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Motor vehicle collisions remain a persistent public health challenge, with risks often concentrated in specific locations rather than distributed randomly. While the COVID-19 pandemic altered mobility patterns and traffic volumes, limited research has examined how the spatial distribution of severe collisions evolved across pre-pandemic, pandemic and post-pandemic periods. This study analysed injury and fatal collisions in Halifax Regional Municipality, Nova Scotia, using road collision records from 2018 to 2025. Collision records were aggregated into 1.5 km × 1.5 km spatial grids and divided into three periods: Pre-COVID (January 2018 to February 2020), COVID (March 2020 to June 2021) and Post-COVID (July 2021 to December 2025). Annualised collision counts were calculated to standardise time durations across periods. Spatial clustering was evaluated using the Getis-Ord hotspot statistic in a GIS environment, and hotspot transition analysis was used to identify persistent, emerging and diminishing clusters across periods. Injury-related hotspots remained concentrated in the Halifax-Dartmouth-Bedford urban core across all periods. The spatial extent of these clusters declined during the COVID period but expanded again afterwards. Fatal collision hotspots were more spatially dispersed, with several freeway-associated hotspots diminishing during the pandemic. In the Post-COVID period, fatal hotspots re-emerged in the urban core and expanded into surrounding inland areas, indicating shifting spatial risk patterns. Pandemic-related disruptions temporarily altered collision hotspot patterns, but clustering re-emerged as travel activity resumed. Persistent urban hotspots and emerging peripheral clusters highlight the value of spatiotemporal hotspot analysis for guiding targeted road safety interventions.

The BODY-Q is a validated patient-reported outcome measure for assessing perceptions of appearance, health-related quality of life and healthcare experiences. Perception of appearance and body image are influenced by cultural, demographic and societal factors that vary across populations. This study aimed to generate Australian normative BODY-Q data. Secondary aims were to understand variation across sociodemographic groups and between geographic regions. Participants aged 18 years and older and currently living in Australia provided sociodemographic information and completed appearance and health-related quality of life domains of the BODY-Q. Scale scores were compared across socio-demographic groups, and means compared to published North American and European normative data. Data were collected from 805 Australian participants. Women reported lower scores than men in four of the five appearance scales and five of the six health-related quality of life scales. Presence of chronic health condition(s) was associated with lower scores in four of the five appearance scales and five of the six health-related quality of life scales. Higher body mass index was associated with lower scores in all BODY-Q scales. Younger age was associated with worse Appearance-related Psychosocial Distress but minimal difference in other scales. Australian participants showed similar scores to Europeans, and both were higher than in North America. This study provides the first Australian normative scores for the BODY-Q and represents the second publication of normative BODY-Q data internationally. The findings highlight the importance of region-specific normative scores and collecting relevant socio-demographics in patient-reported outcome measures research.

Helper plasmids that depend on native adenovirus gene expression have long been the standard for transient adeno-associated virus (AAV) production. Here, we demonstrate that engineering the required helper gene expression can greatly increase AAV production relative to the use of native adenovirus gene regulation. Two different engineered helper plasmid designs improved AAV vector genome (VG) titers up to 5-fold compared to a standard helper plasmid. A substantial decrease in adenovirus E4orf6 and an increase in L4 22K and 33K gene expression were associated with the improved engineered helper plasmids. VG titer improvement across capsid serotypes, plasmid transfection platforms and genome designs suggest that engineering helper gene expression is widely suited to improving AAV manufacturing yields while also maintaining consistent vector quality attributes.

The growing emergence of new psychoactive substances (NPS) challenges traditional approaches to drug monitoring, highlighting a need for innovative surveillance strategies. We explored the potential to better understand the NPS market in Australia by combining wastewater analysis with toxicosurveillance programs. Focussing on a time of year of likely higher NPS and drug use, influent wastewater samples were collected from four Australian states (South Australia, Victoria, Queensland and New South Wales) over the New Year period from 2019-20 to 2024-25. Clinical samples presenting between 15 December and 15 January each period from the toxicosurveillance systems Emerging Drugs Network of Australia (including Western Australia, South Australia and Queensland), Emerging Drugs Network of Australia Victoria (Victoria) and Prescription, Recreational and Illicit Substance Evaluation - PRISE (New South Wales) were extracted. In total, 294 wastewater and 117 clinical samples were included in this work. A total of 47 individual NPS were found in both datasets. This included: 21 only in wastewater, 37 only in clinical, and 12 in both. Overall, 743 instances of NPS were found in all wastewater samples and 172 in clinical data. In wastewater samples, N,N-dimethylpentylone (54%), mitragynine (52%) and bromazolam (45%) were the most frequently detected. In the clinical samples, the most common were bromazolam (44%) and clonazolam (21%). Overall, synthetic cathinones and plant-based compounds were more prevalent in wastewater, and synthetic opioids and benzodiazepines in clinical samples. Differences in detected NPS classes illustrate the complementary nature of these surveillance systems. Higher wastewater concentrations may indicate broader use and lower acute harm than drugs identified clinically. Integrating these datasets with additional sources such as surveys, coronial records, police seizures, and drug-checking services can strengthen NPS monitoring.

Non-invasive ventilation (NIV) improves quality of life and extends survival for people with motor neurone disease (pwMND); however, uptake in Australia remains modest. This study explored the factors that influence the uptake of NIV from the perspectives of pwMND, caregivers, and healthcare professionals. Thirty-nine semi-structured interviews were conducted with pwMND (n = 8), family caregivers of pwMND (n = 4), and healthcare professionals (n = 27). A two-stage deductive-inductive analysis was performed to identify common themes that influence the uptake of NIV in MND. Twenty-six key influencing factors were identified, relating to three major themes: influences on the pwMND's decision to trial NIV; healthcare professional knowledge, beliefs and behaviors; and inequity and lack of responsiveness in the healthcare system. Inductive analysis also identified a fourth theme, disparities in NIV uptake. Within this theme, women, older people, and First Nations Australians were acknowledged as demographic groups experiencing challenges to NIV uptake that warrant further investigation. This research identified multiple modifiable factors influencing the uptake of NIV that can inform the design of targeted interventions to reduce inequitable access to NIV, increase uptake, and optimize quality of life for pwMND. For people living with motor neurone disease (MND), non-invasive ventilation (NIV) effectively improves quality of life and increases survival.Despite the well-established benefits, the uptake of NIV by people with MND is highly variable.This study found that the barriers to accessing NIV outweighed the barriers to accepting NIV when it is offered.Strategies that empower people with MND with knowledge about NIV, skills to proactively manage their health, and connections with the MND community are crucial to improving NIV uptakeInterventions targeting healthcare professionals’ knowledge, skills, and attitudes regarding NIV are also needed, particularly for healthcare professionals who do not specialize in MND.

Females are the fastest growing demographic among United States (US) veterans and are increasingly seeking substance use- and gender-specific care through the Veterans Health Administration. Given high risks for adverse maternal and infant outcomes, the perinatal period (i.e., pregnancy and 1-year postpartum) is a critical time for substance use intervention, however, little is known about perinatal substance use among US veterans and servicemembers. We conducted a scoping review to summarize existing research on perinatal substance use among US veterans and servicemembers. A systematic search identified 3,534 records, which were screened and reviewed by the research team. Of the 17 articles included, 14 reported prevalence, 10 reported correlates, and 6 reported maternal/obstetric outcomes of perinatal substance use in US veterans or servicemembers. Alcohol and tobacco/cigarette use were overrepresented compared to other substances, and many articles collapsed across substance use categories. Prevalence of alcohol use ranged between 1%-17% and tobacco use ranged between 2-18% during the perinatal period. Perinatal substance use was associated with veteran status, exposure to trauma, and increased likelihood of pre-term delivery and low infant birth weights. We emphasize the gaps in the literature on perinatal substance use among US veterans and servicemembers. Research was scarce about substances other than alcohol and tobacco, and methodologies varied greatly, making it difficult to infer prevalence and patterns. The absence of intervention or qualitative studies underscores the necessity for research exploring specific needs and treatment preferences of this unique population.

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The analytic mind is a way of thinking that includes understanding the effects of the unconscious on behavior, relationships and decisions expressed in myriad ways. A supervisor and supervisee reflect upon the development of their psychoanalytic minds through their own experiences of training and supervision. The two do not have the same experiences and goals even in the same supervision. A supervisor aims to impart analytic thinking and practice; a supervisee strives to become an analyst. Their goals are achieved within a supervisory relationship holding an optimal tension-the supervisor balances between teacher and analyst and the supervisee between support and autonomy. The learning relationship with its overlapping goals contains convergence (support and scaffolding) and divergence (differing thoughts about what helps a person learn).

Colorectal (bowel) cancer and its treatment can seriously affect a person's quality of life, including physical, social, work‑related, and emotional wellbeing. Young people with colorectal cancer experience worse psychological wellbeing, including marked emotional distress and prominent levels of anxiety. This disease is less common in people under 50, but cases of early‑onset colorectal cancer (EOCRC) are rising around the world. The object of this research was to derive a deeper understanding of the challenges and impact on quality of life faced by EOCRC compared to older patients following a colorectal cancer diagnosis. Recruitment of participants from a larger mixed method project of surviving EOCRC patients from 2013 to 2023 and a matched sample of colorectal cancer patients. 1 Participants invited to take part in an in‑depth semi-structured interview conducted by telephone or virtual meeting and audio taped, transcribed, and analysed using an interpretive phenomenological approach. Twenty participants participated in interviews. Three themes (Headspace, physical impact and future) and eight corresponding sub themes encompassing poorer psychological quality of life, emotional distress and heightened anxiety faced by EOCRC. Barriers in current diagnostic services and treatment pathways more often reported by EOCRC. Older and younger cancer patients highlight a shift from active to passive social roles with both groups reporting substantial reductions in overall quality of life and role functioning, but longer lasting impact for EOCRC, who are focused on family, fertility, career, and survival. A review of current diagnostic services and treatment pathways is required, tailoring care for all patients and importantly address the unique needs of EOCRC. Colorectal (bowel) cancer and its treatment can seriously affect a person’s QoL, including physical, social, work‑related, and emotional wellbeing. It is still less common in people under 50, but cases of early‑onset colorectal cancer are rising around the world.Younger adults are often building careers, forming long‑term relationships, and raising families, so cancer can disrupt their lives in separate ways than it does for older people. Research so far has not fully explored these differences, but this study shows that a colorectal cancer diagnosis and its treatment have a particularly strong negative impact on the QoL of younger patients.Young people with colorectal cancer tend to experience worse psychological wellbeing, including marked emotional distress and elevated levels of anxiety. These findings highlight the need for diagnostic services and treatment pathways to be better tailored to support all people with colorectal cancer, and to specifically address the unique needs of those under 50 years of age.

This review discusses the achievements of the National Echo Database of Australia (NEDA), a unique Australian resource facilitated by a collaborative nationwide approach and a common purpose to improve understanding of heart diseases through the gathering and analysis of big data. It is a first of its kind world-wide, with >2.1 million echocardiograms on >1.2 million individuals, linked to other national databases reporting outcomes. This article provides an overview of the methodological structure and function of NEDA, and an analysis of NEDA's clinical impact. In the first 10 years of NEDA's existence, it has undergone three large-scale expansions and data linkages and generated 57 high impact studies with a combined citation index >1,100. Beyond its impact on guidelines, NEDA has driven practice change and contributed to changes in global cardiac care. Future directions for NEDA include an emphasis on objectively measuring clinical quality of echocardiography, evaluating its prognostic utility and providing real-world data on Australian cardiac health. Its engagement with digital health and artificial intelligence techniques broaden new avenues of cardiac innovation on a global level.

Advanced glycation end products (AGEs) accumulate in the serum of people with diabetes, some chronic conditions, and aging and impair osseointegration by reshaping the protein corona and activating oxidative stress pathways at the biomaterial interface. Here, we introduce a pathology-adaptive surface engineering strategy in which plasma polymer coatings with defined functional chemistries are designed to selectively modulate AGE adsorption while preserving physiological protein interactions. Titanium was functionalized with carboxyl (-COOH), amine (-NH2), or hydrocarbon (-CH3) plasma polymers to precisely modulate interfacial chemistry. Carboxyl- and amine-functionalized surfaces significantly reduced AGE adsorption compared to hydrophobic controls while maintaining total serum protein adsorption, indicating selective exclusion of glycated species. This modulation of the AGE-modified protein corona attenuated the generation of reactive oxygen species, suppressed apoptosis, and restored osteogenic gene expression in bone marrow mesenchymal stem cells following exposure to AGEs. Functionalized coatings supported sustained proliferation and enhanced mineralization, demonstrating the recovery of regenerative capacity in a metabolically compromised environment. The AGE-RAGE axis was identified as a key driver of macrophage inflammatory activation. These findings establish pathology-adaptive surface chemistry as a materials strategy to selectively regulate disease-associated protein adsorption and restore regenerative performance under glycation stress.

Research has trialled many initiatives to support caregivers to shape young children's health behaviours. However, translating evidence to public health practice and policy is a challenge, in part due to access to such evidence. We aimed to co-design a child health evidence dashboard, and to understand the expected enablers and barriers to use of the dashboard with next-users (e.g., Australian child service managers, program planners). Using an integrated knowledge translation approach, we conducted a mixed-methods study involving five online co-design workshops. Next-users were invited to participate in the workshops and completed pre- and post-workshop surveys. Pragmatic data analysis occurred after each workshop to identify next-user requirements and inform iterative dashboard development alongside workshops. 15 next-users participated in the workshop series (median of 9 per workshop). Next-user preferences were categorised into desired uses, content, features and functionality, and design for the dashboard. Key enablers to use of the dashboard included relevance, promotion and credibility of the dashboard, positive user experience, time and resources to support use of the dashboard. We identified what and how next-users want evidence on child health initiatives to inform policy and practice. Findings enabled development of an initial evidence dashboard prototype informed by next-user preferences. Understanding the enablers and barriers to using and engaging with the dashboard will inform ongoing development and implementation.

Soldo [1] raises concerns about the reliability of citizen science-derived photographic records for identifying lamnid sharks in the Mediterranean Sea. Using a recently published juvenile white shark from Croatian waters [2] as a representative case, the author reinterprets the specimen as a porbeagle shark (Lamna nasus) rather than a white shark (Carcharodon carcharias), based primarily on selected dental characters. Given the critically endangered status of white sharks in the Mediterranean [3] and the limited number of confirmed observations [4,5], occurrences of the species in this region serve as valuable population data points [6,7] and merit careful examination. Species identifications and reinterpretations should therefore be well-supported, which includes verification of source materials and firsthand communication with citizen scientists, and make use of multiple diagnostic characters whenever possible. Here, we re-examined the specimen using all observable external and dental characters and show that it is consistent with the white shark. We further demonstrate that reliance on single, variably expressed traits-particularly dental characters affected by ontogeny and individual variation-can lead to erroneous identifications, and emphasize that rigorous taxonomic identifications should depend on a holistic, integrative assessment of all available morphological (and if available genetic) evidence.

Medicine shortages can disrupt glaucoma management and necessitate therapeutic substitution. Understanding how shortages affect access to first-line treatments for glaucoma is important for optometrists when monitoring intraocular pressure control, and pharmacists when counselling patients and coordinating care during periods of limited medicine availability. Timolol, a non-selective beta-blocker, is a first-line treatment for glaucoma and ocular hypertension and has experienced international shortages in recent years. Between August 2024 and May 2025, Australia experienced a nationwide shortage of timolol-containing eye drops, raising concerns regarding continuity of care, access to treatment, and therapeutic substitution. To descriptively examine the impact of the 2024-2025 timolol eye drop shortage on dispensing patterns of antiglaucoma medicines in Australia and assess the contribution of imported products in mitigating the shortage. A retrospective drug utilisation study was conducted using publicly available aggregate Pharmaceutical Benefits Scheme (PBS) and Repatriation PBS dispensing data from January 2020 to August 2025. Monthly dispensings of antiglaucoma preparations (ATC S01E) were standardised per 100,000 population and analysed using descriptive time-series methods. Dispensing trends were compared before, during, and after the shortage, with stratification by timolol formulation, therapeutic class, and product type (locally supplied versus overseas imports). The late 2024 and early 2025 timolol shortage was associated with a sustained decline in dispensing of single-ingredient extended-release timolol, decreasing from approximately 40 dispensings per 100,000 population per month before the shortage to 1.07 by March 2025. Dispensing of standard-release timolol increased temporarily in October 2024 before declining in a similar pattern. Overseas imports accounted for 24.3% of all timolol dispensings during the shortage period and peaked at 87% of timolol dispensings in March 2025. Despite regulatory approval of imported products, overall timolol utilisation remained below pre-shortage levels. Alternative therapeutic classes, including prostaglandin analogues and carbonic anhydrase inhibitors, showed modest increases in dispensing, suggesting potentially limited therapeutic substitution. The timolol shortage disrupted access to a cornerstone first-line treatment for glaucoma. Regulatory intervention through the approval of imported products partially mitigated the shortage but did not restore utilisation to pre-shortage levels in Australia. Future shortage management strategies should prioritise rapid policy activation and closer alignment of imported products with formulations routinely available in Australia.

Endovascular therapies are increasingly becoming the primary approach for treating cerebrovascular disorders.1,2 However, these procedures rely on DSA, which provides limited visualization due to inherently limited spatial resolution.3 Intravascular optical coherence tomography (OCT) enables 3D, high-resolution visualization of coronary arteries, allowing detailed assessment of the vascular wall, atherosclerotic plaque characteristics, and stent deployment.4 This has lead cardiology societies to recommend intravascular OCT for the management of complex coronary interventions (level 1A evidence).5,6 OCT is now being adapted for neurointerventional applications.7 A dedicated neuro-OCT (nOCT™, Spryte Medical) technology, designed to enable OCT imaging in tortuous intracranial arteries, has been recently introduced.8 Initial studies showed nOCT safety and feasibility for neurovascular use and explored its potential value for improved intracranial vascular imaging in stroke settings.9 The successful integration of nOCT technology into clinical workflows requires standardized principles for image acquisition and interpretation.10,11 This video describes how to use nOCT in clinical practice. VIDEO.

Mindfulness-based stress reduction (MBSR) is recommended as a noninvasive, evidence-based treatment for chronic low back pain (CLBP); however, access and uptake are often constrained among medically underserved populations. Telehealth-delivered MBSR may scale access, yet little is known about the characteristics of underserved patients who have experience using telehealth and are willing to enroll in pragmatic trials evaluating MBSR. This study examined individual- and county-level social vulnerability characteristics associated with telehealth use experience among people living with CLBP who enrolled in OPTIMUM (Optimizing Pain Treatment in Medical Settings Using Mindfulness), a pragmatic randomized clinical trial of telehealth-delivered MBSR. We conducted a cross-sectional analysis of baseline measures from the OPTIMUM trial, focusing on participants from a safety-net health institution and a federally qualified health center. The primary outcome was telehealth use experience (having had a prior telehealth visit at or before enrollment). Guided by Andersen's Behavioral Model of Health Services Use, we evaluated predisposing, enabling, and need factors. Prespecified measures included the following: demographics; employment and education; internet access and comfort using Zoom; neighborhood indices (Area Deprivation Index [ADI], Social Vulnerability Index [SVI]); rurality; back-pain duration; and validated patient-reported outcomes. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and 95% CIs. Of 244 enrolled participants (mean age 50.6, SD 13.5 y; n=162, 66.7% female; n=124, 50.8% non-Hispanic Black), 174 (71.3%) reported previous telehealth use. Predisposing factors associated with lower telehealth use included race or ethnicity (non-Hispanic Black: AOR 0.38, 95% CI 0.2-0.8; Hispanic: AOR 0.21, 95% CI 0.06-0.7) and part-time employment (AOR 0.33, 95% CI 0.1-0.9) vs full-time employment, whereas educational attainment above or below a high school degree was associated with higher odds of telehealth use (AORs 2.7-3.2). Enabling factors showed that lower comfort with Zoom was associated with lower telehealth use (AOR 0.5, 95% CI 0.2-0.9), whereas home internet access was common and not independently significant in adjusted models. Neighborhood socioeconomic disadvantages, social vulnerability, and rurality did not demonstrate significant associations. Needs factors indicated that longer CLBP duration was positively associated with telehealth experience (>5 y: AOR 3.5, 95% CI 1.4-8.8). Other patient-reported outcomes, comorbidity burden, and surgical history were not significantly associated. In a safety-net and federally qualified health center context, prior telehealth experience was common among patients with CLBP willing to enroll in a telehealth-delivered MBSR trial. Although certain predisposing factors (race or ethnicity, employment status) were associated with lower odds of telehealth experience, these factors did not prevent trial enrollment. Targeted outreach to improve digital comfort and inclusive engagement strategies may further reduce disparities and support broader implementation of telehealth for CLBP.

Cognitive changes after treatment of ruptured anterior communicating artery (AComA) aneurysms have been recognized for decades. Whether such deficits occur after elective treatment of unruptured aneurysms remains uncertain. A systematic search in MEDLINE (via PubMed and via Ovid), Embase, Scopus, Web of Science, CENTRAL and PsycINFO was conducted from inception to 31 August 2025, in accordance with PRISMA guidelines. Duplicate records were removed prior to screening. Studies were eligible if they included adult patients undergoing elective treatment of at least 1 unruptured AComA aneurysm, reported pre- and post-treatment neurocognitive testing across at least one cognitive subdomain, and differentiated outcomes from other aneurysm locations. Critical appraisal was performed using the Newcastle-Ottawa Scale, and certainty of evidence was assessed using the GRADE framework. Eight studies comprising 95 patients were included. In most studies, patients underwent surgical clipping (n = 82), with a minority treated endovascularly (n = 13). In five out of eight studies, patients who underwent elective treatment of an AComA aneurysm had worse cognitive outcomes than patients with aneurysms at non-AComA locations. Neurocognitive deficits may be detected in a substantial proportion of patients undergoing elective treatment of unruptured AComA aneurysms when sensitive neuropsychological assessment is applied. However, the current evidence base is limited by small sample sizes, heterogeneity in neuropsychological assessment, and a predominance of surgically treated cases.

The bladder is innervated by a complex network of sensory neurons that detect and transmit mechanical and chemical signals to the central nervous system, regulating both urine storage and voiding, and mediating sensations of bladder fullness and pain. While stretch-sensitive afferents within the bladder wall are known to monitor bladder tension, the contribution of stretch-insensitive afferents that reside within the bladder mucosa to bladder sensation and function remains unclear. Here, we establish a mouse model of selective bladder mucosal afferent denervation using intravesical instillation of resiniferatoxin to define the functional roles of these fibers in health and disease. We assessed the impact of mucosal denervation on sensory nerve activity and bladder function in healthy mice and in a model of urinary tract infection (UTI) induced by acute bacterial challenge with uropathogenic Escherichia coli. We show that mucosa-innervating afferents do not influence bladder distension responses or voiding function under healthy conditions. In contrast, during UTI, these afferents become hypersensitive and serve as important drivers of infection-induced pelvic pain and urinary frequency, responses that contribute to bacterial clearance. Together, these findings identify bladder mucosal afferents as key sensors of pathogenic challenge and reveal a previously unrecognized mechanism that drives behavioral responses to reduce the burden and extent of UTI.