HIV-related Legal Needs, Demographic Change, and Trends in Australia since 1992: A Review of Legal Administrative Data.

An enabling legal environment is essential for an effective HIV response. Using legal administrative data from the HIV/AIDS Legal Centre (HALC), Australia's specialist HIV community legal service, this article characterizes the nature and trends in the legal issues and needs of those with HIV-related legal issues in New South Wales, Australia since 1992. At present, approximately 40% of all PLHIV living in NSW receive a legal service from HALC during the most recent five-year period. Clients received legal services relating to immigration law at a greatly increased rate (2010: 36%; 2019: 53%), discrimination matters decreased (2010: 17%; 2019: 5.9%), wills and estates remained steady (2010: 9%; 2019: 8.3%). Most clients identify as male (76.9%), homosexual (55%) and are aged between 35 and 49 years of age (34.6%). This demographic profile of clients changed over time, becoming younger and more likely to have been born overseas, and increasingly identifying as heterosexual.

Controlling Colloidal Crystal Nucleation and Growth with Photolithographically Defined Templates.

Colloidal crystallization provides a means to synthesize hierarchical nanostructures by design and to use these complex structures for nanodevice fabrication. In particular, DNA provides a means to program interactions between particles with high specificity, thereby enabling the formation of particle superlattice crystallites with tailored unit cell geometries and surface faceting. However, while DNA provides precise control of particle-particle bonding interactions, it does not inherently present a means of controlling higher-level structural features such as the size, shape, position, or orientation of a colloidal crystallite. While altering assembly parameters such as temperature or concentration can enable limited control of crystallite size and geometry, integrating colloidal assemblies into nanodevices requires better tools to manipulate higher-order structuring and improved understanding of how these tools control the fundamental kinetics and mechanisms of colloidal crystal growth. In this work, photolithography is used to produce patterned substrates that can manipulate the placement, size, dispersity, and orientation of colloidal crystals. By adjusting aspects of the pattern, such as feature size and separation, we reveal a diffusion-limited mechanism governing crystal nucleation and growth. Leveraging this insight, patterns are designed that can produce wafer-scale substrates with arrays of nanoparticle superlattices of uniform size and shape. These design principles therefore bridge a gap between a fundamental understanding of nanoparticle assembly and the fabrication of nanostructures compatible with functional devices.

Personal Data for Public Benefit: The Regulatory Determinants of Social Licence for Technologically Enhanced Antimicrobial Resistance Surveillance.

Technologically enhanced surveillance systems have been proposed for the task of monitoring and responding to antimicrobial resistance (AMR) in both human, animal and environmental contexts. The use of these systems is in their infancy, although the advent of COVID-19 has progressed similar technologies in response to that pandemic. We conducted qualitative research to identify the Australian public's key concerns about the ethical, legal and social implications of an artificial intelligence (AI) and machine learning-enhanced One Health AMR surveillance system. Our study provides preliminary evidence of public support for AI/machine learning-enhanced One Health monitoring systems for AMR, provided that three main conditions are met: personal health care data must be deidentified; data use and access must be tightly regulated under strong governance; and the system must generate high-quality, reliable analyses to guide trusted health care decision-makers.

Post-intensive care syndrome and pulmonary fibrosis in patients surviving ARDS-pneumonia of COVID-19 and non-COVID-19 etiologies.

The purpose was to examine patient-centered outcomes and the occurrence of lung fibrotic changes on Chest computed tomography (CT) imaging following pneumonia-related acute respiratory distress syndrome (ARDS). We sought to investigate outpatient clinic chest CT imaging in survivors of COVID19-related ARDS and non-COVID-related ARDS, to determine group differences and explore relationships between lung fibrotic changes and functional outcomes. A retrospective practice analysis of electronic health records at an ICU Recovery Clinic in a tertiary academic medical center was performed in adult patients surviving ARDS due to COVID-19 and non-COVID etiologies. Ninety-four patients with mean age 53 ± 13 and 51% male were included (n = 64 COVID-19 and n = 30 non-COVID groups). There were no differences for age, sex, hospital length of stay, ICU length of stay, mechanical ventilation duration, or sequential organ failure assessment (SOFA) scores between the two groups. Fibrotic changes visualized on CT imaging occurred in a higher proportion of COVID-19 survivors (70%) compared to the non-COVID group (43%, p < 0.001). Across both groups, patients with fibrotic changes (n = 58) were older, had a lower BMI, longer hospital and ICU LOS, lower mean RASS scores, longer total duration of supplemental oxygen. While not statistically different, patients with fibrotic changes did have reduced respiratory function, worse performance on the six-minute walk test, and had high occurrences of anxiety, depression, emotional distress, and mild cognitive impairment regardless of initial presenting diagnosis. Patients surviving pneumonia-ARDS are at high risk of impairments in physical, emotional, and cognitive health related to Post-Intensive Care Syndrome. Of clinical importance, pulmonary fibrotic changes on chest CT occurred in a higher proportion in COVID-ARDS group; however, no functional differences were measured in spirometry or physical assessments at ICU follow-up. Whether COVID infection imparts a unique recovery is not evident from these data but suggest that long-term follow up is necessary for all survivors of ARDS.

Self-Assembling Systems for Optical Out-of-Plane Coupling Devices.

Micromirrors are used in integrated photonics to couple extraplanar light into the planar structure of a device by redirecting light via specular reflection. Compared with grating or prism-based couplers, micromirrors allow for coupling of light over a broader range of wavelengths, provided that the micromirror is fabricated with a specific 3D shape to ensure proper reflection angles. In principle, self-assembly methods could enable reliable, parallelizable fabrication of such devices with a high degree of precision by designing self-assembling components that produce the desired microscale geometry as their thermodynamic products. In this work, we use DNA-functionalized nanoparticles to assemble faceted crystallites with predetermined crystal shapes, and demonstrate with microscale retroreflectance measurements that these self-assembled nanoparticle arrays do indeed behave like optically flat mirrors. Furthermore, we show that the tilt angle of the micromirrors can be intentionally controlled by altering the crystallographic symmetry and preferred crystal orientations as a function of the self-assembly process, thereby altering the resulting specular angle in a programmable manner. Measurements of optical coupling from normal incidence into the substrate plane via an optical fiber confirm that the faceted structures can function as optical out-of-plane coupling devices, and coating these structures with reflective materials allows for high efficiency of light reflection in addition to the angular control. Together, these experiments demonstrate how self-assembled nanoparticle materials can be used to generate optically relevant architectures, enabling a significant step in the development of self-assembly as a materials fabrication tool for integrated optical devices.

The Legal Needs of People Living with a Sexually Transmissible Infection or Blood-Borne Virus: Perspectives From a Sample of the Australian Sexual Health and Blood Borne Virus Workforce.

Law and the legal environment are important factors in the epidemiology and prevention of sexually transmissible infections (STIs) and blood-borne viruses (BBVs). However, there has been no sustained effort to monitor the legal environment surrounding STIs and BBVs. This article presents the first data on the incidence and impacts of unmet legal needs for those affected by an STI or BBV in Australia using a survey administered to a sample of the Australian sexual health and BBV workforce. Migration, Housing, Money/Debt, Health (including complaints about health services), and Crime (accused/offender) were reported as the five most common legal need areas, with 60% of respondents describing these legal problems as generating a "severe" impact on health. These results indicate that unmet legal needs generate significant negative impacts in terms of individual health, on public health, and the ability to provide sustainable services such as testing and treatment to those facing unmet legal needs.

Regulating Health Care Safety: Enforcement and Responsibility Attribution in Response to Iatrogenic Harm.

The regulation of health care safety is undertaken in the name of the public and is motivated and justified by their protection. This regulatory action generates debate concerning the proper limits of responsibility attribution and enforcement, while the actions and opinion - both imagined and real - of the public loom large in this field. However, there exists limited knowledge of public opinion on key aspects of health care safety enforcement and responsibility attribution following iatrogenic harm. This article reports on the results of a survey-administered experimental study to determine how the Australian general public attributes responsibility, moral censure and enforcement actions in the event of health care safety failures in hospital and outpatient settings. The study provide evidence that the general public are sensitive to corporate and individual sources of error; attribute responsibility in a pluralistic manner; differentiate between recklessness and negligence; and will attempt both formal and social enforcement actions in response to harm.

Falling through the cracks: the invisible hospital cleaning workforce.

PURPOSE: This paper explores the role of hospital cleaners and their contribution to healthcare safety. Few studies have examined the activities and input of hospital cleaners, rendering them largely invisible in healthcare research. Yet, as coronavirus disease 2019 (COVID-19) has demonstrated, this sizeable workforce carries out tasks critical to healthcare facilities and wider health system functioning. DESIGN/METHODOLOGY/APPROACH: Drawing on the work of Habermas, the authors examine the literature surrounding cleaners and quality and safety in healthcare. The authors theorise cleaners' work as both instrumental and communicative and examine the perceptions of healthcare professionals and managers, as well as cleaners themselves, of healthcare professionals and managers' role and contribution to quality and safety. FINDINGS: Cleaners are generally perceived by the literature as performing repetitive - albeit important - tasks in isolation from patients. Cleaners are not considered part of the "healthcare team" and are excluded from decision-making and interprofessional communication. Yet, cleaners can contribute to patient care; ubiquity and proximity of cleaners to patients offer insights and untapped potential for involvement in hospital safety. ORIGINALITY/VALUE: This paper brings an overdue focus to this labour force by examining the nature and potential of their work. This paper offers a new application of Habermas' work to this domain, rendering visible how the framing of cleaners' role works to exclude this important workforce from participation in the patient safety agenda.

Privacy breaches and electronic communication: Lessons for practitioners and researchers.

BACKGROUND: In the era of socially distanced clinical and medical research practices, the use of electronic communication has flourished. The Australian Information Commissioner recently ordered a Victorian general practice to pay $16,400 in compensation following a breach of privacy. This is the largest award of compensation made by the Commissioner in the context of a medical or healthcare privacy matter. The practice had inadvertently sent an email containing sensitive information to an incorrect email address. The email included information concerning the human immunodeficiency virus status of the complainants. OBJECTIVE: The aim of this article is to provide an overview of this important case in Australian information and privacy law, which relates to the operation of an Australian general practice and research activity undertaken within the practice context. DISCUSSION: In an era marked by a great increase in the use of electronic communication in the medical setting, it is essential that practices both manage electronic communication well and respond appropriately when an error arises.

'She Wanted to Listen to her General Practitioner's Advice ': Exploring and Explaining Antibiotic Prescribing as a Regulatory Encounter.

This article examines the pressing global problem of antimicrobial resistance (AMR), applying motivational posture theory to demonstrate how AMR and the prescribing that drives it can be considered a regulatory challenge. Following an outline of AMR and the threat of the 'superbugs' to which it gives rise, the article assesses the regulatory nature of the 'prescribing encounter' in the primary care setting. It applies both a responsive regulatory lens and motivational posture theory to analyse over 100 narrative accounts of encounters between a general practitioner and a patient. In so doing, the article examines the discursive repertoires and cultural resources available to primary care patients to explain the prescribing encounter and the dynamics within it. It concludes that patients conceive of prescribers as regulatory authorities and prescribing itself as a regulatory encounter. On this basis, the article argues that applying responsive regulatory theory and practice in response to the AMR challenge is likely to find reasonable patient acceptance, offering a new approach to this currently intractable challenge. This article then offers an analysis of what factors indicate patient drift towards defiance of regulatory aims, and what engagement and support encourage a return to cooperation.

APOΕ4 lowers energy expenditure in females and impairs glucose oxidation by increasing flux through aerobic glycolysis.

BACKGROUND: Cerebral glucose hypometabolism is consistently observed in individuals with Alzheimer's disease (AD), as well as in young cognitively normal carriers of the Ε4 allele of Apolipoprotein E (APOE), the strongest genetic predictor of late-onset AD. While this clinical feature has been described for over two decades, the mechanism underlying these changes in cerebral glucose metabolism remains a critical knowledge gap in the field. METHODS: Here, we undertook a multi-omic approach by combining single-cell RNA sequencing (scRNAseq) and stable isotope resolved metabolomics (SIRM) to define a metabolic rewiring across astrocytes, brain tissue, mice, and human subjects expressing APOE4. RESULTS: Single-cell analysis of brain tissue from mice expressing human APOE revealed E4-associated decreases in genes related to oxidative phosphorylation, particularly in astrocytes. This shift was confirmed on a metabolic level with isotopic tracing of 13C-glucose in E4 mice and astrocytes, which showed decreased pyruvate entry into the TCA cycle and increased lactate synthesis. Metabolic phenotyping of E4 astrocytes showed elevated glycolytic activity, decreased oxygen consumption, blunted oxidative flexibility, and a lower rate of glucose oxidation in the presence of lactate. Together, these cellular findings suggest an E4-associated increase in aerobic glycolysis (i.e. the Warburg effect). To test whether this phenomenon translated to APOE4 humans, we analyzed the plasma metabolome of young and middle-aged human participants with and without the Ε4 allele, and used indirect calorimetry to measure whole body oxygen consumption and energy expenditure. In line with data from E4-expressing female mice, a subgroup analysis revealed that young female E4 carriers showed a striking decrease in energy expenditure compared to non-carriers. This decrease in energy expenditure was primarily driven by a lower rate of oxygen consumption, and was exaggerated following a dietary glucose challenge. Further, the stunted oxygen consumption was accompanied by markedly increased lactate in the plasma of E4 carriers, and a pathway analysis of the plasma metabolome suggested an increase in aerobic glycolysis. CONCLUSIONS: Together, these results suggest astrocyte, brain and system-level metabolic reprogramming in the presence of APOE4, a 'Warburg like' endophenotype that is observable in young females decades prior to clinically manifest AD.

Use of Personal Health Information under Consent - Exempt Circumstances for Research: Views of the Australian General Public.

Many human research regulatory systems permit human research to be undertaken without first gaining informed consent. In the Australian context, a "waiver of the consent requirement" may be granted by a Human Research Ethics Committee where research would be otherwise "impracticable" and there is "no known or likely reason" for thinking participants would not have consented. In this article, results of a national survey of Australian adults are presented to illustrate the general public's view of such "consent-exempt" research. The results show that despite strong support for medical research, the general public is deeply reticent regarding consent exemption. Moreover, the results indicate that members of the general public do not believe there is a general obligation to participate in research, that the threshold for accepting consent exemption on the basis of "impracticability" is very high, and presumed consent can only be safely relied upon as a justification in very limited circumstances.

Self-Medication with Antibiotics for Protection against COVID-19: The Role of Psychological Distress, Knowledge of, and Experiences with Antibiotics.

: Self-medication with antibiotics is a major contributing factor to antimicrobial resistance. Prior research examining factors associated with antibiotic self-medication has focused on an individual's knowledge about antibiotics, antibiotic usage practices, accessibility to antibiotic medication, and demographic characteristics. The role of psychological distress associated with perceived health risks in explaining antibiotic self-medication is less understood. This study was designed to address this knowledge gap in the context of the COVID-19 pandemic in Australia. An online survey of 2217 participants was conducted at the height of the initial outbreak and revealed that 19.5% of participants took antibiotics to protect themselves from COVID-19. Multivariate logistic analysis examined the predictors of taking antibiotics for protection against COVID-19. An integrative framework developed from the results illustrates potential pathways and facilitating factors that may contribute to prophylactic self-medication with antibiotics. Specifically, COVID-19 pandemic-induced psychological distress was significantly positively related to self-medication. Preventive use of antibiotics was also facilitated by a lack of understanding about antibiotics, inappropriate antibiotics usage practices, the nature of the patient-doctor relationship, and demographic characteristics. The findings highlight that to combat antimicrobial resistance due to self-medication, interventions need to focus on interrupting entrenched behavioural responses and addressing emotional responses to perceived health risks.

Using DNA to Control the Mechanical Response of Nanoparticle Superlattices.

Nanoparticle superlattice assembly has been proposed as an ideal means of programming material properties as a function of hierarchical organization of different building blocks. While many investigations have focused on electromagnetic, optical, and transport behaviors, nanoscale self-assembly via supramolecular interactions is also a potentially desirable method to program material mechanical behavior, as it allows the strength and three-dimensional organization of chemical bonds to be used as handles to manipulate how a material responds to external stress. DNA-grafted nanoparticles are a particularly promising building block for such hierarchically organized materials because of DNA's tunable and nucleobase sequence-specific complementary binding. Using nanoindentation, we show here that the programmability of oligonucleotide interactions allows the modulus of DNA-grafted nanoparticle superlattices to be easily tuned overly nearly 2 orders of magnitude. Additionally, we demonstrate that alterations to the supramolecular bond strength between particles can alter how a lattice deforms under applied mechanical force. As a result, the superlattices can be programmed either to reorganize their internal structures to dissipate mechanical energy or to completely recover their initial structure upon relaxation, independently of how the particles are arranged in 3D space. These behaviors are subsequently explained as a function of the hierarchical structure of the DNA-guided assemblies by using a simple truss-structure model. Altering the supramolecular DNA connections between particles therefore provides a simple and rational means of dictating different aspects of material mechanical response to produce tailorable properties that are not typically observed in conventional bulk materials. Ultimately, these studies enable control over the deformation behavior of future DNA-assembled nanomaterials and provide evidence that supramolecular chemistry is an effective tool in controlling the mechanical properties of nanomaterials as a function of their hierarchical design.

Capture and Release of Protein-Nanoparticle Conjugates by Reversible Covalent Molecular Linkers.

A hybrid approach to covalently detachable molecules for nanoparticle capture and release from several custom-functionalized surfaces is described. This new surface chemistry capability provides a means for reversible binding of functionalized nanoparticles without relying on costly nucleic acid-based complexation. A new surface linker motif was devised wherein custom molecules were synthesized with components for surface anchoring, cleavage, and target capture through biotin-streptavidin binding. All capture-and-release chemistry is performed using physiological conditions (aqueous, pH 7). Covalent cleavage of linker molecules was achieved through incorporation of a tunable orthogonal reversible covalent (TORC) hydrazone functional group which underwent exchange with a competitive hydrazide aided by an aniline catalyst. The influence of the linker architecture on hydrazone exchange and nanoparticle release was probed by altering the distance between hydrazone and biotin groups using different length PEG spacers. Cleavable linkers were used to functionalize microwells, magnetic separation beads, and gold-coated glass surfaces. Upon functionalization, all surface types bound streptavidin and conjugated nanoparticles regardless of the linker structure. Conversely, the extent of hydrazone exchange as well as release of nanoparticles were influenced both by the hydrazone surface density and the linker molecular structure.

Single-crystal Winterbottom constructions of nanoparticle superlattices.

Colloidal nanoparticle assembly methods can serve as ideal models to explore the fundamentals of homogeneous crystallization phenomena, as interparticle interactions can be readily tuned to modify crystal nucleation and growth. However, heterogeneous crystallization at interfaces is often more challenging to control, as it requires that both interparticle and particle-surface interactions be manipulated simultaneously. Here, we demonstrate how programmable DNA hybridization enables the formation of single-crystal Winterbottom constructions of substrate-bound nanoparticle superlattices with defined sizes, shapes, orientations and degrees of anisotropy. Additionally, we show that some crystals exhibit deviations from their predicted Winterbottom structures due to an additional growth pathway that is not typically observed in atomic crystals, providing insight into the differences between this model system and other atomic or molecular crystals. By precisely tailoring both interparticle and particle-surface potentials, we therefore can use this model to both understand and rationally control the complex process of interfacial crystallization.

Chronic disease management support in Australian workplaces-low base, rising need.

ISSUE ADDRESSED: This study investigates the current nature, levels and perceived need for workplace support among mature age Australian workers with chronic illness. METHODS: A cross-sectional population survey was conducted via a double opt-in panel sample of Australian workers aged 45 years and older with one or more of six major chronic diseases (diabetes and/or chronic heart, kidney, lung, mental health and/or musculoskeletal conditions). RESULTS: Three hundred and fourteen respondents reported being in the workforce and having at least one of the chronic conditions under investigation, of which almost one third reported having more than one of the conditions. The findings reveal a number of considerable gaps in Australian workplace support for employees 45 years and older with chronic illness, including workplace flexibility, supportive policies and co-worker support. CONCLUSIONS: This research adds to a scarce existing literature base on workplace support for workers with chronic illness in Australia. Future research is needed to identify opportunities for effective public policy and implementation of workplace interventions to better support this cohort. SO WHAT?: If timely progress is not made in this area, the projected increase in the aged population and scheduled public policy changes impacting retirement age will multiply potential adverse effects on the health of employees with chronic illness and Australia's labour market productivity.

The Patient's Voice: Australian Health Care Quality and Safety Regulation from the Perspective of the Public.

The quality and safety of health care is a topic of permanent debate in the field of health services policy and regulation. Often absent from this debate, however, are the views and values of the public. These are excluded by a dominant narrative of health care regulation which understands the regulation of quality and safety in health care as principally a technical and instrumental undertaking. This approach constrains the application of law and legal regulation, devaluing their normative and expressive function in this field. In-part as a form of corrective, we offer an analysis based on recent survey data, of the attitudes and perceptions held by the Australian public towards stakeholder responsibility for, and the regulation of, health care quality and safety.

Building Public Confidence in Medical Registration Revalidation: Reform of Medical Registration Law in Australia, a New Risk-based Approach.

This article examines the reform of the Health Practitioner National Law to introduce a form of medical registration revalidation. Revalidation is a regulatory performance management practice designed to confirm the competence of medical practitioners regularly and proactively. Its implementation will shift the law's current contribution to constraining dangerous practice from a largely reactive stance onto a more proactive footing. In aid of advancing the case for registration revalidation, we describe the recent history of the National Law, provide analysis of the proposed revalidation reforms and then apply a novel empirical method of a discrete choice experiment to determine the Australian general public's acceptance of and preferred approach to medical registration revalidation regulation. We argue that the reform represents a potentially effective and, importantly, acceptable reform to existing regulatory performance management and disciplinary systems.