Australian Government Department Research Articles

Communities of practice as an effective ECB approach for nonevaluation specialists: A case study in an Australian state government department

AbstractAmong the various evaluation capacity building strategies, there is an important opportunity to enhance the evidence on the effectiveness of communities of practice (CoPs). We argue that evaluation CoPs have great potential to develop evaluative thinking among nonevaluation specialists and build the foundations of a sustainable organizational evaluation culture. This article presents a case study of an evaluation community of practice in an Australian state government agency, with evidence collected over 4 years against a comprehensive evaluation framework. It outlines in detail an empirically tested evaluation‐CoP good practice from the initial design and logic model to implementation and measurement against individual, group, and organizational outcomes.

Evaluation of the Adult Migrant English Program for the Australian Government Department of Home Affairs

Objective and ApproachThe Adult Migrant English Program (AMEP) is a free service to help eligible migrants and humanitarian entrants with low English proficiency to improve their English skills and elevate their participation in Australian society. In partnership with AMEP funder, the Australian Government Department of Home Affairs, we have completed a longitudinal research study analysing the effectiveness of AMEP by linking participant information for over 400,000 AMEP clients with administrative data from social services, taxation, and the national census, from 2003 – 2019. This is the first time AMEP participant data has been linked with other data assets and represents the most comprehensive evaluation of AMEP since program inception in 1948. ResultsAMEP participation was associated with improved English proficiency of clients, especially when clients studied for longer periods. Migrants with higher levels of English on-entry had better labour market outcomes, higher income levels (male and female), lower rates of public housing tenancy, and were less likely to receive income support in the years following program exit. ConclusionsWhile the design does not support true causal inference, this evaluation provides good evidence that AMEP is effective at improving English proficiency and suggests AMEP participation can improve a range of economic and social outcomes for eligible migrants with low English proficiency. ImplicationsThe launch of these results coincided with new investment in AMEP and a broadening of eligibility criteria to make AMEP available to a wider range of migrants with low English proficiency.

A model-based assessment of social isolation practices for COVID-19 outbreak response in residential care facilities

BackgroundResidential aged-care facilities (RACFs, also called long-term care facilities, aged care homes, or nursing homes) have elevated risks of respiratory infection outbreaks and associated disease burden. During the COVID-19 pandemic, social isolation policies were commonly used in these facilities to prevent and mitigate outbreaks. We refer specifically to general isolation policies that were intended to reduce contact between residents, without regard to confirmed infection status. Such policies are controversial because of their association with adverse mental and physical health indicators and there is a lack of modelling that assesses their effectiveness.MethodsIn consultation with the Australian Government Department of Health and Aged Care, we developed an agent-based model of COVID-19 transmission in a structured population, intended to represent the salient characteristics of a residential care environment. Using our model, we generated stochastic ensembles of simulated outbreaks and compared summary statistics of outbreaks simulated under different mitigation conditions. Our study focuses on the marginal impact of general isolation (reducing social contact between residents), regardless of confirmed infection. For a realistic assessment, our model included other generic interventions consistent with the Australian Government’s recommendations released during the COVID-19 pandemic: isolation of confirmed resident cases, furlough (mandatory paid leave) of staff members with confirmed infection, and deployment of personal protective equipment (PPE) after outbreak declaration.ResultsIn the absence of any asymptomatic screening, general isolation of residents to their rooms reduced median cumulative cases by approximately 27%. However, when conducted concurrently with asymptomatic screening and isolation of confirmed cases, general isolation reduced the median number of cumulative infections by only 12% in our simulations.ConclusionsUnder realistic sets of assumptions, our simulations showed that general isolation of residents did not provide substantial benefits beyond those achieved through screening, isolation of confirmed cases, and deployment of PPE. Our results also highlight the importance of effective case isolation, and indicate that asymptomatic screening of residents and staff may be warranted, especially if importation risk from the outside community is high. Our conclusions are sensitive to assumptions about the proportion of total contacts in a facility accounted for by casual interactions between residents.

Curriculum Indigenization in oral health professions' education worldwide: A scoping review.

To explore the literature on Indigenous content within the oral health professions' education curricula. This scoping review included all types of literature on oral health care educational programs on Indigenous content, following the JBI (Joanna Briggs Institute) methodology. An initial search using "Indigenous," "education," and "oral health" as keywords informed a full search strategy for MEDLINE, CINAHL, Embase, Scopus, ERIC, EPPI, MedEdPORTAL, Google Scholar, ProQuest Dissertations and Theses Global, Australian Government Department of Health, and Australian Indigenous HealthInfoNet. The search included literature available until November 1, 2023, irrespective of language. Two reviewers independently screened the studies, and data were extracted and presented in tabular and narrative summary formats. A total of 948 records were identified, and 101 studies were chosen for full-text review. Twenty-three studies met the criteria for data extraction. Of all studies, 95.6% were published between 2007 and 2021, mostly from Australia and New Zealand. The most frequently covered content included Indigenous culture, followed by history, Indigenous oral health, and Indigenous Peoples' health. Rural and clinical placements were the most employed delivery methods, and evaluation surveys were the most employed assessment technique. Barriers to delivering an Indigenous curriculum included students' disinterest and limited interaction with Indigenous communities, while facilitators included cultural immersion and supportive mentorship. Despite progress in integrating Indigenous content into oral health education, challenges persist. Prioritizing Indigenous perspectives, community partnerships, and standardized assessment tools is needed. Future research should focus on long-term impacts and best practices for Indigenous curriculum development and delivery.

First Australian estimates of incidence and prevalence of uterine fibroids: a data linkage cohort study 2000-2022.

What is the estimated prevalence and incidence of uterine fibroids diagnosed in Australian women of reproductive age? An estimated 7.3% of Australian women had a diagnosis of uterine fibroids by the age of 45-49 years, with age-specific incidence highest in women aged 40-44 years (5.0 cases per 1000 person-years). Uterine fibroids are associated with a high symptom burden and may affect overall health and quality of life. Studies in different countries show a wide variation in both the prevalence (4.5-68%) and incidence (2.2-37.5 per 1000 person-years) of uterine fibroids, which may be partly explained by the type of investigation, method of case ascertainment, or the age range of the study population, necessitating the reporting of country-specific estimates. This observational prospective cohort study using self-report survey and linked administrative data (2000-2022) included 8066 women, born between 1973 and 1978, in the Australian Longitudinal Study on Women's Health. A combination of self-report survey and linked administrative health data (hospital, emergency department, the Medicare Benefits Schedule, and the Pharmaceutical Benefits Scheme) were used to identify women with a report of a diagnosis of uterine fibroids between 2000 and 2022. Of the 8066 Australian women followed for 22 years, an estimated 7.3% of women (95% CI 6.9, 7.6) had a diagnosis of uterine fibroids by the age of 45-49 years. The incidence increased with age and was highest in women aged 40-44 years (5.0 cases per 1000 person-years, 95% CI 4.3, 5.7 cases per 1000 person-years). Women with uterine fibroids were more likely to experience heavy or painful periods. They were also more likely to report low iron levels, endometriosis, and poor self-rated health and to have two or more annual visits to their general practitioner. Our estimates are based on self-report of doctor diagnosis or treatment for fibroids and/or data linked to treatment and procedure administrative records. This predominantly captures women with symptomatic fibroids, but has the potential for misclassification of asymptomatic women and an underestimate of overall prevalence and incidence. In addition, questions on fibroids were only asked in surveys when women were 37-42 years of age to 43-48 years of age, so cases at younger ages may have been underestimated (particularly in women with less severe symptoms) as these were only ascertained through data linkage. These are the first population-based estimates of the prevalence and incidence of uterine fibroids in women of reproductive age in Australia. Establishing these first estimates will help inform health policy and health care provision in the Australian context. The ALSWH is funded by the Australian Government Department of Health and Aged Care. L.FW. was supported by an Australian National Health and Medical Research Council (NHMRC) Centres for Research Excellence grant (APP1153420) and G.D.M. was supported by an NHMRC Leadership Fellowship (APP2009577). The funding bodies played no role in the design, the collection, analysis or interpretation of data, the writing of the manuscript, or the decision to submit the manuscript for publication. There are no competing interests. N/A.

Healthcare-associated infections and antimicrobial use at a major referral hospital in Papua New Guinea: a point prevalence survey

Healthcare-associated infections (HAI) and antimicrobial use (AMU) are drivers for antimicrobial resistance, and robust data are required to inform interventions and track changes. We aimed to estimate the prevalence of HAI and AMU at Port Moresby General Hospital (PMGH), the largest hospital in Papua New Guinea. We did a point prevalence survey (PPS) on HAI and AMU at PMGH in May 2023 using the European Centre for Disease Prevention and Control (ECDC) PPS protocol. We included all critical care patients and randomly sampled half of the patients in other acute-care wards. We calculated weighted HAI and AMU prevalence estimates to account for this sampling strategy. Weighted HAI estimates were also calculated for an expanded definition that included physician diagnosis. Of 361 patients surveyed in 18 wards, the ECDC protocol identified 28 HAIs in 26 patients, resulting in a weighted HAI prevalence of 6.7% (95% CI: 4.6, 9.8). Surgical site infections (9/28, 32%) were the most common HAI. When adding physician diagnosis to the ECDC definitions, more skin and soft tissue, respiratory, and bloodstream HAIs were detected, and the weighted HAI prevalence was 12.4% (95% CI: 9.4, 16.3). The prevalence of AMU was 66.5% (95%CI: 61.3, 71.2), and 73.2% (263/359) of antibiotics were from the World Health Organization Access group. This is the first reported hospital PPS of HAI and AMU in Papua New Guinea. These results can be used to prioritise interventions, and as a baseline against which future point prevalence surveys can be compared. Australian Government Department of Foreign Affairs and Trade and Therapeutic Guidelines Limited Australia.

EXERCISE PRESCRIPTION TO SUPPORT THE MANAGEMENT OF OSTEOPOROSIS: AN EXPERT STATEMENT FOR EXERCISE PHYSIOLOGISTS

INTRODUCTION & AIMS Low bone density, which includes osteopenia and osteoporosis, leads to roughly 183,000 fractures annually in Australia, with associated direct costs of $2.59B. Osteoporosis is underdiagnosed. Exercise is effective therapy but is underutilised due to a lack of knowledge and unfounded concerns about risk of injury. The aim of the newly developed Exercise Prescription for the Prevention of Osteoporosis Fracture National Statement is to provide clear, actionable, evidence-based exercise advice to improve the bone health of people living with osteopenia and osteoporosis. The project was led and supported by Healthy Bones Australia with funding awarded by the Australian Government Department of Health, Public Health and Chronic Disease Program Osteoporosis – Education and Prevention. METHODS An expert working group (scientists, AEP, physiotherapist, endocrinologist and orthopaedic resident) and advisory committee (practising AEPs and physiotherapists) reviewed current evidence and existing guidelines to formulate recommendations for a national statement in the Australian context. A National Exercise Roundtable was convened, including consumers and stakeholders across multiple disciplines, to adapt the recommendations for clinical practice and consumer acceptability. RESULTS The final statement is presented as an evidence-based document, and a 2-page user summary. The Statement outlines the general principles of osteogenic loading and falls prevention, then presents a comprehensive exercise prescription based on those principles, along with special considerations for comorbid conditions. Level A consensus was achieved on five summary statements. CONCLUSION Bone health is an essential part of general health. While exercise prescription for other chronic diseases, such as, heart health and diabetes, is quite well established, there is a care gap for bone which we have addressed. Our National Statement, informed by high level evidence and expert insight, delivers best practice for prescribing exercise for osteoporosis to achieve best patient outcomes. We will present the document to the intended end users – exercise physiologists.

Addressing the teacher shortage in Australia: what do the Initial Teacher Education (ITE) completion data tell us?

With projections from the Australian federal government indicating an impending exacerbation of the teacher shortage by 2025, it is timely to explore potential approaches that could help mitigate this imminent national crisis. In teaching, there is an historical tendency for the teaching profession to attract more women than men and this study therefore aims to analyse trends in female completion rates of Initial Teacher Education (ITE) degrees. The study objective was to identify the specific teaching degree levels (undergraduate and postgraduate) and modes of attendance that are most likely to continue attracting women to pursue careers in teaching. This research relies on non-identifiable open access data obtained from Australian ITE providers between 2001 and 2021, which have been collected by the Australian Government Department of Education, Skills and Employment. The study findings reveal an upward trend in female completions of ITE programs offered through external and multimodal study modes, while the internal mode of attendance show a decline. These findings hold significant implications for policy and practice, suggesting the need to enhance the accessibility of external and multimodal ITE degrees for women.

Viral clearance as a surrogate of clinical efficacy for COVID-19 therapies in outpatients: a systematic review and meta-analysis

Surrogates of antiviral efficacy are needed for COVID-19. We aimed to investigate the relationship between the virological effect of treatment and clinical efficacy as measured by progression to severe disease in outpatients treated for mild-to-moderate COVID-19. In this systematic review and meta-analysis, we searched PubMed, Scopus, and medRxiv from database inception to Aug 16, 2023, for randomised placebo-controlled trials that tested virus-directed treatments (ie, any monoclonal antibodies, convalescent plasma, or antivirals) in non-hospitalised individuals with COVID-19. We only included studies that reported both clinical outcomes (ie, rate of disease progression to hospitalisation or death) and virological outcomes (ie, viral load within the first 7 days of treatment). We extracted summary data from eligible reports, with discrepancies resolved through discussion. We used an established meta-regression model with random effects to assess the association between clinical efficacy and virological treatment effect, and calculated I2 to quantify residual study heterogeneity. We identified 1718 unique studies, of which 22 (with a total of 16 684 participants) met the inclusion criteria, and were in primarily unvaccinated individuals. Risk of bias was assessed as low in 19 of 22 studies for clinical outcomes, whereas for virological outcomes, a high risk of bias was assessed in 11 studies, some risk in ten studies, and a low risk in one study. The unadjusted relative risk of disease progression for each extra log10 copies per mL reduction in viral load in treated compared with placebo groups was 0·12 (95% CI 0·04-0·34; p<0·0001) on day 3, 0·20(0·08-0·50; p=0·0006) on day 5, and 0·53 (0·30-0·94; p=0·030) on day 7. The residual heterogeneity in our meta-regression was estimated as low (I2=0% [0-53] on day 3, 0% [0-71] on day 5, and 0% [0-43] on day 7). Despite the aggregation of studies with differing designs, and evidence of risk of bias in some virological outcomes, this review provides evidence that treatment-induced acceleration of viral clearance within the first 5days after treatment is a potential surrogate of clinical efficacy to prevent hospitalisation with COVID-19. This work supports the use of viral clearance as an early phase clinical trial endpoint of therapeutic efficacy. Australian Government Department of Health, Medical Research Future Fund, and Australian National Health and Medical Research Council.

The Seventh State and the Barnes Dance: Deciding the Future for the Territory of Papua and New Guinea

The most momentous change to the political make-up of the Australian state was undoubtedly the independence of Papua New Guinea in 1975. But decolonisation was not a foregone conclusion until late in the 1960s. Through the mid-1960s politicians on both sides of the Torres Strait considered the option that the Territory of Papua and New Guinea (TPNG) might become the seventh state of Australia. The option had global and domestic implications and exposed the fault lines of Australian policies towards its northern most territories. The rights to free movement within the nation state, the right to welfare, and the benefits of full citizenship for Papua New Guineans were considered across Australian government departments before being comprehensively rejected following an extraordinary Canberra meeting in 1966 between the elected representatives of the TPNG and federal ministers led by Charles (Ceb) Barnes whose equivocation on statehood fed speculation throughout TPNG.

Simulating the healthcare workforce impact and capacity for pancreatic cancer care in Victoria: a model-based analysis

BackgroundThe incidence of pancreatic cancer is rising. With improvements in knowledge for screening and early detection, earlier detection of pancreatic cancer will continue to be more common. To support workforce planning, our aim is to perform a model-based analysis that simulates the potential impact on the healthcare workforce, assuming an earlier diagnosis of pancreatic cancer.MethodsWe developed a simulation model to estimate the demand (i.e. new cases of pancreatic cancer) and supply (i.e. the healthcare workforce including general surgeons, medical oncologists, radiation oncologists, pain medicine physicians, and palliative care physicians) between 2023 and 2027 in Victoria, Australia. The model compares the current scenario to one in which pancreatic cancer is diagnosed at an earlier stage. The incidence of pancreatic cancer in Victoria, five-year survival rates, and Victoria’s population size were obtained from Victorian Cancer Registry, Cancer Council NSW, and Australian Bureau of Statistics respectively. The healthcare workforce data were sourced from the Australian Government Department of Health and Aged Care’s Health Workforce Data. The model was constructed at the remoteness level. We analysed the new cases and the number of healthcare workforce by profession together to assess the impact on the healthcare workforce.ResultsIn the status quo, over the next five years, there will be 198 to 220 stages I-II, 297 to 330 stage III, and 495 to 550 stage IV pancreatic cancer cases diagnosed annually, respectively. Assuming 20–70% of the shift towards pancreatic cancer’s earlier diagnosis (shifting from stage IV to stages I-II pancreatic cancer within one year), the stages I-II cases could increase to 351 to 390 or 598 to 665 per year. The shift to early diagnosis led to substantial survival gains, translating into an additional 284 or 795 out of 5246 patients with pancreatic cancer remaining alive up to year 5 post-diagnosis. Workforce supply decreases significantly by the remoteness levels, and remote areas face a shortage of key medical professionals registered in delivering pancreatic cancer care, suggesting travel necessities by patients or clinicians.ConclusionImproving the early detection and diagnosis of pancreatic cancer is expected to bring significant survival benefits, although there are workforce distribution imbalances in Victoria that may affect the ability to achieve the anticipated survival gain.

The Australian Group on Antimicrobial Resistance

Antimicrobials are an integral component of healthcare delivery. When resistance to an antimicrobial emerges, it has a significant impact on an individual’s treatment and the community more broadly. In Australia, to monitor antimicrobial resistance in human health, the Australian Group on Antimicrobial Resistance (AGAR) performs three ongoing blood-based antimicrobial surveillance programs: the Australian Staphylococcus aureus Surveillance Outcome Program (ASSOP); the Australian Enterococcal Surveillance Outcome Program (AESOP); and the Gram-negative Surveillance Outcome Program (GnSOP). All data are available on the AGAR website and are included in the Australian Government Department of Health and Aged Care’s Antimicrobial Use and Resistance in Australia Surveillance System.

Food, nutrition and the dining experience in aged care settings: Findings of a nationwide survey.

Previous research on food, nutrition and dining practices in Australian residential aged care (RAC) homes has been based on a limited sample of single-home or multiple-home providers, but a nationwide study has not been conducted. The aim of this study was to provide a preliminary overview of current food, nutrition and dining practices across Australian RAC facilities using a nationwide survey. A survey was distributed to Australian RAC homes in August-September 2020, as part of the National Congress on Food, Nutrition and the Dining Experience in Aged Care (February 2021). The survey, administered via an online portal, consisted of 38 semistructured questions including yes/no or multiple-choice responses, free text, frequency scales and number entry. Six key topics were explored, including 'food service system and environment', 'catering style', 'menu planning and evaluation', 'nutrition planning and requirements', 'nutrition-related screening and assessment' and 'training and additional information', which were informed by the Australian Government Department of Health and reflected the interests of the Congress. The final sample included 292 respondents (204 individual homes and 88 multiple-home proprietors) representing 1152 homes and 125,393 residents, encompassing approximately 43% of RAC homes (of a possible 2671) and 57% of residents (of a possible 219,965) in Australia. Survey respondents representing RAC homes included service managers, catering managers, Chief Executive Officers, cooks, chefs, dietitians or staff from other roles within homes. A number of potential areas of need were identified, included increasing the autonomy of residents to select the foods they desire, increasing the variety and choice (including timing) of meals, enhancing the dining environments in homes to stimulate food intake and increasing staff training and the number of trained chefs in homes, so that meals are prepared which address diverse nutritional needs of residents. This study provides insight into the food service and mealtime practices of over a third of Australian RAC homes. The findings of this survey may help to identify key targets for intervention to improve the food, nutrition and quality of life of aged care residents.

Impact of the COVID-19 pandemic on delivery of prostate cancer care in Australia: An interrupted time series analysis.

The COVID-19 pandemic led to a major disruption to health services across the world. The aim of this population-based study was to assess the downstream effects of the pandemic on diagnostic tests and treatment activities related to prostate cancer (PC). The Australian Government Department of Health Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme databases were queried from January 2010 to June 2022. Two interrupted time series were performed Pre-COVID (January 2010 to February 2020) and peri-COVID (March 2020 to June 2022). Temporal modeling was performed to account for seasonal variation. Pre-COVID-19, monthly prostate-specific antigen (PSA) testing showed a declining trend and testing decreased by 81 tests per 100 000 annually. A single-month 38% drop in PSA testing was observed in April 2020; this corresponded to Australia's first wave. No change was observed in the rate of prostate biopsies. Peri-COVID-19 outbreaks, there was a slight shift toward the use of long-acting androgen deprivation therapy (ADT) at 4% with a predilection still for short-acting agents. with no registered change in the overall volume of radiotherapy or surgery. There were no deficits in the number of diagnostic and treatment activities for men with PC. Aside from a slight shift toward long-acting ADT use during the pandemic, no other patterns were observed. The longer-term impact such as missed diagnosis or late presentation affecting chances of survival due to COVID-19 is yet to be ascertained.

Determinants of passive antibody efficacy in SARS-CoV-2 infection: a systematic review and meta-analysis

Randomised controlled trials of passive antibodies as treatment and prophylaxis for COVID-19 have reported variable efficacy. However, the determinants of efficacy have not been identified. We aimed to assess how the dose and timing of administration affect treatment outcome. In this systematic review and meta-analysis, we extracted data from published studies of passive antibody treatment from Jan 1, 2019, to Jan 31, 2023, that were identified by searching multiple databases, including MEDLINE, PubMed, and ClinicalTrials.gov. We included only randomised controlled trials of passive antibody administration for the prevention or treatment of COVID-19. To compare administered antibody dose between different treatments, we used data on in-vitro neutralisation titres to normalise dose by antibody potency. We used mixed-effects regression and model fitting to analyse the relationship between timing, dose and efficacy. We found 58 randomised controlled trials that investigated passive antibody therapies for the treatment or prevention of COVID-19. Earlier clinical stage at treatment initiation was highly predictive of the efficacy of both monoclonal antibodies (p<0·0001) and convalescent plasma therapy (p=0·030) in preventing progression to subsequent stages, with either prophylaxis or treatment in outpatients showing the greatest effects. For the treatment of outpatients with COVID-19, we found a significant association between the dose administered and efficacy in preventing hospitalisation (relative risk 0·77; p<0·0001). Using this relationship, we predicted that no approved monoclonal antibody was expected to provide more than 30% efficacy against some omicron (B.1.1.529) subvariants, such as BQ.1.1. Early administration before hospitalisation and sufficient doses of passive antibody therapy are crucial to achieving high efficacy in preventing clinical progression. The relationship between dose and efficacy provides a framework for the rational assessment of future passive antibody prophylaxis and treatment strategies for COVID-19. The Australian Government Department of Health, Medical Research Future Fund, National Health and Medical Research Council, the University of New South Wales, Monash University, Haematology Society of Australia and New Zealand, Leukaemia Foundation, and the Victorian Government.

Effectiveness of COVID-19 vaccination against COVID-19 specific and all-cause mortality in older Australians: a population based study

Few studies have examined effectiveness of COVID-19 vaccines against COVID-19 and all-cause mortality across different pandemic periods in2022. We used linked whole-of-population data from the 2021 Australian Census, Australian Immunisation Register, death registrations and other national datasets including migration data. Among 3.8 million adults aged 65+ years and >170,000 aged care residents, we used survival analysis to estimate vaccine effectiveness (VE) against COVID-19 specific mortality and all-cause mortality, by vaccine dose and time since receipt, adjusted for age, sex and other factors. We also estimated absolute COVID-19 mortality rates. From January-May 2022 (Omicron BA.1/2), 3250 COVID-19 deaths occurred; from June-November (Omicron BA.4/5) 3185 COVID-19 deaths occurred. During January-May, VE of a 3rd COVID-19 vaccine dose within 3 months was 93% (95% CI 93-94%) whilst VE of a 2nd dose >6 months since receipt was 34% (26-42%). During June-November, VE of a 4th COVID-19 vaccine dose within 3 months was 84% (82-86%) whilst VE of a 3rd dose >6 months since receipt was 56% (50-62%). VE estimates for aged care residents were similar, but absolute risk reductions were substantially greater. During June-November 2022, for all-cause mortality, VE of a 4th dose within 3 months was 58% (56-59%) whilst VE of a 3rd dose >6 months since receipt was 19% (16-22%). COVID-19 vaccination is highly effective against COVID-19 mortality among older adults although effectiveness wanes with time since the last dose. Our findings emphasise the importance of continuing to administer booster doses, particularly to those at highest risk. This study was funded by the Health Economics Research Division in the Australian Government Department of Health and Aged Care.

Rapid detection of monkeypox virus using a CRISPR-Cas12a mediated assay: a laboratory validation and evaluation study

The 2022 outbreak of mpox (formerly known as monkeypox) led to the spread of monkeypox virus (MPXV) in over 110 countries, demanding effective disease management and surveillance. As current diagnostics rely largely on centralised laboratory testing, our objective was to develop a simple rapid point-of-care assay to detect MPXV in clinical samples using isothermal amplification coupled with CRISPR and CRISPR-associated protein (Cas) technology. In this proof-of-concept study, we developed a portable isothermal amplification CRISPR-Cas12a-based assay for the detection of MPXV. We designed a panel of 22 primer-guide RNA sets using pangenome and gene-agnostic approaches, and subsequently shortlisted the three sets producing the strongest signals for evaluation of analytical sensitivity and specificity using a fluorescence-based readout. The set displaying 100% specificity and the lowest limit of detection (LOD) was selected for further assay validation using both a fluorescence-based and lateral-flow readout. Assay specificity was confirmed using a panel of viral and bacterial pathogens. Finally, we did a blind concordance study on genomic DNA extracted from 185 clinical samples, comparing assay results with a gold-standard quantitative PCR (qPCR) assay. We identified the optimal time to detection and analysed the performance of the assay relative to qPCR using receiver operating characteristic (ROC) curves. We also assessed the compatibility with lateral-flow strips, both visually and computationally, where strips were interpreted blinded to the fluorescence results on the basis of the presence or absence of test bands. With an optimal run duration of approximately 45 min from isothermal amplification to CRISPR-assay readout, the MPXV recombinase polymerase amplification CRISPR-Cas12a-based assay with the selected primer-guide set had an LOD of 1 copy per μL and 100% specificity against tested viral pathogens. Blinded concordance testing of 185 clinical samples resulted in 100% sensitivity (95% CI 89·3-100) and 99·3% specificity (95% CI 95·7-100) using the fluorescence readout. For optimal time to detection by fluorescence readout, we estimated the areas under the ROC curve to be 0·98 at 2 min and 0·99 at 4 min. Lateral-flow strips had 100% sensitivity (89·3-100) and 98·6% specificity (94·7-100) with both visual and computational assessment. Overall, lateral-flow results were highly concordant with fluorescence-based readouts (179 of 185 tests, 96·8% concordant), with discrepancies associated with low viral load samples. Our assay for the diagnosis of mpox displayed good performance characteristics compared with qPCR. Although optimisation of the assay will be required before deployment, its usability and versatility present a potential solution to MPXV detection in low-resource and remote settings, as well as a means of community-based, on-site testing. Victorian Medical Research Accelerator Fund and the Australian Government Department of Health.

Stop being a wuss: People's perceptions of men experiencing grief in Australia.

Three years have passed since the Australian Government's Department of Health released its National Men's Health Strategy 2020-2030. Presently, little evidence is available to show whether the strategy has achieved success in rectifying men's mental-ill health, particularly the experience of stigma when expressing vulnerable emotions such as grief. Concurrently, research within the field of psychology continues to show that men experience significant pressure to conform faithfully to their socialised gender role. Given the focus to better men's mental health in Australia, this study ascertained people's perceptions of men experiencing grief. The study adopted social constructionism to explore how participants perceived a fictious character living with grief using a hypothetical vignette by way of convenience sampling. Nine males and seven females who resided in Australia participated in answering seven questions concerning the character's experience of grief. Inductive thematic analysis yielded three themes which collectively represented perceptions of masculinised grief. Notably, avoid stigma by fixing grief, avoid stigma by quickly getting over grief, and avoid stigma by suppressing the expression of grief. SO WHAT?: The study suggests that a stronger research focus should be targeted towards rectifying stigma resulting from men's expression of vulnerable emotions by incorporating in depth interviews in order to create worthwhile public awareness initiatives. Such initiatives should seek to minimise societal pressures that are placed upon men to ensure conformity to dominant masculine ideologies and their socialised gendered role when experiencing and expressing vulnerable emotions such as grief.

Current approaches in the recognition and management of eating disorders.

Eating disorders are now well acknowledged mental health problems that are common and present in people from diverse sociodemographic backgrounds. The past decade has seen a rapid expansion in research into eating disorder interventions. In response to the increasing burden of eating disorders, the Australian Government Department of Health and Aged Care has implemented significant policy changes to improve patient access to Medicare and inpatient treatment facilities. There are several international clinical practice guidelines and a robust evidence base particularly for first line care with specific psychological therapies, including guidelines for the management of eating disorders in individuals with a high weight. Medications play an important adjunct role in care, and novel neuromodulating treatments, such as psychostimulants, are under study. There is emerging evidence for increased person-centred care, with more choice in the form of alternatives to hospital inpatient programs and more respectful consideration of care for all who experience an eating disorder, including people with high weight.

Responding to rural children and their families seeking paediatric services-Can we do better?

Australian Journal of Rural HealthEarly View PRACTICE INSIGHTS Responding to rural children and their families seeking paediatric services—Can we do better? Anne Somerville GDip, Corresponding Author Anne Somerville GDip [email protected] orcid.org/0000-0002-7867-0886 St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Correspondence Anne Somerville, St Anthony's Family Medical Practice, Bendigo, PO Box 319, Eaglehawk, Victoria 3556, Australia. Email: [email protected] Contribution: Writing - original draftSearch for more papers by this authorKaren Riley GDip, Karen Riley GDip St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Conceptualization, Funding acquisition, Methodology, Writing - original draftSearch for more papers by this authorAshlee Lance BSc Physio, Ashlee Lance BSc Physio St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorStephanie McIntosh MBBS, Stephanie McIntosh MBBS St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorTania Collins, Tania Collins St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Project administrationSearch for more papers by this authorNicole Brereton RN, Nicole Brereton RN St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorKatherine Hyde MBBS, BMedSc, Katherine Hyde MBBS, BMedSc St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this author Anne Somerville GDip, Corresponding Author Anne Somerville GDip [email protected] orcid.org/0000-0002-7867-0886 St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Correspondence Anne Somerville, St Anthony's Family Medical Practice, Bendigo, PO Box 319, Eaglehawk, Victoria 3556, Australia. Email: [email protected] Contribution: Writing - original draftSearch for more papers by this authorKaren Riley GDip, Karen Riley GDip St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Conceptualization, Funding acquisition, Methodology, Writing - original draftSearch for more papers by this authorAshlee Lance BSc Physio, Ashlee Lance BSc Physio St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorStephanie McIntosh MBBS, Stephanie McIntosh MBBS St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorTania Collins, Tania Collins St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Project administrationSearch for more papers by this authorNicole Brereton RN, Nicole Brereton RN St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this authorKatherine Hyde MBBS, BMedSc, Katherine Hyde MBBS, BMedSc St Anthony's Family Medical Practice, Bendigo, Victoria, Australia Contribution: Writing - review & editingSearch for more papers by this author First published: 16 June 2023 https://doi.org/10.1111/ajr.13006Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES 1 Royal Far West. Stories of the Invisible Children: the state of country children's health and development in their own words [Internet]. 2017 (cited 2023 Feb 15). Available from: Stories-of-The-Invisible-Children.pdf (royalfarwest.org.au). p. 3. 2 Royal Far West. The Invisible Children: the state of country children's health and development in Australia [Internet]. 2017 (cited 2023 Feb 15). Available from: The-Invisible-Children-Report.pdf (royalfarwest.org.au). p. 4. 3 Australian Government Strengthening Medicare Taskforce Report [Internet]. Strengthening Medicare taskforce report. Canberra, Australia: Australian Government Department of Health and Aged Care; 2022 (cited 2023 Feb 15). p. 5– 13. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation