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Organisations and governments seeking to implement genomics into clinical practice face numerous challenges across multiple, diverse aspects of the health care system. It is not sufficient to tackle any one aspect in isolation: to create a system that supports genomic medicine, they must be addressed simultaneously. The growing body of global knowledge can guide decision-making, but each jurisdiction or organisation needs a model for genomic (or personalised) medicine that is tailored to its unique context, its priorities and the funds available. Poor decisions could greatly reduce the benefits that could potentially arise from genomic medicine. Demonstration projects enable models to be tested, providing valuable evidence and experience for subsequent implementation. Here, we present the Melbourne Genomics Health Alliance demonstration project as an exemplar of a collaborative, holistic approach to phased implementation of genomics across multiple autonomous institutions. The approach and lessons learned may assist others in determining how best to integrate genomics into their healthcare system.

[This corrects the article DOI: 10.1038/s41525-017-0017-4.].

HL7 International’s Fast Healthcare Interoperability Resources (FHIR) standard provides a common format for sharing health data (eg, FHIR resources) and a RESTful Application Programming Interface (eg, FHIR API) for accessing those resources via a FHIR server connected to an electronic health record system or any other system storing clinical data. Substitutable Medical Applications and Reusable Technologies (SMART) leverages FHIR to create an electronic health record (EHR) agnostic app platform. It utilizes the OAuth standard to provide for authorization and authentication. This paper describes the development and informal evaluation of Case Based Learning on FHIR (CBL on FHIR), a prototype EHR-connected FHIR/SMART platform to provide interactive digital cases for use in medical education. The project goals were to provide a more interactive form of CBL than is possible on paper to more realistically simulate clinical decision making and to expose medical students to modern informatics systems and tools for use in patient care.

The distribution of water and air phases in small blocks of porous sandstone is examined by using a simulated annealing technique that finds the minimum interfacial energy distributions at different saturations. Simulations are based on existing sandstone microstructures that were determined by X-ray microtomography. At low saturations, some of the water is distributed in films along the walls of larger pore spaces, and connects to pendular structures in the crevices and smaller pores. As the amount of water in the pores increases the water films become thicker and pores fill from the pendular structures. The distribution of water voxels in the pore space is examined by calculating interfacial areas, by classifying water voxels as to whether they lie within films or clusters, and by determining the size and distribution of these film clusters. An exponential relationship is found between the fraction of water voxels in the films and the degree of saturation. In addition, the dependency of small-sample electrical conductivity on saturation is examined by using a random walk method.

Health systems globally are looking to make better use of the data they capture in order to improve their services, both for service provision and clinical outcome. One way of doing this is to integrate existing data sources. However, major technical and legal questions exist concerning data integration, data quality, data security and privacy in health data usage. In this paper, we present the HDITM tool, that is currently under development at the e-Health Research Centre. Firstly we describe the HDITM architecture and its data integration capabilities. We then consider two of its core capabilities (1) privacy-preserving similarity linkage and (2) on-line analytical techniques and report generating. Finally, we discuss how HDI functionality can be used to provide the capabilities of a knowledge based medical system. The e-Health Research Centre is currently working with the Queensland Health department to deploy the software in practice.

Although ambivalence characterizes the stance of scholars toward the desirability of close opinion-policy linkages in general, it is especially evident with regard to immigration. The controversy and disagreement about whether public opinion should drive immigration policy are among the factors making immigration one of the most difficult political debates across the West. Leading international experts and aspiring researchers from the fields of political science and sociology use a range of case studies from North America, Europe and Australia to guide the reader through the complexities of this debate offering an unprecedented comparative examination of public opinion and immigration. part one discusses the socio-economic and contextual determinants of immigration attitudes across multiple nations part two explores how the economy can affect public opinion part three presents different perspectives on the issue of causality - do attitudes about immigration drive politics, or do politics drive attitudes? part four investigates how several types of framing are critical to understanding public opinion and how a wide range of political factors can mould public opinion, and often in ways that work against immigration and immigrants part five examines the views of the largest immigrant group in the U.S. - Latinos - as well as how opinions are shaped by contact with and opinions about immigrants in the U.S. and Canada. An essential read to all who wish to understand the nature of immigration research from a theoretical as well as practical point of view.

To explore the impact of COVID-19 lockdown on premature birth rates in Denmark, a nationwide register-based prevalence proportion study was conducted on all 31 180 live singleton infants born in Denmark between 12 March and 14 April during 2015–2020.The distribution of gestational ages (GAs) was significantly different (p=0.004) during the lockdown period compared with the previous 5 years and was driven by a significantly lower rate of extremely premature children during the lockdown compared with the corresponding mean rate for the same dates in the previous years (OR 0.09, 95% CI 0.01 to 0.40, p<0.001). No significant difference between the lockdown and previous years was found for other GA categories.The reasons for this decrease are unclear. However, the lockdown has provided a unique opportunity to examine possible factors related to prematurity. Identification of possible causal mechanisms might stimulate changes in clinical practice.

Medical conditions are often complicated by major depression, with consequent additional impairment of quality of life. We aimed to compare the effectiveness of an integrated treatment programme for major depression in patients with cancer (depression care for people with cancer) with usual care. SMaRT Oncology-2 is a parallel-group, multicentre, randomised controlled effectiveness trial. We enrolled outpatients with major depression from three cancer centres and their associated clinics in Scotland, UK. Participants were randomly assigned in a 1:1 ratio to the depression care for people with cancer intervention or usual care, with stratification (by trial centre) and minimisation (by age, primary cancer, and sex) with allocation concealment. Depression care for people with cancer is a manualised, multicomponent collaborative care treatment that is delivered systematically by a team of cancer nurses and psychiatrists in collaboration with primary care physicians. Usual care is provided by primary care physicians. Outcome data were collected up until 48 weeks. The primary outcome was treatment response (≥50% reduction in Symptom Checklist Depression Scale [SCL-20] score, range 0–4) at 24 weeks. Trial statisticians and data collection staff were masked to treatment allocation, but participants could not be masked to the allocations. Analyses were by intention to treat. This trial is registered with Current Controlled Trials, number ISRCTN40568538. 500 participants were enrolled between May 12, 2008, and May 13, 2011; 253 were randomly allocated to depression care for people with cancer and 247 to usual care. 143 (62%) of 231 participants in the depression care for people with cancer group and 40 (17%) of 231 in the usual care group responded to treatment: absolute difference 45% (95% CI 37–53), adjusted odds ratio 8·5 (95% CI 5·5–13·4), p<0·0001. Compared with patients in the usual care group, participants allocated to the depression care for people with cancer programme also had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all timepoints (all p<0·05). During the study, 34 cancer-related deaths occurred (19 in the depression care for people with cancer group, 15 in the usual care group), one patient in the depression care for people with cancer group was admitted to a psychiatric ward, and one patient in this group attempted suicide. None of these events were judged to be related to the trial treatments or procedures. Our findings suggest that depression care for people with cancer is an effective treatment for major depression in patients with cancer. It offers a model for the treatment of depression comorbid with other medical conditions. Cancer Research UK and Chief Scientist Office of the Scottish Government.