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Despite notable progress, TB remains a critical public health challenge in the Western Pacific Region. To address this, the WHO developed the Western Pacific Regional Framework to End TB, which aligns with global health targets, such as the End TB Strategy and the Sustainable Development Goals. Here, we critically review the Framework, highlighting its strengths and ongoing challenges, with suggestions as to how it might adapt. Although the Framework offers a comprehensive strategy for reducing the TB burden, its success depends on effective implementation across diverse socio-economic contexts. Key obstacles include undiagnosed infectious TB cases, limited healthcare infrastructure, persistent inequities in access to TB services, and drug-resistant TB. The COVID-19 pandemic exacerbated these challenges, disrupting TB services and delaying progress towards 2030 targets. The Framework's reliance on multisectoral partnerships and innovative technologies presents opportunities but requires substantial political commitment, sustained funding and system-wide health reforms. Additionally, gaps remain in addressing social determinants of TB. Ensuring equity, maintaining political will, and fostering international collaboration are essential to overcoming these barriers. Continuous evaluation and adaptation will be crucial in ensuring the Framework's effectiveness in eliminating TB in the Region by 2030., (© 2025 World Health Organization.)

A substantial proportion of people with tuberculosis (TB)-one of the world's deadliest infectious diseases-live in resource-poor, food insecure settings. It is widely recognised that undernutrition significantly heightens vulnerability to TB, as well as contributes to poor treatment adherence and outcomes. However, more attention is needed to understand what shapes food insecurity and undernutrition in a particular setting. We use the concept of "foodscapes" to explore the distinct food environment on Daru Island, a recognised "hotspot" for multidrug-resistant TB in the Western Province of Papua New Guinea. Drawing on 128 qualitative interviews and 10 focus groups (conducted July 2019 and July 2020) with people with TB, family members, healthcare providers, community leaders and other stakeholders, we seek to elucidate the critical entwinement of food insecurity, people with TB, and their treatment experiences on Daru Island. We argue that potential solutions need to focus on the social and structural conditions that contribute to undernutrition in the first place, rather than on undernutrition itself., Competing Interests: Declaration of competing interest The authors have declared that no competing interests exist., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Psoriasis is a chronic immune-mediated skin condition. Evidence supporting dietary management of psoriasis is limited. However, People Living with Psoriasis (PLwP) trial dietary interventions as a management strategy, often taken from popular literature. Social media is a popular source of nutrition information. However, little is known about the dietary information suggested for psoriasis on these platforms. The aim of this study was to explore the dietary approaches suggested for psoriasis on Instagram and evaluate their quality., Methodology: Cross-sectional content analysis of Instagram posts providing dietary information for plaque psoriasis management, posted under the 12 most popular psoriasis hashtags. Posts were evaluated for quality using the DISCERN instrument., Results: Overall, 138 Instagram posts were analysed. The most common type of dietary recommendation was 'exclusion', most frequently of alcohol and dairy. Detox and 'clean eating' were also frequently mentioned, as well as the inclusion of protein, and adherence to a gluten-free diet. The most common content creators were those with those with lived experience of psoriasis (29.7%). None of the posts were created by qualified nutrition professionals and only 6.5% were by healthcare professionals (HCPs). The majority (99%) of posts identified were of 'poor' quality., Conclusion: Most dietary information on Instagram for managing psoriasis is poor quality, restrictive, unsubstantiated and shared by non-HCPs. Therefore, PLwP may be subject to dietary misinformation when using Instagram. HCPs should be equipped to counter diet and psoriasis misinformation. Further research is needed to investigate appropriate ways to provide dietary support for PLwP., (© 2025 The Author(s). Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Background and Objectives: Chronic breathlessness is a frequent diagnostic challenge in primary care. Our aim is to evaluate the feasibility of a stepwise breathlessness diagnostic algorithm for primary care., Method: This mixed-methods study included: (1) a general practitioner (GP) nominal group technique study; (2) focus groups on GPs' views on the algorithm; and (3) analysis of algorithm alignment against patterns of diagnostic referrals and diagnoses of breathlessness presentations (2014-19) from the MedicineInsight primary care electronic health record (EHR) dataset of 1,961,264 patients (405 general practice sites)., Results: All the tests in our algorithm, except for echocardiography, were ranked in the top 10 tests used by most GPs for patients presenting with chronic breathlessness. Themes from the focus group include similarity with current practice and test accessibility. Analysis of EHR diagnostic referrals revealed that all tests in the algorithm are regularly utilised and covered the major tests needed for breathlessness diagnoses recorded., Discussion: The results of the three studies support the acceptability and feasibility of the clinical algorithm in primary care.

Support for Ukraine against Russian aggression has been strong across Europe, but it is far from uniform. An expert survey of the positions taken by political parties in 29 countries conducted mid-2023 reveals that 97 of 269 parties reject one or more of the following: providing weapons, hosting refugees, supporting Ukraine's path to European Union membership, or accepting higher energy costs. Where the perceived threat from Russia is most severe, we find the greatest levels of support for Ukraine. However, ideology appears to be far more influential. The level of a party's populist rhetoric and its European Union skepticism explain the bulk of variation in support for Ukraine despite our finding that many strongly populist and European Union-skeptical parties take moderate pro-Ukraine positions when in government., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Objective: To evaluate associations of wildfire fine particulate matter ≤2.5 mm in diameter (PM2.5) with diabetes across multiple countries and territories., Research Design and Methods: We collected data on 3,612,135 diabetes hospitalizations from 1,008 locations in Australia, Brazil, Canada, Chile, New Zealand, Thailand, and Taiwan during 2000-2019. Daily wildfire-specific PM2.5 levels were estimated through chemical transport models and machine-learning calibration. Quasi-Poisson regression with distributed lag nonlinear models and random-effects meta-analysis were applied to estimate associations between wildfire-specific PM2.5 and diabetes hospitalization. Subgroup analyses were by age, sex, location income level, and country or territory. Diabetes hospitalizations attributable to wildfire-specific PM2.5 and nonwildfire PM2.5 were compared., Results: Each 10 µg/m3 increase in wildfire-specific PM2.5 levels over the current day and previous 3 days was associated with relative risks (95% CI) of 1.017 (1.011-1.022), 1.023 (1.011-1.035), 1.023 (1.015-1.032), 0.962 (0.823-1.032), 1.033 (1.001-1.066), and 1.013 (1.004-1.022) for all-cause, type 1, type 2, malnutrition-related, other specified, and unspecified diabetes hospitalization, respectively. Stronger associations were observed for all-cause, type 1, and type 2 diabetes in Thailand, Australia, and Brazil; unspecified diabetes in New Zealand; and type 2 diabetes in high-income locations. An estimate of 0.67% (0.16-1.18%) and 1.02% (0.20-1.81%) for all-cause and type 2 diabetes hospitalizations were attributable to wildfire-specific PM2.5. Compared with nonwildfire PM2.5, wildfire-specific PM2.5 posed greater risks of all-cause, type 1, and type 2 diabetes and were responsible for 38.7% of PM2.5-related diabetes hospitalizations., Conclusions: We show the relatively underappreciated links between diabetes and wildfire air pollution, which can lead to a nonnegligible proportion of PM2.5-related diabetes hospitalizations. Precision prevention and mitigation should be developed for those in advantaged communities and in Thailand, Australia, and Brazil., (© 2024 by the American Diabetes Association.)

Background: Community champions have been employed across various settings to disseminate evidence-based public health information. The Building Babies' Brains programme trains champions to work with parents in communities, equipping them with child development knowledge and parental engagement strategies. We explored what makes community champions effective in distributing information to parents, including how the champion-parent relationship and champions' personal characteristics affect information dissemination., Methods: Champions included both peers and professionals working with parents in target communities. We administered an online survey ( n = 53) and follow-up interviews ( n = 14) with champions, with representation from across all training cohorts. We conducted a realist-informed reflexive thematic analysis to generate themes in the data and highlight the contexts, mechanisms, and outcome patterns identified., Results: We observed 15 Context-Mechanism-Outcome configurations across five themes: information sharing opportunities, information relevance, the nature of the champion-parent relationship, interaction expectations, and champion confidence. Our programme theory for how the community champion approach works identified that peer champions focused more on building rapport, modelling behaviours, and being a trusted community resource than direct information transfer. Professional champions, in contrast, showed greater expertise and confidence in discussing parenting practices directly. For both groups, traits such as friendliness and the ability to establish a trusting relationship enhanced effectiveness., Conclusions: This research identifies the impacts of champion role, characteristics, and the champion-parent relationship on the effectiveness of knowledge mobilisation in this context, with implications for training and recruitment of champions. Those using a champion model in comparable settings should ensure that champions have the necessary knowledge, skills, and confidence to engage parents and share information effectively., Competing Interests: The authors declare no conflicts of interest.

Background: Transanal surgery facilitates organ preservation in select patients with benign and early malignant rectal lesions to avoid the functional consequences of radical surgery. The transanal endoscopic microsurgery (TEM) platform created a standard for local excision with lower margin positivity and recurrence rates than traditional transanal excision. The single-port robot (SP r) presents a promising alternative transanal platform. The goal of this study was to compare perioperative and pathologic outcomes of TEM and SP r for excision of rectal lesions., Methods: A review of consecutive patients who underwent local excision of rectal lesions at a tertiary referral center from 1/2001 to 5/2022 was performed. Cases were stratified into TEM or SP rTAMIS in a 1:1 propensity score-matched cohort, adjusting for all baseline characteristics. Clinical, tumor-specific, and perioperative outcomes were compared using χ 2 , and Mann-Whitney U-tests. The main outcomes were oncologic quality measures, complications, and operative time., Results: Matching resulted 50 patients in each cohort. Groups had similar age, gender, body mass index, comorbidity, diagnosis, lesion characteristics, and neoadjuvant chemoradiation rates. There were no intraoperative complications in either cohort. Three SP rTAMIS cases were converted intraoperatively; there were no conversions in TEM. SP rTAMIS had significantly shorter operative times than TEM (mean 104 vs. 245, p = 0.027). The rates of positive distal margins (2% TEM, 0% SP rTAMIS) and piecemeal resection (4% TEM, 0% SP rTAMIS) were similar. SP rTAMIS had significantly lower postoperative morbidity rates than TEM (9% vs. 20%, p = 0.031). There was no mortality in either cohort., Conclusions: SP robotics provided high-quality outcomes similar to TEM for local excision of rectal lesions. SP robotics had faster operative time with comparable clinical and oncologic outcomes to TEM. These early data are promising for expanding use of SP robotic platforms., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Long-term exposure to fine particulate matter (≤2.5 µm (PM 2.5 )) has been associated with pulmonary tuberculosis (TB) notifications or incidence in recent publications. Studies quantifying the relative contribution of long-term PM 2.5 on TB notifications have not been documented. We sought to perform a health impact assessment to estimate the PM 2.5 - attributable TB notifications during 2007-2017 in Ningxia Hui Autonomous Region (NHAR), China., Methods: PM 2.5 attributable TB notifications were estimated at township level (n=358), stratified by age group and summed across NHAR. PM 2.5 -associated TB-notifications were estimated for total and anthropogenic PM 2.5 mass and expressed as population attributable fractions (PAFs). The main analysis used effect and uncertainty estimates from our previous study in NHAR, defining a counterfactual of the lowest annual PM 2.5 (30 µg/m 3 ) level, above which we assumed excess TB notifications. Sensitivity analyses included counterfactuals based on the 5th (31 µg/m 3 ) and 25th percentiles (38 µg/m 3 ), and substituting effect estimates from a recent meta-analysis. We estimated the influence of PM 2.5 concentrations, population growth and baseline TB-notification rates on PM 2.5 attributable TB notifications., Results: Over 2007-2017, annual PM 2.5 had an estimated average PAF of 31.2% (95% CI 22.4% to 38.7%) of TB notifications while the anthropogenic PAF was 12.2% (95% CI 9.2% to 14.5%). With 31 and 38 µg/m 3 as counterfactuals, the PAFs were 29.2% (95% CI 20.9% to 36.3%) and 15.4% (95% CI 10.9% to 19.6%), respectively. PAF estimates under other assumptions ranged between 6.5% (95% CI 2.9% to 9.6%) and 13.7% (95% CI 6.2% to 19.9%) for total PM 2.5 , and 2.6% (95% CI 1.2% to 3.8%) to 5.8% (95% CI 2.7% to 8.2%) for anthropogenic PM 2.5 . Relative to 2007, overall changes in PM 2.5 attributable TB notifications were due to reduced TB-notification rates (-23.8%), followed by decreasing PM2.5 (-6.2%), and population growth (+4.9%)., Conclusion: We have demonstrated how the potential impact of historical or hypothetical air pollution reduction scenarios on TB notifications can be estimated, using public domain, PM 2.5 and population data. The method may be transferrable to other settings where comparable TB-notification data are available., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

If some countries lead by example, standards may increasingly become normalized.

Background: The transanal abdominal transanal radical proctosigmoidectomy was developed in 1984 as a sphincter preservation surgery in patients with low rectal cancers after preoperative radiation therapy. While serving as a catalyst for disruptive sphincter preservation surgery, it continues to be used and evolve. With the controversy over safety and local recurrence in other sphincter-preserving surgery, review of transanal abdominal transanal radical proctosigmoidectomy long-term oncologic outcomes is warranted., Objective: To assess local recurrence and survival after transanal abdominal transanal radical proctosigmoidectomy after neoadjuvant chemoradiation therapy., Design: Retrospective cohort study of a prospectively maintained database., Settings: Tertiary rectal cancer referral center., Patients: Patients with low adenocarcinoma (≤5 cm anorectal ring) receiving neoadjuvant chemoradiation therapy and then transanal abdominal transanal radical proctosigmoidectomy for curative resection between 1998 and 2021., Main Outcome Measures: Local recurrence rates and overall survival rates., Results: Of 255 included patients, 67.8% were men (n = 173); the mean age was 58.7 years (SD 11.5) and the mean BMI was 27.1 (SD 5.4), with 50.2% (n = 128) having ASA class II and 49.8% (n = 127) having ASA class III/IV. The mean tumor size was 4.8 cm (SD 1.9), the majority of patients had clinical T3 disease (81.8%; n = 184), and 52.1% had nodal disease (n = 100). The median radiation dose was 5400 cGy, with 73.7% (n = 149) achieving good response and 90.2% (n = 230) receiving minimally invasive surgery. The complete total mesorectal excision rate was 94.3%, and 100% of patients (n = 255) had negative distal margins. The mean number of examined lymph nodes were 13.9 (SD 10.7). After a median follow-up of 55.4 months, 5.1% of patients (n = 13) developed local recurrence at a median time of 29.6 months. The 5-year overall survival was 84.1% (95% CI, 78.8-89.4)., Limitations: Retrospective review with risk of bias and lack of generalizability., Conclusions: In this longitudinal study, the transanal abdominal transanal radical proctosigmoidectomy demonstrated excellent long-term locoregional control and survival in very low rectal cancers. The superior transanal abdominal transanal radical proctosigmoidectomy outcomes are durable over time, warranting expansion of the sphincter-preserving surgery technique. See Video Abstract ., Anlisis Longitudinal De La Recurrencia Local Y La Supervivencia Despus De La Proctosigmoidectoma Radical Transanal Abdominal Tata Para El Cncer De Recto Bajo Tratado Con Quimiorradiacin Neoadyuvante: ANTECEDENTES:La proctosigmoidectomía radical transanal abdominal se desarrolló en 1984 como una cirugía de preservación del esfínter en cánceres de recto bajo después de la radiación preoperatoria. Si bien sirve como catalizador para la cirugía disruptiva de preservación del esfínter, continúa utilizándose y evolucionando. Con la controversia sobre la seguridad y la recurrencia local en otras cirugías que preservan el esfínter, se justifica la revisión de los resultados oncológicos a largo plazo de la proctosigmoidectomía radical transanal abdominal.OBJETIVO:Evaluar localmente después de Proctosigmoidectomía Radical Transanal Abdominal Transanal después de quimiorradiación neoadyuvante.DISEÑO:Estudio de cohorte retrospectivo de una base de datos mantenida de forma prospectiva.AJUSTES:Centro terciario de referencia para el cáncer de recto.PACIENTES:Adenocarcinoma bajo (=/

Background: Asthma remission has emerged as a potential treatment goal. This study evaluated the effectiveness of two biologics (mepolizumab/omalizumab) in achieving asthma remission., Methods: This observational study included 453 severe asthma patients (41% male; mean age ± SD 55.7 ± 14.7 years) from two real-world drug registries: the Australian Mepolizumab Registry and the Australian Xolair Registry. The composite outcome clinical remission was defined as zero exacerbations and zero oral corticosteroids during the previous 6 months assessed at 12 months and 5-item Asthma Control Questionnaire (ACQ-5) ≤1 at 12 months. We also assessed clinical remission plus optimization (post-bronchodilator FEV1 ≥80%) or stabilization (post-bronchodilator FEV1 not greater than 5% decline from baseline) of lung function at 12 months. Sensitivity analyses explored various cut-offs of ACQ-5/FEV1 scores. The predictors of clinical remission were identified., Results: 29.3% (73/249) of AMR and 22.8% (37/162) of AXR cohort met the criteria for clinical remission. When lung function criteria were added, the remission rates were reduced to 25.2% and 19.1%, respectively. Sensitivity analyses identified that the remission rate ranged between 18.1% and 34.9% in the AMR cohort and 10.6% and 27.2% in the AXR cohort. Better lung function, lower body mass index, mild disease and absence of comorbidities such as obesity, depression and osteoporosis predicted the odds of achieving clinical remission., Conclusion: Biologic treatment with mepolizumab or omalizumab for severe asthma-induced asthma remission in a subgroup of patients. Remission on treatment may be an achievable treatment target and future studies should consider remission as an outcome measure., (© 2023 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)

BACKGROUND: The value, speed of completion and robustness of the evidence generated by TB treatment trials could be improved by implementing standards for best practice. METHODS: A global panel of experts participated in a Delphi process, using a 7-point Likert scale to score and revise draft standards until consensus was reached. RESULTS: Eleven standards were defined: Standard 1, high quality data on TB regimens are essential to inform clinical and programmatic management; Standard 2, the research questions addressed by TB trials should be relevant to affected communities, who should be included in all trial stages; Standard 3, trials should make every effort to be as inclusive as possible; Standard 4, the most efficient trial designs should be considered to improve the evidence base as quickly and cost effectively as possible, without compromising quality; Standard 5, trial governance should be in line with accepted good clinical practice; Standard 6, trials should investigate and report strategies that promote optimal engagement in care; Standard 7, where possible, TB trials should include pharmacokinetic and pharmacodynamic components; Standard 8, outcomes should include frequency of disease recurrence and post-treatment sequelae; Standard 9, TB trials should aim to harmonise key outcomes and data structures across studies; Standard 10, TB trials should include biobanking; Standard 11, treatment trials should invest in capacity strengthening of local trial and TB programme staff. CONCLUSION: These standards should improve the efficiency and effectiveness of evidence generation, as well as the translation of research into policy and practice.

Background: The impact of wildfire smoke is a growing public health issue, especially for those living with preexisting respiratory conditions. Understanding perceptions and behaviors relevant to the use of individual protective strategies, and how these affect the adoption of these strategies, is critical for the development of future communication and support interventions. This study focused on the use of masks by people living in the Australian community with asthma or chronic obstructive pulmonary disease (COPD)., Methods: Semi-structured phone interviews were undertaken with people living in the community aged 18 years and over. Participants lived in a bushfire-prone area and reported having been diagnosed with asthma or COPD., Results: Twenty interviews were undertaken between July and September 2021. We found that, during wildfire episodes, there was an overwhelming reliance on closing windows and staying inside as a means of mitigating exposure to smoke. There was limited use of masks for this purpose. Even among those who had worn a mask, there was little consideration given to the type of mask or respirator used. Reliance on sensory experiences with smoke was a common prompt to adopting an avoidance behavior. Participants lacked confidence in the information available from air-quality apps and websites, however they were receptive to the idea of using masks in the future., Conclusions: Whilst COVID-19 has changed the nature of community mask use over the last couple of years, there is no guarantee that this event will influence an individual's mask behavior during other events like bushfires. Instead, we must create social support processes for early and appropriate mask use, including the use of air quality monitoring., (© 2023. The Author(s).)

Achieving gender equity is a long-standing and ubiquitous challenge in marine science. Creating equitable experiences for all genders in marine science requires recognizing scientists' intersectional identities, and how this leads to unique lived experiences of privilege and marginalization. One approach to increase equitable experiences for women in marine science is to create affinity groups where women can learn from each other, share their experiences, and provide support and mentorship. The Society for Women in Marine Science (SWMS) is one such organization, founded to amplify the work of early career women in marine science and create community, through events such as full-day symposium events. This study investigates the experiences of symposium attendees for four events held from 2018 through 2020, as reported in pre- and post-symposium surveys. We used quantitative analysis of the open-ended survey questions to examine the demographics of attendees and their fields of study. Qualitative thematic analysis identified the most effective aspects of the symposia, areas of logistical and content improvement for future symposia, and emphasized the unique challenges women in marine science experience. The majority of symposium attendees were white graduate students. Nearly all attendees identified as women, with a small number of men and non-binary individuals. Symposia attendees enjoyed opportunities for professional development and interactions with colleagues across career stages. We present recommendations for continuing to foster a sense of belonging in marine science and STEM more broadly, both specific to SWMS and transferable actions that can be applied for other affinity groups. These suggestions include empathetic event logistics, continual democratic evaluation, identity reflexivity among group leaders, and professional development activities targeted towards the unique needs of the affinity group. The positive responses received from SWMS's adaptive integration of survey results into symposia demonstrate that incorporating these recommendations and findings will help create an inclusive wave in marine science., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

We reconstructed hydroclimate variability in the Yucatán Peninsula (YP) based on stalagmite oxygen and carbon isotope records from a well-studied cave system located in the northeastern YP, a region strongly influenced by Caribbean climate dynamics. The new stalagmite isotopic records span the time interval between 43 and 26.6 ka BP, extending a previously published record from the same cave system covering the interval between 26.5 and 23.2 ka BP. Stalagmite stable isotope records show dominant decadal and multidecadal variability, and weaker variability on millennial timescales. These records suggest significant precipitation declines in the broader Caribbean region during Heinrich events 4 and 3 of ice-rafted discharge into the North Atlantic, in agreement with the antiphase pattern of precipitation variability across the equator suggested by previous studies. On millennial timescales, the stalagmite isotope records do not show the distinctive saw-tooth pattern of climate variability observed in Greenland during Dansgaard-Oeschger (DO) events, but a pattern similar to North Atlantic sea surface temperature (SST) variability. We propose that shifts in the mean position of the Intertropical Convergence Zone (ITCZ), per se, are not the dominant driver of last glacial hydroclimate variability in the YP on millennial timescales but instead that North Atlantic SSTs played a dominant role. Our results support a negative climate feedback mechanism whereby large low latitude precipitation deficits resulting from AMOC slowdown would lead to elevated salinity in the Caribbean and ultimately help reactivate AMOC and Caribbean precipitation. However, because of the unique drivers of future climate in the region, predicted twenty-first century YP precipitation reductions are unlikely to be modulated by this negative feedback mechanism., (© 2023. Springer Nature Limited.)

Introduction: This study aims to explore the perspectives of patients and carers with chronic breathlessness on current provision of care, care expectations, and self-management needs to develop relevant health services and resources to improve clinical outcomes., Methods: In-depth semistructured interviews were conducted on patients living with chronic breathlessness and carers., Results: Thirteen patients (cardiac, respiratory, and noncardiorespiratory) and two carers were interviewed (mean age 57 years, 47% female, median duration with breathlessness 5 years). Four main themes were identified: (1) living with breathlessness, (2) diagnosis delays, misdiagnosis, and knowledge gaps, (3) beyond curing disease: symptom relief and improving quality of life, and (4) self-management and limited support for it., Conclusion: Breathlessness has a high personal impact but remains a neglected condition in Australia. Patients suffer from lack of personal, community, and provider awareness, discontinuity of care, and too few clinical and self-management options., (© 2023 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)

This is an account that should be heard of an important struggle: the struggle of a large group of experts who came together at the beginning of the COVID-19 pandemic to warn the world about the risk of airborne transmission and the consequences of ignoring it. We alerted the World Health Organization about the potential significance of the airborne transmission of SARS-CoV-2 and the urgent need to control it, but our concerns were dismissed. Here we describe how this happened and the consequences. We hope that by reporting this story we can raise awareness of the importance of interdisciplinary collaboration and the need to be open to new evidence, and to prevent it from happening again. Acknowledgement of an issue, and the emergence of new evidence related to it, is the first necessary step towards finding effective mitigation solutions., Competing Interests: Potential conflicts of interest. J. H. reports an unpaid position as secretary/treasurer of BOD of IEQ-GA. F. F. reports an SBIR grant from Franchimon ICM, informal shares and co-founder stock from BlueCanary and iventionair, consulting fees for professional papers and reports from Franchimon ICM, payment for lectures from TVVL (Member Association for HVAC), and payment for webinars from the Dutch Green Building Council. A. B. reports a position at Delft University of Technology and consultancy with a company specialized in indoor environmental quality. J. L. J. reports grants or contracts from NASA, US National Science Fund, and Balvi Filantropic Fund; payment for lectures at Peking University; and unpaid roles on the committee for Testing of Air Cleaning Devices of ASTM and Aireamos volunteer group on ventilation solutions for the Spanish-speaking world. Y. L. reports a collaborative research grant and 3 general research grants from the Hong Kong Research Grants Council (RGC), a grant from the Health and Medical Research Fund (HMRF), and grants or contracts from P&G Singapore. Marcel G.L.C. Loomans reports grants or contracts from TVVL, RVO government program TNO for P3Venti project, a grant from TKI NL Health Holland for the CLAIRE project, and a grant from NOW for the MIST project (all paid to the author's institution); M. G. L. C. L. also serves as an ISIAQ.nl board member, and is a member of Impulgroep TVVL (Dutch Association of Building Services Engineers), Kennisgroep VCCN (Dutch Association on Contaminant Control), and WHO, for which they sit on the Environment and Engineering Control Expert Advisory Panel (ECAP) for COVID-19. L. C. M. reports a contract with the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH) Department of Health and Human Services (HHSN272201400007C); grants or contracts from the Flu Lab and Wellcome Leap (all paid to the author's institution); consulting fees paid to the author from MITRE Corporation, Freedman Consulting, and The New York Times; payment or honoraria paid to the author from the University of Toronto, University of Hong Kong, Queensland University of Technology, and Virginia Tech Carilion School of Medicine; support for meetings and/or travel from MITRE Corporation and the International Society for Influenza and Other Respiratory Viruses. G. M. reports their role as president of the International Union Against TB & Lung Disease. D. K. M. reports the following grants or contracts—US NIAID U19 AI 162130, for Evaluating Modes of Influenza Transmission (EMIT-2) using Innovative Technologies and Designs in Controlled Environments; US NIAID contract number 75N93021C00014, for the Centers of Excellence for Influenza Research and Response, for Wearable Micro Air Cleaner for Protection of Workers’ Health during Prolonged Use (US NSF Project 75D30121C10610); US NIAID AI148689, A Phase 3, Randomized, Stratified, Observer-Blind, Placebo-Controlled Study to Evaluate the Efficacy, Safety, and Immunogenicity of mRNA-1273 SARS-CoV-2 Vaccine in Adults Aged 18 Years and Older; US NIAID F3038571, Implementing Vaccine and Treatment Evaluation Unit (VTEU) clinical site protocols (CoVPN 3004 Novavax Supplement); US NIAID R21 AI161501, Elucidating Airborne SARS-CoV-2 Infectivity at Single Aerosol Resolution; US National Institute of Environmental Health Sciences (NIEHS) R01 ES034303, Research Employing Environmental Systems and Occupational Health Policy Analyses to Interrupt the Impact of Structural Racism on Agricultural Workers and Their Respiratory Health (RESPIRAR); Bill & Melinda Gates Foundation INVO022295, COVID-19: Quantifying viral RNA in exhaled breath; US NIAID 025806864609, COVID-19 Surveillance and Exhaled Breath Aerosol Assessment Study; US National Science Foundation (NSF) CMMI2034755, EAGER: Protecting University Communities from COVID-19 with Model-Based Risk Management; US NSF 2030502, COVID: Collaborative Research: RAPID: Understanding and Facilitating Remote Triage and Rehabilitation During Pandemics via Visual Based Patient Physiology Sensing, WMATA Bus Air Cleaning Effectiveness with Novel Air Cleaning Systems, College Band Directors National Association Aerosol Generation from Playing Band Instruments and Risk of Infectious Disease Transmission; US Centers for Disease Control and Prevention (CDC) COVID-19: Real-World Tests of Face Coverings as Source Control for COVID-19 and US DARPA, BARDA Contagious Phenotypes of Acute Respiratory Infection: Identification, Characterization, and Biomarkers. D. K. M. also reports payment or honoraria for the American Conference of Governmental Hygienists from the American Dental Association, support for meetings and/or travel from the Flu Lab, and receipt of UVC fixtures from Aeromed, Inc, and FarUV, Inc. C. N. reports the following grants or contracts paid to their institution: Class-ACT (Co-Investigator [CoI]), 2021–22, DHSC-funded project on air cleaning interventions in schools; Far UV projects (CoI), 2021 DHSC funding, 2022 NHS Scotland Assure funding collaboration led by St Andrews with Leeds, Dundee, Ninewells Hospital, Colombia University; PROTECT National Core Study on Transmission (CoI, theme lead), 2020–2023, £21 M program led by HSE; CONTACT (CoI), 2020–2023, NIHR, £1.6 M, Breathing City: Future Urban Ventilation Network (Principal Investigator [PI]), 2020–2023, UKRI SPF Clean Air Programme Network, £500 K; TRACK: Transport Risk Assessment for COVID Knowledge (PI), 2020–2023; EPSRC, £3.4. Multi-partner project with Universities of Manchester, Cambridge, Newcastle, Imperial, UKHSA, Dstl, Department for Transport and multiple transport stakeholders, CECAM, Engineering and Physical Sciences Research Council (EPSRC) £950 K funding to support a new bioaerosol chamber (2021–2025); Centre for Doctoral Training in Fluid Dynamics (Co-Director, PI Prof P. Jimack), 2019–2027, EPSRC, £4.2 M; Cross-faculty programme to train 50 PhD students over 8 years; and EPSRC National Fellowships in Fluid Dynamics coordination hub (CoI), 2022–2025. C. N. also reports honoraria for Royal Institution Christmas Lecture; payment from BBC Life Scientific; accommodation and registration fees for Indoor Air June 2022, Kuopio, Finland, and BOHS annual conference, June 2022, Belfast; travel expenses for the International Symposium on Stratified Fluid, August 2022; travel and registration fees for IHEEM annual conference (October 2022). C. N. served as co-chair for SAGE Environment and Modelling Group (April 2020–May 2022) and participated in multiple UK government advisory groups during COVID, serves as Chair for HSE Science Quality Assurance Group, is a member of the UKRI SPF clean air programme steering board, a member of the WHO Environment and Engineering Control Expert Advisory Panel (ECAP) on ventilation and WHO European High Level Expert Group on COVID-19 leading the ventilation subgroup, and as a Member of the Royal Academy of Engineering COVID-19 Working Group on Infection Resilient Buildings and co-author of reports in July 2021 and May/June 2022. C. N. also received 3 Aranet CO2 sensors from Naltic Industrials. S. M. reports a leadership role as the Vice President for the Academy of Fellows, International Society for Indoor Air Quality and Climate, and on the Aerosol Science and Technology Journal advisory board (both of which are unpaid positions). W. B. reports an unpaid role as chair of the ASHRAE Epidemic Task Force. P. M. B. serves in a leadership or fiduciary role on the KNAW Commission and the Pandemic Disaster Preparedness Centre (both unpaid positions). All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: Spirometric small airways obstruction (SAO) is common in the general population. Whether spirometric SAO is associated with respiratory symptoms, cardiometabolic diseases, and quality of life (QoL) is unknown., Methods: Using data from the Burden of Obstructive Lung Disease study (N = 21,594), we defined spirometric SAO as the mean forced expiratory flow rate between 25 and 75% of the FVC (FEF 25-75 ) less than the lower limit of normal (LLN) or the forced expiratory volume in 3 s to FVC ratio (FEV 3 /FVC) less than the LLN. We analysed data on respiratory symptoms, cardiometabolic diseases, and QoL collected using standardised questionnaires. We assessed the associations with spirometric SAO using multivariable regression models, and pooled site estimates using random effects meta-analysis. We conducted identical analyses for isolated spirometric SAO (i.e. with FEV 1 /FVC ≥ LLN)., Results: Almost a fifth of the participants had spirometric SAO (19% for FEF 25-75 ; 17% for FEV 3 /FVC). Using FEF 25-75, spirometric SAO was associated with dyspnoea (OR = 2.16, 95% CI 1.77-2.70), chronic cough (OR = 2.56, 95% CI 2.08-3.15), chronic phlegm (OR = 2.29, 95% CI 1.77-4.05), wheeze (OR = 2.87, 95% CI 2.50-3.40) and cardiovascular disease (OR = 1.30, 95% CI 1.11-1.52), but not hypertension or diabetes. Spirometric SAO was associated with worse physical and mental QoL. These associations were similar for FEV 3 /FVC. Isolated spirometric SAO (10% for FEF 25-75 ; 6% for FEV 3 /FVC), was also associated with respiratory symptoms and cardiovascular disease., Conclusion: Spirometric SAO is associated with respiratory symptoms, cardiovascular disease, and QoL. Consideration should be given to the measurement of FEF 25-75 and FEV 3 /FVC, in addition to traditional spirometry parameters., (© 2023. The Author(s).)

When exposed to convective thunderstorm conditions, pollen grains can rupture and release large numbers of allergenic sub-pollen particles (SPPs). These sub-pollen particles easily enter deep into human lungs, causing an asthmatic response named thunderstorm asthma (TA). Up to now, efforts to numerically predict the airborne SPP process and to forecast the occurrence of TAs are unsatisfactory. To overcome this problem, we have developed a physically-based pollen model (DREAM-POLL) with parameterized formation of airborne SPPs caused by convective atmospheric conditions. We ran the model over the Southern Australian grass fields for 2010 and 2016 pollen seasons when four largest decadal TA epidemics happened in Melbourne. One of these TA events (in November 2016) was the worldwide most extreme one which resulted to nine deaths and hundreds of hospital patient presentations. By executing the model on a day-by-day basis in a hindcast real-time mode we predicted SPP peaks exclusively only when the four major TA outbreaks happened, thus achieving a high forecasting success rate. The proposed modelling system can be easily implemented for other geographical domains and for different pollen types., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2022 Elsevier B.V. All rights reserved.)

There is growing evidence for trained assistance dogs promoting the health, wellbeing, and quality of life of people in a variety of circumstances, including for those with dementia. Little is known about people with younger (early)-onset dementia (YOD) and family carers. As part of a larger study involving 14 people with YOD matched with trained assistance dogs over a two-year period, we report analyses of interviews with 10 family carers conducted on multiple occasions investigating their experience with an assistance dog. Interviews were recorded, transcribed and subjected to inductive thematic analysis. They told a range of experiences; the good and the challenging. Findings fell into three areas: the human-animal bond; relationship dynamics; and responsibility for caring. Concerns were raised with respect to the resources required of carers together with the financial resources needed to support an assistance dog. The study concludes that trained assistance dogs can play an important role promoting the health and wellbeing of both people with YOD and of their family carers. However, support needs to be in place as the circumstances of the family member with YOD changes and the role of the assistance dog as part of the family also changes. Practical (financial) support of a scheme such as the Australian National Disability Insurance Scheme (NDIS) could be important to sustaining such support.

Why do some international organizations (IO) accrete delegated authority over time while in others delegation is static or declines? We hypothesize that the dynamics of delegation are shaped by an IO's founding contract. IOs rooted in an open-ended contract have the capacity to discover cooperation over time: as new problems arise these IOs can adopt new policies or strengthen collaboration in existing areas. This, in turn, triggers a demand for delegation. However, this logic is mediated by the political regime of the IO. In predominantly democratic IOs, delegation is constrained by politicization which intensifies as an IO's policy portfolio broadens. These claims are tested using an updated version of the Measure of International Authority dataset covering 41 regional IOs between 1950 and 2019. Controlling for alternative explanations and addressing potential endogeneity across a range of model specifications, we find robust support for our argument., Supplementary Information: The online version contains supplementary material available at 10.1007/s11558-022-09482-0., Competing Interests: Conflicts of interestThe authors have no relevant financial or non-financial interests to disclose., (© The Author(s) 2022.)

BACKGROUND: Access to affordable inhaled medicines for chronic respiratory diseases (CRDs) is severely limited in low- and middle-income countries (LMICs), causing avoidable morbidity and mortality. The International Union Against Tuberculosis and Lung Disease convened a stakeholder meeting on this topic in February 2022. METHODS: Focused group discussions were informed by literature and presentations summarising experiences of obtaining inhaled medicines in LMICs. The virtual meeting was moderated using a topic guide around barriers and solutions to improve access. The thematic framework approach was used for analysis. RESULTS: A total of 58 key stakeholders, including patients, healthcare practitioners, members of national and international organisations, industry and WHO representatives attended the meeting. There were 20 pre-meeting material submissions. The main barriers identified were 1) low awareness of CRDs; 2) limited data on CRD burden and treatments in LMICs; 3) ineffective procurement and distribution networks; and 4) poor communication of the needs of people with CRDs. Solutions discussed were 1) generation of data to inform policy and practice; 2) capacity building; 3) improved procurement mechanisms; 4) strengthened advocacy practices; and 5) a World Health Assembly Resolution. CONCLUSION: There are opportunities to achieve improved access to affordable, quality-assured inhaled medicines in LMICs through coordinated, multi-stakeholder, collaborative efforts.

This article explores socio-spatial dimensions of risk and how they can enhance understanding of a high burden tuberculosis (TB) context in the South Fly District of Papua New Guinea. We report on select findings from a qualitative study that included 128 semi-structured in-depth interviews and 10 focus group discussions with a wide range of South Fly District community members. Using the conceptual framework of 'riskscapes' to examine emic perspectives on risk, space and practice, we map key elements of TB riskscapes on Daru Island, South Fly District, along with solutions for navigating through these riskscapes. Overcrowding, lack of water, sanitation and hygiene, as well as food insecurity and undernutrition, were identified as common elements within participants' riskscapes, that compounded upon each other to create the perception of an assemblage of risk favourable to TB transmission.

Background: To determine whether Positive Health Check, a highly tailored video doctor intervention, can improve viral suppression and retention in care., Setting: Four clinics that deliver HIV primary care., Methods: A hybrid type 1 effectiveness-implementation randomized trial design was used to test study hypotheses. Participants (N = 799) who were not virally suppressed, were new to care, or had fallen out of care were randomly assigned to receive Positive Health Check or the standard of care alone. The primary endpoint was viral load suppression, and the secondary endpoint was retention in care, both assessed at 12 months, using an intention-to-treat approach. A priori subgroup analyses based on sex assigned at birth and race were examined as well., Results: There were no statistically significant differences between Positive Health Check (N = 397) and standard of care (N = 402) for either endpoint. However, statistically significant group differences were identified from a priori subgroup analyses. Male participants receiving Positive Health Check were more likely to achieve suppression at 12 months than male participants receiving standard of care adjusted risk ratio [aRR] [95% confidence interval (CI)] = 1.14 (1.00 to 1.29), P = 0.046}. For retention in care, there was a statistically significant lower risk for a 6-month visit gap in the Positive Health Check arm for the youngest participants, 18-29 years old [aRR (95% CI) = 0.55 (0.33 to 0.92), P = 0.024] and the oldest participants, 60-81 years old [aRR (95% CI) = 0.49 (0.30 to 0.81), P = 0.006]., Conclusions: Positive Health Check may help male participants with HIV achieve viral suppression, and younger and older patients consistently attend HIV care., Registry Name: Positive Health Check Evaluation Trial. Trial ID: 1U18PS004967-01. URL: https://clinicaltrials.gov/ct2/show/NCT03292913., Competing Interests: V.C.M. has received investigator-initiated research grants (to the institution) and consultation fees (both unrelated to the current work) from Eli Lilly, Bayer, Gilead Sciences, and ViiV. V.C.M. has received funding from the Emory University Center for AIDS Research (NIH Grant 2P30-AI-050409). This research was supported by a Cooperative Agreement from the Centers for Disease Control and Prevention to Megan A. Lewis (U18PS004967). The other authors have no conflicts of interest to disclose., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)

We characterize the association between engagement in care and durable viral suppression among persons newly diagnosed with HIV infection. Persons newly diagnosed with HIV with unsuppressed viral loads when they initiated care at one of six HIV clinics in the US were observed for up to 24 months. We describe the percentage who achieved durable viral suppression and number of days to achieve durable viral suppression. These outcomes were examined by the proportion of scheduled primary care appointments kept and demographic variables. Overall, 62% of patients achieved durable viral suppression and it took 174 days for 50% of patients to reach the beginning of the event. As the proportion of kept medical appointments increased, the proportion who achieved durable viral suppression increased, with 84% of patients who kept >75% of their appointments achieving the outcome. Higher adherence to appointments shortened the time to the beginning of durable viral suppression. Age, race/ethnicity, and risk factor for acquiring HIV infection were correlated with the outcomes. Adherence to primary care appointments is strongly associated with achieving durable viral suppression in persons newly diagnosed with HIV. Identifying and addressing patient barriers and unmet needs may increase the number who achieve durable viral suppression.

Tobacco smoking is a leading cause of premature death. Smoking prevalence in Vietnam ranks among the highest in Southeast Asia. Given the important role of health care workers (HCWs) in promoting and supporting smoking cessation, this project aimed to characterize the prevalence of smoking among HCWs in Vietnam, and their attitudes toward smoking cessation interventions. A cross-sectional survey was conducted among care workers in four levels of the health system, within four provinces of Vietnam. Descriptive statistics evaluated participant attitudes, perception, behaviors, and knowledge about smoking. Multivariable logistic regression models evaluated risk factors for smoking. Among 3343 HCWs, 7.5% identified as current smokers, comprising 22.2% males and 0.5% of females. Males had substantially greater odds (adjusted odds ratio = 55.3; 95% confidence interval [29.0, 105.6] of identifying as current smokers compared with females. HCWs in urban settings had higher odds of identifying as smokers compared with rural workers (adjusted odds ratio = 1.72; 95% confidence interval [1.23, 2.24]. Strong support for smoking cessation policies and interventions were identified, even among staff who smoked. HCWs play an integral role in identifying smokers and supporting smoking cessation interventions for their patients. Efforts to support affordable smoking cessation interventions within health facilities are likely to contribute to a reduction in smoking prevalence in Vietnam.

Study Objective: Determine whether an expanded emergency medicine (EM) pharmacist scope of practice reduces the frequency of major delays in subsequent antibiotic administration in patients boarded in the emergency department (ED)., Methods: A pre-post, quasi-experimental study conducted from November 2019-March 2020 at a single-center tertiary academic medical center following the implementation of an expanded EM pharmacist scope of practice. Adult patients were included if they received an initial antibiotic dose in the ED and deemed to be high-risk. Subsequent antibiotic doses were reordered by EM pharmacists for up to 24-h after the initial order pending ED length of stay (LOS). The historical control group consisted of retrospective chart review of cases from the previous year., Results: The study identified that of the 181 participants enrolled, major delays in subsequent antibiotic administration occurred in 13% of the intervention group and 48% of the control group (p < 0.01). When compared to the control group, the intervention group had a significant decrease in the number of delays among antibiotics dosed at 6-h (39% vs 13%) and 8-h (60% vs 8%) intervals. For antibiotics dosed at 12-h intervals, no statistically significant difference was observed between the control and intervention groups respectively (19% vs 5%). A statistically significant lower incidence of in-hospital mortality was observed in the intervention group (3% vs 11%, p = 0.02). In the intervention group, 97% of patients received subsequent antibiotic doses while boarded in the ED, compared to 65% in the control group (<0.01)., Conclusion: Expanding EM pharmacist scope of practice was associated with a significant reduction in the frequency of major delays in subsequent antibiotic administration as well as a decreased incidence of hospital mortality., Competing Interests: Declaration of Competing Interest All authors have no conflicts of interest to disclose., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Azole-resistant environmental Aspergillus fumigatus presents a threat to public health but the extent of this threat in Southeast Asia is poorly described. We conducted environmental surveillance in the Mekong Delta region of Vietnam, collecting air and ground samples across key land-use types, and determined antifungal susceptibilities of Aspergillus section Fumigati (ASF) isolates and azole concentrations in soils. Of 119 ASF isolates, 55% were resistant (or non-wild type) to itraconazole, 65% to posaconazole and 50% to voriconazole. Azole resistance was more frequent in A. fumigatus sensu stricto isolates (95%) than other ASF species (32%). Resistant isolates and agricultural azole residues were overrepresented in samples from cultivated land. cyp51A gene sequence analysis showed 38/56 resistant A. fumigatus sensu stricto isolates carried known resistance mutations, with TR 34 /L98H most frequent (34/38)., (© 2021 Society for Applied Microbiology and John Wiley & Sons Ltd.)

Respirable aerosols (< 5 µm in diameter) present a high risk of SARS-CoV-2 transmission. Guidelines recommend using aerosol precautions during aerosol-generating procedures, and droplet (> 5 µm) precautions at other times. However, emerging evidence indicates respiratory activities may be a more important source of aerosols than clinical procedures such as tracheal intubation. We aimed to measure the size, total number and volume of all human aerosols exhaled during respiratory activities and therapies. We used a novel chamber with an optical particle counter sampling at 100 l.min -1 to count and size-fractionate close to all exhaled particles (0.5-25 µm). We compared emissions from ten healthy subjects during six respiratory activities (quiet breathing; talking; shouting; forced expiratory manoeuvres; exercise; and coughing) with three respiratory therapies (high-flow nasal oxygen and single or dual circuit non-invasive positive pressure ventilation). Activities were repeated while wearing facemasks. When compared with quiet breathing, exertional respiratory activities increased particle counts 34.6-fold during talking and 370.8-fold during coughing (p < 0.001). High-flow nasal oxygen 60 at l.min -1 increased particle counts 2.3-fold (p = 0.031) during quiet breathing. Single and dual circuit non-invasive respiratory therapy at 25/10 cm.H 2 O with quiet breathing increased counts by 2.6-fold and 7.8-fold, respectively (both p < 0.001). During exertional activities, respiratory therapies and facemasks reduced emissions compared with activities alone. Respiratory activities (including exertional breathing and coughing) which mimic respiratory patterns during illness generate substantially more aerosols than non-invasive respiratory therapies, which conversely can reduce total emissions. We argue the risk of aerosol exposure is underappreciated and warrants widespread, targeted interventions., (© 2021 Association of Anaesthetists.)

Particulate matter with aerodynamic diameter ≤2.5 μm (PM 2.5 ) concentrations vary between countries with similar carbon dioxide (CO 2 ) emissions, which can be partially explained by differences in air pollution control efficacy. However, no indicator of air pollution control efficacy has yet been developed. We aimed to develop such an indicator, and to evaluate its global and temporal distribution and its association with country-level health metrics. A novel indicator, ambient population-weighted average PM 2.5 concentration per unit per capita CO 2 emission (PM 2.5 /CO 2 ), was developed to assess country-specific air pollution control efficacy (abbreviated as APCI). We estimated and mapped the global average distribution of APCI and its changes during 2000-2016 across 196 countries. Pearson correlation coefficients and Generalized Additive Mixed Model (GAMM) were used to evaluate the relationship between APCI and health metrics. APCI varied by country with an inverse association with economic development. APCI showed an almost stable trend globally from 2000 to 2016, with the low-income groups increased and several countries (China, India, Bangladesh) decreased. The Pearson correlation coefficients between APCI and life expectancy at birth (LE), infant-mortality rate (IMR), under-five year of age mortality rate (U5MR) and logarithm of per capita GDP (LPGDP) were -0.57, 0.65, 0.66, -0.59 respectively (all P values < 0.001). APCI could explain international variation of LE, IMR and U5MR. The associations between APCI and LE, IMR, U5MR were independent of per capita GDP and climatic factors. We consider APCI to be a good indicator for air pollution control efficacy given its relation to important population health indicators. Our findings provide a new metric to interpret health inequity across the globe from the point of climate change and air pollution control efficacy., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background and Objective: Use of in-laboratory polysomnography (PSG) to diagnose obstructive sleep apnoea (OSA) is cost and resource intensive. Questionnaires, physical measurements and home monitors have been studied as potential simpler alternatives. This study aimed to develop a diagnostic model for OSA for use in primary care., Methods: Primary care practitioners were trained to recognize symptoms of sleep apnoea and recruited patients based on the clinical need to investigate OSA. Assessment was by symptom questionnaires, anthropomorphic measurements, digital facial photography, and a single-channel nasal flow monitor (Flow Wizard©, DiagnoseIT, Sydney, Australia) worn at home for 3 nights. The in-laboratory PSG was the reference test, with OSA defined as apnoea-hypopnoea index (AHI) ≥10 events/h., Results: In the model development phase, 25 primary care practitioners studied 315 patients in whom they suspected OSA, of which 57% had AHI≥10 and 22% had AHI≥30. Published OSA questionnaires provided low to moderate prediction of OSA (area under the curve [AUC] 0.53-0.73). The nasal flow monitor alone yielded high accuracy for predicting OSA with AUC of 0.87. Sensitivity was 0.87 and specificity 0.77 at a threshold respiratory event index (REI) of 18 events/h. A model adding age, gender, symptoms and BMI to the nasal flow monitor REI only modestly improved OSA prediction (AUC 0.89), with similar AUC (0.88) confirmed in the validation population of 114 patients., Conclusion: Sleep apnoea can be diagnosed in the primary care setting with a combination of clinical judgement and portable monitor test outcomes., (© 2021 Asian Pacific Society of Respirology.)

Objective: The main sources of nitrogen dioxide (NO 2 ), road vehicles and electricity generation, are currently in a period of technological change. We assessed the number of cases of childhood asthma in New South Wales that could be avoided by lowering exposure to NO 2 by 25% from current levels., Methods: Health impact assessment calculations for each of the 128 local government areas were based on the population of children aged 2 to 14, the prevalence of asthma derived from the 2017 NSW health survey, NO 2 exposure from a land-use regression model using satellite data, and risk estimates derived from two meta-analyses and one Australian study., Results: A 25% reduction in NO 2 below current exposure would lead to between 2,597 and 12,286 fewer children with asthma in NSW. The wide range in these estimates reflects the variation in concentration-response functions used., Conclusions: Even the lowest of these estimates would be a worthwhile reduction in this common childhood illness. Implications for public health: A 25% reduction in NO 2 is ambitious, but it is achievable through improved vehicle exhaust standards, increasing electric vehicle numbers, and reform of the electricity sector. Current Australian ambient air quality standards for annual NO 2 should be revised downwards., (© 2021 The Authors.)

Rationale: The Global Burden of Disease program identified smoking and ambient and household air pollution as the main drivers of death and disability from chronic obstructive pulmonary disease (COPD). Objectives: To estimate the attributable risk of chronic airflow obstruction (CAO), a quantifiable characteristic of COPD, due to several risk factors. Methods: The Burden of Obstructive Lung Disease study is a cross-sectional study of adults, aged ≥40, in a globally distributed sample of 41 urban and rural sites. Based on data from 28,459 participants, we estimated the prevalence of CAO, defined as a postbronchodilator FEV 1 -to-FVC ratio less than the lower limit of normal, and the relative risks associated with different risk factors. Local relative risks were estimated using a Bayesian hierarchical model borrowing information from across sites. From these relative risks and the prevalence of risk factors, we estimated local population attributable risks. Measurements and Main Results: The mean prevalence of CAO was 11.2% in men and 8.6% in women. The mean population attributable risk for smoking was 5.1% in men and 2.2% in women. The next most influential risk factors were poor education levels, working in a dusty job for ≥10 years, low body mass index, and a history of tuberculosis. The risk of CAO attributable to the different risk factors varied across sites. Conclusions: Although smoking remains the most important risk factor for CAO, in some areas, poor education, low body mass index, and passive smoking are of greater importance. Dusty occupations and tuberculosis are important risk factors at some sites.

BACKGROUND: Exposure to people with TB substantially elevates a person's risk of tuberculous infection and TB disease. Systematic screening of TB contacts enables the early detection and treatment of co-prevalent disease, and the opportunity to prevent future TB disease. However, scale-up of contact investigation in high TB transmission settings remains limited. METHODS: We undertook a narrative review to evaluate the evidence for contact investigation and identify strategies that TB programmes may consider when introducing contact investigation and management. RESULTS: Selection of contacts for priority screening depends upon their proximity and duration of exposure, along with their susceptibility to develop TB. Screening algorithms can be tailored to the target population, the availability of diagnostic tests and preventive therapy, and healthcare worker expertise. Contact investigation may be performed in the household or at communal locations. Local contact investigation policies should support vulnerable patients, and ensure that drop-out during screening can be mitigated. Ethical issues should be anticipated and addressed in each setting. CONCLUSION: Contact investigation is an important strategy for TB elimination. While its epidemiological impact will be greatest in lower-transmission settings, the early detection and prevention of TB have important benefits for contacts and their communities.