Research Publications and Outputs

Climate Change, Place and Mental Health Incubator Submission to the NSW Minimum Energy Efficiency Rental Standards Consultation 2026

Fri, 29 May 2026 00:00:00 GMT

Climate Change, Place and Mental Health Incubator Submission to the NSW Minimum Energy Efficiency Rental Standards Consultation 2026 Bower, Marlee; Smout, Scarlett; Dawkins, Jacqueline; Sedgwick, Camilla; Haddad, Shamila; Brambilla, Arianna; Bryant, Gareth; Daniel, Lyrian; Lynch, A; Palmer, S; Cheung, A; K, C; Howard, Amanda; Jegasothy, Edward; McClellan, Jo; McGrath, Laura; O'Sullivan, Kimberley; Stapinski, Lexine; Swain, Jon; Teesson, Maree We are pleased to see that the NSW Department of Climate Change, Energy, the Environment and Water and NSW Fair Trading are seeking feedback on the introduction of minimum energy efficiency rental standards, and we welcome the opportunity to provide input. Our submission seeks to highlight the importance of considering mental health in the design, implementation, and evaluation of MEERS. The submission combines empirical evidence collated by the Investigator team with rich insights from the real-world experiences of the Lived Experience Advisory Group. Rather than being structured by consultation questions, the submission is organised by 1. The potential impacts of MEERS on mental health, 2. Other considerations for the design and implementation of MEERS, 3. Learnings from other jurisdictions, and a final note on measurement and evaluation.

Integrating rural community screening initiatives into general practice: a qualitative evaluation of the Care2U rural outreach pilot program

Thu, 01 Jan 2026 00:00:00 GMT

Integrating rural community screening initiatives into general practice: a qualitative evaluation of the Care2U rural outreach pilot program Wong, Kam Cheong; Osuagwu, Uchechukwu Levi; Wenkart, Edweana; Bapat, Yash; McCrossin, Timothy; Mahns, David Diabetes and cardiovascular disease profoundly affect rural Australians. The Care2U program was proposed to integrate rural community-based screening with general practice systems. Its innovative feature is a closed-loop communication model between outreach teams and general practitioners (GPs), enabling systematic tracking of diagnoses, management and outcomes for screening-detected medical conditions. This study explored the acceptability, feasibility and sustainability of the proposed model from healthcare providers’ perspectives.

Designing a research room for a National Hybrid Particle Therapy Facility (protons, carbon and other ions) - white paper

Mon, 23 Mar 2026 00:00:00 GMT

Designing a research room for a National Hybrid Particle Therapy Facility (protons, carbon and other ions) - white paper Ahern, Verity; Haworth, Annette Representatives from research institutes across Australia, international particle therapy centres, ANSTO and leading universities attended a workshop to examine how a dedicated research room at the proposed National Hybrid Particle Therapy Facility could complement existing programs and infrastructure, enable new scientific opportunities and support workforce development across nuclear science, health, space, accelerator physics and related fields. This white paper and supplementary material capture the workshop's findings.

Stakeholder Perspectives on the Term Time Toxicity to Describe Health Care Contact Time Associated With Cancer Treatments

Thu, 01 Jan 2026 00:00:00 GMT

Stakeholder Perspectives on the Term Time Toxicity to Describe Health Care Contact Time Associated With Cancer Treatments Stevens, Samuel Xavier; El-Katateny, Ella; Gupta, Arjun; De Abreu Lourenço, Richard; Shaw, Joanne; Booth, Christopher M; Vardy, Janette L Purpose: The labeling of the time-opportunity costs of cancer care as time toxicity has stimulated research into the impact of treatment time on patients, yet stakeholder views on this potentially value-laden term remain unreported. Existing qualitative research highlights significant individual differences in the perception of burden from treatment-related time. The purpose of this study was to report patient, caregiver, and oncologist reactions to the term time toxicity. Methods: Semistructured interviews were conducted with purposively selected adults with advanced GI cancers and their caregivers from one metropolitan and one regional center, as well as GI oncologists recruited from participating sites, email, and social media advertising. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis tied to a framework approach. Results: Forty-five people, including patients (n = 20), caregivers (n = 10), and GI medical oncologists (n = 15) were interviewed. Thematic analysis identified three major themes: (1) Critiques of toxicity, (2) supportive perspectives, and (3) alternative terminology. Although some participants felt that describing time as a treatment-related toxicity was both accurate and provided a potential benefit to health systems optimization, many felt that the word toxicity conveyed an unhelpful value judgment on time invested for treatment and could overlook positive experiences of care. Alternative value-neutral or positive terms were suggested (eg, time commitment). Conclusion: We identified divergent perspectives on the terminology used to describe treatment-related health care contact time. These differences likely reflect subjective experiences of treatment time. Further research should explore this concept in more diverse populations.

Transmission and Non-transmission of Melanoma From Deceased Solid Organ Donors to Transplant Recipients: Risks and Missed Opportunities

Mon, 01 Jan 2024 00:00:00 GMT

Transmission and Non-transmission of Melanoma From Deceased Solid Organ Donors to Transplant Recipients: Risks and Missed Opportunities Rosales, Brenda; Hedley, James; De La Mata, Nicole; Cavazzoni, Elena; Vajdic, Claire; Thompson, John; Kelly, Patrick; Wyburn, Kate; Webster, Angela Background. Biovigilance concerns are in tension with the need to increase organ donation. Cancer transmission risk from donor to recipient may be overestimated, as non-transmission events are rarely reported. We sought to estimate melanoma transmission risk in deceased organ donation and identify missed opportunities for donation in an Australian cohort with high melanoma prevalence. Methods. We used a population-based approach and linked deceased organ donors, transplant recipients, and potential donors forgone, 2010–2018, with the Central Cancer Registry (CCR), 1976–2018. We identified melanomas using ICD-O-3 classification, assessed the probability of transmission, and compared suspected melanoma history in potential donors forgone with melanoma notifications in the CCR. Results. There were 9 of 993 donors with melanoma in CCR; 4 in situ low-risk and 5 invasive high-to-unacceptable risk. Four were unrecognized before donation. Of 16 transplant recipients at risk, we found 0 of 14 transmission events (2 recipients had insufficient follow-up). Of 35 of 3588 potential donors forgone for melanoma risk alone, 17 were otherwise suitable for donation; 6 of 35 had no melanoma in CCR, 2 of 35 had in situ melanomas and 9 of 35 had thin invasive melanomas (localized, ≤0.8 mm thickness). Conclusions. Our findings contribute to current evidence that suggests donors with melanomas of low metastatic potential may provide an opportunity to safely increase organ donation and so access to transplantation.

Cancer mortality in kidney transplant recipients: An Australian and New Zealand population-based cohort study, 1980-2013

Wed, 01 Jan 2020 00:00:00 GMT

Cancer mortality in kidney transplant recipients: An Australian and New Zealand population-based cohort study, 1980-2013 Rosales, Brenda; De La Mata, Nicole; Vajdic, Claire; Kelly, Patrick; Wyburn, Kate; Webster, Angela Cancer burden is increasing in kidney transplant recipients, but differences in mortality compared to the general population remain unclear. We sought to compare cancer mortality in paediatric and adult kidney transplant recipients with the general population and describe any differences, by site, age and sex, country and over time. We included kidney transplant recipients from the Australian and New Zealand Dialysis and Transplantation Registry, 1980–2013. Date of death and underlying cause of death were ascertained by data-linkage and classified using ICD10AM codes. Indirect standardisation was used to estimate standardised mortality ratios (SMR). There were 5,284 deaths in 17,628 kidney transplant recipients over 175,084 person-years of observation, including 1,061 (20%) cancer deaths. Relative cancer mortality was higher than the general population for all-site (SMR 2.9, 95% CI 2.7–3.1) cancer and highest for nonmelanoma skin cancer (SMR 50.9, 95% CI 43.5–59.6) and lymphoma (SMR 42.2, 95% CI 35.3–50.5). Relative cancer mortality decreased with increasing age in men (p < 0.001) and women (p = 0.001) but never reached parity with the general population. Relative mortality did not change with age for skin and lip, or colorectal cancers (p-value >0.1). Only relative colorectal cancer mortality increased over time (p = 0.002). Our study shows cancer mortality in kidney transplant recipients was higher than expected in the general population. The magnitude of excess mortality varied by cancer site, age and sex. Further evidence is needed to identify whether this variation is due to differences at diagnosis or access and effectiveness of cancer treatments in this population.

Decoding Surgical Complexity: Measuring the Impact of Operative Difficulty on Quality Outcomes Following Hepatectomy for Liver Cancer over Two Decades

Thu, 01 Jan 2026 00:00:00 GMT

Decoding Surgical Complexity: Measuring the Impact of Operative Difficulty on Quality Outcomes Following Hepatectomy for Liver Cancer over Two Decades Patel, Meet; Daniel, Jonathan Ben; Bhimani, Nazim; Glover, Anthony R; Hugh, Thomas J Introduction: Operative time is commonly used as a surrogate marker for operative difficulty in liver resection, but the contribution of other intraoperative factors is less well understood. This study aimed to develop an objective, composite score to assess operative difficulty and evaluate its association with postoperative and oncological outcomes. Methods: A retrospective cohort study was conducted on patients who underwent liver resection for malignant disease between 1999 and 2023 at an Australian tertiary hospital, using a prospectively maintained database. Principal component analysis (PCA) was applied to operative time, estimated blood loss, total time of hepatic inflow occlusion and the number of packed red bloods transfused intraoperatively to derive a composite operative difficulty score. Patients were then stratified into low, moderate and high difficult groups using Gaussian mixture models (GMM). Comparison of textbook oncological outcomes (TOO) achievement and futile resection rates were assessed using Chi-squared analysis. Kaplan-Meier analysis was used to assess recurrence-free and overall survival in subgroup analysis. Results: Of 729 patients, 699 met the inclusion criteria. GMM identified three distinct operative difficulty groups: low (n=540), moderate (n=143), and high (n=16). TOO and non-futile resection rates declined with increasing difficulty: 77% and 58% (low), 47% and 52% (moderate), and 6% and 19% (high), respectively (p<0.001, p=0.004 respectively). Among patients with cholangiocarcinoma, median overall survival was inversely correlated with operative difficulty (40 months low, 16 months moderate, 7 months high, p=0.004). In patients with colorectal liver metastases, there was a trend towards worse overall survival and disease-free survival with increasing operative difficulty, however, this did not reach statistical significance. Conclusion: An objective intraoperative difficulty score was developed and demonstrated a significant inverse association with both quality and oncological outcomes. While external validation is required, these findings support the potential of operative difficulty assessment to enhance perioperative decision-making, inform patient counselling, and optimise postoperative care planning.

Non-Retrieval and Non-Utilisation of Deceased Donor Kidneys for Transplantation: An Australian Cohort Study

Wed, 01 Jan 2025 00:00:00 GMT

Non-Retrieval and Non-Utilisation of Deceased Donor Kidneys for Transplantation: An Australian Cohort Study Cutting, Rachel; De La Mata, Nicole; Singla, Animesh; Hedley, James; Opdam, Helen; Clayton, Philip; Wyburn, Kate; Cavazzoni, Elena; Robertson, Paul; Pleass, Henry; Webster, Angela Background: An efficient organ donation programme must maximise transplantation following initiation of organ recovery procedures. Methods: We conducted a cohort study of deceased donors in Australia (2014-2021) using Australia and New Zealand Organ Donation Registry data to characterise kidney non-retrieval (post-incision) and non-utilisation (retrieved, not transplanted). Donor characteristics included kidney side (left/right), kidney-only procurement, kidney donor profile index (KDPI), cause of death, resuscitation, donation after circulatory/neurological determination of death (DCDD/DNDD) and donor criteria (standard SCD/extended ECD), year, age, sex, blood group, ethnicity, comorbidities, smoking, BMI, weight, remoteness, occupation and socioeconomic disadvantage. System characteristics included jurisdiction of donor hospital, retrieval team and recipient's hospital. Results: Among 7211 kidneys (3683 donors) accepted for retrieval, 675 (9%) were non-retrieved and 430 (7%) were non-utilised. Crude non-retrieval rates doubled from 5% to 10% between 2014 and 2021 (p = 0.01) while non-utilisation remained around 7% (p = 0.1). After adjustment, non-retrieval was greater among donors with KDPI ≥ 75 (OR: 4.28, 95% CI: 2.08-8.81, p < 0.001), diabetes (OR: 1.74, 95% CI: 1.25-2.43, p = 0.001) and in recent years (annual OR: 1.08, 95% CI: 1.03-1.55, p = 0.002), and lower for ECD DCDD (OR: 0.46, 95% CI: 0.26-0.81, p = 0.01). Non-utilisation was greater for SCD DCDD (OR: 1.90, 95% CI: 1.28-2.82, p < 0.001), blood group AB (OR: 2.05, 95% CI: 1.16-3.64, p = 0.03) and in recent years (annual OR: 1.08, 95% CI: 1.02-1.15, p = 0.01), and lower in Tasmania (OR: 0.28, 95% CI: 0.08-0.97) and Queensland (OR: 0.57, 95% CI: 0.36-0.92, p = 0.03). Documented reasons for non-utilisation lacked transparency but included poor perfusion (17%). Conclusion: Increasing utilisation of higher KDPI kidneys and enhancing perfusion could help maximise kidney transplantation.

Values, Preferences, and Risk Tolerance of People Waitlisted for a Kidney Transplant Regarding Potential Deceased Donor Organ Profiles: A Systematic Review

Wed, 01 Jan 2025 00:00:00 GMT

Values, Preferences, and Risk Tolerance of People Waitlisted for a Kidney Transplant Regarding Potential Deceased Donor Organ Profiles: A Systematic Review Cutting, Rachel; Muscat, Danielle; Patel, Pinika; De La Mata, Nicole; Irish, Georgina; Wyld, Melanie; White, Sarah; Webster, Angela Background: Incorporating the views of people waitlisted for a kidney transplant is important when clinicians consider any donor kidney offer. Methods: We conducted a systematic review of quantitative and qualitative studies in adult patients on, or under assessment for, the kidney waitlist. We focused on views of extended criteria, increased viral (blood-borne virus), or increased cancer risk in deceased donor kidneys. We systematically searched databases and conference proceedings until April 2024, excluding studies of children, case reports, and commentaries. Studies were appraised using the Johanna Briggs Institute checklists and synthesized using a convergent segregated approach, incorporating narrative and thematic methods. Results: We included 25 studies (2630 participants) comprising quantitative surveys, questionnaires, conjoint analysis, and discrete choice experiments (n = 16; 64%) and qualitative semi-structured, in-depth interviews and focus groups (n = 9; 36%). Most studies were from the United States (n = 19; 76%) and focused on extended criteria and increased viral risk donors (n = 24; 96%), with 1 study considering general risks (4%). None focused on increased cancer-risk donors. We identified 4 themes and 2 subthemes: (1) I want to be free from dialysis, (2) I do not want more health problems, (3) I might not get another chance, (4) I desire shared decision-making but feel powerless to contribute, (4a) I need more information about my health status, prognosis and the transplant process, and (4b) I need more information about donor risk factors. Conclusion: Waitlist patients desired information and involvement in decision-making, yet individual prognoses were not fully understood. Integrating shared decision-making from pre- to post-offer will increase knowledge and enhance treatment satisfaction.

Advances in the Genetics and Pathology of Lewy Body Dementia

Wed, 01 Jan 2025 00:00:00 GMT

Advances in the Genetics and Pathology of Lewy Body Dementia Scholz, Sonja W; Okubadejo, Njideka U; Prakash, Priya; Liddelow, Shane A; Ryten, Mina; Halliday, Glenda M Lewy body dementia is a heterogeneous disease that is underdiagnosed and poorly understood. Pathologically, Lewy body dementia is characterized by the accumulation of intraneuronal aggregates of misfolded α-synuclein, known as Lewy bodies and Lewy neurites. The genetic architecture of Lewy body dementia is complex, involving both common genetic variants with small risk effects and rare genetic variants with large effects. Alzheimer’s disease pathology frequently coexists with Lewy body pathology and influences the clinical presentation. A deeper understanding of the pathophysiological pathways, including mitochondrial dysfunction, lysosomal dysfunction, and neuroinflammation, can enhance disease modeling, and this knowledge will ultimately facilitate the development of therapeutic interventions. The biological relationships that Lewy body dementia shares with other neurodegenerative and psychiatric disorders may also prove crucial for the development of therapeutic strategies.

AcceSS and Equity in Transplantation (ASSET) New Zealand: protocol for a population-wide data linkage platform to investigate equity in access to kidney failure health services in New Zealand

Sat, 01 Jan 2022 00:00:00 GMT

AcceSS and Equity in Transplantation (ASSET) New Zealand: protocol for a population-wide data linkage platform to investigate equity in access to kidney failure health services in New Zealand Cutting, Rachel; Webster, Angela; Cross, Nicholas; Dunckley, Heather; Beaglehole, Ben; Dittmer, Ian; Irvine, John; Walker, Curtis; Jones, Merryn; Wyld, Melanie; Kelly, Patrick; Wyburn, Kate; De La Mata, Nicole Background: Kidney transplantation is considered the ideal treatment for most people with kidney failure, conferring both survival and quality of life advantages, and is more cost effective than dialysis. Yet, current health systems may serve some people better than others, creating inequities in access to kidney failure treatments and health outcomes. AcceSS and Equity in Transplantation (ASSET) investigators aim to create a linked data platform to facilitate research enquiry into equity of health service delivery for people with kidney failure in New Zealand. Methods: The New Zealand Ministry of Health will use patients’ National Health Index (NHI) numbers to deterministically link individual records held in existing registry and administrative health databases in New Zealand to create the data platform. The initial data linkage will include a study population of incident patients captured in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), New Zealand Blood Service Database and the Australia and New Zealand Living Kidney Donor Registry (ANZLKD) from 2006 to 2019 and their linked health data. Health data sources will include National Non-Admitted Patient Collection Data, National Minimum Dataset, Cancer Registry, Programme for the Integration of Mental Health Data (PRIMHD), Pharmaceutical Claims Database and Mortality Collection Database. Initial exemplar studies include 1) kidney waitlist dynamics and pathway to transplantation; 2) impact of mental illness on accessing kidney waitlist and transplantation; 3) health service use of living donors following donation. Conclusion: The AcceSS and Equity in Transplantation (ASSET) linked data platform will provide opportunity for population-based health services research to examine equity in health care delivery and health outcomes in New Zealand. It also offers potential to inform future service planning by identifying where improvements can be made in the current health system to promote equity in access to health services for those in New Zealand.

Outcomes of Foundational Learning in Research Methods Following Primary Medical Qualification on Surgical Research: A Retrospective Review

Wed, 01 Jan 2025 00:00:00 GMT

Outcomes of Foundational Learning in Research Methods Following Primary Medical Qualification on Surgical Research: A Retrospective Review Patel, Meet; Sun, David; Starr, Maya Jane; Solanki, Dhaval; Upadhyay, Jeet; Edwards, Dominic J.A.; Raju, Arjun; Maouris, Thomas; Lombardo, Alexander; Wang, Daphne; Nagi, Karamveer; Bhimani, Nazim; Glover, Anthony R Introduction: Limited knowledge exists on how post-graduate surgical coursework programs impact surgical research outputs in Australia. This study evaluated the impact of university-based teaching in research methods and supervisor characteristics on research quality and short-term research output for students undertaking the Master of Surgery (MS) post-graduate coursework degree within Australia. Methods: A retrospective cohort analysis of students enrolled in the dissertation for The University of Sydney MS program between 2010-2020. Grades for the dissertation and research subjects were extracted from the central university analytics. PubMed and Web of Science were used to determine if the dissertation was published and identify other publications by the students. A Google search was completed to identify supervisor characteristics. Statistical analysis involved logistic regression, multiple linear regression and negative binomial regression. Results: 379 students were included in this study. Fifty-three percent of the students had an associated publication from their dissertation at a median of 18-months post-enrolment and median journal impact-factor 2.19. Students averaged 2.1 additional publications (range 0-30) two years post-dissertation completion. Students with a distinction/high distinction grade in the dissertation subject or ≥three journal publications prior were significantly more likely to publish their dissertation (OR 2.26, 95% CI=1.42-3.61, p<0.001; OR 3.35, 95% CI=1.90-5.92, p<0.001 respectively). Students who received a distinction/high distinction in the research methods subject had 64% more first-author publications within two years of finishing the dissertation (95% CI=1.20–2.23, p=0.002). Conclusion: Engagement in structured teaching in research methods and prior research experience significantly improves short-term research output amongst early surgical researchers.

Navigating complexity in liver resection: A narrative review of factors influencing intra-operative difficulty

Wed, 01 Jan 2025 00:00:00 GMT

Navigating complexity in liver resection: A narrative review of factors influencing intra-operative difficulty Patel, Meet; Glover, Anthony; Hugh, Thomas J Background: Liver resection remains the cornerstone for curative management in primary liver malignancies. Liver surgery ranges from simple wedge resections to complex hepatectomies involving vascular or biliary reconstructions. The anatomical complexity of the liver and these varied surgical approaches create challenges in assessing operative difficulty. This literature review explores the key factors influencing operative difficulty in liver resection for primary liver malignancy across surgical techniques. Methods: A broad literature review was conducted to determine the factors that were associated with increased operative difficulty in liver resection using Embase, PubMed and Cochrane databases for studies published between 2000-2025. Results: This review identifies several patient, tumour, and surgical factors that influence operative difficulty in liver resection. Numerous difficult scoring systems were identified, yet their applicability across different operative approaches remains uncertain. Across open and minimally invasive techniques, tumour size and location are commonly used to determine complexity. However, debate remains regarding the optimal cut-off for tumour diameter. Other identified factors include extent of resection, patient-specific variables (e.g., cirrhosis, body mass index, previous surgeries), and surgical technique. Additionally, liver resection procedures classified based off the 2000 Brisbane terminology have been stratified into three groups of increasing difficulty. Conclusion: The ability to predict operative difficulty is useful for case selection, surgical planning, and risk stratification for meaningful shared decision making. Future research should focus on refining predictive models by integrating composite measures, including patient-reported outcomes and long-term survival. A unified, validated scoring system applicable across surgical techniques could enhance consistency in clinical practice and research to improve outcomes.

Health economic data collection tools for health care research and practice: Protocol for a systematic scoping review

Mon, 12 Jan 2026 00:00:00 GMT

Health economic data collection tools for health care research and practice: Protocol for a systematic scoping review Szewczyk, Zoe; Creagh, Nicola; Belramoul, Emile; Smith, Ben; Phongsavan, Philayrath; Sarkies, Mitchell Background: Reliable cost and resource use data (hereafter referred to as cost data) forms the foundation of all economic evaluations and is essential for informing the implementation and scale-up of interventions found to be effective and efficient. Despite their importance, health intervention cost estimates are often missing, their methods of collection lack sufficient detail required for replication, and the quality of the tools used is seldom addressed in the literature. Cost data collection tools have been developed for a variety of contexts and study designs; however, none are widely adopted in practice. Aims: Undertake a systematic scoping review of scientific and grey literature to identify cost data collection tools for health services and public health research. Methods: A systematic scoping review of scientific (peer reviewed) literature and a scoping review of grey literature will be conducted in parallel. Both searches will be limited to tools available in English between January 2015 and December 2025. The tools must be publicly available (both free and for fee) for immediate use (requiring minimal adaptation). Discussion: The findings of this scoping review will provide researchers and health service staff cost data collection tools available for immediate use. This information is also intended to inform the development of future tools for cost data collection in health services and prevention research. Such a tool will facilitate collection of urgently needed cost and resource use data to inform investment decision making, policy and practice in health services and population health care.

How Important is Healthcare‑Contact Time to Systemic Treatment Decision‑Making in Advanced Gastrointestinal Cancers: Developing Attributes to Include in a Discrete Choice Experiment

Wed, 01 Jan 2025 00:00:00 GMT

How Important is Healthcare‑Contact Time to Systemic Treatment Decision‑Making in Advanced Gastrointestinal Cancers: Developing Attributes to Include in a Discrete Choice Experiment Stevens, Samuel X; El-Katateny, Ella; Addo, Isaac Yeboah; Street, Deborah; Booth, Christopher; Shaw, Joanne; Vardy, Janette L.; De Abreu Lourenço, Richard Abstract Background People receiving treatment for advanced cancer invest substantial portions of their survival time receiving healthcare, labelled the ‘time toxicity’ of treatment. Although qualitative research has examined the impact of time burden on patients and their caregivers, its influence on treatment decision-making is unclear. Objective: Our objective was to explore treatment decision-making with patients with advanced gastrointestinal cancer, their caregivers, and oncologists, and unmask the role of time burden in those decisions. The objective was to inform the design of a subsequent discrete-choice experiment (DCE) investigating the importance of time burden in treatment decision-making. Methods: A two-step process was used. Factors relevant to treatment decision-making were discussed as part of semistructured interviews. Responses were analysed using thematic analysis with a focus on measurable themes relevant to the development of candidate attributes for a DCE. Second, we reviewed stated-preferences studies in the field of treatment decision-making in cancer and compared the results with the candidate attributes identified from interviews. Results: Interviews with 45 participants (20 patients, 10 caregivers,15 gastrointestinal oncologists; 53% metropolitan) revealed 4 themes and 6 candidate attributes: expected survival benefit of treatment, impact of physical side effects, effect on day-to-day functioning, route of administration, healthcare contact days, and planned length of the treatment course. Review of 45 published studies yielded no additional attributes. Conclusions: This study identified six candidate attributes for a forthcoming DCE on time burden in advanced cancer care. These findings support growing efforts to quantify and address time toxicity in cancer treatment decision-making.

“The Cancer is My Life”: patient and caregiver perceptions of the time toxicity of palliative systemic cancer treatments for advanced gastrointestinal cancers

Wed, 01 Jan 2025 00:00:00 GMT

“The Cancer is My Life”: patient and caregiver perceptions of the time toxicity of palliative systemic cancer treatments for advanced gastrointestinal cancers Stevens, Samuel X.; El-Katateny, Ella; De Abreu Lourenço, Richard; Booth, Christopher M.; Shaw, Joanne; Vardy, Janette L. Purpose Treatment for advanced cancer entails substantial time commitments, which has been labelled the ‘time toxicity’ of treatment, though the perspectives of people affected by cancer are still being established. We aimed to establish patient and caregiver perspectives on the ‘time toxicity’ of palliative systemic treatments. Methods :Semi-structured qualitative interviews were conducted using an inductive approach. Purposively selected adults with advanced gastrointestinal cancers who had received palliative systemic therapy and caregivers were recruited from one metropolitan and regional site. Interviews were analysed using thematic analysis. Results: Twenty patients and ten caregivers participated. Eighty percent were Australian-born, 60% were 55–74 years old, 57% had colorectal cancer, 50% were female, and 50% were regionally situated. Five themes emerged: (1) treatment as work, (2) opportunity costs of receiving care, (3) treatment time as an investment, (4) time in treatment decision-making, and (5) tools for managing treatment time. Participants found it burdensome to organise their lives around treatment requirements. Perception of time burdens related to understandings of treatment benefit, experience of downsides, and psychological reactions to illness. Time spent coordinating and recovering from treatment had a substantial impact on participants’ lives outside of contact days. However, participants valued the potential benefits of treatment and described healthcare time as a modifier, rather than a driver, of treatment decision-making. Conclusion: This qualitative analysis contributes a foundational understanding of perceptions, sources, and impacts of healthcare time burdens in an Australian context. Further research will identify, assess, and address modifiable sources of time burdens in cancer care.

Phenomenology of humiliation: feeling injustice in healthcare

Wed, 01 Jan 2025 00:00:00 GMT

Phenomenology of humiliation: feeling injustice in healthcare Subramani, Supriya In this paper, I show how humiliation, as a moral emotion, is a pervasive yet neglected dimension of medicine, health and ethics discourse. Although often conflated with shame, humiliation names a distinct self-conscious emotion: not an internalised sense of personal failure, but a relational harm imposed by others and institutions that undermines dignity and self-respect. Recently, medical humanities and ethics literature has attended extensively to shame and stigma, yet humiliation remains underexplored, despite its salience in patient accounts of dismissal, disrespect and degradation. I begin by explaining why it helps to have a conceptual distinction between humiliation and shame, showing how humiliation is an externally inflicted injury rather than a private moral lapse. Drawing on my ethnographic and phenomenological research in India and Zurich, in this conceptual paper, I illustrate how humiliation surfaces in healthcare encounters and spaces, where patients, especially those who are marginalised, are silenced or disregarded. I show that humiliation is diagnostic and has inherent moral insights and reveals injustice. Thus, in this paper, I argue that reclaiming humiliation as a moral and phenomenological category opens new ethical and analytical possibilities: it calls for reimagining medicine as a relational practice grounded in dignity, recognition and justice—one that acknowledges those once humiliated not as passive sufferers but as moral agents whose emotions reveal the truth of injustice.

Biological effects of pathologies in Lewy body diseases: why timing matters

Wed, 01 Jan 2025 00:00:00 GMT

Biological effects of pathologies in Lewy body diseases: why timing matters Halliday, Glenda; Elie, Matar The emergence of promising biomarkers of α-synuclein Lewy pathology has led to new biological definitions and staging systems for Parkinson's disease and dementia with Lewy bodies. These research frameworks aim to enhance patient selection for studies of biomarkers and disease-modifying therapies. Building on approaches developed for Alzheimer's disease, these new frameworks focus on hallmark neuropathological findings in Lewy body diseases, including abnormal α-synuclein aggregates and neurodegeneration, particularly nigrostriatal dopaminergic loss. Understanding the temporal inter-relationships between Lewy pathology, Alzheimer's disease, and other co-pathologies and symptom manifestation is central to any biological staging system. Neuropathological and in vivo evidence demonstrates substantial temporal and biological heterogeneity in the progression of clinical and pathological events across Lewy body disorders, highlighting knowledge gaps. Staging systems must incorporate this evidence into a nuanced conceptual framework of biological progression. Such revision will be crucial for the appropriate selection of participants and correct timing of targeted interventions in clinical research.

Building readiness in community-based organisations to enable the implementation of public health interventions for adults and older adults: a scoping review

Mon, 24 Nov 2025 00:00:00 GMT

Building readiness in community-based organisations to enable the implementation of public health interventions for adults and older adults: a scoping review Hassett, Leanne; Moseley, Anne M; Nettlefold, Lindsay; Pearce, Louise M N; Franke, Thea; Macdonald, Heather M; Tiedemann, Anne; McKay, Heather A Data and supplementary file from: 'Building readiness in community-based organisations to enable the implementation of public health interventions for adults and older adults: a scoping review' Background: A key challenge to implementing and scaling up evidence-based interventions (EBIs) into practice is organisational readiness; described as an organisation’s motivation, general capacities, and capabilities specific to the EBI. Building organisational readiness has been investigated in some health disciplines (e.g., mental health). However, the importance of building organisational readiness to effectively implement public health EBIs for adults and older adults in the community setting remains largely unexplored. Our aim was to examine how readiness was defined and measured, what strategies were used to build readiness, and the relationship between readiness-building strategies and implementation, service-level, and person-level outcomes. Methods: In this scoping review, we searched seven databases and conducted forward and backward citation tracking. From a pool of eight reviewers, combinations of two reviewers independently screened references for eligibility. A single reviewer extracted data, and a second reviewer checked data. Results for each implementation, service-level and person-level outcome in each study were extracted and categorised as favourable, nonsignificant, or unfavourable. Results: Twelve studies were included, which implemented a mix of different public health EBIs to almost 40,000 participants (n = 37,883; 54% women) across varied community settings. Only four studies defined readiness; all used different definitions. Five studies used five different instruments to assess readiness, all with poor psychometric properties. All studies used multiple strategies to build readiness (range 4–20 strategies per study), with all using strategies to assess, plan and monitor implementation of the EBI (i.e., ‘evaluative and iterative strategies’) and strategies to support collaboration between organisations delivering the EBI (i.e., ‘develop interest-holder interrelationships’). Three-quarters of the strategies focused on building the organisation’s capability to deliver the specific EBI (e.g., assessing readiness, conducting educational meetings) and were delivered by external support teams. Exploring the relationship between readiness-building strategies and study outcomes indicated more favourable than unfavourable outcomes, particularly for implementation and service-level outcomes (38/48; 79% favourable). Conclusions: Within this limited sample, the use of readiness-building strategies improved the implementation of public health EBIs in community organisations. However, consistency of definitions and terminology and more sophisticated testing of readiness-building strategies will help confirm how best to do this. Trial registration: Open Science Framework, May 5, 2024.

Dementia with Lewy bodies and Parkinson’s disease dementia – the same or different and is it important?

Wed, 01 Jan 2025 00:00:00 GMT

Dementia with Lewy bodies and Parkinson’s disease dementia – the same or different and is it important? Halliday, Glenda; Fu, Yuhong Biological definitions of neurological diseases are now becoming a reality, although still in the research phase. This development will recategorize neurological diseases, providing objective diagnostics and the promise of therapeutics that target biological mechanisms - similar to the strategy that has proven successful in tumours and other conditions. In this Perspective article, we discuss this development for dementias with dominant Lewy pathology, as the availability of biological assays for this pathology has sparked new interest in a single disease diagnosis for all individuals positive for α-synuclein. On the basis of current evidence, we argue that an α-synuclein assay alone is unlikely to be a specific criterion for a spectrum of clinical syndromes with Lewy pathology or a definitive diagnostic marker for Lewy body dementia. We advocate that one biological assay will not reflect the complex spatiotemporal features of brain pathology. Diverse sequential mechanisms underpin the highly heterogeneous phenotypes and clinicopathological processes of Lewy body dementias. Disease modification, if possible, will be most effective when it targets the early underlying mechanisms, especially those leading to aggressive phenotypes.

Safe and Affirmed: Building and Evaluating Capacity to Support LGBTIQA+ Young People in Mental Health Services in New South Wales

Mon, 25 May 2026 00:00:00 GMT

Safe and Affirmed: Building and Evaluating Capacity to Support LGBTIQA+ Young People in Mental Health Services in New South Wales Davies, Cristyn; Berger, Matthew N.; Mowbray, Ellen; Robinson, Kerry H.; Knox, Sara L.; Lum, Steph; Byron, Paul; McGowan, Natalie; Kang, Melissa; Marino, Jennifer L.; Skinner, S. Rachel Background: The Twenty-Ten Association Incorporated (Twenty-ten) is a New South Wales (NSW)-based not-for-profit organisation. This service provides housing, case management, psychosocial support, counselling, mental health, health, family and domestic violence and legal services for young people (aged 12-25 years) of diverse genders and sexualities, and those born with innate variations of sex characteristics, for their families and communities who support them. Lesbian, Gay, Bisexual, Transgender, Intersex, Queer/Questioning, Asexual, and other diverse gender and sexual identities (LGBTIQA+) young people can experience significant stigma and discrimination, leading to higher rates of mental health conditions compared to their heterosexual, cisgender and endosex peers. Healthcare systems that are cisgender-heteronormative and that privilege endosex individuals often exclude LGBTIQA+ young people. As a result, these young people may disengage from healthcare systems, resulting in poorer health and wellbeing. Some may turn to social media and online communities to help address their healthcare concerns. Effective and culturally safe LGBTIQA+ healthcare requires incorporating lived experiences of stakeholders, understanding health disparities, and practising respectful communication. Mental health professionals too often lack confidence and skills in providing affirming and culturally safe care to LGBTIQA+ clients. Connection to the community and access to culturally safe healthcare are critical protective factors for these young people. LGBTIQA+ affirming practice training is essential for reducing discrimination and improving care. Studies show that while healthcare professionals benefit from LGBTIQA+ training, there is limited access to such programs, and evidence weighing the effectiveness of that training is scarce. Improving culturally safe care and inclusivity through targeted training can significantly enhance the mental health and wellbeing of LGBTIQA+ young people. Aim and objectives: The overall aim was to evaluate the knowledge of mental health professionals about culturally safe healthcare for LGBTIQA+ young people pre- and post- the Safe and Affirmed program, presented through professional development workshops. Our objectives were to evaluate the program to determine if participants have (1) gained knowledge and skills to enhance clinical practices supporting LGBTIQA+ young people in managing family, carer, school, and social relationships, (2) improved system responsiveness and care experiences for LGBTIQA+ young people in mental health care settings, and (3) applied their learnings to clinical practice, advocacy, and affirmative care for LGBTIQA+ young people. Methods: A pre- and post-evaluation was conducted to assess the Safe and Affirmed LGBTIQA+ program for mental health professionals in NSW. The evaluation included pre- and post-surveys administered on the same day as the professional development workshop, and a follow-up survey conducted three to six months later. A sub-sample of consenting participants were invited to take part in semi-structured interviews, which were conducted online three- to six-months post-training. The professional development, provided by Twenty-ten, comprised face-to-face and online education sessions and was implemented across all NSW government and several private health services (i.e., not-for-profit organisations and private healthcare organisations). This program was designed to primarily support Child and Adolescent Mental Health Services (CAMHS). Eligible participants were mental health professionals (e.g., medical practitioners, nurses, social workers, occupational therapists, and peer workers) working in youth mental health services in NSW who completed the training. Recruitment strategies included engaging CAMHS services and disseminating flyers to potential participants. Quantitative data were analysed using paired t-tests to assess average changes in pre- and post-training survey scores. Descriptive statistics summarised demographic and professional characteristics, and the study was designed to detect score changes with statistical significance (p<0.05). All interviews were audio-recorded with participant consent and transcribed verbatim to ensure accuracy. Transcripts were then analysed thematically using both inductive and deductive approaches. This involved a systematic coding process to identify, analyse, and interpret key patterns and themes, drawing on both data-driven insights and pre-identified areas of interest related to the training objectives. Key findings: Three hundred and thirty-four (n=334) participants completed the pre-evaluation survey, and 271 completed the post-evaluation survey; thus, 18.9% (n=63) were lost to follow-up. Participants completing the post-evaluation survey were predominantly social workers (25.4%, n=66), psychologists (23.1%, n=60) and registered nurses (18.5%, n=48). Most participants practised in regional or rural locations (n=171, 65.8%), compared to metropolitan (30%, n=78) or remote (3.5%, n=9) locations. An insufficient number of participants completed the three- to six-month follow-up survey; therefore, this data could not be included in the analysis. The pre- and post-evaluation surveys highlight the significant improvements in participants' knowledge and confidence following their completion of the professional development. Participants reported significantly improved confidence in their knowledge and skills to provide gender affirming approaches for children, adolescents, and young people. Further, there was a marked improvement in participants' confidence in providing culturally safe mental health care to gender and sexuality diverse young people and those with innate variations of sex characteristics. Participants indicated an increased understanding of the co-occurrence of gender diversity with diagnoses such as eating disorders and neurodivergence. They also reported a better understanding of the co-occurrence of sexuality diversity with conditions like anxiety, depression, and post-traumatic stress disorder (PTSD). Participants demonstrated a significant improvement in their confidence in supporting and advocating for young people with an innate variation of sex characteristics. Pre-training 36.7% (n=95/260) of participants could name three unique needs of LGBTIQA+ young people when accessing mental health care services, compared to 94.2% (n=244/259) post-training. The ability to identify three barriers to accessing safe and equitable mental health care for LGBTQIA+ young people increased from 53.1% (n=138/260) pre-training to 97.7% (n=254/260) post-training. Awareness of the NSW LGBTIQ+ Health Strategy increased from 30.8% (n=80/260) pre-training to 96.5% (n=251/260) post-training. Awareness of the NSW Specialist Trans and Gender Diverse Health Service for young people under 25 increased from 48.1% (n=125/260) pre-training to 95.4% (n=248/260) post-training. Fifteen participants were interviewed three to six months after attending the workshop. Most identified as cisgender female (n=12, 80%), followed by cisgender male (n=2, 13.3%) and trans woman (n=1, 6.7%). Eleven participants identified as heterosexual (73.3%), three as gay or lesbian (20%), and one as bisexual (6.7%). The majority were working in regional or rural settings (n=10, 67.7%), with the remainder based in city or urban areas (n=5, 33.3%). Interviews underscored the importance of inclusive documentation in creating affirming healthcare environments for LGBTIQA+ young people. Participants highlighted small changes, such as including chosen names and pronouns on forms, that can significantly affirm identities and influence broader team culture. However, structural barriers, such as electronic medical records with binary gender options, were noted. In response, staff employed local solutions and emphasised the importance of team communication, training, and leadership. While the Safe and Affirmed professional development promoted inclusive values and critical reflection, participants emphasised the need for systemic reform, noting that lasting change requires a whole-of-setting approach that extends beyond individual efforts. Conclusion: These findings underscore the effectiveness of the Safe and Affirmed program in enhancing the participants' capabilities to support and provide culturally safe care for LGBTIQA+ young people. Continued investment in targeted and tailored professional development for mental health professionals providing care to LGBTIQA+ young people is required to build the knowledge and capacity of the health workforce. Quality training with a face-to-face component delivered by experts with lived experience enhanced the learning experience. Regional and rural health professionals must be included in quality face-to-face LGBTIQA+ culturally safe training opportunities.

The drivers of influenza vaccination in adults: Insights from a national Australian survey

Mon, 15 Sep 2025 00:00:00 GMT

The drivers of influenza vaccination in adults: Insights from a national Australian survey Christou-Ergos, Maria; Sabahelzain, Majdi; Steffens, Maryke; Kaufman, Jessica; Bolsewicz, Katarzyna; Danchin, Margie; Leask, Julie Study: Influenza vaccination coverage is suboptimal in the Australian adult population. The National Vaccination Insights Project [1] was established in 2024 to annually measure the behavioural and social drivers of vaccination in the Australian population. Prior to this, while coverage data were used to monitor uptake, there was no systematic data collection to understand the reasons for coverage gaps. The inaugural survey of Australian adults used a globally standardized survey tool [2] adapted for the Australian context to measure constructs related to influenza vaccination within four domains (i) vaccination-related thoughts and feelings, (ii) social processes, (iii) motivation, and (iv) practical issues. This study provides a foundation for ongoing national monitoring of the drivers of influenza vaccination and will help tailor timely strategies to population needs. Dataset: A de-identified dataset from an online survey conducted in March 2024 with a nationally representative sample of 2,055 Australian adults recruited through an online panel [1] https://ncirs.org.au/our-work/national-vaccination-insights-project [2] Behavioural and social drivers of influenza vaccination: tools and practical guidance for achieving high uptake. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.

The multifaceted nature of impulsivity in Parkinson’s disease

Tue, 01 Jan 2019 00:00:00 GMT

The multifaceted nature of impulsivity in Parkinson’s disease O'Callaghan, Claire This scientific commentary refers to "Mosley PE, Paliwal S, Robinson K, Coyne T, Silburn P, Tittgemeyer M, Stephan KE, Breakspear M, Perry A. The structural connectivity of discrete networks underlies impulsivity and gambling in Parkinson's disease. Brain. 2019 Dec 1;142(12):3917-3935. doi: 10.1093/brain/awz327. PMID: 31665241.

Cognition in Parkinson's disease

Sun, 01 Jan 2017 00:00:00 GMT

Cognition in Parkinson's disease O'Callaghan, Claire Cognitive decline is now recognised as a common non-motor symptom of Parkinson’s disease, and it has been the subject of increasing research in recent decades. Cognitive deficits in Parkinson’s disease can be distinguished as dopaminergically-mediated executive dysfunction seen in the milder stages, versus a global dementia syndrome that can occur with disease progression. The neural basis of these deficits has been explored from the perspective of multimodal imaging techniques to measure the structural, functional and metabolic correlates of cognitive decline in Parkinson’s disease. Increasingly, changes in neurotransmitter systems beyond dopamine, including the noradrenergic, serotonergic and cholinergic systems, are being recognised for their contribution to cognitive decline. The impact of certain genetic variations on cognitive function has also been established, including links between cognitive decline and polymorphisms affecting COMT, MAPT, APOE and GBA genotypes. Although therapeutic options for cognitive decline are still far less established than for motor systems, both pharmacological and non-pharmacological strategies are continuing to develop.

Beyond the Bondi Junction tragedy: Strategies to Address System Failures & Subsequent Dangers affecting Homeless, Itinerant & Alienated Individuals living with Complex Mental Health Disorders in NSW

Wed, 16 Jul 2025 00:00:00 GMT

Beyond the Bondi Junction tragedy: Strategies to Address System Failures & Subsequent Dangers affecting Homeless, Itinerant & Alienated Individuals living with Complex Mental Health Disorders in NSW Bennett, M R; Rosen, A Major investment and reform of NSW mental health services are urgently needed in response to the Bondi Junction tragedy of 13 April 2024. This is a major challenge for the NSW Government. There have been overlapping and cumulative crises in NSW mental health services for some years. This culminated in 2024 in the Bondi Junction Tragedy which alerted the public to the serious system failures in the mental health system. This was compounded by the impending collapse of public health psychiatrist services in 2025. A NSW Coroner’s Inquest is soon to investigate these related system failures, and what can we do to prevent their recurrence. A chronology of events at the Bondi Junction tragedy indicates at least 20 cumulative system failures and missed opportunities [ see Box 1 pp 20-24]. How to avoid these tragedies has been evident for some time. So far there has been a lack of action by NSW Government Authorities to take the necessary coherent action, even after a year. It is possible that only recommendations of a Royal Commission may be able to generate and sustain effective solutions. But why must we wait further for a long-drawnout Royal Commission when we know what needs doing? Some of the most rigorous studies which generated and replicated international evidence of the effectiveness of the methods recommended below, were completed in NSW for Australian conditions. NSW often led the way in Australia & internationally with this evidence base and subsequent reforms. Over recent years, these reforms have been eroded, diluted and underfunded by NSW Health and inadvertant neglect by successive governments.

Deep learning enables MV-based real-time image guided radiation therapy for prostate cancer patients.

Sun, 01 Jan 2023 00:00:00 GMT

Deep learning enables MV-based real-time image guided radiation therapy for prostate cancer patients. Chrystall, D; Mylonas, A; Hewson, E; Martin, J; Booth, J; Keall, P; Nguyen, D T Objective. Using MV images for real-time image guided radiation therapy (IGRT) is ideal as it does not require additional imaging equipment, adds no additional imaging dose and provides motion data in the treatment beam frame of reference. However, accurate tracking using MV images is challenging due to low contrast and modulated fields. Here, a novel real-time marker tracking system based on a convolutional neural network (CNN) classifier was developed and evaluated on retrospectively acquired patient data for MV-based IGRT for prostate cancer patients.Approach. MV images, acquired from 29 volumetric modulated arc therapy (VMAT) prostate cancer patients treated in a multi-institutional clinical trial, were used to train and evaluate a CNN-based marker tracking system. The CNN was trained using labelled MV images from 9 prostate cancer patients (35 fractions) with implanted markers. CNN performance was evaluated on an independent cohort of unseen MV images from 20 patients (78 fractions), using a Precision-Recall curve (PRC), area under the PRC plot (AUC) and sensitivity and specificity. The accuracy of the tracking system was evaluated on the same unseen dataset and quantified by calculating mean absolute (±1 SD) and [1st, 99th] percentiles of the geometric tracking error in treatment beam co-ordinates using manual identification as the ground truth.Main results. The CNN had an AUC of 0.99, sensitivity of 98.31% and specificity of 99.87%. The mean absolute geometric tracking error was 0.30 ± 0.27 and 0.35 ± 0.31 mm in the lateral and superior-inferior directions of the MV images, respectively. The [1st, 99th] percentiles of the error were [-1.03, 0.90] and [-1.12, 1.12] mm in the lateral and SI directions, respectively.Significance. The high classification performance on unseen MV images demonstrates the CNN can successfully identify implanted prostate markers. Furthermore, the sub-millimetre accuracy and precision of the marker tracking system demonstrates potential for adaptation to real-time applications.

Image Reconstruction with B0 Inhomogeneity using a Deep Unrolled Network on an Open-bore MRI-Linac

Mon, 01 Jan 2024 00:00:00 GMT

Image Reconstruction with B0 Inhomogeneity using a Deep Unrolled Network on an Open-bore MRI-Linac Shan, Shanshan; Gao, Yang; Waddington, David; Chen, Hongli; Whelan, Brendan; Liu, Paul; Wang, Yaohui; Liu, Chunyi; Gan, Hongping; Gao, Mingyuan; Liu, Feng MRI-Linac systems require fast image reconstruction with high geometric fidelity to localize and track tumours for radiotherapy treatments. However, B0 field inhomogeneity distortions and slow MR acquisition potentially limit the quality of the image guidance and tumour treatments. In this study, we develop an interpretable unrolled network, referred to as RebinNet, to reconstruct distortion-free images from B0 inhomogeneity-corrupted k-space for fast MRI-guided radiotherapy applications. RebinNet includes convolutional neural network (CNN) blocks to perform image regularizations and nonuniform fast Fourier Transform (NUFFT) modules to incorporate B0 inhomogeneity information. The RebinNet was trained on a publicly available MR dataset (3300 images) from eleven healthy volunteers for both fully sampled and subsampled acquisitions. 768 grid phantom and 12 human brain images acquired from an open-bore 1T MRI-Linac scanner were used to evaluate the performance of the proposed network. The RebinNet was compared with the conventional regularization algorithm and our recently developed UnUNet method in terms of root mean squared error (RMSE), structural similarity (SSIM), residual distortions, and computation time. Imaging results demonstrated that the RebinNet reconstructed images with lowest RMSE (<0.05) and highest SSIM (>0.92) at four-time acceleration for simulated brain images. The RebinNet preserved more image details and substantially increased the computational efficiency (3s, ten-fold faster) compared to the conventional regularization methods (30s), and had better generalization ability than the UnUNet method. The proposed RebinNet can achieve rapid image reconstruction and overcome the B0 inhomogeneity distortions simultaneously, which would facilitate accurate and fast image guidance in radiotherapy treatments.

Teaching Sexual and Reproductive Health and Rights at the University: A Toolkit for Nursing and Social Work Educators (Australian Edition)

Mon, 05 May 2025 00:00:00 GMT

Teaching Sexual and Reproductive Health and Rights at the University: A Toolkit for Nursing and Social Work Educators (Australian Edition) Wong, Horas; Butel, Rosie; Zhang, Kelly; Klinner, C; Wong, Janet Yuen Ha; Turner, George; Lovell, Renee; Choi, EPH; Spencer, Margaret; Roberts, SJ; Wong, Adam SM; Lin, Jamie Yun Ting; van Diggele, Christie; Bloomfield, Jacqueline; Nugent, Colleen; Chow, Hannah; Fontaine, Colette; Cui, Jialiang The SWAN-SR Teaching Toolkit is a co-designed educational resource developed to support university educators in teaching sexual and reproductive health and rights (SRHR) to Nursing and Social Work students. Created through a cross-national collaboration between educators, students, and frontline practitioners in Australia and Hong Kong, the toolkit responds to identified gaps in SRHR education by offering inclusive, trauma-informed, and practice-oriented content. It includes adaptable lesson plans, case studies, reflective exercises, and guidance to help educators facilitate safe, supportive, and person-centred learning environments. The resource promotes critical thinking, professional readiness, and inclusive care, and is intended for integration into both standalone sessions and broader curricula.

Universal Health Care Delivery Mitigates Socioeconomic-Related Risk for Adverse Outcomes in Hospitalised Patients : Lessons from the COVID-19 Pandemic in Australia

Tue, 01 Apr 2025 00:00:00 GMT

Universal Health Care Delivery Mitigates Socioeconomic-Related Risk for Adverse Outcomes in Hospitalised Patients : Lessons from the COVID-19 Pandemic in Australia Fahimeh, Faqihi; Perri, Rita; Chien, Jimmy; Cho, Jin Gun; Milne, Stephen; Bag, Shopna; Gilroy, Nicole; Wheatley, John R; Kairaitis, Kristina Objectives: Internationally, socioeconomic disadvantage is related to severe outcomes of COVID-19. We investigated the impact of socioeconomic disadvantage on infection rates, hospitalisation, and in-hospital outcomes for COVID-19 with standardised medical care. Design: Retrospective cross-sectional study. Setting: SARS-CoV-2 PCR-confirmed patients, ≥18 years old, admitted to a major public hospital between January 2020 and December 2021. Main outcome measurements: Severe COVID-19 outcomes were defined by a composite outcome of in-hospital death or other critical complications. A generalised linear regression model of demographic features, co-existing conditions, and socioeconomic status [Socioeconomic Index for Area (SEIFA)] was used to determine the risks of the composite outcome. Results: Of 797,343 individuals aged ≥18 in the health district, 50,906 (6.4%) were PCR-positive, and 1,962 were hospitalised. Compared with the whole health district population, infected individuals were younger (median [interquartile range] age 35 [25-48] years vs 42 [31-58] years) and from areas with the greatest socioeconomic disadvantage (34.4% vs 20%; both p<0.0001). Hospitalised patients were older, with more females compared to the PCR-positive group (46 years [33-61], 53.5%, respectively; p<0.001), and 51.2% were from postcodes with greatest socioeconomic disadvantage (p<0.0001). The composite outcome occurred in 11.5%, with an in-hospital mortality of 3.8%. Higher risk of the composite outcome was observed in males (OR 1.72, 95% CI [1.26-2.42], p <0.001), patients aged ≥ 65 years (OR 6.96, [3.3-14.6], p <0.001), those with ≥4comorbidities (OR 2.67, [1.54-4.63], p <0.001), and unvaccinated patients (OR 1.57, [1.05-2.38], p < 0.05). The risk of composite outcome did not increase with socioeconomic disadvantage (OR 0.97, [0.68, 1.42], p = 0.64). Conclusion: In the absence of capacity restraints, socioeconomic disadvantage was not associated with severe in-hospital outcomes in a well-resourced care environment despite the increased rates of infection and hospitalisation. This highlights the impact of universally accessible, standardised, protocolised, high-quality in-hospital care in reducing the risk of adverse in-hospital outcomes in socioeconomically disadvantaged patients.

Longitudinal study in autosomal recessive PROM1 Inherited Retinal Disease

Mon, 31 Mar 2025 00:00:00 GMT

Longitudinal study in autosomal recessive PROM1 Inherited Retinal Disease Yates, William PROM1, encoding prominin-1, inherited retinal diseases (IRDs) result in significant phenotypic heterogeneity ranging from macular dystrophy to severe rod-cone dystrophy. This study examined a cohort of patients with autosomal recessive (AR) PROM1-associated IRD to determine important potential biomarkers of disease progression on multimodal imaging. Ophthalmic phenotyping included clinical examination, OCT, fundus autofluoresence and electrophysiology. The cohort included 6 patients with bi-allelic variants, including 2 novel variants, and a median of 11.8 years of follow-up. Best corrected visual acuity (BCVA) was maintained until a steep decline around 15 years of age. This was preceded by contraction of the subfoveal ellipsoid zone length (EZL), measured on OCT. Review of the literature demonstrated that cone or cone-rod dystrophy was the most frequently identified clinical phenotype. Loss of function variants including nonsense, frameshift and splice variants were particularly common. This study provides detailed insights into the natural history of AR PROM1 IRD and current understanding in the published literature. Contraction of the subfoveal EZL appears to be a potential biomarker for disease progression and occurs earlier than reduction in BCVA.

Building Mentally Healthy Futures: A Call to Action

Fri, 07 Mar 2025 00:00:00 GMT

Building Mentally Healthy Futures: A Call to Action Australia's Mental Health Think Tank; Smout, Scarlett; Scott, Lauren; Donohoe-Bales, Amarina; Sedgwick, Camilla; Spallek, Sophia; Bower, Marlee Two years ago, Australia’s Mental Health Think Tank (2022) released the policy paper Building Mentally Healthy Futures: Australian Youth Recovery Plan. The plan put forward eight evidence-based policy recommendations addressing three primary drivers of the disproportionate mental health burden on young Australians: economic inequalities, social disconnection and lack of access to quality mental health services. In light of the compounding effects of additional economic and social crises in recent years, Australia’s Mental Health Think Tank have identified the critical need to take stock of progress made against the original policy paper recommendations, re-examine the evidence, and issue a renewed call for policy action. As the 2025 federal election approaches, this timely policy report focuses on actionable, evidence-based steps a newly elected government can take to address the drivers of escalating mental health issues in the Australian population.

Mentally Healthy Futures Project submission to the Standing Committee on Social Issues: Inquiry into the prevalence, causes and impacts of loneliness in New South Wales

Wed, 01 Jan 2025 00:00:00 GMT

Mentally Healthy Futures Project submission to the Standing Committee on Social Issues: Inquiry into the prevalence, causes and impacts of loneliness in New South Wales Bower, Marlee; Donohoe-Bales, Amarina; Scott, Lauren; Kent, Jennifer; Smout, Scarlett; Teesson, Maree This report includes a policy submission from members of the Mentally Healthy Futures Project (The Matilda Centre, University of Sydney) to the Standing Committee on Social Issues: Inquiry into the prevalence, causes and impacts of loneliness in New South Wales. The submission highlights key recommendations including: 1) The NSW government should prioritise social connection as a policy focus, expanding beyond just addressing loneliness and social isolation, 2) NSW government should implement a cross-departmental policy approach to social connection, 3) NSW government should promote public awareness of social connection through public health campaigns which reduce stigma, 4) NSW government should invest in community-level infrastructure, improving its accessibility and quality, to support neighbourhood-level social connection, 5) NSW should invest in expanding the evidence base around loneliness, and 6) NSW government should create supportive conditions for NSW residents to reduce social isolation and loneliness.

Tumor-infiltrating lymphocyte grade (TIL grade) is an independent predictor of sentinel lymph node status and survival in cutaneous melanoma patients

Sun, 01 Jan 2012 00:00:00 GMT

Tumor-infiltrating lymphocyte grade (TIL grade) is an independent predictor of sentinel lymph node status and survival in cutaneous melanoma patients Azimi, Farhad; Scolyer, Richard A.; Moncrieff, Marc; Rumcheva, Pavlina; Murali, Rajmohan; McCarthy, Stanley W.; Saw, Robyn P.; Thompson, John F. Purpose: To determine whether density and distribution of tumor-infiltrating lymphocytes (TIL) (TIL grade) is an independent predictor of sentinel node (SLN) status and survival in patients with clinically localized primary cutaneous melanoma. Methods: From the Melanoma Institute Australia database, 1865 patients with a single primary melanoma >0.75mm in thickness were identified. The associations of clinical and pathologic factors with SLN status, recurrence-free survival (RFS) and melanomaspecific survival (MSS) were analyzed. Results: The majority of patients had either no (TIL grade 0, 35.4%) or few (TIL grade 1, 45.1%) TILs, with a minority showing moderate (TIL grade 2, 16.3%) or marked (TIL grade 3, 3.2%) TILs. Tumor thickness, mitotic rate and Clark level were inversely correlated with TIL grade (each p<0.0001). SLN biopsy was performed in 1138 (61%) patients and was positive in 237 (21%). There was a significant inverse association between SLN status and TIL grade (SLN positivity rates for each TIL grade: 0=27.8%, 1=20.1%, 2=18.3%, 3=5.6%; p<0.0001). Predictors of SLN positivity were decreasing age (p<0.0001), decreasing TIL grade (p<0.0001), ulceration (p=0.003), increasing tumor thickness (p=0.01)satellitosis (p=0.03) and increasing mitoses (p=0.03). 5-year MSS and RFS rates were 83% and 76%, respectively (median follow-up 43 months). Tumor thickness (p<0.0001), ulceration (p<0.0001), satellitosis (p<0.0001), mitotic rate (p=0.003), TIL grade (p<0.0001) and gender (p=0.01) were independent predictors of MSS. Patients with TIL grade 3 tumors had 100% survival. Conclusion: TIL grade is an independent predictor of survival and SLN status in melanoma patients. Patients with a pronounced TIL infiltrate have an excellent prognosis.

PD-L1 expression in melanoma has prognostic significance but shows marked heterogeneity within and between patients- implications for anti-PD-1/PD-L1 clinical trials

Thu, 01 Jan 2015 00:00:00 GMT

PD-L1 expression in melanoma has prognostic significance but shows marked heterogeneity within and between patients- implications for anti-PD-1/PD-L1 clinical trials Madore, Jason; Vilain, Ricardo; Menzies, Alexander M.; Kakavand, Hojabr; Wilmott, James S.; Hyman, Jessica; Yearley, Jennifer H.; Kefford, Richard F.; Thompson, John Francis; Long, Georgina V.; Hersey, Peter; Scolyer, Richard A. This study evaluated the expression of PD-L1 in immunotherapy-naive metastatic melanoma patients to determine longitudinal intrapatient concordance and correlate PD-L1 status with clinicopathologic characteristics and outcome. PD-L1 expression was assessed by immunohistochemistry in 58 patients (43 primary tumors, 96 metastases). Seventy-two percent of patients had at least one specimen expressing PD-L1 in >/= 1% of tumor cells. Median positive tumor cell count overall was low (8% in nonzero specimens). PD-L1 expression was frequently discordant between primary tumors and metastases and between intrapatient metastases, such that 23/46 longitudinal patient specimens were discordant. PD-L1 was associated with higher TIL grade but not with other known prognostic features. There was a positive univariate association between PD-L1 expression in locoregional metastases and melanoma-specific survival, but the effect was not observed for primary melanoma. In locoregional lymph node metastasis, PD-L1+/TIL+ patients had the best outcome, and PD-L1+/TIL- patients had poor outcome.

CD103(+) Tumor-Resident CD8(+) T Cells Are Associated with Improved Survival in Immunotherapy-Naive Melanoma Patients and Expand Significantly During Anti-PD-1 Treatment

Mon, 01 Jan 2018 00:00:00 GMT

CD103(+) Tumor-Resident CD8(+) T Cells Are Associated with Improved Survival in Immunotherapy-Naive Melanoma Patients and Expand Significantly During Anti-PD-1 Treatment Thompson, John Francis Purpose: Therapeutic blockade of immune checkpoints has revolutionized cancer treatment. Durable responses, however, occur in less than half of those treated, and efforts to improve treatment efficacy are confounded by a lack of understanding of the characteristics of the cells that initiate antitumor immune response.Patients and Methods: We performed multiparameter flow cytometry and quantitative multiplex immunofluorescence staining on tumor specimens from immunotherapy-naive melanoma patients and longitudinal biopsy specimen obtained from patients undergoing anti-PD-1 therapy.Results: Increased numbers of CD69(+)CD103(+) tumor-resident CD8(+) T cells were associated with improved melanoma-specific survival in immunotherapy-naive melanoma patients. Local IL15 expression levels strongly correlated with these tumor-resident T-cell numbers. The expression of several immune checkpoints including PD-1 and LAG3 was highly enriched in this subset, and these cells significantly expanded early during anti-PD-1 immunotherapy.Conclusions: Tumor-resident CD8(+) T-cell numbers are more prognostic than total CD8(+) T cells in metastatic melanoma. In addition, they are likely to initiate response to anti-PD-1 and anti-LAG-3 treatments. We propose that the immune profile of these cells prior to treatment could inform strategies for immune checkpoint blockade. Clin Cancer Res; 24(13); 3036-45. (c)2018 AACR.

Adjuvant lymph-node field radiotherapy versus observation only in patients with melanoma at high risk of further lymph-node field relapse after lymphadenectomy (ANZMTG 01.02/TROG 02.01): 6-year follow-up of a phase 3, randomised controlled trial

Thu, 01 Jan 2015 00:00:00 GMT

Adjuvant lymph-node field radiotherapy versus observation only in patients with melanoma at high risk of further lymph-node field relapse after lymphadenectomy (ANZMTG 01.02/TROG 02.01): 6-year follow-up of a phase 3, randomised controlled trial Thompson, John Francis BACKGROUND: Adjuvant radiotherapy is recommended for patients with melanoma after lymphadenectomy. We previously showed this treatment reduced risk of repeat lymph-node field cancer in patients with a high risk of recurrence but had no effect on overall survival. Here, we aim to update the relapse and survival data from that trial and assess quality of life and toxic effects. METHODS: In the ANZMTG 01.02/TROG 02.01 randomised controlled trial, we enrolled patients who had undergone lymphadenectomy for a palpable lymph-node field relapse and were at high risk of recurrence at 16 hospitals (11 in Australia, three in New Zealand, one in Netherlands, and one in Brazil). We randomly assigned patients (1:1) to adjuvant radiotherapy (48 Gy in 20 fractions, given over a maximum of 30 days) or observation, stratified by institution, areas of lymph-node field (parotid and cervical, axilla, or groin), number of involved nodes (3), maximum involved node diameter (4 cm), and extent of extracapsular extension (none, limited, or extensive). Participants, those giving treatment, and those assessing outcomes were not masked to treatment allocation, but participants were unaware of each other's treatment allocation. In this follow-up, we assessed outcomes every 3 months from randomisation for the first 2 years, then every 6 months up to 5 years, then annually. The primary endpoint was lymph-node field relapse as a first relapse, assessed in patients without major eligibility infringements (determined by an independent data monitoring committee). We assessed late adverse effects (occurring >90 days after surgery or start of radiotherapy) with standard criteria in the as-treated population. This study is registered with ClinicalTrials.gov, number NCT00287196. FINDINGS: Between March 21, 2003, and Nov 15, 2007, we randomly assigned 123 patients to adjuvant radiotherapy (109 eligible for efficacy assessments) and 127 to observation (108 eligible). The final follow-up date was Nov 15, 2011. Median follow-up was 73 months (IQR 61-91). 23 (21%) relapses occurred in the adjuvant radiotherapy group compared with 39 (36%) in the observation group (adjusted hazard ratio [HR] 0.52 [95% CI 0.31-0.88], p=0.023). Overall survival (HR 1.27 [95% CI 0.89-1.79], p=0.21) and relapse-free survival (0.89 [0.65-1.22], p=0.51) did not differ between groups. Minor, long-term toxic effects from radiotherapy (predominantly pain, and fibrosis of the skin or subcutaneous tissue) were common, and 20 (22%) of 90 patients receiving adjuvant radiotherapy developed grade 3-4 toxic effects. 18 (20%) of 90 patients had grade 3 toxic effects, mainly affecting skin (nine [10%] patients) and subcutaneous tissue (six [7%] patients). Over 5 years, a significant increase in lower limb volumes was noted after adjuvant radiotherapy (mean volume ratio 15.0%) compared with observation (7.7%; difference 7.3% [95% CI 1.5-13.1], p=0.014). No significant differences in upper limb volume were noted between groups. INTERPRETATION: Long-term follow-up supports our previous findings. Adjuvant radiotherapy could be useful for patients for whom lymph-node field control is a major issue, but entry to an adjuvant systemic therapy trial might be a preferable first option. Alternatively, observation, reserving surgery and radiotherapy for a further recurrence, might be an acceptable strategy. FUNDING: National Health and Medical Research Council of Australia, Cancer Council Australia, Melanoma Institute Australia, and the Cancer Council South Australia.

Mentally Healthy Futures Project submission to the NSW Public Accounts Committee’s Parliamentary Inquiry: A framework for performance reporting and driving wellbeing outcomes in NSW

Mon, 16 Dec 2024 00:00:00 GMT

Mentally Healthy Futures Project submission to the NSW Public Accounts Committee’s Parliamentary Inquiry: A framework for performance reporting and driving wellbeing outcomes in NSW Smout, Scarlett; Bower, Marlee; Donohoe-Bales, Amarina; Meas, Danica; Guo, Kailin; Yan, Fulin; Scott, Lauren; Teesson, Maree This report includes a policy submission from members of the Mentally Healthy Futures Project (The Matilda Centre, University of Sydney) to the NSW Public Accounts Committee’s Parliamentary Inquiry: A framework for performance reporting and driving wellbeing outcomes in NSW. The submission provides 1) an overview of the The Mentally Healthy Futures Project and The Matilda Centre; 2) feedback on the proposed wellbeing themes and outcomes; 3) suggested scales to consider for the measurement of population mental health and social and emotional wellbeing; 4) highlights the importance of meaningful consultation, particularly with young people; and 5) findings from a youth consultation conducted by the Mentally Healthy Futures Team, in response to the Performance and Wellbeing Consultation Paper.

Australian Aboriginal and Torres Strait Islander Psychiatry

Mon, 01 Jan 2024 00:00:00 GMT

Australian Aboriginal and Torres Strait Islander Psychiatry Towney, John; Shields, Robyn; Walke, Emma; Talbot, Daniel; Burns, Nicholas This chapter explores the concept of social and emotional well-being (SEWB) as a foundational framework for understanding health among Aboriginal and Torres Strait Islander Australians. Unlike Western medical models, which focus primarily on individual pathology, SEWB adopts a holistic approach, emphasizing the interconnectedness of physical, mental, and spiritual health with cultural identity, community, and the natural environment. Central to this framework are seven domains of connection: body, mind and emotions, family and kinship, community, culture, country, and spirituality. The chapter also examines the significant social determinants and historical forces, such as colonization, institutional racism, and government policies, that have shaped the well-being of Aboriginal and Torres Strait Islander peoples. Epidemiological data on psychological distress, mental disorders, substance use, and related health outcomes are presented, highlighting the disproportionate burden of mental illness and substance use disorders within these communities. Intergenerational trauma is also discussed, underscoring its profound and enduring impact on the social and emotional health of Aboriginal and Torres Strait Islander Australians. This chapter emphasizes the need for culturally informed, community-driven approaches to health that acknowledge the resilience and strengths embedded within Aboriginal and Torres Strait Islander cultures.

Placing Social Connection at the Heart of Public Policy in the United Kingdom and Australia

Mon, 04 Nov 2024 00:00:00 GMT

Placing Social Connection at the Heart of Public Policy in the United Kingdom and Australia Bower, Marlee; Smout, Scarlett; Johnson, Sonia; Costello, Anthony; Andres, Lauren; Donohoe-Bales, Amarina; Leach, Matt; Pellicano, Liz; Hiller, Rachel; Fonagy, Peter; Ypsilanti, Antonia; Kumar, Sarabajaya; Scott, Lauren; Pearson, Sarah; Hobson, Harry; Barclay, David; Harding, Sarah; Teesson, Lily; Baggaley, James; Stears, Marc; Teesson, Maree This report summarises the discussions and outcomes of a roundtable on the Future of Social Connection held at University College London, which brought together recognised UK and Australian expert stakeholders on social connection, including psychiatrists and psychologists, social scientists, community organisers, campaigners, advocates, and policymakers. Together they reflected on the best available academic and community evidence, and collaboratively charted innovative, impactful and sustainable strategies to combat loneliness strengthen social connection into the future.

Factors informing funding of health services for Aboriginal and Torres Strait Islander children: perspectives of decision-makers

Mon, 01 Jan 2024 00:00:00 GMT

Factors informing funding of health services for Aboriginal and Torres Strait Islander children: perspectives of decision-makers Chando, Shingisai; Howell, Martin; Dickson, Michelle; Jaure, Allison; Craig, Jonathan C.; Eades, Sandra J.; Howard, Kirsten Background. The factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children are unclear. This study's objective aimed to describe decision-makers’ perspectives on factors informing decisions to fund health services for Aboriginal and Torres Strait Islander children. Methods. We conducted semi-structured interviews with 13 participants experienced in making funding decisions at organisational, state, territory and national levels. Decision-makers were from New South Wales, Northern Territory, Queensland, Victoria and Western Australia. Transcripts were analysed thematically following the principles of grounded theory. Results. We identified five themes, each with subthemes. First, prioritising engagement for authentic partnerships (opportunities to build relationships and mutual understanding, co-design and co-evaluation for implementation). Second, valuing participant experiences to secure receptiveness (cultivating culturally safe environments to facilitate acceptability, empowering for self-determination and sustainability, strengthening connectedness and collaboration for holistic care, restoring confidence and generational trust through long-term commitments). Third, comprehensive approaches to promote health and wellbeing (linking impacts to developmental milestones, maintaining access to health care, broadening conceptualisations of child health). Fourth, threats to optimal service delivery (fractured and outdated technology systems amplify data access difficulties, failure to ‘truly listen’ fuelling redundant policy, rigid funding models undermining innovation). Fifth, navigating political and ideological hurdles to advance community priorities (negotiating politicians’ willingness to support community-driven objectives, pressure to satisfy economic and policy considerations, countering entrenched hesitancy to community-controlled governance). Conclusion. Decisionmakers viewed participation, engagement, trust, empowerment and community acceptance as important indicators of service performance. This study highlights factors that influence decisions to fund health services for Aboriginal and Torres Strait Islander children.

Real-time motion management in MRI-guided radiotherapy: Current status and AI-enabled prospects.

Mon, 01 Jan 2024 00:00:00 GMT

Real-time motion management in MRI-guided radiotherapy: Current status and AI-enabled prospects. Lombardo, Elia; Dhont, Jennifer; Page, Denis; Garibaldi, Cristina; Kunzel, Luise; Hurkmans, Coen; Tijssen, Rob; Paganelli, Chiara; Liu, Paul; Keall, Paul; Riboldi, M; Kurz, Christopher; Landry, Guillaume; Cusumano, Davide; Fusella, Marco; Placidi, Lorenzo MRI-guided radiotherapy (MRIgRT) is a highly complex treatment modality, allowing adaptation to anatomical changes occurring from one treatment day to the other (inter-fractional), but also to motion occurring during a treatment fraction (intra-fractional). In this vision paper, we describe the different steps of intra-fractional motion management during MRIgRT, from imaging to beam adaptation, and the solutions currently available both clinically and at a research level. Furthermore, considering the latest developments in the literature, a workflow is foreseen in which motion-induced over- and/or under-dosage is compensated in 3D, with minimal impact to the radiotherapy treatment time. Considering the time constraints of real-time adaptation, a particular focus is put on artificial intelligence (AI) solutions as a fast and accurate alternative to conventional algorithms.

CBCT-DRRs superior to CT-DRRs for target-tracking applications during pancreatic SBRT

Mon, 01 Jan 2024 00:00:00 GMT

CBCT-DRRs superior to CT-DRRs for target-tracking applications during pancreatic SBRT Madden, Levi; Ahmed, Abdella; Stewart, Maegan; Chrystall, Danielle; Mylonas, Adam; Brown, Ryan; Nguyen, Doan Trang; Keall, Paul; Booth, Jeremy Objective.In current radiograph-based intra-fraction markerless target-tracking, digitally reconstructed radiographs (DRRs) from planning CTs (CT-DRRs) are often used to train deep learning models that extract information from the intra-fraction radiographs acquired during treatment. Traditional DRR algorithms were designed for patient alignment (i.e.bone matching) and may not replicate the radiographic image quality of intra-fraction radiographs at treatment. Hypothetically, generating DRRs from pre-treatment Cone-Beam CTs (CBCT-DRRs) with DRR algorithms incorporating physical modelling of on-board-imagers (OBIs) could improve the similarity between intra-fraction radiographs and DRRs by eliminating inter-fraction variation and reducing image-quality mismatches between radiographs and DRRs. In this study, we test the two hypotheses that intra-fraction radiographs are more similar to CBCT-DRRs than CT-DRRs, and that intra-fraction radiographs are more similar to DRRs from algorithms incorporating physical models of OBI components than DRRs from algorithms omitting these models.Approach.DRRs were generated from CBCT and CT image sets collected from 20 patients undergoing pancreas stereotactic body radiotherapy. CBCT-DRRs and CT-DRRs were generated replicating the treatment position of patients and the OBI geometry during intra-fraction radiograph acquisition. To investigate whether the modelling of physical OBI components influenced radiograph-DRR similarity, four DRR algorithms were applied for the generation of CBCT-DRRs and CT-DRRs, incorporating and omitting different combinations of OBI component models. The four DRR algorithms were: a traditional DRR algorithm, a DRR algorithm with source-spectrum modelling, a DRR algorithm with source-spectrum and detector modelling, and a DRR algorithm with source-spectrum, detector and patient material modelling. Similarity between radiographs and matched DRRs was quantified using Pearson's correlation and Czekanowski's index, calculated on a per-image basis. Distributions of correlations and indexes were compared to test each of the hypotheses. Distribution differences were determined to be statistically significant when Wilcoxon's signed rank test and the Kolmogorov-Smirnov two sample test returnedp≤ 0.05 for both tests.Main results.Intra-fraction radiographs were more similar to CBCT-DRRs than CT-DRRs for both metrics across all algorithms, with allp≤ 0.007. Source-spectrum modelling improved radiograph-DRR similarity for both metrics, with allp< 10-6. OBI detector modelling and patient material modelling did not influence radiograph-DRR similarity for either metric.Significance.Generating DRRs from pre-treatment CBCT-DRRs is feasible, and incorporating CBCT-DRRs into markerless target-tracking methods may promote improved target-tracking accuracies. Incorporating source-spectrum modelling into a treatment planning system's DRR algorithms may reinforce the safe treatment of cancer patients by aiding in patient alignment.

Assessing surgeons’ attitude to teaching intra-corporeal anastomosis

Mon, 01 Jan 2024 00:00:00 GMT

Assessing surgeons’ attitude to teaching intra-corporeal anastomosis Patel, Meet; Naseem, Zainab; Young, Christopher J. Introduction: There is controversy in minimally invasive colorectal procedures regarding choosing optimal technique between intra-corporeal (ICA) and extra-corporeal anastomosis (ECA). Previous studies recognise the short-term benefits in right hemicolectomy with intra-corporeal approach, however, ICA can result in increased operative difficulty. The aim of this study is to understand attitudes towards teaching ICA in colorectal procedures and how this varies between subspeciality training. Methods: Active members of General Surgeons Australia were contacted through email to participate in a voluntary, unincentivized survey. Demographic details were collected and participants were asked to rate agreement for simulation-based training for increasing adoption of ICA through a Likert scale and when preferences for teaching ICA. Descriptive statistics were completed to describe frequencies and ordinal regression was completed to determine factors for Likert scale question. Results: There were 43 respondents and most participants recognised that ECA was easier to teach trainees and should be taught first. 53.5% of respondents recognised that simulation-based training would assist the adoption of ICA. Surgeons who routinely close bowel or enteric defects intra-corporeally are 354% more likely to show an interest in simulation-based training for adopting ICA, however, surgeons who are not involved in teaching trainees did not show an interest in simulation-based training. Conclusion: There is significant agreement that ECA forms the basis to learn ICA and simulation-based training would assist with the uptake of ICA. However, a multimodal approach, including expanding training avenues and providing financial incentives, would be necessary to enhance the adoption of ICA in colorectal surgery.

The efficacy and safety of a supplement combination for hand osteoarthritis pain: an internet-based randomised placebo-controlled trial - The RADIANT study dataset

Tue, 16 Jul 2024 00:00:00 GMT

The efficacy and safety of a supplement combination for hand osteoarthritis pain: an internet-based randomised placebo-controlled trial - The RADIANT study dataset Hunter, David This dataset includes 106 participants aged over 40 years with symptomatic hand osteoarthritis with radiographic confirmation recruited into the RADIANT study, which was an internet-based, double-blind, randomised, placebo-controlled trial. Baseline data includes demographics, medical history, primary and secondary outcomes and the modified computer self-efficacy scale. Outcome measure assessments were completed at baseline, weeks 2, 6, and 12 and included patient-reported outcomes (hand pain intensity, hand function, patient global assessment of disease activity and quality of life.

The effects of sport participation for adults with physical or intellectual disability: a scoping review

Fri, 05 Jul 2024 00:00:00 GMT

The effects of sport participation for adults with physical or intellectual disability: a scoping review Hassett, Leanne; Moseley, Anne M; McKay, Marnee J; Cole, Jenni; Chagpar, Sakina; Geerts, Minke P J; Kwok, Wing S; Jensen, Connie; Sherrington, Catherine; Shields, Nora This is the Supplementary Data, Supplementary File, and Supplementary Table for the article: Hassett L, Moseley AM, McKay MJ, Cole J, Chagpar S, Geerts MPJ, Kwok WS, Jensen C, Sherrington C, Shields N. The effects of sport participation for adults with physical or intellectual disability: a scoping review. Journal of Physical Activity & Health 2024

Work-related suicide: Evolving understandings of etiology & intervention

Mon, 01 Jan 2024 00:00:00 GMT

Work-related suicide: Evolving understandings of etiology & intervention Glozier, Nick Previously published analyses of suicide case investigations suggest that work or working conditions contribute to 10-13% of suicide deaths. Yet, the way in which work may increase suicide risk is a relatively under-developed area of epidemiologic research. In this Commentary, we propose a definition of work-related suicide from an occupational health and safety perspective, and review the case investigation-based and epidemiologic evidence on work-related causes of suicide. We identified six broad categories of potential work-related causes of suicide, which are: (1) workplace chemical, physical, and psychosocial exposures; (2) exposure to trauma on the job; (3) access to means of suicide through work; (4) exposure to high stigma work environments; (5) exposure to normative environments promoting extreme orientation to work; and (6) adverse experiences arising from work-related injury or illness. We summarise current evidence in a schema of potential work-related causes that can also be applied in workplace risk assessment and suicide case investigations. There are numerous implications of these findings for policy and practice. Various principle- and evidence-based workplace suicide prevention intervention strategies exist, some of which have been shown to improve suicide prevention literacy, reduce stigma, enhance helping behaviours, and in some instances maybe even reduce suicide rates. Prevailing practice in workplace suicide prevention, however, overly emphasises individual- and illness-directed interventions, with little attention directed to addressing the working conditions that may increase suicide risk. We conclude that a stronger emphasis on improving working conditions will be required for workplace suicide prevention to reach its full preventive potential.

RESPite: REducing Sonographer Pain through ergonomics education.

Mon, 24 Jun 2024 00:00:00 GMT

RESPite: REducing Sonographer Pain through ergonomics education. Sweeney, Kristie; Mackey, Martin; Clarke, Jillian; Ginn, Karen; Spurway, Jacqueline An interactive educational resource to reduce musculoskeletal pain in sonographers.

The QUEST Initiative: 12-month manuscript dataset

Fri, 03 May 2024 00:00:00 GMT

The QUEST Initiative: 12-month manuscript dataset Tait, Margaret-Ann; Rutherford, Claudia; Campbell, Rachel; Costa, Daniel; Norman, Richard; Warne, Leon; Schug, Stephan Dataset and dictionary for 12-month results reported in the manuscript for the QUEST Initiative : Longitudinal observational study of patients with chronic health conditions prescribed medicinal cannabis in Australia.

Best Practice for Who? The role of national guidelines in best practice guidance in early childhood intervention

Thu, 02 May 2024 00:00:00 GMT

Best Practice for Who? The role of national guidelines in best practice guidance in early childhood intervention Johnsson, Genevieve; Bulkeley, Kim In early 2023, Reimagine convened a National Taskforce to provide insights into updating the ECIA National Guidelines on Best Practice in Early Childhood Intervention (2016). The taskforce meeting was chaired by the University of Sydney and comprised of members from 14 early childhood organisations and identified a set of principles to apply to review of guidance. The Centre for Disability Research and Policy at the University of Sydney partnered with Reimagine to develop a vision and a set of considerations that can be taken into account in the review of best practice guidance in early childhood intervention in Australia. A best practice consultation was undertaken which consisted of 14 online focus group sessions and 5 individual interviews (conducted April to August 2023) with 105 unique participants. Participants included those working with children with disability in allied health, early childhood education and care, community services, government and non-government organisations, and with families. A set of 19 recommendations were drawn from the consultations and were socialised with the early childhood community at the ReImagine Conference in November 2023. This report summarises the findings from each phase of the process to grow the discourse around guidance for all stakeholders in supporting children with development delays, difference and disability and their families.

3D visualization systems improve operator efficiency during difficult laparoscopic cholecystectomy: a retrospective blinded review of surgical videos

Mon, 01 Jan 2024 00:00:00 GMT

3D visualization systems improve operator efficiency during difficult laparoscopic cholecystectomy: a retrospective blinded review of surgical videos Patel, Meet; Tranter-Entwistle, Isaac; Sirimanna, Pramudith; Hugh, Thomas J Background: 3D visualisation systems in laparoscopic surgery have been proposed to improve manual task handling compared to 2D, however, few studies have compared the intra-operative efficacy in laparoscopic cholecystectomy (LC). The aim of this study is to determine if there is a benefit in intra-operative efficiency when using a 3D visualisation in difficult LC compared to traditional 2D visualisation systems. Methods: Retrospective analysis of “difficult” LCs (grade 3 or 4) was completed. The assessor was blinded as all cases were recorded and viewed in 2D only. Variables collected included time to complete steps, missed hook diathermy attempts, failed grasp attempts, missed clip attempts and preparation steps for intra-operative cholangiogram (IOC). Multiple linear regression was undertaken for time variables, Poisson regression or negative binomial regression was completed for continuous variables. Results: 52 operative videos of “difficult” LC were reviewed. 3D systems were associated with reduced operative times, although this was not statistically significant (CI: -2.93-14.93, p-value=0.183). Dissection of the anterior fold to achieve the critical view of safety was significantly faster by 3.55 minutes (CI: 1.215-9.206, p-value=0.002), and with considerably fewer errors when using 3D systems. Fewer IOC preparation errors were observed with a 3D system compared with a 2D system. Conclusions: 3D systems appear to enhance operator efficiency, allowing faster completion of critical steps with fewer errors. This pilot study underscores the utility of video annotation for intra-operative assessment and suggests that, in larger multi-centre studies, 3D systems may demonstrate superior intra-operative efficiency over 2D systems during a “difficult” LC.