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Antimicrobial resistance (AMR) is a global pandemic, however, estimating its burden is a complex process. As a result, many countries rely on global estimates to infer burden within their own setting. With a growing number of recent publications quantifying AMR burden in Australia, and an expansion of surveillance programs, enumerating AMR mortality for Australia is feasible. We aimed to leverage existing published data to assess methodological factors contributing to the considerable variation in AMR-related mortality and provide two reliable estimates of AMR mortality in Australia. This is a necessary step towards generating meaningful measures of AMR burden in Australia. What is known about the topic? Antimicrobial resistance is a significant global health threat, but estimating the burden of disease is complicated by data challenges. What does this paper add? This paper highlights progress in estimating the number of people dying from antimicrobial resistance in Australia and highlights the importance of rigorous antimicrobial resistance mortality estimates in Australia to assess burden of disease. What are the implications for practitioners? Practitioners should use only rigorous estimates of burden of disease to inform actions on reducing the threat of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Dynamic prediction models make use of patient-specific longitudinal data to update individualized survival probability predictions based on current and past information. Colonoscopy (COL) and fecal occult blood test (FOBT) results were collected from two Australian surveillance studies on individuals characterized as high-risk based on a personal or family history of colorectal cancer. Motivated by a Poisson process, this paper proposes a generalized nonlinear model with a complementary log-log link as a dynamic prediction tool that produces individualized probabilities for the risk of developing advanced adenoma or colorectal cancer (AAC). This model allows predicted risk to depend on a patient's baseline characteristics and time-dependent covariates. Information on the dates and results of COLs and FOBTs were incorporated using time-dependent covariates that contributed to patient risk of AAC for a specified period following the test result. These covariates serve to update a person's risk as additional COL, and FOBT test information becomes available. Model selection was conducted systematically through the comparison of Akaike information criterion. Goodness-of-fit was assessed with the use of calibration plots to compare the predicted probability of event occurrence with the proportion of events observed. Abnormal COL results were found to significantly increase risk of AAC for 1 year following the test. Positive FOBTs were found to significantly increase the risk of AAC for 3 months following the result. The covariates that incorporated the updated test results were of greater significance and had a larger effect on risk than the baseline variables. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background and Aims There is limited information about the interplay between multiple risk factors contributing to the risk of advanced neoplasia. We determined the actual risk for advanced neoplasia in relation to lapsed time between colonoscopies in people enrolled in a structured surveillance program. This risk information can be used to guide the selection of optimal surveillance intervals. Methods Patients were recruited into programs at two major tertiary hospitals, with a personal or family history of advanced neoplasia. Five thousand one hundred forty-one patients had an index and one or more surveillance colonoscopies. Fifty-one percent had a family history of colorectal neoplasia while the remainder had a personal history. Results Patients with an immediately prior colonoscopy result (prior result) of advanced adenoma had a risk for advanced neoplasia 7.1 times greater than those with a normal prior result. Cancer as a prior result did not confer a greater risk than either a hyperplastic polyp or a nonadvanced adenoma. Being female reduced risk, age increased risk. Only a family history of a first-degree relative diagnosed under 55, or definite or suspected hereditary nonpolyposis colorectal cancer ( HNPCC) conferred an increased risk over a personal history of advanced neoplasia. Conclusions Most family history categories did not confer excess risk above personal history of advanced neoplasia. A prior cancer poses less of a risk than a prior advanced adenoma. Based on our models, a person with an advanced adenoma should be scheduled for colonoscopy at 3 years, corresponding to a 15% risk of advanced neoplasia for a male aged under 56. Guidelines should be updated that uses a 15% risk as a benchmark for calculating surveillance intervals. [ABSTRACT FROM AUTHOR]

1. Butyrate, a bacteria fermentative product in the colonic lumen, has been shown to produce a wide variety of biological effects in human cancer cells in vitro. However, there are pharmacological drawbacks associated with the use of butyrate therapy and there are limited published data on the structure–activity relationship of butyrate analogues in colorectal cancer cells. Previously, we determined structure–activity relationship using HT-29 human colorectal cancer cells. However, it was viewed as important to explore similar relationships in another colorectal cancer cell line. 2. Therefore, in the present study, the in vitro structure–activity relationship of butyrate analogues was examined by investigating their effects on apoptosis, cell proliferation, histone deacetylase (HDAC) activity and lactate dehydrogenase (LDH) leakage as a measure of cell toxicity in HCT-116 human colorectal cancer cells. 3. Of the 32 analogues tested, only 4-benzoylbutyrate, 3-benzo-ylpropionate, 4-(4-nitrophenyl)butyrate and 3-(4-fluorobenzoyl)propionate exhibited comparable biological effects to butyrate. The common structural properties of the compounds of interest were to lack amino or hydroxyl substitutions at the 2-, 3- and/or 4-position of the aliphatic moiety of butyrate. 4. The present study reveals a dissociation between the induction of apoptosis, inhibition of cell proliferation, HDAC activity and LDH leakage. The results indicate differential responses of butyrate analogues in HT-29 and HCT-116 colorectal cancer cells. [ABSTRACT FROM AUTHOR]

1. Butyrate is a well known product of starch fermentation by colonic bacteria and is of interest owing to its ability to induce in vitro apoptosis and cell differentiation, as well as to inhibit cell growth in colorectal and other cancer cells. Synthetic analogues of butyrate may also possess cellular activities in a variety of cultured cells. The aim of the present study was to evaluate the effects of butyrate analogues on apoptosis, proliferation and histone deacetylase (HDAC) activity in HT-29 colorectal cancer cells. In addition, the effects of these analogues on lactate dehydrogenase leakage, as a measure of non-specific cytotoxicity, were evaluated in HT-29 cells. 2. Of the 26 analogues examined, four (propionate, 4-benzoylbutyrate, 4-(4-aminophenyl)butyrate and benzyloxyacetate) exhibited comparable effects to butyrate. Interestingly, no activity was noted for compounds carrying amino, hydroxyl or methyl substitutions at the 2-, 3- or 4-position of the aliphatic moiety of butyrate. 3. In conclusion, chemical changes to the structure of butyrate can significantly modify the biological activity assayed in HT-29 colorectal cancer cells in vitro. [ABSTRACT FROM AUTHOR]

Abstract: This paper is concerned with the problem of balancing the competing objectives of allowing statistical analysis of confidential data while maintaining standards of privacy and confidentiality. Remote analysis servers have been proposed as a way to address this problem by delivering results of statistical analyses without giving the analyst any direct access to data. Several national statistical agencies operate remote analysis servers [Australian Bureau of Statistics Remote Access Data Laboratory (RADL), ; Luxembourg Income Study, ]. Remote analysis servers are not free from disclosure risk, and current implementations address this risk by “confidentialising” the underlying data and/or by denying some queries. In this paper we explore the alternative solution of “confidentialising” the output of a server so that no confidential information is revealed or can be inferred. In this paper we review results on remote analysis servers, and provide a list of measures for confidentialising the output from a single regression query to a remote server as developed by Sparks et al. [R. Sparks, C. Carter, J. Donnelly, J. Duncan, C.M. O’Keefe, L. Ryan, A framework for performing statistical analyses of unit record health data without violating either privacy or confidentiality of individuals, in: Proceedings of the 55th Session of the International Statistical Institute, Sydney, 2005; R. Sparks, C. Carter, J. Donnelly, C.M. O’Keefe, J. Duncan, T. Keighley, D. McAullay, Remote access methods for exploratory data analysis and statistical modelling: privacy-preserving Analytics™, Comput. Meth. Prog. Biomed. 91 (2008) 208–222.] We provide a fully worked example, and compare the confidentialised output from the query with the output from a traditional statistical package. Finally, we provide a comparison the confidentialised regression diagnostics with the synthetic regression diagnostics generated by the alternative method of Reiter [J.P. Reiter, Model diagnostics for remote-access regression servers, Statistics and Computing 13 (2003) 371–380]. [Copyright &y& Elsevier]

The Electronic Medical Record (EMR) provides an opportunity to manage patient care efficiently and accurately. This includes clinical decision support tools for the timely identification of adverse events or acute illnesses preceded by deterioration. This paper presents a machine learning-driven tool developed using real-time EMR data for identifying patients at high risk of reaching critical conditions that may demand immediate interventions. This tool provides a pre-emptive solution that can help busy clinicians to prioritize their efforts while evaluating the individual patient risk of deterioration. The tool also provides visualized explanation of the main contributing factors to its decisions, which can guide the choice of intervention. When applied to a test cohort of 18,648 patient records, the tool achieved 100% sensitivity for prediction windows 2–8 h in advance for patients that were identified at 95%, 85% and 70% risk of deterioration. [ABSTRACT FROM AUTHOR]

These authors contributed equally: Aida Brankovic and Hamed Hassanzadeh. Correction to: I Scientific Reports i https://doi.org/10.1038/s41598-022-15877-1, published online 11 July 2022 The original version of this Article contained an error in Figure 1, where the labels for "Flag %" and "No Flag %" were interchanged in the legend of the graphs. [Extracted from the article]

Objective Despite significant workflow reform to comply with the federally mandated National Emergency Access Target ( NEAT), Australian public hospitals continue to face significant barriers in achieving good ED patient flow. This study was undertaken to identify and analyse the impact of individual waypoints on an ED patient's journey and identify which waypoints act as bottlenecks to a hospital's 4 h ED disposition performance. Methods This study involves retrospective analysis and simulation employing 2 years of ED administrative data from a sample of two major and two large metropolitan hospitals in Queensland, Australia. The main outcome measures included waypoint wait times (Treatment Delay and Departure Delay), ED length of stay ( EDLOS) and compliance with the NEAT target, measured for all (overall NEAT) and admitted (Admitted NEAT) patients. Variations in outcome measures were analysed as functions of hour of day, day of week, departure status and triage category. Simulations identified the impact of potential ED workflow changes in the context of NEAT performance. Results Departure Delay accounted for 60 and 20% of EDLOS across large and major metropolitan hospitals, respectively. Higher gains in NEAT compliance are associated with improvements in departure delay rather than treatment delay. Simulation identified that halving Departure Delay improves Admitted NEAT by up to 22 and 4% at large and major metropolitan hospitals, respectively. Conclusions The results reinforces the need for a whole-of-hospital effort to address flow bottlenecks, and identify moving a patient from emergency to inpatient care as the critical bottleneck in ED system performance. [ABSTRACT FROM AUTHOR]

Objectives The study aims to investigate the effect of time of day and ED occupancy on the ability of EDs to admit or discharge patients within 4 h in accordance with the National Emergency Access Target (NEAT), and to compare this with corresponding levels of access block, the measure for ED performance before NEAT. Methods: This is a retrospective analysis of 5 years of ED data from 30 reporting public hospitals in Queensland, Australia. Relationships between these and variations in time of day and occupancy were explored using a Poisson generalised linear model. The main outcome measures are cases of NEAT non-compliance (ED length of stay >4 h for all patients [i.e. admitted and non-admitted] leaving the ED) and access block (ED length of stay >8 h for admitted patients). Results: NEAT performance is found to be dependent on hospital size, and levels vary significantly for admitted and non-admitted patients. A higher proportion of patients breach NEAT during early mornings and low occupancy periods, a trend not observed with the previous access block metric. NEAT non-compliance is also found to rise between 13.00 hours and 17.00 hours, a period when the proportion of access block cases typically drops. Conclusions: EDs face rising levels of NEAT non-compliance at times when corresponding access block levels have traditionally not been a concern. A higher proportion of patients breach the target during periods that would intuitively not be flagged as flow bottlenecks. The findings support the need for service level analysis and new solutions to guide workflow reform and maximise NEAT compliance. [ABSTRACT FROM AUTHOR]

Objectives To investigate the effect of hospital occupancy levels on inpatient and ED patient flow parameters, and to simulate the impact of shifting discharge timing on occupancy levels. Methods Retrospective analysis of hospital inpatient data and ED data from 23 reporting public hospitals in Queensland, Australia, across 30 months. Relationships between outcome measures were explored through the aggregation of the historic data into 21 912 hourly intervals. Main outcome measures included admission and discharge rates, occupancy levels, length of stay for admitted and emergency patients, and the occurrence of access block. The impact of shifting discharge timing on occupancy levels was quantified using observed and simulated data. Results The study identified three stages of system performance decline, or choke points, as hospital occupancy increased. These choke points were found to be dependent on hospital size, and reflect a system change from 'business-as-usual' to 'crisis'. Effecting early discharge of patients was also found to significantly ( P < 0.001) impact overcrowding levels and improve patient flow. Conclusions Modern hospital systems have the ability to operate efficiently above an often-prescribed 85% occupancy level, with optimal levels varying across hospitals of different size. Operating over these optimal levels leads to performance deterioration defined around occupancy choke points. Understanding these choke points and designing strategies around alleviating these flow bottlenecks would improve capacity management, reduce access block and improve patient outcomes. Effecting early discharge also helps alleviate overcrowding and related stress on the system. [ABSTRACT FROM AUTHOR]

Objective: To determine whether after‐hours presentation to EDs is associated with differences in 7‐day and 30‐day mortality. The influence of patient case‐mix and workforce staffing differences are also explored. Methods: We conducted a retrospective observational study of 3.7 million ED episodes across 30 public hospitals in Queensland, Australia during May 2013–September 2015 using routinely collected hospital data linked to hospital staffing data and the death registry. Episodes were categorised as within/after‐hours using time of presentation. Staffing was derived from payroll records and explored by defining 11 staffing ratios. Results: Weekend presentation was slightly more associated (7‐day mortality odds ratio 1.05, 95% confidence interval [CI] 1.01–1.10) or no more associated (30‐day mortality odds ratio 1.01, 95% CI 0.98–1.03) with death than weekday presentation. When weeknights are included in the 'after‐hours' period, odds ratios are smaller, so that after‐hours presentation is no more associated (7‐day mortality odds ratio 1.03, 95% CI 0.99–1.08) or less associated (30‐day mortality odds ratio 0.95, 95% CI 0.93–0.97) with death. No significant after‐hours patient case‐mix differences were observed between weekday and weekend presentations for 7‐day mortality. In other combinations of outcome and after‐hours definition, some differences (especially measures relating to severity of presenting condition) were found. Staffing ratios were not strongly associated with any within/after‐hours differences in ED mortality. Conclusions: After‐hours presentation on the weekend to an ED is associated with higher 7‐day mortality even after controlling for case‐mix. [ABSTRACT FROM AUTHOR]

Aim: To describe the relationship between emergency department (ED) diagnosis of infectious disease and immunisation status in children ≤5 years. We also aimed to demonstrate feasibility of proof-of-concept linkage between disparate databases.Methods: Data from a cohort of 3404 children born in Southeast Queensland/Far North New South Wales between 2006 and 2011 were linked to Australian Childhood Immunisation Registry data and Emergency Department Information System data for presentations between 2006 and 2014. Immunisation status was assigned using the 2009 National Immunisation Program schedule.Results: Of 1490 children (79% of those consented) with data on immunisation status, 87.2 and 84.6% were fully immunised by 12 and 24 months, respectively. Adding partially immunised children increased this to 93.2 and 91.4% at 12 and 24 months, respectively. Nearly two-thirds of all children made at least one ED presentation. Children presenting to ED with an infectious disease did not differ in immunisation status compared to children with other (non-infectious disease type) presentations but were younger, more likely to live with other children and had a longer ED stay and higher admission rate. Respiratory syncytial virus (RSV) was more frequently diagnosed in unimmunised children.Conclusions: In an existing birth cohort, immunisation rates were lower than the national average. RSV was more prevalent in unimmunised children presenting to ED, but immunisation status was not significantly associated with other infectious disease presentations. Linkage between national immunisation data and Australian ED data is feasible and has the potential to identify previously unrecognised factors related to child immunisation status and health-care utilisation. [ABSTRACT FROM AUTHOR]

Aim To describe and compare standard practice with a revised, assisted method for calculating emergency department nursing workforce requirements (using the emergency nursing workforce tool, ENWT) within 27 Queensland public hospital emergency departments ( ED). Background Despite the presence of several methodologies used for staffing calculations, there is a necessity to refine measures of emergency department complexity and workload to determine appropriate staffing in order to meet patient safety needs and health service key priority indicators. Methods A descriptive comparative study design was employed. Of the 27 ED nurse unit managers ( NUM) invited, 18 (67%) participated. Results No significant difference was noted in the full time equivalent ( FTE) nursing requirement when standard vs. new ( ENWT) methods were compared. The ENWT was more efficient (i.e. timely) and had better predictability than existing methods for calculating FTE nursing requirement. Conclusion The methodology underpinning the ENWT may be useful to apply or adapt to settings other than the ED (e.g. intensive care, operating room) and disciplines within the ED other than nursing (e.g. medicine, allied health, porterage) to inform staffing requirements. Implications for nursing management Findings from this research can be used to inform ED managers and health service planners regarding a standardized approach to calculating emergency nursing workforce needs. [ABSTRACT FROM AUTHOR]

Abstract: The ‘preclinical’ phase of Alzheimer''s disease is a future target for treatment, but additional research is essential to understand the relationship between β-amyloid burden and cognition during this time. We investigated this relationship using a large sample of apparently healthy older adults (N =177), which also enabled examination of whether the relationship differed according to age, gender, years of education, apolipoprotein E status, and the presence of subjective memory complaints. In addition to episodic memory, a range of cognitive measures (global cognition, semantic memory, visuospatial performance, and executive function) were examined. Participants were aged over 60 years with no objective cognitive impairment and came from the imaging arm of the Australian Imaging, Biomarkers, and Lifestyle (AIBL) study of ageing. 11C-PiB PET was used to measure β-amyloid burden and a PiB ‘cut-off’ level of 1.5 was used to separate participants with low PiB retention from those with high PiB retention. Thirty-three percent of participants had a PiB positive scan. PiB positive participants were 5 years older, twice as likely to carry an apolipoprotein E ɛ4 allele, and their composite episodic memory was 0.26 SD worse than PiB negative volunteers. Linear regressions with β-amyloid burden as a dichotomous predictor, revealed an interaction between β-amyloid burden and gender, as well as age and education effects, in predicting episodic memory and visuospatial performance. In females, but not in males, increased β-amyloid was related to worse episodic memory and visuospatial performance. Furthermore, an interaction between β-amyloid burden and APOE status was found in predicting visuospatial performance, whereby there was a trend for increased β-amyloid to relate to worse visuospatial performance for those without an APOE ɛ4 allele. There were no other main or interaction effects of β-amyloid on any of the other composite cognitive measures. These cross-sectional findings suggest that β-amyloid burden does not have a large effect on cognition in this subset of apparently healthy older people. The finding of gender differences deserves further research to answer definitively the important question of gender susceptibility to adverse cognitive effects from β-amyloid. [Copyright &y& Elsevier]

The effects of improvements in fishing gear and technology on prawn and scallop catches from the Queensland trawl fishery were investigated. The species, the spatial distribution of the stocks, and the management regulations were used to partition the fishery into five main sectors: Torres Strait tiger prawns, north Queensland tiger prawns, shallow-water (<50 fathoms) eastern king prawns, deep-water (>50 fathoms) eastern king prawns and saucer scallops. For each sector, annual changes in average relative fishing power were calculated as a function of the fishing gear and technology parameters estimated in a generalised linear model and the average and/or percentage use of different gears and technologies in the sector. Over the 11 years from 1989 to 1999, fishing power for an average vessel increased at a low of 4% in the saucer scallop sector to a high of 27% in the shallow-water eastern king prawn sector. Fishing power in the shallow-water eastern king and tiger prawn sectors had the highest rates of increase and was largely attributed to vessels upgrading to larger engines. Increases in the number of vessels using global positioning systems and computer mapping software also contributed to increased fishing power in the two tiger prawn sectors. In the deep-water eastern king prawn sector, increased fishing power was associated with net head rope length, however, current management controls over engine size and head rope length are likely to limit this source of increase in fishing power. Fishing power in the scallop sector was associated with a relatively low average trawl speed of about 2.2 kn, which differed from the prawn sectors where higher catches were generally taken at trawl speeds of at least 3 kn. The results should be used to standardise fishing effort and be incorporated into stock assessments for each sector. [Copyright &y& Elsevier]

Aim: Infants under 12 months of age are disproportionately represented amongst emergency department (ED) presentations, and infants are more likely to be frequent ED users. This study aimed to describe and identify psychosocial predictors of ED presentation in infants.Methods: A prospective birth cohort from Queensland and New South Wales (Environments for Healthy Living) was used to understand infant health service use. Baseline and 12-month questionnaire data pertaining to children born between 2006 and 2011 were used to identify predictors of ED presentation, using multiple regression analysis.Results: Of the 2184 children in the cohort with available baseline and 12-month data, 579 (27%) presented at least once to an ED during their first 12 months of life. Statistically significant predictors of ED presentation in the multivariate analysis included the mother having asthma (odds ratio (OR) 1.67, 95% confidence interval (CI) 1.15-2.39) and a higher Kessler-6 score (a measure of psychological distress) of the primary carer at baseline (OR 1.04, 95% CI 1.01-1.08). Maternal education level was not associated with ED presentations of infants.Conclusions: This study describes maternal and child factors of children who present to the ED in the first year of life. Factors related to an infant's support system were found to be predictors for an ED presentation in the first year of life. This study emphasises the need to review the maternal medical history and psychosocial situation. There may be benefits for health-care practitioners to take the opportunity (such as during routine childhood immunisation) to perform a brief screening tool (such as the Kessler-6) to understand psychological distress experienced by mothers. This may influence the likelihood of a child presenting to an ED within the first 12 months of life. [ABSTRACT FROM AUTHOR]