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Background: Bacterial meningitis is a medical emergency and timely management has been shown to improve outcomes. The aim of this study was to compare the early assessment and management of adults with suspected community‐onset meningitis between hospitals and identify opportunities for clinical practice improvement. Methods: This retrospective cohort study was conducted at three principal referral hospitals in Sydney, Australia. Adult patients with suspected meningitis undergoing cerebrospinal fluid sampling between 1 July 2018 and 31 June 2019 were included. Relevant clinical and laboratory data were extracted from the medical record. Differences between sites were analysed and factors associated with time to antimicrobial therapy were assessed by Cox regression. Results: In 260 patients, the median time from triage to antibiotic administration was 332 min with a difference of up to 147 min between hospitals. Median time from triage to lumbar puncture (LP) was 366 min with an inter‐hospital difference of up to 198 min. Seventy per cent of patients had neuroimaging prior to LP, and this group had a significantly longer median time to antibiotic administration (367 vs 231 min; P = 0.001). Guideline concordant antibiotics were administered in 84% of patients, with only 39% of those administered adjunctive corticosteroids. Seven (3%) patients had confirmed bacterial meningitis. Modifiable factors associated with earlier antimicrobial administration included infectious diseases involvement (adjusted hazard ratio [aHR], 1.50 [95% confidence interval (CI), 1.01–2.24]) and computed tomography (CT) scanning (aHR, 0.67 [95% CI, 0.46–0.98]). Conclusion: Opportunities for improvement include reducing the time to LP and antibiotic administration, improving coadministration of corticosteroids and avoiding potentially unnecessary CT scanning. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the role of viral polymerase chain reaction (PCR) testing in patients with aseptic meningitis and identify opportunities for improvement in clinical management. All cerebrospinal fluid samples collected in 1 year from four teaching hospitals in Sydney, Australia, were reviewed. Patients with aseptic meningitis were selected, and clinical and diagnostic features, hospital length of stay (LOS), and treatment were analyzed. Identifying a cause by viral PCR did not reduce hospital LOS (median 3 days) or antibiotic use (median 2 days), but the turnaround time of the PCR test correlated with LOS (Rs = 0.3822, p = 0.0003). Forty‐one percent of patients received intravenous acyclovir treatment, which was more frequent in patients admitted under neurologists than infectious diseases physicians (56% vs. 24%; p = 0.013). The majority of patients did not have investigations for alternative causes of aseptic meningitis such as human immunodeficiency virus and syphilis if the viral PCR panel was negative. The benefit of PCR testing in aseptic meningitis in adults in reducing LOS and antibiotic use is unclear. The reasons for unnecessary aciclovir use in meningitis syndromes require further assessment. [ABSTRACT FROM AUTHOR]

Background and Aims: Significant barriers exist with hepatitis B (HBV) case detection and effective linkage to care (LTC). The emergency department (ED) is a unique healthcare interaction where hepatitis screening and LTC could be achieved. We examined the efficacy and utility of automated ED HBV screening for Overseas Born (OB) patients. Methods: A novel‐automated hepatitis screening service "SEARCH" (Screening Emergency Admissions at Risk of Chronic Hepatitis) was piloted at a metropolitan hospital. A retrospective and comparative analysis of hepatitis testing during the SEARCH pilot compared to a period of routine testing was conducted. Results: During the SEARCH pilot, 4778 OB patients were tested for HBV (86% of eligible patient presentations), compared with 1.9% of eligible patients during a control period of clinician‐initiated testing. SEARCH detected 108 (2.3%) hepatitis B surface antigen positive patients including 20 (19%) in whom the diagnosis was new. Among 88 patients with known HBV, 57% were receiving medical care, 33% had become lost to follow‐up and 10% had never received HBV care. Overall, 30/88 (34%) patients with known HBV were receiving complete guideline‐based care prior to re‐engagement via SEARCH. Following SEARCH, LTC was successful achieved in 48/58 (83%) unlinked patients and 19 patients were commenced on anti‐viral therapy. New diagnoses of cirrhosis and hepatocellular carcinoma were made in five and one patient(s) respectively. Conclusions: Automated ED screening of OB patients is effective in HBV diagnosis, re‐diagnosis and LTC. Prior to SEARCH, the majority of patients were not receiving guideline‐based care. [ABSTRACT FROM AUTHOR]

Background and Aims: Achieving Hepatitis B e antigen seroconversion (HBeAg SC) at an earlier age confers a better prognosis. We examined baseline and post‐partum factors associated with HBeAg SC after pregnancy. We developed a tool, the SydPregScore, to estimate the likelihood of HBeAg SC in the years after pregnancy. Methods: A retrospective analysis of an HBeAg‐positive pregnant cohort was conducted. Variables including baseline age, parity, alanine aminotransferase level, HBV viral load, quantitative HBsAg, use of antiviral therapy and post‐partum flare were collected. Univariate and multivariate Cox regression analyses to determine predictors of HBeAg SC and develop a predictor score were performed. Results: We analysed HBeAg SC rates in 220 pregnancies to 149 HBeAg‐positive women from 2006 to 2019. At baseline, their median age was 33 (IQR 29–37), ALT 23 U/L (IQR 17–33) and viral load 8 log10IU/mL (IQR 6.3–8.2 log10IU/mL). The majority (133/198, 67.2%) received short‐course antiviral therapy to prevent mother‐to‐child transmission, and 109/192 (56.8%) had a post‐partum flare. HBeAg SC occurred in 74/220 (33.6%) after pregnancy (median follow‐up 814 days, IQR 405–1531). Multivariate analysis identified baseline viral load <8 log10IU/mL (HR 2.426 [1.224–4.809], p =.011), baseline ALT ≥2 ULN (HR 2.726 [1.299–5.721], p =.008) and age <35 (HR 2.859 [1.255–6.513], p =.012) to be positive predictors of HBeAg SC. The 'SydPreg Score' estimated the probability of HBeAg SC at 2000 days as 10%, 30%, 70% and 80% for 0, 1, 2, and 3 predictors respectively. Conclusion: The SydPreg Score allows the prediction of HBeAg SC in the years after pregnancy. Even in those without elevated ALT, age <35 and viral load <8 log10IU/mL can identify women with a good chance of subsequent HBeAg SC. Those without a chance may benefit from viral suppression. [ABSTRACT FROM AUTHOR]

Objectives: In 2016, The Royal College of Pathologists of Australasia (RCPA) initiated the formation of a working group comprising medical microbiologists to establish guidelines to assist Australian laboratories to implement selective and cascade reporting of antimicrobials-the first guidelines of this type in the world.Methods: A 2017 audit of antimicrobial reporting in Australian and New Zealand laboratories identified significant opportunities for improvement and standardization of selective reporting.Results: The first draft of the RCPA Selective Reporting Guidelines was circulated to all RCPA Microbiology fellows for feedback in August 2018 and the first version was published in February 2019. Subsequently, version two of the guidelines has recently been published in Australia, and New Zealand adapted these guidelines for formulation of their own national guidelines to accommodate local needs.Conclusions: Here we describe the processes, acceptance and challenges associated with the establishment of these guidelines and measurement of their impact. [ABSTRACT FROM AUTHOR]

The ability to treat gonorrhoea with current first-line drugs is threatened by the global spread of extensively drug resistant (XDR) Neisseria gonorrhoeae (NG) strains. In Australia, urban transmission is high among men who have sex with men (MSM) and importation of an XDR NG strain in this population could result in an epidemic that would be difficult and costly to control. An individual-based, anatomical site-specific mathematical model of NG transmission among Australian MSM was developed and used to evaluate the potential for elimination of an imported NG strain under a range of case-based and population-based test-and-treat strategies. When initiated upon detection of the imported strain, these strategies enhance the probability of elimination and reduce the outbreak size compared with current practice (current testing levels and no contact tracing). The most effective strategies combine testing targeted at regular and casual partners with increased rates of population testing. However, even with the most effective strategies, outbreaks can persist for up to 2 years post-detection. Our simulations suggest that local elimination of imported NG strains can be achieved with high probability using combined case-based and population-based test-and-treat strategies. These strategies may be an effective means of preserving current treatments in the event of wider XDR NG emergence. Author summary: In most high-income settings, gonorrhoea is endemic among men who have sex with men (MSM). While gonorrhoea remains readily treatable with antibiotics, there are major concerns about the threat of antimicrobial resistance arising from recent reports of treatment failure with first-line therapy and limited remaining treatment options. Here we investigated the potential for test-and-treat response strategies to eliminate such strains before their prevalence reaches a level requiring a shift to new first line therapies. Rather than directly consider resistance, we explore the mitigating effect of various test-and-treat measures on outbreaks of a generic imported strain which remains treatable. This is done within the framework of a realistic mathematical model of gonorrhoea spread in an MSM community that captures cases, anatomical sites of infection and sexual contacts at an individual level, calibrated to relevant Australian epidemiological data. The results indicate that strategies such as partner testing and treatment in combination with elevated asymptomatic community testing are highly effective in mitigating outbreaks but can take up to 2 years to achieve elimination. As there are currently no clear alternative drugs of proven efficacy and safety to replace ceftriaxone in first-line therapy, these promising results suggest potential for use of these outbreak response strategies to preserve current treatment recommendations. [ABSTRACT FROM AUTHOR]

Frederic Charles Schaffer, The Hidden Costs of Clean Election Reform. Ithaca, NY and London: Cornell University Press, 2008, 264 pp., $35.00 (cloth). "A TRUTH THAT'S told with bad intent," wrote [...]

The World Health Organization has set ambitious viral hepatitis elimination targets; however, difficulties in identifying and engaging patients remain. The emergency visit is an opportunity for enhanced linkage to care (LTC). We assessed the effectiveness of an automated Emergency Department (ED) screening service in identifying patients with hepatitis C (HCV) and achieving LTC. A retrospective evaluation was undertaken, analysing the first 5000 patients screened through an automatic Australian service termed 'Screening Emergency Admissions at Risk of Chronic Hepatitis' (SEARCH). Screening was performed for those recommended in the Australian national testing policy, specifically overseas born (OB) and Aboriginal or Torres Strait Islanders (ATSI). Healthcare worker education, patient information materials and opt‐out informed consent were used to test sera already collected for biochemistry assays. 5000 of 5801 (86.2%) consecutive eligible patients were screened (OB: 4778, ATSI: 222) from 14 093 ED presentations. HCV antibody was positive in 181 patients (3.6%); 51 (1.0%) were HCV RNA positive. Of 51 HCV RNA–positive patients, 12 were new diagnoses, 32 were 're‐diagnoses' (aware but lost to follow‐up [LTFU]), and 7 were previously known but treatment contraindicated. LTC was successful in 38 viraemic patients (7 deceased, 4 LTFU, 1 treatment ineligible and 1 declined). Of RNA‐negative patients, 75 were previously treated and 49 had presumed spontaneous clearance. Opt‐out consent was acceptable to all patients and staff involved. ED screening can lead to additional diagnosing and 're‐diagnosing' of HCV, with high rates of LTC. Opt‐out consent and automation removed major obstacles to testing. [ABSTRACT FROM AUTHOR]

Recent years have witnessed the flourishing of literatures dealing with electoral integrity and forensic techniques by which electoral fraud can be identified and analysed. Statistical techniques are now available through which highly improbable patterns of voting can be highlighted as part of the process of investigating whether an election deserves to be categorised as free and fair. Yet relatively little use has been made on the ground of such forensic techniques by the international community when fraud is suspected. By contrast, in Afghanistan in 2009, a ‘sampling’ process was deployed to investigate suspicions of fraud; and in 2014, a box-by-box ‘audit’ of ballot boxes was carried out. At the end of the day, significant groups were left deeply dissatisfied with the ways in which suspected fraud had been investigated; and such dissatisfaction could potentially be the basis for further elite fragmentation and a deepening legitimacy crisis. It is argued in this article that it is important to ensure that mechanisms for investigating fraud be defensible not just in terms of what has been done in the past, but in terms also of what is methodologically rigorous and defensible. [ABSTRACT FROM PUBLISHER]

Background: VRE are prevalent among patients in ICUs. Non-typeable vanA VRE, due to loss of one of the genes used for MLST (pstS), have increased in Australia, suggestive of a new, hospital-acquired lineage.Objectives: To understand the significance of this lineage and its transmission using WGS of strains isolated from patients in ICUs across New South Wales, Australia.Methods: A total of 240 Enterococcus faecium isolates collected between February and May 2016, and identified by conventional PCR as vanA positive, were sequenced. Isolates originated from 12 ICUs in New South Wales, grouped according to six local health districts, and represented both rectal screening swab (n = 229) and clinical (n = 11) isolates.Results: ST analysis revealed the absence of the pstS gene in 84.2% (202 of 240) of vanA isolates. Two different non-typeable STs were present based on different allelic backbone patterns. Loss of the pstS gene appeared to be the result of multiple recombination events across this region. Evidence for pstS-negative lineage spread across all six local health districts was observed suggestive of inter-hospital transmission. In addition, multiple outbreaks were detected, some of which were protracted and lasted for the duration of the study.Conclusions: These findings confirmed the evolution, emergence and dissemination of non-typeable vanA E. faecium. This study has highlighted the utility of WGS when attempting to describe accurately the hospital-based pathogen epidemiology, which in turn will continue to inform optimal infection control measures necessary to halt the spread of this important nosocomial organism. [ABSTRACT FROM AUTHOR]

The article focuses on a study which examined the rate of perinatal hepatitis B virus (HBV) transmission in Australia, along with the maternal virological factors associated with risk of transmission. The study included pregnant women attending Sydney South West Area Health Service antenatal clinics who were hepatitis B surface antigen (HBsAg) positive, and their babies. It discovered that HBV perinatal transmission is prevalent in hepatitis B "e" antigen (HBeAg)-positive mothers with very high viral loads.

This essay examines the role of both larger social and economic forces and local agency in shaping the character and challenges facing urban communities. Drawing on Chicago's Uptown community, I examine how the larger structural forces that impact neighborhoods as well as the role of leaders and residents to channel such effects, In Uptown, through community conflict and cooperation community leaders frame and interpret these forces. Uptown illustrates that local level efforts often challenge our assumptions of the trajectory of a community when it comes to things like racial change or gentrification. The essay ends with a discussion of the dialectical relationships between local agents and external force. [ABSTRACT FROM AUTHOR]

The concept of optimal healing environments (OHE) includes a variety of elements that require exploration, definition, measurement, and interpretation. One key element is the relationships between healer and patient/client and between healers themselves. These complexities mean that models of OHE that include relationship dynamics as resources in the healing processes need information to help planning, execution and measurement. This paper examines aspects of a proposed model of optimal healing that utilizes relational dynamics as central to healing processes. The dynamics of relationships between healers and clients are critical to the effectiveness of healing as a process of transformation. Conscious examination of healers' emotional availability in relationship-centered care may be important in determining primary roles in delivering care. [ABSTRACT FROM AUTHOR]

This paper outlines the history of Australia's federal electoral machinery, and describes the current structure and functions of the Australian Electoral Commission.1 [ABSTRACT FROM PUBLISHER]

Examines the extent to which progress made towards Cambodia's democratic development in 1993 has been sustained in the 1998 elections. Struggle between two approaches of governance in the country; Deficiencies in the conduct of elections; Steps taken towards liberal democracy; Authoritarian reaction to the democratic movement.

We outline the history of election night forecasting in Australia. We first identify the major structural features of the Australian voting system which determine how the problem must be approached: single-member constituencies; preferential voting; the counting on election night, in polling booths. of first preference votes only, and the existence of a two-party system. We note that the major statistical difficulty associated with election night forecasting in Australia is that progressive counts in a seat, far from being random samples of the votes cast. are non-random and systematically biased samples. We finally outline the increasingly sophisticated computer models which have been used to correct for this bias, culminating in the 'matched polling places' model implemented by the Australian Electoral Commission at the 1990 election, which has effectively eliminated the problem of bias. [ABSTRACT FROM AUTHOR]

The article presents information on a study which investigates the relationship between the states of anxiety and depression and corresponding galvanic skin response activity, and the relationships between clinical states, psychogalvanic activity and psychiatric diagnoses. Data used in computations were converted from resistance to conductance units. There were four measures calculated to represent the psychogalvanic activity of each patient. Results are consistent with indications from prior research that the presence of anxiety is associated with higher levels of skin conductance and the presence of depression is associated with lower levels of skin conductance.

There has been a progressive rise in the incidence of blood stream infections (BSI) caused by multidrug-resistant Gram-negative organisms (MDR GN), which cause increased morbidity and mortality. For this reason, recent studies have focused on risk factors of acquisition of carbapenemase-producing Enterobacteriaceae and extended-spectrum beta-lactamase producers. However, there is limited data on risk factors for BSI caused by AmpC-producing Enterobacteriaceae (AmpC EC), especially in low prevalence settings such as Australia. This study was performed to identify risk factors for acquisition of AmpC E. coli, using a retrospective matched case control design over a 3-year period. Patients with BSI caused by AmpC E. coli were matched with controls (third generation cephalosporin susceptible E. coli) by age and site of infection (n = 21). There was no significant difference in age, sex, clinical outcome, time to onset of BSI, recent antibiotic use (last 3 months), comorbidities (type 2 diabetes mellitus, renal failure) intensive care unit admission, underlying hematological condition, immunosuppressant use, APACHE II score, or any recent urological procedures (within last 3 months) between the two groups. On univariate analysis, the AmpC E. coli group were more likely to have had a surgical procedure in hospital and lived in a residential aged care facility. On multivariate logistic regression analysis, a recent surgical procedure was associated with the onset of AmpC E. coli BSI (Odd's Ratio (OR) 4.78, p = 0.034). We concluded that in a relatively low prevalence setting such as Australia, AmpC E. coli BSI is potentially associated with surgery performed in hospital due to previous antibiotic exposure and longer hospitalization. [ABSTRACT FROM AUTHOR]

The article describes the case of a 32-year-old Maori man who was diagnosed with Mycobacterium chelonae infection on the sites of his tattoos. The patient complained of worsening erythema, edema and pain in the tattoo sites. The infection was found to be introduced by a trauma to the patient's skin due to tattooing. The patient was placed under an antimicrobial treatment regimen for four months.

The document titled "Author Index" is a list of authors and their corresponding page numbers in the Journal of Gastroenterology & Hepatology. It includes a diverse range of authors from various backgrounds and countries. This index can be helpful for library patrons conducting research to quickly locate articles written by specific authors in the journal. However, without further investigation, the significance or context of the list is not clear. [Extracted from the article]

In 2019, the High Court of Australia used the term 'level playing field' no less than 18 times when considering limits on electoral campaign expenditure. This article examines the usefulness of this metaphor when assessing the opportunity to compete in elections on an equal basis. It shows that the metaphor is often used in electoral jurisprudence and by electoral monitoring bodies, but rarely subject to analysis. One place where it has been analysed is in the democratisation literature, where it is defined in terms of access to state resources, media, and the law. However, it needs further elaboration to make it useful in analysing the fairness of electoral competition in established democracies. The assumption of only two teams, incumbents and opposition, needs to be modified through considering the hierarchy of incumbency benefits. A case study of the 2019 Australian federal election illustrates the differential access to state resources of electoral contenders as well as the need to add the role of private money to the attributes of the playing field. It finds that although there has been some levelling of the playing field at the State and Territory level, at the federal level there has been further tilting. This article examines the usefulness of the concept of the level playing field in assessing electoral fairness. It presents a case study of the 2019 Australian federal election, suggesting the concept needs to include the hierarchy of incumbency benefits and regulation of the role of private money. [ABSTRACT FROM AUTHOR]

The editors would like to thank the following colleagues who reviewed submitted articles in 2019. [Extracted from the article]

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