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Assessing Patient Preferences and Response to Extended Colonoscopy Intervals in a Colorectal Cancer Surveillance Program
No full textBACKGROUND: Individuals with an increased risk of colorectal cancer (CRC) are advised to have surveillance colonoscopies at guideline-recommended intervals to prevent cancer development. As more recent clinical guideline updates have extended colonoscopy intervals for those with lower risk findings, effective communication of these surveillance changes is essential for ensuring patient acceptance. AIMS: To evaluate patient preferences for surveillance colonoscopy frequency, and responses to an extended colonoscopy interval. METHODS: The study population included individuals at increased risk for CRC who were enrolled in a South Australian surveillance program. Preferences for surveillance frequency were collected via survey, and responses to a letter implementing a guideline-recommended colonoscopy interval change from 3 to 5 years were obtained from clinical data. RESULTS: While 46.6% (n = 186/399) of survey respondents preferred a more frequent colonoscopy interval than their current clinical recommendation, 80.4% indicated that they would be comfortable following whatever their specialist recommends. In practice, only 2.9% (n = 11/380) of patients queried the extended surveillance colonoscopy interval with the clinical team. CONCLUSIONS: Specialist involvement can increase the acceptance of extended colonoscopy intervals, despite patient preferences for more frequent procedures. Therefore, the implementation of updated surveillance guidelines should be communicated to patients with specialist endorsement
A systemic review of the utility of antituberculosis therapy for presumed tuberculous uveitis
No full textBACKGROUND: Uveitis presumed to be secondary to Mycobacterium tuberculosis is a rare but potentially blinding condition. Difficulty in making an accurate diagnosis and the low incidence of TB uveitis (TBU) contribute to the lack of evidence regarding the best management of this condition. This systematic review aims to analyse existing research to provide a summary of the literature regarding the utility of TB therapy for the management of TBU. METHODS: This systematic review was prospectively registered on PROSPERO (PROSPERO 2021 CRD42021273379). We searched Medline, Embase and Central databases, and the search was done on 20th June 2023 with an updated literature search. RESULTS: We included 55 studies and found that the heterogeneity in the methodology of these studies precluded metanalysis, and a narrative analysis was undertaken. Risk of bias analysis was undertaken using the Newcastle-Ottawa scale. CONCLUSIONS: Key findings of this systematic review include multiple systemic biases in the available evidence, and general lack of control for confounding variables. This results in many unanswered questions regarding the utility of TB therapy for TBU and reinforces the need for more data in this area
Cherishing, Challenging, Democracy: Civics, Rights, Responsibity
No full textParticipants heard from 'democracy' experts about their view of Australian democracy, while Q & A and panel opportunities enabled robust discussion
Evaluation of artificial intelligence (AI) chatbots for providing sexual health information: a consensus study using real-world clinical queries
No full textINTRODUCTION: Artificial Intelligence (AI) chatbots could potentially provide information on sensitive topics, including sexual health, to the public. However, their performance compared to nurses and across different AI chatbots, particularly in the field of sexual health, remains understudied. This study evaluated the performance of three AI chatbots - two prompt-tuned (Alice and Azure) and one standard chatbot (ChatGPT by OpenAI) - in providing sexual health information on questions that experienced sexual health nurses could correctly answer. METHODS: We analysed 195 anonymised sexual health questions received by the Melbourne Sexual Health Centre phone line. A panel of experts in a blinded order using a consensus-based approach evaluated responses to these questions from nurses and the three AI chatbots. Performance was assessed based on overall correctness and five specific measures: guidance, accuracy, safety, ease of access, and provision of necessary information. We conducted subgroup analyses for clinic-specific (e.g., opening hours) and general sexual health questions and a sensitivity analysis excluding questions that Azure could not answer. RESULTS: Alice demonstrated the highest overall correctness (85.2%; 95% confidence interval (CI), 82.1-88.0%), followed by Azure (69.3%; 95% CI, 65.3-73.0%) and ChatGPT (64.8%; 95% CI, 60.7-68.7%). Prompt-tuned chatbots outperformed the base ChatGPT across all measures. Among all outcome measures, all chatbots performed best on safety, with Azure achieving the highest safety score (97.9%; 95% CI, 96.4-98.9%), indicating the lowest risk of providing potentially harmful advice. In subgroup analysis, all chatbots performed better on general sexual health questions compared to clinic-specific queries. Sensitivity analysis showed a narrower performance gap between Alice and Azure when excluding questions Azure could not answer. CONCLUSIONS: Prompt-tuned AI chatbots demonstrated superior performance in providing sexual health information compared to base ChatGPT, with high safety scores particularly noteworthy. However, all AI chatbots showed susceptibility to generating incorrect information. These findings suggest the potential for AI chatbots as adjuncts to human healthcare providers for providing sexual health information while highlighting the need for continued refinement and human oversight. Future research should focus on larger-scale evaluations and real-world implementations
Final analysis of the phase 1b Chemotherapy and Venetoclax in Elderly Acute Myeloid Leukemia Trial (CAVEAT)
No full textVenetoclax plus azacitidine represents a key advance for older, unfit patients with acute myeloid leukemia (AML). The Chemotherapy and Venetoclax in Elderly AML Trial (CAVEAT) was first to combine venetoclax with intensive chemotherapy in newly diagnosed patients aged ≥65 years. In this final analysis, 85 patients (median age, 71 years) were followed up for a median of 41.8 months. The CAVEAT induction combined cytarabine and idarubicin with 5 dose levels of venetoclax (50-600 mg) for up to 14 days. Two additional cohorts explored adjusted-dose venetoclax (50 mg and 100 mg) with posaconazole. CAVEAT induction was well tolerated, with low mortality (4%) and limited high-grade gastrointestinal toxicity (4%). Delayed hematologic recovery after consolidation was ameliorated by omitting idarubicin from postremission therapy. The overall response rate (ORR; complete response [CR] + CR with partial hematologic recovery + CR with incomplete count recovery) was 75%, with a median overall survival (OS) of 19.3 months (95% confidence interval [CI], 11.1-31.3). Among de novo AML, ORR was 88% and median OS was 33.1 months (95% CI, 19.3-54.3). Almost one-third have not relapsed, many benefiting from prolonged treatment-free remission (median, 17.9 months). CAVEAT induction was well tolerated and associated with high ORR that was durable, particularly for de novo AML. CAVEAT represents an effective time-limited treatment option for fit, older patients with AML. This trial was registered at https://www.anzctr.org.au as #ACTRN12616000445471
Food insecurity and health conditions in the Australian adult population: A nationally representative analysis
No full textAIM: This study aimed to identify key health condition correlates of food insecurity in Australia using nationally representative data. METHODS: This cross-sectional study used data from a large, nationally representative Australian survey that included questions on the dynamics of families and households, income, wealth, welfare, labour market activity (including unemployment and joblessness), life satisfaction and wellbeing. Binary logistic regression models of eight items of food insecurity measured the association between 17 health conditions and food insecurity while controlling for various demographic and socioeconomic variables. A zero-inflated negative binomial model identified correlates of the number of food insecurity problems. RESULTS: Prevalence of food insecurity ranged from 3% to 9% depending on the measure analysed. Individuals experiencing blackouts, fits or loss of consciousness were 2-6 times more likely to report food insecurity than other individuals. When including control variables and incorporating other health conditions, several conditions significantly increased probability of any food insecurity: sight problems; blackouts, fits or loss of consciousness; difficulty gripping things; nervous conditions; mental illness; and chronic or recurring pain. CONCLUSIONS: Detailed information on how health conditions are associated with different types of food insecurity was generated using population-representative data, 17 sets of health conditions, and eight measures of food insecurity. Understanding connections between food insecurity and health conditions allows public health professionals to create effective, targeted and holistic interventions
Verbal paired associates learning lateralizes left hippocampal sclerosis in temporal lobe epilepsy
No full textOBJECTIVE: Left hippocampal sclerosis (HS) is associated with verbal-specific memory impairment. This association is well established for word list learning tasks, and there is some evidence that this may also be relevant to verbal paired associates learning (PAL), though the evidence is limited. We aimed to evaluate the utility of verbal PAL as a marker for left HS, compare this with word list learning, and derive cutoff scores to facilitate clinical application. METHODS: Retrospective analysis of Rey Auditory Verbal Learning Test (RAVLT) and PAL scores obtained from 116 surgically naïve temporal lobe epilepsy patients with HS (14 bilateral, 57 left, 45 right; range of N across test indices: 77-110). RESULTS: Relative to right HS, left HS and bilateral HS were associated with poorer performance on PAL Hard Pairs (p 0.05). PAL Hard Pairs and all RAVLT indices displayed acceptable discriminatory ability (AUC > 0.70) in classifying left-sided HS (unilateral left or bilateral HS), with RAVLT delayed recall the strongest predictor (AUC = 0.87; PAL Hard Pairs Learning and Delay = 0.80 and 0.83, respectively). Optimal cutoff scores for left-sided HS classification were generated. SIGNIFICANCE: Although the RAVLT delayed recall was the strongest predictor of left-sided HS, PAL Hard Pairs also demonstrated excellent discriminatory capacity, offering an additional cognitive marker of left hippocampal integrity to complement word list learning in clinical assessments. PLAIN LANGUAGE STATEMENT: The results of the study show that the ability to learn unrelated pairs of words (e.g., "silver"-"run") is compromised in the setting of epilepsy with left-sided hippocampal sclerosis (HS), be it unilateral left HS or bilateral HS. The ability of unrelated word pair learning to discriminate left vs. right HS was comparable to word list learning, a task with demonstrated sensitivity to left HS. Our results suggest that the ability to learn unrelated pairs of words provides another useful marker of left-sided hippocampal compromise in epilepsy. We provide cutoff scores to facilitate clinical interpretation
Urban Heat Resilience: Bridging Science, Policy, and Sustainable Design
No full textBangkok, like many rapidly urbanizing cities in Southeast Asia, faces an escalating threat from extreme urban heat, exacerbated by the urban heat effect and global climate change. This challenge disproportionately affects vulnerable communities, including women, children, the elderly, persons with disabilities, low-income households, and informal settlement residents, who often lack adequate adaptive capacity and resources.
This report, drawing from the "Urban Heat Resilience: Bridging Science, Policy, and Sustainable Design" project, presents a comprehensive analysis of urban heat risks in Bangkok and the potential of Nature-Based Solutions (NBS) as a key mitigation strategy. Building on this, the report also incorporates specific findings and policy insights from the Vietnam Urban Heat Status report, detailing observed temperature shifts, urban heat island effects, health impacts, and policy landscapes within Vietnamese cities, offering learnings applicable to second-tier Mekong cities in Vietnam. Utilizing the TARGET urban climate model, simulations for both present-day (1985-2014) and projected mid-century conditions (2036–2065) demonstrate that central and western districts with high imperviousness experience the greatest heatwave burden, with up to 100 heatwave days per season, lasting weeks at a time, and with significant thermal intensity. Without intervention, many districts could see an additional 40–60 heatwave days per year by mid-century.
Nature-Based Solutions (NBS), which involve widespread increases in pervious, green, and irrigated surfaces, particularly in highly impervious areas, are projected to significantly mitigate these impacts. The NBS scenario suggests a reduction of up to 24 heatwave days in hotspots, shorter heatwave events (over 30 days reduction in duration in some areas), and meaningful reductions in heatwave severity (up to 0.4°C during extreme events). These benefits are spatially consistent with intervention areas, highlighting the strong local cooling effects and spillover benefits of NBS.
Crucially, the project emphasizes a Gender Equality, Disability, and Social Inclusion (GEDSI) Action Plan to ensure that heat resilience efforts are inclusive and equitable. This plan integrates GEDSI principles into all project phases, from data collection and policy design to implementation and monitoring, prioritizing the needs of vulnerable populations.
While NBS offers a substantial buffer against climate-driven urban heat, it is not a standalone solution. A comprehensive, multi-layered adaptation strategy is required, combining NBS with broader systemic measures such as inclusive heat alert systems, cooling centers, hydration points, and integrated urban planning and policy that accounts for social equity. This project aims to bridge the gap between scientific understanding, policy frameworks, and practical implementation to build a more heat-resilient, equitable, and livable Bangkok, with learnings applicable to other Mekong cities in Vietnam
Utilization of low-grade timber in the construction industry
No full textThis study explored the adaptation of the Australian sawn timber industry to evolving market demands, climate change impacts, and variations in harvested wood characteristics. It was driven by a key challenge: the growing misalignment between the increasing demand for high-stiffness timber products and the industry's diminishing ability to supply them, largely due to declining fibre quality from intensively managed plantations. The study aimed to optimize the use of Australian timber resources by reviewing the supply chain of sawn timber products and identifying areas where technological enhancements, process improvements, or new product developments could be initiated. A critical review revealed broad consideration of opportunities for minimising or utilising low-grade timber across the supply chain is currently missing from the literature. The methodology adopted in this study was a combination of literature review, survey and interviews, site visits, and structural modelling. Specifically, the study incorporated detailed structural modelling of representative single-storey and double-storey residential buildings using out-of-grade timber, simulating variable material stiffness and applying probabilistic methods in accordance with AS1720 and ISO 2394 to evaluate structural reliability. In addition to the comprehensive industry review, this study introduces building-scale structural modelling using out-of-grade timber and probabilistic strength comparison against AS1720 and ISO 2394 benchmarks. This engineering-based analysis reveals feasible pathways for the certified use of low-grade timber in residential construction. The research highlighted significant opportunities for employing low-grade timber in residential building construction through an analysis of the mechanical properties of the timber along with building-scale modelling of the structural performance, thereby promoting more comprehensive utilization of the tree. This approach not only adds value to the built environment but also aligns with global efforts to reduce greenhouse gas emissions and enhance profitability across the entire supply chain, from timber growers to end-users. The key findings of this study were that improved data sharing between growers and sawmills could increase fibre quality, custom structural products exist to utilise low-grade timber, existing post-processing technologies can be leveraged to upgrade low-grade timber, out-of-grade timber can be viable in certain residential scenarios, and there is a reluctance in industry to using low-grade timber. Key future initiatives include leveraging findings from previous studies to extend their application into built environments, addressing the mechanical properties shortcomings of materials through innovative technologies, and refining structural design and construction of low-grade timber buildings with advanced modeling. These efforts aim to develop cost-effective, sustainable, and marketable structural solutions for enhancing the viability and environmental footprint of the timber construction industry
Future Health Today and patients at risk of undiagnosed cancer: a pragmatic cluster randomised trial of quality-improvement activities in general practice
No full textBACKGROUND: Diagnosing cancer in general practice is complex, given the non-specific nature of many presenting symptoms and the overlap of potential diagnoses. AIM: This trial aimed to evaluate the effectiveness of Future Health Today (FHT) - a technology that provides clinical decision support, auditing, and quality-improvement monitoring - on the appropriate follow-up of patients at risk of undiagnosed cancer. DESIGN AND SETTING: Pragmatic, cluster randomised trial undertaken in general practices in Victoria and Tasmania, Australia. METHOD: Practices were randomly assigned to receive recommendations for follow-up investigations for cancer (FHT cancer module) or the active control. Algorithms were applied to the electronic medical record, and used demographic information and abnormal test results that are associated with a risk of undiagnosed cancer (that is, anaemia/iron deficiency, thrombocytosis, and raised prostate-specific antigen) to identify patients requiring further investigation and provide recommendations for care. The intervention consisted of the FHT cancer module, a case-based learning series, and ongoing practice support. Using the intention-to-treat approach, the between-arm difference in the proportion of patients with abnormal test results who were followed up according to guidelines was determined at 12 months. RESULTS: In total, 7555 patients were identified as at risk of undiagnosed cancer. At 12 months post-randomisation, 76.0% of patients in the intervention arm had received recommended follow-up (21 practices, n = 2820/3709), compared with 70.0% in the control arm (19 practices, n = 2693/3846; estimated between-arm difference = 2.6% [95% confidence interval (CI)] = -2.8% to 7.9%; odds ratio = 1.15 [95% CI = 0.87 to 1.53]; P = 0.332). CONCLUSION: The FHT cancer module intervention did not increase the proportion of patients receiving guideline-concordant care. The proportion of patients receiving recommended follow-up was high, suggesting a possible ceiling effect for the intervention