Australian Database Research Articles

Area-level socioeconomic status impacts healthcare visit frequency by Australian inflammatory arthritis patients: results from the Australian Rheumatology Association Database.

Individuals with inflammatory arthritis (IA) require long-term rheumatologist care for optimal outcomes. We sought to determine if socioeconomic status (SES) influences general practitioner (GP) and specialist physician visit frequency and out of pocket (OOP) visit costs. We linked data from Australian Rheumatology Association Database (ARAD) participants with rheumatoid arthritis or psoriatic arthritis to the Pharmaceutical Benefits (PBS) and Medicare Benefits Schedule (MBS) from 2011-2018. Small-area SES was approximated as quintiles of the Index of Relative Socieconomic Advantage and Disadvantage. A comorbidity index (Rx-Risk) was determined from PBS data. Analysis was performed using panel regression methods. We included 1916 ARAD participants (76.3% rheumatoid arthritis, 71.1% women, mean [SD] age 54 [12] years and disease duration 6 [4] years). Participants averaged 9.0 (95% CI 8.6, 9.4) annual GP visits and 3.9 (3.8 to 4.1) annual specialist physician visits. After adjustment for sex, age, education, remoteness and comorbidity, there was an inverse relationship between annual GP visit frequency and higher SES quintile (-0.6 [-0.9, -0.3] visits/quintile) and a direct relationship between more frequent specialist visits and higher SES (linear slope 0.3 [0.2, 0.5] visits/quintile). Average OOP costs/visit were higher for specialist physician (AUD$38.43 [37.34, 39.53] versus GP visits (AUD$7.86 [7.42, 8.31], and higher SES was associated with greater OOP cost. Higher SES patients have relatively fewer GP visits and more specialist physician visits compared with lower SES patients, suggesting lower SES patients may receive suboptimal specialist physician care. OOP costs may be a contributing factor.

A Retrospective Analysis of 190 Patients With Scoliosis Referred to a Private Australian Clinical Advisory Service Between 2017 and 2020

ObjectiveThe aim of this study was to describe the demographic and clinical characteristics of patients with scoliosis from Australian primary care practices. MethodsA retrospective review of 190 patient records from August 2017 to April 2020 from a private Australian clinical advisory service database was performed. Deidentified demographic and clinical data were collated and analyzed, along with information regarding the referring practitioners and any accompanying clinical or paraclinical information. Numerical data were summarized with median and IQR, while categorical data were summarized with counts and percentages. Salient qualitative data from the advisory service records were also collated, coded, and summarized. ResultsPatients were aged between 3 and 87 years; the majority (71%) of patients were female, with a median age of 16 years (IQR, 13; range, 3-87 years). The most common type of spinal deformity seen in the sample was scoliosis (92%), with hyperkyphosis (7%) and other deformity (1%) making up the remaining cases. There was a wide variety of scoliosis presentations; however, curves were commonly (45%) located in the thoracic region of the spine. Observed scoliosis cases were of moderate severity with a median Cobb angle measuring 26.5° (IQR, 20°). Reports of pain were in the lower trunk/pelvis (46%), the middle trunk (16%), or throughout multiple bodily regions (27%). Alterations in normal spinal anatomy (eg, hemivertebrae) were common (55% of cases). The majority (86%) of patient cases came from chiropractors, whereas 9% were from osteopaths, 4% from physiotherapists, and 1% from other types of practitioners (eg, medical practitioners). ConclusionThe findings from this study suggest that patients presenting to practitioners in primary care settings in Australia present with a range of scoliosis and related spinal deformity presentations.

Risk of Suicide, Hair Loss, and Aspiration with GLP1-Receptor Agonists and Other Diabetic Agents: A Real-World Pharmacovigilance Study.

With the increasing popularity of glucagon-like peptide 1 receptor agonists (GLP1-RAs), numerous safety concerns arose pertaining to suicide, hair loss, and aspiration risks. We attempted to validate these concerns. We queried four pharmacovigilance databases to compare GLP1-RAs to sodium-glucose transporter 2 inhibitors (SGLT2is) with respect to these adverse events (AE): the FDA Adverse Event Reporting System (FAERS), the Australian Database of Adverse Event Notifications (DAEN), the European Medicines Agency's (EudraVigilance), and the World Health Organization-Vigibase. OpenVigil 2.1 was utilized to perform a disproportionality analysis for GLP1-RAs, SGLT2is, dipeptidyl peptidase 4 inhibitors (DPP4is), sulfonylureas, metformin, and insulin. The following indices were extracted from the FAERS database from Q4/2003 until Q3/2023: relative reporting ratio (RRR), proportional reporting ratio (PRR), reporting odds ratio (ROR), and chi-squared (χ2). A positive signal was detected if PRR > 2 and χ2 > 4 for any drug-event pair. No positive signals were observed between GLP1-RAs and either suicide, hair loss, or aspiration risks. Semaglutide [ROR = 0.60 (0.51-0.71)] and liraglutide [ROR = 0.28 (0.23-0.35)] had higher suicidal events than DPP4is and SGLT2is. GLP1-RAs were the most reported class with hair loss [ROR = 0.61 (0.60-0.64)], and semaglutide, liraglutide, and dulaglutide were the three leading medications. GLP1-RAs ranked lower with aspiration events, which were led by sitagliptin and DPP4is as a group. GLP1-RAs exhibit higher reporting of suicide, hair loss, and aspiration events when compared to several other antidiabetic medications despite not meeting the criteria for positive signals yet. This warrants intensive monitoring and reporting.

Bauxite mine and alumina refinery workers: mortality and cancer risk.

Aluminium industry workers are at risk of long-term health consequences. To investigate mortality and cancer incidence in bauxite mine and alumina refinery workers. A pre-existing cohort of workers was re-linked with the Australian National Death Index, and the Australian Cancer Database to provide additional death (7 years) and cancer (9 years) data. Standardized mortality ratios (SMRs) and standardized incidence rates (SIRs) were estimated by job category, duration of employment and time since first employment. Linkage was performed for 6935 (6207 male) workers. Compared with the general population, there was a reduced or similar risk of death for mine/refinery workers for all causes except mesothelioma which was increased amongst male production workers [SMR 2.42, 95% CI 1.11-4.60]. Mesothelioma incidence was also increased amongst males [SIR 2.50, 95% CI 1.60-3.71]. Male office workers had a greater incidence of prostate cancer [SIR 1.30, 95% CI 1.06-1.57] and thyroid cancer [SIR 3.47, 95% CI 1.66-6.38]. Melanoma incidence was increased in female office workers [SIR 2.27, 95% CI 1.36-3.54]. Lip cancer incidence was increased in male maintenance/production workers [SIR 2.04, 95% CI 1.02-3.65]. Overall cancer incidence was otherwise similar to the general Australian population. Overall risk of death and incidence of cancer for bauxite mine and alumina refinery workers was similar to the general population. Incidence and risk of death from mesothelioma were higher, likely due to historic asbestos exposure in this and other industries. The increased risk of melanoma, lip, prostate and thyroid cancers requires further investigation.

Pre-hospital 'dirty adrenaline': A descriptive case series of patients receiving peripheral dilute adrenaline infusions in Central Australian remote nurse-led clinics prior to aeromedical retrieval.

'Dirty adrenaline' is the informal term used for a rapidly made peripheral dilute adrenaline infusion in the emergency treatment of shock, most commonly 1 mg adrenaline in 1 L 0.9% NaCl. It has long been part of the remote clinician's arsenal despite no supporting scientific literature. Remote clinics in Central Australia can be hours away from critical care support. The region's high prevalence of renal and cardiac disease means that access to early vasopressors and inotropes is a necessity for treating shock. To tackle this, remote clinicians often use 'dirty adrenaline'. We present a review of 'dirty adrenaline' use in this region. Central Australian Retrieval Service's database was screened to identify cases in which a peripheral dilute adrenaline infusion was administered in a remote clinic prior to patient aeromedical retrieval. A retrospective chart review collected: patient demographics; clinical characteristics; infusion details; adverse events; hospital lengths of stay; and mortality outcomes. Fifty-seven cases were identified. Median patient age was 50 (range: 2-96). Septic shock was the most common clinical indication (40/57). Median infusion duration was 155 min. Median systolic BP from commencement until retrieval increased from 75.5 to 91 mmHg. Survival to hospital discharge was 86% (49/57). No significant adverse events associated with 'dirty adrenaline' were recorded. 'Dirty adrenaline' is safe to administer and appears to considerably improve survival when used to treat fluid-resistant shock in remote nurse-led clinics guided by an off-site critical care physician.

The Australian Biosecurity Genomic Database: a new resource for high-throughput sequencing analysis based on the National Notifiable Disease List of Terrestrial Animals.

The Australian Biosecurity Genomic Database (ABGD) is a curated collection of reference viral genome sequences based on the Australian National Notifiable Disease List of Terrestrial Animals. It was created to facilitate the screening of high-throughput sequencing (HTS) data for the potential presence of viruses associated with notifiable disease. The database includes a single verified sequence (the exemplar species sequence, where relevant) for each of the 60 virus species across 21 viral families that are associated with or cause these notifiable diseases, as recognized by the World Organisation for Animal Health. The open-source ABGD on GitHub provides usage guidance documents and is intended to support building a culture in Australian HTS communities that promotes the use of quality-assured, standardized, and verified databases for Australia's national biosecurity interests. Future expansion of the database will include the addition of more strains or subtypes for highly variable viruses, viruses causing diseases of aquatic animals, and genomes of other types of pathogens associated with notifiable diseases, such as bacteria. Database URL: https://github.com/ausbiopathgenDB/AustralianBiosecurityGenomicDatabase.

Markers of positive affect and brain state synchrony discriminate melancholic from non-melancholic depression using naturalistic stimuli.

Melancholia has been proposed as a qualitatively distinct depressive subtype associated with a characteristic symptom profile (psychomotor retardation, profound anhedonia) and a better response to biological therapies. Existing work has suggested that individuals with melancholia are blunted in their display of positive emotions and differ in their neural response to emotionally evocative stimuli. Here, we unify these brain and behavioural findings amongst a carefully phenotyped group of seventy depressed participants, drawn from an established Australian database (the Australian Genetics of Depression Study) and further enriched for melancholia (high ratings of psychomotor retardation and anhedonia). Melancholic (n = 30) or non-melancholic status (n = 40) was defined using a semi-structured interview (the Sydney Melancholia Prototype Index). Complex facial expressions were captured whilst participants watched a movie clip of a comedian and classified using a machine learning algorithm. Subsequently, the dynamics of sequential changes in brain activity were modelled during the viewing of an emotionally evocative movie in the MRI scanner. We found a quantitative reduction in positive facial expressivity amongst participants with melancholia, combined with differences in the synchronous expression of brain states during positive epochs of the movie. In non-melancholic depression, the display of positive affect was inversely related to the activity of cerebellar regions implicated in the processing of affect. However, this relationship was reduced in those with a melancholic phenotype. Our multimodal findings show differences in evaluative and motoric domains between melancholic and non-melancholic depression through engagement in ecologically valid tasks that evoke positive emotion. These findings provide new markers to stratify depression and an opportunity to support the development of targeted interventions.

Perinatal outcomes after a prenatal diagnosis of a fetal copy number variant: a retrospective population-based cohort study

BackgroundThere are no established guidelines for the follow up of infants born after a prenatal diagnosis of a genomic copy number variant (CNV), despite their increased risk of developmental issues. The aims of this study were (i) to determine the perinatal outcomes of fetuses diagnosed with and without a CNV, and (ii) to establish a population-based paediatric cohort for long term developmental follow up.MethodsAn Australian state-wide research database was screened for pregnant individuals who had a prenatal chromosomal microarray (CMA) between 2013–2019 inclusive. Following linkage to laboratory records and clinical referrer details, hospital records were manually reviewed for study eligibility. Eligible participants were mother–child pairs where the pregnancy resulted in a livebirth, the mother was able to provide informed consent in English (did not require a translator) and the mother was the primary caregiver for the child at hospital discharge after birth. Research invitations were sent by registered post at an average of six years after the prenatal diagnostic test. Statistical analysis was performed in Stata17.ResultsOf 1832 prenatal records examined, 1364 (74.5%) mother–child pairs were eligible for recruitment into the follow up cohort. Of the 468 ineligible, 282 (60.3%) had ‘no live pregnancy outcome’ (209 terminations of pregnancy (TOP) and 73 miscarriages, stillbirths, and infant deaths), 157 (33.5%) required a translator, and 29 (6.2%) were excluded for other reasons. TOP rates varied by the type of fetal CNV detected: 49.3% (109/221) for pathogenic CNVs, 18.2% (58/319) for variants of uncertain significance and 3.3% (42/1292) where no clinically significant CNV was reported on CMA. Almost 77% of invitation letters were successfully delivered (1047/1364), and the subsequent participation rate in the follow up cohort was 19.2% (201/1047).ConclusionsThis study provides Australia’s first population-based data on perinatal outcomes following prenatal diagnostic testing with CMA. The relatively high rates of pregnancy loss for those with a prenatal diagnosis of a CNV presented a challenge for establishing a paediatric cohort to examine long term outcomes. Recruiting a mother–child cohort via prenatal ascertainment is a complex and resource-intensive process, but an important step in understanding the impact of a CNV diagnosis in pregnancy and beyond.Trial registrationACTRN12620000446965p; Registered on April 6, 2020.

Outcomes for people admitted to Australian and New Zealand intensive care units with primary, exacerbating, or incidental SARS-CoV-2 infections, 2022-23: a retrospective analysis of ANZICS data.

To compare in-hospital mortality and intensive care unit (ICU) length of stay for people admitted to Australian and New Zealand ICUs during 2022-23 with coronavirus disease 2019 (COVID-19) pneumonitis, incidental or exacerbating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, or without SAR-CoV-2 infections. Retrospective cohort study; analysis of Australian and New Zealand Intensive Care Society (ANZICS) Adult Patient Database data. Adults (16 years or older) admitted to participating ICUs in Australia or New Zealand, 1 January 2022- 30 June 2023. The primary outcome was in-hospital mortality, the secondary outcome ICU length of stay, each by SARS-CoV-2 infection attribution classification: primary COVID-19; exacerbating SARS-CoV-2 infection (SARS-CoV-2 infection was a contributing factor to the primary cause of ICU admission); incidental SARS-CoV-2 infections (SARS-CoV-2 infection detected during ICU admission but did not contribute to admission diagnosis); no SARS-CoV-2 infection. A total of 207 684 adults were admitted to 195 Australian and New Zealand ICUs during 2022-23; 2674 people (1.3%) had incidental SARS-CoV-2 infections, 4923 (2.4%) exacerbating infections, and 3620 (1.7%) primary COVID-19. Unadjusted in-hospital mortality for people with incidental SARS-CoV-2 infections (288 deaths, 10.8%) was lower than for those with exacerbating infections (928 deaths, 18.8%) or primary COVID-19 (830 deaths, 22.9%), but higher than for patients without SARS-CoV-2 infections (15 486 deaths, 7.9%). After adjusting for illness severity, frailty, geographic region, and type of hospital, mortality was higher for patients with incidental SARS-CoV-2 infections (adjusted odds ratio [aOR], 1.28; 95% confidence interval [CI], 1.10-1.50), exacerbating infections (aOR, 1.35; 95% CI, 1.22-1.48), or primary COVID-19 (aOR, 2.54; 95% CI, 2.30-2.81) than for patients without SARS-CoV-2 infections. After adjusting for diagnosis and illness severity, ICU stays were longer for people with incidental (mean difference, 3.3 hours; 95% CI, 2.4-4.2 hours) or exacerbating infections (0.8 hours; 95% CI, 0.2-1.5 hours) than for those without SARS-CoV-2 infections. Risk-adjusted in-hospital mortality and ICU length of stay are higher for people admitted to intensive care who have concomitant SARS-CoV-2 infections than for people who do not.

Australian adaptation and external validation of Commissioning for Quality in Rheumatoid Arthritis-RA-Patient Reported Experience Measure (CQRA-RA-PREM).

To evaluate the reliability and validity of an adapted Commissioning for Quality in Rheumatoid Arthritis-RA-Patient-Reported Experience Measure (CQRA-RA-PREM) for assessing care experience in an Australian rheumatology outpatient cohort. Individual patient interviews were performed to check the language and completion time of the CQRA-RA-PREM before modification. Australian Rheumatology Association Database (ARAD) participants completed the CQRA-PREM-Australian version (CQRA-PREM-AU) (22 items, 5 domains), disease activity measure (RAPID-3, BASDAI) and Assessment of Quality of Life (AQOL-6D) index. Exploratory factor analysis (EFA) assessed item correlation. Cronbach's α assessed internal consistency. Individual patient interviews (n = 8, 62% male, mean age 50 years, mean disease duration 4.5 years) informed CQRA-RA-PREM modification. The ARAD survey response rate was 707/1124 (63%); 459 (65%) RA, 134 (19%) PsA, 114 (16%) AS; 67% female, mean age 62 years, mean disease duration 22 years. The median instrument completion time was 299 s (interquartile range 284-414). Scoring of responses allowed an averaged overall score. EFA extracted five factors: all items loading similarly onto factor 1, indicating validity of the overall score. The CQRA-PREM-AU score correlated with the AQOL-6D score (ρ = 0.23, P < 0.01); partial correlation with disease activity was not significant (ρ = 0.03, P = 0.45), indicating divergent validity. Reliability was comparable across disease subgroups (Cronbach's α >0.94). The mean overall score did not differ by disease subgroup [4.1 (s.d. 0.6, P = 0.73) and there was no floor/ceiling effect. CQRA-PREM-AU is a valid and reliable instrument to measure self-reported care experience in Australian rheumatology patients and may be interpreted as an average overall numerical score.

Experiences of antenatal care practices to reduce stillbirth: surveys of women and healthcare professionals pre-post implementation of the Safer Baby Bundle

BackgroundThe Safer Baby Bundle (SBB) aimed to reduce stillbirth rates in Australia through improving pregnancy care across five elements; smoking cessation, fetal growth restriction (FGR), decreased fetal movements (DFM), side sleeping in late pregnancy and decision making around timing of birth. We assessed experiences of women and healthcare professionals (HCPs) with antenatal care practices around the five elements.MethodsA pre-post study design using online surveys was employed to assess change in HCPs awareness, knowledge, and frequency of performing recommended practices (22 in total) and women’s experiences of care received related to reducing their chance of stillbirth. Women who had received antenatal care and HCPs (midwives and doctors) at services participating in the SBB implementation program in two Australian states were invited to participate. Surveys were distributed over January to July 2020 (pre) and August to December 2022 (post). Comparison of pre-post responses was undertaken using Fisher’s exact, Pearson’s chi-squared or Wilcoxon rank-sum tests.Results1,225 women (pre-1096/post-129) and 1,415 HCPs (pre-1148/post-267, ≥ 83% midwives) completed the surveys. The frequency of HCPs performing best practice ‘all the time’ significantly improved post-SBB implementation across all elements including providing advice to women on side sleeping (20.4–79.4%, p < 0.001) and benefits of smoking cessation (54.5–74.5%, p < 0.001), provision of DFM brochure (43.2–85.1%, p < 0.001), risk assessments for FGR (59.2–84.1%, p < 0.001) and stillbirth (44.5–73.2%, p < 0.001). Practices around smoking cessation in general showed less improvement e.g. using the ‘Ask, Advise and Help’ brief advice model at each visit (15.6–20.3%, p = 0.088). Post-implementation more women recalled conversations about stillbirth and risk reduction (32.2–50.4%, p < 0.001) and most HCPs reported including these conversations in their routine care (35.1–83.0%, p < 0.001). Most HCPs agreed that the SBB had become part of their routine practice (85.0%).ConclusionsImplementation of the SBB was associated with improvements in practice across all targeted elements of care in stillbirth prevention including conversations with women around stillbirth risk reduction. Further consideration is needed around strategies to increase uptake of practices that were more resistant to change such as smoking cessation support.Trial registrationThe Safer Baby Bundle Study was retrospectively registered on the Australian New Zealand Clinical Trials Registry database, ACTRN12619001777189, date assigned 16/12/2019.

Cross-Sectional and Longitudinal Associations Between Treatment for Herpes Virus Infection and the Dispensing of Antidementia Medicines: An Analysis of the Australian Pharmaceutical Benefits Scheme Database.

Evidence from previous observational studies suggest that infection by herpes simplex virus (HSV) and varicella zoster virus (VZV) increase the risk of dementia. To investigate if older adults exposed to HSV treatment have lower risk of dementia than the rest of the population. We used the 10% Australian Pharmaceutical Benefits Scheme (PBS) database from 2013 to 2022 to ascertain the cross-sectional, time-series and longitudinal association between exposure to HSV treatment and the dispensing of antidementia medicines. Participants were men and women aged 60 years or older. We used Anatomical Therapeutic Chemical (ATC) codes to identify medicines dispensed for the treatment of HSV and dementia. During the year 2022 6,868 (1.2%) of 559,561 of participants aged 60 years or over were dispensed antidementia agent. The odds ratio (OR) of being dispensed an antidementia agent among individuals dispensed treatment for HSV was 0.73 (99% CI = 0.56-0.95). Multilevel logistic regression for the 2013-2022 period for those dispensed HSV treatment was 0.87 (99% CI = 0.75-1.00). Split-time span series from 2013 was associated with hazard ratio of 0.98 (99% CI = 0.89-1.07) for individuals dispensed relative to those not dispensed HSV treatment. All analyses were adjusted for age, sex, and the dispensing of medicines for the treatment of diabetes, hyperlipidemia, hypertension, and ischemic heart disease. The dispensing of antiviral medicines for the treatment of HSV and VZV is consistently, but not conclusively, associated with decreased dispensing of antidementia medicines. This suggests that treatment of HSV and VZV infections may contribute to reduce the risk of dementia.

Monitoring the Mineral Content of Plant Foods in Food Composition Databases

Declines in the mineral content of food have been reported in several countries. This study monitored reported changes in the mineral content of plant foods in Australian food composition databases between 1991 and 2022. Commonly consumed plant foods (n = 130), grouped as fruit, vegetables, legumes, grains, and nuts in raw unprocessed form, were matched between three reference databases from 1991, 2010, and 2022. Absolute and percentage differences in mineral content (iron, zinc, calcium, and magnesium) were calculated. During this 30-year period, 62 matched foods had updated mineral content. Iron content decreased significantly for fruit (48%) and vegetables (20%), although absolute differences were small (0.09–0.14 mg/100 g). Zinc content declined by 15% for fruit (&lt;0.1 mg/100 g, absolute difference 0.03 mg/100 g), but no differences were observed for calcium and magnesium content. Potential reasons for any reported differences could not be explored using food composition data alone, likely due to biological, agricultural, and/or analytical factors. Nutritionally, these small differences are unlikely to have a major impact on the population’s nutritional status, although efforts to improve fruit and vegetable consumption are encouraged to meet recommendations.

Unveiling a Health Disparity: Comparative Analysis of Head and Neck Cancer Trends between First Nations People and Non-Indigenous Australians (1998-2015).

We aim to assess and compare the HNC trends between the First Nations and non-Indigenous population. HNC incidence (1998-2013) and mortality (1998-2015) data in First Nations people and non-Indigenous Australians were utilised from the Australian Cancer Database. The age-standardised incidence and mortality trends along with annual percentage changes were analysed using Joinpoint models. Age-standardised incidence and mortality rates according to remoteness, states, and five-year survival rates among First Nations people and non-Indigenous Australians were presented as graphs. First Nations people had over twice the age-standardised incidence (2013; 29.8/100,000 vs. 14.7/100,000) and over 3.5 times the age-standardised mortality rates (2015; 14.2/100,000 vs. 4.1/100,000) than their non-Indigenous counterparts. Both populations saw a decline in mortality, but the decline was only statistically significant in non-Indigenous Australians (17.1% decline, 1998: 4.8/100,000, 2015: 4.1/100,000; p < 0.05). Across all remoteness levels and states, First Nations people consistently had higher age-standardised incidence and mortality rates. Furthermore, the five-year survival rate was lower by 25% in First Nations people. First Nations people continue to shoulder a disproportionate HNC burden compared to non-Indigenous Australians.

The strategic importance of Australian farmland as a property sector for institutional investors

PurposeFarmland is an important property sector that has attracted the attention of institutional investors globally in recent years. This paper examines the risk-adjusted performance and portfolio diversification benefits of Australian farmland in a portfolio over the eight-year period of Q2:2015–Q2:2023, highlighting the unique property management dimensions to this property sector for its effective role in an institutional investor's property portfolio.Design/methodology/approachUsing the quarterly ANREV Australian farmland index over Q2:2015–Q2:2023, the risk-adjusted performance and portfolio diversification potential of Australian farmland is assessed. Constrained mixed-asset portfolios are used to assess the potential added-value role of Australian farmland in a mixed-asset portfolio. Analyses are also done for the farmland sub-sectors of annual farmland and permanent farmland.FindingsAustralian farmland is seen to show strong risk-adjusted performance but at a much higher risk level than that seen for direct property. Diversification benefits from Australian farmland are also evident, with an important role by Australian farmland seen in the mixed-asset portfolio. Specific farmland property management strategies are identified for the effective inclusion of farmland in an institutional investor's property portfolio, including the potential benefits towards net zero carbon strategies.Originality/valueThis is the first research that provides an independent empirical examination of the strategic importance of Australian farmland property for institutional investors using the institutional investment-grade ANREV Australian farmland database, from both an investment and environmental perspective. The unique property management implications for Australian farmland property are also highlighted, including the potential role of Australian farmland in net zero carbon strategies by institutional investors.

The association of out-of-hospital cardiac arrest barriers to cardiopulmonary resuscitation initiation and continuation during the emergency call: A retrospective cohort study

BackgroundIn a previous study, we identified eight types of potential barriers to bystander cardiopulmonary resuscitation (CPR) initiation and continuation until the arrival of emergency medical services (EMS) on scene, in the context of emergency calls for out-of-hospital cardiac arrest (OHCA). Many cases had multiple barriers. In this study, we aimed to estimate the independent effects of these barriers after adjusting for case characteristics. MethodsWe used data for the 295 non-trauma OHCAs from the St John Western Australian (SJ-WA) OHCA Database. Excluded cases were: EMS-witnessed OHCA, callers not with/close to the patient, OHCA not recognised during the emergency call, bystander CPR in progress prior to the call and calls coded as obvious death by SJ-WA. We conducted two multivariable logistic regression models including the eight barriers (callers: 1) perceived inappropriateness of CPR, 2) emotional distress, 3) reluctance to perform CPR, 4) physical limitations, 5) access to the patient, 6) leaving the scene, 7) communication failure, and 8) on-scene distractions) and case characteristics. ResultsThe callers perceiving CPR as inappropriate (adjusted odds ratio [AOR] = 0.20, 0.11–0.37) and witnessed arrest (AOR = 2.88, 95% CI 1.48–5.60) were independently associated with CPR initiation. Caller distractions such as performing other tasks or relaying information to other bystanders were negatively significantly associated with callers continuing CPR to EMS arrival (AOR = 0.27, 0.10–0.73). ConclusionsPerceptions of inappropriateness and caller distractions were independent risk factors for the delivery of bystander CPR. Further research around how call-takers navigate these barriers and encourage callers should be performed.

Modelling and comparing the use of IVF and ICSI in Australia

PurposeThis study estimates the need of IVF/ICSI in Australia as compared to its actual uptake.MethodsWe created a model estimating for the annual demand for IVF/ICSI in a hypothetical infertile population, using demographic data from medical literature and Australian government databases. For each category of infertility (tubal, severe male, endometriosis, anovulation and unexplained), our estimated need for IVF/ICSI was compared to the actual IVF/ICSI uptake (ANZARD 2019). The model consisted of three categories depending on couples’ cause of infertility, i.e. couples with absolute indications for IVF/ICSI (couples with severe male factor infertility and tubal obstruction); couples with anovulatory infertility (couples with ovulation disorders) and couples with ovulatory infertility (couples suffering from unexplained infertility and endometriosis). The model was applied to each of these categories to determine the number of couples that would require IVF/ICSI treatment after failing to conceive naturally or after following alternative treatment plans. The main outcomes of this study were the estimate of IVF/ICSI cycles and the difference between the estimate and the reported number of IVF/ICSI cycles (2019 ANZARD report).ResultsWe estimated that approximately 35,300 couples required IVF/ICSI treatment in Australia in 2019, while in 2019 according to ANZARD, 46,000 couples underwent IVF/ICSI. A higher uptake of IVF/ICSI cycles than expected was specifically reported in couples with unexplained infertility, ovulation disorders and endometriosis, while for tubal and severe male infertility uptake seemed adequate.ConclusionIn Australia, there seems to be overservicing of IVF/ICSI, specifically for unexplained, ovulatory and endometriosis-related infertility.

Kafka’s beautiful eyes: Forensic intelligence utilisation of phenotypic information

Franz Kafka had beautiful eyes. So striking, that many of the famous author’s friends and peers commented on them – but quite variously (‘dark’, ‘brown’, ‘grey’ & ‘blue’). Eye colour as perceived by an observer is subjective, being influenced by physiological, environmental, and even sociocultural factors. In a policing context, this does not mean that trait information such as eye colour is not valuable (far from it), but that it must be managed carefully. The Australian Federal Police has recently implemented a forensic DNA phenotyping (FDP, aka. physical trait prediction or PTP) capability, utilising massively parallel sequencing DNA technology to predict an individual’s eye colour, biogeographical ancestry and sex from a crime scene sample. This information alone is not itself ‘intelligence’, but can be used to generate intelligence through holistic analyses undertaken within a transdisciplinary, all-source forensic intelligence (FORINT) framework. FORINT outputs posit abductive propositions typically at the activity/offence level, to provide insight and influence decision making. However, the use of predicted traits requires that they are compared to something; all Australian police databases include fields for physical traits, but no uniform standard is applied across all agencies. Moreover, collection is inconsistent and no automated systems are in place to capture such data systematically. Consider the ‘Kafka problem’: his peers gave multiply divergent descriptions of his eyes. If a Biology unit had predicted the eye colour of an ‘unidentified author’ using DNA – how would Kafka be confidently nominated as the contributor? We posit three maxims for law enforcement: (1) To expand the operational utility of forensic science in line with police demands, forensic science should operationalise FDP (e.g. operationally to rank a list of persons of interest, focus lines of enquiry in serious & organised crime, or assist with human remains identification). (2) Such advanced biological techniques are best delivered through an all-source FORINT framework, to maximise opportunities and minimise risk. (3) One cannot pursue techno-scientific advancements in isolation; it is also necessary to influence the operational posture for their implementation. In this paper we explore these issues and provide recommendations relating to (a) police practices, (b) image capture systems, and (c) research opportunities. Phenotypic trait prediction has great potential and can be operationalised effectively through a rigorous FORINT framework. However, there is (continual) work to be done to enhance the operational capabilities that are complementary to – but necessary for – effective forensic science contribution to investigations.

In search of an empirical foundation: Firearms trade and Pacific history

AbstractWhile the importance of economic relationships and structures to the functioning of the Empire has received considerable attention for other regions, the Pacific has only begun to be more fully integrated into these discourses. This article explores how histories of maritime trade might take advantage of recent innovations in digitised sources to rectify this exclusion. The firearms trade is the key focus, as this item was almost a universal trade good for much of the nineteenth century Pacific. Given that these weapons were both a complex industrial product and also often attributed to devastating social impacts, they offer unique potential both for indicating the global nature of nineteenth century Pacific trade, and for querying the role of Europeans in impacting indigenous island populations. The use of data provided by careful cross referencing of traditional primary material with large digital archives such as the Australian National Library's TROVE database offers the potential to lift such discussion above supposition and assumption, providing valuable contributions for many regional histories in the Pacific and beyond.

Impact of Comorbidities and Drug Interactions in Patients With Metastatic Castration-Resistant Prostate Cancer Receiving Androgen Receptor Pathway Inhibitors.

Androgen receptor pathway inhibitors (ARPIs) are widely prescribed in metastatic castration-resistant prostate cancer (mCRPC). Real-world frequencies and potential impacts of comorbidities and concomitant medication (conmed) interactions with ARPIs are not well described. Patients receiving ARPIs for mCRPC were identified from the electronic Prostate Cancer Australian Database (ePAD). Demographics, clinicopathologic characteristics, and outcome data were extracted. Conmeds and comorbidities were collected from medical records. Potential interacting comorbidities were defined from trial and post-trial data. Clinically significant drug-drug interactions (DDIs) were identified using UpToDate Lexicomp and Stockley's databases. Patient characteristics, comorbidity interactions, DDIs, and outcomes were analyzed. Two hundred thirty-five patients received first- or second-line ARPIs for mCRPC from 2012 to 2021, with a median follow-up of 27 months. One hundred sixteen received abiraterone acetate (AAP) and 135 received enzalutamide (ENZ). The median age was 74 years, and the median number of conmeds was 4. Clinically significant DDIs occurred in 55 (47%) AAP patients and 90 (67%) ENZ patients. Only 5% of DDIs were predicted to affect ARPI pharmacokinetics (PK) or pharmacodynamics, whereas 95% were predicted to impact conmed PK or increase toxicity risk. In patients receiving ENZ, DDIs were associated with lower PSA50 (50% v 74%, P = .04) and poorer overall survival (28 v 45 months, P = .04), although statistical significance was not maintained on multivariate analysis. No significant survival differences were seen with DDIs in patients receiving AAP. Potential interactions between comorbidities and ARPI were present in 72% on AAP and 14% on ENZ with no significant associated survival differences. DDIs and drug-comorbidity interactions in real-world patients receiving ARPIs for mCRPC are common and may affect outcomes. Ongoing clinician education regarding DDIs is necessary to optimize patient outcomes.