TAFE Queensland Gold Coast

Cervical total disc replacement (TDR) is intended to preserve motion and reduce adjacent segment degeneration compared to anterior cervical discectomy and fusion (ACDF). The Simplify Cervical Disc (Globus Medical, Audubon, Pennsylvania), a polyetheretherketone (PEEK)-on-ceramic device with titanium-coated endplates, was approved following encouraging short-term outcomes. However, emerging registries and the Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) reports suggest an increase in device failures and revision surgeries, raising concerns about the device's long-term durability and biological compatibility. We reviewed publicly available FDA MAUDE adverse event reports related to the Simplify disc replacement and the published literature on PEEK-on-ceramic wear mechanisms and titanium coating delamination. Representative clinical cases revised to ACDF procedures were also examined. Device bench testing data from the FDA summary were compared with real-world failure modes. Reported complications were categorized into wear, subsidence, migration, osteolysis, and revision outcomes. Analysis of 96 MAUDE reports revealed diverse complications: osteolysis, device migration, persistent or worsening pain, and intraoperative retrieval difficulties. Histological evaluation of revision specimens demonstrated benign bone and fibrocartilage with foreign material, consistent with PEEK, titanium, and zirconia wear debris, an associated inflammatory reaction, and osteolysis. In vitro data confirm that PEEK-on-ceramic couples generate volumetric wear rates of 0.7-2.1mm³/Mc, with titanium coating delamination further contributing to particulate load. Bench testing demonstrated mechanical adequacy under idealized conditions. However, retrieval findings highlight wear, coating failure, and osteolysis as potential failure pathways in real-world applications. Clinical outcomes after ACDF revision were favorable, suggesting effective salvage treatment. Despite promising early trial results, the Simplify disc demonstrates concerning failure mechanisms, including PEEK wear, titanium coating delamination, and subsequent osteolysis. The discrepancy between bench testing and retrieval analysis underscores the limitations of preclinical simulation in predicting in vivo wear. Vigilant post-market surveillance, independent registry reporting, and further long-term outcome studies are essential. Until durability is confirmed, cautious patient selection and readiness for revision remain critical in clinical practice.

Abstract Introduction Obstructive sleep apnoea (OSA) frequently causes excessive daytime sleepiness (EDS). EDS impairs quality-of-life and can induce motor vehicle accidents or workplace injuries. Treatment dogma would suggest that CPAP (continuous positive airway pressure), the gold standard treatment, should abolish EDS, but up to 22% of CPAP-treated OSA patients can have residual EDS. Our tertiary health service serves a large catchment within the eastern coast of Australia. We aimed to examine the prevalence and precipitating causes of post-CPAP residual EDS in our local OSA population. Methods This was a single-centre retrospective study. Data set was compiled from the medical records of patients aged ≥18 years presenting to outpatients with OSA diagnosis in 2019-2024. Results Out of 354 patients, 35 (10%) had residual EDS on post-CPAP commencement follow-up. Median age was 58 years (IQR 54-75); 60% (n = 21) were males. Chronic pain and mental health co-morbidities were prevalent in 46%. Median Epworth Sleepiness Scale and Apnoea-Hypopnoea Index at diagnosis were 14 and 31.7, respectively. Most had home-based diagnostic study (n = 20) and lab-based CPAP titration (n = 24). 6 repeat in-lab titration studies and 3 vigilance tests were performed to evaluate residual EDS. Co-existing insomnia and CPAP-related issues were commonly identified as causing residual EDS. Conclusion OSA treatment is often undertaken to improve patients’ daytime somnolence and quality-of-life. Therefore, from the outset, patients should be informed about the CPAP acclimatisation process and of co-existing non-OSA conditions that may be perpetuating their EDS. Insomnia is not uncommon in modern society and should be screened for at index clinic reviews for OSA.

Rheumatic heart disease (RHD) is a devastating consequence of group A streptococcus (StrepA) infections, being associated with 15 [...]

ABSTRACT Affect plays a significant role in language teaching and learning and in use of languages, and this includes the phenomenon of linguistic shame. Although shame is considered personal by many, its origins are social; linguistic shame is inextricably connected to language use as a social practice. In this paper, we focus on English language teacher education in settings outside the Anglosphere where English is taught and learned as an additional language, in which pre-service English teachers are generally also learners of English. Awareness and understanding of linguistic shame within language teacher education in such settings has implications for participation in the learning of pre-service teachers. Drawing on data from pre-service English teacher education in the non-Anglophone setting of Sri Lanka, we discuss the understanding of linguistic shame and shaming as a social practice, awareness of and responses to it in teacher education classrooms, and the implications.

Occupational heat stress, exacerbated by factors such as climate change and insufficient cooling solutions, endangers the health and productivity of workers, especially in low-resource workplaces. To evaluate the effectiveness of two cooling strategies in reducing physiological strain and productivity of piece-rate workers over a 9-h work shift in a southern Thailand sawmill. In a crossover randomized control trial design, 12 (33 ± 7 y; 1.58 ± 0.05 m; 51 ± 9 kg; n = 5 females) medically screened sawmill workers were randomly allocated into three groups comprising an established phase change material vest (VEST), an on-site combination cooling oasis (OASIS) (i.e., hydration, cold towels, fans, water dousing), and no cooling (CON) across 3 consecutive workdays. Physiological strain was measured via core temperature telemetry and heart rate monitoring. Productivity was determined by counting the number of pallets of wood sorted, stacked, and stowed each day. Relative to CON, OASIS lowered core temperature by 0.25°C [95% confidence interval = 0.24, 0.25] and heart rate by 7 bpm [6, 9] bpm, compared to 0.17°C [0.17, 0.18] and 10 [9,12] bpm reductions with VEST. It was inconclusive whether productivity was statistically lower in OASIS compared to CON (mean difference [MD] = 2.5 [-0.2, 5.2]), and was not statistically different between VEST and CON (MD = 1.4 [-1.3, 4.1]). Both OASIS and VEST were effective in reducing physiological strain compared to no cooling. Their effect on productivity requires further investigation, as even small differences between interventions could lead to meaningful disparities in piece-rate worker earnings over time.

This research explores how the use of home language and the language environment influence the development of English speaking skills in Thai children attending Australian kindergartens. Using a mixed-methods approach, it investigates the relationship between home language exposure and English proficiency. The study involves Thai children, their parents, and kindergarten teachers, collecting data through questionnaires and language assessments. The findings will help us understand the impact of home language and the kindergarten environment on language development and can inform educational strategies for these children.

Ultrasound is the first-line imaging modality for suspected acute cholecystitis. This can be radiology-performed ultrasound or point-of-care ultrasound (POCUS). POCUS can potentially streamline patient assessment in the emergency department (ED). The primary objective was to evaluate the literature for the diagnostic accuracy of POCUS performed for acute cholecystitis in the ED. Secondary objectives were to assess the effect of POCUS operator training on diagnostic accuracy for acute cholecystitis, utility of POCUS measurement of the common bile duct and POCUS impact on resource utilisation. A systematic scoping review of articles was conducted using Medline, Embase, CENTRAL and CINAHL. Original studies of adults with POCUS performed for the diagnosis of acute cholecystitis in the ED were included. The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist (PRISMA-ScR). A total of 1090 publications were identified. Forty-six met the eligibility criteria. Studies were thematically grouped into categories according to specified objectives. Point-of-care ultrasound was of acceptable but variable accuracy, contributed to by the absence of a consistent reference standard and uniform training requirements. It may positively impact ED resource utilisation through reduced ED length of stay and radiology-performed imaging, whilst improving patient experience. This review highlights the heterogeneity of existing research, emphasising the need for standardisation of training and reference standards in order to precisely define the utility of POCUS for acute cholecystitis in the ED and its benefits on ED resource utilisation.

PurposeThe purpose of this study was to evaluate whether the lung ultrasound (LUS) scores applied to an international cohort of patients presenting to the emergency department (ED) with suspected COVID‐19, and subsequently admitted with proven disease, could prognosticate clinical outcomes.MethodsThis was an international, multicentre, prospective, observational cohort study of patients who received LUS and were followed for the composite primary outcome of intubation, intensive care unit (ICU) admission or death. LUS scores were later applied including two 12‐zone protocols (‘de Alencar score’ and ‘CLUE score’), a 12‐zone protocol with lung and pleural findings (‘Ji score’) and an 11‐zone protocol (‘Tung‐Chen score’). The primary analysis comprised logistic regression modelling of the composite primary outcome, with the LUS scores analysed individually as predictor variables.ResultsBetween April 2020 to April 2022, 129 patients with COVID‐19 had LUS performed according to the protocol and 24 (18.6%) met the composite primary endpoint. No association was seen between the LUS score and the composite primary end point for the de Alencar score [odds ratio (OR) = 1.04; 95% confidence interval (CI): 0.97–1.11; P = 0.29], the CLUE score (OR = 1.03; 95% CI: 0.96–1.10; P = 0.40), the Ji score (OR = 1.02; 95% CI: 0.97–1.07; P = 0.40) or the Tung‐Chen score (OR = 1.02; 95% CI: 0.97–1.08).DiscussionCompared to these earlier studies performed at the start of the pandemic, the negative outcome of our study could reflect the changing scenario of the COVID‐19 pandemic, including patient, disease, and system factors. The analysis suggests that the study may have been underpowered to detect a weaker association between a LUS score and the primary outcome.ConclusionIn an international cohort of adult patients presenting to the ED with suspected COVID‐19 disease who had LUS performed and were subsequently admitted to hospital, LUS severity scores did not prognosticate the need for invasive ventilation, ICU admission or death.