. All surviving patients remain in New York Heart Association functional class I with normal biventricular function., Conclusions: DCD heart transplant outcomes are excellent. Despite a higher requirement for mechanical circulatory support for delayed graft function, primarily in recipients with ventricular assist device support, overall survival and rejection episodes are comparable to outcomes from contemporary brain-dead donors., (Copyright © 2019. Published by Elsevier Inc.)

Aims: Impaired left ventricular diastolic function leading to elevated left atrial pressures, particularly during exertion, is a key driver of symptoms and outcomes in heart failure with preserved ejection fraction (HFpEF). Insertion of an interatrial shunt device (IASD) to reduce left atrial pressure in HFpEF has been shown to be associated with short-term haemodynamic and symptomatic benefit. We aimed to investigate the potential effects of IASD placement on HFpEF survival and heart failure hospitalization (HFH)., Methods and Results: Heart failure with preserved ejection fraction patients participating in the Reduce Elevated Left Atrial Pressure in Patients with Heart Failure study (Corvia Medical) of an IASD were followed for a median duration of 739 days. The theoretical impact of IASD implantation on HFpEF mortality was investigated by comparing the observed survival of the study cohort with the survival predicted from baseline data using the Meta-analysis Global Group in Chronic Heart Failure heart failure risk survival score. Baseline and post-IASD implant parameters associated with HFH were also investigated. Based upon the individual baseline demographic and cardiovascular profile of the study cohort, the Meta-analysis Global Group in Chronic Heart Failure score-predicted mortality was 10.2/100 pt years. The observed mortality rate of the IASD-treated cohort was 3.4/100 pt years, representing a 33% lower rate (P = 0.02). By Kaplan-Meier analysis, the observed survival in IASD patients was greater than predicted (P = 0.014). Baseline parameters were not predictive of future HFH events; however, poorer exercise tolerance and a higher workload-corrected exercise pulmonary capillary wedge pressure at the 6 months post-IASD study were associated with HFH., Conclusions: The current study suggests IASD implantation may be associated with a reduction in mortality in HFpEF. Large-scale ongoing randomized studies are required to confirm the potential benefit of this therapy., (© 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)

Objective: To investigate differences in the profile and outcomes between Aboriginal and non-Aboriginal Western Australians (WAs) hospitalized with traumatic brain injury (TBI)., Setting: WA hospitals., Participants: TBI cases aged 15 to 79 years surviving their first admission during 2002-2011., Design: Patients identified from diagnostic codes and followed up for 12 months or more using WA-wide person-based linked hospital and mortality data., Main Measures: Demographic profile, 5-year comorbidity history, injury mechanism, injury severity, 12-month readmission, and mortality risks. Determinants of 12-month readmission., Results: Of 16 601 TBI survivors, 14% were Aboriginal. Aboriginal patients were more likely to be female, live remotely, and have comorbidities. The mechanism of injury was an assault in 57% of Aboriginal patients (vs 20%) and transport in 33% of non-Aboriginal patients (vs 17%), varying by remoteness. One in 10 Aboriginal TBI patients discharged themselves against medical advice. Crude 12-month readmission but not mortality risk was significantly higher in Aboriginal patients (48% vs 36%). The effect of age, sex, and injury mechanism on 12-month readmission was different for Aboriginal and non-Aboriginal patients., Conclusion: These findings suggest an urgent need for multisectoral primary prevention of TBI, as well as culturally secure and logistically appropriate medical and rehabilitation service delivery models to optimize outcomes.

Purpose: Acquired communication disorders (ACD), following stroke and traumatic brain injury, may not be correctly identified in Aboriginal Australians due to a lack of linguistically and culturally appropriate assessment tools. Within this paper we explore key issues that were considered in the development of the Aboriginal Communication Assessment After Brain Injury (ACAABI) - a screening tool designed to assess the presence of ACD in Aboriginal populations., Method: A literature review and consultation with key stakeholders were undertaken to explore directions needed to develop a new tool, based on existing tools and recommendations for future developments., Result: The literature searches revealed no existing screening tool for ACD in these populations, but identified tools in the areas of cognition and social-emotional wellbeing. Articles retrieved described details of the content and style of these tools, with recommendations for the development and administration of a new tool. The findings from the interview and focus group views were consistent with the approach recommended in the literature., Conclusions: There is a need for a screening tool for ACD to be developed but any tool must be informed by knowledge of Aboriginal language, culture and community input in order to be acceptable and valid.

Background: Appropriate communication between general practitioners (GPs) and physiotherapists is vital for providing optimal care. Differing opinions exist as to key inclusion in this communication. This study aims to identify the key components that both GPs and physiotherapists would include in inter-professional communication., Methods: Qualitative study design, using 14 in-depth, semi-structured telephone interviews., Results: Physiotherapists identified relevant past medical history, psycho-social history, yellow flags, anticipated time frame for follow-up and objective measures of current function as the more useful inclusions in written communication. GPs identified the inclusion of a working diagnosis, treatment summary and likely long-term outcomes as the key components to effective communication., Discussion: Effective interprofessional communication requires the provision of information that is both succinct and relevant. While there are individual preferences, this study suggests that certain key characteristics exist, and the inclusion of these in interprofessional communication may lead to improved communication and patient outcomes.

Purpose: Limited research exists on acquired communication disorders (ACD) in Aboriginal Australians despite their high rates of stroke. Their uptake of rehabilitation services is low, and little information is available on functional consequences for this population. This pilot study explored consequences of ACD for Aboriginal Australians after stroke, including their experiences of services received., Method: Semi-structured interviews were collected with 13 Aboriginal people with ACD, and family members, in Perth. Ages ranged from 30 to 78 years and time post stroke from 0.5 to 29 years. A qualitative, thematic analysis of interview transcripts was undertaken., Results: The key themes which emerged were "getting on with life", coping with change, independence/interdependence, the importance of communication for maintaining family and community connection, role and identity issues and viewing the stroke consequences within the broader context of co-morbidities., Conclusions: While similar life disruptions were found to those previously reported in the general stroke population, this study highlighted differences, which reflect the particular context of ACD for Aboriginal people and which need to be considered when planning future services. While implications are limited due to small numbers, the findings emphasise the importance of a holistic approach, and integration of communication treatments into community-led social activities. Implications for Rehabilitation Aboriginal Australians frequently experience a range of concurrent and complex co-morbidities and demanding social or family circumstances at the same time as coping with communication disorders post-stroke. A holistic approach to post stroke rehabilitation may be appropriate with services that accommodate communication disorders, delivered in collaboration with Aboriginal organisations, emphasising positive attitudes and reintegration into community as fully as possible. Communication and yarning are important for maintaining family and community connection and identity, and family and community context should be incorporated into all assessment and treatment activities.

Introduction: The incidence, mechanisms, clinical associations, and outcomes in patients with late-onset (>3 months) atrioventricular (AV) block following heart transplantation are not well known. This study will characterize late-onset AV block following cardiac transplantation., Methods: We retrospectively reviewed our databases to identify patients who required pacemakers for late-onset AV block postheart and heart-lung transplantation from January 1990 to December 2007. Orthotopic heart and heart-lung transplantation were separately analyzed., Results: This study included 588 adults who received cardiac transplants over a 17-year period at our center (519 orthotopic, 64 heart-lung transplants, and five heterotopic heart transplants). Of the 519 patients with orthotopic heart transplant, 39 required pacing (7.5%), 17 (3.3%) within 3 months posttransplant, 11 (2.1%) for late-onset sinus node dysfunction (SND), 11 (2.1%) for late-onset AV block. Also, five patients (7.8%) out of 64 heart-lung transplants required pacemakers, two (3.1%) for late-onset SND, three (4.7%) for late-onset AV block. None of the five patients who underwent heterotopic transplant required cardiac pacing prior to or posttransplant., Conclusions: Late-onset AV block occurs in 2.4% of patients with orthotopic heart transplant or heart-lung transplant. AV block is predominantly intermittent and, often, does not progress to permanent AV block. There are no predictable factors for its onset., (©2010, The Authors. Journal compilation ©2010 Wiley Periodicals, Inc.)

A species of Gyrodactylus collected from 2 species of anguillid eels (Anguilla australis Richardson, 1841 and Anguilla reinhardtii Steindachner, 1867) from Australia is identified as Gyrodactylus anguillae Ergens, 1960. The morphology of sclerites of G. anguillae specimens from Australia is in accordance with previous descriptions of specimens collected from A. anguilla (Linnaeus, 1758) from Europe and A. anguilla imported into Japan. Gyrodactylus anguillae was previously thought to be a parasite specific to A. anguilla, an eel that is native to freshwater catchments throughout Europe. Information on eel translocations and host and parasite biology is reviewed and it is hypothesized that G. anguillae is a naturally occurring parasite in Australia and not an introduction.

Members of the subfamily Thoracocotylinae are gastrocotylid monogeneans of Spanish mackerels (scombrid fishes of the genus Scomberomorus) from warm to warm-temperate seas around the world. We revise the diagnosis of the subfamily and recognise two genera and three species as valid. The genus Paradawesia Bravo Hollis & Lamothe Argumedo, 1976 is synonymised with Thoracocotyle MacCallum, 1913, and Dawesia Unnithan, 1965 and Methoracocotyle Lebedev, 1984 are synonymised with Pseudothoracocotyla Yamaguti, 1963. Thoracocotyle crocea MacCallum, 1913 (syns T. paradoxica Meserve, 1938 and Paradawesia bychowskyi Bravo Hollis & Lamothe Argumedo, 1976) is recorded from two species of Scomberomorus in the eastern Pacific (California to Peru) and four in the western Atlantic (South Carolina to Brazil). Pseudothoracocotyla ovalis (Tripathi, 1956) Yamaguti, 1963 (new syns Dawesia indica Unnithan, 1965, D. incisa Lebedev, 1970, Methoracocotyle scomberomori (Young, 1968) Lebedev, 1984, M. gigantica (Rohde, 1976) Lebedev, 1984 and Thoracotyle indica (Unnithan, 1965) Murugesh, 1995) is recorded from the gills of seven species of Scomberomorus from the Indo-west Pacific (eastern South Africa north to the Persian Gulf, and east to Fiji). Pseudothoracocotyla whittingtoni n. sp. is described from an eighth Indo-west Pacific scomberomorid, S. munroi, in Australian waters.

Scomberomorocotyle munroi n. g., n. sp. is described from the gills of Scomberomorus munroi, a Spanish mackerel from the coasts of northern Australia and southern Papua New Guinea. The genus belongs to the suborder Gastrocotylinea because a pair of basal accessory sclerites is present in the clamps. However, the worm does not belong to any of the eight gastrocotylinean families as they are currently recognised. The worm appears to be a member of the Thoracocotylidae, in that the male copulatory organ has relatively weakly developed spines, and that the haptor is one-sided with two rows of clamps. However, the worm differs from all thoracocotylids in that the clamps lack the characteristic lateral rib-like thickenings. To accommodate the new genus and species, the diagnosis of the Thoracocotylidae Price is amended to include worms lacking ribs in their clamps, and a new subfamily, the Scomberomorocotylinae n. subfam., is erected; a key to the four subfamilies which we recognise as valid is provided.

Four-hundred and fifty-three Scomber australasicus, ranging in length from 14.1 to 46.5 cm and taken in 12 samples over 5 years from a single locality in south-eastern Australia, were examined. Ten species of ectoparasites were recorded: six monogeneans, three copepods and one isopod. The maximum number of parasite species in any one fish reached five, and the maximum total parasite intensity reached 39. Host size is an important determinant of the structure of ectoparasite assemblages of slimy mackerel: the average number of species per host peaked at 2.2 in fishes between 20 and 25 cm in length, then declined in larger fish; the abundance of all parasites on each fish similarly peaked in fishes 20-25 cm (mean of 9.9). The monogenean Pseudokuhnia minor had the highest prevalence and abundance of all parasites, infecting almost 80% of fish < 25 cm long. Over half of the total number of parasites belonged to this species, and it was dominant in intensity in just over half of the fish in which it occurred. When approximate volume was considered, assemblages were dominated by Kuhnia scombercolias in fish < 20 cm, by Kuhnia scombri in fish 20-34.9 cm, and by P. minor in fish larger than 35 cm long. The intensities of these three monogeneans were very strongly and positively correlated with each other, as were the intensities of P. minor and Grubea australis; the intensities of only one pair of species were associated negatively (K. scombercolias and the isopod Ceratothoa imbricata). A nested subset analysis indicates that the ectoparasite assemblages are random. This and the low prevalences and abundances of infection, as well as low species richness per fish, indicate that infra-assemblages are isolationist.

Aspects of the community ecology of metazoan ectoparasites of Lethrinus miniatus (Teleostei. Lethrinidae) from 3 localities on the Great Barrier Reef were examined. Twelve species of Monogenea, 6 of Copepoda, 2 species of adult and several larval Isopoda and 1 leech were found. Total parasite numbers reach 3500 per host, and prevalence of infection with a particular parasite species reached 100% in some species. Numbers of parasite species per fish varied from 5 to 11. Four parasite species were most dominant on different fish if intensities of infection were used to calculate dominance, one species representing about 80% of all parasite individuals on a particular fish at 2 localities and about 50% at the third locality. Ten parasite species were most dominant on different fish, if volume (biomass) was used for calculating dominance, one species representing about 55% at one and 80% of total parasite volume at 2 localities. Parasites included at least 12 congeneric species of 4 or more genera, and those (of 2 genera) occurring on the gills showed much overlap in their distribution. Congeneric Monogenea of the families Dactylogyridae and Diplectanidae occurring in the same sites differ markedly in the size and structure of their copulatory sclerites. Positive associations between species were much more common than negative ones. The bony parts of the gills (gill arches) were never found to be infected, indicating the availability of empty niches.