Publications by authors named "Sara Lal"

32 Publications

Classifying Multi-Level Stress Responses From Brain Cortical EEG in Nurses and Non-Health Professionals Using Machine Learning Auto Encoder.

IEEE J Transl Eng Health Med 2021 5;9:2200109. Epub 2021 May 5.

FEIT, School of Computer ScienceAustralian Artificial Intelligence Institute, University of Technology Sydney Ultimo NSW 2007 Australia.

Objective: Mental stress is a major problem in our society and has become an area of interest for many psychiatric researchers. One primary research focus area is the identification of bio-markers that not only identify stress but also predict the conditions (or tasks) that cause stress. Electroencephalograms (EEGs) have been used for a long time to study and identify bio-markers. While these bio-markers have successfully predicted stress in EEG studies for binary conditions, their performance is suboptimal for multiple conditions of stress.

Methods: To overcome this challenge, we propose using latent based representations of the bio-markers, which have been shown to significantly improve EEG performance compared to traditional bio-markers alone. We evaluated three commonly used EEG based bio-markers for stress, the brain load index (BLI), the spectral power values of EEG frequency bands (alpha, beta and theta), and the relative gamma (RG), with their respective latent representations using four commonly used classifiers.

Results: The results show that spectral power value based bio-markers had a high performance with an accuracy of 83%, while the respective latent representations had an accuracy of 91%.
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http://dx.doi.org/10.1109/JTEHM.2021.3077760DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8172183PMC
May 2021

Smart Devices and Wearable Technologies to Detect and Monitor Mental Health Conditions and Stress: A Systematic Review.

Sensors (Basel) 2021 May 16;21(10). Epub 2021 May 16.

Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Broadway, Sydney, NSW 2007, Australia.

Recently, there has been an increase in the production of devices to monitor mental health and stress as means for expediting detection, and subsequent management of these conditions. The objective of this review is to identify and critically appraise the most recent smart devices and wearable technologies used to identify depression, anxiety, and stress, and the physiological process(es) linked to their detection. The MEDLINE, CINAHL, Cochrane Central, and PsycINFO databases were used to identify studies which utilised smart devices and wearable technologies to detect or monitor anxiety, depression, or stress. The included articles that assessed stress and anxiety unanimously used heart rate variability (HRV) parameters for detection of anxiety and stress, with the latter better detected by HRV and electroencephalogram (EGG) together. Electrodermal activity was used in recent studies, with high accuracy for stress detection; however, with questionable reliability. Depression was found to be largely detected using specific EEG signatures; however, devices detecting depression using EEG are not currently available on the market. This systematic review highlights that average heart rate used by many commercially available smart devices is not as accurate in the detection of stress and anxiety compared with heart rate variability, electrodermal activity, and possibly respiratory rate.
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http://dx.doi.org/10.3390/s21103461DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156923PMC
May 2021

Electrophysiological Brain-Cardiac Coupling in Train Drivers during Monotonous Driving.

Int J Environ Res Public Health 2021 04 2;18(7). Epub 2021 Apr 2.

Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, P.O. Box 123, Broadway, NSW 2007, Australia.

Electrophysiological research has previously investigated monotony and the cardiac health of drivers independently; however, few studies have explored the association between the two. As such the present study aimed to examine the impact of monotonous train driving (indicated by electroencephalogram (EEG) activity) on an individual's cardiac health as measured by heart rate variability (HRV). Sixty-three train drivers participated in the present study, and were required to complete a monotonous train driver simulator task. During this task, a 32 lead EEG and a three-lead electrocardiogram were recorded from each participant. In the present analysis, the low (LF) and high frequency (HF) HRV parameters were associated with delta ( < 0.05), beta ( = 0.03) and gamma ( < 0.001) frequency EEG variables. Further, total HRV was associated with gamma activity, while sympathovagal balance (i.e., LF:HF ratio) was best associated fronto-temporal delta activity ( = 0.02). HRV and EEG parameters appear to be coupled, with the parameters of the delta and gamma EEG frequency bands potentially being the most important to this coupling. These relationships provide insight into the impact of a monotonous task on the cardiac health of train drivers, and may also be indicative of strategies employed to combat fatigue or engage with the driving task.
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http://dx.doi.org/10.3390/ijerph18073741DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8038250PMC
April 2021

Associations Between Workplace Factors and Depression and Anxiety in Australian Heavy Vehicle Truck Drivers.

Ann Work Expo Health 2021 06;65(5):581-590

Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Sydney, Australia.

Introduction: A number of health issues have been identified as prevalent within the Australian heavy vehicle driving population. Mental illnesses, such as depression and anxiety, are among those disorders that have been regularly reported, however, the contributing factors are yet to be elucidated.

Methods: This study aimed to assess the associations between workplace factors such as years of employment, social interaction and shift length, with depressive and anxious symptomology in a cohort of 60 Australian heavy vehicle drivers.

Results: Significant positive associations were identified between depression and alcohol use (P = 0.044), coffee consumption (P = 0.037), number of accidents during career (P = < 0.004), and number of hours driving per shift (P ≤ 0.001). Anxiety was found to be positively associated with a number of hours driving per week (P ≤ 0.001), and the number of accidents or near misses during a driving career (P = 0.039).

Conclusion: Several workplace factors were identified as being correlated to depression or anxiety within this cohort, suggesting potential changes to rostering systems and education regarding alcohol use may benefit the mental health of this driver population.
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http://dx.doi.org/10.1093/annweh/wxaa134DOI Listing
June 2021

Electroencephalographic prediction of global and domain specific cognitive performance of clinically active Australian Nurses.

Physiol Meas 2020 10 6;41(9):095001. Epub 2020 Oct 6.

Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, 115 Health & Human Development Building, University Park, PA 16802, United States of America.

Objective: To investigate the relationship between EEG activity and the global and domain specific cognitive performance of healthy nurses, and determine the predictive capabilities of these relationships.

Approach: Sixty-four nurses were recruited for the present study, and data from 61 were utilised in the present analysis. Global and domain specific cognitive performance of each participant was assessed psychometrically using the Mini-mental state exam and the Cognistat, and a 32-lead monopolar EEG was recorded during a resting baseline phase and an active phase in which participants completed the Stroop test.

Main Results: Global cognitive performance was successfully predicted (81%-85% of variance) by a combination of fast wave activity variables in the alpha, beta and theta frequency bands. Interestingly, predicting domain specific performance had varying degrees of success (42%-99% of the variance predicted) and relied on combinations of both slow and fast wave activity, with delta and gamma activity predicting attention performance; delta, theta, and gamma activity predicting memory performance; and delta and beta variables predicting judgement performance.

Significance: Global and domain specific cognitive performance of Australian nurses may be predicted with varying degrees of success by a unique combination of EEG variables. These proposed models image transitory cognitive declines and as such may prove useful in the prediction of early cognitive impairment, and may enable better diagnosis, and management of cognitive impairment.
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http://dx.doi.org/10.1088/1361-6579/abb12aDOI Listing
October 2020

Impact of acute stress on cortical electrical activity and cardiac autonomic coupling.

J Integr Neurosci 2020 Jun;19(2):239-248

Neuroscience Research Unit, School of Technology Sydney, PO Box 123, Australia.

Assessment of heart rate variability (reflective of the cardiac autonomic nervous system) has shown some predictive power for stress. Further, the predictive power of the distinct patterns of cortical brain activity and - cardiac autonomic interactions are yet to be explored in the context of acute stress, as assessed by an electrocardiogram and electroencephalogram. The present study identified distinct patterns of neural-cardiac autonomic coupling during both resting and acute stress states. In particular, during the stress task, frontal delta waves activity was positively associated with low-frequency heart rate variability and negatively associated with high-frequency heart rate variability. Low high-frequency power is associated with stress and anxiety and reduced vagal control. A positive association between resting high-frequency heart rate variability and frontocentral gamma activity was found, with a direct inverse relationship of low-frequency heart rate variability and gamma wave coupling at rest. During the stress task, low-frequency heart rate variability was positively associated with frontal delta activity. That is, the parasympathetic nervous system is reduced during a stress task, whereas frontal delta wave activity is increased. Our findings suggest an association between cardiac parasympathetic nervous system activity and frontocentral gamma and delta activity at rest and during acute stress. This suggests that parasympathetic activity is decreased during acute stress, and this is coupled with neuronal cortical prefrontal activity. The distinct patterns of neural-cardiac coupling identified in this study provide a unique insight into the dynamic associations between brain and heart function during both resting and acute stress states.
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http://dx.doi.org/10.31083/j.jin.2020.02.74DOI Listing
June 2020

The roles of dispositional coping style and social support in helping people with respiratory disease cope with a breathlessness crisis.

J Adv Nurs 2019 Sep 11;75(9):1953-1965. Epub 2019 Jun 11.

IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.

Aim: To explore the role of coping moderators in self-management of breathlessness crises by people with advanced respiratory disease.

Design: A secondary analysis of semi-structured interview data.

Methods: Interviews with patients who had advanced respiratory disease, chronic breathlessness and at least one experience where they considered presenting to Emergency but self-managed instead (a "near miss"). Participants were recruited from New South Wales, Queensland, Victoria, South Australia or Tasmania. Eligible caregivers were those who contributed to Emergency-related decision-making. Interviews were coded inductively and then deductively against the coping moderators social support and dispositional coping style, defined by the Transactional Model of Stress and Coping.

Results: Interviews were conducted between October 2015 - April 2016 with 20 patients and three caregivers. Social networks offered emotional and practical support but also had potential for conflict with patients' 'hardy' coping style. Patient hardiness (characterized by a sense of 'commitment' and 'challenge') promoted a proactive approach to self-management but made some patients less willing to accept support. Information-seeking tendencies varied between patients and were sometimes shared with caregivers. An optimistic coping style appeared to be less equivocally beneficial.

Conclusion: This study shows that social support and coping style may influence how people self-manage through their breathlessness crises and identified ways coping moderators can facilitate or hinder effective self-management.

Impact: This study confers insights into how social-support and coping style can be supported and optimized to facilitate breathlessness self-management. Acknowledging coping moderator interactions is beneficial for developing resources and strategies that recognise patient mastery.
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http://dx.doi.org/10.1111/jan.14039DOI Listing
September 2019

A systematic review of the current evidence regarding interventions for anxiety, PTSD, sleepiness and fatigue in the law enforcement workplace.

Ind Health 2019 Nov 13;57(6):655-667. Epub 2019 Feb 13.

Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Australia.

Law enforcement is inherently stressful, and police officers are particularly vulnerable to mental and physical disorders. As such, researchers are currently assessing intervention strategies that may combat or manage these psychological, physical and mental issues. To review most recent information regarding anxiety, PTSD, and sleepiness and fatigue and identify the interventions and treatments proposed to overcome work related stressors and associated mental illnesses inflicting law enforcement officers. The EMBASE, OVID MEDLINE and PsycINFO databases were canvassed for articles investigating anxiety, post-traumatic stress disorder, sleepiness, and fatigue. Initial article selections were made based on title, whilst final inclusion was informed by a full critical appraisal with respect to the primary and secondary effects. The systematic search returned 363 records, of which 183 were unique. Following screening, 43 records were included in the final review. The included literature assessed the efficacy of several interventions, and provided a number of recommendations regarding interventions, and policy. Moreover, literature indicates that police officers benefit from interventions targeting work-related stress and potential psychological disorders, if these interventions are continuous. Furthermore, larger controlled studies are required to further elucidate the benefits of psychosocial intervention in law enforcement.
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http://dx.doi.org/10.2486/indhealth.2018-0088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885597PMC
November 2019

Prevalence and Risk Factors of Depression, Anxiety, and Stress in a Cohort of Australian Nurses.

Int J Environ Res Public Health 2018 12 27;16(1). Epub 2018 Dec 27.

Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW 2007, Australia.

Nurses remain at the forefront of patient care. However, their heavy workload as a career can leave them overworked and stressed. The demanding nature of the occupation exposes nurses to a higher risk of developing negative mental states such as depression, anxiety, and stress. Hence, the current study aimed to assess the prevalence and risk factors of these mental states in a representative sample of Australian nurses. The Depression Anxiety Stress Scale was administered to 102 nurses. Information about demographic and work characteristics were obtained using lifestyle and in-house designed questionnaires. Prevalence rates of depression, anxiety, and stress were found to be 32.4%, 41.2%, and 41.2% respectively. Binominal logistic regressions for depression and stress were significant ( = 0.007, = 0.009). Job dissatisfaction significantly predicted a higher risk of nurses developing symptoms of depression and stress respectively ( = 0.009, = 0.011). Poor mental health among nurses may not only be detrimental to the individual but may also hinder professional performance and in turn, the quality of patient care provided. Further research in the area is required to identify support strategies and interventions that may improve the health and wellbeing of nursing professionals and hence the quality of care delivered.
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http://dx.doi.org/10.3390/ijerph16010061DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339147PMC
December 2018

Peripheral Biomarker for Vascular Disorders.

Biomark Insights 2018 29;13:1177271918812467. Epub 2018 Nov 29.

School of Life Sciences and Centre for Health Technologies, University of Technology Sydney, Broadway, NSW, Australia.

Atherosclerosis is the underlying cause of most myocardial infarction (MI) and ischaemic stroke episodes. An early sign of atherosclerosis is hypertrophy of the arterial wall. It is known that increased intima media thickness (IMT) is a non-invasive marker of arterial wall alteration, which can easily be assessed in the carotid arteries by high-resolution B-mode ultrasound. Similarly, the other key element of MI and ischaemic strokes is the N-methyl-D-aspartate (NMDA) receptor which is an ionotropic glutamate receptor that mediates the vast majority of excitatory neurotransmission in the brain. NMDA activation requires the binding of both glutamate and a coagonist like D-serine to its glycine site. A special enzyme, serine racemase (SR), is required for the conversion of L-serine into D-serine, and alterations in SR activities lead to a variety of physiological and pathological conditions ranging from synaptic plasticity to ischemia, MI, and stroke. The amount of D-serine available for the activation of glutamatergic signalling is largely determined by SR and we have developed ways to estimate its levels in human blood samples and correlate it with the IMT. This research based short communication describes our pilot study, which clearly suggests that there is a direct relationship between the SR, D-serine, and IMT. In this article, we will discuss whether the activity of SR can determine the future consequences resulting from vascular pathologies such as MI and stroke.
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http://dx.doi.org/10.1177/1177271918812467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287300PMC
November 2018

Electroencephalography as a predictor of self-report fatigue/sleepiness during monotonous driving in train drivers.

Physiol Meas 2018 10 30;39(10):105012. Epub 2018 Oct 30.

Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, PO Box 123, Broadway NSW 2007, Australia. Indicates an equal joint first author contribution.

Objective: In this study, electroencephalography activity recorded during monotonous driving was investigated to examine the predictive capability of monopolar EEG analysis for fatigue/sleepiness in a cohort of train drivers.

Approach: Sixty-three train drivers participated in the study, where 32- lead monopolar EEG data was recorded during a monotonous driving task. Participant sleepiness was assessed using the Pittsburgh sleep quality index (PSQI), the Epworth sleepiness scale (ESS), the Karolinksa sleepiness scale (KSS) and the checklist of individual strength 20 (CIS20).

Main Results: Self-reported fatigue/sleepiness scores of the train driver cohort were primarily associated with EEG delta, theta, and alpha variables; however, some beta and gamma associations were also implicated. Furthermore, general linear models informed by these EEG variables were able to predict self-reported scores with varying degrees of success, representing between 48% and 54% of variance in fatigue scores.

Significance: Self-reported fatigue/sleepiness scores of train drivers were predicted with varying degrees of success (dependent upon the self-reported fatigue/sleepiness measure) by alterations to monopolar delta, theta, and alpha band activity variables, indicating EEG as a potential indicator for fatigue/sleepiness in train drivers.
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http://dx.doi.org/10.1088/1361-6579/aae42eDOI Listing
October 2018

Heart Rate Variability as a Biomarker for Predicting Stroke, Post-stroke Complications and Functionality.

Biomark Insights 2018 18;13:1177271918786931. Epub 2018 Jul 18.

Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia.

Background: Heart rate variability (HRV) is a non-invasive measure of the function of the autonomic nervous system, and its dynamic nature may provide a means through which stroke and its associated complications may be predicted, monitored, and managed.

Objective: The objective of this review is to identify and provide a critique on the most recent uses of HRV in stroke diagnosis/management and highlight areas that warrant further research.

Methods: The MEDLINE, CINAHL, and OVID MEDLINE databases were canvassed using a systematic search strategy, for articles investigating the use of HRV in stroke diagnosis and management. Initial paper selections were based on title alone, and final paper inclusion was informed by a full-text critical appraisal.

Results: The systematic search returned 98 records, of which 51 were unique. Following screening, 22 records were included in the final systematic review. The included papers provided some information regarding predicting incident stroke, which largely seems to be best predicted by time- and frequency-domain HRV parameters. Furthermore, post-stroke complications and functionality are similarly predicted by time- and frequency-domain parameters, as well as non-linear parameters in some instances.

Conclusions: Current research provides good evidence that HRV parameters may have utility as a biomarker for stroke and for post-stroke complications and/or functionality. Future research would benefit from the integration of non-linear, and novel parameters, the hybridisation of HRV parameters, and the expansion of the utilisation of predictive regression and hazard modelling.
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http://dx.doi.org/10.1177/1177271918786931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6052496PMC
July 2018

Nattokinase: A Promising Alternative in Prevention and Treatment of Cardiovascular Diseases.

Biomark Insights 2018 5;13:1177271918785130. Epub 2018 Jul 5.

School of Life Sciences, University of Technology Sydney, Broadway, NSW, Australia.

Cardiovascular disease (CVD) is the leading cause of death in the world and our approach to the control and management of CVD mortality is limited. Nattokinase (NK), the most active ingredient of natto, possesses a variety of favourable cardiovascular effects and the consumption of Natto has been linked to a reduction in CVD mortality. Recent research has demonstrated that NK has potent fibrinolytic activity, antihypertensive, anti-atherosclerotic, and lipid-lowering, antiplatelet, and neuroprotective effects. This review covers the major pharmacologic effects of NK with a focus on its clinical relevance to CVD. It outlines the advantages of NK and the outstanding issues pertaining to NK pharmacokinetics. Available evidence suggests that NK is a unique natural compound that possesses several key cardiovascular beneficial effects for patients with CVD and is therefore an ideal drug candidate for the prevention and treatment of CVD. Nattokinase is a promising alternative in the management of CVD.
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http://dx.doi.org/10.1177/1177271918785130DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6043915PMC
July 2018

Repeated sleep-quality assessment and use of sleep-promoting interventions in ICU.

Nurs Crit Care 2017 Nov 16;22(6):348-354. Epub 2017 Oct 16.

Intensive Care Unit, Royal North Shore Hospital, St Leonards, NSW 2065, Australia, (in place of University of London).

To describe sleep quality using repeated subjective assessment and the ongoing use of sleep-promoting interventions in intensive care. It is well known that the critically ill experience sleep disruption while receiving treatment in the intensive care unit. Both the measurement and promotion of sleep is challenging in the complex environment of intensive care unit. Repeated subjective assessment of patients' sleep in the intensive care unit and use of sleep-promoting interventions has not been widely reported. An observational study was conducted in a 58-bed adult intensive care unit. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ) each morning. intensive care unit audit sleep-promoting intervention data were compared to data obtained prior to the implementation of a sleep guideline. Patients answered open-ended questions about the facilitators and deterrents of their sleep in intensive care unit. The sample (n = 50) was predominately male (76%) with a mean age: 62.6±16.9 years. Sleep quality was assessed on 2 days or more for 21 patients. The majority of patients (98%) received sleep-promoting interventions. Sleep quality had not improved significantly since the guideline was first implemented. The mean Richards-Campbell Sleep Questionnaire score was 47.9±24.1 mm. The main sleep deterrents were discomfort and noise. Frequently cited facilitators were nothing (i.e. nothing helped) and analgesia. The Richards-Campbell Sleep Questionnaire was used on repeated occasions, and sleep-promoting interventions were used extensively. There was no evidence of improvement in sleep quality since the implementation of a sleep guideline. The use of the Richards-Campbell Sleep Questionnaire for the subjective self-assessment of sleep quality in intensive care unit patients and the implementation of simple-promoting interventions by intensive care unit clinicians is both feasible and may be the most practical way to assess sleep in the intensive care unit context.
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http://dx.doi.org/10.1111/nicc.12315DOI Listing
November 2017

The Effects of Twelve Weeks of Tai Chi Practice on Anxiety in Stressed But Healthy People Compared to Exercise and Wait-List Groups-A Randomized Controlled Trial.

J Clin Psychol 2018 Jan 13;74(1):83-92. Epub 2017 Jun 13.

University of Technology Sydney.

Objective: This randomized controlled trial was undertaken to determine whether 12 weeks of Tai Chi (TC) practice can reduce anxiety in healthy but stressed people.

Method: Fifty participants were randomized into TC (n=17), exercise (n=17), and wait-list (WL) groups (n=16). Outcome measures used were State Trait Anxiety Inventory, Perceived Stress Scale 14 (PSS14), blood pressure and heart rate variability, visual analogue scale (VAS), and Short Form 36.

Results: Significant improvements were observed from baseline for both TC and exercise groups for both state (p <0.01) and trait (p <0.01) anxiety, PSS14 (p <0.01), VAS (p <0.01), mental health domain (p <0.01), and vitality domain (p <0.01). Superior outcomes were also observed for TC when compared with WL for state and trait anxiety (p <0.01) and mental health domain (p <0.05).

Conclusion: TC reduces stress levels in healthy individuals and provides a safer, cost effective, and less physically vigorous alternative to exercise.
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http://dx.doi.org/10.1002/jclp.22482DOI Listing
January 2018

CRISPR-targeted genome editing of mesenchymal stem cell-derived therapies for type 1 diabetes: a path to clinical success?

Stem Cell Res Ther 2017 03 9;8(1):62. Epub 2017 Mar 9.

The School of Life Sciences, Chronic Disease Solutions Team and the Centre for Health Technologies, University of Technology Sydney, PO Box 123, Broadway, NSW, 2007, Australia.

Due to their ease of isolation, differentiation capabilities, and immunomodulatory properties, the therapeutic potential of mesenchymal stem cells (MSCs) has been assessed in numerous pre-clinical and clinical settings. Currently, whole pancreas or islet transplantation is the only cure for people with type 1 diabetes (T1D) and, due to the autoimmune nature of the disease, MSCs have been utilised either natively or transdifferentiated into insulin-producing cells (IPCs) as an alternative treatment. However, the initial success in pre-clinical animal models has not translated into successful clinical outcomes. Thus, this review will summarise the current state of MSC-derived therapies for the treatment of T1D in both the pre-clinical and clinical setting, in particular their use as an immunomodulatory therapy and targets for the generation of IPCs via gene modification. In this review, we highlight the limitations of current clinical trials of MSCs for the treatment of T1D, and suggest the novel clustered regularly interspaced short palindromic repeat (CRISPR) gene-editing technology and improved clinical trial design as strategies to translate pre-clinical success to the clinical setting.
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http://dx.doi.org/10.1186/s13287-017-0511-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5345178PMC
March 2017

Recent advances in molecular biomarkers for diabetes mellitus: a systematic review.

Biomarkers 2017 Nov 24;22(7):604-613. Epub 2017 Jan 24.

a Neuroscience Research Unit , School of Life Sciences, Faculty of Science, University of Technology Sydney , Broadway , NSW , Australia.

Context: Diabetes is a growing global metabolic epidemic. Current research is focussing on exploring how the biological processes and clinical outcomes of diabetes are related and developing novel biomarkers to measure these relationships, as this can subsequently improve diagnostic, therapeutic and management capacity.

Objective: The objective of this study is to identify the most recent advances in molecular biomarkers of diabetes and directions that warrant further research.

Methods: Using a systematic search strategy, the MEDLINE, CINAHL and OVID MEDLINE databases were canvassed for articles that investigated molecular biomarkers for diabetes. Initial selections were made based on article title, whilst final inclusion was informed by a critical appraisal of the full text of each article.

Results: The systematic search returned 246 records, of which 113 were unique. Following screening, 29 records were included in the final review. Three main research strategies (the development of novel technologies, broad biomarker panels, and targeted approaches) identified a number of potential biomarkers for diabetes including miR-126, C-reactive protein, 2-aminoadipic acid and betatrophin.

Conclusion: The most promising research avenue identified is the detection and quantification of micro RNA. Further, the utilisation of functionalised electrodes as a means to detect biomarker compounds also warrants attention.
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http://dx.doi.org/10.1080/1354750X.2017.1279216DOI Listing
November 2017

Addressing the stroke evidence-treatment gap.

Contemp Nurse 2016 Apr-Jun;52(2-3):253-7. Epub 2016 Aug 3.

e Nursing Research Institute, Australian Catholic University & St Vincent's Health (Sydney) , Sydney , Australia.

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http://dx.doi.org/10.1080/10376178.2016.1215235DOI Listing
May 2017

Association Between Heart Rate Variability Measures and Blood Glucose Levels: Implications for Noninvasive Glucose Monitoring for Diabetes.

Diabetes Technol Ther 2016 06;18(6):366-76

1 Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney , Broadway, New South Wales, Australia .

Background: Diabetes mellitus (DM) is a global metabolic epidemic associated with numerous adverse complications. Invasive finger prick tests or invasive monitors are currently the most common means of monitoring and controlling blood glucose levels (BGLs). Heart rate variability (HRV) is a noninvasive measure of the autonomic nervous system, and its dynamic physiological nature may provide an alternative means of blood glucose monitoring. However, the relationship between BGL and HRV parameters remains relatively unknown.

Materials And Methods: Thirty-two participants with diabetes (39.97 ± 17.21 years of age) and 31 without diabetes (27.87 ± 10.55 years of age) participated in the current study. Fasting preceded a 10-min three-lead electrocardiogram (ECG), which was followed by a finger prick blood glucose assessment. Following this, a regular meal was consumed, and 30 min after ingestion, a second postprandial 10-min ECG was obtained, and blood glucose assessment was conducted.

Results: Low-frequency (LF) power, high-frequency (HF) power, and total power (TP) of HRV were negatively associated with BGL in participants with DM. Additionally, the ratio of LF to HF was positively correlated with BGL. Duration of DM was also associated with multiple HRV parameters, with negative associations to both LF and HF parameters as well as TP.

Conclusions: This study demonstrates links between specific HRV variables and BGL. In the future the dynamic nature of HRV could provide a unique and real-time method for monitoring BGL, for continuous noninvasive prediction and/or management of DM.
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http://dx.doi.org/10.1089/dia.2016.0010DOI Listing
June 2016

Electroencephalogram associations to cognitive performance in clinically active nurses.

Physiol Meas 2016 07 31;37(7):968-80. Epub 2016 May 31.

Neuroscience Research Unit, School of Life Sciences, University of Technology, Sydney PO Box 123, Broadway NSW 2007, Australia.

Cognitive impairment is traditionally identified via cognitive screening tools that have limited ability in detecting early or transitional stages of impairment. The dynamic nature of physiological variables such as the electroencephalogram (EEG) may provide alternate means for detecting these transitions. However, previous research examining EEG and cognitive performance is largely confined to samples with diagnosed cognitive impairments, and research examining non-impaired, and occupation specific samples, is limited. The present study aimed to investigate the associations between frontal pole and central EEG and cognitive performance in a sample of male and female nurses, and to determine the significance of these associations. Fifty seven nurses participated in the study, in which two lead bipolar EEG was recorded at positions Fp1 (frontal polar), Fp2, C3 (central) and C4 during a baseline and an active phase involving the common neuropsychological Stroop test. Participants' cognitive performance was assessed using the mini-mental state exam (MMSE) and Cognistat screening tools. Significant correlations between EEG beta activity and the outcome of MMSE and Cognistat were revealed, where an increased beta activity was associated to an increased global cognitive performance. Additionally, domain specific cognitive performance was also significantly associated to various EEG variables. The study identified potential EEG biomarkers for global and domain specific cognitive performance, and provides initial groundwork for the development of future EEG based biomarkers for detection of cognitive pathologies.
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http://dx.doi.org/10.1088/0967-3334/37/7/968DOI Listing
July 2016

Stress and its Impact on the Neurocognitive Performance of Australian Nurses.

Authors:
Ty Lees Sara Lal

Stress Health 2017 Feb 24;33(1):45-54. Epub 2016 Feb 24.

Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Ultimo, NSW, Australia.

Nurses function inside a particularly stressful occupation that requires the provision of continuous care to individuals who are often in great need. Stress has been shown to impair performance and specifically shown to impair nursing quality. However, we do not yet know how stress influences the cognitive performance of nurses, and hence, the present study investigated the associations between stress and cognitive performance in nurses using electroencephalography and administered cognitive assessments. Thirty-six nurses (34 women) of mean age 37.77 ± 11.40 years were recruited. Stress was examined using the Lifestyle Appraisal Questionnaire. Broad spectrum electroencephalogram activity at positions Fp1, Fp2, C3 and C4 was recorded for a 5-min baseline and active phase to physiologically assess cognitive performance. Additionally, the Mini-Mental State Exam and Cognistat were also used to measure cognitive performance. Assessed cognitive performance was not associated to stress, however, lifestyle factors, as well as a number of the examined cognitive electroencephalographic variables including changes in theta, alpha activity and gamma reactivity were. Definitively determining how stress affects the cognitive performance of nurses requires additional research; the present study forms a foundation from which future research can further expand the examination of stress exposure in nurses. Copyright © 2016 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/smi.2672DOI Listing
February 2017

Blood Pressure, Sleep Quality and Fatigue in Shift Working Police Officers: Effects of a Twelve Hour Roster System on Cardiovascular and Sleep Health.

Int J Environ Res Public Health 2016 Jan 29;13(2):172. Epub 2016 Jan 29.

Neuroscience Research Unit, School of Life Sciences, University of Technology Sydney, Broadway, New South Wales 2007, Australia.

Background: Police officers have been reported to exhibit a high incidence of pathologies, which present prematurely in an otherwise healthy population. Shift work has also been associated with an increased risk of cardiovascular and sleep disorders, attributable to its propensity for circadian rhythm dysfunction. However, contention exists as to whether shift work has a direct effect upon blood pressure (BP) regulation.

Methods: This cross-sectional study sought to determine changes in BP and associations with the overall sleep quality and fatigue in 206 general duties police officers (n = 140 males) of the New South Wales Police Force in Australia. The subjects' BP was assessed before and after their twelve hour shift, during which time they also completed the Lifestyle Appraisal Questionnaire, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale and Fatigue Severity Scale (FSS).

Results: Poor sleep quality (PSQI) and fatigue severity (FSS) were found to predominate in the sample (69% and 51% respectively). Although there was no change in BP for male participants, female officers' systolic blood pressure (SBP) was found to increase significantly across the shift (p < 0.001), but with no change found in females' diastolic blood pressure (DBP). Finally, higher pre and post-shift SBP (r = -0.26, p = 0.001; r = -0.25, p = 0.001, respectively) and DBP (r = -0.26, p = 0.001; r = -0.26, p = 0.001, respectively) were significantly correlated with lower FSS scores after accounting for age, waist-hip ratio and lifestyle risk factors.

Conclusions: Based on these preliminary findings, there was a significant increase in SBP of female police officers after shift work, while BP and fatigue levels in all police officers were strongly related. Moreover, the predominating poor sleep quality and impact of fatigue in this sample remain a concern. Further research is required to ensure the physiological welfare of police officers, while strategies must be implemented to manage the detrimental effects shift work may be having upon their cardiovascular and sleep health.
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http://dx.doi.org/10.3390/ijerph13020172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772192PMC
January 2016

Women's use of herbal and alternative medicines for preconception care.

Aust N Z J Obstet Gynaecol 2015 Jun 5;55(3):222-6. Epub 2015 Jun 5.

School of Medicine, University of Queensland, Herston, Queensland, Australia.

Background: Use of complementary and alternative medicine (CAM), particularly herbal and alternative medicine supplements, for preconception care and fertility management is becoming increasingly common.

Aims: To determine the factors associated with the use of CAMs by women for preconception care.

Materials And Methods: 412 women who had visited an antenatal 'first visit' clinic situated at a Brisbane obstetric hospital or had visited a private ultrasound clinic in the same city for the purposes of a routinely indicated ultrasound scan in the first trimester were recruited into the study. Data were collected via a cross-sectional questionnaire.

Results: Complementary and alternative medicines (not including multivitamins) were used during preconception by 8.3% of women attending for obstetric care. Approximately half (55.8%) of women taking herbal and alternative medicines ceased these medications on discovery of their pregnancy, though fewer (17.4%) ceased taking multivitamin supplements. Baseline characteristics (age, education and income) are not significantly different between CAM users and those who did not take CAMs preconception. The results of statistical analyses showed that only visiting a practitioner to check for health (OR = 2.00; 95% CI: 1.33, 3.00) and trying to lose weight prior to pregnancy (OR = 1.53; 95% CI: 1.00, 2.36) were the key predictors for women using CAM during preconception.

Conclusions: Women do consume CAMs to enhance preconception care to a certain extent, though CAM users remain in the minority. CAM users also tend to cease use once pregnant.
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http://dx.doi.org/10.1111/ajo.12324DOI Listing
June 2015

Thirst in chronic heart failure: a review.

J Clin Nurs 2015 Apr 28;24(7-8):916-26. Epub 2014 Nov 28.

Centre for Cardiovascular & Chronic Care, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia.

Aims And Objectives: This review will (1) explore factors related to thirst in chronic heart failure and (2) describe interventions to alleviate thirst in chronic heart failure patients.

Background: Thirst is a common and troublesome symptom of chronic heart failure. Despite the burden and prevalence of this symptom, there are limited strategies to assist in its management.

Design: This is a review of literature on the burden of thirst, contributors to thirst and potential management strategies of thirst in patients with chronic heart failure.

Methods: Medline, Cumulative Index for Nursing and Allied Health, PubMed and Scopus were searched using the key words thirst, chronic heart failure, angiotensin II, fluid restriction and intervention. Of the 165 citations yielded, nine studies (n = 9) were included. The eligibility criteria included participants with confirmed diagnosis of chronic heart failure, randomised controlled studies or any studies with thirst as primary or secondary outcome, in humans and in English. There was no limit to the years searched.

Results: Factors related to thirst in chronic heart failure were condition; prolonged neurohormonal activation, treatment; pharmacological interventions and fluid restriction and emotion. No intervention studies were found in chronic heart failure patients. Interventions such as artificial saliva and chewing gum have been investigated for their effectiveness as a thirst reliever in haemodialysis patients.

Conclusion: Thirst is a frequent and troublesome symptom for individuals with chronic heart failure. It is highly likely that this contributes to poor adherence with fluid restrictions. Chewing gum can help alleviate thirst, but investigation in people with heart failure is needed.

Relevance To Clinical Practice: Increasing awareness of thirst and interventions to relieve it in clinical practice is likely to improve the quality of care for people with chronic heart failure.
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http://dx.doi.org/10.1111/jocn.12732DOI Listing
April 2015

Heart rate variability and the anxious client: cardiac autonomic and behavioral associations with therapeutic alliance.

J Nerv Ment Dis 2014 Aug;202(8):613-9

*University of Technology (UTS), Department of Medical and Molecular Biosciences, Sydney, NSW, Australia; and †Academic Governing Board, Gestalt Therapy, Queensland, Australia.

This exploratory study was designed to investigate the link between a client's heart rate variability (HRV) and the forming of a therapeutic alliance (TA) during psychotherapy. Change in HRV is associated with many psychological and physiological situations, including cardiac mortality. Cardiac effects were evaluated during therapy in 30 symptomatically anxious clients using HRV during six weekly 1-hour therapy sessions (S1-S6). Therapeutic index (TI), a measure of TA, was evaluated using skin conductance resonance between client and therapist. The Working Alliance Inventory provides a subjective measure of TA. State and trait anxiety and mood states were also assessed. Most HRV parameters were highest during S4. The sympathovagal balance was highest in S1 but stabilized after S2. In S4, TI was linked to high HRV parameters. Overall higher anxiety levels seem to be associated to lower HRV parameters. Conversely, in S4, high HRV parameters were linked to higher mood scores. This study found that a subjective measure of TA contradicted the physiological outcome. Results suggest that physiological data collected during therapy are a more accurate barometer of TA forming. These research findings suggest a need for further research identifying physiological markers in clients with a variety of mental health disorders over long-term therapy.
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http://dx.doi.org/10.1097/NMD.0000000000000163DOI Listing
August 2014

Protocol: the effect of 12 weeks of Tai Chi practice on anxiety in healthy but stressed people compared to exercise and wait-list comparison groups: a randomized controlled trial.

J Acupunct Meridian Stud 2014 Jun 11;7(3):159-65. Epub 2014 Feb 11.

School of Medical and Molecular Biosciences, Faculty of Science, University of Technology, Sydney, Australia.

Stress is a major problem in today's fast-paced society and can lead to serious psychosomatic complications. The ancient Chinese mind-body exercise of Tai Chi may provide an alternative and self-sustaining option to pharmaceutical medication for stressed individuals to improve their coping mechanisms. The protocol of this study is designed to evaluate whether Tai Chi practice is equivalent to standard exercise and whether the Tai Chi group is superior to a wait-list control group in improving stress coping levels. This study is a 6-week, three-arm, parallel, randomized, clinical trial designed to evaluate Tai Chi practice against standard exercise and a Tai Chi group against a nonactive control group over a period of 6 weeks with a 6-week follow-up. A total of 72 healthy adult participants (aged 18-60 years) who are either Tai Chi naïve or have not practiced Tai Chi in the past 12 months will be randomized into a Tai Chi group (n = 24), an exercise group (n = 24) or a wait-list group (n = 24). The primary outcome measure will be the State Trait Anxiety Inventory with secondary outcome measures being the Perceived Stress Scale 14, heart rate variability, blood pressure, Short Form 36 and a visual analog scale. The protocol is reported using the appropriate Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) items.
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http://dx.doi.org/10.1016/j.jams.2014.01.003DOI Listing
June 2014

Estimating sleep disordered breathing based on heart rate analysis.

Annu Int Conf IEEE Eng Med Biol Soc 2013 ;2013:6571-4

Heart rate variability and the analysis of the ECG with ECG derived respiration has been used to diagnose sleep disordered breathing. Recently it was possible to distinguish obstructive sleep apnea and central sleep apnea. This can be achieved by analyzing both, heart rate variability and the more mechanically induced ECG derived respiration in parallel. In addition the analysis of cardiopulmonary coupling facilitates to predict the personal risk factor for cardiovascular disorders. The analysis of heart rate, ECG and respiration goes beyond this analysis. Some studies indicate that it is possible to derive sleep stages from these signals. In order to derive sleep stages a more complex analysis of the signals is applied taking into account non-linear properties by using methods of statistical physics. To extract coupling information supports the distinction between sleep stages. Results are reported in this review.
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http://dx.doi.org/10.1109/EMBC.2013.6611061DOI Listing
September 2015

Peripheral arterial disease and chronic heart failure: a dangerous mix.

Heart Fail Rev 2013 Jul;18(4):457-64

Centre for Cardiovascular and Chronic Care, Faculty of Nursing, Midwifery and Health, University of Technology Sydney, PO BOX 123, Broadway, 235 Jones Street, Ultimo, Sydney, NSW 2007, Australia.

Chronic heart failure (CHF) is associated with a high comorbidity burden, adverse impact on quality of life and high health care utilisation. Peripheral arterial disease (PAD) and CHF share many risk, pathophysiological and prognostic features, and each has been associated with increased morbidity and mortality. PAD often goes undetected, and yet in spite of the availability of screening tools, this is not commonly considered in CHF care. A review of the electronic databases Medline, CINAHL and Cochrane CENTRAL was undertaken using the MeSH terms peripheral arterial disease, peripheral vascular disease, intermittent claudication and heart failure to identify studies examining the prevalence and clinical outcomes of coexisting PAD in patients with CHF. Five studies were identified. There are limited data describing the impact of PAD on CHF outcomes. As PAD may contribute to decreased capacity to exercise and other self-care behaviours, identifying those at risk and providing appropriate therapy are important. Based on this review, patients who are smokers and those with diagnosed coronary heart disease and diabetes should be targeted for the screening of PAD.
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http://dx.doi.org/10.1007/s10741-012-9331-1DOI Listing
July 2013

Neuroanalysis of therapeutic alliance in the symptomatically anxious: the physiological connection revealed between therapist and client.

Am J Psychother 2012 ;66(1):1-21

University of Technology, Department of Medical and Molecular Biosciences, Sydney, Australia.

This study was an attempt to establish neurophysiological correlates, particularly brain activity, during high therapeutic alliance (TA) between client and therapist. The aim was to assess electroencephalography (EEG) activity in clients with symptomatic anxiety during high TA using skin conductance resonance measurements from both client and therapist. Thirty clients, aged 43.8 +/- 11.5 years (males: n=15 females: n=15), underwent six, weekly, 1-hour sessions (180 hours of repeated measures). The EEG activity was measured from the prefrontal, temporal, parietal and occipital sites during the sessions. State and trait anxiety, Working Alliance Inventory (WAI) and heart rate measures were obtained before and after each session. Prefrontal, parietal and occipital sites were associated with TA. Anxiety and heart rate were found to decrease after therapy, and for both the client and the therapist, the WAI score increased significantly in later sessions. The results are discussed from the perspective of further understanding the neurophysiological associations to TA.
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http://dx.doi.org/10.1176/appi.psychotherapy.2012.66.1.1DOI Listing
May 2012

Driver drowsiness classification using fuzzy wavelet-packet-based feature-extraction algorithm.

IEEE Trans Biomed Eng 2011 Jan 20;58(1):121-31. Epub 2010 Sep 20.

ARC Centre of Excellence for Autonomous Systems, Faculty of Engineering and Information Technology, University of Technology, Sydney, Broadway NSW 2007, Australia.

Driver drowsiness and loss of vigilance are a major cause of road accidents. Monitoring physiological signals while driving provides the possibility of detecting and warning of drowsiness and fatigue. The aim of this paper is to maximize the amount of drowsiness-related information extracted from a set of electroencephalogram (EEG), electrooculogram (EOG), and electrocardiogram (ECG) signals during a simulation driving test. Specifically, we develop an efficient fuzzy mutual-information (MI)- based wavelet packet transform (FMIWPT) feature-extraction method for classifying the driver drowsiness state into one of predefined drowsiness levels. The proposed method estimates the required MI using a novel approach based on fuzzy memberships providing an accurate-information content-estimation measure. The quality of the extracted features was assessed on datasets collected from 31 drivers on a simulation test. The experimental results proved the significance of FMIWPT in extracting features that highly correlate with the different drowsiness levels achieving a classification accuracy of 95%-- 97% on an average across all subjects.
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http://dx.doi.org/10.1109/TBME.2010.2077291DOI Listing
January 2011
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