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A 2-Min Cytomegalovirus (CMV) Awareness Video Improves Pregnant Women's Knowledge and Planned Adherence to Hygiene Precautions
No full textINTRODUCTION: Congenital cytomegalovirus (cCMV) is a leading infectious cause of life-long neurodevelopmental disabilities, but public awareness of CMV is low. This study evaluated a short educational video on cCMV for its acceptability and impact on pregnant women's knowledge and planned hygiene adherence. MATERIALS AND METHODS: Participants were pregnant women recruited from an Australian tertiary maternity hospital clinic and social media (May 2023 to May 2024). Participants completed online surveys: before the video (T1), immediately after (T2), and 8 weeks later (T3). Linear mixed effects models assessed changes in knowledge and intended adherence to CMV precautions, adjusting for previous CMV education, and parity. RESULTS: A total of n = 296 eligible pregnant women were recruited, n = 270 completed the T1 survey and watched the video. Participants (n = 270) had a median age of 33 years (range: 18-43 years), 21% were multiparous and 30% had received previous CMV education. Of the 270 participants who completed the T1 survey and viewed the video, 202 (75%) and 109 (40%) completed surveys at T2 and T3 respectively. Adjusted total mean CMV knowledge scores increased significantly between T1 and T2 (+2.38; p < 0.001) and remained higher at T3 (+2.14; p < 0.001). Self-reported adherence to hygiene precautions improved from T1 to T2 (p < 0.001) and were maintained for four out of five key behaviours at T3. Participants (99%) found the content valuable, and 91% agreed that CMV precautions were "easy" to follow. CONCLUSION: A CMV education video is a simple, effective method to improve pregnant women's knowledge and planned adherence to hygiene precautions
An exact algorithm for disaster-resilience augmentation of planar straight-line graphs
No full textAbstract
We consider the problem of adding a minimum length set of edges to a geometric graph so that the resultant graph is resilient against partition from the effect of a single disaster. Disasters are modeled by discs of given maximum radius, and a disaster destroys all edges intersecting its interior. It is assumed that the input and output graphs are planar with a straight-line embedding. We provide a computationally simple characterisation of feasible input instances in terms of the convex hull of the given graph, and present a fast ILP algorithm for generating optimal solutions. We also perform a computational study which shows that our algorithm is able to solve randomly generated instances with hundreds of nodes
Evaluation of phylogroup, sequence type, resistome and virulome in Escherichia coli resulting in feline bacterial cystitis and subclinical bacteriuria
No full textThere is limited information on E. coli from feline urine and whether associated virulence and antimicrobial resistance patterns contribute to disease manifestations. This study aimed to characterise E. coli isolates, sequence types (ST), antimicrobial resistance (ARG) and virulence associated genes (VAG) from cats in primary care with subclinical bacteriuria (SBU) or lower urinary tract infection (LUTI). Whole genome sequencing (WGS) was performed on E. coli isolates that had been stored from a longitudinal health monitoring programme. Clinical records were reviewed to determine underlying disease conditions, phenotypic susceptibility and SBU and LUTI status. Descriptive review of phylogroup and ST was assessed together with evaluation of ARG and VAG by ST and based on SBU or LUTI status. WGS data was available for 152 E. coli isolates from cats (n = 26 with LUTI, n = 126 with SBU). The most common phylogroup was B2 with ST73, ST80, ST83 and ST127 predominating and ST80 being associated with clinical LUTI. Evaluating all isolates, there was no difference in prevalence of MDR status, total VAG or ARG count from cats with SBU or LUTI. Exploring individual VAG, ibeA, an invasin, and kpsT, part of the group 2 polysaccharide capsule, were associated with LUTI whilst P-fimbrial genes (pap) were associated with SBU. Based on this study, evidence is limited that expression of LUTI is directly related to ST or virulome and there is no evidence for increased resistome with SBU. However, low prevalence of cats with clinical LUTI may have precluded identification of associations
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No full textTemporal and geographical lineage dynamics of invasive Streptococcus pyogenes in Australia from 2011 to 2023: a retrospective, multicentre, clinical and genomic epidemiology study
No full textBackground: Defining the temporal dynamics of invasive Streptococcus pyogenes (group A Streptococcus) and differences between hyperendemic and lower-incidence regions provides crucial insights into pathogen evolution and, in turn, informs preventive measures. We aimed to examine the clinical and temporal lineage dynamics of S pyogenes across different disease settings in Australia to improve understanding of drivers of pathogen diversity. Methods: In this retrospective, multicentre, clinical and genomic epidemiology study, we identified cases of invasive S pyogenes infection from normally sterile sites between Jan 1, 2011, and Feb 28, 2023. Data were collected from five hospital networks across low-incidence regions in temperate southeast Australia and the hyperendemic, tropical, and largely remote Top End of the Northern Territory of Australia. The crude incidence rate ratio (IRR) of bloodstream S pyogenes infection comparing the Top End and southeast Australia and in First Nations people compared with non-First Nations people was estimated by quasi-Poisson regression. We estimated odds ratios (ORs) of intensive care unit (ICU) admission, in-hospital mortality, and 30-day mortality for the Top End versus southeast Australia using logistic regression. Retrieved and successfully sequenced isolates were assigned lineages at whole-genome resolution. Temporal trends in the composition of co-circulating lineages were compared between the two regions. We used an S pyogenes-specific multistrain simulated transmission model to examine the relationship between host population-specific parameters and observed pathogen lineage dynamics. The prevalence of accessory genes (those present in 5–95% of all genomes) was compared across geographies and temporal periods to investigate genomic drivers of diversity. Findings: We identified 500 cases of invasive S pyogenes infection in patients in the Top End and 495 cases in patients in southeast Australia. The crude IRR of bloodstream infection for the Top End compared with southeast Australia was 5·97 (95% CI 4·61–7·73) across the entire study period; in the Top End, infection disproportionately affected First Nations people compared with non-First Nations people (5·41, 4·28–6·89). The odds of in-hospital mortality (OR 0·43, 95% CI 0·26–0·70), 30-day mortality (0·38, 0·23–0·63), and ICU admission (0·42, 0·30–0·59) were lower in the Top End than in southeast Australia. Longitudinal lineage analysis of 642 S pyogenes genomes identified waves of replacement with distinct lineages in the Top End, whereas southeast Australia had a small number of dominant lineages that persisted and cycled in frequency. The transmission model qualitatively reproduced a similar pattern of replacement with distinct lineages when using a high transmission rate, small population size, and high levels of human movement—characteristics similar to those of communities in the hyperendemic Top End. Using a lower transmission rate, larger population size, and lower levels of migration similar to those of communities in urbanised southeast Australia, the transmission model qualitatively reproduced a pattern of dominant lineages that cycled in frequency. Despite distinct circulating lineages, the prevalence of accessory genes in the bacterial population was maintained across geographies and temporal periods. Interpretation: In a hyperendemic setting, the replacement of distinct S pyogenes lineages occurred in waves, which could be linked to the disproportionate burden of disease and sparse human population in this setting. The maintenance of bacterial gene frequency could be consistent with multilocus selection. These findings suggest that lineage-specific interventions—such as vaccines under development—should consider disease setting and, without broad cross-protection, might lead to lineage replacement. Funding: National Health and Medical Research Council, and Leducq Foundation
NEDD4 Promotes Sertoli Cell Proliferation and Adult Leydig Cell Differentiation in the Murine Testis
No full textSuccessful testis development relies on the coordinated differentiation and assembly of various cell types to establish both endocrine and reproductive functions. The ubiquitin ligase NEDD4 has emerged as a key player in murine testis development, with this enzyme being implicated in gonadal sex determination and spermatogonial stem cell differentiation. Here, we report hitherto uncharacterized roles of NEDD4 in postnatal testis development. Utilizing Nr5a1- and Amh-Cre drivers to conditionally ablate Nedd4 in testicular somatic cells, we show that NEDD4 promotes Sertoli cell proliferation through the modulation of the PI3K-AKT signaling pathway. This ubiquitin ligase also ensures proper differentiation of adult Leydig cells and may contribute to murine steroidogenesis. Furthermore, NEDD4 is essential for adrenal gland differentiation, as its loss results in adrenal dysgenesis. These findings highlight NEDD4 as a crucial factor in testis development, emphasizing the importance of ubiquitination and post-translational modifications in reproductive biology
Timelines of psychological, physical and sexual intimate partner violence among a nationally representative sample of Australian women
No full textBACKGROUND: Violent and abusive behavior in relationships causes immense individual and community harm. Mapping the emergence of different types of abuse over time and recognising behavioral patterns, could enable more targeted intimate partner violence (IPV) prevention, screening, and early intervention. While there has been some qualitative research into early warning signs of abuse and escalating homicide risks in relationships, no known studies have asked a large sample of survivors to document the sequence of abusive behaviors in a recent relationship. OBJECTIVES: To explore timelines of psychologically, physically, and sexually abusive behaviors and life events in a recent relationship (during the last 5 years) to create a macro timeline of abuse. DESIGN: Cross sectional survey of a nationally representative sample (gender, age, state, locality). DATA SOURCES AND METHODS: Eight hundred and fifteen Australian IPV women survivors. RESULTS: Results indicated that psychological abuse was a feature of most violent relationships, and almost always underpinned physical and sexual abuse. Psychological abuse often began before couples moved in together, while physical and sexual abuse came later. The earliest indicators for survivors that something was wrong was being isolated from others and feeling controlled by their partner. For many survivors, growing concern about the impact of abuse on their children occurred around the same time as leaving their relationship and trying to get help. CONCLUSION: Findings indicate a pattern of escalating behaviors over the course of a relationship that are consistent with the concept of coercive control. The macro timeline contains important learnings for intervening early with future survivors
Refuge at a Price
No full textAbstract
Social entrepreneurship is presented by its supporters as an alternative to traditional charity, viewing those who would be beneficiaries on a charitable model as customers instead. In this essay, I explore the idea of social entrepreneurship as an alternative model for service-provision by thinking about the specific service of women’s refuges. I ask whether it would be possible to shift women’s refuges out of the government or charitable sectors and into the market. I also consider two speculative proposals for market-based provision
A Physical Activity Clinical Practice Guideline for People With Moderate to Severe Traumatic Brain Injury
No full textABSTRACT
Introduction
In 2020 the World Health Organization (WHO) released the first international public health guideline on physical activity for people with disability. However, the evidence informing the guideline was not specific to people with traumatic brain injury (TBI), nor did it provide guidance for health professionals to promote and deliver physical activity in rehabilitation. We aimed to develop an Australian Physical Activity Clinical Practice Guideline for people with moderate to severe TBI (msTBI).
Questions
This guideline sought to answer the following question: ‘Should [physical activity intervention] compared to control be used for [people with] msTBI?’ The question was adapted to five physical activity interventions (structured aerobic exercise, muscle strengthening, gait/balance/functional exercise, sport and physical recreation, and promotion of physical activity) and two populations (children and adolescents; adults and older adults).
Methods
We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) ADOLOPMENT approach to determine whether to ‘adapt’ or ‘adopt’ the WHO guideline or develop de novo recommendations. We established guideline steering, leadership and development groups, conducted a rapid review to identify direct evidence in msTBI, and reviewed guidelines in other relevant health conditions (i.e., stroke, cerebral palsy) to identify indirect evidence. To address evidence gaps and inform implementation considerations, we conducted an audit of brain injury services in Australia and qualitative consultations with key interest‐holders, including people with msTBI.
Recommendations
The guideline incorporates 10 de novo recommendations for people with msTBI for the delivery and promotion of physical activity across the rehabilitation continuum of care. The guideline includes good practice and precautionary points, and subgroup considerations to guide usability and implementation. Data from the clinical audit and interest‐holder focus groups indicated feasibility and acceptability of physical activity interventions. The guideline seeks to support health professionals' clinical decision‐making and increase uptake of physical activity by people with msTBI