Association between rheumatoid arthritis disease activity, progression of functional limitation and long-term risk of orthopaedic surgery : Combined analysis of two prospective cohorts supports EULAR treat to target DAS thresholds

Objectives: To examine the association between disease activity in early rheumatoid arthritis (RA), functional limitation and long-term orthopaedic episodes. Methods: Health Assessment Questionnaire (HAQ) disability scores were collected from two longitudinal early RA inception cohorts in routine care; Early Rheumatoid Arthritis Study and Early Rheumatoid Arthritis Network from 1986 to 2012. The incidence of major and intermediate orthopaedic surgical episodes over 25 years was collected from national data sets. Disease activity was categorised by mean disease activity score (DAS28) annually between years 1 and 5; remission (RDAS≤2.6), low (LDAS>2.6-3.2), low-moderate (LMDAS≥3.2-4.19), high-moderate (HMDAS 4.2-5.1) and high (HDAS>5.1). Results: Data from 2045 patients were analysed. Patients in RDAS showed no HAQ progression over 5 years, whereas there was a significant relationship between rising DAS28 category and HAQ at 1 year, and the rate of HAQ progression between years 1 and 5. During 27 986 person-years follow-up, 392 intermediate and 591 major surgeries were observed. Compared with the RDAS category, there was a significantly increased cumulative incidence of intermediate surgery in HDAS (OR 2.59 CI 1.49 to 4.52) and HMDAS (OR 1.8 CI 1.05 to 3.11) categories, and for major surgery in HDAS (OR 2.48 CI 1.5 to 4.11), HMDAS (OR 2.16 CI 1.32 to 3.52) and LMDAS (OR 2.07 CI 1.28 to 3.33) categories. There was no significant difference in HAQ progression or orthopaedic episodes between RDAS and LDAS categories. Conclusions: There is an association between disease activity and both poor function and long-term orthopaedic episodes. This illustrates the far from benign consequences of persistent moderate disease activity, and supports European League Against Rheumatism treat to target recommendations to secure low disease activity or remission in all patients.Peer reviewedFinal Published versio

Menstrual health and hygiene among Indigenous Australian girls and women: barriers and opportunities

Health inequities inhibit global development and achievement of the Sustainable Development Goals. One gendered health area, Menstrual Health & Hygiene (MHH), has received increasing attention in Low- and Middle-Income Countries as a barrier to health, wellbeing, and gender equity. Recent anecdotal evidence in Australia highlights that MHH also present challenges to High Income Countries, particularly among underrepresented populations, such as Indigenous Australian peoples, people from low socio-economic backgrounds, or communities that are remotely located. In this article, we chart the emergence of attention to MHH in the Australian context and highlight key considerations for the conduct of research with Aboriginal and Torres Strait Islander Peoples within the culturally- and gender-sensitive area of MHH. Further we draw on insights offered by a partnership between female Aboriginal and Torres Strait Islander leaders, NGO stakeholders, and non-Indigenous researchers. Through a convening (yarning circle) held in March 2018, the group identified multiple socioecological considerations for MHH research and practice, including: affordability and access to menstrual products, barriers to knowledge and culturally sensitive education, infrastructure and supply chain challenges, and the necessity of Indigenous-led research and community-driven data collection methods in addressing the sensitive topic. We draw together these insights to develop recommendations for future research, advocacy, and action in Australia

Loss of the yeast SR protein Npl3 alters gene expression due to transcription readthrough

Yeast Npl3 is a highly abundant, nuclear-cytoplasmic shuttling, RNA-binding protein, related to metazoan SR proteins. Reported functions of Npl3 include transcription elongation, splicing and RNA 3' end processing. We used UV crosslinking and analysis of cDNA (CRAC) to map precise RNA binding sites, and strand-specific tiling arrays to look at the effects of loss of Npl3 on all transcripts across the genome. We found that Npl3 binds diverse RNA species, both coding and non-coding, at sites indicative of roles in both early pre-mRNA processing and 3' end formation. Tiling arrays and RNAPII mapping data revealed 3' extended RNAPII-transcribed RNAs in the absence of Npl3, suggesting that defects in pre-mRNA packaging events result in termination readthrough. Transcription readthrough was widespread and frequently resulted in down-regulation of neighboring genes. We conclude that the absence of Npl3 results in widespread 3' extension of transcripts with pervasive effects on gene expression

Water and health interlinkages of the sustainable development goals in remote Indigenous Australia

Australia has committed to the 17 Sustainable Development Goals (SDGs) goals under the UN's 2030 Agenda. However, these goals may not be fully achieved in Australia under current policy settings. Australia reports success in achieving the goal for quality and access to safe drinking water and sanitation (SDG 6), though for Australians living in remote Indigenous communities, the experience is very different. Furthermore, the burden of disease is higher in remote communities (SDG 3). Many of these diseases are waterborne or hygiene-related, including prevalence in some remote Indigenous communities of endemic trachoma eye infection, preventable through access to functioning water services and available soap. This research provides a case for identifying, then understanding the interlinkages between SDGs 3, 6, and others locally, as well as nationally. This will enable governments to enact policies for long-term sustainable solutions for remotely-located and marginalised peoples in Australia in line with Agenda 2030 commitments

Enabling Indigenous education success beyond regional borders

Geographical and social isolation have often been linked to the ‘success’, or rather ‘non-success’, of Indigenous Australian students. What if their geographic location and social situation were seen as supportive mechanisms? What if their culture, local community and extended family networks were seen as strengths in their learning journeys? What if their home and community environments were understood as platforms for learning? The Tertiary Entry Program (TEP), offered by the Office of Indigenous Engagement at CQUniversity, was a face-to-face on campus enabling/bridging program offered to Aboriginal and Torres Strait Islander students in Central Queensland. It is now an external, flexible, on-line learning program offered to Indigenous Australians in urban areas, regional and remote communities and in correctional centres. It is no longer governed by the regional borders of the region in which it was developed, and enables Indigenous Australians throughout Australia to develop confidence, affirm their identity and take pride in being who they are as Indigenous peoples. The program builds the knowledge and skills to achieve within a university environment and allows Indigenous students to achieve their goals regardless of their geographic and social location. This presentation will not only demonstrate how Indigenous learners are using digital technology to study from within their communities, but are progressing successfully from their enabling program through to graduation

Tertiary Entry Program (TEP)

This presentation will focus on the Tertiary Entry Program, which was developed at Central Queensland University in 2000 and began to be offered in 2001.The overview for the program states that ‘TEP prepares students for successful participation in a university undergraduate or postgraduate degree program. TEP introduces students to university culture, computing skills, academic essays, reports and seminars’. Since this time, staff and community members have revisited the original goals of the program and there has been an effort to revitalise the program aligned to the changing needs of Indigenous peoples within the University sector and the funds that support such initiatives. The presentation will focus on the changes made and the plans for the program for the future

Enabling Indigenous education success beyond regional borders

Geographical and social isolation have often been linked to the ‘success’, or rather ‘non-success’, of Indigenous Australian students. What if their geographic location and social situation were seen as supportive mechanisms? What if their culture, local community and extended family networks were seen as strengths in their learning journeys? What if their home and community environments were understood as platforms for learning? The Tertiary Entry Program (TEP), offered by the Office of Indigenous Engagement at CQUniversity, was a face-to-face on campus enabling/bridging program offered to Aboriginal and Torres Strait Islander students in Central Queensland. It is now an external, flexible, on-line learning program offered to Indigenous Australians in urban areas, regional and remote communities and in correctional centres. It is no longer governed by the regional borders of the region in which it was developed, and enables Indigenous Australians throughout Australia to develop confidence, affirm their identity and take pride in being who they are as Indigenous peoples. The program builds the knowledge and skills to achieve within a university environment and allows Indigenous students to achieve their goals regardless of their geographic and social location. This presentation will not only demonstrate how Indigenous learners are using digital technology to study from within their communities, but are progressing successfully from their enabling program through to graduation

Enabling Indigenous education success beyond regional borders

Higher education is a powerful tool for reducing social and economic disadvantage. But access to higher education can be difficult, particularly for Indigenous Australians who face multiple levels of social, economic and geographical isolation. While enabling programs can support Indigenous students to gain university entry, the experience at Central Queensland University (CQUniversity) suggests that their past success has been limited. In this paper, the authors describe the enabling program available to Indigenous students at CQUniversity. They suggest that the newly developed, flexible, online version of the program is helping to address geographical and social isolation and improve successful outcomes for Indigenous Australians