Publications by authors named "Emily Hansen"

31 Publications

Increased peripheral blood neutrophil activation phenotypes and NETosis in critically ill COVID-19 patients: a case series and review of the literature.

Clin Infect Dis 2021 May 14. Epub 2021 May 14.

Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA.

Background: Increased inflammation has been well defined in COVID-19, while definitive pathways driving severe forms of this disease remain uncertain. Neutrophils are known to contribute to immunopathology in infections, inflammatory diseases and acute respiratory distress syndrome (ARDS), a primary cause of morbidity and mortality in COVID-19. Changes in neutrophil function in COVID-19 may give insight into disease pathogenesis and identify therapeutic targets.

Methods: Blood was obtained serially from critically ill COVID-19 patients for eleven days. Neutrophil extracellular trap formation (NETosis), oxidative burst, phagocytosis and cytokine levels were assessed. Lung tissue was obtained immediately post-mortem for immunostaining. Pubmed searches for neutrophils, lung and COVID-19 yielded ten peer-reviewed research articles in English.

Results: Elevations in neutrophil-associated cytokines IL-8 and IL-6, and general inflammatory cytokines IP-10, GM-CSF, IL-1b, IL-10 and TNF, were identified both at first measurement and across hospitalization (p<0.0001). COVID neutrophils had exaggerated oxidative burst (p<0.0001), NETosis (p<0.0001) and phagocytosis (p<0.0001) relative to controls. Increased NETosis correlated with leukocytosis and neutrophilia, and neutrophils and NETs were identified within airways and alveoli in lung parenchyma of 40% of SARS-CoV-2 infected lungs available for examination (2 out of 5). While elevations in IL-8 and ANC correlated with disease severity, plasma IL-8 levels alone correlated with death.

Conclusions: Literature to date demonstrates compelling evidence of increased neutrophils in the circulation and lungs of COVID-19 patients. importantly, neutrophil quantity and activation correlates with severity of disease. Similarly, our data shows that circulating neutrophils in COVID-19 exhibit an activated phenotype with enhanced NETosis and oxidative burst.
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http://dx.doi.org/10.1093/cid/ciab437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241438PMC
May 2021

The Impact on Service Collaboration of Co-location of Early Childhood Services in Tasmanian Child and Family Centres: An Ethnographic Study.

Int J Integr Care 2021 Apr 29;21(2):14. Epub 2021 Apr 29.

School of Social Sciences, University of Tasmania; Private Bag 22, Hobart, TAS 7001, Australia.

Introduction: There is a global trend towards place-based initiatives (PBIs) to break the cycle of disadvantage and promote positive child development. Co-location is a common element of these initiatives and is intended to deliver more coordinated services for families of young children. This paper examines how co-locating early childhood services (ECS) from health and education in Child and Family Centres (CFCs) has impacted collaboration between services.

Methods: This ethnographic study included 130 participant observation sessions in ECS between April 2017 and December 2018 and semi-structured interviews with 45 early childhood service providers and 39 parents/carers with pre-school aged children.

Results: Service providers based in CFCs reported that co-location of services was facilitating local cooperation and collaboration between services. However, insufficient information sharing between services, prioritising client contact over collaborative practice and limited shared professional development remained barriers to collaborative practice. For parents, co-location improved access to services, but they experienced services independently of each other.

Discussion And Conclusion: Co-location of ECS in CFCs contributed to greater cooperation and collaboration between services. However, for the potential of CFCs to be fully realised there remains a need for governance that better integrates service policies, systems and processes that explicitly support collaborative practice.
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http://dx.doi.org/10.5334/ijic.5581DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086726PMC
April 2021

Survey Outcomes of Lipedema Reduction Surgery in the United States.

Plast Reconstr Surg Glob Open 2021 Apr 23;9(4):e3553. Epub 2021 Apr 23.

Total Lipedema Care, Los Angeles, Calif.

Background: Lipedema is a loose connective tissue disease affecting the limbs of women, that is difficult to lose by diet, exercise, or bariatric surgery. Publications from Europe demonstrate that lipedema reduction surgery improves quality of life for women with lipedema. There are no comparable studies in the United States (USA). The aim of this study was to collect data from women with lipedema in the USA who have undergone lipedema reduction surgery in the USA to determine if quality of life, pain, and other measures improved after lipedema reduction surgery.

Methods: Subjects were recruited and consented online for a 166-item questionnaire in REDCap. In total, 148 women answered the questionnaire after undergoing lipedema reduction surgery in the USA. Significance set at < 0.05 was determined by ANOVA, Tukey's multiple comparison test, or paired -test.

Results: Quality of life improved in 84% and pain improved in 86% of patients. Ambulation improved most in lipedema Stage 3 (96%). Weight loss occurred in all stages by 3 months after surgery. Complications included growth of loose connective tissue within and outside treated areas, tissue fibrosis, anemia, blood clots, and lymphedema.

Conclusions: Women with lipedema noticed significant benefits after lipedema reduction surgery in the USA. Prospective studies are needed to assess benefits and complications after lipedema reduction surgery in the USA.
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http://dx.doi.org/10.1097/GOX.0000000000003553DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8078351PMC
April 2021

Exploring opportunities for general practice registrars to manage older patients with chronic disease: A qualitative study.

Aust J Gen Pract 2019 07;48(7):451-456

MBBS (Hons), MFM (Clin), PhD, DRANZCOG, FRACGP, Professor of General Practice, School of Medicine, University of Wollongong, NSW.

Method: Three focus groups and 21 interviews (18 supervisors, 17 registrars) were conducted, recorded and transcribed. The main themes were derived using thematic analysis.

Results: Three main themes were reported: context influences registrars' exposure to older patients; opportunities for continuity of care need ongoing negotiation and communication; registrars are competent - trust and confidence follows.

Discussion: Developing tailored models of shared patient care that suit different practices and supervisors will require ongoing negotiation and communication. This study confirms the need to enhance exposure for general practice registrars in ways that build on the competence of registrars and the trust in registrars by older patients and supervisors.
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http://dx.doi.org/10.31128/AJGP-09-18-4694DOI Listing
July 2019

Women's experiences of ceasing to breastfeed: Australian qualitative study.

BMJ Open 2019 05 6;9(5):e026234. Epub 2019 May 6.

School of Social Sciences, University of Tasmania, Hobart, Tasmania, Australia.

Objective: To investigate mothers' infant feeding experiences (breastfeeding/formula milk feeding) with the aim of understanding how women experience cessation of exclusive breastfeeding.

Design: Multimethod, qualitative study; questionnaire, focus groups and interviews.

Setting: Northern and Southern Tasmania, Australia.

Participants: 127 mothers of childbearing age from a broad sociodemographic context completed a questionnaire and participated in 22 focus groups or 19 interviews across Tasmania, 2011-2013.

Results: Mothers view breastfeeding as 'natural' and 'best' and formula milk as 'wrong' and 'unnatural'. In an effort to avoid formula and prolong exclusive breastfeeding, mothers will endure multiple issues (eg, pain, low milk supply, mastitis, public shaming) and make use of various forms of social and physical capital; resources such as father/partner support, expressing breast milk, bottles and dummies. The cessation of exclusive breastfeeding was frequently experienced as unexpected and 'devastating', leaving mothers with 'breastfeeding grief' (a prolonged sense of loss and failure).

Conclusions And Implications: For many mothers, the cessation of exclusive breastfeeding results in lingering feelings of grief and failure making it harmful to women's emotional well-being. Reframing breastfeeding as a family practice where fathers/partners are incorporated as breastfeeding partners has the potential to help women negotiate and prolong breastfeeding. Proactive counselling and debriefing are needed to assist women who are managing feelings of 'breastfeeding grief'.
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http://dx.doi.org/10.1136/bmjopen-2018-026234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528004PMC
May 2019

What does inclusive sexual and reproductive healthcare look like for bisexual, pansexual and queer women? Findings from an exploratory study from Tasmania, Australia.

Cult Health Sex 2020 03 8;22(3):247-260. Epub 2019 Apr 8.

School of Social Sciences, University of Tasmania, Hobart, Tasmania, Australia.

Increased awareness of the health disparities faced by lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ) people has driven the need for LGBTIQ-inclusive medical practices internationally. However, despite bisexual, pansexual and queer women's increased sexual health risks and reduced engagement with health services, there is little qualitative research examining their healthcare experiences. In addition, healthcare practitioners continue to report lack of awareness and competence in inclusive practice, particularly regarding these groups. To address these gaps in the literature and practice, this study draws on 21 qualitative interviews with women and general practitioners, comparing and contrasting their understandings and experiences of inclusive sexual and reproductive healthcare. Findings reveal that women value practitioners who take a non-judgemental approach, use inclusive language and are knowledgeable or willing to self-educate about LGBTIQ issues. Practitioners describe prioritising visual indicators of inclusivity, using inclusive language and embracing professional development. However, women and doctors both identify knowledge gaps among healthcare providers and the need for additional training opportunities to support effective inclusive practice.
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http://dx.doi.org/10.1080/13691058.2019.1584334DOI Listing
March 2020

'They're born to get breastfed'- how fathers view breastfeeding: a mixed method study.

BMC Pregnancy Childbirth 2018 Jun 18;18(1):238. Epub 2018 Jun 18.

Public Health, College of Health and Medicine, University of Tasmania, Private Bag 135, Hobart, TAS, 7001, Australia.

Background: Fathers' attitudes and actions can positively or negatively affect mothers' intentions to breastfeed, breastfeeding duration and exclusivity. In-depth information about fathers' perspectives on breastfeeding are largely absent in the literature about infant feeding. The objective of this research was to investigate how fathers view breastfeeding.

Methods: This mixed method study recruited Tasmanian fathers with children < 24 months of age. Fathers completed a questionnaire and participated in either semi structured one-on-one or group interviews. Transcripts were analysed using a process of iterative thematic analysis.

Results: Twenty-six fathers participated in the study. They had a mean age of 34 years and just over half were first time fathers. A total of 13 fathers lived in areas classified by SEIFA as disadvantaged. Twenty-one reported they had decided as a couple to breastfeed their current child. Fathers' views on breastfeeding are complex, multi-layered and change over time: as babies get older, as fathers get more familiar with feeding babies, when feeding practices change and when family circumstances change. Four thematic categories related to how fathers view breastfeeding were identified; Breastfeeding as healthy and natural, the value of breast feeding and breastmilk, a pragmatic approach to breastfeeding and Breastfeeding as something achieved or imposed.

Conclusion: Fathers in our study valued breastfeeding and saw it as healthy and natural for babies. However, many of the fathers in our study had seen their partners struggle with breastfeeding. As a result some also viewed breastfeeding as a potentially harmful practice for mothers. Their accounts demonstrated that breastfeeding problems affect families, not just mothers and infants. There is scope for improvement in the care of women during and after birth to reduce breastfeeding problems and for fathers to learn more about breastfeeding prior to the birth of their child.
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http://dx.doi.org/10.1186/s12884-018-1827-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6006837PMC
June 2018

CD4+ cell-derived interleukin-17 in a model of dysregulated, Borrelia-induced arthritis.

Pathog Dis 2016 10 21;74(7). Epub 2016 Aug 21.

Department of Biomedical Sciences, University of Wisconsin-Milwaukee, Milwaukee WI 53211, USA

Lyme borreliosis, which is caused in the United States by the spirochete Borrelia burgdorferi, may manifest as different arrays of signs, symptoms and severities between infected individuals. Recent studies have indicated that particularly severe forms of Lyme borreliosis in humans are associated with an increased Th17 response. Here, we hypothesized that a murine model combining the dysregulated immune response of an environment lacking interleukin-10 (IL-10) with a robust T-cell-driven inflammatory response would reflect arthritis associated with the production of IL-17 by CD4+ cells. We demonstrate that IL-10 regulates the production of IL-17 by Borrelia-primed CD4+ cells early after interaction with Lyme spirochetes in vitro and that infection of Borrelia-primed mice with B. burgdorferi leads to significant production of IL-17 that contributes to the development of severe arthritis. These results extend our previous findings by demonstrating that a dysregulated adaptive immune response to Lyme spirochetes can contribute to severe, Th17-associated arthritis. These findings may lead to therapeutic measures for individuals with particularly severe symptoms of Lyme borreliosis.
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http://dx.doi.org/10.1093/femspd/ftw084DOI Listing
October 2016

Staying a smoker or becoming an ex-smoker after hospitalisation for unstable angina or myocardial infarction.

Health (London) 2017 09 21;21(5):461-477. Epub 2016 Apr 21.

University of Tasmania, Australia; Monash University, Australia.

The aim of our study was to better understand processes of ongoing smoking or smoking cessation (quitting) following hospitalisation for myocardial infarction or unstable angina (acute cardiac syndromes). In-depth interviews were used to elicit participants' stories about ongoing smoking and quitting. In total, 18 interviews with smokers and 14 interviews with ex-smokers were analysed. Our findings illustrate the complex social nature of smoking practices including cessation. We found that smoking cessation following hospitalisation for acute cardiac syndromes is to some extent a performative act linked to 'doing health' and claiming a new identity, that of a virtuous ex-smoker in the hope that this will prevent further illness. For some ex-smokers hospitalisation had facilitated this shift, acting as a rite of passage and disrupting un-contemplated habits. Those participants who continued to smoke had often considered quitting or had even stopped smoking for a short period of time after hospitalisation; however, they did not undergo the identity shift described by ex-smokers and smoking remained firmly entrenched in their sense of self and the pattern of their daily lives. The ongoing smokers described feeling ashamed and stigmatised because of their smoking and felt that quitting was impossible for them. Our study provides an entry point into the smokers' world at a time when their smoking has become problematised and highly visible due to their illness and when smoking cessation or continuance carries much higher stakes and more immediate consequences than might ordinarily be the case.
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http://dx.doi.org/10.1177/1363459316644493DOI Listing
September 2017

Complex young lives: a collective qualitative case study analysis of young fatherhood and breastfeeding.

Int Breastfeed J 2016 2;11. Epub 2016 Apr 2.

University of Tasmania School of Social Science, Hobart, Tasmania Australia.

Background: Of all births in Australia, 10 % are to young fathers aged less than 24 years. How young fathers experience any breastfeeding and how this is shaped by their social context is poorly understood. Our aim is to increase understanding of the lived experience of young fathers (aged less than 24 years) and to explore the way they speak about breastfeeding in the context of their lives and parenting.

Methods: This collective case study analysis uses qualitative data from interviews and focus groups with young fathers (aged less than 24 years) and community support staff. The research was undertaken in Tasmania, Australia, March to December 2013.

Results: Young fathers in our study had complex social and emotional circumstances that meant breastfeeding was not a high priority despite them valuing the health benefits of breastfeeding for their babies. If supported by peers and their community they appear to have a more positive parenting experience.

Conclusion: Breastfeeding although understood by the young fathers in our study as healthy and desirable is not a priority in their lives. Learning to be a parent and support their partners to breastfeed may be more effectively gained through mentoring and father-to-father localized community based support services.
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http://dx.doi.org/10.1186/s13006-016-0066-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818881PMC
April 2016

Cumulative risks and cessation of exclusive breast feeding: Australian cross-sectional survey.

Arch Dis Child 2015 Sep 8;100(9):863-8. Epub 2015 Jun 8.

Menzies Research Institute, Hobart, Tasmania, Australia.

Objectives: To estimate the prevalence of cessation of exclusive breast feeding at each month up to 6 months and document key factors and cumulative risks associated with exclusive breastfeeding cessation for children aged from 0 to 6 months.

Methods: Secondary analysis using a national representative sample of 22 202 mother and infant pairs derived from the 2010 Australian Institute of Health and Welfare cross-sectional survey, the Australian Infant Feeding Survey.

Results: Among breastfed infants, 49% had ceased exclusive breast feeding before they had reached 2 months of age. In the final Cox proportional hazards model, cessation of exclusive breast feeding was most strongly associated with partners preferring bottle feeding (HR 1.86, 95% CI 1.69 to 20.6) or having no preference (HR 1.37, 95% CI 1.33 to 1.42), regular dummy use (HR 1.35, 95% CI 1.31 to 1.39) and maternal obesity (HR 1.29, 95% CI 1.24 to 1.35). Living within the most disadvantaged areas of Australia (quintile 1) was not strongly associated with cessation (HR 1.08, 95% CI 1.02 to 1.14) compared with least disadvantaged areas. Having three risk factors significantly increased the risk of cessation by 31% (HR 1.31, 95% CI 1.07 to 1.6).

Conclusions: The prevalence of early cessation of exclusive breast feeding is alarmingly high with 50% of infants no longer exclusively breast fed by age 2 months. Given that not one factor is associated with cessation of exclusive breast feeding, the greatest public health impact is likely to be achieved when multiple risk factors are modified or prevented.
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http://dx.doi.org/10.1136/archdischild-2014-307833DOI Listing
September 2015

Evaluating the prevention of premature cessation of exclusive breastfeeding in the general practice setting during the scheduled child immunisation consultation: a pilot study.

Aust J Prim Health 2015 ;21(3):299-304

The purpose of this study was to test and evaluate the feasibility and clinical acceptability of the use of an infant feeding data collection tool during the scheduled childhood immunisation consultation, and to explore the appropriateness of this consultation as a site for a future intervention aiming to increase exclusive breastfeeding through the provision of advice and support to mothers. This descriptive exploratory (quantitative and qualitative) study used purposeful sampling to enrol five general practices in Hobart, Tasmania. General practitioners (GPs) and practice nurses (PNs) trialled and evaluated a paper-based data collection tool over a 6-week period from May through to June 2011. Twenty-two (13 GPs; 2 GP registrars and 7 PNs) participants trialled and evaluated the data collection tool (n = 54). From the evaluation questionnaire, field notes and informal interviews (n = 7), six conceptual headings emerged: setting; time pressures; resources and collaboration; mothers need to talk; professional exclusion; and lack of collaboration. The scheduled childhood immunisation consultation provides an opportunity for mothers and primary health practitioners to talk briefly about infant feeding and for the collection of infant feeding data. However, the immunisation consultation is not well suited to a breastfeeding support intervention as it is already very busy focusing on immunisation issues. Consideration should be given to the evaluation of a dedicated general practice/primary health 'infant feeding' consultation.
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http://dx.doi.org/10.1071/PY13152DOI Listing
February 2016

Family-based clinical associations and functional characterization of the serotonin 2A receptor gene (HTR2A) in autism spectrum disorder.

Autism Res 2014 Aug 17;7(4):459-67. Epub 2014 Apr 17.

Department of Pharmacology, OSU College of Medicine Center for Pharmacogenomics, The Ohio State University, Columbus, Ohio.

The serotonin 2A receptor gene (HTR2A) harbors two functional single nucleotide polymorphisms (SNPs) that are frequent in populations of African and European descent; rs6311, which affects mRNA expression, and rs6314, which changes the amino acid sequence of the encoded protein and affects the signaling properties of the receptor. Multiple clinical associations support a role for these SNPs in cognitive and neuropsychiatric phenotypes, although studies in autism spectrum disorder (ASD) remain equivocal. Here, we tested transmission disequilibrium of rs6311 and rs6314 in a cohort of 158 ASD trios (simplex and multiplex), observing significant under-transmission of the minor "A" allele of rs6311 to offspring with ASD (permuted P = 0.0004). Consistent with our previous findings in the dorsolateral prefrontal cortex of unaffected individuals, rs6311/A decreases expression of HTR2A mRNA with an extended 5' untranslated region (UTR) in the frontopolar cortex in brain samples from 54 ASD patients and controls. Interpreting the clinical results in the context of our mRNA expression analysis, we speculate that any risk associated with rs6311 is conferred by greater expression of the long 5'UTR mRNA isoform. The current study corroborates earlier associations between rs6311 and ASD in a family study, supporting the hypothesis that rs6311 plays a modulatory role in ASD risk.
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http://dx.doi.org/10.1002/aur.1383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134733PMC
August 2014

Young adult perceptions of Australia's physical activity recommendations for adults.

Health Promot J Austr 2013 Dec;24(3):199-205

School of Social Sciences, University of Tasmania, Private Bag 22, Hobart, Tas. 7001, Australia.

Issues Addressed: Physical activity recommendations for adults worldwide advise participation in moderate-intensity physical activity, such as walking, on most days of the week. Younger adults report the lowest prevalence of walking. This mixed-methods study explores the salience of Australia's activity recommendations around moderate-intensity physical activity, particularly walking, for young Australian adults.

Methods: Semistructured interviews were conducted with 24 young Australians aged 17-25 years. During interviews, Australia's physical activity recommendations for adults were explained to participants, highlighting the inclusion of moderate-intensity physical activity such as walking. Participants were asked to comment on the recommendations and walking for physical activity and exercise. Data from interviews underwent an iterative thematic form of analysis. Participants also completed the International Physical Activity Questionnaire (IPAQ) and were asked to complete a pedometer diary.

Results: No participant was classified as sedentary; twenty three participants reported walking for transport and nine for leisure (IPAQ). During interviews, the majority of participants (n=20) did not identify walking as physical activity or exercise. Participants focussed on the cardiorespiratory (fitness) benefits associated with physical activity and believed walking was of insufficient intensity to achieve these benefits at their age.

Conclusions: Walking was considered an everyday activity and of insufficient intensity to achieve any health or fitness benefits. SO WHAT?: The belief that only vigorous physical activity conveys any fitness benefits may act as a barrier to participation in moderate-intensity physical activity such as walking, particularly among sedentary young people.
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http://dx.doi.org/10.1071/HE13041DOI Listing
December 2013

Interleukin-10 (IL-10) inhibits Borrelia burgdorferi-induced IL-17 production and attenuates IL-17-mediated Lyme arthritis.

Infect Immun 2013 Dec 16;81(12):4421-30. Epub 2013 Sep 16.

Department of Biomedical Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA.

Previous studies have shown that cells and cytokines associated with interleukin-17 (IL-17)-driven inflammation are involved in the arthritic response to Borrelia burgdorferi infection. Here, we report that IL-17 is a contributing factor in the development of Lyme arthritis and show that its production and histopathological effects are regulated by interleukin-10 (IL-10). Spleen cells obtained from B. burgdorferi-infected, "arthritis-resistant" wild-type C57BL/6 mice produced low levels of IL-17 following stimulation with the spirochete. In contrast, spleen cells obtained from infected, IL-10-deficient C57BL/6 mice produced a significant amount of IL-17 following stimulation with B. burgdorferi. These mice developed significant arthritis, including erosion of the bones in the ankle joints. We further show that treatment with antibody to IL-17 partially inhibited the significant hind paw swelling and histopathological changes observed in B. burgdorferi-infected, IL-10-deficient mice. Taken together, these findings provide additional evidence of a role for IL-17 in Lyme arthritis and reveal an additional regulatory target of IL-10 following borrelial infection.
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http://dx.doi.org/10.1128/IAI.01129-13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3837975PMC
December 2013

Interleukin-6 receptor polymorphism is prevalent in HIV-negative Castleman Disease and is associated with increased soluble interleukin-6 receptor levels.

PLoS One 2013 23;8(1):e54610. Epub 2013 Jan 23.

Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America.

Multicentric Castleman Disease is largely driven by increased signaling in the pathway for the plasma cell growth factor interleukin-6. We hypothesized that interleukin-6/interleukin-6 receptor/gp130 polymorphisms contribute to increased interleukin-6 and/or other components of the interleukin-6 signaling pathway in HIV-negative Castleman Disease patients. The study group was composed of 58 patients and 50 healthy donors of a similar racial/ethnic profile. Of seven polymorphisms chosen for analysis, we observed an increased frequency between patients and controls of the minor allele of interleukin-6 receptor polymorphism rs4537545, which is in linkage disequilibrium with interleukin-6 receptor polymorphism rs2228145. Further, individuals possessing at least one copy of the minor allele of either polymorphism expressed higher levels of soluble interleukin-6 receptor. These elevated interleukin-6 receptor levels may contribute to increased interleukin-6 activity through the trans-signaling pathway. These data suggest that interleukin-6 receptor polymorphism may be a contributing factor in Castleman Disease, and further research is warranted.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054610PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553080PMC
July 2013

Exploring the relationship between physical activity and leisure in the lives of young Australians.

J Phys Act Health 2013 Jan;10(1):54-61

Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.

Background: Leisure-time physical activity is a term used by physical activity researchers to describe physical activity undertaken during nonwork time. In this study we explore how young people speak about physical activity in relation to leisure.

Methods: Eight focus groups and one group interview were conducted with 50 participants aged 16-26 years. Participants included males and females, rural and urban dwellers, and a mixture of active/inactive young people. Focus group transcripts underwent an iterative thematic analysis.

Results: Participants found it difficult to recognize leisure time activities in their day to day lives and only rarely mentioned their physical activity involvement when asked about leisure time activities. When discussing physical activity study participants commonly focused on high intensity physical activity such as sport and gym use. Three major themes relating to leisure and physical activity were identified: the meanings ascribed to physical activity, the experience of physical activity, and routines of participation.

Conclusion: These findings suggest that the relationship between physical activity and leisure is complex and the term leisure with its associated concepts of satisfaction, relaxation and pleasure may not accurately reflect the way young people view their participation in physical activity.
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http://dx.doi.org/10.1123/jpah.10.1.54DOI Listing
January 2013

Factors associated with initiation and exclusive breastfeeding at hospital discharge: late preterm compared to 37 week gestation mother and infant cohort.

Int Breastfeed J 2012 Nov 26;7(1):16. Epub 2012 Nov 26.

School of Sociology and Social Work, University of Tasmania, Hobart, Australia.

Unlabelled:

Background: To investigate and examine the factors associated with initiation of, and exclusive breastfeeding at hospital discharge of, late preterm (34 0/7 - 36 6/7 weeks) compared to 37 week gestation (37 0/7 - 37 6/7 week) mother and baby pairs.

Methods: A retrospective population-based cohort study using a Perinatal National Minimum Data Set and clinical medical records review, at the Royal Hobart Hospital, Tasmania, Australia in 2006.

Results: Late preterm and 37 week gestation infants had low rates of initiation of breastfeeding within one hour of birth, 31 (21.1%) and 61 (41.5%) respectively. After multiple regression analysis, late preterm infants were less likely to initiate breastfeeding within one hour of birth (OR 0.3 95% CI 0.1, 0.7 p = 0.009) and were less likely to be discharged exclusively breastfeeding from hospital (OR 0.4 95% CI 0.1, 1.0 p = 0.04) compared to 37 week gestation infants.

Conclusion: A late preterm birth is predictive of breastfeeding failure, with late preterm infants at greater risk of not initiating breastfeeding and/or exclusively breastfeeding at hospital discharge, compared with those infants born at 37 weeks gestation. Stratifying breastfeeding outcomes by gestational age groups may help to identify those sub-populations at greatest risk of premature cessation of breastfeeding.
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http://dx.doi.org/10.1186/1746-4358-7-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546019PMC
November 2012

Thalidomide in total therapy 2 overcomes inferior prognosis of myeloma with low expression of the glucocorticoid receptor gene NR3C1.

Clin Cancer Res 2012 Oct 1;18(19):5499-506. Epub 2012 Aug 1.

University of Arkansas for Medical Sciences, Little Rock, AR, USA.

Purpose: Because dexamethasone remains a key component of myeloma therapy, we wished to examine the impact of baseline and relapse expression levels of the glucocorticoid receptor gene NR3C1 on survival outcomes in the context of treatment with or without thalidomide.

Experimental Design: We investigated the clinical impact of gene expression profiling (GEP)-derived expression levels of NR3C1 in 351 patients with GEP data available at baseline and in 130 with data available at relapse, among 668 subjects accrued to total therapy 2 (TT2).

Results: Low NR3C1 expression levels had a negative impact on progression-free survival (PFS; HR, 1.47; P = 0.030) and overall survival (OS; HR, 1.90; P = 0.002) in the no-thalidomide arm. Conversely, there was a significant clinical benefit of thalidomide for patients with low receptor levels (OS: HR, 0.54; P = 0.015; PFS: HR, 0.54; P = 0.004), mediated most likely by thalidomide's upregulation of NR3C1. In the context of both baseline and relapse parameters, post-relapse survival (PRS) was adversely affected by low NR3C1 levels at relapse in a multivariate analysis (HR, 2.61; P = 0.012).

Conclusion: These findings justify the inclusion of NR3C1 expression data in the work-up of patients with myeloma as it can significantly influence the choice of therapy and, ultimately, OS. The identification of an interaction term between thalidomide and NR3C1 underscores the importance of pharmacogenomic studies in the systematic study of new drugs.
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http://dx.doi.org/10.1158/1078-0432.CCR-12-0019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677537PMC
October 2012

Management of hypertension in general practice--a qualitative needs assessment of Australian GPs.

Aust Fam Physician 2012 May;41(5):317-23

Menzies Research Institute Tasmania, University of Tasmania.

Background: This study aimed to identify strategies to improve the management of hypertension in general practice.

Methods: Four focus groups (25 general practitioners and general practice registrars) were conducted, recorded and transcribed. Common emerging themes were analysed by an iterative thematic process.

Results: Four main themes were identified: uncertainty about blood pressure measurement, achieving consensus in practice, accommodating patient differences and addressing systematic barriers. General practitioners want a more standardised approach to measuring and interpreting blood pressure with consistent, valid readings taken on one device that accurately measures patients blood pressure in the 'real world'. General practitioners want to be upskilled in specific areas related to hypertension management.

Discussion: To facilitate improvements in blood pressure management, the most pressing needs of this group of GPs is to reduce the uncertainty surrounding the measurement and interpretation of blood pressure readings. This study has identified that sections of existing hypertension guidelines need to be reviewed and implemented.
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May 2012

A comparison of two classes of methods for estimating false discovery rates in microarray studies.

Scientifica (Cairo) 2012 8;2012:519394. Epub 2012 Jul 8.

Cancer Research and Biostatistics, Seattle, WA 98101, USA.

The goal of many microarray studies is to identify genes that are differentially expressed between two classes or populations. Many data analysts choose to estimate the false discovery rate (FDR) associated with the list of genes declared differentially expressed. Estimating an FDR largely reduces to estimating π 1, the proportion of differentially expressed genes among all analyzed genes. Estimating π 1 is usually done through P-values, but computing P-values can be viewed as a nuisance and potentially problematic step. We evaluated methods for estimating π 1 directly from test statistics, circumventing the need to compute P-values. We adapted existing methodology for estimating π 1 from t- and z-statistics so that π 1 could be estimated from other statistics. We compared the quality of these estimates to estimates generated by two established methods for estimating π 1 from P-values. Overall, methods varied widely in bias and variability. The least biased and least variable estimates of π 1, the proportion of differentially expressed genes, were produced by applying the "convest" mixture model method to P-values computed from a pooled permutation null distribution. Estimates computed directly from test statistics rather than P-values did not reliably perform well.
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http://dx.doi.org/10.6064/2012/519394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3820438PMC
November 2013

How cardiac patients describe the role of their doctors in smoking cessation: a qualitative study.

Aust J Prim Health 2011 ;17(3):268-73

School of Sociology and Social Work, University of Tasmania, Hobart, Tas. 7001, Australia.

This article reports a qualitative study investigating patients' experiences of ongoing smoking or smoking cessation after hospitalisation for an acute coronary syndrome (myocardial infarction or unstable angina) and describes how study participants spoke about the role of their doctors in smoking cessation. We invited individuals who had been admitted to an Australian public hospital in 2005 with a discharge diagnosis of an acute cardiac syndrome and who were smokers at the time of their hospitalisation to participate. Participants underwent a semi-structured interview and ongoing smokers also completed a 'stages of change' questionnaire. In total, 35 participants were interviewed, including 14 who were no longer smoking at least 12 months after their admission and 21 who were. Findings gave insight into the ways that cardiac patients perceive smoking cessation advice from their doctors, the perceived stigma of smoking and how lay understandings about smoking and smoking cessation emphasise the role of choice and individual responsibility. Our findings also indicate considerable scope for GPs and other doctors to offer better smoking cessation support to patients with established cardiovascular disease, particularly after a period of hospitalisation when the majority are highly motivated to stop smoking.
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http://dx.doi.org/10.1071/PY10082DOI Listing
December 2011

Using pedometers to estimate ambulatory physical activity in Vietnam.

J Phys Act Health 2011 Jan;8(1):52-61

Menzies Research Institute, University of Tasmania, Hobart, Australia.

Background: Pedometer measurement of physical activity (PA) has been shown to be reliable and valid in industrialized populations, but its applicability in economically developing Vietnam remains untested. This study assessed the feasibility, stability and validity of pedometer estimates of PA in Vietnam.

Methods: 250 adults from a population-based survey were randomly selected to wear Yamax pedometers and record activities for 7 consecutive days. Stability and concurrent validity were assessed using intraclass correlation coefficients (ICC) and Spearman correlation coefficients.

Results: Overall, 97.6% of participants provided at least 1 day of usable recordings, and 76.2% wore pedometers for all 7 days. Only 5.2% of the sample participants were involved in work activities not measurable by pedometer. The number of steps increased with hours of wear. There was no significant difference between weekday and weekend in number of steps, and at least 3 days of recordings were required (ICC of the 3 days of recordings: men 0.96, women 0.97). Steps per hour were moderately correlated (men r = .42, women r = .26) with record estimates of total PA.

Conclusions: It is feasible to use pedometers to estimate PA in Vietnam. The measure should involve at least 3 days of recording irrespective of day of the week.
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http://dx.doi.org/10.1123/jpah.8.1.52DOI Listing
January 2011

Barriers to diagnosing and managing hypertension - a qualitative study in Australian general practice.

Aust Fam Physician 2010 Jul;39(7):511-6

Discipline of General Practice, Menzies Research Institute, Hobart, Tasmania.

Background: Elevated blood pressure (BP) is a major modifiable risk factor. However hypertension still remains underdiagnosed, untreated or suboptimally treated. This study aimed to identify and explore barriers to initiating medication and treating elevated BP to target levels in the general practice setting.

Methods: Six focus groups involving 30 clinicians were audio recorded, transcribed in full and analysed for common emerging themes using an iterative thematic analysis.

Results: After making the decision to commence treatment, medication initiation was relatively straightforward. Clinical uncertainty about true underlying BP, distrust of measurement technology, and distrust of the evidence underpinning hypertension management were expressed. Patient age, gender and comorbidity influenced treatment strategy. Related themes included perceived patient attitude, clinical inertia, and patient centred care. Systems issues included lack of resources and lack of time.

Discussion: The management of an asymptomatic chronic disease within a patient centred, encounter based primary care context can be challenging.
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July 2010

Preliminary crystallographic analysis of GpgS, a key glucosyltransferase involved in methylglucose lipopolysaccharide biosynthesis in Mycobacterium tuberculosis.

Acta Crystallogr Sect F Struct Biol Cryst Commun 2008 Dec 28;64(Pt 12):1121-4. Epub 2008 Nov 28.

Mycobacteria Research Laboratories, Department of Microbiology, Immunology and Pathology, Colorado State University, Fort Collins, CO 80523-168, USA.

Glucosyl-3-phosphoglycerate synthase (GpgS) is a key enzyme that catalyses the first glucosylation step in methylglucose lipopolysaccharide biosynthesis in mycobacteria. These important molecules are believed to be involved in the regulation of fatty-acid and mycolic acid synthesis. The enzyme belongs to the recently defined GT81 family of retaining glycosyltransferases (CAZy, Carbohydrate-Active Enzymes Database; see http://www.cazy.org). Here, the purification, crystallization and preliminary crystallographic analysis are reported of GpgS from Mycobacterium tuberculosis and of its complex with UDP. GpgS crystals belonged to space group I4, with unit-cell parameters a = 98.85, b = 98.85, c = 127.64 A, and diffracted to 2.6 A resolution. GpgS-UDP complex crystals belonged to space group I4, with unit-cell parameters a = 98.32, b = 98.32, c = 127.96 A, and diffracted to 3.0 A resolution.
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http://dx.doi.org/10.1107/S1744309108032892DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2593697PMC
December 2008

General practitioners' experiences and understandings of diagnosing dementia: factors impacting on early diagnosis.

Soc Sci Med 2008 Dec 20;67(11):1776-83. Epub 2008 Oct 20.

Menzies Research Institute, University of Tasmania, Australia.

This article reports findings from three linked qualitative research projects that explored how Australian general practitioners (GPs) spoke about their experiences in diagnosing dementia and their views on early diagnosis and barriers towards early diagnosis. The authors conducted this research with the aim of elucidating the GP perspective and using this to better understand the process of diagnosing dementia and delays in diagnosing dementia. Twenty-four GPs based in Australia participated in the study (eleven females and thirteen males). Six of these GPs worked in rural practices, eight in a large town and the remainder in urban practices in a capital city. The major themes in GPs' accounts of the diagnosis of dementia could be grouped under the headings of 'recognizing dementia', 'holistic viewpoint', 'family members and patients' and 'medication'. Key findings are that dementia is a complex condition that takes time to diagnose. Diagnosis may involve conflict between GPs, family members/carers and the person with dementia (PWD). GPs did not consider that diagnosing dementia early was particularly important and may in fact be harmful to some patients. They are skeptical about the advantages of dementia medications. GPs assess the need for a formal diagnosis of dementia within the broader context of their older patients' lives. They are more likely to pursue a formal diagnosis in situations where they see it leading to benefits for their patient such as accessing dementia specific services. Increasing the availability of support services for PWD and educating GPs about the benefits of a formal diagnosis of dementia for stakeholders other than PWD, for example family members and carers may increase the likelihood that they will diagnose dementia early.
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http://dx.doi.org/10.1016/j.socscimed.2008.09.020DOI Listing
December 2008

Under-diagnosis of chronic obstructive pulmonary disease: a qualitative study in primary care.

Respir Med 2008 May 28;102(5):738-43. Epub 2008 Jan 28.

Menzies Research Institute, University of Tasmania, 43 Collins Street, Hobart TAS 7001, Australia.

Background: Chronic obstructive pulmonary disease (COPD) is under-diagnosed and diagnosis often occurs late thereby reducing opportunities to prevent deterioration. Investigation of causes has focused on the use of spirometry but the role of attitudes of doctors and patients has not been directly investigated.

Methods: A cross-sectional study of patients diagnosed with COPD and their general practitioners in two general practices in Tasmania who participated in semi-structured interviews and focus groups. Practice records were examined and patients underwent spirometry, quality of life and symptom assessment. Iterative content analysis identified themes that were compared with quantitative data.

Findings: For the 32 participating patients, mean recorded duration of COPD was 8.0 (SD 6.8) years and mean FEV(1)% predicted 38.4% (SD 19.8). Qualitative data were obtained from 14 (44%) of patients with COPD (5M/9F) and 16 general practitioners (GPs) (10M/6F). We identified three themes around the diagnosis of COPD in primary care: patients' labels, acquiring and communicating a diagnosis and consequences of delaying or withholding diagnosis. Doctors correctly recognised that patients were unfamiliar with COPD. They intentionally avoided early diagnosis as a result of nihilism and misperception of patients' attitudes. Patients often received the diagnosis from other sources and found delayed diagnosis frustrating.

Interpretation: Nihilistic attitudes to COPD may explain the disappointing results from promotion of spirometry in primary care. Education about COPD for doctors in primary care is needed and action to increase awareness and understanding of COPD in the community.
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http://dx.doi.org/10.1016/j.rmed.2007.12.008DOI Listing
May 2008

Explaining chronic obstructive pulmonary disease (COPD): perceptions of the role played by smoking.

Sociol Health Illn 2007 Jul;29(5):730-49

Discipline of General Practices, School of Medicine, University of Tasmania, Tasmania, Australia.

There are few studies that investigate how people personally affected by a chronic disease associated with cigarette smoking account for their illness. Chronic obstructive pulmonary disease (COPD) is a respiratory condition largely caused by cigarette smoking. In order to better understand how people diagnosed with COPD view the relationship between cigarette smoking and their illness we conducted semi-structured interviews with 19 participants. We found a widespread scepticism among our respondents about medical attempts to link their illness with cigarette smoking, and doubts about whether their illness was in fact COPD at all. Only four participants described smoking as the principal reason why they had developed breathing problems. Most participants gave multi-causal accounts that emphasised explanatory factors such as a familial tendency to respiratory illness or workplace exposure to pollution. Our findings have relevance for the development of smoking cessation interventions for people with COPD.
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http://dx.doi.org/10.1111/j.1467-9566.2007.01013.xDOI Listing
July 2007

The GP's response to pandemic influenza: a qualitative study.

Fam Pract 2006 Jun 11;23(3):267-72. Epub 2006 Apr 11.

Southern Tasmanian Division of General Practice, University of Tasmania, Hobart 7000, Australia.

Background: Current pandemic influenza plans to place GPs at the front line of a pandemic influenza response. However, little is known about GPs' perceptions of their role and preparedness in the event of a pandemic occurring.

Objective: Our aim was to assess general practice preparedness to respond to pandemic influenza and to identify issues that need to be addressed to enhance preparedness for the next pandemic.

Methods: We conducted a series of semi-structured interviews to explore GPs' views regarding their role in responding to pandemic influenza, practice preparedness and planning issues, and the expectations and requirements of GPs for provision of professional services during a pandemic. The subjects were 60 Australian GPs, purposively selected to maximize diversity within the sample.

Results: GPs in this study expressed a willingness to provide professional services in a pandemic. The motivation for this was largely altruistic and was in the context of high personal risk of becoming infected. Participants did not have stockpiles of antivirals or personal protective equipment within their practices and felt that government had a duty of care to stockpile on behalf of the general practice workforce. Participants were enthusiastic about receiving further information and training in pandemic preparedness. The most appropriate setting for this was within practices.

Conclusions: GPs were willing to provide clinical services in a pandemic. However, appropriate education, training and supply of equipment were necessary to support them in this role. This information will inform further planning for the public health response to pandemic influenza.
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http://dx.doi.org/10.1093/fampra/cml014DOI Listing
June 2006

Barriers to the use of spirometry in general practice.

Aust Fam Physician 2005 Mar;34(3):201-3

University of Tasmania.

Background: Guidelines advise chronic obstructive pulmonary disease (COPD) should be diagnosed and managed by using spirometry to demonstrate irreversible airflow limitation and monitor change in smokers and ex-smokers aged over 35 years.

Methods: A cross-sectional study of patients and their general practitioners investigating use of spirometry in COPD in two practices by lung function assessment, review of practice records, interviews and focus groups.

Results: Sixteen GPs, and 38 patients with a diagnosis of COPD participated. At diagnosis, although 72% had spirometry, this occurred in only 41% of 17 patients diagnosed by a GP; but in all 19 cases when a specialist was involved. Diagnosis often occurred late, despite all patients having previously recorded symptoms typical of COPD. General practitioners expressed a preference to diagnose COPD on clinical grounds. Although 58% of patients had recent spirometry for current management, only 32% were performed by their GP. There were organisational and technical barriers to spirometry and poor recognition of the essential role of spirometry in the diagnosis of COPD.

Discussion: There are a number of potentially reversible factors that hinder practice recommendations regarding the use of spirometry in general practice to diagnose and manage COPD.
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March 2005
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