The lessons learned from reviewing national risk assessments to modernise the Australian Standard for the post-mortem inspection and disposition judgement of beef, sheep, goat, and pig carcases are discussed. The initial risk profiles identified priorities for quantitative assessments. Broadly, the main difficulty encountered was the paucity of quantified performance for the current inspection. Resolving this involved acquiring gross abnormality data representing regional production/proportional abattoir volumes, the range of gross abnormalities appearing nationally, proportional occurrence at carcase sites, and seasonality to enable the comparison of procedures. The methodologies followed the Codex Alimentarius Commission’s risk assessment guidelines and are fully documented in the associated publications. The evidence and discussion are provided for the associated challenges experienced, including preventing contamination, the use of food chain information to support amendment, inspection as a part of industry Quality Assurance programmes, and opportunities to improve inspector training. The criteria considered by the Competent Authority for the determination of the equivalence of alternative post-mortem inspection techniques included comparisons of public health risk, non-detection rates for gross abnormalities, and microbial contamination resulting from inspection activities, as appropriate. Most of the gross abnormalities detected arose from animal health and welfare conditions affecting wholesomeness and did not present as food safety hazards. The non-detection rates between the current and alternative inspection (observation) were negligible. A quantitative risk assessment for Cysticercus bovis was conducted. Carcases with multiple gross abnormalities predominantly reflected historic infections (prior septicaemia), where trimming achieved wholesomeness unless they were cachexic.

Better knowledge regarding the Listeria monocytogenes dose–response (DR) model is needed to refine the assessment of the risk of foodborne listeriosis. In 2018, the European Food Safety Agency (EFSA) derived a lognormal Poisson DR model for 14 different age–sex sub-groups, marginally to strain virulence. In the present study, new sets of parameters are developed by integrating the EFSA model for these sub-groups together with three classes of strain virulence characteristics (“less virulent”, “virulent”, and “more virulent”). Considering classes of virulence leads to estimated relative risks (RRs) of listeriosis following the ingestion of 1000 bacteria of “less virulent” vs. “more virulent” strains ranging from 21.6 to 24.1, depending on the sub-group. These relatively low RRs when compared with RRs linked to comorbidities described in the literature suggest that the influence of comorbidity on the occurrence of invasive listeriosis for a given exposure is much more important than the influence of the virulence of the strains. The updated model parameters allow better prediction of the risk of invasive listeriosis across a population of interest, provided the necessary data on population demographics and the proportional contribution of strain virulence classes in food products of interest are available. An R package is made available to facilitate the use of these dose–response models.

Tilapia culture is an important source of income and nutrition to many rural families. Since 2000, the production of tilapia increased and reached domestic and global markets. Major farmed species is Nile tilapia (Oreochromis niloticus), in earthen ponds and cage cultures. Intensification contributed to global tilapia disease outbreaks, with bacterial infections causing mortalities and morbidities, threatening sustainable production. At tilapia farms, high nutrient concentrations, water temperature and fish densities enhance bacterial growth including virulent bacterial clones and potential zoonotic bacteria. Global warming favours this. This review respectively provides a comprehensive overview of the most common and emerging bacterial pathogens, diseases, clinical presentations and diagnostics of tilapia, including bacteria and diseases with zoonotic potential. First, common bacterial disease outbreaks, including streptococcosis, motile Aeromonas septicaemia, francisellosis, columnaris disease and vibriosis are described. Then, information on emerging bacterial infections of concern for tilapia, like edwardsiellosis through Edwardsiella ictaluri and E. tarda, as well as Aeromonas schubertii is provided. Reports of infectious bacterial tilapia disease outbreaks from other bacteria, including Lactococcus garvieae, Aerococcus viridans, Pseudomonas spp., Mycobacterium marinum and Chlamydia spp., and others are reviewed. Furthermore, bacteria with zoonotic potential, like Streptococcus agalactiae ST283, S. iniae, Aeromonas sp., E. tarda, Vibrio vulnificus pathovar (pv) piscis and M. marinum are included in the review, to provide the most current overview of the disease risks affecting production and post-harvest stages. Additionally, the status and risks of antimicrobial resistance in bacteria from tilapia and other cultured fish through imprudent use of antibiotics, and its future at a global level are provided.

A one-year survey was undertaken of the microbiological quality of carcases and the derived primal cuts, manufacturing meat and offals at twelve Australian export establishments (six beef, three sheep/lamb and three pork). A total of 27,157 microbiological results for aerobic plate count (APC) and generic Escherichia coli were gathered, 15,155 from beef, 8405 from sheep and 3597 from pig establishments. The mean log10 APCs on beef, sheep and pig carcases were 0.84, 1.60 and 1.30 log10 cfu/cm2, respectively. For primals, the mean log10 APC was higher for beef but was similar for sheep and pork primals, with ‘outside’ cuts having higher counts. For manufacturing meat, the concentration was 2–3 log10 cfu/g, irrespective of species. The prevalence (%) of generic E. coli from beef, sheep and pork was 2.3, 28.4 and 5.4 on carcases; 7.0, 20.6 and 3.2 on primals; and 5.8, 33.6 and 6.1 on manufacturing meat, respectively. The mean log10 APCs of beef, sheep and pork offal were 3.23, 3.18 and 3.37 log10 cfu/g, with tripes and tongues having APCs 1–2 log10 units higher than organ offals. The results reflect improvements in total bacterial loadings compared with previous national baseline surveys.

Pectenotoxins (PTXs) are produced by Dinophysis spp., along with okadaic acid, dinophysistoxin 1, and dinophysistoxin 2. The okadaic acid group toxins cause diarrhetic shellfish poisoning (DSP), so are therefore regulated. New Zealand currently includes pectenotoxins within the DSP regulations. To determine the impact of this decision, shellfish biotoxin data collected between 2009 and 2019 were examined. They showed that 85 samples exceeded the DSP regulatory limit (0.45%) and that excluding pectenotoxins would have reduced this by 10% to 76 samples. The incidence (1.3%) and maximum concentrations of pectenotoxins (0.079 mg/kg) were also found to be low, well below the current European Food Safety Authority (EFSA) safe limit of 0.12 mg/kg. Inclusion within the DSP regulations is scientifically flawed, as pectenotoxins and okadaic acid have a different mechanism of action, meaning that their toxicities are not additive, which is the fundamental principle of grouping toxins. Furthermore, evaluation of the available toxicity data suggests that pectenotoxins have very low oral toxicity, with recent studies showing no oral toxicity in mice dosed with the PTX analogue PTX2 at 5000 µg/kg. No known human illnesses have been reported due to exposure to pectenotoxins in shellfish, a fact which combined with the toxicity data indicates that they pose negligible risk to humans. Regulatory policies should be commensurate with the level of risk, thus deregulation of PTXs ought to be considered, a stance already adopted by some countries.

INTRODUCTION:The antenatal diagnosis of sagittal craniosynostosis can be challenging, but there are several published papers describing a traumatic outcome to both the affected fetus and the mother during delivery of a scaphocephalic child. The antenatal imaging from affected children was collected along with the mother's obstetric history. The aim of this study was to identify antenatal ultrasound features that may assist the diagnosis of sagittal synostosis before birth, to enable appropriate delivery planning and avoid both maternal and fetal trauma during birth.METHODS:Antenatal ultrasound scans in both the second and third trimesters were traced for 36 children with sagittal synostosis. The initially diagnostic CT scans were also sourced. A delivery history was collected from the hospital case notes where available.RESULTS:The affected group showed a statistically significant reduction in cephalic index during the second half of pregnancy compared with the normal population which became slightly more brachycephalic (P = 0.001). Regression analysis showed an average reduction in cephalic index of 0.57 units per month. There was also a much higher rate of malpresentation and surgical deliveries in the affected group than the normal population. There was a relationship between sagittal craniosynostosis and breech presentation and an associated higher rate of surgical deliveries.CONCLUSION:It is possible to detect sagittal synostosis in the third trimester of pregnancy which may assist with delivery planning.

The cephalic index (CI) is used in the evaluation of individuals with craniosynostosis. There is little agreement as to the normal range and stability of the CI during the fetal period, partly due to limited literature. We sought to determine the range, distribution and stability of the fetal CI in the second half of pregnancy. We also aimed to identify any relationship to delivery complications such as obstructed labor and malpresentation.The fetal head circumference, biparietal diameter (BPD) and occipitofrontal diameter (OFD) measurements were obtained from standard ultrasound images. Each of 4304 fetuses had measurements taken at morphology scan performed between 17 and 22 weeks' gestation, and at growth scanning at 28 to 33 weeks' gestation. The cephalic index was calculated using the formula: CI = BPD/OFD × 100. The distribution of the CI at both scans is very close to a normal distribution. The mean CI at 17 to 22 weeks was 75.9 (SD, 3.7); the mean CI at 28 to 33 weeks was 77.8 (SD, 3.5). The mean change in CI was 1.9 (SD, 4.28), which is not statistically significantly different from zero (t = 0.656, P = 0.512, 95% confidence interval). No relationship was found between the CI in normal fetuses and delivery complications. There is a wide variation in the change in CI in the third trimester. A value below the normal range in the third trimester or a progressive reduction in CI during the latter half of pregnancy should provoke detailed scanning of the fetal cranial sutures to check for craniosynostosis.

Humans are the primary host of the tapeworm Taenia saginata, and the tapeworm eggs are passed in human faeces. Viable eggs can be ingested by cattle and form cysts (Taenia saginata cysticercus, more commonly known as Cysticercus bovis) in their muscles. While cysts become non-viable over time, the life cycle is completed if viable cysts are ingested by humans in raw or undercooked beef. In Australia, T. saginata is not endemic in the human population and cattle are generally not grazed on pastures that have been irrigated with sewage. Nevertheless, all cattle are inspected post-mortem for lesions, including incisions of the heart and masseters, despite the lack of sensitivity of inspection when infections are light. A Quantitative Risk Assessment (QRA) model was adapted and updated to quantify the risk of human T. saginata infection from consumption of Australian beef domestically and in key export markets. The model was used to investigate the effect of reducing current post-mortem inspection (PMI) protocols by removing the need to incise the masseters, or by removing all incisions, for low risk cattle. The results of the QRA indicate that the risk of human T. saginata infection from consumption of Australian beef is very low-a median 0.37 (95% Credibility Interval: 0.03-10.5) and 0.27 (0.01-3.8) cases per 1 billion (10(9)) portions consumed in the domestic and top 5 export markets (USA, Japan, Korea, China and Canada), or equivalently 0.56 (0.04-15.8) and 0.97 (0.05-13.4) illness per year, respectively. Moving to reduced PMI, which only includes incisions of the heart, was estimated to result in a negligible increase in risk, equivalent to one additional infection every 12.5 and 33.3 years in the domestic and all export markets, respectively. Further reduction in PMI requirements, i.e. visual only PMI, was estimated to result in a small increase in risk to 0.7 (0.05-19.0) and 1.1 (0.06-16.5) illness per year-a median increase of about one additional case in domestic and export markets each per seven years. The evidence present in this QRA demonstrates that alternative post-mortem inspection procedures for C. bovis achieve equivalent food safety outcomes to the current domestic standard.

Despite well-established guidelines on the age at which mechanical and bioprosthetic aortic valves are to be recommended to patients, it is observed that mechanical prosthesis are being eschewed in favour of bioprostheses. One potential explanation for this effect is the impact of TAVI which has

BACKGROUND:This retrospective, population-based cohort study aims to determine if differences in the regional distribution of procedures or variation in regional mortality contributes to the variable pancreaticoduodenectomy (PD) mortality between Australian states and territories.METHODS:De-identified procedural data from public hospitals between 1 July 2005 and 30 June 2015 from the Australian Institute of Health and Welfare were analysed. The regional distribution of procedures and variation in perioperative mortality rate (POMR) were investigated in New South Wales (NSW), Victoria and Queensland (QLD) using logistic regression analysis.RESULTS:NSW performed the highest proportion of city-based procedures (93.8%) while QLD performed the highest proportion of regional procedures (15.3%). QLD demonstrated the lowest city mortality (1.9%) and lowest POMR overall (2.0%). City, regional and state-wide mortality was highest in NSW (5.0%, 8.4% and 5.3%). No significant difference in POMR was demonstrated between regional and city hospitals in each of the states (P = 0.46) or across all states (P = 0.50).CONCLUSION:This study demonstrates comparable regional PD distribution across Australia. The difference in PD POMR between city and regional areas was not found to be statistically significant. NSW exhibited the highest city, regional and overall PD POMR, potentially warranting further investigation.

Alternative postmortem inspection procedures for the detection of gross abnormalities due to Caseous Lymphadenitis (CLA) of sheep and goats were compared quantitatively against the current Australian Standard (AS4696). Studies on sheep and goats in Australia during 2016 addressed data gaps regarding current prevalence, combinations of multiple lesions within affected carcases and sensitivity of inspection procedures enabling a comparison of alternative with current procedures. Using these contemporary inspection data from 54 915 sheep and 48 577 goats a desktop study estimated the effect of implementing alternative procedures of reduced palpation from eleven carcase sites to the four sites most commonly affected. Under current procedures it was estimated that 86 sheep and 34 goat carcases with CLA lesions are missed per 10,000 carcases. Under alternative procedures it is estimated that an additional 48.4 sheep and 10.5 goat carcases with CLA lesions would be missed per 10 000 carcases. Of these, 38.2 sheep and 5.6 goat per 10 000 carcases would contain CLA only in routinely discarded, non‐edible tissue sites. Hence, only an additional 10.2 sheep and 4.9 goat carcases per 10 000 inspected, with CLA in edible tissue sites are estimated to be missed. These alternative procedures have now been officially implemented in the Australian domestic standard.

IntroductionIsolated sagittal craniosynostosis is the most common premature sutural fusion, but is rarely diagnosed antenatally. There are now a number of reports in the literature describing delivery issues in infants later diagnosed with sagittal synostosis(1-6). The aim of this study was to investigate whether delivery issues are more common in children diagnosed with sagittal synostosis, and identify markers at antenatal ultrasound that could help diagnose the condition before birth.MethodsThe antenatal ultrasound images of children born in South Australia and the Northern Territory after 1/1/2000 who have diagnosed with isolated sagittal synostosis were compared with antenatal imaging from normal infants without any craniofacial defects. The delivery details from the affected children were also compared to the population delivery data over an extended time period.ResultsThere was a statistically significantly higher rate of malpresentation and surgical delivery in the sagittal synostosis population. There no significant difference in the cephalic index between the 2 groups at mid trimester morphology scanning. The ultrasound scans showed progressive scaphocephaly during the second half of pregnancy in the affected children while the control population showed minimal change in head shape with a slight tendency towards brachycephaly.Conclusions1. Isolated sagittal synostosis typically begins in the second half of pregnancy, and is not detectable antenatally at the mid trimester morphology scan.2. It is possible to diagnose sagittal synostosis in the third trimester by noting a progressive decrease in the fetal cephalic index, which should provoke 3D ultrasound scanning of the fetal skull to examine the sagittal suture.3. There is a clear relationship between the presence of sagittal craniosynostosis and breech presentation at delivery in affected fetuses, with a marked increase in the rate surgical deliveries in this group of infants.

Aim: The choice of bioprosthetic or mechanical prosthetic heart valves depends on the competing risks of anticoagulation for mechanical valves and structural valve deterioration for bioprostheses. Therefore, patient age at implant is a large determinant of the valve selected. Recent published recommendations for the selection of heart valves are ambiguous in patients aged between 60 and 65 years for aortic valves, and between 65 and 70 years for mitral valves. Therefore, factors other than purely age (including medical comorbidities and lifestyle factors) are considered when recommending a prosthetic valve for a patient. The purpose of this study was to identify the age at which half of heart valves implanted in Australia are mechanical and half bioprosthetic, and to see whether this age has changed over recent times.

Oesophagectomy (OG) and pancreaticoduodenectomy (PD) remain associated with significant perioperative mortality rates (POMR). Improved outcomes in high-volume centres have led to these procedures being centralised in some countries. This retrospective, population-based cohort study was conducted to determine the Australian national, and state and territory based POMR associated with OG and PD, and assess trends over time.

Pork burgers could be expected to have an elevated risk of salmonellosis compared to other pork products due to their comminuted nature. A stochastic risk assessment was performed to estimate the risk of salmonellosis from Australian pork burgers and considered risk-affecting factors in the pork supply chain from retail to consumption at home. Conditions modeled included prevalence and concentration of Salmonella in pork mince, time and temperature effects during retail, consumer transport, and domestic storage and the effect of cooking, with the probability of illness from consumption estimated based on these effects. The model was two-dimensional, allowing for the separation of variability and uncertainty. Potential changes to production practices and consumer behaviors were examined through alternative scenarios. Under current conditions in Australia, the mean risk of salmonellosis from consumption of 100 g pork burgers was estimated to be 1.54x10-8 per serving or one illness per 65,000,000 servings consumed. Under a scenario in which all pork mince consumed is served as pork burgers, and with conservative (i.e., worst-case) assumptions, 0.746 cases of salmonellosis per year from pork burgers in Australia were predicted. Despite the adoption of several conservative assumptions to fill data gaps, it is predicted that pork burgers have a low probability of causing salmonellosis in Australia.

A risk-based assessment of post-mortem inspection activities and disposition judgment criteria was undertaken for cattle, sheep, goats and pigs in Australia against the current Australian Standard (AS 4696). The assessment utilized Codex Alimentarius Commission principles and guidelines for the conduct of microbiological risk assessment and the Code of Hygienic Practice for Meat. The assessment aimed to identify priorities for evaluating alternative procedures that deliver equivalent or better food safety outcomes to the current standard. An initial qualitative risk assessment used contemporary public health and industry data for differentiating gross abnormalities as meat safety or wholesomeness issues and to assess the likely effect of current inspection procedures on overall food safety outcomes. This article details the approach taken and reports the results of the qualitative risk assessment. The priorities identified for further validation of alternative post-mortem inspection procedures, matched against the risk managers’ primary concerns include: (1) bovine tuberculosis, Cysticercus bovis and Caseous Lymphadenitis of sheep and goats - removing post-mortem inspection procedures that are no longer necessary due to the improving animal health status of Australian animals; (2) inspection of spleens and unenucleated kidneys of sheep and goats - altering or removing procedures where new knowledge of animal or foodborne disease indicates current risk management procedures are not effective; (3) routine visual inspection of pigs, visual inspection of offal of sheep and goats - assessing the effect of inspection on microbial contamination of edible product; (4) melanoma of pigs, peri-acute pneumonia of cattle and pigs, polyarthritis of cattle and pigs - reviewing the criteria used to determine disposition judgments; and (5) pleurisy of pigs - identifying procedures that are principally related to detecting gross abnormalities that affect product wholesomeness (AS4696) rather than food safety and might, therefore, be managed within quality assurance arrangements. The outcome sought from this work will be a standard where post-mortem inspection is commensurate with risk.

OBJECTIVES:The aim of this study was to determine (1) the diagnostic efficacy of orthopantomography (OPG) in the diagnosis of sinus diseases by using cone beam computed tomography (CBCT) as the imaging gold standard, (2) which diseases can be diagnosed by using panoramic radiography or CBCT, and (3) the interobserver agreement of 2 experienced dental radiologists. STUDY DESIGN:The images of 714 individuals who underwent OPG and CBCT on the same day were assessed separately by 2 dental radiologists. The results were compared by using Gwet's AC1 statistical methods. RESULTS:In total, 1322 maxillary sinuses were imaged. The sensitivity of OPG for the detection of any maxillary sinus pathology was poor compared with CBCT, but the specificity was high. The sensitivity of OPG for detecting mucosal thickening was 36.7%. The positive predictive value of OPG for diagnosing mucosal thickening was 79.9 %, but the negative predictive value was 51.9%. Interobserver agreement was strong (≥0.912) for all lesions except mucosal thickening. CONCLUSIONS:Panoramic imaging has low efficacy in the diagnosis of sinus disease, even when examined by experienced dental radiologists. OPG can be useful in excluding disease, but 3-dimensional scanning is necessary for the definitive investigation of sinus lesions.

Paralytic shellfish toxins (PST) were identified in the hepatopancreas of Southern Rock Lobster (Jasus edwardsii) during Alexandrium tamarense blooms in Tasmania, Australia. Human health risk from PST in lobsters was unknown – this study assesses exposure to PST from hepatopancreas consumption. Lobster hepatopancreas samples collected during blooms (n = 181) were mostly positive for PST (>88%), the highest concentration was 4032 μg STX-2HCl eq/kg. Consumer exposure to PST was estimated using a 2-D Monte Carlo model. Mean PST intake (pi) from hepatopancreas consumption (raw and cooked) was below the lowest-observed-adverse-effect-level (LOAEL) for PST (<2.0 μg/kg bw), however the 97.5th percentile pi for raw meals (2.64 μg/kg bw) exceeded the LOAEL. A total of 4.1% of raw hepatopancreas meals were estimated to exceed the LOAEL. Lobster hepatopancreas consumption during A. tamarense blooms may be concerning for a small proportion of consumers, particularly those that eat large meals at the bloom peak. However, when the model was re-run with PST concentration capped at the bivalve regulatory limit (800 μg STX-2HCl eq/kg) pi decreased, with the 97.5th percentile values below the LOAEL. Thus, issuing public health warnings and harvesting restrictions for lobsters when levels exceed 800 μg STX-2HCl eq/kg would reduce the probability of illness occurring.

It is unclear whether incidental carotid artery calcification (CAC) on radiographs has a defined relationship to clinically significant carotid artery stenosis, and therefore risk of stroke. The primary objective of this study was to ascertain the relationship between dental radiograph detected carotid calcification and carotid artery stenoses ≥50% on carotid duplex ultrasound. We carried out an observational study of patients undergoing routine dental orthopantomogram (OPG) examinations. Consecutive patients with CAC on OPG were prospectively matched to those without CAC based on age and gender. Ultrasound of the carotid arteries was performed to determine the presence of stenosis (≥50%) in either vessel. Of 5780 consecutive OPG examinations with suitable images for analysis, CAC was detected in 10.8%. A total of 233 patients underwent carotid ultrasound (130 with and 103 without CAC on OPG). The prevalence of a clinically significant (≥50%) carotid stenosis on ultrasound was 15.4% (20/130) in those with CAC and 5.8% (6/103) for those without CAC on OPG. Incidental CAC detected on routine OPG requires both radiological reporting and clinical follow-up since 1 in 7 patients will have a clinically significant carotid artery stenosis as compared with 1 in 20 patients who do not have CAC. Trial Registration: Australian and New Zealand Clinical Trials Registry website (U1111-1148-1066). http://www.ANZCTR.org.au/ACTRN12613001038785.aspx.

BACKGROUND:In addition to technical expertise, surgical competence requires effective non-technical skills to ensure patient safety and maintenance of standards. Recently the Royal Australasian College of Surgeons implemented a new Surgical Education and Training (SET) curriculum that incorporated non-technical skills considered essential for a competent surgeon. This study sought to compare the non-technical skills of experienced surgeons who completed their training before the introduction of SET with the non-technical skills of more recent trainees.METHODS:Surgical trainees and experienced surgeons undertook a simulated scenario designed to challenge their non-technical skills. Scenarios were video recorded and participants were assessed using the Non-Technical Skills for Surgeons (NOTSS) scoring system. Participants were divided into subgroups according to years of experience and their NOTSS scores were compared.RESULTS:For most NOTSS elements, mean scores increased initially, peaking around the time of Fellowship, before decreasing roughly linearly over time. There was a significant downward trend in score with increasing years since being awarded Fellowship for six of the 12 NOTSS elements: considering options (score -0·015 units per year), implementing and reviewing decisions (-0·020 per year), establishing a shared understanding (-0·014 per year), setting and maintaining standards (-0·024 per year), supporting others (-0·031 per year) and coping with pressure (-0·015 per year).CONCLUSION:The drop in NOTSS score was unexpected and highlights that even experienced surgeons are not immune to deficiencies in non-technical skills. Consideration should be given to continuing professional development programmes focusing on non-technical skills, regardless of the level of professional experience.