Background: Adolescents with obesity participate in self-directed weight loss attempts, and these may be associated with disordered eating. This study aimed to understand prior engagement with a dietitian and previous dieting practices of adolescents presenting for obesity treatment. Additionally, we aimed to understand the association between prior dieting and eating disorder risk, binge eating, weight bias internalisation and body image. Methods: This cross-sectional study included 141 adolescents (median [IQR] age: 14.8 [13.8–15.7] years) with BMI 35.28 (31.99–38.57) kg/m2 and ≥1 related complication presenting for a prescriptive dietary intervention. Adolescents were asked whether they had previously seen a dietitian (yes/no) and/or previously trialled any other diets for weight management. Associations between reported diets and the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale, the Weight Bias Internalisation scale and Body Appreciation Scale scores were assessed using multiple one-way ANOVAs. Results: A total of 68 (48.2%) adolescents had previously seen a dietitian and 106 (75.2%) had trialled at least one diet. Most adolescents had used one diet type (n = 74; 52.5%), and 29 (20.6%) had used two or three different diets. Most adolescents reported following a healthy eating pattern (n = 76; 53.9%), with 11 trying a low-carbohydrate diet (7.8%) or a specific eating plan, e.g., low sugar, vegetarian (n = 11; 7.8%). There were no associations between dieting attempts and scores of measures of disordered eating, weight bias or body appreciation. Conclusions: Many adolescents presenting for obesity treatment will have trialled diets, with or without the support of a dietitian. Clinicians providing nutrition education and prescribing dietary interventions should be aware of this and the potential influence on adolescent perceptions of dieting practices.

The COVID-19 pandemic resulted in high mortality rates in immunocompromised people, especially those who have received solid organ transplants. In this cohort of 540 transplant recipients who received tixagevimab/cilgavimab (Evusheld®) in Australia and New Zealand between January 2022 and January 2023, 11 (2%) Evusheld®-treated recipients experienced moderate to severe COVID-19 infection, with two deaths from COVID-19 pneumonitis. Less than 0.5% experienced adverse events from Evusheld®. Prophylactic monoclonal antibody therapy may be considered an important adjunct to vaccination among immunocompromised patients to prevent severe infection during future viral outbreaks.

To describe the frequency and nature of non-pharmacological de-escalation methods used for children and adolescents presenting to emergency departments (EDs) with acute severe behavioural disturbance (ASBD). Secondary analysis of a randomised, controlled, open-label, multicentre trial of oral olanzapine versus oral diazepam for the management of ASBD. Nine EDs in Australia between October 2021 and November 2023. Children aged 9-17 years, for whom information on non-pharmacological de-escalation attempts was recorded, who ultimately required oral sedative medication to manage their ASBD. The frequency and nature of the use of non-pharmacological de-escalation methods for children and adolescents presenting to EDs in a state of ASBD. There were 348 participants enrolled in the randomised controlled trial. This study reports on the 337 of 348 participants (97%) for whom information was recorded regarding non-pharmacological de-escalation attempts during the trial period. Verbal de-escalation was the most commonly attempted technique (96%) followed by active listening (75%). The frequency and nature of de-escalation techniques used were similar across the nine participating sites. A variety of non-pharmacological de-escalation strategies are used among patients who require oral sedative medication. There is a need for studies to investigate whether there are optimal first-line de-escalation strategies and to determine their effectiveness and order of use in children and adolescents presenting to EDs with ASBD.

Abstract Introduction: The ZERO Childhood Cancer Program is Australia’s national precision medicine initiative for children with cancer. Through rapid integration of tumor and germline whole genome sequencing (WGS), RNA-seq, and methylome analysis, ZERO aims to determine the precise molecular diagnosis for every child and inform precision-guided treatment. We present updated findings from 764 consecutively enrolled high-risk patients, highlighting the diagnostic utility of multi-omics profiling and its unique insights into pediatric cancer biology. Methods: Tumor and germline WGS, RNA-seq, methylome and microbial analysis were performed using in-house Graphene, Carbonite, Methyliser and Micrite platforms. CNS tumors and sarcomas were classified using the MNP methylation classifier. Leukemias were classified using RNA-seq classifiers: LSC17, ALLSorts, and in-house tools. Integrated data were reviewed via the ZeroDash platform, with molecular reports issued within 4 weeks and therapeutic recommendations within 8 weeks following national tumor board discussion. Results: We identified genetic driver alterations in 95% of cases, including 912 SNVs/indels, 738 copy number variants, and 401 structural variants (SVs). Canonical drivers such as EWSR1 and PAX3 fusions in sarcomas, and TP53 and H3-3A mutations in CNS tumors were among the most frequently altered genes. Strikingly, 29% of reportable SVs were intragenic, disrupting gene structure & typically missed by clinical testing. RNA-seq validated >90% of these, revealing novel isoforms, aberrant splicing, or loss of expression. Among 78 complex SVs, including genome shattering events, multi-hop rearrangements, and paralogous gene fusions, RNA-seq resolved their transcriptional consequences, supporting assessment of pathogenicity and identified 10 missed by WGS. The MNP classifier provided a matching diagnosis in 93% of CNS tumors and 82% of sarcomas, resolving diagnostically ambiguous cases. RNA-based classifiers refined subtype classification in >75% of leukemias. In AML, stratification using LSC17 scores identifies an ultra-high-risk group with a hazard ratio of 0.18 compared to the least adverse group, indicating they are five times more likely to die. Among the 40 tumors with no reportable findings, 30 had low (<20%) tumor purity. Interestingly, 13% of these cases showed evidence of Epstein-Barr virus (EBV) infection, suggesting a possible viral etiology in a subset of undiagnosed tumors. Retrospective review of the 10 high purity samples identified the driver in 9 leaving only a germ cell tumour without a known driver. Conclusions: Multi-omics profiling provides a detailed molecular view of high-risk childhood cancers, with each platform offering complementary insights. WGS captures genomic alterations, RNA-seq detects all mutation types and informs pathogenicity, and methylome analysis supports classification. Together, these approaches maximize diagnostic yield, refine risk stratification, and guide treatment. This strategy has enabled ZERO’s expansion to all children with cancer across Australia. Citation Format: Chelsea Mayoh, Pamela Ajuyah, Ann Altekoester, Frank Alvaro, Paulette Barahona, Noemi Fuentes-Bolanos, Susan Corley, Lujing Cui, Ben Curran, Kimberly Dias, David D Eisenstat, Paul G Ekert, Raylene Endersby, Christian Fares, Jamie Fletcher, Emmy DG Fleuren, Andrew Gifford, Nicholas G Gottardo, Jordan Hansford, Sophie Jessop, Sam El-Kamand, Seong-Lin Khaw, Rishi S Kotecha, Loretta MS Lau, Angela Lin, Richard B Lock, Neevika Manoharan, Glenn M Marshall, Marion Mateos, Geoffrey McCowage, Andrew S Moore, Sumanth Nagabushan, Wayne Nicholls, Natacha Omer, Luciana Dalla Pozza, Peter Priestley, Dong-Anh Khuong Quang, Megan Rumford, Akanksha Senapati, Charles Shale, Ashleigh Sullivan, Patricia Sullivan, Kamile Taouk, Toby N Trahair, Marie Wong-Erasmus, Paul J Wood, David S Ziegler, Vanessa Tyrrell, Michelle Haber, Mark J Cowley. Precision Diagnosis in High-Risk Pediatric Oncology through Integrated Whole Genome, Transcriptome, and Epigenome Profiling [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Discovery and Innovation in Pediatric Cancer— From Biology to Breakthrough Therapies; 2025 Sep 25-28; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2025;85(18_Suppl_2):Abstract nr A002-PR011.

The correction of microtia, whether isolated or associated with other facial malformations, follows the same fundamental principle: sculpting a framework from autologous costal cartilage to replicate the contours of the normal ear and covering this framework with skin using the available local tissue. Cartilage carving can be mastered with training and continually refined through self-assessment. However, the skin coverage technique must be mastered from the outset, as complications at this stage can lead to poor outcomes that are difficult to correct. It is therefore essential to have a clear vision of the overall strategy, as well as its precise application to each individual case. Over the past 40 years and with more than 3000 cases operated on, Françoise Firmin and later myself, have encountered all the challenges and explored the solutions to address them. In this "How I do it?" article, the authors aim to share this experience, which will hopefully help to accelerate the learning curve.

Asthma affects > 10% of children in Australia and New Zealand (NZ), with up to 5% of those having severe disease, presenting a management challenge. We aimed to survey tertiary paediatric respiratory services across Australia and NZ using a custom-designed questionnaire, to conduct a cross-sectional observational study of the numbers of children with problematic severe asthma (PSA) seen, the number treated with biologic therapy, outpatient clinic/multidisciplinary team (MDT) services available, investigations and tools routinely used and approaches utilised for transition to adult care. A custom-designed online survey was distributed via email to Directors of public paediatric respiratory services across Australia and NZ (n = 14). Reminders to prompt completion were emailed regularly over 3 months. All sites provided survey responses. The estimated number of children with PSA across 12 sites was 561 (53 prescribed biologic treatment); two sites felt unable to provide accurate estimations. Most sites (n = 8) did not have a MDT approach either as MDT clinics or meetings; patients were managed in either asthma (n = 7, 50%) or general respiratory clinics. Most sites (85%) utilised questionnaires regarding asthma control for assessment, although some utilised additional questionnaires. Remaining tools and investigations varied widely across centres. Only four sites (29%) had established processes for transition to adult care. Given notable heterogeneity in service availability and PSA management across tertiary sites, children may experience variability in care dependent on their location. Most centres lack MDT models of care, which are considered the international best-practise standard for management of children with PSA.

Life participation has been identified as a critically important core outcome to be reported in all trials in people receiving peritoneal dialysis (PD). Life participation is defined as the ability to participate in meaningful activities such as work (e.g. employment, housework, study), family, social (e.g. time with friends) and leisure (travel, hobbies, exercise) activities. However, life participation is rarely and inconsistently reported in trials in PD. The standardised outcomes in nephrology-life participation (SONG-LP) instrument was validated in adult kidney transplant recipients and demonstrated internal consistency and test-retest reliability. In this article, we outline the rationale and process for validating the SONG-LP instrument in people receiving PD.