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Caparros-Martin J, Saladie M, Agudelo-Romero P, Reen J, Ware R, Sly P, Stick S, O’Gara F. 488: Bile acids, bacterial colonization, and lung inflammatory markers in infants with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01912-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Foti A, Ware R, Tiddens H, Sly P, Stick S. 577: Outcomes from COMBAT CF: A phase 3 multicenter, randomized, placebo-controlled trial of azithromycin in primary prevention of radiologically defined bronchiectasis in infants with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)02000-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Caparros-Martin J, Saladie M, Agudelo-Romero P, Ware R, Sly P, Stick S, O’Gara F. 489: Relationships between antibiotic exposure and early lung microbial colonization in infants with cystic fibrosis. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01913-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van Eijk L, Seidel M, Pannek K, George JM, Fiori S, Guzzetta A, Coulthard A, Bursle J, Ware RS, Bradford D, Rose S, Colditz PB, Boyd RN, Fripp J. Automating Quantitative Measures of an Established Conventional MRI Scoring System for Preterm-Born Infants Scanned between 29 and 47 Weeks' Postmenstrual Age. AJNR Am J Neuroradiol 2021; 42:1870-1877. [PMID: 34413061 DOI: 10.3174/ajnr.a7230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 05/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Conventional MR imaging scoring is a valuable tool for risk stratification and prognostication of outcomes, but manual scoring is time-consuming, operator-dependent, and requires high-level expertise. This study aimed to automate the regional measurements of an established brain MR imaging scoring system for preterm neonates scanned between 29 and 47 weeks' postmenstrual age. MATERIALS AND METHODS This study used T2WI from the longitudinal Prediction of PREterm Motor Outcomes cohort study and the developing Human Connectome Project. Measures of biparietal width, interhemispheric distance, callosal thickness, transcerebellar diameter, lateral ventricular diameter, and deep gray matter area were extracted manually (Prediction of PREterm Motor Outcomes study only) and automatically. Scans with poor quality, failure of automated analysis, or severe pathology were excluded. Agreement, reliability, and associations between manual and automated measures were assessed and compared against statistics for manual measures. Associations between measures with postmenstrual age, gestational age at birth, and birth weight were examined (Pearson correlation) in both cohorts. RESULTS A total of 652 MRIs (86%) were suitable for analysis. Automated measures showed good-to-excellent agreement and good reliability with manual measures, except for interhemispheric distance at early MR imaging (scanned between 29 and 35 weeks, postmenstrual age; in line with poor manual reliability) and callosal thickness measures. All measures were positively associated with postmenstrual age (r = 0.11-0.94; R2 = 0.01-0.89). Negative and positive associations were found with gestational age at birth (r = -0.26-0.71; R2 = 0.05-0.52) and birth weight (r = -0.25-0.75; R2 = 0.06-0.56). Automated measures were successfully extracted for 80%-99% of suitable scans. CONCLUSIONS Measures of brain injury and impaired brain growth can be automatically extracted from neonatal MR imaging, which could assist with clinical reporting.
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Affiliation(s)
- L van Eijk
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia.,Faculty of Medicine (L.V.E., M.S.), The University of Queensland, Brisbane, Australia
| | - M Seidel
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia.,Faculty of Medicine (L.V.E., M.S.), The University of Queensland, Brisbane, Australia
| | - K Pannek
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - J M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, The University of Queensland, Brisbane, Australia
| | - S Fiori
- Department of Developmental Neuroscience (S.F., A.G.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy
| | - A Guzzetta
- Department of Developmental Neuroscience (S.F., A.G.), Istituto di Ricovero e Cura a Carattere Scientifico Stella Maris, Pisa, Italy.,Department of Clinical and Experimental Medicine (A.G.), University of Pisa, Pisa, Italy
| | - A Coulthard
- Department of Medical Imaging (A.C., J.B.), Royal Brisbane and Women's Hospital, Brisbane, Australia.,Discipline of Medical Imaging (A.C.), The University of Queensland, Brisbane, Australia
| | - J Bursle
- Department of Medical Imaging (A.C., J.B.), Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - R S Ware
- Menzies Health Institute Queensland (R.S.W.), Griffith University, Brisbane, Australia
| | - D Bradford
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - S Rose
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - P B Colditz
- Perinatal Research Centre (P.B.C.), University of Queenland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Perinatal Research Centre, Brisbane and Women's Hospital (P.B.C.), Brisbane, Australia
| | - R N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, The University of Queensland, Brisbane, Australia
| | - J Fripp
- From The Australian e-Health Research Centre (L.v.E., M.S., K.P., D.B., S.R., J.F.), Health and Biosecurity, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
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Le HTCH, Dang TN, Ware R, Phung D, Thai PK, Sly PD, Le An P. Using the health beliefs model to explore children's attitudes and beliefs on air pollution. Public Health 2021; 196:4-9. [PMID: 34126559 DOI: 10.1016/j.puhe.2021.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 02/26/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Traffic-related air pollution (TRAP) negatively impacts children's health. Self-protective measures are available, but population uptake is variable. It is essential to understand human beliefs and behaviours related to air pollution in order to understand the lack of self-protection in communities. As a prelude to undertaking a comprehensive assessment of children's attitudes and beliefs on the health effects of TRAP exposure, we sought to develop and validate an appropriate instrument. STUDY DESIGN This study used exploratory sequential mixed methods. METHODS This instrument, based on the constructs of the health belief model (HBM), aimed to determine factors predicting wearing a mask to protect against TRAP exposure. An initial literature-based questionnaire was modified using in-depth interviews, focus group discussions, and a quantitative survey pilot. This study included 121 school students and nine professional experts in Vietnam. The questionnaire was tested for content validity, agreement, test-retest reliability, and internal consistency. RESULTS The concordance of questionnaire items between two repeated assessments ranged from 47.2% to 78.3%, intraclass correlation coefficients ranged from 0.16 to 0.87 and Cronbach's internal reliability coefficient for the instrument was 0.60. CONCLUSION The self-administered instrument, based on the HBM, is suitable to understand health attitudes and beliefs related to self-protective behaviours to reduce TRAP exposure.
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Affiliation(s)
- H T C H Le
- Faculty of Medicine, The University of Queensland, Australia; Children's Health and Environment Program, Centre for Children's Health Research, Queensland, Australia
| | - T N Dang
- Department of Environmental Health, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - R Ware
- Menzies Health Institute Queensland, Griffith University, Australia
| | - D Phung
- Centre for Environment and Population Health, Griffith University, Australia
| | - P K Thai
- Queensland Alliance for Environmental Health Sciences (QAEHS), The University of Queensland, Australia
| | - P D Sly
- Children's Health and Environment Program, Centre for Children's Health Research, Queensland, Australia
| | - P Le An
- Centre for the Training of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam.
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Kerr E, Malo J, Field E, Si D, Ware R, Bennett S, Lambert S. What can viral suppression indicators tell us? Monitoring progress towards improvement in HIV care for those newly diagnosed in Queensland, Australia. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Song M, Ware R, Doan TN, Harley D. Psychotropic medication use in adults with intellectual disability in Queensland, Australia, from 1999 to 2015: a cohort study. J Intellect Disabil Res 2020; 64:45-56. [PMID: 31478300 DOI: 10.1111/jir.12685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/03/2019] [Accepted: 08/12/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Longitudinal data on medication use in adults with intellectual disability (ID) are scarce. We describe the longitudinal use of and factors associated with psychotropic medication prescribing in adults with ID living in the Australian community. METHODS Longitudinal data were obtained from adults with ID in the community in Queensland, Australia, between 1999 and 2015. Participant characteristics and medication use information were extracted from baseline questionnaires and health check booklets. Logistic regression was used to investigate the associations between participant characteristics and psychotropic medication use, commencement or cessation. RESULTS Longitudinal data were available for 138 participants on 697 reviews. The proportion of participants prescribed psychotropic medications increased from 43% to 54% between 1999 and 2015. The rates of commencement and cessation of psychotropic medications between consecutive time periods ranged from 9% to 18% and 7% to 15%, respectively. Challenging behaviour was associated with psychotropic medication use (adjusted odds ratio = 4.1; 95% confidence interval: 2.1-7.9). Presence of challenging behaviour, either consistent or newly identified, was positively associated with ongoing use or commencement of psychotropic medications. CONCLUSIONS Psychotropic medications are commonly prescribed to adults with ID. Challenging behaviour is positively associated with ongoing use and commencement.
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Affiliation(s)
- M Song
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute-University of Queensland (MRI-UQ), QLD, Australia
| | - R Ware
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - T N Doan
- Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, VIC, Australia
| | - D Harley
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), Mater Research Institute-University of Queensland (MRI-UQ), QLD, Australia
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Saiepour N, Najman JM, Ware R, Baker P, Clavarino AM, Williams GM. Does attrition affect estimates of association: A longitudinal study. J Psychiatr Res 2019; 110:127-142. [PMID: 30639918 DOI: 10.1016/j.jpsychires.2018.12.022] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/10/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
Survey research frequently involves missing cases attributable to refusals to participate, lack of success in accessing all potential respondents or loss to follow-up in longitudinal studies. There is concern that those not recruited or those lost are a select group whose absence from a study may bias the findings of the study. This study provides a test of the extent to which selective loss to follow-up in a longitudinal study may lead to biased findings. The Mater-University Study of Pregnancy collected baseline information for 7718 pregnant women. Follow-ups occurred five years, 14 years, 21 years and 27 years after the birth, for 6753 eligible women. Participants at baseline were partitioned according to follow-up status for each follow-up. We compare baseline (at recruitment) measures of association, with these same measures of association for those retained in the study (Group A) and those lost to follow-up (Group B) at each phase of data. Using univariate logistic regression we compared the strength of association between maternal mental health and various baseline socio-demographic factors for different rates of loss to follow-up. Estimates of association at baseline, and at each follow-up are similar irrespective of the rate of loss to follow-up and whether the comparison is with those retained in the study or those lost to follow-up. There were no statistically significant differences in 90.8% of baseline comparisons with Group A, and 96.9% of comparisons with Group B measures of association. We conclude that differential loss to follow-up rarely affects estimates of association. We suggest that loss to follow-up may produce misleading findings only in circumstances where loss to follow-up is combined with a number of other sources of bias.
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Affiliation(s)
- N Saiepour
- School of Public Health, The University of Queensland, Herston 4006, Australia
| | - J M Najman
- School of Public Health, The University of Queensland, Herston 4006, Australia; School of Social Sciences, The University of Queensland, St. Lucia 4067, Australia.
| | - R Ware
- School of Public Health, The University of Queensland, Herston 4006, Australia
| | - P Baker
- School of Public Health, The University of Queensland, Herston 4006, Australia
| | - A M Clavarino
- School of Pharmacy, The University of Queensland, Woolloongabba 4102, Australia
| | - G M Williams
- School of Public Health, The University of Queensland, Herston 4006, Australia
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Xu F, He J, Wang Z, Ware RS. The relationship between socio-economic status and diagnosed Type 2 diabetes is changing with economic growth in Nanjing, China. Diabet Med 2018; 35:567-575. [PMID: 29417617 DOI: 10.1111/dme.13597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/02/2018] [Indexed: 11/30/2022]
Abstract
AIM In developed countries, the relationship between socio-economic status (SES) and Type 2 diabetes was positive several decades ago but is now negative. However, in developing societies such as China the relationship remains positive. It is likely that at some stage of economic development the SES-Type 2 diabetes association will become negative in developing communities. This study aimed to examine whether this inflexion is approaching in China. METHODS Two cross-sectional surveys were undertaken in Nanjing, China, in 2000 and 2011. The same sampling approach was used to randomly select participants. Diagnosed Type 2 diabetes was the outcome variable. SES was measured using monthly family average income and divided into thirds. Mixed-effects models were used to calculate the association between SES and Type 2 diabetes. RESULTS There were 19 861 (response rate, 90.1%) and 7824 (response rate, 82.8%) participants in 2000 and 2011, respectively. A 2.6-fold increase in Type 2 diabetes prevalence was observed from 3.0% (95% confidence interval 2.8%, 3.3%) in 2000 to 8.2% (7.7%, 8.8%) in 2011 (P < 0.01). After controlling for potential confounders, the odds ratios of having Type 2 diabetes decreased from 2.06 (95% CI 1.55, 2.73) and 1.83 (1.40, 2.37) in 2000 to 1.58 (1.23, 2.02) and 1.35 (1.06, 1.74) in 2011 for the higher and middle SES groups respectively, compared with those in the lower SES category. CONCLUSIONS The SES-Type 2 diabetes association remained positive in Nanjing, China, in 2011 but the disparity diminished significantly compared with 2000. These results can inform the delivery of appropriate interventions to people at risk of developing Type 2 diabetes.
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Affiliation(s)
- F Xu
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - J He
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Z Wang
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - R S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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Nikles J, Keijzers G, Mitchell G, Schug S, Ware R, McLean SA, Connelly L, Gibson S, Farrell SF, Sterling M. Pregabalin versus placebo in targeting pro-nociceptive mechanisms to prevent chronic pain after whiplash injury in at-risk individuals - a feasibility study for a randomised controlled trial. Trials 2018; 19:44. [PMID: 29343280 PMCID: PMC5773126 DOI: 10.1186/s13063-018-2450-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Whiplash-associated disorders (WAD) are an enormous and costly burden to Australian society. Up to 50% of people who experience a whiplash injury will never fully recover. Whiplash is resistant to treatment and no early management approach has yet been shown to prevent chronic pain. The early presence of central sensitization is associated with poor recovery. Pregabalin's effects on central sensitization indicate the potential to prevent or modulate these processes after whiplash injury and to improve health outcomes, but this has not been investigated. This paper describes the protocol for a feasibility study for a randomised controlled trial of pregabalin plus evidence-based advice compared to placebo plus evidence-based advice for individuals with acute whiplash injury who are at risk of poor recovery. METHODS This double blind, placebo-controlled randomised feasibility study will examine the feasibility and potential effectiveness of pregabalin and evidence-based advice (intervention) compared to placebo and evidence-based advice (control) for individuals with acute whiplash injury at risk of poor recovery. Thirty participants (15 per group) aged 18-65 years with Grade II WAD, within 48 hours of injury and currently experiencing at least moderate pain (NRS: ≥ 5/10) will be recruited from Emergency Departments of public hospitals in Queensland, Australia. Pregabalin will be commenced at 75 mg bd and titrated up to 300 mg bd as tolerated for 4 weeks followed by 1 week of weaning. RESULTS The feasibility of trial procedures will be tested, as well as the potential effect of the intervention on the outcomes. The primary outcome of neck pain intensity at 3 months from randomisation will be compared between the treatment groups using standard analysis of variance techniques. DISCUSSION Feasibility and potential effectiveness data will inform an appropriately powered full trial, which if successful, will provide an effective and cost-effective intervention for a costly and treatment resistant condition. It will also have implications for the early management of other traumatic conditions beyond whiplash. TRIAL REGISTRATION Clinical Trials Primary Registry: Australian and New Zealand Clinical Trials Registry. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12617000059369 . Date of Registration: 11/01/2017. Primary Trial Sponsor: The University of Queensland, Brisbane QLD 4072 Australia.
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Affiliation(s)
- J. Nikles
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia
| | - G. Keijzers
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland Australia
- School of Medicine, Bond University, Gold Coast, QLD Australia
- School of Medicine, Griffith University, Gold Coast, QLD Australia
| | - G. Mitchell
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - S. Schug
- School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - R. Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - S. A. McLean
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina School of Medicine, Chapel Hill, USA
| | - L. Connelly
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
- Dipartimento di Sociologia e Diritto dell’Economia, University of Bologna, Bologna, Italy
| | - S. Gibson
- Caulfield Pain Management and Research Centre, Melbourne, Australia
| | - S. F. Farrell
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - M. Sterling
- Recover Injury Research Centre, NHMRC Centre of Research Excellence in Recovery Following Road Traffic Injuries, The University of Queensland, Herston, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
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George JM, Fiori S, Fripp J, Pannek K, Bursle J, Moldrich RX, Guzzetta A, Coulthard A, Ware RS, Rose SE, Colditz PB, Boyd RN. Reply. AJNR Am J Neuroradiol 2017; 39:E40-E41. [PMID: 29170274 DOI: 10.3174/ajnr.a5478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- J M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre Centre for Children's Health Research Faculty of Medicine, University of Queensland Brisbane, Australia
| | - S Fiori
- Department of Developmental Neuroscience Stella Maris Scientific Institute Pisa, Italy
| | - J Fripp
- Health and Biosecurity The Australian e-Health Research Centre Commonwealth Scientific and Industrial Research Organisation Brisbane, Australia
| | - K Pannek
- Health and Biosecurity The Australian e-Health Research Centre Commonwealth Scientific and Industrial Research Organisation Brisbane, Australia
| | - J Bursle
- Department of Medical Imaging Royal Brisbane and Women's Hospital Brisbane, Australia
| | - R X Moldrich
- Centre for Clinical Research Faculty of Medicine, University of Queensland Brisbane, Australia
| | - A Guzzetta
- Department of Developmental Neuroscience Stella Maris Scientific Institute Pisa, Italy
| | - A Coulthard
- Department of Medical Imaging Royal Brisbane and Women's Hospital Brisbane, Australia.,Discipline of Medical Imaging University of Queensland Brisbane, Australia
| | - R S Ware
- Menzies Health Institute Queensland Griffith University Brisbane, Australia.,Queensland Centre for Intellectual and Developmental Disability University of Queensland Brisbane, Australia
| | - S E Rose
- Health and Biosecurity The Australian e-Health Research Centre Commonwealth Scientific and Industrial Research Organisation Brisbane, Australia
| | - P B Colditz
- Centre for Clinical Research Faculty of Medicine, University of Queensland Brisbane, Australia.,Perinatal Research Centre Royal Brisbane and Women's Hospital Brisbane, Australia
| | - R N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre Centre for Children's Health Research Faculty of Medicine, University of Queensland Brisbane, Australia
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Abstract
UNLABELLED The objective of this study was to assess methodological and reporting quality of systematic reviews in hand and wrist pathology. MEDLINE, EMBASE and Cochrane Library were searched from inception to November 2016 for relevant studies. Reporting quality was evaluated using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and methodological quality using a measurement tool to assess systematic reviews, the Assessment of Multiple Systematic Reviews (AMSTAR). Descriptive statistics and linear regression were used to identify features associated with improved methodological quality. A total of 91 studies were included in the analysis. Most reviews inadequately reported PRISMA items regarding study protocol, search strategy and bias and AMSTAR items regarding protocol, publication bias and funding. Systematic reviews published in a plastics journal, or which included more authors, were associated with higher AMSTAR scores. A large proportion of systematic reviews within hand and wrist pathology literature score poorly with validated methodological assessment tools, which may affect the reliability of their conclusions. LEVEL OF EVIDENCE I.
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Affiliation(s)
- J Wasiak
- 1 Department of Nursing, University of Melbourne, Parkville, Australia
| | - A Y Shen
- 2 Eastern Health, Victoria, Australia
| | - R Ware
- 3 UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia.,4 Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | | | - C M Faggion
- 6 Department of Periodontology and Restorative Dentistry, University of Münster, Münster, Germany
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Allen J, Rey-Conde T, North JB, Kruger P, Babidge WJ, Wysocki AP, Ware RS, Veerman JL, Maddern GJ. Processes of care in surgical patients who died with hospital-acquired infections in Australian hospitals. J Hosp Infect 2017; 99:17-23. [PMID: 28890286 DOI: 10.1016/j.jhin.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/01/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infection may complicate surgical patients' hospital admission. The effect of hospital-acquired infections (HAIs) on processes of care among surgical patients who died is unknown. AIM To investigate the effect of HAIs on processes of care in surgical patients who died in hospital. METHODS Surgeon-recorded infection data extracted from a national Australian surgical mortality audit (2012-2016) were grouped into HAIs and no infection. The audit included all-age surgical patients, who died in hospital. Not all patients had surgery. Excluded from analysis were patients with community-acquired infection and those with missing timing of infection. Multivariate logistic regression was used to determine the adjusted effects of HAIs on the processes of care in these patients. Costs associated with HAIs were estimated. FINDINGS One-fifth of surgical patients who died did so with an HAI (2242 out of 11,681; 19.2%). HAI patients had increased processes of care compared to those who died without infection: postoperative complications [51.0% vs 30.3%; adjusted odds ratio (aOR): 2.20; 95% confidence interval (CI): 1.98-2.45; P < 0.001]; unplanned reoperations (22.6% vs 10.9%; aOR: 2.38; 95% CI: 2.09-2.71; P < 0.001) and unplanned intensive care unit admission (29.3% vs 14.8%; aOR: 2.18; 95% CI: 1.94-2.45; P < 0.001). HAI patients had longer hospital admissions and greater hospital costs than those without infection. CONCLUSION HAIs were associated with increased processes of care and costs in surgical patients who died; these outcomes need to be investigated in surgical patients who survive.
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Affiliation(s)
- J Allen
- Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, East Brisbane, Queensland, Australia; University of Queensland, School of Public Health, Herston, Brisbane, Queensland, Australia.
| | - T Rey-Conde
- Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, East Brisbane, Queensland, Australia
| | - J B North
- Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, East Brisbane, Queensland, Australia
| | - P Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Woolloongabba, Queensland, Australia; University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - W J Babidge
- Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - A P Wysocki
- Department of Surgery, Logan Hospital, Yatala, Queensland, Australia
| | - R S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - J L Veerman
- University of Queensland, School of Public Health, Herston, Brisbane, Queensland, Australia; Cancer Council NSW, Kings Cross Sydney, New South Wales, Australia
| | - G J Maddern
- Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia; Discipline of Surgery, University of Adelaide and The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, Australia
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George JM, Fiori S, Fripp J, Pannek K, Bursle J, Moldrich RX, Guzzetta A, Coulthard A, Ware RS, Rose SE, Colditz PB, Boyd RN. Validation of an MRI Brain Injury and Growth Scoring System in Very Preterm Infants Scanned at 29- to 35-Week Postmenstrual Age. AJNR Am J Neuroradiol 2017; 38:1435-1442. [PMID: 28522659 DOI: 10.3174/ajnr.a5191] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/21/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE The diagnostic and prognostic potential of brain MR imaging before term-equivalent age is limited until valid MR imaging scoring systems are available. This study aimed to validate an MR imaging scoring system of brain injury and impaired growth for use at 29 to 35 weeks postmenstrual age in infants born at <31 weeks gestational age. MATERIALS AND METHODS Eighty-three infants in a prospective cohort study underwent early 3T MR imaging between 29 and 35 weeks' postmenstrual age (mean, 32+2 ± 1+3 weeks; 49 males, born at median gestation of 28+4 weeks; range, 23+6-30+6 weeks; mean birthweight, 1068 ± 312 g). Seventy-seven infants had a second MR scan at term-equivalent age (mean, 40+6 ± 1+3 weeks). Structural images were scored using a modified scoring system which generated WM, cortical gray matter, deep gray matter, cerebellar, and global scores. Outcome at 12-months corrected age (mean, 12 months 4 days ± 1+2 weeks) consisted of the Bayley Scales of Infant and Toddler Development, 3rd ed. (Bayley III), and the Neuro-Sensory Motor Developmental Assessment. RESULTS Early MR imaging global, WM, and deep gray matter scores were negatively associated with Bayley III motor (regression coefficient for global score β = -1.31; 95% CI, -2.39 to -0.23; P = .02), cognitive (β = -1.52; 95% CI, -2.39 to -0.65; P < .01) and the Neuro-Sensory Motor Developmental Assessment outcomes (β = -1.73; 95% CI, -3.19 to -0.28; P = .02). Early MR imaging cerebellar scores were negatively associated with the Neuro-Sensory Motor Developmental Assessment (β = -5.99; 95% CI, -11.82 to -0.16; P = .04). Results were reconfirmed at term-equivalent-age MR imaging. CONCLUSIONS This clinically accessible MR imaging scoring system is valid for use at 29 to 35 weeks postmenstrual age in infants born very preterm. It enables identification of infants at risk of adverse outcomes before the current standard of term-equivalent age.
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Affiliation(s)
- J M George
- From the Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, Faculty of Medicine
| | - S Fiori
- Stella Maris Scientific Institute (S.F., A.G.), Department of Developmental Neuroscience, Pisa, Italy
| | - J Fripp
- Health and Biosecurity (J.F., K.P., S.E.R.), The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - K Pannek
- Health and Biosecurity (J.F., K.P., S.E.R.), The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - J Bursle
- Department of Medical Imaging (J.B., A.C.)
| | - R X Moldrich
- University of Queensland Centre for Clinical Research (R.X.M., P.B.C.)
| | - A Guzzetta
- Stella Maris Scientific Institute (S.F., A.G.), Department of Developmental Neuroscience, Pisa, Italy
| | - A Coulthard
- Discipline of Medical Imaging (A.C.)
- Department of Medical Imaging (J.B., A.C.)
| | - R S Ware
- Queensland Centre for Intellectual and Developmental Disability (R.S.W.), The University of Queensland, Brisbane, Australia
- Menzies Health Institute Queensland (R.S.W.), Griffith University, Brisbane, Australia
| | - S E Rose
- Health and Biosecurity (J.F., K.P., S.E.R.), The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - P B Colditz
- University of Queensland Centre for Clinical Research (R.X.M., P.B.C.)
- Perinatal Research Centre (P.B.C.), Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - R N Boyd
- From the Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, Faculty of Medicine
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Dewar R, Claus AP, Tucker K, Ware R, Johnston LM. Reproducibility of the Balance Evaluation Systems Test (BESTest) and the Mini-BESTest in school-aged children. Gait Posture 2017; 55:68-74. [PMID: 28419876 DOI: 10.1016/j.gaitpost.2017.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 04/03/2017] [Accepted: 04/05/2017] [Indexed: 02/02/2023]
Abstract
This study evaluated the intra-rater, inter-rater and test-retest reproducibility of the Full-BESTest and Mini-BESTest when assessing postural control in children. Thirty-four children aged 7-17 years participated in intra-rater and inter-rater evaluation, and 22 children repeated assessment six weeks later for evaluation of test-retest reliability. Postural control was assessed using the Full Balance Evaluation Systems Test (Full-BESTest) and the short-form Mini-BESTest. Intra-rater, inter-rater and test-retest reproducibility were examined using video assessment. Test-retest reproducibility was also assessed in real-time. Reproducibility was examined by agreement and reliability statistics. Agreement was calculated using percentage of agreement, Limits of Agreement and Smallest Detectable Change. Reliability was calculated using Intra-class Correlation Coefficients. Results showed that the reliability of Total Scores was excellent for the Full-BESTest for all conditions (all ICCs>0.82), whereas the Mini-BESTest ranged from fair to excellent (ICC=0.56-0.86). Percentage of Domain Scores with good-excellent reliability (ICCs>0.60) was slightly higher for the Full-BESTest (66%) compared to the Mini-BESTest (59%). Smallest Detectable Change scores were good to excellent for the Full-BESTest (2%-6%) and for the Mini-BESTest (5%-10%) relative to total test scores. Both the Full-BESTest and Mini-BESTest can discriminate postural control abilities within and between days in school-aged children. The Full-BESTest has slightly better reproducibility and a broader range of items, which could be the most useful version for treatment planning. We propose minor modifications to improve reproducibility for children, and indicate the modified version by the title Kids-BESTest. Future psychometric research is recommended for specific paediatric clinical populations.
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Affiliation(s)
- R Dewar
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia.
| | - A P Claus
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - K Tucker
- The University of Queensland, School of Biomedical Sciences, Brisbane, Australia
| | - R Ware
- Griffith University, Menzies Health Institute Queensland, Australia; The University of Queensland, Queensland Centre for Intellectual and Developmental Disability, Brisbane, Australia
| | - L M Johnston
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
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16
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Heffernan AL, English K, Toms L, Calafat AM, Valentin-Blasini L, Hobson P, Broomhall S, Ware RS, Jagals P, Sly PD, Mueller JF. Cross-sectional biomonitoring study of pesticide exposures in Queensland, Australia, using pooled urine samples. Environ Sci Pollut Res Int 2016; 23:23436-23448. [PMID: 27613627 DOI: 10.1007/s11356-016-7571-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/31/2016] [Indexed: 06/06/2023]
Abstract
A range of pesticides are available in Australia for use in agricultural and domestic settings to control pests, including organophosphate and pyrethroid insecticides, herbicides, and insect repellents, such as N,N-diethyl-meta-toluamide (DEET). The aim of this study was to provide a cost-effective preliminary assessment of background exposure to a range of pesticides among a convenience sample of Australian residents. De-identified urine specimens stratified by age and sex were obtained from a community-based pathology laboratory and pooled (n = 24 pools of 100 specimens). Concentrations of urinary pesticide biomarkers were quantified using solid-phase extraction coupled with isotope dilution high-performance liquid chromatography-tandem mass spectrometry. Geometric mean biomarker concentrations ranged from <0.1 to 36.8 ng/mL for organophosphate insecticides, <0.1 to 5.5 ng/mL for pyrethroid insecticides, and <0.1 to 8.51 ng/mL for all other biomarkers with the exception of the DEET metabolite 3-diethylcarbamoyl benzoic acid (4.23 to 850 ng/mL). We observed no association between age and concentration for most biomarkers measured but noted a "U-shaped" trend for five organophosphate metabolites, with the highest concentrations observed in the youngest and oldest age strata, perhaps related to age-specific differences in behavior or physiology. The fact that concentrations of specific and non-specific metabolites of the organophosphate insecticide chlorpyrifos were higher than reported in USA and Canada may relate to differences in registered applications among countries. Additional biomonitoring programs of the general population and focusing on vulnerable populations would improve the exposure assessment and the monitoring of temporal exposure trends as usage patterns of pesticide products in Australia change over time.
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Affiliation(s)
- A L Heffernan
- National Research Centre for Environmental Toxicology, The University of Queensland, 39 Kessels Rd, Coopers Plains, QLD, 4108, Australia.
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia.
| | - K English
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Lml Toms
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - A M Calafat
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - P Hobson
- Sullivan Nicolaides Pathology Taringa, Taringa, QLD, Australia
| | - S Broomhall
- Australian Government Department of the Environment, Canberra, ACT, Australia
| | - R S Ware
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - P Jagals
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - P D Sly
- Children's Health and Environment Program, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - J F Mueller
- National Research Centre for Environmental Toxicology, The University of Queensland, 39 Kessels Rd, Coopers Plains, QLD, 4108, Australia
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17
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Samidurai AJ, Ware RS, Davies PSW. Advantages of collecting multiple urinary iodine concentrations when assessing iodine status of a population. Acta Paediatr 2015; 104:e524-9. [PMID: 26317993 DOI: 10.1111/apa.13168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/10/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the effect of collecting multiple (four) urine samples on the extensive variance often observed within a cohort when determining iodine status via urinary iodine concentration (UIC). METHODS Fifty-one children aged two to three years and thirty children aged 8-10 years participated in the study in South East Queensland, Australia. Each child's four urine samples were analysed using ammonium persulphate digestion before a Sandell-Kolthoff reaction method. Analysis of variance techniques were used to assess the effect of using multiple urine samples. RESULTS The median UICs were 223.3 and 141 μg/L for two- to three-year-olds and eight- to 10-year-olds, respectively. The coefficient of variance (CV) of UIC for children aged two to three years was reduced by 35.6%, 36.5% and 39.7% when two, three and four samples were included in the adjustment, respectively. Similarly, the CV of UIC for children aged 8-10 years was reduced by 24.7%, 30.7% and 34.7%, respectively. CONCLUSION Although the practicality and cost of collecting multiple UICs need to be considered, collecting multiple UIC samples from each participant provides a more accurate reflection of a cohort iodine status.
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Affiliation(s)
- AJ Samidurai
- Children's Nutrition Research Centre; Child Health Research Centre; The University of Queensland; Herston QLD Australia
- School of Medicine; The University of Queensland; Herston QLD Australia
| | - RS Ware
- Child Health Research Centre; School of Medicine; The University of Queensland; Herston QLD Australia
- Queensland Children's Medical Research Institute; Herston QLD Australia
- School of Public Health; The University of Queensland; Herston QLD Australia
| | - PSW Davies
- Children's Nutrition Research Centre; Child Health Research Centre; The University of Queensland; Herston QLD Australia
- School of Medicine; The University of Queensland; Herston QLD Australia
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18
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Jensen DE, Nguo K, Baxter KA, Cardinal JW, King NA, Ware RS, Truby H, Batch JA. Fasting gut hormone levels change with modest weight loss in obese adolescents. Pediatr Obes 2015; 10:380-7. [PMID: 25559355 DOI: 10.1111/ijpo.275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 09/27/2014] [Accepted: 10/13/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gut hormones change with weight loss in adults but are not well studied in obese youth. OBJECTIVE The primary aim was to evaluate how gut hormones and subjective appetite measure change with dietary weight loss in obese adolescents. METHODS Participants were a subset of those taking part in the 'Eat Smart Study'. They were aged 10-17 years with body mass index (BMI) > 90th centile and were randomized to one of three groups: wait-listed control, structured reduced carbohydrate or structured low-fat dietary intervention for 12 weeks. Outcomes were fasting glucose, insulin, leptin, adiponectin, total amylin, acylated ghrelin, active glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide (GIP), pancreatic polypeptide (PP) and total peptide tyrosine-tyrosine. Pre- and postprandial subjective sensations of appetite were assessed using visual analogue scales. RESULTS Of 87 'Eat Smart' participants, 74 participated in this sub-study. The mean (standard deviation) BMI z-score was 2.1 (0.4) in the intervention groups at week 12 compared with 2.2 (0.4) in the control group. Fasting insulin (P = 0.05) and leptin (P = 0.03) levels decreased, while adiponectin levels increased (P = 0.05) in the intervention groups compared with control. The intervention groups were not significantly different from each other. A decrease in BMI z-score at week 12 was associated with decreased fasting insulin (P < 0.001), homeostatic model of assessment-insulin resistance (P < 0.001), leptin (P < 0.001), total amylin (P = 0.03), GIP (P = 0.01), PP (P = 0.02) and increased adiponectin (P < 0.001). There was no significant difference in appetite sensations. CONCLUSIONS Modest weight loss in obese adolescents leads to changes in some adipokines and gut hormones that may favour weight regain.
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Affiliation(s)
- D E Jensen
- Children's Health Queensland Hospital and Health Service, Department of Endocrinology and Diabetes, Royal Children's Hospital, Herston, Queensland, Australia.,Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia
| | - K Nguo
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia
| | - K A Baxter
- Children's Nutrition Research Centre, University of Queensland, Herston, Queensland, Australia
| | - J W Cardinal
- Chemical Pathology, Pathology Queensland, Herston, Queensland, Australia
| | - N A King
- Institute of Health and Biomedical Innovation, School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - R S Ware
- Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia.,School of Population Health, University of Queensland, Herston, Queensland, Australia
| | - H Truby
- Department of Nutrition and Dietetics, Monash University, Clayton, Victoria, Australia
| | - J A Batch
- Children's Health Queensland Hospital and Health Service, Department of Endocrinology and Diabetes, Royal Children's Hospital, Herston, Queensland, Australia.,Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia
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19
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Zhang J, Donald M, Baxter KA, Ware RS, Burridge L, Russell AW, Jackson CL. Impact of an integrated model of care on potentially preventable hospitalizations for people with Type 2 diabetes mellitus. Diabet Med 2015; 32:872-80. [PMID: 25615800 DOI: 10.1111/dme.12705] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 01/04/2023]
Abstract
AIMS To evaluate the impact of an integrated model of care for patients with complex Type 2 diabetes mellitus on potentially preventable hospitalizations. METHODS A prospective controlled trial was conducted comparing a multidisciplinary, community-based, integrated primary-secondary care diabetes service with usual care at a hospital diabetes outpatient clinic. Study and hospital admissions data were linked for the period from 12 months before to 24 months after commencement of the trial. The primary outcome was the number of potentially preventable hospitalizations with diabetes-related principal diagnoses. Length of stay once hospitalized was also reported. RESULTS Of 327 adult participants, 206 were hospitalized and accounted for 667 admissions during the study period. Compared with the usual care group, patients in the integrated model of care group were nearly half as likely to be hospitalized for a potentially preventable diabetes-related principal diagnosis in the 24 months after study commencement (incidence rate ratio 0.53, 95% CI 0.29, 0.96; P = 0.04). The magnitude of the result remained similar after adjusting for age, sex, education and baseline HbA1c concentration (incidence rate ratio 0.54, 95% CI 0.29, 1.01; P = 0.05).When hospitalized, patients in the integrated care group had a similar length of stay compared with those in the usual care group (median difference -2 days, 95% CI -6.5, 2.3; P = 0.33). CONCLUSIONS Patients receiving the integrated model of care had a reduction in the number of hospitalizations when the principal diagnosis for admission was a diabetes-related complication. Integrated models of care for people with complex diabetes can reduce hospitalizations and help attempts to curtail increasing demand on finite health services.
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Affiliation(s)
- J Zhang
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
| | - M Donald
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
| | - K A Baxter
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
| | - R S Ware
- School of Population Health, University of Queensland, Herston, Queensland, Australia
| | - L Burridge
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
| | - A W Russell
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- School of Medicine, University of Queensland, Herston, Queensland, Australia
| | - C L Jackson
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
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20
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Marshall J, Ware R, Ziviani J, Hill RJ, Dodrill P. Efficacy of interventions to improve feeding difficulties in children with autism spectrum disorders: a systematic review and meta-analysis. Child Care Health Dev 2015; 41:278-302. [PMID: 24962184 DOI: 10.1111/cch.12157] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND Feeding difficulties are relatively common in children with autism spectrum disorders (ASD), but current evidence for their treatment is limited. This review systematically identifies, reviews and analyses the evidence for intervention in young children with ASD and feeding difficulties. METHODS A comprehensive search strategy was used to identify studies from January 2000 to October 2013. Studies were included if they described interventions where the goal was to increase desirable eating behaviours or decrease undesirable eating behaviours using an experimental design, including single-subject research methodology. Studies were reviewed for descriptive information, and research quality was appraised using a formal checklist. Individual study findings were compared using Improvement Rate Difference (IRD), a method for calculating effect size in single-subject research. RESULTS Overall, 23 papers were included. All studies reviewed had five or fewer participants, and reported on operant conditioning style intervention approaches, where the child is prompted to perform an action, and receives a contingent response. Where quality measures were not met, it was primarily due to lack of detail provided for the purposes of replication, or failure to meet social validity criteria. Meta-analysis indicated a medium-large effect size [mean = 0.69, 95% confidence interval (CI) 0.60 to 0.79] when the outcome measured was an increase in desirable behaviours (e.g. consuming food), but a small-negligible effect size (mean = 0.39, 95% CI 0.18 to 0.60) when the outcome measured was a decrease in undesirable mealtime behaviours (e.g. tantrums). Only a small proportion of studies reported outcomes in terms of increased dietary variety rather than volume of food consumed. CONCLUSIONS The reviewed literature consisted primarily of low-level evidence. Favourable intervention outcomes were observed in terms of increasing volume, but not necessarily variety of foods consumed in young children with ASD and feeding difficulties. Further research in the form of prospective randomized trials to further demonstrate experimental effect in this area is required.
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Affiliation(s)
- J Marshall
- Queensland Children's Medical Research Institute, Children's Nutrition Research Centre, The University of Queensland, Brisbane, Qld, Australia
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21
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Nguyen M, Lennox N, Ware R. Hand-held health records for individuals with intellectual disability: a systematic review. J Intellect Disabil Res 2014; 58:1172-1178. [PMID: 24289283 DOI: 10.1111/jir.12104] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/05/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Hand-held health records (HHHRs) aim to empower individuals with intellectual disability (ID) and improve the communication between all those involved in their health care. HHHRs can be used to identify additional health needs and contribute to improved treatment for individuals with ID. This review summarises evidence concerning the use of HHHRs with individuals with ID. METHODS Systematic searching of electronic databases and email contact with established researchers in the field were used to identify relevant articles related to the use of HHHRs among individuals with ID. RESULTS Seven articles were identified and included for review. Studies involved the development, evaluation, acceptability and facilitators and barriers of implementation of HHHRs. HHHRs did not lead to improved short-term healthcare activity, but did lead to more discussion about health problems, increased health-related knowledge and awareness of personal health issues. CONCLUSIONS HHHRs are well accepted among users with ID. However, no short-term benefits were found and future research needs to examine the long-term effects of HHHRs.
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Affiliation(s)
- M Nguyen
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine, The University of Queensland, Mater Hospital, South Brisbane, Queensland, Australia
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22
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Dias S, Ware RS, Kinner SA, Lennox NG. Physical health outcomes in prisoners with intellectual disability: a cross-sectional study. J Intellect Disabil Res 2013; 57:1191-1196. [PMID: 23106788 DOI: 10.1111/j.1365-2788.2012.01621.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND People with intellectual disability (ID) in the general population and people in prison experience unrecognised medical conditions and inadequate disease prevention. Among prisoners, those with an ID may be particularly disadvantaged. The aim of this study was to identify demographic, health and health-related characteristics of adult prisoners who screened positive for ID. METHODS Cross-sectional data were collected via face-to-face administration of a structured questionnaire in seven prisons in Queensland, Australia, between 2008 and 2010. Participants were adult prisoners within 6 weeks of release from custody. We identified ID using a pragmatic screening tool. Prisoners who scored <85 on the Hayes Ability Screening Index and either (a) reported having attended a special school or (b) reported having been diagnosed with an ID were considered to have screened positive for ID. We compared the characteristics of participants who screened positive and negative for ID using univariable and multivariable logistic regression. RESULTS Screening positive for ID was associated with younger age, identifying as Indigenous and lower educational achievement. Prisoners who screened positive for ID were more likely to have been diagnosed with medical conditions such as heart disease (odds ratio; 95% confidence interval = 2.1; 1.0-4.2) and hearing problems (2.2; 1.3-3.7), after adjustment for age, sex, education level and Indigenous status. Screen-positive prisoners were less likely to have received preventive care interventions such as testing for hepatitis A infection (0.4; 0.2-0.6), and immunisation for tuberculosis (0.4; 0.2-0.8). Prisoners with possible ID were more likely to be obese (1.7; 1.1-2.7). CONCLUSIONS Adult prisoners who screen positive for ID have worse health outcomes than their non-disabled peers. An improved understanding of physical health characteristics prior to release can direct treatment and support pathways out of the criminal justice system and inform transitional planning of health services for this profoundly disadvantaged group.
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Affiliation(s)
- S Dias
- Queensland Centre for Intellectual and Developmental Disability (QCIDD), School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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23
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Lennox NG, Brolan CE, Dean J, Ware RS, Boyle FM, Taylor Gomez M, van Dooren K, Bain C. General practitioners' views on perceived and actual gains, benefits and barriers associated with the implementation of an Australian health assessment for people with intellectual disability. J Intellect Disabil Res 2013; 57:913-922. [PMID: 22774940 DOI: 10.1111/j.1365-2788.2012.01586.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Health assessments for people with intellectual disability have been implemented in the UK, New Zealand and Australia, and have led to improved health outcomes. The Comprehensive Health Assessment Program (CHAP) has been shown to improve the health of people with intellectual disability. Similar to other health assessments, it is designed to address healthcare needs, many of which are often overlooked in this population, through better communication between the general practitioner (GP), support worker and the person with intellectual disability. This study investigates GP views of the perceived and actual benefits, gains and barriers associated with its uptake and use in practice. METHOD As part of a larger randomised controlled trial of the CHAP, 46 GPs in Queensland, Australia, completed two telephone interviews that included open-ended questions about their perceptions of the health assessment. The GPs were enrolled in the intervention arm of the trial. Interviews took place at commencement and conclusion of the trial to gain the views of GPs as they experienced using the CHAP. Thematic analysis was used to identify key themes and patterns from the GP responses. RESULTS Four themes were identified: better healthcare and uncertain benefits captured GP perceptions of the potential gains associated with use of the CHAP, while two further themes, organisational barriers in the general practice setting and engagement across the healthcare triad highlighted strengths and barriers related to implementation. Anticipated concerns about time raised by GPs at commencement of the trial were borne out in practice, but concerns about communication and cooperation of people with disabilities were not. Matters associated with support worker engagement emerged as an area of concern. CONCLUSIONS GPs perceive the CHAP as a structured and comprehensive approach to the detection of medical problems as well as an aid in overcoming communication barriers between the doctor and the person with disability. Our findings suggest that some GPs may find it difficult to predict the benefits of using health assessments such as the CHAP. Achieving optimal uptake is likely to require attention at policy and systems levels to address: GP time constraints in providing healthcare to this population; enhancement of support worker training and organisational structures to encourage comprehensive health assessment and follow-up activities; and GP awareness of the improved health outcomes shown to derive from the use of comprehensive health assessments.
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Affiliation(s)
- N G Lennox
- Queensland Centre for Intellectual and Developmental Disability, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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24
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Russell AW, Baxter KA, Askew DA, Tsai J, Ware RS, Jackson CL. Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial. Diabet Med 2013; 30:1112-21. [PMID: 23758279 DOI: 10.1111/dme.12251] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/28/2013] [Accepted: 06/06/2013] [Indexed: 12/23/2022]
Abstract
AIMS To evaluate patient outcomes for a novel integrated primary/specialist model of community care for complex Type 2 diabetes mellitus management compared with outcomes for usual care at a tertiary hospital for diabetes outpatients. METHODS This was a prospective open controlled trial performed in a primary and tertiary care setting in Australia. A total of 330 patients with Type 2 diabetes aged >18 years were allocated to an intervention (n=185) or usual care group (n=145). The intervention arm was a community-based model of care led by a general practitioner with advanced skills and an endocrinologist partnership. Usual care was provided via the hospital diabetes outpatient department. The primary end point was HbA(1c) concentration at 12 months. Secondary end points included serum lipids and blood pressure. RESULTS The mean change in HbA1c concentration in the intervention group was -9 mmol/mol (-0.8%) at 12 months and in the usual care group it was -2 mmol/mol (-0.2%) (95% CI -5,1). The percentage of patients in the intervention group achieving the HbA(1c) target of ≤53 mmol/mol (7%) increased from 21 to 42% (P<0.001); for the usual care group there was a 1% increase to 39% of patients attaining this target (P=0.99). Patients in the intervention group experienced significant improvements in blood pressure and total cholesterol compared with those in the usual care group. The percentage of patients achieving clinical targets was greater in the intervention group for the combined target of HbA(1c) concentration, blood pressure and LDL cholesterol. CONCLUSIONS A community-based, integrated model of complex diabetes care, delivered by general practitioners with advanced skills, produced clinical and process benefits compared with a tertiary diabetes outpatient clinic.
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Affiliation(s)
- A W Russell
- Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Qld, Australia.
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North JB, Blackford FJ, Wall D, Allen J, Faint S, Ware RS, Rey-Conde T. Analysis of the causes and effects of delay before diagnosis using surgical mortality data. Br J Surg 2012; 100:419-25. [PMID: 23225342 DOI: 10.1002/bjs.8986] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of the study was to assess the causes and effects of delay in diagnosis in surgical patients who died in 20 public hospitals participating in the Queensland Audit of Surgical Mortality (QASM) in Australia. METHODS This was a retrospective cross-sectional analysis (June 2007 to December 2011) of deaths reported to QASM. Deaths were assigned to one of two groups (no delay or delay in diagnosis). Logistic regression was used to compare the association of delay with surgical complications, both overall and by surgical specialty. RESULTS A total of 3139 deaths were reported. Diagnostic delay was reported in 293 (9·3 per cent). The primary cause of delay was attributed to diagnostic support services (41·7 per cent). Some 174 (13·8 per cent) of 1259 general (gastrointestinal) surgery patients experienced delayed diagnosis. Delay across all surgical specialties was associated with an increased risk of unplanned return to theatre (odds ratio (OR) 1·77, 95 per cent confidence interval 1·24 to 2·52), of being treated in intensive care (OR 1·71, 1·15 to 2·54) and of postoperative complications (OR 1·39, 1·05 to 1·85). CONCLUSION General (gastrointestinal) surgery patients who experienced delayed diagnosis were at increased risk of postoperative complications.
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Affiliation(s)
- J B North
- Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, Brisbane, Queensland, Australia
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Brolan CE, Boyle FM, Dean JH, Taylor Gomez M, Ware RS, Lennox NG. Health advocacy: a vital step in attaining human rights for adults with intellectual disability. J Intellect Disabil Res 2012; 56:1087-1097. [PMID: 23106752 DOI: 10.1111/j.1365-2788.2012.01637.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND People with intellectual disability (ID) experience health inequity compared with the general population, a key contributing factor being disparities in social determinants of health. The enactment of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) provides a platform for the progression and promotion of health and other interconnected rights to address barriers to the highest attainable standard of health for this populace. Rights can be brought to life through advocacy efforts. This paper explores the meaning, perceptions and experiences of advocacy by family members and paid support workers of adults with ID and locates the findings within a health and human rights discourse. METHODS As part of a larger randomised controlled trial, 113 parents and 84 support workers of adults with ID completed a telephone interview that included open-ended questions about their understanding and experiences of advocacy. Thematic analysis was used to identify relevant themes. RESULTS Five key themes were identified. The first underscored how advocacy to 'speak up' for the person with ID is integral to both parent and support worker roles. The second and third themes considered the contexts for advocacy efforts. Access to quality health care was a core concern, along with advocacy across other areas and sectors to address the person's wider psychosocial needs. The remaining themes highlighted the many dimensions to advocacy, including differences between parent and support worker views, with parental advocacy being an expression of 'caring' and support workers motivated by a 'duty of care' to protect the individual's 'rights'. CONCLUSION Parent and support worker advocacy provides one means to address the social determinants of health and fulfilment of health rights of and for people with ID. Policy and practice in the context of governmental obligation under the CRPD should support advocacy and make health rights the reality not rhetoric for this group of men and women.
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Affiliation(s)
- C E Brolan
- School of Population Health, University of Queensland, Herston, Australia.
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White M, Murphy AJ, Hallahan A, Ware RS, Fraser C, Davies PSW. Survival in overweight and underweight children undergoing hematopoietic stem cell transplantation. Eur J Clin Nutr 2012; 66:1120-3. [DOI: 10.1038/ejcn.2012.109] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Xu F, Wang Y, Ware RS, Tse LA, Dunstan DW, Liang Y, Wang Z, Hong X, Owen N. Physical activity, family history of diabetes and risk of developing hyperglycaemia and diabetes among adults in Mainland China. Diabet Med 2012; 29:593-9. [PMID: 22004456 DOI: 10.1111/j.1464-5491.2011.03495.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the joint influence of physical activity and family history of diabetes on the subsequent risk of developing hyperglycaemia and Type 2 diabetes among Chinese adults. METHODS A prospective community-based cohort study was conducted among adults aged 35 years and older during 2004-2007 in Nanjing, China. Four communities (three urban and one rural) were randomly selected from 11 urban districts and two rural counties. Hyperglycaemia and Type 2 diabetes were defined using World Health Organization criteria based on fasting blood glucose concentration and physicians' diagnosis, respectively. Physical activity, parental diabetes history, and other important covariates were assessed at baseline and in the third-year follow-up survey. RESULTS At study conclusion data were collected from 3031 participants (follow-up rate 81.3%). The 3-year cumulative incidence of hyperglycaemia and Type 2 diabetes was 6.2% and 2.4%, respectively. After adjustment for potential confounding variables, compared with those with positive family history and insufficient physical activity, the adjusted relative risk ratio (95% CI) of developing hyperglycaemia was 0.19 (0.02, 1.51) for participants with sufficient physical activity and a positive family history; 0.55 (0.31, 0.97) for participants with insufficient physical activity and a negative family history; and 0.36 (0.19, 0.70) for participants with sufficient physical activity but a negative family history. Participants who had a negative family history and insufficient physical activity were also less likely to develop Type 2 diabetes (RRR = 0.28; 0.14, 0.54), and participants with a negative family history and sufficient physical activity were the least likely to develop Type 2 diabetes (0.23; 0.10, 0.56). CONCLUSIONS Sufficient physical activity and negative family history of diabetes may jointly reduce the risk of developing hyperglycaemia and Type 2 diabetes in Chinese adults.
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Affiliation(s)
- F Xu
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
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Hawkes A, Patrao T, Ware R, Oldenburg B, Atherton J, Taylor C. Predictors of Health-related Quality of Life Outcomes in a Telephone-delivered Secondary Prevention Program (PROACTIVE HEART). Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Eagleson K, Justo R, Boyle F, Ware R, Johnson S. Health-Related Quality of Life and Congenital Heart Disease in Australia. Heart Lung Circ 2012. [DOI: 10.1016/j.hlc.2012.05.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Kee D, Liu W, Devitt BA, Wolfe R, Ware R, Salemi R, Dobrovic A, Brglevska S, Kelly J, Callahan J, Katsifis A, Roselt P, Neels OC, Bourdier T, Hicks RJ, McArthur GA. Melanoma pigmentation affects melanoma-specific survival and provides a potential target for radiopharmaceutical-based imaging and therapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Elder J, Mattingly M, Ferda A, DeSimone C, Ware R, Ueland F, van Nagell J, Carlson J, Seamon L. The use of bevacizumab and cytotoxic and consolidation chemotherapy for the upfront treatment of advanced ovarian cancer: Practice patterns among medical and gynecologic oncology SGO members. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Seamon L, Podzielinski I, Huang B, DeSimone C, Shelton B, Randall M, Ware R, van Nagell J, Cibull M, Ueland F. Survival following ovarian versus uterine carcinosarcoma. Gynecol Oncol 2011. [DOI: 10.1016/j.ygyno.2010.12.289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The present study presents a brief summary of four extensive psychometric analyses of the Myers-Briggs Type Indicator (MBTI) items. Positive empirical evidence supports the MBTI item validity. However, several measurement issues on item construction were raised to caution the future users.
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Affiliation(s)
- O C Tzeng
- Dept. of Psychology, Purdue University School of Science, Indianapolis, IN 46223, USA
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Baldwin L, Ware R, Huang B, Tucker T, Goodrich S, Podzielinski I, DeSimone CP, Vannagell J, Ueland F, Seamon LG. Ten-year relative suvival for ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ware R, Baldwin L, Huang B, Tucker T, Goodrich S, Podzielinski I, DeSimone CP, Ueland F, Vannagell J, Seamon LG. Relative conditional survival in 41,476 patients with ovarian cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
AIMS To explore the relationship between family average income (FAI; an index of socio-economic status) and Type 2 diabetes in a region of mainland China. METHODS Population-based cross-sectional study, conducted between October 2000 and March 2001 in administrative villages (n = 45) randomly selected from three urban districts and two rural counties of NanJing municipality, mainland China, with a regional population of 5.6 million. Participants were all local residents aged > or = 35 years old (n = 29 340); 67.7% from urban areas, 32.3% from rural areas, 49.8% male and 50.2% female. RESULTS The response rate of eligible participants was 90.1%. The overall prevalence of self-reported Type 2 diabetes was 1.9%. After adjustment for possible confounding variables (age, gender, area of residence, body mass index, educational level, smoking status, occupational and leisure-time physical activity), participants in the higher and middle FAI categories were more than twice as likely to have Type 2 diabetes as those in the lower FAI category. CONCLUSIONS The prevalence of Type 2 diabetes is positively related to socio-economic status (indexed by FAI) in Chinese at the population level. After controlling for potential confounding factors, people in higher socio-economic status groups are more likely to have Type 2 diabetes. These associations are consistent with other effects of epidemiological transition and identify a need for preventive initiatives.
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Affiliation(s)
- F Xu
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.
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Masters IB, Eastburn MM, Wootton R, Ware RS, Francis PW, Zimmerman PV, Chang AB. A new method for objective identification and measurement of airway lumen in paediatric flexible videobronchoscopy. Thorax 2005; 60:652-8. [PMID: 16061706 PMCID: PMC1747475 DOI: 10.1136/thx.2004.034421] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Accurate measurements of airway and lesion dimensions are important to the developmental progress of paediatric bronchoscopy. The malacia disorders are an important cause of respiratory morbidity in children, but no methods are currently available to measure these lesions or the airway lumen accurately. A new measurement technique is described here. METHODS The magnification power of a paediatric videobronchoscope was defined and a simple and user friendly computer based program (Image J) was used to develop an objective technique (colour histogram mode technique, CHMT) for measurement of the airway lumen. RESULTS In vivo intra-observer and inter-observer repeatability coefficients for repeated area measurements from 28 images using the Bland-Altman method were 0.9 mm2 and 1.6 mm2, respectively. The average intraclass correlation coefficient for repeated measurements of area was 0.93. In vitro validation measurements using a 2 mm diameter tube resolved radii measurements to within 0.1 mm (coefficient of variability 8%). An "acceptable result" was defined in 92% of 734 images completed with the CHMT alone and 8% with its modification. The success rate for two of three images being within 10% of each other's area was 100%. Measurements of cricoid cross sectional areas from 116 patients compared with expected airway areas for age derived from endotracheal tube sizes were comparable. CONCLUSIONS The CHMT method of identifying and measuring airway dimensions is objective, accurate, and versatile and, as such, is important to the future development of flexible videobronchoscopy.
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Affiliation(s)
- I B Masters
- Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia.
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Masters IB, Eastburn MM, Francis PW, Wootton R, Zimmerman PV, Ware RS, Chang AB. Quantification of the magnification and distortion effects of a pediatric flexible video-bronchoscope. Respir Res 2005; 6:16. [PMID: 15705204 PMCID: PMC549513 DOI: 10.1186/1465-9921-6-16] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2004] [Accepted: 02/10/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Flexible video bronchoscopes, in particular the Olympus BF Type 3C160, are commonly used in pediatric respiratory medicine. There is no data on the magnification and distortion effects of these bronchoscopes yet important clinical decisions are made from the images. The aim of this study was to systematically describe the magnification and distortion of flexible bronchoscope images taken at various distances from the object. METHODS Using images of known objects and processing these by digital video and computer programs both magnification and distortion scales were derived. RESULTS Magnification changes as a linear function between 100 mm (x1) and 10 mm (x9.55) and then as an exponential function between 10 mm and 3 mm (x40) from the object. Magnification depends on the axis of orientation of the object to the optic axis or geometrical axis of the bronchoscope. Magnification also varies across the field of view with the central magnification being 39% greater than at the periphery of the field of view at 15 mm from the object. However, in the paediatric situation the diameter of the orifices is usually less than 10 mm and thus this limits the exposure to these peripheral limits of magnification reduction. Intraclass correlations for measurements and repeatability studies between instruments are very high, r = 0.96. Distortion occurs as both barrel and geometric types but both types are heterogeneous across the field of view. Distortion of geometric type ranges up to 30% at 3 mm from the object but may be as low as 5% depending on the position of the object in relation to the optic axis. CONCLUSION We conclude that the optimal working distance range is between 40 and 10 mm from the object. However the clinician should be cognisant of both variations in magnification and distortion in clinical judgements.
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Affiliation(s)
- IB Masters
- School of Medicine, Discipline of Paediatric and Child Health, University of Queensland, Herston 4029, Brisbane, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia
| | - MM Eastburn
- University of Queensland, Department of Information Technology and Electrical Engineering, St Lucia 4072, Brisbane, Australia
| | - PW Francis
- School of Medicine, Discipline of Paediatric and Child Health, University of Queensland, Herston 4029, Brisbane, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia
| | - R Wootton
- University of Queensland Centre for Online Health, Level 3 Foundation Building, Royal Children's Hospital, Herston 4029, Brisbane, Australia
| | - PV Zimmerman
- Department of Thoracic Medicine, The Prince Charles Hospital, Rode Rd, Chermside 4032, Brisbane, Australia
| | - RS Ware
- Longitudinal Studies Unit, School of Population Health, The University of Queensland, Herston 4006, Brisbane, Australia
| | - AB Chang
- School of Medicine, Discipline of Paediatric and Child Health, University of Queensland, Herston 4029, Brisbane, Australia
- Department of Respiratory Medicine, Royal Children's Hospital, Herston 4029, Brisbane, Australia
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Abstract
The use of a fully parametric Bayesian method for analysing single patient trials based on the notion of treatment 'preference' is described. This Bayesian hierarchical modelling approach allows for full parameter uncertainty, use of prior information and the modelling of individual and patient sub-group structures. It provides updated probabilistic results for individual patients, and groups of patients with the same medical condition, as they are sequentially enrolled into individualized trials using the same medication alternatives. Two clinically interpretable criteria for determining a patient's response are detailed and illustrated using data from a previously published paper under two different prior information scenarios.
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Affiliation(s)
- P J Schluter
- Longitudinal Studies Unit, School of Population Health, The University of Queensland, Herston, Qld 4006, Australia.
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Hill R, Ware R, Wade J. Influence of topical mupirocin on the colonisation of central venous cannulae and related bacteraemia. J Infect 2002. [DOI: 10.1016/s0163-4453(02)90375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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MacManus MP, Hicks RJ, Ball DL, Ciavarella F, Binns D, Hogg A, Kalff V, Ware R, Wirth A, Salminen E, McKenzie A. Imaging with F-18 FDG PET is superior to Tl-201 SPECT in the staging of non-small cell lung cancer for radical radiation therapy. Australas Radiol 2001; 45:483-90. [PMID: 11903182 DOI: 10.1046/j.1440-1673.2001.00960.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thallium-201 (Tl-201) single photon emission computed tomography (SPECT) is funded for evaluation of malignancy in Australia and may have utility for staging of non-small cell lung cancer (NSCLC) if CT results are equivocal. Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET) is superior to CT for staging NSCLC but is more expensive and less widely available than Tl-201 SPECT. Therefore, these techniques were prospectively compared in 27 radical radiation therapy candidates. Patients were allocated a conventional, PET and Tl-201 stage. Tumour to background ratios (TBR) were recorded for the primary on both techniques. Metastatic disease was confirmed by surgical pathology, serial imaging or clinical follow up. Tumour to background ratios were consistently higher for FDG PET than Tl-201 SPECT (P < 0.0001). Positron emission tomography detected all known primary tumours but Tl-201 failed to image four primary tumours (15%). In 10 of 18 cases of discordance between PET and Tl-201 SPECT regarding stage, corroboration was available from pathology or disease progression. Positron emission tomography was shown to have a 100% positive predictive value, including all three patients with PET-detected distant metastases (P=0.002). Results indicate that PET is superior to Tl-201 SPECT scanning in the staging of NSCLC for radical radiation therapy, and that the low sensitivity for detection of local and metastatic disease is likely to limit the clinical impact and cost-effectiveness of this technique despite its lower cost.
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Affiliation(s)
- M P MacManus
- Division of Radiation Oncology and Department of Diagnostic Imaging, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia.
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O'Brien TJ, Hicks RJ, Ware R, Binns DS, Murphy M, Cook MJ. The utility of a 3-dimensional, large-field-of-view, sodium iodide crystal--based PET scanner in the presurgical evaluation of partial epilepsy. J Nucl Med 2001; 42:1158-65. [PMID: 11483674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
UNLABELLED (18)F-FDG PET is an accurate and reliable technique for localizing medically refractory temporal lobe epilepsy, but widespread use has been hindered by limited reimbursement in many countries because of the high cost of traditional PET equipment and radioisotopes. Additionally, the place of FDG PET as a cost-effective tool for presurgical evaluation of epilepsy has been questioned because of limited data showing that FDG PET provides localization information incremental to that provided by more established techniques, particularly MRI and ictal electroencephalography (EEG). Three-dimensional (3D), large-field-of-view, sodium iodide crystal-based scanners have lower equipment and running costs and better multiplanar resolution than traditional 2-dimensional bismuth germinate (BGO) systems but have not yet been validated for evaluation of epilepsy. Our purpose was to investigate the localization rate, accuracy, and prognostic value of FDG PET images acquired on a 3D, large-field-of-view, sodium iodide crystal-based PET scanner in the presurgical evaluation of intractable partial epilepsy. We also wanted to establish the incremental value of FDG PET over established MRI and ictal EEG techniques. METHODS Fifty-five patients who were surgical candidates because of medically refractory partial epilepsy were examined. For most of these patients, the lesions had not been clearly localized on conventional assessment. The FDG PET scans were reviewed independently by 2 reviewers who were unaware of the patients' clinical details, ictal EEG findings, and volumetric MRI results, and the FDG PET results were correlated with those of MRI and EEG and with postsurgical outcome. RESULTS Forty-two patients (76%) had localizing FDG PET images (37 temporal, 5 extratemporal). The ictal EEG recordings were localizing in 66%, and the MRI findings were localizing in 27% (which increased to 35% after the MRI findings were reviewed again after PET). Concordance between the site of the PET localizations and the site of the MRI or EEG localizations was 100%. The PET images were localizing in 63% and 69% of patients with nonlocalizing ictal EEG and MRI findings, respectively. Twenty-one of 24 patients who subsequently underwent epilepsy surgery had localizing FDG PET images; of these 21 patients, 18 (86%) had a class I outcome. Multiple regression analysis showed the FDG PET results to be predictive of postsurgical outcome independently of the MRI findings. CONCLUSION For intractable partial epilepsy, FDG PET using a 3D, large-field-of-view, sodium iodide crystal-based scanner provided clinically useful localizing information that was at least as accurate as the results reported for traditional BGO-based scanners. The PET images provided prognostically significant localization information incremental to that provided by volumetric MRI and ictal EEG, particularly if 1 of these studies was nonlocalizing.
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Affiliation(s)
- T J O'Brien
- Australian Center for Clinical Neuropharmacology, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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Kalff V, Hicks R, Ware R, Binns D, McKenzie A. 29. F-18 FDG PET for Suspected or Confirmed Regional Recurrence of Colon Cancer. A Prospective Study of Impact and Outcome. Clin Positron Imaging 2000; 3:183. [PMID: 11150786 DOI: 10.1016/s1095-0397(00)00095-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Purpose: Survival of patients (pts) undergoing "curative" treatment for colorectal carcinoma remains poor. Retrospective studies suggest that F-18 FDG PET is more accurate than CT for restaging suspected recurrent disease and favourably impacts management. The aim of this study was to confirm this by prospective analysis.Patient Population and Methods: 102 consecutive patients for whom the referring clinicians had prospectively committed to a treatment plan based on conventional staging investigations and who then underwent F-18 FDG PET scanning were evaluated for management change and outcome. The accuracy of PET results was assessed by surgical findings or clinical follow-up.Results: Overall PET changed management in 66/102 (65%) pts including14 pts changed from observation to active treatment after PET localized disease and 6 pts planned for local therapy to observation after negative PET. Planned surgery was cancelled in 28 pts whereas surgery was initiated in 11 pts. Radiotherapy was prevented in 5 pts, initiated in 11 and the radiation field altered in 5 others. The accuracy of the PET results could be assessed in 63/66 (95%) pts in whom management was changed. Relapse was confirmed in 50/51 pts with a positive PET but disease extent was underestimated in 4 cases. False negative PET results were confirmed in 5 cases.Conclusion: FDG PET has a high and appropriate impact on patient management in patients with suspected recurrent disease. PET can miss small volume disease but the major benefit of PET is to prevent futile attempts at local salvage therapies.
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Affiliation(s)
- V Kalff
- The Peter MacCallum Cancer Institute, Melbourne, Australia
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Shepherd JJ, Burgess JR, Greenaway TM, Ware R. Preoperative sestamibi scanning and surgical findings at bilateral, unilateral, or minimal reoperation for recurrent hyperparathyroidism after subtotal parathyroidectomy in patients with multiple endocrine neoplasia type 1. Arch Surg 2000; 135:844-8. [PMID: 10896380 DOI: 10.1001/archsurg.135.7.844] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
HYPOTHESES Preoperative parathyroid radioisotope scanning is of little or no value in patients with multiple endocrine neoplasia type 1 when 4 or more hypertrophied glands are present. Scanning using technetium Tc 99m sestamibi and single photon emission computed tomography will achieve a high level of sensitivity and specificity after 3 or more glands have previously been removed, justifying limited surgical reexploration. DESIGN In a prospective study, the preoperative documented report of the predicted site of residual parathyroid was compared with the surgical findings in 13 patients having 19 scans and 17 reoperations. SETTING All patients belonged to one family, previously described as Tasman family 1, and were confirmed by genetic testing as having multiple endocrine neoplasia type 1. In 10 of 13 patients, reexploration was being undertaken more than 10 years after the first operation. MAIN OUTCOME MEASURES Scanning was regarded as successful when the documented preoperative report correctly predicted the side and quadrant in which a gland was found at surgery. Surgery was regarded as successful when calcium levels decreased to or below normal levels and were maintained. RESULTS All 13 scans before first reexploration were successful in identifying the location of a residual parathyroid. From a statistical viewpoint, this equates to 100% sensitivity and 92% specificity. However, despite accurate localization of 1 residual gland in every patient, 7 supernumerary glands in 4 patients and 1 parathyroid remnant in a fifth patient were not localized so that sensitivity in locating all glands in every patient was only 61%. Scans performed for persistent hypercalcemia 48 to 72 hours after reexploration in 2 patients were unsuccessful in demonstrating any residual parathyroid. Scans performed 3 months after surgery in the same 2 patients and a third patient were successful, with sensitivity and specificity of 100%. Apart from patient 11, who awaits reexploration, normocalcemia was eventually achieved in every patient, with 11 of 12 having an initial period of hypocalcemia. CONCLUSIONS Three months after reexploration and trimming or resection with transplant of half a gland left at first operation, sestamibi scanning achieved sensitivity and specificity of 100% in locating supernumerary parathyroids in patients with multiple endocrine neoplasia type 1 and persistent hypercalcemia. Before first reexploration, however, scans rarely provided new information, predominantly showing only the hypertrophied half-gland remnant.
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Affiliation(s)
- J J Shepherd
- Department of Surgery, University of Tasmania and Royal Hobart Hospital, Australia.
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Mac Manus M, Hicks R, Matthews J, Hogg A, McKenzie A, Wirth A, Ware R, Ball D. High rate of detection of unsuspected distant metastases by pet in apparent stage III non small cell lung cancer: Implications for radical radiation therapy. Int J Radiat Oncol Biol Phys 2000. [DOI: 10.1016/s0360-3016(00)80052-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hicks RJ, MacManus M, Kalff V, Binns DS, Ware R, Hogg A, Ball DL. Clinical Impact of PET Scanning in Patients Being Staged with Non-Small-Cell Lung Cancer (NSCLC) in a Radiation Oncology Facility. ACTA ACUST UNITED AC 1999; 2:329. [PMID: 14516626 DOI: 10.1016/s1095-0397(99)00089-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- R J. Hicks
- The Peter MacCallum Cancer Institute, Melbourne, Australia
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Bank I, Bushkin Y, Kritchevsky A, Langevitz P, Book M, Shenkman B, Ware R, Chess L. A novel 26 kilodalton antigen expressed on the surface membrane of activated T cells. Immunobiology 1999; 200:49-61. [PMID: 10084695 DOI: 10.1016/s0171-2985(99)80032-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We have identified and characterized the tissue distribution of the antigen recognized by a novel monoclonal antibody (mAb) 1B10, raised against an activated gammadelta T cell clone. Immunohistochemistry of tissue sections, and analysis of single cell suspensions by flow cytometry revealed that mAb 1B10 weakly reacted with <6% of normal human peripheral blood mononuclear cells (PBMC). After 5-6 days of in vitro culture of PBMC activated with phytohemagglutinin (PHA), 55% of the CD4+ and 25% of the CD8+ T cells became 1B10+. 1B10 expression was maintained on long term cultured interleukin 2 (IL-2)-dependent T cell receptor (TCR) alphabeta+ and gammadelta+ clones, and importantly, in contrast to resting T cells, the majority of in vivo activated synovial T lymphocytes from a patient with rheumatoid arthritis were 1B10+. In addition, myelo-monocytic U927 cells, tissue macrophages and some epithelia and fibroblasts were found to react with mAb 1B10. Sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) of molecules immuno-precipitated by mAb 1B10 from radio-iodinated cell surface membrane lysates of T lymphocyte and U937 cells revealed 26 and 29 kiloDalton (kDa) glycoproteins respectively. In conclusion, mAb 1B10 recognizes a novel <<late>> appearing 26 kDa T cell activation antigen that may be useful for further studies of activated T cells in health and disease.
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MESH Headings
- Antibodies, Monoclonal
- Antigens, Differentiation, T-Lymphocyte/immunology
- Antigens, Differentiation, T-Lymphocyte/isolation & purification
- Arthritis, Rheumatoid/immunology
- Cells, Cultured
- Clone Cells
- Glycoproteins/immunology
- Glycoproteins/isolation & purification
- Humans
- Lymphocyte Activation
- Receptors, Antigen, T-Cell, gamma-delta
- Synovial Fluid/immunology
- T-Lymphocytes/immunology
- Tissue Distribution
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Affiliation(s)
- I Bank
- Department of Medicine F, Chaim Sheba Medical Center and Tel Aviv University, Israel
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Rocken C, Anthes R, Exner M, Hunt D, Sokolovskiy S, Ware R, Gorbunov M, Schreiner W, Feng D, Herman B, Kuo YH, Zou X. Analysis and validation of GPS/MET data in the neutral atmosphere. ACTA ACUST UNITED AC 1997. [DOI: 10.1029/97jd02400] [Citation(s) in RCA: 429] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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