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Background and aim: The QASC Europe project significantly improved nurse-initiated management of fever, hyperglycaemia (sugar) and swallowing (FeSS) in European stroke units with vastly different health care systems. We examined pre-post country management using the 2021-2022 World Bank income classifications. Method(s): This pan-European pre-test/post-test study (2018-2021) collected data at baseline and three months after FeSS protocol implementation. Clinical champions conducted multidisciplinary workshops to feedback baseline audit data, provided education, and identified barriers to protocol implementation. Outcomes were adjusted for age, sex, NIHSS and for clustering by site and country. The interaction between country classification (high income countries [HIC] vs middle income countries [MIC]) and time (pre/post) tested differences in proportions. Result(s): Pre-implementation data were analysed from 76 hospitals in 18 countries (eight HIC, ten MIC) (n=3999 patients); and post-implementation from 64 hospitals in 17 countries (seven HIC and the same ten MIC) (3257 patients). Significant pre-to-post improvements were made in both HIC and MIC (Adjusted difference in proportion HIC:(24% (16%,33%), MIC:(25% (15%,34%)). Post-implementation FeSS Protocol adherence were broadly similar between HIC and MIC. There was no difference in post-implementation overall FeSS Protocol adherence between HIC and MIC (p=0.8909). Conclusion(s): Our nurse-initiated intervention was highly effective in improving stroke management in all countries irrespective of their income level classification. The clinical significance of these improvements in MIC is noteworthy in that many of these hospitals have limited access to stroke care including acute reperfusion therapies. Upscaling of effective stroke interventions is essential to improving stroke care globally.

Appropriate inspection protocols and mitigation strategies are a critical component of effective biosecurity measures, enabling implementation of sound management decisions. Statistical models to analyze biosecurity surveillance data are integral to this decision-making process. Our research focuses on analyzing border interception biosecurity data collected from a Class A Nature Reserve, Barrow Island, in Western Australia and the associated covariates describing both spatial and temporal interception patterns. A clustering analysis approach was adopted using a generalization of the popular k-means algorithm appropriate for mixed-type data. The analysis approach compared the efficiency of clustering using only the numerical data, then subsequently including covariates to the clustering. Based on numerical data only, three clusters gave an acceptable fit and provided information about the underlying data characteristics. Incorporation of covariates into the model suggested four distinct clusters dominated by physical location and type of detection. Clustering increases interpretability of complex models and is useful in data mining to highlight patterns to describe underlying processes in biosecurity and other research areas. Availability of more relevant data would greatly improve the model. Based on outcomes from our research we recommend broader use of cluster models in biosecurity data, with testing of these models on more datasets to validate the model choice and identify important explanatory variables.

Background and Aim: Assisted implementation of FeSS protocols following stroke significantly reduces 90-day death and disability and longer-term mortality. The QASC Europe project, a novel international collaboration between: Nursing Research Institute (NRI); European Stroke Organisation; Angels Initiative; and Registry of Stroke Care Quality (RES-Q) facilitated implementation of nurseinitiated Fever, hyperglycaemia (Sugar) and Swallowing (FeSS) protocols into stroke units across Europe. Method(s): A multi-country, multi-centre pre-test/post-test study was conducted (2017-2021). Baseline and post-implementation data (3-months after FeSS protocol introduction) were entered into RES-Q. Nursing clinical champions, with support from the Project team (European Liaison Officer, Angels Consultants, Country Coordinators and the NRI) conducted multidisciplinary workshops identifying barriers and facilitators to protocol implementation and held education sessions. Outcomes were adjusted for clustering by country and hospital controlling for age/sex/NIHSS. Result(s): At baseline, 76 hospitals in 18 countries (n=4196 patients); and post-implementation, 64 hospitals in 17 countries (3348 patients) participated (Total n=7544). There were improvements in: temperature monitoring on day of admission (Pre: 43%; Post: 79%, p<0.00001); treatment of fever >37.5degreeC with paracetamol within one hour (Pre: 57%; Post: 79%, p<0.00001); blood glucose monitoring on day of admission (Pre: 38%; Post: 75%, p<0.00001); treatment of hyperglycemia >10mmol/L with insulin within one hour (Pre: 59%; Post: 75%, p<0.00001); and swallow screening before food or fluids (Pre: 59%; Post: 83%, p<0.00001). Conclusion(s): This international collaboration has enabled the success of large-scale implementation of FeSS protocols into countries with vastly different health care systems. Similar partnerships should be considered for future translation of effective stroke interventions to reach a greater proportion

Background and Aims: The QASC Europe project significantly improved nurse-initiated management of: fever, hyperglycaemia (sugar) and swallowing (FeSS) in European stroke units with varying health care systems. We examined pre-post management for low-and-middle-income-countries (LMIC). Method(s): Data from this multi-site, multi-country, pre-test/post-test study (2018-2021) were collected at baseline and three months after FeSS protocol implementation. Clinical champions conducted multidisciplinary workshops to feedback baseline audit data results, provided education, and identified barriers to protocol implementation. Outcomes were adjusted for age, sex, NIHSS, country and within clustering by site. Result(s): Data were received from 76 hospitals in 18 countries (n=4196 patients); and post-implementation, 64 hospitals in 17 countries (3348 patients). 13 hospitals (pre-implementation, n=648 patients) and 9 hospital (post-implementation, n=444 patients) from six LMIC Significant improvements were achieved from pre-to-post implementation in LMIC for: monitoring of temperature at least four times on day three (26% vs 62%, p=0.018); venous blood glucose level (BLG) on admission (86% vs 98%, p=0.0256); BGL monitored four times/day on day of admission to stroke unit (51% vs 84%, p=0.001); swallow screen/assessment performed before oral medication (73% vs 94%, p=0.039); and swallow screen/assessment before being given oral food or fluid (76% vs 93%, p=0.007). Results from LMIC were broadly consistent with those from high-income countries. Conclusion(s): Our nurse-initiated intervention was highly effective in improving stroke outcomes in LMIC. While LMIC are known to have reduced thrombolysis rates, that they are providing comparable evidenced-based care for fever, hyperglycaemia and swallowing is noteworthy. Upscaling of effective stroke interventions is essential to improving stroke outcomes globally.

Biosecurity in Australia and globally is based on understanding and protection of our national health, economy, industries, and environment from the negative effects associated with invasive pests and pathogens. The biosecurity continuum includes pre-border preparedness, border protection and post-border management, eradication, and control. The biosecurity system in Australia aims to manage risks and reduce the likelihood and adverse consequences of pest and disease incursions on human, animal and plant health, the environment, and the economy. To identify biosecurity risks and solve pertinent issues in biosecurity, analysts must gather and collate information for multiple factors and from a variety of sources in areas including agriculture, the environment and public health. The amount and complexity of biosecurity data have exposed the limitations in traditional statistical methodologies in addressing issues in biosecurity management. Biosecurity surveillance data is challenging in terms of non-normality, over-dispersion and typically zero-inflated. This type of data follows a natural process rather than a pre-specified process or distribution models, and often contains a large proportion of zeros. Application of appropriate statistical models to analyse these unique data sets is essential to effective biosecurity decision-making. The data used throughout this thesis were typically characteristic of biosecurity data, containing a large proportion of zeros, non-normality, and over-dispersion. Data used were collected as part of a biosecurity program implemented on Barrow Island, a remote island off the western Australian coastline, prior to and during the development of an industrial project on the island. In the following research, the first step encompassed evaluation of a range of candidate statistical models for describing biosecurity border and post-border detection of terrestrial non-indigenous species. The dataset was fitted with a variety of models includi

Background: Total hip replacements (THA) done for intracapsular neck of femur fractures (NOF) have a dislocation rate of up to 14%. This is seven times higher than in THA done for osteoarthritis. Using a dual mobility cup (DMC) has been shown to be effective in addressing dislocation in elective THA. Our hypothesis is that the use of DMC in NOF will do the same. This study aims to determine the incidence proportion of dislocation of DMCs one year after surgery in patients who received THA for NOF and to compare it to dislocation rates as documented in existing studies. Methods: A retrospective study was done on 86 patients treated with DMC-THA for an intracapsular NOF fracture from 2012 until 2016. A minimum one-year follow-up period was required for inclusion into the study. The number of dislocations at one year after surgery were noted. Results: Forty-one patients with a mean age of 60,7 years were included (26 females and 15 males). All patients were operated via the posterior approach. None of the patients had dislocated after one year. Conclusion: Low dislocation rates can be achieved using DMC THA in the management of intracapsular NOF fractures. Our one-year dislocation rate of 0% compares favourably to conventional THA and is comparable to similar DMC studies done outside of South Africa.

Background: The aim of this study was to establish if the degree of deformity correction during total knee arthroplasty (TKA) has an influence on post-operative patient satisfaction. Patient and methods: This was a retrospective, descriptive analytical study of 180 patients that underwent an elective TKA using computer assisted software. Patients were divided into two groups according to the degree of deformity correction required to obtain a neutral mechanical axis: 3-degrees-andmore or less-than-3-degrees. Knee injury and Osteoarthritis Outcome Scores (KOOS) were collected at the pre-operative, 6 week and 1 year post-operative intervals. The mean KOOS scores were compared at each interval and the difference between mean KOOS scores were compared for the following intervals: pre-operative to 6 weeks postoperative; pre-operative to 1 year postoperative; 6 weeks to 1 year postoperative. Results: The pre-operative mean KOOS scores for the group of patients that required a 3-degree-andmore deformity correction were statistically higher than the group requiring less-than-3-degreedeformity correction. At 6 week and 1 year follow ups there was no statistical difference between the two comparison groups. With respect to mean KOOS score improvement between intervals, the group that required less than 3 degrees of deformity correction showed statistically significant improvement in symptoms for the pre-operative to 1 year follow up period. Conclusion: Results of the study showed that patients requiring a lesser correction of their malalignment do better after TKA.

INTRODUCTION: Cerclage cable systems are manufactured by different companies to assist in fracture reduction and fixation; their usefulness extends to various specialties, including trauma, tumour surgery and arthroplasty, especially in revision total hip replacements. Two types of systems exist, namely, monofilament and multifilament systems. Multifilament cables grip systems are reported to have good outcomes; however, these attractive fixation devices are not without complications, with a reported failure rate that ranges from 27% to 44%. Loosening is one the modes of failure that can occur intraoperatively, after clamp fixation, or postoperatively because of micro motion and displacement caused by soft tissue interposition and bone resorption. The aim of this study is to determine whether the initial force that is applied to the cylindrical structure reflects the value of the force indicated by the manufacturer of the tensioning device. METHOD: This is a descriptive study that was undertaken during January 2020 at the University of the Free State, Universitas Academic Hospital’s Department of Orthopaedics. A measuring device was manufactured to measure the true force exerted by the cable systems. The researcher used five different cerclage cable systems from different companies in order to evaluate the forces exerted by these systems. The measuring device had a cylindrical structure to which these forces we applied at four different sites. The force applied was measured and compared to the forces indicated by the manufacturer of the tensioning device. These values were recorded on the data collection sheet.RESULTS: Out of the five cable systems evaluated, only one cable system indicated the correct force at all four different sites. However the other four cable systems reflected higher forces on the tensioning device when the true measured forces were lower. Retensioning the cables more than twice caused fraying of the cables. CONCLUSION: The force applied to th