St John of God Subiaco Hospital

Sustainable groundwater management in water-scarce semiarid environments is challenging because it relies on understanding the intricate coupling between episodic recharge and hydrochemical evolution. In this study, conducted in the Pilbara region of Western Australia, ~6000 water analyses from ~1,800 groundwater boreholes and ~300 surface-water sites collected over a decade of monitoring (2015–2024) were used to develop a conceptual model of groundwater hydrochemical evolution.Stable hydrogen and oxygen isotope compositions indicate that groundwater recharge is not seasonal but instead occurs during sporadic tropical cyclones, which deliver precipitation with distinctly lower δ2H and δ18O values than local groundwater. Self-Organizing Maps (SOM), applied to stable isotope and hydrochemical data, identified five distinct categories that capture hydrochemical transition from recharge sources to endorheic basins. The evolutionary pathway begins in freshwater headwaters, where sulfide oxidation generates acidity that enhances carbonate dissolution and silicate weathering. As groundwater moves to alluvial plains, geochemical control shifts towards cation exchange, ultimately cumulating in low-lying zones where evaporative concentration dominates, and brine formation occurs. Structural Equation Modelling (SEM) confirms a fundamental spatial regime shift between inland and coastal systems. Inland chemistry is primarily controlled by topography and, at times, by internal rock-water interactions. Conversely, coastal water hydrochemistry is related to distance to the coast.Hydrochemical categories serve as effective proxies for hydraulic behaviour. Hydrochemically "young" recharge freshwaters exhibit dynamic water level responses to cyclonic events, whereas evolved, saline waters in the alluvial plains maintain comparatively stable water tables. These patterns demonstrate that hydrochemical evolution and hydraulic dynamics are tightly coupled, reflecting systematic differences in water retention times across the landscape. Together, they reveal a clear transition from lithological controls in recharge zones to salinity-driven physical controls in terminal areas.These findings indicate that sustainable yield assessments should distinguish between the rapid-response behaviour of headwater systems and the storage-dominated dynamics of downstream alluvial basins.

Arthroscopic surgical takedown and repair of symptomatic partial-thickness rotator cuff tears are commonly undertaken. An alternative approach is the use of a bioinductive collagen implant to augment the rotator cuff tear. To investigate early function and rotator cuff tendon integrity in patients undergoing arthroscopic bioinductive collagen implant augmentation (REG group) versus rotator cuff takedown and repair (RCR group) for high-grade partial-thickness rotator cuff tears. Randomized controlled clinical trial; Level of evidence, 2. Patients 35 to 75 years of age with symptoms >3 months and unresponsive to nonoperative treatment, with high-grade partial-thickness rotator cuff tears confirmed on 3-T magnetic resonance imaging (MRI), were randomly allocated to RCR or REG groups. Exclusion criteria included previous ipsilateral shoulder surgery, multitendon tears/pathology, and concomitant surgery including labral repair, long head of biceps tenodesis, or chondroplasty/microfracture. Patients were assessed preoperatively and at 6 weeks as well as 3, 6, and 12 months postoperatively. The primary study outcome was the Western Ontario Rotator Cuff Index (WORC) at 3 months after surgery. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) and Constant scores, and the time taken to return to work and activities of daily living (ADLs). MRI-based rotator cuff repair integrity was assessed using the Sugaya grading system. This study recruited 41 patients (REG n = 21; RCR n = 20). No group differences (P > .05) were observed in mean age (REG 57.1 years; RCR 57.8 years), preoperative duration of symptoms, and previous nonoperative treatments. The REG group reported superior outcomes for the WORC at 6 weeks (P = .001) and 3 months (P = .026) as well as the ASES at 6 weeks (P < .001) and WORC Work, Sport, and Emotions domains at 6 weeks and 3 months (P < .05). There were no group-based differences (P > .05) in patient-reported outcomes at 6 or 12 months after surgery. The REG group was faster (P < .05) to permanently remove the sling, drive a motor vehicle, and return to office duties and moderate-intensity chores. No MRI-based differences were observed, with 19 (90%) and 17 (85%) REG and RCR patients, respectively, graded Sugaya 1 to 2 at 12 months. For symptomatic high-grade partial-thickness rotator cuff tears, bioinductive collagen implant augmentation versus standard rotator cuff repair demonstrated improved early function with equivalent MRI-based healing rates. Australian New Zealand Clinical Trials Register (ACTRN12620000926932p).

Benefit or harm from early mobilisation (EM) in mechanically ventilated patients may vary by individual patient characteristics. We used machine learning to predict individualised treatment effects (ITEs) in the "Early Active Mobilization during Mechanical Ventilation in the ICU" (TEAM) trial. This was a secondary analysis of the TEAM trial using a causal inference approach to estimate ITEs, which compared enhanced EM to usual care EM. Baseline variables in the original publication were used as predictor variables. The primary outcome was death by day 180. The dataset was randomly split into two halves (train and test) by site. In the training data, fivefold cross-validation was used to compare six candidate machine learning algorithms. The best-performing model was evaluated in the test dataset. Patients were stratified into tertiles based on predicted ITEs, reflecting estimated benefit, no effect or harm. We included 687 patients from 40 sites, and 141 (20.5%) patients died by day 180. Predicted ITEs in the test cohort ranged from an absolute 34.0% reduction to a 39.3% increase in mortality with enhanced EM. The interaction term between the model predictions and treatment assignment demonstrated significant heterogeneity of treatment effect (p = 0.006). Patients predicted to respond poorly to enhanced EM therapy were more likely to receive vasopressors, have diabetes and have lower RASS scores at baseline, compared to patients predicted to have benefit. Using baseline characteristics, a machine learning model identified patients with estimated benefit or harm with enhanced EM. Future testing of a personalised approach to mobilisation in the ICU is warranted.

Abstract Purpose The present study aimed to gain a deeper understanding of how oncology healthcare professionals’ (HCPs) manage sleep disturbances. Methods Semi-structured interviews were conducted with 10 oncology HCPs (medical oncologists, oncology nurse practitioners, clinical nurse consultants) working in metropolitan Perth, Western Australia. Reflexive thematic analysis was used to understand oncology HCPs perspectives on treating sleep disturbances, explore challenges and barriers to their management, as well as opportunities for improvement. Results Four main themes were developed: (1) sleep disturbances are underreported and underassessed, (2) poor sleep can be difficult to manage, (3) limited capacity to address sleep issues and (4) opportunities for the future. Conclusion Understanding current clinical management practices used by oncology HCPs to manage sleep disturbances, along with their perceived opportunities to improve the management of sleep in cancer care are crucial. Efforts to implement these opportunities should focus on co-design with relevant stakeholders at all levels.

As the demand for copper increases, processing increasingly low-grade ore has become a critical challenge. Most of these ores are dominated by aluminosilicate gangue minerals, among which Fe-bearing phyllosilicates are the most reactive. The effect of Fe-bearing minerals on the acid leaching of chalcopyrite, the most common primary Cu ore mineral was investigated by comparing mixtures of chalcopyrite with (i) chamosite, (ii) berthierine-chamosite, and (iii) pyrite. The lixiviant consisted of solutions with 0.1 m Fe 2 (SO 4 ) 3 + 0.3 m H 2 SO 4 , and the experiments were conducted in an orbital shaking water bath at 50 ° C for 43 days. The solution pH increased and Eh decreased for all systems, resulting in conditions that became less optimal for Cu recovery. Scanning electron microscope imaging highlighted the porous nature and variable elemental composition of the (partially) dissolved phyllosilicate minerals/amorphous-silica-residue after leaching. Micro X-ray Absorption Near Edge Structure (μXANES) measurements revealed that sulfur exists in multiple oxidation states both within the silicate gangue and around chalcopyrite, emphasising how the formation of an amorphous-silica-residue increased the complexity of the system. This complexity is related to the fact that (partial) dissolution of phyllosilicate gangue minerals during acid leaching results in the release of ions that change the solution chemistry; and form an amorphous-silica-residue, that contains numerous pores. These pores can act as local micro-reactors with non-equilibrium conditions and promote a heterogenous chemical composition. Subsequent mineral surface-fluid interactions in (partially) dissolved phyllosilicate/amorphous-silica-residue pores can vary, depending on the local chemical composition, making the leaching behaviour of chalcopyrite highly dependent on local conditions and on the mineralogical composition of the ores. • Porous, non-crystalline Si residue formed during leaching of (Phyllo-) silicates • Leaching solution can penetrate and interact with Si residue, leading to ion sorbtion • Sulfur exists in multiple oxidation states in and around the silicates and ore minerals • Ions from dissolving aluminosilicate gangue can influence the S oxidation state

TPS3187 Background: While it is well known that HER2 overexpression, amplification, and mutation drives various tumors, there remains an unmet need for effective, oral, HER2-targeted therapies. Zongertinib is an irreversible tyrosine kinase inhibitor (TKI) that selectively inhibits HER2 while sparing EGFR, thereby limiting associated toxicities. In the ongoing Phase Ia/Ib trial (NCT04886804), zongertinib showed manageable safety and confirmed responses in patients (pts) with HER2-overexpressed/amplified and HER2 -mutant tumors (Wilding et al, Cancer Discov. 2024). Based on these encouraging data, the Beamion PANTUMOR-1 basket trial (NCT06581432) is evaluating the efficacy and safety of zongertinib monotherapy in pts with HER2 -mutant or HER2-overexpressed/amplified solid tumors. Methods: In this global Phase II basket trial, ~200 pts with HER2-driven ( HER2 -mutant or HER2-overexpressed/amplified) tumors will be enrolled at ~60 sites in 13 countries. Pts will be enrolled to 10 cohorts: 8 cohorts of specific tumor types and 2 tumor-agnostic cohorts (see Table). The specific tumor type cohorts will initially recruit 10 pts, with potential for expansion to up to 20 pts after an interim analysis. In the tumor-agnostic cohorts, 20 pts will be recruited directly without an interim analysis. Pts will receive 120 mg zongertinib until disease progression, unacceptable toxicity, or withdrawal. Patients must be ≥18 years old, have documented HER2-positive (HER2-overexpressed/amplified) status or a HER2 mutation (established by local testing), ≥1 measurable lesion outside the central nervous system, an ECOG performance score of 0 or 1, and have progressed following prior treatment or have no alternative treatment options. Exclusion criteria include HER2 -mutant non-small cell lung cancer (NSCLC) and previous/concomitant malignancies. Primary endpoint is objective response, as assessed by central independent review according to RECIST v1.1. Secondary endpoints include duration of response, progression-free survival, disease control, occurrence of treatment-emergent adverse events, and health-related quality of life. Enrollment is ongoing. Clinical trial information: NCT06581432 . HER2 overexpression/amplification cohorts Tumor type HER2 mutation cohorts Tumor type Cohort 1 Urothelial cancer Cohort 7 Urothelial cancer Cohort 2 Biliary tract cancer Cohort 8 Breast cancer Cohort 3 Uterine cancer Cohort 9 Gastroesophageal cancer Cohort 4 Cervical cancer Cohort 10 Other HER2 -mutant solid tumors † Cohort 5 Non-squamous NSCLC Cohort 6 Other HER2 overexpressed/amplified solid tumors* *Except breast cancer, gastric, gastroesophageal junction, or esophageal adenocarcinoma. † Except NSCLC.

8066 Background: The Australian National Lung Cancer Screening Program (NLCSP) commences in July 2025. Thoracic surgery is a key treatment option in screen-detected early-stage lung cancers. St. John of God Subiaco Hospital is a private hospital in Western Australia (WA) and is part of the Australian and New Zealand Thoracic Clinical Quality Registry (ANZTHOR) collaborative database as one of the inaugural sites. We examined the resected primary lung cancers at our centre to assess if our cohort aligned with the characteristics of the targeted at-risk patient population as defined by the NLCSP proposed screening criteria. Methods: Demographic patient data was retrieved from ANZTHOR at our centre who underwent surgical resection for primary lung cancer between March 2023 to November 2024. Retrospective data analysis was then conducted on the mode and symptoms at time of diagnosis, age and smoking history. The NLCSP criteria for screening (aged 50-70 years, history of ≥30 pack-years smoking in current smokers or ex-smokers who quit within the last 10 years) was then applied to this cohort of privately insured primary lung cancer patients to evaluate the proportion of patients that would have been eligible/ineligible for screening. Results: Of the 107 patients, median age was 71 (range 42-87) and 67 (63%) were females. 96 (90%) patients were asymptomatic and 98 (92%) were early-stage cancers (Stage 2 and below). 58 (54%) patients were &gt;70 years old and 34 (32%) were never-smokers. Conclusions: A substantial proportion (86%) of this cohort of asymptomatic resected lung cancer patients would not have been identified via lung cancer screening by NLCSP screening criteria. This is likely in part related to the different demographics of patients attending private hospitals but nonetheless raises the possibility that the current screening criteria is overly stringent and will miss many primary lung cancer presentations. Supplementary methods (i.e. blood biomarker testing) may improve screen detection rates of lung cancer and enable better identification of at-risk groups. Total patients (n=107) Asymptomatic patients (n=96) Ineligibility based on age 61 (57%) 56 (58%) Ineligibility based on smoking history 73 (68%) 67 (70%) Ineligibility based on full NLCSP criteria 91 (85%) 83 (86%)