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Purpose. Retinal blood vessel image segmentation is an important step in ophthalmological analysis. However, it is difficult to segment small vessels accurately because of low contrast and complex feature information of blood vessels. The objective of this study is to develop an improved retinal blood vessel segmentation structure (WA-Net) to overcome these challenges. Methods. This paper mainly focuses on the width of deep learning. The channels of the ResNet block were broadened to propagate more low-level features, and the identity mapping pathway was slimmed to maintain parameter complexity. A residual atrous spatial pyramid module was used to capture the retinal vessels at various scales. We applied weight normalization to eliminate the impacts of the mini-batch and improve segmentation accuracy. The experiments were performed on the DRIVE and STARE datasets. To show the generalizability of WA-Net, we performed cross-training between datasets. Results. The global accuracy and specificity within datasets were 95.66% and 96.45% and 98.13% and 98.71%, respectively. The accuracy and area under the curve of the interdataset diverged only by 1%∼2% compared with the performance of the corresponding intradataset. Conclusion. All the results show that WA-Net extracts more detailed blood vessels and shows superior performance on retinal blood vessel segmentation tasks. [ABSTRACT FROM AUTHOR]

Aim This paper acknowledges the relationship between resilience and the new managerialism of contemporary nursing. Methods Qualitative portraiture methodology. Discussion The new managerialism in hospital settings results in a rapidly increasing turnover of acutely ill or comorbid patients, which directly relates to retention and quality service. In education settings, the management imperative to recruit more students into the profession combined with financial cutbacks leads to similar tensions. In aged care the trend equates care directly with funding, with the same effect. Yet despite this, many registered nurses remain working. Portraiture explored 'why' nurses remain in workplaces often described as awful. The resilience of nurses is seen through their stories and reframed to highlight resilience as a form of resistance to the new managerialism inherent in contemporary healthcare. Conclusion This paper describes some of the hallmarks of new managerialism where workforce pressures force practices that do not value the 'human resource'. Implications for nursing management The quotes from the field give insight into the nurse's world view and have implications for managers, educators and employers, as well as for consumers of nursing care. [ABSTRACT FROM AUTHOR]

This paper explores the engagement in physical activity as a potential coping strategy for asylum seekers living in the Australian community without the right to work and with prolonged uncertainty, and benefits or barriers to undertaking such activity. Semi-structured in-depth interviews were held with 29 asylum seekers who had arrived to Australia by boat and were living in the community in the cities of Perth, Sydney or Melbourne in July-October 2013 after their release from immigration detention. The ratio of the numbers of men and women interviewed (23 men and 6 women) was comparable to the ratio of men and women who came by boat to Australia seeking asylum in 2012-2013. Nine participants reported that they participated in physical activity as a coping strategy. Seven other participants were so worried about their future and their families that they did not have the mental or physical energy to engage in physical activity. A further six wanted to participate in physical activity but faced a number of barriers to doing so. The seven remaining participants were either not asked about their physical activity engagement because they focused their discussion on other challenges or did not elaborate on why they were not engaging in physical activity. The findings suggest that physical activity, coupled with other coping strategies, are important for some asylum seekers in trying to manage the distress of being denied the right to work and living with prolonged uncertainty. In addition, these findings highlight the critical barrier that government policy plays in disabling engagement in physical activity, which further compounds social exclusion. This includes the lack of welfare support provided, which hinders people's financial ability to access activities and support in the community. [ABSTRACT FROM AUTHOR]

Aboriginal Australians are at higher risk of developing certain types of cancer and, once diagnosed, they have poorer outcomes than their non-Aboriginal counterparts. Lower access to cancer screening programmes, deficiencies in treatment and cultural barriers contribute to poor outcomes. Additional logistical factors affecting those living in rural areas compound these barriers. Cancer support groups have positive effects on people affected by cancer; however, there is limited evidence on peer-support programmes for Aboriginal cancer patients in Australia. This paper explores the roles played by an Aboriginal women's cancer support network operating in a regional town in Western Australia. Data were collected through semi-structured interviews with 24 participants including Aboriginal and mainstream healthcare service providers, and network members and clients. Interviews were audiotaped and transcribed verbatim. Transcripts were subjected to inductive thematic analysis. Connecting and linking people and services was perceived as the main role of the network. This role had four distinct domains: (i) facilitating access to cancer services; (ii) fostering social interaction; (iii) providing a culturally safe space; and (iv) building relationships with other agencies. Other network roles included providing emotional and practical support, delivering health education and facilitating engagement in cancer screening initiatives. Despite the network's achievements, unresolved tensions around role definition negatively impacted on the working relationship between the network and mainstream service providers, and posed a threat to the network's sustainability. Different perspectives need to be acknowledged and addressed in order to build strong, effective partnerships between service providers and Aboriginal communities. Valuing and honouring the Aboriginal approaches and expertise, and adopting an intercultural approach are suggested as necessary to the way forward. [ABSTRACT FROM AUTHOR]

This paper aimed to explore pelvic lymphadenectomy for gynecological malignant tumors guided by computed tomography angiography (CTA) images under region-growing algorithm (RGA). 100 cases of malignant tumor patients who received pelvic lymphadenectomy in hospital from January 2018 to January 2020 were analyzed. Patients were classified into control group (CTA image) and experimental group (RGA-based CTA image), each with 50 cases. The overall accuracy (OA) of the pelvic CT image segmentation parameters under RGA, the watershed segmentation algorithm (WA), and the swarm intelligence optimization algorithm (SIOA) was compared. Comparisons of segmentation parameters, denoising performance, and CT imaging of patients as well as diagnosis rate and total efficiency rate were carried out. The results showed that overall accuracy (OA) of RGA was considerably higher versus watershed segmentation algorithm (WA) and swarm intelligence optimization algorithm (SIOA). However, false positive rate (FPR) and false negative rate (FNR) of RGA were greatly lower than those of other algorithms. RGA greatly improved the accuracy of pelvic tumor detection. The peak signal-to-noise ratio (PSNR) of RGA was superior to that of WA and SIOA, but differences in edge preservation index (EPI) value were not significant. The diagnosis rate of the experimental group was 48/50 (96%), while the diagnosis rate by manual means was 38/50 (76%). For the diagnosis rate and total efficiency, results of the experimental group were evidently higher in contrast to the control group (P < 0.05). In conclusion, under RGA, CTA image-guided pelvic lymphadenectomy had good segmentation accuracy and denoising performance, and it was superior in total efficiency and diagnosis rate, which was worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Identifying the influential factors in incident duration is important for traffic management agency to mitigate the impact of traffic incidents on freeway operation. Previous studies have proposed a variety of approaches to determine the significant factors for traffic incident clearance time. These methods commonly select a single "true" model among a majority of alternative models based on some model selection criteria. However, the conventional methods generally neglect the uncertainty related to the choice of models. This paper proposes a Bayesian Model Averaging (BMA) model to account for model uncertainty by averaging all plausible models using posterior probability as the weight. The BMA model is used to analyze the 2,584 freeway incident records obtained from I-5 corridor in Seattle, WA, USA. The results show that the BMA approach has the capability of interpreting the causal relationship between explanatory variables and clearance time. In addition, the BMA approach can provide better prediction performance than the Cox proportional hazards model and the accelerated failure time models. Overall, the findings in this study can be useful for traffic emergency management agency to apply an alternative methodology for predicting traffic incident clearance time when model uncertainty is considered. [ABSTRACT FROM AUTHOR]

Accurate and reliable prediction of groundwater depth is a critical component in water resources management. In this paper, a new method based on coupling wavelet decomposition method (WA), autoregressive moving average (ARMA) model, and BP neural network (BP) model for groundwater depth forecasting applications was proposed. The relative performance of the proposed coupled model (WA-ARMA-BP) was compared to the regular autoregressive integrated moving average (ARIMA) and BP models for annual average groundwater depth forecasting using leave-one-out cross-validation (LOO-CV). The variables used to develop and validate the models were average groundwater depth data recorded from 1981 to 2010 in Jinghui Canal Irrigation District in the northwest of China. It was found that the WA-ARMA-BP model provided more accurate annual average groundwater depth forecasts compared to the ARIMA and BP models. The results of the study indicate the potential of the WA-ARMA-BP model in forecasting nonstationary time series such as groundwater depth. [ABSTRACT FROM AUTHOR]

Introduction. Dental bleaching is the first choice to improve smile esthetics, but, in some cases, it needs to be associated with resin composite restoration to obtain a satisfactory result. Unfortunately, the bonding of resin-based materials can be impaired due to residual oxygen molecules, which can decrease the durability of the restoration. Objectives. To evaluate the effect of the antioxidant application on the bond strength of bleached enamel after 24 hr and 3 years of water storage. Methods. In total, 84 bovine teeth were used in this study. Of these, 77 were bleached with 35% hydrogen peroxide in a single session for three cycles of 15 min. Then, the specimens were divided into groups (n = 7 each): control (without bleaching), without antioxidant (WA) use; application of 10% sodium ascorbate (SA) gel, grape seed (GS) extract, and aloe vera (AV). The restorative procedure was performed immediately after bleaching, 7 and 14 days after bleaching. Specimens were sectioned and evaluated using microtensile bond strength (μTBS). Half of the resin-enamel sticks were tested after 24 hr, and the remaining half after 3 years of water storage. µTBS data were analyzed using a three-way analysis of variance, Tukey's test, and Dunnett's test. Results. The lowest µTBS values were observed when the restoration was performed immediately after bleaching in the AV, GS, and WA groups when compared with the SA group (p < 0.005). However, no significant differences were observed among all groups after 3 years of water storage (p < 0.001). Conclusions. SA at 10% was the most effective antioxidant agent for improving the immediate bond strength. However, independent of the antioxidant agent used, the bond strength values were maintained or recovered after 3 years of water storage. SA at 10% could be used to avoid delayed bonding procedures after in-office whitening without compromising bond strength over time. Clinical Significance. The use of antioxidants after dental bleaching can be effective in improving the bonding durability of the adhesive restorations. [ABSTRACT FROM AUTHOR]

The objective of the study was to identify whether creating a responsive, respectful and trustworthy environment that provides free dental care for clients who are homeless using volunteer dental professionals was effective in meeting their oral health needs in Fremantle, Western Australia. Qualitative research conducted between October 2018 and August 2019 was guided by a social constructivist paradigm to gather and analyse data. Semi‐structured interviews were conducted with adults experiencing homelessness accessing a community dental clinic and health providers and other stakeholders involved in its establishment, management and service delivery. An inductive approach to analysis was used to organise themes under the categories of 'establishing the oral health clinic' (OHC) and 'responses to the implementation of the clinic' Thirty‐nine semi‐structured interviews were conducted across eight participant groups: clients, executive management, the oral health clinical reference group, volunteer dentists, employed staff, nursing students, volunteer staff and other stakeholders. Key findings across all groups included positive responses to the establishment and implementation of the OHC, the quality of care and the safe and respectful environment in which services were delivered. Challenges related to sustainability include uncertainty around ongoing funding and recruitment of dental professionals. Whilst volunteer dental services fill a gap in meeting the complex needs of this population group, mainstream services must consider and address issues of equity in this context. Findings can be used to guide this process that includes creating environments of respect and trust where adults who are homeless or at risk of homelessness feel safe, welcomed and more likely to return to the service. [ABSTRACT FROM AUTHOR]

This paper examines the supportive care in place to meet the needs of patients receiving radiotherapy at a regional oncology service in Bunbury, Western Australia. Semi‐structured in‐depth interviews with 21 service providers and 17 adults diagnosed with cancer who underwent radiotherapy at the Service were recorded, transcribed and analysed thematically. Key themes relevant were co‐operation and collaboration of interdisciplinary team members; support from organisations to assist with accommodation, transport, emotional support and provision of practical assistance, as well as barriers to accessing support. Most participants were positive about the support available, recognising the needs of rural radiotherapy patients for assistance with travel, accommodation and psychosocial support to help deal with the stressors they face. Collaboration between the various service providers maximised the support available to patients but the drop off in psychosocial support once the intensity of treatment was completed was identified as a weakness in the support available. The support system, established around a regional radiotherapy service, was enhanced by the collaborative professional relationships developed among service providers. The service extends beyond clinical service delivery by recognising financial, logistical and psychosocial support needs, factors to be considered to ensure rural radiotherapy patients are provided with holistic care. [ABSTRACT FROM AUTHOR]

On-site wastewater treatment systems (OWTS) are widely used in Western Australia (WA) to treat and dispose of household wastewater in areas where centralized sewerage systems are unavailable. Septic tanks, aerobic treatment units (ATUs), and composting toilets with greywater systems are among the most well established and commonly used OWTS. However, there are concerns that some OWTS installed in WA are either performing below expected standards or failing. Poorly performing OWTS are often attributed to inadequate installation, inadequate maintenance, poor public awareness, insufficient local authority resources, ongoing wastewater management issues, or inadequate adoption of standards, procedures, and guidelines. This paper is to review the installations and failures of OWTS in WA. Recommendations to the Department of Health Western Australia (DOHWA) and Local Government (LG) in regard to management strategies and institutional arrangements of OWTS are also highlighted. [ABSTRACT FROM AUTHOR]

A 14-year-old adolescent was referred to a regional paediatric outpatient clinic with anosmia by her family doctor in Western Australia. The patient has no recollection of her previous ability to smell, suggesting the possibility of congenital anosmia. She was assessed in the paediatric outpatient clinic. A "noncontrast high-resolution MRI-brain scan with Anosmia-Protocol" was requested as the first-line investigation of choice by the treating paediatrician. The MRI was reported as "absence of olfactory tracts with preserved olfactory bulb volume." We report an extremely rare case of "isolated agenesis of the olfactory tract with intact olfactory bulbs" and discuss the clinical approach in bedside assessment of isolated congenital anosmia (ICA). Congenital anosmia can be a presentation of olfactory bulb aplasia; however, little is known about isolated olfactory tract agenesis and its treatment options. The patient was counselled on the diagnosis and safety advice provided. [ABSTRACT FROM AUTHOR]

Objective: To investigate in a population‐based pediatric cohort: prevalence of moderate–severe diabetic ketoacidosis (DKA) at type 1 diabetes (T1D) diagnosis over two decades and its association with long‐term glycemic control. Research Design and Methods: Children <16 years diagnosed with T1D in Western Australia 2000–2019 were included and followed up for ≤14 years. Moderate–severe DKA at diagnosis was defined as serum pH < 7.2 or bicarbonate<10 mmol/L with hyperglycemia and ketosis. HbA1c was measured ~3‐monthly. Trend in prevalence of moderate–severe DKA at diagnosis was investigated using a logistic regression model adjusting for sex, age, socioeconomic status, and area of residence. Long‐term glycemic control associated with DKA at diagnosis was investigated using linear mixed models adjusting for the same variables and also for visit frequency, CGM and pump use. Results: Moderate–severe DKA occurred in 534 of 2111 (25.3%) participants. Odds of presenting with moderate–severe DKA increased by 4.1% (95% CI: 2.3, 5.9; p < 0.001) per year. Patients with moderate–severe DKA at diagnosis had higher HbA1c levels than other patients initially; the groups were similar between 2 and 6 years duration; from 7 years HbA1c levels tracked higher in the group with moderate–severe DKA at diagnosis with significant differences at 8 and 12 years (p < 0.05). Conclusion: The increasing prevalence of DKA at diagnosis of pediatric T1D is concerning and highlights the need for early detection programs. Unlike a similar US study, this study did not find a consistent, clinically significant relationship between DKA at diagnosis and long‐term HbA1c, raising important questions about the influence of other factors on long‐term glycemic outcomes. [ABSTRACT FROM AUTHOR]

We have little knowledge of differences in end‐of‐life care between home settings and residential aged care facilities (RACFs) where people spend most of their last year of life. This study aimed to compare end‐of‐life care between home settings and RACFs from the perspective of Australian general practitioners (GPs). A descriptive study was conducted with 62 GPs from Western Australia, Queensland and Victoria. Participants were asked to provide reports on end‐of‐life care of decedents in their practice using a validated clinic‐based data collection process developed by our team between September 2018 and August 2019. Of the 213 reported expected deaths, 66.2% mainly lived at home in the last year of life. People living at home were more likely to die at a younger age (median 77 vs. 88, p < 0.001), to be male (51.1% vs. 33.3%, p = 0.01) and to die of cancer (53.9% vs. 4.2%, p < 0.001) compared to those in RACFs. There were no significant differences between the two patient groups for seven out of the eight assessed symptoms, except nausea. GPs' perceived roles in caring for patients and levels of their involvement in provision of common palliative care services were comparable between the two groups. The usual accommodation setting was most frequently considered the preferred place of death in both groups. However, more home residents ended up dying in hospital compared to RACF residents. There were significantly higher frequencies of end‐of‐life discussions (ORs ranged 5.46–9.82 for all topic comparisons) with GPs associated with people living at home versus RACFs. One opportunity for improved care is through promoting greater involvement of GPs in end‐of‐life discussions with RACF residents and staff. In general, more Australians could potentially remain at home until death if provided with greater access to essential specialist palliative care services and supportive services in home settings. [ABSTRACT FROM AUTHOR]

Objectives: To determine demographic and clinical characteristics of youth diagnosed with type 1 (T1D) or type 2 (T2D) diabetes aged ≤15 years from 1999 to 2019 in Western Australia, and examine time to first diagnosis of diabetes complications. Methods: A retrospective cohort study was conducted of patients identified from the population‐based, prospective Western Australian Children's Diabetes Database and longitudinal data extracted for available demographic and clinical variables. Patients were followed from diagnosis to transition to adult services, death, or December 31, 2019. Cox proportional hazards regression models were used to analyse time to first diagnosis of hypertension, high cholesterol or microalbuminuria, after adjusting for sex, age at diagnosis, time period of diagnosis, hemoglobin A1c, and body max index Z‐score. Results: 2438 eligible patients were identified (2209 [91%] T1D: 229 [9%] T2D). The mean age at diagnosis was lower in patients with T1D (8.5 [±4.0] vs. 12.7 [±2.0] years). A higher proportion of patients with T2D were female (58% vs. 47%) and of Aboriginal ethnicity (59% vs. 2%). The median HbA1c (interquartile range) at diagnosis was lower 8.9% [6.7, 11.5] (74 mmol/mol [50, 102]) versus 11.6% [10.1, 13.3] (103 mmol/mol [87, 122]) and mean body max index Z‐score higher (2.05 [±0.66] vs. 0.37 [±0.95]), in patients with T2D compared to T1D. Patients with T2D had a higher risk of hypertension, high cholesterol, and microalbuminuria (aHR 3.39 [95%CI:2.04, 5.63], 2.69 [95%CI:1.21, 5.98], and 19.79 [95%CI:10.99, 35.64] respectively). [ABSTRACT FROM AUTHOR]

Vegetables, drinking water, and preserved meats may contain sodium nitrite (NaNO2), which causes liver disease by inducing oxidative stress. Phytochemicals are highly recommended as an alternative to synthetic drugs and affordable medicines to treat liver disease because they have fewer or no side effects. Therefore, this study aims to determine the antioxidant and hepatoprotective potential of red okra fruit ethanol extract against NaNO2-induced liver damage. Thirty-six male mice were separated into six groups. The normal control group (WA) was given distilled water only, and the NaNO2 (SN) group was given only 50 mg/kg BW NaNO2. The other four groups (P1, P2, P3, and P4) were given NaNO2 and red okra ethanol extract at doses of 25, 50, 75, and 100 mg/kg BW, respectively. Gavage was administered orally for 21 consecutive days. Commercial kits define all biochemical parameters according to the manufacturer's instructions. Liver tissue staining followed standard protocols using hematoxylin and eosin. The study revealed that NaNO2 induction causes oxidative stress and damages the liver. The activity of antioxidant enzymes (superoxide dismutase and catalase) significantly increased in the groups treated (P2–P4) with ethanol extract of red okra (p < 0.05). Besides, the oxidants (malondialdehyde, F2-isoprostanes, and nitric oxide) in the liver homogenate significantly decreased in the P4 group, which were given red okra ethanol extract (p < 0.05). Likewise, red okra pods decreased significantly for the serum biochemical parameters of liver damage (aspartate aminotransferase, alkaline phosphatase, and alanine aminotransferase) in the P3 and P4 groups (p < 0.05). Then, it led to a restoration of the histological structure compared to exposed mice (SN), as the pathological scores decreased significantly in the P3 and P4 groups (p < 0.05), as well as the number of the necrotic and swollen liver cells was reduced. Hepatocytes returned to normal. The results showed that the ethanol extract of red okra fruit could be helpful as an affordable medicine. It is an antioxidant and hepatoprotective agent to protect the liver from damage caused by NaNO2. [ABSTRACT FROM AUTHOR]

The study objective was to explore the characteristics of rural general practice which exemplify optimal end‐of‐life (EOL) care from the perspective of people diagnosed with cancer, their informal carers and general practitioners (GPs); and the extent to which consumers perceived that actual EOL care addressed these characteristics. Semi‐structured telephone interviews were conducted with six people diagnosed with cancer, three informal carers and four GPs in rural and regional Australia. Using a social constructionist approach, thematic analysis was undertaken. Seven characteristics were perceived to be essential for optimal EOL care: (1) commitment and availability, (2) building of therapeutic relationships, (3) effective communication, (4) psychosocial support, (5) proficient symptom management, (6) care coordination and (7) recognition of the needs of carers. Most GPs consistently addressed these characteristics. Comprehensive EOL care that meets the needs of people dying with cancer is not beyond the resources of rural and regional GPs and communities. [ABSTRACT FROM AUTHOR]

Aims: To explore the differences in organisational communication satisfaction between ward paediatric nurses and middle managers, and to assess whether there is a difference in organisational communication satisfaction between paediatric nurses and middle managers with different educational levels, years of nursing and managerial experience, contracted hours, area of work, age and gender. Background: Previous studies reported a connection between job satisfaction, work commitment and organisational communication; however, nurses' and nursing middle managers' satisfaction with organisational communication has not been extensively studied in recent years and not at all among paediatric nurses. Methods: A cross‐sectional quantitative research design using online and hard copy self‐reported questionnaires was used. Data were collected at one point in time from paediatric nurses and middle (nursing) managers working in a tertiary paediatric hospital in Australia. Statistical methods were employed for data analysis. Results: The middle management group were significantly more dissatisfied with organisational communication than the paediatric ward nurse group. Middle managers were found in this study to effectively manage and maintain communication lines with the personnel who reported to them; however, communication within the management cohort itself was found to be suboptimal. Conclusion: Further research to understand how horizontal and vertical communications at the nurse manager and executive level can be optimised is required. Implications for nursing management: It is anticipated that the findings from this study may increase the understanding of communication satisfaction between paediatric nurses and middle managers. The study has highlighted the need for improvement with information flow in the management cohort with the addition of extra managerial support and empowerment. [ABSTRACT FROM AUTHOR]

A Multi-Model Ensemble (MME) based seasonal rainfall forecast customization tool called FOCUS was developed for Myanmar in order to provide improved seasonal rainfall forecast to the country. The tool was developed using hindcast data from 7 Global Climate Models (GCMs) and observed rainfall data from 49 meteorological surface observatories for the period of 1982 to 2011 from the Department of Meteorology and Hydrology. Based on the homogeneity in terms of the rainfall received annually, the country was divided into six climatological zones. Three different operational MME techniques, namely, (a) arithmetic mean (AM-MME), (b) weighted average (WA-MME), and (c) supervised principal component regression (PCR-MME), were used and built-in to the tool developed. For this study, all 7 GCMs were initialized with forecast data of May month to predict the rainfall during June to September (JJAS) period, which is the predominant rainfall season for Myanmar. The predictability of raw GCMs, bias-corrected GCMs, and the MMEs was evaluated using RMSE, correlation coefficients, and standard deviations. The probabilistic forecasts for the terciles were also evaluated using the relative operating characteristics (ROC) scores, to quantify the uncertainty in the GCMs. The results suggested that MME forecasts have shown improved performance (RMSE = 1.29), compared to the raw individual models (ECMWF, which is comparatively better among the selected models) with RMSE = 4.4 and bias-corrected RMSE = 4.3, over Myanmar. Specifically, WA-MME (CC = 0.64) and PCR-MME (CC = 0.68) methods have shown significant improvement in the high rainfall (delta) zone compared with WA-MME (CC = 0.57) and PCR-MME (CC = 0.56) techniques for the southern zone. The PCR method suggests higher predictability skill for the upper tercile (ROC = 0.78) and lower tercile categories (ROC = 0.85) for the delta region and is less skillful over lower rainfall zones like dry zones with ROC = 0.6 and 0.63 for upper and lower terciles, respectively. The model is thus suggested to perform relatively well over the higher rainfall (Wet) zones compared to the lower (Dry) zone during the JJAS period. [ABSTRACT FROM AUTHOR]

A novel Group A rotavirus, first identified clinically in racing, feral and fancy pigeons in Western Australia, had spread throughout Australia by March 2017. In December 2016, the putative index case of rotavirus in racing pigeons in the state of Victoria was confirmed at a regional bird sale, with rapid spread to peri‐urban Melbourne, the capital city. A survey sent to approximately 400 Victorian pigeon fanciers identified eight (of 85 respondents) with a confirmed rotavirus infection in their loft(s). If a fancier had purchased live birds, either from the regional sale or from another source, there was a 13%–38% increased likelihood of the loft subsequently being confirmed rotavirus‐positive. An increased loft‐level risk of rotavirus was also positively associated with the number of neighbouring lofts within a 5‐km radius of a home loft. It was concluded that rotavirus was primarily transmitted beyond the Victorian index case through the movement of live birds into a loft, either deliberately through bird purchase and/or inadvertently through the entry of pigeons from neighbouring lofts. As pigeon racing inherently requires consistent contact between birds from different lofts, vaccination is recommended as a primary method of rotavirus control in this unique industry. [ABSTRACT FROM AUTHOR]

Aim: The primary aim of the present study was to determine if it is cost effective to use human leukocyte antigen (HLA) typing as a first‐line screening test for celiac disease (CD) in children with type 1 diabetes (T1D), as recommended by the European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). The second aim was to investigate whether anti‐tissue transglutaminase IgA (anti‐tTGA) antibodies can be used to diagnose CD without the need for a confirmatory duodenal biopsy in T1D. Methods: Data for all T1D patients aged <18 years, who attended the diabetes clinics in Western Australia up to June 2017, were extracted from the Western Australian Children's Diabetes Database (WACDD) and analyzed for their demographic data and CD permissive HLA alleles (DQ2, DQ8, and DQ7). For T1D patients already diagnosed with CD, the mode of diagnosis of CD, anti‐tTGA titers, and CD permissive HLA alleles were analyzed. Results: Of the 936 eligible T1D patients identified, HLA‐DQ typing was available for 551 (59%). Of these 551 patients, 504 (91.2%) were positive for celiac permissive HLA alleles. Eight percent (n = 75) of the T1D patients had a co‐diagnosis of CD. High anti‐tTGA titers were observed in those who were diagnosed with a positive duodenal biopsy. Conclusion: HLA‐DQ typing is not cost effective as a first‐line screening test for CD in T1D patients because of over‐representation of CD permissive HLA alleles in this group. Anti‐tTGA titers may be useful in diagnosing CD in T1D without duodenal biopsy, as high levels were found to be strongly predictive of CD. [ABSTRACT FROM AUTHOR]

The number of falls and fall‐associated injury rates among older people continues to rise worldwide. Increased efforts to influence older people's falls prevention behaviour are needed. A two‐phase exploratory community‐based participatory study was conducted in Western Australia. First, three prototype audio‐visual (AV) falls prevention messages were designed collaboratively with six older people. Second, the messages' effect on community‐dwelling older people's knowledge, awareness and motivation to take action regarding falls prevention was explored using focus groups. Data were analysed using thematic analysis to explore participants' responses to the messages. The participants' (n = 54) perspectives on the AV messages varied widely and stereotypes of ageing appeared to influence these. The presented falls facts (including falls epidemiology statistics) increased some participants' falls risk awareness and falls prevention knowledge. Other participants felt ready‐to‐use falls prevention information was lacking. Some expressed positive emotions or a personal connection to the messages and suggested the messages helped reduce ageing‐related stigma. Strongly opposing viewpoints suggested that other participants identified implicit negative messages about ageing, which reduced their motivation with the messages. Suggestions to improve the message persuasiveness included adding more drama and tailoring messages to appeal to multiple age groups. Overall, the AV falls prevention messages designed in collaboration with older people elicited a divergent range of positive and negative perspectives from their peers, which was conceptualised by the overarching theme 'we all look at things different ways'. Opinions differed regarding whether the messages would appeal to older people. Public campaigns targeting falls prevention should be designed and tailored towards older peoples' differing perspectives about ageing. [ABSTRACT FROM AUTHOR]

Background: Maturity‐onset diabetes of the young (MODY) is caused by autosomal dominant mutations in one of 13 confirmed genes. Estimates of MODY prevalence vary widely, as genetic screening is usually restricted based on clinical features, even in population studies. We aimed to determine prevalence of MODY variants in a large and unselected pediatric diabetes cohort. Methods: MODY variants were assessed using massively parallel sequencing in the population‐based diabetes cohort (n = 1363) of the sole tertiary pediatric diabetes service for Western Australia (population 2.6 million). All individuals were screened, irrespective of clinical features. MODY variants were also assessed in a control cohort (n = 993). Results: DNA and signed consent were available for 821 children. Seventeen children had pathogenic/likely pathogenic variants in MODY genes, two diagnosed with type 2 diabetes, four diagnosed with antibody‐negative type 1 diabetes (T1DM), three diagnosed with antibody‐positive T1DM, and eight previously diagnosed with MODY. Prevalence of MODY variants in the sequenced cohort was 2.1%, compared to 0.3% of controls. Conclusions: This is the first comprehensive study of MODY variants in an unselected population‐based pediatric diabetes cohort. The observed prevalence, increasing access to rapid and affordable genetic screening, and significant clinical implications suggest that genetic screening for MODY could be considered for all children with diabetes, irrespective of other clinical features. [ABSTRACT FROM AUTHOR]

Abstract: Rapid ageing in western societies is placing increasing strain on health and social care services. In response, governments and health agencies have sought to promote healthy ageing through a range of interventions, many of which aim to enhance social engagement and participation among older people. Such interventions are based on evidence that being socially engaged through participation in various activities leads to better physical, mental and psychosocial health outcomes. The research reported here employed focus groups and individual interviews to address research aims: (a) identify enablers and barriers to participation in community‐based group activities among a sample of older people (n = 35, median age 71 years) living in a local government area in the northern suburbs of Perth, Western Australia, and (b) examine how these factors differ between those who regularly participate and those who do not. Our research highlighted four themes: Friendship and Function; Availability and Accessibility; Competing Responsibilities and Priorities; and Changing of the Guard. In particular, this research highlighted the importance of group activities in offering social support as a platform to develop friendships. The findings also indicated that opportunities for social interaction should be embedded in the structure of the group, beyond that which may occur incidentally during activities. This is important, given that while interest may motivate older people to join a group, a sense of belonging and connectedness generated through the group is more likely to maintain their attendance. Barriers included limited availability of local programmes, limited accessibility related to programme scheduling, and lack of programmes relevant to those who do not find traditional seniors’ centres appealing. Recommendations include incorporating social engagement as an outcome measure when evaluating the efficacy of programmes targeting older people, and encouraging local governments to work with seniors’ centres in developing activities attractive to a broader cohort of older people. [ABSTRACT FROM AUTHOR]

Abstract: This feasibility study aimed to identify and address the support needs of family carers (FCs) of people living with dementia and to assess whether the use of the Carer Support Needs Assessment Tool (CSNAT) intervention in home‐based care was acceptable and relevant to FCs. The CSNAT intervention comprised two FC support needs assessment visits, 7 weeks apart, plus associated actions addressing prioritised needs by the Client Care Advisors of a community care service in Western Australia in 2015. Telephone interviews were conducted with FCs on their experience using the CSNAT at the end of the intervention. Twenty‐one FCs were involved in the intervention and 15 of them completed the feedback interviews. Care recipients had moderate to severe dementia. The top five support needs reported by FCs were: having time to yourself in the day; knowing what to expect in the future; practical help in the home; looking after your own health and dealing with your feelings and worries. Three themes summarised their experience: a straightforward structured approach; awareness, acknowledgement and acceptance of their situation; and provision of support. FCs appreciated the opportunity to be heard and acknowledged, to have their practical and psychosocial support needs facilitated, to identify what is important to them and to receive a response in a timely manner. The CSNAT approach offered a structured carer‐led, person‐centred, supportive intervention that facilitated discussion between the family carer and the service provider about support needs and strategies to address them. [ABSTRACT FROM AUTHOR]

Advanced-stage diagnosis of colorectal cancer (CRC) leads to poor prognosis and reduced survival rates. The current study seeks to explore the reasons for diagnostic delays in a sample of Australian men with CRC. Semi-structured interviews were conducted in a purposive sample of 20 male CRC patients. Data collection ceased when no new data emerged. Interviews were audiotaped, transcribed and thematically analysed using Andersen's Model of Total Patient Delay as the theoretical framework. Most participants (18/20) had experienced lower bowel symptoms prior to diagnosis. Patient-related delays were more common than delays attributable to the health-care system. Data regarding patient delays fit within the first four stages of Andersen's model. The barriers to seeking timely medical advice were mainly attributed to misinterpretation of symptoms, fear of cancer diagnosis, reticence to discuss the symptoms or consulting a general practitioner. Treatment delays were a minor cause for delayed diagnosis. Delay in referral and scheduling for colonoscopy were among the system-delay factors. In many instances, delays resulted from men's failure to attribute their symptoms to cancer and, subsequently, delay in diagnosis. [ABSTRACT FROM AUTHOR]