https://hdl.handle.net/2123/7297 2026-06-07T09:02:39Z https://hdl.handle.net/2123/34939 The Sydney Textbook of Psychiatry Boyce, Philip Manley; Harris, Anthony Walter Forster; Malhi, Gin S. The Sydney Textbook of Psychiatry is an essential resource for medical students and healthcare professionals. It offers a succinct and practical introduction to mental health. Key Features: Broad Curriculum: This textbook provides critical knowledge and skills necessary for effective psychiatric practice, equipping readers with a practical knowledge of key concepts in general adult psychiatry, and in addition, child and adolescent psychiatry, old age psychiatry, consultation-liaison psychiatry and addiction medicine. Clinical Skills Development: The essential clinical skills of how to conduct psychiatric interviews, perform mental state examinations, and formulate thorough patient assessments are emphasised. In-Depth Exploration of Disorders: Detailed information from content experts allow you to dive deep into major psychiatric disorders, including schizophrenia, anxiety disorders, and mood disorders, with comprehensive coverage of diagnostic criteria, causal factors, and treatment options. Diverse Populations: Understand the unique considerations for various groups across the age span including indigenous and culturally diverse communities ensuring trauma aware, culturally sensitive and age-appropriate care. Evidence-Based Treatments: A treatment approach that is grounded in a bio-psycho-socio-cultural understanding of the person. It explores the wide range of evidence-based treatments available including psychological, pharmacological, physical and social interventions. Self-Care Guidance: Recognising the emotional challenges inherent in psychiatric practice, this book addresses self-care for medical students and other health professionals, offering strategies to maintain personal well-being. 2024-01-01T00:00:00Z https://hdl.handle.net/2123/34222 Sexual and Reproductive Health of Rohingya Refugees In Bangladesh: A Systematic Review Hossain, Muhammad Anwar; Shailendra, Sawleshwarkar; Iryna, Zablotska-Manos Introduction: The Rohingya refugees in Bangladesh, a severely persecuted ethnic minority of Myanmar, face numerous challenges related to their sexual and reproductive health (SRH), including access to appropriate services. This systematic review examines the SRH status of Rohingya refugee women in Bangladesh, focusing on barriers to accessing SRH services and interventions to address their specific SRH needs. Methods: Following PRISMA guidelines, a systematic search was conducted across databases, including PubMed, CINAHL, Embase, Web of Science, and Scopus, as well as gray literature, from August 2017 to July 2023. Both quantitative and qualitative studies were included, with data extraction and analysis performed independently by two authors using a narrative synthesis approach. Results: Out of 394 citations, ten studies met the criteria. The findings revealed that 48.9% of Rohingya women were unaware of SRH service access, only 11% received frequent (once fortnightly) visits by family planning personnel, 70% lacked knowledge about HIV/STIs, and over two-thirds believed that family planning required husband approval. The prevalence of contraceptive use was 50.9%, with cultural and religious beliefs and gender dynamics significantly influencing family size decisions. Discussion: Cultural preferences impacted family size decisions, and limited awareness of permanent birth control widened the SRH education gap. The review emphasizes the need for comprehensive, community-based interventions, including door-to-door visits, culturally tailored outreach programs, and SRH education within refugee camps. To address the SRH needs of Rohingya women, adopting a multifaceted approach that promotes SRH education, improves service accessibility, and empowers women to make informed reproductive choices is essential. 2025-01-01T00:00:00Z https://hdl.handle.net/2123/33826 The Role of Artificial Intelligence in Diagnostic Neurosurgery: A Systematic Review. Li, William; Gumera, Armand; Surya, Shrusthi This is a poster presentation at the Royal Australasian College of Surgeon's 93rd Annual Scientific Congress. This is based at the International Convention Centre based in Darling Harbour Sydney on the 3rd to 6th of May. As attached in supplementary files is the poster, correspondence that our poster has been accepted and is to be presented, and the ticket cost of attending one day of this conference. This research was done under the guidance of Professor Behzad Eftikhar, a professor of neurosurgery at Sydney University, based at Nepean Hospital. 2025-04-17T00:00:00Z https://hdl.handle.net/2123/29654 The changing dynamics of HIV/AIDS during the COVID-19 pandemic in the Rohingya refugee camps in Bangladesh -a call for action Hossain, Muhammad Anwar; Zablotska-Manos, Iryna The COVID-19 pandemic has affected every country's health service and plunged refugees into the most desperate conditions. The plight of Rohingya refugees is among the harshest. COVID-19 has severely affected their existing HIV/STI prevention and management services and further increased the risk of violence and onward HIV transmission within the camps. In this commentary, we discuss the context and the changing dynamics of HIV/AIDS during COVID-19 pandemic, among the Rohingya refugee community in Bangladesh. What we currently observe is the worst crisis in the Rohingya refugee camps thus far. Because of being displaced, Rohingya refugees have increased vulnerability to HIV, STIs and other poor health outcomes. They have inadequate access to HIV testing, treatment, and care. Their host country has poor capacity to provide services. Complex economic, socio-cultural and behavioural factors exacerbate their poor access to HIV testing, treatment, and care. The unfolding COVID-19 pandemic has changed priorities in the Rohingya refugee camps so that more emphasis is being placed on COVID-19 prevention and treatment rather than other health issues. This exacerbates the already dire situation with HIV detection, management, and prevention among the refugees.Although the government of Bangladesh and different non-governmental organisations provide harm reduction, HIV care, and COVID-19 care to refugees, a comprehensive response is needed to maintain and strengthen health programs for refugees, for both HIV and COVID-19 care. This comprehensive response should include behavioural intervention, community mobilisation, and effective treatment and care. Without addressing the disadvantage of social conditions, it will be challenging to reduce the burden of HIV and COVID-19 among refugees. While the COVID-19 crisis is a global challenge, the international community has an obligation to improve the life, livelihood and health of those who are most vulnerable. Rohingya refugees are among them. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/29644 A Systematic review of sexual and reproductive health needs, experiences, access to services, and interventions among the rohingya and the afghan refugee women of reproductive age in Asia Hossain, Muhammad Anwar; Dawson, Angela Introduction: Approximately 9.2 million refugees live in Asia, with most originating from Afghanistan and Myanmar, and half of them are women, girls, and children. Humanitarian crises disrupt the existing health-care system, limiting access to sexual and reproductive health (SRH) services. This review explores the SRH status of Afghan and Rohingya refugee women of reproductive age in Asia and their needs and experiences in accessing these services and commodities. Materials and Methods: We used the PRISMA checklist and searched for qualitative and quantitative peer-reviewed studies from five online bibliographic databases, SCOPUS, EMBASE (Ovid), MEDLINE (Ovid), CINAHL, and PROQUEST, from January 2000 to April 2021. Content analysis was undertaken following the minimum initial service package objectives. Results: Fifteen studies were included in this review from four countries: Bangladesh (5), Pakistan (5), Iran (4), and Malaysia (1). Approximately 50.91% of Rohingya and 54% of Afghan refugee women used contraceptives. About 56.6% of Afghan refugee mothers experienced pregnancy-related complications, one-third received antenatal care, and low birth weight was 2.6 times higher among infants born to Afghan refugee mothers than to Pakistani-born mothers. One out of five Rohingya women received delivery-related care. Approximately 72% of Rohingya and 79.8% of Afghan refugee women had experienced gender-based violence, and 56.5% of Rohingya women engaged in unwanted sexual intercourse with their husbands. Conclusion: Social norms, stigma, cultural values, distrust of providers, inadequate staff, and prohibition by family members limit their access to SRH services and influence their needs, knowledge, and perceptions regarding SRH. Keywords: Afghan, Asia, minimum initial service package, refugee, Rohingya, sexual and reproductive health 2022-01-01T00:00:00Z https://hdl.handle.net/2123/29146 Personality dimensions and disorders and coping with the COVID-19 pandemic Starcevic, V.; Janca, A. Purpose of review The COVID-19 pandemic has tested people's coping and resilience. This article reviews research and scholarly work aiming to shed more light on personality-based factors that account for adjustment to the pandemic situation. Recent findings Most studies relied on a cross-sectional design and were conducted using personality dimensions based on the Big Five personality model. Findings suggest that high levels of neuroticism constitute a risk for pandemic-induced distress and poor overall coping. People with prominent extraversion, conscientiousness or agreeableness have generally demonstrated a good adjustment to the pandemic, including compliance with containment and mitigation measures imposed by the authorities to limit the spread of COVID-19. A few studies of individuals with borderline personality disorder identified social isolation as the most destabilising factor for them. Poor compliance with containment and mitigation measures has been strongly associated with various antisocial personality traits. Summary Personality-based factors account for some individual differences in coping with both COVID-19-related threat and distress and requirements to comply with containment and mitigation measures. Better understanding of these factors could contribute to a more effective adjustment to the challenges of future public health crises. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/29017 Hospital-treated intentional self-poisoning events and in-hospital mortality in Tehran before and during the COVID-19 pandemic Hadeiy, Seyed Kaveh; Gholami, Narges; McDonald, Rebecca; Rezaei, Omidvar; Kolahi, Ali-Asghar; Zamani, Nasim; Shamsi-Lahijani, Alireza; Noghrehchi, Firouzeh; Carter, Gregory; Hassanian-Moghaddam, Hossein Abstract Hospital-treated intentional self-poisoning is common. The possibility of changed (increased) suicidal behaviors during the COVID-19 pandemic has been raised. To compare frequencies in self-poisoning events (SPEs) and the proportions with in-hospital mortality, in the year prior to and following the official onset of the COVID-19 pandemic, in a population of hospital-treated self-poisoning patients in Iran. All self-poisoned patients admitted to Loghman-Hakim Hospital, a clinical toxicology specialty hospital in Tehran, were included. The frequency of SPEs was compared between the one-year periods immediately before and after the onset of COVID-19 pandemic using Poisson regression. Differences in proportions of in-hospital mortality were also compared using logistic regression. A total of 14,478 patients with 15,391 SPEs (8,863 [61.2%] females) were evaluated in the study. There was no difference in the overall frequency of SPEs (relative risk [RR] of 0.99 [CI95% 0.96–1.03]), but a small increase in males (RR 1.07; 1.02–1.13) and a minor decrease in females (RR 0.95; 0.91–0.99). In total, 330 patients died (2.3% of all SPEs). There was no difference in overall in-hospital mortality odds ratio (OR: 0.98 [0.79–1.22]), in females (OR = 1.14 [0.80–1.60]) or males (OR = 0.92 [0.69–1.23]). There was no change in the frequency of SPEs and no difference in the in-hospital mortality proportions, suggesting that the COVID-19 pandemic had little or no effect on these aspects of suicidal behavior in Iran. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/29008 Factors influencing refugees’ willingness to accept COVID‐19 vaccines in Greater Sydney: a qualitative study Mahimbo, Abela; Kang, Melissa; Sestakova, Lidija; Smith, Mitchell; Dawson, Angela OBJECTIVES: Achieving high vaccination coverage is a critical strategy to reducing the spread of COVID-19 infection. This study, undertaken before the Delta variant outbreak, aimed to understand potential drivers and barriers influencing COVID-19 vaccine uptake for refugees. METHODS: Four focus group interviews were conducted with 37 refugees from four language groups (Arabic, Dari, Dinka and Karen). Data were analysed thematically. RESULTS: Willingness to accept COVID-19 vaccines was associated with participants' perceptions of disease severity, and benefits such as increased immunity against COVID-19 disease and prevention of the spread of the disease. Cues for increasing individual willingness to get vaccinated included obtaining information from trusted sources and community engagement. By contrast, information gaps on vaccines compounded by misinformation on social media contributed to a reluctance to be vaccinated. CONCLUSION: As this study was conducted before the Delta variant outbreak, participants' stance on COVID-19 vaccines may have changed. However, addressing vaccine literacy needs for this group remains an on-going priority. Health promotion initiatives must be tailored to the different socio-cultural contexts of each community. IMPLICATIONS FOR PUBLIC HEALTH: Engagement with refugee populations is critical for optimising access and uptake of vaccines to protect health, prevent death and ensure that control of the pandemic is equitable. This may also provide valuable public health lessons for other marginalised populations. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/28998 COVID-19 IDD: Findings from a global survey exploring family members’ and paid staff’s perceptions of the impact of COVID-19 on individuals with intellectual and developmental disabilities (IDD) and their caregivers. Linehan, Christine; Birkbeck, Gail; Araten-Bergman, Tal; Baumbusch, Jennifer; Beadle-Brown, Julie; Bigby, Christine; Bradley, Valerie; Brown, Michael; Bredewold, Femmianne; Chirwa, Masauso; Cui, Jialiang; Gimenez, Marta Godoy; Gomeiro, Tiziano; Kanova, Šárka; Kroll, Thilo; Li, Henan; MacLachlan, Mac; Narayan, Jayanthi; Nearchou, Finiki; Nolan, Adam; O'Donovan, Mary-Ann; Santos, Flavia H; Šiška, Jan; Stainton, Tim; Tideman, Magnus; Tossebro, Jan Background: A growing body of evidence attests to the disproportionate impact of COVID-19 on persons with intellectual and developmental disabilities (IDD) during the pandemic. This study asked caregivers about their perceptions of how COVID-19 impacted them and the people they support. Method: An online survey was conducted in 12 countries during August-September 2020 and sought information on demographics, support practices, information and training, experiences of COVID-19, social distancing, and wellbeing, as measured by the DASS12. This study reports on 3,754 family members, direct support professionals, and managers who participated in the survey. Results: Caregivers observed increases in depression/anxiety, stereotyped behaviours, aggression towards others and weight gain in the person(s) they supported. They also reported difficulties supporting the person(s) to access healthcare. Families reported reducing or ceasing employment and absorbed additional costs when supporting their family member. Direct support professionals experienced changes in staff shifts, staff absences, increased workload and hiring of casual staff. Caregivers' wellbeing revealed high levels of stress, depression, and less so anxiety. The strongest predictor of wellbeing among families was observation of changes in mood in the person(s) they supported, while for direct support professionals, the strongest predictors of wellbeing were reorganisation of staff shifts and increases in new direct support staff. Discussion: Findings support the contention of this population experiencing a disproportionate burden during the COVID-19 pandemic, reflecting historical inequities in access to healthcare and other human rights violations which are now protected under the United Nations Convention on the Rights of Persons with Disabilities. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/28986 SARS-CoV-2 Within-Host and in vitro Genomic Variability and Sub-Genomic RNA Levels Indicate Differences in Viral Expression Between Clinical Cohorts and in vitro Culture Agius, Jessica E.; Johnson-Mackinnon, Jessica C.; Fong, Winkie; Gall, Mailie; Lam, Connie; Basile, Kerri; Kok, Jen; Arnott, Alicia; Sintchenko, Vitali; Rockett, Rebecca J. Background: Low frequency intrahost single nucleotide variants (iSNVs) of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) have been increasingly recognised as predictive indicators of positive selection. Particularly as growing numbers of SARS-CoV-2 variants of interest (VOI) and concern (VOC) emerge. However, the dynamics of subgenomic RNA (sgRNA) expression and its impact on genomic diversity and infection outcome remain poorly understood. This study aims to investigate and quantify iSNVs and sgRNA expression in single and longitudinally sampled cohorts over the course of mild and severe SARS-CoV-2 infection, benchmarked against an in vitro infection model. Methods: Two clinical cohorts of SARS-CoV-2 positive cases in New South Wales, Australia collected between March 2020 and August 2021 were sequenced. Longitudinal samples from cases hospitalised due to SARS-CoV-2 infection (severe) (n = 16) were analysed and compared with cases that presented with SARS-CoV-2 symptoms but were not hospitalised (mild) (n = 23). SARS-CoV-2 genomic diversity profiles were also examined from daily sampling of culture experiments for three SARS-CoV-2 variants (Lineage A, B.1.351, and B.1.617.2) cultured in VeroE6 C1008 cells (n = 33). Results: Intrahost single nucleotide variants were detected in 83% (19/23) of the mild cohort cases and 100% (16/16) of the severe cohort cases. SNP profiles remained relatively fixed over time, with an average of 1.66 SNPs gained or lost, and an average of 4.2 and 5.9 low frequency variants per patient were detected in severe and mild infection, respectively. sgRNA was detected in 100% (25/25) of the mild genomes and 92% (24/26) of the severe genomes. Total sgRNA expressed across all genes in the mild cohort was significantly higher than that of the severe cohort. Significantly higher expression levels were detected in the spike and the nucleocapsid genes. There was significantly less sgRNA detected in the culture dilutions than the clinical cohorts. Discussion and Conclusion: The positions and frequencies of iSNVs in the severe and mild infection cohorts were dynamic overtime, highlighting the importance of continual monitoring, particularly during community outbreaks where multiple SARS-CoV-2 variants may co-circulate. sgRNA levels can vary across patients and the overall level of sgRNA reads compared to genomic RNA can be less than 1%. The relative contribution of sgRNA to the severity of illness warrants further investigation given the level of variation between genomes. Further monitoring of sgRNAs will improve the understanding of SARS-CoV-2 evolution and the effectiveness of therapeutic and public health containment measures during the pandemic. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/28442 Determinants of passive antibody effectiveness in SARS-CoV-2 infection Stadler, Eva; Chai, Khai Li; Schlub, Timothy E; Cromer, Deborah; Polizzotto, Mark N; Kent, Stephen J; Skoetz, Nicole; Estcourt, Lise; McQuilten, Zoe K; Wood, Erica M; Khoury, David S; Davenport, Miles P Neutralising antibodies are an important correlate of protection from SARS-CoV-2 infection. Multiple studies have investigated the effectiveness of passively administered antibodies (either monoclonal antibodies, convalescent plasma or hyperimmune immunoglobulin) in preventing acquisition of or improving the outcome of infection. Comparing the results between studies is challenging due to different study characteristics including disease stage, trial enrolment and outcome criteria, and different product factors, including administration of polyclonal or monoclonal antibody, and antibody targets and doses. Here we integrate data from 37 randomised controlled trials to investigate how the timing and dose of passive antibodies predicts protection from SARS-CoV-2 infection. We find that both prophylactic and early therapeutic administration (to symptomatic ambulant subjects) have significant efficacy in preventing infection or progression to hospitalisation respectively. However, we find that effectiveness of passive antibody therapy in preventing clinical progression is significantly reduced with administration at later clinical stages (p<0.0001). To compare the dose-response relationship between different treatments, we normalise the administered antibody dose to the predicted neutralisation titre (after dilution) compared to the mean titre observed in early convalescent subjects. We use a logistic model to analyse the dose-response curve of passive antibody administration in preventing progression from symptomatic infection to hospitalisation. We estimate a maximal protection from progression to hospitalisation of 70.2% (95% CI: 62.1 - 78.3%). The dose required to achieve 50% of the maximal effect (EC-50) for prevention of progression to hospitalisation was 0.19-fold (95% CI: 0.087 - 0.395) of the mean early convalescent titre. This suggests that for current monoclonal antibody regimes, doses between 7- and >1000-fold lower than currently used could still achieve around 90% of the current effectiveness (depending on the variant) and allow much more widespread use at lower cost. For convalescent plasma, most current doses are lower than required for high levels of protection. This work provides a framework for the rational design of future passive antibody prophylaxis and treatment strategies for COVID-19. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/28409 Clonal dynamics of SARS-CoV-2-specific T cells in children and adults with COVID-19 Khoo, Weng Hua; Jackson, Katherine; Phetsouphanh, Chansavath; Zaunders, John J.; Alquicira-Hernandez, José; Yazar, Seyhan; Ruiz-Diaz, Stephanie; Singh, Mandeep; Dhenni, Rama; Kyaw, Wunna; Tea, Fiona; Merheb, Vera; Lee, Fiona X. Z.; Burrell, Rebecca; Howard-Jones, Annaleise; Koirala, Archana; Zhou, Li; Yuksel, Aysen; Catchpoole, Daniel R.; Lai, Catherine L.; Vitagliano, Tennille L.; Rouet, Romain; Christ, Daniel; Tang, Benjamin; West, Nicholas P.; George, Shane; Gerrard, John; Croucher, Peter I.; Kelleher, Anthony D.; Goodnow, Christopher G.; Sprent, Jonathan D.; Powell, Joseph D.; Brilot, Fabienne; Nanan, Ralph; Hsu, Peter S.; Deenick, Elissa K.; Britton, Philip N.; Phan, Tri Giang SUMMARY Children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develop less severe coronavirus disease 2019 (COVID-19) than adults. The mechanisms for the age-specific differences and the implications for infection-induced immunity are beginning to be uncovered. We show by longitudinal multimodal analysis that SARS-CoV-2 leaves a small footprint in the circulating T cell compartment in children with mild/asymptomatic COVID-19 compared to adult household contacts with the same disease severity who had more evidence of systemic T cell interferon activation, cytotoxicity and exhaustion. Children harbored diverse polyclonal SARS-CoV- 2-specific naïve T cells whereas adults harbored clonally expanded SARS-CoV-2-specific memory T cells. More naïve interferon-activated CD4+ T cells were recruited into the memory compartment and recovery was associated with the development of robust CD4+ memory T cell responses in adults but not children. These data suggest that rapid clearance of SARS-CoV-2 in children may compromise their cellular immunity and ability to resist reinfection. HIGHLIGHTS: Children have diverse polyclonal SARS-CoV-2-specific naïve T cells, Adults have clonally expanded exhausted SARS-CoV-2-specific memory T cells, Interferon-activated naïve T cells differentiate into memory T cells in adults but not children, Adults but not children develop robust memory T cell responses to SARS-CoV-2 2022-01-01T00:00:00Z https://hdl.handle.net/2123/28378 Translaryngeal ultrasound in thyroid surgery: state of the art review Phung, Daniel; Fradet, Laurent; Riffat, Faruque; Novakovic, Daniel; Elliott, Michael Sowden; Nguyen, Kevin; Makeham, John; Palme, Carsten Erich BACKGROUND: Clinical voice assessment prior to thyroid and parathyroid surgery is essential, but the paradigm of indirect laryngoscopy (IDL), when indicated, has been challenged by the risk of aerosolised SARS-Cov-2 during endoscopy of the aerodigestive tract. Translaryngeal ultrasound (TLUS) to assess the vocal cords has been proposed as a safe, non-invasive and sensitive alternative. The aim of this review was to verify TLUS as a viable tool for perioperative laryngeal assessment. METHOD: A literature review was performed using Medline, Embase, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials and Scopus with the following search strategy: (vocal cord OR vocal fold OR glottic OR glottis OR vocal ligaments OR rima glottidis) AND (ultras* OR sonograph* OR echography OR echotomography). RESULTS: Fifteen studies were included in this review. All studies compared TLUS to IDL in visualizing the vocal cords in adults. Ten studies compared pre-operative TLUS to IDL where 50.6-100% of vocal cords were successfully visualized. Nine studies compared post-operative TLUS to IDL and reported visualization between 39.6% and 100%. Pre- and post-operative negative predictive values ranged from 60% to 100%. CONCLUSION: Whilst promising, successful visualization of the cords is limited by inter-user variability, older age and male gender. Thus, we see the role of TLUS as an alternative to IDL in the post-operative setting in the young patient following uncomplicated surgery with a normal voice on clinical examination, to confirm recurrent laryngeal nerve integrity while minimizing the risk of aerosolization. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/28371 Obesity in children and adolescents: epidemiology, causes, assessment, and management Jebeile, Hiba; Kelly, Aaron S; O'Malley, Grace; Baur, Louise A This Review describes current knowledge on the epidemiology and causes of child and adolescent obesity, considerations for assessment, and current management approaches. Before the COVID-19 pandemic, obesity prevalence in children and adolescents had plateaued in many high-income countries despite levels of severe obesity having increased. However, in low-income and middle-income countries, obesity prevalence had risen. During the pandemic, weight gain among children and adolescents has increased in several jurisdictions. Obesity is associated with cardiometabolic and psychosocial comorbidity as well as premature adult mortality. The development and perpetuation of obesity is largely explained by a bio-socioecological framework, whereby biological predisposition, socioeconomic, and environmental factors interact together to promote deposition and proliferation of adipose tissue. First-line treatment approaches include family-based behavioural obesity interventions addressing diet, physical activity, sedentary behaviours, and sleep quality, underpinned by behaviour change strategies. Evidence for intensive dietary approaches, pharmacotherapy, and metabolic and bariatric surgery as supplemental therapies are emerging; however, access to these therapies is scarce in most jurisdictions. Research is still needed to inform the personalisation of treatment approaches of obesity in children and adolescents and their translation to clinical practice. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/28325 Risk factors, contemporary challenges and psychological well_being of the Rohingya refugees in Bangladesh: Policy implications Hossain, Muhammad Anwar; Huda, Nazmul; Ullah, A. K. M Ahsan; Renzaho, Andre Over the last few years, the number of Rohingya refugees in Bangladesh has increased exponentially. On arrival, they experience poor mental health and psychological well-being. This commentary explores the risk factors and contemporary challenges that deteriorate Rohingyas' psychological well-being in Bangladesh. The onslaught of Covid-19 compounds the pre-existing psychological health conditions of the Rohingyas living in cramped and flimsy camps. The recent relocation to Bhashan Char may likely trigger tensions and eventually exacerbates their existing psychological well-being. The relocation to Bhashan Char has presumably happened against their volition. Meanwhile, the Myanmar military's coup has added additional fear about their bleak future of a safe and dignified return from Bangladesh to Myanmar. All these have contributed to the worsening of their existing psychological well-being. In order to subside their psychological health challenges, this commentary suggests: (a) the immediate execution of 'National Deployment and Vaccination Plan for Covid-19 Vaccines and initiation of vaccine rollout among the refugees; and (b) involving Rohingyas in economic activities and making them a self-reliant and economically empowered community. We suggest that safe and dignified repatriation is the only solution to the challenges they have been going through in Bangladesh and to preserve their psychological well-being. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/28293 INTERNATIONAL IMPACT OF THE COVID-19 PANDEMIC LOCKDOWN ON INTRAVITREAL THERAPY OUTCOMES Zarranz-Ventura, Javier; Nguyen, Vuong; Creuzot-Garcher, Catherine; Verbraak, Frank; O'Toole, Louise; Invernizzi, Alessandro; Viola, Francesco; Squirrel, David; Barthelmes, Daniel; Gillies, Mark C. PURPOSE: To evaluate the impact of the COVID-19 pandemic lockdowns on the outcomes of eyes treated for neovascular age-related macular degeneration, diabetic macular edema, and retinal vein occlusion in eight countries. METHODS: A multicenter international database study of 5,782 eyes (4,708 patients) receiving intravitreal antivascular endothelial growth factor injections before, during, and after national lockdowns. The baseline visit was defined as the last visit within 3 months before lockdown, and prelockdown and postlockdown periods were defined as 6 months before and after the lockdown date. RESULTS: Eyes with neovascular age-related macular degeneration (n = 4,649) lost vision in all countries in proportion to the reduced number of injections. The mean visual acuity change postlockdown ranged from -0.4 to -3.8 logarithm of the minimum angle of resolution letters, and the median number of injections/visits decreased from 4-5/4-7 to 2-4/2-4 postlockdown. The diabetic macular edema (n = 654) and retinal vein occlusion (n = 479) eyes' mean visual acuity change ranged from -2.8 to +1.7 letters and -1.6 to +0.1 letters, and the median number of injections/visits decreased from 2.5-5/4-6 to 1-3/2-4 and from 3-5.5/4-5 to 1-3.5/2-3.5, respectively. The 6-month dropout rates postlockdown were 20% for neovascular age-related macular degeneration, 27% for diabetic macular edema, and 28% for retinal vein occlusion. CONCLUSION: This international study provides estimates of the impact of COVID-19 pandemic lockdown on intravitreal therapy and suggests that prioritizing neovascular age-related macular degeneration eyes seems appropriate. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/28289 Gaming disorder and the COVID-19 pandemic: Treatment demand and service delivery challenges. King, Daniel L; Achab, Sophia; Higuchi, Susumu; Bowden-Jones, Henrietta; Müller, Kai W; Billieux, Joël; Starcevic, Vladan; Saunders, John B; Tam, Philip; Delfabbro, Paul H Gaming activities have conferred numerous benefits during the COVID-19 pandemic. However, some individuals may be at greater risk of problem gaming due to disruption to adaptive routines, increased anxiety and/or depression, and social isolation. This paper presents a summary of 2019-2021 service data from specialist addiction centers in Germany, Switzerland, Japan, and the United Kingdom. Treatment demand for gaming disorder has exceeded service capacity during the pandemic, with significant service access issues. These data highlight the need for adaptability of gaming disorder services and greater resources and funding to respond effectively in future public health crises. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/28246 The COVID-19 pandemic and access to health care in people with chronic kidney disease: A systematic review and meta_analysis Deng, Danny; Liang, Amy; Chui, Juanita N.; Wong, Germaine; Cooper, Tess E. Aim: This systematic review aims to evaluate the effect of the COVID-19 pandemic on access to health care for patients with CKD. Methods MEDLINE and EMBASE databases were searched up to July 2021 (PROSPERO CRD42021230831). Data relevant to access to health care before and during the COVID-19 pandemic were extracted, including outcomes related to access to general nephrology consultations, telehealth, dialysis services and kidney transplantations. Relative and absolute effects were pooled using a random effects model to account for between-study heterogeneity. Risk of bias was assessed using a modified Quality in Prognostic Studies tool. The certainty of the evidence was rated using the GRADE approach. Results Twenty-three studies across five WHO regions were identified. Reductions in transplantation surgeries were observed during the COVID-19 pandemic compared with the pre-COVID-19 era (risk ratio=2.15, 95%CI=1.51-3.06, I2=90%, p<.001). Additionally, six studies reported increased use of telehealth services compared with pre-COVID-19 times. Four studies found reduced access to in-person general nephrology services and six studies reported interruptions to dialysis services during the COVID-19 pandemic. Conclusion Our findings suggest COVID-19 pandemic may have led to reductions in access to kidney transplantation, dialysis and in-person nephrology care. Meanwhile, whilst the use of telehealth has emerged as a promising alternate mode of health care delivery, its utility during the pandemic warrants further investigation. This study has highlighted major barriers to accessing care in a highly vulnerable chronic disease group. 2022-01-01T00:00:00Z https://hdl.handle.net/2123/27043 SARS-CoV-2 variants: levels of neutralisation required for protective immunity Cromer, Deborah; Steain, Megan; Reynaldi, Arnold; Schlub, Timothy E; Wheatley, Adam K; Juno, Jennifer A; Kent, Stephen J; Triccas, James A; Khoury, David S; Davenport, Miles P Abstract A number of SARS-CoV-2 variants of concern (VOC) have been identified that partially escape serum neutralisation activity elicited by current vaccines. Recent studies have also shown that vaccines demonstrate reduced protection against symptomatic infection with SARS-CoV-2 variants. Here we integrate published data on in vitro neutralisation and clinical protection to understand and predict vaccine efficacy against existing SARS-CoV-2 variants. We find that neutralising activity against the ancestral SARS-CoV-2 is highly predictive of neutralisation of the VOC, with all vaccines showing a similar drop in neutralisation to the variants. Neutralisation levels remain strongly correlated with protection from infection with SARS-CoV-2 VOC (r=0.81, p=0.0005). We apply an existing model relating in vitro neutralisation to protection (parameterised on data from ancestral virus infection) and find this remains predictive of vaccine efficacy against VOC once drops in neutralisation to the VOC are taken into account. Modelling of predicted vaccine efficacy against variants over time suggests that protection against symptomatic infection may drop below 50% within the first year after vaccination for some current vaccines. Boosting of previously infected individuals with existing vaccines (which target ancestral virus) has been shown to significantly increase neutralising antibodies. Our modelling suggests that booster vaccination should enable high levels of immunity that prevent severe infection outcomes with the current SARS-CoV-2 VOC, at least in the medium term. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/27042 Neutralising antibody titres as predictors of protection against SARS-CoV-2 variants and the impact of boosting: a meta-analysis Cromer, Deborah; Steain, Megan; Reynaldi, Arnold; Schlub, Timothy E; Wheatley, Adam K; Juno, Jennifer A; Kent, Stephen J; Triccas, James A; Khoury, David S; Davenport, Miles P Background Several SARS-CoV-2 variants of concern have been identified that partly escape serum neutralisation elicited by current vaccines. Studies have also shown that vaccines demonstrate reduced protection against symptomatic infection with SARS-CoV-2 variants. We explored whether in-vitro neutralisation titres remain predictive of vaccine protection from infection with SARS-CoV-2 variants. Methods In this meta-analysis, we analysed published data from 24 identified studies on in-vitro neutralisation and clinical protection to understand the loss of neutralisation to existing SARS-CoV-2 variants of concern. We integrated the results of this analysis into our existing statistical model relating in-vitro neutralisation to protection (parameterised on data from ancestral virus infection) to estimate vaccine efficacy against SARS-CoV-2 variants. We also analysed data on boosting of vaccine responses and use the model to predict the impact of booster vaccination on protection against SARS-CoV-2 variants. Findings The neutralising activity against the ancestral SARS-CoV-2 was highly predictive of neutralisation of variants of concern. Decreases in neutralisation titre to the alpha (1·6-fold), beta (8·8-fold), gamma (3·5-fold), and delta (3·9-fold) variants (compared to the ancestral virus) were not significantly different between different vaccines. Neutralisation remained strongly correlated with protection from symptomatic infection with SARS-CoV-2 variants of concern (r S=0·81, p=0·0005) and the existing model remained predictive of vaccine efficacy against variants of concern once decreases in neutralisation to the variants of concern were incorporated. Modelling of predicted vaccine efficacy against variants over time suggested that protection against symptomatic infection might decrease below 50% within the first year after vaccination for some vaccines. Boosting of previously infected individuals with existing vaccines (which target ancestral virus) is predicted to provide a higher degree of protection from infection with variants of concern than primary vaccination schedules alone. Interpretation In-vitro neutralisation titres remain a correlate of protection from SARS-CoV-2 variants and modelling of the effects of waning immunity predicts a loss of protection to the variants after vaccination. However, booster vaccination with current vaccines should enable higher neutralisation to SARS-CoV-2 variants than is achieved with primary vaccination, which is predicted to provide robust protection from severe infection outcomes with the current SARS-CoV-2 variants of concern, at least in the medium term. Funding The National Health and Medical Research Council (Australia), the Medical Research Future Fund (Australia), and the Victorian Government. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/27037 Good Engraftment but Quality and Donor Concerns for Cryopreserved HPC Products Collected During the COVID-19 Pandemic. Purtill, Duncan; Hutchins, Cheryl; Kennedy, Glen; McClean, Andrea; Fraser, Chris; Shaw, Peter J; Chiappini, Paul; Tao, Helen; Ma, David Df; Kabani, Karieshma; Bai, Lijun; Greenwood, Matthew; Bajel, Ashish; O'Flaherty, Elizabeth; Curtis, David J; Purins, Leanne; Perera, Travis; Tan, Sarah; Butler, Andrew; Micklethwaite, Ken; Antonenas, Vicki; Gottlieb, David; Hamad, Nada Changes to donor availability, collection center capacity, and travel restrictions during the early phase of the COVID-19 pandemic led to routine cryopreservation of most unrelated donor products for hematopoietic transplantation prior to the recipient commencing the conditioning regimen. We investigated the effect of this change on unrelated donor product quality and clinical outcomes. Product information was requested from transplantation centers in Australia and New Zealand and clinical outcome data from the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR). In total, 191 products were collected between April 1, 2021, and September 30, 2021, and most (74%) were from international collection centers. Median post-thaw CD34 recovery was 78% (range 25% to 176%) and median post-thaw CD34 viability was 87% (range 34% to 112%). Median time to neutrophil recovery was 17 days (interquartile range 10 to 24 days), and graft failure occurred in 6 patients (4%). These clinical outcomes were similar to those of "fresh" unrelated donor transplants reported to the ABMTRR in 2019. However, recipient transplantation centers reported problems with 29% of products in the form of damage during transit, low cell dose, inadequate labeling, missing representative samples, or missing documentation. These problems were critical in 7 cases (4%). At last follow-up, 22 products (12%) had not been infused. Routine cryopreservation of unrelated donor hemopoietic progenitor cell products has enabled safe continuation of allogeneic transplant services during the COVID-19 pandemic. However, practices for product tracing, documentation, and transportation can be optimized, and measures to reduce the incidence of unused unrelated donor product are required. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/27006 IFI27 transcription is an early predictor for COVID-19 outcomes; a multi-cohort observational study Shojaei, Maryam; Shamshirian, Amir; Monkman, James; Grice, Laura; Tran, Minh; Tan, Chin Wee; Rossi, Gustavo Rodrigues; McCulloch, Timothy R.; Nalos, Marek; Chew, Keng Yih; Zhu, Yanshan; Xia, Yao; Wells, Timothy J.; Senegaglia, Alexandra Cristina; Rebelatto, Carmen Lúcia Kuniyoshi; Franck, Claudio Luciano; dos Santos, Anna Flavia Ribeiro; de Noronha, Lucia; Motamen, Sepideh; Valadan, Reza; Amjadi, Omolbanin; Gogna, Rajan; Madan, Esha; Alizadeh-Navaei, Reza; Lamperti, Liliana; Zuñiga, Felipe; Nova-Lamperti, Estefania; Labarca, Gonzalo; Knippenberg, Ben; Herwanto, Velma; Wang, Ya; Phu, Amy; Chew, Tracy; Kwan, Timothy; Kim, Karan; Teoh, Sally; Pelaia, Tiana M; Kuan, Win Sen; Jee, Yvette; Iredell, Jon; O’Byrne, Ken; Fraser, John F.; Davis, Melissa J.; Belz, Gabrielle; Warkiani, Majid; Gallo, Carlos Salomon; Souza-Fonseca-Guimaraes, Fernando; Nguyen, Quan; Mclean, Anthony; Kulasinghe, Arutha; Short, Kirsty R.; Tang, Benjamin Robust biomarkers that predict disease outcomes amongst COVID-19 patients are necessary for both patient triage and resource prioritisation. Numerous candidate biomarkers have been proposed for COVID-19. However, at present, there is no consensus on the best diagnostic approach to predict outcomes in infected patients. Moreover, it is not clear whether such tools would apply to other potentially pandemic pathogens and therefore of use as stockpile for future pandemic preparedness. We conducted a multi-cohort observational study to investigate the biology and the prognostic role of interferon alpha-inducible protein 27 (IFI27) in COVID-19 patients. We show that IFI27 is expressed in the respiratory tract of COVID-19 patients and elevated IFI27 expression is associated with the presence of a high viral load. We further demonstrate that systemic host response, as measured by blood IFI27 expression, is associated with COVID-19 severity. For clinical outcome prediction (e.g. respiratory failure), IFI27 expression displays a high positive (0.83) and negative (0.95) predictive value, outperforming all other known predictors of COVID-19 severity. Furthermore, IFI27 is upregulated in the blood of infected patients in response to other respiratory viruses. For example, in the pandemic H1N1/09 swine influenza virus infection, IFI27-like genes were highly upregulated in the blood samples of severely infected patients. These data suggest that prognostic biomarkers targeting the family of IFI27 genes could potentially supplement conventional diagnostic tools in future virus pandemics, independent of whether such pandemics are caused by a coronavirus, an influenza virus or another as yet-to-be discovered respiratory virus. We searched the scientific literature using PubMed to identify studies that used the IFI27 biomarker to predict outcomes in COVID-19 patients. We used the search terms “IFI27”, “COVID-19, “gene expression” and “outcome prediction”. We did not identify any study that investigated the role of IFI27 biomarker in outcome prediction. Although ten studies were identified using the general terms of “gene expression” and “COVID-19”, IFI27 was only mentioned in passing as one of the identified genes. All these studies addressed the broader question of the host response to COVID-19; none focused solely on using IFI27 to improve the risk stratification of infected patients in a pandemic. Here, we present the findings of a multi-cohort study of the IFI27 biomarker in COVID-19 patients. Our findings show that the host response, as reflected by blood IFI27 gene expression, accurately predicts COVID-19 disease progression (positive and negative predictive values; 0.83 and 0.95, respectively), outperforming age, comorbidity, C-reactive protein and all other known risk factors. The strong association of IFI27 with disease severity occurs not only in SARS-CoV-2 infection, but also in other respiratory viruses with pandemic potential, such as the influenza virus. These findings suggest that host response biomarkers, such as IFI27, could help identify high-risk COVID-19 patients - those who are more likely to develop infection complications - and therefore may help improve patient triage in a pandemic. This is the first systemic study of the clinical role of IFI27 in the current COVID-19 pandemic and its possible future application in other respiratory virus pandemics. The findings not only could help improve the current management of COVID-19 patients but may also improve future pandemic preparedness. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/27000 SARS-CoV-2-specific IgM screening has low sensitivity for identifying potentially infectious travellers Hasan, Tasnim; Lim, H Ling; Hueston, Linda; Dwyer, Dominic E; O'Sullivan, Matthew 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26547 Special Issue: Travel and Tropical Medicine Rashid, Harunor; Badahdah, Al-Mamoon; Khatami, Ameneh Historically, travel is known to be associated with an amplified risk of acquisition and transmission of infectious diseases, including pandemics [...]. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26532 Senior medical students as assistants in medicine in COVID-19 crisis: a realist evaluation protocol Monrouxe, Lynn V; Hockey, Peter; Khanna, Priya; Klinner, Christiane; Mogensen, Lise; O'Mara, Deborah A; Roach, Abbey; Tobin, Stephen; Davids, Jennifer Ann INTRODUCTION: The assistant in medicine is a new and paid role for final-year medical students that has been established in New South Wales, Australia, as part of the surge workforce management response to the COVID-19 pandemic. Eligibility requires the applicant to be a final-year medical student in an Australian Medical Council-accredited university and registered with the Australian Health Practitioner Regulation Agency. While there are roles with some similarities to the assistant in medicine role, such as assistantships (the UK) and physician assistants adopted internationally, this is completely new in Australia. Little is known about the functionality and success factors of this role within the health practitioner landscape, particularly within the context of the COVID-19 pandemic. Given the complexity of this role, a realist approach to evaluation has been undertaken as described in this protocol, which sets out a study design spanning from August 2020 to June 2021. METHODS AND ANALYSIS: The intention of conducting a realist review is to identify the circumstances and mechanisms that determine the outcomes of the assistant in medicine intervention. We will start by developing an initial programme theory to explore the potential function of the assistant in medicine role through realist syntheses of critically appraised summaries of existing literature using relevant databases and journals. Other data sources such as interviews and surveys with key stakeholders will contribute to the refinements of the programme theory. Using this method, we will develop a set of hypotheses on how and why the Australian assistants in medicine intervention might 'work' to achieve a variety of outcomes based on examples of related international interventions. These hypotheses will be tested against the qualitative and quantitative evidence gathered from all relevant stakeholders. ETHICS AND DISSEMINATION: Ethics approval for the larger study was obtained from the Western Sydney Local Health District (2020/ETH01745). The findings of this review will provide useful information for hospital managers, academics and policymakers, who can apply the findings in their context when deciding how to implement and support the introduction of assistants in medicine into the health system. We will publish our findings in reports to policymakers, peer-reviewed journals and international conferences. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26151 MERS-CoV and Its Impact in the Middle East/Arab World Banik, Gouri R.; Kok, Jen; Rashid, Harunor Middle East respiratory syndrome coronavirus (MERS-CoV) that causes a severe lower respiratory tract infection in humans is considered a pandemic threat to the Gulf region. In this chapter, the latest information on MERS-CoV biology, epidemiology, transmission dynamics, clinical features, diagnosis, treatment, and preventive strategy are summarized. The current epidemiology is characterized by slow and sustained transmission with occasional sparks in the Middle East. Although the transmission cycle of MERS-CoV is not fully understood yet, the dromedary camel is considered to be the intermediate host of the virus and believed to play an important role in the epidemiology of the virus. MERS-CoV is particularly severe in men with comorbidities and rare in children. Several vaccine approaches have shown efficacy in animal models and begun to enter clinical trials. Travellers to the Middle East may benefit from health education on avoidance of exposure to camels and ill persons and refraining from consuming raw camel products. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26127 Off-season RSV epidemics in Australia after easing of COVID-19 restrictions Eden, John-Sebastian; Sikazwe, Chisha; Xie, Ruopeng; Deng, Yi-Mo; Sullivan, Sheena G.; Michie, Alice; Levy, Avram; Cutmore, Elena; Blyth, Christopher C; Britton, Philip N; Crawford, Nigel; Dong, Xiaomin; Dwyer, Dominic E.; Edwards, Kimberly M.; Horsburgh, Bethany A.; Foley, David; Kennedy, Karina; Minney-Smith, Cara; Speers, David; Tulloch, Rachel L.; Holmes, Edward C.; Dhanasekaran, Vijaykrishna; Smith, David W.; Kok, Jen; Barr, Ian G. Human respiratory syncytial virus (RSV) is an important cause of acute respiratory infection (ARI) with the most severe disease in the young and elderly1,2. Non-pharmaceutical interventions (NPIs) and travel restrictions for controlling COVID-19 have impacted the circulation of most respiratory viruses including RSV globally, particularly in Australia, where during 2020 the normal winter epidemics were notably absent3–6. However, in late 2020, unprecedented widespread RSV outbreaks occurred, beginning in spring, and extending into summer across two widely separated states of Australia, Western Australia (WA) and New South Wales (NSW) including the Australian Capital Territory (ACT). Genome sequencing revealed a significant reduction in RSV genetic diversity following COVID-19 emergence except for two genetically distinct RSV-A clades. These clades circulated cryptically, likely localized for several months prior to an epidemic surge in cases upon relaxation of COVID-19 control measures. The NSW/ACT clade subsequently spread to the neighbouring state of Victoria (VIC) and caused extensive outbreaks and hospitalisations in early 2021. These findings highlight the need for continued surveillance and sequencing of RSV and other respiratory viruses during and after the COVID-19 pandemic as mitigation measures introduced may result in unusual seasonality, along with larger or more severe outbreaks in the future. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26125 Pandemic Viruses at Hajj: Influenza and COVID-19 Alfelali, Mohammad; Koul, Parvaiz A.; Rashid, Harunor Hajj is the largest annual mass gathering event on the planet and usually attracts two to three million people from all over the world and is one of the most significant events in the life of a practicing Muslim. Viruses that may cause pandemic outbursts, such as influenza and COVID-19, are important public health threats at Hajj. Influenza, both seasonal and pandemic, has been reported at Hajj at variable frequencies. Preventive measures including vaccination and hand hygiene are known to be beneficial. The vaccination uptake is still suboptimal but improving, and time is ripe to consider using quadrivalent influenza vaccine that provides protection against both lineages of influenza B. In response to COVID-19, Hajj pilgrimage was essentially cancelled in 2020, downscaling to just a few thousand local pilgrims who were required to comply with strict preventive measures including maintaining optimum physical distance from fellow pilgrims, and no case of Hajj-associated COVID-19 has been reported. To combat COVID-19 in the coming years, all evidence-based preventive measures, including hand hygiene and use of personal protective equipment, should be considered for Hajj pilgrims in addition to limiting the number of attendees. The recently approved and rolled out COVID-19 vaccines would be important preventive measures for prospective Hajj pilgrims. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26108 Clinical Teacher Training for health professionals: From blended to online and (maybe) back again? Burgess, Annette; Bansal, Akhil; Clarke, Antonia; Ayton, Tom; Diggele, Christie; Clark, Tyler; Matar, Elie Background The Clinical Teacher Training (CTT) programme was originally developed as an interprofessional, blended learning programme, to support health professionals working across health services within Australia, although it has also been delivered internationally. With the disruption of COVID-19, we rapidly moved to ‘online only’ delivery. We sought to modify the programme, ensuring that the constructivist paradigms important for our learner experience through the original blended format were maintained in the online platform. Approach Consisting of 10 modules on a range of topics, the new CTT online only programme was facilitated online across 6 weeks with asynchronous and synchronous assessable activities, and provision of peer and facilitator feedback. The learning outcomes for each module were similar to the ‘blended learning’ format. The new programme was delivered three times throughout 2020 and completed by a total of 208 health professionals from across 10 metropolitan and rural health districts. Evaluation The focus of our evaluation was on the programme's final 2020 iteration, for which we had ethics approval. Participants (n = 59) were from diverse health professions, across five metropolitan and rural health districts. We prioritised the learner experience in constructing our evaluation strategy. Quantitative and qualitative data were collected by post-course questionnaire and analysed using descriptive statistics and thematic analysis. Twenty participants (34%) responded to the post-course questionnaire. Participants valued the structure, topics, clear outcomes, timeframe, online resources, small group activities, feedback and the flexibility and accessibility afforded by online only delivery. However, participants identified a need for additional ‘real-time’ engagement in activities. Faculty were surprised by the time required to adequately facilitate online learning, and similarly, valued the real-time interactions. Implications The online only CTT programme provided an excellent, scalable framework to ensure continued provision of a relevant and accessible training resource for clinicians working in metropolitan and regional/rural health services. Learner-reported achievement of programme learning outcomes was not negatively impacted by online only delivery. Balancing these resource advantages with learner preferences and our desire to build active teaching networks, we will continue to host the majority of the programme online, while offering short face-to-face sessions within local contexts. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26100 Sars-CoV-2 Genome Sequencing Methods Differ In Their Ability To Detect Variants From Low Viral Load Samples. Lam, C.; Gray, K.; Gall, M.; Sadsad, R.; Arnott, A.; Johnson-Mackinnon, J.; Fong, W.; Basile, K.; Kok, J.; Dwyer, D. E.; Sintchenko, V.; Rockett, R.J. SARS-CoV-2 genomic surveillance has been vital in understanding the spread of COVID-19, the emergence of viral escape mutants and variants of concern. However, low viral loads in clinical specimens affect variant calling for phylogenetic analyses and detection of low frequency variants, important in uncovering infection transmission chains. We systematically evaluated three widely adopted SARS-CoV-2 whole genome sequencing methods for their sensitivity, specificity, and ability to reliably detect low frequency variants. Our analyses highlight that the ARTIC v3 protocol consistently displays high sensitivity for generating complete genomes at low viral loads compared with the probe-based Illumina respiratory viral oligo panel, and a pooled long-amplicon method. We show substantial variability in the number and location of low-frequency variants detected using the three methods, highlighting the importance of selecting appropriate methods to obtain high quality sequence data from low viral load samples for public health and genomic surveillance purposes. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26061 Combining a convolutional neural network with autoencoders to predict the survival chance of COVID-19 patients Khozeimeh, Fahime; Sharifrazi, Danial; Izadi, Navid Hoseini; Joloudari, Javad Hassannataj; Shoeibi, Afshin; Alizadehsani, Roohallah; Gorriz, Juan M.; Hussain, Sadiq; Sani, Zahra Alizadeh; Moosaei, Hossein; Khosravi, Abbas; Nahavandi, Saeid; Islam, Sheikh Mohammed Shariful COVID-19 has caused many deaths worldwide. The automation of the diagnosis of this virus is highly desired. Convolutional neural networks (CNNs) have shown outstanding classification performance on image datasets. To date, it appears that COVID computer-aided diagnosis systems based on CNNs and clinical information have not yet been analysed or explored. We propose a novel method, named the CNN-AE, to predict the survival chance of COVID-19 patients using a CNN trained with clinical information. Notably, the required resources to prepare CT images are expensive and limited compared to those required to collect clinical data, such as blood pressure, liver disease, etc. We evaluated our method using a publicly available clinical dataset that we collected. The dataset properties were carefully analysed to extract important features and compute the correlations of features. A data augmentation procedure based on autoencoders (AEs) was proposed to balance the dataset. The experimental results revealed that the average accuracy of the CNN-AE (96.05%) was higher than that of the CNN (92.49%). To demonstrate the generality of our augmentation method, we trained some existing mortality risk prediction methods on our dataset (with and without data augmentation) and compared their performances. We also evaluated our method using another dataset for further generality verification. To show that clinical data can be used for COVID-19 survival chance prediction, the CNN-AE was compared with multiple pre-trained deep models that were tuned based on CT images. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26055 International Survey of Operative Practices for Otologists and Neurotologists During the COVID-19 Crisis. Ridge, Sarah E; Chari, Divya A; Kozin, Elliott D; Remenschneider, Aaron K; Adunka, Oliver F; Aristegui, Miguel; Chang, Wai Tsz; Cheng, Yen-Fu; Chung, Jong Woo; Cohen, Michael S; Crowson, Matthew G; Golub, Justin S; Handzel, Ophir; Isaacson, Brandon; Iyer, Arunachalam; Kakehata, Seiji; Marchioni, Daniele; Nogueira, Jo�o Fl�vio; Patel, Nirmal; Quesnel, Alicia M; Rivas, Alejandro; Saeed, Shakeel R; Salzman, Richard; Santos, Felipe; Saxby, Alexander J; Tarabichi, Muaaz; Verhaert, Nicolas; Vincent, Robert; Wanna, George; Wolpert, Stephan; Lee, Daniel J OBJECTIVE: To investigate the influence of the COVID-19 pandemic on operative practices of otology and neurotology providers internationally. STUDY DESIGN: Cross-sectional survey. METHODS: A 78-question survey was distributed to otologists and neurotologists between May 12, 2020 and June 8, 2020 to assess the impact of the pandemic on surgical practices. Sections within the survey delineated time periods: prior to the crisis, onset of the crisis, during the crisis, postcrisis transition. RESULTS: Of 396 survey respondents, 284 participants from 38 countries met inclusion criteria.Respondents were 16.9% female and 82.4% male, with a most common age range of 40 to 49 years (36.3%). 69.8% of participants had been in practice for over 10_years and most respondents worked in an academic medical center (79.2%). The average operative weekly caseload was 5.3 (SD 3.9) per surgeon prior to the crisis, 0.7 (SD 1.2) during the COVID-19 crisis, and 3.5 (SD 3.3) for those who had begun a postcrisis transition at the time of survey administration (p 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26052 The Impact of COVID-19 on the Provision of Adult Cardiac Surgery at a Dedicated COVID Hospital in Australia McNamara, Nicholas; Robinson, Benjamin; Bannon, Paul BACKGROUND: Internationally, the response to the COVID-19 pandemic has resulted in fewer cardiac surgical procedures being performed and an increase in the proportion of non-elective cases. To date there has been no study examining the impact of COVID-19 on the provision of cardiac surgery in Australia. AIM: The aim of this study was to evaluate the impact that the COVID-19 pandemic has had on the provision of cardiac surgery in a single, large major cardiac centre and dedicated COVID-19 hospital. A retrospective cohort study was undertaken utilising prospectively collected data. METHODS: Prospectively collected patient and operative data was examined to assess whether there was a reduction in the number of cases performed and whether there was a difference in patient demographics, surgical procedures or case urgency. Data was examined from the period of COVID-restrictions in 2020 and compared with data from the same time period in 2019. RESULTS: From 3 March 2020 to 30 June 2020, 136 adults underwent cardiac surgery at our institution, representing an overall reduction in operative caseload of 21%. The largest impact was noticed in May and April and coincided with statewide restrictions on elective surgery. Surgical acuity was unchanged with 58% of operations classified as non-elective procedures performed during the index admission. There was a small non-significant increase in the proportion of isolated coronary artery bypass surgery and aortic valve surgeries performed. CONCLUSION: From March to June 2020 our local hospital response to the COVID-19 pandemic resulted in a reduction in cardiac surgery service delivery. No change was seen in the urgency or type of surgeries performed. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26046 Domestic Saudi Arabian Travellers' Understanding about COVID-19 and Its Vaccination. Alshahrani, Najim Z; Alshahrani, Sultan M; Farag, Shehata; Rashid, Harunor BACKGROUND: There is a lack of data on Saudi domestic air travellers' understanding regarding COVID-19 and their attitude towards the COVID-19 vaccination. OBJECTIVES: This study aimed to assess Saudi domestic air travellers' understanding regarding COVID-19 and attitude towards mandating the COVID-19 vaccination for travellers. METHODS: A survey using a self-administered, structured, and closed-ended questionnaire was conducted among domestic air travellers in Saudi Arabia. Participants' socio-demographic information, travel history, health status, and attitudes and willingness to accept the COVID-19 vaccination were collected and analysed. RESULTS: Of the 2236 respondents who participated in the survey, 542 (24.25%) had a history of COVID-19, 803 (35.9%) were exposed to a COVID-19 case, 1425 (63.7%) were concerned about catching COVID-19 during air travel, 796 (35.6%) thought the COVID-19 vaccination should be obligatory for travellers, 1105 (49.4%) thought it should be optional, and 335 (15.0%) thought the vaccination was unnecessary. Being of the male gender (adjusted odds ratio [aOR] 1.41, 95% confidence interval [95% CI] 1.14-1.69), being concerned about contracting COVID-19 (aOR 1.34, 95% CI 1.12-2.10) and frequent travelling (aOR 1.40, 95% CI 1.10-3.40) were predictors of vaccination uptake. CONCLUSION: This study demonstrates that although domestic Saudi travellers were concerned about COVID-19 infection, vaccine hesitancy was prevalent among them. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26047 Australia and New Zealand Transplant and Cellular Therapies COVID_19 vaccination consensus position statement Hamad, Nada; Ananda_Rajah, Michelle; Gilroy, Nicole; MacIntyre, Raina; Gottlieb, David; Ritchie, David; Harrison, Simon; Kennedy, Glen; Watson, Anne M.; Greenwood, Matthew; Doocey, Richard; Perera, Travis; Spencer, Andrew; Wong, Eric; O'Brien, Tracey; Shaw, Peter; Conyers, Rachel; Milliken, Samuel; Bardy, Peter; Larsen, Stephen; Ho, Phoebe J.; Lai, Hock; Bajel, Ashish; Butler, Jason; Tiley, Campbell; D'Rozario, James; Johnston, Anna; Cochrane, Tara; Mills, Tony; Irving, Ian; Pullon, Humprey; Purtill, Duncan Australia and New Zealand have achieved excellent community control of COVID-19 infection. In light of the imminent COVID-19 vaccination roll out in both countries, representatives of all adult and paediatric allogeneic bone marrow transplant and cellular therapy (TCT) centres as well as representatives from autologous transplant only centres in Australia and New Zealand collaborated with infectious diseases specialists with expertise in TCT on this consensus position statement regarding COVID-19 vaccination in TCT patients in Australia and New Zealand. It is our recommendation that TCT patients, should have expedited access to high-efficacy COVID-19 vaccines given that these patients are at high risk of morbidity and mortality from COVID-19 infection. We also recommend prioritising vaccination of TCT healthcare workers and household members of TCT patients. Vaccination should not replace other public health measures in TCT patients given the effectiveness of COVID-19 vaccination in TCT patients is unknown. Furthermore, given the limited available data, prospective collection of safety and efficacy data of COVID-19 vaccination in this patient group is a priority. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26049 Vaccines for COVID-19: where do we stand in 2021? Sharma, Ketaki; Koirala, Archana; Nicolopoulos, Katrina; Chiu, Clayton; Wood, Nicholas; Britton, Philip N As of July 2021, over 3 billion doses of a COVID-19 vaccines have been administered globally, and there are now 19 COVID-19 vaccines approved for use in at least one country. Several of these have been shown to be highly effective both in clinical trials and real-world observational studies, some of which have included special populations of interest. A small number of countries have approved a COVID-19 vaccine for use in adolescents or children. These are laudable achievements, but the global vaccination effort has been challenged by inequitable distribution of vaccines predominantly to high income countries, with only 0.9% of people in low-income countries having received at least one dose of a COVID-19 vaccine. Addressing this inequity is of critical importance and will result in better control of SARS-CoV-2 globally. Other challenges include: the reduced protection from COVID-19 vaccines against some strains of SARS-CoV-2, necessitating the development of variant specific vaccines; and uncertainties around the duration of protection from vaccine-induced immunity. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/26042 Incidence and Outcomes of COVID-19 in People With CKD: A Systematic Review and Meta-analysis Chung, Edmund Ym; Palmer, Suetonia C; Natale, Patrizia; Krishnan, Anoushka; Cooper, Tess E; Saglimbene, Valeria M; Ruospo, Marinella; Au, Eric; Jayanti, Sumedh; Liang, Amy; Deng, Danny Jia Jie; Chui, Juanita; Higgins, Gail Y; Tong, Allison; Wong, Germaine; Teixeira-Pinto, Armando; Hodson, Elisabeth M; Craig, Jonathan C; Strippoli, Giovanni Fm RATIONALE & OBJECTIVE: Coronavirus disease 2019 (COVID-19) disproportionately affects people with chronic diseases such as chronic kidney disease (CKD). We assessed the incidence and outcomes of COVID-19 in people with CKD. STUDY DESIGN: Systematic review and meta-analysis by searching MEDLINE, EMBASE, and PubMed through February 2021. SETTING & STUDY POPULATIONS: People with CKD with or without COVID-19. SELECTION CRITERIA FOR STUDIES: Cohort and case-control studies. DATA EXTRACTION: Incidence of COVID-19, death, respiratory failure, dyspnea, recovery, intensive care admission, hospital admission, need for supplemental oxygen, hospital discharge, sepsis, short-term dialysis, acute kidney injury, and fatigue. ANALYTICAL APPROACH: Random-effects meta-analysis and evidence certainty adjudicated using an adapted version of GRADE (Grading of Recommendations Assessment, Development and Evaluation). RESULTS: 348 studies (382,407 participants with COVID-19 and CKD; 1,139,979 total participants with CKD) were included. Based on low-certainty evidence, the incidence of COVID-19 was higher in people with CKD treated with dialysis (105 per 10,000 person-weeks; 95% CI, 91-120; 95% prediction interval [PrI], 25-235; 59 studies; 468,233 participants) than CKD not requiring kidney replacement therapy (16 per 10,000 person-weeks; 95% CI, 4-33; 95% PrI, 0-92; 5 studies; 70,683 participants) and kidney or pancreas-kidney transplant recipients (23 per 10,000 person-weeks; 95% CI, 18-30; 95% PrI, 2-67; 29 studies; 120,281 participants). Based on low-certainty evidence, the incidence of death in people with CKD and COVID-19 was 32 per 1000 person-weeks (95% CI, 30-35; 95% PrI, 4-81; 229 studies; 70,922 participants), which may be higher compared to people with CKD without COVID-19 (incidence rate ratio, 10.26; 95% CI, 6.78-15.53; 95% PrI, 2.62-40.15; 4 studies; 18,347 participants). LIMITATIONS: Analyses were generally based on low-certainty evidence. Few studies reported outcomes in people with CKD without COVID-19 to calculate the excess risk attributable to COVID-19 and potential confounders were not adjusted for in most studies. CONCLUSIONS: The incidence of COVID-19 may be higher in people receiving maintenance dialysis compared to those with CKD not requiring kidney replacement therapy or those who are kidney or pancreas-kidney transplant recipients. People with CKD and COVID-19 may have a higher incidence of death than people with CKD without COVID-19. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/25781 Redfern Needle and Syringe Automatic Dispensing Machine Evaluation White, Bethany; Day, Carolyn; Lees, Shannon 2014-01-01T00:00:00Z https://hdl.handle.net/2123/25779 Quit Because You Care: Evaluation Report Day, Carolyn; Ross, Louise 2018-01-01T00:00:00Z https://hdl.handle.net/2123/25778 A Health Justice Partnership in Inner-city Sydney: Attendance Patterns and Client Perceptions Day, Carolyn; Moensted, Maja 2019-01-01T00:00:00Z https://hdl.handle.net/2123/25764 Neurobiology and Biophysics of Synapses: A Memoir Bennett, Maxwell A summary of research carried out at Sydney over the past 50 years by Maxwell Bennett. 2021-07-26T00:00:00Z https://hdl.handle.net/2123/25741 Genomics-informed responses in the elimination of COVID-19 in Victoria, Australia: an observational, genomic epidemiological study. Lane, Courtney R; Sherry, Norelle L; Porter, Ashleigh F; Duchene, Sebastian; Horan, Kristy; Andersson, Patiyan; Wilmot, Mathilda; Turner, Annabelle; Dougall, Sally; Johnson, Sandra A; Sait, Michelle; Goncalves da Silva, Anders; Ballard, Susan A; Hoang, Tuyet; Stinear, Timothy P; Caly, Leon; Sintchenko, Vitali; Graham, Rikki; McMahon, Jamie; Smith, David; Leong, Lex Ex; Meumann, Ella M; Cooley, Louise; Schwessinger, Benjamin; Rawlinson, William; van Hal, Sebastiaan J; Stephens, Nicola; Catton, Mike; Looker, Clare; Crouch, Simon; Sutton, Brett; Alpren, Charles; Williamson, Deborah A; Seemann, Torsten; Howden, Benjamin P BACKGROUND: A cornerstone of Australia's ability to control COVID-19 has been effective border control with an extensive supervised quarantine programme. However, a rapid recrudescence of COVID-19 was observed in the state of Victoria in June, 2020. We aim to describe the genomic findings that located the source of this second wave and show the role of genomic epidemiology in the successful elimination of COVID-19 for a second time in Australia. METHODS: In this observational, genomic epidemiological study, we did genomic sequencing of all laboratory-confirmed cases of COVID-19 diagnosed in Victoria, Australia between Jan 25, 2020, and Jan 31, 2021. We did phylogenetic analyses, genomic cluster discovery, and integrated results with epidemiological data (detailed information on demographics, risk factors, and exposure) collected via interview by the Victorian Government Department of Health. Genomic transmission networks were used to group multiple genomic clusters when epidemiological and genomic data suggested they arose from a single importation event and diversified within Victoria. To identify transmission of emergent lineages between Victoria and other states or territories in Australia, all publicly available SARS-CoV-2 sequences uploaded before Feb 11, 2021, were obtained from the national sequence sharing programme AusTrakka, and epidemiological data were obtained from the submitting laboratories. We did phylodynamic analyses to estimate the growth rate, doubling time, and number of days from the first local infection to the collection of the first sequenced genome for the dominant local cluster, and compared our growth estimates to previously published estimates from a similar growth phase of lineage B.1.1.7 (also known as the Alpha variant) in the UK. FINDINGS: Between Jan 25, 2020, and Jan 31, 2021, there were 20 451 laboratory-confirmed cases of COVID-19 in Victoria, Australia, of which 15 431 were submitted for sequencing, and 11 711 met all quality control metrics and were included in our analysis. We identified 595 genomic clusters, with a median of five cases per cluster (IQR 2-11). Overall, samples from 11 503 (98.2%) of 11 711 cases clustered with another sample in Victoria, either within a genomic cluster or transmission network. Genomic analysis revealed that 10 426 cases, including 10 416 (98.4%) of 10 584 locally acquired cases, diagnosed during the second wave (between June and October, 2020) were derived from a single incursion from hotel quarantine, with the outbreak lineage (transmission network G, lineage D.2) rapidly detected in other Australian states and territories. Phylodynamic analyses indicated that the epidemic growth rate of the outbreak lineage in Victoria during the initial growth phase (samples collected between June 4 and July 9, 2020; 47.4 putative transmission events, per branch, per year [1/years; 95% credible interval 26.0-85.0]), was similar to that of other reported variants, such as B.1.1.7 in the UK (mean approximately 71.5 1/years). Strict interventions were implemented, and the outbreak lineage has not been detected in Australia since Oct 29, 2020. Subsequent cases represented independent international or interstate introductions, with limited local spread. INTERPRETATION: Our study highlights how rapid escalation of clonal outbreaks can occur from a single incursion. However, strict quarantine measures and decisive public health responses to emergent cases are effective, even with high epidemic growth rates. Real-time genomic surveillance can alter the way in which public health agencies view and respond to COVID-19 outbreaks. FUNDING: The Victorian Government, the National Health and Medical Research Council Australia, and the Medical Research Future Fund. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/25628 COVID-19 and Coronary Heart Disease Naz, Adiba; Billah, Muntasir Coronary heart disease (CHD) is the leading cause of mortality worldwide. One of the main contributions of mortality and morbidity in CHD patients is acute myocardial infarction (AMI), which is the result of abrupt occlusion of an epicardial coronary artery due to a sudden rupture of atherosclerotic plaque, causing myocardial ischemia. In the initial stage of myocardial ischemia, lack of oxygen and nutrient supply results in biochemical and metabolic changes within the myocardium. Depletion of oxygen switches the aerobic cellular metabolism to anaerobic metabolism and impairs the oxidative phosphorylation pathway eventually leading to cardiomyocyte death. Several studies suggest an interlink between COVID-19 and ischemic heart disease. An increased ACE2 receptor expression in the myocardium may partly contribute to the myocardial injuries that are observed in patients affected by SARS-CoV-2. Furthermore, pre-existing cardiovascular disease, in conjunction with an aggravated inflammatory response which causes an up-regulation in pro-inflammatory cytokines. Moreover, patients with atherosclerosis are observed to be more prone to ischemic attacks when affected by COVID-19, due to hypercoagulation in the blood as well as elevated pro-inflammatory markers. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/25596 Lessons learnt during the COVID‐19 pandemic: Why Australian schools should be prioritised to stay open Koirala, Archana; Goldfeld, Sharon; Bowen, Asha C; Choong, Catherine; Ryan, Kathleen; Wood, Nicholas; Winkler, Noni; Danchin, Margie; Macartney, Kristine; Russell, Fiona M In 2020, school and early childhood educational centre (ECEC) closures affected over 1.5 billion school-aged children globally as part of the COVID-19 pandemic response. Attendance at school and access to ECEC is critical to a child's learning, well-being and health. School closures increase inequities by disproportionately affecting vulnerable children. Here, we summarise the role of children and adolescents in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission and that of schools and ECECs in community transmission and describe the Australian experience. In Australia, most SARS-CoV-2 cases in schools were solitary (77% in NSW and 67% in Victoria); of those that did progress to an outbreak, >90% involved fewer than 10 cases. Australian and global experience has demonstrated that SARS-CoV-2 is predominantly introduced into schools and ECECs during periods of heightened community transmission. Implementation of public health mitigation strategies, including effective testing, tracing and isolation of contacts, means schools and ECECs can be safe, not drivers of transmission. Schools and ECEC are essential services and so they should be prioritised to stay open for face-to-face learning. This is particularly critical as we continue to manage the next phase of the COVID-19 pandemic. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/25591 Medical Oncology Group of Australia position statement: COVID‐19 vaccination in patients with solid tumours Kanjanapan, Yada; Blinman, Prunella; Underhill, Craig; Karikios, Deme; Segelov, Eva; Yip, Desmond People with cancer are vulnerable to increased morbidity and mortality from the coronavirus disease 2019 (COVID-19). COVID-19 vaccination is key to protecting the population of people with cancer from adverse outcomes of SARS-CoV-2 infection. The Medical Oncology Group of Australia aimed to address the considerations around COVID-19 vaccination in people with cancer, in particular, safety and efficacy of vaccination. The assessment of patients with generalised allergic reaction to anti-cancer therapy containing vaccine components and practical implementation of vaccination of people on active anti-cancer therapy are also discussed. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/25492 Time for tocilizumab in COVID-19? Butler E.; Munch M.W.; Venkatesh B. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/25327 Long-term persistence of RBD+ memory B cells encoding neutralizing antibodies in SARS-CoV-2 infection Abayasingam, A.; Balachandran, H.; Agapiou, D.; Hammoud, M.; Rodrigo, C.; Keoshkerian, E.; Li, H.; Brasher, N.A.; Christ, D.; Rouet, R.; Burnet, D.; Grubor-Bauk, B.; Rawlinson, W.; Turville, S.; Aggarwa,l A.; Stella, A.O.; Fichter, C.; Brilot, F.; Mina, M.; Post, J.J.; Hudson, B.; Gilroy, N.; Dwyer, D.; Sasson, S.C.; Tea, F.; Pilli, D.; Kelleher, A.; Tedla, N.; Lloyd, A.R.; Martinello, M.; Bull, R.A.; on Behalf of the COSIN Study Group Considerable concerns relating to the duration of protective immunity against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) exist, with evidence of antibody titers declining rapidly after infection and reports of reinfection. Here, we monitor the antibody responses against SARS-CoV-2 receptor-binding domain (RBD) for up to 6 months after infection. While antibody titers are maintained, _13% of the cohort's neutralizing responses return to background. However, encouragingly, in a selected subset of 13 participants, 12 have detectable RBD-specific memory B cells and these generally are increasing out to 6 months. Furthermore, we are able to generate monoclonal antibodies with SARS-CoV-2 neutralizing capacity from these memory B cells. Overall, our study suggests that the loss of neutralizing antibodies in plasma may be countered by the maintenance of neutralizing capacity in the memory B cell repertoire. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/25303 Therapeutic targets in lung tissue remodelling and fibrosis Liu, G.; Philp, A.M.; Corte, T.; Travis ,M.A.; Schilter, H.; Hansbro, N.G.; Burns, C.J.; Eapen, M.S.; Sohal, S.S.; Burgess, J.K.; Hansbro, P.M. Structural changes involving tissue remodelling and fibrosis are major features of many pulmonary diseases, including asthma, chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF). Abnormal deposition of extracellular matrix (ECM) proteins is a key factor in the development of tissue remodelling that results in symptoms and impaired lung function in these diseases. Tissue remodelling in the lungs is complex and differs between compartments. Some pathways are common but tissue remodelling around the airways and in the parenchyma have different morphologies. Hence it is critical to evaluate both common fibrotic pathways and those that are specific to different compartments; thereby expanding the understanding of the pathogenesis of fibrosis and remodelling in the airways and parenchyma in asthma, COPD and IPF with a view to developing therapeutic strategies for each. Here we review the current understanding of remodelling features and underlying mechanisms in these major respiratory diseases. The differences and similarities of remodelling are used to highlight potential common therapeutic targets and strategies. One central pathway in remodelling processes involves transforming growth factor (TGF)-_ induced fibroblast activation and myofibroblast differentiation that increases ECM production. The current treatments and clinical trials targeting remodelling are described, as well as potential future directions. These endeavours are indicative of the renewed effort and optimism for drug discovery targeting tissue remodelling and fibrosis. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/25267 Real-Time Telehealth Treatment Team Consultation for Self-Injury by Individuals with Autism Spectrum Disorder Singh, Nirbhay N.; Lancioni, Giulio E.; Medvedev, Oleg N.; Hwang, Yoon-Suk; Myers, Rachel E. ObjectivesSelf-injurious behavior (SIB) refers to any repeated self-directed, non-suicidal, behavior that may cause or has the potential to cause physical harm to the person’s body. Behavioral interventions provide the standard evidence-based treatments for SIB by people with autism spectrum disorder (ASD) and intellectual disabilities (ID). Translating the proven effectiveness of behavioral interventions to treatment of self-injury in community settings by clinicians and caregivers has not been totally successful. The aim of the present study was to advance translational research by providing real-time telehealth consultation to a treatment team at a community-based mental health agency that provided inpatient and outpatient services to individuals with ASD and ID.MethodThe participants of this single-case experimental study were three adolescents with ASD who had been referred for services because of their increasingly unmanageable SIB both at home and at school. The telehealth consultant provided real-time assistance to the treatment team within a translational model of care in the development and implementation of a behavior support plan and an informal mindfulness-based Soles of the Feet (SoF) program.ResultsBoth visual and statistical analyses demonstrated reductions in the frequency of SIB for all three adolescents, with overall clinically significant reductions only with the SoF intervention.ConclusionThe results of this translational study suggest that telehealth consultation might be a viable technological alternative in situations which preclude face-to-face consultation. Telehealth consultation could be one method of supporting people with behavioral difficulties during pandemics, such as COVID-19. 2021-01-01T00:00:00Z https://hdl.handle.net/2123/25232 Adapting harm reduction services during COVID-19: lessons from the supervised injecting facilities in Australia Roxburgh, Amanda; Jauncey, Marianne; Day, Carolyn; Bartlett, Mark; Cogger, Shelley; Dietze, Paul; Nielsen, Suzanne; Latimer, Julie; Clark, Nico The COVID-19 crisis has had profound impacts on health service provision, particularly those providing client facing services. Supervised injecting facilities and drug consumption rooms across the world have been particularly challenged during the pandemic, as have their client group—people who consume drugs. Several services across Europe and North America closed due to difficulties complying with physical distancing requirements. In contrast, the two supervised injecting facilities in Australia (the Uniting Medically Supervised Injecting Centre—MSIC—in Sydney and the North Richmond Community Health Medically Supervised Injecting Room—MSIR—in Melbourne) remained open (as at the time of writing—December 2020). Both services have implemented a comprehensive range of strategies to continue providing safer injecting spaces as well as communicating crucial health information and facilitating access to ancillary services (such as accommodation) and drug treatment for their clients. This paper documents these strategies and the challenges both services are facing during the pandemic. Remaining open poses potential risks relating to COVID-19 transmission for both staff and clients. However, given the harms associated with closing these services, which include the potential loss of life from injecting in unsafe/unsupervised environments, the public and individual health benefits of remaining open are greater. Both services are deemed ‘essential health services’, and their continued operation has important benefits for people who inject drugs in Sydney and Melbourne. 2021-01-01T00:00:00Z