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Huang X, Choi KS, Liang S, Zhang Y, Zhang Y, Poon S, Pedrycz W. Frequency Domain Channel-Wise Attack to CNN Classifiers in Motor Imagery Brain-Computer Interfaces. IEEE Trans Biomed Eng 2024; 71:1587-1598. [PMID: 38113159 DOI: 10.1109/tbme.2023.3344295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE Convolutional neural network (CNN), a classical structure in deep learning, has been commonly deployed in the motor imagery brain-computer interface (MIBCI). Many methods have been proposed to evaluate the vulnerability of such CNN models, primarily by attacking them using direct temporal perturbations. In this work, we propose a novel attacking approach based on perturbations in the frequency domain instead. METHODS For a given natural MI trial in the frequency domain, the proposed approach, called frequency domain channel-wise attack (FDCA), generates perturbations at each channel one after another to fool the CNN classifiers. The advances of this strategy are two-fold. First, instead of focusing on the temporal domain, perturbations are generated in the frequency domain where discriminative patterns can be extracted for motor imagery (MI) classification tasks. Second, the perturbing optimization is performed based on differential evolution algorithm in a black-box scenario where detailed model knowledge is not required. RESULTS Experimental results demonstrate the effectiveness of the proposed FDCA which achieves a significantly higher success rate than the baselines and existing methods in attacking three major CNN classifiers on four public MI benchmarks. CONCLUSION Perturbations generated in the frequency domain yield highly competitive results in attacking MIBCI deployed by CNN models even in a black-box setting, where the model information is well-protected. SIGNIFICANCE To our best knowledge, existing MIBCI attack approaches are all gradient-based methods and require details about the victim model, e.g., the parameters and objective function. We provide a more flexible strategy that does not require model details but still produces an effective attack outcome.
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van der Weerden NL, Parisi K, McKenna JA, Hayes BM, Harvey PJ, Quimbar P, Wevrett SR, Veneer PK, McCorkelle O, Vasa S, Guarino R, Poon S, Gaspar YM, Baker MJ, Craik DJ, Turner RB, Brown MB, Bleackley MR, Anderson MA. The Plant Defensin Ppdef1 Is a Novel Topical Treatment for Onychomycosis. J Fungi (Basel) 2023; 9:1111. [PMID: 37998916 PMCID: PMC10672221 DOI: 10.3390/jof9111111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023] Open
Abstract
Onychomycosis, or fungal nail infection, causes not only pain and discomfort but can also have psychological and social consequences for the patient. Treatment of onychomycosis is complicated by the location of the infection under the nail plate, meaning that antifungal molecules must either penetrate the nail or be applied systemically. Currently, available treatments are limited by their poor nail penetration for topical products or their potential toxicity for systemic products. Plant defensins with potent antifungal activity have the potential to be safe and effective treatments for fungal infections in humans. The cystine-stabilized structure of plant defensins makes them stable to the extremes of pH and temperature as well as digestion by proteases. Here, we describe a novel plant defensin, Ppdef1, as a peptide for the treatment of fungal nail infections. Ppdef1 has potent, fungicidal activity against a range of human fungal pathogens, including Candida spp., Cryptococcus spp., dermatophytes, and non-dermatophytic moulds. In particular, Ppdef1 has excellent activity against dermatophytes that infect skin and nails, including the major etiological agent of onychomycosis Trichophyton rubrum. Ppdef1 also penetrates human nails rapidly and efficiently, making it an excellent candidate for a novel topical treatment of onychomycosis.
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Sierla R, Dylke E, Poon S, Shaw T, Kilbreath S. Attaining consensus on a core dataset for upper limb lymphoedema using the Delphi method: A foundational step in creating a clinical support system. HEALTH INF MANAG J 2023:18333583231188396. [PMID: 37653585 DOI: 10.1177/18333583231188396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Lymphoedema is a condition of localised swelling caused by a compromised lymphatic system. The protein-rich fluid accumulating in the interstitial tissue can create inflammation and irreversible changes to the skin and underlying tissue. An array of methods has been used to assess and report these changes. Heterogeneity is evident in the clinic and in the literature for the domains assessed, outcomes and outcome measures selected, measurement protocols followed, methods of analysis, and descriptors used to report change. Objective: This study seeks consensus on the required items for inclusion in a core data set for upper limb lymphoedema to digitise the monitoring and reporting of upper limb lymphoedema. Methods: The breadth of outcomes and descriptors in common use were captured in prior studies by this research group. This list was refined by frequency and proposed to experts in the field (n = 70) through a two-round online modified Delphi study. These participants rated the importance of each item for inclusion in the dataset and identified outcomes or descriptors they felt were missing in Round 1. In Round 2, participants rated any new outcomes or descriptors proposed and preference for how numeric data is displayed. Results: The core dataset was confirmed on completion of Round 2. Interlimb difference as a percentage, and limb volume were preferred for graphed display over time; and descriptors for observed and palpated change narrowed from 42 to 20. Conclusion: This dataset provides the foundation to create a clinical support system for upper limb lymphoedema.
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Iuliano S, Poon S, Robbins J, Wang X, Bui M, Seeman E. Provision of High Protein Foods Slows the Age-Related Decline in Nutritional Status in Aged Care Residents: A Cluster-Randomised Controlled Trial. J Nutr Health Aging 2023; 27:166-171. [PMID: 36806871 DOI: 10.1007/s12603-022-1868-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Malnutrition, particularly protein insufficiency, is common in institutionalised older adults and increases morbidity, mortality, and costs. We aimed to determine whether 12 months supplementation using high-protein foods (milk, cheese, yoghurt) prevents malnutrition in older adults. DESIGN Cluster randomised control study. SETTING Sixty Australian aged care facilities. PARTICIPANTS Older adults living in aged care homes (n=654, mean age 86.7±7.2 years, 72% females). Intervention Facilities randomly allocated to a high-protein (n=30 intervention) or regular (n=30 controls) menu. MEASUREMENTS Nutritional status assessed using the Mini Nutrition Assessment (MNA) tool and fasting morning blood samples (n=302) assayed for haemoglobin (Hb) and albumin. Food intake was monitored 3-monthly using visual plate waste assessment. Measurements at baseline and month 12 were analysed using random effects model accounting for clustering (facility), repeated measure and confounders. RESULTS Addition of 11g of protein as 1.5 servings of high-protein foods daily preserved nutritional status that deteriorated in controls [MNA screen (-0.68, 95%CI: -1.03, -0.32, p<0.001) and total (-0.90, 95%CI: -1.45, -0.35, p=0.001) scores], resulting in group differences in MNA screen (0.62, 95%CI: 0.17, 1.06, p=0.007) and total (0.81, 95%CI: 0.11, 1.51, p=0.023) scores and group difference in Hb (3.60g/L, 95%CI: 0.18, 7.03, p=0.039), the net result of preservation with intervention (0.19g/L, 95%CI: -2.04, 2.42, p=0.896) and a decline in controls (-3.41g/L, 95%CI: -6.01, -0.82, p=0.010). No group differences were observed for serum albumin. CONCLUSION Consumption of high-protein foods is a pragmatic approach to maintaining nutritional status in older adults in aged-care.
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Gewarges M, Sklar J, Wilkinson K, Gentilin A, McLean B, Hajjaj O, Worme M, Lalonde S, Patel R, Lin Y, Callum J, Poon S. PUMPING IRON: A QUALITY IMPROVEMENT STUDY FOR THE TREATMENT OF IRON DEFICIENCY ANEMIA IN AMBULATORY HEART FAILURE PATIENTS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Lindsay P, Anderson K, Ducharme A, Lee D, McKelvie R, Poon S, Desmarais O, Desbiens M, Virani S. THE STATE OF HEART FAILURE SERVICES IN CANADA: FINDINGS OF THE HEART & STROKE NATIONAL HEART FAILURE RESOURCES AND SERVICES INVENTORY. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Iuliano S, Poon S, Robbins J, Bui M, Wang X, De Groot L, Van Loan M, Zadeh AG, Nguyen T, Seeman E. Effect of dietary sources of calcium and protein on hip fractures and falls in older adults in residential care: cluster randomised controlled trial. BMJ 2021; 375:n2364. [PMID: 34670754 PMCID: PMC8527562 DOI: 10.1136/bmj.n2364] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To assess the antifracture efficacy and safety of a nutritional intervention in institutionalised older adults replete in vitamin D but with mean intakes of 600 mg/day calcium and <1 g/kg body weight protein/day. DESIGN Two year cluster randomised controlled trial. SETTING 60 accredited residential aged care facilities in Australia housing predominantly ambulant residents. PARTICIPANTS 7195 permanent residents (4920 (68%) female; mean age 86.0 (SD 8.2) years). INTERVENTION Facilities were stratified by location and organisation, with 30 facilities randomised to provide residents with additional milk, yoghurt, and cheese that contained 562 (166) mg/day calcium and 12 (6) g/day protein achieving a total intake of 1142 (353) mg calcium/day and 69 (15) g/day protein (1.1 g/kg body weight). The 30 control facilities maintained their usual menus, with residents consuming 700 (247) mg/day calcium and 58 (14) g/day protein (0.9 g/kg body weight). MAIN OUTCOME MEASURES Group differences in incidence of fractures, falls, and all cause mortality. RESULTS Data from 27 intervention facilities and 29 control facilities were analysed. A total of 324 fractures (135 hip fractures), 4302 falls, and 1974 deaths were observed. The intervention was associated with risk reductions of 33% for all fractures (121 v 203; hazard ratio 0.67, 95% confidence interval 0.48 to 0.93; P=0.02), 46% for hip fractures (42 v 93; 0.54, 0.35 to 0.83; P=0.005), and 11% for falls (1879 v 2423; 0.89, 0.78 to 0.98; P=0.04). The risk reduction for hip fractures and falls achieved significance at five months (P=0.02) and three months (P=0.004), respectively. Mortality was unchanged (900 v 1074; hazard ratio 1.01, 0.43 to 3.08). CONCLUSIONS Improving calcium and protein intakes by using dairy foods is a readily accessible intervention that reduces the risk of falls and fractures commonly occurring in aged care residents. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613000228785.
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Liu Y, Evans L, Kwan T, Callister J, Poon S, Byth K, Harnett P. Developing a maturity model for cancer multidisciplinary teams. Int J Med Inform 2021; 156:104610. [PMID: 34649110 DOI: 10.1016/j.ijmedinf.2021.104610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 09/11/2021] [Accepted: 09/30/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Multidisciplinary teams (MDTs) are considered the "gold standard" of care for patients with cancer but how well they function and the role they play in decision making varies widely. Although several observational tools have been developed to evaluate MDT performance, they are resource intensive and only assess MDT performance at a static point in time. The aim of this study was to develop a validated maturity model as a self-assessment instrument for MDTs to evaluate their performance and monitor improvement over time. METHODS The authors used a three-phase methodology to develop a maturity model. In the first phase, using a modified Delphi technique, we identified 20 indicators (within five components), each having five levels of maturity [1]. In the second phase, further Delphi iterations were undertaken to refine the content and structure of the model. By the end of the second phase six components and 17 indicators had been established. In the third phase, the refined model was distributed to members from 11 MDTs to test for validity and reliability. 101 valid responses were received. Principal Component Analysis was used to determine the optimal number of components that fit the indicators. Factors with eigenvalue greater than one were extracted. Cronbach's alpha (α) was used to measure the internal consistency of components. Bivariate correlation analysis, measuring pair-wise relationships between indicators (r), was undertaken to assess convergent and discriminant validity. RESULTS Five factors were extracted from Principal Component Analysis. For the factors extracted, 16 out of 17 indicators showed loadings greater than the 0.4 threshold. All components demonstrated good levels of internal consistency (α > 0.8) and convergent validity (r > 0.6). Discriminant validity cannot be established. Ratings for ease of use (3.6/5) and usefulness (3.4/5) were considered acceptable. CONCLUSIONS Further work is required to establish discriminant validity and refine the components and indicators. Once further refinement and validation are completed, the maturity model should be a simple tool for MDTs to measure their performance and monitor improvement over time.
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Vaghasiya MR, Penm J, Kuan KKY, Gunja N, Liu Y, Kim ED, Petrina N, Poon S. Implementation of an Electronic Medication Management System in a large tertiary hospital: a case of qualitative inquiry. BMC Med Inform Decis Mak 2021; 21:226. [PMID: 34315447 PMCID: PMC8314474 DOI: 10.1186/s12911-021-01584-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitals across Australia are implementing Clinical Information Systems, e.g. Electronic Medication Management Systems (EMMS) at a rapid pace to moderate health services. The benefits of the EMMS depend on the acceptance of the system by the clinicians. The study hospital used a unique patient-centric implementation strategy that was based on the guiding principle of "one patient, one chart" to avoid a patient being on a hybrid medication chart. This paper aims to study the factors facilitating or hindering the adoption of the EMMS as viewed by clinicians and the implementation team. METHODS Four focus groups (FG), one each for (1) doctors, (2) nurses, (3) pharmacists, and (4) implementation team, were conducted. A guide for the FG was based on the Unified Theory of Acceptance and Use of Technology (UTAUT). RESULTS A total of 23 unique subthemes were identified and were grouped into five main themes (1) implementation strategy, (2) organisational outcome of EMMS, (3) individual impact of EMMS, (4) IT product, and (5) organisational culture. Clinicians reported improvement in their workflow efficiency post-EMMS implementation. They also reported some challenges in using the EMMS that centered around the area of infrastructure, technical and design issues. Additionally, the implementation team highlighted two crucial factors influencing the success of EMMS implementation, namely: (1) the patient-centric implementation strategy, and (2) the organisation readiness. CONCLUSION Overall, this study outlines the implementation process of the EMMS in a large healthcare facility from the clinicians' and the implementation team's perspectives using UTAUT model. The result suggests that clinicians' acceptance of the EMMS was highly influenced by the unique implementation strategy (namely, patient-centric approach and clinical leadership in the implementation team). Whereas the level of adoption of EMMS by clinicians was determined by their level of perceived and realised benefits. On the other hand, a number of barriers to the adoption of EMMS were discovered, namely, general training instead of customised training based on local needs, technical and design issues and lack of availability of computer systems. It is suggested that promptly resolving these issues can improve the adoption of the EMMS.
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Wong ELY, Ho KF, Dong D, Cheung AWL, Yau PSY, Chan EYY, Yeoh EK, Chien WT, Chen FY, Poon S, Zhang Q, Wong SYS. Compliance with Standard Precautions and Its Relationship with Views on Infection Control and Prevention Policy among Healthcare Workers during COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073420. [PMID: 33806138 PMCID: PMC8038100 DOI: 10.3390/ijerph18073420] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/23/2021] [Accepted: 03/23/2021] [Indexed: 12/20/2022]
Abstract
Background: Standard precautions prevent the spread of infections in healthcare settings. Incompliance with infection control guidelines of healthcare workers (HCWs) may increase their risk of exposure to infectious disease, especially under pandemics. The purpose of this study was to assess the level of compliance with the infection prevention and control practices among HCWs in different healthcare settings and its relationship with their views on workplace infection control measures during the COVID-19 pandemic. Methods: Nurses in Hong Kong were invited to respond to a cross-sectional online survey, in which their views on workplace infection and prevention policy, compliance with standard precautions and self-reported health during pandemics were collected. Results: The respondents were dissatisfied with workplace infection and prevention policy in terms of comprehensiveness (62%), clarity (64%), timeliness (63%), and transparency (60%). For the protective behavior, the respondents did not fully comply with the standard precautions when they were involved in medical care. Their compliance was relatively low when having proper patient handling (54%) and performing invasive procedures (46%). A multivariate analysis model proved that the level of compliance of the standard precautions was positively associated with the satisfaction on infection control and prevention policy among high risk group (0.020; 95% CI: 0.005–0.036), while older respondents had higher level of compliance among the inpatient and outpatient groups (coefficient range: 0.065–0.076). The higher level of compliance was also significantly associated with working in designated team and having chronic condition of the respondents among high-risk and inpatient groups. Conclusions: Standard precautions are the most important elements to reduce cross-transmission among HCWs and patients while the satisfaction on infection control and prevention policy would increase the compliance among the high-risk group. An overall suboptimal compliance and poor views on the infection prevention and control guidelines is a warning signal to healthcare system especially during pandemics.
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Wang Z, Poon J, Wang S, Sun S, Poon S. A novel method for clinical risk prediction with low-quality data. Artif Intell Med 2021; 114:102052. [PMID: 33875163 DOI: 10.1016/j.artmed.2021.102052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 02/16/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
In real-world data, predictive models for clinical risks (such as adverse drug reactions, hospital readmission, and chronic disease onset) are constantly struggling with low-quality issues, namely redundant and highly correlated features, extreme category imbalances, and most importantly, a large number of missing values. In most existing work, each patient is represented as a value vector with the fixed-length from some feature space, and missing values are forced to be imputed, which introduces much noise for prediction if the data set is highly incomplete. Besides, other challenges are either remaining unresolved or only partially solved when modeling, but without a systematic approach. In this paper, we propose a novel framework to address these low-quality problems, that we first treat patients as bags with the various number of feature-value pairs, called instances, and map them to an embedding space through our proposed feature embedding method to learn from it directly. In this way, predictive models can avoid the negative impact of missing data naturally. A novel multi-instance neural network is then connected, using two computational modules to deal with the problems of correlated and redundant features: multi-head attention and attention-based multi-instance pooling. They are capable of capturing the instance correlations and locating valuable information in each instance or bag. The feature embedding and multi-instance neural network are parameterized and optimized jointly in an end-to-end manner. Moreover, the training process is under both main and auxiliary supervision with focal loss functions to avoid the caveat of a highly imbalanced label set. This proposed framework is named AMI-Net3. We evaluate it on three suitable data sets from real-world settings with different clinical risk prediction tasks: adverse drug reaction of risperidone, schizophrenia relapse, and invasive fungi infection, respectively. The comprehensive experimental results demonstrate the effectiveness and superiority of our proposed method over competitive baselines.
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Sierla R, Dylke ES, Shaw T, Poon S, Kilbreath SL. Clinician Assessment of Upper Limb Lymphedema: An Observational Study. Lymphat Res Biol 2020; 19:159-164. [PMID: 32986511 DOI: 10.1089/lrb.2020.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Background: Clinical management of lymphedema requires assessment, initially for detection, and then for determining treatment response and informing the treatment plan. It is unknown how the components of a lymphedema assessment are used in a clinical environment. Methods and Results: Experienced lymphedema therapists were observed assessing patients presenting with new or existing upper body lymphedema. Occupational and physiotherapists specializing in lymphedema management (n = 14) from public and private, rural and urban settings in Australia were visited at their work sites and observed with a minimum of two patients. In total, 37 upper limb assessments were observed. Reasons for attendance included: initial assessment with new swelling (n = 4); screening/detection for possible lymphedema (n = 3); bandaging as part of an intensive treatment program (n = 2); and review (n = 28). Clinicians were observed, in order of frequency, using (1) patient-reported outcomes, (2) palpation, (3) visual assessment, (4) assessment of limb size using circumference measurements, and (5) assessment of extracellular fluid using bioimpedance spectroscopy. Although clinicians selected similar assessments, differences were observed in the measurement protocols and informed reported. Objective assessment was commonly absent when the time available for an appointment was 30 minutes. Conclusions: While clinicians spent a significant portion of an appointment time assessing the limb, a standardized approach to the assessment of lymphedema was not observed. In the absence of a standardized assessment set, therapists have developed bespoke assessment routines.
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Sierla R, Dylke ES, Shaw T, Poon S, Kilbreath SL. Assessment of Upper Limb Lymphedema: A Qualitative Study Exploring Clinicians' Clinical Reasoning. Lymphat Res Biol 2020; 19:151-158. [PMID: 32808861 DOI: 10.1089/lrb.2020.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: A variety of objective and subjective assessments are available for clinical assessment of lymphedema. The aim of this study was to explore the clinical reasoning underpinning the assessment of upper limb lymphedema by experienced lymphedema clinicians. Methods and Results: Semistructured, individual, interviews were conducted with lymphedema therapists (n = 14) from a variety of treatment settings. These interviews were conducted after observations of these therapists assessing patients with lymphedema and focused on: (1) the therapists' rationale for the assessments selected, (2) how the data were analyzed, and (3) how the information was then used. Assessment selection was guided by the purpose of the visit, patient preference, resources, and time available. Subjective measures of visible and palpated tissue changes were used to target treatment, and objective measures of circumference and bioimpedance spectroscopy and patient report of symptoms informed treatment evaluation and disease progression. Objective data collected were primarily analyzed for interlimb difference and change between appointments. Conclusions: A range of clinical assessments were used in the evaluation of lymphedema to detect the presence of lymphedema, estimate the extent of soft tissue change, understand the patient experience of lymphedema, and evaluate treatment response. A primary determinant for the collection of objective measures was the appointment duration. Current methods of data analysis and reporting do not facilitate the review of change over time.
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Parisi K, Poon S, Renda RF, Sahota G, English J, Yalpani N, Bleackley MR, Anderson MA, van der Weerden NL. Improving the Digestibility of Plant Defensins to Meet Regulatory Requirements for Transgene Products in Crop Protection. FRONTIERS IN PLANT SCIENCE 2020; 11:1227. [PMID: 32922418 PMCID: PMC7456892 DOI: 10.3389/fpls.2020.01227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/27/2020] [Indexed: 06/01/2023]
Abstract
Despite the use of chemical fungicides, fungal diseases have a major impact on the yield and quality of plant produce globally and hence there is a need for new approaches for disease control. Several groups have examined the potential use of antifungal plant defensins for plant protection and have produced transgenic plants expressing plant defensins with enhanced resistance to fungal disease. However, before they can be developed commercially, transgenic plants must pass a series of strict regulations to ensure that they are safe for human and animal consumption as well as the environment. One of the requirements is rapid digestion of the transgene protein in the gastrointestinal tract to minimize the risk of any potential allergic response. Here, we examine the digestibility of two plant defensins, NaD1 from Nicotiana alata and SBI6 from soybean, which have potent antifungal activity against major cereal pathogens. The native defensins were not digestible in simulated gastrointestinal fluid assays. Several modifications to the sequences enhanced the digestibility of the two small proteins without severely impacting their antifungal activity. However, these modified proteins did not accumulate as well as the native proteins when transiently expressed in planta, suggesting that the protease-resistant structure of plant defensins facilitates their stability in planta.
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Evans L, Liu Y, Kwan T, Callister J, Byth K, Poon S, Harnett PR. Developing a performance matrix for multidisciplinary teams. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e19200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e19200 Background: While multidisciplinary teams (MDTs) are considered the “gold standard” of care for cancer patients, their performance varies widely. This study aimed to develop a user friendly, reliable and valid self-assessment tool for MDTs to evaluate their performance and monitor improvement over time. Methods: Using maturity modelling methodology, key themes from the literature were developed into a 2-dimensional matrix comprising 17 indicators (within 6 components) across 5 levels of performance. A modified Delphi methodology (where 38 MDT members each assigned the contents to components and performance levels using card sorting software) was used to establish face and content validity. A 10 minute on-line version of the matrix was piloted across 11 MDTs. Each participant estimated where they thought the MDT performed for each indicator. Correlation and factor analyses examining convergent and discriminant validity were conducted using SPSS. Cronbach alpha was used to measure internal consistency and evaluate reliability. Ease of use and usefulness were also examined. Results: A total of 109 members completed the matrix, with representation from medical, nursing and allied health professionals. The mean results for each indicator are shown below (maximum 5). Overall results for the different teams varied from 1.2 to 4.2, with standard deviations ranging from 0.4 to 0.8. Conclusions: This matrix has the potential to be a simple, valid and reliable tool for MDTs to measure their performance and monitor improvement over time. The tool will now be refined and then disseminated to a wider audience for further validation and feedback. [Table: see text]
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Gupta J, Patrick J, Poon S. Clinical Safety Incident Taxonomy Performance on C4.5 Decision Tree and Random Forest. Stud Health Technol Inform 2019; 266:83-88. [PMID: 31397306 DOI: 10.3233/shti190777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The paper applies an artificial intelligence centered method to classify 12 clinical safety incident (CSI) classes. The paper aims to establish a taxonomy that classifies the CSI reports into their correct classes automatically and with high accuracy. The study investigates feasibility of applying the C4.5 decision tree (DT) classifier and the random forest (RF) classifier for this purpose. The classifiers were trained using randomly selected 3600 CSIs from an Incident Information Management System (IIMS) used by seven hospitals. The taxonomies investigated were the Generic Reference Model (GRM) and the World Health Organization (WHO) patient safety classification. The classifiers trained 13 GRM CSI classes and 9 WHO CSI classes using a bag-of-words approach. The overall taxonomies performance on the RF classifier was better than on the DT classifier. The performance achieved by the classifier applying the WHO taxonomy was better than the GRM taxonomy. Four of the five poorly performing classes in the GRM taxonomy significantly improved their performance on changing the taxonomy. To improve the WHO taxonomy performance the improved WHO (WHO-I) taxonomy was built by adding a new class that did not exist in WHO but existed in GRM. The performance of the RF classifier applied to the WHO-I taxonomy further improved.
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Jackson MA, Yap K, Poth AG, Gilding EK, Swedberg JE, Poon S, Qu H, Durek T, Harris K, Anderson MA, Craik DJ. Rapid and Scalable Plant-Based Production of a Potent Plasmin Inhibitor Peptide. FRONTIERS IN PLANT SCIENCE 2019; 10:602. [PMID: 31156672 PMCID: PMC6530601 DOI: 10.3389/fpls.2019.00602] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/24/2019] [Indexed: 05/03/2023]
Abstract
The backbone cyclic and disulfide bridged sunflower trypsin inhibitor-1 (SFTI-1) peptide is a proven effective scaffold for a range of peptide therapeutics. For production at laboratory scale, solid phase peptide synthesis techniques are widely used, but these synthetic approaches are costly and environmentally taxing at large scale. Here, we developed a plant-based approach for the recombinant production of SFTI-1-based peptide drugs. We show that transient expression in Nicotiana benthamiana allows for rapid peptide production, provided that asparaginyl endopeptidase enzymes with peptide-ligase functionality are co-expressed with the substrate peptide gene. Without co-expression, no target cyclic peptides are detected, reflecting rapid in planta degradation of non-cyclized substrate. We test this recombinant production system by expressing a SFTI-1-based therapeutic candidate that displays potent and selective inhibition of human plasmin. By using an innovative multi-unit peptide expression cassette, we show that in planta yields reach ~60 μg/g dry weight at 6 days post leaf infiltration. Using nuclear magnetic resonance structural analysis and functional in vitro assays, we demonstrate the equivalence of plant and synthetically derived plasmin inhibitor peptide. The methods and insights gained in this study provide opportunities for the large scale, cost effective production of SFTI-1-based therapeutics.
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Gunja N, Dunlop I, Vaghasiya M, Kuan K, Poon S. Patient-centric implementation of an electronic medication management system at a tertiary hospital in Western Sydney. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:169-175. [PMID: 30398460 DOI: 10.14236/jhi.v25i3.1005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/01/2018] [Accepted: 04/30/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Traditional implementations of electronic medication management (EMM) systems have involved two common formats - a 'big bang' approach on the day of go-live, or a phased ward-by-ward approach over months. OBJECTIVE To describe the patient-centric roll-out, a novel implementation model in converting from paper to EMM. METHOD This model iteratively converted a large tertiary teaching hospital to electronic from paper medication charts, commencing the roll-out in the emergency department (ED). The tenet of 'one patient, one chart' was maintained with new patients commenced on EMM, while existing inpatients were maintained on paper charts until their discharge. In the second week, all other intake points commenced patients on EMM, and in the third week, all remaining patients were manually converted to EMM. The implementation was assessed with training completion rates, staff satisfaction surveys, focus group interviews and incident logs. RESULTS At go-live, 79% of doctors, 68% of nurses and 90% of pharmacists were trained in the EMM system. The ED converted to electronic prescribing within 24 hours; by day 20, all patients were on EMM. Two hundred and thirty issues were logged, none critical, of which 22 were escalated. Of the 51,063 medications administered, there were 13 EMM-related clinical incidents including three double dosing errors, none of which led to an adverse event or death. Overall, 77% of staff surveyed were satisfied with the EMM implementation. CONCLUSIONS The patient-centric roll-out model represents an innovative and safe approach with a single medication chart reducing transcription and improved medication safety for the patient and the organisation.
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Gorji N, Zador Z, Poon S. A Configurational Analysis of Risk Patterns for Predicting the Outcome After Traumatic Brain Injury. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2017:780-789. [PMID: 29854144 PMCID: PMC5977564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Exploring relationships between admission variables and outcome using regression models has been the focus of Traumatic Brain Injury (TBI) research. Although practical and well established, these approaches do not evaluate interactions between predictors. We therefore applied a set-theoretic logical analysis to the Corticosteroid Randomization after Significant Head Injury (CRASH) trial database. Complete data analysis of 6945 patients demonstrated 9 different configurations of admission variables were sufficient for favorable outcome in 87.5% of all cases and explained 57% of favorable outcomes (moderate disability or good outcome). We also evaluated the contrasting configurations for unfavorable versus favorable outcome. Results are largely in line with findings of previous studies however the influence of age fell behind GCS components, which is unexpected. Specifying a combination of admission parameters that are likely to translate into a given clinical outcome is appealing from a clinician's perspective therefore our results have considerable translational value.
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Fleming K, Steinberg D, Poon S. Cardiovascular Risk Factors in Women with History Hypertensive Disorder of Pregnancy Seen at Post Partum Maternal Health Clinic: A Retrospective Study. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Tang MHY, Ching CK, Poon S, Chan SSS, Ng WY, Lam M, Wong CK, Pao R, Lau A, Mak TWL. Evaluation of three rapid oral fluid test devices on the screening of multiple drugs of abuse including ketamine. Forensic Sci Int 2018; 286:113-120. [PMID: 29574346 DOI: 10.1016/j.forsciint.2018.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/23/2018] [Accepted: 03/02/2018] [Indexed: 11/28/2022]
Abstract
Rapid oral fluid testing (ROFT) devices have been extensively evaluated for their ability to detect common drugs of abuse; however, the performance of such devices on simultaneous screening for ketamine has been scarcely investigated. The present study evaluated three ROFT devices (DrugWipe® 6S, Ora-Check® and SalivaScreen®) on the detection of ketamine, opiates, methamphetamine, cannabis, cocaine and MDMA. A liquid chromatography tandem mass spectrometry (LCMS) assay was firstly established and validated for confirmation analysis of the six types of drugs and/or their metabolites. In the field test, the three ROFT devices were tested on subjects recruited from substance abuse clinics/rehabilitation centre. Oral fluid was also collected using Quantisal® for confirmation analysis. A total of 549 samples were collected in the study. LCMS analysis on 491 samples revealed the following drugs: codeine (55%), morphine (49%), heroin (40%), methamphetamine (35%), THC (8%), ketamine (4%) and cocaine (2%). No MDMA-positive cases were observed. Results showed that the overall specificity and accuracy were satisfactory and met the DRUID standard of >80% for all 3 devices. Ora-Check® had poor sensitivities (ketamine 36%, methamphetamine 63%, opiates 53%, cocaine 60%, THC 0%). DrugWipe® 6S showed good sensitivities in the methamphetamine (83%) and opiates (93%) tests but performed relatively poorly for ketamine (41%), cocaine (43%) and THC (22%). SalivaScreen® also demonstrated good sensitivities in the methamphetamine (83%) and opiates (100%) tests, and had the highest sensitivity for ketamine (76%) and cocaine (71%); however, it failed to detect any of the 28 THC-positive cases. The test completion rate (proportion of tests completed with quality control passed) were: 52% (Ora-Check®), 78% (SalivaScreen®) and 99% (DrugWipe® 6S).
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Poon S, Harris KS, Jackson MA, McCorkelle OC, Gilding EK, Durek T, van der Weerden NL, Craik DJ, Anderson MA. Co-expression of a cyclizing asparaginyl endopeptidase enables efficient production of cyclic peptides in planta. JOURNAL OF EXPERIMENTAL BOTANY 2018; 69:633-641. [PMID: 29309615 PMCID: PMC5853369 DOI: 10.1093/jxb/erx422] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 11/04/2017] [Indexed: 05/18/2023]
Abstract
Cyclotides are ultra-stable, backbone-cyclized plant defence peptides that have attracted considerable interest in the pharmaceutical industry. This is due to their range of native bioactivities as well as their ability to stabilize other bioactive peptides within their framework. However, a hindrance to their widespread application is the lack of scalable, cost-effective production strategies. Plant-based production is an attractive, benign option since all biosynthetic steps are performed in planta. Nonetheless, cyclization in non-cyclotide-producing plants is poor. Here, we show that cyclic peptides can be produced efficiently in Nicotiana benthamiana, one of the leading plant-based protein production platforms, by co-expressing cyclotide precursors with asparaginyl endopeptidases that catalyse peptide backbone cyclization. This approach was successful in a range of other plants (tobacco, bush bean, lettuce, and canola), either transiently or stably expressed, and was applicable to both native and engineered cyclic peptides. We also describe the use of the transgenic system to rapidly identify new asparaginyl endopeptidase cyclases and interrogate their substrate sequence requirements. Our results pave the way for exploiting cyclotides for pest protection in transgenic crops as well as large-scale production of cyclic peptide pharmaceuticals in plants.
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Hines M, Brunner M, Poon S, Lam M, Tran V, Yu D, Togher L, Shaw T, Power E. Tribes and tribulations: interdisciplinary eHealth in providing services for people with a traumatic brain injury (TBI). BMC Health Serv Res 2017; 17:757. [PMID: 29162086 PMCID: PMC5697081 DOI: 10.1186/s12913-017-2721-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/09/2017] [Indexed: 11/10/2022] Open
Abstract
Background eHealth has potential for supporting interdisciplinary care in contemporary traumatic brain injury (TBI) rehabilitation practice, yet little is known about whether this potential is being realised, or what needs to be done to further support its implementation. The purpose of this study was to explore health professionals’ experiences of, and attitudes towards eHealth technologies to support interdisciplinary practice within rehabilitation for people after TBI. Methods A qualitative study using narrative analysis was conducted. One individual interview and three focus groups were conducted with health professionals (n = 17) working in TBI rehabilitation in public and private healthcare settings across regional and metropolitan New South Wales, Australia. Results Narrative analysis revealed that participants held largely favourable views about eHealth and its potential to support interdisciplinary practice in TBI rehabilitation. However, participants encountered various issues related to (a) the design of, and access to electronic medical records, (b) technology, (c) eHealth implementation, and (d) information and communication technology processes that disconnected them from the work they needed to accomplish. In response, health professionals attempted to make the most of unsatisfactory eHealth systems and processes, but were still mostly unsuccessful in optimising the quality, efficiency, and client-centredness of their work. Conclusions Attention to sources of disconnection experienced by health professionals, specifically design of, and access to electronic health records, eHealth resourcing, and policies and procedures related to eHealth and interdisciplinary practice are required if the potential of eHealth for supporting interdisciplinary practice is to be realised.
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Iuliano S, Poon S, Robbins J, Ejlsmark-Svensson H, Sones A. Improved nutritional status in female aged-care residents with 12 months of dairy supplementation: A cluster randomised trial. JOURNAL OF NUTRITION & INTERMEDIARY METABOLISM 2017. [DOI: 10.1016/j.jnim.2017.04.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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