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The healthcare burden of atrial fibrillation (AF) is dominated by hospitalizations, but data on 30-day unplanned readmissions after AF hospitalization and impact on mortality are limited.To assess causes and trends of 30-day unplanned readmission in incident (first-ever) hospitalized AF patients, and the risk of readmission for subsequent all-cause mortality.Patients aged 25-94 years, with an incident AF hospitalization (principal diagnosis) between 2001 and 2015, and surviving 30 days post discharge, were identified from linked Western Australian hospitalization and mortality data. Unplanned 30-day readmissions were categorized by principal diagnosis. Multivariable logistic and Cox regression analyses determined the independent predictors of readmission and the hazard ratio (HR) with 95% confidence intervals (CI) of readmission for subsequent 1-year mortality.Of 22,814 patients, 57.7% male, mean age 67.8 ± 13.8 (standard deviation) years, 9.5% experienced 1 or more 30-day unplanned readmissions, with standardized rates increasing 2.0% annually (95% CI, 1.0%-3.1%). Among all readmissions, 64.8% were cardiovascular-related, with AF (31.7%), coronary events (12.2%), and heart failure (8.5%) being the most frequent. In 30-day survivors, 4.3% died within 1 year. Patients with any cardiovascular or noncardiovascular readmission (vs none) had a multivariable-adjusted mortality HR of 2.12 (95% CI, 1.82-2.45). Coexistent comorbidities were independently associated with 30-day unplanned readmission and 1-year mortality.Following incident AF hospitalization, 30-day unplanned readmissions were common, mostly cardiovascular-related, but any readmission, regardless of cause, was associated with a 2-fold higher adjusted mortality risk. Our findings also support the importance of comorbidity optimization within an integrated care pathway to reduce adverse outcomes in AF patients.

Background: Heterozygous familial hypercholesterolemia (HeFH) is under-detected and undertreated. A general practitioner-led screening and care program for HeFH effectively identified and managed patients with HeFH. We evaluated the cost-effectiveness and the return on investment of an enhanced-care strategy for HeFH in primary care in Australia. Methods: We developed a multistate Markov model to estimate the outcomes and costs of a general practitioner-led detection and management strategy for HeFH in primary care compared with the standard of care in Australia. The population comprised individuals aged 50 to 80 years, of which 44% had prior cardiovascular disease. Cardiovascular risk, HeFH prevalence, treatment effects, and acute and chronic health care costs were derived from published sources. The study involved screening for HeFH using a validated data-extraction tool (TARB-Ex), followed by a consultation to improve care. The detection rate of HeFH was 16%, and 74% of the patients achieved target LDL-C (low-density lipoprotein cholesterol). Quality-adjusted life years, health care costs, productivity losses, incremental cost-effectiveness ratio, and return on investment ratio were evaluated, outcomes discounted by 5% annually, adopting a health care and a societal perspective. Results: Over the lifetime horizon, the model estimated a gain of 870 years of life lived and 1033 quality-adjusted life years when the general practitioner-led program was employed compared with standard of care. This resulted in an incremental cost-effectiveness ratio of AU$14 664/quality-adjusted life year gained from a health care perspective. From a societal perspective, this strategy, compared with standard of care was cost-saving, with a return on investment of AU$5.64 per dollar invested. Conclusions: An enhanced general practitioner-led model of care for HeFH is likely to be cost-effective.

Objectives Societal and health system pressures associated with the coronavirus disease 2019 (COVID-19) pandemic exacerbated the burden of chronic pain and limited access to pain management services for many. Online multidisciplinary pain programs offer an effective and scalable treatment option, but have not been evaluated within the context of COVID-19. This study aimed to investigate the uptake and effectiveness of the Reboot Online chronic pain program before and during the first year of the COVID-19 pandemic. Methods Retrospective cohort analyses were conducted on routine service users of the Reboot Online program, comparing those who commenced the program during the COVID-19 pandemic (March 2020–March 2021), to those prior to the pandemic (April 2017–March 2020). Outcomes included the number of course registrations; commencements; completion rates; and measures of pain severity, interference, self-efficacy, pain-related disability, and distress. Results Data from 2,585 course users were included (n = 1138 pre-COVID-19 and n = 1,447 during-COVID-19). There was a 287% increase in monthly course registrations during COVID-19, relative to previously. Users were younger, and more likely to reside in a metropolitan area during COVID-19, but initial symptom severity was comparable. Course adherence and effectiveness were similar before and during COVID-19, with moderate effect size improvements in clinical outcomes post-treatment (g = 0.23–0.55). Discussion Uptake of an online chronic pain management program substantially increased during the COVID-19 pandemic. Program adherence and effectiveness were similar pre- and during-COVID. These findings support the effectiveness and scalability of online chronic pain management programs to meet increasing demand.

Background:The impacts of COVID-19 for people with obsessive-compulsive disorder (OCD) may be considerable. Online cognitive behavioural therapy (iCBT) programmes provide scalable access to psychological interventions, although the effectiveness of iCBT for OCD during COVID-19 has not been evaluated.Aim:This study investigated the uptake and effectiveness of iCBT for OCD (both self- and clinician-guided courses) during the first 8 months of the pandemic in Australia (March to October 2020) and compared outcomes with the previous year.Method:1,343 adults (824/1343 (61.4%) female, mean age 33.54 years, SD = 12.00) commenced iCBT for OCD (1061 during the pandemic and 282 in the year before) and completed measures of OCD (Dimensional Obsessive-Compulsive Scale) and depression (Patient Health Questionaire-9) symptom severity, psychological distress (Kessler-10), and disability (WHO Disability Assessment Schedule) pre- and post-treatment.Results:During COVID-19, there was a 522% increase in monthly course registrations compared with the previous year, with peak uptake observed between April and June 2020 (a 1191% increase compared with April to June 2019). OCD and depression symptom severity were similar for the COVID and pre-COVID groups, although COVID-19 participants were more likely to enrol in self-guided courses (versus clinician-guided). In both pre- and during-COVID groups, the OCD iCBT course was associated with medium effect size reductions in OCD (g = 0.65–0.68) and depression symptom severity (g = 0.56–0.65), medium to large reductions in psychological distress (g = 0.77–0.83) and small reductions in disability (g = 0.35–.50).Conclusion:Results demonstrate the considerable uptake of online psychological services for those experiencing symptoms of OCD during COVID-19 and highlight the scalability of effective digital mental health services.

Incident heart failure (HF) hospitalisation rates in most high-income countries are stable or declining. However, HF incidence may be increasing in younger people linked to changing risk factor profiles in the general population. We examined age and sex-specific patterns of incidence, comorbidities and mortality of hospitalised HF in Western Australia (WA) between 2001 and 2016.All WA residents aged 25-94 years, with an incident (first-ever) principal HF discharge diagnosis between 2001 and 2016 were included (n = 22,476). Poisson regression derived annual age and sex-standardised rates of incident HF and 1-year mortality overall, and by age groups (25-54, 55-74, 75-94), across the study period. Overall, the age and sex-standardised rates of incident HF increased marginally by 0.6% per year (95% confidence interval (CI), 0.3, 0.8) whereas incidence increased by 3.1% per year (95% CI, 2.2, 4.0) in the 25-54 year age-group (trend p 0.0001). There was a high prevalence (≥15%) of obesity, diabetes mellitus, cardiomyopathy, hypertension, ischemic heart disease, atrial fibrillation, and chronic kidney disease in younger HF patients. Overall standardised 1-year mortality declined by -1.0% per year (95%CI, -0.4, -1.6), driven largely by the mortality decline in the 55-74 year age group.Incident HF hospitalisation rates have been rising in WA since 2006, notably in individuals under 55 years. The underlying reasons require further investigation, particularly the population-attributable risk related to increasing obesity and diabetes mellitus in the general population. Rising HF incidence along with declining mortality rates portends to an increasing HF burden in the community.

University degree completions by equity groups in Australia have grown. It is, however, unknown whether graduates from equity backgrounds have equitable work and study outcomes. This study uses nat...

Online cognitive behavioural therapy for insomnia (iCBT-I) provides scalable access to psychological interventions; however, the effectiveness of these courses during COVID-19 has not been examined...

This paper focusses on how careers advice provided to Australian secondary school students varies according to students’ socio-economic background. National data for students in Years 11 and 12 from five cohorts of the Longitudinal Surveys of Australian Youth initiated between 1998 and 2015 are analysed. Students from higher socio-economic backgrounds are found to be more likely to access multiple forms of careers information, particularly information relating to university entrance, compared to students from low-SES backgrounds. Conversely, students from lower socio-economic backgrounds are more likely to receive information on pathways to non-professional vocations. This socioeconomic divide has become more pronounced over time. Importantly, access to nonprofessional careers information appears to have declined over time, while there is evidence to suggest this form of advice is more highly valued by students of low-socioeconomic background relative to those of high-socioeconomic background.

PurposeThere are ongoing concerns regarding university degree credentials leading to graduate-level employment. Tracking graduate underemployment is complicated by inconsistent measures and tendencies to report on outcomes soon after graduation. Our study explored transition into graduate-level work beyond the short-term, examining how determining factors change over time.Design/methodology/approachWe considered time-based underemployment (graduates are working less hours than desired) and overqualification (skills in employment not matching education level/type) perspectives. We used a national data set for 41,671 graduates of Australian universities in 2016 and 2017, surveyed at four months and three years' post-graduation, to explore determining factors in the short and medium-term. Descriptive statistical techniques and binary logistic regression were used to address our research aims.FindingsGraduates' medium-term employment states were generally positive with reduced unemployment and increased full-time job attainment. Importantly, most graduates that were initially underemployed transited to full-time work at three years post-graduation. However, around one-fifth of graduates were overqualified in the medium-term. While there was some evidence of the initially qualified transitioning to matched employment, supporting career mobility theory, over one-third remaining overqualified. Skills, personal characteristics and degree-related factors each influenced initial overqualification, while discipline was more important in the medium-term.Originality/valueOur study explores both time-based underemployment and overqualification, and over time, builds on earlier work. Given the longer-term, negative effects of mismatch on graduates' career and wellbeing, findings highlight the need for career learning strategies to manage underemployment and consideration of future labour market policy for tertiary graduates.

Study Objectives Insomnia and anxiety are highly prevalent and frequently co-occur. Given limited therapeutic resources and time constraints, the aim of this study was to compare which treatment—internet cognitive behavioral therapy (CBT) for insomnia or internet CBT for anxiety—leads to the best outcomes in individuals with comorbid insomnia and anxiety. Methods 120 participants with comorbid insomnia and clinical anxiety (as defined by scores above the clinical cutoff on the insomnia severity index (ISI) and the generalized anxiety disorder 7-item scale (GAD-7)) were randomized to receive internet-based cognitive behavioral therapy (iCBT) for insomnia or iCBT for anxiety. The primary outcome measures were the ISI and the generalized anxiety disorder 7-item scale. Primary outcome measures were assessed before treatment, at mid-treatment, at post-treatment, and 3 months after treatment. Secondary outcome measures assessed depression symptoms, distress, and sleep diary parameters. Results Participants in both groups experienced large reductions in symptoms of insomnia, anxiety, depression, and distress, as well as improvements in sleep efficiency and total sleep time. Improvements were maintained at follow-up. Crucially, at the end of treatment, the insomnia treatment was more effective in reducing symptoms of insomnia than the anxiety treatment, and equally effective in reducing symptoms of anxiety. Treatment gains were maintained at 3-month follow-up, however, there were no differences between groups at that time point. Conclusions These results suggest that in the common case of a patient presenting with comorbid insomnia and anxiety, treatment for insomnia may be the most efficient treatment strategy. Trial Registration The trial was registered with the Australian and New Zealand Clinical Trials Registry, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001141235. Trial ID: ACTRN12618001141235. Trial name: a comparison of internet-based CBT for insomnia versus internet-based CBT for anxiety in a comorbid sample.

ObjectiveTo estimate the prevalence of hand-arm vibration (HAV) in Australian workplaces.MethodsThe Australian Workplace Exposure Survey (AWES)—Hearing was a cross-sectional telephone survey of Australian workers conducted in 2016–2017. Respondents were asked about the time spent using tools or performing tasks known to be associated with HAV during their most recent working day. We created a library of HAV magnitude levels for each tool/task and estimated each worker’s daily HAV exposure level using standard formulae. We categorized each worker as to whether they exceeded the daily occupational limits of 2.5 and 5.0 m/s2. Results were extrapolated to the Australian working population using a raked weighting method.ResultsIn our sample of 4991 workers, 5.4% of men and 0.7% of women exceeded the HAV action limit of 2.5 m/s2 on their most recent working day. We estimate that 3.8% of the Australian workforce exceeds the HAV limit of 2.5 m/s2 and 0.8% exceeds the 5 m/s2 limit. Men were more likely to exceed the HAV limits than women, as were those with trade qualifications, and those who worked in remote locations. Workers in the construction, farming, and automobile industries had the highest prevalence of HAV exposure. Tool groups that contributed to higher exposure levels included: compactors, rollers, and tampers; power hammers and jackhammers; and underground mining equipment.ConclusionsHAV is common in the Australian working population. Given the health risks associated with this exposure, reduction strategies and interventions should be developed, with engineering controls as the starting point for exposure reduction strategies.

ObjectiveTo determine the incidence, risk predictors and relative mortality risk of incident heart failure (HF) in patients following atrial fibrillation (AF) hospitalisation.MethodsThe Western Australian Hospitalisation Morbidity Data Collection was used to identify patients aged 25–94 years with index (first-in-period) AF hospitalisation, but without a prior HF admission, between 2000 and 2013. We evaluated the risk of incident HF hospitalisation within 3 years after AF admission, and the impact of HF hospitalisation on all-cause mortality.ResultsThe cohort comprised 52 447 patients, 57.5% men, with a median age of 73.1 (IQR 63.2-80.8) years. At 3 years after AF discharge, the cumulative incidence of HF (n=6153) was 11.7% (95% CI 11.5% to 12.0%) and all-cause death (n=9702) was 18.5% (95% CI 18.2% to 18.8%). Independent predictors of incident HF included advancing age, any history of myocardial infarction (MI), peripheral vascular disease, valvular heart disease, chronic kidney disease, chronic obstructive pulmonary disease, hypertension, diabetes, obesity and excessive alcohol use (all pConclusionHospitalisation for new HF is common in patients with AF and independently associated with a 3-fold hazard for death. The clinical predictors of incident HF emphasise the importance of integrated management of common comorbid conditions and lifestyle risk factors in patients with AF to reduce their morbidity and mortality.

CD33 and FLT3 are validated targets for myeloid malignancies, including acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS). These malignancies have poor prognosis and high clinical unmet need, and current targeted therapies present ample limitations. One challenge is that untargeted leukemic stem cells (LSCs) can contribute to eventual relapse; however, targeting the LSC markers FLT3 and CD33 can contribute to off-tumor toxicities against normal hematopoietic stem cells and progenitor cells (HSCs/HPCs), leading to bone marrow toxicities such as thrombocytopenia, neutropenia, and infectious complications. SENTI-202 is designed to address these challenges and provide a broader therapeutic window. SENTI-202 is a preclinical CAR-NK cell product candidate engineered with an OR and NOT logic gated gene circuit onto allogeneic healthy adult peripheral blood NK cells along with multi-arming via expression of calibrated release IL-15 (crIL-15) to enhance therapeutic activity and tolerability. The OR gate is implemented using a bivalent CAR (aCAR) that binds both CD33 and FLT3 to target both AML blasts and LSCs. Additionally, the NOT gate is implemented using an inhibitory CAR (iCAR) that recognizes the healthy cell protective antigen endomucin (EMCN) and targets endomucin which is designed to prevent CAR-mediated cytotoxicity against healthy cells, such as HSCs and early HPCs, potentially reducing on-target/off-tumor toxicities. Finally, crIL-15 provides NK cell activation and persistence via simultaneous autocrine, juxtracrine, and paracrine activities. Preclinical studies demonstrated the [antitumor] activity and tolerability of SENTI-202. All SENTI-202 components are stably expressed via a single g-retroviral vector. SENTI-202 preclinical pharmacokinetics and secondary pharmacodynamics demonstrated CAR target engagement, function, as well as mechanism of action for all components in different AML models. SENTI-202 CAR-NK cells demonstrated cytotoxic activity when co-cultured with AML target cells and primary patient-derived samples and had increased antitumor capacity compared to non-engineered NK cells. SENTI-202 induced the production of cytotoxic cytokines and increased expression of activation and cytotoxicity markers consistent with CAR-mediated activation of the NK cells. The presence of EMCN iCAR reduced cytotoxicity in an EMCN-dependent manner in target cells and primary HSCs. crIL-15 expression yielded functional pSTAT5 signaling and increased persistence of SENTI-202 in vitro and in vivo. These results demonstrate the antitumor activity and tolerability of SENTI-202 and warrant further clinical development as a novel therapeutic option for patients with CD33+ and/or FLT3+ tumors. Citation Format: Alba Gonzalez, Enping Hong, Gozde Yucel, Elizabeth Leitner, Pearley Chinta, Han Deng, Ian Li, Alice Lam, Abla Bakir, Brandon Lee, Papia Chakraborty, Carmina Blanco, Chen-Ting Lee, Niran Almudhfar, Mengxi Tian, Wenqi Song, Andrew Banicki, Otto Contreras, Martin Gieldin, Brian Garrison, Timothy K. Lu, Kanya Rajangam. Preclinical development of SENTI-202, an off-the-shelf logic gated CAR-NK cell therapy, for the treatment of CD33/FLT3+ hematologic malignancies including AML [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3195.

This paper examines the social realist paintings of the art groups Yiyanhui and the Equator Art Society which emerged during the 1950s in Malaya and Singapore. Their works centred on the social functions of art and its subject matters featured the working class, the Japanese occupation and anti-British colonial sentiment. Their artworks are viewed here as cultural productions shaped by the negotiation between dominant-subordinate relationships within a postcolonial framework. It is argued that the artistic productions examined here may be viewed not only for its overarching “social realist” endeavours but, also as a struggle to rewrite the narrative of the Chinese in Malaya against of the prevailing static representations forwarded by the colonial campaign. The first part of the paper illustrates how colonial discourse in the local press propagated an image of the Chinese as inherently susceptible to communism, untrustworthy, and opportunistic. The second part of the paper shows how the artists resisted this essentialist image of Chinese identity and offered a more complex picture of a Chinese-Malayan identity. Through a combination of interviews, written artist’s statements, formal and contextual considerations of the artworks, as well as a cultural studies framework, I demonstrate how a different narrative is being offered by these artists through two related processes in identity construction: qualifications for authenticity and belonging, the articulation of ambivalence. Resistance thus, is explored as encompassing a network of strategies employed by these artists as a way to reject colonialist representations of otherness and gain authorial agency against the intellectual and ideological dominance of colonial discourse.

Wellbeing trajectories around key life events are calculated using HILDA data for Australia. Employing a panel quantile approach, a pan-distributional analysis of these major events identifies distinctive adjustment patterns across the subjective wellbeing distribution and differing orders of magnitudes. For all life aspects analysed, immediate impacts tend to be more acute at the lower end of the wellbeing distribution. The implication of this is that if we are concerned with measuring changes in wellbeing, the point at which we measure these changes is important. Given the increasing importance of wellbeing to broader measures of economic prosperity, these findings touch upon a number of important policy areas. A focus upon social ostracization and a reduction in the persistence of long-term unemployment are all suggested as ways of alleviating the detrimental impact of this important policy variable.

Insomnia and anxiety are highly prevalent and frequently co-occur. Given limited therapeutic resources and time constraints, the aim of this study was to compare which treatment - internet CBT for insomnia or internet CBT for anxiety - leads to the best outcomes in individuals with comorbid insomnia and anxiety.120 participants with comorbid insomnia and clinical anxiety (as defined by scores above the clinical cut off on the ISI and the GAD-7) were randomized to receive internet-based cognitive behavioral therapy (iCBT) for insomnia or iCBT for anxiety. The primary outcome measures were the insomnia severity index and the generalized anxiety disorder-7 item scale. Primary outcome measures were assessed before treatment, at mid-treatment, at post-treatment, and 3 months after treatment. Secondary outcome measures assessed depression symptoms, distress, and sleep diary parameters.Participants in both groups experienced large reductions in symptoms of insomnia, anxiety, depression, and distress, as well as improvements in sleep efficiency and total sleep time. Improvements were maintained at follow-up. Crucially, at the end of treatment, the insomnia treatment was more effective in reducing symptoms of insomnia than the anxiety treatment, and equally effective in reducing symptoms of anxiety. Treatment gains were maintained at 3-month follow-up, however, there were no differences between groups at that time point.These results suggest that in the common case of a patient presenting with comorbid insomnia and anxiety, treatment for insomnia may be the most efficient treatment strategy.