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Background Central nervous system tuberculosis (CNS‐TB) is a rare complication of tuberculosis. There is a lack of data surrounding investigation and management of this in Australia. Aim To review CNS‐TB cases in Western Sydney, Australia, and understand the epidemiology, investigation, diagnosis, management and outcomes in a low‐prevalence setting. Methods Retrospective cohort study of all CNS‐TB patients managed in Western Sydney from 2013 to 2022. Demographics, risk factors, clinical presentation, investigations and management were reviewed. Clinical outcomes like hospital length‐of‐stay, adverse drug reactions, paradoxical reactions, functional disability and treatment outcomes, including cure, treatment failure, loss to follow‐up and death, were also measured. Results Thirty‐nine CNS‐TB cases were identified, with 16 (41%) confirmed by nucleic acid amplification test or culture of CNS specimens and 23 (59%) diagnosed presumptively without CNS microbiological confirmation. The median age was 32 years. Thirty‐seven (95%) were overseas‐born; 27 (69%) had no comorbidities. Presenting symptoms included fever (82%), headache (64%) and weight loss (51%). Twenty‐five (64%) used fluoroquinolones and nine (23%) used high‐dose rifampicin. Steroids were used in all patients. Six (15%) were prescribed aspirin for primary stroke prevention. Twenty‐eight (73%) completed treatment, with one requiring re‐treatment for presumed treatment failure. Six (15%) were lost to follow‐up, and five (13%) died during their treatment course. Twenty‐one (54%) experienced an adverse drug reaction. Conclusion Tuberculosis is an ongoing public health issue in Australia, with CNS‐TB being its most devastating form, and all clinicians to be aware of this rare complication. The efficacy of newer treatment options requires further study.

Background Catheter ablation (CA) is efficacious for the treatment of ventricular tachycardia (VT) in patients with structural heart disease; however, heart failure contributes to long‐term mortality in this cohort. Whether CA worsens left ventricular function requires investigation. Methods We retrospectively analyzed 142 consecutive patients with structural heart disease undergoing CA for VT. Pre‐ablation left ventricular ejection fraction (LVEF) was compared to LVEF postablation, predictors of change in LVEF were identified, and the relationship between change in LVEF and arrhythmic recurrence was assessed. Results Patients with ischemic cardiomyopathy (ICM) had lower pre‐ablation LVEF than patients with non‐ischemic cardiomyopathy (NICM) (36.2 ± 14.3% vs. 50.8 ± 12.8%, p < 0.001). There was no statistically significant change in LVEF following ablation for patients with ICM (p = 0.45) or NICM (p = 0.75). Patients with pre‐ablation LVEF ≤20% experienced the largest recovery in LVEF, mean recovery 5.3% (95% CI: 0.6–10.1), p = 0.03, with LVEF recovery postablation similar in ICM and NICM patients (p = 0.69). Recovery of LVEF was associated with a decreased incidence of ventricular arrhythmia (VA) recurrence (p = 0.03) and an increased VA‐recurrence‐free survival (p = 0.04). Conclusion CA for VT does not cause a decline in LVEF among patients with structural heart disease. The subset of patients with severely impaired LVEF may experience an increase in LVEF following ablation and an associated reduction in VA recurrence.

Embedded in the framework of intergenerational solidarity, this paper explores the interactions between older immigrants' participation in volunteering activities and intergenerational family relationships in the Chinese community in Sydney, Australia. The study investigates the effects of volunteering on the lives of older Chinese immigrants. It draws on 57 in‐depth interviews and 6 focus groups with older immigrants, the vast majority of whom were from China. The findings suggest that volunteering among older immigrant parents is shaped by intergenerational family relationships. Volunteering serves to improve the wellbeing of older people who would otherwise suffer from social isolation and often helps to mend strained family relationships. For older Chinese immigrants, volunteering provides a means to access public services, navigate social service systems and reduce dependency on their children, thereby fostering functional, normative and affective solidarity. This study also uncovers the interconnectedness of the six dimensions of intergenerational family relationships, showing that when adult children actively support their older parents' volunteering, it benefits the elderly immigrants, their families as well as the broader community. The paper calls for better preparedness for aging in the context of immigration, advocating for capacity‐building initiatives for both older immigrants and their adult children.

Purpose This study longitudinally assessed the quality of life (QoL) in patients who completed chemoradiation (CRT) for cervical cancer in Botswana and compared the QoL for those living with and without HIV infection. Methods Patients with cervical cancer recommended for curative CRT were enrolled from August 2016 to February 2020. The European Organisation for Research and Treatment of Cancer Core Quality-of-Life (QLQ-C30) and cervical cancer-specific (QLQ-Cx24) questionnaires, translated into Setswana, were used to assess the QoL of patients prior to treatment (baseline), at the end of treatment (EOT) and in 3 month intervals post-treatment for 2 years, and statistical analyses were performed. Results A total of 294 women (median age: 46 years) were enrolled and followed up for an average of 16.4 months. Of women with recorded staging, most had FIGO stage III/IV disease (64.4%). Women living with HIV (WLWH; 74.1%) presented at earlier ages than those without HIV (44.8 years vs 54.7 years, p<0.001). The QoL for all domains did not differ by HIV status at baseline, EOT or 24 month follow-up. Per QLQ-C30, the mean global health status score (72.21 vs 78.37; p<0.01) and the symptom (12.70 vs 7.63; p=0.04) and functional scales (88.34 vs 91.85; p<0.01) improved significantly from the EOT to the 24 month follow-up for all patients; however, using the QLQ-Cx24 survey, no significant differences in the symptom burden (12.53 vs 13.67; p=0.6) or functional status (91.23 vs 89.90; p=0.53) were found between these two time points. Conclusion The QoL increased significantly for all patients undergoing CRT, underscoring the value of pursuing curative CRT, regardless of the HIV status.

Objective To qualitatively explore the perceptions of general practitioners in regional New South Wales, Australia, on diagnosing, managing and preventing Q fever. Setting Q fever is a prevalent zoonosis in regional New South Wales, but diagnosis may be missed as patients have symptoms similar to influenza or COVID. Perspectives of general practitioners who are the primary health care providers in rural areas are important to understand the logistical difficulties in providing optimum care to Q fever patients. Participants General practitioners practicing outside of metropolitan Sydney in regional postcodes of New South Wales, Australia. Methods Eligible general practitioners were interviewed online using a semi‐structured interview guide on their approach to diagnosis, management and prevention of Q fever. The data were transcribed, coded using NVivo software, and analysed to identify emerging overarching themes. Results Thematic saturation was achieved after 11 interviews. Diagnostic delays due to prioritising more common differential diagnoses for an influenza‐like illness, difficulties in navigating the complex serological test interpretations for diagnosis, logistical difficulties in arranging immunisation, and the need for continuing medical education were the broad themes emerging from the data analysis. Conclusions Investment in continuing medical education and expansion of the reference resources made available to general practitioners regarding the diagnosis and management of Q fever will improve health care for people suffering from and at risk of Q fever in regional New South Wales.

Coronary bifurcation lesions present complex challenges in interventional cardiology, necessitating effective stenting techniques to achieve optimal results. This literature review comprehensively examines the application of computational and bench testing methods in coronary bifurcation stenting, offering insights into procedural aspects, stent design considerations, and patient‐specific characteristics. Structural mechanics finite element analysis, computational fluid dynamics, and multi‐objective optimization are valuable tools for evaluating stenting strategies, including provisional side branch stenting and two‐stenting techniques. We highlight the impact of procedural factors, such as balloon positioning and rewiring techniques, and stent design features on the outcome of percutaneous coronary interventions with stents. We discuss the importance of patient‐specific characteristics in deployment strategies, such as bifurcation angle and plaque properties. This understanding informs present and future research and clinical practice on bifurcation stenting. Computational simulations are a continuously maturing advance that has significantly enhanced stenting devices and techniques for coronary bifurcation lesions over the years. However, the accurate account of patient‐specific vessel and lesion characteristics, both in terms of anatomical and accurate physiological behavior, and their large variation between patients, remains a significant challenge in the field. In this context, advancements in multi‐objective optimization offer significant opportunities for refining stent design and procedural practices.

Background Diffusion‐weighted imaging (DWI), a quantitative magnetic resonance imaging (qMRI) technique, has the potential to aid in disease characterization and treatment response monitoring. MR‐Linacs (MRLs) enable simultaneous DWI acquisitions during radiotherapy, uniquely aiding in the collection of large‐scale datasets for imaging biomarkers, such as the DWI‐derived apparent diffusion coefficient (ADC), without additional patient burden. However, the limited data reporting on variability in MRL scanner performance characteristics, and a lack of established clinical trial quality assurance (QA) procedures, are barriers to this route for biomarker validation. Purpose This study aims to quantify the accuracy, intra‐scanner repeatability, and inter‐scanner reproducibility of ADC measurements across three MRLs in Australia in both a phantom and in vivo. These measurements will inform the feasibility of carrying out prospective multi‐center studies in Australia investigating ADC as a biomarker and form a core set of QA procedures and baselines to assess biomarker and sequence suitability. Methods An isotropic diffusion phantom (at 0°C) and one healthy volunteer were scanned on three Unity MRLs (Elekta AB, Stockholm, Sweden). Standardized (QIBA Diffusion Profile) and anatomy‐specific DWI sequences, including sequences recommended by the MR‐Linac Consortium Imaging Biomarker Working Group, were used to image the phantom and volunteer. ADC maps generated using the MRL scanner software (inline ADC) and diffusion‐weighted (b‐value) images were exported from the scanner console. The latter was used to generate ADC maps using commercial software (offline ADC) for a separate comparative analysis. Performance metrics were computed for each sequence, including a coefficient of variation to assess between‐session intra‐scanner repeatability (CVBS) and inter‐scanner reproducibility (CV), for each phantom vial and contoured organ. Additionally, using the phantoms’ known ADC vial values, a percentage bias (bias) was calculated to determine ADC accuracy. Results Phantom‐based measurements for the standardized QIBA sequence had intra‐ and inter‐scanner CV and bias well within recommended guideline (QIBA Diffusion Profile) tolerance limits of 2.2% and ±3.6%, respectively. All anatomy‐specific phantom DWI sequences were also within these tolerances, except for the cervix sequence at one site which showed an average intra‐scanner bias of +4.5%. Both accuracy and reproducibility for all sequences were worse for lower diffusivity vials measured in the phantom. Additionally, inline and offline ADC maps had high similarity with average percent differences of +0.2%. Volunteer‐based results had worse reproducibility, with the average inter‐scanner CV for the brain and pancreas sequences within 9.0%, however, reaching up to 27.1% for pelvis and abdomen sequences. Conclusions This study demonstrated accuracy, intra‐scanner repeatability, and inter‐scanner reproducibility comparable to metrics reported in the literature, using both the phantom and volunteer datasets. The cervix sequence had the largest variability in both phantom and volunteer results and was recommended for further investigation. This study suggests that qMRI techniques utilizing DWI could be a viable option for future multi‐centered patient‐based studies utilizing Australian MRLs, with phantom‐based quality assurance recommended alongside patient imaging.

The human genome contains instructions to transcribe more than 200,000 RNAs. However, many RNA transcripts are generated from the same gene, resulting in alternative isoforms that are highly similar and that remain difficult to quantify. To evaluate the ability to study RNA transcript expression, we profiled seven human cell lines with five different RNA-sequencing protocols, including short-read cDNA, Nanopore long-read direct RNA, amplification-free direct cDNA and PCR-amplified cDNA sequencing, and PacBio IsoSeq, with multiple spike-in controls, and additional transcriptome-wide N⁶-methyladenosine profiling data. We describe differences in read length, coverage, throughput and transcript expression, reporting that long-read RNA sequencing more robustly identifies major isoforms. We illustrate the value of the SG-NEx data to identify alternative isoforms, novel transcripts, fusion transcripts and N⁶-methyladenosine RNA modifications. Together, the SG-NEx data provide a comprehensive resource enabling the development and benchmarking of computational methods for profiling complex transcriptional events at isoform-level resolution.

Targeted maximum likelihood estimation (TMLE) is an increasingly popular framework for the estimation of causal effects. It requires modeling both the exposure and outcome but is doubly robust in the sense that it is valid if at least one of these models is correctly specified. In addition, TMLE allows for flexible modeling of both the exposure and outcome with machine learning methods. This provides better control for measured confounders since the model specification automatically adapts to the data, instead of needing to be specified by the analyst a priori . Despite these methodological advantages, TMLE remains less popular than alternatives in part because of its less accessible theory and implementation. While some tutorials have been proposed, none address the case of a time‐to‐event outcome. This tutorial provides a detailed step‐by‐step explanation of the implementation of TMLE for estimating the effect of a point binary or multilevel exposure on a time‐to‐event outcome, modeled as counterfactual survival curves and causal hazard ratios. The tutorial also provides guidelines on how best to use TMLE in practice, including aspects related to study design, choice of covariates, controlling biases and use of machine learning. R‐code is provided to illustrate each step using simulated data ( https://github.com/detal9/SurvTMLE ). To facilitate implementation, a general R function implementing TMLE with options to use machine learning is also provided. The method is illustrated in a real‐data analysis concerning the effectiveness of statins for the prevention of a first cardiovascular disease among older adults in Québec, Canada, between 2013 and 2018.

Proteuxoa Hampson, 1903, became the largest Australian Noctuidae genus in 1996, when E.D. Edwards referred 77 species to it for the Checklist of the Lepidoptera of Australia . However, the Noctuidae subfamily classifications in the Checklist are acknowledged to be problematic, and because the Australian fauna has received little scientific attention since it was published, the taxonomy of many species is yet to be clarified. As a step towards the assimilation of Australasian fauna into the modern classification of Noctuidae, the largest known Australian genus is here reviewed using a combination of morphological characters, COI data from 409 specimens representing 58 species of Proteuxoa Hampson, 1903 ( sensu Edwards) and the outgroup Athetis tenuis (Butler, 1886) and data from five additional genes (CPS‐CAD, EF‐1a, GAPDH, RpS5, Wgl) representing 26 species of Proteuxoa ( sensu Edwards) and A. tenuis . Peripyra Hampson, 1908 reinst. stat. , and Androdes Turner, 1920 reinst. stat. , are removed from synonymy with Proteuxoa and re‐established as valid genera, each with two described species, based on phylogenetic analyses of those DNA‐based data, as well as the morphological evidence. Adult morphological characters are described for distinguishing Proteuxoa sensu stricto from its closest known relatives in Australasia, that is, Peripyra , Androdes and Thoracolopha Turner, 1939, all of which are morphologically consistent with adult Noctuinae sensu lato from other parts of the world. To assist future studies of world Noctuidae, reference COI sequences are now available in BOLD for 55 described species, and data from three to five additional gene regions are available for a subset of 27 species via GenBank.

Background: There has been a gradual shift from open spine surgery to minimally invasive techniques such as endoscopic spine surgery to reduce approach-related trauma, collateral damage, and complications. While recovery following surgery has been measured using subjective measures including patient-reported outcome measures, the introduction of smart wearable devices now provides both an objective and continuous method of patient assessment. This prospective study compares patient recovery after uniportal endoscopic and open lumbar spine surgery by analyzing mobility and gait metrics captured by a wearable sensor. Methods: Participants included 24 patients who underwent a single-level uniportal endoscopic lumbar decompression or open posterior lumbar fusion. During the first 48 hours after surgery, patients wore a sensor that continuously monitored position, step count, and gait metrics. Results: In the immediate postoperative period, endoscopic spine surgery patients experienced a quicker return to mobility, with less time lying down, higher step count, faster gait velocity, lower double support percentage, and reduced variability, compared with open spine surgery patients. Conclusion: There are key differences in patient mobility and gait following uniportal endoscopic and open spine surgery. Endoscopic spine surgery patients had faster recovery, which can guide resource allocation toward the development of training programs and support the advancement of spine endoscopy to address a broader range of pathologies. This pilot study highlights the potential for wearable devices to be used in further studies to form spine surgery recovery trajectories, allowing targeted rehabilitation and prompt intervention for deviations in patient recovery. Clinical relevance: This study demonstrates the benefits of endoscopic spine surgery for improved postoperative recovery in terms of mobility and gait metrics. Additionally, it highlights the potential for wearable sensor technology to provide an objective and continuous method for assessing postoperative outcomes and for the development of individualized rehabilitation protocols. These findings support the broader adoption of endoscopic techniques and emphasize the value of incorporating wearable devices into postoperative monitoring to optimize patient care.

Background Australia and New Zealand face the world's highest skin cancer rates, with non‐metropolitan regions bearing a greater burden. Mohs micrographic surgery (MMS) is the gold‐standard treatment for keratinocyte cancers (KCs) due to high cure rates and tissue‐sparing benefits. This study evaluates whether Outside Metropolitan Sydney (OMS) patients present with larger tumours and defects than Sydney Metropolitan Area (SMA) patients. Methods This retrospective study examined MMS cases at The Skin Hospital in 2017. Patients were divided into Sydney Metropolitan Area (SMA) and Outside Metropolitan Sydney (OMS), with OMS sub‐grouped into Non‐Sydney Metropolitan (NSM) and Regional, Rural and Remote (RRR). Tumour and defect sizes were compared between OMS, SMA, and RRR and NSM, with additional exploratory analyses assessing surgical outcomes and tumour characteristics. Results Of 2073 patients undergoing MMS, 1870 basal cell carcinomas and 203 squamous cell carcinomas were included. Tumours and defects were significantly larger in OMS patients (median tumour size: 0.8 cm ² , defect size: 2.1 cm ² ) compared to SMA patients (median tumour size: 0.7 cm ² , defect size: 1.8 cm ² ). No correlation was found between distance travelled and tumour or defect size. SMA patients also had greater flap and primary closures than OMS. Subgroup analysis of RRR and NSM showed no significant difference in tumour or defect sizes. Conclusions Patients from OMS presented with larger KCs, suggesting barriers to earlier access to specialised care. This highlights geographic disparities in skin cancer management outside major cities in Australia in the context of MMS, emphasising the need for improved access and dermatological workforce distribution.