The long-term survival of children discharged from PICUs and factors associated with mortality following discharge have not been systematically studied. The objective was to describe the long-term survival of children discharged alive from Australian PICUs and identify factors associated with death after discharge.A cohort data linkage study.The Australian and New Zealand Paediatric Intensive Care Registry linked with the Australian National Death Index.Children discharged from PICUs in Australia between 1997 and 2018.None.Exposures included the time period of admission, demographic, social, and admission factors. A multivariable Cox proportional hazards model and Kaplan-Meier survival curves were used to investigate exposures associated with mortality. The records of 96,743 children were available for analysis. The risk of death reduced over time: compared with children admitted from 1997 to 2002, the hazard ratios for death after discharge for children admitted from 2003-2008, 2009-2013, to 2014-2018 were 0.92 (95% CI, 0.85-0.99), 0.69 (0.64-0.745), and 0.60 (0.55-0.65). The risk of death associated with low-risk underlying conditions, such as asthma, was 70% lower than the reference (standard risk) group, while there was a seven-fold increase in the risk of death with very-high-risk underlying conditions, such as malignancy. Residing in outer regional and very remote areas was associated with higher risk of death.The survival of children discharged from Australian PICUs has improved over time; the risk of death reduced by 40% over the study period. The underlying disease, age, and residing in locations with reduced access to healthcare were associated with reduced probability of survival after discharge.

Emergency and critical care services are essential to universal health coverage. World Health Assembly (WHA) Resolution 76.2, adopted in 2023, outlined the importance of integrated emergency, critical and operative care systems in strengthening primary healthcare capabilities. Recent research has determined that system strengthening and partnership-based approaches to healthcare capacity development have the potential to achieve greater equity and sustainability. The Regional Emergency and Critical Care Systems Strengthening Initiative (RECSI) is an Australian Government funded programme under the Partnerships for a Healthy Region (PHR) initiative. It aims to enhance acute care capacity and healthcare system resilience across the Pacific and Timor Leste. RECSI is led by a consortium of acute care organisations and provides a vehicle for progressing WHA 76.2. The programme focuses on four thematic areas: workforce capacity and training, systems and processes, data and research, and leadership and governance. As part of RECSI's inception, a structured programme logic was developed, which describes programme activities and outputs, and how they contribute to defined intermediate and end-of-programme outcomes. RECSI's monitoring, evaluation and learning (MEL) plan, which supplements the programme logic, incorporates sustainability indicators that are focused on monitoring the impact of mechanisms designed to enable ongoing benefits from programme outcomes. Utilising a partner-led and context-specific programme design, RECSI represents a rigorous approach to acute care system strengthening. This strategy aims to build genuine partnerships to leverage skills, knowledge and opportunity across the Pacific and Timor-Leste.

Genomic diversity in pathogen populations is foundational for evolution and adaptation. Understanding population-level diversity is also essential for tracking sources and revealing detailed pathways of transmission and spread. For bacteria, culturing, isolating, and sequencing the large number of individual colonies required to adequately sample diversity can be prohibitively time-consuming and expensive. While sequencing directly from a mixed population will show variants among reads, they cannot be linked to reveal allele combinations associated with phylogenetic inheritance patterns. Here, we describe the theory and method for using population sequencing directly from a mixed sample, along with a minimal number of individually sequenced colonies, to describe the phylogenetic diversity of a population without haplotype reconstruction. To demonstrate the utility of population sequencing in capturing phylogenetic diversity, we compared isogenic clones to population sequences of from sputum of a single patient. Our results point to the pathogen population being highly structured, suggesting that for some pathogens, sputum sampling may preserve structuring in the lungs and thus present a noninvasive alternative to understanding colonization, movement, and pathogen/host interactions. We also analyzed population sequences of derived from different people and different body sites to reveal directionality of transmission between hosts and across body sites, demonstrating the power and utility for characterizing the spread of disease and identification of reservoirs at the finest levels. We anticipate that population sequencing and analysis can be broadly applied to accelerate research in a wide range of fields reliant on a foundational understanding of population phylogenetic diversity.

There is a lack of a comprehensive bronchiectasis severity assessment tool specific for Indigenous people that corrects for normative references established for the non-Indigenous population.An innovative bronchiectasis assessment tool is developed for use in adult Indigenous patients - the Indigenous bronchiectasis assessment scale '(IBAS)'.A total of 454 adult Indigenous Australian patients, with chest CT confirmed bronchiectasis diagnosed between 2011 and 2020, were included. Age, sex, residence location, body mass index, radiological findings, sputum microbiology, lung function parameters and medical comorbidities were utilised to predict 5-year all-cause mortality and 5-year hospitalisations. Scores of parameters with P < 0.20 from univariate Cox regressions were derived.The resultant IBAS included age (<30, 30-50, 50-70 and 70+ years), urban residence, forced vital capacity (% predicted) (>50%, 30%-50% and <30%), right lower lobe involvement, history of Haemophilus spp., Pseudomonas spp., yeast spp. or Moraxella spp., 2-year respiratory condition hospitalisation history (<2, 2 and 3+ admissions), and comorbid chronic obstructive pulmonary disease, asthma and arterial hypertension. The maximum score was 18, with thresholds at 0-4 (mild, n = 78, 34.4%), 5-7 (moderate, n = 111, 48.9%) and ≥ 8 (severe, n = 38, 16.7%). The area under the curve for 5-year mortality was 0.743 (95% confidence interval (CI) 0.683, 0.803). The IBAS score demonstrated significant delineation in mortality between mild and moderate (moderate hazard ratio (HR) 3.45 (95% CI 1.57, 7.58)) and between moderate and severe (severe HR 2.43 (95% CI 1.45, 4.07)).The proposed IBAS tool could be of aid in assessing bronchiectasis severity in Indigenous patients.

PS5 Standard for Pharmacy Based Immunisation Programs

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