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During pandemics Agent Based Models (ABMs) can model complex, fine-grained behavioural interactions occurring in social networks, that contribute to disease transmission by novel viruses such as SARS-CoV-2. We present a new agent-based model (ABM) called the Discrete-Event, Simulated Social Agent based Network Transmission model (DESSABNeT) and demonstrate its ability to model the spread of COVID-19 in large cities like Sydney, Melbourne and Gold Coast. Our aim was to validate the model with its disease dynamics and underlying social network. DESSABNeT relies on disease transmission within simulated social networks. It employs an epidemiological SEIRD+M (Susceptible, exposed, infected, recovered, died and managed) structure. One hundred simulations were run for each city, with simulated social restrictions closely modelling real restrictions imposed in each location. The mean predicted daily incidence of COVID-19 cases were compared to real case incidence data for each city. Reff and health service utilisation outputs were compared to the literature, or for the Gold Coast with daily incidence of hospitalisation. DESSABNeT modelled multiple physical distancing restrictions and predicted epidemiological outcomes of Sydney, Melbourne and the Gold Coast, validating this model for future simulation work. DESSABNeT is a valid platform to model the spread of COVID-19 in large cities in Australia and potentially internationally. The platform is suitable to model different combinations of social restrictions, or to model contact tracing, predict, and plan for, the impact on hospital and ICU admissions, and deaths; and also the rollout of COVID-19 vaccines and optimal social restrictions during vaccination.

We report a survey in regional Queensland to understand the reasons for suboptimal uptake of the COVIDSafe app. A short five‐minute electronic survey disseminated to healthcare professionals, mining groups and school communities in the Central Queensland region. Free text responses and their topics were modelled using natural language processing and a latent Dirichlet model. We received a total of 723 responses; of these, 69% had downloaded the app and 31% had not. The respondents’ reasons for not downloading the app were grouped under four topics: lack of perceived risk of COVID‐19/lack of perceived need and privacy issues; phone‐related issues; tracking and misuse of data; and trust, security and credibility. Among the 472 people who downloaded the app and provided text amenable to text mining, the two topics most commonly listed were: to assist with contact tracing; and to return to normal. This survey of a regional population found that lack of perceived need, concerns around privacy and technical difficulties were the major barriers to users downloading the application. Health promotion campaigns aimed at increasing the uptake of the COVIDSafe app should focus on promoting how the app will assist with contact tracing to help return to ‘normal’. Additionally, health promotors should address the app's impacts on privacy, people's lack of perceived need for the app and technical barriers.

Abstract BACKGROUND: The Timed Up and Go Test (TUG Test) has previously been described as a reliable tool to evaluate objective functional impairment in patients with degenerative disc disease. OBJECTIVE: The aim of this study was to assess the minimum clinically important difference (MCID) of the TUG Test. METHODS: The TUG Test (measured in seconds) was correlated with validated patient-reported outcome measures (PROs) of pain intensity (Visual Analog Scale for back and leg pain), functional impairment (Oswestry Disability Index, Roland Morris Disability Index), and health-related quality of life measures (Short Form-12 and EuroQol 5D). Three established methods were used to establish anchor-based MCID values using responders of the following PROs (Visual Analog Scale back and leg pain, Oswestry Disability Index, Roland Morris Disability Index, EuroQol 5D index, and Short Form-12 Physical Component Summary) as anchors: (1) average change, (2) minimum detectable change, and (3) change difference approach. RESULTS: One hundred patients with a mean ± SD age of 56.2 ± 16.1 years, 57 (57%) male, 45 patients undergoing microdiscectomy, 35 undergoing lumbar decompression, and 20 undergoing fusion surgery were studied. The 3 MCID computation methods revealed a range of MCID values according to the PRO used from 0.9 s (Oswestry Disability Index based on the change difference approach) to 6.0 s (EuroQol 5D index based on the minimum detectable change approach), with a mean MCID of 3.4 s for all measured PROs. CONCLUSION: The MCID for the TUG Test time is highly variable depending on the computation technique used. The average TUG Test MCID was 3.4 s using all 3 methods and all anchors.

Obtaining a stool specimen for diagnostic testing of enteric conditions (e.g., gastroenteritis) can be a challenging and unpleasant experience. A person is required to obtain a sample pot from a healthcare location, return home and wait until they have a bowel motion, and then deal with the challenges of returning the sample to the clinic or pathology centre. This trial aims to identify whether the simpler approach of obtaining a rectal swab is effective for diagnosing enteric conditions. Recruitment will take place in a variety of settings, including suspected norovirus clusters, Hepatitis A clusters, in both hospital, and community settings. We will compare paired stool and rectal swab sample polymerase chain reaction (PCR) testing to determine whether rectal swabs are a reliable proxy for faecal sampling. Persons who would normally be provided with a faecal specimen container, will also be provided with a rectal swab for self-collection or clinician-collection (within 24 hours of the bulk faeces collection). We will assess the sensitivity, specificity, positive predictive value, negative predictive value using standard confusion matrix. The gold standard reference will be considered the bulk faeces PCR tests. We hypothesise that rectal swab PCR testing will be equally as effective as bulk faeces PCR testing. If successful, rectal swab PCR testing could be implemented as routine practice with several key benefits. Firstly, it would improve the patient experience by conveniently enabling stool collection at the point of care, which is rarely possible currently. Secondly, it would reduce healthcare costs, and streamline collection processes by eliminating the need for persons to return to a clinic to deliver specimen. Thirdly, the ease of testing will likely increase testing rates and compliance, leading to better diagnoses and more accurate clinical care. The protocol described has the potential to revolutionise daily clinical practice. Trial registration : Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12624000095561.

Ameloblastoma is the second most common odontogenic tumor, known to be slow-growing, persistent, and locally aggressive. Recent data suggests that ameloblastoma is best treated with wide resection and adequate margins. Following primary excision, bony reconstruction is often necessary for a functional and aesthetically satisfactory outcome, making early diagnosis paramount. Despite earlier diagnosis potentially limiting the extent of resection and reconstruction, an understanding of the growth rate and natural history of ameloblastoma has been notably lacking from the literature. A systematic review of the literature was conducted by reviewing relevant articles from PubMed and Web of Science databases. Each article's level of evidence was formally appraised according to the Centre of Evidence Based Medicine (CEBM), with data from each utilized in a meta-analysis of growth rates for ameloblastoma. Literature regarding the natural history of ameloblastoma is limited since the tumor is immediately acted upon at its initial detection, unless the patient voluntarily refuses a surgical intervention. From the limited data, it is derived that the highest estimated growth rate is associated with solid, multicystic type and the lowest rate with peripheral ameloblastomas. After meta-analysis, the calculated mean specific grow rate is 87.84% per year. The growth rate of ameloblastoma has been demonstrated, offering prognostic and management information, particularly in cases where a delay in management is envisaged.

There is a large burden of norovirus disease in child-care centers in Australia and around the world. Despite the ubiquity of norovirus outbreaks in child-care centers, little is known about the extent of this burden within the child-care center and the surrounding household clusters. Therefore, we performed an in-depth analysis of a gastroenteritis outbreak to examine the patterns of transmissions, household attack rates and the basic reproduction number (R 0 ) for Norovirus in a child-care facility. We used data from parental interviews of suspected cases sent home with gastroenteritis at a child-care center between 24 th of August and 18 th of September 2020. A total of 52 persons in 19 household clusters were symptomatic in this outbreak investigation. Of all transmissions, 23 (46.9%) occurred in the child-care center, the rest occurring in households. We found a household attack rate of 36.5% (95% CI 27.3, 47.1%). Serial intervals were estimated as mean 2.5 ± SD1.45 days. The R 0 , using time-dependent methods during the growth phase of the outbreak (days 2 to 8) was 2.4 (95% CI 1.50, 3.50). The count of affected persons of a child-care center norovirus outbreak is approximately double the count of the total symptomatic staff and attending children. In the study setting, each symptomatic child-care attendee likely infected one other child-care attendee or staff and just over one household contact on average.

Malignant ameloblastoma, comprising metastasizing ameloblastoma and ameloblastic carcinoma, represents 1.6-2.2% of all odontogenic tumors. Due to its rare nature, malignant ameloblastoma has only been reported in the literature in small case series or case reports. Using the Surveillance, Epidemiology and End-Results (SEER) database, we have performed a population-based study to determine the incidence rate and the absolute survival of malignant ameloblastoma. Using the International Classification of Diseases for Oncology (ICD-O) codes 9310/3 and 9270/3, data from the SEER database were used to calculate the incidence rate and absolute survival rate of population with malignant ameloblastoma. The overall incidence rate of malignant ameloblastoma was 1.79 per 10 million person/year. The incidence rate was higher in males than females and also higher in black versus white population. The median overall survival was 17.6 years from the time of diagnosis and increasing age was associated with a statistically significant poorer survival. To our best knowledge, we report the largest population-based series of malignant ameloblastoma. The incidence rate was 1.79 per 10 million person/year and the overall survival was 17.6 years.

Measles in persons with secondary vaccination failure (SVF) may be less infectious than cases in unvaccinated persons. Our systematic review aimed to assess transmission risk for measles after SVF. We searched PubMed, Embase, and Web of Science databases from their inception dates. Inclusion criteria were articles describing persons who were exposed to measles-infected persons who had experienced SVF. Across the included 14 studies, >3,030 persons were exposed to measles virus from SVF cases, of whom 180 were susceptible, indicating secondary attack rates of 0%-6.25%. We identified 109 cases of SVF from the studies; 10.09% (n = 11) of case-patients transmitted the virus, resulting in 23 further cases and yielding an effective reproduction number of 0.063 (95% CI 0.0-0.5). These findings suggest a remarkably low attack rate for SVF measles cases, suggesting that, In outbreak situations, public health management of unvaccinated persons could be prioritized over persons with SVF.

BACKGROUND:There are few objective measures of functional impairment to support clinical decision making in lumbar degenerative disc disease (DDD). OBJECTIVE:We present the validation (and reliability measures) of the Timed Up and Go (TUG) test. METHODS:In a prospective, 2-center study, 253 consecutive patients were assessed using the TUG test. A representative cohort of 110 volunteers served as control subjects. The TUG test values were assessed for validity and reliability. RESULTS:The TUG test had excellent intra- (intraclass correlation coefficient0.97) and interrater reliability (intraclass correlation coefficient0.99), with a standard error of measurement of 0.21 and 0.23 seconds, respectively. The validity of the TUG test was demonstrated by a good correlation with the Visual Analog Scale (VAS) back (Pearsonʼs correlation coefficient [PCC]0.25) and VAS (PCC0.29) leg pain, functional impairment (Roland-Morris Disability Index [PCC0.38] and Oswestry Disability Index [PCC0.34]), as well as with health-related quality of life (Short Form-12 Mental Component Summary score [PCC−0.25], Short Form-12 Physical Component Summary score [PCC−0.32], and EQ-5D [PCC−0.28]). The upper limit of “normal” was 11.52 seconds. Mild (lower than the 33rd percentile), moderate (33rd to 66th percentiles), and severe objective functional impairment (higher than the 66th percentile) as determined by the TUG test was <13.4 seconds, 13.4 to 18.4 seconds, and >18.4 seconds, respectively. CONCLUSION:The TUG test is a quick, easy-to-use, valid, and reliable tool to evaluate objective functional impairment in patients with lumbar degenerative disc disease. In the clinical setting, patients scoring a TUG test time of over 12 seconds can be considered to have functional impairment. ABBREVIATIONS:BMI, body mass indexDDD, degenerative disc diseaseHRQOL, health-related quality of lifeICC, intraclass correlationLDH, lumbar disc herniationLSS, lumbar spinal stenosisODI, Oswestry Disability IndexOFI, objective functional impairmentPCC, Pearsonʼs correlation coefficientPCS, Physical Component SummaryRMDI, Roland-Morris Disability IndexSF, Short FormVAS, visual analog scale

Background Patients with palliative care needs often rely on emergency departments for management of acute symptoms due to limited access to timely and appropriate outpatient care, however they can be poorly equipped to meet patients’ complex needs. Rapid access clinics exist for addressing health issues such as chest pain but are not routinely established for palliative care. In 2020, the Sunshine Coast Health Palliative Care Service introduced a rapid access clinic to address patients’ unmet acute care needs. This research aimed to understand the impact on clinical outcomes. Methods A retrospective observational analysis of patient health records was undertaken for 283 admissions for 172 patients who attended the clinic between 1 January 2020 and 31 December 2022, and included demographic and diagnostic information, reason for admission and date of death. Statistical analysis of differences using the chi squared test was conducted for age (< 70 years vs. ≥ 70 years), gender and mortality at 30 days after discharge from the clinic. Fisher’s exact test was used to assess associations between the type of admission and the likelihood of preventing an emergency department visit. Confidence interval was set at 95%. Results Attendance at the rapid access clinic was judged to likely result in avoidance of an emergency department visit for 11.7% of admissions. A potentially avoided emergency department visit was associated with mortality within 30 days (22.9%), X 2  (1)= 9.82, p  =.002, and urgent admission to the rapid access clinic (31.5%), p  <.001, OR = 22.6 (95% CI: 7.63, 66.87). There were more planned (67.5%) than urgent admissions. Mortality within 30 days of presentation to the clinic was 24.6%, and significantly associated with male gender (31.3%), X 2  (1) = 6.02, p  =.014 and urgent admission (34.8%), X 2  (1) = 6.7, p  =.008. Conclusions A newly established palliative care rapid access clinic addressed acute symptoms in a timely manner and may offer a valuable alternative to emergency department care, particularly for patients nearing the end of life. Further prospective research using control groups and validated patient outcome measures would provide more robust evidence about the clinic’s effectiveness in optimising end-of-life care and reducing the burden on our emergency departments.