A systematic review and meta-synthesis of the complex and interconnected factors that influence planning for driving retirement.

INTRODUCTION: With an aging population there are more older drivers than ever before. To reduce unnecessary road accidents and assist older drivers to successfully transition to non-driving, a better understanding of the factors that influence planning for driving retirement is required. This review explores documented factors that may influence older adults in planning for driving retirement, thus providing new understandings that can inform future preventative road safety measures, interventions, and policies. METHOD: A systematic search was performed using four databases to locate qualitative studies on the factors that influenced older drivers to plan for driving retirement. To identify factors influencing planning for driving retirement, a thematic synthesis approach was utilized. Identified themes were categorized in relation to elements of the Social Ecological Model theoretical framework. RESULTS: The systematic search resulted in 12 included studies from 4 countries. Four major themes and 11 subthemes were identified regarding planning driver retirement. Each subtheme denotes a factor that may facilitate and/or impede older drivers planning for driving retirement. CONCLUSION: These results indicate that it is vitally important to encourage older drivers to plan for driving retirement as early as possible. Stakeholders involved in the safety of older drivers (including family, clinicians, road authorities, and policy makers) should work together on interventions and policies that empower older drivers to successfully plan for driving retirement in order to improve road safety and quality of life. PRACTICAL APPLICATIONS: Introducing conversations about driving retirement via medical appointments, family, media, and peer-support groups could facilitate planning for driving retirement. Community-based ride-sharing systems and subsidized private transport options are needed to ensure continued mobility of older adults, especially in rural and regional areas that lack alternate transport services. When devising urban and rural planning, transport, license renewal, and medical testing rules, policy makers should consider older drivers' safety, mobility, and quality of life after driving retirement.

Transforming Primary Care: Developing Health Precincts as Models for Sustainable Integrated Community-Based Healthcare.

Holistic healthcare precincts are an emerging service model to address the growing health service demands of ageing consumers and an increasing prevalence of chronic diseases. In Australia and similar countries with universal publicly funded Medicare systems, the first point of access to healthcare is provided by general medical practitioners. This case report focuses on successful components of a private, integrated, patient-centred primary care model located in a low socioeconomic population in North Brisbane, Queensland. Successful components included a focus on sustainability, general practice as an anchor tenant in the health precinct, the integration of multiple services, team-based care for shared clinical services, flexible expansion options, the use of MedTech, support for small businesses and a cluster structure. The Morayfield Health Precinct (MHP) offers appropriate, safe and individualised healthcare to residents across their life continuum. Its success was built on a foundation of pre-planning, to ensure the design/build, anchor tenant and collaborative ecosystem were sustainable in the long term. MHP planning was based on an adaptation of the WHO-IPCC framework supporting true patient-centred, integrated care. Its shared vision and collaborative care are supported by its internal governance structure, tenant selection, established and emerging referral networks and partnerships. Evidence-based and informed care is further supported by internal and external research and education partnerships.

Diagnosis and management of cutaneous melanoma.

BACKGROUND: In the field of melanoma, clinical trials evaluating the impact of sentinel node biopsy, completion lymph node dissection and adjuvant medical therapies on patient outcomes have provided evidence that has changed practice significantly over the past five years. OBJECTIVE: The aim of this article is to discuss key evidence that has informed new Cancer Council Australia melanoma management guidelines. DISCUSSION: General practitioners play a critical role in melanoma diagnosis and follow-up. Complete excisional biopsy to achieve accurate tumour microstaging is essential for obtaining reliable prognostic information, planning further management and accessing adjuvant medical therapies. The management of patients with Stage III disease has changed dramatically over the past few years. Less surgery is now recommended, and patients may be offered potentially life-prolonging systemic therapies. Multidisciplinary discussion of management is recommended. Rapid advances in therapeutic options for patients with advanced melanoma have placed new emphasis on the importance of accurate staging and early management. Accordingly, the Australian national melanoma management guidelines have recently been updated. These evidence-based guidelines are now readily available on Cancer Council Australia's electronic Wiki platform, which facilitates regular further updating.

Onsite investigation at a mail-order hatchery following a multistate Salmonella illness outbreak linked to live poultry-United States, 2018.

Centers for Disease Control and Prevention (CDC), health departments, and other state and federal partners have linked contact with live poultry to 70 human Salmonella outbreaks in the United States from 2000 to 2017, which resulted in a total of 4,794 illnesses, 894 hospitalizations, and 7 deaths. During human salmonellosis outbreaks environmental sampling is rarely conducted as part of the outbreak investigation. CDC was contacted by state health officials on June 12, 2018, to provide support during an investigation of risk factors for Salmonella infections linked to live poultry originating at a mail-order hatchery. From January 1, 2018, to June 15, 2018, 13 human Salmonella infections in multiple states were attributed to exposure to live poultry from a single hatchery. Two serotypes of Salmonella were associated with these infections, Salmonella Enteritidis and Salmonella Litchfield. Molecular subtyping of the S. Enteritidis clinical isolates revealed they were closely related genetically (within 0 to 9 alleles) by core genome multi-locus sequence typing (cgMLST) to isolates obtained from environmental samples taken from hatchery shipping containers received at retail outlets. Environmental sampling and onsite investigation of practices was conducted at the mail-order hatchery during an investigation on June 19, 2018. A total of 45 environmental samples were collected, and 4 (9%) grew Salmonella. A chick box liner from a box in the pre-shipping area yielded an isolate closely related to the S. Enteritidis outbreak strain (within 1 to 9 alleles by cgMLST). The onsite investigation revealed lapses in biosecurity, sanitation, quality assurance, and education of consumers. Review of Salmonella serotype testing performed by the hatchery revealed that the number of samples and type of samples collected monthly varied. Also, S. Enteritidis was identified at the hatchery every year since testing began in 2016. Recommendations to the hatchery for biosecurity, testing, and sanitation measures were made to help reduce burden of Salmonella in the hatchery and breeding flocks, thereby reducing the occurrence of human illness.

Lessons from the reestablishment of Public Health Laboratory activities in Puerto Rico after Hurricane Maria.

Public Health Laboratories (PHLs) in Puerto Rico did not escape the devastation caused by Hurricane Maria. We implemented a quality management system (QMS) approach to systematically reestablish laboratory testing, after evaluating structural and functional damage. PHLs were inoperable immediately after the storm. Our QMS-based approach began in October 2017, ended in May 2018, and resulted in the reestablishment of 92% of baseline laboratory testing capacity. Here, we share lessons learned from the historic recovery of the largest United States' jurisdiction to lose its PHL capacity, and provide broadly applicable tools for other jurisdictions to enhance preparedness for public health emergencies.

Antimycobacterial activity of veterinary antibiotics (Apramycin and Framycetin) against Mycobacterium abscessus: Implication for patients with cystic fibrosis.

Background: Antimicrobial resistance has rendered certain species of Mycobacterium difficult to treat clinically, particularly the nontuberculous Mycobacterium and Mycobacterium abscessus. While veterinary medicine and human medicine share many classes of antibiotics, there are several antibiotics which are uniquely licensed to veterinary medicine but not human medicine. It was, therefore, the aim of this study to examine the action of eight veterinary antibiotics to a population of multi- and pan-resistant M. abscessus, isolated from the sputum of patients with cystic fibrosis (CF). Methods: Antibiotic susceptibility studies were performed on human clinical isolates of M. abscessus (n = 16), including 11 smooth isolates, 4 rough isolates, and 1 reference isolate (NCTC 13031), against the following 7 veterinary antibiotics (antibiotic class): apramycin (aminoglycoside), cefovecin (cephalosporin), ceftiofur (cephalosporin), framycetin (aminoglycoside), lincomycin (lincosamide), pirlimycin (lincosamide), and spectinomycin (aminocyclitol). Results: M. abscessus isolates were sensitive (100%) to apramycin and framycetin but resistant (100%) to cefovecin, ceftiofur, lincomycin, pirlimycin, and spectinomycin. Conclusion: This study identified that the veterinary aminoglycosides, apramycin, and framycetin, have in vitro activity against multi-resistant clinical isolates of M. abscessus. Further studies should now compare the activity of these antibiotics against amikacin and the human aminoglycoside, advocated in the treatment of disease in CF patients, to determine if these novel antibiotics have a future role for the development in human medicine with such chronic disease patients.

Initial Public Health Laboratory Response After Hurricane Maria - Puerto Rico, 2017.

Hurricane Maria made landfall in Puerto Rico on September 20, 2017, causing major damage to infrastructure and severely limiting access to potable water, electric power, transportation, and communications. Public services that were affected included operations of the Puerto Rico Department of Health (PRDOH), which provides critical laboratory testing and surveillance for diseases and other health hazards. PRDOH requested assistance from CDC for the restoration of laboratory infrastructure, surveillance capacity, and diagnostic testing for selected priority diseases, including influenza, rabies, leptospirosis, salmonellosis, and tuberculosis. PRDOH, CDC, and the Association of Public Health Laboratories (APHL) collaborated to conduct rapid needs assessments and, with assistance from the CDC Foundation, implement a temporary transport system for shipping samples from Puerto Rico to the continental United States for surveillance and diagnostic and confirmatory testing. This report describes the initial laboratory emergency response and engagement efforts among federal, state, and nongovernmental partners to reestablish public health laboratory services severely affected by Hurricane Maria. The implementation of a sample transport system allowed Puerto Rico to reinitiate priority infectious disease surveillance and laboratory testing for patient and public health interventions, while awaiting the rebuilding and reinstatement of PRDOH laboratory services.

Engaging rural Australian communities in National Science Week helps increase visibility for women researchers.

During a week-long celebration of science, run under the federally supported National Science Week umbrella, the Catch a Rising Star: women in Queensland research (CaRS) programme flew scientists who identify as women to nine regional and remote communities in the Australian State of Queensland. The aim of the project was twofold: first, to bring science to remote and regional communities in a large, economically diverse state; and second, to determine whether media and public engagement provides career advancement opportunities for women scientists. This paper focuses on the latter goal. The data show: (i) a substantial majority (greater than 80%) of researchers thought the training and experience provided by the programme would help develop her career as a research scientist in the future, (ii) the majority (65%) thought the programme would help relate her research to end users, industry partners or stakeholders in the future, and (iii) analytics can help create a compelling narrative around engagement metrics and help to quantify influence. During the week-long project, scientists reached 600 000 impressions on one social media platform (Twitter) using a program hashtag. The breadth and depth of the project outcomes indicate funding bodies and employers could use similar data as an informative source of metrics to support hiring and promotion decisions. Although this project focused on researchers who identify as women, the lessons learned are applicable to researchers representing a diverse range of backgrounds. Future surveys will help determine whether the CaRS programme provided long-term career advantages to participating scientists and communities.

Coat Protein Mutations That Alter the Flux of Morphogenetic Intermediates through the ϕX174 Early Assembly Pathway.

Two scaffolding proteins orchestrate ϕX174 morphogenesis. The internal scaffolding protein B mediates the formation of pentameric assembly intermediates, whereas the external scaffolding protein D organizes 12 of these intermediates into procapsids. Aromatic amino acid side chains mediate most coat-internal scaffolding protein interactions. One residue in the internal scaffolding protein and three in the coat protein constitute the core of the B protein binding cleft. The three coat gene codons were randomized separately to ascertain the chemical requirements of the encoded amino acids and the morphogenetic consequences of mutation. The resulting mutants exhibited a wide range of recessive phenotypes, which could generally be explained within a structural context. Mutants with phenylalanine, tyrosine, and methionine substitutions were phenotypically indistinguishable from the wild type. However, tryptophan substitutions were detrimental at two sites. Charged residues were poorly tolerated, conferring extreme temperature-sensitive and lethal phenotypes. Eighteen lethal and conditional lethal mutants were genetically and biochemically characterized. The primary defect associated with the missense substitutions ranged from inefficient internal scaffolding protein B binding to faulty procapsid elongation reactions mediated by external scaffolding protein D. Elevating B protein concentrations above wild-type levels via exogenous, cloned-gene expression compensated for inefficient B protein binding, as did suppressing mutations within gene B. Similarly, elevating D protein concentrations above wild-type levels or compensatory mutations within gene D suppressed faulty elongation. Some of the parental mutations were pleiotropic, affecting multiple morphogenetic reactions. This progressively reduced the flux of intermediates through the pathway. Accordingly, multiple mechanisms, which may be unrelated, could restore viability.IMPORTANCE Genetic analyses have been instrumental in deciphering the temporal events of many biochemical pathways. However, pleiotropic effects can complicate analyses. Vis-à-vis virion morphogenesis, an improper protein-protein interaction within an early assembly intermediate can influence the efficiency of all subsequent reactions. Consequently, the flux of assembly intermediates cumulatively decreases as the pathway progresses. During morphogenesis, ϕX174 coat protein participates in at least four well-defined reactions, each one characterized by an interaction with a scaffolding or structural protein. In this study, genetic analyses, biochemical characterizations, and physiological assays, i.e., elevating the protein levels with which the coat protein interacts, were used to elucidate pleiotropic effects that may alter the flux of intermediates through a morphogenetic pathway.

A Transdisciplinary Approach to Managing Emerging and Resurging Mosquito-Borne Diseases in the Western Pacific Region.

Mosquitoes transmit a number of harmful diseases that have an impact on local communities and visitors, and many pose a threat to neighboring countries. As federal monitoring budgets shrink across the world, the increasing importance of citizen scientists in monitoring and identifying invasive species, as well as acting to prevent these diseases, are discussed. Examples of past mosquito management programs are provided, and future directions are discussed with an emphasis on the Western Pacific Region.

Examining uptake of online education on obstructive sleep apnoea in general practitioners: a randomised trial.

BACKGROUND: Obstructive sleep apnoea (OSA) affects up to 28 % of the adult population in Western countries. The detection and management of OSA by general practitioners (GPs) can be poor. The study aimed to examine what influence enhanced invitations had on uptake of on-line learning modules for OSA by GPs, and whether recent referrals of patients to sleep specialists influenced uptake. METHODS: Practicing GPs in regional Australia were identified and randomised to receive either an enhanced or standard invitation letter to a new on-line education module for OSA. The enhanced letter included indication that the module was eligible for professional accreditation and described the prevalence and burden of sleep disorders. Some included extra emphasis if the GP had recently referred a patient for diagnostic investigation of OSA. Two reminder letters were sent. RESULTS: Of 796 eligible GPs who received the letters, sixteen (2 %) accessed the website and four completed the modules over the four-month study period. GPs who received an enhanced invitation letter were not significantly more likely to access the website compared to GPs who received the standard invitation letter. Recent referral of a patient for diagnostic investigation was also not a significant factor in influencing use of the module. CONCLUSION: GP interest in on-line education about OSA appears low, and emphasis of relevant recent past patient(s) and the opportunity for professional education points was not successful in increasing engagement. There is a need to identify effective approaches to improving the detection and management of OSA in general practice.

Venomous and poisonous Australian animals of veterinary importance: a rich source of novel therapeutics.

Envenomation and poisoning by terrestrial animals (both vertebrate and invertebrate) are a significant economic problem and health risk for domestic animals in Australia. Australian snakes are some of the most venomous animals in the world and bees, wasps, ants, paralysis ticks, and cane toads are also present as part of the venomous and poisonous fauna. The diagnosis and treatment of envenomation or poisoning in animals is a challenge and can be a traumatic and expensive process for owners. Despite the potency of Australian venoms, there is potential for novel veterinary therapeutics to be modeled on venom toxins, as has been the case with human pharmaceuticals. A comprehensive overview of envenomation and poisoning signs in livestock and companion animals is provided and related to the potential for venom toxins to act as therapeutics.

Site-specific Labeling of a Protein Lysine Residue By Novel Kinetic Labeling Combinatorial Libraries.

The first example of a kinetic labeling library designed to enable the discovery of affinity labels is presented. Each library component (1) consists of a variable peptidyl component linked to a biotinyl moiety by a 4-mercaptobenzoyl linker in thioester format. We demonstrate that an affinity label can be uncovered by measuring reaction rates between library pools and the protein target, human serum albumin (HSA) and identifying significant outliers. By choosing peptide functionality compatible with a potentially reactive thioester labeling entity, libraries can be screened in pools. It is noteworthy that a limited subset of amino acids (R, S, E, F, Y, l, M, W, and Q) that compose the affinity moiety is sufficient to produce rate variances that guide the discovery process. After two rounds of deconvolution, J-FLYEE-NH2 (7-E) emerges as a bona fide affinity label of HSA. Unlike known affinity labels, the affinity moiety is not retained in the protein product, but is extruded upon acylation of the protein. This feature affords a method of introducing various payloads, without extraneous elements, onto protein frameworks.

Resistance is not Futile: It Shapes Insecticide Discovery.

Conventional chemical control compounds used for the management of insect pests have been much maligned, but still serve a critical role in protecting people and agricultural products from insect pests, as well as conserving biodiversity by eradicating invasive species. Although biological control can be an effective option for area-wide management of established pests, chemical control methods are important for use in integrated pest management (IPM) programs, as well as in export treatments, eradicating recently arrived invasive species, and minimizing population explosions of vectors of human disease. Cogitated research and development programs have continued the innovation of insecticides, with a particular focus on combating insecticide resistance. Recent developments in the fields of human health, protecting the global food supply, and biosecurity will be highlighted.