Australia And New Zealand Research Articles

Current practice, education and recommendations for training of central line insertion for trainees and fellows in adult intensive care units across Australia and New Zealand.

Central venous access device (CVAD) is a common procedure in ICU which, although generally safe, can lead to acute and delayed complications. Training and accreditation process for its insertion vary worldwide. The objective of this study was to explore variability in existing training and accreditation processes for central venous access device (CVAD) insertion among different intensive care units (ICU), current practices of CVAD insertion among fellows of the College of Intensive Care Medicine (CICM) working in Australia and New Zealand (ANZ) and their recommendations for improvement. A prospective cross-sectional web-based survey was sent through email and CICM e-newsletter to intensivists and directors of ICU across ANZ. All responses were tabulated, post-hoc exploratory analysis using multivariable ordinal logistic regression was used and free texts were analysed thematically and summarised. A total of 115 responses was received from various public and private ICU from all states of ANZ; 32% of the participants did not have any accreditation process for CVAD insertion skill in their ICU, whereas 91% of respondents revealed there were no processes to assess deskilling. Most intensivists recommended supervision, simulation, various education tools and ultrasound training to improve training and assessment. Thirty-five percent of the participants inserted 0-5 CVAD and more than half of the intensivists had inserted <10 CVAD in a 1-year period. Two-thirds of the respondents recommended inserting between 6 and 20 CVAD each year to maintain competence. The study identified wide variability in current practice, training methods and accreditation process for CVAD insertion among intensivists and ICU trainees in ANZ. Policy makers should consider revising the current clinical practice and training policies to new policies for accreditation and ongoing assessment for CVAD insertions across ANZ ICU.

Anti-Death Penalty Advocacy: A Lawyer’s View From Australia

This article reviews the executions of Australians in the region and the Australian responses over the past two decades. Informed by the author’s legal defence role in death penalty cases in Singapore and Indonesia, the article explores developments in anti–death penalty advocacy since 2015: the parliamentary enquiry, the ‘whole of government’ strategy led by the Department of Foreign Affairs and Trade and the efforts made by Australia and Australians in Asia.

Association Between Centralization and Outcome for Children Admitted to Intensive Care in Australia and New Zealand: A Population-Based Cohort Study.

To describe regional differences and change over time in the degree of centralization of pediatric intensive care in Australia and New Zealand (ANZ) and to compare the characteristics and ICU mortality of children admitted to specialist PICUs and general ICUs (GICUs). A retrospective cohort study using registry data for two epochs of ICU admissions, 2003-2005 and 2016-2018. Population-based study in ANZ. A total of 43,256 admissions of children aged younger than 16 years admitted to an ICU in ANZ were included. Infants aged younger than 28 days without cardiac conditions were excluded. None. The primary outcome was risk-adjusted ICU mortality. Logistic regression was used to investigate the association of mortality with the exposure to ICU type, epoch, and their interaction. Compared with children admitted to GICUs, children admitted to PICUs were younger (median 25 vs 47 mo; p < 0.01) and stayed longer in ICU (median 1.6 vs 1.0 d; p < 0.01). For the study overall, 93% of admissions in Australia were to PICUs whereas in New Zealand only 63% of admissions were to PICUs. The adjusted odds of death in epoch 2 relative to epoch 1 decreased (adjusted odds ratio [AOR], 0.50; 95% CI, 0.42-0.59). There was an interaction between unit type and epoch with increased odds of death associated with care in a GICU in epoch 2 (AOR, 1.63; 95% CI, 1.05-2.53 for all admissions; 1.73, CI, 1.002-3.00 for high-risk admissions). Risk-adjusted mortality of children admitted to specialist PICUs decreased over a study period of 14 years; however, a similar association between time and outcome was not observed in high-risk children admitted to GICUs. The results support the continued use of a centralized model of delivering intensive care for critically ill children.

Ventilator weaning and extubation practices in critically ill children: An Australian and New Zealand survey of practice

ObjectivesWe aimed to (i) describe current weaning and extubation practices in children (protocols to identify weaning candidates, spontaneous breathing trials, and other aspects of care such as sedation weaning) and (ii) understand responsibilities for ventilation weaning decisions across Australia and New Zealand (ANZ). MethodsA cross-sectional survey of ANZ intensive care units who routinely intubate and ventilate children (<18 years) was conducted. We worked with the Australian and New Zealand Intensive Care Society Paediatric Study Group to identify units and potential respondents (senior nurse representative per unit) and to administer questionnaires. Survey questions (n = 35) examined current protocols, practices, unit staffing, and decision-making responsibilities for ventilation weaning and extubation. Open-ended questions examined respondents' experiences of weaning and extubation. ResultsA senior nursing respondent from 18/22 intensive care units (82%) completed the survey. Across units, most used sedation assessment tools (88%), and less often, sedation weaning tools (55%). Spontaneous awakening protocols were not used; one unit (5%) reported the use of a spontaneous breathing protocol. Two respondents reported that ventilation weaning protocols (11%) were in use, with 44% of units reporting the use of extubation protocols. Weaning and extubation practices were largely perceived as medically driven, with qualitative data demonstrating a desire from most respondents for greater shared decision-making. ConclusionIn ANZ, ventilation weaning and extubation practices are largely medically driven with variation in the use of protocols to support mechanical ventilation weaning and extubation in children. Our findings highlight the importance of future research to determine the impact of greater collaboration of the multidisciplinary team on weaning practices.

Use of Bacopa monnieri in the Treatment of Dementia Due to Alzheimer Disease: Systematic Review of Randomized Controlled Trials.

BackgroundBacopa monnieri, a herb that has been used for many centuries in India, has shown neuroprotective effects in animal and in vitro studies; human studies on patients with Alzheimer disease have been inconclusive.ObjectiveThe primary objective of this review was to determine the clinical efficacy and safety of B. monnieri in persons with mild, moderate, or severe dementia, or mild cognitive impairment, due to Alzheimer disease.MethodsWe searched PubMed, Embase, Cochrane Library, clinical trial registries (World Health Organization, Australia-New Zealand, United States, and South Africa), the metaRegister of Controlled Trials, and CINAHL. We intended to include all randomized and quasi-randomized controlled trials that compared B. monnieri, its extract or active ingredients (at any dosage), with a placebo or a cholinesterase inhibitor among adults with dementia due to Alzheimer disease and in those with mild cognitive impairment due to Alzheimer disease.ResultsOur comprehensive search yielded 5 eligible studies. A total of 3 studies used B. monnieri in combination with herbal extracts while the remaining 2 used B. monnieri extracts only. Two studies compared B. monnieri with donepezil while the others used a placebo as the control. There was considerable variation in the B. monnieri dose used (ranging between 125 mg to 500 mg twice daily) and heterogeneity in treatment duration, follow-up, and outcomes. The major outcomes were Mini-Mental State Examination scores reported in 3 trials, Cognitive subscale scores of the Alzheimer’s Disease Assessment Scale in 1 study, and a battery of cognitive tests in 2 studies. Using the Cochrane risk-of-bias tool, overall, we judged all 5 studies to be at high risk of bias. While all studies reported a statistically significant difference between B. monnieri and the comparator in at least one outcome, we rated the overall quality of evidence for the Alzheimer’s Disease Assessment Scale-Cognitive Subscale, Postgraduate Institute Memory Scale, Mini-Mental State Examination, and Wechsler Memory Scale to be very low due to downgrading by 2 levels for high risk of bias and 1 more level for impreciseness due to small sample sizes and wide CIs.ConclusionsThere was no difference between B. monnieri and the placebo or donepezil in the treatment of Alzheimer disease based on very low certainty evidence. No major safety issues were reported in the included trials. Future randomized controlled trials should aim to recruit more participants and report clinically meaningful outcomes.Trial RegistrationPROSPERO CRD42020169421; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=169421

The Australia and New Zealand Congenital Outcomes Registry for Surgery (ANZCORS): methodology and preliminary results.

Analysis of multi-institutional data and benchmarking is an accepted accreditation standard in cardiac surgery. Such a database does not exist for congenital cardiac surgery in Australia and New Zealand (ANZ). To fill this gap, the ANZ Congenital Outcomes Registry for Surgery (ANZCORS) was established in 2017. Inclusion criteria included all cardiothoracic and extracorporeal membrane oxygenation (ECMO) procedures performed at five participating centres. Data was collected by data managers, validated by the surgical team, and securely transmitted to a central repository. Between 2015 and 2019, 9723 procedures were performed in 7003 patients. Cardiopulmonary bypass was utilized for 59% and 9% were ECMO procedures. Fifty-seven percent (n=5531) of the procedures were performed in children younger than 1year of age. Twenty-four percent of procedures (n=2365) were performed in neonates (≤28 days) and 33% (n=3166) were performed in children aged 29 days to 1year (infants). The 30-day mortality for cardiac cases (n=6572) was 1.3% and there was no statistical difference between the participating centres (P=0.491). Sixty-nine percent of cases had no major post-operative complications (5121/7456). For cardiopulmonary bypass procedures (n=5774), median stay in intensive care and hospital was 2 days (IQR 1, 4) and 9 days (IQR 5, 18), respectively. ANZCORS has facilitated pooled data analysis for paediatric cardiac surgery across ANZ for the first time. Overall mortality was low. Non-risk-adjusted 30-day mortality for individual procedures was similar in all units. The continued evaluation of surgical outcomes through ANZCORS will drive quality assessment in paediatric cardiac surgery across ANZ.

Report of the Editor for 2021 and Announcements of the President

Report of the Editor for 2021 and Announcements of the President

A comparison of arteriovenous fistula failure between Malaysian and Australian and New Zealand participants enrolled in the FAVOURED trial.

To describe and compare de novo arteriovenous fistula (AVF) failure rates between Australia and New Zealand (ANZ), and Malaysia. AVFs are preferred for haemodialysis access but are limited by high rates of early failure. A post hoc analysis of 353 participants from ANZ and Malaysia included in the FAVOURED randomised-controlled trial undergoing de novo AVF surgery was performed. Composite AVF failure (thrombosis, abandonment, cannulation failure) and its individual components were compared between ANZ (n = 209) and Malaysian (n = 144) participants using logistic regression adjusted for patient- and potentially modifiable clinical factors. Participants' mean age was 55 ± 14.3 years and 64% were male. Compared with ANZ participants, Malaysian participants were younger with lower body mass index, higher prevalence of diabetes mellitus and lower prevalence of cardiovascular disease. AVF failure was less frequent in the Malaysian cohort (38% vs 54%; adjusted odds ratio (OR) 0.53, 95% confidence interval (CI) 0.31-0.93). This difference was driven by lower odds of cannulation failure (29% vs 47%, OR 0.45, 95% CI 0.25-0.80), while the odds of AVF thrombosis (17% vs 20%, OR 1.24, 95% CI 0.62-2.48) and abandonment (25% vs 23%, OR 1.17, 95% CI 0.62-2.16) were similar. The risk of AVF failure was significantly lower in Malaysia compared to ANZ and driven by a lower risk of cannulation failure. Differences in practice patterns, including patient selection, surgical techniques, anaesthesia or cannulation techniques may account for regional outcome differences and warrant further investigation.

Measuring accounting educators’ views on the teaching–research nexus (TRN): an international comparative study

ABSTRACT The relationship between teaching and research in the modern university has been the subject of vigorous scholarly enquiry in the education literature for several decades. Few international comparative studies are reported in the literature. This study compares and discusses the teaching–research nexus (TRN) in accounting in three international regions: the UK and Ireland (UKI); Australia and New Zealand (ANZ); and South Africa (SA). The purpose of this study is to provide evidence of that the TRN empirical model operates in the different regions, and more so to describe the TRN that remains challenging for the accounting academic profession globally. Positive synergies from the TRN are evident in all jurisdictions in this study but are largely ignored by academic institutions and professional accounting bodies (PABs) that influence the university accounting curriculum. Formal government research assessment measures, coupled by PABs pressures, result in accounting becoming more a teaching-led rather than research-informed academic discipline. This has implications for: the status of accounting academics; the public perception of the professional standing of accounting in society; and the learning experiences of accounting students.

Expansion of Liver Transplantation Criteria for Hepatocellular Carcinoma from Milan to UCSF in Australia and New Zealand and Justification for Metroticket 2.0.

Simple SummaryLiver transplantation (LT) is considered the only curative therapeutic option for early, unresectable, and unablatable hepatocellular carcinoma (HCC), particularly in the setting of chronic liver disease. The criteria for selecting patients for LT for HCC have evolved since the description of the Milan Criteria by Professor Mazzaferro. In Australia and New Zealand (ANZ), the choice of criteria has expanded over the last 24 years from the Milan to the University of California San Francisco (UCSF) criteria and, more recently, to Metroticket 2.0 (MT2). This study analysed the overall and HCC-related deaths following LT in ANZ through the last 24 years to clarify the impact of the expansion of these criteria. Our data confirm that overall survival following LT for HCC has significantly improved over time despite expanding criteria from Milan to UCSF. Patients fulfilling the MT2 criteria have a survival comparable to the UCSF cohort. Thus, the expansion of criteria to MT2 is justifiable.Background: Expansion in liver transplantation (LT) criteria for HCC from Milan to UCSF has not adversely impacted overall survival, prompting further expansion towards Metroticket 2.0 (MT2). In this study, we compared patient survival post-transplant before and after 2007 and long-term outcomes for LT within Milan versus UCSF criteria (to determine the true benefit of the expansion of criteria) and retrospectively validated the MT2 criteria. Methods: Retrospective analysis of ANZLITR (including all patients transplanted for HCC since July 1997). The entire cohort was divided based on criteria used at the time of listing, namely, Milan era (1997–2006) and the UCSF era (2007–July 2015). Results: The overall 5- and 10-year cumulative survival rates for the entire cohort of 691 patients were 78% and 69%, respectively. Patients transplanted in UCSF era had significantly higher 5- and 10-year survival rates than in the Milan era (80% vs. 73% and 72% vs. 65%, respectively; p = 0.016). In the UCSF era, the 5-year survival rate for patients transplanted within Milan criteria was significantly better than those transplanted outside Milan but within UCSF criteria (83% vs. 73%; p < 0.024). Patients transplanted within the MT2 criteria had a significantly better 5- and 10-year survival rate as compared to those outside the criteria (81% vs. 64% and 73% vs. 50%, respectively; p = 0.001). Conclusion: Overall survival following LT for HCC has significantly improved over time despite expanding criteria from Milan to UCSF. Patients fulfilling the MT2 criteria have a survival comparable to the UCSF cohort. Thus, expansion of criteria to MT2 is justifiable.

Regional variance in treatment and outcomes of locally invasive (T4) rectal cancer in Australia and New Zealand: analysis of the Bi-National Colorectal Cancer Audit.

BackgroundsLocally invasive T4 rectal cancer often requires neoadjuvant treatment followed by multi‐visceral surgery to achieve a radical resection (R0), and referral to a specialized exenteration quaternary centre is typically recommended. The aim of this study was to explore regional variance in treatment and outcomes of patients with locally advanced rectal cancer in Australia and New Zealand (ANZ).MethodsData were collected from the Bi‐National Colorectal Cancer Audit (BCCA) database. Rectal cancer patients treated between 2007 and 2019 were divided into six groups based on region (state/country) using patient postcode. A subset analysis of patients with T4 cancer was performed. Primary outcomes were positive circumferential resection margin (CRM+), and positive circumferential and/or distal resection margin (CRM/DRM+).ResultsA total of 9385 patients with rectal cancer were identified, with an overall CRM+ rate of 6.4% and CRM/DRM+ rate of 8.6%. There were 1350 patients with T4 rectal cancer (14.4%). For these patients, CRM+ rate was 18.5%, and CRM/DRM+ rate was 24.1%. Significant regional variation in CRM+ (range 13.4–26.0%; p = 0.025) and CRM/DRM+ rates (range 16.1–29.3%; p = 0.005) was identified. In addition, regions with higher CRM+ and CRM/DRM+ rates reported lower rates of multi‐visceral resections: range 24.3–26.8%, versus 32.6–37.3% for regions with lower CRM+ and CRM/DRM+ rates (p < 0.0001).ConclusionPositive resection margins and rates of multi‐visceral resection vary between the different regions of ANZ. A small subset of patients with T4 rectal cancer are particularly at risk, further supporting the concept of referral to specialized exenteration centres for potentially curative multi‐visceral resection.

Institutional variation in early mortality following isolated coronary artery bypass graft surgery

Background:Thirty-day mortality following coronary artery bypass grafting (CABG) is a widely accepted marker for quality of care. Although surgical mortality has declined, the utility of this measure to profile quality has not been questioned. We assessed the institutional variation in risk-standardised mortality rates (RSMR) following isolated CABG within Australia and New Zealand (ANZ).Methods: We used an administrative dataset from all public and most private hospitals across ANZ to capture all isolated CABG procedures recorded between 2010 and 2015. The primary outcome was all-cause death occurring in-hospital or within 30-days of discharge. Hospital-specific RSMRs and 95% CI were estimated using a hierarchical generalised linear model accounting for differences in patient characteristics.Results: Overall, 60,953 patients (mean age 66.1 ± 10.1y, 18.7% female) underwent an isolated CABG across 47 hospitals. The observed early mortality rate was 1.69% (n = 1029) with 81.8% of deaths recorded in-hospital. The risk-adjustment model was developed with good discrimination (C-statistic = 0.81). Following risk-adjustment, a 3.9-fold variation was observed in RSMRs among hospitals (median:1.72%, range:0.84–3.29%). Four hospitals had RSMRs significantly higher than average, and one hospital had RSMR lower than average. When in-hospital mortality alone was considered, the median in-hospital RSMR was 1.40% with a 5.6-fold variation across institutions (range:0.57–3.19%).Conclusions: Average mortality following isolated CABG is low across ANZ. Nevertheless, in-hospital and 30-day mortality vary among hospitals, highlighting potential disparities in care quality and the enduring usefulness of 30-day mortality as an outcome measure. Clinical and policy interventions, including participating in clinical quality registries, are needed to standardise CABG care.

Research monitoring practices in critical care research: a survey of current state and attitudes

Background/AimsIn 2016, international standards governing clinical research recommended that the approach to monitoring a research project should be undertaken based on risk, however it is unknown whether this approach has been adopted in Australia and New Zealand (ANZ) throughout critical care research. The aims of the project were to: 1) Gain an understanding of current research monitoring practices in academic-led clinical trials in the field of critical care research, 2) Describe the perceived barriers and enablers to undertaking research monitoring.MethodsElectronic survey distributed to investigators, research co-ordinators and other research staff currently undertaking and supporting academic-led clinical trials in the field of critical care in ANZ.ResultsOf the 118 respondents, 70 were involved in the co-ordination of academic trials; the remaining results pertain to this sub-sample. Fifty-eight (83%) were working in research units associated with hospitals, 29 (41%) were experienced Research Coordinators and 19 (27%) Principal Investigators; 31 (44%) were primarily associated with paediatric research. Fifty-six (80%) develop monitoring plans with 33 (59%) of these undertaking a risk assessment; the most common barrier reported was lack of expertise. Nineteen (27%) indicated that centralised monitoring was used, noting that technology to support centralised monitoring (45/51; 88%) along with support from data managers and statisticians (45/52; 87%) were key enablers. Coronavirus disease-19 (COVID-19) impacted monitoring for 82% (45/55) by increasing remote (25/45; 56%) and reducing onsite (29/45; 64%) monitoring.ConclusionsContrary to Good Clinical Practice guidance, risk assessments to inform monitoring plans are not being consistently performed due to lack of experience and guidance. There is an urgent need to enhance risk assessment methodologies and develop technological solutions for centralised statistical monitoring.

Safety culture and incident learning systems in radiation oncology: Staff perceptions across Australia and New Zealand.

Radiation therapy has a highly complex pathway and uses detailed quality assurance protocols and incident learning systems (ILSs) to mitigate risk; however, errors can still occur. The safety culture (SC) in a department influences its commitment and effectiveness in maintaining patient safety. Perceptions of SC and knowledge and understanding of ILSs and their use were evaluated for radiation oncology staff across Australia and New Zealand (ANZ). A validated healthcare survey tool (the Hospital Survey on Patient Safety Culture) was used, with additional specialty-focussed supporting questions. A total of 220 radiation oncologists, radiation therapists and radiation oncology medical physicists participated. An overall positive SC was indicated, with strength in teamwork (83.7%), supervisor/manager/leader support (83.3%) and reporting events (77.1%). The weakest areas related to communication about error (63.9%), hospital-level management support (60.5%) and handovers and information exchange (58.0%). Barriers to ILS use included 'it takes too long' and that many respondents must use multiple reporting systems, including mandatory hospital-level systems. These are generally not optimal for specific radiation oncology needs. Varied understanding was indicated of what and when to report. The findings report the ANZ perspective on ILS and SC, highlighting weaknesses, barriers and areas for further investigation. Differences observed in some areas suggest that a unified state, national or bi-national ILS specific to radiation oncology might eliminate multiple reporting systems and reduce reporting time. It could also provide more consistent and robust approaches to incident reporting, information sharing and analysis.

Assessing the combined threats of artificial light at night and air pollution for the world’s nocturnally migrating birds

AbstractAimTwo important environmental hazards for nocturnally migrating birds are artificial light at night (ALAN) and air pollution, with ambient fine particulate matter (PM2.5) considered to be especially harmful. Nocturnally migrating birds are attracted to ALAN during seasonal migration, which could increase exposure to PM2.5. Here, we examine PM2.5concentrations and PM2.5trends and the spatial correlation between ALAN and PM2.5within the geographical ranges of the world’s nocturnally migrating birds.LocationGlobal.Time period1998–2018.Major taxa studiedNocturnally migrating birds.MethodsWe intersected a global database of annual mean PM2.5concentrations over a 21‐year period (1998–2018) with the geographical ranges (breeding, non‐breeding and regions of passage) of 225 nocturnally migrating bird species in three migration flyways (Americas,n = 143; Africa–Europe,n = 36; and East Asia–Australia,n = 46). For each species, we estimated PM2.5concentrations and trends and measured the correlation between ALAN and PM2.5, which we summarized by season and flyway.ResultsCorrelations between ALAN and PM2.5were significantly positive across all seasons and flyways. The East Asia–Australia flyway had the strongest ALAN–PM2.5correlations within regions of passage, the highest PM2.5concentrations across all three seasons and the strongest positive PM2.5trends on the non‐breeding grounds and within regions of passage. The Americas flyway had the strongest negative air pollution trends on the non‐breeding grounds and within regions of passage. The breeding grounds had similarly negative air pollution trends within the three flyways.Main conclusionsThe combined threats of ALAN and air pollution are greatest and likely to be increasing within the East Asia–Australia flyway and lowest and likely to be decreasing within the Americas and Africa–Europe flyways. Reversing PM2.5trends in the East Asia–Australia flyway and maintaining negative PM2.5trends in the Americas and Africa–Europe flyways while reducing ALAN levels would likely be beneficial for the nocturnally migrating bird populations in each region.

Botanical, Ethnopharmacological, Phytochemical &amp; Pharmacological Standards of Plant Ichnocarpus frutescens

The plant Ichnocarpus frutescens belongs to family Apocynaceae, commonly known as ‘Black creeper’ (In Odia: Syamolota; Hindi: Kali-dudhi, Krishna sariva; Sanskrit: Syamalata, Sariva). It is native to India, China, Java, Ceylon, Southeast Asia, and northern Australia. It is a large, evergreen, woody climbing plant. In India, tribes used this plant as a substitute of Indian Sersaparilla (Hemidesmus indicus). Phytochemical investigation indicates that plant belong to various category viz. phytosterol, triterpenes, flavonoids and various other phenolic compounds. Pharmacological activities of different parts of the plant reported include anti-urolithiasis, hepatoprotective, antioxidant, analgesic, antipyretic, anti-inflammatory, antidiabetic, antihyperlipidemic and antitumor activity etc. The presented review article aims to highlight a brief and comparative data on botanical, ethnopharmacological, phytochemical &amp; pharmacological standards of plant Ichnocarpus frutescens.

Multiple phylogenetically-diverse, differentially-virulent Burkholderia pseudomallei isolated from a single soil sample collected in Thailand.

Burkholderia pseudomallei is a soil-dwelling bacterium endemic to Southeast Asia and northern Australia that causes the disease, melioidosis. Although the global genomic diversity of clinical B. pseudomallei isolates has been investigated, there is limited understanding of its genomic diversity across small geographic scales, especially in soil. In this study, we obtained 288 B. pseudomallei isolates from a single soil sample (~100g; intensive site 2, INT2) collected at a depth of 30cm from a site in Ubon Ratchathani Province, Thailand. We sequenced the genomes of 169 of these isolates that represent 7 distinct sequence types (STs), including a new ST (ST1820), based on multi-locus sequence typing (MLST) analysis. A core genome SNP phylogeny demonstrated that all identified STs share a recent common ancestor that diverged an estimated 796-1260 years ago. A pan-genomics analysis demonstrated recombination between clades and intra-MLST phylogenetic and gene differences. To identify potential differential virulence between STs, groups of BALB/c mice (5 mice/isolate) were challenged via subcutaneous injection (500 CFUs) with 30 INT2 isolates representing 5 different STs; over the 21-day experiment, eight isolates killed all mice, 2 isolates killed an intermediate number of mice (1-2), and 20 isolates killed no mice. Although the virulence results were largely stratified by ST, one virulent isolate and six attenuated isolates were from the same ST (ST1005), suggesting that variably conserved genomic regions may contribute to virulence. Genomes from the animal-challenged isolates were subjected to a bacterial genome-wide association study to identify genomic regions associated with differential virulence. One associated region is a unique variant of Hcp1, a component of the type VI secretion system, which may result in attenuation. The results of this study have implications for comprehensive sampling strategies, environmental exposure risk assessment, and understanding recombination and differential virulence in B. pseudomallei.

Current status of intra-cranial stereotactic radiotherapy and stereotactic radiosurgery in Australia and New Zealand: key considerations from a workshop and surveys

Recently, there has been increased interest worldwide in the use of conventional linear accelerator (linac)-based systems for delivery of stereotactic radiosurgery/radiotherapy (SRS/SRT) contrasting with historical delivery in specialised clinics with dedicated equipment. In order to gain an understanding and define the current status of SRS/SRT delivery in Australia and New Zealand (ANZ) we conducted surveys and provided a single-day workshop. Prior to the workshop ANZ medical physicists were invited to complete two surveys: a departmental survey regarding SRS/SRT practises and equipment; and an individual survey regarding opinions on current and future SRS/SRT practices. At the workshop conclusion, attendees completed a second opinion-based survey. Workshop discussion and survey data were utilised to identify areas of consensus, and areas where a community consensus was unclear. The workshop was held on the 8th Sept 2020 virtually due to pandemic-related travel restrictions and was attended by 238 radiation oncology medical physicists from 39 departments. The departmental survey received 32 responses; a further 89 and 142 responses were received to the pre-workshop and post-workshop surveys respectively. Workshop discussion indicated a consensus that for a department to offer an SRS/SRT service, a minimum case load should be considered depending on availability of training, peer-review, resources and equipment. It was suggested this service may be limited to brain metastases only, with less common indications reserved for departments with comprehensive SRS/SRT programs. Whilst most centres showed consensus with treatment delivery techniques and image guidance, opinions varied on the minimum target diameter and treatment margin that should be applied.

Latitudinal and interhemispheric differences of the ionospheric semi-diurnal lunitidal perturbations during the 2009 Arctic sudden stratospheric warming event in the eastern Asia\u2013Australia sector

The ionosphere exhibits some characteristic perturbations during sudden stratospheric warming (SSW) events, of which the mechanism is not thoroughly understood. This study focuses on the latitudinal and interhemispheric differences of the enhanced semi-diurnal lunitidal (M2) perturbations related to SSW using total electron content calculated from the network of Global Navigation Satellite System and ionosonde data in the eastern Asia–Australia sector during the January 2009 SSW. Our results show that the most distinct M2 perturbations in the northern and southern hemispheres occur near the Equatorial Ionization Anomaly crest regions around ± 15° geomagnetic latitudes, but corresponds to different moon phases, respectively. Clear M2 perturbations extend to middle latitudes only in the southern hemisphere and have another local maximum in the southern middle latitude. Such latitudinal and interhemispheric features of ionospheric M2 perturbations in the low latitude in the eastern Asia–Australia sector are similar as those in the American sector during the same SSW event. This supports previous suggestion that such latitudinal and interhemispheric differences in the low latitude can be primarily explained by the summer–winter thermospheric wind modulation on equatorial plasma fountain and thus emphasize its role in the vertical coupling process of M2 perturbation. The clear differences of M2 perturbations in the southern middle latitude between the eastern Asia–Australia and American sectors indicate that the thermospheric circulation related to the Weddell Sea Anomaly may have influence on the lower atmosphere–ionosphere coupling.Graphical

Decoupling from China: how U.S. Asian allies responded to the Huawei ban

ABSTRACT As the U.S.-China strategic rivalry has intensified, Washington has looked to its close allies and partners to counter Chinese clout in global technology leadership. With the Huawei ban as a proxy for the U.S.-China competition, the paper focuses on the concept of the alliance halo and analyzes how the three key U.S. allies in Asia—Australia, Japan, and South Korea—responded to Washington’s expectations of mutual support on the decoupling of Chinese technology companies from global supply chains. We argue that given that the Huawei ban is about future risks associated with China’s economy, as opposed to demonstrated military threats, it was more challenging to establish allied reliability within the U.S. alliance network as a whole. Our comparative analysis shows that Australia’s reactions have been the most direct, banning Huawei before the United States, showing a contrast with South Korea’s relatively muted responses. Japan’s decision to ban Huawei was as decisive as Australia’s but Tokyo sought to keep a low profile. Rather than the diplomatic pressure from the Trump administration, these allies’ varied responses resulted from their own assessments of security risks associated with Huawei.