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Background and purpose -- Total knee replacement (TKR) studies usually analyze all-cause revision when considering relationships with patient and prosthesis factors. We studied how these factors impact different revision diagnoses. Patients and methods -- We used data from 2003 to 2019 of TKR for osteoarthritis from the arthroplasty registries of Sweden, Australia, and Kaiser Permanente, USA to study patient and prosthesis characteristics for specific revision diagnoses. There were 1,072,924 primary TKR included and 36,626 were revised. Factors studied included age, sex, prosthesis constraint, fixation method, bearing mobility, polyethylene type, and patellar component use. Revision diagnoses were arthrofibrosis, fracture, infection, instability, loosening, pain, patellar reasons, and wear. Odds ratios (ORs) for revision were estimated and summary effects were calculated using a meta-analytic approach. Results -- We found between-registry consistency in 15 factor/reason analyses. Risk factors for revision for arthro- fibrosis were age < 65 years (OR 2.0; 95% CI 1.4--2.7) and mobile bearing designs (MB) (OR 1.7; CI 1.1--2.5), for fracture were female sex (OR 3.2; CI 2.2--4.8), age ≥ 65 years (OR 2.8; CI 1.9--4) and posterior stabilized prostheses (PS) (OR 2.1; CI 1.3--3.5), for infection were male sex (OR 1.9; CI 1.7--2.0) and PS (OR 1.5; CI 1.2--1.8), for instability were age < 65 years (OR 1.5; CI 1.3--1.8) and MB (OR 1.5; CI 1.1--2.2), for loosening were PS (OR 1.5; CI 1.4--1.6), MB (OR 2.2; CI 1.6--3.0) and use of ultra-high molecular weight polyethylene (OR 2.3; CI 1.8--2.9), for patellar reasons were not resurfacing the patella (OR 13.6; CI 2.1--87.2) and MB (OR 2.0; CI 1.2--3.3) and for wear was cementless fixation (OR 4.9; CI 4.3--5.5). Interpretation -- Patients could be counselled regarding specific age and sex risks. Use of minimally stabilized, fixed bearing, cemented prostheses, and patellar components is encouraged to minimize revision risk. [ABSTRACT FROM AUTHOR]

Background and purpose -- Characteristics of patients receiving total knee arthroplasty (TKA) and prostheses used vary between regions and change with time. How these practice variations influence revision remains unclear. We combined registry data for better understanding of the impact of variation, which could potentially improve revision rates. Patients and methods -- We used data from 2003 to 2019 for primary TKA from arthroplasty registries of Sweden (SKAR), Australia (AOANJRR), and Kaiser Permanente (KPJRR). We included 1,072,924 TKA procedures for osteoarthritis. Factors studied included age, sex, ASA class, BMI category, prosthesis constraint, fixation, bearing mobility, patellar resurfacing, and polyethylene type. Cumulative percentage revision (CPR) was calculated using Kaplan-- Meier estimates, and unadjusted Cox hazard ratios were used for comparisons. Random-effects generic inverse-variance meta-analytic methods were used to determine summary effects. Results -- We found similarities in age and sex, but between-registry differences occurred in the other 7 factors studied. Patients from Sweden had lower BMI and ASA scores compared with other registries. Use of cement fixation was similar in the SKAR and KPJRR, but there were marked differences in patellar resurfacing and posterior stabilized component use. Meta-analysis results regarding survivorship favored patients aged ≥ 65 years and minimally stabilized components. There were inconsistent results with time for sex, fixation, and bearing mobility, and no differences for the patellar resurfacing or polyethylene type comparisons. Interpretation -- Marked practice variation was found. Use of minimally stabilized and possibly also cemented and fixed bearing prostheses is supported. [ABSTRACT FROM AUTHOR]

African swine fever (ASF) is a viral disease of the pigs that was first described in Africa during the early part of the twentieth century. The disease has periodically occurred outside of Africa, including an ongoing epidemic in Europe and Asia that started in 2007; the disease has never occurred in Australia or New Zealand. Once introduced into a country, spread can occur through direct and indirect routes of transmission. Infected feral pig populations have the potential to act as a long‐term reservoir for the virus, making eradication difficult. Just before and throughout the period of clinical signs, ASF virus is shed in oronasal fluids, urine, faeces and blood. This results in contamination of the pig's environment, including flooring, equipment and vehicles. Transportation‐related risk factors therefore are likely to play an important role in ASF spread, though evidence thus far has been largely anecdotal. In addition to the existing AUSVETPLAN ASF plan, efforts should be made to improve transportation biosecurity, from the time a pig leaves the farm to its destination. Collection of data that could quantify the capabilities and capacity of Australia to clean and disinfect livestock trucks would help to determine if private and/or public sector investment should be made in this area of biosecurity. No peer‐reviewed research was identified that described a specific process for cleaning and disinfecting a livestock truck known to be contaminated with ASF virus, though literature suggests that transportation is an important route of transmission for moving the virus between farms and countries. [ABSTRACT FROM AUTHOR]

Background and purpose — Rates of knee replacement (KR) are increasing worldwide. Based on population and practice changes, there are forecasts of a further exponential increase in primary knee replacement through to 2030, and a corresponding increase in revision knee replacement. We used registry data to document changes in KR over the past 15 years, comparing practice changes across Sweden, Australia, and the United States. This may improve accuracy of future predictions. Patients and methods — Aggregated data from the Swedish Knee Arthroplasty Register (SKAR), the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), and the Kaiser Permanente Joint Replacement Registry (KPJRR) were used to compare surgical volume of primary and revision KR from 2003 to 2017. Incidence was calculated using population census statistics from Statistics Sweden and the Australian Bureau of Statistics, as well as the yearly active membership numbers from Kaiser Permanente. Further analysis of KR by age < 65 and ≥ 65 years was carried out. Results — All registries recorded an increase in primary and revision KR, with a greater increase seen in the KPJRR. The rate of increase slowed during the study period. In Sweden and Australia, there was a smaller increase in revision surgery compared with primary procedures. There was consistency in the mean age at surgery, with a steady small decrease in the proportion of women having primary KR. The incidence of KR in the younger age group remained low in all 3 registries, but the proportional increases were greater than those seen in the ≥ 65 years of age group. Interpretation — There has been a generalized deceleration in the rate of increase of primary and revision KR. While there are regional differences in KR incidence, and rates of change, the rate of increase does not seem to be as great as previously predicted. [ABSTRACT FROM AUTHOR]

Australia and New Guinea (together referred to as Sahul) were linked by land for much of the late Tertiary and share many biotic elements. However, New Guinea is dominated by rainforest, and northern Australia by savannah. Resolving patterns of biotic interchange between these two regions is critical to understanding the expansion and contraction of both habitat types. The green tree frog (Litoria caerulea) has a vast range across northern and eastern Australia and New Guinea. An assessment of mitochondrial and morphological diversity in this nominal taxon in New Guinea reveals two taxa. True Litoria caerulea occurs in disjunct savannahs of the Trans-Fly, Central Province and across northern Australia, with very low genetic divergence, implying late Pleistocene connectivity. A previously unrecognised taxon is endemic to New Guinea and widespread in lowland swampy rainforest. Date estimates for the divergence of the new species suggest Pliocene connectivity across lowland tropical habitats of northern Australia and New Guinea. In contrast, the new species shows shallow phylogeographic structuring across the central mountains of New Guinea, implying recent dispersal between the northern and southern lowlands. These results emphasise that the extent and connectivity of lowland rainforest and savannah environments across northern Australia and southern New Guinea have undergone profound shifts since the late Pliocene. http://zoobank.org/urn:lsid:zoobank.org:pub:A577A415-0B71-4663-B4C1-7271B97298CD An assessment of mitochondrial and morphological diversity in frogs previously assigned to Litoria caerulea from New Guinea reveals two taxa. Shallow genetic divergence in true L. caerulea from across southern New Guinea and Australia implies recent Pleistocene connectivity across now isolated savannahs, while the more deeply divergent new species suggests earlier Pliocene divergence across lowland tropical habitats of Sahul. Photo by S. J. Richards. [ABSTRACT FROM AUTHOR]

Background: In contemporary Western liberal society, patient participation has become a key goal in psychiatric healthcare treatment. Health professionals must encourage patients to play an active and involved part in their treatment. According to Danish health law, patients have the right to participate in their treatment, and the mental health system therefore needs to be reformed in order to ensure that treatment is based on individual, liberal, values. However, patient participation is not clearly defined, and it is therefore a challenge to transfer it to clinical practice. Aims: This integrative review's aims are to explore how professionals perceive the challenges regarding patient participation in the treatment course in mental health care. Design: An integrative review. Findings: Seven studies met the inclusion criteria: six employed qualitative methodologies and one utilised a mixed‐methods approach. The empirical studies took place in Norway, the UK and Australia, all in a mental health setting. Three themes were identified: ‘Patient participation as collaboration between the healthcare professional and patient’, ‘Challenges to participation’ and ‘From a professional's perspective – what expectations do patients have when participating in decision‐making?’ Conclusion: Different synonymous terms describing the patient's active role during treatment – user participation, collaboration, partnership, user involvement and patient participation – are linked to a recovery‐oriented approach, shared decision‐making, shared ownership and care plans. This integrative review achieves specific knowledge around patient participation, comparing the situation for adult patients with various mental disorders. However, upon reflecting on the included studies, patient participation is not clearly defined, and it is therefore difficult to transfer it to clinical practice. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to test moderators of therapeutic improvement in an adolescent cognitive‐behavioral and mindfulness‐based group sleep intervention. Specifically, we examined whether the effects of the program on postintervention sleep outcomes were dependent on participant gender and/or measures of sleep duration, anxiety, depression, and self‐efficacy prior to the interventions. Method: Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 59.34%; mean age = 14.48 years, range 12.04–16.31 years) who had elevated levels of sleep problems and anxiety symptoms. Participants were randomized into either a group sleep improvement intervention (n = 63) or group active control ‘study skills’ intervention (n = 60). The sleep intervention (‘Sleep SENSE’) was cognitive behavioral in approach, incorporating sleep education, sleep hygiene, stimulus control, and cognitive restructuring, but also had added anxiety‐reducing, mindfulness, and motivational interviewing elements. Components of the active control intervention (‘Study SENSE’) included personal organization, persuasive writing, critical reading, referencing, memorization, and note taking. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Center for Epidemiologic Studies Depression Scale (CES‐D), and General Self‐Efficacy Scale (GSE) and wore an actigraph and completed a sleep diary for five school nights prior to the interventions. Sleep assessments were repeated at postintervention. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001177842; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12612001177842&isBasic=True). Results: The results showed that compared with the active control intervention, the effect of the sleep intervention on self‐reported sleep quality (PSQI global score) at postintervention was statistically significant among adolescents with relatively moderate to high SCAS, CES‐D, and GSE prior to the intervention, but not among adolescents with relatively low SCAS, CES‐D, and GSE prior to the intervention. The results were consistent across genders. However, the effects of the sleep intervention on actigraphy‐measured sleep onset latency and sleep diary‐measured sleep efficiency at postintervention were not dependent on actigraphy‐measured total sleep time, SCAS, CES‐D, or GSE prior to the intervention. Conclusions: This study provides evidence that some sleep benefits of adolescent cognitive‐behavioral sleep interventions are greatest among those with higher levels of anxiety and depressive symptoms, suggesting that this may be an especially propitious group to whom intervention efforts could be targeted. Furthermore, adolescents with lower levels of self‐efficacy may need further targeted support (e.g. additional motivational interviewing) to help them reach treatment goals. [ABSTRACT FROM AUTHOR]

Outdoor stays in green settings are regarded as beneficial for preschoolers, but not much is known about the characteristics of the sites that are chosen and used by outdoor preschools, the so-called ‘forest sites’. Therefore, this paper investigates the characteristics and use of forest sites in a Danish forest preschool and the activities and features in use during time for child-initiated activities. Staff and children (approx. 3–6.5 years) walked to a forest site and stayed for 2–5 h on a daily basis. Fifteen forest sites were observed in school hours at 24 stays during one year. This was supplemented by short interviews and informal talks with children and staff to learn more about the forest sites. The findings were organised according to the following ten classes of outdoor features: Open Ground, Sloping Terrain, Shielded Places, Rigid Fixtures, Moving Fixtures, Loose Objects, Loose Material, Water, Creatures and Fire. Most forest sites were glades or pillar halls, often situated at the intersection between different plantings. Staff avoided locations near deep water bodies with steep sides, but at most sites open water was either available at the site or nearby. The daily choice of forest site was connected to the location and features of the site, as well as the weather and season, the actual group of children, and the level of staffing. Children and staff opinion on sites often coincided. Children used features from all classes, but ‘loose objects’ were most often referred to in the interviews. Children as well as staff valued ‘shielded places’, but for staff this was only to a certain degree, since surveillance was important. It is suggested that the results, although derived from a single case, may inspire design and management of green spaces and forest in relation to preschools. [ABSTRACT FROM AUTHOR]

Background: Current estimates suggest over 218,000 individuals in Australia are chronically infected with hepatitis B virus. The majority of these people are migrants and refugees born in hepatitis B endemic countries, where attitudes towards health, levels of education, and English proficiency can be a barrier to accessing the Australian health care system, and best managing chronic hepatitis B. This study aimed to assess the knowledge of transmission and consequences of chronic hepatitis B among these patients. Method: A prospective study was conducted between May and August 2012. Patients with chronic hepatitis B were recruited from three Royal Melbourne Hospital outpatient clinics. Two questionnaires were administered. Questionnaire 1, completed during observation of a prospective participants' consultation, documented information given to the patient by their clinician. After the consultation, Questionnaire 2 was administered to assess patient demographics, and overall knowledge of the effect, transmission and treatment of hepatitis B. Results: 55 participants were recruited. 93% of them were born overseas, 17% used an interpreter, and the average time since diagnosis was 9.7 years. Results from Questionnaire 1 showed that the clinician rarely discussed many concepts. Questionnaire 2 exposed considerable gaps in hepatitis B knowledge. Few participants reported a risk of cirrhosis (11%) or liver cancer (18%). There was a high awareness of transmission routes, with 89% correctly identifying sexual transmission, 93% infected blood, and 85% perinatal transmission. However, 25% of participants believed hepatitis B could be spread by sharing food, and over 50% by kissing and via mosquitoes. A knowledge score out of 12 was assessed for each participant. The average score was 7.5. Multivariate analysis found higher knowledge scores among those with a family member also diagnosed with chronic hepatitis B and those routinely seeing the same clinician (p = 0.009 and p = 0.002, respectively). Conclusion: This is the largest Australian study assessing knowledge and understanding of the effect, transmission, and treatment of hepatitis B among chronically infected individuals. The findings highlight the knowledge gaps and misconceptions held by these patients, and the need to expand education and support initiatives. [ABSTRACT FROM AUTHOR]

Hearing loss is an etiologically heterogeneous trait with differences in the age of onset, severity and site of lesion. It is caused by a combination of genetic and/or environmental factors. A longitudinal study to examine the efficacy of early intervention for improving child outcomes is ongoing in Australia. To determine the cause of hearing loss in these children we undertook molecular testing of perinatal “Guthrie” blood spots of children whose hearing loss was either detected via newborn hearing screening or detected later in infancy. We analyzed the GJB2 and SLC26A4 genes for the presence of mutations, screened for the mitochondrial DNA (mtDNA) A1555G mutation, and screened for congenital CMV infection in DNA isolated from dried newborn blood spots. Results were obtained from 364 children. We established etiology for 60% of children. One or two known GJB2 mutations were present in 82 children. Twenty-four children had one or two known SLC26A4 mutations. GJB2 or SLC26A4 changes with unknown consequences on hearing were found in 32 children. The A1555G mutation was found in one child, and CMV infection was detected in 28 children. Auditory neuropathy spectrum disorder was confirmed in 26 children whose DNA evaluations were negative. A secondary objective was to investigate the relationship between etiology and audiological outcomes over the first 3 years of life. Regression analysis was used to investigate the relationship between hearing levels and etiology. Data analysis does not support the existence of differential effects of etiology on degree of hearing loss or on progressiveness of hearing loss. [ABSTRACT FROM AUTHOR]

Background: There is a lack of information on prevalence, cause and consequences of slight/mild bilateral sensorineural hearing loss (SNHL) in children. We report the first systematic genetic analysis of the GJB2 gene in a population-derived sample of children with slight/mild bilateral SNHL. Methods: Hearing tests were conducted in 6240 Australian elementary school children in Grades 1 and 5.55 children (0.88%) were found to have a slight/mild sensorineural hearing loss. 48 children with slight/mild sensorineural hearing loss and a matched group of 90 children with normal hearing participated in a genetic study investigating mutations in the GJB2 gene, coding for connexin 26, and the presence of the del(GJB6-D1351830) and del(GJB6-D13S1854) deletions in the GJB6 gene, coding for connexin 30. Results: Four of 48 children with slight/mild sensorineural hearing loss were homozygous for the GJB2 V37I change. The four children with homozygous V37I mutations were all of Asian background and analysis of SNPs in or near the GJB2 gene suggests that the V37I mutation arose from a single mutational event in the Asian population. Discussion: Based on the prevalence of carriers of this change we conclude that V37I can be a causative mutation that is often associated with slight/mild sensorineural hearing loss. No other children in the slight/mild hearing loss group had a hearing loss related to a GJB2 mutation. One child with normal hearing was homozygous for the R127H change and we conclude that this change does not cause hearing loss. Two children of Asian background were carriers of the V37I mutation. Our data indicate that slight/mild sensorineural hearing loss due to the GJB2 V37I mutation is common in people of Asian background. [ABSTRACT FROM AUTHOR]

In Australia the image of nurses has not changed, despite advances in nursing practice, education and research. The stereotype image affects how nurses practice and the future of the nursing profession. Below, a look at how the nurses' image affects nursing practice and suggestions on how this image can be improved. [ABSTRACT FROM AUTHOR]

Introduction and Purpose: In recent years, there has been renewed interest in using unicompartmental knee arthroplasty (UKA). Several studies have reported increasing numbers of UKAs for osteoarthritis in patients who are less than 65 years of age, with low revision rates. To describe and compare the use and outcome of UKA in this age group, we have combined data from the Australian and Swedish knee registries., Patients and Methods: More than 34,000 UKA procedures carried out between 1998 and 2007 were analyzed, and we focused on over 16,000 patients younger than 65 years to determine usage and to determine differences in the revision rate. Survival analysis was used to determine outcomes of revision related to age and sex, using any reason for revision as the endpoint., Results: Both countries showed a decreasing use of UKA in recent years in terms of the proportion of knee replacements and absolute numbers undertaken per year. The 7-year cumulative risk of revision of UKA in patients younger than 65 years was similar in the two countries. Patients younger than 55 years had a statistically significantly higher cumulative risk of revision than patients aged 55 to 64 years (19% and 12%, respectively at 7 years). The risk of revision in patients less than 65 years of age was similar in both sexes., Interpretation: The results of the combined UKA data from the Australian and Swedish registries show a uniformity of outcome between countries with patients aged less than 65 having a higher rate of revision than patients who were 65 or older. Surgeons and patients should be aware of the higher risk of revision in this age group.