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Objectives: This study aimed to determine which method to triage intensive care patients using chronic comorbidity in a pandemic was perceived to be the fairest by the general public. Secondary objectives were to determine whether the public perceived it fair to provide preferential intensive care triage to vulnerable or disadvantaged people, and frontline healthcare workers. Methods: A postal survey of 2000 registered voters randomly selected from the Australian Electoral Commission electoral roll was performed. The main outcome measures were respondents' fairness rating of four hypothetical intensive care triage methods that assess comorbidity (chronic medical conditions, long-term survival, function and frailty); and respondents' fairness rating of providing preferential triage to vulnerable or disadvantaged people, and frontline healthcare workers. Results: The proportion of respondents who considered it fair to triage based on chronic medical conditions, long-term survival, function and frailty, was 52.1, 56.1, 65.0 and 62.4%, respectively. The proportion of respondents who considered it unfair to triage based on these four comorbidities was 31.9, 30.9, 23.8 and 23.2%, respectively. More respondents considered it unfair to preferentially triage vulnerable or disadvantaged people, than fair (41.8% versus 21.2%). More respondents considered it fair to preferentially triage frontline healthcare workers, than unfair (44.2% versus 30.0%). Conclusion: Respondents in this survey perceived all four hypothetical methods to triage intensive care patients based on comorbidity in a pandemic disaster to be fair. However, the sizable minority who consider this to be unfair indicates that these triage methods could encounter significant opposition if they were to be enacted in health policy. What is known about the topic? Triage systems can be used to prioritise the order in which patients are treated in a pandemic, but the views of the general public on using chronic comorbidity as intensive care unit (ICU) triage criteria are unknown. What does this paper add? This Australian survey, conducted during the coronavirus disease 2019 pandemic, demonstrated that the majority of respondents perceived ICU triage methods based on comorbidity to be fair, but significant ethical issues exist. What are the implications for practitioners? It may be possible to develop an ICU triage protocol for future pandemics in Australia, but further research is required. [ABSTRACT FROM AUTHOR]

Background: Pulmonary arterial hypertension (PAH) is a high‐risk condition during pregnancy, with recent literature describing mortality rates of up to 23%. Aim: To describe the course and outcomes of pregnancy for women with PAH in a major Australian metropolitan referral centre over a 15‐year period. Methods: Retrospective review of medical records of all pregnant women with PAH over the period 2005–2020. Results: We report the outcomes of nine pregnancies in six women. In five women, seven pregnancies proceeded to term with birth of a healthy neonate, five vaginal births and two caesareans. Two women opted for a termination of pregnancy in the first trimester following counselling. The planning of care and patient‐centred decision‐making was individually tailored by a multidisciplinary team. The pulmonary hypertension clinic provided specialist support including the management of pulmonary vasodilators. All women who delivered a live offspring received neuraxial anaesthesia. Conclusions: Women with this condition are ideally managed in a centre with expertise in PAH; counselling regarding the risks is imperative. Regional anaesthesia, irrespective of the mode of delivery, facilitated safe delivery and improved patient experience. The option of aiming for a term vaginal birth needs to be considered in these complex women. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "A survey of Australian public opinion on using comorbidity to triage intensive care patients in a pandemic" which appeared in the last issue of the periodical.

Background: Early, accurate diagnosis of invasive fungal disease (IFD) improves clinical outcomes. 1,3‐beta‐d‐glucan (BDG) (Fungitell, Associates of Cape Cod, Inc., Falmouth, MA, USA) detection can improve IFD diagnosis but has been unavailable in Australia. Aims: To assess performance of serum BDG for IFD diagnosis in a high‐risk Australian haematology population. Methods: We compared the diagnostic value of weekly screening of serum BDG with screening by Aspergillus polymerase chain reaction and Aspergillus galactomannan in 57 at‐risk episodes for the diagnosis of IFD (proven, probable, possible IFD). Results: IFD episodes were: proven (n = 4); probable (n = 4); possible (n = 18); and no IFD (n = 31). Using two consecutive BDG results of ≥80 pg/mL to call a result 'positive', the sensitivity, specificity, positive predictive value and negative predictive value was 37.5%, 64.5%, 23.1% and 80.7% respectively. For invasive aspergillosis, test performance increased to 50%, 90.3%, 57.1% and 87.5% respectively if any two of serum BDG/Aspergillus polymerase chain reaction/galactomannan yielded a 'positive' result. In proven/probable IFD, five of eight episodes returned a positive BDG result earlier (mean 6.6 days) than other diagnostic tests. False‐negative BDG results occurred in three of eight episodes of proven/probable IFD, and false positive in 10 of 31 patients with no IFD. Erratic patterns of BDG values predicted false positive results (P = 0.03). Using serum BDG results, possible IFD were reassigned to either 'no' or 'probable' IFD in 44% cases. Empiric anti‐fungal therapy use may have been optimised by BDG monitoring in 38.5% of courses. Conclusions: The BDG assay can add diagnostic speed and value but was hampered by low sensitivity and positive predictive value in Australian haematology patients. [ABSTRACT FROM AUTHOR]

This article discusses the clinical outcomes of COVID-19 patients who were transferred between hospitals in Australia. The study compared the outcomes of 17 patients who were transferred for capacity reasons with 54 patients who remained in the intensive care unit (ICU). The study found that the mortality rate was higher among transferred patients, but this difference was not statistically significant. Transferred patients also had longer durations of mechanical ventilation, ICU stay, and hospital stay. The findings suggest that capacity-related transfers may have unintended consequences and further analysis is needed. [Extracted from the article]

Background: Placenta praevia is characterised by an inferior placental margin that overlies or falls within 20 mm of the endocervical os. It remains a common cause of antepartum haemorrhage and is associated with adverse maternal and neonatal outcomes. Aims: We aimed to determine the association between antepartum and postpartum haemorrhage and adverse outcomes in cases of placenta praevia. Materials and Methods: The study population included women diagnosed with placenta praevia, who delivered between 1 April 2007 and 30 April 2017. The endpoints of interest included blood transfusion, emergency caesarean section, peripartum hysterectomy and admission to intensive care. Results: There were 513 cases of placenta praevia, of which 67.3% delivered at term. Antepartum haemorrhage was associated with an increased risk of blood transfusion (relative risk (RR) 3.29; 95% CI 2.04–5.32), emergency caesarean section (RR 1.38; 95% CI 1.18–1.62) and preterm delivery, after 32 weeks gestation (RR 4.21; 95% CI 2.77–6.38). Postpartum haemorrhage more than doubled the risk of blood transfusion (RR 9.08 95% CI 5–16.44) and admission to the intensive care unit (RR 10.44; 95% CI 2.34–46.59), as well as increased the risk of peripartum hysterectomy (1.4%). We also described the management of 12 cases of placenta praevia (2.3% of the study population) delivered vaginally. Conclusions: Antepartum and postpartum haemorrhage in cases of placenta praevia are predictors of several adverse outcomes. However, the high rate of term deliveries reaffirms the current practice of expectant management. [ABSTRACT FROM AUTHOR]

Chickpea is one of the most economically important food legumes, and a significant source of proteins. It is cultivated in more than 50 countries across Asia, Africa, Europe, Australia, North America, and South America. Chickpea production is limited by various abiotic stresses (cold, heat, drought, salt, etc.). Being a winter-season crop in northern south Asia and some parts of the Australia, chickpea faces low-temperature stress (0–15°C) during the reproductive stage that causes substantial loss of flowers, and thus pods, to inhibit its yield potential by 30–40%. The winter-sown chickpea in the Mediterranean, however, faces cold stress at vegetative stage. In late-sown environments, chickpea faces high-temperature stress during reproductive and pod filling stages, causing considerable yield losses. Both the low and the high temperatures reduce pollen viability, pollen germination on the stigma, and pollen tube growth resulting in poor pod set. Chickpea also experiences drought stress at various growth stages; terminal drought, along with heat stress at flowering and seed filling can reduce yields by 40–45%. In southern Australia and northern regions of south Asia, lack of chilling tolerance in cultivars delays flowering and pod set, and the crop is usually exposed to terminal drought. The incidences of temperature extremes (cold and heat) as well as inconsistent rainfall patterns are expected to increase in near future owing to climate change thereby necessitating the development of stress-tolerant and climate-resilient chickpea cultivars having region specific traits, which perform well under drought, heat, and/or low-temperature stress. Different approaches, such as genetic variability, genomic selection, molecular markers involving quantitative trait loci (QTLs), whole genome sequencing, and transcriptomics analysis have been exploited to improve chickpea production in extreme environments. Biotechnological tools have broadened our understanding of genetic basis as well as plants' responses to abiotic stresses in chickpea, and have opened opportunities to develop stress tolerant chickpea. [ABSTRACT FROM AUTHOR]

Background: Pregnancies in patients with solid organ transplants have higher rates of complications and caesarean sections (CS). Aim: To perform an audit of the pregnancy outcomes in transplant recipients, to determine the rate of CS in our cohort, the appropriate skin incision for CS in these patients and to formulate recommendations for preoperative planning. Materials and Methods: This is a retrospective cohort study. All patients who had a solid organ transplant were identified from the obstetrics database. The operation records of the transplant recipients who delivered by CS were reviewed and the de‐identified data were evaluated for pregnancy outcomes. Results: This cohort consisted of 22 women: six had simultaneous pancreas and kidney (SPK) transplants and 16 had kidney transplants. Over a ten‐year period, four women had two pregnancies and one had a twin pregnancy, thus 27 babies were born. The rate of CS was 58% (n = 15) and the surgical approach in 13 of these patients was by Pfannenstiel incision. One patient had an elective midline incision at the first CS, which was repeated in the next pregnancy. Two CS were complicated by bladder injury, both occurring in SPK recipients. Conclusion: Patients with solid organ transplants have a higher rate of CS and SPK patients may be at a higher risk of bladder injuries during CS. Our data suggest that Pfannenstiel skin incision is still suitable for these patients. We recommend reviewing the operative details of the transplant operation and a pelvic magnetic resonance imaging for pre‐operative planning. [ABSTRACT FROM AUTHOR]

Primary objective: To examine the effect of a patient's sex on measures of outcome in a matched sample of patients admitted for acute traumatic brain injury (TBI). Research design: A prospective multi-centred group comparison study based in metropolitan Sydney, Australia. Methods and procedures: Data was collected on 25 women admitted for treatment following non-penetrating TBI. Forty-five men were then matched with regards to age and injury severity. All subjects met the study criteria of having a moderate-to-severe TBI and aged 50 years old or younger. Exclusion criteria included history of previous head injury, psychiatric disturbance and significant alcohol and/or substance abuse. Data included injury details and physiological and psychometric measures of outcome. Main outcomes and results: Women demonstrated better outcomes as indicated by their Glasgow Outcome Scale scores (adjusted for initial injury severity and age at injury odds ratio [OR] 4.2, 95% CI 1.4-12.7) and having shorter Length of Stay (adjusted OR 9.03, 95% CI 3.13-26.08). Conclusions: Understanding the presence of sex differences in outcome following TBI is an emerging area of research. This study indicated that, after matching for initial injury severity and age at injury, women with severe TBI demonstrate a better early outcome than men. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is a common arrhythmia in an intensive care unit. We performed a prospective observational study over a period of three months, to study the incidence, risk factors and outcome of patients who develop atrial fibrillation in a multidisciplinary intensive care unit. All patients above the age of 50 years were eligible. Exclusion criteria were: cardiac or oesophageal surgery during current hospitalisation, atrial fibrillation at admission, implanted pacemaker and expected intensive care unit stay of less than 24 hours. Sixty-one patients were included in the study. Eighteen patients (29.5%, confidence interval 18-40) developed atrial fibrillation. Incidence of atrial fibrillation was 4.02 episodes per 100 patient days. Patients who developed atrial fibrillation had higher age (71.3 years vs. 63.2 years, P=0.001), severity of illness (APACHE II 25.4 vs. 20.0, P=0.005) and sepsis at admission (9/18 vs. 9/43, P=0.01). They also had higher in-hospital mortality (Risk ratio 2.7, 95% confidence interval 1.3-5.4). Standardised mortality ratio was higher in patients who developed atrial fibrillation (1.08 vs. 0.63). Patients who developed atrial fibrillation required a longer period of mechanical ventilation and inotropic support. Multivariate logistic regression analysis showed age >75 years, APACHE II score >20 and sepsis at admission were independent predictors for development of atrial fibrillation in critically ill patients. Although atrial fibrillation by itself is unlikely to be the cause of higher mortality, it is likely to be a marker for increased mortality and resource utilisation in the intensive care unit. [ABSTRACT FROM AUTHOR]

Rock art is globally recognized as significant, yet the resources allocated to the study and exploration of this important form of cultural heritage are often scarce. In areas where numerous rock art sites exist, much of the rock art is unidentified and therefore remains, unrecorded and unresearched. Manually identifying rock art is time-consuming, tedious, and expensive. Therefore, it is necessary to automate many processes in rock art research, which can be accomplished by Machine Learning. Artificial Intelligence (AI) and Machine Learning (ML) can greatly facilitate rock art research in many ways, such as through Object Recognition and Detection, Motif Extraction, Object Reconstruction, Image Knowledge Graphs, and Representations. This article is a reflective work on the future of ML for rock art research. As a proof-of-concept, it presents a machine learning method based on recent advances in deep learning to train a model to identify images with painted rock art (pictograms). The efficacy of the proposed method is shown using data collected from fieldwork in Australia. Furthermore, our proposed method can be used to train models that are specific to the rock art found in different regions. We provide the code and the trained models in the supplementary section. [ABSTRACT FROM AUTHOR]