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Penicillin allergy is a significant burden on patient, prescribing and hospital outcomes. There has been increasing interest in the incorporation of penicillin allergy testing (i.e. delabelling) into antimicrobial stewardship (AMS) programmes to reduce the burden of penicillin allergy labels and improve prescribing. In particular, there has been a focus on point‐of‐care penicillin allergy assessment and direct oral challenge for low‐risk phenotypes. The National Antibiotic Allergy Network has provided a guide to assist AMS clinicians with the incorporation of penicillin allergy programmes, in particular direct oral challenge, into Australian hospitals. [ABSTRACT FROM AUTHOR]

Background: Individuals with spinal cord injuries (SCIs) are at an increased risk of poor oral health compared to the general population. However, little is known about the related barriers and facilitators experienced by these individuals within the hospital setting. Objectives: Understand the oral health knowledge, attitudes and practices of people with SCIs, barriers and facilitators to managing their oral health, and recommendations to improve oral care at acute/rehabilitation hospital settings. Methods: Semi‐structured interviews were conducted with 11 participants, from a major metropolitan hospital in Sydney, Australia. The interviews were thematically analysed. Results: Three themes were constructed. Participants believed that the onus was on them to manage their oral health. Individuals also had limited knowledge of its importance to general health, and placed a lower priority on oral health compared to other aspects of health. All participants identified a combination of factors, such as cost, time, resources and prior negative experiences, that contributed to the neglect of their oral care. Participants also discussed the need of support from the multidisciplinary team and family/carers to facilitate oral care and identified various appropriate oral health education formats. Conclusion: This study highlighted some areas where oral health knowledge among people with SCIs could be improved. It also identified the need for oral health training for the multidisciplinary team, as well as carers, to better integrate oral care during rehabilitation in the hospital. The development of oral health interventions would need to utilise a co‐design approach to best support clients and their carers to facilitate oral care self‐management. [ABSTRACT FROM AUTHOR]

Culturally and linguistically diverse (CALD) is used broadly and inclusively to describe communities with diverse language, ethnic background, nationality, dress, traditions, food, societal structures, art and religion characteristics. Domestic CALD people are either refugees or voluntary migrants and have obtained permanent residency or citizenship. This paper identifies the key issues, challenges and needs of first year domestic CALD students from refugee backgrounds at a multi-campus regional university in Queensland, Australia. The term refugee background is used in the paper as the students are no longer refugees having successfully transitioned from refugee status to being permanent residents. Qualitative data was collected through one-on-one semi-structured interviews and focus groups with domestic CALD students from refugee backgrounds, and from key informants including teaching, administrative, and senior management staff members. Other than language and differences in education styles, this cohort of students faced other challenges, particularly in a regional setting, including socio-cultural issues, technology issues, family and health challenges and limited staff awareness of refugee needs. The findings provide insights into how Australian regional university policy makers could develop effective strategies, practices, procedures and policies to support CALD students from refugee backgrounds and to improve their retention and progression.

A key concern of washback research in language testing is with the value of test preparation for facilitating learning and improving test performance. Although test takers may draw on a wide range of preparation activities, the majority of research studies examining test preparation have taken place in classroom settings, leaving self-access approaches largely unexamined. The aim of the current study was to (a) explore possible links between self-access test preparation activities and improved test performance and (b) examine how repeat test takers adjust their test preparation activities from test sitting to test sitting while preparing for the Pearson Test of English (Academic). The study involved the collection and analysis of interviews from 60 recent repeat test takers. The interview data were coded for themes and sub-themes and analyzed for the kind of test preparation activities in which learners engaged, and how these changed over time. The interviews showed that the test takers were strategic in their preparation, by changing their approaches depending on their previous test results. The largest number of significant improvements was identified for speaking, where test takers engaged in a variety of strategies, some of which were construct-irrelevant. The findings are discussed in relation to test validity and washback.

Ear infection or otitis media (OM) occurs in many Aboriginal and Torres Strait Islander children at a young age and tends to persist over a long period of time. Chronic OM is associated with conductive hearing loss that reduces a child's access to sounds. This can have a negative impact on development of listening and communication skills. Primary health and early childhood workers are best positioned to detect children with hearing and listening problems. However, they lack appropriate tools to screen and triage young children for early referral. By using a co-design approach with Aboriginal primary health workers and early childhood teachers, we have developed the Parents' Evaluation of Listening and Understanding Measure (PLUM) listening skills questionnaire. The PLUM provides a systematic framework for front-line workers to explore a parent's observations of their child's listening behaviour in everyday situations to detect hearing and listening problems in young Aboriginal children. This paper reports the development of the scale. PLUM scores for 438 children from urban, regional and remote communities in Australia were collected. The internal consistency reliability was 0.87. Normative data from 235 children with normal hearing (hearing thresholds averaged between 0.5 and 4 kHz in the better ear to be no greater than 20 dB HL) were used to define the relationship between PLUM scores and age. The functions allow performance of individual children to be related to their normal-hearing peers.

Many Aboriginal and Torres Strait Islander children are affected by chronic middle ear infection or otitis media from infancy that has a negative impact on development of listening and communication skills. Deficits in these skills are often not detected until school-age when the opportunity for early intervention is lost. Primary health and early childhood workers need screening tools to assist them with detecting the problem early, but there is a scarcity of tools. This study reports the development and validation of a screening tool for detecting communication problems in young Aboriginal and Torres Strait Islander children. The tool, called the Hearing and Talking Scale (HATS), relies on a systematic use of parent observations of communication behaviours of their children in everyday situations. Developed by using a co-design approach, the HATS is culturally and linguistically appropriate for use with parents/carers of young children by front-line workers not trained in speech-language pathology. We validated the HATS by comparing the HATS score of 68 children (46 Indigenous and 22 non-Indigenous children) with their performance in standardised assessments. The accuracy of the HATS was 80% and 81% when compared to the ASQ-TRAK and the Expressive Vocabulary Test respectively. The HATS takes 5 minutes to administer, and is easy to score and interpret. It can be used as part of a standard ear and hearing health check for young children to support early detection so that those with problems can be referred for specialist diagnosis and treatment at a young age.

Widening higher education participation can deliver benefits to individuals, societies and economies but rural populations experience factors which inhibit their aspiration for and participation in higher education. When designing outreach programs, universities need to consider this landscape of factors, many of which are socio-cultural. This article reports evaluation results from a project that trialled three university outreach programs designed to align with rural contexts with the aim of identifying aspects which were effective in addressing factors of rurality, revealing obscured future options and showing higher education pathways as attainable. Universities can work effectively with rural communities to inform people's higher education aspirations through 'disruptions', interventions that inform educational aspiration, and 'bridges' which support higher education participation through facilitating access to information, physical, financial, academic and social resources. A model including both 'disruptions' and 'bridges', jointly resourced and drawing on social capital resources of communities and higher education institutions is presented.

Loneliness contributes to mortality risk, comparable to the risks associated with smoking and obesity, although the causal determinants of loneliness remain less clear. This paper leverages mandatory stay-at-home orders in Australia as a natural experiment and employs data from a panel study to investigate the causal link between physical isolation and loneliness. By analyzing variations in the number of lockdown days experienced by respondents up until their interview dates, and utilizing difference-in-differences analyses with individual, region, and year fixed-effects estimations, we find, contrary to expectations, that the number of days in lockdown does not significantly impact loneliness. Our study examines cumulative, concurrent, and non-linear effects, and assesses external validity through community morale and peer effects during lockdowns using spatial analysis. Additionally, we delve into heterogeneous effects across various factors, such as income, age, personality, living arrangements, and remoteness, finding statistically and empirically insignificant effects. However, for extroverts and young people, we observe weak statistical significance. We investigate exclusion restrictions by analyzing factors including social contacts, internet access, job industry, and household characteristics in relation to loneliness; as well as time use and relationship satisfaction to better understand the underlying mechanism. Our study challenges the notion that 'being alone' and 'being lonely' are interchangeable concepts, providing the first empirical causal evidence of no links between the two. Furthermore, our findings refine earlier understandings of social isolation, highlighting that it likely encompasses factors beyond physical isolation. [ABSTRACT FROM AUTHOR]

Context Omnipod DASH Insulin Management System is a tubeless insulin pump that overcomes the physical inconveniences of conventional tubed insulin pump therapy (IPT). Objective We compared treatment satisfaction with Omnipod DASH System to usual care (multiple daily injections [MDIs] or tubed IPT) in adults with type 1 diabetes using self-monitoring blood glucose (SMBG). Methods Adults with type 1 diabetes on MDI (n = 40) or IPT (n = 25) from 4 diabetes centers in Australia were randomly assigned in a 1:1 nonblinded manner to Omnipod DASH System (Omnipod group) or continue usual care (Usual Care group) for 12 weeks, followed by a further 12-week extension during which all participants used the device. The primary outcome was treatment satisfaction assessed by change in Diabetes Technology Questionnaire "current" (ΔDTQ-current) score at 12 weeks (study end). Secondary outcomes included ΔDTQ-current following extension and other participant-reported outcomes (PROs) measuring quality of life, burden of disease treatment, and glycemic and device-related outcomes at 12 weeks (study end) and 24 weeks (end extension). Results Treatment satisfaction improved more in the Omnipod group vs the Usual Care group (ΔDTQ-current score of 16.4 [21.2] vs 0.0 [12.8]; P <.001) at study end. Significantly greater improvements in other PROs and glycated hemoglobin A1c were also observed. Improvements in DTQ-current and other PROs comparing study end and end extension were similar. While percentage in time in range change from baseline did not differ at study end (−2.0 [12.7] %), it was significantly greater at end extension (5.6 [10.9] %; P =.016). Conclusion The Omnipod DASH System resulted in greater treatment satisfaction at 12 weeks in adults with type 1 diabetes using SMBG that was sustained after 24 weeks of device use without compromising sleep quality and fear of hypoglycemia. Improvements in glycemia were also observed. [ABSTRACT FROM AUTHOR]

Background and Aims: Lurbinectedin is a novel oncogenic transcription inhibitor active in several cancers, including small cell lung cancer (SCLC). We aimed to describe the first Australian experience of the clinical efficacy and tolerability of lurbinectedin for the treatment of SCLC after progression on platinum‐containing therapy. Methods: Multicentre real‐world study of individuals with SCLC initiating lurbinectedin monotherapy (3.2 mg/m2 three‐weekly) on an early access programme between May 2020 and December 2021. Key outcomes were clinical utilisation, efficacy and tolerability. Progression‐free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method. Outcome data were collected within the AUstralian Registry and biObank of thoRacic cAncers (AURORA). Results: Data were analysed for 46 individuals across seven sites. Lurbinectedin was given as second‐ (83%, 38/46) or subsequent‐ (17%, 8/46) line therapy, mostly with prior chemoimmunotherapy (87%, 40/46). We report dose modifications (17%, 8/46), interruptions/delays (24%, 11/46), high‐grade toxicities (28%, 13/46) and hospitalisations (54%, 25/46) during active treatment. The overall response rate was 33% and the disease control rate was 50%. Six‐month OS was 44% (95% confidence interval (CI): 29.0–57.1). Twelve‐month OS was 15% (95% CI: 6.5–26.8). From lurbinectedin first dose, the median PFS was 2.5 months (95% CI: 1.8–2.9) and OS was 4.5 months (95% CI: 3.5–7.2). From SCLC diagnosis, the median OS was 12.9 months (95% CI: 11.0–17.2). Individuals with a longer chemotherapy‐free interval prior to lurbinectedin had longer PFS and OS. Conclusion: This real‐world national experience of lurbinectedin post‐platinum chemotherapy and immunotherapy for individuals with SCLC was similar to that reported in clinical trials. [ABSTRACT FROM AUTHOR]

With the globalization and internationalization of education, many teachers from Asian countries pursue their professional development in English-speaking settings. However, there seems to be scarce research on these teachers' expectations, lived experiences and identities in these contexts, and how their personal experiences influence their views and teaching when they return to their home countries. Using interviews and email correspondences, the current article examines the perceptions and personal experiences of three teachers of English (from Vietnam, China and Taiwan) who studied in Australia. Among others, findings suggest that the participants negotiated their expectations, lived experiences and sense of identity in different ways regardless of the degree to which their experiences in Australia matched their expectations. As teachers of English, they were constantly reflecting on the suitability of applying the teaching methods learned in their local teaching contexts. When they returned to their home countries, all of them found it useful to share their personal experiences of living and studying abroad with their students. Their strategic and practical application of what they had learned and/or experienced in Australia assisted them in having new options in dealing with teaching and learning issues in their home countries. This article hopes to shed light on aspects that may influence the growth of teachers of English.

Background: Severe COVID‐19 causes acute inflammation, which is complicated by venous thromboembolism events (VTE). However, it is unclear if VTE risk has evolved over time since the COVID‐19 outbreak. Aims: To determine markers of thrombo‐inflammation and rates of symptomatic VTE in patients hospitalised for COVID‐19 in a metropolitan hospital in Sydney, Australia. Methods: A retrospective, single‐centre, cohort study was performed by reviewing electronic medical records of consecutive patients admitted to Royal Prince Alfred Hospital between March 2020 and September 2021. This period included three waves of COVID‐19 outbreaks in Australia with the ancestral, alpha and delta variants. Standard coagulation assays and inflammatory markers were recorded over 4 weeks. Results: A total of 205 patients were consecutively admitted during the study period. Activated partial thromboplastin time, neutrophil count and C‐reactive protein (CRP) were significantly increased in patients hospitalised in the intensive care unit (ICU) compared with non‐ICU patients. The use of anti‐inflammatory medication increased in 2021 compared with 2020. The mortality rate was 7.3% in our cohort. Ninety‐four per cent of patients received anticoagulation with 6.3% of patients developing VTE. Conclusion: We observed lower rates of VTE compared to the internationally reported rate for the same period. We conclude that in the setting of controlled hospital admission rate and standard anticoagulation guidelines, COVID‐19 resulted in similar thrombo‐inflammatory response and VTE rates over the first 1.5 years of the pandemic. [ABSTRACT FROM AUTHOR]

The Rehabilitation Medicine Society of Australia and New Zealand advocates the safe, effective and evidence‐based use of botulinum toxin type A for spasticity management. The process requires appropriate training, alongside considerable knowledge and skills, to maximise efficacy. The processes before and after injection contribute to effectiveness. The gold standard of managing spasticity is for assessment by a multidisciplinary specialist team, deriving patient‐centric goals, and designing an injection protocol to match these goals. The patient and/or carers are considered part of the decision‐making team. Postinjection therapy and measurement of goal achievement are highly recommended as part of the wider holistic approach to management. The Society believes treatment failures can be minimised by following clear clinical guidelines. [ABSTRACT FROM AUTHOR]

BowerBird is an open platform biodiversity website (http://www.BowerBird.org.au) and a nationally funded project under management of the Atlas of Living Australia (ALA) and Museum Victoria. Members post sightings and information about local species of plants and animals, and record other features of ecosystems. Charles Darwin University's Northern Institute Elder on Country researcher, Kathy Guthadjaka, has shared pictures and information about the biodiversity of her homelands in the Yol?u community of Gäwa, on Elcho Island in north east Arnhem Land, Northern Territory. The extent to which this knowledge can be exposed in the same way as other open resources, can pose dilemmas about the level of "openness" that is appropriate. Open sharing of educational materials can be promoted as a basic human right. This paper will explore the extent to which traditional knowledge can be made openly available. What are the implications for sharing this knowledge in a westernised context that compartmentalises it, and how can a western academic perspective learn from this knowledge and engage functionally with it for the purposes of learning? The existence of this project on the interface between traditional knowledge and western technocratic information management also has implications for how information is presented and valued.

This study detected two potential pathogens, Vibro parahaemolyticus, which causes acute hepatopancreatic necrosis disease (AHPND), and white spot syndrome virus (WSSV), in fishing bait in South Korea. However, their infectious nature was not confirmed, possibly due to the degradation caused by freezing/thawing or prolonged storage under frozen conditions. While infectivity was not confirmed in this study, there is still a significant risk of exposure to these aquatic products. Furthermore, fishing bait and feed should be handled with caution as they are directly exposed to water, increasing the risk of disease transmission. In Australia, cases of WSSV infection caused by imported shrimp intended for human consumption have occurred, highlighting the need for preventive measures. While freezing/thawing is a method for inactivating pathogens, there are still regulatory and realistic issues to be addressed. [ABSTRACT FROM AUTHOR]

Many TESOL (Teaching English to Speakers of Other Languages) programmes focus on providing professional knowledge to Asian teachers who are pursuing their degrees in English-speaking countries. However, not much attention is given to their expectations, personal lived experiences and identity construction while studying in these countries. These aspects are important in their development as users and teachers of English. This article explores these aspects through interviews and email correspondence with Thinh, a highly accomplished TESOL professional who pursued a Master of TESOL degree as an international student in Australia. Findings suggest that when she was in Australia, she displayed strong agency as she changed some aspects of her identity in order to adapt to studying and living in the country. Nevertheless, there is also continuity in her identity construction, as she maintained other aspects of the identity that she brought from her home country. Her identity construction is best seen in the context of her investment in her career in her home country. As a resilient individual, Thinh demonstrates how she manages her process of identity construction through her reflections and strategic thinking. The findings of this study suggest the need for TESOL programmes to actively connect international students' lived experiences outside class to their pursuit of professional knowledge.

Laws and policies in different jurisdictions provide a range of mechanisms that allow children involved in child protection processes and care proceedings to express their views when decisions that affect them are being made. Whether these mechanisms facilitate children's involvement and whether they result in children's views being heard and "given due weight in accordance with the age and maturity of the child", as required by article 12 of the UN Convention on the Rights of the Child, is the focus of this article. The law, policy and practice in New South Wales, Australia, are used to provide a contextual illustration of the wider theoretical and practical issues, drawing on international comparisons and research. It is clear there is still some way to go to satisfy the requirements of article 12 in Australia and other jurisdictions. These mechanisms often do not provide the information children need to understand the process, nor do they consistently encourage meaningful participation through trusted advocates who can accurately convey children's views to those making the decisions. It is generally unclear how children's views are heard, interpreted, and weighted in decision-making processes. The research findings from a number of countries, however, are clear and consistent that children often feel 'unheard' and that they have had few opportunities to say what is important to them. A number of conclusions and practice suggestions are outlined for how the law could better accommodate children's views. [ABSTRACT FROM AUTHOR]

Western mothers use more mental state talk with children than do Chinese mothers (e.g., "think", "like", "happy"). The present study aimed to examine whether Western mothers not only produced a greater amount of mental state talk, but also used a wider range of mental state terms (i.e., greater lexical variety) compared to Chinese mothers. We compared maternal mental state talk in 271 mother-child dyads from New Zealand, Australia and China, and coded both quantity (i.e., frequency) and quality (i.e., type, variety, valence) of mothers' mental state talk to their 2.5- to 5-year-olds. Western mothers produced more talk about cognitions and emotions, as well as modulations of assertions, but a similar amount of desire talk, compared to Chinese mothers, with the same patterns found in the variety of talk. Western mothers produced an overall higher amount of mental state talk and a greater variety of mental state terms, but crucially, still produced more MS talk after controlling for the variety. Neither the amount nor the variety of maternal MS talk was correlated with children's theory of mind. These findings shed light on the diverse ways that mothers construe and describe mental states in different cultures, and highlight the importance of examining different aspects of maternal mental state talk and their impact on children's theory of mind in future longitudinal studies. [ABSTRACT FROM AUTHOR]

The Midwifery Initiated Oral Health-Dental Service was developed to train midwives to promote maternal oral health, and a large trial showed it substantially improved the oral health, knowledge and behaviours of pregnant women. Evaluate the long-term effectiveness of the program (post-trial) on maternal oral health knowledge, dental behaviours, and early childhood caries in offspring. A prospective cohort study involving 204 women and children 3–4 years (followed after trial) was conducted in Sydney, Australia from 2017 to 2019. The program did not have a significant impact on the study measures. Mothers who received the program did have comparatively better knowledge around preventative behaviours to reduce early childhood caries and significantly more mothers were engaging in a key behaviour of using a cup to feed their child. Overall maternal oral health knowledge and level of education did have a protective effect on the dental decay of children. Higher knowledge and levels of education reduced the odds of having a dmft of one or more by over half (OR 0.473), and almost 80% (OR 0.212) respectively. Although the MIOH-DS program was not effective, there is still value in exploring other complementary interventions to improve maternal oral health, especially for disadvantaged families. Future research should focus on co-designing an antenatal and postnatal oral health intervention and exploring its long-term impact on the oral health of children. [ABSTRACT FROM AUTHOR]

The aim of this project was to determine research priorities, barriers, and enablers for adult primary brain tumour research in Australia and New Zealand. Consumers, health professionals, and researchers were invited to participate in a two-phase modified Delphi study. Phase 1 comprised an initial online survey (n = 91) and then focus groups (n = 29) which identified 60 key research topics, 26 barriers, and 32 enablers. Phase 2 comprised two online surveys to (1) reduce the list to 37 research priorities which achieved consensus (>75% 2-point agreement) and had high mean importance ratings (n = 116 participants) and (2) determine the most important priorities, barriers, and enablers (n = 90 participants). The top ten ranked research priorities for the overall sample and sub-groups (consumers, health professionals, and researchers) were identified. Priorities focused on: tumour biology, pre-clinical research, clinical and translational research, and supportive care. Variations were seen between sub-groups. The top ten barriers to conducting brain tumour research related to funding and resources, accessibility and awareness of research, collaboration, and process. The top ten research enablers were funding and resources, collaboration, and workforce. The broad list of research priorities identified by this Delphi study, together with how consumers, health professionals, and researchers prioritised items differently, and provides an evidence-based research agenda for brain tumour research that is needed across a wide range of areas. [ABSTRACT FROM AUTHOR]

We formulate a new, computationally inexpensive framework based on Mean–Variance Portfolio Theory to determine the optimal allocation of wind and solar capacity, which can leverage the complementarity between intermittent solar and wind generation to meet electricity demand at the lowest cost, with gas acting as reserve generation in times of insufficient wind and solar output, and the variance of the mismatch between demand and the output of wind and solar is taken as the risk indicator. We then apply this framework to the context of the National Electricity Market in Australia. Our result reveals that, assuming sufficient network capacity, the estimated lowest generation cost achievable is $45.26/MWh, where the expected percentage of unserved energy (USE) is 0.0044%. For a risk-averse planner, a level of USE less than 0.0001% may be achieved at the expense of almost doubling the cost to $88.23/MWh. Under the current network capacity constraints, we estimate these costs to increase to $53.09/MWh and $89.90/MWh respectively, while the USE could rise to 0.017%. Moreover, network expansions in Queensland are found to be the most beneficial. On the other hand, a 4-hour battery storage system with power capacity equivalent to 20% of the peak load could help reduce the cost by up to 6.8% alongside further decrease in the USE. Our results are also shown to differ drastically from the conventional, output-based approach. Since the two approaches address two different questions depending on whether demand is flexible, demand flexibility is also an important factor. • New demand and cost based portfolio selection methodology for wind and solar. • Minimise cost of meeting demand, with gas generation as backup energy source. • Variance of difference between demand and wind and solar output is risk indicator. • Results differ significantly from conventional output based approach. • Quantify marginal impact of transmission expansion on portfolio cost and risk. [ABSTRACT FROM AUTHOR]

Background: Escherichia coli sequence type (ST)131 is an important urinary tract pathogen, and is responsible for considerable healthcare-associated problems and costs worldwide. A better understanding of the factors that contribute to its rapid worldwide spread may help in arresting its continual spread. We studied a large collection of fecal and urinary E. coli ST131 and E. coli non-ST131 phylogenetic group B2 isolates, from women, men and children, in regional NSW, Australia. Results: We found out that there was a step up in ST131 prevalence (and possibly in virulence) from fecal to clinical (urinary) isolates in general, and specifically among ciprofloxacin resistant isolates, in the 3 host groups. Furthermore, our results revealed that the inferred virulence potential of the ST131 isolates (as measured by VF gene scores) was much higher than that of non-ST131 phylogenetic group B2 isolates, and this was much more pronounced amongst the urinary isolates. This finding suggests presence of possible E. coli phylogenetic B2 subgroups with varying levels of virulence, with ST131 being much more virulent compared to others. A strong association between ST131 and fluoroquinolone (FQ) resistance was also demonstrated, suggesting that FQ use is related to ST131 emergence and spread. Specifically, about 77% of ST131 isolates from women and men, and 47% from children, were extended spectrum β- lactamase (ESBL) producers. Moreover, FQ resistant ST131 ESBL isolates on average harbored more VF genes than all other isolates. Conclusions: The strong association between ST131 prevalence and FQ resistance amongst the studied isolates suggests that FQ use is related to ST131 emergence and spread. Furthermore, our results demonstrate that FQ resistance and a plurality of VF genes can exist together in ST131, something that has traditionally been regarded as being inversely related. This may partly contribute to the emergence and worldwide spread of ST131. [ABSTRACT FROM AUTHOR]

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programmes in primary care. This study aimed to design a GP/pharmacist antimicrobial stewardship (GPPAS) model for primary care in Australia. An exploratory study design was followed that included seven studies conducted from 2017 to 2021 for the development of the GPPAS model. We generated secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components, and a pilot study of a GPPAS submodel. All study evidence was synthesised, reviewed, merged, and triangulated to design the prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. The secondary evidence provided effective GPPAS interventions, and the primary evidence identified GP/CP interprofessional issues, challenges, and future needs for implementing GPPAS interventions. The framework of the GPPAS model informed five GPPAS implementation submodels to foster implementation of AMS education program, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescriptions, through improved GP–CP collaboration. The GPPAS model could be used globally as a guide for GPs and CPs to collaboratively optimise antimicrobial use in primary care. Implementation studies on the GPPAS model and submodels are required to integrate the GPPAS model into GP/pharmacist interprofessional care models in Australia for improving AMS in routine primary care. [ABSTRACT FROM AUTHOR]

Aim: The neuro‐oncology community in Australia is well positioned to collaborate internationally, with a motivated trials group, strong regulatory bodies and an attractive fiscal environment. We sought to identify gaps in the Australian neuro‐oncology clinical trials landscape and describe strategies to increase international trial access in Australia. Methods: We searched clinical trial registries to identify active adult primary brain cancer trials. We compared the participation rate and phase of these trials between tumour types and countries. A survey was distributed to the Cooperative Trials Group for Neuro‐Oncology membership to identify barriers and solutions to effective international collaboration. Results: Globally, 307 trials for adult primary brain cancers were identified. These included 50% pharmaceutical agents, 18% cellular therapies and 9% radiation therapy. Twelve adult primary brain cancer trials were actively recruiting in Australia at the time the survey was sent out. There were more early phase brain cancer trials (34%) compared with colorectal and breast cancer (21% and 24%, respectively). In Australia, 92% of brain cancer trials were involving pharmaceutical agents. The most commonly cited barrier was lack of funding for international trials (86%) and insufficient research time (75%). High ranking solutions included increasing the availability of funding for international trials and creating opportunities to develop personal relationships with collaborators. Accreditation of clinical research key performance indicators into practice (88%) and hospital accreditation (73%) also ranked highly. Conclusions: Participation in international research in Australia could be improved by embedding clinical research targets into institutional funding, provision of funding for early phase studies and streamlining mutual ethics schemes. [ABSTRACT FROM AUTHOR]

Background: Considering the interdisciplinary role dental staff can play in addressing overweight and obesity in childhood, this study aimed to codesign guideline implementation strategies for children's growth assessment and dietary advice guidelines in the dental setting. Methods: This qualitative study utilised principles of codesign and appreciative inquiry through a series of four, two-hour focus groups with dental staff and parents. Focus groups were analysed using content analysis. Results: Discussion fell into two main themes, engaging patients throughout their care journey and supporting staff to engage with the guidelines. Six strategies were developed within these themes: (1) providing growth assessment information to patients and families before appointments, (2) providing refresher training to staff, (3) involving dental assistants in the growth assessment, (4) keeping dental staff updated regarding referral outcomes, (5) culturally appropriate information resources for patients and families, and (6) enabling longitudinal growth tracking in patient information systems. Conclusions: This study successfully designed six implementation strategies for children's growth assessment guidelines in the dental setting. Further research is required to determine their impact on guideline adherence. Plain English summary: Being above a healthy weight in childhood is a major public health issue. In parts of Australia, dental staff need to screen for and promote healthy weight among children. As this is not a normal part of dental care, it could be hard for this change to come about. So, this study aimed to create strategies to help dental staff to screen for and promote healthy weight among children. As we wanted those impacted by the strategies to have a say, we worked with public dental staff and parents. When health staff and the community come together to design ways to improve health care, this is known as codesign. In groups, these people codesigned a series of strategies. Strategies for parents included: (1) informing parents about what to expect in their child's appointment; and (2) creating resources for parents from other cultures. Strategies for dental staff included (1) ensuring staff were trained; (2) involving the whole dental team to save time; (3) ensuring dental staff heard back from services they sent children to for healthy weight support; and (4) creating a way to record children's growth over time. Bringing in both parents and dental staff gave them a voice to codesign strategies to help dental staff screen and promote healthy weight among children. This produced a suite of strategies that were appropriate for all involved. [ABSTRACT FROM AUTHOR]

Background: Otitis media with effusion (OME) is common and occurs at disproportionately higher rates among Indigenous children. Left untreated, OME can negatively affect language, development, learning, and health and wellbeing throughout the life-course. Currently, OME care includes observation for 3 months followed by consideration of surgical ventilation tube insertion. The use of a non-invasive, low-cost nasal balloon autoinflation device has been found beneficial in other populations but has not been investigated among Aboriginal and Torres Strait Islander children.Methods/design: This multi-centre, open-label, randomised controlled trial will determine the effectiveness of nasal balloon autoinflation compared to no nasal balloon autoinflation, for the treatment of OME among Aboriginal and Torres Strait Islander children in Australia. Children aged 3-16 years with unilateral or bilateral OME are being recruited from Aboriginal Health Services and the community. The primary outcome is the proportion of children showing tympanometric improvement of OME at 1 month. Improvement is defined as a change from bilateral type B tympanograms to at least one type A or C1 tympanogram, or from unilateral type B tympanogram to type A or C1 tympanogram in the index ear, without deterioration (type A or C1 to type C2, C3, or B tympanogram) in the contralateral ear. A sample size of 340 children (170 in each group) at 1 month will detect an absolute difference of 15% between groups with 80% power at 5% significance. Anticipating a 15% loss to follow-up, 400 children will be randomised. The primary analysis will be by intention to treat. Secondary outcomes include tympanometric changes at 3 and 6 months, hearing at 3 months, ear health-related quality of life (OMQ-14), and cost-effectiveness. A process evaluation including perspectives of parents or carers, health care providers, and researchers on trial implementation will also be undertaken.Discussion: INFLATE will answer the important clinical question of whether nasal balloon autoinflation is an effective and acceptable treatment for Aboriginal and Torres Strait Islander children with OME. INFLATE will help fill the evidence gap for safe, low-cost, accessible OME therapies.Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12617001652369 . Registered on 22 December 2017. The Australia New Zealand Clinical Trials Registry is a primary registry of the WHO ICTRP network and includes all items from the WHO Trial Registration data set. Retrospective registration. [ABSTRACT FROM AUTHOR]

Purpose: Distant recurrence is a devastating occurrence after colorectal cancer resection. This study aimed to identify the risk factors for distant recurrence following surgery. Methods: All consecutive colorectal cancer resections with curative intent were included from a prospectively maintained colorectal cancer database. The primary outcome was to identify predictive factors for distant recurrence of colorectal cancer. Results: A total of 670 eligible cases were identified with 88 (13.1%) developing distant recurrence during the follow-up period. The median time to distant recurrence was 1.2 years with the most common sites of distant recurrence being the lung (44.3%) and liver (44.3%). Predictive factors for distant recurrence in colon cancer included a high tumor, nodal, and overall stage of the primary cancer (p < 0.001 for all). Surgical complications (p = 0.007), including anastomotic leak (p = 0.023), were associated with a higher risk of developing distant recurrence in rectal cancer patients. Independent variables associated with distant recurrence included tumor stage (OR 1.61, p = 0.011), nodal stage (OR 2.18, p < 0.001), and both KRAS (OR 11.04, p < 0.001) and MLH/PMS2 (OR 0.20, p = 0.035) genetic mutations. Among patients with distant recurrence, treatment with surgery conferred the best survival, with patients < 50 years of age having the best overall 5-year survival. Conclusion: Predictive factors for distant recurrence include advanced tumor and nodal stages, and the presence of KRAS and MLH/PSM2 mutations. Clinicians should be cognizant of these risk factors, and instate close surveillance plans for patients exhibiting these features. [ABSTRACT FROM AUTHOR]

Despite decades of research demonstrating that early intervention is critical to diagnosing and treating ear disease in Aboriginal and Torres Strait Islander children, not enough progress has been made in providing culturally safe, accessible and equitable hearing health services. In the discussion below, Aboriginal and Torres Strait Islander health leaders Professor Tom Calma, Professor Kelvin Kong and Associate Professor Boe Rambaldini examine the problems and solutions for creating better services to meet the needs of communities where hearing health problems are being neglected, often with catastrophic results for Aboriginal and Torres Strait Islander children and their families. [ABSTRACT FROM AUTHOR]

Background: Despite reports of increasing adoption of robotics in colorectal surgery worldwide, data regarding its uptake in Australasia are lacking. This study examines the trends of robotic colorectal surgery in Australia during the last 10 years. Methods: Data from patients undergoing robotic colorectal surgery with the da Vinci robotic platform between 2010 and 2019 were obtained. Overall, numbers of specific colorectal procedures across Australia were obtained from the Medicare Benefit Schedule data over the same period. Pearson’s correlation analysis was used to determine the statistical trends of overall and specific robotic colorectal procedures over time. Results: A total of 6110 robotic general surgery procedures were performed across Australia during the study period. Of these, 3522 (57.6%) were robotic colorectal procedures. An increasing trend of overall robotic colorectal procedures was seen over 10 years (Pearson’s coefficient of 0.875; P = 0.001). While this applied to both the public and private sectors, 90.7% of the procedures were undertaken in the private sector. Restorative rectal resections, rectopexies, and right hemicolectomies accounted for 82.6% of the robotic colorectal procedures performed during this period with an increasing trend seen over time for each intervention. Moreover, a robotic approach was utilized in 12.5%, 41.0% and 9.0% of all restorative rectal resections, rectopexies and right hemicolectomies undertaken in Australia during 2019, respectively. Conclusion: Robotic colorectal surgery has increased dramatically in Australia over the last 10 years, especially in the private sector. Penetration of robotic colorectal surgery in the public healthcare system will require focussed cost–benefit evaluations and governmental investment. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has resulted in global disruptions to the delivery of healthcare. The national responses of Australia and New Zealand has resulted in unprecedented changes to the care of colorectal cancer patients, amongst others. This paper aims to determine the impact of COVID‐19 on colorectal cancer diagnosis and management in Australia and New Zealand. Methods: This is a multicentre retrospective cohort study using the prospectively maintained Binational Colorectal Cancer Audit (BCCA) registry. Data is contributed by over 200 surgeons in Australia and New Zealand. Patients receiving colorectal cancer surgery during the pandemic were compared to averages from the same period over the preceding 3 years. Results: There were fewer operations in 2020 than the historical average. During April to June, patients were younger, more likely to have operations in public hospitals and more likely to have urgent or emergency operations. By October to December, proportionally less patients had Stage I disease, proportionally more had Stage II or III disease and there was no difference in Stage IV disease. Patients were less likely to have rectal cancer, were increasingly likely to have urgent or emergency surgery and more likely to have a stoma created. Conclusion: This study shows that the response to COVID‐19 has had measurably negative effects on the diagnosis and management of colorectal cancer in two countries that have had significantly fewer COVID‐19 cases than many other countries. The long‐term effects on survival and recurrence are yet to be known, but could be significant. [ABSTRACT FROM AUTHOR]

Deriving water quality criteria (WQC) for aquatic risk assessment requires sufficient toxicity data, which can determine the accuracy of WQC. Given that toxicity data vary between test species and endpoints, there is a great need to compare such data to generate the most suitable data set for WQC derivation. In the present study, a series of 11 ammonia exposure bioassays were conducted on Chironomidae species in either China or Australia, with test species and test endpoints varied (2 Chironomus sp., enzymatic up to lethal endpoints, and no‐observed‐effect concentration up to median lethal concentration [LC50] as endpoint metrics). There were no statistically significant differences between toxicity results generated from China compared to Australia using Chironomus sp., indicating that published data on native species generated in different countries could be appropriate for inclusion in the development of local Chinese WQC. In addition, the Chironomidae larvae laboratory‐based toxicity value (LC50 = 384.6 mg/L) was lower than that of the in situ field‐based toxicity value (LC50 ≥ 451.2 mg/L) where sensitive life stages are used, and, specifically for C. riparius, endpoints linked to biochemical and gene expression effects could be as sensitive as or more sensitive than chronic endpoints, both of which were more sensitive than acute endpoints. These findings help in the development of WQC by demonstrating the suitability of inclusion of toxicity data from a range of sources, as well as adding to the overall pool of knowledge regarding sensitivity to ammonia which can be used in aquatic risk assessment. Environ Toxicol Chem 2021;40:2899–2911. © 2021 SETAC [ABSTRACT FROM AUTHOR]

Australia introduced 'lockdown' measures to control COVID-19 on 22 March 2020 which continued for a period of two months. We aimed to investigate the impact this had on sexual and reproductive health (SRH). Australians aged 18+ were eligible to participate in an online survey from 23 April to 11 May 2020. We report on the experiences of 518 female participants aged <50 years. Pregnancy intentions and contraceptive use were analysed using descriptive statistics. Odds ratios and 95% confidence intervals were calculated to investigate difficulty accessing SRH products and services. Qualitative data were analysed using conventional content analysis. Most participants were aged 18–24 years, and indicated they were trying to avoid pregnancy. The oral contraceptive pill was the most common single method used however nearly 20% reported they were not using contraception. Women who were employed had less trouble accessing contraception during lockdown. Participants reported delaying childbearing or deciding to remain childfree due to COVID-19. COVID-19 lockdown impacted the SRH of Australian women. Findings highlight the importance of continued access to SRH services and products during global emergencies. [ABSTRACT FROM AUTHOR]