ANU Scholarly Output

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The Australian National University's Scholarly output collection is an online location for collecting, preserving and disseminating the scholarly output of the University. This service allows members of the University to share research with the wider community. ANU Open Research accepts journal articles, conference papers, book chapters, working or technical papers and other forms of scholarly communication.

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Now showing 1 - 20 of 37

Embargo
3D laparoscopic partial nephrectomy in Australia: a pilot study
(Wiley-Blackwell Publishing Ltd, 2017) Mare, A; Haxhimolla, Hodo
Introduction and Objectives: Laparoscopic partial nephrectomy is a technically challenging procedure and important limitations with conventional laparoscopy include spatial orientation and depth perception. Three-dimensional (3D) video display has been introduced with robotic surgery, however the higher initial investment and associated running costs accompanying robotic technology makes it not cost-effective in certain centres. We developed a pilot study to compare the clinical outcomes of 3D laparoscopic partial nephrectomy with conventional twodimensional (2D) laparoscopic partial nephrectomy by a single surgeon in the ACT. The aim of this study was to assess whether 3D nephron-sparing laparoscopic surgery has better intraoperative and oncological outcomes compared to conventional 2D nephron-sparing laparoscopic surgery. Methods: Retrospective review of all consecutive patients who underwent laparoscopic partial nephrectomy since the introduction of a 3D video system at National Capital Private Hospital in 2012 under a single surgeon (HH). Clinical outcomes measured were the length of hospital stay, total operative time, blood transfusion, positive surgical margins and tumour margin clearance. These outcomes were measured for those patients that underwent 3D laparoscopic partial nephrectomy (LPN) and compared to historical data by the 110 © 2017 The Authors BJU International © 2017 BJU International | 119, Supplement 2, 82--118 110 Poster Abstracts same surgeon for patients that underwent conventional 2D LPN over the preceding 4 years. Statistical analysis of the data with chi-square and Fisher’s exact test was performed with SPSS v.23.0. Results: 22 patients were included in 3D laparoscopic partial nephrectomy (LPN) cohort with 17 patients included in the 2D LPN cohort. Conclusions: 3D laparoscopic partial nephrectomy is non-inferior to conventional 2D laparoscopic partial nephrectomy in our pilot study. The application of 3D technology in a training setting to decrease the learning curve for inexperienced laparoscopic surgeons is worth investigating.
Embargo
Accuracy and Prognostic Significance of Oncologists' Estimates and Scenarios for Survival Time in A Randomised Phase II Trial of Regorafenib in Advanced Gastric Cancer
(Wiley, 2017) Vasista, A; Martin, Andrew; Pavlakis, N.; Sjoquist, Katrin; Snow, Stephanie; Jonker, Derek J; Chua, YuJo; Epstein, Richard; Bonaventura, Antonino; Khasraw, M; Varma, Suresh
Background: We have proposed that best, worst and typical scenarios for survival, based on simple multiples of an individual's expected survival time (EST) estimated by their oncologist, are a useful way of formulating and explaining prognosis in advanced cancer. We aimed to determine the accuracy and prognostic significance of such estimates in a multicentre, randomised trial. Methods: Sixty‐six oncologists estimated the EST at baseline for each of 152 participants in the INTEGRATE trial. We expected oncologists’ estimates of EST to be well calibrated (∼50% of patients living longer than their EST) and imprecise (<33% living within 0.67–1.33 times their EST), but to provide accurate scenarios for survival time (∼10% dying within a quarter of their EST, ∼10% living longer than three times their EST and ∼50% living for half to double their EST). We hypothesised that oncologists’ estimates of EST would be independently predictive of overall survival in a Cox model including conventional prognostic factors. Results: Oncologists’ estimates of EST were well calibrated (45% shorter than observed), imprecise (29% lived within 0.67–1.33 times observed), and moderately discriminative (Harrell C‐statistic 0.62, P = 0.001). Scenarios derived from oncologists’ estimates were remarkably accurate: 9% of patients died within a quarter of their EST, 12% lived longer than three times their EST and 57% lived within half to double their EST. Oncologists estimates of EST were independently significant predictors of overall survival (HR = 0.89; 95% CI, 0.83–0.95; P = 0.001) in a Cox model including conventional prognostic factors. Conclusions: Oncologists’ estimates of survival time were well calibrated, moderately discriminative and independently significant predictors of overall survival. Best, worst and typical scenarios for survival based on simple multiples of the EST were remarkably accurate and would provide a useful method for estimating and explaining prognosis in this setting.
Open Access
Application of Magnetic Circular Dichroism spectroscopy to the study of the OEC in Photosystem II from cyanobacteria and higher plants.
Morton, Jennifer; Krausz, Elmars; Craig, Vincent; Cox, Nicholas; Smith, Paul; Shen, Jian-Ren
Absorption from the OEC was expected to be too weak to be measured through basic optical spectroscopy, with a molar extinction coefficient of <100, compared to 106 for chlorophyll. We therefore used circular dichroism (CD) and magnetic circular dichroism (MCD) to search for this absorption.
Open Access
Australia's Dynamic Habitat Template 2003
(2004) Mackey, Brendan; Bryan, Jane; Randall, Lucy
Remote sensing of seasonal changes in new biomass produced by vegetation provides insight into spatial and temporal variation in habitat resources for wildlife. The map shows spatial variation in a surrogate measure of relative vegetation productivity for 2003. The analysis is based on three indices calculated from monthly estimates of the fraction of photosynthetically active radiation absorbed by vegetation (fPAR) for the year 2003. These data were generated by the Terra satellite as part of the NASA Earth Orbiting System.
Open Access
Chemoprevention with the metabolism modifying drugs dichloroacetate and metformin in the Li-Fraumeni Syndrome model, Trp53+/- mice
(BioMed Central, 2014-05-28) Blackburn, Anneke; Rooke, Melissa; Li, Yiming; Dahlstrom, Jane; Board, Philip G
BACKGROUND: While genetic testing for familial cancer has excelled, the prevention options for those carrying high risk alleles have not. Altered bioenergetics is now acknowledged as a hallmark of cancer, and several very safe drugs are available that can target this phentoype. Dichloroacetate (DCA) inactivates pyruvate dehydrogenase kinase, resulting in activation of pyruvate dehydrogenase, reduced lactic acid production and increased mitochondrial activity. Metformin, a type 2 diabetes treatment which activates AMPK, thereby inhibiting mTOR, has unambiguously been demonstrated to reduce the risk of many cancer types in diabetics. We have tested these drugs as chemopreventive agents against the mammary tumours that occur in the BALB/c-Trp53+/- mouse spontaneous tumour model. MATERIALS and METHODS Breast cancer cell lines were examined for cell viability after DCA and/or metformin treatment in vitro (neutral red uptake assay). Four groups of female BALB/c-Trp53+/- mice were given distilled water (n=75), DCA (1.5 g/L in drinking water, ~180 mg/ kg/day, n=53), metformin (0.25 g/L in drinking water, ~30 mg/kg/day, n=61) or DCA +metformin (n=51) from 8 weeks of age, and monitored for tumour development over 78 weeks, and Kaplan-Meier survival analysis was performed. RESULTS In vitro, DCA (1-5 mM) and metformin (30-300 uM), alone or combined, significantly inhibited breast cancer cell growth. In vivo, the overall tumour-free survival curves for BALB/c-Trp53+/- mice were not significantly different between treatment groups, suggesting that metformin does not reduce cancer risk in non-diabetics. However, analysis of mammary tumours alone found that DCA reduced the number and increased their latency (28.0% vs 20.8% of mice with mean latency of 55.0 vs 63.8 weeks, untreated vs DCA respectively), whereas metformin had no effect (26.2% of mice, mean latency 54.7 weeks). DCA appeared to eliminate the early onset mammary tumours (latency <52 weeks, p=0.02), while not affecting the occurrence of longer latency tumours. In contrast, the two drug combination had worse outcomes for tumour development, (35.3% of mice, latency 48.8 weeks, p<0.02 compared to DCA alone). Preliminary western blotting results in MDA-MB-468 breast cancer cells found that DCA could block the activation of AMPK by metformin, indicating the potential for drug interactions.
Open Access
Concentration (and transport?) of conodonts in internal sediments in limestone breccias: Silurian-Lower Devonian Chillagoe "Formation", "Bellevue" area, Hodgkinson Province, north Queensland, Australia
(Tipografia Compositori, 1998) Fordham, Barry
An internal sediment has been sampled for conodonts as part of an inquiry (Webb and others, ms.) into the mode of formation of the enclosing breccias. The brecciation appears to be confined to a broad irregular zone within a long (3.5 x 0.25 km) lenticular limestone body within the Silurian-Lower Devonian Chillagoe "Formation"...
Embargo
Critical case analysis of adverse events associated with failure to use interpreters for non-English speaking patients.
(The Australian National University, 2016) Rowse, Janine; Anderson, Katrina Judith; Phillips, Christine; Chan, Brian
Embargo
Determination of Fetal Fat Distribution in Pregnancy and its Correlation with Maternal Subcutaneous Fat and BMI
(Wiley-Blackwell Publishing Asia, 2018) Daly, A; Pineda, Maylene; Nanan, Ralph; Peek, Michael; Quinton, A.E.; Liu, Anthony J. W.; Caroline de Costa
Open Access
Developing and validating an isotrigon texture discrimination task using Amazon Mechanical Turk
(BioMed Central, 2015-12-04) Seamons, John W; Barbosa, Marconi; Victor, Jonathan D; Coy, Dominique; Maddess, Ted
The human visual system must employ mechanisms to minimize informational redundancy whilst maintaining that which is behaviorally relevant [1, 2]. Previous research has concentrated on two-point correlations via spatial frequency and orientation tuning. Higher-order correlations are less studied, but they may inform us about cortical functioning [3]. Isotrigon textures can be used to probe the sensitivity of the human visual system as their structure is exclusively due to 4th and higher-order spatial correlations [4]. Although artificially generated, the same features that give isotrigons salience also create salience in natural images [2]. We implemented an isotrigon discrimination task using the crowdsourcing platform Amazon Mechanical Turk (mTurk) [5]. An important secondary aim was to evaluate the suitability of mTurk for visual psychometric studies as very few exist [6]. 960 HITs were uploaded to mTurk and 121 naïve subjects participated. Based on data quality, 91% of HITs were retained at a cost of $0.132 AUD per HIT. The mTurk data was compared to two supervised lab datasets. Lab and mTurk performance functions were very similar (Figure 1A) and highly correlated (Figure 1B). Bland-Altman plots were examined and the mean lab/mTurk coefficient of repeatability was 15.5%. Factor analysis was performed on the combined data and 2 principal factors were identified. Previous studies support that the number of mechanisms is less than 10 [7] and more likely 2-4 [8, 9]. The congruence between the lab and mTurk data is striking considering the unsupervised mode of delivery. In conclusion, mTurk is an underutilized platform for visual psychometric research which can produce data of comparable quality to lab samples at reduced cost and increased scale.
Open Access
Do cash incentives increase the uptake of chlamydia testing in pharmacies?
(BMJ Publishing Group, 2012) Martin, S. J.; Currie, M. J.; Deeks, L. S.; Cooper, G. M.; Parker, R. M.; Del Rosario, R.; Hocking, J. S.; Bowden, Francis
BACKGROUND: Chlamydia screening uptake rates in Australian and overseas pharmacies vary widely (11% to 58%). AIM: To determine the effect on the uptake of chlamydia screening in community pharmacies when a cash reward is offered to young people and participating pharmacies. METHODS: The study was advertised in print and electronic media. People aged 16–30 years requested, or were offered, chlamydia testing kits by pharmacy staff (assistants and pharmacists). Participants who provided a urine sample and completed a questionnaire received AUD$10; pharmacies received AUD$10 per person recruited. Urine specimens were tested in pools using PCR, with reflex testing of individual samples when the pool tested positive. Positive cases were notified by sexual health nurses and offered treatment. RESULTS: Six urban community pharmacies took part in the study, each for 15 days. 979 testing kits were given out and 970 sample pots returned (99.1%); 66 (7%) did not contain urine. 74% (670/904) of the urine samples were determined to be from unique individuals, 65% of whom were male. 19 people (13 females and 6 males) tested positive; positivity rates were 5.2% (95% CI 2.8 to 8.8) for females and 1.4% for males. 11 (61%) of those testing positive were contacted and eight attended a local sexual health centre for treatment, three were treated elsewhere. Of the eight people treated at the sexual health centre, two females aged 15 and 20 years were diagnosed with pelvic inflammatory disease. Contact with the remaining eight positive individuals was not possible due to disconnected, incorrect or non-existent telephone numbers. CONCLUSION: The 68% specimen return rate found in this study significantly exceeds those reported elsewhere. Strategies to prevent repeat testing, non-urine specimens and incorrect contact numbers are needed to ensure good clinical care and optimum use of resources.
Open Access
Effective data management to promote reproducibility
(The Australian National Centre for the Public Awareness of Science, The Australian National University., 2019-02) Ganguly, Diep; Crisp, Peter; Schwessinger, Benjamin
Embargo
Effectiveness of acute stroke team in a primary health care hospital
(SAGE Publications Ltd, 2016) Jones, B; Patel, Ronak; Siracusa, E; Sahathevan, R; Gawarikar, Yash
Introduction: Studies have shown significant benefit of an acute stroke team (AST) in improving thrombolysis rates, reducing door-to-CT, door-toneedle and in-hospital mortality, but this model is largely adapted by metropolitan tertiary health care hospitals. The benefit of implementing acute stroke service in a primary care hospital is not known. Aim: We undertook an internal audit to evaluate the effectiveness of AST in improving thrombolysis rates, door-to-CT, door-to-needle, length of stay (LOS) and mortality in a primary health care hospital. Methods: Data from 6 months pre and post commencement of AST and stroke unit was collected retrospectively. Results: We identified 152 and 160 patients pre and post commencement of services respectively. There was a 3 fold increase in the number of stroke calls and thrombolysis rates increased from 7.6% to 12.9%. A reduction of 44mins and 20mins was seen in door-to-CT and door-toneedle times respectively. The mean LOS reduced from 8 to 4 days while in-hospital mortality dropped from 12.5% to 6.25%. Failure rate of admission swallow screening improved from 51% to 5%. Cost-benefit analysis showed $600 saving per patient. Conclusions: Our study highlights the advantage of an AST in improving thrombolysis rates, time to treatment, and swallow screening. It reduces LOS and in-hospital mortality and results in an annual saving of has a $96,000. We plan to expand our service after hours and perform a larger prospective study to confirm our findings with the long-term aim of providing service to a wider catchment area.
Open Access
Evidence for ancestry in taxonomic studies: lessons from mid-Cretaceous biserial planktonic foraminifera
(The American Geosciences Institute, 2016-08-27) Fordham, Barry; Huber, Brian T; Haynes, Shannon J
The TimeScale Creator visualization suite accesses an extensive database to draw a wide range of Earth-history events against standard global and regional time-scale charts. It is the prime vehicle for incorporating updates to the International Geologic Time Scale. An evolutionary-tree function has recently been added to TimeScale Creator, allowing trees to be seamlessly scaled against the entire event suite, and to employ built-in visualization features such as continuous zoom to desired levels of precision. Stratigraphic ranges of taxa on the trees can be graded by abundance, color coded by taxonomic or other criteria, and easily recognized by thumbnail images magnified relative to actual size. For each taxon a mouse-over pop-up can display diverse user-chosen text and visuals such as hot-links to external sites, taxonomic information, and labeled images ordered by, e.g., stratigraphic position. This content can be generated from a back-end relational database, which becomes a valuable resource in itself. So, what have been static, stand-alone evolutionary trees, published as text-figures or derived from phylogenetic programs, can become a living resource and knowledge base of evolution and stratigraphy. As part of the on-going development of the TimeScale Creator evolutionary-tree function, a taxonomic study of extraordinarily well-preserved Cenomanian-Coniacian biserial planktic was chosen to assess the relevance of the visualization tool. As the published tree was presented against an up-to-date time scale, conversion to the TimeScale Creator could provide only relatively minor overall improvements to the tree. These included: explicit correlation to other zonations relevant to range determinations referred to in the study; automated labeling of origins of genera; and display of entire stratigraphic ranges for taxa extending higher than the scope of the published tree. The visualization includes several features that provide flexibility for presentation of varying degrees of certainty and access to extra information. Conjectured range extensions are shown to identify stratigraphic intervals that should be targeted for follow-up investigations of species whose ancestor-descendent relationships are not understood. Mouse-over pop-up windows provide quick access to more nuanced stratigraphic information, including detailed comments and references to the relevant literature. Illustrated specimens are displayed in order of location and stratigraphic level within their species pop-up, providing a powerful illustration of infra-specific variation observed up-section. Also, thumbnail images selected for the tree can be magnified relative to actual size; given that size was an important element of the evolution of lineages in this group, this providing a much more pertinent means of display for the tree. Categorization of the evidence for the ancestor–descendant proposals in the visualized tree provided added insights into the published study’s reconstruction of phylogeny. Of more general significance, such an approach could prove to be the beginnings of a template for standard documentation in taxonomic studies employing stratophenetic methods and encourage their incorporation into project planning. Given that e.g. cladistic approaches to phylogeny provide a highly explicit approach to presentation and analysis of evidence, the raising of this issue could prove timely for contemporary biostratigraphic studies wanting to employ stratophenetic approaches.
Open Access
Food policy for future generations: integrating public health and environmental goals [poster]
(2012) Kharis, Ruth; Friel, Sharon
The aim of this research is to identify how well Australian food policy adopts a public health approach and integrates considerations of climate change. In addition, the barriers and opportunities for Australian food policy to achieve a coherent public health and climate change foci will be identified. The specific objectives are to: identify the paradigms and values that exist in the policy community relating to food policy, public health and climate change; map and critically examine the existing policies in each domain (food, health, climate change); describe the actors, processes, power and governance structures that currently exist across the policy domains; develop strategies with which to address the: process and power barriers for developing and implementing Australian food policy; identify opportunities for creating Australian food policy with a coherent public health and climate change approach. This research is timely given the Australian Federal government's current food policy focus with the release of the: draft Australian Dietary Guidelines (NHMRC 2011), National Food Plan Issues paper (DAFF 2011), Food and Health Dialogue (DoHA 2011) and Australia and Food Security in a Changing World (PMSEIC 2010). In addition, it is necessary due to the Australian Federal government's release of the draft Proposed Basin Plan (MDBA 2011) and Carbon Credits (Carbon Farming Initiative) Bill 2011(ComLaw). This poster will provide a summary of the interim literature review's findings, in particular: an assessment of the paradigms and values that exist in the policy community relating to food policy, public health and climate change.
Open Access
Home range size and sleeping site use by the Critically Endangered Cat Ba langurs (Trachypithecus poliocephalus)
(Canberra, ACT : NECTAR, The Australian National University, 2017) Hendershott, Rebecca; Behie, Alison; Rawson, Benjamin M
Home range size and habitat utilisation are affected by access to key resources including food, water and sleeping sites, all of which change seasonally. Limestone langurs (a group within the Trachypithecus genus) live on limestone karst hills with shrubby, stunted, and discontinuous vegetation. This study assesses home range size and sleeping site use in two groups of Critically Endangered Cat Ba langurs (Trachypithecus poliocephalus). Over 180 days of observations, we found that the larger group (n=10-13) had a home range size of 50ha, while the smaller group (n=7) ranged within a 22ha area. There was also a small 5 ha area of home range overlap, which represents 10% of the larger group and 24% of the smaller group’s home range; although this area was not used at the same time. Home range sizes increased in the wet season, which may for fruit, which is eaten more at this time of year. Most sleeping sites were ledges (61%) followed by caves (17%), however the caves that were used seemed to be preferentially chosen. Sleeping sites did not vary seasonally. The lack of reuse on consecutive nights indicates they may be chosen to provide safety from predators (primarily study of this highly threatened species to assess patterns of home range use and sleeping sites. This is key to conservation management plan-ning as it can provide a measure of habitat use, which has implications long term viability.
Metadata only
HST Observations of a z = 2.38 Galaxy Cluster
(Space Telescope Science Institute Symposium, 2000) Williger, G.; Francis, Paul; Collins, N.; Malumuth, E.; Teplitz, H.; Woodgate, B.
Open Access
Hydrogenation in doped poly-Si passivated contact solar cells
(2018-12-06) Truong, Thien; Nguyen, Hieu
In c-Si solar cells, doped poly-Si/SiOx stacks both form carrier selective junctions and provide excellent surface passivation. They are key components of novel passivating-contact solar cell structures.  The doped poly-Si films often contain a high density of defects which can potentially affect the quality of the passivating-contact structures and thus the overall performance of the solar cells.  Hydrogenation techniques could be used to passivate defects within the doped poly-Si films themselves to improve the overall performance of doped poly-Si/SiOx passivating contacts. Here, we explore such possibilities
Open Access
‘*iCu’ in Australia: Phonotactics beyond the syllable level
(2017-12-13) Nash, David
Phonotactic typology can extend to (intramorphemic) vowel patterns beyond the syllable level. Many Australian languages more or less avoid the iCu sequence, and prefer iCi and uCu.
Embargo
Increased non-shivering thermogenesis had preventive but no therapeutic effects on non-alcoholic steatohepatitis
(Elsevier B.V, 2017) Poekes, Laurence; HORSMANS, YVES; Farrell, Geoffrey; Leclercq, Isabelle A
Background and Aims: Non-alcoholic steatohepatitis (NASH) is the progressive form of non-alcoholic fatty liver disease spectrum. No treatment has been proven efficacious except for lifestyle modifications coupling physical exercise with weight reduction. We recently identified defective adaptive thermogenesis as a contributing factor to obesity and metabolic syndrome in foz/foz mice. We now aim to test whether increased non-shivering thermogenesis prevent and/or improve pre-existing NASH in mice. Methods: A HFD for 4 or 8weeks induced a metabolic syndromewith fatty liver or NASH, respectively in male foz/foz mice. Mice were randomized and treated with a beta 3-adrenergic receptor (B3AR) POSTER PRESENTATIONS Journal of Hepatology 2017 vol. 66 | S333–S542 S433 agonist (CL-316,243–1mg/kg/day) to enhance thermogenic capacities or with vehicle (untreated) together with HFD for 2 or 4 weeks, respectively. C57Bl6 and db/db mice were fed a methionine and choline deficient (MCD) diet to induce NASH and treated with B3AR agonist for 4 additional weeks (n = 6–8/group). Results: In foz/foz mice with metabolic syndrome and liver steatosis, B3AR agonist improved brown adipose tissue (BAT) function assessed by increased cAMP and UCP1 BAT contents and upregulation of thermogenic genes (UCP1, DIO2). It also caused browning of white adipose tissue. All this resulted in increased tolerance to cold exposure and was associated with a better glucose tolerance (p < 0.05), a decreased NAS score (2 ± 1.3 vs 3.7 ± 1.6; p < 0.05) and decreased transaminases levels (p < 0.05) with no change in body weight. When treatment was initiated after the onset of NASH (NAS score = 5 ± 1.15) in foz/foz mice, B3AR agonist treatment restored BAT function, induced a slight 2%weight loss (p < 0.05), increased glucose tolerance (p < 0.001) but had no on impact liver pathology (NAS score 5.6 ± 2.1 vs 6.7 ± 1.3; ALT 286 ± 117 vs 396 ± 190 U/L) compared to untreated mice. Similarly, B3AR agonist has no therapeutic effect when administrated for 4 weeks on MCD-induced NASH whether in C57Bl6 or in obese and diabetics db/db mice. Conclusions: B3AR agonist treatment improved BAT function and glucose tolerance, prevented the progression of a simple steatosis to NASH but was not sufficient to cure a pre-established NASH, supporting previous observation that control over metabolic syndrome is insufficient to treat NASH. In our study, B3AR agonist caused no major weight loss and therefore, it will be of interest to evaluate whether BAT stimulation offers an additional advantage over weight loss therapy in NASH management.
Embargo
Influence of Climate Variables on the Rising Incidence of Nontuberculous Mycobacterial (NTM) Infections in Queensland, Australia 2001-2016
(American Thoracic Society, 2019-05) Thomson, R.; Furuya-Kanamori, Luis; Coffey, Cushla; Bell, S.; Knibbs, Luke; Lau, Colleen
Reports from different countries indicate a rising incidence of NTM pulmonary disease. Many infectious diseases have seasonal variation in incidence and major weather events and climate change have been implicated in disease emergence and outbreaks. The aim of this study was to describe the incidence of NTM infection in Queensland, Australia over a 16 year period and to explore the relationship between climate variables and NTM notifications.Methods: NTM data were obtained from the Queensland notifiable conditions database for the period 2001-2016. Data on average rainfall and temperature were obtained from the Australian Bureau of Meteorology. Poisson regressions models were built to model the notification rates per 100,000 population over time and to estimate the incidence rate ratios (IRR) by sex, age, and Hospital and Health service (HHS) district. Analyses were conducted for total NTM notifications, individual NTM species, and for all slow-(SGM) and all rapid-growing NTM (RGM) species for differences in notification rates by sex, age, and HHS over time. Cross correlation coefficients were used to examine the relationship between rainfall and temperature data and NTM incidence over time in each HHS. Results: 12,219 cases of NTM were reported. The most common species were M. intracellulare, followed by M. avium, M abscessus, M. fortuitum, M. chelonae, and M. kansasii. The estimated incidence rate increased from 11.10 (2001) to 25.88 per 100,000 (2016). The estimated IRR increased for all common NTM species, except M. kansasii which remained stable. Each NTM species showed a similar pattern in patients’ sex and age; the highest IRR was observed among patients aged 50-79 years. Although increased IRRs were observed for most NTM species, geospatial heterogeneity was observed. Overall NTM incidence increased 9 months after the rainy season in the north; SGM notifications increased 8-10 months after rainfall increased, however 6 months after increased rainfall, RGM notifications decreased. Three months after an increase in rainfall, NTM incidence decreased in the west (predominantly M. avium). Variation in temperature was not found to be associated with overall NTM incidence; however, M. abscessus incidence decreased 6 months after an increase in temperature in the north. M. intracellulare incidence was not associated with rainfall or temperature in any region. Conclusions: The incidence of NTM infections increased from 2001-2016. Variations in rainfall may play a role in environmental exposure to some species of NTM. Spatial variation in IRR suggest that there may also be other environmental drivers of transmission.

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