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.

Australia has the world's highest skin cancer rates. The keratinocyte cancers (basal cell carcinoma [BCC] and squamous cell carcinoma [SCC]) are the most common and costly, yet unlike melanoma, they are not nationally registered, and the lack of registry data hinders control efforts. The Tasmanian cancer registry collects data on BCC and SCC incidence, revealing concerning trends and high-risk groups. International examples show how registry data inform policy and prevention. Comprehensive registration would enable similar benefits for Australia. We propose a phased approach, starting with high-risk lesions, alongside standardised pathology reporting and the potential use of artificial intelligence, and recommend an evaluation of the cost of this integrated strategy.

PS5 Standard for Pharmacy Based Immunisation Programs

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