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BackgroundIdentification of people with deteriorating health is essential for quality patient-centred care and optimal management. The Supportive and Palliative Care Indicators Tool (SPICT) is a guide to identifying people with deteriorating health for care planning without incorporating a prognostic time frame.ObjectivesTo improve renal nursing staff confidence in identifying patients approaching end-of-life and advocate for appropriate multidisciplinary care planning.DesignThis pilot feasibility prospective cohort study conducted in the renal ward of a major metropolitan health service during 2019 included a preintervention/postintervention survey questionnaire. A programme of education was implemented training staff to recognise end-of-life and facilitate appropriate care planning.ResultsSeveral domains in the postintervention survey demonstrated a statistically significant improvement in renal nurses’ perception of confidence in their ability to recognise end of life. Of the 210 patients admitted during the study period, 16% were recognised as SPICT positive triggering renal physicians to initiate discussions about end-of-life care planning with patients and their families and to document a plan. Six months poststudy, 72% of those patients recognised as SPICT positive had died with a documented plan of care in place.ConclusionThe use of SPICT for hospital admissions and the application of education in topics related to end-of-life care resulted in a significant improvement in nurses’ confidence in recognising deteriorating and frail patients approaching their end of life. The use of this tool also increased the number of deteriorating patients approaching end of life with goals of care documented.

Background: Reducing the burden of dementia in First Nations populations may be addressed through developing population specific methods to quantify future risk of dementia.Objective: To adapt existing dementia risk models to cross-sectional dementia prevalence data from a First Nations population in the Torres Strait region of Australia in preparation for follow-up of participants. To explore the diagnostic utility of these dementia risk models at detecting dementia.Methods: A literature review to identify existing externally validated dementia risk models. Adapting these models to cross-sectional data and assessing their diagnostic utility through area under the receiver operating characteristic curve (AUROC) analyses and calibration using Hosmer-Lemeshow Chi2.Results: Seven risk models could be adapted to the study data. The Aging, Cognition and Dementia (AgeCoDe) study, the Framingham Heart Study (FHS), and the Brief Dementia Screening Indicator (BDSI) had moderate diagnostic utility in identifying dementia (i.e., AUROC >0.70) before and after points for older age were removed.Conclusion: Seven existing dementia risk models could be adapted to this First Nations population, and three had some cross-sectional diagnostic utility. These models were designed to predict dementia incidence, so their applicability to identify prevalent cases would be limited. The risk scores derived in this study may have prognostic utility as participants are followed up over time. In the interim, this study highlights considerations when transporting and developing dementia risk models for First Nations populations.

Stereotactic ablative radiotherapy (SABR) can be a curative option for non‐small cell lung cancer (NSCLC) and oligometastatic lung disease. Volumetric modulated arc therapy (VMAT) has offered further advancements in terms of radiation dose shaping without compromising treatment times however there is potential for greater low‐dose exposure to the lung. This study was to assess whether VMAT lung SABR would result in any increase to the dosimetry parameters compared with three‐dimensional conformal radiotherapy (3D‐CRT) that could confer increased risk of radiation pneumonitis. A total of 53 and 30 3D‐CRTtreatment plans of patients treated with 48 Gyin 4 fractions were compared. No statistically significant difference in planning target volumes between the VMAT 29.9 cc (range 12.4–58.5 cc) and 3D‐CRT 31.2 cc (range 12.3–58.3 cc) P= 0.79. The mean of total lung V5, ipsilateral lung V5 and contralateral lung V5 all showed a trend of being smaller in the VMAT treatment group‐ 14% versus 15.8%, 25.6% versus 30.4% and 1.6% versus 2.2%, respectively, but all were not statistically significant differences. Mean of the mean lung dose MLD, again showed a trend of being lower in the VMAT treatments but was also non‐significant, 2.6 Gy versus 3.0 Gy, P= 1.0. Mean V20 was the same in both cohorts, 3.3%. The dosimetry for 3D‐CRT and VMAT plans were not significantly different including V5, and therefore we conclude that VMAT treatment is unlikely to be associated with an increased risk of radiation pneumonitis. This paper evaluates the dosimetry of volumetric arc therapy in comparison to 3D‐Conformal technique in delivery of lung stereotactic ablative radiotherapy. No significant dosimetric differences were found between the two techniqiues that could potentially lead to an increased risk of radiation pneumonitis.

The objective of this study was to investigate the impact of daily screening for medical readiness to participate in early mobilisation in the paediatric intensive care unit (PICU), on reducing time to mobilisation and to explore the safety-, feasibility-, and patient-level barriers to the practice.

Diagnosis and assessment of patients with prostate cancer is dependent on accurate interpretation and grading of histopathology. However, morphology does not necessarily reflect the complex biological changes occurring in prostate cancer disease progression, and current biomarkers have demonstrated limited clinical utility in patient assessment. This study aimed to develop biomarkers that accurately define prostate cancer biology by distinguishing specific pathological features that enable reliable interpretation of pathology for accurate Gleason grading of patients. Online gene expression databases were interrogated and a pathogenic pathway for prostate cancer was identified. The protein expression of key genes in the pathway, including adaptor protein containing a pleckstrin homology (PH) domain, phosphotyrosine-binding (PTB) domain, and leucine zipper motif 1 (Appl1), Sortilin and Syndecan-1, was examined by immunohistochemistry (IHC) in a pilot study of 29 patients with prostate cancer, using monoclonal antibodies designed against unique epitopes. Appl1, Sortilin, and Syndecan-1 expression was first assessed in a tissue microarray cohort of 112 patient samples, demonstrating that the monoclonal antibodies clearly illustrate gland morphologies. To determine the impact of a novel IHC-assisted interpretation (the utility of Appl1, Sortilin, and Syndecan-1 labelling as a panel) of Gleason grading, versus standard haematoxylin and eosin (H&E) Gleason grade assignment, a radical prostatectomy sample cohort comprising 114 patients was assessed. In comparison to H&E, the utility of the biomarker panel reduced subjectivity in interpretation of prostate cancer tissue morphology and improved the reliability of pathology assessment, resulting in Gleason grade redistribution for 41% of patient samples. Importantly, for equivocal IHC-assisted labelling and H&E staining results, the cancer morphology interpretation could be more accurately applied upon re-review of the H&E tissue sections. This study addresses a key issue in the field of prostate cancer pathology by presenting a novel combination of three biomarkers and has the potential to transform clinical pathology practice by standardising the interpretation of the tissue morphology.

Oxytocin is a key hormone in the transition to motherhood. The maternal endogenous oxytocin system facilitates many physiological and biological adaptations, including breastfeeding, maternal wellbeing, and brain plasticity. Additionally, maternal endogenous oxytocin works as a finetuned orchestrator prior to, during, and after the birth of a child to support birth progression and mother-infant bonding. Exogenous oxytocin may be administered to induce or augment labour when this is not progressing naturally and is a common obstetric intervention worldwide. However, the lasting impact of these widely varying levels of systemic exogenous oxytocin on mother-infant bonding is currently unknown. This study aimed to investigate the association between exogenous oxytocin administered to induce or augment labour and quality of observed mother-infant bonding.

While all attorneys must adhere to their jurisdiction's version of the standards laid out in the American Bar Association's Model Rules of Professional Conduct, the particular complexities of environmental law [...]

Introduction The realisation of the clinical and cost effectiveness of warfarin in the prevention and treatment of thromboembolic disease, especially for reducing the risk of stroke in patients with atrial [...]

The study aims to seek public opinion on the reporting of medical errors and the anonymity of healthcare workers who report medical errors. It is concluded that most respondents believed that, when a healthcare worker makes an error, an incident report should be written and the individual should be identified on the report.

This article discusses the lessons learned from Australia's response to the COVID-19 pandemic and how they can be applied to future pandemics. The experts highlight key areas such as quarantine protocols, treatments, vaccine rollout, mode of transmission, and national unity. They emphasize the need for consistent protocols, improved access to information on treatments, rapid development and evaluation of new treatments, and a cohesive approach among different jurisdictions. The article provides valuable insights for researchers and individuals interested in understanding Australia's pandemic response and preparing for future outbreaks. [Extracted from the article]

The article discusses a book written by two economists, Steven Hamilton and Richard Holden, that examines Australia's response to the COVID-19 pandemic. The authors praise Australia's quick border closures but criticize the country's early response, particularly in regards to screening incoming travelers from Italy. They also discuss the formation of a National Cabinet and the gradual and indecisive nature of the response. The authors commend Australia's economic response, including the implementation of the JobKeeper wage subsidy program, but criticize the government's failure to secure enough effective vaccines. They briefly touch on lockdowns and testing, advocating for mass testing and Rapid Antigen Tests. The authors conclude that Australia performed well compared to other countries. [Extracted from the article]

The article focuses on the current mpox outbreak in Australia, highlighting that the strain here is less severe compared to the one causing the recent global health emergency in Africa. Topics include the differences in mpox strains between Australia and Africa, the rise in cases across Australian states, and the overall symptoms and history of the disease.

Objectives: To investigate the effect on participation in colorectal cancer screening of testing for blood products in faeces using technologies that remove dietary restrictions (i.e. immunochemical tests) and simplify faecal [...]

A control study of patients with acute respiratory conditions living in western and northern Adelaide, Australia, was conducted in 1999 to determine if coordinated care would reduce the need for hospitalization. The results of the study suggest that coordinated care given to patients with chronic respiratory disease did not affect hospitalisation and are associated with an improvement in some quality-of-life measures.

Byline: Abbie L. Esterman, Thomas H. Finlay, Jeffrey D. Lee, Joseph Dancis Keywords: Human immunodeficiency virus; gp120; trophoblast; CD4 Abstract: OBJECTIVE: Our purpose was to determine whether human trophoblast has a cell surface CD4 antigen that will bind to gp120, the envelope protein of human immunodeficiency virus. STUDY DESIGN: Uptake of iodine 125 - labeled gp120 by trophoblast in culture was measured. Particular attention was paid to technical details that may have caused the contradictory results reported by previous investigators: the source of the recombinant gp120, the method of radioiodination, and the isolation procedure of trophoblast to ensure elimination of contaminating cells, particularly macrophages. RESULTS: Uptake of transferrin-free iodine 125 - labeled gp120 to trophoblast was unaffected by adding a 200 molar excess of gp120, by preincubating gp120 with soluble CD4 to block the CD4 binding sites on gp120 and by preincubation of trophoblast with a blocking antibody to CD4 (OKT4a). In contrast, uptake of gp120 by CD4-positive H9 human lymphocytes was reduced 79% by a 200 molar excess of gp120 and >50% by a CD4-blocking antibody. CONCLUSIONS: Uptake of gp120 to trophoblast is by a high capacity, CD4-independent mechanism that is probably nonspecific and may be related to the mechanism for binding other circulating glycoproteins in maternal blood. (AM J OBSTET GYNECOL 1996;174:49-54.) Author Affiliation: New York, New York Article History: Received 11 January 1995; Revised 9 May 1995; Accepted 18 May 1995 Article Note: (footnote) [star] From the Departments of Pediatrics and Obstetrics and Gynecology, New York University Medical Center., [star][star] Supported by National Institutes of Health grant No. AI32298., a Reprint requests: Joseph Dancis, MD, Department of Pediatrics, Room TH528, New York University Medical Center, 550 First Ave., New York, NY 10016., aa 0002-9378/96 $5.00 + 0 6/1/66343

Adverse events associated with umbilical catheters include malposition, bloodstream infections, thrombosis, tip migration, and extravasation, resulting in loss of vascular access and increased risk of morbidity and mortality. There is a need for greater understanding of risk factors associated with adverse events to inform safe practice.

Ultrasound is a safe and inexpensive way to image the adult liver. Recently a valid and reliable equation was developed to determine the size of the adult liver using three simple ultrasound measurements. An upper limit of normal using this equation of 2223 cm3has been reported. This study aimed to determine the sensitivity, specificity, and predictive values of this cut off to determine hepatomegaly. A low‐risk and a high‐risk group participant group were recruited, each with 30 participants. Each participant had a liver ultrasound and liver volume calculated from the equation and an MRI where liver volume was calculated. The ultrasound volume equation using a hepatomegaly cut off 2223 cm3, was compared to the reference standard of MRI volume using a hepatomegaly cut off of 2185 cm3as reported by Kromrey et al. The ultrasound demonstrated a sensitivity of 90.9% (CI 58.7–99.7), a specificity of 97.9% (CI 89.1–99.9), a positive predictive value of 90.9 (CI 58.7–98.6) and a negative predictive value of 97.9% (CI 88.1–99.7). Liver volume calculated by using three linear ultrasound measurements in an equation, and an upper limit of 2223 cm3, has high diagnostic accuracy to determine hepatomegaly.

Background: Arteriovenous fistula (AVF) management for haemodialysis (HD) is one of the most challenging aspects of clinical care. A successful cannulation outcome when an AVF or arteriovenous graft (AVG) is used for the first time can be influenced by many factors, including access maturity, staff skill, and patient factors. This study examined AVF/AVG outcomes at initiation of HD across two major metropolitan public hospitals.Methods: Electronic medical records were reviewed to collect data retrospectively for a cohort of all newly commencing ESRD HD starts during 2018 to identify cannulation outcomes in the first 6 weeks.Results: Of the 117 patients included, AVG use was low (5%). Twenty-four percent of patients required a surgical intervention to salvage a poorly functioning AVF prior to commencing HD. About 32.5% of the cohort had an uneventful start with all successful cannulations. For the remainder of the cohort the number of treatments with unsuccessful cannulation ranged from 1 to 4 or more. About 36% required a surgical intervention for a poorly functioning AVF after commencing HD. Commencing HD with a CVC is associated with a lower likelihood of subsequent successful cannulation (p< 0.001).Conclusion: Even in experienced centres, a subset of patients experienced complicated cannulation in the first 6 weeks of HD. Several areas of improvement could be considered for these patients; timely referral for access creation, post-operative surveillance to ensure AVF maturation inclusive of duplex ultrasonography, gentle induction using small gauge needles and low blood flows, and consideration of a single needle HD initiation pathway.

COVID‐19 has seen a series of lockdowns and suspension on non‐urgent elective surgeries. Subsequently, there was a drop in the number of diagnostic imaging services billed in April, May, 2020. A survey was undertaken from March to June 2020 to determine the initial impact of COVID‐19 on Australasian Sonographers. This article, the first in a 3‐part series presents and discusses the results of this survey pertaining to changes in the number of scans performed, and changes in the working hours of sonographers. The remaining two articles in this series address other initial COVID‐19 impacts on Australasian Sonographers. An online survey was conducted containing questions regarding changes to work hours and examination numbers. 444 participants answered the survey. Seventy eight percent of sonographers reported a decrease in the number of examinations being performed in their department A decrease in work hours was reported by 68% of sonographers with almost a quarter of these reporting that they had lost all their hours. A higher percentage of work hours changes were seenin private practices. Many reductions in work hours were reported to be voluntary. Scan numbers in ultrasound departments were affected by COVID‐19, as were sonographers' work hours.

COVID‐19 brought with it the requirement for healthcare workers to limit community transmission of the virus as much as possible by limiting patient contact and wearing Personal Protective Equipment (PPE). This study aimed to capture the initial adaptations to sonographic examination protocols within ultrasound departments and sonographer access to PPE. An online survey was used to gather data on sonographer reflections of sonographic examination protocol changes seen in their departments and access to PPE between the 11th of March 2020 and the 14th of June 2020. To reduce the time sonographers spent with the patients and hence reduce the risk of exposure to COVID‐19, sonographers reported adjustments to sonographic examination protocols including their duration and scheduling. Access to PPE was reported as poor. Numerous sonographic examination protocol changes were observed within ultrasound departments in Australasia in the initial response to COVID‐19. Access to PPE was varied along with sonographer feelings around the impact of these changes.

The wellbeing of front‐line healthcare workers can be impacted during a pandemic. This paper reports the initial impact on the wellbeing of COVID‐19 on Australasian sonographers. An online qualitative and quantitative survey was conducted between March and June 2020 to explore the wellbeing of Australasian sonographers in the early stages of the COVID‐19 pandemic. Whilst most sonographers felt supported at work (300/379), those working in public hospitals felt more so than those in private practice. Sonographers in private practice felt more as though their job was at risk and were more likely to consider an alternate source of income. Sonographers felt they were working on the front line and many felt anxious about themselves (74%) or family (78%) contracting COVID‐19 due to their employment. Forty‐one percent of sonographers felt more isolated than normal, with younger age groups (18‐34 years) feeling less like they had enough hobbies or selfcare activities to get them through. Twelve percent of sonographers reported never, or rarely, coping with the juggle of work and home life. The initial impact of the COVID‐19 pandemic on the wellbeing of sonographers is evident. Longitudinal data will enable wellbeing to be tracked over time.

LB.1, also known as D-FLiRT, is a new subvariant of COVID that has been detected in multiple countries, including Australia. It is believed to be more transmissible than earlier Omicron subvariants, but there is no evidence to suggest it causes more severe illness. LB.1 has an additional mutation in the spike protein called S:S31del, which has led to its nickname "D-FLiRT" or "DeFLiRT." Preliminary research suggests that LB.1 and another subvariant called KP.2.3 may have higher transmissibility than other subvariants. While LB.1 infections are currently low, they may increase over time and potentially cause another wave of cases. The current vaccines should still provide some cross immunity against LB.1, and updated vaccines based on KP.2 are expected to provide better protection. [Extracted from the article]

A study conducted by Swiss and UK researchers found that only 5% of therapies tested in animals receive regulatory approval for use in humans and end up on the market. The process of approval takes an average of ten years. Animal studies can provide valuable information about diseases and potential drug targets, but they cannot fully predict the safety and effectiveness of treatments for humans. The researchers recommend improving the quality and relevance of animal studies and promoting closer collaboration between animal and human researchers. The high failure rate of animal studies in translating to human therapies raises ethical concerns and questions the scientific validity of relying solely on animal data for drug development decisions. However, the development of alternative research methods, such as computer modeling and artificial intelligence, may reduce the need for animal testing in the future. [Extracted from the article]

Abstract Objectives To determine whether moving clinical medical education out of the tertiary hospital into a community setting compromises academic standards. Design Cohort study. Setting Flinders University four year graduate [...]

Objective: To determine the effect of caesarean section on breast milk transfer (BMT) to the normal term infant over the first week of life. Method: A sample of 88 healthy [...]

Introduction: A functioning long-term vascular access is required for haemodialysis therapy; however, establishing this can be challenging in the setting of advanced age and vessels damaged by diabetes. Complications include the inability to insert two needles for the treatment resulting in miscannulation trauma and in some cases insertion of a temporary central venous access device. The broad objective of this review is to define the evidence base regarding cannulation practices in the initiation of haemodialysis via an arteriovenous fistula or an arteriovenous graft.Methods: This review uses the framework recommended by the Joanna Briggs Institute and the process by which papers were included or excluded followed the standard Preferred Reporting Items for Systematic Reviews and Meta-Analyses group approach. A total of 20 primary research studies met the inclusion criteria.Results: Cannulation in the 10- to 15-week period rather than delaying past this time frame is associated with the best outcomes. New vascular access given time to mature through single-needle haemodialysis treatments may improve long-term patency. Duplex ultrasound mapping prior to initiation of cannulation supports the clinical decision-making process on timing of and selection of cannulation sites.Conclusion: Cannulation trauma at the initiation of haemodialysis could potentially be reduced with a strategy of incremental haemodialysis using single-needle treatment supported with duplex ultrasonography assessment to ‘map’ the vascular access as a guide for clinicians prior to cannulation initiation.

•Numerous neurocognitive factors contribute to sustained attention.•Attention fluctuates alongside shifting arousal, effort, and resource allocation.•An information processing approach reveals the consequences of attention fluctuations.•An integrated perspective incorporates multiple models of sustained attention.•This integrated perspective has implications for a range of clinical populations.

Knowledge of the size of the adult liver is an essential factor in diagnosing liver disease and in the monitoring of treatment response over time. Although there are multiple methods to determine liver size using ultrasound, currently, no clinical practice guideline exists. Recently, a reference range and equation to determine liver volume using ultrasound was developed. In order to guide the development of a clinical guideline, a scoping review was conducted in order to identify the potential barriers and facilitators to the implementation of this new measurement technique in clinical practice. A total of 40 articles were included in the review. The most commonly cited barriers to guideline adherence can be divided into categories that are related to individual barriers (knowledge and attitude) and external factors (guideline and environmental). The facilitators to overcome such barriers were also identified. It was reported that implementation is most beneficial when a range of strategies that aim to address the identified barriers are used. In conclusion, this scoping review has identified barriers and facilitators to aid in the development of interventions to improve sonographers' adherence to clinical practice guidelines in the clinical environment.

Introduction: Peripheral intravenous catheter insertion is a clinical procedure commonly performed by nurses for pediatric patients in Bhutan. This study describes peripheral intravenous catheter first attempt success and factors associated with such insertions.Methods: A cross-sectional survey was conducted from October 2016 to March 2017, comprised of a national sample of the Bhutan pediatric patient population (0–12 years). We collected data on peripheral intravenous catheter first time insertion success rate of admitted pediatric patients, to identify predictors of a successful first time attempt. Clustered log binomial generalized linear models were used to obtain the prevalence of first time attempt success and predictors of success.Results: The prevalence rate of successful first time attempt adjusted for clustering was 64% (95% confidence interval: 51%–80%). Predictors of a successful first time attempt were older patient age, lighter skin color, the vein being visible with a tourniquet, and the left hand being used for insertion. A transilluminator was used in 52 patients, and the peripheral intravenous catheter was eventually successfully placed in 82% of the patients.Discussion: Our first time successful cannulation rate is substantially lower than that found in similar studies in other countries. Considering the impact a peripheral intravenous catheter has on patients’ clinical outcomes and cost implications, reducing the number of failed attempts should be of high importance. Better education and simulation, combined with the adoption of vessel locating technology, are required to improve insertion practice in Bhutan. This could lead to greater efficiency of the health facilities in Bhutan.

COVID cases are surging in Australia, particularly in New South Wales and Victoria. However, data collection has become less comprehensive, making it difficult to accurately track the extent of the wave. The Australian government's Department of Health website provides some data, but it is not up to date and lacks state and territory breakdowns. The JN.1 variant is currently circulating in Australia and is also causing waves in other countries. The current COVID vaccines are expected to be effective against the JN.1 variant, and the Australian Technical Advisory Group on Immunisation recommends booster shots for certain age groups. However, only a small percentage of older adults have received their boosters. It is likely that there will be repeated waves of infections in 2024, but unless a new subvariant causes more severe disease, hospitals should not become overwhelmed. It is important for vulnerable populations to stay up to date with booster shots and take necessary precautions. [Extracted from the article]

The risk of venous thromboembolism (VTE) may be reduced if a vein of appropriate diameter is used for peripherally inserted central catheter (PICC) insertion. However, clinicians may have predilections to cannulate certain vein types and use particular insertion sites (eg, right or left arm) and therefore do not necessarily assess all veins available to determine the most optimal vessel to introduce a catheter. It is important that clinicians have an understanding of the diameter of veins used for PICC insertion and the effect of patient factors such as hand dominance on vein size to determine whether their clinical practice is appropriate.

Umbilical catheters are commonly inserted in newborns in the neonatal intensive care unit (NICU) yet are associated with serious adverse events (AEs) such as malposition, migration, infection, thrombosis, hepatic complications, cardiac effusion, and cardiac tamponade. There is a need to determine the incidence and risk factors for AEs to inform safe practice.

The primary activity of the DFMLC Technical Committee is organizing the DFMLC Conference at the ASME IDETC. It has become a primary international forum for the exchange of technical and [...]

PURPOSE:To compare “total keratometry” measurements with Goggin nomogram adjusted anterior keratometry (GNAK) for toric intraocular lens calculation.METHODS:Routine biometry provided measured total keratometry values from which astigmatism was derived. The Goggin nomogram was applied to anterior keratometry values on the same eyes to provide nomogram-adjusted anterior keratometry values (GNAK) that estimate total corneal astigmatism. The agreement between total keratometry and GNAK was analyzed.RESULTS:Overall, in 46 eyes there was no statistically significant difference between median GNAK and total keratometry power values (Overall, in 46 eyes there was no statistically significant difference between median GNAK and total keratometry power values (P= .746). No statistically significant difference remained in against-the-rule and oblique subgroup analyses. Absolute and signed steep axis of astigmatism was statistically significantly different for GNAK and total keratometry in the overall analysis (P< .001 and = .029, respectively) and for against-the-rule and oblique subgroup analyses. The with-the-rule subgroup showed a statistically significant difference in astigmatic power and no significant signed steep axis difference between GNAK and total keratometry.CONCLUSIONS:Total keratometry appears able to measure total corneal astigmatism to match closely (clinically and statistically) GNAK estimation of that parameter. This indicates that it would be safe and reasonable to use total keratometry data for planning of cataract surgery with toric IOLs.[[J Refract Surg.2018;34(8):521–526.]

Dementia is highly prevalent among Australia's First Nations peoples, including Torres Strait Islander and Aboriginal peoples in Far North Queensland (FNQ). It is likely that historically recent exposure to modifiable risk factors underlies these rates, and a large proportion of dementia may be potentially preventable.

Letters of art historian Meyer Shapiro to Lillian Milgram during his journey to Europe and the Near East are presented. The complete records of Shapiro's journey are the letters and his travel journal. The historian's experiences in Spain and France are also presented.

The majority of research examining affective attentional bias in posttraumatic stress disorder (PTSD) has not examined the influence of co-occurring psychiatric disorders. This study examined the individual and interactive effects of PTSD symptoms and substance use disorders (SUDs) on affective attentional processing among 323 veterans deployed to Iraq or Afghanistan. Participants were divided into those with SUD (SUD+, n= 46) and those without (SUD−, n= 277). Substance use disorder was determined using the Structured Clinical Interview for DSM-IV. Posttraumatic stress disorder was measured using the Clinician Administered PTSD Scale. A computerized go/no-go task (Robbins et al., 1994, Robbins et al.,1998) assessed affective attentional processing. Relative to those without SUD, those with SUD showed a significant association between PTSD symptoms and increased omission and commission accuracy rates and decreased d prime. No effects of valence were found. Findings suggest the need to consider co-occurring SUD when investigating the effects of PTSD on attentional control.

While perceived as safe, diagnostic ultrasound has the potential to cause biological effects on the body tissues. The aim of this study was to evaluate knowledge, attitudes and practices of Australasian sonographers on bioeffects and safety of ultrasound scanning. Focus groups were used to develop a questionnaire to explore knowledge, attitudes and practices of ultrasound safety, which was then distributed to Australasian sonographers. Thematic (focus groups) and descriptive (questionnaires) analyses were undertaken. A 37‐item questionnaire addressed knowledge, attitudes and practices of ultrasound safety. In 47 collected responses, sonographers demonstrated good familiarity of thermal index (TI) (79%), mechanical index (MI) (68%) and ‘as low as reasonably achievable’ (ALARA) principle (85%). However, most sonographers could not accurately define TI (13%) and had poor knowledge of safety guidelines relating to TI (19%) and MI (14%). Over 30% were uncertain about their attitudes to ultrasound safety issues. While 52% ‘always’ and 30% ‘most of the time’ adhere to ALARA, 37% of sonographers reported never monitoring TI and MI. While familiar with safety terms, knowledge of safety guidelines was lacking. Many sonographers were uncertain about their attitudes to the safety of scans; and safety practices involving monitoring for bioeffects were not a high priority.

Emerging rodent-borne hantaviruses cause severe diseases in humans with no approved vaccines or therapeutics. We recently isolated a monoclonal broadly neutralizing antibody (nAb) from a Puumala virus–experienced human donor. Here, we report its structure bound to its target, the Gn/Gc glycoprotein heterodimer comprising the viral fusion complex. The structure explains the broad activity of the nAb: It recognizes conserved Gc fusion loop sequences and the main chain of variable Gn sequences, thereby straddling the Gn/Gc heterodimer and locking it in its prefusion conformation. We show that the nAb’s accelerated dissociation from the divergent Andes virus Gn/Gc at endosomal acidic pH limits its potency against this highly lethal virus and correct this liability by engineering an optimized variant that sets a benchmark as a candidate pan-hantavirus therapeutic.