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Holbert MD, Duff J, Wood F, Holland AJA, Teague W, Frear C, Crellin D, Phillips N, Storey K, Martin L, Singer Y, Dimanopoulos TA, Cuttle L, Vagenas D, McPhail S, Calleja P, De Young A, Kimble RM, Griffin BR. Barriers and co-designed strategies for the implementation of negative pressure wound therapy in acute pediatric burn care in Australia: A mixed method study. J Pediatr Nurs 2024:S0882-5963(24)00200-8. [PMID: 38762422 DOI: 10.1016/j.pedn.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/24/2023] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE Pediatric burn injuries are a global clinical issue causing significant morbidity. Early adjunctive negative pressure wound therapy improves re-epithelialization rates in children with burns, yet adoption in acute burn care is inconsistent. This investigation aimed to determine barriers to the implementation of adjunctive negative pressure wound therapy for the acute management of pediatric burns and co-design targeted implementation strategies. METHODS A sequential mixed methods design was used explore barriers to adjunctive negative pressure wound therapy implementation in acute pediatric burn care. An online questionnaire was disseminated to healthcare professionals within four major Australian pediatric hospitals, each with a dedicated burns service. Barriers were coded according to the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews with senior clinicians tailored implementation strategies to local contexts. A stakeholder consensus meeting consolidated implementation strategies and local processes. RESULTS Sixty-three healthcare professionals participated in the questionnaire, and semi-structured interviews involved nine senior burn clinicians. We identified eight implementation barriers across all five CFIR domains then co-designed targeted strategies to address identified barriers. Barriers included lack of available resources, limited access to knowledge and information, individual stage of change, patient needs and resources, limited knowledge and beliefs about the intervention, lack of external policies, intervention complexity, and poor implementation planning. CONCLUSION Multiple contextual factors affect negative pressure wound therapy uptake in acute pediatric burn settings. Results will inform a multi-state stepped-wedge cluster randomized controlled trial. Additional resources, education, training, updated policies, and guidelines are required for successful implementation. It is anticipated that adjunctive negative pressure wound therapy, in conjunction with tailored implementation strategies, will enhance adoption and sustainability. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12622000166774. Registered 1 February 2022.
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Affiliation(s)
- Maleea D Holbert
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia.
| | - Jed Duff
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Australia
| | - Fiona Wood
- Perth Children's Hospital, Nedlands, WA 6009, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, WA 6009, Australia
| | - Andrew J A Holland
- The Burns Unit, The Children's Hospital at Westmead, NSW 2145, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, NSW 2050, Australia
| | - Warwick Teague
- Surgical Research, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Burns Service, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC 3052, Australia; School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Cody Frear
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Dianne Crellin
- Surgical Research, Murdoch Children's Research Institute, Parkville, VIC 3052, Australia; Burns Service, The Royal Children's Hospital Melbourne, Parkville, VIC 3052, Australia; Department of Nursing, The University of Melbourne, Victoria 3010, Australia
| | - Natalie Phillips
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Child Health Research Centre, University of Queensland, South Brisbane, QLD 4101, Australia
| | - Kristen Storey
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Lisa Martin
- Perth Children's Hospital, Nedlands, WA 6009, Australia; Burn Injury Research Unit, University of Western Australia, Crawley, WA 6009, Australia
| | - Yvonne Singer
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia
| | - Tanesha A Dimanopoulos
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Leila Cuttle
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology
| | - Dimitrios Vagenas
- School of Biomedical Sciences, Faculty of Health, Queensland University of Technology
| | - Steven McPhail
- Australian Centre for Health Services Innovation, and Centre for Healthcare Transformation, School of Public health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Australia
| | - Pauline Calleja
- College of Healthcare Sciences, James Cook University, Cairns 4870, Australia
| | - Alexandra De Young
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
| | - Roy M Kimble
- Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia; Faculty of Medicine, University of Queensland, Herston, Brisbane, QLD 4006, Australia
| | - Bronwyn R Griffin
- School of Nursing and Midwifery, Griffith University, Nathan Campus, QLD 4111, Australia; Children's Health Queensland Hospital and Health Service, South Brisbane, QLD 4101, Australia
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Feigl B, Lewis SJ, Burr LD, Schweitzer D, Gnyawali S, Vagenas D, Carter DD, Zele AJ. Efficacy of biologically-directed daylight therapy on sleep and circadian rhythm in Parkinson's disease: a randomised, double-blind, parallel-group, active-controlled, phase 2 clinical trial. EClinicalMedicine 2024; 69:102474. [PMID: 38361993 PMCID: PMC10867415 DOI: 10.1016/j.eclinm.2024.102474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/18/2024] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
Background New non-pharmacological treatments for improving non-motor symptoms in Parkinson's disease (PD) are urgently needed. Previous light therapies for modifying sleep behaviour lacked standardised protocols and were not personalised for an individual patient chronotype. We aimed to assess the efficacy of a biologically-directed light therapy in PD that targets retinal inputs to the circadian system on sleep, as well as other non-motor and motor functions. Methods In this randomised, double-blind, parallel-group, active-controlled trial at the Queensland University of Technology, Australia, participants with mild to moderate PD were computer randomised (1:1) to receive one of two light therapies that had the same photometric luminance and visual appearance to allow blinding of investigators and participants to the intervention. One of these biologically-directed lights matched natural daylight (Day Mel), which is known to stimulate melanopsin cells. The light therapy of the other treatment arm of the study, specifically supplemented the stimulation of retinal melanopsin cells (Enhanced Mel), targeting deficits to the circadian system. Both lights were administered 30 min per day over 4-weeks and personalised to an individual patient's chronotype, while monitoring environmental light exposure with actigraphy. Co-primary endpoints were a change from baseline in mean sleep macrostructure (polysomnography, PSG) and an endocrine biomarker of circadian phase (dim light melatonin secretion onset, DLMO) at weeks 4 and 6. Participants data were analysed using an intention to treat principle. All endpoints were evaluated by applying a mixed model analysis. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12621000077864. Findings Between February 4, 2021 and August 8, 2022, 144 participants with PD were consecutively screened, 60 enrolled and randomly assigned to a light intervention. There was no significant difference in co-primary outcomes between randomised groups overall or at any individual timepoint during follow-up. The mean (95% CI) for PSG, N3% was 24.15 (19.82-28.48) for Day Mel (n = 23) and 19.34 (15.20-23.47) for the Enhanced Mel group (n = 25) in week 4 (p = 0.12); and 21.13 (16.99-25.28) for Day Mel (n = 26) and 18.48 (14.34-22.62) for the Enhanced Mel group (n = 25) in week 6, (p = 0.37). The mean (95% CI) DLMO (decimal time) was 19.82 (19.20-20.44) for Day Mel (n = 22) and 19.44 (18.85-20.04) for the Enhanced Mel group (n = 24) in week 4 (p = 0.38); and 19.90 (19.27-20.53) for Day Mel (n = 23) and 19.04 (18.44-19.64) for the Enhanced Mel group (n = 25) in week 6 (p = 0.05). However, both the controlled daylight (Day Mel) and the enhanced melanopsin (Enhanced Mel) interventions demonstrated significant improvement in primary PSG sleep macrostructure. The restorative deep sleep phase (PSG, N3) significantly improved at week 6 in both groups [model-based mean difference to baseline (95% CI): -3.87 (-6.91 to -0.83), p = 0.04]. There was a phase-advance in DLMO in both groups which did not reach statistical significance between groups at any time-point. There were no safety concerns or severe adverse events related to the intervention. Interpretation Both the controlled daylight and melanopsin booster light showed efficacy in improving measures of restorative deep sleep in people with mild to moderate PD. That there was no significant difference between the two intervention groups may be due to the early disease stage. The findings suggest that controlled indoor daylight that is personalised to the individuals' chronotype could be effective for improving sleep in early to moderate PD, and further studies evaluating controlled daylight interventions are now required utilising this standardised approach, including in advanced PD. Funding The Michael J Fox Foundation for Parkinson's Research, Shake IT Up Australia, National Health and Medical Research Council, and Australian Research Council.
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Affiliation(s)
- Beatrix Feigl
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- Queensland Eye Institute, South Brisbane, QLD, 4101, Australia
| | - Simon J.G. Lewis
- Brain and Mind Centre, The University of Sydney, New South Wales, 2006, Australia
| | - Lucy D. Burr
- Department of Respiratory and Sleep Medicine, Mater Health, South Brisbane, QLD, 4101, Australia
- Mater Research, University of Queensland, QLD, 4072, Australia
| | - Daniel Schweitzer
- Centre of Neurosciences, Mater Health, South Brisbane, QLD, 4101, Australia
- Wesley Hospital, Auchenflower, QLD, 4066, Australia
| | - Subodh Gnyawali
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
- School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Drew D. Carter
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
| | - Andrew J. Zele
- Centre for Vision and Eye Research, Queensland University of Technology (QUT), Brisbane, QLD, 4059, Australia
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Bairagi A, Tyack Z, Kimble RM, McPhail SM, McBride CA, Patel B, Vagenas D, Dettrick Z, Griffin B. Effectiveness of a Regenerative Epithelial Suspension (RES), on the pigmentation of split-thickness skin graft donor sites in children: the d RESsing pilot randomised controlled trial protocol. BMJ Open 2024; 14:e077525. [PMID: 38417964 PMCID: PMC10900329 DOI: 10.1136/bmjopen-2023-077525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/04/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Paediatric donor site wounds are often complicated by dyspigmentation following a split-thickness skin graft. These easily identifiable scars can potentially never return to normal pigmentation. A Regenerative Epidermal Suspension (RES) has been shown to improve pigmentation in patients with vitiligo, and in adult patients following a burn injury. Very little is known regarding the efficacy of RES for the management of donor site scars in children. METHODS AND ANALYSIS A pilot randomised controlled trial of 40 children allocated to two groups (RES or no RES) standard dressing applied to donor site wounds will be conducted. All children aged 16 years or younger requiring a split thickness skin graft will be screened for eligibility. The primary outcome is donor site scar pigmentation 12 months after skin grafting. Secondary outcomes include re-epithelialisation time, pain, itch, dressing application ease, treatment satisfaction, scar thickness and health-related quality of life. Commencing 7 days after the skin graft, the dressing will be changed every 3-5 days until the donor site is ≥ 95% re-epithelialised. Data will be collected at each dressing change and 3, 6 and 12 months post skin graft. ETHICS AND DISSEMINATION Ethics approval was confirmed on 11 February 2019 by the study site Human Research Ethics Committee (HREC) (HREC/18/QCHQ/45807). Study findings will be published in peer-reviewed journals and presented at national and international conferences. This study was prospectively registered on the Australian New Zealand Clinical Trials Registry (available at https://anzctr.org.au/ACTRN12620000227998.aspx). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry [Available at https://anzctr.org.au/ACTRN12620000227998.aspx].
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Affiliation(s)
- Anjana Bairagi
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Digital Health and Informatics, Metro South Health, Brisbane, Queensland, Australia
| | - Craig Antony McBride
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Bhaveshkumar Patel
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zoe Dettrick
- Research Methods Group, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia
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Hayes SC, Spence RR, Janda M, Eakin E, Shannon C, Goh J, Beesley VL, Vagenas D, Webb P, Coward J, Gordon LG, O'Neill H, Williams M, Rye S, Newton MJ, Baniahmadi S, Nascimento M, Nicklin J, Garret A, Obermair A. Pre-post feasibility trial of a telephone-delivered exercise intervention for patients during chemotherapy for recurrent ovarian cancer: the ECHO-R trial protocol. BMJ Open 2024; 14:e077158. [PMID: 38238061 PMCID: PMC10806642 DOI: 10.1136/bmjopen-2023-077158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION The benefits of exercise in reducing treatment-related morbidity and improving quality of life following a primary diagnosis of cancer have been well documented and have led to exercise being recommended by oncology societies for all people with a cancer diagnosis. However, these recommendations are derived from research typically involving cohorts with more common cancers and relatively good prognosis, such as breast and prostate. Evidence from these cancers may not apply to women with recurrent ovarian cancer. Therefore, the primary objective of this trial is to evaluate the feasibility and safety of a home-based, telephone-delivered exercise intervention for women undergoing chemotherapy for recurrent ovarian cancer. METHODS AND ANALYSIS The Exercise During Chemotherapy for Recurrent Ovarian Cancer (ECHO-R) trial is a single-arm, phase II, pre/postintervention trial of a 6-month, telephone-delivered exercise intervention (consistent with recommended exercise oncology prescription). The target sample size is 80 women who are currently undergoing (or are scheduled to receive) chemotherapy for recurrent ovarian cancer. Recruitment is through participating hospital sites in Queensland, Australia, or via self-referral. The exercise intervention comprises 12 telephone sessions over a 6-month period delivered by trial-trained exercise professionals and supplemented (where feasible) by five sessions face to face. Exercise prescription is individualised and works towards an overall goal of achieving a weekly target of 150 min of moderate-intensity, mixed-mode exercise. Assessments via self-administered survey and physical fitness and function tests occur at baseline and then at 6 and 9 months postbaseline. Data to inform feasibility and safety are recorded as case notes by the exercise professional during each session. ETHICS AND DISSEMINATION Ethics approval for the ECHO-R trial was granted by the Metro North Human Research Ethics Committee (HREC/2020/QRBW/67223) on 6 November 2020. Findings from the trial are planned to be disseminated via peer-reviewed publications and both national and international exercise and oncology conferences. TRIAL REGISTRATION NUMBER ACTRN12621000042842.
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Affiliation(s)
- Sandra C Hayes
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Rosalind R Spence
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Monika Janda
- Faculty of Medicine, Centre of Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth Eakin
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Catherine Shannon
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Herston, Queensland, Australia
| | - Jeffrey Goh
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Herston, Queensland, Australia
| | - Vanessa L Beesley
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Queensland University of Technology Faculty of Health, Kelvin Grove, Queensland, Australia
| | - Penny Webb
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Jermaine Coward
- Faculty of Medicine and ICON Cancer Care Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Louisa G Gordon
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Helene O'Neill
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Herston, Queensland, Australia
| | - Merran Williams
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Herston, Queensland, Australia
| | - Sheree Rye
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Melissa J Newton
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Sara Baniahmadi
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Herston, Queensland, Australia
| | | | - James Nicklin
- Gynaecological Cancer, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Andrea Garret
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Herston, Queensland, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Herston, Queensland, Australia
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Hawas S, Vagenas D, Haque A, Totsika M. Bladder-draining lymph nodes support germinal center B cell responses during urinary tract infection in mice. Infect Immun 2023; 91:e0031723. [PMID: 37882531 PMCID: PMC10652902 DOI: 10.1128/iai.00317-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023] Open
Abstract
Bacterial urinary tract infections (UTIs) are both common and exhibit high recurrence rates in women. UTI healthcare costs are increasing due to the rise of multidrug-resistant (MDR) bacteria, necessitating alternative approaches for infection control. Here, we directly observed host adaptive immune responses in acute UTI. We employed a mouse model in which wild-type C57BL/6J mice were transurethrally inoculated with a clinically relevant MDR UTI strain of uropathogenic Escherichia coli (UPEC). Firstly, we noted that rag1-/- C57BL/6J mice harbored larger bacterial burdens than wild-type counterparts, consistent with a role for adaptive immunity in UTI control. Consistent with this, UTI triggered in the bladders of wild-type mice early increases of myeloid cells, including CD11chi conventional dendritic cells, suggesting possible involvement of these professional antigen-presenting cells. Importantly, germinal center B cell responses developed by 4 weeks post-infection in bladder-draining lymph nodes of wild-type mice and, although modest in magnitude and transient in nature, could not be boosted with a second UTI. Thus, our data reveal for the first time in a mouse model that UPEC UTI induces local B cell immune responses in bladder-draining lymph nodes, which could potentially serve to control infection.
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Affiliation(s)
- Sophia Hawas
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Research Methods Group, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Ashraful Haque
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Microbiology and Immunology, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia
| | - Makrina Totsika
- Centre for Immunology and Infection Control, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Hayes SC, Vagenas D, Janda M. Towards gender equity in Australian health and medical research funding. Med J Aust 2023; 219:135. [PMID: 37343957 DOI: 10.5694/mja2.52007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/04/2023] [Accepted: 05/05/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Sandra C Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD
- Improving Health Outcomes for People (ihop) Research Group, Brisbane, QLD
| | | | - Monika Janda
- Queensland University of Technology, Brisbane, QLD
- Centre for Health Services Research, Queensland University of Technology, Brisbane, QLD
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Vagenas D, Pispas S. Triple Hydrophilic Statistical Terpolymers via RAFT Polymerization: Synthesis and Properties in Aqueous Solutions. Polymers (Basel) 2023; 15:polym15112492. [PMID: 37299291 DOI: 10.3390/polym15112492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/28/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
In this work, we report the synthesis of novel triple hydrophilic statistical terpolymers consisting of three different methacrylate monomers with varying degrees of responsivity to solution conditions. Terpolymers of the type poly(di(ethylene glycol) methyl ether methacrylate-co-2-(dimethylamino)ethylmethacrylate-co-oligoethylene glycol methyl ether methacrylate), P(DEGMA-co-DMAEMA-co-OEGMA), and of different compositions, were prepared by using the RAFT methodology. Their molecular characterization was carried out using size exclusion chromatography (SEC) and spectroscopic techniques, including 1H-NMR and ATR-FTIR. Studies in dilute aqueous media by dynamic and electrophoretic light scattering (DLS and ELS) show their potential responsiveness regarding changes in temperature, pH, and kosmotropic salt concentration. Finally, the change in hydrophilic/hydrophobic balance of the formed terpolymer nanoparticles during heating and cooling was studied using fluorescence spectroscopy (FS) in conjunction with pyrene giving additional information on the responsiveness and internal structure of the self-assembled nanoaggregates.
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Affiliation(s)
- Dimitrios Vagenas
- Theoretical and Physical Chemistry Institute, National Hellenic Research Foundation, 48 Vassileos Constantinou Ave., 11635 Athens, Greece
| | - Stergios Pispas
- Theoretical and Physical Chemistry Institute, National Hellenic Research Foundation, 48 Vassileos Constantinou Ave., 11635 Athens, Greece
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Hayes S, Obermair A, Mileshkin L, Davis A, Gordon LG, Eakin E, Janda M, Beesley VL, Barnes EH, Spence RR, Sandler C, Jones T, Vagenas D, Webb P, Andrews J, Brand A, Lee YC, Friedlander M, Pumpa K, O'Neille H, Williams M, Stockler M. Exercise during CHemotherapy for Ovarian cancer (ECHO) trial: design and implementation of a randomised controlled trial. BMJ Open 2023; 13:e067925. [PMID: 37055210 PMCID: PMC10106078 DOI: 10.1136/bmjopen-2022-067925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Epidemiological evidence supports an association between higher levels of physical activity and improved cancer survival. Trial evidence is now needed to demonstrate the effect of exercise in a clinical setting. The Exercise during CHemotherapy for Ovarian cancer (ECHO) trial is a phase III, randomised controlled trial, designed to determine the effect of exercise on progression-free survival and physical well-being for patients receiving first-line chemotherapy for ovarian cancer. METHODS AND ANALYSIS Participants (target sample size: n=500) include women with newly diagnosed primary ovarian cancer, scheduled to receive first-line chemotherapy. Consenting participants are randomly allocated (1:1) to either the exercise intervention (plus usual care) or usual care alone, with stratification for recruitment site, age, stage of disease and chemotherapy delivery (neoadjuvant vs adjuvant). The exercise intervention involves individualised exercise prescription with a weekly target of 150 minutes of moderate-intensity, mixed-mode exercise (equivalent to 450 metabolic equivalent minutes per week), delivered for the duration of first-line chemotherapy through weekly telephone sessions with a trial-trained exercise professional. The primary outcomes are progression-free survival and physical well-being. Secondary outcomes include overall survival, physical function, body composition, quality of life, fatigue, sleep, lymphoedema, anxiety, depression, chemotherapy completion rate, chemotherapy-related adverse events, physical activity levels and healthcare usage. ETHICS AND DISSEMINATION Ethics approval for the ECHO trial (2019/ETH08923) was granted by the Sydney Local Health District Ethics Review Committee (Royal Prince Alfred Zone) on 21 November 2014. Subsequent approvals were granted for an additional 11 sites across Queensland, New South Wales, Victoria and the Australian Capital Territory. Findings from the ECHO trial are planned to be disseminated via peer-reviewed publications and international exercise and oncology conferences. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ANZCTRN12614001311640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367123&isReview=true).
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Affiliation(s)
- Sandra Hayes
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, University of Queensland, Brisbane, Queensland, Australia
| | | | - Alison Davis
- Department of Medical Oncology, The Canberra Hospital and ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Louisa G Gordon
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Vanessa L Beesley
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Elizabeth H Barnes
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Rosalind Renee Spence
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Carolina Sandler
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Sport and Exercise Science, School of Health Science, Western Sydney University, Sydney, New South Wales, Australia
| | - Tamara Jones
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Penny Webb
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - John Andrews
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Alison Brand
- Department of Gynaecological Oncology, Westmead Hospital, Westmead, New South Waled and University of Sydney, Sydney, New South Wales, Australia
| | - Yeh Chen Lee
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
- Prince of Wales Clinical School, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Michael Friedlander
- Prince of Wales Clinical School, Faculty of Medicine and Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Kate Pumpa
- Research Institute for Sport and Exercise, University of Canberra, Canberra, Australian Capital Territory, Australia
| | | | | | - Martin Stockler
- University of Sydney, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
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9
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Walsh K, Eggins E, Hine L, Mathews B, Kenny MC, Howard S, Ayling N, Dallaston E, Pink E, Vagenas D. Child protection training for professionals to improve reporting of child abuse and neglect. Cochrane Database Syst Rev 2022; 7:CD011775. [PMID: 35788913 PMCID: PMC9301923 DOI: 10.1002/14651858.cd011775.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many nations require child-serving professionals to report known or suspected cases of significant child abuse and neglect to statutory child protection or safeguarding authorities. Considered globally, there are millions of professionals who fulfil these roles, and many more who will do so in future. Ensuring they are trained in reporting child abuse and neglect is a key priority for nations and organisations if efforts to address violence against children are to succeed. OBJECTIVES To assess the effectiveness of training aimed at improving reporting of child abuse and neglect by professionals and to investigate possible components of effective training interventions. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 18 other databases, and one trials register up to 4 June 2021. We also handsearched reference lists, selected journals, and websites, and circulated a request for studies to researchers via an email discussion list. SELECTION CRITERIA All randomised controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies examining the effects of training interventions for qualified professionals (e.g. teachers, childcare professionals, doctors, nurses, and mental health professionals) to improve reporting of child abuse and neglect, compared with no training, waitlist control, or alternative training (not related to child abuse and neglect). DATA COLLECTION AND ANALYSIS We used methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We synthesised training effects in meta-analysis where possible and summarised findings for primary outcomes (number of reported cases of child abuse and neglect, quality of reported cases, adverse events) and secondary outcomes (knowledge, skills, and attitudes towards the reporting duty). We used the GRADE approach to rate the certainty of the evidence. MAIN RESULTS We included 11 trials (1484 participants), using data from 9 of the 11 trials in quantitative synthesis. Trials took place in high-income countries, including the USA, Canada, and the Netherlands, with qualified professionals. In 8 of the 11 trials, interventions were delivered in face-to-face workshops or seminars, and in 3 trials interventions were delivered as self-paced e-learning modules. Interventions were developed by experts and delivered by specialist facilitators, content area experts, or interdisciplinary teams. Only 3 of the 11 included studies were conducted in the past 10 years. Primary outcomes Three studies measured the number of cases of child abuse and neglect via participants' self-report of actual cases reported, three months after training. The results of one study (42 participants) favoured the intervention over waitlist, but the evidence is very uncertain (standardised mean difference (SMD) 0.81, 95% confidence interval (CI) 0.18 to 1.43; very low-certainty evidence). Three studies measured the number of cases of child abuse and neglect via participants' responses to hypothetical case vignettes immediately after training. A meta-analysis of two studies (87 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.81, 95% CI 1.30 to 2.32; very low-certainty evidence). We identified no studies that measured the number of cases of child abuse and neglect via official records of reports made to child protection authorities, or adverse effects of training. Secondary outcomes Four studies measured professionals' knowledge of reporting duty, processes, and procedures postintervention. The results of one study (744 participants) may favour the intervention over waitlist for training (SMD 1.06, 95% CI 0.90 to 1.21; low-certainty evidence). Four studies measured professionals' knowledge of core concepts in all forms of child abuse and neglect postintervention. A meta-analysis of two studies (154 participants) favoured training over no training, but the evidence is very uncertain (SMD 0.68, 95% CI 0.35 to 1.01; very low-certainty evidence). Three studies measured professionals' knowledge of core concepts in child sexual abuse postintervention. A meta-analysis of these three studies (238 participants) favoured training over no training or waitlist for training, but the evidence is very uncertain (SMD 1.44, 95% CI 0.43 to 2.45; very low-certainty evidence). One study (25 participants) measured professionals' skill in distinguishing reportable and non-reportable cases postintervention. The results favoured the intervention over no training, but the evidence is very uncertain (SMD 0.94, 95% CI 0.11 to 1.77; very low-certainty evidence). Two studies measured professionals' attitudes towards the duty to report child abuse and neglect postintervention. The results of one study (741 participants) favoured the intervention over waitlist, but the evidence is very uncertain (SMD 0.61, 95% CI 0.47 to 0.76; very low-certainty evidence). AUTHORS' CONCLUSIONS The studies included in this review suggest there may be evidence of improvements in training outcomes for professionals exposed to training compared with those who are not exposed. However, the evidence is very uncertain. We rated the certainty of evidence as low to very low, downgrading due to study design and reporting limitations. Our findings rest on a small number of largely older studies, confined to single professional groups. Whether similar effects would be seen for a wider range of professionals remains unknown. Considering the many professional groups with reporting duties, we strongly recommend further research to assess the effectiveness of training interventions, with a wider range of child-serving professionals. There is a need for larger trials that use appropriate methods for group allocation, and statistical methods to account for the delivery of training to professionals in workplace groups.
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Affiliation(s)
- Kerryann Walsh
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | - Elizabeth Eggins
- School of Social Science, University of Queensland, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Lorelei Hine
- School of Social Science, University of Queensland, Brisbane, Australia
| | - Ben Mathews
- School of Law, Queensland University of Technology, Brisbane, Australia
| | - Maureen C Kenny
- Department of Psychology, Florida International University, Miami, FL, USA
| | - Sarah Howard
- Library Services Directorate, Queensland University of Technology, Brisbane, Australia
| | - Natasha Ayling
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | | | - Elizabeth Pink
- School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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10
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Spence RR, Sandler CX, Singh B, Tanner J, Pyke C, Eakin E, Vagenas D, Hayes SC. A Randomised, Comparative, Effectiveness Trial Evaluating Low- versus High-Level Supervision of an Exercise Intervention for Women with Breast Cancer: The SAFE Trial. Cancers (Basel) 2022; 14:cancers14061528. [PMID: 35326679 PMCID: PMC8946819 DOI: 10.3390/cancers14061528] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/16/2022] [Accepted: 03/12/2022] [Indexed: 02/01/2023] Open
Abstract
The aim of this comparative, effectiveness trial was to evaluate the safety, feasibility and effect of an exercise intervention delivered via low-level versus high-level supervision. The target population were women who were diagnosed with ≥stage II breast cancer, had ≥ one comorbidity and/or persistent treatment-related side-effects, and were insufficiently physically active. Sixty women (50 ± 9 years) were randomized to the low-supervision group (n = 30) or high-supervision group (n = 30). The low-supervision group participated in a 12-week, individually-tailored exercise intervention supported by five supervised sessions with an exercise professional. The high-supervision group participated in the same exercise intervention but received 20 supervised sessions across the 12-week period. The target weekly dosage of 600 metabolic equivalent minutes of exercise per week (MET-mins/wk) and the session content, such as safety and behaviour change topics, were standardized between the groups. The primary outcomes were intervention safety, defined as the number, type, and severity of exercise-related adverse events (e.g., musculoskeletal injury or exacerbated treatment-related side effects), and feasibility, which was defined as compliance to target exercise dosage. The effect of the intervention on quality of life, physical activity, self-efficacy, fitness, and strength was also assessed (pre- and post-intervention, and at 12-week follow-up). The intervention was safe, with no exercise-related adverse events of grade 3 or above in either group. Both groups reported high compliance to the target exercise dosage (median MET-mins/wk: High = 817; Low = 663), suggesting the exercise intervention was feasible, irrespective of supervision level. Improvements in quality of life, physical activity and fitness were observed post-intervention and maintained at follow-up for both groups (p < 0.05). Only the high-supervision group showed clinically-relevant improvements in strength and self-efficacy at post-intervention (p < 0.05). Individually-targeted exercise delivered under high- or low-levels of supervision is safe, feasible and beneficial for women with stage II+ breast cancer. Future research needs to assess whether the greater gains observed in the group who received higher supervision may contribute to longer term maintenance of physical activity levels and overall health benefits. Australian and New Zealand Clinical Trials Registry: ACTRN12616000547448.
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Affiliation(s)
- Rosalind R. Spence
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD 4222, Australia;
- Correspondence: (R.R.S.); (S.C.H.)
| | - Carolina X. Sandler
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD 4222, Australia;
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia
- Kirby Institute, UNSW Sydney, Kensington, NSW 2052, Australia
| | - Benjamin Singh
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia; (B.S.); (J.T.)
| | - Jodie Tanner
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia; (B.S.); (J.T.)
| | - Christopher Pyke
- Mater Health Services, South Brisbane, QLD 4101, Australia;
- Mater Clinical Unit, Faculty of Medicine, The University of Queensland, South Brisbane, QLD 4101, Australia
| | - Elizabeth Eakin
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia;
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia;
| | - Sandra C. Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD 4222, Australia;
- Correspondence: (R.R.S.); (S.C.H.)
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11
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Snoswell CL, Whitty JA, Caffery LJ, Kho J, Horsham C, Loescher LJ, Vagenas D, Gillespie N, Soyer HP, Janda M. Consumer Preference and Willingness to Pay for Direct-to-Consumer Mobile Teledermoscopy Services in Australia. Dermatology 2021; 238:358-367. [PMID: 34515087 DOI: 10.1159/000517257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/21/2021] [Accepted: 04/18/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate consumer preference and willingness to pay for mobile teledermoscopy services in Australia. METHODS Consumers who were taking part in a randomised controlled trial comparing mobile teledermoscopy and skin self-examination were asked to complete a survey which incorporated a discrete choice experiment (DCE) and a contingent valuation question. Responses were used to determine their willingness to pay for mobile teledermoscopy services in Australia and their overall service preferences. RESULTS The 199 consumers who responded were 71% female and had a mean age of 42 years (range, 18-73). The DCE results showed that consumers prefer a trained medical professional to be involved in their skin cancer screening. Consumers were willing to pay AUD 41 to change from a general practitioner reviewing their lesions in-person to having a dermatologist reviewing the teledermoscopy images. Additionally, they were willing to pay for services that had shorter waiting times, that reduced the time away from their usual activities, and that have higher accuracy and lower likelihood of unnecessary excision of a skin lesion. When asked directly about their willingness to pay for a teledermoscopy service using a contingent valuation question, the majority (73%) of consumers selected the lowest two value brackets of AUD 1-20 or AUD 21-40. CONCLUSION Consumers are willing to pay out of pocket to access services with attributes such as a dermatologist review, improved accuracy, and fewer excisions.
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Affiliation(s)
- Centaine L Snoswell
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia.,School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Jennifer A Whitty
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia.,Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Liam J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Joanna Kho
- UQ Business School, The University of Queensland, Brisbane, Queensland, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lois J Loescher
- College of Nursing, Arizona Cancer Center, and Skin Cancer Institute at The University of Arizona, Tucson, Arizona, USA
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Directorate, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Brisbane, Queensland, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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12
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Munday J, Higgins N, Jones L, Vagenas D, Van Zundert A, Keogh S. Zero-Heat-Flux and Esophageal Temperature Monitoring in Orthopedic Surgery: An Observational Study. J Multidiscip Healthc 2021; 14:1819-1827. [PMID: 34285500 PMCID: PMC8286425 DOI: 10.2147/jmdh.s313310] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/14/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Perioperative hypothermia prevention requires regular, accurate, and consistent temperature monitoring. Zero-heat-flux (ZHF) thermometry offers a non-invasive, measurement method that can be applied across all surgical phases. The purpose of this study was to measure agreement between the zero-heat-flux device and esophageal monitoring, sensitivity, and specificity to detect hypothermia and patient acceptability amongst patients undergoing upper and lower limb orthopedic surgery. Patients and Methods This prospective, observational study utilized Bland–Altman analysis and Lin’s concordance coefficient to measure agreement between devices, sensitivity and specificity to detect hypothermia and assessed patient acceptability amongst 30 patients between December 2018 and June 2019. Results Bias was observed between devices via Bland Altman, with bias dependent on actual temperature. The mean difference ranged from −0.16°C at 34.9°C (where the mean of ZHF was lower than the esophageal device) to 0.46°C at 37.25°C (where the mean of ZHF was higher than esophageal device), with 95% limits of agreement (max) upper LOA = 0.80 to 1.41, lower LOA = −1.12 to −0.50. Seventy-five percentage of zero-heat-flux measurements were within 0.5°C of esophageal readings. Patient acceptability was high; 96% (n=27) stated that the device was comfortable. Conclusion ZHF device achieved lesser measurement accuracy with core (esophageal) temperature compared to earlier findings. Nonetheless, due to continuous capability, non-invasiveness and patient reported acceptability, the device warrants further evaluation. Title Registration The study was registered at www.ANZCTR.org.au (reference: ACTRN12619000842167).
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Affiliation(s)
- Judy Munday
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Department of Health and Nursing Science, Faculty of Health and Sports Sciences, University of Agder, Grimstad, Norway
| | - Niall Higgins
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Lee Jones
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Research Methods Group, Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - André Van Zundert
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia & Queensland University of Technology, Brisbane, QLD, Australia
| | - Samantha Keogh
- School of Nursing & Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia.,Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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13
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Srinivasan S, Pritchard N, Sampson GP, Edwards K, Vagenas D, Russell AW, Malik RA, Efron N. Focal loss volume of ganglion cell complex in diabetic neuropathy. Clin Exp Optom 2021; 99:526-534. [DOI: 10.1111/cxo.12379] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/18/2015] [Accepted: 11/28/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sangeetha Srinivasan
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Nicola Pritchard
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Geoff P Sampson
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
- Deakin University, Geelong, Victoria, Australia,
| | - Katie Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
| | - Anthony W Russell
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia,
- School of Medicine, University of Queensland, Woolloongabba, Queensland, Australia,
| | - Rayaz A Malik
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, UK,
- Weill Cornell Medical College in Qatar, Doha, Qatar,
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia,
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14
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Dhouib R, Vagenas D, Hong Y, Verderosa AD, Martin JL, Heras B, Totsika M. Antivirulence DsbA inhibitors attenuate Salmonella enterica serovar Typhimurium fitness without detectable resistance. FASEB Bioadv 2021; 3:231-242. [PMID: 33842848 PMCID: PMC8019255 DOI: 10.1096/fba.2020-00100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 11/15/2022] Open
Abstract
Inhibition of the DiSulfide Bond (DSB) oxidative protein folding machinery, a major facilitator of virulence in Gram‐negative bacteria, represents a promising antivirulence strategy. We previously developed small molecule inhibitors of DsbA from Escherichia coli K‐12 (EcDsbA) and showed that they attenuate virulence of Gram‐negative pathogens by directly inhibiting multiple diverse DsbA homologues. Here we tested the evolutionary robustness of DsbA inhibitors as antivirulence antimicrobials against Salmonella enterica serovar Typhimurium under pathophysiological conditions in vitro. We show that phenylthiophene DsbA inhibitors slow S. Typhimurium growth in minimal media, phenocopying S. Typhimurium isogenic dsbA null mutants. Through passaging experiments, we found that DsbA inhibitor resistance was not induced under conditions that rapidly induced resistance to ciprofloxacin, an antibiotic commonly used to treat Salmonella infections. Furthermore, no mutations were identified in the dsbA gene of inhibitor‐treated S. Typhimurium, and S. Typhimurium virulence remained susceptible to DsbA inhibitors. Our work demonstrates that under in vitro pathophysiological conditions, DsbA inhibitors can have both antivirulence and antibiotic action. Importantly, our finding that DsbA inhibitors appear to be evolutionarily robust offers promise for their further development as next‐generation antimicrobials against Gram‐negative pathogens.
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Affiliation(s)
- Rabeb Dhouib
- Institute of Health and Biomedical Innovation School of Biomedical Sciences Queensland University of Technology Herston QLD Australia.,Centre for Immunology and Infection Control School of Biomedical Sciences Queensland University of Technology Herston QLD Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation School of Biomedical Sciences Queensland University of Technology Herston QLD Australia
| | - Yaoqin Hong
- Institute of Health and Biomedical Innovation School of Biomedical Sciences Queensland University of Technology Herston QLD Australia.,Centre for Immunology and Infection Control School of Biomedical Sciences Queensland University of Technology Herston QLD Australia
| | - Anthony D Verderosa
- Institute of Health and Biomedical Innovation School of Biomedical Sciences Queensland University of Technology Herston QLD Australia.,Centre for Immunology and Infection Control School of Biomedical Sciences Queensland University of Technology Herston QLD Australia
| | - Jennifer L Martin
- Griffith Institute for Drug Discovery Griffith University Nathan QLD Australia.,University of Wollongong Wollongong NSW Australia
| | - Begoña Heras
- La Trobe Institute for Molecular Science La Trobe University Bundoora VIC Australia
| | - Makrina Totsika
- Institute of Health and Biomedical Innovation School of Biomedical Sciences Queensland University of Technology Herston QLD Australia.,Centre for Immunology and Infection Control School of Biomedical Sciences Queensland University of Technology Herston QLD Australia
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15
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Jones T, Sandler C, Vagenas D, Janda M, Obermair A, Hayes S. Physical activity levels among ovarian cancer survivors: a prospective longitudinal cohort study. Int J Gynecol Cancer 2021; 31:553-561. [PMID: 33462088 DOI: 10.1136/ijgc-2020-002107] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/21/2020] [Accepted: 12/23/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Physical activity following cancer diagnosis is associated with improved outcomes, including potential survival benefits, yet physical activity levels among common cancer types tend to decrease following diagnosis and remain low. Physical activity levels following diagnosis of less common cancers, such as ovarian cancer, are less known. The objectives of this study were to describe physical activity levels and to explore characteristics associated with physical activity levels in women with ovarian cancer from pre-diagnosis to 2 years post-diagnosis. METHODS As part of a prospective longitudinal study, physical activity levels of women with ovarian cancer were assessed at multiple time points between pre-diagnosis and 2 years post-diagnosis. Physical activity levels and change in physical activity were described using metabolic equivalent task hours and minutes per week, and categorically (sedentary, insufficiently, or sufficiently active). Generalized Estimating Equations were used to explore whether participant characteristics were related to physical activity levels. RESULTS A total of 110 women with ovarian cancer with a median age of 62 years (range 33-88) at diagnosis were included. 53-57% of the women were sufficiently active post-diagnosis, although average physical activity levels for the cohort were below recommended levels throughout the 2-year follow-up period (120-142.5min/week). A decrease or no change in post-diagnosis physical activity was reported by 44-60% of women compared with pre-diagnosis physical activity levels. Women diagnosed with stage IV disease, those earning a lower income, those receiving chemotherapy, and those currently smoking or working were more likely to report lower physical activity levels and had increased odds of being insufficiently active or sedentary. CONCLUSIONS Interventions providing patients with appropriate physical activity advice and support for behavior change could potentially improve physical activity levels and health outcomes.
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Affiliation(s)
- Tamara Jones
- School of Allied Health Sciences, Griffith University, Brisbane, Queensland, Australia
| | - Carolina Sandler
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Sandra Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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16
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Fleming S, Jones T, Janda M, Vagenas D, Ward L, Reul-Hirche H, Sandler C, Obermair A, Hayes S. Physical activity trajectories following gynecological cancer: results from a prospective, longitudinal cohort study. Int J Gynecol Cancer 2020; 30:1784-1790. [PMID: 32727928 DOI: 10.1136/ijgc-2020-001543] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Participating in physical activity after a diagnosis of cancer is associated with reduced morbidity and improved outcomes. However, declines in, and low levels of, physical activity are well documented in the broader cancer population, but with limited evidence following gynecological cancer. OBJECTIVE To describe physical activity levels from before and up to 2 years after gynecological cancer surgery; to explore the relationship between physical activity patterns and quality of life; and to describe characteristics associated with physical activity trajectories post-gynecological cancer. METHODS Women with gynecological cancer (n=408) participated in a prospective study that assessed physical activity and quality of life pre-surgery (baseline), at 6 weeks, and 3, 6, 9, 12, 15, 18 and 24 months post-surgery. Validated questionnaires were used to assess physical activity (Active Australia Survey) and quality of life outcomes (Functional Assessment of Cancer Therapy-General). Generalized estimating equation modeling, group-based trajectory analysis, and analysis of variance were used to identify physical activity levels over time, to categorize women into physical activity trajectory groups, and to assess the relationship between physical activity levels and quality of life, respectively. RESULTS Women had a mean±SD age of 60±11.4 years at diagnosis, with the majority diagnosed with endometrial cancer (n=235, 58%) or stage I disease (n=241, 59%). Most women (80%) started with and maintained low levels of physical activity (1-10 metabolic equivalent task hours per week), reported no physical activity throughout the follow-up period, or reduced physical activity levels over time. Only 19% of women maintained or doubled physical activity levels, so that by 24 months post-diagnosis they were engaging in sufficient levels of physical activity. Women with endometrial cancer (58% of the sample) were more likely to be overweight or obese and to report low levels of physical activity or none at all. Higher physical activity levels were associated with higher quality of life (p<0.05). CONCLUSION The low baseline and surveillance levels of physical activity show that the vast majority of gynecological cancer survivors have the ability to improve their physical activity levels. Integration of physical activity advice and support into standard care could lead to gains in quality of life during gynecological cancer survivorship.
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Affiliation(s)
- Steven Fleming
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
| | - Tamara Jones
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Centre for Health Services Research, The University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Leigh Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Hildegard Reul-Hirche
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Carolina Sandler
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Andreas Obermair
- Queensland Centre of Gynecological Research, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Sandra Hayes
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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17
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Pigott A, Obermair A, Janda M, Vagenas D, Ward LC, Reul-Hirche H, Hayes SC. Incidence and risk factors for lower limb lymphedema associated with endometrial cancer: Results from a prospective, longitudinal cohort study. Gynecol Oncol 2020; 158:375-381. [PMID: 32499070 DOI: 10.1016/j.ygyno.2020.04.702] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Evidence on the incidence and risk factors for lower limb lymphedema (LLL) associated with endometrial cancer is limited. Our objective was to use data from a prospective, longitudinal gynecological cancer cohort study to determine LLL incidence up to 24 months post-diagnosis of endometrial cancer and to explore the relationship between personal and treatment-related factors and risk of developing LLL. METHODS Women recently diagnosed with endometrial cancer (n = 235) were evaluated at regular intervals post-diagnosis (up to 3-monthly) using bioimpedance spectroscopy (BIS) and self-reported leg swelling (SRLS). RESULTS Incidence of LLL at 24 months post-diagnosis was 33% and 45% according to BIS and SRLS, respectively. When analyses were restricted to obese women, incidence at 24 months post-diagnosis increased to 67% (BIS) and 54% (SRLS). Following adjusted analyses, higher body mass index was associated with higher odds of baseline lymphedema (BIS: OR 1.91, 95% CI 1.47-2.49, p < .01; SRLS: OR 1.06, 95% CI 1.00-1.12, p < .01) and LLL incidence by 24 months post-diagnosis (BIS: OR 1.29, 95% CI: 0.99-1.68, p = .055; SRLS: OR 1.06, 95% CI 1.02-1.11, p = .008). According to SRLS, presence of comorbidities was also associated with baseline lymphedema (OR: 1.43, 95% CI: 1.15-1.78, p = .001), and more extensive lymph node dissection (OR 1.06, 95% CI: 1.01-1.12, p = .026) and receipt of chemotherapy (OR: 2.65, 95% CI: 1.12-6.29, p = .027) were identified as risk factors for lymphedema incidence. CONCLUSIONS These findings suggest that LLL following endometrial cancer is common, particularly in women with high body mass index, or comorbidities, and those requiring more extensive lymph node dissection or chemotherapy. Future studies should examine the potential of weight loss intervention as a strategy to reduce LLL incidence.
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Affiliation(s)
- Amanda Pigott
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia; Princess Alexandra Hospital, Occupational Therapy Department, Brisbane, Queensland, Australia.
| | - Andreas Obermair
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Queensland Centre of Gynaecological Research, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Leigh C Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Hildegard Reul-Hirche
- Royal Brisbane and Women's Hospital, Physiotherapy Department, Brisbane, Queensland, Australia
| | - Sandra C Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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18
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Roberts K, Rickett K, Feng S, Vagenas D, Woodward N. Letter to the editor: re Lu et al. Support Care Cancer 2020; 29:1-2. [PMID: 32417967 DOI: 10.1007/s00520-020-05523-9] [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] [Received: 02/29/2020] [Accepted: 05/06/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Kate Roberts
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, Australia.
- University of Queensland, Brisbane, Australia.
| | - Kirsty Rickett
- The University of Queensland, Mater McAuley Library, Brisbane, Australia
| | - Sophie Feng
- Department of Medical Oncology, Mater Hospital, Brisbane, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Natasha Woodward
- University of Queensland, Brisbane, Australia
- Department of Medical Oncology, Mater Hospital, Brisbane, Australia
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19
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Steele ML, Janda M, Vagenas D, Ward LC, Cornish BH, Box R, Gordon S, Matthews M, Poppitt SD, Plank LD, Yip W, Rowan A, Reul-Hirche H, Obermair A, Hayes SC. A Bioimpedance Spectroscopy-Based Method for Diagnosis of Lower-Limb Lymphedema. Lymphat Res Biol 2020; 18:101-109. [DOI: 10.1089/lrb.2018.0078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Megan L. Steele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- School of Clinical Medicine, The University of Queensland, Brisbane, Australia
| | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Faculty of Health, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Leigh C. Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Bruce H. Cornish
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Robyn Box
- Queensland Lymphedema & Breast Oncology Physiotherapy, Brisbane, Australia
| | - Susan Gordon
- College of Healthcare Sciences, James Cook University, Townsville, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Melanie Matthews
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Sally D. Poppitt
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Lindsay D. Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Wilson Yip
- Human Nutrition Unit, School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Angela Rowan
- Fonterra Co-operative Group Limited, Auckland, New Zealand
| | | | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Australia
| | - Sandra C. Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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20
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Horsham C, Snoswell C, Vagenas D, Loescher LJ, Gillespie N, Soyer HP, Janda M. Is Teledermoscopy Ready to Replace Face-to-Face Examinations for the Early Detection of Skin Cancer? Consumer Views, Technology Acceptance, and Satisfaction with Care. Dermatology 2020; 236:90-96. [PMID: 32114570 DOI: 10.1159/000506154] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 11/22/2019] [Accepted: 01/06/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous cross-sectional research indicates high acceptance of mobile teledermoscopy-enhanced skin self-examination (SSE) by consumers based on the technology acceptance model (TAM) domains: perceived usefulness, ease of use, compatibility, attitude and intention, subjective norms, facilitator, and trust. However, no study has assessed this outcome longitudinally among people who actually used the technology in their own homes. METHODS Participants were living in Brisbane, Australia, aged 18 years or older, and at high risk of skin cancer. Participants randomly assigned to the intervention group (n = 98) completed a self-administered questionnaire on mobile teledermoscopy acceptance for skin cancer detection both before use and after performing mobile teledermoscopy-enhanced SSE in their homes. The survey included a 25-item scale assessing seven TAM domains. Item scores ranged from 5 (strongly agree) to 1 (strongly disagree). Participants also answered survey questions on satisfaction with use of teledermoscopy, and a 9-item "thoughts about melanoma" scale that measures cancer worry. RESULTS Participants were 19-73 years old, had high skin cancer risk, blue or grey eyes (53.1%), fair or very fair skin (88.8%), and previous skin cancer treatments (61.2%). Participants were more accepting of mobile teledermoscopy at baseline: mean TAM score of 4.15 (SE 0.05); their level of acceptance decreased significantly after teledermoscopy use: mean score 3.94 (SE 0.05; p = 0.001). In linear regression analysis, the decrease in TAM scores was similar across demographic and skin cancer risk categories. Ninety-two percent (n = 90) of participants agreed that mobile teledermoscopy was easy to use. The mean score of the "thoughts about melanoma" scale did not change significantly from baseline to follow-up. CONCLUSION Consumers had high TAM scores before they used mobile teledermoscopy within a randomised control trial. At the end of the intervention period, TAM scores decreased, although participants' average score still indicated "agreement" that mobile teledermoscopy was acceptable.
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Affiliation(s)
- Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Centaine Snoswell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lois J Loescher
- The University of Arizona Colleges of Nursing and Public Health, and The University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Brisbane, Queensland, Australia
| | - H Peter Soyer
- The University of Queensland Diamantina Institute, The University of Queensland, Dermatology Research Centre, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia, .,Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia,
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21
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Janda M, Horsham C, Vagenas D, Loescher LJ, Gillespie N, Koh U, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Halpern A, Whiteman DC, Whitty JA, Smithers BM, Soyer HP. Accuracy of mobile digital teledermoscopy for skin self-examinations in adults at high risk of skin cancer: an open-label, randomised controlled trial. Lancet Digit Health 2020; 2:e129-e137. [PMID: 33334577 DOI: 10.1016/s2589-7500(20)30001-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/16/2019] [Accepted: 01/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Skin self-examinations supplemented with mobile teledermoscopy might improve early detection of skin cancers compared with naked-eye skin self-examinations. We aimed to assess whether mobile teledermoscopy-enhanced skin self-examination can improve sensitivity and specificity of self-detection of skin cancers when compared with naked-eye skin self-examination. METHODS This randomised, controlled trial was done in Brisbane (QLD, Australia). Eligible participants (aged ≥18 years) had at least two skin cancer risk factors as self-reported in the eligibility survey and had to own or have access to an iPhone compatible with a dermatoscope attachment (iPhone versions 5-8). Participants were randomly assigned (1:1), via a computer-generated randomisation procedure, to the intervention group (mobile dermoscopy-enhanced self-skin examination) or the control group (naked-eye skin self-examination). Control group and intervention group participants received web-based instructions on how to complete a whole body skin self-examination. All participants completed skin examinations at baseline, 1 month, and 2 months; intervention group participants submitted photographs of suspicious lesions to a dermatologist for telediagnosis after each skin examination and control group participants noted lesions on a body chart that was sent to the research team after each skin examination. All participants had an in-person whole-body clinical skin examination within 3 months of their last skin self-examination. Primary outcomes were sensitivity and specificity of skin self-examination, patient selection of clinically atypical lesions suspicious for melanoma or keratinocyte skin cancers (body sites examined, number of lesions photographed, types of lesions, and lesions missed), and diagnostic concordance of telediagnosis versus in-person whole-body clinical skin examination diagnosis. All primary outcomes were analysed in the modified intention-to-treat population, which included all patients who had a clinical skin examination within 3 months of their last skin self-examination. This trial was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12616000989448. FINDINGS Between March 6, 2017, and June 7, 2018, 234 participants consented to enrol in the study, of whom 116 (50%) were assigned to the intervention group and 118 (50%) were assigned to the control group. 199 participants (98 participants in the intervention group and 101 participants in the control group) attended the clinical skin examination and thus were eligible for analyses. Participants in the intervention group submitted 615 lesions (median 6·0 per person; range 1-24) for telediagnosis and participants in the control group identified and recorded 673 lesions (median 6·0 per person; range 1-16). At the lesion level, sensitivity for lesions clinically suspicious for skin cancer was 75% (95% CI 63-84) in the intervention group and 88% (95% CI 80-91) in the control group (p=0·04). Specificity was 87% (95% CI 85-90) in the intervention group and 89% (95% CI 87-91) in the control group (p=0·42). At the individual level, the intervention group had a sensitivity of 87% (95% CI 76-99) compared with 97% (95% CI 91-100) in the control group (p=0·26), and a specificity of 95% (95% CI 90-100) compared with 96% (95% CI 91-100) in the control group. The overall diagnostic concordance between the telediagnosis and in-person clinical skin examination was 88%. INTERPRETATION The use of mobile teledermoscopy did not increase sensitivity for the detection of skin cancers compared with naked-eye skin self-examination; thus, further evidence is necessary for inclusion of skin self-examination technology for public health benefit. FUNDING National Health and Medical Research Council (Australia).
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Affiliation(s)
- Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Lois J Loescher
- Mel and Enid Zuckerman College of Public Health, Colleges of Nursing and Public Health, The University of Arizona, Tucson, AZ, USA; University of Arizona Cancer Center, The University of Arizona, Tucson, AZ, USA
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Brisbane, QLD, Australia
| | - Uyen Koh
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Allan Halpern
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David C Whiteman
- QIMR Berghofer Institute of Medical Research, Brisbane, QLD, Australia
| | - Jennifer A Whitty
- Department of Population Health, University of East Anglia, Norwich, UK; National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, Cambridge, UK
| | - B Mark Smithers
- Queensland Melanoma Project, The University of Queensland, Brisbane, QLD, Australia
| | - H Peter Soyer
- The Diamantina Institute, The University of Queensland, Brisbane, QLD, Australia; Dermatology Department, Princess Alexandra Hospital, Brisbane, QLD, Australia
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22
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Kho J, Gillespie N, Horsham C, Snoswell C, Vagenas D, Soyer HP, Janda M. Skin Doctor Consultations Using Mobile Teledermoscopy: Exploring Virtual Care Business Models. Telemed J E Health 2020; 26:1406-1413. [PMID: 32058835 DOI: 10.1089/tmj.2019.0228] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Background: Technological advances have given rise to virtual health care services, resulting in a shift in how traditional health care services are being delivered. Consumers are increasingly demanding efficient access to health care information and services irrespective of time and distance, which is further driving the digitization of health care. This digital economy has created new opportunities for innovative new business models to meet the needs of these new markets. This study explores several in-use business models of virtual health care service platforms that incorporate mobile teledermoscopy (MTD) technologies. By comparing the different building blocks of these commercial ventures, we provide insights on business model choices and discuss the elements that contribute to economically sustainable and viable service offerings incorporating MTD applications. Materials and Methods: We searched the literature on teledermatology, complemented by searches using Google and other mobile app store platforms, and identified seven commercial ventures using teledermoscopy. We analyzed the building blocks of each business model by using an adapted version of Ash Maurya's Lean Canvas and Alexander Osterwalder's Business Model Canvas. Results: We identified three business elements that support the viability, sustainability, and growth of online dermatology services: developing key partnerships, clinician involvement in the design and implementation process, and managing the medico-legal risks and liabilities that are relevant for each country. Conclusions: Leveraging mobile technologies to deliver virtual health care present new business opportunities for health care providers. A better understanding of the business features associated with existing commercial ventures may increase uptake and improve financial viability of MTD applications as a complementary tool to traditional patient care models.
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Affiliation(s)
- Joanna Kho
- UQ Business School, The University of Queensland, St Lucia, Australia
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, St Lucia, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| | - Centaine Snoswell
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Woolloongabba, Australia
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23
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Roberts KE, Rickett K, Feng S, Vagenas D, Woodward NE. Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database Syst Rev 2020; 1:CD012988. [PMID: 31994181 PMCID: PMC6987034 DOI: 10.1002/14651858.cd012988.pub2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 01/04/2023]
Abstract
BACKGROUND Survival for stage I to III, hormone receptor-positive, breast cancer has substantially improved over time due to advances in screening, surgery and adjuvant therapy. However many adjuvant therapies have significant treatment-related toxicities, which worsen quality of life for breast cancer survivors. Postmenopausal women with hormone receptor-positive breast cancer are now prescribed aromatase inhibitors (AI) as standard, with longer durations of therapy, up to 10 years, being considered for certain women. AI treatment is associated with a high incidence of AI-induced musculoskeletal symptoms (AIMSS), often described as symmetrical pain and soreness in the joints, musculoskeletal pain and joint stiffness. AIMSS reduces compliance with AI therapy in up to one half of women undergoing adjuvant AI therapy, potentially compromising breast cancer outcomes. Exercise has been investigated for the prevention and treatment of AIMSS but the effect of this intervention remains unclear. OBJECTIVES To assess the effects of exercise therapies on the prevention or management of aromatase inhibitor-induced musculoskeletal symptoms (AIMSS) in women with stage I to III hormone receptor-positive breast cancer. SEARCH METHODS We searched Cochrane Breast Cancer's Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases up to 13 December 2018. We also searched two conference proceedings portals and two clinical trials registries for ongoing studies or unpublished trials, or both, in August 2019. We also reviewed reference lists of the included studies. SELECTION CRITERIA We included randomised controlled trials that compared exercise versus a comparator arm. We did not impose any restriction on the comparator arm, which could include an alternative type of exercise, no exercise or a waiting list control. Both published and non-peer-reviewed studies were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, assessed risk of bias and certainty of the evidence using the GRADE approach. The outcomes investigated were pain, joint stiffness, grip strength, health-related quality of life, cancer-specific quality of life, adherence to AI therapy, adverse events, incidence of AIMSS, breast cancer-specific survival and overall survival. For continuous outcomes that were assessed with the same instrument, we used the mean difference (MD); for those outcomes that used different instruments, we used the standardised mean difference (SMD) for the analysis. For dichotomous outcomes, we reported outcomes as an odds ratio (OR). MAIN RESULTS We included seven studies with 400 randomised participants; one study assessed exercise for preventing AIMSS and six studies assessed treating AIMSS. For preventing AIMSS, the single study reported no difference in pain scores, grip strength or compliance to taking AI medication between groups. Data values were not provided in the study and no other outcomes were reported. For managing AIMSS, we found that the evidence for the effect of exercise therapies on overall change in worst pain scores was very uncertain (SMD -0.23, 95% confidence interval (CI) -0.78 to 0.32; 4 studies, 284 women; very low-certainty evidence). The evidence suggested that exercise therapies result in little to no difference in overall change in stiffness scores (Western Ontario McMasters Universities Osteoarthritis Index (WOMAC) stiffness score MD -0.76, 95% CI -1.67 to 0.15 and Visual Analogues Scale (VAS) stiffness score MD -0.42, 95% CI -2.10 to 1.26; 1 study, 53 women; low-certainty evidence). The evidence was very uncertain for the outcomes of overall change in grip strength (MD 0.30, 95% CI -0.55 to 1.15; 1 study, 83 women; very low-certainty evidence); overall change in health-related quality of life (subscales of SF-36 tool ranged from least benefit of MD 1.88, 95% CI -2.69 to 6.45 to most benefit of MD 9.70, 95% CI 1.67 to 17.73; 2 studies, 123 women, very low-certainty evidence); overall change in cancer-specific quality of life (MD 4.58, 95% CI -0.61 to 9.78; 2 studies, 136 women; very low-certainty evidence); and adherence to aromatase inhibitors (OR 2.43, 95% CI 0.41 to 14.63; 2 studies, 224 women; very low-certainty evidence). There were no adverse events identified across four studies in either arm (0 events reported; 4 studies; 331 participants; low-certainty evidence). There were no data reported on incidence of AIMSS, breast cancer-specific survival or overall survival. AUTHORS' CONCLUSIONS Given the wide-ranging benefits of exercise for people affected by cancer, it was surprising that this review provided no clear evidence of benefit for exercise therapies in women with early breast cancer with AIMSS. This review only yielded seven eligible studies with 400 participants, which is likely to have underpowered the findings. The meta-analysis was challenging due to the considerable heterogeneity amongst the trials, with a wide range of exercise regimens and follow-up periods. Despite these inconclusive findings, exercise needs to be part of routine care for women with breast cancer due to its wide-ranging benefits. Future research in this area would be enhanced with further understanding of the mechanism of AIMSS, a single clear definition of the condition, and phase III randomised controlled trials that are adequately powered to test targeted exercise interventions on the key clinical outcomes in this condition.
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Affiliation(s)
- Kate E Roberts
- Princess Alexandra HospitalDepartment of Medical OncologyIpswich RoadWoolloongabbaQueenslandAustralia
- Mater Hospital, University of QueenslandSchool of Clinical Medicine, Mater Clinical UnitSouth BrisbaneAustralia4101
| | - Kirsty Rickett
- UQ/Mater McAuley LibraryThe University of Queensland LibraryRaymond TerraceBrisbaneQueenslandAustralia4101
| | - Sophie Feng
- Mater Misericordiae LtdDepartment of Medical Oncology1 Raymond TceSouth BrisbaneQueenslandAustralia4101
| | - Dimitrios Vagenas
- Queensland University of TechnologyInstitute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Natasha E Woodward
- Mater Hospital, University of QueenslandSchool of Clinical Medicine, Mater Clinical UnitSouth BrisbaneAustralia4101
- Mater Misericordiae LtdDepartment of Medical Oncology1 Raymond TceSouth BrisbaneQueenslandAustralia4101
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Sarkar S, Hutton ML, Vagenas D, Ruter R, Schüller S, Lyras D, Schembri MA, Totsika M. Intestinal Colonization Traits of Pandemic Multidrug-Resistant Escherichia coli ST131. J Infect Dis 2019; 218:979-990. [PMID: 29471349 PMCID: PMC6093498 DOI: 10.1093/infdis/jiy031] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/01/2018] [Indexed: 01/09/2023] Open
Abstract
Background Epidemiological studies point to the gut as a key reservoir of multidrug resistant Escherichia coli multilocus sequence type 131 (ST131), a globally dominant pathogenic clone causing urinary tract and bloodstream infections. Here we report a detailed investigation of its intestinal lifestyle. Methods Clinical ST131 isolates and type 1 fimbriae null mutants were assessed for colonization of human intestinal epithelia and in mouse intestinal colonization models. Mouse gut tissue underwent histologic analysis for pathology and ST131 localization. Key findings were corroborated in mucus-producing human cell lines and intestinal biopsy specimens. Results ST131 strains adhered to and invaded human intestinal epithelial cells more than probiotic and commensal strains. The reference ST131 strain EC958 established persistent intestinal colonization in mice, and expression of type 1 fimbriae mediated higher colonization levels. Bacterial loads were highest in the distal parts of the mouse intestine and did not cause any obvious pathology. Further analysis revealed that EC958 could bind to both mucus and underlying human intestinal epithelia. Conclusions ST131 strains can efficiently colonize the mammalian gut and persist long term. Type 1 fimbriae enhance ST131 intestinal colonization, suggesting that mannosides, currently developed as therapeutics for bladder infections and Crohn’s disease, could also be used to limit intestinal ST131 reservoirs.
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Affiliation(s)
- Sohinee Sarkar
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
- School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
| | - Melanie L Hutton
- Infection and Immunity Program, Monash Biomedicine Discovery Institute, Clayton, Australia
- Department of Microbiology, Monash University, Clayton, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
- School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
| | - Rinaldo Ruter
- Gut Health and Food Safety Programme, Quadram Institute Bioscience, Norwich, United Kingdom
| | - Stephanie Schüller
- Gut Health and Food Safety Programme, Quadram Institute Bioscience, Norwich, United Kingdom
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Dena Lyras
- Infection and Immunity Program, Monash Biomedicine Discovery Institute, Clayton, Australia
- Department of Microbiology, Monash University, Clayton, Australia
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane
- Australian Infectious Diseases Research Centre, University of Queensland, Brisbane
| | - Makrina Totsika
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
- School of Biomedical Sciences, Queensland University of Technology, Queensland, Australia
- Correspondence: M. Totsika, PhD, Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, QLD 4059, Australia ()
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Janda M, Horsham C, Koh U, Gillespie N, Vagenas D, Loescher LJ, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Peter Soyer H. Evaluating healthcare practitioners' views on store-and-forward teledermoscopy services for the diagnosis of skin cancer. Digit Health 2019; 5:2055207619828225. [PMID: 30792879 PMCID: PMC6376520 DOI: 10.1177/2055207619828225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 01/13/2019] [Indexed: 12/02/2022] Open
Abstract
Objective The aim of the study is to evaluate healthcare practitioners’ views on and
satisfaction with (i) digital image acquisition and storage and (ii)
store-and-forward teledermoscopy services for the diagnosis of skin cancer
in their clinical practice. Methods An online survey was conducted among 59 healthcare practitioners (GPs
(n=17), dermatologists (n=22),
dermatology registrars (n=18), a dermatology research
fellow (n=1) and a plastic surgeon (n=1))
to assess usability of digital image acquisition and storage for when the
imaging process is conducted by the healthcare practitioners themselves, or
by their patients. The study identifies the enablers and barriers of this
emerging mode of medical practice. A thematic analysis was used to extract
key themes from open-ended responses, which involved identifying themes and
patterns within and across participants. Results Thirty-four healthcare practitioners (58%) had previously used a mobile
dermatoscope within their practice. Participants most appreciated its use in
their practice for lesion monitoring (59%) and record keeping (39%).
Challenges reported were the increased time to support the additional
workload (45%), technical issues (33%) and cost of equipment (27%).
Practitioners were unsure (36%) or did not advocate teledermoscopy for
direct-to-consumer use (41%). Only 23% supported the use of
direct-to-consumer teledermoscopy. Conclusion While most practitioners are receptive to mobile teledermoscopy, there was
less support for patient-initiated use, whereby the patient controls the
imaging process. As technology improves rapidly it is important to evaluate
practitioners’ acceptance and satisfaction of evolving telehealth services,
moving forward with models of practice where healthcare practitioners and
other healthcare providers will feel comfortable engaging in telehealth
services.
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Affiliation(s)
- Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Caitlin Horsham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Uyen Koh
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Lois J Loescher
- Colleges of Nursing and Public Health, The University of Arizona, Tucson, Arizona, United States of America
| | | | | | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia
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Bairagi A, Griffin B, Tyack Z, Vagenas D, McPhail SM, Kimble R. Comparative effectiveness of Biobrane®, RECELL® Autologous skin Cell suspension and Silver dressings in partial thickness paediatric burns: BRACS randomised trial protocol. Burns Trauma 2019; 7:33. [PMID: 31696127 PMCID: PMC6822367 DOI: 10.1186/s41038-019-0165-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 07/26/2019] [Indexed: 05/05/2023]
Abstract
BACKGROUND Mixed partial thickness burns are the most common depth of burn injury managed at a large Australian paediatric hospital specialty burns unit. Prolonged time until re-epithelialisation is associated with increased burn depth and scar formation. Whilst current wound management approaches have benefits such as anti-microbial cover, these are not without inherent limitations including multiple dressing changes. The Biobrane® RECELL® Autologous skin Cell suspension and Silver dressings (BRACS) trial aims to identify the most effective wound management approach for mixed partial thickness injuries in children. METHODS All children presenting with an acute burn injury to the study site will be screened for eligibility. This is a single-centre, three-arm, parallel group, randomised trial. Children younger than 16 years, with burns ≥ 5% total body surface area involving any anatomical location, up to 48 h after the burn injury, and of a superficial partial to mid-dermal depth, will be included. A sample size of 84 participants will be randomised to standard silver dressing or a Regenerative Epithelial Suspension (RES™) with Biobrane® or Biobrane® alone. The first dressing will be applied under general anaesthesia and subsequent dressings will be changed every 3 to 5 days until the wound is ≥ 95% re-epithelialised, with re-epithelialisation time the primary outcome. Secondary outcomes of acute pain, acute itch, scar severity, health-related quality of life, treatment satisfaction, dressing application ease and healthcare resource use will be assessed at each dressing change and 3, 6 and 12 months post-burn injury. DISCUSSION The findings of this study can potentially change the wound management approach for superficial partial to mid-dermal burns in children locally and worldwide. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry (ACTRN12618000245291) approved prospective registration on 15 February 2018. Registration details can be viewed at https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374272&isReview=true.
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Affiliation(s)
- Anjana Bairagi
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Steven M. McPhail
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, Centre for Children’s Health Research, Brisbane, Queensland, Australia
- Pegg Leditschke Children’s Burns Centre, Queensland Children’s Hospital, Brisbane, Queensland, Australia
- School of Nursing, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
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Steele ML, Janda M, Vagenas D, Ward LC, Cornish BH, Box R, Gordon S, Matthews M, Poppitt SD, Plank LD, Yip W, Rowan A, Reul-Hirche H, Obermair A, Hayes SC. Normative Interlimb Impedance Ratios: Implications for Early Diagnosis of Uni- and Bilateral, Upper and Lower Limb Lymphedema. Lymphat Res Biol 2018; 16:559-566. [DOI: 10.1089/lrb.2017.0082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Megan L. Steele
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Leigh C. Ward
- School of Chemistry and Molecular Biosciences, The University of Queensland, Brisbane, Australia
| | - Bruce H. Cornish
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Robyn Box
- Queensland Lymphoedema & Breast Oncology Physiotherapy, Brisbane, Australia
| | - Susan Gordon
- College of Healthcare Sciences, James Cook University, Townsville, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia
| | - Melanie Matthews
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Sally D. Poppitt
- Human Nutrition Unit and School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Lindsay D. Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Wilson Yip
- Human Nutrition Unit and School of Biological Sciences, University of Auckland, Auckland, New Zealand
| | - Angela Rowan
- Fonterra Co-operative Group Limited, Auckland, New Zealand
| | - Hildegard Reul-Hirche
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Andreas Obermair
- Queensland Centre for Gynaecological Cancer Research, The University of Queensland, Brisbane, Australia
| | - Sandra C. Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
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28
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Hacker E, Horsham C, Vagenas D, Jones L, Lowe J, Janda M. A Mobile Technology Intervention With Ultraviolet Radiation Dosimeters and Smartphone Apps for Skin Cancer Prevention in Young Adults: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e199. [PMID: 30487115 PMCID: PMC6291679 DOI: 10.2196/mhealth.9854] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 08/02/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022] Open
Abstract
Background Skin cancer is the most prevalent and most preventable cancer in Australia. Despite Australia’s long-running public health campaigns, young Australian adults continue to report high levels of ultraviolet radiation (UVR) exposure and frequent sunburns. Young people are now increasingly turning away from traditional media, such as newspapers and TV, favoring Web-based streaming, which is challenging the health care sector to develop new ways to reach this group with targeted, personalized health promotion messages. Advances in technology have enabled delivery of time- and context-relevant health interventions. Objective The primary aim of this randomized controlled trial was to test the effect of UVR feedback from a smartphone app or a UVR dosimeter feedback device on sun protection habits, sun exposure behaviors, sunburn, and physical activity levels in young adults. Methods Young adults aged 18-35 years (n=124) were recruited from Queensland, Australia, between September 2015 and April 2016, via social or traditional media campaigns and outreach activities in the local community. Participants were randomized into 3 groups for a 4-week intervention: (1) no intervention control group; (2) UVR monitor group, who were asked to wear a UVR dosimeter feedback device set to their skin type; and (3) a SunSmart app group, who were asked to download and use the SunSmart phone app. Data were self-assessed through Web-based surveys at baseline and 1 week and 3 months postintervention. Results Complete data were available for 86.2% (107/124) of participants (control group, n=36; UVR monitor group, n=36; and SunSmart app group, n=35). Intervention uptake in the UVR monitor group was high, with 94% (34/36) of participants using the device all or some of the time when outdoors. All SunSmart app group participants downloaded the app on their smartphone. There was no significant difference in the change in the sun protection habits (SPH) index (main outcome measure) across the 3 groups. However, compared with the control group, a significantly greater proportion of the participants in the UVR monitor group reduced their time unprotected and exposed to UVR on weekends during the intervention compared with the baseline (odds ratio [OR]: 2.706, 95% CI 1.047-6.992, P=.04). This significant effect was sustained with greater reductions observed up to 3 months postintervention (OR: 3.130, 95% CI 1.196-8.190, P=.02). There were no significant differences between the groups in weekday sun exposure, sunscreen use, sunburn, suntan, or physical activity. Conclusions Using technology such as apps and personal UVR monitoring devices may improve some sun exposure behaviors among young adults, but as the SPH index did not increase in this study, further research is required to achieve consistent uptake of sun protection in young people. Trial Registration The Australian and New Zealand Clinical Trials register ACTRN12615001296527; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368458 (Archived by WebCite at http://www.webcitation.org/731somROx)
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Affiliation(s)
- Elke Hacker
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Caitlin Horsham
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Lee Jones
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - John Lowe
- School of Health and Sport Sciences, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Maroochydore, Australia
| | - Monika Janda
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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29
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Janda M, Horsham C, Koh U, Gillespie N, Loescher LJ, Vagenas D, Soyer HP. Redesigning Skin Cancer Early Detection and Care Using a New Mobile Health Application: Protocol of the SKIN Research Project, a Randomised Controlled Trial. Dermatology 2018; 235:11-18. [PMID: 30404085 DOI: 10.1159/000493729] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 08/16/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022] Open
Abstract
Patients often detect melanoma themselves; therefore, regular skin self-examinations (SSEs) play an important role in the early detection and prompt treatment of melanoma. Mobile teledermoscopy is a technology that may facilitate consumer SSEs and rapid communication with a dermatologist. This paper describes the planned randomised controlled trial of an intervention to determine whether mobile technologies can help improve the precision of SSE in consumers. A randomised controlled trial will be conducted to evaluate mobile teledermoscopy-enhanced SSE versus naked-eye SSE. Participants in each group will conduct three home whole-body SSEs at baseline, 1 and 2 months, then present for a clinical skin examination (CSE) by a doctor after the 2-month SSE. Specifically, participants will identify skin lesions that meet the AC (asymmetry and colour) rule for detecting a suspicious skin spot. The primary outcomes are sensitivity and specificity of the skin lesions selected by the participants as needing attention by a doctor, compared to the clinical diagnosis by the dermatologist that will serve as the reference standard for this analysis. For the mobile teledermoscopy-enhanced SSE group, researchers will assess the number, location and type of lesions (1) sent by the participant via mobile teledermoscopy, (2) found at CSE or (3) missed by the participant. For the naked-eye SSE group, researchers will assess the number, location and type of lesions (1) recorded on their body chart by the participant, (2) found at CSE or (3) missed by the participant. Secondary outcomes are based on participants' self-reported data via online questionnaires.
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Affiliation(s)
- Monika Janda
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia, .,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia,
| | - Caitlin Horsham
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Uyen Koh
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicole Gillespie
- Mel and Enid Zuckerman College of Public Health, Colleges of Nursing and Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Lois J Loescher
- UQ Business School, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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30
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Koh U, Horsham C, Soyer HP, Loescher LJ, Gillespie N, Vagenas D, Janda M. Consumer Acceptance and Expectations of a Mobile Health Application to Photograph Skin Lesions for Early Detection of Melanoma. Dermatology 2018; 235:4-10. [PMID: 30404081 DOI: 10.1159/000493728] [Citation(s) in RCA: 24] [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] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/03/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Mobile teledermoscopy may facilitate skin self-examinations (SSEs) and further improve monitoring and detection of melanoma. OBJECTIVE To assess consumer acceptability and expectations of a mobile health app used to: (i) instruct SSE and (ii) conduct consumer-performed mobile teledermoscopy. METHODS People aged 18 years and above were invited to participate in either (i) an online survey or (ii) focus group in Brisbane, Australia. Participants were asked about their SSE practices, mobile teledermoscopy acceptance, and app design and functionality. The online survey responses and focus group discussions were coded by two researchers who conducted thematic analysis. RESULTS Four focus groups were held with a total of 28 participants; 88 participants completed the online survey. The mean ages of participants in the focus group and online survey were 46 and 38 years, respectively. There were more males in the focus groups (61%, 17/28) compared to the online survey (19%, 17/88). Regular SSEs were conducted by 56 (64%) of the online survey participants. Barriers to SSE were forgetfulness (44%), low self-perceived risk of melanoma (25%) and low confidence in conducting SSEs (25%). The large majority of online survey participants (95%) would consider sending photos of their skin lesions to a medical practitioner via an app. Focus group participants reported that they would accept using mobile teledermoscopy; however, they would prefer to use it to monitor lesions between face-to-face consultations. CONCLUSIONS Overall, participants had positive views on using mobile teledermoscopy to send images of skin lesions to a dermatologist or other medical practitioner.
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Affiliation(s)
- Uyen Koh
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Caitlin Horsham
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - H Peter Soyer
- Dermatology Research Centre, The University of Queensland, The University of Queensland Diamantina Institute, Brisbane, Queensland, Australia.,Dermatology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Lois J Loescher
- Colleges of Nursing and Public Health, The University of Arizona, Tucson, Arizona, USA
| | - Nicole Gillespie
- UQ Business School, The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia, .,School of Public Health and Social Work, Institute for Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia,
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31
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Vagenas D, Totsika V. Modelling correlated data: Multilevel models and generalized estimating equations and their use with data from research in developmental disabilities. Res Dev Disabil 2018; 81:1-11. [PMID: 29786528 DOI: 10.1016/j.ridd.2018.04.010] [Citation(s) in RCA: 6] [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] [Received: 09/29/2017] [Revised: 03/19/2018] [Accepted: 04/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The use of Multilevel Models (MLM) and Generalized Estimating Equations (GEE) for analysing clustered data in the field of intellectual and developmental disability (IDD) research is still limited. METHOD We present some important features of MLMs and GEEs: main function, assumptions, model specification and estimators, sample size and power. We provide an overview of the ways MLMs and GEEs have been used in IDD research. RESULTS While MLMs and GEEs are both appropriate for longitudinal and/or clustered data, they differ in the assumptions they impose on the data, and the inferences made. Estimators in MLMs require appropriate model specification, while GEEs are more resilient to misspecification at the expense of model complexity. Studies on sample size seem to suggest that Level 1 coefficients are robust to small samples/clusters, with any higher-level coefficients less so. MLMs have been used more frequently than GEEs in IDD research, especially for fitting developmental trajectories. CONCLUSIONS Clustered data from research in the IDD field can be analysed flexibly using MLMs and GEEs. These models would be more widely used if journals required the inclusion of technical specification detail, simulation studies examined power for IDD study characteristics, and researchers developed core skills during basic studies.
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Affiliation(s)
- Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
| | - Vasiliki Totsika
- Centre for Educational Development, Appraisal, and Research (CEDAR) and Centre for Education Studies (CES), University of Warwick, UK; Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, Monash University, Australia
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Abstract
AIMS DsbA catalyzes disulfide bond formation in secreted and outer membrane proteins in bacteria. In pathogens, DsbA is a major facilitator of virulence constituting a target for antivirulence antimicrobial development. However, many pathogens encode multiple and diverse DsbA enzymes for virulence factor folding during infection. The aim of this study was to determine whether our recently identified inhibitors of Escherichia coli K-12 DsbA can inhibit the diverse DsbA enzymes found in two important human pathogens and attenuate their virulence. RESULTS DsbA inhibitors from two chemical classes (phenylthiophene and phenoxyphenyl derivatives) inhibited the virulence of uropathogenic E. coli and Salmonella enterica serovar Typhimurium, encoding two and three diverse DsbA homologues, respectively. Inhibitors blocked the virulence of dsbA null mutants complemented with structurally diverse DsbL and SrgA, suggesting that they were not selective for prototypical DsbA. Structural characterization of DsbA-inhibitor complexes showed that compounds from each class bind in a similar region of the hydrophobic groove adjacent to the Cys30-Pro31-His32-Cys33 (CPHC) active site. Modeling of DsbL- and SrgA-inhibitor interactions showed that these accessory enzymes could accommodate the inhibitors in their different hydrophobic grooves, supporting our in vivo findings. Further, we identified highly conserved residues surrounding the active site for 20 diverse bacterial DsbA enzymes, which could be exploited in developing inhibitors with a broad spectrum of activity. Innovation and Conclusion: We have developed tools to analyze the specificity of DsbA inhibitors in bacterial pathogens encoding multiple DsbA enzymes. This work demonstrates that DsbA inhibitors can be developed to target diverse homologues found in bacteria. Antioxid. Redox Signal. 29, 653-666.
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Affiliation(s)
- Makrina Totsika
- 1 Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology , Queensland, Australia
| | - Dimitrios Vagenas
- 1 Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology , Queensland, Australia
| | - Jason J Paxman
- 2 Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University , Bundoora, Australia
| | - Geqing Wang
- 2 Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University , Bundoora, Australia
| | - Rabeb Dhouib
- 1 Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology , Queensland, Australia
| | - Pooja Sharma
- 3 Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University , Parkville, Australia
| | - Jennifer L Martin
- 4 Institute for Molecular Bioscience, University of Queensland , Queensland, Australia
| | - Martin J Scanlon
- 3 Medicinal Chemistry, Monash Institute of Pharmaceutical Sciences, Monash University , Parkville, Australia
| | - Begoña Heras
- 2 Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University , Bundoora, Australia
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Roberts KE, Rickett K, Vagenas D, Woodward NE. Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Hippokratia 2018. [DOI: 10.1002/14651858.cd012988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Kate E Roberts
- Mater Health Services; Department of Medical Oncology; Raymond Terrace South Brisbane Queensland Australia 4101
- Mater Hospital, University of Queensland; School of Clinical Medicine, Mater Clinical Unit; South Brisbane Australia 4101
- Princess Alexandra Hospital; Department of Medical Oncology; Brisbane Australia
| | - Kirsty Rickett
- UQ/Mater McAuley Library; The University of Queensland Library; Raymond Terrace Brisbane Queensland Australia 4101
| | - Dimitrios Vagenas
- Queensland University of Technology; Institute of Health and Biomedical Innovation; 60 Musk Avenue Kelvin Grove Brisbane Queensland Australia 4059
| | - Natasha E Woodward
- Mater Health Services; Department of Medical Oncology; Raymond Terrace South Brisbane Queensland Australia 4101
- Mater Hospital, University of Queensland; School of Clinical Medicine, Mater Clinical Unit; South Brisbane Australia 4101
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Lovie-Toon YG, Chang AB, Newcombe PA, Vagenas D, Anderson-James S, Drescher BJ, Otim ME, O’Grady KAF. Longitudinal study of quality of life among children with acute respiratory infection and cough. Qual Life Res 2018; 27:891-903. [DOI: 10.1007/s11136-017-1779-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 12/25/2022]
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35
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Lovie-Toon YG, McPhail SM, Au-Yeung YT, Hall KK, Chang AB, Vagenas D, Otim ME, O'Grady KAF. The Cost of Acute Respiratory Infections With Cough Among Urban Aboriginal and Torres Strait Islander Children. Front Pediatr 2018; 6:379. [PMID: 30560110 PMCID: PMC6287573 DOI: 10.3389/fped.2018.00379] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/16/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction: Acute respiratory infections with cough (ARIwC) contribute considerably to childhood morbidity, yet few studies have examined the cost of these illnesses among Australian children. Moreover, of the few studies that have, none are inclusive of Aboriginal and/or Torres Strait Islander children, despite this population experiencing a greater burden of respiratory illnesses. This study aimed to determine the costs of ARIwC among urban Aboriginal and/or Torres Strait Islander children from the perspective of caretakers, the public healthcare system, and employers. Methods: This cost of illness study used data collected from Aboriginal and/or Torres Strait Islander children aged <5 years enrolled in a 12 month prospective cohort study conducted through an urban primary healthcare clinic in Queensland, Australia. Illness-related resource use was collected for each episode of ARIwC reported, and costed at market rates. Linear regression was used to (a) examine cost per episode by season of illness onset and cough duration and (b) examine cost per month of observation by baseline child and family characteristics. Results: During the study period, a total of 264 episodes of ARIwC were reported among 138 children. The total mean cost was estimated to be $AU252 per non-hospitalized episode (95%CI 169-334). Caretakers, the public healthcare system and employers incurred 44, 39, and 17% of costs per episode, respectively. After accounting for months of completed follow-ups, the total mean cost per child per year was estimated to be $991 (95%CI 514-1468). Winter episodes and episodes resulting in chronic cough were associated with significantly higher costs per episode. A prior history of wheezing, connections to traditional lands and parent/guardian belief that antibiotics should be given until symptoms resolved were associated with significantly higher cost per child month of observation. Conclusion: The cost of ARIwC in this predominantly disadvantaged population is substantial, particularly for caretakers and this needs to be considered in both clinical management and public health initiatives. The importance of cultural factors on health and burden of illness should not be overlooked. Further research into the prevention of chronic cough may play an important role in reducing the economic burden of pediatric respiratory infections.
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Affiliation(s)
- Yolanda G Lovie-Toon
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Steven M McPhail
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia.,Centre for Functioning and Health Research, Metro South Health, Woolloongabba, QLD, Australia
| | - Yin To Au-Yeung
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Kerry K Hall
- School of Human Services and Social Work, Menzies Health Institute Queensland, Griffith University, Nathan, QLD, Australia
| | - Anne B Chang
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia.,Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia.,Lady Cilento Children's Hospital, Queensland Children's Hospital and Health Services, South Brisbane, QLD, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Michael E Otim
- Department of Health Services Administration, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Public Health, Virtual University Uganda, Kampala, Uganda
| | - Kerry-Ann F O'Grady
- Institute of Health and Biomedical Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
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Wan Y, Vagenas D, Salazar C, Kenny L, Perry C, Calvopiña D, Punyadeera C. Salivary miRNA panel to detect HPV-positive and HPV-negative head and neck cancer patients. Oncotarget 2017; 8:99990-100001. [PMID: 29245955 PMCID: PMC5725146 DOI: 10.18632/oncotarget.21725] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 07/26/2017] [Indexed: 01/20/2023] Open
Abstract
Head and neck squamous cell carcinomas (HNSCC) are a heterogeneous group of tumours that originate predominantly from the oral cavity, pharynx and larynx. Our aim was to determine whether salivary miRNA expression levels can diagnose these cancer subtypes. Saliva samples were collected from healthy controls (n=113, smoker and non-smokers), HPV-positive (n=54) and HPV-negative (n=47) HNSCC patients. The miRNA expression levels in saliva was quantified using qPCR. The potential of salivary miRNAs to discriminate these groups of patients was evaluated using multiple logistic regression with ROC analysis and a 10-fold cross-validation analysis. Salivary miRNA-9, -127, -134, -191, -222 and -455 were shown to discriminate a control group from a HPV-negative HNSCC patient group with a sensitivity of 60% and a specificity of 94%; whilst salivary miRNA-9,-134, -196b, -210, and -455 were the most parsimonious subset discriminating a control group from a HPV-positive HNSCC group, with a sensitivity of 65% and a specificity of 95%. Furthermore, miRNA-9, -134, -196b, -210 and -455 as a panel, was the most parsimonious subset to discriminate HPV-positive HNSCC patients from HPV-negative HNSCC patients. In addition, the expression levels of miRNA-9, -127, -196a, -196b, -210, -222 and -455 were significantly increased in the saliva collected from early stage HNSCC patients compared to controls. A future multi-centre confirmatory study is warranted to test the diagnostic performance of these salivary miRNA prior to clinical implementation.
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Affiliation(s)
- Yunxia Wan
- School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, Woolloongabba, Queensland, Australia
| | - Carolina Salazar
- The School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia
- The University of Queensland Diamantina Institute, The University of Queensland, The Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Liz Kenny
- The School of Medicine, University of Queensland, Queensland, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, Central Integrated Regional Cancer Service, Queensland Health, Woolloongabba, Queensland, Australia
| | - Chris Perry
- Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
| | - Diego Calvopiña
- The School of Chemistry and Molecular Biosciences, The University of Queensland, Queensland, Australia
- The University of Queensland Diamantina Institute, The University of Queensland, The Translational Research Institute, Woolloongabba, Queensland, Australia
| | - Chamindie Punyadeera
- School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Kelvin Grove, Brisbane, Australia
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Roberts K, Mason R, Vagenas D, Lwin Z, Hughes B, Jain V, O’Byrne K. P2.07-032 Outcomes of Nivolumab in Metastatic NSCLC Patients via the Access Program Across Multiple Tertiary Oncology Centres. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.11.091] [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: 10/18/2022]
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Srinivasan S, Pritchard N, Sampson GP, Edwards K, Vagenas D, Russell AW, Malik RA, Efron N. Diagnostic capability of retinal thickness measures in diabetic peripheral neuropathy. J Optom 2017; 10:215-225. [PMID: 27423690 PMCID: PMC5595257 DOI: 10.1016/j.optom.2016.05.003] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/22/2016] [Accepted: 05/31/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE To examine the diagnostic capability of the full retinal and inner retinal thickness measures in differentiating individuals with diabetic peripheral neuropathy (DPN) from those without neuropathy and non-diabetic controls. METHODS Individuals with (n=44) and without (n=107) diabetic neuropathy and non-diabetic control (n=42) participants underwent spectral domain optical coherence tomography (SDOCT). Retinal thickness in the central 1mm zone (including the fovea), parafovea and perifovea was assessed in addition to ganglion cell complex (GCC) global loss volume (GCC GLV) and focal loss volume (GCC FLV), and retinal nerve fiber layer (RNFL) thickness. Diabetic neuropathy was defined using a modified neuropathy disability score (NDS) recorded on a 0-10 scale, wherein, NDS ≥3 indicated neuropathy and NDS indicated <3 no neuropathy. Diagnostic performance was assessed by areas under the receiver operating characteristic curves (AUCs), 95 per cent confidence intervals (CI), sensitivities at fixed specificities, positive likelihood ratio (+LR), negative likelihood ratio (-LR) and the cut-off points for the best AUCs obtained. RESULTS The AUC for GCC FLV was 0.732 (95% CI: 0.624-0.840, p<0.001) with a sensitivity of 53% and specificity of 80% for differentiating DPN from controls. Evaluation of the LRs showed that GCC FLV was associated with only small effects on the post-test probability of the disease. The cut-off point calculated using the Youden index was 0.48% (67% sensitivity and 73% specificity) for GCC FLV. For distinguishing those with neuropathy from those without neuropathy, the AUCs of retinal parameters ranged from 0.508 for the central zone to 0.690 for the inferior RNFL thickness. For distinguishing those with moderate or advanced neuropathy from those with mild or no neuropathy, the inferior RNFL thickness demonstrated the highest AUC of 0.820, (95% CI: 0.731-0.909, p<0.001) with a sensitivity of 69% and 80% specificity. The cut-off-point for the inferior RNFL thickness was 97μm, with 81% sensitivity and 72% specificity. CONCLUSIONS The GCC FLV can differentiate individuals with diabetic neuropathy from healthy controls, while the inferior RNFL thickness is able to differentiate those with greater degrees of neuropathy from those with mild or no neuropathy, both with an acceptable level of accuracy. Optical coherence tomography represents a non-invasive technology that aids in detection of retinal structural changes in patients with established diabetic neuropathy. Further refinement of the technique and the analytical approaches may be required to identify patients with minimal neuropathy.
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Affiliation(s)
- Sangeetha Srinivasan
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
| | - Nicola Pritchard
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Geoff P Sampson
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia; School of Medicine, Faculty of Health, Deakin University, Victoria, Australia
| | - Katie Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Anthony W Russell
- Princess Alexandra Hospital, Queensland, Australia; School of Medicine, University of Queensland, Woolloongabba, Queensland, Australia
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Education City, Doha, Qatar; Central Manchester University Hospitals Foundation Trust, Manchester, UK
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
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39
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Edwards K, Pritchard N, Dehghani C, Vagenas D, Russell A, Malik RA, Efron N. Corneal confocal microscopy best identifies the development and progression of neuropathy in patients with type 1 diabetes. J Diabetes Complications 2017; 31:1325-1327. [PMID: 28551295 DOI: 10.1016/j.jdiacomp.2017.04.025] [Citation(s) in RCA: 25] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/02/2017] [Accepted: 04/11/2017] [Indexed: 11/25/2022]
Abstract
A sub-set of 38 individuals with type 1 diabetes that fulfilled a strict criterion of "normal" classification for all 7 measures of neuropathy at baseline, were identified and followed. Corneal nerve morphology, as captured with corneal confocal microscopy demonstrated the greatest, and most sustained degeneration over a 4 year period.
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Affiliation(s)
- Katie Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia.
| | - Nicola Pritchard
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Cirous Dehghani
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Anthony Russell
- School of Medicine, University of Queensland, Queensland, Australia; Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Rayaz A Malik
- Center for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom; Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
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40
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Totsika V, Hastings RP, Vagenas D. Informal caregivers of people with an intellectual disability in England: health, quality of life and impact of caring. Health Soc Care Community 2017; 25:951-961. [PMID: 27653756 DOI: 10.1111/hsc.12393] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 08/25/2016] [Indexed: 06/06/2023]
Abstract
There is wide variation in reported impact of caring on caregiver well-being, and often a negative appraisal of caregiving. Researchers are beginning to question the robustness of the evidence base on which negative appraisals are based. The present study aimed to draw on data from a population-representative sample to describe the health, quality of life and impact of caring of informal caregivers of people with an intellectual disability. Informal carers of people with intellectual disability (N = 260) were identified among 2199 carers in the English Survey of Carers in Households 2009/10. Generalised estimating equations explored the association between socio-demographic and caring profile with quality of life, physical health status, and impact on psychological health and personal life. Compared to other caregivers, providing care to a person with intellectual disability was not associated with reduced quality of life. There was an 82% increased risk of reporting poorer health status, even though poorer health was not likely to be attributed to care-giving. A higher risk of negative impact on personal life was seen in comparison with the wider group of caregivers, but not in comparison with more similar-sized caregiver groups (mental health or dementia). Carers of people with intellectual disability were more likely to be struggling financially and have a high caring load. These factors were systematically related to lower well-being. A uniformly negative appraisal of caring for people with intellectual disability was not supported by these English population-representative data. Poverty and long care-giving hours may make caregivers more susceptible to negative well-being. Support for caregivers of people with intellectual disability should focus on alleviating those two factors.
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Affiliation(s)
- Vasiliki Totsika
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - Richard P Hastings
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland Institute of Technology, Brisbane, Queensland, Australia
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41
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Srinivasan S, Pritchard N, Sampson GP, Edwards K, Vagenas D, Russell AW, Malik RA, Efron N. Retinal tissue thickness in type 1 and type 2 diabetes. Clin Exp Optom 2016; 99:78-83. [PMID: 26875856 DOI: 10.1111/cxo.12318] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 02/19/2015] [Revised: 04/09/2015] [Accepted: 04/26/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The objective was to investigate full retinal and inner retinal thickness in individuals with type 1 and type 2 diabetes. METHODS Eighty-four individuals with type 1 diabetes (T1DM), 67 individuals with type 2 diabetes (T2DM) and 42 non-diabetic individuals (control group) were enrolled. Participants underwent full retinal thickness evaluation in the central retinal, parafoveal and perifoveal zones and in the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC), using spectral domain optical coherence tomography. As a preliminary step, the key variables of interest - age, sex, diabetic retinopathy (DR), duration of diabetes and HbA1c levels - were analysed and compared between the three groups. Full retinal thickness, RNFL and GCC thicknesses were also compared between the groups. The relationship between the type of diabetes and retinal tissue thickness was explored, adjusting for the five potential confounders. RESULTS Compared to individuals with T1DM, individuals with T2DM had significantly reduced full retinal thickness in the parafovea and perifovea and reduced RNFL and GCC thickness. The mean differences were six (p = 0.020), seven (p = 0.008), six (p = 0.021) and four micrometres (p = 0.013) for the parafovea, perifovea, RNFL and GCC thicknesses, respectively. Thicknesses within the central zone (p = 0.018) and at the parafovea (p = 0.007) were significantly reduced in T2DM when compared to the control group. After adjusting for age, sex, diabetic retinopathy, duration of diabetes and HbA1c levels, the relationship between type of diabetes and retinal tissue thickness was not statistically significant (p > 0.056). CONCLUSION Retinal tissue thickness is not significantly different between type 1 and type 2 diabetes, when adjusted for age, sex, diabetic retinopathy, duration of diabetes and HbA1c levels.
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Affiliation(s)
- Sangeetha Srinivasan
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Nicola Pritchard
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Geoff P Sampson
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.,Deakin University, Geelong, Victoria, Australia
| | - Katie Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Anthony W Russell
- Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.,School of Medicine, University of Queensland, Woolloongabba, Queensland, Australia
| | - Rayaz A Malik
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, United Kingdom.,Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
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Lim Y, Wan Y, Vagenas D, Ovchinnikov DA, Perry CFL, Davis MJ, Punyadeera C. Salivary DNA methylation panel to diagnose HPV-positive and HPV-negative head and neck cancers. BMC Cancer 2016; 16:749. [PMID: 27663357 PMCID: PMC5034533 DOI: 10.1186/s12885-016-2785-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/15/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous group of tumours with a typical 5 year survival rate of <40 %. DNA methylation in tumour-suppressor genes often occurs at an early stage of tumorigenesis, hence DNA methylation can be used as an early tumour biomarker. Saliva is an ideal diagnostic medium to detect early HNSCC tumour activities due to its proximity to tumour site, non-invasiveness and ease of sampling. We test the hypothesis that the surveillance of DNA methylation in five tumour-suppressor genes (RASSF1α, p16 INK4a , TIMP3, PCQAP/MED15) will allow us to diagnose HNSCC patients from a normal healthy control group as well as to discriminate between Human Papillomavirus (HPV)-positive and HPV-negative patients. METHODS Methylation-specific PCR (MSP) was used to determine the methylation levels of RASSF1α, p16 INK4a , TIMP3 and PCQAP/MED15 in DNA isolated from saliva. Statistical analysis was carried out using non-parametric Mann-Whitney's U-test for individually methylated genes. A logistic regression analysis was carried out to determine the assay sensitivity when combing the five genes. Further, a five-fold cross-validation with a bootstrap procedure was carried out to determine how well the panel will perform in a real clinical scenario. RESULTS Salivary DNA methylation levels were not affected by age. Salivary DNA methylation levels for RASSF1α, p16 INK4a , TIMP3 and PCQAP/MED15 were higher in HPV-negative HNSCC patients (n = 88) compared with a normal healthy control group (n = 122) (sensitivity of 71 % and specificity of 80 %). Conversely, DNA methylation levels for these genes were lower in HPV-positive HNSCC patients (n = 45) compared with a normal healthy control group (sensitivity of 80 % and specificity of 74 %), consistent with the proposed aetiology of HPV-positive HNSCCs. CONCLUSIONS Salivary DNA tumour-suppressor methylation gene panel has the potential to detect early-stage tumours in HPV-negative HNSCC patients. HPV infection was found to deregulate the methylation levels in HPV-positive HNSCC patients. Large-scale double-blinded clinical trials are crucial before this panel can potentially be integrated into a clinical setting.
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Affiliation(s)
- Yenkai Lim
- The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Yunxia Wan
- The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Dimitrios Vagenas
- The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Dmitry A Ovchinnikov
- Australian Institute for Bioengineering and Nanotechnology, University of Queensland, St Lucia, Brisbane, QLD, 4072, Australia
| | - Chris F L Perry
- Department of Otolaryngology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.,School of Medicine, University of Queensland, 288 Herston Road, Herston, Brisbane, QLD, 4006, Australia
| | - Melissa J Davis
- Department of Biomedical Engineering, University of Melbourne, Parkville, Melbourne, VIC, 3010, Australia
| | - Chamindie Punyadeera
- The School of Biomedical Sciences, Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, 60 Musk Avenue, Kelvin Grove, Brisbane, QLD, 4059, Australia.
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Sarkar S, Vagenas D, Schembri MA, Totsika M. Biofilm formation by multidrug resistant Escherichia coli ST131 is dependent on type 1 fimbriae and assay conditions. Pathog Dis 2016; 74:ftw013. [PMID: 26940589 DOI: 10.1093/femspd/ftw013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 11/12/2022] Open
Abstract
Escherichia coli sequence type 131 (ST131) has emerged as a pandemic lineage of important multidrug resistant pathogens worldwide. Despite many studies examining the epidemiology of ST131, only a few studies to date have investigated the capacity of ST131 strains to form biofilms. Some of these studies have reported contrasting findings, with no specific ST131 biofilm-promoting factors identified. Here, we examined a diverse collection of ST131 isolates for in vitro biofilm formation in different media and assay conditions, including urine from healthy adult women. We found significant differences among strains and assay conditions, which offers an explanation for the contrasting findings reported by previous studies using a single condition. Importantly, we showed that expression of type 1 fimbriae is a critical determinant for biofilm formation by ST131 strains and that inhibition of the FimH adhesin significantly reduces biofilm formation. We also offer direct genetic evidence for the contribution of type 1 fimbriae in biofilm formation by the reference ST131 strain EC958, a representative of the clinically dominant H30-Rx ST131 subgroup. This is the first study of ST131 biofilm formation in biologically relevant conditions and paves the way for the application of FimH inhibitors in treating drug resistant ST131 biofilm infections.
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Affiliation(s)
- Sohinee Sarkar
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Queensland 4072, Australia Australian Infectious Disease Research Centre, University of Queensland, Brisbane, Queensland 4072, Australia Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia
| | - Mark A Schembri
- School of Chemistry and Molecular Biosciences, University of Queensland, Brisbane, Queensland 4072, Australia Australian Infectious Disease Research Centre, University of Queensland, Brisbane, Queensland 4072, Australia
| | - Makrina Totsika
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, Queensland 4059, Australia
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Srinivasan S, Pritchard N, Vagenas D, Edwards K, Sampson GP, Russell AW, Malik RA, Efron N. Retinal Tissue Thickness is Reduced in Diabetic Peripheral Neuropathy. Curr Eye Res 2016; 41:1359-1366. [PMID: 26928267 DOI: 10.3109/02713683.2015.1119855] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To investigate the relationship between diabetic peripheral neuropathy (DPN) and retinal tissue thickness. METHODS Full retinal thickness in the central retinal, parafoveal, and perifoveal zones and thickness of the ganglion cell complex and retinal nerve fiber layer (RNFL) were assessed in 193 individuals (84 with type 1 diabetes, 67 with type 2 diabetes, and 42 healthy controls) using spectral domain optical coherence tomography. Among those with diabetes, 44 had neuropathy defined using a modified neuropathy disability score recorded on a 0-10 scale. Multiple regression analysis was performed to investigate the relationship between diabetic neuropathy and retinal tissue thickness, adjusted for the presence of diabetic retinopathy (DR), age, sex, duration of diabetes, and HbA1c levels. RESULTS In individuals with diabetes, perifoveal thickness was inversely related to the severity of neuropathy (p < 0.05), when adjusted for age, sex, duration of diabetes, and HbA1c levels. DR was associated with reduced thickness in parafovea (p < 0.01). The RNFL was thinner in individuals with greater degrees of neuropathy (p < 0.04). CONCLUSIONS DPN is associated with structural compromise involving several retinal layers. This compromise may represent a threat to visual integrity and therefore warrants examination of functional correlates.
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Affiliation(s)
- Sangeetha Srinivasan
- a Institute of Health and Biomedical Innovation , Queensland University of Technology , Queensland , Australia
| | - Nicola Pritchard
- a Institute of Health and Biomedical Innovation , Queensland University of Technology , Queensland , Australia
| | - Dimitrios Vagenas
- a Institute of Health and Biomedical Innovation , Queensland University of Technology , Queensland , Australia
| | - Katie Edwards
- a Institute of Health and Biomedical Innovation , Queensland University of Technology , Queensland , Australia
| | - Geoff P Sampson
- a Institute of Health and Biomedical Innovation , Queensland University of Technology , Queensland , Australia
| | - Anthony W Russell
- b Princess Alexandra Hospital , Queensland , Australia.,c School of Medicine , University of Queensland , Woolloongabba , Queensland , Australia
| | - Rayaz A Malik
- d Division of Cardiovascular Medicine , University of Manchester , Manchester , UK.,e Central Manchester Foundation Trust , Manchester , UK
| | - Nathan Efron
- a Institute of Health and Biomedical Innovation , Queensland University of Technology , Queensland , Australia
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45
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Srinivasan S, Pritchard N, Sampson GP, Edwards K, Vagenas D, Russell AW, Malik RA, Efron N. Retinal thickness profile of individuals with diabetes. Ophthalmic Physiol Opt 2015; 36:158-66. [DOI: 10.1111/opo.12263] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Accepted: 10/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Sangeetha Srinivasan
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
| | - Nicola Pritchard
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
| | - Geoff P. Sampson
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
| | - Katie Edwards
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
| | - Anthony W. Russell
- Princess Alexandra Hospital; Woolloongabba Australia
- School of Medicine; University of Queensland; Woolloongabba Australia
| | - Rayaz A. Malik
- Centre for Endocrinology and Diabetes; Institute of Human Development; University of Manchester; Manchester UK
- Weill Cornell Medical College in Qatar; Doha Qatar
| | - Nathan Efron
- Institute of Health and Biomedical Innovation; Queensland University of Technology; Kelvin Grove Australia
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Affiliation(s)
- Ben Mathews
- Queensland University of Technology; Faculty of Law, Australian Centre for Health Law Research; GPO Box 2434 Brisbane Queensland Australia 4001
| | - Kerryann Walsh
- Queensland University of Technology; Faculty of Education; Victoria Park Road Brisbane Queensland Australia 4059
| | - Sandra Coe
- Queensland University of Technology; Faculty of Law; GPO Box 2434 Brisbane Queensland Australia 4004
| | - Maureen C Kenny
- Florida International University; College of Education; University Park Miami Florida USA 33199
| | - Dimitrios Vagenas
- Queensland University of Technology; Institute of Health and Biomedical Innovation; 60 Musk Avenue Kelvin Grove Brisbane Queensland Australia 4059
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Manahan MN, Soyer HP, Loescher LJ, Horsham C, Vagenas D, Whiteman DC, Olsen CM, Janda M. A pilot trial of mobile, patient-performed teledermoscopy. Br J Dermatol 2015; 172:1072-80. [PMID: 25418126 DOI: 10.1111/bjd.13550] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early detection by skin self-examination (SSE) could improve outcomes for melanoma. Mobile teledermoscopy may aid this process. OBJECTIVES To establish the clinical accuracy of SSE plus mobile teledermoscopy vs. clinical skin examination (CSE) and to test whether providing people with detailed SSE instructions improves accuracy. METHODS Men and women aged 50-64 years (n = 58) performed SSE plus mobile teledermoscopy in their homes between May and November 2013 and were given technical instructions plus detailed SSE instructions (intervention) or technical instructions only (control). Within 3 months, they underwent a CSE. Outcome measures included (i) body sites examined, lesions photographed, and missed; (ii) sensitivity of SSE plus mobile teledermoscopy vs. in-person CSE using either patients or lesions as denominator; and (iii) concordance of telediagnosis with CSE. RESULTS Overall 49 of 58 randomized participants completed the study, and submitted 309 lesions to the teledermatologist. Intervention-group participants were more likely to submit lesions from their legs compared with controls (P = 0·03), with no other differences. Eleven participants (22%) did not photograph 14 pigmented lesions that the dermatologist considered worthwhile photographing or monitoring. The sensitivity of SSE plus mobile teledermoscopy was 82% using the patient as denominator and 42% using the lesion as denominator. There was substantial agreement between telediagnosis and CSE (κ = 0·90), accounting for differential diagnoses. CONCLUSIONS SSE plus mobile teledermoscopy is promising for surveillance of particular lesions even without detailed SSE instructions. However, in the format tested in this study, consumers may overlook lesions and send many nonpigmented lesions. This investigation demonstrates that high-quality dermoscopic images can be taken by patients at home with high accuracy.
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Affiliation(s)
- M N Manahan
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland Institute of Technology, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia
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Vagenas D, DiSipio T, Battistutta D, Demark-Wahnefried W, Rye S, Bashford J, Pyke C, Saunders C, Hayes SC. Weight and weight change following breast cancer: evidence from a prospective, population-based, breast cancer cohort study. BMC Cancer 2015; 15:28. [PMID: 25637285 PMCID: PMC4318545 DOI: 10.1186/s12885-015-1026-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 01/15/2015] [Indexed: 12/04/2022] Open
Abstract
Background While weight gain following breast cancer is considered common, results supporting these findings are dated. This work describes changes in body weight following breast cancer over 72 months, compares weight with normative data and explores whether weight changes over time are associated with personal, diagnostic, treatment or behavioral characteristics. Methods A population-based sample of 287 Australian women diagnosed with early-stage invasive breast cancer was assessed prospectively at six, 12, 18 and 72 months post-surgery. Weight was clinically measured and linear mixed models were used to explore associations between weight and participant characteristics (collected via self-administered questionnaire). Those with BMI changes of one or more units were considered to have experienced clinically significant changes in weight. Results More than half (57%) of participants were overweight or obese at 6 months post-surgery, and by 72 months post-surgery 68% of women were overweight or obese. Among those who gained more weight than age-matched norms, clinically significant weight gain between 6 and 18 months and 6 and 72 months post-surgery was observed in 24% and 39% of participants, respectively (median [range] weight gain: 3.9 kg [2.0-11.3 kg] and 5.2 kg [0.6-28.7], respectively). Clinically-significant weight losses were observed in up to 24% of the sample (median [range] weight loss between 6 and 72 months post-surgery: −6.4 kg [−1.9--24.6 kg]). More extensive lymph node removal, being treated on the non-dominant side, receiving radiation therapy and lower physical activity levels at 6 months was associated with higher body weights post-breast cancer (group differences >3 kg; all p < 0.05). Conclusions While average weight gain among breast cancer survivors in the long-term is small, subgroups of women experience greater gains linked with adverse health and above that experienced by age-matched counterparts. Weight change post-breast cancer is a contemporary public health issue and the integration of healthy weight education and support into standard breast cancer care has potential to significantly improve the length and quality of cancer survivorship.
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Affiliation(s)
- Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Tracey DiSipio
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia. .,School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, Australia.
| | - Diana Battistutta
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
| | | | - Sheree Rye
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia. .,School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, Australia.
| | - John Bashford
- The Haematology and Oncology Clinic, Wesley Hospital, Brisbane, Queensland, Australia.
| | - Chris Pyke
- The Mater Hospital, Brisbane, Queensland, Australia.
| | | | - Sandra C Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia. .,School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Queensland, Australia.
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Dehghani C, Pritchard N, Edwards K, Vagenas D, Russell AW, Malik RA, Efron N. Natural history of corneal nerve morphology in mild neuropathy associated with type 1 diabetes: development of a potential measure of diabetic peripheral neuropathy. Invest Ophthalmol Vis Sci 2014; 55:7982-90. [PMID: 25406279 DOI: 10.1167/iovs.14-15605] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate longitudinal changes of subbasal nerve plexus (SNP) morphology and its relationship with conventional measures of neuropathy in individuals with diabetes. METHODS A cohort of 147 individuals with type 1 diabetes and 60 age-balanced controls underwent detailed assessment of clinical and metabolic factors, neurologic deficits, quantitative sensory testing, nerve conduction studies, and corneal confocal microscopy at baseline and four subsequent annual visits. The SNP parameters included corneal nerve fiber density (CNFD), branch density (CNBD), and fiber length (CNFL), and were quantified using a fully automated algorithm. Linear mixed models were fitted to examine the changes in corneal nerve parameters over time. RESULTS At baseline, 27% of the participants had mild diabetic neuropathy. All SNP parameters were significantly lower in the neuropathy group compared with controls (P < 0.05). Overall, 89% of participants examined at baseline also completed the final visit. There was no clinically significant change to health and metabolic parameters and neuropathy measures from baseline to the final visit. Linear mixed model revealed a significant linear decline of CNFD (annual change rate, -0.9 nerve/mm(2), P = 0.01) in the neuropathy group compared with controls, which was associated with age (β = -0.06, P = 0.04) and duration of diabetes (β = -0.08, P = 0.03). In the neuropathy group, absolute changes of CNBD and CNFL showed moderate correlations with peroneal conduction velocity and cold sensation threshold, respectively (r, 0.38 and 0.40, P < 0.05). CONCLUSIONS This study demonstrates dynamic small fiber damage at the SNP, thus providing justification for our ongoing efforts to establish corneal nerve morphology as an appropriate adjunct to conventional measures of diabetic peripheral neuropathy.
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Affiliation(s)
- Cirous Dehghani
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Nicola Pritchard
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Katie Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Dimitrios Vagenas
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
| | - Anthony W Russell
- School of Medicine, University of Queensland, Queensland, Australia Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Rayaz A Malik
- Center for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, United Kingdom Weill Cornell Medical College in Qatar, Doha Qatar
| | - Nathan Efron
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia
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Edwards K, Pritchard N, Vagenas D, Russell A, Malik RA, Efron N. Standardizing corneal nerve fibre length for nerve tortuosity increases its association with measures of diabetic neuropathy. Diabet Med 2014; 31:1205-9. [PMID: 24750318 DOI: 10.1111/dme.12466] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 08/16/2013] [Revised: 01/28/2014] [Accepted: 04/08/2014] [Indexed: 12/14/2022]
Abstract
AIMS Recent studies on corneal markers have advocated corneal nerve fibre length as the most important measure of diabetic peripheral neuropathy. The aim of this study was to determine if standardizing corneal nerve fibre length for tortuosity increases its association with other measures of diabetic peripheral neuropathy. METHODS Two hundred and thirty-one individuals with diabetes with either predominantly mild or absent neuropathic changes and 61 control subjects underwent evaluation of diabetic neuropathy symptom score, neuropathy disability score, testing with 10-g monofilament, quantitative sensory testing (warm, cold, vibration detection) and nerve conduction studies. Corneal nerve fibre length and corneal nerve fibre tortuosity were measured using corneal confocal microscopy. A tortuosity-standardised corneal nerve fibre length variable was generated by dividing corneal nerve fibre length by corneal nerve fibre tortuosity. Differences in corneal nerve morphology between individuals with and without diabetic peripheral neuropathy and control subjects were determined and associations were estimated between corneal morphology and established tests of, and risk factors for, diabetic peripheral neuropathy. RESULTS The tortuosity-standardised corneal nerve fibre length variable was better than corneal nerve fibre length in demonstrating differences between individuals with diabetes, with and without neuropathy (tortuosity-standardised corneal nerve fibre length variable: 70.5 ± 27.3 vs. 84.9 ± 28.7, P < 0.001, receiver operating characteristic area under the curve = 0.67; corneal nerve fibre length: 15.9 ± 6.9 vs. 18.4 ± 6.2 mm/mm², P = 0.004, receiver operating characteristic area under the curve = 0.64). Furthermore, the tortuosity-standardised corneal nerve fibre length variable demonstrated a significant difference between the control subjects and individuals with diabetes, without neuropathy, while corneal nerve fibre length did not (tortuosity-standardised corneal nerve fibre length variable: 94.3 ± 27.1 vs. 84.9 ± 28.7, P = 0.028; corneal nerve fibre length: 20.1 ± 6.3 vs. 18.4 ± 6.2 mm/mm², P = 0.084). Correlations between corneal nerve fibre length and established measures of neuropathy and risk factors for neuropathy were higher when a correction was made for the nerve tortuosity. CONCLUSIONS Standardizing corneal nerve fibre length for tortuosity enhances the ability to differentiate individuals with diabetes, with and without neuropathy.
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Affiliation(s)
- K Edwards
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Woolloongabba, Qld, Australia
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