Shiga Toxin‒Producing Escherichia coli Diagnoses from Health Practitioners, Queensland, Australia.

In Queensland, Australia, 31 of 96 Shiga toxin‒producing Escherichia coli cases during 2020-2022 were reported by a specialty pathology laboratory servicing alternative health practitioners. Those new cases were more likely to be asymptomatic or paucisymptomatic, prompting a review of the standard public health response.

"Hospitals respond to demand. Public health needs to respond to risk": health system lessons from a case study of northern Queensland's COVID-19 surveillance and response.

BACKGROUND: The vast region of northern Queensland (NQ) in Australia experiences poorer health outcomes and a disproportionate burden of communicable diseases compared with urban populations in Australia. This study examined the governance of COVID-19 surveillance and response in NQ to identify strengths and opportunities for improvement. METHODS: The manuscript presents an analysis of one case-unit within a broader case study project examining systems for surveillance and response for COVID-19 in NQ. Data were collected between October 2020-December 2021 comprising 47 interviews with clinical and public health staff, document review, and observation in organisational settings. Thematic analysis produced five key themes. RESULTS: Study findings highlight key strengths of the COVID-19 response, including rapid implementation of response measures, and the relative autonomy of NQ's Public Health Units to lead logistical decision-making. However, findings also highlight limitations and fragility of the public health system more generally, including unclear accountabilities, constraints on local community engagement, and workforce and other resourcing shortfalls. These were framed by state-wide regulatory and organisational incentives that prioritise clinical health care rather than disease prevention, health protection, and health promotion. Although NQ mobilised an effective COVID-19 response, findings suggest that NQ public health systems are marked by fragility, calling into question the region's preparedness for future pandemic events and other public health crises. CONCLUSIONS: Study findings highlight an urgent need to improve governance, resourcing, and political priority of public health in NQ to address unmet needs and ongoing threats.

Low-Temperature X-ray Microanalysis Sheds New Light on Mineral Nutrition Aspects of Insect Leaf Galling.

Manipulation of host plant physiology by leaf-galling insects is a multifaceted process. Among fundamental knowledge gaps surrounding this scientifically intriguing phenomenon is the appropriation of plant mineral nutrients and moisture for galling advantage. Small, soluble mineral ions and watery cell contents in dense gall tissues risk disruption during routine sample preparations. In this study, an X-ray microanalysis was applied to investigate gall mineral nutrition. Morphologically diverse leaf galls were sampled from three Australian rainforest tree species. Using cryo-analytical scanning electron microscopy, real-time X-ray analytical maps of cellular mineral nutrients and water were integrated with anatomical images of gall and leaf cross-sectional surfaces. A comparison of host-leaf and gall anatomies bore direct evidence of drastic changes to leaf cells through the galling process. Distinct "wet" and "dry" regions within galls were anatomically and/or chemically differentiated, suggesting specific functionality. "Wet" regions comprising hydrated cells including soft gall-cavity linings where larvae are known to feed contained soluble plant mineral nutrients, while C-rich "dry" tissues largely devoid of mineral nutrients likely contribute structural support. Mapping immobile nutrients such as Mn may provide a means of "matching" specific gall cell types to those in ungalled host-leaf tissues. The findings here provided otherwise inaccessible insights into leaf-gall mineral nutrition.

Differential pheromone profile as a contributor to premating isolation between two sympatric sibling fruit fly species.

Bactrocera tryoni (Froggatt) and Bactrocera neohumeralis (Hardy) are sibling fruit fly species that are sympatric over much of their ranges. Premating isolation of these close relatives is thought to be maintained in part by allochrony-mating activity in B. tryoni peaks at dusk, whereas in B. neohumeralis, it peaks earlier in the day. To ascertain whether differences in pheromone composition may also contribute to premating isolation between them, this study used solid-phase microextraction and gas chromatography-mass spectrometry to characterize the rectal gland volatiles of a recently collected and a more domesticated strain of each species. These glands are typical production sites and reservoirs of pheromones in bactrocerans. A total of 120 peaks were detected and 50 were identified. Differences were found in the composition of the rectal gland emissions between the sexes, species, and recently collected versus domesticated strains of each species. The compositional variation included several presence/absence and many quantitative differences. Species and strain differences in males included several relatively small alcohols, esters, and aliphatic amides. Species and strain differences in females also included some of the amides but additionally involved many fatty acid esters and 3 spiroacetals. While the strain differences indicate there is also heritable variation in rectal gland emissions within each species, the species differences imply that compositional differences in pheromones emitted from rectal glands could contribute to the premating isolation between B. tryoni and B. neohumeralis. The changes during domestication could also have significant implications for the efficacy of Sterile Insect Technique control programs.

Safe Access Zone Legislation and Its Compliance with the Human Rights of Anti-Abortion Protesters in Australia.

Terminating a pregnancy is now lawful in all Australian jurisdictions, although on diverse bases. While abortions have not been subject to the same degree of heated debate in Australia as elsewhere, protests aimed at persuading women not to have a termination of their pregnancy have occurred outside abortion service providers in the past. Over the last decade, this has led to the introduction of laws setting out so-called safe access zones around provider premises. Anti-abortion protests are prohibited within a specific distance from abortion services and infringements attract criminal liability. As safe access zone laws prevent protesters from expressing their views in certain spaces, the question arises as to the laws' compliance with protesters' human rights. This article analyses this by considering the human rights compliance of the Queensland ban in light of Queensland human rights legislation. It concludes that the imposed prohibition of anti-abortion protests near abortion clinics is compatible with human rights.

Nocardia australiensis sp. nov. and Nocardia spumae sp. nov., isolated from sea foam in Queensland, Australia.

Strains USC-21046T and USC-21048T were isolated from foaming coastal marine waters on the Sunshine Coast, Queensland, Australia. Both strains displayed growth and morphological characteristics typical for members belonging to the genus Nocardia. The major polar lipids were diphosphatidylglycerol and phosphatidylethanolamine, and the major fatty acids were C16 : 0, C18 : 1 ω9c, C18 : 0 and C18 : 0 10-methyl. The mycolic acids of strains USC-21046T and USC-21048T consisted of chain lengths between 50-64 and 56-68, respectively. Moreover, both of those strains contained meso-diaminopimelic acid and ribose, arabinose, glucose and galactose as whole cell sugars. Based on the phylogenomic results, both strains belonged to the genus Nocardia with strain USC-21046T showing an 80.4 % genome similarity to N. vinacea NBRC 16497T and N. pseudovaccinii NBRC 100343T, whereas USC-21048T strain showed an 83.6 % genome similarity to N. aobensis NBRC 100429T. Both strains were delineated from their closely related relatives based on physiological (e.g. growth on sole carbon source) and chemotaxonomic (e.g. cellular fatty composition) differences. The digital DNA-DNA hybridization (dDDH) values between USC-21046T and USC-21048T and their closely related relatives were below the dDDH threshold value of ≤70 % used for the taxonomic classification of novel species status. The genome length of strains USC-21046T and USC-21048T were 6 878 863 and 7 066 978 bp, with G+C contents of 65.2 and 67.8 mol%, respectively. For the novel isolates, we propose the names Nocardia australiensis sp. nov. with the type strain USC-21046T (=DSM 111727T=NCCB 100867T) and Nocardia spumae sp. nov. with the type strain USC-21048T (=DSM 111726T=NCCB 100868T).

Historical epidemics of scrub typhus in Queensland and Papua New Guinea.

Undifferentiated febrile diseases (e.g., Mossman fever) from northern Queensland were eventually partially attributed to mite-transmitted rickettsial infections known as scrub typhus or tsutsugamushi fever. Scrub typhus became a major medical threat to military operations in Papua New Guinea during the Second World War and killed more Australian soldiers than malaria in the pre-antibiotic era. Further investigations showed scrub typhus to be an occupational disease of rural workers in north Queensland especially around Cairns and Innisfail. Occasional small epidemics of scrub typhus still occur during military exercises in Queensland, but as scrub typhus is not a reportable disease, its presence in the civilian community is largely unknown. Increased use of serological testing in patients with fever and rash illnesses after exposure in northern Queensland is likely to show that scrub typhus is a modern infection that remains treatable with antibiotics once it is identified.

Peculiarities of Q fever and human cases reported so far in the Czech Republic.

INTRODUCTION: Q fever is a zoonosis with a worldwide occurrence. Coxiella burnetii infection is most commonly transmitted by inhalation of air containing contaminated dust in cow, sheep and goat farming areas. The other modes of transmission are alimentary route (ingestion) and through sucking ticks. We set ourselves the goal of presenting a descriptive analysis of cases of Q fever in the Czech Republic (CZ) and former Czechoslovakia and draw attention to this often-overlooked issue. METHODS: Summary of available information about Q fever was processed, and a narrative search of published cases of Q fever in the CZ and former Czechoslovakia, in Czech, Slovak and English, without time restrictions was performed. Furthermore, a descriptive analysis of Q fever cases reported to the Czech infectious diseases reporting system in 1982-2021 was done. After analysis, the available information system data were supplemented with data from a search of published scientific literature and weekly reports on the current epidemiological situation of the public health protection authorities of the CZ. RESULTS: The disease has been reported in former Czechoslovakia and then in CZ since 1952. In 1952-1954, six outbreaks were reported with a total of 150 cases, mostly in connection with work with cattle. In 1980, a large-scale outbreak of Q fever affected 526 employees of the cotton production plant at Staré Mesto near Uherské Hradiste. Otherwise, units to dozens of cases were reported. From 1993 to 2021, 27 cases of the disease were detected in the CZ, of which 22 (81.5%) occurred in men. The age range was 0-60 years (mean 31, median 30 years). Seasonality by reporting month was highest in January and September. CONCLUSION: There has been a decline in human cases of Q fever in the European Union (EU) in recent years, and only few cases of the disease occur in the CZ. Still, due to potential severity of the disease, the current climate change with the consequent increase in the spread of ticks as vectors of Coxiella, and animal movements associated with the global market, it is important to consider Q fever in the differential diagnosis. As part of the prevention, it is necessary to ensure compliance with basic hygiene rules, especially in at-risk occupations, and to consume only pasteurized dairy products. Vaccination of humans is not available in EU countries, although vaccination of livestock is possible.

A baseline profile of the Queensland Cardiac Record Linkage Cohort (QCard) study.

BACKGROUND: Cardiovascular disease (CVD) is one of the leading causes of death in Australia. Longitudinal record linkage studies have the potency to influence clinical decision making to improve cardiac health. This paper describes the baseline characteristics of the Queensland Cardiac Record Linkage Cohort study (QCard). METHODS: International Classification of Disease, 10th Revision Australian Modification (ICD-10-AM) diagnosis codes were used to identify CVD and comorbidities. Cost and adverse health outcomes (e.g., comorbidities, hospital-acquired complications) were compared between first-time and recurrent admissions. Descriptive statistics and standard tests were used to analyse the baseline data. RESULTS: There were 132,343 patients with hospitalisations in 2010, of which 47% were recurrent admissions, and 53% were males. There were systematic differences between characteristics of recurrent and first-time hospitalisations. Patients with recurrent episodes were nine years older (70 vs. 61; p < 0.001) and experienced a twice higher risk of multiple comorbidities (3.17 vs. 1.59; p < 0.001). CVD index hospitalisations were concentrated in large metropolitan hospitals. CONCLUSIONS: Our study demonstrates that linked administrative health data provide an effective tool to investigate factors determining the progress of heart disease. Our main finding suggests that recurrent admissions were associated with higher hospital costs and a higher risk of having adverse outcomes.

Group B streptococcal bacteraemia: changing trends in a tropical region of Australia.

BACKGROUND: Group B streptococcus (GBS) is a recognised perinatal and neonatal pathogen. There are reports of increasing GBS sepsis globally outside this demographic. North Queensland is part of tropical Australia, with a relatively high proportion of Indigenous Australians. AIMS: To analyse the epidemiology of GBS bacteraemia and explore associated risk factors. METHODS: This was a 10-year retrospective review of GBS bacteraemia in a tertiary facility in North Queensland, between 2010 and February 2020. Data variables collected included: demographics, risk factors, clinical source and outcomes. Multivariable logistic regression was performed to examine the association of indigenous status and other relevant clinical factors with mortality from GBS bacteraemia at 3 months. RESULTS: Of the 164 total cases, 123 were not pregnancy related. The annual rate of GBS bacteraemia for the indigenous population was 12.48 per 100 000 and 4.84 per 100 000 for the non-indigenous population. Indigenous patients were more likely to have diabetes and chronic kidney disease compared with the non-indigenous patients. Males (adjusted odds ratio (AOR) = 4.34; 95% CI 1.14-16.56; P = 0.031) and immunosuppressed patients (AOR = 11.49; 95% CI 2.73-48.42; P < 0.001) were more likely to experience mortality at 3 months from GBS bacteraemia even after adjusting for other risk factors respectively. CONCLUSION: GBS bacteraemia is deviating from being primarily a neonatal disease. While the indigenous population of North Queensland are disproportionately affected, the demographics affected differ. GBS appears to target the older non-indigenous patients with greater comorbidities. In the non-indigenous population, invasive GBS disease is an emerging issue. Three-month mortality appears to be increased in males and the immunosuppressed.

Stillbirth risks and rates for Aboriginal and Torres Strait Islander women and their babies in North Queensland.

BACKGROUND: The stillbirth rate for Australian Aboriginal and Torres Strait Islander infants remains higher than non-Indigenous rates. Risks for stillbirth include maternal factors such as ethnicity, age, geographic location, and physical health. Fetal risk factors include gestational age, birthweight and congenital anomalies. The total stillbirth rate for all babies born at the Townsville University Hospital during the study period was 11 per 1000 births. AIMS: To identify Aboriginal and Torres Strait Islander stillbirth rates, risk factors and causes in North Queensland. MATERIALS AND METHODS: A retrospective chart audit was conducted to identify Indigenous women who had experienced stillbirth in the Townsville University Hospital between January 2005 and December 2014. RESULTS: Thirty-two charts were available for audit. The stillbirth rate for non-Indigenous infants was 10.3 per 1000 births. The stillbirth rate for Indigenous infants was 11.7 per 1000 births. Almost half of the women lived in rural, remote or very remote areas. Maternal risk factors included poorer physical health, such as obesity, diabetes, hypertension, and smoking, fertility issues and lack of antenatal care. Fetal risk factors included congenital anomalies, including cardiac and skeletal abnormalities, placental disorders, and preterm birth. CONCLUSIONS: Stillbirth risk remains higher for Aboriginal and Torres Strait Islander women and their babies. Supporting women to enhance their health is paramount, particularly during pregnancy. Further, increasing awareness of stillbirth risk factors through education for both women and healthcare professionals will support culturally responsive care for women and their families to mitigate stillbirth risk and enhance pregnancy outcomes in non-urban Queensland.

Establishing the Queensland Pelvic Mesh Service: Preliminary experience.

BACKGROUND: Transvaginal mesh (TVM) has been used for treatment of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Mesh-related complications are reported in 3% of women receiving mid-urethral sling surgery for SUI and in up to 20% of women who receive TVM for POP. The Australian Senate Enquiry report in March 2018 recommended that each Australian state establish specialist multidisciplinary units for management of TVM complications. AIMS: The aims of this study are to report on the setting up of the Queensland Pelvic Mesh Service (QPMS) and summarise its first 24 months to provide a potential framework for the establishment of similar service models within Australia and internationally. MATERIALS AND METHODS: The planning and implementation of QPMS was a complex two-stage co-design process involving clinicians and consumers representing women with TVM complications. Consumer input in planning was important for the optimal establishment of QPMS to meet women's holistic needs. RESULTS: From April 2019 to April 2021, 484 women had been treated by the medical team; 257 women had undergone cystoscopy and examination under anaesthesia; 91 patients had undergone mesh revision surgery - 65 complete excision and 25 partial excision and one sling division; and 180 women had been discharged from QPMS. CONCLUSIONS: Providing a comprehensive multidisciplinary service for managing TVM complications requires careful planning with consumer involvement before initiation. Addition of these patients to an existing service may not succeed. Emphasis on surgery may be misplaced for many. QPMS patients, as in sufferers with chronic pain conditions, benefit from psychological support and allied healthcare.

Understanding Autonomous Shuttle Adoption Intention: Predictive Power of Pre-Trial Perceptions and Attitudes.

The capability of 'demand-responsive transport', particularly in autonomous shared form, to better facilitate road-based mobility is considered a significant advantage because improved mobility leads to enhanced quality of life and wellbeing. A central point in implementing a demand-responsive transit system in a new area is adapting the operational concept to the respective structural and socioeconomic conditions. This requires an extensive analysis of the users' needs. There is presently limited understanding of public perceptions and attitudes toward the adoption of autonomous demand-responsive transport. To address this gap, a theory-based conceptual framework is proposed to provide detailed empirical insights into the public's adoption intention of 'autonomous shuttle buses' as a form of autonomous demand-responsive transport. South East Queensland, Australia, was selected as the testbed. In this case study, relationships between perceptions, attitudes, and usage intention were examined by employing a partial least squares structural equation modeling method. The results support the basic technology acceptance model casual relationships that correspond with previous studies. Although the direct effects of perceived relative advantages and perceived service quality on usage intention are not significant, they could still affect usage intention indirectly through the attitude factor. Conversely, perceived risks are shown to have no association with perceived usefulness but can negatively impact travelers' attitudes and usage intention toward autonomous shuttle buses. The research findings provide implications to assist policymakers, transport planners, and engineers in their policy decisions and system plans as well as achieving higher public acknowledgment and wider uptake of autonomous demand-responsive transport technology solutions.

Digital Colonialism and the Fourth Industrial Revolution - Preventing Exploitative Bio-economies.

As the traditional use of non-human genetic resources in research and development is increasingly ceded to computerised research activities, current frameworks for access and benefit-sharing face an impending identity crisis. The absence of international consensus on the regulation of digital sequence information presents a critical point of social division between the Global North and Global South, whereby a culture of "open data" promises immeasurable opportunity in high-income nations and threatens a wave of digital bio-piracy for vulnerable communities. This article critically evaluates these problems and considers solutions which draw on Indigenous Data Sovereignty principles. To do so, it uses the recent experience in Queensland to explore how the law might reconcile and balance these competing interests. Insofar as Queensland is one of the most mega biodiverse regions on earth, boasts a globally competitive life sciences sector, and has a vibrant and longstanding Indigenous population, it offers a unique case study.

COVID-19 and social distancing measures in Queensland, Australia, are associated with short-term decreases in recorded violent crime.

Objectives: The objective of this study is to test whether recorded rates of violent crime declined in the context of social distancing regulations in Queensland, Australia. Methods: ARIMA modeling was used to compute 6-month-ahead forecasts of rates for common assault, serious assault, sexual offenses, and breaches of domestic violence orders. These forecasts (and their 95% confidence intervals) are compared to the observed data for March and April 2020. Results: By the end of April, 2020, rates of common, serious, and sexual assault had declined to their lowest level in a number of years. For serious assault and sexual assault, the decline was beyond statistical expectations. The rate at which domestic violence orders were breached remained unchanged. Conclusions: Social distancing regulations are temporally correlated with reductions in some violent crimes. Social distancing is likely to have significantly limited interpersonal interaction, especially in locations and at times when violence is usually prevalent.

Seeking to improve access to COVID-19 therapeutics in the remote Torres and Cape communities of Far North Queensland during the first COVID-19 omicron outbreak.

INTRODUCTION: The first outbreak of the omicron variant of COVID-19 in the Torres and Cape region of Far North Queensland in Australia was declared in late December 2021. A COVID-19 Care at Home program was created to support the health and non-health needs of people with COVID-19 and their families throughout the mandatory isolation periods and included centralising the coordination and delivery of COVID-19 therapeutics. The therapeutics available included one intravenous monoclonal antibody (sotrovimab) and two oral antiviral therapies: nirmatrelvir and ritonavir (Paxlovid®) and molnupiravir (Lagevrio®). This article describes the uptake and delivery of this therapeutics program. METHODS: COVID-19 cases were documented in a notification database, screened to determine eligibility for COVID-19 therapies and prioritised based on case age, vaccination status, immunosuppression status and existing comorbidities, in line with Queensland clinical guidelines. Eligible cases were individually contacted by phone to discuss treatment options, and administration of therapies were coordinated in partnership with local primary healthcare centres and hospitals. RESULTS: A total of 4744 cases were notified during the outbreak period, of which 217 (4.6%) were deemed eligible for treatment after medical review. Treatment was offered to 148/217 cases (68.2%), with 90/148 cases (60.8%) declining treatment and 53/148 cases (35.8%) receiving therapeutic treatment for COVID-19. Among these 53 cases, 29 received sotrovimab (54.7%), 20 received Paxlovid (37.7%) and four received Lagevrio (7.5%). First Nations people accounted for 48/53 cases (90.6%) who received treatment, and COVID-19 therapeutics were delivered to cases in 16 remote First Nations communities during the outbreak period. CONCLUSION: The COVID-19 Care at Home program demonstrated a novel, public health led approach to delivering time-critical medications to individuals across a large, remote and logistically complex region. The application of similar models to outbreaks and chronic conditions of public health importance offers potential to address many health access inequities experienced by remote Australian First Nations communities.

Assessing fitness for trial in a Children's Court.

In 2016, Queensland introduced changes to mental health legislation, providing additional powers to Magistrates in relation to soundness of mind and fitness for trial. This article explores the application of fitness for trial to young people in the Magistrate's Court. It begins with a discussion of fitness for trial broadly, exploring issues with the current legal test, and discusses the unique application of the test in Queensland. By highlighting the inherent vulnerabilities of young people involved in the legal system, we identify the gaps and challenges of assessing fitness for trial with this population. In conclusion we recommend further exploration of alternative models for resolving questions of fitness for trial for young people involved in the criminal justice system.

Christensen House: A Case Study for Inclusive Decision-making within Professional Associations.

Accounts of dental history in Queensland are few and almost invariably authored by those who either held or hold power. The focus is 'who, what, when' rather than 'why and how'. House-related developments as a case study provide an opportunity to assess aspects of the Australian Dental Association Queensland Branch's (ADAQ) model of administration in the early 1970s. The authors use literature review and historical methods. The ADAQ's articles of association, codes of conduct and memoranda centralized Brisbane-based authority and elite leadership into its management. The ADAQ council's decision to build Christensen House in Brisbane, prompted by the posthumous benevolence of George Christensen, was informed, logical, measured and appeared timely. The advocates for the house were innovative, optimistic, resolute, and well-intentioned, with their design and selected location of the building being appropriate. However, the decision occurred at a time of latent discontent within the membership, many of whom did not support the project financially. Distance in Queensland dictates that provincial members either accept or tolerate Brisbane-based centralized authority within ADAQ administration. Nonetheless, when it comes to policy warranting membership subscription, the Christensen House experience demonstrates that the modus operandi of the ADAQ council should be, as far as possible, inclusive, and representative.

Colin Robertson, Smile A While: Dentistry, History, Theater and Golf.

Many commentators argue that, until the 1980s, Brisbane and Queensland were cultural backwaters within the Australian context. However, with the hosting of the highly successful XII Commonwealth Games (1982) and World Expo 88 (1988) and with the development of the Queensland Cultural (1976-) and South Bank (1974-) Precincts, Brisbane and Queensland cast aside perennial apologism to acquire prominence, maturity, and self-respect. Within these national, state, and municipal settings, the theme, timing, and venue for the 24th Australian Dental Congress (1985) involved risk. Enter a Brisbane dental practitioner, Colin Robertson: a theater critic and a scriptwriter, who possessed competitive and entrepreneurial streaks, a vivid imagination, a steely resolve, and a love of golf. Robertson became an erudite, incisive, and prolific commentator, who penned much of the historical musical Smile A While (aka Smile Awhile) for the abovementioned congress. He contributed to an outstanding Dental Health Week (1980), served on the Australian Dental Association Queensland Branch Council (1981), its Fluoridation Committee (1973) and chaired both its Oral Health Education Committee (1981) and the Congressional Entertainment Division within the Congress Organizing Committee (1982-1985). Accordingly, the authors use historical methods to expose and explore a scarcely acknowledged narrative within dental history in Queensland.

Increased Incidence of Melioidosis in Far North Queensland, Queensland, Australia, 1998-2019.

During January 1998-December 2019, the annual incidence of melioidosis in Far North Queensland, Queensland, Australia, more than doubled. Because climate and prevalence of predisposing medical conditions remained stable during that time, we hypothesize that the increased incidence was caused by urban expansion and increased construction, resulting in greater exposure to Burkholderia pseudomallei.