Publications by authors named "S Claxton"

34 Publications

Diagnosing community-acquired pneumonia via a smartphone-based algorithm: a prospective cohort study in primary and acute-care consultations.

Br J Gen Pract 2021 Apr 26;71(705):e258-e265. Epub 2021 Mar 26.

Joondalup Health Campus, Joondalup; Genesis Care Sleep and Respiratory, Perth.

Background: Community-acquired pneumonia (CAP) is an essential consideration in patients presenting to primary care with respiratory symptoms; however, accurate diagnosis is difficult when clinical and radiological examinations are not possible, such as during telehealth consultations.

Aim: To develop and test a smartphone-based algorithm for diagnosing CAP without need for clinical examination or radiological inputs.

Design And Setting: A prospective cohort study using data from participants aged >12 years presenting with acute respiratory symptoms to a hospital in Western Australia.

Method: Five cough audio-segments were recorded and four patient-reported symptoms (fever, acute cough, productive cough, and age) were analysed by the smartphone-based algorithm to generate an immediate diagnostic output for CAP. Independent cohorts were recruited to train and test the accuracy of the algorithm. Diagnostic agreement was calculated against the confirmed discharge diagnosis of CAP by specialist physicians. Specialist radiologists reported medical imaging.

Results: The smartphone-based algorithm had high percentage agreement (PA) with the clinical diagnosis of CAP in the total cohort ( = 322, positive PA [PPA] = 86.2%, negative PA [NPA] = 86.5%, area under the receiver operating characteristic curve [AUC] = 0.95); in participants 22-<65 years ( = 192, PPA = 85.7%, NPA = 87.0%, AUC = 0.94), and in participants aged ≥65 years ( = 86, PPA = 85.7%, NPA = 87.5%, AUC = 0.94). Agreement was preserved across CAP severity: 85.1% ( = 80/94) of participants with CRB-65 scores 1 or 2, and 87.7% ( = 57/65) with a score of 0, were correctly diagnosed by the algorithm.

Conclusion: The algorithm provides rapid and accurate diagnosis of CAP. It offers improved accuracy over current protocols when clinical evaluation is difficult. It provides increased capabilities for primary and acute care, including telehealth services, required during the COVID-19 pandemic.
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http://dx.doi.org/10.3399/BJGP.2020.0750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007248PMC
April 2021

Diagnosing Chronic Obstructive Airway Disease on a Smartphone Using Patient-Reported Symptoms and Cough Analysis: Diagnostic Accuracy Study.

JMIR Form Res 2020 Nov 10;4(11):e24587. Epub 2020 Nov 10.

School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Australia.

Background: Rapid and accurate diagnosis of chronic obstructive pulmonary disease (COPD) is problematic in acute care settings, particularly in the presence of infective comorbidities.

Objective: The aim of this study was to develop a rapid smartphone-based algorithm for the detection of COPD in the presence or absence of acute respiratory infection and evaluate diagnostic accuracy on an independent validation set.

Methods: Participants aged 40 to 75 years with or without symptoms of respiratory disease who had no chronic respiratory condition apart from COPD, chronic bronchitis, or emphysema were recruited into the study. The algorithm analyzed 5 cough sounds and 4 patient-reported clinical symptoms, providing a diagnosis in less than 1 minute. Clinical diagnoses were determined by a specialist physician using all available case notes, including spirometry where available.

Results: The algorithm demonstrated high positive percent agreement (PPA) and negative percent agreement (NPA) with clinical diagnosis for COPD in the total cohort (N=252; PPA=93.8%, NPA=77.0%, area under the curve [AUC]=0.95), in participants with pneumonia or infective exacerbations of COPD (n=117; PPA=86.7%, NPA=80.5%, AUC=0.93), and in participants without an infective comorbidity (n=135; PPA=100.0%, NPA=74.0%, AUC=0.97). In those who had their COPD confirmed by spirometry (n=229), PPA was 100.0% and NPA was 77.0%, with an AUC of 0.97.

Conclusions: The algorithm demonstrated high agreement with clinical diagnosis and rapidly detected COPD in participants presenting with or without other infective lung illnesses. The algorithm can be installed on a smartphone to provide bedside diagnosis of COPD in acute care settings, inform treatment regimens, and identify those at increased risk of mortality due to seasonal or other respiratory ailments.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001521213; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375939.
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http://dx.doi.org/10.2196/24587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685920PMC
November 2020

Emotional Outcomes of Casual Sexual Relationships and Experiences: A Systematic Review.

J Sex Res 2020 Sep 29:1-16. Epub 2020 Sep 29.

Nebraska Center for Research on Children, Youth, Families and Schools, University of Nebraska- Lincoln.

Casual sexual relationships and experiences (CSREs) are common and emotionally significant occurrences. Given the uncommitted, often emotionally complicated nature of CSREs, researchers have asked whether these experiences may have positive and/or negative emotional consequences. We reviewed 71 quantitative articles examining emotional outcomes of CSREs, including subjective emotional reactions (e.g., excitement, regret) and emotional health (e.g., depression, self-esteem). Overall, people evaluated their CSREs more positively than negatively. In contrast, CSREs were associated with short-term declines in emotional health in most studies examining changes in emotional health within a year of CSRE involvement. Emotional outcomes of CSREs differed across people and situations. Women and individuals with less permissive attitudes toward CSREs experienced worse emotional outcomes of CSREs. Alcohol use prior to CSREs, not being sexually satisfied, and not knowing a partner well were also associated with worse emotional outcomes. These findings suggest directions for prevention/intervention related to CSREs. For example, skill-building related to sexual decision-making may help individuals decide whether, and under what circumstances, CSREs are likely to result in positive or negative emotional outcomes. In addition, the limitations of extant research suggest directions for future inquiry (e.g., examining whether verbal and nonverbal consent practices predict emotional outcomes of CSREs).
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http://dx.doi.org/10.1080/00224499.2020.1821163DOI Listing
September 2020

Author Correction: YAP1/TAZ drives ependymoma-like tumour formation in mice.

Nat Commun 2020 Sep 28;11(1):4934. Epub 2020 Sep 28.

Kinases and Brain Development Laboratory, The Francis Crick Institute, London, NW1 1AT, UK.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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http://dx.doi.org/10.1038/s41467-020-18851-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522079PMC
September 2020

YAP1/TAZ drives ependymoma-like tumour formation in mice.

Nat Commun 2020 05 13;11(1):2380. Epub 2020 May 13.

Kinases and Brain Development Laboratory, The Francis Crick Institute, London, NW1 1AT, UK.

YAP1 gene fusions have been observed in a subset of paediatric ependymomas. Here we show that, ectopic expression of active nuclear YAP1 (nlsYAP5SA) in ventricular zone neural progenitor cells using conditionally-induced NEX/NeuroD6-Cre is sufficient to drive brain tumour formation in mice. Neuronal differentiation is inhibited in the hippocampus. Deletion of YAP1's negative regulators LATS1 and LATS2 kinases in NEX-Cre lineage in double conditional knockout mice also generates similar tumours, which are rescued by deletion of YAP1 and its paralog TAZ. YAP1/TAZ-induced mouse tumours display molecular and ultrastructural characteristics of human ependymoma. RNA sequencing and quantitative proteomics of mouse tumours demonstrate similarities to YAP1-fusion induced supratentorial ependymoma. Finally, we find that transcriptional cofactor HOPX is upregulated in mouse models and in human YAP1-fusion induced ependymoma, supporting their similarity. Our results show that uncontrolled YAP1/TAZ activity in neuronal precursor cells leads to ependymoma-like tumours in mice.
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http://dx.doi.org/10.1038/s41467-020-16167-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220953PMC
May 2020