Ankle foot orthoses (AFOs) and foot orthoses (FOs) are 2 commonly prescribed lower limb orthoses. Traditionally produced using artisanal methods, the design and manufacture of these devices have increasingly used computer-aided design (CAD) and computer-aided manufacturing technologies in recent decades. The CAD workflows can vary considerably, making generalization of research findings difficult. In this scoping review, research studies of any design that reported using CAD to produce designs for AFOs or FOs were eligible for inclusion. The review was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Six electronic databases were searched till December 2024. Seventy-three articles were included in this review. A wide range of CAD programs was used to produce orthotic devices; however, the procedures and reproducibility of the design processes were poorly or not at all described in 46.6% of the included articles. A mix of general-purpose and orthotic-specific CAD software was recorded, with SolidWorks and Rhinoceros being the most popular options. OrthoModel and Rodin4D were the most reported currently available orthotic-specific CAD software for FOs and AFOs, respectively. The CAD operation time for general-purpose software was generally longer than that for orthotic-specific ones. In addition, we have developed a checklist to assist in standardizing and ensuring reproducibility of FOs and AFOs studies. Researchers, clinicians, and those in industry need to exchange their knowledge to help address real-world need, enhance CAD functionalities, and support CAD programs in clinical studies.

Severe dilated cardiomyopathy in children may uncommonly be caused by abnormal loading conditions such as mid-aortic pathology and renal artery stenosis. Refractory hypertension and left ventricular dilatation with hypertrophy are important clues to reversible causes. We present a case of dilated cardiomyopathy in a child secondary to mid-aortic syndrome with renal artery stenosis.

To evaluate growth and body composition at NICU discharge in term-born neonates with structural congenital anomalies and identify predictors of body fat percentage. This prospective observational study included 61 term neonates (≥ 37 weeks' gestation) with cardiac or non-cardiac congenital anomalies requiring surgery. Anthropometric measures at birth and discharge and body composition at discharge were measured. Mean z-scores declined significantly between birth and discharge for weight (-0.38 to -1.53), length (-0.02 to -0.64), and head circumference (-0.04 to -0.79) (all p < 0.001). Infants with congenital heart disease demonstrated a more pronounced weight z-score decline. At discharge, mean body fat was 9% (SD 4.9), with no significant differences between cardiac and non-cardiac anomalies or sexes. Fat-free mass was relatively preserved (91%, 910 g/kg). Multivariate analysis identified time of full enteral feeds (p = 0.02) and maternal ethnicity (p = 0.03) as independent predictors of body fat. Term neonates with congenital anomalies experience significant postnatal growth restriction and reduced fat mass by NICU discharge. Maternal ethnicity and time to full enteral feeds independently influence body fat percentage. These findings support the need for individualised nutrition and routine body composition monitoring to optimise outcomes in this high-risk group.

Background.Globally, deceased donor kidney allocation algorithms prioritize HLA matching, potentially disadvantaging transplant candidates with less common HLA alleles. This study developed an Australian Matchability score (M-score) to assess access to transplantation and posttransplant outcomes based on HLA match probability.Methods.M-scores were calculated by comparing all recipients and donors with complete HLA-A, HLA-B, and HLA-DR data from the Australia and New Zealand Dialysis and Transplant Registry (July 1, 2006–December 31, 2023). Multivariable Cox regression was used to analyze associations between M-score quartiles and time to transplantation as well as transplantation outcomes.Results.HLA data from 14 836 recipients and 7708 donors were used to generate M-scores. Of these, 10 760 recipients had available waitlist data and were included in the models. M-scores were normally distributed with a mean ± SD of 11.4 ± 0.9. The proportion of non-European Australians increased significantly with each quartile (ie, more difficult to HLA match), Q1: 16%, Q2: 26%, Q3: 40% Q4: 60% (P < 0.001). Compared with Q1, patients in Q4 were significantly less likely to receive a deceased donor kidney transplant (adjusted hazard ratio [aHR] 0.56; 95% confidence interval [CI], 0.52-0.60; P < 0.001) had the highest risk of death-censored graft loss (aHR 1.39; 95% CI, 1.01-1.91; P = 0.05) and acute rejection (aHR, 1.29; 95% CI, 1.09-1.52; P = 0.002).Conclusions.The M-score identifies transplant recipients with difficult-to-match HLA profiles. Higher M-scores were associated with a lower likelihood of transplantation and an increased risk of death-censored graft loss and acute rejection. These findings highlight significant inequities in the current HLA-based algorithm for deceased donor allocation.

To estimate the risk of death after hospitalisation with non-fatal intentional self-poisoning in New South Wales, and to estimate the associated number of years of life lost. Retrospective observational study; analysis of Poisoning And enVenomation Linkage to evaluate Outcomes and clinical Variation in Australia (PAVLOVA) study data. All index admissions to New South Wales public and private hospitals of people after non-fatal intentional self-poisoning (ie, were discharged from the index admission alive), 1 January 2011 - 30 September 2020. Standardised mortality ratio (compared with general population mortality rate; SMR), overall, and by cause of death (data available only for 2011-2018); years of life lost (YLL) overall, and by cause of death (2011-2018), age group, and sex. Index admissions of people with non-fatal intentional self-poisoning were identified for 48 951 people; their median age was 32.8 years (interquartile range [IQR], 20.8-47.5 years), 30 274 were girls or women (61.8%), and 3449 died during follow-up (median, 4.9 years; IQR, 2.7-7.3 years). The all-cause SMR was 3.1 (95% confidence interval [CI], 3.0-3.2); by cause of death, the SMR was highest for external cause deaths (16.8; 95% CI, 15.9-17.8), including accidental poisoning (30.3; 95% CI, 27.4-33.2) and suicide deaths (25.1; 95% CI, 23.2-27.1). Among natural causes of death, the SMR was highest for infectious and parasitic diseases (5.4; 95% CI, 3.9-6.8), digestive diseases (4.2; 95% CI, 3.4-5.0), and respiratory diseases (3.0; 95% CI, 2.5-3.4). The estimated overall premature mortality burden was 110 301.4 YLL; the median value per death was similar for women (31.1 YLL; IQR, 15.0-43.0 YLL) and men (33.2 YLL; IQR, 19.7-44.9 YLL). During 2011-2018, the total mortality burden was 79 821.6 YLL; by cause of death, the major contributors were deaths from suicide (26 945.2 YLL; 33.8%), accidental poisoning (17 436.1 YLL; 21.8%), other injuries (6026.8 YLL; 7.5%), and natural causes (29 413.5 years; 36.8%). The risk of death is markedly higher after hospitalisation with intentional self-poisoning than for the general population, but suicide deaths only cause about one-third of the mortality burden in terms of lost years of life; deaths from accidental poisoning and natural causes are also major contributors. Referrals to specialist psychiatric and physical health care and brief interventions for treating psychiatric and substance use conditions are appropriate after hospitalisation with intentional self-poisoning.

ObjectiveAutistic children’s ability to access mental health services can be challenging due to the limited availability of therapists with autism experience, service ineligibility, and financial strain. This systematic review evaluated and synthesized literature regarding the impact of government policy levers on the access to, and utilization of, mental health services by Autistic children and their families.MethodInterdisciplinary databases together with gray literature and supplementary searches were used to identify relevant articles. Peer-reviewed, English language studies which reported on the impact of government policy levers on the utilization of, and access to, mental health services by Autistic children and their families were included.ResultsSearches resulted in the identification of 2305 articles (database searches = 744, additional searches = 1531), six of which were included in the final review. All six articles were from the United States of America, published between 2013 and 2020, with a focus on national and state regulatory policy levers targeting insurance companies. Results indicated that most policy levers did not improve service access to, or utilization of, mental health services. Gray literature searches identified that several countries had implemented autism specific policy levers, most however had not been evaluated regarding their impact on mental health service access and utilization by Autistic children or their families.ConclusionThe majority of identified policy levers have not resulted in greater utilization or access of mental health services for Autistic children or their families. More global research, focusing on datasets that have allowed policies time to impact change, is needed.

The 2017 Paediatric Research in Emergency Departments International Collaborative (PREDICT) Bronchiolitis Knowledge Translation (KT) Study, a cluster randomised trial in 26 Australasian hospitals, found targeted interventions provided over one bronchiolitis season effectively de-implemented five low-value practices (salbutamol, glucocorticoids, chest radiography, antibiotics and epinephrine) by 14.1% (adjusted risk difference, 95% CI 6.5% to 21.7%; p<0.001). A 2-year follow-up study found de-implementation was sustained. This process evaluation aimed to identify factors that influenced sustainability of de-implementation of these five low-value practices in PREDICT Bronchiolitis KT Study intervention hospitals and examine fidelity and/or adaptation of the targeted interventions over 4 years post intervention delivery (sustainment). Semistructured qualitative interviews were conducted, over 2021 and 2022, with a purposive sample of emergency department (ED) and paediatric inpatient clinicians. Data were analysed thematically into facilitators and barriers using the Consolidated Framework for Sustainability Constructs in Healthcare (CFSCH). The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies was used to explore fidelity and adaptation. 50 clinicians (nurses: n=26; doctors: n=24) from 12 intervention hospitals were interviewed. Eight themes were identified and mapped to three CFSCH domains: (1) organisational setting; (2) initiative design and delivery and (3) people involved. Facilitators were a culture of evidence-based practice, ongoing multimodal education, strong clinical leadership as unofficial champions and the previous effectiveness of the PREDICT Bronchiolitis KT Study interventions. Barriers were lack of paediatric trained ED staff, assumptions by senior clinicians that junior doctors can provide evidence-based bronchiolitis management, bronchiolitis not a current improvement priority and lack of bronchiolitis education sessions. Use of the targeted interventions reduced over time and, when used, was adapted locally. This study provides insights into factors influencing the sustainability of de-implementation of low-value care in acute care settings. Fostering an evidence-based practice culture, supported by senior leadership and ongoing multimodal education, supports sustainability of improvements in this setting. Australian and New Zealand Clinical Trials Registry No: ACTRN12621001287820.

Abstract Background Joubert Syndrome (JS) is a rare autosomal recessive neurodevelopmental disorder, characterised by hypotonia, developmental delay, and a “molar tooth sign” on MRI brain. Sleep disordered breathing (SDB) is common, although referral for polysomnography (PSG) is variable. The aim of this study was to collate overnight PSG results from a series of patients with JS, and monitor the pattern of SDB over time. Methods A retrospective analysis of children with JS in a tertiary paediatric hospital from 2010-2025. Progess to date Twenty-one children (16 males) with confirmed JS were identified during the study period. Fourteen had PSGs, at a median age of 4 years (1mo – 10 years), while 11 had repeat PSGs at a median age of 5 years. Genetic sequencing has been performed in 18. Initial and repeat PSGs have been analysed. The mean initial AHI was 9.4 events/hr, compared to 7.2 events/hr in the repeat. The mean OAHI in initial studies was 5.4 events/hr compared to 2.2 events/hr in repeat studies. Six children received treatment between studies, including adenotonsillectomy, non-invasive ventilation, or a combination of both. Objective improvement was seen in 7 children, while 3 had stable but persisting SDB. SDB worsened in 1 child. Intended outcome and impact Children with JS show a range of SDB, ranging from normal PSGs, to those showing severe OSA requiring varying levels of intervention. Patients with JS would benefit from serial PSGs during childhood, although not all are referred for sleep assessment. More awareness is required to ensure these children get adequate monitoring.

Abstract Behavioural sleep problems are highly prevalent in children with neurodisability (ND) and can severely impact daytime function and family wellbeing. Management strategies are extrapolated from neurotypical populations and may not address the complex needs of children with ND. This study describes the development and pilot testing of a behavioural sleep intervention tailored for children with ND, aiming to determine feasibility and acceptability prior to use in a randomised controlled trial. A tailored behavioural sleep program for children with ND was developed using a collaborative framework that incorporated consumer and stakeholder consultation. Stakeholders included allied health professionals, paediatric sleep nurses and sleep specialists. The final program prototype was piloted with eight caregivers of children with ND recruited from a tertiary sleep clinic. Caregivers received the intervention through two psychologist led telehealth sessions. The intervention program comprised two sessions (1) Sleep Foundations and (2) Sleep Strategies and Relapse Prevention. Within pilot testing, Child Sleep Habits Questionnaire total scores reduced by 10%, 4 weeks after program completion. Greatest improvements were observed in sleep onset delay (22%), sleep duration (14.8%) and sleep anxiety (13.9%) subscales. Acceptability and feasibility of the program was high (84%). Parents found the program valuable, relevant and appropriately tailored for their child’s needs. This study demonstrates the use of a collaborative framework with consumer and stakeholder consultation to develop a tailored behavioural sleep program for children with ND. Pilot results show promise for efficacy of this intervention which is being evaluated in a multi-centre randomised controlled trial.