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Clostridioides difficile poses an ongoing threat as a cause of gastrointestinal disease in humans and animals. Traditionally considered a human healthcare-related disease, increases in community-associated C. difficile infection (CDI) and growing evidence of inter-species transmission suggest a wider perspective is required for CDI control. In horses, C. difficile is a major cause of diarrhoea and life-threatening colitis. This study aimed to better understand the epidemiology of CDI in Australian horses and provide insights into the relationships between horse, human and environmental strains. A total of 752 faecal samples from 387 Western Australian horses were collected. C. difficile was isolated from 104 (30.9%) horses without gastrointestinal signs and 19 (37.8%) with gastrointestinal signs. Of these, 68 (55.3%) harboured one or more toxigenic strains, including C. difficile PCR ribotypes (RTs) 012 (n = 14), 014/020 (n = 10) and 087 (n = 7), all prominent in human infection. Whole-genome analysis of 45 strains identified a phylogenetic cluster of 10 closely related C. difficile RT 012 strains of equine, human and environmental origin (0–62 SNP differences; average 23), indicating recent shared ancestry. Evidence of possible clonal inter-species transmission or common-source exposure was identified for a subgroup of three horse and one human isolates, highlighting the need for a One Health approach to C. difficile surveillance. [ABSTRACT FROM AUTHOR]

A 2014 SSO-ASTRO guideline on surgical margins aimed to reduce unnecessary reoperation after breast conserving surgery (BCS). We investigate whether publication of the guideline was associated with a reduction in reoperation in Western Australia (WA). In this retrospective, population-based cohort study, cases of newly-diagnosed breast cancer were identified from the WA Cancer Registry. Linkage to the Hospital Morbidity Data Collection identified index BCS for invasive cancer between January 2009 and June 2018 (N = 8059) and reoperation within 90 days. Pre-guideline (2009–2013) and post-guideline (2014–2018) reoperation proportions were compared, and temporal trends were estimated with generalised linear regression. The pre-guideline reoperation proportion was 25.8% compared with 21.7% post-guideline (difference −4.0% [95% CI —5.9, −2.2, p < 0.001], odds ratio [OR] 0.80 [95% CI 0.72, 0.89, p < 0.001]). Absolute reductions were similar for repeat BCS (16.3% versus 14.6%; difference −1.8% [95% CI —3.4, −0.2, p = 0.03]) and conversion to mastectomy (9.4% versus 7.2%; difference −2.2% [95% CI —3.4, −1.0, p < 0.001]). Over the study period, there was an annual absolute change in reoperation of −0.8% (95% CI —1.2, −0.5, p < 0.001). Accounting for this linear trend, the difference in reoperation between time periods was −0.5% (95% CI —4.3, 3.3; p = 0.81), reflecting a non-significant reduction in conversion to mastectomy. Comparisons of pre- versus post-guideline time periods in WA showed reductions in reoperation that were similar to international estimates; however, an annual decline in reoperation predated the guideline. Analyses that do not account for temporal trends are likely to overestimate changes in reoperation associated with the guideline. • The reoperation rate was lower after than before the SSO-ASTRO margins guideline. • However, an annual decline in reoperation preceded publication of the guideline. • Accounting for this trend, a smaller reduction was associated with the guideline. [ABSTRACT FROM AUTHOR]

Process-based nearshore morphodynamic models are commonly used tools by coastal engineers and planners to predict the nearshore morphology change of sandy beaches across various spatiotemporal scales. Accurate modeling of the morphological response on medium and long time scales is imperative for quantitative assessments of coastal infrastructure over a project's intended life-span. However, most previous modeling applications have focused on single/sub-seasonal storm events and are often limited to an assessment of the subaerial beach (i.e. berm and dune). This not only leaves uncertainty concerning the quality of morphology predictions on extended (> weeks) time scales, but also the capacity of process-based models to emulate realistic nearshore sandbar dynamics and the corresponding exchange of sediment between the nearshore-beach system. To shed light on these meso-scale dynamics, CSHORE, a 1D phase-averaged, process-based nearshore morphodynamic model, was applied on an annual scale to a multi-barred, dissipative beach in Oysterville, WA, USA. Thousands of unique sediment transport and hydrodynamic parameter combinations were executed during model calibration. A large portion of these simulations displayed physically realistic sandbar dynamics, including the growth, decay, and migration of intertidal and subtidal sandbars. To explore the model mechanisms enabling realistic bar behavior, the binary and multinomial logistic regression model were used to quantify the relationship between model parameter selection and the probability of various categorical bar configurations occurring in the final predicted profile. The results indicate the most sensitive parameters associated with barred morphology, in this study, and support the use of separate sediment transport parameters for low and high wave energy conditions. The co-utilization of numerical and statistical modeling outlined in this publication is generalizable to future exploratory modeling and/or calibration routines concerned with categorical outcomes. • CSHORE is used to simulate annual scale nearshore and intertidal sandbar evolution. • Novel logistic regression methods inform model parameter influence on bar behavior. • Intertidal (subtidal) bars are most influenced by low (high) wave energy processes. • Low values of the breaker index favor barred morphology predictions. [ABSTRACT FROM AUTHOR]

Aims: To investigate if Clostridium (Clostridioides) difficile infection (CDI), traditionally thought of as hospital‐acquired, can be genomically linked to hospital or community environmental sources, and to define possible importation routes from the community to the hospital. Methods and Results: In 2019, C. difficile was isolated from 89/300 (29.7%) floor and 96/300 (32.0%) shoe sole samples at a tertiary hospital in Western Australia. Non‐toxigenic C. difficile ribotype (RT) 010 predominated among floor (96.6%) and shoe sole (73.2%) isolates, while toxigenic RT 014/020 was most prevalent among contemporaneous clinical cases (33.0%) at the hospital. Whole‐genome sequencing and high‐resolution core genome single nucleotide polymorphism (cgSNP) analysis on C. difficile strains from hospital and community sources showed no clinical C. difficile RT 014/020 strains were genetically related, and evidence of frequent long‐distance, multi‐directional spread between humans, animals and the environment. In addition, cgSNP analysis of environmental RT 010 strains suggested transportation of C. difficile via shoe soles. Conclusions: While C. difficile RT 014/020 appears to spread via routes outside the healthcare system, RT 010 displayed a pattern of possible importation from the community into the hospital. Significance and Impact of Study: These findings suggest developing community‐based infection prevention and control strategies could significantly lower rates of CDI in the hospital setting. [ABSTRACT FROM AUTHOR]

Despite Western Australia having low COVID-19 case numbers and limited community transmission, cancer service delivery changes were introduced early in the pandemic, including adoption of telehealth. Patients attending telehealth appointments during COVID-19 between 11 May 2020 and 7 August 2020 reported that telehealth lessened their concerns and met their needs to varying degrees. Despite this, 56% of patients still preferred in-person appointments. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to determine whether a shared care model (SCM) during chemotherapy treatment improved emotional wellbeing, empowerment, and prevalence of symptoms for people being treated for cancer. Methods: People receiving chemotherapy for hematologic, breast, ovarian, or colorectal malignancies at two cancer centers were randomly assigned to receive SCM or standard care. The SCM involved a patient-held record, a project coordinator, routine contact between the patient and general practitioner/primary care physician, and primary care physician education. Participants completed the Hospital Anxiety and Depression Scale, the Mini-Mental Adjustment to Cancer, and an empowerment questionnaire before, in the middle of, and on completion of chemotherapy. The presence and severity of adverse effects of chemotherapy were recorded by patients in a symptom diary. Results: Ninety-seven eligible participants were randomly allocated, less than half the intended recruitment. There were no significant differences between the groups for empowerment, symptom prevalence, or Mini-Mental Adjustment to Cancer scores. The proportion with clinical anxiety (Hospital Anxiety and Depression Scale anxiety score of ≥ 11) decreased over time in both groups (P = .013) but decreased more in the intervention group (P = .002). Depression was unchanged over time. Conclusion: Our study was limited by low recruitment and predominance of patients with breast cancer, and was underpowered for the main analyses. Results should therefore be interpreted with caution. Little benefit was seen for SCM in the majority of domains including empowerment, symptom prevalence, and psychological adjustment to cancer. The SCM showed efficacy in clinically anxious patients. Such interventions may be better implemented by using a targeted approach to identify at-need subgroups. [ABSTRACT FROM AUTHOR]

Keywords: Cancer; Cost of illness EN Cancer Cost of illness 525 526 2 06/16/20 20200615 NES 200615 Out-of-pocket expenses for cancer care are of growing concern for patients, clinicians, service providers, non-governmental organisations, private insurers, and politicians. One hundred and seventeen of the 119 outer metropolitan participants (98%) and 294 of the 308 rural participants (95%) incurred out-of-pocket expenses for their cancer care, chiefly for surgery, medical tests, and medical appointments. Cancer, Cost of illness. [Extracted from the article]

Mortality rates from breast cancer are stabilizing or falling in many developed countries including Australia, however, survival outcomes are known to vary by social, demographic and treatment related factors. The aim of the present study was to investigate how hospital, social and demographic factors were associated with survival outcomes from surgically treated breast cancer for all women living in Western Australia. The WA Data Linkage System was used to access hospital morbidity, death and cancer information for all women diagnosed with invasive breast cancer in Western Australia 1982−2000. Relative survival and Cox proportional hazards regression analyses were used to identify social, demographic and hospital factors associated with an increased risk of dying from breast cancer or dying from any cause. Survival outcomes improved in all women diagnosed in more recent calendar periods. However, a significantly increased risk of dying was observed for women who underwent initial surgical treatment in regional public hospitals outside of the state capital, Perth. Consistent with other reports, women aged greater than 80 years and younger than 35 years at diagnosis also had poorer survival outcomes. Residential location, socioeconomic status and race were not associated with survival after adjusting for treatment, health and hospital related factors. Despite overall improvements in survival of women diagnosed with breast cancer in Western Australia, initial surgical treatment in public hospitals outside of Perth was associated with significantly poorer outcomes. [ABSTRACT FROM AUTHOR]

Background: Trastuzumab (Herceptin) targets the epidermal growth factor receptor HER2, and was PBS listed on October 1 2006 for HER2+ early breast cancer patients. We undertook an audit of the first year of PBS availability of Herceptin at the 2 major teaching hospitals in Western Australia. Aims: • Determine % of patients with HER2 positive early breast cancer • Determine if patients were omitted from testing • Ascertain % of HER2 positive patients referred for Herceptin treatment and if not why • Examine compliance and short term morbidity and survival. Methods: All early breast cancer patients presenting to Royal Perth and Sir Charles Gairdner Hospitals were identified over the audit period from hospital based cancer registries, cross checked with State Cancer Registry, pathology records, pharmacy data and medical notes. Follow up was to November 2008. Results: 468 eligible patients were identified. 85 had HER 2+/3+ pathology and 22% were aged over 70. Five did not undergo ISH testing (2 because of co-morbidities, 2 because of small disease volume). Of the other 80 only 33 (7% of the total) were eligible for Herceptin after ISH testing. 28 of these were prescribed Herceptin. Reasons for exclusion included co-morbidities, age, metastases, small disease volume and patient choice. 68% of ISH results were not available in time for the multidisciplinary meeting. One patient failed to comply with treatment and 5 stopped early due to co-morbidities. Conclusion: A surprisingly small percentage of patients received Herceptin. Timely communication of ISH results is important. [ABSTRACT FROM AUTHOR]