Search

Summary: Gender inequity remains an issue in anaesthesia despite increasing numbers of women training and achieving fellowship in the speciality. Women are under‐represented in all areas of anaesthetic research, academia and leadership. The Gender Equity Subcommittee of the Australian and New Zealand College of Anaesthetists recently conducted a survey asking "Does gender still matter in the pursuit of a career in anaesthesia in 2022?". The survey was distributed to a randomly selected sample of 1225 anaesthetic consultants and completed by 470 respondents (38% response rate) with 793 free‐text comments provided. Three overarching themes were identified: gender effects on the career and family interface; women do not fit the mould; and gender equity changes the status quo. Women respondents described a need to make a choice between career and family, which was not described by men, as well as stigmatisation of part‐time work, a lack of access to challenging work and negative impacts of parental leave. Women respondents also described a sense of marginalisation within anaesthesia due to a 'boys' club' mentality, a lack of professional respect and insufficient structural supports for women in leadership. This was compounded for women from ethnically and culturally diverse backgrounds. A need for specific strategies to support anaesthetic careers for women was described as well as normalisation of flexibility in workplaces, combined with a broadening of our definition of success to allow people of all genders to experience fulfilment both at home and at work. This study is the first published qualitative data on factors affecting gender equity for anaesthetists in Australia and Aotearoa New Zealand. It highlights the need for further exploration, as well providing a foundation for changes in attitude and structural changes towards advancing gender equity. [ABSTRACT FROM AUTHOR]

Background: Previous research shows considerable variation in pre-registration paediatric podiatry curricula, and thus the clinical skills realised prior to graduation. Whilst pre-registration training is guided by regulatory bodies, these high level principles only refer briefly to standards in paediatric practice. An estimated 9% of podiatry caseloads in the United Kingdom (UK) and Australia are dedicated to paediatric service provision. Therefore, it is imperative that curricula support the consistent development of paediatric practice enabling newly registered podiatrists to work safely and effectively with children. Given that the global healthcare work force provides unique opportunities to explicitly align international curricula, the aim of this study was to determine the priorities for a UK and Australian binational pre-registration paediatric podiatry curriculum. Methods: A four round modified Delphi design was employed to ascertain consensus and agreement of a panel of experts with a special interest in paediatrics working in the UK and Australia. Round 1 contained open questions designed to promote diverse responses on the broad topics of lecturer experience and curriculum organisation and delivery. The answers from Round 1 were developed, through content analysis, into a series of statements presented to the panel for agreement in Rounds 2, 3 and 4. Results: Of the 297 statements generated following Round 1, 183 were accepted and 114 rejected by the end of Round 4. 109 of the accepted statements related to curriculum content. Participants also agreed on areas relating to lecturer experience, clinical education, and assessment of paediatric skills. Conclusions: This study is the first of its kind to describe elements of a curriculum for pre-registration podiatry training. The recommendations highlight opportunities that education providers can work towards during curriculum design. They also emphasise the collaboration that is needed between professional bodies, clinicians and higher education institutions when defining guidelines and expectations for paediatric specific skills. [ABSTRACT FROM AUTHOR]

We present the clinico-radiological findings of neuroendocrine tumour metastases to the orbit. This was a multicentre, retrospective study of patients with neuroendocrine tumour metastases to the orbit. Data was collected from medical records across five different sites within Australia and the United Kingdom. Nine patients (eleven lesions) were identified. The most common presenting complaint was diplopia (5/9, 56%). Disease occurred bilaterally in two patients. Seven patients (78%) had extraocular muscle involvement. The lateral recti (4/9, 44%) and superior recti (2/9, 22%) were the most commonly affected. Ocular presentation preceded primary tumour diagnosis in three patients (33%). On orbital imaging, metastases were most commonly reported as well circumscribed, ovoid or round, heterogeneous, contrast-enhancing masses. Features of intralesional haemorrhage and bony invasion are uncommonly reported. Neuroendocrine tumour metastasis to the orbit is uncommon. Metastases have a propensity for the extraocular muscles, commonly presenting as heterogeneous, well circumscribed, contrast-enhancing lesions on neuroimaging. New ocular symptoms, a history of neuroendocrine tumours, and these radiological findings, should lead to high clinical suspicion of metastatic disease. Atypical findings warrant biopsy to exclude other causes of orbital lesions. [ABSTRACT FROM AUTHOR]

Echidnas are commonly known as 'spiny ant-eaters', but long-beaked echidnas (Zaglossus spp.) do not eat ants, whereas short-beaked echidnas (Tachyglossus aculeatus) eat other invertebrates as well as ants. The differences in skull morphology between short- and long-beaked echidnas are related to the differences in their diets, and I tested the hypothesis that there would be differences in beak length of short-beaked echidnas from populations with different diets. Published data on diet from echidnas from different parts of Australia show that echidnas from arid and semi-arid areas (subspecies acanthion) and Kangaroo Island (subspecies multiaculeatus) principally eat ants and termites, whereas the main dietary items of echidnas from south-eastern Australia (subspecies aculeatus) and Tasmania (subspecies setosus) are ants and scarab larvae. Using museum specimens and photographs I measured skull dimensions on echidnas from different parts of Australia: acanthion and multiaculeatus have narrower skulls and shorter beaks than aculeatus and setosus , with setosus being the only Australian subspecies where beak length exceeds cranium length. Australian short-beaked echidnas fall into two groups: aculeatus and setosus from the wetter east and south-east, which eat ant and scarab larvae, and the arid and semi-arid zone acanthion and multiaculeatus , with shorter, narrower skulls, and which eat ants and termites. Echidnas occur all over Australia, but echidnas from different regions vary greatly in the length of the spines and hair. This paper shows there are also big differences in beak length. Tasmanian echidnas have the longest beaks, whereas arid zone echidnas have very short beaks. Beak length is related to diet and feeding behaviour: longer beaks are better suited to probing for scarab larvae, while short beaks are better for ploughing through the soil for ants and termites. Diet, beak length and claw lengths divide Australian echidnas into two groups. [ABSTRACT FROM AUTHOR]

Tsunami warnings issued by the Joint Australian Tsunami Warning Centre (JATWC) are derived from a database (T2) consisting of more than two thousand pre-computed tsunami scenarios. Following any potentially tsunamigenic earthquake, warnings are issued for individual coastal zones with three different levels of threat: Land Threat, Marine Threat or No Threat. The decision is based on the 95th percentile (P95) of the maximum wave amplitudes (over time) of the relevant T2 scenario within each coastal zone. Threshold values for P95 have previously been derived through analysis of observed impacts for recent events. Given that historical records are available for only a short time period and no observations exist for which a Land Threat would have been issued for Australia, it has been difficult to determine the appropriate threshold for a Land Threat. Several recent tsunami hazard assessment studies have used inundation models nested within T2 scenarios. These modelling results are used to evaluate the threshold values for JATWC tsunami warnings and provide guidance on a possible further warning tier—Major Land Threat. The optimal Land Threat threshold for P95 is found to be 48.5 cm, however, it is not recommended that any changes are made from the existing operational threshold of 55 cm. The optimal threshold for P95 a Major Land Threat is found to be 150.5 cm. [ABSTRACT FROM AUTHOR]

Responses in the parent interviews revealed that many trainees were still home based and family dependent. Some parents were prolonging the dependence of their young people rather than reinforcing the independent living skills training at the center. (Author)

Echidnas are egg‐laying mammals found across Australia, and in Tasmania they hibernate, resulting in a most unusual mating system: males enter hibernation in late summer–early autumn and arouse in late autumn–early winter to mate, although females are still hibernating. Groups of males compete for matings and both males and females mate with multiple partners. Females that mate early return to hibernation even when pregnant, and males continue to mate with pregnant females. We asked to what extent can the bizarre combination of behavioural and physiological features that characterize reproduction of Tasmanian echidnas be attributed to their phylogeny, and how much is a consequence of their ecology?To understand the interaction between energetics and the echidna mating system in determining the timing of echidna hibernation, we analysed data from an 18‐year study of a wild population of Tasmanian echidnas (Tachyglossus aculeatus setosus)Males in best condition arouse earliest and seek out suitable females, and females that mate early in the mating season re‐enter hibernation while pregnant.Competition between males drives early mating and while mating with males in the best condition could be advantageous for females and their young, egg‐laying in winter is potentially disadvantageous, and post‐mating hibernation by females is a means of delaying hatching of young until environmental conditions are more favourable. This post‐mating hibernation by females is usually disrupted by males which mate with them although they are already pregnant.Comparisons with other echidna populations suggest that a decreased activity period due to hibernation has not increased male–male competition.Similar competition between groups of males for access to females is seen in chlamyphorid armadillos, which occupy a similar ecological niche to echidnas. A free Plain Language Summary can be found within the Supporting Information of this article. [ABSTRACT FROM AUTHOR]

We present data from an 18-year study of a wild population of Tasmanian echidnas, which show that the presence of spurs in an adult are a reliable indicator of sex, and that there is a slight but significant sexual dimorphism in size, with a male to female mass ratio of 1.1. Minimum age at first breeding in the wild for Tasmanian echidnas was 5 years, as has been found on Kangaroo Island, compared with 3 years in captive echidnas. It is often assumed that although the echidna is distributed throughout Australia, New Guinea and off-shore islands that all aspects of its basic biology are the same in all populations, but comparisons of our results with data from other populations suggest that there may be differences in size and sexual dimorphism. [ABSTRACT FROM AUTHOR]

Background: The eastern quoll (Dasyurus viverrinus) is an endangered carnivorous marsupial that has recently suffered significant population declines. Several small captive breeding populations have been established, with plans to translocate wild and captive individuals to areas of their former distribution. Accordingly, hematologic and serum biochemical reference intervals (RIs) established from wild eastern quoll populations are essential for monitoring the health and disease status of both captive and wild populations, and to evaluate the health of individuals before, during, and after translocation. Objectives: We aimed to establish hematologic and serum biochemical RIs for wild eastern quolls, and examine the effects of age, sex, and season. Methods: We collected a total of 202 hematologic samples, 309 packed cell volume samples, and 335 serum biochemical samples from 168 individual quolls between May 2011 and November 2013. Species‐level RIs were established, as well as RIs of groups separated by age (juvenile, adult) and sex (adult male, adult female) using nonparametric, robust, and parametric methods. Seasonal variation in age‐ and sex‐specific reference values was also assessed. Results: Strong age and seasonal variation were evident in many hematologic and serum biochemical analytes, with significant variation observed in serum biochemical analytes between the sexes. Conclusions: The observed age, sex, and seasonal variation reflect differences in the timing of growth and reproductive stressors, which interact with seasonal energetic demands. Our findings highlight the importance of using age‐, sex‐, and season‐specific RIs for clinical evaluation of eastern quolls, as species‐level RIs will inadvertently smooth and mask important seasonal fluctuations that reflect reproductive status at different times. [ABSTRACT FROM AUTHOR]

Background Over the past decade, managing the disclosure of findings of genomic research has been the subject of extensive scientific, ethical and legal commentary and is a major challenge for biobanks. Aims To examine views of the general Australian public about the disclosure of individual research results (IRR) and incidental findings (IF) from biobank genomic research. Methods A national computer assisted telephone interview was conducted amongst a representative sample of ( n = 800) adult residents across each Australian State and Territory. Results The majority of the Australian general public would be interested in receiving IRR and IF if they allowed their blood/tissue to be used in research; 94.4% ( n = 800) reported that they would like to receive 'specific information obtained from your sample that may be important to your health or treatment', and 83.4% their 'potential genetic risk of an inherited disease'. Although fewer desired to receive 'any IF that were not directly related to your (potential) diagnosed condition' (70.0%), most would still like to receive IF. A latent class analysis on the desire to receive (or not) all types of results revealed differences in preferences in the information they wished to receive. Conclusion The majority of Australians desire to receive most information arising from research involving their tissue, including IRR and IF. Differences in the extent and type of information they desire to receive are noted. Biobanks must establish strategies to identify information needs of donors, assess research data and communicate with donors and donor families. Processes need to take account of differences in donor preferences and in the clinical or research context(s). [ABSTRACT FROM AUTHOR]

The only specialized ant-eating mammal in Australia and New Guinea is the egg-laying short-beaked echidna (Tachyglossus aculeatus), and this single species occurs throughout Australia in a wide range of habitats. Despite the diversity of habitats and density and distribution of prey species, home-range sizes throughout Australia seem remarkably similar. We radiotracked echidnas in a population in Tasmania over a 13-year period and calculated home-range sizes using the fixed kernel method and the minimum convex polygon method. No relationship was found between body mass and home-range size, and mean annual home-range size of males (90% kernels) was 107 ha ± 48 SD, twice that of females (48 ± 28 ha). Male home ranges overlapped considerably and also overlapped with those of several females. The echidna follows the pattern seen in many solitary eutherian mammals: both sexes are promiscuous, and males have larger home ranges than females. Echidnas show a high degree of home-range fidelity but can make rare excursions out of their normal area. Hibernating echidnas move between shelters during their periodic arousals, resulting in home-range sizes similar to those of the active period. Consistent with their very low metabolic rate, echidnas have home-range sizes considerably smaller than predicted for carnivorous or omnivorous mammals. Examination of data from other ant-eating mammals shows that as a group anteaters not only have smaller than predicted home ranges but they depart significantly from the normal relationship between home-range size and body mass. [ABSTRACT FROM AUTHOR]

From July 1 2018, the Australian Therapeutic Goods Administration (TGA) introduced a ban on the marketing of advertised stem cell products direct to the consumer. This regulatory reform was directed towards curbing the marketing practices of clinics selling stem cell interventions direct to the public with little to no evidence of safety or benefit. Specifically, the ban prohibits direct advertising to consumers of autologous cell and tissue products: advertising cannot refer to specific autologous HCT products, trade names or use the term 'stem cells'. Importantly, services (that do not mention specific products) are still permitted to be advertised. In this paper we identify what changes have been made to the marketing practices of Australian clinics following the introduction of the TGA's ban on advertising. We draw on data collected from 51 clinic websites prior to and six months following the TGA's ban. In so doing we highlight the improvements and limitations of this welcomed regulatory reform, and consider the extent to which it has addressed concerns over consumer safety and protection associated with misleading and deceptive advertising of experimental stem cell interventions in the Australian context. We conclude by considering the significance of these findings to other international jurisdictions seeking to regulate and curb the exploitative practices of businesses selling purported stem cell 'treatments' direct to consumers. [ABSTRACT FROM AUTHOR]

Over the last decade there has been a growing prevalence of privately owned clinics in Australia providing autologous interventions to patients based on 'stem cells' isolated from their own fat, blood or bone marrow. These claimed stem cell-based interventions have primarily been marketed for osteoarthritis treatment, but have also been available for facial rejuvenation, hair restoration, and the treatment of motor neurone disease, Parkinson's disease and dementia. Such interventions are rarely part of a clinical research program, lack high level evidence of efficacy, and are not reimbursed by public or private insurers, resulting in patients paying significant out of pocket expenses (AUD$6,000 or more per intervention). Due to a regulatory exemption that broadly excluded the manufacturing and administration of autologous cells and tissues from the oversight of the Australian Therapeutic Goods Administration, clinics have been able to market directly and aggressively to patients in a manner that both exaggerates benefits and underplays risks. This study explores how Australian patients and their carers understood and experienced these interventions, and in particular how their presumptions about autologous stem cells, the ethics of medical practice, and the regulatory environment in Australia have conditioned their preparedness to undergo unproven treatments. Findings were drawn from two workshops conducted in 2016 with patients, their carers and family members (22 participants) and 15 semi-structured interviews (conducted in 2017). Patients' consideration of, and decision to undergo, an autologous stem cell-based intervention was shaped by five factors: illness experience, disillusion with current medical practice, unrealistic expectations about the intervention, lack of information from providers, and trust in the health care system and clinicians more broadly. While recently announced regulatory amendments may in time provide greater patient protection, the previous 'light touch' regulatory approach clearly created the preconditions in Australia for clinical practices with questionable evidentiary basis, and for a market where patient vulnerability and risk could be monetized. In future, we argue, efforts to enhance consumer awareness of the unregulated and unproven nature of autologous stem cell-based interventions need to be coupled with sound regulation and periodic policy review to avoid exceptionalism and patient exploitation. [ABSTRACT FROM AUTHOR]