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Abstract Background Abnormal remodeling of distal pulmonary arteries in patients with pulmonary arterial hypertension (PAH) leads to progressively increased pulmonary vascular resistance, followed by right ventricular hypertrophy and failure. Despite considerable advancements in PAH treatment prognosis remains poor. We aim to evaluate the potential for using the cytokine resistin as a genetic and biological marker for disease severity and survival in a large cohort of patients with PAH. Methods Biospecimens, clinical, and genetic data for 1121 adults with PAH, including 808 with idiopathic PAH (IPAH) and 313 with scleroderma-associated PAH (SSc-PAH), were obtained from a national repository. Serum resistin levels were measured by ELISA, and associations between resistin levels, clinical variables, and single nucleotide polymorphism genotypes were examined with multivariable regression models. Machine-learning (ML) algorithms were applied to develop and compare risk models for mortality prediction. Results Resistin levels were significantly higher in all PAH samples and PAH subtype (IPAH and SSc-PAH) samples than in controls (P

Aims: Young adults undergoing total hip arthroplasty (THA) largely have different indications for surgery, preoperative function, and postoperative goals compared to a standard patient group. The aim of our study was to describe young adult THA preoperative function and quality of life, and to assess postoperative satisfaction and compare this with functional outcome measures. Methods: A retrospective cohort analysis of young adults (aged < 50 years) undergoing THA between May 2018 and May 2023 in a single tertiary centre was undertaken. Median follow-up was 31 months (12 to 61). Oxford Hip Score (OHS) and focus group-designed questionnaires were distributed. Searches identified 244 cases in 225 patients. Those aged aged under 30 years represented 22.7% of the cohort. Developmental dysplasia of the hip (50; 45.5%) and Perthes’ disease (15; 13.6%) were the commonest indications for THA. Results: Preoperatively, of 110 patients, 19 (17.2%) were unable to work before THA, 57 (52%) required opioid analgesia, 51 (46.4%) were reliant upon walking aids, and 70 (63.6%) had sexual activity limited by their pathology. One patient required revision due to instability. Mean OHS was 39 (9 to 48). There was a significant difference between the OHS of cases where THA met expectation, compared with the OHS when it did not (satisfied: 86 (78.2%), OHS: 41.2 (36.1%) vs non-satisfied: 24 (21%), OHS: 31.6; p ≤ 0.001). Only one of the 83 patients (75.5%) who returned to premorbid levels of activity did so after 12 months. Conclusion: Satisfaction rates of THA in young adults is high, albeit lower than commonly quoted figures. Young adults awaiting THA have poor function with high requirements for mobility aids, analgesia, and difficulties in working and undertaking leisure activities. The OHS provided a useful insight into patient function and was predictive of satisfaction rates, although it did not address the specific demands of young adults undertaking THA. Function at one year postoperatively is a good indication of overall outcomes. Cite this article: Bone Jt Open 2024;5(4):304–311.

Abstract Background Early detection of long-term, often asymptomatic, middle ear infection in young Aboriginal and Torres Strait Islander children is more likely to be achieved when ear health and hearing checks are routinely undertaken in primary healthcare. Evidence consistently demonstrates the adverse impacts of this condition on the development and wellbeing of children and their families. We aimed to develop feasible, evidence- and consensus-based primary healthcare recommendations addressing the components and timing of ear health and hearing checks for Aboriginal and Torres Strait Islander children aged under 6 years, not already known to have, nor being actively managed for, ear and hearing problems. Methods A 22-person working group comprising Aboriginal and Torres Strait Islander and non-Indigenous members from the primary healthcare, ear, hearing, and research sectors provided guidance of the project. A systematic scoping review addressed research questions relating to primary health ear health and hearing checks for Aboriginal and Torres Strait Islander and other populations at increased risk of persistent ear health problems. Twelve primary studies and eleven guidelines published between 1998 and 2020 were identified and reviewed. Quality and certainty of evidence and risk of bias ratings were completed for studies and guidelines. In the absence of certain and direct evidence, findings and draft recommendations were presented for consensus input to a 79-member expert panel using a modified e-Delphi process. Recommendations were finalised in consultation with working group members and presented to expert panel members for input on considerations relating to implementation. Results Overall, the quality, certainty, and directness of evidence in the studies and guidelines reviewed was low. However, the findings provided a basis and structure for the draft recommendations presented during the consensus-building process. After two e-Delphi rounds, seven goals and eight recommendations on the components and timing of Ear Health and Hearing Checks in primary healthcare for young Aboriginal and Torres Strait Islander children were developed. Conclusions The systematic scoping review and consensus-building process provided a pragmatic approach for producing strong recommendations within a reasonably short timeframe, despite the low quality and certainty of evidence, and paucity of studies pertaining to primary healthcare settings.

Objective Health programs for Indigenous people are most effective, acceptable, and sustainable when Indigenous perspectives are prioritized. Codesign builds on Indigenous people's creativity and propensity to experiment with new technologies and ensures research is designed and implemented in a culturally safe and respectful manner. Limited research has focused on older Indigenous people as partners in digital health. No research has focused on the acceptability and feasibility of older Indigenous people using wearables for heart health monitoring. This study provides insights into the acceptability and feasibility for ≥55-year-old Indigenous people living in remote locations to use wearables (watches and patches) to detect atrial fibrillation (AF) and high blood pressure. Methods This mixed methods study was codesigned and coimplemented with the local Aboriginal Controlled Health Service in a remote area of New South Wales, Australia. It included active involvement and codesign with the participants. The devices used in this study included a Withings Scan watch and a Biobeat patch. Results Despite challenging conditions (>36°C) and variable internet connectivity, 11 Indigenous older adults participated in a five-day wearables program in a remote location. Participants indicated that using digital health devices was acceptable and feasible for older Indigenous users. They described high levels of comfort, safety and convenience when using wearables (patches and watches) to detect AF. They were active participants in codesigning the program. Conclusion Older Indigenous Australians are motivated to use wearable health devices. They are keen to participate in codesign innovative health tech programs to ensure new health technologies are acceptable to Indigenous people and feasible for remote locations.

BackgroundChronic disease risk factors are increasing amongst adolescents, globally. Digital health prevention programs, which provide education and information to reduce chronic disease risk factors need to be equitable and accessible for all. For their success, multiple highly engaged stakeholders should be involved in development and implementation. This study aimed to evaluate stakeholders’ support for, and perspectives on potential public health impact of digital health prevention programs for adolescents and potential pathways for future implementation.MethodsQualitative semi-structured online interviews with stakeholders. Stakeholder mapping identified key individuals, groups and organizations across Australia that may influence the implementation of digital health prevention programs for adolescents. Recorded and transcribed interviews were analyzed within the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework, using deductive content analysis.FindingsNineteen interviews were conducted in 2023 with stakeholders from government, health, non-government organizations, youth services, education, community settings and others. Four overarching themes were identified: (i) existing digital health initiatives are not fit for purpose; (ii) the co-creation of digital health prevention programs is critical for successful implementation; (iii) digital health prevention programs must address equity and the unique challenges raised by technology and; (iv) system level factors must be addressed.InterpretationStakeholders broadly supported digital health prevention programs, yet raised unique insights to ensure that future programs create public health impact by improving chronic disease risk factors among adolescents. These insights can be applied in future development of digital health prevention programs for adolescents to strengthen widespread implementation.

Abstract Objective To evaluate if existing Australian public policy related to screening, diagnosis, treatment and follow up care for breast cancer addresses the needs of and outcomes for Indigenous1 women? Methods This review of policy employed a modified Delphi method via an online panel of experts (n = 13), who were purposively recruited according to experience and expertise. A series of online meetings and online surveys were used for data collection. The aims of the study were to: Identify all existing and current breast cancer policy in Australia; Analyse the extent to which consideration of Indigenous peoples is included in the development, design and implementation of the policy; and Identify policy gaps and make recommendations as to how they could be addressed. The policies were evaluated using ‘A Guide to Evaluation under the Indigenous Evaluation Strategy, 2020’. Results A list of current breast cancer policies (n = 7) was agreed and analysed. Five draft recommendations to improve breast cancer outcomes for Indigenous women were developed and refined by the panel. Conclusions Current breast cancer policy in Australia does not address the needs of Indigenous women and requires change to improve outcomes.

Abstract Background Breast cancer continues to be the second most diagnosed cancer overall and the most diagnosed cancer for women in Australia. While mortality rates overall have declined in recent years, Indigenous women continue to be diagnosed at more marginal rates (0.9 times) and are more likely to die (1.2 times). The literature provides a myriad of reasons for this; however, the voices of Indigenous women are largely absent. This study sets out to understand what is happening from the perspectives of Australian Indigenous women with a view to charting culturally safer pathways that improve participation in screening and treatment by Indigenous women. Methods This co-design study was conducted using semi-structured, in-depth interviews and focus group discussions. Recruitment of study participants was via snowball sampling. Participants were subsequently consented into the study through the Aboriginal Health Service and the research team. Interviews were audio recorded and transcribed verbatim, and data coded in NVivo12 using inductive thematic analysis. Results A total of 21 Indigenous women and 14 health service providers were interviewed predominantly from the same regional/rural area in NSW, with a small proportion from other states in Australia. Six major themes were identified: Access, Awareness, Community and Family, Lack of control, Negative feelings and associations and Role of services. Conclusion To improve access and participation of Indigenous women and ultimately improve mortality rates, breast cancer services must explicitly address cultural and community needs.

Introduction Digital health technologies have the potential to provide cost-effective care to remote and underserved populations. To realise this potential, research must involve people not traditionally included. No research focuses on the acceptability and feasibility of older Indigenous people using wearables for early atrial fibrillation (AF) detection. This protocol compares digital augmentation against standard practice to detect AF, evaluate heart health self-efficacy and health literacy changes and identify barriers in collaboration with Aboriginal Community Controlled Health Organisations. It will establish a framework for implementing culturally safe and acceptable wearable programmes for detecting and managing AF in Indigenous adults ≥55 years and older.Methods This mixed-methods research will use the Rambaldini model of collective impact, a user-centred, co-design methodology and yarning circles, a recognised Indigenous research methodology to assess the cultural safety, acceptability, feasibility and efficacy of incorporating wearables into standard care for early AF detection.Analysis Qualitative data will be analysed to create composite descriptions of participants' experiences and perspectives related to comfort, cultural safety, convenience, confidence, family reactions and concerns. Quantitative device data will be extracted and analysed via Statistical Product and Service Solutions (SPSS).Conclusion Prioritising perspectives of older Indigenous adults on using wearables for detecting and monitoring cardiovascular disease will ensure that the findings are effective, relevant and acceptable to those impacted.Ethics and dissemination Findings will be published in open-source peer-reviewed journals, shared at professional conferences, described in lay terms and made available to the public. The AHMRC HREC Reference Number approved 1135/15.

Abstract Introduction Custom acetabular components have become an established method of treating massive acetabular bone defects in hip arthroplasty. Complication rates, however, remain high and migration of the cup is still reported. Ischial screw fixation (IF) has been demonstrated to improve mechanical stability for non-custom, revision arthroplasty cup fixation. We hypothesize that ischial fixation through the flange of a custom acetabular component aids in anti-rotational stability and prevention of cup migration. Methods Electronic patient records were used to identify a consecutive series of 49 custom implants in 46 patients from 2016 to 2022 in a unit specializing in complex joint reconstruction. IF was defined as a minimum of one screw inserted into the ischium passing through a hole in a flange on the custom cup. The mean follow-up time was 30 months. IF was used in 36 cups. There was no IF in 13 cups. No difference was found between groups in age (68.9 vs. 66.3, P = 0.48), BMI (32.3 vs. 28.2, P = 0.11) or number of consecutively implanted cups (3.2 vs. 3.6, P = 0.43). Aseptic loosening with massive bone loss was the primary indication for revision. There existed no difference in Paprosky grade between the groups (P = 0.1). 14.2% of hips underwent revision and 22.4% had at least one dislocation event. Results No ischial fixation was associated with a higher risk of cup migration (6/13 vs. 2/36, X 2 = 11.5, P = 0.0007). Cup migration was associated with an increased risk for all cause revision (4/8 vs. 3/38, X 2 = 9.96, P = 0.0016, but not with dislocation (3/8 vs. 8/41, X 2 = 1.2, P = 0.26). Conclusion The results suggest that failure to achieve adequate ischial fixation, with screws passing through the flange of the custom component into the ischium, increases the risk of cup migration, which, in turn, is a risk factor for revision.

Aims: Minimally manipulated cells, such as autologous bone marrow concentrates (BMC), have been investigated in orthopaedics as both a primary therapeutic and augmentation to existing restoration procedures. However, the efficacy of BMC in combination with tissue engineering is still unclear. In this study, we aimed to determine whether the addition of BMC to an osteochondral scaffold is safe and can improve the repair of large osteochondral defects when compared to the scaffold alone. Methods: The ovine femoral condyle model was used. Bone marrow was aspirated, concentrated, and used intraoperatively with a collagen/hydroxyapatite scaffold to fill the osteochondral defects (n = 6). Tissue regeneration was then assessed versus the scaffold-only group (n = 6). Histological staining of cartilage with alcian blue and safranin-O, changes in chondrogenic gene expression, microCT, peripheral quantitative CT (pQCT), and force-plate gait analyses were performed. Lymph nodes and blood were analyzed for safety. Results: The results six months postoperatively showed that there were no significant differences in bone regrowth and mineral density between BMC-treated animals and controls. A significant upregulation of messenger RNA (mRNA) for types I and II collagens in the BMC group was observed, but there were no differences in the formation of hyaline-like cartilage between the groups. A trend towards reduced sulphated glycosaminoglycans (sGAG) breakdown was detected in the BMC group but this was not statistically significant. Functional weightbearing was not affected by the inclusion of BMC. Conclusion: Our results indicated that the addition of BMC to scaffold is safe and has some potentially beneficial effects on osteochondral-tissue regeneration, but not on the functional endpoint of orthopaedic interest.

Aims: Acetabular edge-loading was a cause of increased wear rates in metal-on-metal hip arthroplasties, ultimately contributing to their failure. Although such wear patterns have been regularly reported in retrieval analyses, this study aimed to determine their in vivo location and investigate their relationship with acetabular component positioning. Methods: 3D CT imaging was combined with a recently validated method of mapping bearing surface wear in retrieved hip implants. The asymmetrical stabilizing fins of Birmingham hip replacements (BHRs) allowed the co-registration of their acetabular wear maps and their computational models, segmented from CT scans. The in vivo location of edge-wear was measured within a standardized coordinate system, defined using the anterior pelvic plane. Results: Edge-wear was found predominantly along the superior acetabular edge in all cases, while its median location was 8° (interquartile range (IQR) -59° to 25°) within the anterosuperior quadrant. The deepest point of these scars had a median location of 16° (IQR -58° to 26°), which was statistically comparable to their centres (p = 0.496). Edge-wear was in closer proximity to the superior apex of the cups with greater angles of acetabular inclination, while a greater degree of anteversion influenced a more anteriorly centred scar. Conclusion: The anterosuperior location of edge-wear was comparable to the degradation patterns observed in acetabular cartilage, supporting previous findings that hip joint forces are directed anteriorly during a greater portion of walking gait. The further application of this novel method could improve the current definition of optimal and safe acetabular component positioning.

Background: People with avascular necrosis of the hip have very limited treatment options currently available to stop the progression of this disease; this often results in the need for a hip replacement. There is some weak evidence that a class of drugs called bisphosphonates may delay the course of the disease, and this trial was commissioned and set up to provide robust evidence regarding the use of bisphosphonates in adults aged ≥ 18 years with this condition. Objectives: The aim of the Managing Avascular Necrosis Treatments: an Interventional Study (MANTIS) trial was to evaluate the clinical effectiveness and cost-effectiveness of a 12-month course of alendronate in the treatment of avascular necrosis. Design: This was a 66-month, definitive, multisite, two-arm, parallel-group, placebo-controlled, double-blind, randomised controlled trial, with an internal pilot phase. Setting: Eight secondary care NHS hospitals across the UK. Participants: Planned trial size – 280 adult patients with avascular necrosis. Intervention: Participants in the intervention group received 70 mg of alendronate (an oral bisphosphonate) weekly for 12 months. Main outcomes: The main outcomes were Oxford Hip Score at 12 months (short-term outcome) and the time to decision that a hip replacement is required at 36 months (long-term outcome). Results: Twenty-one patients were recruited and randomised to receive either the intervention drug, alendronate, or a placebo-matched tablet. Limitations: This trial was principally limited by low disease prevalence. Other limitations included the late disease stage at which participants were identified and the rapid progression of the disease. Future work: This trial was limited by a low recruitment rate. Avascular necrosis of the hip should be treated as a rare disease. Future trials would need to recruit many more sites and recruit over a longer time period, and, for this reason, a registry may provide a more effective means of collecting data pertaining to this disease. Conclusions: The MANTIS trial was terminated at the end of the pilot phase, because it did not meet its go/no-go criteria. The main issue was a poor recruitment rate, owing to a lower than expected disease prevalence and difficulties in identifying the condition at a sufficiently early stage. Those patients who were identified and screened either were too advanced in their disease progression or were already taking medication. We would not recommend that a short-term interventional study is conducted on this condition until its prevalence, geographic foci and natural history and better understood. The difficulty of acquiring this understanding is likely to be a barrier in most health-care markets. One means of developing this understanding would be the introduction of a database/registry for patients suffering from avascular necrosis of the hip. Trial registration: The trial is registered as ISRCTN14015902. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 43. See the NIHR Journals Library website for further project information.

Aims: The aim of this study was to present the first retrieval analysis findings of PRECICE STRYDE intermedullary nails removed from patients, providing useful information in the post-market surveillance of these recently introduced devices. Methods: We collected ten nails removed from six patients, together with patient clinical data and plain radiograph imaging. We performed macro- and microscopic analysis of all surfaces and graded the presence of corrosion using validated semiquantitative scoring methods. We determined the elemental composition of surface debris using energy dispersive x-ray spectroscopy (EDS) and used metrology analysis to characterize the surface adjacent to the extendable junctions. Results: All nails were removed at the end of treatment, having achieved their intended lengthening (20 mm to 65 mm) and after regenerate consolidation. All nails had evidence of corrosion localized to the screw holes and the extendable junctions; corrosion was graded as moderate at the junction of one nail and severe at the junctions of five nails. EDS analysis showed surface deposits to be chromium rich. Plain radiographs showed cortical thickening and osteolysis around the junction of six nails, corresponding to the same nails with moderate – severe junction corrosion. Conclusion: We found, in fully united bones, evidence of cortical thickening and osteolysis that appeared to be associated with corrosion at the extendable junction; when corrosion was present, cortical thickening was adjacent to this junction. Further work, with greater numbers of retrievals, is required to fully understand this association between corrosion and bony changes, and the influencing surgeon, implant, and patient factors involved. Cite this article: Bone Jt Open 2021;2(8):599–610.

Abstract Background Capitation models of care in dentistry started around 1973 with varying degrees of success in meeting the needs of the individuals and expectations of the participating private practitioners. These studies mostly identified that capitation payments resulted in under treatment whilst fee-for-service models often led to over treatment. The objective of this study was to develop a new way of doing business using an outsourcing capitation model of care to meet population health needs and activity-based funding requirements of rural Local Health Districts with a local university dental school. This payment model is an alternate referral pathway for public oral health practitioners from the existing New South Wales Oral Health Fee-for-Service Scheme that focuses on urgent treatment to one that offers an all-inclusive preventive approach that concentrates on sustaining good long-term oral health for the individual. Method The reflective study analysed various adult age cohorts (18–24, 25–34, 35–44, 45–54, 55–64, 65–74 and 75 + years) based on 950 participants randomly selected from the Greater Southern adult public dental waiting lists. The study’s capitation formula was derived from NSW government adult treatment items (n = 447,625). Dental care was provided through the local university’s dental clinics utilising only dental students under clinical supervision. All data were sourced from NSW Oral Health Data Warehouse during 1 January 2012–30 June 2018 and analysed by using SAS 9.3 and Version 13 Microsoft Excel. Results There were 10,305 dental care items and 1129 capitation courses of care totalling A$599,026. This resulted in an average of 11 dental care items being provided to each participant. The capitation payment formula utilising the most provided dental care items of 100 individual patients proved to be economical and preventive focused. Conclusion The systematic reflection showed that this unique methodology in developing an adult capitation payment formula associated to diagnostic pathways that resulted in: (i) more efficient usage of government expenditure on public dental services, (ii) provision of person-centred courses of dental care, and (iii) utilisation of university dental education programs to best practice treatment and holistic care.

Aims: The main advantage of 3D-printed, off-the-shelf acetabular implants is the potential to promote enhanced bony fixation due to their controllable porous structure. In this study we investigated the extent of osseointegration in retrieved 3D-printed acetabular implants. Methods: We compared two groups, one made via 3D-printing (n = 7) and the other using conventional techniques (n = 7). We collected implant details, type of surgery and removal technique, patient demographics, and clinical history. Bone integration was assessed by macroscopic visual analysis, followed by sectioning to allow undecalcified histology on eight sections (~200 µm) for each implant. The outcome measures considered were area of bone attachment (%), extent of bone ingrowth (%), bone-implant contact (%), and depth of ingrowth (%), and these were quantified using a line-intercept method. Results: The two groups were matched for patient sex, age (61 and 63 years), time to revision (30 and 41 months), implant size (54 mm and 52 mm), and porosity (72% and 60%) (p > 0.152). There was no difference in visual bony attachment (p = 0.209). Histological analysis showed greater bone ingrowth in 3D-printed implants (p < 0.001), with mean bone attachment of 63% (SD 28%) and 37% (SD 20%), respectively. This was observed for all the outcome measures. Conclusion: This was the first study to investigate osseointegration in retrieved 3D-printed acetabular implants. Greater bone ingrowth was found in 3D-printed implants, suggesting that better osseointegration can be achieved. However, the influence of specific surgeon, implant, and patient factors needs to be considered.

Aims: Periprosthetic joint infection (PJI) is a debilitating condition with a substantial socioeconomic burden. A novel autologous blood glue (ABG) has been developed, which can be prepared during surgery and sprayed onto prostheses at the time of implantation. The ABG can potentially provide an antimicrobial coating which will be effective in preventing PJI, not only by providing a physical barrier but also by eluting a well-known antibiotic. Hence, this study aimed to assess the antimicrobial effectiveness of ABG when impregnated with gentamicin and stem cells. Methods: Gentamicin elution from the ABG matrix was analyzed and quantified in a time-dependent manner. The combined efficiency of gentamicin and ABG as an anti-biofilm coating was investigated on titanium disks. Results: ABG-gentamicin was bactericidal from 10 μg/ml and could release bactericidal concentrations over seven days, preventing biofilm formation. A concentration of 75 μg/ml of gentamicin in ABG showed the highest bactericidal effect up to day 7. On titanium disks, a significant bacterial reduction on ABG-gentamicin coated disks was observed when compared to both uncoated (mean 2-log reduction) and ABG-coated (mean 3-log reduction) disks, at days 3 and 7. ABG alone exhibited no antimicrobial or anti-biofilm properties. However, a concentration of 75 μg/ml gentamicin in ABG sustains release over seven days and significantly reduced biofilm formation. Its use as an implant coating in patients with a high risk of infection may prevent bacterial adhesion perioperatively and in the early postoperative period. Conclusion: ABG’s use as a carrier for stem cells was effective, as it supported cell growth. It has the potential to co-deliver compatible cells, drugs, and growth factors. However, ABG-gentamicin’s potential needs to be further justified using in vivo studies.

Abstract Background To review the international literature on community-based interventions aiming to improve the oral health of Indigenous adolescents and identify which demonstrate a positive impact. Methods Data sources were MEDLINE, EMBASE, CINAHL, SCOPUS, the COCHRANE library and the Australian Indigenous HealthInfoNet. Articles were included where they: were published in English from 1990 onwards; described oral health outcomes for Indigenous adolescents aged 10 to 19 years; implemented a community based oral health intervention. The Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project was applied. Results Nine studies met inclusion criteria; two rated strong in quality; only one study was conducted with an urban community; five reported moderate community engagement. Five intervention strategies were identified, and schools were the most common setting reported. Statistically significant improvements were described in eight studies with the most frequently reported outcome being change in decayed missing or filled teeth. Conclusions Few good quality peer reviewed international studies of community-based oral health interventions which address the needs of Indigenous adolescents exist. Studies must include strong Indigenous community leadership and governance at all stages of the research, adopt participatory action-based research approaches, and are required in urban communities.

Objectives To critically evaluate the cost-effectiveness of the Midwifery Initiated Oral Health-Dental Service (MIOH-DS) designed to improve oral health of pregnant Australian women. Previous efficacy and process evaluations of MIOH-DS showed positive outcomes and improvements across various measures.Design and setting The evaluation used a cost-utility model based on the initial study design of the MIOH-DS trial in Sydney, Australia from the perspective of public healthcare provider for a duration of 3 months to 4 years.Participants Data were sourced from pregnant women (n=638), midwives (n=17) and dentists (n=3) involved in the MIOH trial and long-term follow-up.Cost measures Data included in analysis were the cost of the time required by midwives and dentists to deliver the intervention and the cost of dental treatment provided. Costs were measured using data on utilisation and unit price of intervention components and obtained from a micro-costing approach.Outcome measures Utility was measured as the number of Disability Adjusted Life Years (DALYs) from health-benefit components of the intervention. Three cost-effectiveness analyses were undertaken using different comparators, thresholds and time scenarios.Results Compared with current practice, midwives only intervention meets the Australian threshold (A$50 000) of being cost-effective. The midwives and accessible/affordable dentists joint intervention was only ‘cost-effective’ in 6 months or beyond scenarios. When the midwife only intervention is the comparator, the midwife/dentist programme was ‘cost-effective’ in all scenarios except at 3 months scenario.Conclusions The midwives’ only intervention providing oral health education, assessment and referral to existing dental services was cost-effective, and represents a low cost intervention. Midwives’ and dentists’ combined interventions were cost-effective when the benefits were considered over longer periods. The findings highlight short and long term economic benefits of the programme and support the need for policymakers to consider adding an oral health component into antenatal care Australia wide.Trial registration number ACTRN12612001271897; Post-results.

Abstract Background Australian Aboriginal children experience high levels of dental caries (tooth decay) and are less likely to access preventive dental health services. High-strength fluoride varnish has been shown to reduce the incidence of dental caries and is commonly used in community-based preventive dental health service programs. In New South Wales, Australia, the application of fluoride varnish is restricted to dental and medical professionals. This is problematic in communities with a high Aboriginal population and limited access to oral health services, contributing to the increased risk of developing dental caries in Aboriginal children. Dental assistants are essential members of the oral health team; however, they do not have a defined scope of practice in Australia. Other countries have created formal scopes of practice for dental assistants to include the application of fluoride varnish. This protocol presents a pathway for qualified Aboriginal dental assistants to undertake additional training to legally apply fluoride varnish in New South Wales. The primary objective of this study will be to evaluate the feasibility and acceptability of utilising Aboriginal dental assistants to apply fluoride varnish to Aboriginal children in a school setting at regular 3-month intervals. Methods Six schools across New South Wales (NSW) that enrol at least 12% Aboriginal children will be invited to participate in the 12-month study. Aboriginal children aged 5–12 years enrolled in these schools will be enrolled in the study. Six Aboriginal dental assistants will undertake training to apply fluoride varnish. Fluoride varnish (Duraphat) will be applied at 3-month intervals by the dental assistants to the teeth using a small brush. An evaluation will be undertaken to determine the feasibility and cost-effectiveness of this innovative approach. This study protocol has been approved by the NSW Aboriginal Health and Medical Research Council and the NSW State Education Research Application Process. Discussion A qualified Aboriginal dental assistant workforce in NSW (or Australia) legally approved to apply fluoride varnish may increase the sustainability and scalability of fluoride varnish programs and improve the oral health of Aboriginal children in Australia. Trial registration ISRCTN26746753.

Heart (right) failure is the most frequent cause of death in patients with pulmonary arterial hypertension. Although historically, increased right ventricular afterload has been considered the main contributor to right heart failure in such patients, recent evidence has suggested a potential role of load-independent factors. Here, we tested the hypothesis that resistin–like molecule α (RELMα), which has been implicated in the pathogenesis of vascular remodeling in pulmonary artery hypertension, also contributes to cardiac metabolic remodeling, leading to heart failure. Recombinant RELMα (rRELMα) was generated via a Tet-On expression system in the T-REx 293 cell line. Cultured neonatal rat cardiomyocytes were treated with purified rRELMα for 24 h at a dose of 50 nM. Treated cardiomyocytes exhibited decreased mRNA and protein expression of peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α) and transcription factors PPARα and ERRα, which regulate mitochondrial fatty acid metabolism, whereas genes that encode for glycolysis-related proteins were significantly upregulated. Cardiomyocytes treated with rRELMα also exhibited a decreased basal respiration, maximal respiration, spare respiratory capacity, ATP-linked OCR, and increased glycolysis, as assessed with a microplate-based cellular respirometry apparatus. Transmission electron microscopy revealed abnormal mitochondrial ultrastructure in cardiomyocytes treated with rRELMα. Our data indicate that RELMα affects cardiac energy metabolism and mitochondrial structure, biogenesis, and function by downregulating the expression of the PGC-1α/PPARα/ERRα axis.

Australia’s local, state, territory and federal governments have agreed that the 10-year life expectancy gap between Indigenous and non-Indigenous Australians will be closed by 2031. However, annual Closing the Gap reports tabled by the various prime ministers in the Australian Parliament (for the past 12 years) have consistently indicated that the life expectancy gap continues to widen. Australia has seen more than three decades of government policies since the landmark 1989 National Aboriginal health strategy. What has been missing from these policy commitments is the genuine enactment of the knowledges that are held by Indigenous Australians relating to their cultural ways of being, knowing and doing. Privileging Indigenous knowledges, cultures and voices must be front and centre in developing, designing and implementing policies and programs. The sharing of power, provision of resources, culturally informed reflective policy making, and program design are critical elements. In this paper, we provide a conceptual model of practice, working at the cultural interface where knowledges are valued and innovations can occur. This model of practice is where knowledges and cultures can co-exist, and it could be the answer to Closing the Gap in life expectancy by 2031. Despite a growing willingness and need to consider these models, there remains a deep-seated resistance to identifying and addressing institutional and systemic racism and racist attitudes, including unconscious biases held by individuals. Further, western non-Indigenous worldviews of ways of being, knowing and doing continue to dominate the decisions and actions of governments – and consequentially dominate public health policies and practices. There is an unacceptable standard approach, for and about Indigenous health instead of with Indigenous peoples, resulting in the neglectful dismissal of Indigenous knowledges and Indigenous cultures of ways of being, knowing and doing.

There are major disparities in oral health between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander people. The New South Wales (NSW) Aboriginal Oral Health Plan 2014–2020 was developed to improve the oral health of Aboriginal people. This scoping review describes programs that have been undertaken to implement the NSW Aboriginal Oral Health Plan 2014–2020. The methodology by Arksey and O’Malley was used to guide this review. Academic and grey literature were searched using a structured Medline, Lowitja and advanced Google searches. Articles were included if they aligned with the strategic directions of the Plan. Key information, including the aims of the study, methodology and results were recorded in a template on Microsoft Excel software. A total of 31 articles were included in this review. This included 25 articles from the academic literature and six initiatives from the grey literature. Included articles were categorised according to the six strategic directions in the NSW Aboriginal Oral Health Plan. Four studies were related to the first strategic direction, six related to strategic direction two, four related to strategic direction three, six initiatives related to strategic direction four, five related to strategic direction five, and eight related to strategic direction six. While there has been significant progress in achieving the strategic directions of the NSW Aboriginal Oral Health Plan, there is scope for continued collaboration between oral health service providers, universities and Aboriginal communities to improve oral health outcomes for Aboriginal people in NSW.

A correction in the paper by Lazo et al. [(2021). J. Synchrotron Rad. 28, 1649–1661] is made.

With the recent developments in microcrystal handling, synchrotron microdiffraction beamline instrumentation and data analysis, microcrystal crystallography with crystal sizes of less than 10 µm is appealing at synchrotrons. However, challenges remain in sample manipulation and data assembly for robust microcrystal synchrotron crystallography. Here, the development of micro-sized polyimide well-mounts for the manipulation of microcrystals of a few micrometres in size and the implementation of a robust data-analysis method for the assembly of rotational microdiffraction data sets from many microcrystals are described. The method demonstrates that microcrystals may be routinely utilized for the acquisition and assembly of complete data sets from synchrotron microdiffraction beamlines.

This paper presents the findings of the National Fluoride Varnish Workshop in 2018 along with subsequent actions to scale-up the use of fluoride varnish nationally in Australia. The use of fluoride varnish programs to prevent dental caries in high-risk child populations is an evidence-based population health approach used internationally. Such programs have not been implemented at scale nationally in Australia. A National Fluoride Varnish Consensus Workshop was held in Sydney in November 2018 with an aim of sharing the current work in this area being undertaken by various Australian jurisdictions and seeking consensus on key actions to improve the scale-up nationally. Forty-four people attended the Workshop with oral health representatives from all Australian state and territory health departments, as well as the Australian Dental Association (ADA) at both NSW branch and Federal levels. There was strong support for further scale-up of fluoride varnish programs nationally and to see the wider use of having non-dental professionals apply the varnish. This case study identifies key actions required to ensure scale-up of systematic fluoride varnish programs as part of a strategic population oral health approach to preventing dental caries among high-risk children who may not routinely access dental care.

The aim of this review was to assess relevant global literature on capped-fee (CF) and fee-for-service (FFS) payment models as used by public dental services. Research data were assessed through the PRISMA check list and sourced from MEDLINE, PubMed, ProQuest, Cochrane Library, and other methods. The inclusion criteria were peer reviewed articles published between 2004 and 2020 and (i) other countries’ health systems that were evaluated in contrast to Australia; (ii) care provided to individuals; (iii) payment models for private services that were the same as Australian government policy (CF and FFS); and (iv) care provided by dentists. We used a mixed methodology for data collection. A total of 262 references were reviewed with 10 references meeting the inclusion criteria with the quality rating being: three—strong, six—moderate, and one—weak. The literature included studies from Sweden (three references), Ireland (three references), United Kingdom (six references), United States of America (two references), and Norway (one reference). Four references included studies within multiple countries. The sample size varied between 20 and 106,874 participants. The two payment systems can impact on individual outcomes, such as by overtreatment in an FFS system and undertreatment in a CF system.

(1) Background: Genomic precision medicine (PM) utilises people’s genomic data to inform the delivery of preventive and therapeutic health care. PM has not been well-established for use with people of Aboriginal and Torres Strait Islander ancestry due to the paucity of genomic data from these communities. We report the development of a new protocol using co-design methods to enhance the potential use of PM for Aboriginal Australians. (2) Methods: This iterative qualitative study consists of five main phases. Phase-I will ensure appropriate governance of the project and establishment of a Project Advisory Committee. Following an initial consultation with the Aboriginal community, Phase-II will invite community members to participate in co-design workshops. In Phase-III, the Chief Investigators will participate in co-design workshops and document generated ideas. The notes shall be analysed thematically in Phase-IV with Aboriginal community representatives, and the summary will be disseminated to the communities. In Phase-V, we will evaluate the co-design process and adapt our protocol for the use in partnership with other communities. (3) Discussion: This study protocol represents a crucial first step to ensure that PM research is relevant and acceptable to Aboriginal Australians. Without fair access to PM, the gap in health outcome between Aboriginal and non-Aboriginal Australians will continue to widen.

Objective: This study investigated the delivery of paediatric (0-17 years) government dental services in New South Wales (NSW), Australia through public dental clinics and the commissioned payments models of Fee-for-Service and Capped-Fee. Method: De-identified patient data from government provided dental care and the commissioned services was sourced from NSW Oral Health Data Warehouse for evaluation and interpretation using descriptive analysis during the period 1 January 2012 to 31 December 2013. Result: The breakdown of dental care provided the associated cost analysis for the study’s cohort that resulted in both years, more than 50 percent dental services offered to paediatric patients were preventive care in all payment systems. The most common preventive items offered were fluoride treatment, dietary advice, oral health education and fissure sealants. Conclusion: There was little difference in the mix of dental care provided between study years and age groups through the three payment systems in NSW. The difference between the government services and those provided via the Fee-for-Service and Capitation payment systems was negligible. This has important implications for the delivery of dental care to public dental care, particularly when patients may not live close to a public dental clinic and also with the interest nationally in giving patients greater choice.

Abstract Objective: To investigate the potential social and behavioural risk factors influencing the oral health of teenagers aged 14 and 15 years living in New South Wales Australia. Methods: Quantitative and qualitative methodologies were used in this research project. Data were obtained from both the clinical and questionnaire components of the NSW Teen Dental Survey 2010 and were analysed in SAS 9.2. The analyses allowed for various demographic and behavioural risk factors to be assessed using caries experience, severe caries and DMFT (decayed, missing or filled teeth) counts as the key outcome variables. Results: Of the 1,256 14– and 15‐year‐olds who had a dental examination, 1,199 (95.5%) provided questionnaire data. The clinical examinations found that 44.4% of teenagers overall had caries experience in at least one tooth, while 10.6% of the sample had experienced severe caries. Severe dental caries was found to be significantly related to a variety of factors, including family income, fluoridation status, tooth brushing behaviour and sugary drink consumption. Conclusions: The oral health of 14– and 15‐year‐olds in NSW is influenced by social and dietary factors as well as access to fluoridated water supplies. There was also a strong relationship between self‐rated oral health status with DMFT and with caries experience. Implications: The findings of this study will assist policy makers by highlighting the current caries risk factors that should be part of future health promotion programs.

Ewing’s sarcoma is a common bone tumour of childhood but is a rare occurrence in individuals over 20 years of age. Few cases are reported as originating from peripheral nerves. We present an unusual case of extraosseous Ewing’s sarcoma originating from the sciatic nerve in a 66-year-old patient which had the clinical hallmarks of a benign nerve sheath tumour. Following discussion at a multidisciplinary meeting, excision biopsy of the suspected benign nerve sheath tumour was planned. At operation, the mass had malignant features. Histology confirmed the presence of Ewing’s sarcoma. Due to the morbidity of nerve resection, radiotherapy and chemotherapy were commenced. Ewing’s sarcoma is known to mimic benign pathologies. In this case there were subtle signs of a malignant process in the form of unremitting pain. It is vital to keep in mind the less common tumours that can affect the peripheral nervous system in such cases.

Granular Cell Tumours are rare mesenchymal soft tissue tumours that arise throughout the body and are believed to be of neural origin. They often present as asymptomatic, slow-growing, benign, solitary lesions but may be multifocal. 1-2% of cases are malignant and can metastasise. Described series in the literature are sparse. We identified eleven cases in ten patients treated surgically and followed-up for a period of over 6 years in our regional bone and soft tissue tumour centre. Five tumours were located in the lower limb, four in the upper limb, and two in the trunk. Mean patient age was 31.2 years (range 8–55 years). Excision was complete in one case, marginal in five cases and intralesional in five cases. No patients required postoperative adjuvant treatment. Mean follow-up was 19.3 months (range 1–37 months). One case was multifocal, but there were no cases of local recurrence or malignancy. Histopathological and immunohistochemical analysis revealed the classical granular cell tumour features in all cases. We believe this case series to be the largest of its type in patients presenting to an orthopaedic soft tissue tumour unit. We present our findings and correlate them with findings of other series in the literature.

Abstract Very little is known about the dormice of Africa south of the Sahara, even their current classification is suspect. This paper summarises the information available in the literature on the four (probable) species of dormouse found in southern Africa. Mean body masses are approximately >55 g, 50 g, 27 g and Graphiurus ocularis, G. platyops, G. murinus, and G. parvus respectively. All four species are silver-grey dorsally and buffy-white ventrally with varying degress of black around the eyes. G. ocularis and G. platyops prefer rocky hillsides and koppies while G. murinus and G. parvus are primarily arboreal. Breeding in southern Africa is probably limited to the warm, wet summer months with a normal litter size of three or four and one or two litters per year. At least in G. ocularis breeding pairs appear to be territorial. Torpor can be induced in individuals in captivity but the use and extent of hibernation in the wild depends on local climatic conditions. G. ocularis seems to be purely carnivorous while the other three species are omnivores. Riassunto I Mioxidi del Sud Africa - Molto poco è conosciuto sui mioxidi dell'Africa a sud del Sahara, persino la loro classificazione attuale è dubbia. Nel presente lavoro vengono riassunte le informazioni disponibili in letteratura sulle quattro (probabili) specie di mioxidi del Sud Africa. I pesi corporei medi sono approssimativamente superiori a 55 g, 50 g, 27 g ed inferiori a 27 g in Graphiurus ocularis, G. platyops, G. murinus e G. parvus rispettivamente. Tutte e quattro le specie presentano una colorazione grigio-argentea dorsalmente e bianco-marrone ventralmente con gradi variabili di nero intorno agli occhi. G. ocularis e G. parvus sono essenzialmente arborei. La riproduzione in sud Africa è probabilmente limitata ai caldi e umidi mesi estivi con una o due figliate per anno, costituite da tre o quattro piccoli. Almeno in G. ocularis le coppie riproduttive sembrano essere territoriali. I1 torpore può essere indotto in individui in cattività ma l'uso ed il grado di letargo in condizioni naturali dipendono da condizioni climatiche locali. G. ocularis sembra essere esclusivamente carnivoro mentre le altre tre specie sono onnivore.

CDATA96. Available from: Australian Bureau of Statistics, St Andrew's House, Sydney Square, Sydney, NSW 2000. Phone (02) 92684634, fax (02) 92684100. $9000 for New South Wales data and a Maplnfo® 4.12 Licence (additional states data costs extra).