Australia New Research Articles

Ceasing or gradually reducing incubator humidity after 7days for extremely preterm infants: a randomised clinical trial.

Ceasing or gradually reducing incubator humidification after day 7 of life had no effect on the number of episodes of hypothermia or hyperthermia in this cohort of extremely preterm infants (EPTI). There was also no effect on the number of episodes of hyponatraemia or hypernatraemia. ANZCTR.org.au (Australia New Zealand Clinical Trials Registry). ACTRN 1261 9000 266167 Registered 21/2/2019. • Incubator humidification is a widely accepted and routine practice in the management of EPTI as it influences transepidermal water loss (TEWL) and supports thermoregulation. However, weaning practices remain varied and inconsistent across the globe. • There remains a paucity of data to inform specific evidenced-based humidification practices. • Ceasing or gradually reducing incubator humidification after 7days had no effect on temperature stability, serum sodium levels, or frequency of skin injury in this cohort of EPTI between day 8 and day 14. • There is no apparent benefit in prolonging incubator humidity beyond day 7 of life in these EPTI.

Investigating reformulation in the Canadian food supply between 2017 and 2020 and its impact on food prices.

This study examined the relationship between reformulation and food price in Canadian packaged foods and beverages between 2017 and 2020. Matched foods and beverages in the University of Toronto Food Label Information and Price 2017 and 2020 databases were analyzed (n=5774). Price change by food category and by retailer were compared using Wilcoxon signed-rank tests. The proportion of products with changes in calories and nutrient levels were determined and mixed-effects models were used to examine the relationship between reformulation and price changes. The Food Standards Australia New Zealand (FSANZ) nutrient profiling model was applied to calculate nutritional quality scores and mixed-effects models were used to assess if changes in nutritional quality score were associated with price changes. Large grocery retailers by market share in Canada. Foods and beverages available in 2017 and 2020. Food price changes differed by retailer and by food category (e.g., increased in Bakery, Snacks etc; decreased in Beverages, Miscellaneous etc.). Nutrient reformulation was minimal and bidirectional with the highest proportion of products changing in sodium (17.8%; 8.4% increased and 9.4% decreased). The relationship between nutrient reformulation and price change was insignificant for all nutrients overall and was not consistent across food categories. Average FSANZ score did not change (7.5 in both years). For Legumes and Combination dishes, improvements in nutritional quality were associated with a price decrease and increase, respectively. Stronger policies are required to incentivize reformulation in Canada. Results do not provide evidence of reformulation impacting food prices.

University-based academic programs in addiction studies in the regions of Australia and Aotearoa New Zealand: An overview.

Current trends in the addiction field reflect a significant emphasis on the workforce development and education. There are already some data about university-based addiction studies programs, but not much from Australasia. The aim is to provide an overview and describe the academic programs for addiction professionals in Australia and Aotearoa NZ. The research was conducted in 2017 and updated in 2023. Firstly, university websites were searched using pre-defined keywords, followed by a content analysis of the identified programs. The data were analysed and interpreted by using descriptive statistics. We found 21 universities in Australia (13) and Aotearoa NZ (8) where 46 single programs are provided. There are three bachelor programs, nine masters, and the majority of degrees include (post)graduate certificates and diplomas. No doctorate programs are identified. The taught courses provide comprehensive coverage of the addiction field topics. Twelve programs state clearly that there is clinical practice/internship included. Application to most programs requires completion of a relevant degree and in some cases possible clinical experience. In comparison to educational options in other regions, we observe a trend towards preparing university graduates for the workforce, thereby expanding the range of programs at lower levels. Most programs possibly represent clinically oriented education primarily specialising in addictions, and graduate programs in addictions for professionals with other disciplinary bases. Great emphasis is given to the quality standards of education, and also to relationship between education and labour market. Findings help opening opportunities to collaborate globally.

Surgeons’ Views on Hypospadias Care Journey: A Qualitative Study.

BackgroundThree major parties are involved in the hypospadias treatment journey – the patient, their parents/carers, and the surgeon. There is a strong trend towards involving all three, where possible, in deriving evidence around the care pathways. Currently, there are little data available on surgeons’ perspectives of distal hypospadias care. AimThis study explored the reflections of Australian and Aotearoa New Zealand Paediatric hypospadias surgeons on the journey and experience of children born with distal hypospadias and their families, with the aim to improve this journey to achieve a better healthcare experience and satisfaction. We sought to understand a) what informs the content and process of a hypospadias surgeon’s consultation with parents/carers, b) how hypospadias surgeons negotiate surgical outcomes, parents/carers’ views and preferences, social circumstances, cultural context, and their clinical opinions and treatment recommendations, and c) how surgeons perceive the journey for families with a child born with distal hypospadias could be improved. MethodsWe conducted a qualitative descriptive study to generate rich descriptions of the lived experiences of hypospadias surgeons caring for children with distal hypospadias and their families. Data were collected using semi-structured interviews with nine paediatric hypospadias surgeons in Australia and Aotearoa New Zealand. All participants had routinely practised hypospadias surgery as a consultant for at least five years. Participants were purposively sampled to obtain a diverse representation of perspectives. Data were collected and analysed using the reflexive thematic analysis methodology. ResultsTwo overarching themes reflecting the lived experiences of paediatric hypospadias surgeons emerged: The journey is as varied as the children and their families, and The best possible journey. The first overarching theme is characterised by three themes: Journey feature, Journey process, and Journey influences, each illuminating main elements informing participants’ perspective of the treatment journey. Surgeons perceive the journey as highly individualised; they mark the start of the journey differently but put a great emphasis on the consultation and identify several essential parts of it. The second overarching theme reflects participants’ ideas on key elements of hypospadias care that could improve the treatment journey, such as better information for carers and non-surgeon healthcare providers, more communication training for surgeons in their formative years, and societal acceptance of anatomical variance. ConclusionThe journey of children and families is perceived by surgeons as variable, individualised, and affected by different influences. Those influences highlight the importance of knowing your patient/family and creating tailored, individualised, family-centred communication and care.

Genomic and Acoustic Biogeography of the Iconic Sulphur-crested Cockatoo Clarifies Species Limits and Patterns of Intraspecific Diversity.

Many highly recognizable species lack genetic data important for conservation due to neglect over their hyperabundance. This likely applies to the Sulfur-crested Cockatoo (Cacatua galerita), one of the world's most iconic parrots. The species is native to Australia, New Guinea, and some surrounding Melanesian islands of the latter. Four subspecies are currently recognised based on morphology. Australian subspecies and populations are abundant, but several factors threaten those in New Guinea and Melanesia. Genetic data from natural populations are scarce-information that is vital to identifying evolutionarily significant units (ESUs) important for modern conservation planning. We used whole-genome resequencing to investigate patterns of differentiation, evolutionary affinities, and demographic history across C. galerita's distribution range to assess whether currently recognised subspecies represent ESUs. We complement this with an assessment of bioacoustic variation across the species' distribution landscape. Our results point to C. galerita sensu lato (s.l.) comprising two species. We restrict C. galerita sensu stricto (s.s.) to populations in Australia and the Trans-Fly ecodomain of southern New Guinea. The second species, recognised here as Cacatua triton, likely occurs over much of the rest of New Guinea. Restricting further discussion of intraspecific diversity in C. triton, we show that within C. galerita s.s. two ESUs exist, which align to Cacatua galerita galerita in eastern Australia and southern New Guinea and Cacatua galerita fitzroyi in northern and north-western Australia. We suggest that the evolution of these species and ESUs are linked to Middle and Late Pleistocene glacial cycles and their effects on sea level and preferential habitats. We argue that conservation assessments need updating, protection of preferential forest and woodland habitats are important and reintroductions require careful management to avoid possible negative hybridization effects of non-complementary lineages.

A slide into obscurity? The current state of histology education in Australian and Aotearoa New Zealand medical curricula in 2022-2023.

Australia and Aotearoa New Zealand (AANZ) medical schools have been impacted by curricular changes and the introduction of virtual microscopy (VM). No survey has explicitly described the outcome of these events on histology education in AANZ. This study provides a cross-sectional overview of histology education in accredited medical schools across AANZ in 2022-2023. Responses were received from 83% (19/23) of Australian medical schools, and 50% (1/2) of medical schools in Aotearoa New Zealand. VM, either exclusively (42%) or combined with traditional microscopy (37%), emerged as the preferred mode for delivering histology education. Common instructional methods included face-to-face lectures (26%) and synchronous online live lectures (26%). A significant proportion (84%) of educators supplemented resources with virtual microscopy websites. Integration of histology education was prevalent (79%), primarily with pathology (32%) or gross anatomy (26%). On average, medical students in the region spent a maximum of 21 ± 17 h in face-to-face histology laboratories throughout their degree. Histology education was predominantly taught by academics with a PhD degree. This study also examined the similarities and differences in histology education between AANZ and the global landscape. Through this examination, the present study positions AANZ within the broader context of histology education worldwide discusses key factors impacting histology education, and advocates for action to mitigate a looming shortage of pathologists in AANZ. In light of these findings, AANZ medical schools should integrate histology and pathology, establish a core curriculum, and promote flexible teaching modalities.

Genetic diversity of soybean dwarf virus in two regions of mainland Australia

Soybean dwarf virus (SbDV; family Tombusviridae, genus Luteovirus, species Luteovirus glycinis) is an RNA plant virus that is transmitted solely by aphids in a persistent, circulative and non-propagative manner. SbDV causes significant losses in cultivated Fabaceae, especially in subterranean clover (Trifolium subterraneum) pastures of mainland Australia. SbDV isolates are classified into four phenotypically distinguishable strains: YP, YS, DP, and DS. Y and D strains differ primarily in their host range, and P and S strains in their primary vector species. Genetically, Y and D strains separate into two clades in every genomic region except for the N-terminal region of the readthrough domain (N-RTD), in which P and S strains separate. SbDV diversity in Australia has yet to be investigated, so in this study, 41 isolates were collected from six different host species across two production regions of Australia: the south coast of Western Australia (‘south-west’) and northern New South Wales/southern Queensland (‘north-east’). A near-complete genome sequence of each isolate was obtained, and together with all 50 whole-genome sequences available in the GenBank database, underwent phylogenetic analysis of the whole genome nt and the N-RTD aa sequences. At the whole-genome level, the isolates separated into D and Y clades. At the N-RTD level, most of the isolates separated into P and S clades. All south-west isolates and 11 of the 31 north-east isolates were in the Y clade, and the remaining 20 north-east isolates were in the D clade. Except for one isolate that fell outside the P and S clades, all south-west and north-east isolates were in the P clade, suggesting that they are transmitted by Acyrthosiphon pisum and Myzus persicae. Available biological data largely supported the phenotypic inferences made from the phylogenetic analysis, suggesting that genetic data can provide critical epidemiological insights, provided that sufficient biological data have been collected.

Cost-utility and cost consequence of a telehealth intervention targeting improvement in addictive eating for Australian adults (the TRACE program).

The TRACE (Targeted Research for Addictive and Compulsive Eating) intervention was evaluated in a 3-month randomized controlled trial which demonstrated significant improvement in Yale Food Addiction Scale scores favoring dietitian-led telehealth (active intervention) compared with passive and control groups. This study aimed to determine intervention costs and cost-utility. Costs of each intervention (2021$AUD) and incremental net monetary benefit (iNMB; incremental benefit, defined as Quality-Adjusted Life Years (QALY) gained, multiplied by willingness to pay threshold minus incremental cost) were calculated to estimate differences between groups. The active intervention (n=38) cost $294 (95% UI: $266, $316) per person compared to $47 (95% UI: $40, $54) in the passive intervention (n=24), and $26 in the control group (n=37). At a cost-effectiveness threshold of $50 000 per QALY score gained, the active intervention iNMB was -$186 (95% UI: -$1137, $834) and the passive group $127 (95% UI: -$1137, $834). Compared to the control group, estimates indicate a 30% chance of the active intervention, and a 60% chance of the passive intervention being cost effective. Although the overall cost of the active intervention was low, this was not considered cost-effective in comparison to the passive intervention, given small QALY score gains. Australia New Zealand Clinical Trial Registry ACTRN12621001079831.

Investigating the impact of a multicomponent positive participatory organisational intervention on burnout in New Zealand emergency department staff: a prospective, multisite, before and after, mixed methods study.

The well-being of healthcare workers (HCWs) is critical to providing excellent care. Recent evidence concerns the well-being of emergency department (ED) HCWs in New Zealand, with high levels of burnout found in a 2020 survey. This threat to providing high-quality acute care warrants improvement interventions. The causes of burnout are complex and multifactorial, the solutions are not straightforward. A prospective, multisite, before and after, mixed methods study assessing a multicomponent intervention, adaptable to local context, that targets three organisation levels (the individual, the group and the system levels) and meaningfully involves frontline HCWs may reduce HCW burnout and improve HCW well-being. Individual HCWs will choose from three individual-level psychological interventions and participate in those most appropriate for them. Local champions will decide which group-level intervention their ED will use. The system-level intervention will build capacity and capability for quality improvement (QI) with QI training and the establishment of a Quality Improvement Learning System. This system-level intervention has several important features that may ultimately empower HCWs to contribute to improving the quality of ED healthcare.We will enrol nine EDs, from which there will be at least 900 HCW participants. EDs will be enrolled in three waves from March 2023 to April 2024, with interventions taking place in each ED over 12 months.Methods of assessment will include baseline and repeat survey measures of burnout and well-being. Process evaluation at each ED will provide details of context, the intervention and the fidelity of the implementation. Ethics committee approval was provided, with locality approval at each site.Individual site feedback will be provided to each ED and executive leadership. Dissemination of findings will be through publication in peer-reviewed journals, presentation at national and international scientific meetings and through national healthcare quality bodies. Australia New Zealand Clinical Trials Registry (ACTRN12623000342617).

Affirming schools, population-level data, and holistic public health are key to addressing mental ill-health and substance use disparities among gender and sexuality diverse young people in Australia and Aotearoa New Zealand

Affirming schools, population-level data, and holistic public health are key to addressing mental ill-health and substance use disparities among gender and sexuality diverse young people in Australia and Aotearoa New Zealand

The future is bright: artificial intelligence for trainee medical officers in Australia and New Zealand.

Given their frontline role in Australia and Aotearoa New Zealand (ANZ) healthcare, trainee medical officers (TMOs) will play a crucial role in the development and use of artificial intelligence (AI) for clinical care, ongoing medical education and research. As 'digital natives', particularly those with technical expertise in AI, TMOs should also be leaders in informing the safe uptake and governance of AI within ANZ healthcare as they have a practical understanding of its associated risks and benefits. However, this is only possible if a culture of broad collaboration is instilled while the use of AI in ANZ is still in its initial phase.

A Position Modification Device for the Prevention of Supine Sleep During Pregnancy: A Randomised Crossover Trial.

To assess the effectiveness and acceptability of a pillow-like position modification device to reduce supine sleep during late pregnancy, and to determine the impacts on the severity of sleep-disordered breathing (SDB) and foetal well-being. Randomised cross-over study. Individuals in the third trimester of pregnancy receiving antenatal care at a tertiary maternity hospital in Australia. Participants used their own pillow for a control week and an intervention pillow for a week overnight, in randomised order. Sleep position and total sleep time for each night of both weeks were objectively monitored, with a sleep study and foetal heart rate monitoring performed on the last night of each week. Primary outcome = percentage of sleep time in the supine position; secondary outcomes = apnoea-hypopnoea index, foetal heart rate decelerations and birthweight centile. Forty-one individuals were randomised with data collected on 35 participants over 469 nights. There was no difference in percentage of total sleep time in the supine position overnight between the control or intervention pillow week (13.0% [6.1, 25.5] vs. 16.0% [5.6, 27.2], p = 0.81 with a mean difference of 2.5% [95% CI] = -0.7, 5.6, p = 0.12), and no difference in the severity of SDB or foetal heart rate decelerations across weeks. However, increased supine sleep was significantly related to a higher apnoea-hypopnoea index (rs = 0.37, p = 0.003), lower birthweight (rs = -0.45, p = 0.007) and lower birthweight centile (rs = -0.45, p = 0.006). The proportion of supine sleep each night of the week varied widely both within and across participants, despite awareness of side-sleeping recommendations. We found no evidence to suggest that the adoption of a pillow designed to discourage supine sleep was effective in late pregnancy, with women spending an average of 1 h per night supine. Alternative devices should be investigated, incorporating lessons learnt from this study to inform trials of supine sleep minimisation in pregnancy. Clinical Trial: (Australia New Zealand Clinical Trials Registry): ACTRN12620000371998.

Independent repeated mutations within the alphaviruses Ross River virus and Barmah Forest virus indicates convergent evolution and past positive selection in ancestral populations despite ongoing purifying selection.

Ross River virus (RRV) and Barmah Forest virus (BFV) are arthritogenic arthropod-borne viruses (arboviruses) that exhibit generalist host associations and share distributions in Australia and Papua New Guinea (PNG). Using stochastic mapping and discrete-trait phylogenetic analyses, we profiled the independent evolution of RRV and BFV signature mutations. Analysis of 186 RRV and 88 BFV genomes demonstrated their viral evolution trajectories have involved repeated selection of mutations, particularly in the nonstructural protein 1 (nsP1) and envelope 3 (E3) genes suggesting convergent evolution. Convergent mutations in the nsP1 genes of RRV (residues 248 and 441) and BFV (residues 297 and 447) may be involved with catalytic enzyme mechanisms and host membrane interactions during viral RNA replication and capping. Convergent E3 mutations (RRV site 59 and BFV site 57) may be associated with enzymatic furin activity and cleavage of E3 from protein precursors assisting viral maturation and infectivity. Given their requirement to replicate in disparate insect and vertebrate hosts, convergent evolution in RRV and BFV may represent a dynamic link between their requirement to selectively 'fine-tune' intracellular host interactions and viral replicative enzymatic processes. Despite evidence of evolutionary convergence, selection pressure analyses did not reveal any RRV or BFV amino acid sites under strong positive selection and only weak positive selection for nonstructural protein sites. These findings may indicate that their alphavirus ancestors were subject to positive selection events which predisposed ongoing pervasive convergent evolution, and this largely supports continued purifying selection in RRV and BFV populations during their replication in mosquito and vertebrate hosts.

Nutritional Composition, Physicochemical, and Sensory Properties of Snack Bars Produced from Catfish Head Powder (Clarias gariepinus) and Purple Sweet Potatoes (Ipomoea batatas var Ayumurasaki) as Emergency Food

Graphical Abstract Highlight Research 1. The development of snack bars from catfish head powder (CHP). 2. The CHP was rich in nutritional composition and could be an additive ingredient in snack bars. 3. Adding CHP increased protein, lipid, and fibre content in the snack bars. 4. Snack bars with the addition of CHP were acceptable on all sensory attributes. 5. Snack bars produced from CHP could be used as an alternative emergency food. Abstract During natural disasters, emergency food is often needed to meet the victims’ nutritional intake such as protein, fat, carbohydrates, and energy. As an alternative, catfish heads, which are usually rich in nutritional content, can be developed into a snack bar product as emergency food. This research aimed to evaluate the chemical, physical and sensory properties of snack bars produced from catfish head powder (CHP) and purple sweet potato flour (PSPF). This research consisted of several stages, namely making CHP and PSPF, preparing snack bars, and analysing snack bars' chemical, physical, and sensory properties. The ratios of CHP and PSPF in the preparation of snack bars stage were F0 (0:100), F1 (25:75), F2 (50:50), and F3 (75:25). The CHP contained 43.52% protein, 21.24% lipid, 4.6% fibre, and 384.38 Kcal/100 g total energy. The addition of CHP and PSPF affected the chemical (proximate and antioxidant activity), physical (redness and hardness values), and sensory (aroma and overall acceptance) properties of the produced snack bars. All snack bars had protein content that complied with Indonesian National Standards (INS) for cereal bar biscuits. The protein, lipid, carbohydrate, and total energy content of the snack bar were in accord with the standards of the United States Department of Agriculture (USDA), Food Standards Australia New Zealand (FSANZ), and emergency food standards. It is also revealed that F2 was the best treatment based on its chemical, physical, and sensory properties. Indeed, snack bars from CHP and PSPF can be utilised as an emergency food alternative.

Editorial: Marine Biotechnology and Bioproducts session of the 13th Asia-Pacific Marine Biotechnology Conference (13th APMBC) and 5th Australia New Zealand Marine Biotechnology Society Conference (5th ANZMBS)

Editorial: Marine Biotechnology and Bioproducts session of the 13th Asia-Pacific Marine Biotechnology Conference (13th APMBC) and 5th Australia New Zealand Marine Biotechnology Society Conference (5th ANZMBS)

Evaluating anti-bullying training in surgery: surgeons' perceptions from Australia and Aotearoa New Zealand.

ObjectiveTo evaluate how surgeons in Australia and Aotearoa New Zealand perceive the effectiveness of the Operating with Respect (OWR) face-to-face training program in reducing workplace bullying.MethodsA cross-sectional survey examined the perceived effectiveness of the Royal College of Surgeons' (RACS) face-to-face OWR training and complementary interventions in reducing workplace bullying in surgical settings. The sample included supervisory surgeons, RACS committee members, and targeted educators. The survey instrument had 35 questions, including five related to the research question. In December 2020, the survey was distributed by RACS to all surgeons who undertook OWR training between April 2017 and December 2019. Likert scales and coded free text responses were used to explore the effectiveness of face-to-face OWR training and other interventions included in the 2015 RACS Action Plan.ResultsOf the 756 surveys sent, 252 were received. The face-to-face OWR training program was rated as moderately effective. RACS's overarching approach to anti-bullying was almost equally important, highlighting the need to consider a broader ecosystem of reform.ConclusionsThis study finds the RACS full-day anti-bullying training moderately effective in reducing bullying in surgical workplaces. However, enhancing its impact requires a sustained, multi-faceted strategy, including broader policy reforms, accountability measures, and cultural changes, to foster a long-term respectful environment in surgical settings.

Passive sensing data predicts stress in university students: a supervised machine learning method for digital phenotyping.

University students are particularly susceptible to developing high levels of stress, which occur when environmental demands outweigh an individual's ability to cope. The growing advent of mental health smartphone apps has led to a surge in use by university students seeking ways to help them cope with stress. Use of these apps has afforded researchers the unique ability to collect extensive amounts of passive sensing data including GPS and step detection. Despite this, little is known about the relationship between passive sensing data and stress. Further, there are no established methodologies or tools to predict stress from passive sensing data in this group. In this study, we establish a clear machine learning-based methodological pipeline for processing passive sensing data and extracting features that may be relevant in the context of mental health. We then use this methodology to determine the relationship between passive sensing data and stress in university students. In doing so, we offer the first proof-of-principle data for the utility of our methodological pipeline and highlight that passive sensing data can indeed digitally phenotype stress in university students. Australia New Zealand Clinical Trials Registry (ANZCTR), identifier ACTRN12621001223820.

Building culturally meaningful chronologies: negotiating Indigenous and Western temporalities in Oceania

ABSTRACTThis paper examines some of the ways in which Indigenous and Western archaeological chronologies are being negotiated and entwined in Oceania. Indigenous pasts are often known through oral traditions, genealogies and ancestral landscapes; these are vital pasts populated by the ancestors. The archaeological past is often interpreted through taphonomy, stratigraphy and direct dating techniques. There are tensions and intersections between these perspectives, and research partnerships between archaeologists and Indigenous communities must negotiate how to build chronologies and narrate the past. Drawing on case studies from our research in Australia and Papua New Guinea, we discuss how these seemingly different ways of knowing the past can be brought into productive conversation and how these understandings are transforming today. We argue that incorporating diverse temporalities for ancestral places can generate richer historical narratives of value to communities and researchers.

Heavy metals accumulation in the meat, kidney and liver of cattle, broilers and goats sold in Quetta, northwestern city of Balochistan, Pakistan

ABSTRACT 1. It was assumed that the concentrations of arsenic (As), chromium (Cr), cobalt (Co), lead (Pb), manganese (Mn) and mercury (Hg) in the meat, kidney and liver of cattle, broilers and goats within Quetta city potentially exceeded the permissible limits for heavy metal content. Risk assessment of these heavy metals on human health were estimated based on daily intake (EDI), target hazard quotient (THQ) and hazard index (HI). 2. Samples of the meat, liver and kidney of cattle, broilers and goats were collected from butcher shops and slaughterhouses in 20 different areas of Quetta city. Overall, 180 samples were analysed, each for six heavy metals. After acid digestion of meat samples, heavy metals analysis was carried out via atomic absorption spectroscopy. 3. The results varied in levels depending upon the species and organ type. The average concentrations of As, Pb and Hg were within the established reference limits of the Australia New Zealand Food Authority (ANZFA 2015) and the European Commission (EC, 2006), although some samples exceeded these limits. Compared with the kidney and meat, the liver was the primary tissue for Cr, Pb and Hg bioaccumulation. Metals concentration were mostly within the normal range in samples from cattle and goats, while the Mn concentration was elevated in broilers. 4. The estimated daily intake (EDI) revealed that the intake of As, Co, Pb and Hg was mainly derived from goat and cattle products, whereas broiler samples were more contaminated with Cr and Mn. The EDIs of Cr and Hg in adults exceeded the oral reference dose, referring to potential adverse effects. The EDIs for Co and Mn were low, suggesting that additional intake sources were necessary. Except for As, none of the determined elements had a target hazard quotient (THQ) above 1.

Lung cancer (internet-based) Delphi (LUCiD): A modified eDelphi consensus process to establish Australasian clinical quality indicators for thoracic cancer.

Approximately 16,000 new cases of lung cancer are diagnosed each year in Australia and Aotearoa New Zealand, and it is the leading cause of cancer death in the region. Unwarranted variation in lung cancer care and outcomes has been described for many years, although clinical quality indicators to facilitate benchmarking across Australasia have not been established. The purpose of this study was to establish clinical quality indicators applicable to lung and other thoracic cancers across Australia and Aotearoa New Zealand. Following a literature review, a modified three round eDelphi consensus process was completed between October 2022 and June 2023. Participants included clinicians from all relevant disciplines, patient advocates, researchers and other stakeholders, with representatives from all Australian states and territories and Aotearoa New Zealand. Consensus was set at a threshold of 70%, with the first two rounds conducted as online surveys, and the final round held as a hybrid in person and virtual consensus meeting. The literature review identified 422 international thoracic oncology indicators, and a total of 71 indicators were evaluated over the course of the Delphi consensus. Ultimately, 27 clinical quality indicators reached consensus, covering the continuum of thoracic oncologic care from diagnosis to first line treatment. Indicators benchmarking supportive care were poorly represented. Attendant numeric quality standards were developed to facilitate benchmarking. Twenty-seven clinical quality indicators relevant to thoracic oncology care in Australasia were developed. Real world implementation will now be explored utilizing a prospective dataset collected across Australia.