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Introduction: Speech Language Therapy First Point of Contact Clinic (SLT-FPOCC) models can assist assessment of low-risk patient populations referred to ear, nose and throat (ENT) services. To further improve ENT waitlist management and compliance with best-practice care, consideration of other low-risk populations that could be safely managed through this service model is needed. The aims of this paper are to evaluate the clinical and service outcomes of completing vocal cord check (VCC) assessments for patients' pre and post thyroid/parathyroid surgery within an SLT-FPOCC model and examine consumer perceptions. Methods & Procedures: The service followed existing SLT-FPOCC procedures, with ENT triaging referrals, then SLT completing pre- and postoperative VCC assessment (interview, perceptual assessment, flexible nasendoscopy), with assessment data later reviewed by ENT to diagnose laryngeal pathology. Clinical and service outcomes were collected prospectively. Patients completed an anonymous post-service satisfaction survey. Results: Of the first 100 patients referred for preoperative VCCs, SLT assessment identified 42 with dysphonia and 30 reporting dysphagia, while ENT confirmed 9 with significant preoperative anatomical findings. Eighty-three underwent surgery, with 63 (95 nerves at surgical risk) returning for a postoperative VCC. Postoperative VCC identified three temporary neuropraxias (3.2%) and three unilateral vocal fold paresis (3.2%). Patients were highly satisfied with the service. All 163 pre-/postoperative VCCs were completed with no adverse events. Conclusion & Implications: The current data support SLT-FPOCC service expansion to include pre and post thyroid/parathyroid surgery VCC checks, with positive consumer perception. The model supports delivery of best practice management (i.e., pre- and postoperative VCC) for patients receiving surgery for thyroid/parathyroid dysfunction, and associated efficiencies for ENT services.

Simple Summary: Australian horticulture is at risk from incursions by exotic tephritid fruit fly species, particularly oriental fruit fly. An incursion by exotic fruit flies is likely to result in global trade restrictions and will cause significant economic losses. In this study, we investigated global management strategies for exotic fruit fly species and compared them with available local strategies in Australia to identify areas where Australian management practices could be improved. We identified that although Australia has a good understanding of the main exotic fruit fly threats, there remains no species-specific emergency response plan available to implement in the case of an incursion. Australia has effective tools for exotic fruit fly detection, an early warning surveillance network is in place across Australia and control measures used successfully for eradication elsewhere are available in Australia. However, the speed at which Australia could respond to an incursion is currently limited by the lack of a response plan, and this could have major implications for the effectiveness of management strategies for containment and eradication, likely leading to a more severe and costly incursion outcome. Exotic tephritid incursions are of high concern to Australia's biosecurity and its horticultural industries. It is vital that Australia remains ready to respond to incursions as they arise, as an incursion of tephritid fruit fly species will result in significant economic losses. In this review, we compared Australian incursion management strategies for fruit flies with global management strategies and identified possible areas where improvements could be made in an Australian context. Overall, Australia has a good understanding of the main tephritid threats, of which Bactrocera species from across the Torres Strait (northern Australia) are of most concern. Effective tools for tephritid detection and early warning surveillance at points of entry are in place at ports and in horticultural areas Australia-wide and provide the basis for initiating biosecurity responses in the event of an incursion. Area-wide control measures used in successful eradication attempts globally are available for use in Australia. However, a specific tephritid emergency response plan identifying suitable response measures and control options for species of concern is not yet available. We have identified that Australia has the policies and management tools available to respond to an exotic tephritid incursion, but the speed at which this could be accomplished would be greatly improved by the development of species-specific emergency response plans. [ABSTRACT FROM AUTHOR]

Simple Summary: Fruit fly (Tephritidae) present a global market-access issue for horticultural produce. A key method of control for tephritidae pests is the sterile insect technique (SIT). Australia has released a bisex strain, i.e., males and females of sterile Queensland fruit fly, Bactrocera tryoni Froggatt, although only the males contribute to wild-population decline. While the number of stings were higher in one SIT release orchard, compared with the control, we showed that sterile female B. tryoni released in large numbers do not lead to degraded or unmarketable fruit, and therefore are suitable for release in commercial nectarine, peach and plum orchards. Global markets do not tolerate the presence of fruit fly (Tephritidae) in horticultural produce. A key method of control for tephritidae pests, is the sterile insect technique (SIT). Several countries release a bisex strain, i.e., males and females, however the sterile male is the only sex which contributes to wild population declines when released en masse. In commercial orchards, there are concerns that sterile females released as part of bisex strains, may oviposit, i.e., 'sting' and cause damage to fruit, rendering it unmarketable. Australia has released a bisex strain of sterile Queensland fruit fly, Bactrocera tryoni Froggatt, for several decades to suppress wild pest populations, particularly in peri-urban and urban environments. Here, we assessed fruit damage in two commercially grown stone fruit orchards where bisex sterile B. tryoni were released, and in an orchard that did not receive sterile flies. The number of detected stings were higher in only one SIT release orchard, compared with the control; however, there was no difference between SIT and control orchards in the number of larvae detected. We showed that there is no evidence that sterile female B. tryoni released in large numbers caused stings, or damage that led to downgraded or unsaleable fruit. The bisex strain of sterile B. tryoni is recommended for use in commercial stone-fruit orchards, under the conditions in which this trial was conducted. [ABSTRACT FROM AUTHOR]

Larval diets used for artificial rearing can have a significant effect on insect biology. The Queensland fruit fly (aka "Qfly"), Bactrocera tryoni (Froggatt) (Diptera: Tephritidae), is one of the greatest challenges for fruit growers in Australia. The sterile insect technique (SIT) is being developed to manage outbreaks in regions that remain free of Qfly and to reduce populations in regions where this species is endemic. Factory scale rearing is essential for SIT; however, artificial larval diets are known to affect the microbiome of Qfly, which may then affect fly performance. In this study, high-throughput Illumina sequencing was used to assess the Qfly microbiome in colonies reared, for five generations from nature, on two common artificial diets (carrot and gel). At generation five (G5), the microbiome was assessed in larvae, pupae, adult males and adult females and standard fly quality control parameters were assessed together with additional performance measures of mating propensity and survival under nutritional stress. At the genus level, bacterial communities were significantly different between the colonies reared on the two larval diets. However, communities converged at Phyla to family taxonomic levels. Bacterial genera of Morganella, Citrobacter, Providencia , and Burkholderia were highly abundant in all developmental stages of Qfly reared on the gel diet, when compared to the carrot diet. Despite abundance of these genera, a greater percentage of egg hatching, heavier pupal weight and a higher percentage of fliers were found in the Qfly reared on the gel diet. Mating propensity and survival under nutritional stress was similar for adult Qfly that had been reared on the two larval diets. Overall, our findings demonstrate that the artificial larval diet strongly influences the microbiome and quality control measures of Qfly, with likely downstream effects on performance of flies released in SIT programs. [ABSTRACT FROM AUTHOR]

Tephritid fruit flies are among the most destructive horticultural pests posing risks to Australia's multi-billion-dollar horticulture industry. Currently, there are 11 pest fruit fly species of economic concern in Australia. Of these, nine are native to this continent (Bactrocera aquilonis, B. bryoniae, B. halfordiae, B. jarvisi, B. kraussi, B. musae, B. neohumeralis, B. tryoni and Zeugodacus cucumis), while B. frauenfeldi and Ceratitis capitata are introduced. To varying degrees these species are costly to Australia's horticulture through in-farm management, monitoring to demonstrate pest freedom, quarantine and trade restrictions, and crop losses. Here, we used a common species distribution model, Maxent, to assess climate suitability for these 11 species under baseline (1960–1990) and future climate scenarios for Australia. Projections indicate that the Wet Tropics is likely to be vulnerable to all 11 species until at least 2070, with the east coast of Australia also likely to remain vulnerable to multiple species. While the Cape York Peninsula and Northern Territory are projected to have suitable climate for numerous species, extrapolation to novel climates in these areas decreases confidence in model projections. The climate suitability of major horticulture areas currently in eastern Queensland, southern-central New South Wales and southern Victoria to these pests may increase as climate changes. By highlighting areas at risk of pest range expansion in the future our study may guide Australia's horticulture industry in developing effective monitoring and management strategies. [ABSTRACT FROM AUTHOR]

Queensland fruit fly (Qfly) is a native Australian species originally endemic to Queensland and coastal northern New South Wales. Horticultural production of imported hosts has contributed to Qfly spreading to all eastern Australian states. Market access for horticultural production was protected by the creation of pest-free areas such as the Fruit Fly Exclusion Zone (FFEZ) and Greater Sunraysia Pest Free Area (GSPFA) to assist trade from south eastern Australia. These zones had hot, dry summers and cold winters which were less likely to support Qfly establishment and persistence. Eradication was therefore more likely. In recent years, the FFEZ and GSPFA experienced an increase in Qfly outbreaks during the growing season, which may be attributed to an increased summer rainfall and warmer winters. This is an observed change in Australia's climate since the year 2000. Such climatic conditions enhance the suitability of southern Australian regions for Qfly establishment and proliferation. To assess this, the potential current and future distribution and abundance of Qfly was modelled using two global climate models and two emission scenarios. Results indicated that climate change is likely to cause a southern and coa stal shift in the climatic suitability and support an increase in abundance. Horticultural production areas that are currently modelled as marginal for Qfly infestation were projected to become suitable by 2030, with areas that are currently unsuitable projected to become marginal. This change will place horticultural production areas under increasing pressure from Qfly. This change will place new challenges on area wide management and require the development of alternative control measures. [ABSTRACT FROM AUTHOR]

Bactrocera cucumis is a lesser known native fruit fly in Australia. There are 44 reported hosts including cucurbits, papaws and tomatoes with a strong preference for cucurbits. Adult flies are not attracted to the known male lures such as cuelure, methyl eugenol or zingerone. They are weakly attracted to protein lures and a recently discovered cucumber volatile. For this reason, surveillance for this fruit fly remains problematic. Its range is predominantly coastal and appears to be centred north of Rockhampton in Queensland. It is known in the Northern Territory, Queensland and in New South Wales north of 29 º S latitude. Internationally, it is not reported in any Pacific countries or other parts of the world. [ABSTRACT FROM AUTHOR]

Bactrocera cucumis is one of many fruit fly species of concern for Australia's international trade partners. This species is one of the lesser known native fruit flies in Australia and its distribution and hosts have been reviewed. Eggs are larger than in most other species with a short hatching period. The adults and larvae are also larger than most other Australian fruit flies. Adults are long lived and have a high rate of reproduction. Stridulation and pheromones appear not to be used in the mating process. Adults can be managed using a range of measures including chemosterilants, the sterile insect technique and chemical sprays. Produce can be disinfested using a range of post-harvest treatments. Current export protocols include hot air and chilling treatments, irradiation, methyl bromide fumigation and winter window. [ABSTRACT FROM AUTHOR]

Abstract: For several decades, control of fruit fly pests in Australia has depended to a large degree on dimethoate, a broad-spectrum organophosphate insecticide that has been widely used on many different crops as well as on ornamental plants. However, many dimethoate use patterns were withdrawn in 2011 following a review by regulatory authorities. This manuscript places dimethoate in context as the latest in a long line of pre-harvest pesticides such as the arsenics, tartar emetic, sodium fluosilicate, nicotine sulphate, the organochlorines, and organophosphates, that have been lost from the fruit fly control toolkit over the past century. The succession of postharvest treatments such as fumigants, dips and sprays is also examined. Dimethoate and fenthion have offered relatively easy and cost effective pest control solutions since the 1960s, but in the absence of equivalent alternatives it is now necessary to develop “systems approaches” based on multiple control strategies and risk assessment. Such approaches represent a fundamental shift in pest management strategy, and will require improved understanding of fruit fly biology to prevent infestation in the field, combined with postharvest surveillance and non-chemical treatments. Some options are briefly discussed. [Copyright &y& Elsevier]

The fruit fly Bactrocera tryoni (Froggatt) (Diptera: Tephritidae) is a species of significant quarantine concern to many countries. Currently, B. tryoni is found in parts of Australia and on some Pacific islands. Understanding dispersal behavior is important for the development of scientifically justified trade restrictions or quarantine distances for B. tryoni. These distances ensure adequate protection for overseas markets while also ensuring that growers sufficiently distant from the affected area are able to retain unrestricted access to markets. This review considers scientific data on dispersal and uses this information to make recommendations for appropriate quarantine distances. Most studies conclude that the lifetime dispersal distance of this species rarely exceeds 1 km, although three studies indicate that longer dispersal distances of a small number of individuals may occasionally occur. These short dispersal distances are consistent with findings for other fruit fly species. Triggers for long-distance dispersal, the fate of these individual flies, nutritional requirements to support this dispersal, and reasons for discrepancies in the dispersal distances reported in different studies are reviewed. Reasons for the inability of B. tryoni to establish along southern parts of the east coast of Australia before European colonization are postulated. A proposed quarantine distance is based on the scientific basis of the mean and 3 SD, with a 3-fold level of protection based on distance. It is proposed that an area contained by a circle with a radius of 1.2 km is a reasonable quarantine area for B. tryoni outbreaks where flies are contained within 200 m of an epicenter. Where total trappings are contained within 400 m of the epicenter, a quarantine distance of 2.4 km is recommended. Three other quarantine distances are proposed based on the formula by using the mean. [ABSTRACT FROM AUTHOR]

The Queensland fruit fly (Qfly; Bactrocera tryoni Froggatt) is a major horticultural pest species in Australia and considered a serious quarantine concern, both domestically and internationally. When a Qfly outbreak is declared in the main horticultural regions of southeast Australia, a 15 km radius suspension zone is established (area of 707 km2) around the epicentre of the outbreak. This suspension radius was originally adopted in the early 1990s. Here, we analysed trapping data in New South Wales (Australia) from 2002 to 2010 to evaluate the suitability of the 15 km suspension radius. There were 439 Qfly incursions recorded in Qfly-free zones, but only 9.9% of these incursions resulted in a declared outbreak. For these outbreaks, we conducted two distinct analyses. First, we modelled the distribution of infestation radii from the outbreaks and predicted the suspension distance using multiple levels of risk protection (e.g. probit 8.7, probit 9). Second, we fitted various probability distributions to individual fly trapping data and then estimated upper confidence limits for suspension distances, based on dispersal patterns of Qfly. Overall, the predicted suspension radii were substantially smaller than the current 15 km radius. Our results concur with other studies suggesting that Qfly are relatively poor colonisers. We propose that the current 15 km could be reduced substantially to 3 or 4 km. • Queensland fruit flies disperse much shorter distances compared to current perceptions. • Generally, dispersal is much less than one kilometre. • Current quarantine distances are excessive and result in needless disinfestation. • Quarantine distances of 3–4 km are supported by the data. [ABSTRACT FROM AUTHOR]

Cylindrospermopsis raciborskii, a potentially toxic blooming cyanobacterium (blue-green alga), responsible for public health problems in Australia, was identified in France in 1994 in a shallow pond south of Paris. A program monitoring the occurrence of C. raciborskii in this pond was conducted from July 1998 to October 1999. The phytoplankton assemblages were studied, and limnological parameters (water temperature, dissolved oxygen, pH, conductivity, and dissolved inorganic nutrients) were measured. By multivariate analysis (principal component analysis), we showed that sufficiently high temperatures to allow the germination of akinetes, relatively low nutrient concentrations (soluble reactive phosphorus with a mean concentration of 1 μM and nitrate between 0 and 5 μM, except in February 1999 (21 μM)) and a characteristic high and constant sulfate concentration (8981±471 μM) seemed to be the main factors involved in the proliferation of C. raciborskii in the “Francs–Pêcheurs” (FP) pond. In the light of these findings and of bibliographic data, C. raciborskii would seem to be characterized by good adaptability, but also by low competitiveness with other phytoplanktonic species in the temperate study area. [Copyright &y& Elsevier]

Background: As health systems face increasing demands, non-medical prescribing is a workforce redesign strategy adopted within some services. Despite successful implementation in other professional groups, non-medical prescribing within speech pathology (SP) has not yet been described., Aims: To provide a descriptive account of the development and planned implementation of two SP prescribing models., Methods & Procedures: The evolution of two SP-led prescribing models, including relevant training and credentialing, for use of (1) nystatin oral drops (100,000 units/mL); and (2) lidocaine (lignocaine) and phenylephrine nasal spray (5 mg/500 μg/spray), in the outpatient setting is detailed. Challenges to implementation are outlined., Main Contribution: The development of relevant governance structures, a research evidenced-based project evaluation framework, and an overview of training pathways and credentialing was successfully completed. However, implementation of the models was unable to be achieved. A thorough review of the requirements and a discussion of contextual considerations that had a negative influence on the implementation of SP-led prescribing within this specific service context is provided., Conclusions & Implications: The successful implementation of SP-led prescribing is complex and highly context dependent. This work offers a discussion and review of the complexities of introducing a non-medical prescribing model in an outpatient hospital setting., What This Paper Adds: What is already known on the subject Allied Health prescribing is an emerging practice area aiming to reduce current pressures on health services. SP-led prescribing has not been thoroughly investigated in the Australian context. What this study adds to existing knowledge This study describes the development of a SP-led prescribing process in the outpatient setting, and a thorough review and discussion of the drivers and barriers to the model's implementation. What are the potential or actual clinical implications of this work? The successful implementation of SP-led prescribing was identified to be complex from a legislative and operational perspective, as well as being highly context dependent. This study further highlights the importance of a thorough context evaluation and workflow mapping prior to full-scale implementation of SP prescribing trials., (© 2022 Commonwealth of Australia. International Journal of Language & Communication Disorders © 2022 Royal College of Speech and Language Therapists.)

Background: This study is the first clinical trial for a parenteral non-replicating rotavirus vaccine developed using virus-like particle (VLP) technology., Methods: This open-labeled, randomized, placebo-controlled trial was conducted in two parts: Part A (a first-in-human study in Australian adults) and Part B (ascending dose and descending age in South African adults, toddlers and infants). In Part A, two cohorts of 10 adults were assigned to receive a single intramuscular injection of 1 of 2 escalating dose levels of the rotavirus VLP (Ro-VLP) vaccine (7 μg or 21 μg) or placebo. In Part B, one cohort of 10 adults was assigned to receive a single injection of the Ro-VLP vaccine (21 μg) or placebo, two cohorts of 10 toddlers were assigned to receive 2 injections of 1 of 2 escalating dose levels of the Ro-VLP vaccine (7 μg or 21 μg) or placebo 28 days apart, and three cohorts of 20 infants were assigned to receive 3 injections of 1 of 3 escalating dose levels of the Ro-VLP vaccine (2.5 μg, 7 μg or 21 μg) or placebo or 2 doses of oral Rotarix 28 days apart. Safety, reactogenicity and immunogenicity were assessed., Results: There were no safety or tolerability concerns after administration of the Ro-VLP vaccine. The Ro-VLP vaccine induced an anti-G1P[8] IgG response in infants 4 weeks after the second and third doses. Neutralizing antibody responses against homologous G1P[8] rotavirus were higher in all Ro-VLP infant groups than in the placebo group 4 weeks after the third dose. No heterotypic immunity was elicited by the Ro-VLP vaccine., Conclusions: The Ro-VLP vaccine was well tolerated and induced a homotypic immune response in infants, suggesting that this technology platform is a favorable approach for a parenteral non-replicating rotavirus vaccine., Clinical Trial Registration: NCT03507738., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: MM (Monica McNeal) has laboratory service agreements with Merck &Co., Inc, outside of the submitted work. No other 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., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: Expansion of the scopes of practice of allied health practitioners has the potential to improve the efficiency and cost-effectiveness of healthcare, given the identified shortages in medical personnel. Despite numerous examples in other allied health disciplines, this has yet to be applied to pediatric Audiology. This study aimed to investigate the effectiveness and safety of using audiologists with advanced training to independently triage children referred to otolaryngology (ORL) services, and compare the subsequent use of specialist resources, and postoperative grommet care to a standard medical ORL service., Design: One hundred twenty children consecutively referred to a large ORL outpatient service in Queensland, Australia, for middle ear and hearing concerns were prospectively allocated to either the ORL service or Advanced Audiology-led service. Demographic and clinical data were extracted from electronic medical records and compared between the two services. Clinical incidents and adverse events were recorded for the Advanced Audiology-led service., Results: Approximately half of all children referred to ORL for middle ear or hearing concerns were discharged without requiring any treatment, with the remaining half offered surgical treatment. The Advanced Audiology-led model increased the proportion of children assessed by ORL that proceeded to surgery from 57% to 82% compared with the standard medical ORL model. Children followed up by the audiologists after grommet insertion were more likely to be discharged independently and at the first postoperative review appointment compared with the standard medical ORL service. There were no reports of adverse events or long-term bilateral hearing loss after discharge by the Advanced Audiology-led service., Conclusions: These findings indicate that an Advanced Audiology-led service provides a safe and effective triaging model for the independent management of children not requiring treatment, and children requiring routine postoperative grommet review, and improves the effective use of specialist resource compared with the standard medical ORL service.

The role of human papillomavirus type 16 (HPV16) in oral potentially malignant disorders (OPMD) and oral cavity carcinoma (OC) is still under debate. We investigated HPV16 prevalence in unstimulated saliva, oral rinse samples, oral swabs and tumour biopsies collected from OPMD ( n = 83) and OC ( n = 106) patients. HPV16 genotype, viral load, physical status (episomal vs. integrated) and tumour p16INK4a expression were determined. Oral HPV16 prevalence was higher in OC than in OPMD, but this difference was not statistically significant (7.5% (8/106) versus 3.6% (3/83), odds ratio (OR): 2.18, 95% confidence interval (CI): 0.56, 8.48, p = 0.26). There was a significant association ( p < 0.05) between oral HPV16 infection and heavy tobacco consumption. Real-time PCR results indicated that no integration events occurred in either OPMD or OC cases based on the HPV16 E2/E6 ratio. HPV16 positive OPMD and OC patients had similar HPV16 E2 and E6 viral loads. The inter-rater agreement between tumour p16INK4a expression and oral HPV16 infection was considered as fair (k = 0.361) for OC. Our data suggest that the involvement of HPV16 in oral carcinogenesis is limited., Competing Interests: The authors declare no conflict of interest.

Purpose: To analyze the extent of improved adherence preceding a clinic visit ("white coat compliance") in a clinical trial and its potential impact on the utility of therapeutic drug monitoring (TDM)., Method: In this randomized, open-label trial, 190 antiretroviral-naïve, HIV-1-infected subjects received lopinavir/ritonavir capsules, once or twice daily, with tenofovir DF and emtricitabine (both once daily) for 96 weeks. Lopinavir/ritonavir compliance was assessed using MEMS., Results: 178 subjects (107 once daily, 71 twice daily) had plasma samples collected for lopinavir concentration resulting in 768 visits with pharmacokinetic (PK) assessment. The results were not used to provide feedback or recommend dose changes. For 239 (31%) of these visits, drug intake was perfect 1-3 days before PK sampling, whereas compliance during the remainder of the inter-PK visit period was < or = 95%. This phenomenon was noted in 66% of subjects, more frequently among twice-daily than once-daily subjects (85% vs. 54%; p < .0001), and may have led to determination of "therapeutic" drug levels despite overall adherence < or = 95%. The opposite phenomenon (>95% compliance reported during the inter-PK visit period, yet a dose missed the day before PK sampling) was observed for 1% of PK visits and clustered in 5% of subjects., Conclusions: In a substantial portion of visits and a majority of subjects, a white coat compliance pattern was observed. Drug concentration results obtained at these visits could deliver unreliable estimates of long-term drug exposure.

The genetic diversity of Cylindrospermopsis strains (cyanobacteria) was examined using mainly the 16S-23S internally transcribed spacer (ITS1) sequences. Strains were grouped in three clusters: (i) America, (ii) Europe, and (iii) Africa and Australia. These results suggested a recent spread of Cylindrospermopsis across the American and European continents from restricted warm refuge areas instead of exchanges between continents. On the other hand, they also suggested a recent colonization of Australia by African strains.