It takes two (seconds): decreasing encoding time for two-choice functional near-infrared spectroscopy brain-computer interface communication.

Significance: Brain-computer interfaces (BCIs) can provide severely motor-impaired patients with a motor-independent communication channel. Functional near-infrared spectroscopy (fNIRS) constitutes a promising BCI-input modality given its high mobility, safety, user comfort, cost-efficiency, and relatively low motion sensitivity. Aim: The present study aimed at developing an efficient and convenient two-choice fNIRS communication BCI by implementing a relatively short encoding time (2 s), considerably increasing communication speed, and decreasing the cognitive load of BCI users. Approach: To encode binary answers to 10 biographical questions, 10 healthy adults repeatedly performed a combined motor-speech imagery task within 2 different time windows guided by auditory instructions. Each answer-encoding run consisted of 10 trials. Answers were decoded during the ongoing experiment from the time course of the individually identified most-informative fNIRS channel-by-chromophore combination. Results: The answers of participants were decoded online with an accuracy of 85.8% (run-based group mean). Post-hoc analysis yielded an average single-trial accuracy of 68.1%. Analysis of the effect of number of trial repetitions showed that the best information-transfer rate could be obtained by combining four encoding trials. Conclusions: The study demonstrates that an encoding time as short as 2 s can enable immediate, efficient, and convenient fNIRS-BCI communication.

Travel-associated lineages and unique endemic antimicrobial-susceptible lineages of Neisseria gonorrhoeae predominate in Western Australia.

In Australia, gonococcal isolates are monitored for antimicrobial susceptibilities. In Western Australia (WA), gonorrhoea notification rates increased by 63 % between 2013 and 2016, with the steepest increase occurring between 2015 and 2016, before stabilizing at this higher baseline between 2017 and 2020. This increased prevalence was associated with antimicrobial-susceptible (AMS) lineages. To understand the provenance of these isolates causing gonorrhoea in WA, whether they were introduced or expanded from endogenous lineages, 741 isolates were collected in 2017 and characterized by both iPLEX typing and whole genome sequencing (WGS). Antibiograms and genocoding of the isolates revealed that AMS isolates were most prevalent in the remote regions, while the urban/rural regions were characterized by antimicrobial-resistant (AMR) isolates. iPLEX typing identified 78 iPLEX genotypes (WA-1 to WA-78) of which 20 accounted for over 88 % of isolates. WA-10 was the most frequently identified genotype in the urban/rural regions whilst WA-29 was the most frequently identified genotype in the remote regions. Genotypes WA-38, WA-52 and WA-13 accounted for 81 % (n=36/44) of the azithromycin-resistant N. gonorrhoeae (AziR) isolates. A representative isolate of each iPLEX genotype and AMR biotype was whole genome sequenced and analysed using MLST, NG-MAST and NG-STAR, and the novel core genome clustering Ng_cgc_400 typing scheme. Five predominant Bayesian population groups (termed BPG-1 to 5) were identified in the study collection. BPG-1 and BPG-2 were associated with AMS isolates from the remote regions. BPG-1 and BPG-2 were shown to be unique to the remote regions based on a minimum spanning tree against 4000 international isolates. AMS isolates in urban/rural regions were dominated by international lineages. AziR and Cef DS (decreased susceptibility to ceftriaxone) was concentrated in three urban/rural genomic groups (BPG-3, 4 and 5). Azithromycin minimum inhibitory concentrations (0.5-16 mg l-1) correlated with the accumulation of mtrR mutations or/and the fraction of 23S rRNA C2611T mutated copies. The majority of isolates in BPG-3, 4 and 5 could be correlated with known AMR lineages circulating globally and nationally. In conclusion, the surge in AMS isolates in WA in 2017 was due to importation of international AMS lineages into urban/rural regions, whilst the local AMS lineages persisted largely in the remote regions. Bridging between the urban/rural and remote regions was relatively rare, but continued surveillance is required to prevent ingress of AMR strains/lineages into the remote regions of WA.

Spindle-slow oscillation coupling correlates with memory performance and connectivity changes in a hippocampal network after sleep.

After experiences are encoded, post-encoding reactivations during sleep have been proposed to mediate long-term memory consolidation. Spindle-slow oscillation coupling during NREM sleep is a candidate mechanism through which a hippocampal-cortical dialogue may strengthen a newly formed memory engram. Here, we investigated the role of fast spindle- and slow spindle-slow oscillation coupling in the consolidation of spatial memory in humans with a virtual watermaze task involving allocentric and egocentric learning strategies. Furthermore, we analyzed how resting-state functional connectivity evolved across learning, consolidation, and retrieval of this task using a data-driven approach. Our results show task-related connectivity changes in the executive control network, the default mode network, and the hippocampal network at post-task rest. The hippocampal network could further be divided into two subnetworks of which only one showed modulation by sleep. Decreased functional connectivity in this subnetwork was associated with higher spindle-slow oscillation coupling power, which was also related to better memory performance at test. Overall, this study contributes to a more holistic understanding of the functional resting-state networks and the mechanisms during sleep associated to spatial memory consolidation.

A research and evaluation capacity building model in Western Australia.

Evaluation of public health programs, services and policies is increasingly required to demonstrate effectiveness. Funding constraints necessitate that existing programs, services and policies be evaluated and their findings disseminated. Evidence-informed practice and policy is also desirable to maximise investments in public health. Partnerships between public health researchers, service providers and policymakers can help address evaluation knowledge and skills gaps. The Western Australian Sexual Health and Blood-borne Virus Applied Research and Evaluation Network (SiREN) aims to build research and evaluation capacity in the sexual health and blood-borne virus sector in Western Australia (WA). Partners' perspectives of the SiREN model after 2 years were explored. Qualitative written responses from service providers, policymakers and researchers about the SiREN model were analysed thematically. Service providers reported that participation in SiREN prompted them to consider evaluation earlier in the planning process and increased their appreciation of the value of evaluation. Policymakers noted benefits of the model in generating local evidence and highlighting local issues of importance for consideration at a national level. Researchers identified challenges communicating the services available through SiREN and the time investment needed to develop effective collaborative partnerships. Stronger engagement between public health researchers, service providers and policymakers through collaborative partnerships has the potential to improve evidence generation and evidence translation. These outcomes require long-term funding and commitment from all partners to develop and maintain partnerships. Ongoing monitoring and evaluation can ensure the partnership remains responsive to the needs of key stakeholders. The findings are applicable to many sectors.

Funding antiretroviral treatment for HIV-positive temporary residents in Australia prevents transmission and is inexpensive.

Background The aim of this study is to estimate the reduction in new HIV infections and resultant cost outcomes of providing antiretroviral treatment (ART) through Australia's 'universal access' health scheme to all temporary residents with HIV infection living legally in Australia, but currently deemed ineligible to access subsidised ART via this scheme. METHODS: A mathematical model to estimate the number of new HIV infections averted and the associated lifetime costs over 5 years if all HIV-positive temporary residents in Australia had access to ART and subsidised medical care was developed. Input data came from a cohort of 180 HIV-positive temporary residents living in Australia who are receiving free ART donated by pharmaceutical companies for up to 4 years. RESULTS: Expanding ART access to an estimated total 450 HIV+ temporary residents in Australia for 5 years could avert 80 new infections. The model estimated the total median discounted (5%) cost for ART and associated care to be A$36million, while the total savings in lifetime-discounted costs for the new infections averted was A$22million. CONCLUSIONS: It is estimated that expanded access to ART for all HIV-positive temporary residents in Australia will substantially reduce HIV transmission to their sexual partners at little additional cost. In the context of Australia's National HIV strategy and Australia's endorsement of global goals to provide universal access to ART for all people with HIV, this is an important measure to remove inequities in the provision of HIV-related treatment and care.

Early diagnosis of HIV among men who have sex with men in Western Australia: impact of a peer-led sexually transmissible infection testing service.

UNLABELLED: Background In July 2010, the Western Australian AIDS Council established the 'M Clinic', a peer-led STI testing service for MSM. This study describes trends in HIV notifications among MSM in WA from 2004 to 2013, particularly the impact of the M Clinic on newly acquired HIV diagnoses. METHODS: The number and proportion of MSM HIV cases with newly acquired infection were compared for the 2004-2006, 2007-2009 and 2011-2013 time periods. Data from 2010 were excluded as the M Clinic opened in July 2010. RESULTS: Between the 2004-2006 and 2007-2009 periods, the number of MSM with newly acquired HIV increased by 50% (23 to 33 cases) and the number of newly acquired cases as a proportion of all new HIV diagnoses among MSM increased from 27% to 35% (30% increase) (P=0.25). In the 2011-2013 period, the number of newly acquired HIV cases among MSM more than doubled to 70 cases and comprised 53% of all new HIV diagnoses among MSM (P<0.05). Of the 70 newly acquired HIV cases in the 2011-2013 period, 30% (n=21) were diagnosed at the M Clinic. CONCLUSIONS: The proportion of MSM HIV notifications that were newly acquired increased between 2004 and 2013 in WA, with the greatest increase seen after the M Clinic commenced operation. A peer-led approach to HIV testing should be considered in order to achieve early diagnosis and treatment of HIV among MSM.

Subsidized optimal ART for HIV-positive temporary residents of Australia improves virological outcomes: results from the Australian HIV Observational Database Temporary Residents Access Study.

INTRODUCTION: HIV-positive (HIV+) temporary residents living in Australia legally are unable to access government subsidized antiretroviral treatment (ART) which is provided via Medicare to Australian citizens and permanent residents. Currently, there is no information systematically being collected on non-Medicare eligible HIV+ patients in Australia. The objectives of this study are to describe the population recruited to the Australian HIV Observational Database (AHOD) Temporary Residents Access Study (ATRAS) and to determine the short- and long-term outcomes of receiving (subsidized) optimal ART and the impact on onwards HIV transmission. METHODS: ATRAS was established in 2011. Eligible patients were recruited via the AHOD network. Key HIV-related characteristics were recorded at baseline and prospectively. Additional visa-related information was also recorded at baseline, and updated annually. Descriptive statistics were used to describe the ATRAS cohort in terms of visa status by key demographic characteristics, including sex, region of birth, and HIV disease status. CD4 cell count (mean and SD) and the proportion with undetectable (<50 copies/ml) HIV viral load are reported at baseline, 6 and 12 months of follow-up. We also estimate the proportion reduction of onward HIV transmission based on the reduction in proportion of people with detectable HIV viral load. RESULTS: A total of 180 patients were recruited to ATRAS by June 2012, and by July 2013 39 patients no longer required ART via ATRAS, 35 of whom became eligible for Medicare-funded medication. At enrolment, 63% of ATRAS patients were receiving ART from alternative sources, 47% had an undetectable HIV viral load (<50 copies/ml) and the median CD4 cell count was 343 cells/µl (IQR: 222-479). At 12 months of follow-up, 85% had an undetectable viral load. We estimated a 75% reduction in the risk of onward HIV transmission with the improved rate of undetectable viral load. CONCLUSIONS: The immunological and virological improvements highlight the importance of supplying optimal ART to this vulnerable population. The increase in proportion with undetectable HIV viral load shows the potentially significant impact on HIV transmission in addition to the personal health benefit for each individual.

Online chlamydia testing: an innovative approach that appeals to young people.

OBJECTIVE: To evaluate data from an online chlamydia testing program (OLC) developed to increase young people's access to testing for chlamydia, the most commonly notified disease in Australia and Western Australia, with a high proportion of notifications among young people (< 30 years). DESIGN AND SETTING: The OLC was launched in February 2010, and our study covers the period February 2010 to June 2011. Without needing to first visit a doctor, OLC participants receive risk self-assessment, education, testing, and, if necessary, referral for treatment, and can complete an online satisfaction survey. MAIN OUTCOME MEASURES: Number and proportion of downloaded pathology forms that resulted in a test; demographic characteristics of participants; prevalence of chlamydia; completeness and timeliness of follow-up of positive test results; and participant satisfaction. RESULTS: More than half (56%) of the 675 OLC pathology form downloads resulted in a test, and chlamydia was detected in 18% (66/377). Of those tested, over half were men (55%), and 71% were aged < 30 years. All participants with a positive test result received appropriate clinical management, with 50% being treated within 7 days of specimen collection. Of the 17% (55/332) who completed an online satisfaction survey, almost all said they would recommend the service to a friend. CONCLUSION: Internet-based screening for chlamydia is an effective means of increasing access to testing for young people at risk of sexually transmitted infections and is a valuable addition to opportunistic, clinic-based strategies.

Evaluation of a sexual health and blood-borne virus health education website for youth.

ISSUE ADDRESSED: The 'Get the Facts' website, aimed at Western Australian (WA) youth aged 14 -17 years, provides information about sexual health, blood-borne viruses and sexual relationships, and how to access appropriate health services. It was developed as one component of a comprehensive sexually transmitted infection (STI) prevention and control program implemented within Western Australia. METHODS: An evaluation was undertaken to assess how the website might be improved and be more effectively marketed to its target audience. Website usage data, on-line survey responses and qualitative data from focus group testing of the website were collected and analysed. RESULTS: Website visitors were from 194 countries, with the majority being Australian (65%) and 27% of Australian visitors being from WA. Website usage patterns indicated that the site was of greater relevance to WA than other visitors. An estimated 5% of 14-17 year old WA residents had visited the site in 2010. Online survey and focus group data indicated that the website provides sexual health and bloodborne virus information that is relevant to young people and in a format that they find acceptable and accessible. CONCLUSIONS: The 'Get the Facts' website appeals to its target audience and provides them with relevant information. The challenge is to improve its promotion so it reaches its full potential WA youth audience.

Attitudes of WA GPs to chlamydia partner notification - A survey.

BACKGROUND: Partner notification is essential to interrupt transmission of sexually transmissible infections. We surveyed the attitudes to partner notification of general practitioners seeing 1-5 cases of chlamydia annually. METHODS: We collected data on chlamydia notifications received in Western Australia from 1 July 2007 to 30 June 2008. Treating GPs were identified and 200 were randomly selected. RESULTS: One hundred and five (53%) GPs responded. They believed automatic partner notification by the Department of Health occurred following notification (45%) or by ticking the box on the notification form (88%). Ninety-seven percent of GPs encouraged partner notification; 55% ensured it occurred. Printable resources were favoured by 90%, but use of web based resources was low. Practice nurses were seldom involved in partner notification. DISCUSSION: Although GPs believed that partner notification was important, follow up was infrequent. They believed (erroneously) that the Department of Health would routinely undertake partner notification. Printable resources for partner notification would be welcomed.

Conversant or clueless? Chlamydia-related knowledge and practice of general practitioners in Western Australia.

BACKGROUND: A survey of Western Australia's general practitioners' (GPs') knowledge and practices relating to genital chlamydia infection was conducted in mid-2005, prior to a multi-media campaign which encouraged 15-24 year olds to seek chlamydia testing through their general practitioner (GP). The survey aimed to raise GPs' awareness of chlamydia in preparation for the campaign and to establish a baseline measure of their chlamydia-related knowledge and practices. METHODS: All 2038 GPs registered on the Australian Medical Publishing Company's database as practising in Western Australia were sent a survey which covered clinical features of chlamydia, investigations, treatment and public health issues; 576 (29%) responded. RESULTS: Most GPs were aware of chlamydia being common in the 20-24 year old age group, but less than half were aware that it is common in 15-19 year olds. GPs missed many opportunities for chlamydia testing in patients likely to be at risk of STIs, largely because they thought the patient would be embarrassed. It is of concern that public health responsibilities in relation to chlamydia, ie notification and contact tracing, were not undertaken by all GPs. CONCLUSION: Australia is currently piloting chlamydia screening. For this to be successful, GPs will need to maintain current knowledge and clinical suspicion about chlamydia, and be comfortable in asking and receiving information about sexual behaviours. Only then will GPs have a significant impact on curbing Australia's ever-increasing rates of chlamydia.