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What information women want about intrauterine devices and contraceptive implants and where they want to receive this information: findings from an Australian online survey
No full textBackground: Information about contraceptive options is important for informed decision making. We aimed to understand the information needs and preferences of potential users of intrauterine devices and contraceptive implants, methods that are underutilised in Australia. Methods: We conducted an online survey of Australian women aged 18–45 years. The survey comprised mostly close-ended questions, with a few opportunities for free-text comments. Results: In total, 1745 women participated in the survey. Participants had a mean age of 31 years; most identified as heterosexual (67%) and said that they were in a relationship (71%). Overwhelmingly, participants said that the most important information they wanted to know prior to using a contraceptive implant or intrauterine device was potential side effects (97%), signs that something is wrong (91%), effectiveness (90%), cost (87%), how and where to access the method (82%) and the experiences of other people who have used the method (81%). Most participants said that they go to their healthcare provider for information about contraception (86%). However, 78% said they also turn to the internet, and 15% said they use social media. When asked to indicate their preferred source of contraceptive information, participants reported their healthcare provider (93%), the internet (65%), friends (42%) and social media (20%). Conclusions: Our findings suggest that those considering using contraceptive implants and intrauterine devices have clear information needs, and this information should be provided to consumers during contraceptive counselling by a healthcare provider. Although healthcare providers are a preferred and trusted source of information, participants also reported seeking information from the internet
Management of Patients with Advanced Prostate Cancer. Report from the 2024 Advanced Prostate Cancer Consensus Conference (APCCC)
No full textBackground and objective: Innovations have improved outcomes in advanced prostate cancer (PC). Nonetheless, we continue to lack high-level evidence on a variety of topics that greatly impact daily practice. The 2024 Advanced Prostate Cancer Consensus Conference (APCCC) surveyed experts on key questions in clinical management in order to supplement evidence-based guidelines. Here we present voting results for questions from APCCC 2024. Methods: Before the conference, a panel of 120 international PC experts used a modified Delphi process to develop 183 multiple-choice consensus questions on eight different topics. Before the conference, these questions were administered via a web-based survey to the voting panel members (“panellists”). Key findings and limitations: Consensus was a priori defined as ≥75% agreement, with strong consensus defined as ≥90% agreement. The voting results show varying degrees of consensus, as discussed in this article and detailed in the Supplementary material. These findings do not include a formal literature review or meta-analysis. Conclusions and clinical implications: The voting results can help physicians and patients navigate controversial areas of clinical management for which high-level evidence is scant or conflicting. The findings can also help funders and policymakers in prioritising areas for future research. Diagnostic and treatment decisions should always be individualised on the basis of patient and cancer characteristics, and should incorporate current and emerging clinical evidence, guidelines, and logistic and economic factors. Enrolment in clinical trials is always strongly encouraged. Importantly, APCCC 2024 once again identified important gaps (areas of nonconsensus) that merit evaluation in specifically designed trials
Psilocybin-Assisted suppoRtive psychoTherapy in the treatment of prolonged Grief (PARTING) trial: Protocol for an open-label pilot trial for cancer-related bereavement
No full textINTRODUCTION: Prolonged grief disorder (PGD) represents a substantial public health issue, especially in oncology settings where it affects up to 30% of bereaved carers. Current best-practice treatments are lengthy, and up to 50% of participants have persistent PGD. Building on encouraging recent research with psychedelic-assisted therapies, the Psilocybin-Assisted suppoRtive psychoTherapy IN the treatment of prolonged Grief (PARTING) trial is the first study to consider psilocybin-assisted psychotherapy as a potential treatment for prolonged grief. METHODS AND ANALYSIS: PARTING is an open-label pilot trial of psilocybin-assisted psychotherapy for approximately 15 people with cancer-related PGD. It aims to investigate feasibility, safety, acceptability, participant experience and participant-reported therapeutic effects. Over a 5-week intervention period, participants will undergo three preparation sessions before receiving a psychoactive (25 mg) dose of psilocybin alongside non-directive supportive guidance, followed by four integration sessions. All sessions will be delivered by a psychologist and either a nurse or Indigenous Therapist. An artificial intelligence-assisted tool will be used to create an artwork of participants' psychedelic experience.Outcomes will be investigated over a 12-month follow-up period. Feasibility will be assessed through recruitment/retention rates and completion of follow-up assessments. Safety will be evaluated via adverse events over 12 months and the comparison of physiological measures (vital signs, biochemistry, haematology, ECG) recorded during screening and 1 day after the psilocybin dose. Qualitative thematic analysis of semistructured interviews with participants and trial therapists will assess acceptability and the therapeutic potential of the treatment. Diagnostic clinical interviews for PGD and quantitative participant-reported measures of therapeutic effects are also being collected. Participant-reported measures include grief severity, depression, anxiety, grief avoidance, psychological flexibility, connectedness, and quality of life. ETHICS AND DISSEMINATION: Ethics approval has been obtained from QIMR Berghofer Medical Research Institute Human Research Ethics Committee (P3801). Dissemination of results will occur via conference presentations, peer-reviewed publications and media. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN12623000827639)
Cortical hyperexcitability drives dying forward amyotrophic lateral sclerosis symptoms and pathology in mice
No full textDegeneration of both upper motor neurons in the brain and lower motor neurons in the spinal cord defines amyotrophic lateral sclerosis (ALS), but how they are linked in ALS pathophysiology is unclear. Here, we uncover a cortical origin of neurodegeneration in ALS mediated by upper motor neuron hyperexcitability. Chronic hyperexcitability of upper motor neurons induced by excitatory chemogenetics in healthy adult mice induced progressive motor deficits, weakness and core pathological hallmarks of ALS, including upper motor neurons loss, synaptic pathology, corticospinal tract degeneration and reactive gliosis. Importantly, upper motor neuron hyperexcitability and loss were sufficient to drive degeneration of lower motor neurons and their distal axons and neuromuscular junctions, associated with astrocyte and microglial activation in spinal cord. Cortical hyperexcitability also triggered cytoplasmic TAR DNA binding protein 43 (TDP-43) aggregation in upper motor neurons and lower motor neurons, placing hyperexcitability upstream of TDP-43 proteinopathy in ALS. These findings establish a cortical origin of ALS mediated by upper motor neurons, consistent with an anterograde mechanism of neurodegeneration throughout the central and peripheral nervous systems
‘Screening should not be based on ability to pay’: Australian healthcare providers' and consumers' perspectives on public funding for non-invasive prenatal testing
No full textBACKGROUND: Non-invasive prenatal testing (NIPT) does not receive any Medicare rebate. This study investigated the views of Australian healthcare providers and consumers on public funding of NIPT. MATERIALS AND METHODS: Two anonymous online, cross-sectional surveys were conducted from September 2022 to January 2023. Surveys targeted maternity healthcare professionals ('providers'), and individuals who had recently conceived a pregnancy ('consumers'). Quantitative data were analysed using χ2 test. Free-text responses were analysed by inductive content analysis. RESULTS: Responses from 381 providers and 630 consumers were analysed. The overwhelming majority of providers (96.8%) identified financial cost as a consumer barrier to NIPT access. Public funding for NIPT was supported by 86.4% of providers and 90.4% of consumers, with free-text responses citing equity, clinical, health economic, reproductive autonomy, and ethical justifications. Of the 145 consumers who did not use NIPT in a recent pregnancy, 63.1% rated cost as an 'important/very important' factor in foregoing NIPT. NIPT non-users were younger, had lower household income and education, and were more likely to live in a rural or remote area than consumers who used NIPT. CONCLUSION: Maternity healthcare providers and consumers are highly supportive of public funding for NIPT as a first-line screening test on clinical, equity, health economic, and ethical grounds. Our results confirm the presence of significant socioeconomic disparities between NIPT users and non-users, with cost being the most important factor impeding equitable access to best practice in prenatal screening. Further research and advocacy are needed to achieve equitable access to best practice in antenatal care
Long-term glyphosate application and its effects on soil total nitrogen and microbial composition two years after application stopped in biochar-amended soil
No full textGlyphosate is widely used in horticultural land management practices, but its environmental risks, especially in biochar-amended soil, remain poorly understood. This study aimed to evaluate the effects of repeated glyphosate applications on biochar-amended- soils, focusing on changes in soil nitrogen (N) cycling, soil microbial diversity, and community structure. The experiment was conducted in a macadamia orchard where wood-based biochar had been applied for five years prior to our study. Simultaneously, glyphosate (Roundup®) had been applied at the recommended label rate (4 L ha−1) with active ingredient of glyphosate of 360 g L−1, in a strip under tree canopy for 12 years, until its use was stopped two years prior to our sample collection. Thus, biochar and glyphosate were applied concurrently for three years before glyphosate use was stopped. Soil samples were collected from three areas, including: under the tree canopy with and without a history of glyphosate application; and areas outside the tree canopy with no history of glyphosate application. Changes in foliar and soil total carbon (TC), total nitrogen (TN) and soil N isotope composition (δ15N), and microbial community composition, were subsequently assessed. Our findings revealed that soil TN and δ15N were significantly higher under tree canopy with a history of glyphosate application compared with areas without glyphosate application history likely due to the die back of weed because the other sections were mechanically managed. Glyphosate residues were also found under and outside tree canopy where no glyphosate was applied. Therefore, higher TN and δ15N under tree canopy could not directly be attributed to glyphosate application. Overall, neither glyphosate nor biochar influenced the soil microbial diversity and community structure. This study suggested that glyphosate application and farm management practices may have long-term implications for soil N cycling, even after application has stopped
Respiratory admissions and impact of COVID-19 lockdowns for children with severe cerebral palsy
No full textAIM: To explore factors contributing to the burden of respiratory admissions in children with severe cerebral palsy (CP) by comparing admissions to a single tertiary paediatric hospital before, during, and after the period of social restrictions implemented to reduce transmission of COVID-19 (lockdown period). METHOD: For this observational study, three severe CP cohorts (pre-lockdown, lockdown, post-lockdown) were identified from a state-wide cerebral palsy register and linked to patient-level clinical and demographic data. Medical records were manually searched to identify respiratory hospitalizations. Frequency and details of admissions were compared across the three 2-year periods. RESULTS: During the lockdown period, there were 24 hospitalizations for respiratory illness per 100 children compared to 37 and 47 in the pre-lockdown and post-lockdown periods (p < 0.001). Respiratory viruses (excluding picornaviruses) were detected in only 7% of lockdown admissions compared to 24% pre-lockdown and 30% post-lockdown. Sputum sampling was performed in 34% of admissions with gram-positive bacteria cultured in 6% admissions and gram-negative bacteria only in 18%. INTERPRETATION: The study findings highlight an important dynamic contribution of viral infections to respiratory illnesses in children with severe CP and the potential to improve outcomes with personalized approaches based on defining individual factors predisposing to recurrent respiratory admissions
Empowering human research ethics committees to review genomics applications: evaluating the utility of a custom online education resource
No full textComplex genomic technologies are increasingly utilised in research. However, human research ethics committee (HREC) members lack confidence reviewing genomics applications. This study developed and evaluated the acceptability and utility of an online educational resource on genomics and the ethical considerations for HREC members. Resource development and evaluation was theoretically informed. Qualitative semi-structured interviews with HREC members and subject experts were transcribed and deductively analysed. Participants (n = 29) found the content to be comprehensive, appropriately pitched, and optimal in quantity. Most reported the resource was easy to access and intuitive to navigate. HREC members reported improved confidence in reviewing genomics ethics applications and intentions to re-access as needed. Most (n = 28/29) would recommend to other HREC members, and some volunteered that they would recommend to researchers. Suggested navigation improvements included a progress bar, active learning elements, and a more clearly visible menu. Content suggestions included more detail on data storage/management and considerations when engaging diverse communities. This is the first study to develop and evaluate a genomic educational resource tailored to ethics committees. Following refinement and quantitative evaluation, it is hoped that this resource will increase HREC member confidence in reviewing genomics ethics applications and the quality of researchers' submissions.10.1038/s41431-025-01846-
Exposure to low doses of Batrachochytrium dendrobatidis reveals variation in resistance in the Critically Endangered southern corroboree frog
No full textEmerging infectious diseases, such as chytridiomycosis caused by Batrachochytrium dendrobatidis (Bd), pose a significant extinction threat to amphibians, including the Critically Endangered southern corroboree frog (Pseudophryne corroboree). Understanding phenotypic variation in Bd susceptibility is important for developing and applying novel conservation strategies, such as selective breeding, to enhance disease resistance and support population recovery. In one of the largest experimental Bd challenge studies to date, we exposed 972 juvenile P. corroboree bred to represent the extant genetic diversity of the species, encompassing all 15 historical populations. Across three replicate experiments, survival rates ranged from 44 % to 74 %, with frogs from one zoo exhibiting higher mortality. Notably, 21–47 % of Bd-exposed frogs remained uninfected, suggesting significant phenotypic variation in disease resistance in this population. Among infected frogs, disease progression varied, with most reaching terminal stages within 69 days (range: 33–97 days), though a few individuals maintained stable infection loads without developing clinical chytridiomycosis. Experimental factors, such as age, size, and body condition, did not consistently predict survival or infection rates across experiments. While younger and smaller frogs were generally more susceptible, the effects of these factors varied across replicates, highlighting the importance of large sample sizes and repeated experiments to capture phenotypic variation in susceptibility. These findings suggest that a subset of P. corroboree may possess the capacity to resist or tolerate low-dose Bd exposure, offering potential for selective breeding programs to improve conservation outcomes. The dataset generated from this study will be instrumental in guiding breeding strategies that strengthen conservation efforts for this critically endangered, iconic amphibian
Respiratory Nurse Leadership Requires Increased Profile, Role Clarity and Stronger Career Pathways: Binational Delphi Consensus Process and TSANZ Position Statement
No full textINTRODUCTION/AIM: The World Health Organisation recognises the integral role of respiratory nurses in the management and promotion of lung health to minimise substantial international health burden and health system costs. This Position Statement presents the Priorities for the Recognition of Respiratory Nursing as a Specific Field of Expertise, as validated through a binational Delphi consensus process, and endorsed by the Thoracic Society Australia and New Zealand Board on 25th October 2024. METHODS: A cross-sectional online Delphi consensus survey delivered over two rounds using purposive sampling of leading respiratory nurse clinicians, managers, educators and/or researchers. In Round 1, participants rated generated priority statements on a 7-point Likert scale. In Round 2, mean item scores were provided and statements ranked to establish those of highest priority. Consensus cut-off was set at ≥ 75%. RESULTS: One hundred and four Round 1 and sixty-four Round 2 participants from all Australian states and NZ regions confirmed 14 items, under three overarching priorities: the need to (1) raise the profile and influence of nurses within national and international respiratory organisations and policy; (2) define respiratory nursing as a field of specific expertise; and (3) articulate career progression and education frameworks as a roadmap to specialisation. CONCLUSION: Consensus on joint priorities supports respiratory nurses as integral to health strategy and articulates pathways for future workforce. Optimising the scope of nurses, including addressing barriers to contribution, and prioritisation and retention of specialist respiratory workforce, are necessary to meet population and health service demands and adequately support those living with lung conditions