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Approximately 10 million Australians have had confirmed SARS-CoV-2 infection. The waves of infection in the population have been succeeded by smaller waves of people affected by persistent illness following acute infection. Post-COVID-19 symptoms may extend for months following infection. There is a range of symptoms causing mild to debilitating impairment.This article summarises what is currently understood about the pathophysiology, risk factors, symptoms and how to approach both the assessment and care of people with post-COVID-19 sequelae.Currently recommended is a person-centred approach from a multidisciplinary team, with general practitioners centrally coordinating care. As the understanding of post-acute COVID-19 is evolving, regularly updated or 'living guidelines' will be crucial for those affected to be provided with best care within the health system.

A blue depression is found in the spectra of M dwarfs from 4000 to 4500A. This depression shows an increase toward lower temperatures though is particularly sensitive to gravity and metallicity. It is the single most sensitive feature in the optical spectra of M dwarfs. The depression appears as centered on the neutral calcium resonance line at 4227A and leads to nearby features being weaker by about two orders of magnitude than predicted. We consider a variety of possible causes for the depression including temperature, gravity, metallicity, dust, damping constants, and atmospheric stratification. We also consider relevant molecular opacities which might be the cause identifying AlH, SiH, and NaH in the spectral region. However, none of these solutions are satisfactory. In the absence of a more accurate determination of the broadening of the calcium line perturbed by molecular hydrogen, we find a promising empirical fit using a modified Lorentzian line profile for the calcium resonance line. Such fits provide a simplistic line-broadening description for this calcium resonance line and potentially other un-modelled resonance lines in cool high-pressure atmospheres. Thus we claim the most plausible cause of the blue depression in the optical spectra of M dwarfs is a lack of appropriate treatment of line broadening for atomic calcium. The broad wings of the calcium resonance line develop at temperatures below about 4000K and are analogous to the neutral sodium and potassium features which dominate the red optical spectra of L dwarfs., Comment: Accepted by MNRAS

Background Aboriginal and Torres Strait Islander people are disproportionately affected by hepatitis B virus (HBV) infection. A proposed mismatch between standard vaccines and the HBV/C4 sub‐genotype prevalent in Aboriginal people in the Northern Territory (NT) may reduce vaccine effectiveness. Aims To determine HBV prevalence in the NT by Indigenous status and to explore patterns of immunity following implementation of universal vaccination, using a large longitudinal diagnostic dataset. Methods A retrospective analysis of all available HBV serology results in the NT from 1991 to 2011 was conducted, with HBV prevalence and vaccination status analysed according to adigenous status, age and sex using individuals' patterns of HBsAg, anti‐HBs and anti‐HBc serology over repeated tests. Results 100 790 individuals were tested (33.4% Indigenous) between 1991 and 2011 (26.1% of the 2011 NT population), with a total of 211 802 tests performed. In 2011, the proportion of HBV positive individuals in the NT was 3.17% (5.22% in Indigenous populations) compared to previous 2011 estimates of 1.70% (3.70% in Indigenous populations). The vaccine failure rate was lower than expected with only one presumed vaccinated person subsequently developing HBsAg positivity (0.02%). Evidence of suboptimal vaccine efficacy by breakthrough anti‐HBc positivity in vaccinated individuals was demonstrated in 3.1% of the vaccinated cohort, of which 86.4% identified as Indigenous (HR 1.17). No difference in HBeAg positivity or seroconversion was observed between Indigenous and non‐Indigenous individuals living with CHB. Conclusions The burden of CHB in Indigenous people in the NT has previously been underestimated. A higher HBV prevalence in the NT than described in previous cross‐sectional studies was found, including a higher prevalence in Indigenous people. Evidence of suboptimal vaccine efficacy was demonstrated predominantly in Indigenous individuals.

Background Mother-to-child transmission (MTCT) of hepatitis B can be prevented with targeted interventions; however, MTCT continues to occur in Australia and globally. This qualitative research investigated how mothers with chronic hepatitis B (CHB) understand and experience interventions for the prevention of MTCT of CHB (PMTCT-CHB) in Victoria, Australia. Methods Semi-structured interviews were conducted with women with CHB. Participants were recruited through purposive and snowballing sampling. Interviews explored the women’s experience of care for themselves and their infants aimed at PMTCT-CHB. Interviews were conducted over the phone with a qualified interpreter where required. The consolidated criteria for reporting qualitative research framework was used with data thematically analysed. This study was co-designed with mothers with CHB through a Community Advisory Group established for this research; coordinated and supported by LiverWELL and the researchers. Results Sixteen women were interviewed. Although most women understood the purpose of hepatitis B vaccination, there were significant gaps in information and education provided to mothers regarding PMTCT-CHB. These gaps included understanding of the extent of protection of vaccination, breastfeeding with CHB, post-vaccination testing for infants and lack of clarity of the woman’s own hepatitis B status. There was notable fear and worry associated with hepatitis B transmission, with emotional support for mothers identified as a major gap in service delivery. Additionally, some women experienced stigma and discrimination due to their hepatitis B and refugee status. Conclusions This study explored how mothers with CHB understand and experience interventions to prevent MTCT. Our findings reveal substantial gaps in delivery of information and care in the context of PMTCT-CHB in Victoria. Our findings can support development of evidence-based interventions and systems to improve healthcare for mothers with CHB and their infants, and thereby reduce possible CHB transmission and other negative outcomes, including stigma and discrimination.

Background Without intervention, HIV, hepatitis B virus and syphilis can be transmitted from mother-to-child during pregnancy, birth and breastfeeding and these can cause adverse pregnancy and longer-term outcomes. The 22 Pacific Island countries and territories (PICTs) have among the highest global prevalence of syphilis and hepatitis B. Mother-to-child transmission remains a concern, particularly hepatitis B. Global and regional elimination targets have been set to eliminate mother-to-child transmission (EMTCT) however progress of PICTs towards meeting targets is unknown. Methods Data from 2000-2019 relating to EMTCT epidemiological, process and impact targets were extracted from peer reviewed literature, online data repositories and grey literature. Results 27 peer reviewed reports, data from online data repositories for 19 countries and twelve national demographic and/or health reports were collated. Existing online databases report data for only small number of EMTCT indicators and there are few peer-reviewed studies that report EMTCT coverage estimates for PICTs. Availability of data varied between countries and available data suggests that few countries are meeting EMTCT indicator targets. Conclusions Based on the current trach trajectory, PICTs will not reach triple elimination by 2030. Both interventions to improve EMTCT activity coverage and strengthened surveillance, monitoring and evaluation systems are required. Key messages Mother-to-child transmission of HIV, hepatitis B and syphilis is a major concern in the Pacific and increased efforts are required, including strengthened monitoring and evaluation systems.

Objective To compare the concordance and acceptability of saliva testing with standard‐of‐care oropharyngeal and bilateral deep nasal swab testing for severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) in children and in general practice. Design Prospective multicentre diagnostic validation study. Setting Royal Children’s Hospital, and two general practices (cohealth, West Melbourne; Cirqit Health, Altona North) in Melbourne, July–October 2020. Participants 1050 people who provided paired saliva and oropharyngeal‐nasal swabs for SARS‐CoV‐2 testing. Main outcome measures Numbers of cases in which SARS‐CoV‐2 was detected in either specimen type by real‐time polymerase chain reaction; concordance of results for paired specimens; positive percent agreement (PPA) for virus detection, by specimen type. Results SARS‐CoV‐2 was detected in 54 of 1050 people with assessable specimens (5%), including 19 cases (35%) in which both specimens were positive. The overall PPA was 72% (95% CI, 58–84%) for saliva and 63% (95% CI, 49–76%) for oropharyngeal‐nasal swabs. For the 35 positive specimens from people aged 10 years or more, PPA was 86% (95% CI, 70–95%) for saliva and 63% (95% CI, 45–79%) for oropharyngeal‐nasal swabs. Adding saliva testing to standard‐of‐care oropharyngeal‐nasal swab testing increased overall case detection by 59% (95% CI, 29–95%). Providing saliva was preferred to an oropharyngeal‐nasal swab by most participants (75%), including 141 of 153 children under 10 years of age (92%). Conclusion In children over 10 years of age and adults, saliva testing alone may be suitable for SARS‐CoV‐2 detection, while for children under 10, saliva testing may be suitable as an adjunct to oropharyngeal‐nasal swab testing for increasing case detection.

Background and aims Chronic hepatitis B (CHB) is a significant global health concern, and the most prevalent blood-borne virus in Australia. World Health Organization (WHO) member states have committed to global elimination, with targets to diagnose 90% of people living with CHB, treat 80% of those eligible, and reduce attributable deaths by 65% by the year 2030. Australia has committed to national targets of 80% diagnosed, 20% on treatment, and a 30% reduction in deaths by 2022. Approach and results We constructed and implemented a mathematical model to estimate the burden of CHB incorporating vaccination, phases of infection, cirrhosis progression, and mortality attributed to decompensated cirrhosis and hepatocellular carcinoma and examined the population-level impact of antiviral therapy. Diversity was integrated according to migration patterns, CHB prevalence by country of birth, Indigenous status, and age. Modelled outcomes were subjected to multivariate uncertainty analysis. Of the estimated 221,420 people living with CHB in Australia in 2017, 68% were diagnosed and 8.7% were receiving treatment (less than one-third of those estimated to be eligible). Based on current trends, the proportion of people living with CHB who have been diagnosed will reach 71% by 2022 and 81% by 2030, and treatment uptake will rise to 11.2% by 2022 and 12.9% by 2030, resulting in a 5.7% reduction in CHB-attributable deaths from 2015 to 2030. CHB treatment has prevented approximately 2,300 deaths in Australia between 2000 and 2017. Conclusions Australia is not on track to meet local and global targets regarding CHB. Comprehensive and regularly updated modelling approaches accounting for diversity within the population are a useful tool to measure progress and impact of interventions, and quantify further improvements required to meet elimination goals.

Background Hepatitis B is a chronic viral infection, a leading cause of primary liver cancer and identified as a major public health priority by the World Health Organization. Despite a high proportion of people in Australia who have been diagnosed with hepatitis B, significant gaps remain in health care access and in accurate knowledge about hepatitis B. Most people with hepatitis B in Australia were born in China, where the infection has an intergenerational impact with significant social implications resulting from the infection. Understanding how people of Chinese ethnicity with hepatitis B understand and respond to hepatitis B is imperative for reducing morbidity, mortality, and the personal and social impact of the infection. Methods Qualitative semi-structured interviews with people with hepatitis B of Chinese ethnicity recruited through a specialist service identified the advice people with hepatitis B thought was important enough to inform the experience of people newly diagnosed with hepatitis B. A thematic analysis of the data privileged the lived experience of participants and their personal, rather than clinical, explanations of the virus. Results Hepatitis B infection had psychological and physical consequences that were informed by cultural norms, and to which people had responded to with significant behavioural change. Despite this cohort being engaged with specialist clinical services with access to the most recent, comprehensive, and expert information, much of the advice people with hepatitis B identified as important for living with hepatitis B was not based on biomedical understandings. Key suggestions from people with hepatitis B were to form sustainable clinical relationships, develop emotional resilience, make dietary changes, regulate energy, and issues related to disclosure. Conclusions The study highlights conflicts between biomedical and public health explanations and the lived experience of hepatitis B among people of Chinese ethnicity in Australia. Beliefs about hepatitis B are embedded within cultural understandings of health that can conflict with bio-medical explanations of the infection. Acknowledging these perspectives provides for insightful communication between health services and their clients, and the development of nuanced models of care informed by the experience of people with hepatitis B.

METHOD: Data from qualitative semi-structured interviews with 19 participants from primary care settings were thematically analysed. RESULTS: Critical elements in providing clinical care in primary care settings were identified at an organisational and provider level. A supportive organisational culture included leadership, a multidisciplinary team approach, community engagement and cultural competency, while provider-related issues included authorisation to prescribe, access to linguistic and cultural mediators and effective relationships with relevant specialist services. DISCUSSION: The research identified practice leadership, organisational culture and a patient focus supported hepatitis B clinical management transitioning from specialist to primary care services.

Background Antiviral therapy for chronic hepatitis B (CHB) is effective and can substantially reduce the risk of progressive liver disease and hepatocellular carcinoma but is often administered for an indefinite duration. Adherence has been shown in clinical trials to maximize the benefit of therapy and prevent the development of resistance, however the optimal threshold for predicting clinical outcomes has not been identified. The aim of this study was to analyse adherence using the medication possession ration (MPR) and its relation to virological outcomes in a large multi-centre hospital outpatient population, and guide development of an evidence-based threshold for optimal adherence. Methods Pharmacy and pathology records of patients dispensed CHB antiviral therapy from 4 major hospitals in Melbourne between 2010 and 2013 were extracted and analysed to determine their MPR and identify instances of unfavourable viral outcomes. Viral outcomes were classified categorically, with unfavourable outcomes including HBV DNA remaining detectable after 2 years treatment or experiencing viral breakthrough. The association between MPR and unfavourable outcomes was assessed according to various thresholds using ROC analysis and time-to-event regression. Results Six hundred forty-two individuals were included in the analysis. Median age was 46.6 years, 68% were male, 77% were born in Asia, and the median time on treatment was 27.5 months. The majority had favourable viral outcomes (91.06%), with most having undetectable HBV DNA at the end of the study period. The most common unfavourable outcome was a rise of Conclusion Lower adherence as measured using the MPR was strongly associated with unfavourable therapeutic outcomes, including virological failure. Optimising adherence is therefore important for preventing viral rebound and potential complications such as antiviral resistance. The evidence of dose-response highlights the need for nuanced interventions.

Objective: To measure progress towards Australia's National Hepatitis B Strategy 2014–17 targets, and assess geographic variation in disease burden and access to care for those living with chronic hepatitis B (CHB). Methods: Data were generated from routinely collected sources, including risk-group prevalence and population data, infectious diseases notifications, Medicare records, and immunisation registry data, and assessed nationally and according to geographic area for 2013–15. Results: CHB prevalence in 2015 was 239,167 (1.0%), with 62% of those affected having been diagnosed (target 80%). Treatment uptake was 6.1% (target 15%), and only 15.3% of people with CHB received guideline-based care. CHB prevalence ranged within Australia's 31 Primary Health Networks (PHNs) from 1.77% (NT) to 0.56% (Grampians & Barwon South West VIC). No PHN reached the 15% treatment target, with uptake highest in South Western Sydney (13.7%). Immunisation coverage reached the 95% target in three PHNs. Conclusions: The CHB burden in Australia is significant and highly geographically focused, with notable disparities in access to care across Australia. Implications for public health: Efforts to improve progress toward National Strategy targets should focus on priority areas where the prevalence of CHB is substantial but access to treatment and care remains low.

In 2016, hepatitis C direct-acting antivirals (DAAs) became available in Australia. A group of general practitioners (GPs) were surveyed twice to assess hepatitis C knowledge and management; 191/1000 (19.1%) responded at baseline, 164/938 (17.5%) at follow up. Participants’ mean Knowledge score increased: baseline 5.75 (95% CI 5.61–5.91), follow up 6.09 (95% CI 5.95–6.22; P

Objective The aims of this study were to: (1) identify the characteristics of patients with chronic hepatitis B (CHB) who do not attend their hospital liver clinic appointments; and (2) raise awareness among general practitioners (GP) of alternative pathways to care for CHB in order to prevent long-term complications of CHB (liver cancer and cirrhosis). Methods This prospective study was conducted between May 2018 and January 2019 at one site of a tertiary referral hospital in western Melbourne. Patients with minimal liver complications who did not attend their first two initial appointments were included in the study, in addition to referring GPs of new CHB patients to the liver clinic who had minimal liver complications (characterised by minimal fibrosis (

Antiviral therapy for hepatitis B is effective and reduces the risk of progression to cirrhosis and liver cancer but is often required for an indefinite duration. Treatment adherence is important to prevent the development of resistance and optimize outcomes. Pharmacy adherence measures can be used to assess treatment adherence, with the medication possession ratio being less susceptible to bias than physician- or self-reported adherence. The aim of this study was to measure adherence in public hospital outpatients over a 3-year period and to examine factors associated with nonadherence. A retrospective study of pharmacy records of patients dispensed antiviral therapy for hepatitis B from four major hospitals in Melbourne between 2010 and 2013. Hospital record numbers were linked with and de-identified demographic information including age, sex, Indigenous status, country of birth, interpreter requirement, spoken language and postcode of residence. The medication possession ratio was the outcome measure with poor adherence defined

Objective: To estimate the level of access to diagnosis, management and treatment for people living with chronic hepatitis B (CHB) in Australia, and to identify the gaps in clinical care for people living with CHB. Methods: Analysis of publicly available population level data including infectious disease notifications, Medicare and Pharmaceutical Benefits Scheme utilisation data, census-based estimates of CHB prevalence and burden, and mathematical modelling. Results: In 2012, of the estimated 218,567 Australians living with CHB, 57% had been diagnosed, 17,367 people (8%) received recommended HBV DNA viral load testing (without treatment) and 10,987 (5%) received antiviral therapy. Conclusions: This analysis reveals substantial gaps in the cascade of care for CHB in Australia, most notably in diagnosis (with 43% undiagnosed) and in recommended yearly monitoring (87% not in care). The number receiving therapy represents only one-third of those estimated to require treatment to prevent progressive liver disease and liver cancer. Implications: These findings demonstrate that the majority of those affected are not receiving guideline-based care; highlight the need for improvements in opportunistic screening, engagement in care, and access to therapy; and provide a method to assess the impact of public health and clinical interventions in response to CHB over time.

Hepatocellular carcinoma (HCC) surveillance reduces mortality in at-risk people living with chronic hepatitis B (CHB), but is difficult to achieve in practice. The objective of this study was to measure participation and adherence to liver cancer HCC surveillance in eligible patients in a community health centre, following support from the Integrated Hepatitis B Service (IHBS).A retrospective analysis of the medical records of patients with CHB who met the indications for HCC surveillance over a 4.5-year period of IHBS involvement was conducted. Data collected included the date of ultrasound examinations and HBV DNA viral load tests.Sixty-seven patients underwent HCC surveillance, representing 213 person years. The participation rate was 75%. Adherence to surveillance was considered good in 18 (27%) patients, suboptimal in 29 (43%) patients and poor in 20 (30%) patients. A greater proportion of patients were receiving HCC surveillance at the final audit (56%) than at baseline (10%; P DISCUSSION: It is difficult to achieve optimal adherence to HCC surveillance, even with additional support.

To increase access to hepatitis C virus (HCV) treatment, the Pharmaceutical Benefits Scheme (PBS) enabled general practitioners (GPs) to prescribe direct-acting antiviral (DAA) therapy. We conducted a survey to identify GPs' knowledge and management of HCV.A questionnaire consisting of 20 items about HCV knowledge and management was sent to 1000 GPs.One hundred and ninety-one GPs (19.1%) responded; 74% answered correctly that antibody and RNA positivity is diagnostic of HCV. Only 12% could directly request transient elastography. Although 53% of respondents reported interest in prescribing DAAs, 72% continued to refer all patients to specialists. Fifty-five per cent were unsure if people who currently inject drugs were eligible for treatment.Most respondents were interested in prescribing DAAs, but education, access to transient elastography and clear consultation pathways are required to translate this interest into increased treatment availability. PBS eligibility of current injectors needs promotion.

Objective: The number of Australians living with chronic hepatitis B (CHB) is thought to be increasing, as are adverse outcomes including cirrhosis and liver cancer, however, robust, up-to-date estimates of this burden are limited. Contemporary estimates of the prevalence of CHB in Australia are essential to guide appropriate public health and clinical responses. Methods: This study used census-based methodology attributing risk of CHB by country of birth and Aboriginal and Torres Strait Islander status, augmented with priority risk-group based estimates. Deterministic mathematical modelling was used for comparison and for validation of census-derived estimates. Results: An estimated 218,000 Australians (plausible range 192,000–284,000) are living with CHB, a significant increase over previous estimates. The prevalence derived using mathematical modelling was similar, at 204,000. Notable differences were observed by geographic area in both prevalence and the populations predominantly affected. It is estimated that only 56% of people living with CHB in Australia have been diagnosed and notified. Conclusions: The prevalence of CHB in Australia is increasing, with 1% of the population now estimated to be affected. The majority of the burden is experienced by people born overseas in endemic areas, with more than 95% of new cases of CHB entering the population through migration. Implications: It is imperative that more attention and greater resources are devoted to addressing CHB in Australia; to increase the proportion of Australians affected who have been diagnosed and who are on treatment, in accordance with the First National Hepatitis B Strategy.

7 pages; International audience; The purpose of the present work is to make an exhaustive study of the line shape of the triplet 3p-4s Mg line (Mgb triplet), which is perturbed by He in the extreme physical conditions found in the cool atmosphere of DZ white dwarfs. This study is undertaken by inferring both a unified theory of spectral line broadening and ab initio potential energies. Cool white dwarfs require a specific treatment for line broadening owing to the high helium densities that are involved. Beyond the conventional symmetrical Lorentzian core at low density, we show that the line profiles are asymmetrical and have significant additional contributions on the short wavelength side. This blue asymmetry is a consequence of low maxima in the corresponding Mg-He potential energy difference curves at short and intermediate internuclear distances. The new profiles are shown to provide a good fit to an SDSS (Sloan Digital Sky Survey) observation.

La récente préoccupation des milieux cliniques à utiliser des pratiques exemplaires issues de données probantes est grandissante. Nous voyons apparaître différentes formations et ressources pouvant être utilisées par les infirmières en oncologie. Cette étude met en relief, à l’aide d’un devis à séries temporelles, qu’après une intervention sous forme d’une présentation formelle PowerPoint et de cartables distribués aux infirmières sur les données probantes, l’utilisation véritable des données probantes dans la pratique est inchangée. Il en ressort que très peu d’infirmières s’y intéressent et que celles qui les utilisent sont celles qui le font dans le cadre de leurs fonctions (cadre conseil, cliniciennes). Des recommandations pour la pratique, la formation et la recherche sont suggérées.

Antiviral therapy for hepatitis B is effective and reduces the risk of progression to cirrhosis and liver cancer but is often required for an indefinite duration. Treatment adherence is important to prevent the development of resistance and optimize outcomes. Pharmacy adherence measures can be used to assess treatment adherence, with the medication possession ratio being less susceptible to bias than physician- or self-reported adherence. The aim of this study was to measure adherence in public hospital outpatients over a 3-year period and to examine factors associated with nonadherence. A retrospective study of pharmacy records of patients dispensed antiviral therapy for hepatitis B from four major hospitals in Melbourne between 2010 and 2013. Hospital record numbers were linked with and de-identified demographic information including age, sex, Indigenous status, country of birth, interpreter requirement, spoken language and postcode of residence. The medication possession ratio was the outcome measure with poor adherence defined

Ultracool stellar atmospheres show absorption by alkali resonance lines severely broadened by collisions with neutral perturbers. In the coolest and densest atmospheres, such as those of T dwarfs, Na I and K I broadened by molecular hydrogen and helium can come to dominate the entire optical spectrum. Their profiles have been successfully modelled with accurate interaction potentials in the adiabatic theory, computing line profiles from the first few orders of a density expansion of the autocorrelation function. The line shapes in the emergent spectrum also depend on the distribution of absorbers as a function of depth, which can be modelled with improved accuracy by new models of dust condensation and settling. The far red K I wings of the latest T dwarfs still show missing opacity in these models, a phenomenon similar to what has been found for the Na I line profiles observed in extremely cool, metal-rich white dwarfs. We show that the line profile in both cases is strongly determined by multiple-perturber interactions at short distances and can no longer be reproduced by a density expansion, but requires calculation of the full profile in a unified theory. Including such line profiles in stellar atmosphere codes will further improve models for the coolest and densest dwarfs as well as for the deeper atmosphere layers of substellar objects in general., VI Serbian Conference on Spectral Line Shapes in Astrophysics; to be published by the American Institute of Physics, eds. Milan S. Dimitrijevic and Luka C. Popovic; 6 pages, 6 figures