Myocardial infarction (MI) imposes a significant health burden to the Australian population. However, detailed economic implication of MI on the Australian healthcare system has not been exhaustively explored. To estimate the current chronic management cost and project the future healthcare cost burden of MI, from the Australian healthcare system perspective. A generalized linear model with a gamma outcome distribution and negative inverse link function was used to estimate the current chronic management cost burden of MI while a dynamic multistate Markov model constructed to project the future healthcare cost burden of MI over 20 years (2019–2038). For all projected costs, 5

Abstract Background Clinically active inflammatory bowel disease (IBD) impacts 30-50% of women antenatally1,2. Such clinically active disease is associated with an increased risk of adverse pregnancy outcomes, including preterm delivery2. However, the validity of clinical scores to assess antenatal disease activity has been questioned, whilst both faecal calprotectin (FCP) and intestinal ultrasound (IUS) are feasible and accurate in pregnancy3,4. We aimed to assess whether active disease defined by IUS may predict adverse obstetric outcomes in pregnant women with IBD. Methods This international multi-centre prospective cohort study recruited both preconception and pregnant individuals with IBD in Australia and the USA from 2017-2023. Participants underwent clinical assessments and FCP testing six months before conception, in each trimester (T1, T2, and T3), and, when feasible, six weeks postpartum. IUS was performed preconception and in T1 and T2. Clinically active disease in pregnancy was defined by a PGA>1, or a HBI>5 or SCCAI >3. A FCP>100μg/g was considered elevated, and IUS remission was defined as a bowel wall thickness of <3mm in all bowel segments, with normal bowel wall stratification, a lack of extra-mural complications, and an absence of mesenteric fat hypertrophy or hyperaemia. Univariable and multivariable binary logistic regression analyses including relevant confounders were used to determine the independent impact of IUS disease activity on obstetric outcomes. Cohen κ coefficients were used to determine agreement between FCP, IUS and clinical disease activity. Results 379 participants, 200 with Crohn’s Disease (CD), were recruited. Overall, rates of adverse obstetric outcomes were comparable to the general population (Figure 1). Maximal bowel wall thickness (BWT) >6mm in T1 was associated with a three-fold increased risk of neonatal intensive or special care unit admission (RR 3.10;1.27-7.54, p=0.013) and in T2 was associated with a four-fold increased risk of prematurity (4.51; 1.45-14.04, p=0.009). IUS hyperaemia in T2 was associated with a three-fold increase in preeclampsia risk (3.61; 1.07-12.15, p=0.038). FCP >100μg/g in T2 was associated with an increased risk of preterm delivery after adjusting for clinical disease activity (RR 2.90; 1.22-7.50, p=0.028). Agreement between clinical (HBI or SCCAI) and IUS/FCP activity during pregnancy was weak (Figure 2). Conclusion Sub-clinical disease activity identified on IUS in pregnancy is associated with an increased risk of pre-term delivery, with poor agreement between clinical symptoms and objective biomarkers of disease activity during pregnancy. IUS monitoring should be performed as part of routine antenatal IBD care and IUS remission targeted. References 1.Vestergaard T, Julsgaard M, Rosok JF, Vestergaard SV, Helmig RB, Friedman S, Kelsen J. Predictors of disease activity during pregnancy in women with inflammatory bowel disease-a Danish cohort study. Aliment Pharmacol Ther. 2023;57(3):335-344. 2.Mahadevan U, Long MD, Kane SV, Roy A, Dubinsky MC, Sands BE, Cohen RD, Chambers CD, Sandborn WJ. Pregnancy and Neonatal Outcomes After Fetal Exposure to Biologics and Thiopurines Among Women With Inflammatory Bowel Disease. Gastroenterology. 2021;160(4):1131-1139. 3.Flanagan E, Wright EK, Begun J, Bryant RV, An Y-K, Ross AL, Kiburg KV, Bell SJ. Monitoring Inflammatory Bowel Disease in Pregnancy Using Gastrointestinal Ultrasonography. J Crohns Colitis. 2020;14(10):1405-1412. 4.de Voogd F, van Wassenaer EA, Mookhoek A, Bots S, van Gennep S, Löwenberg M, D’Haens GR, Gecse KB. Intestinal Ultrasound Is Accurate to Determine Endoscopic Response and Remission in Patients With Moderate to Severe Ulcerative Colitis: A Longitudinal Prospective Cohort Study. Gastroenterology. 2022;163(6):1569-1581.

Background and AimThe rising incidence of hepatocellular carcinoma (HCC) in Australia is related to increasing rates of metabolic-associated fatty liver disease (MAFLD). This study aimed to prospectively characterize the metabolic profile, lifestyle, biometric features, and response to treatment of HCC patients in an Australian population.MethodMulticenter prospective cohort analysis of newly diagnosed HCC patients at six multidisciplinary team meetings over a 2-year period.ResultsThree hundred and thirteen (313) newly diagnosed HCC patients with MAFLD (n = 77), MAFLD plus other liver disease (n = 57) (the "mixed" group), and non-MAFLD (n = 179) were included in the study. Alcohol-associated liver disease (ALD) (43%) and MAFLD (43%) were the most common underlying liver diseases. MAFLD-HCC patients were older (73 years vs 67 years vs 63 years), more likely to be female (40% vs 14% vs 20%), less likely to have cirrhosis (69% vs 88% vs 85%), showed higher ECOG, and were less likely to be identified by screening (29% vs 53% vs 45%). Metabolic syndrome was more prevalent in the MAFLD and mixed groups. The severity of underlying liver disease and HCC characteristics were the same across groups. While the MAFLD population self-reported more sedentary lifestyles, reported dietary patterns were no different across the groups. Dyslipidemia was associated with tumor size, and those taking statins had a lower recurrence rate.ConclusionEqual to ALD, MAFLD is now the most common underlying liver disease seen in HCC patients in Australia. Future HCC prevention screening and treatment strategies need to take this important group of patients into consideration.

Abstract Background Exposure to maternal inflammation in-utero is associated with an increased risk of neurocognitive developmental disorders in offspring, including cerebral palsy (CP). An increased risk of CP and neurological morbidity has been reported in infants of women with CD and UC in registry but not prospective cohort studies. Unsedated neonatal cerebral MRI (nMRI) allows for early assessment of brain microstructural integrity, with bipartietal diameter (BPD) predictive of cognitive and motor outcomes in preterm infants. Generalised movement assessments evaluate the character of infant’s spontaneous movements, can be undertaken remotely by parents with app-based technology (BabyMoves (BM) and are an early indicator of being high risk for cerebral palsy. nMRI & BM have not been used to screen for adverse neurocognitive outcomes in infants born to women with inflammatory disorders. We aimed to assess the feasibility of nMRI and BM in infants born to women with IBD and correlate abnormalities with maternal biochemical inflammation antenatally. Methods Pregnant women with IBD were assessed clinically and biochemically (faecal calprotectin (FC), CRP) in each trimester of pregnancy in this single centre prospective pilot study. Biochemically active disease was defined by FC >100ug/g or CRP >15mg/L. Infants underwent nMRI using a 1.5T MRI with T1-weighted and T2/proton density-weighted sequences performed at 6-12 weeks post-corrected term. Parents filmed 2 BM videos at 12-14 & 14-16 weeks post-corrected term. nMRIs (Figure 1) and BMs were scored by blinded reviewers with validated scoring systems. Metric nMRI data were corrected for gestational age (cGA). Descriptive statistics and spearman correlation coefficients were performed. Results 40 mother-baby pairs, 19 with CD & 20 exposed to a biologic drug, were recruited. Most patients were in biochemical remission throughout pregnancy with median FC <50ug/g and <13% having a CRP >15g/L in trimesters 1-3. At delivery 2/40 infants were premature, 4/40 low birth weight & 3/40 required neonatal intensive care. The median cGA at nMRI was 46 weeks 6 days (range 42 + 5-53 + 4). 2/39 MRI were of insufficient quality for scoring. 5/37 nMRI and 4/35 BM were abnormal, with 1/7 having a clinically significant adverse outcome (Table 1). Biparietal diameter did not correlate with maternal CRP or FC in any trimester of pregnancy. Conclusion nMRI & BM for infant neurocognitive disorder screening is feasible in the setting of maternal IBD. In this cohort of 40 infants, one clinically significant abnormality was identified in an infant of a mother with inactive IBD. Larger studies are required to stratify the risk of adverse neurocognitive outcomes in infants born to women with maternal inflammatory disorders.

AbstractThe potential contribution that employees can make to retail firms is changing as retailing is increasingly embracing online and digital capabilities. Retailers are tasked with the role of supplementing their primary commercial role by providing unique experiences. Existing theories in service management, for example, job autonomy and service scripting, can only provide part of the solution to the inevitable variability that emerges as employees work with customers to proactively create moments of delight and reactively recover from service failures. The importance of customer service and the customer experience is becoming critical. We propose a new concept of employee-to-customer improvisation, which draws on the strengths of existing theoretical approaches while providing retail managers with fresh insights. We clarify the domain of the employee-to-customer improvisation construct and propose a conceptual framework that integrates individual and organizational antecedents, as well as contingency factors that enable employee-to-customer improvisation. Overall, our work highlights a new concept important to meeting the changing demands associated with contemporary retail encounters.

Despite known sex differences in diabetes-induced heart failure, its treatment is the same across the sexes. Although both sodium glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) reduce major adverse cardiovascular events (MACE) in T2D, whether these reductions are similar in men versus women has not been reported.

The authors draw on the sociological theories of the “liability of newness” and the “liability of adolescence” to generate new insights into relationship evolution. First, they show how a new relationship in its “honeymoon” phase exhibits a unique constellation of two conditions, namely information asymmetry and forbearance. Next, they explain how a relationship evolves along two processes that involve passive learning and decay, respectively. In themselves, these processes will move a relationship toward a long-term “transactional” state and possibly termination, but the processes can also be actively shaped using various governance mechanisms. Doing so, however, requires a nuanced account of types of governance mechanisms and the particular conditions they are intended to induce. The authors consider how the general mechanisms of (1) incentives and (2) information sharing can be deployed in standardized or customized fashions, respectively. Next, they suggest how different manifestation of governance mechanisms impact a relationship's underlying evolutionary processes and evolved relationship states. In general, their framework represents a new perspective on relationship evolution—one that involves the purposeful management of initial conditions and their related evolutionary processes.