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The American College of Surgeons' Minimum Hospital Standardization (MHS) Programme was central to its foundation and subsequent growth over the next 40 years. Its significance was second only to the election of its Fellows. The development of the MHS exactly overlapped the years preceding the foundation of the College of Australasian Surgeons in 1927 and its reputation was well known to Australasian surgeons and governments-yet it was never developed in Australasia. The current interest in Australian Clinical Quality Registries and the upcoming College's Centenary is an opportunity to reappraise a missed opportunity.
Due to the excessive burden and health costs of noncommunicable diseases, public health and clinical practice guidelines emphasize the importance of targeting population changes in risk factors of physical activity and sedentary behavior. Primary healthcare presents a pragmatic setting for embedding interventions targeting sitting less and moving more. However, to design effective implementation strategies for such interventions, it is necessary to understand the determinants that drive implementation in this setting. To determine the barriers and facilitators influencing the implementation of sit-less and move-more interventions within Australian primary healthcare, as perceived by general practitioners and general practice nurses. Ten general practitioners and 10 general practice nurses completed online semi-structured individual interviews. Interviews were digitally transcribed and analyzed deductively; both the interview guide and analysis were guided by the Theoretical Domains Framework. All domains within the Theoretical Domains Framework were represented. Notable barrier domains were: Environmental Context and Resources, related to reported time constraints; Skills, relating to limited formal training; Social Influences, relating to patient engagement challenges. Notable facilitator domains were: Beliefs about Consequences, reflecting perceived health benefits for patients with healthier movement behaviors, Environmental Context and Resources, including use of educational resources and integration of sit-less and move-more assessments within clinic workflows; and Social/Professional Role and Identity, highlighting how both general practitioners and general practice nurses have a role in implementation. These findings provide a foundation for future research focusing on the co-design of strategies supporting the implementation of such interventions within primary healthcare. This research project aimed to identify the barriers and facilitators to the implementation of sit-less and move-more (SLAMM) interventions within Australian primary healthcare settings by conducting individual interviews with general practitioners and general practice nurses. Notable barriers affecting implementation were the competing priorities and time constraints present within primary healthcare, alongside the lack of training and education for clinicians in providing SLAMM advice for their patients. The recognition of the health benefits associated with healthy movement behaviors, the provision of resources (such as clinic posters and educational handouts for patients), and the integration of screening tools within clinic practice management software and workflows were all seen as potential facilitators to implementation. These findings may be used to guide further research focusing on developing strategies to assist adaptable and sustainable implementation of SLAMM interventions within primary healthcare settings.
The late Cenozoic period saw widespread diversification of grazing hoofed mammals characterized by high-crowned molar teeth with low, thinly enameled crests. However, Australia's dominant grazing herbivores, the kangaroos, have much lower-crowned and higher-relief molars that are more akin to some "archaic" placental herbivores. Using x-ray microcomputed tomography scanning, we show that as kangaroos shifted to higher-abrasion grazing diets, their ancestrally vertical, interlocking mode of occlusion favored the acquisition of thick enamel as a durability adaptation. Extant grass-feeding kangaroos have relatively much thicker molar enamel than browsing taxa, especially across the cutting lophs. Data from 41 fossil assemblages reveal a progressive increase in kangaroo enamel thickness from the Late Miocene that correlates with the expansion of arid Australian habitats. The evolutionary success of kangaroos reveals unappreciated contingency in herbivore adaptation and diversification.
Klebsiella pneumoniae is a leading cause of healthcare-associated infections worldwide, yet its population structure and transmission dynamics remain largely uncharacterized in New Zealand hospitals. We conducted a 15-month prospective genomic surveillance pilot at Wellington Regional Hospital, embedding Oxford Nanopore MinION sequencing directly within the diagnostic laboratory. Clinical and screening isolates (n=157) underwent on-site sequencing and genotyping. Following quality control, 121 (77%) high-quality genomes (118 complete assemblies) were analysed for diversity, antimicrobial resistance (AMR), virulence loci and plasmid content and assessed for evidence of in-hospital transmission. The cohort covered many ages (0 to 95 years), with nearly half of the patients aged ≥65 years. The local K. pneumoniae population was highly diverse, comprising 75 distinct sequence types (STs), of which 68% were single-isolate STs. Although a few lineages recurred intermittently (e.g. ST253 and ST17), no clone showed evidence of patient-patient transmission. Plasmid reconstructions showed backbones dominated by F-type, Col, and mosaic multi-replicon elements. Acquired AMR genes were plasmid-borne in 35/118 complete genomes. Chromosomes mostly carried intrinsic determinants typical of K. pneumoniae: bla SHV (intrinsic ampicillin resistance) and fosA and oqxAB (which may raise minimum inhibitory concentrations but, in their intrinsic forms, do not exceed clinical breakpoints). Few isolates carried markers of K. pneumoniae virulence plasmids (iuc/iro siderophores and rmpA/rmpA2; Kleborate virulence score ≥3), and none showed convergence of virulence and acquired AMR. This study shows that prospective, hospital-based nanopore sequencing is feasible in routine diagnostic settings and can deliver high-resolution genomic intelligence for infection prevention and control. In this setting, K. pneumoniae isolates arose from a genotypically heterogeneous background without evidence of patient-patient transmission. This pilot establishes a genomic baseline for K. pneumoniae in a major New Zealand hospital and supports a trigger-based framework for early detection of high-risk clones before they become established.
To co-design, deliver and evaluate a suicide prevention workshop aimed at improving the knowledge, skills and confidence of general practice and community staff in rural South Australia. A 2.5-h in-person workshop was delivered across three rural communities on the Eyre Peninsula, Australia. Sixty-seven individuals attended the workshop. Of these, 61 completed a pre- and post-workshop survey (91% response rate). Participants who completed the survey included practice staff (n = 27), mental health or psychosocial support workers (n = 18), community volunteers (n = 6), suicide prevention network representative (n = 4) and other (n = 6). The design of the workshop was guided by Participatory Action Research principles and underpinned by the Double Diamond model. The workshop was co-designed by a multidisciplinary advisory group, including two individuals with lived experience. The objectives of the workshop were to help attendees to: (1) recognise verbal and non-verbal warning signs of suicidal ideation, (2) respond effectively to provide immediate support and (3) connect individuals with appropriate referral services. A mixed-methods pre-post survey assessed changes in participants' confidence, knowledge and skills aligned with these objectives, along with their perceptions of the workshop. Pre- and post-workshop responses were compared using the Wilcoxon Signed-Rank Test, with statistical significance set at p < 0.001. Open-ended survey responses were analysed using a combination of deductive and inductive content analysis. Statistically significant improvements were observed across all evaluation items from pre- to post-workshop, with the greatest gains in recognising subtle behavioural or emotional changes (1.25 points mean difference) and feeling skilled in knowing what services to recommend (1.28 points mean difference). Participants also reported high satisfaction (4.6 ± 0.73) and found the content highly relevant to their roles (4.5 ± 0.78). Content on referral pathways, local services and strategies for responding to suicidal ideation was identified as the most impactful. Including deeper coverage of culturally safe approaches for First Nations people, greater discussion around the differences among genders in the experiences of suicidality and more detailed exploration of specific mental health conditions and self-care strategies for staff were suggested as enhancements. The co-designed workshop effectively enhanced suicide prevention capabilities among frontline and community staff. Its success highlights the value of locally tailored, collaborative training that integrates lived experience and responds to community-specific needs. This model offers a scalable framework for workforce development in suicide prevention.
There is a need to scale up effective physical activity interventions among the general population, particularly those incorporating resistance training. Ecofit is a community-based, multicomponent intervention promoting resistance and aerobic physical activity through smartphone technology, the outdoor built environment, and social support. This study aimed to scale up ecofit by comparing Low versus Moderate implementation support on the reach (outdoor gym use) of ecofit within two large regional municipalities. A hybrid type 3 implementation-effectiveness trial was conducted across two large municipalities in eastern Australia. Outdoor gyms (n = 18) were randomized to Low (ecofit app only) or Moderate [ecofit app, QR (quick response) codes on equipment, face-to-face workout sessions] implementation support. The primary outcome of "reach" was defined as the baseline-adjusted difference in the number of outdoor gym users (i.e. adults using outdoor gym equipment for resistance training) between groups. Reach was measured at baseline and 3-month follow-up using a modified System for Observing Play and Recreation in Communities tool, with blinded assessors observing community members perceived to be ≥18 years [categorized as Adults (aged 18-59) or Seniors (aged ≥60)]. Secondary outcomes included app uptake, dose received, implementation fidelity, and acceptability, feasibility, and dose-satisfaction regarding the app and guided sessions. There was no significant difference in people using outdoor gym equipment for resistance training between Low and Moderate support groups at 3-month follow-up [incidence rate ratio (IRR) = 1.68, 95% CI: 0.96-2.94]. Among adults (aged 18-59), the Moderate support group showed significantly higher outdoor gym use at follow-up (IRR = 1.83, 95% CI: 1.01-3.31) compared to the Low support group. Over 6 months, 1273 users registered for the app, completing 503 workouts, 62% of which occurred indoors. Ecofit shows promise for promoting resistance training, particularly among adults. Broader marketing and enhanced engagement strategies may be required to increase outdoor gym use and sustain participation over time. Outdoor gyms are increasingly installed in parks to encourage free, accessible exercise, yet they are often underused. We implemented the ecofit intervention, a free mobile app designed to help people use outdoor gyms for resistance and aerobic exercise, across two large regional municipalities in Australia. The app includes predesigned workouts, instructional videos, customizable options, and self-monitoring tools. We compared two levels of implementation support: nine gyms received Low support (ecofit app only), while another nine received Moderate support [ecofit app, QR (quick response) codes on equipment, and three cost-free group workouts led by an exercise professional]. The main aim was to compare the number of people using outdoor gyms receiving Low and Moderate support at baseline and 3 months. There was no significant difference in overall outdoor gym use between the Low and Moderate support groups. However, more adults under 60 used outdoor gyms with Moderate support compared to Low support at follow-up. Over 6 months, more than 1200 people registered for the app and completed 503 workouts. Users found the app easy to use and motivating, though many preferred private settings for exercise. Ecofit shows promise for promoting resistance training using outdoor gyms. Future studies should incorporate broader marketing and collaborate with municipal councils and local government agencies to improve engagement and accessibility.
Cytomegalovirus (CMV) is the most common congenital infection and a leading preventable cause of neurodevelopmental disability. Contemporary maternal CMV seroprevalence estimates are needed to inform antenatal screening policy in Australia. To estimate CMV seroprevalence among women referred for antenatal care at a tertiary maternity hospital, identify clinical and sociodemographic associations with serostatus, and model national and hospital-level seroprevalence by maternal country of birth. CMV serology results from GP antenatal referrals to a Melbourne tertiary hospital over 13 months were analysed. Seroprevalence was stratified by maternal country of birth, grouped by Organisation for Economic Co-operation and Development (OECD) membership. National and hospital-specific seroprevalence were modelled using Australian Bureau of Statistics and research dataset country-of-birth distributions. Of 4377 referrals, 591 (12.5%) included CMV serology; 61.3% were CMV IgG positive. Median gestational age at testing was 5.4 weeks; referral occurred at a median of 9 weeks. Seroprevalence was higher among women born in non-OECD countries (86.6%) versus OECD countries (54.3%) (adjusted OR 6.44, p < 0.001). Modelled national maternal seroprevalence was 63.6%. Across Melbourne public hospitals, estimates ranged from 60% to 74%, reflecting demographic variation. Among 328 women tested for CMV IgM, 17 (5.2%) had positive or equivocal results; one had low avidity IgG, consistent with recent primary infection. Maternal CMV seroprevalence in this cohort is higher than previously reported and strongly associated with maternal country of birth. These data inform evaluation of antenatal CMV screening feasibility and cost-effectiveness studies in Australia.
Artificial intelligence (AI)-driven clinical decision support (CDS) tools offer promising solutions for health care delivery by optimizing resource allocation, detecting deterioration, and enabling early interventions. However, adoption remains limited due to insufficient validation and a lack of transparency and trust. Explainable AI (XAI) seeks to improve user understanding of AI outputs; however, how clinicians interpret and integrate these explanations into their decision-making remains underexplored. Furthermore, discrepancies in explanations, known as the "disagreement problem," can undermine trust and, at worst, lead to poor clinical decisions. This study examines clinicians' perspectives on the role and value of explainability in AI-driven CDS tools within Australian critical care settings and the impact of discrepancies in AI-generated explanations on clinical decision-making. Qualitative data were collected using semistructured interviews with 14 clinical experts, incorporating scenario-based exercises, and were analyzed using inductive thematic analysis. Clinicians valued explainability, particularly in complex or unfamiliar situations, when explanations were clear, plausible, and actionable. Trust and perceived usefulness extended beyond explanation quality, encompassing factors such as system accuracy, alignment with clinicians' reasoning, workflow integration, and perceived reliability. Discrepancies in explanations generated by different XAI methods were not a major concern, provided that the AI-generated predictive alerts were accurate. This study provides design recommendations for developing trustworthy, user-centric CDS tools that incorporate XAI. Findings highlight that explainability is critical for establishing initial trust in AI-driven tools by supporting perceived usefulness, but its importance diminishes over time and with user expertise and familiarity, as learned usefulness takes precedence. Recommendations highlight the importance of aligning the design and implementation of AI tools with clinicians' needs to enhance trust, mitigate risks, and promote successful adoption for improved patient outcomes.
Bilious vomiting in infants is recognized as a sign of potential surgical pathology, and these infants often require retrieval from the peripheral hospital to a surgical center for specialist investigation. We set out to show the frequency of surgical pathology, time-critical pathology, and cardiorespiratory deterioration during retrieval among infants with bilious vomiting. In addition, we aimed to show whether there is an association between the need for cardiorespiratory support at the time of referral and time-critical pathology or cardiorespiratory deterioration during the retrieval. We completed a retrospective observational study of 104 infants younger than 44 weeks' corrected gestational age retrieved for bilious vomiting or aspirates over a 103-month period identified from the electronic retrieval record database of an Australian retrieval service. Of the infants included in the study, 21 (20.19%) had a surgical pathology, 6 (5.77%) had a time-critical pathology, and 10 (9.62%) experienced a cardiorespiratory deterioration during the retrieval. Infants receiving cardiorespiratory support at the time of referral were more likely to have a time-critical pathology (risk difference [RD], 24.45%; 95% confidence interval [CI], 3.23-60.07; risk ratio [RR], 6.93; 95% CI, 1.52-31.5) and more likely to experience a cardiorespiratory deterioration (RD, 50.95%; 95% CI, 18.17-78.19; RR, 9.24; 95% CI, 3.38-25.27). Our findings can help the retrieval service plan their response to referrals for infants with bilious vomiting. Awareness of the frequency of time-critical pathology and of deterioration during retrieval and the increased risk of both among those requiring cardiorespiratory support at the time of referral could inform the timing of response and team composition.
Given injectable HIV preexposure prophylaxis (PrEP) has unique service-delivery requirements, there is a need to investigate the feasibility of its implementation and equitable access for people at risk of HIV. Data were collected from 45 informants (nurses, physicians, general practitioners, policy makers, and community representatives) to identify barriers to and facilitators of implementing long-acting injectable cabotegravir (CAB-LA) in Australian settings. Findings were mapped onto the domains of the updated Consolidated Framework for Implementation Research. Informants welcomed new PrEP options as a way of addressing issues of access equity. However, they questioned the benefits of CAB-LA over oral PrEP, given its dose-scheduling requirements and long pharmacokinetic tail, as well as its cost, complexity, and potential to "remedicalize" PrEP, reversing current trends in PrEP prescribing and consumption. Other concerns included increased resource and capacity implications for clinics resulting from initial assessments and the increased number (and complexity) of subsequent visits.
To explore what is known about the attitudes, beliefs and perceptions of appropriate prescribing from the view of older First Nations Peoples (aged 45 years or older, residing in the community or residential care), substitute decision-makers and health-care professionals working with First Nations Peoples. The scoping review was conducted in accordance with the JBI methodology for scoping reviews and PRISMA-ScR. Databases and grey literature sources were searched with no limitations from inception until 12 May 2025. Titles and abstracts were screened by two independent reviewers, with full-text assessment for inclusion and data extraction undertaken by two independent reviewers. Study characteristics were described descriptively. Five articles were included for analysis. First Nations Peoples represented included Māori, American Indians and Australian Aboriginal and/or Torres Strait Islander Peoples. Health-care workers represented included Aboriginal Health Workers, general practitioners and nurses. From the older First Nations People's perspective, themes regarding traditional medicine use, lack of medication information provision and concerns about adverse effects were identified. Dominant themes from health-care workers included medication information, compliance to medications and continuity of care. Older First Nations Peoples expressed a desire for more medication information and culturally appropriate care. Included studies indicated most health-care workers supported interventions to increase knowledge and understanding of medications for First Nations Peoples. Unfortunately, paternalistic attitudes remain, which limit the provision of information and prevent a trusted partnership from forming.
SYNOPSIS: Access to timely care for hip and knee osteoarthritis (OA) is a growing issue. In Canada and Australia, wait times for total hip and knee joint replacements have risen steadily over the past decade, leaving many patients experiencing increased frailty, and reduced function and quality of life while waiting for surgery. These issues are often framed as problems of surgical capacity. We argue they are warning signs of health care systems failing to deliver effective nonsurgical care earlier in the OA disease continuum. OA is a complex chronic condition that requires ongoing care. Unfortunately, many patients are passively placed on waiting lists without support. This Viewpoint makes the case for physical therapists taking a leading role in hip and knee OA care, from primary care management through surgical triage, to ensure patients receive the right care at the right time. J Orthop Sports Phys Ther 2026;56(5):277-281. Epub 18 February 2026. doi:10.2519/jospt.2026.13577.
Air ambulance helicopters are a scarce and costly resource in New Zealand. Despite widespread use of the Advanced Medical Priority Dispatch System (AMPDS), no validated framework exists to determine which determinant codes are associated with helicopter tasking. This study aimed to examine whether specific AMPDS codes are associated with an increased likelihood of helicopter arrival at the scene in New Zealand. A retrospective observational study using all AMPDS-coded incidents recorded by the Emergency Ambulance Communications Centre from January 1, 2023, to December 31, 2024, was conducted. Exclusions included interhospital transfers, search and rescue events, direct air desk notifications, and nonpatient incidents. For each code, incident volume and helicopter arrivals at the scene were measured. Codes were classified as high volume (≥ 50 helicopter arrivals) or high yield (arrival ratio, ≤ 1:10). Among 1,161,169 AMPDS-coded incidents, 34,869 (3.0%) were reviewed by an air desk clinician and 7,688 (0.66%) resulted in a helicopter arrival. Thirty-seven codes generated ≥ 50 arrivals, accounting for 59.3% of helicopter responses but representing 440,781 incidents overall. An additional 102 codes had arrival ratios of ≤ 1:10, although most had low absolute volumes. Only 3 traffic-related codes (29D06, 29D02N, 29D02K) met both criteria, accounting for 823 incidents (0.07%) and 192 arrivals (2.5%). In contrast, 791 codes never produced a helicopter arrival, including 133 with > 100 incidents. AMPDS codes alone have limited discriminative capacity for helicopter tasking in New Zealand. A small subset of traffic-related codes demonstrated predictive value and may support more targeted referral pathways. Integrating selected high-yield codes with geospatial thresholds and availability of local critical care resources may streamline clinician review, reduce overtriage, and optimize deployment of scarce aeromedical assets.
Prenylopathies such as mevalonate kinase deficiency (MKD) are an emerging family of monogenic autoinflammatory diseases with an underlying defect in isoprenoid lipid synthesis and protein prenylation. The mechanisms linking defective protein prenylation to systemic inflammation remain unclear. We revealed that mice and humans with MKD had significant decreases in the frequency of mature natural killer (NK) cells, impaired trafficking of cytolytic granules, reduced cytotoxic activity, and increased production of the cytokine interferon γ (IFN-γ). Mice with MKD failed to clear murine cytomegalovirus (MCMV) infections and had elevated serum IFN-γ and inflammatory pathology, likely the result of decreased and dysregulated cytotoxic cells. Finally, we describe the beneficial effect of cytokine signaling blockade with a Janus kinase (JAK) inhibitor in an infant with severe MKD. Together, these findings reveal a fundamental role for dysregulated cytotoxic cells and IFN-γ production in MKD and likely other prenylopathies. Importantly, this work provides a rationale for the use of JAK inhibitors in the treatment of MKD.
The therapeutic use of self, first articulated by Peplau in the 1950s, remains fundamental to mental health nursing practice, yet continues to be interpreted in diverse ways. This paper reports findings of a qualitative descriptive study, situated within a constructivist paradigm, exploring how experienced Australian mental health nurses understand and apply the therapeutic use of self in contemporary recovery-oriented contexts. Eleven mental health nurses participated in semi-structured interviews, with data analysed using reflexive thematic analysis. Three interrelated themes were developed: 'Diverse conceptualisations of the therapeutic use of self'; 'The prominence of self-disclosure'; and 'The nurse as a therapeutic instrument'. Participants described the therapeutic use of self as an intentional and reflective use of the professional self to foster connection, presence and trust. While the value of self-awareness and relational authenticity was acknowledged, self-disclosure emerged as a significant, ethically bounded strategy within a broader reflective orientation. By recognising the diverse conceptualisations of the therapeutic use of self, this study offers a more integrative formulation of the practice as relational, contextual and also experiential, with the prominence of self-disclosure reflecting evolving socio-cultural and recovery-oriented frameworks. Such recognition strengthens shared professional language, education and critical reflection in mental health nursing practice.
Plant-based milks have been increasing in popularity amongst Australian consumers, concurrent with a decrease in cow's milk consumption. Given the key role of cow's milk in Australian diets, it is necessary to understand the motivations behind this consumer behaviour and investigate the nutritional implications associated with this shift in dietary choice. Adults, including both omnivores and purposefully targeted vegan individuals, were recruited via social media to complete an online survey and two 24-h dietary recalls using the online Intake24 dietary assessment programme. The survey explored milk type choice and participant perceptions of the health and environmental impact of plant-based milks. Respondents were divided into groups based on whether they reported to consume or not consume dairy products in the survey. Survey and dietary intake data were then compared between these two groups. Of the 217 survey responses received (n = 74 dairy and n = 143 non-dairy consumers), soy, almond and oat plant-based milks were the most popular choices. The primary drivers behind milk type choice were animal rights, self-reported adverse health symptoms and environmental concerns. Additionally, non-dairy consumers were more likely to perceive these products as healthier and better for the environment than cow's milk. Dietary intake data identified that overall non-dairy consumers had significantly lower intakes of saturated fat, iodine and vitamin B12 (14.9 vs. 21.9 g/day; p = 0.001, 70.8 vs. 128.8 μg/day; p < 0.001 and 0.9 vs. 3.0 μg/day; p < 0.001, respectively) and higher amounts of dietary fibre (27.2 vs. 21.3 g/day; p = 0.008) compared to dairy consumers. This study provides novel insights into the motivations to consume, and perceptions of the healthfulness, plant-based milk in Australia and identified that non-dairy consumers may be at increased risk of iodine and vitamin B12 deficiency.
Patient delays in recognizing and acting on acute coronary syndrome (ACS) symptoms worsen outcomes. To evaluate the effectiveness of a heart attack education intervention (Heart Matters) aiming to improve recognition and response to ACS symptoms in communities with elevated cardiovascular risk and low emergency medical service (EMS) use. This stepped-wedge cluster randomized clinical trial was conducted in 8 high-risk communities (local government areas; 4 metropolitan and 4 rural with a combined population of approximately 792 000 adult residents) in Victoria, Australia (December 2021 to March 2023 with follow-up to March 2024), with clusters crossing to the intervention every 4 months. Data were obtained from administrative datasets and registries (analysis complete June 2025). A multicomponent community education program including 490 community sessions (approximately 10 088 residents), more than 174 110 households mailouts, more than 50 000 resource handouts, opportunistic media, and a geotargeted social-media campaign (reach of approximately 350 000 residents). The control period did not include any educational campaign. The primary outcome was the proportion of patients with ACS transported to hospitals by EMS, as recorded in the Victorian Emergency Minimum Dataset. Outcomes were analyzed at the patient level using mixed-effects regression models, reporting risk differences (RDs) and odds ratios (ORs). A program evaluation was also conducted to assess implementation and inform potential replication and scale-up. Among 1775 patients with ACS (865 intervention and 910 control; 924 [52.1%] aged ≥65 years; 1193 male [67.2%]), EMS use was unexpectedly high during the initial control period, coinciding with a COVID-19 wave. EMS transport occurred in 624 of 910 patients with ACS (68.6%) in the control period and 548 of 865 patients (63.4%) in the intervention period (adjusted RD, -8.98%; 95% CI, -17.50% to -0.46%; P = .04; adjusted OR, 0.67; 95% CI, 0.45 to 1.01; P = .05). Reductions were more pronounced in metropolitan areas (RD -10.73%; 95% CI -20.43% to -1.03%) and during a severe flooding event (RD -13.50%; 95% CI -26.52% to -0.47%). Early treatment-seeking was also lower, although estimates were imprecise. The program evaluation identified COVID-19 pandemic and seasonal impacts, as well as community concerns regarding EMS costs, demand, and wait times. In this community ACS education trial conducted in high-risk regions, the intervention did not improve EMS use or prehospital care-seeking. External contextual factors, including the COVID-19 pandemic and natural disasters, appeared to influence patient behavior and may have attenuated intervention effects, highlighting the complexity of achieving behavioral change through community education alone. ClinicalTrials.gov Identifier: NCT04995900.
This study aimed to document trends in lead screening rates and blood lead levels among children residing in Broken Hill aged <5 years at an Aboriginal Community Controlled Health Organisation since beginning screening in 2011. This was a repeat cross-sectional descriptive analysis of lead screening program data. Data were extracted from the New South Wales Health lead database for all blood lead screening tests among children residing in Broken Hill aged 5-59 months undertaken by Maari Ma Health Aboriginal Corporation, 2011-2022. Key outcomes were annual screening coverage, age-standardised annual geometric mean blood lead levels and categorical distribution of blood lead levels. The number of Indigenous children aged 1 to <5 years screened annually increased from 58 in 2010 to 171 in 2012. Average lead screening coverage in children aged <5 years in 2012-2020 was 78% (range 71-82%). In 2021-2022 during the COVID pandemic, screening coverage declined to 50%. Average lead levels in children screened at Maari Ma have remained unchanged over the past 10 years. Over 70% of these children record a blood lead level over the current National Health and Medical Research Council level of concern of 5 μg/dL. Screening of Indigenous children increased substantially following Maari Ma's involvement in the lead screening program. We suggest this reflects the effectiveness of Aboriginal Community Controlled Health Organisation involvement in mainstream program delivery to improve engagement with Indigenous communities. Despite high lead screening coverage and a AU$13 million state government investment to address elevated blood lead levels in Broken Hill since 2015, the majority of Indigenous children residing in Broken Hill continue to record a blood lead level above the National Health and Medical Research Council level of concern, and average blood lead levels in this population remained unchanged over the past 10 years. This suggests that current measures are not working for this population, with the lack of lead-safe housing for Indigenous families being the key driver. More comprehensive strategies specifically targeting Indigenous children are required to close the gap in the disproportionate burden of lead in Broken Hill.
Younger patients are at the highest risk of repeat injury after anterior cruciate ligament (ACL) reconstruction. The hamstring tendon autograft remains the most popular choice of graft in the world, but its use in these high-risk patients is controversial. The aim of this study was to compare revision rates between the bone-patellar tendon-bone (BTB) and hamstring tendon autografts in a high-risk patient population. Prospective data recorded in the New Zealand ACL Registry were analyzed. Primary ACL reconstructions performed between April 2014 and March 2022 were included, allowing for a minimum follow-up of two years. High-risk patients were analyzed using the following criteria: age between 14 and 25 years, ACL rupture during sporting activity, time from injury to surgery within 12 months, grade 2 pivot shift, and a minimum preinjury Marx activity score of 8. The rate of revision was compared between the BTB and hamstring tendon autografts using a univariate chi-squared test and multivariable Cox regression survival analysis to calculate hazard ratios (HRs) with 95% CIs. A total of 3,482 high-risk primary ACL reconstructions were analyzed. A lateral extra-articular procedure was performed in 175 cases with no revisions performed during the study period. The rate of revision was 11.4% (238/2,091) with the hamstring tendon autograft versus 4.3% (60/1,391) with the BTB autograft (p < 0.001). The hamstring tendon autograft had a 2.5-times higher risk of revision compared with the BTB autograft (adjusted HR 2.5 (95% CI 1.9 to 3.3); p < 0.001). The number needed to treat with a BTB autograft to prevent one revision was 14 patients. Isolated hamstring tendon autograft has a high rate of revision and should be avoided in high-risk patients undergoing ACL reconstruction.
Mobilized colistin resistance (mcr) gene has emerged as a major driver of colistin resistance. Therefore, this study aimed to determine the distribution of mcr-variants and mcr-carrying genomes deposited in the NCBI database by sample collection periods and across continents, countries, genera, species, and ecosystems. In this database mining study, the keyword "mcr" was used to identify all mcr-carrying genomes deposited in the NCBI Pathogen Detection database until June 07, 2025, 12h15 GMT. A purely descriptive approach was used in this study, and percentages were calculated by dividing the number of an event by the total number of events (percentage = n/Nx100). Of the 2422739 whole genomes registered in the NCBI database, 18785 (0.78%) carried complete mcr variant sequences. Seventy-seven mcr subvariants were detected, including mostly mcr-1.1 (9431/18785; 50%), and mcr-9.1 (5971/18785; 32%). Mcr-9.1 was the most frequently detected subvariant in several genera, including Serratia spp. (17/17; 100%), Cronobacter spp. (155/160; 97%), and Pluralibacter spp. (19/20; 95%), whereas mcr-1.1 was the most commonly detected subvariant in Escherichia and Shigella spp. (8235/9678; 85%). Regarding geographical distribution, mcr-1.1 was the most observed subvariant in Asia (6759/9033; 75%) and Europe (1886/4680; 40%), whereas mcr-9.1 was the most identified in America (2982/4017; 74%) and Oceania (546/771; 71%). In Africa, mcr-10.1 (52/160; 33%), and mcr-1.1 (50/160; 31%) were the most frequent subvariants. Mcr-carrying genomes deposited in the NCBI database were distributed across ecosystems, including humans (n = 8185), animals (n = 4521), the environment (n = 468), and food (n = 48). The sample collection years for mcr-carrying bacteria ranged from 1953 to 2025, and the distribution of mcr-carrying genomes was as follows: 1953-1990 (n = 49), 1991-1999 (n = 47), 2000-2009 (n = 704), 2010-2019 (n = 12810), and 2020-2025 (n = 4297). Another key finding was that 705 of the 18785 mcr-carrying genomes deposited in the NCBI database (3.8%) harbored multiple mcr genes, including 693 and 12 genomes co-carrying two and three mcr genes, respectively. Mcr-carrying bacteria represent a significant One Health concern because of their major role in colistin resistance and potential for global dissemination. Key actions, such as global surveillance, One Health monitoring, and appropriate stewardship, should be taken to preserve the efficacy of colistin for decades.