Obituary: Gary D. Mitchell, Sr

The Introduction of Extended Out‐of‐Home Care ( OOHC ) Until 21 Years in Australia: A Mapping of Policy, Legislation and Programs in Each Jurisdiction

ABSTRACT It is increasingly recognised by global research that extending out‐of‐home care (OOHC) until at least 21 years of age is the policy reform most likely to advance improved outcomes for care leavers. In recent years, all eight Australian jurisdictions (States and Territories) have introduced forms of extended care programs. Yet, major variations remain between these jurisdictions in terms of the placement types covered, the levels of support and funding, and the terms and language used to describe their programs. This paper maps the existing policy developments in each jurisdiction and the level of program supports provided to care leavers aged 18–21 years. For each jurisdiction, we establish extended care eligibility and coverage, funding and adequacy, and the key terminology used. Our discussion of the commonalities and differences between the jurisdictions suggests that some sub‐groups of care leavers may need additional and specialised forms of support. They include most notably those exiting residential care and Aboriginal and Torres Strait Islander care leavers.

Opportunities in Middle Childhood: Multiple System Involvement During Middle Childhood and Early Adolescence in Northern Territory, Australia

ABSTRACT Middle childhood offers a crucial window to identify and support children at risk of adverse outcomes in adolescence. This retrospective cohort study examined how data from multiple systems could identify children with the greatest need for support during middle childhood and early adolescence. Using individual level linked records from health, education, child protection and justice system for children who were enrolled in Northern Territory government schools in Year 1, we studied the relationships between system involvement/school engagement in middle childhood (ages 5–9) and subsequent system involvement/service usage during early adolescence (ages 10–13). Latent class analysis identified five distinct groups with varying patterns of system involvement. Notably, one group (12.1%) exhibited frequent contact with multiple systems, high school mobility between remote and urban regions, and high educational risk, contributing disproportionately to service usage. Early system involvement during middle childhood often preceded escalating service needs in adolescence, with early multi‐system contact emerging as a leading indicator of service use in later years. Our findings highlight the potential benefits of a ‘systems thinking’ approach, with coordinated cross‐agency responses and enhanced early interventions to better support vulnerable children, especially those engaged with multiple systems.

Prevalence and Factors Associated With Alleged Offending Among Children Aged 10–13 Years in the Northern Territory of Australia

ABSTRACT Recent policy discourse in Australia focuses on the minimum age of criminal responsibility with minimal attention to prevention strategies. Guided by theory which views child development within nested environmental contexts and recognises the cumulative impact of risk factors, this retrospective cohort study uses de‐identified linked administrative data to investigate the prevalence of, and factors associated with, alleged offending among children aged 10–13 years (recorded in police data). The study included all Northern Territory (NT) government school children who turned 10 between 1/7/2014 and 30/6/2015 (turning 14 before 1/7/2019) and remained in NT until age 14 ( n  = 2530). Results showed 10.3% of children had at least one alleged offence before age 14, with higher rates among Aboriginal children. High levels of ‘crossover’ with the child protection system was identified among alleged offenders with 87.8% subject to child protection notifications and 10.0% with experiences of out‐of‐home care. Mental health issues (20.3%), exposure to domestic violence (64.0%) and school changes (57.5%) were common among alleged offenders. The findings suggest alleged youth offending has multiple risk factors, requiring a paradigm shift towards multifaceted, prevention‐focused and culturally responsive interventions. This includes early intervention, public health approaches and acknowledging the existence of institutional racism and intergenerational trauma.

AJSI Transitions From Out‐Of‐Home Care Special Issue Editorial by Philip Mendes, Lynne McPherson , Jemma Venables, Steven Roche and Jenna Bollinger

Patterns of Multisystem Involvement in Adolescence: Implications for Health, Education and Social Services in the Northern Territory of Australia

ABSTRACT Dual‐system young people who crossover between child protection and youth justice systems experience a range of health and educational issues. However, very little research has examined the health and education needs of these young people, especially in Indigenous populations. A retrospective cohort study was established using individual‐level linked records to examine the child protection, youth justice, health, and education (multisystem) involvement of young Aboriginal and non‐Aboriginal people in the Northern Territory (NT) of Australia. Latent class analysis (LCA) was used to identify different groups within the study cohort of 2584 young people with shared patterns and levels of health, education, and social service system involvement from 10 to 17 years of age, inclusive. Three groups of young people were identified, with patterns of higher, more intensive levels of multisystem involvement being associated with a descending social gradient and increasing proportion of health and social service use across the population. A culturally responsive, trauma‐informed approach to multiagency collaboration is needed to better support the most vulnerable young people in the NT based on shared priorities targeting educational engagement, strengthening families, and unmet mental health needs.

Testicular Two‐Dimensional Shear Wave Elastography, Peak Systolic Velocity, Volume and Epididymal Thickness: Establishment of Normal Reference Values and Discrimination From Orchitis in Adult Patients Presenting With Acute Scrotal Pain

ABSTRACT Aim To establish normal testicular stiffness reference values using two‐dimensional shear wave elastography (2D‐SWE) and together with volume, PSV and epididymal thickness to discriminate from inflammatory pathology, specifically orchitis, in adult patients presenting with acute scrotal symptoms. Materials and Methods Retrospective analysis of patients referred for scrotal ultrasonography for investigation of scrotal pain or discomfort. Evaluation of 494 testes included B‐Mode, colour and pulsed wave (PW) Doppler, testicular volume, peak systolic velocity (PSV) and the median elasticity (SWE). Statistical evaluation was performed to identify stiffness threshold values to rule in normal. Results In normal testes, the median volume, PSV and SWE were 13.8 mL (10.3–17.2 mL), 6.3 cm/s (4.9–7.7 cm/s) and 2.5 kPa (2.15–2.85 kPa). The right testes were larger (right 14.4 mL, left 13.2 mL, p  < 0.05) with both decreasing in size and increasing in stiffness with increasing age (> 60 years, p  < 0.05). In patients with normal testes but extra‐testicular pathology, the median volume, PSV and SWE were 13.3 mL (9.75–16.8 mL), 6.3 cm/s (4.55–8.05 cm/s) and 2.8 kPa (2.3–3.3 kPa), respectively. In patients with orchitis, the median volume, PSV and SWE were 18.1 mL (11.5–24.7 mL), 7.9 cm/s (2.8–13 cm/s) and 5.4 kPa (3.4–7.4 kPa), respectively. The PSV and SWE values in this group were age‐ and side‐independent. Differentiating normal testes from orchitis using SWE had AUC, accuracy, sensitivity and specificity of 0.91, 0.801, 0.892 and 0.792. Conclusion Normal adult testes have a median stiffness of 2.5 kPa. A threshold cut‐off median value of 3.6 kPa suggests the diagnosis of an inflammatory testicular pathology such as orchitis, with AUC, accuracy, sensitivity and specificity of 0.922, 0.840, 0.928 and 0.831. Caution is required in the presence of extra‐testicular pathology, where there is a wider range of SWE and other parameters.

Shear Wave Elastography Acquisition Parameters May Bias Shear Wave Velocity Measurements

ABSTRACT Purpose To determine the effects of acquisition parameters on measured shear wave velocity (SWV) in reference phantoms. Methods SWV were measured on three phantoms of certified SWV 0.794 m/s (Phantom 1), 1.711 m/s (Phantom 2) and 2.500 m/s (Phantom 3). Parameters examined were depth, location, region of interest (ROI) size, transducer type, pitch, frame rate and one‐shot mode. Measurements were repeated 10 times for different levels of each parameter at 1.8 MHz and 2.5 MHz transducer frequency on both Canon Aplio i700 and i800 systems. Statistical analyses were performed using linear mixed models with Holm test for multiple comparisons. Results There was an interaction between acquisition depth and phantom stiffness ( p  < 0.001) with 1 cm of depth increasing SWV by 0.037 and 0.012 m/s in Phantoms 1 and 2 but decreasing SWV by −0.049 m/s in phantom 3. Lateral acquisition box location had increased SWV compared to the middle location (left 0.048 m/s, right 0.065 m/s, p  < 0.001). ROI size (10 mm, 0.002 m/s, p  = 0.846) had no statistically significant effect on SWV. Transducer type at 2.5 cm depth had no significant effect on SWV (linear 0.038 m/s, p  = 0.049). Diff pitch setting of 2 had lower SWV (−0.030 m/s, p  = 0.002). Frame rate had no statistically significant effect on SWV (1 frame per second increasing SWV by 0.037 m/s, p  = 0.025). One‐shot mode had higher SWV than continuous mode by 0.042 m/s ( p  < 0.001). Conclusion Acquisition parameters can have statistically significant effects on measured SWV and may bias measured SWV due to cumulative effects.

In office sampling of eosinophil peroxidase to diagnose eosinophilic chronic rhinosinusitis

Abstract Background Practical biomarkers for endotypic characterization of chronic rhinosinusitis (CRS) remain elusive, hindering clinical utility. Eosinophil peroxidase (EPX) is an enzyme released by activated eosinophils. The objective of this study was to evaluate a clinic EPX assay as a marker of eosinophilic CRS. Methods Subjects with and without CRS presenting to a tertiary care rhinology clinic were prospectively enrolled, and nasal cytology brushings were collected from the middle meatus during in‐clinic nasal endoscopy. ELISA assay was used to quantify EPX levels, and a customized multiplex immunoassay was used to quantify inflammatory cytokine mediators. Findings were correlated with clinical data. Results Forty‐two subjects were enrolled, including 31 CRS subjects and 11 controls. Median EPX levels were 125.0 ng/mL (standard deviation [SD] 1745.8) and 6.5 ng/mL (SD 99.0) for CRS group and controls, respectively ( p  = 0.003). EPX levels were associated with history of asthma ( p  = 0.015), allergies ( p  = 0.028), polyps ( p  = 0.0006), smell loss ( p  = 0.006), and systemic eosinophilia or elevated immunoglobulin E ( p  ≤ 0.0001). Twenty‐eight subjects from both the CRS and control groups had prior pathology for comparison, with histologic confirmation of local tissue eosinophilia (>10 eosinophils/hpf) in 11 subjects. This subgroup had a median EPX level of 967.5 ng/mL compared to 10.6 ng/mL in 17 subjects without local tissue eosinophilia ( p  = 0.0008). EPX levels were positively correlated to interleukin‐5 levels ( p  = 0.0005). Conclusion EPX levels can be measured via well‐tolerated in‐clinic collection of nasal mucus. EPX levels are associated with clinical markers of type 2 inflammation and tissue eosinophilia and may provide a valuable diagnostic tool to delineate eosinophilic CRS.

Letter to the Editor Regarding “Perioperative Adjuvant Therapy With Short Course of Dupilumab With ESS for Recurrent CRSwNP”