Publications by authors named "Teresa Neeman"

53 Publications

Predicting effects of warming requires a whole-of-life cycle perspective: a case study in the alpine herb .

Conserv Physiol 2021 28;9(1):coab023. Epub 2021 Apr 28.

National Seed Bank, Australian National Botanic Gardens, Parks Australia, Clunies Ross St, Acton, ACT 2601, Australia.

Global warming is affecting plant phenology, growth and reproduction in complex ways and is particularly apparent in vulnerable alpine environments. Warming affects reproductive and vegetative traits, as well as phenology, but seldom do studies assess these traits in concert and across the whole of a plant's life cycle, particularly in wild species. Thus, it is difficult to extrapolate from such effects to predictions about the persistence of species or their conservation and management. We assessed trait variation in response to warming in , an Australian native montane herb, in which populations vary in germination strategy (degree of dormancy) and growth characteristics as a function of ecological factors. Warming accelerated growth in the early stages of development, particularly for populations with non-dormant seed. The differences in growth disappeared at the transition to reproduction, when an accelerating effect on phenology emerged, to varying degrees depending on germination strategy. Overall, warming reduced flower and seed production and increased mortality, indicating a reduction in reproductive opportunities, particularly for populations with dormant seed. Developmental condition affected germination strategy of the next generation seed, leading to increased degree of dormancy and slowed germination rate. But there were no whole-scale shifts in strategy or total germination percent. Following through the life cycle reveals that warming will have some potentially positive effects (early growth rates) and some negative effects (reduced reproductive output). Ultimately, warming impacts will depend on how those effects play out in the field: early establishment and an accelerated trajectory to seed maturity may offset the tradeoff with overall seed production. Small differences among germination strategies likewise may cascade to larger effects, with important implications for persistence of species in the alpine landscape. Thus, to understand and manage the response of wild species to warming takes a whole-of-life perspective and attention to ecologically significant patterns of within-species variation.
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http://dx.doi.org/10.1093/conphys/coab023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084022PMC
April 2021

Repeatability of lateralisation in mosquitofish Gambusia holbrooki despite evidence for turn alternation in detour tests.

Anim Cogn 2021 Jan 20. Epub 2021 Jan 20.

Division of Ecology and Evolution, Research School of Biology, Australian National University, Canberra, ACT 2600, Australia.

Akin to handedness in humans, some animals show a preference for moving to the left or right. This is often attributed to lateralised cognitive functions and eye dominance, which, in turn, influences their behaviour. In fishes, behavioural lateralisation has been tested using detour mazes for over 20 years. Studies report that certain individuals are more likely to approach predators or potential mates from one direction. These findings imply that the lateralisation behaviour of individuals is repeatable, but this is rarely confirmed through multiple testing of each individual over time. Here we quantify the repeatability of turning behaviour by female mosquitofish (Gambusia holbrooki) in a double sided T-maze. Each female was tested three times in each of six treatments: when approaching other females, males, or an empty space; and when able to swim freely or when forced to choose by being herded from behind with a net. Although there was no turning bias based on the mean population response, we detected significant repeatability of lateralisation in five of the six treatments (R = 0.251-0.625). This is noteworthy as we also found that individuals tended to alternate between left and right turns, meaning that they tend to move back and forth along one wall of the double-sided T-maze. Furthermore, we found evidence for this wall following when re-analysing data from a previous study. We discuss potential explanations for this phenomenon, and its implications for study design.
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http://dx.doi.org/10.1007/s10071-021-01474-8DOI Listing
January 2021

The influence of total knee arthroplasty design on kneeling kinematics: a prospective randomized clinical trial.

Bone Joint J 2021 Jan;103-B(1):105-112

Trauma and Orthopaedic Research Unit, Medical School, Australian National University, Canberra, Australia.

Aims: Modern total knee arthroplasty (TKA) prostheses are designed to restore near normal kinematics including high flexion. Kneeling is a high flexion, kinematically demanding activity after TKA. The debate about design choice has not yet been informed by six-degrees-of-freedom in vivo kinematics. This prospective randomized clinical trial compared kneeling kinematics in three TKA designs.

Methods: In total, 68 patients were randomized to either a posterior stabilized (PS-FB), cruciate-retaining (CR-FB), or rotating platform (CR-RP) design. Of these patients, 64 completed a minimum one year follow-up. Patients completed full-flexion kneeling while being imaged using single-plane fluoroscopy. Kinematics were calculated by registering the 3D implant models onto 2D-dynamic fluoroscopic images and exported for analysis.

Results: CR-FB designs had significantly lower maximal flexion (mean 116° (SD 2.1°)) compared to CR-RP (123° (SD 1.6°)) and PS-FB (125° (SD 2.1°)). The PS-FB design displayed a more posteriorly positioned femur throughout flexion. Furthermore, the CR-RP femur was more externally rotated throughout kneeling. Finally, individual patient kinematics showed high degrees of variability within all designs.

Conclusion: The increased maximal flexion found in the PS-FB and CR-RP designs were likely achieved in different ways. The PS-FB design uses a cam-post to hold the femur more posteriorly preventing posterior impingement. The external rotation within the CR-RP design was surprising and hasn't previously been reported. It is likely due to the polyethylene bearing being decoupled from flexion. The findings of this study provide insights into the function of different knee arthroplasty designs in the context during deep kneeling and provide clinicians with a more kinematically informed choice for implant selection and may allow improved management of patients' functional expectations. Cite this article: 2021;103-B(1):105-112.
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http://dx.doi.org/10.1302/0301-620X.103B1.BJJ-2020-0958.R1DOI Listing
January 2021

A Dual-Antigen Enzyme-Linked Immunosorbent Assay Allows the Assessment of Severe Acute Respiratory Syndrome Coronavirus 2 Antibody Seroprevalence in a Low-Transmission Setting.

J Infect Dis 2021 01;223(1):10-14

Department of Immunology and Infectious Disease, John Curtin School of Medical Research, The Australian National University, Canberra, Australia.

Estimates of seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies have been hampered by inadequate assay sensitivity and specificity. Using an enzyme-linked immunosorbent assay-based approach that combines data about immunoglobulin G responses to both the nucleocapsid and spike receptor binding domain antigens, we show that excellent sensitivity and specificity can be achieved. We used this assay to assess the frequency of virus-specific antibodies in a cohort of elective surgery patients in Australia and estimated seroprevalence in Australia to be 0.28% (95% Confidence Interval, 0-1.15%). These data confirm the low level of transmission of SARS-CoV-2 in Australia before July 2020 and validate the specificity of our assay.
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http://dx.doi.org/10.1093/infdis/jiaa623DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665523PMC
January 2021

Compression Therapy to Prevent Recurrent Cellulitis of the Leg.

N Engl J Med 2020 08;383(7):630-639

From the Physiotherapy Department, Calvary Public Hospital Bruce, Bruce, ACT (E.W.), the Biological Data Science Institute, the Australian National University Joint Colleges of Science, Health, and Medicine (T.N.), and the Medical School (F.J.B.), Australian National University, the University of Canberra Research Institute for Sport and Exercise (J.G.), and the Discipline of Physiotherapy, Faculty of Health, University of Canberra (E.W., B.B.), Canberra, ACT, and the Australian Institute of Health Innovation, Macquarie University, Sydney (V.M.) - all in Australia.

Background: Chronic edema of the leg is a risk factor for cellulitis. Daily use of compression garments on the leg has been recommended to prevent the recurrence of cellulitis, but there is limited evidence from trials regarding its effectiveness.

Methods: In this single-center, randomized, nonblinded trial, we assigned participants with chronic edema of the leg and recurrent cellulitis, in a 1:1 ratio, to receive leg compression therapy plus education on cellulitis prevention (compression group) or education alone (control group). Follow-up occurred every 6 months for up to 3 years or until 45 episodes of cellulitis had occurred in the trial. The primary outcome was the recurrence of cellulitis. Participants in the control group who had an episode of cellulitis crossed over to the compression group. Secondary outcomes included cellulitis-related hospital admission and quality-of-life assessments.

Results: A total of 183 patients were screened, and 84 were enrolled; 41 participants were assigned to the compression group, and 43 to the control group. At the time of a planned interim analysis, when 23 episodes of cellulitis had occurred, 6 participants (15%) in the compression group and 17 (40%) in the control group had had an episode of cellulitis (hazard ratio, 0.23; 95% confidence interval [CI], 0.09 to 0.59; P = 0.002; relative risk [post hoc analysis], 0.37; 95% CI, 0.16 to 0.84; P = 0.02), and the trial was stopped for efficacy. A total of 3 participants (7%) in the compression group and 6 (14%) in the control group were hospitalized for cellulitis (hazard ratio, 0.38; 95% CI, 0.09 to 1.59). Most quality-of-life outcomes did not differ between the two groups. No adverse events occurred during the trial.

Conclusions: In this small, single-center, nonblinded trial involving patients with chronic edema of the leg and cellulitis, compression therapy resulted in a lower incidence of recurrence of cellulitis than conservative treatment. (Funded by Calvary Public Hospital Bruce; Australian and New Zealand Clinical Trials Registry number, ACTRN12617000412336.).
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http://dx.doi.org/10.1056/NEJMoa1917197DOI Listing
August 2020

Shape is only a weak predictor of deep knee flexion kinematics in healthy and osteoarthritic knees.

J Orthop Res 2020 10 10;38(10):2250-2261. Epub 2020 Feb 10.

Trauma and Orthopaedic Research Unit, The Australian National University, Canberra, Australian Capital Territory, Australia.

Tibiofemoral shape influences knee kinematics but little is known about the effect of shape on deep knee flexion kinematics. The aim of this study was to examine the association between tibiofemoral joint shape and kinematics during deep kneeling in patients with and without osteoarthritis (OA). Sixty-one healthy participants and 58 patients with end-stage knee OA received a computed tomography (CT) of their knee. Participants completed full flexion kneeling while being imaged using single-plane fluoroscopy. Six-degree-of-freedom kinematics were measured by registering a three-dimensional (3D)-static CT onto 2D-dynamic fluoroscopic images. Statistical shape modeling and bivariate functional principal component analysis (bfPCA) were used to describe variability in knee shape and kinematics, respectively. Random-forest-regression models were created to test the ability of shape to predict kinematics controlling for body mass index, sex, and group. The first seven modes of the shape model up to three modes of the bfPCAs captured more than 90% of the variation. The ability of the random forest models to predict kinematics from shape was low, with no more than 50% of the variation being explained in any model. Furthermore, prediction errors were high, ranging between 24.2% and 29.4% of the data. Variations in the bony morphology of the tibiofemoral joint were weakly associated with the kinematics of deep knee flexion. The models only explained a small amount of variation in the data with high error rates indicating that additional predictors need to be identified. These results contribute to the clinical understanding of knee kinematics and potentially the expectations placed on high-flexion total knee replacement design.
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http://dx.doi.org/10.1002/jor.24622DOI Listing
October 2020

Faecal calprotectin testing for identifying patients with organic gastrointestinal disease: systematic review and meta-analysis.

Med J Aust 2019 11 3;211(10):461-467. Epub 2019 Nov 3.

Mater Hospital Brisbane, Brisbane, QLD.

Objectives: To assess the clinical effectiveness of faecal calprotectin (FC) testing for distinguishing between organic gastrointestinal diseases (organic GID), such as inflammatory bowel disease (IBD), and functional gastrointestinal disorders (functional GIDs).

Study Design: Studies that assessed the accuracy of FC testing for differentiating between IBD or organic GID and functional GIDs were reviewed. Articles published in English during January 1998 - June 2018 that compared diagnostic FC testing in primary care and outpatient hospital settings with a reference test and employed the standard enzyme-linked immunosorbent FC assay method with a cut-off of 50 or 100 μg/g faeces were included. Study quality was assessed with QUADAS-2, an evidence-based quality assessment tool for diagnostic accuracy studies.

Data Sources: MEDLINE and EMBASE; reference lists of screened articles.

Data Synthesis: Eighteen relevant studies were identified. For distinguishing patients with organic GID (including IBD) from those with functional GIDs (16 studies), the estimated sensitivity of FC testing was 81% (95% CI, 74-86%), the specificity 81% (95% CI, 71-88%); area under the curve (AUC) was 0.87. For distinguishing IBD from functional GIDs (ten studies), sensitivity was 88% (95% CI, 80-93%), specificity 72% (95% CI, 59-82%), and AUC 0.89. Assuming a population prevalence of organic GID of 1%, the positive predictive value was 4.2%, the negative predictive value 100%. The difference in sensitivity and specificity between FC testing cut-offs of 50 μg/g and 100 μg/g faeces was not statistically significant (P = 0.77).

Conclusions: FC testing is clinically useful for distinguishing organic GID (including IBD) from functional GIDs, and its incorporation into clinical practice for evaluating patients with lower gastrointestinal symptoms could lead to fewer patients with functional GIDs undergoing colonoscopy, reducing costs for both patients and the health system.

Prospero Registration: CRD4201810507.
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http://dx.doi.org/10.5694/mja2.50384DOI Listing
November 2019

genotypes correlate with dichloroacetate pharmacokinetics and chronic side effects in multiple myeloma patients in a pilot phase 2 clinical trial.

Pharmacol Res Perspect 2019 12 8;7(6):e00526. Epub 2019 Oct 8.

ACRF Department of Cancer Biology and Therapeutics The John Curtin School of Medical Research The Australian National University Canberra ACT Australia.

Dichloroacetate (DCA) is an investigational drug targeting the glycolytic hallmark of cancer by inhibiting pyruvate dehydrogenase kinases (PDK). It is metabolized by GSTZ1, which has common polymorphisms altering enzyme or promoter activity. GSTZ1 is also irreversibly inactivated by DCA. In the first clinical trial of DCA in a hematological malignancy, DiCAM (DiChloroAcetate in Myeloma), we have examined the relationship between DCA concentrations, genotype, side effects, and patient response. DiCAM recruited seven myeloma patients in partial remission. DCA was administered orally for 3 months with a loading dose. Pharmacokinetics were performed on day 1 and 8. Trough and peak concentrations of DCA were measured monthly. genotypes were correlated with drug concentrations, tolerability, and disease outcomes. One patient responded and two patients showed a partial response after one month of DCA treatment, which included the loading dose. The initial half-life of DCA was shorter in two patients, correlating with heterozygosity for genotype, a high enzyme activity variant. Over 3 months, one patient maintained DCA trough concentrations approximately threefold higher than other patients, which correlated with a low activity promoter genotype (-1002A, rs7160195) for . This patient displayed the strongest response, but also the strongest neuropathy. Overall, serum concentrations of DCA were sufficient to inhibit the constitutive target PDK2, but unlikely to inhibit targets induced in cancer. Promoter polymorphisms may be important determinants of DCA concentrations and neuropathy during chronic treatment. Novel dosing regimens may be necessary to achieve effective DCA concentrations in most cancer patients while avoiding neuropathy.
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http://dx.doi.org/10.1002/prp2.526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6783648PMC
December 2019

Characterization of biological variation of peripheral blood immune cytome in an Indian cohort.

Sci Rep 2019 10 14;9(1):14735. Epub 2019 Oct 14.

National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India.

Immune parameters show characteristic normal baseline levels and variance in the population. We characterised the degree of inter-individual and within-individual variation over one-year time period in 33 immune cell subsets by flow cytometry in peripheral blood mononuclear cells from 43 healthy young adult volunteers. Our analysis revealed that immune subsets that showed low variability between individuals also showed low short-term fluctuations within-individuals, as well as concordance in siblings. However, when baseline levels and degree of fluctuation were considered together, individuals failed to cluster into discreet groups. Together, the data reveal complex inter-relationships between immune subsets in individuals, and provide insights into the observed heterogeneity between individuals and between multiple immune subsets.
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http://dx.doi.org/10.1038/s41598-019-51294-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6791881PMC
October 2019

The prevalence and pregnancy outcomes of intrahepatic cholestasis of pregnancy: A retrospective clinical audit review.

Obstet Med 2019 Sep 25;12(3):123-128. Epub 2018 Oct 25.

The Canberra Hospital, Canberra, Australia.

Background: To determine the prevalence and outcomes of intrahepatic cholestasis of pregnancy.

Methods: A review comparing intrahepatic cholestasis of pregnancy pregnancies to all other pregnancies in three tertiary care Australian hospitals over a 36-month period.

Results: There were 43,876 pregnancies. The prevalence of intrahepatic cholestasis of pregnancies ( = 319) was 0.7%. There were differences between intrahepatic cholestasis of pregnancy and non-intrahepatic cholestasis of pregnancy mothers including higher prevalence of South Asian (22.6% versus 3.1%, p < 0.001), Indigenous Australian (3.8% versus 1.8%, p < 0.05), and Asian ethnicity (8.4% versus 5.7%, p < 0.05), mothers with a body mass index >35 kg/m (10.6% versus 5.5%, p < 0.001), those with diabetes mellitus (25.7% versus 9.8%, p < 0.001), and those with twin births (8.7% versus 2.2%, p < 0.001). The primary clinical outcomes of intrahepatic cholestasis of pregnancy included a median gestational age at delivery of 36.4 (SE 0.09) weeks compared to 38.6 (SE 0.01) weeks (p < 0.001), a lower birth weight (3.12 (SE 0.03) versus 3.31 kg (SE 0.03), p < 0.001), and an increase in special care nursery admissions (44.5% versus 15.3%, p < 0.001).

Conclusion: Treated intrahepatic cholestasis of pregnancy in the population described here had similar mortality outcomes although increased special care nursery admission as compared to the general population.
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http://dx.doi.org/10.1177/1753495X18797749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734627PMC
September 2019

Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic oedema: a randomised controlled trial protocol.

BMJ Open 2019 08 15;9(8):e029225. Epub 2019 Aug 15.

Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia.

Introduction: Cellulitis represents a significant burden to patients' quality of life (QOL) and cost to the healthcare system, especially due to its recurrent nature. Chronic oedema is a strong risk factor for both an initial episode of cellulitis and cellulitis recurrence. Expert consensus advises compression therapy to prevent cellulitis recurrence in individuals with chronic oedema, however, there is little supporting evidence. This research aims to determine if the management of chronic oedema using compression therapy effectively delays the recurrence of lower limb cellulitis.

Methods And Analysis: A randomised controlled trial with cross-over will be used to assess the impact of compression therapy on clinical outcomes (time to next episode of cellulitis, rate of cellulitis-related hospital presentations, QOL and leg volume). Using concealed allocation, 162 participants will be randomised into the intervention (compression) or control (no compression) group. Randomisation will be stratified by prophylactic antibiotic use. Participants will be followed up at 6 monthly intervals for up to 3 years or until 45 episodes of cellulitis occur across the cohort. Following an episode of recurrent cellulitis, control group participants will cross-over to the intervention group. Survival analysis will be undertaken to assess the primary outcome measure of time to cellulitis recurrence. The hypotheses are that compression therapy to control lower limb chronic oedema will delay recurrent lower limb cellulitis, reduce the rate of associated hospitalisations, minimise affected limb volume and improve the QOL of this population.

Ethics And Dissemination: Ethics approval has been obtained from the ethics committees of all relevant institutions. Results will be disseminated through relevant peer-reviewed journal articles and conference presentations.

Trial Registration Number: ACTRN12617000412336; Pre-results. The ICTOC trial is currently in progress. Participant recruitment started in May 2017 and is expected to continue until December 2019.
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http://dx.doi.org/10.1136/bmjopen-2019-029225DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6701661PMC
August 2019

Post-colonoscopy colorectal cancers identified by probabilistic and deterministic linkage: results in an Australian prospective cohort.

BMJ Open 2019 06 21;9(6):e026138. Epub 2019 Jun 21.

Gastroenterology and Hepatology Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia.

Objective: Post-colonoscopy colorectal cancers (PCCRCs) are recognised as a critical quality indicator. Benchmarking of PCCRC rate has been hampered by the strong influence of different definitions and methodologies. We adopted a rigorous methodology with high-detail individual data to determine PCCRC rates in a prospective cohort representing a single jurisdiction.

Setting: We performed a cohort study of individuals who underwent colonoscopy between 2001 and 2008 at a single centre serving Australian Capital Territory (ACT) and enclaving New South Wales (NSW) region. These individuals were linked to subsequent colorectal cancer (CRC) diagnosis, within 5 years of a negative colonoscopy, through regional cancer registries and hospital records using probabilistic and deterministic record linkage. All cases were verified by pathology review. Predictors of PCCRCs were extracted.

Participants: 7818 individuals had a colonoscopy in the cohort. Linkage to cancer registries detected 384 and 98 CRCs for notification dates of 2001-2013 (ACT) and 2001-2010 (NSW). A further 55 CRCs were identified from a search of electronic medical records using International Classification of Diseases-10 diagnosis codes. After verification and exclusions, 385/537 CRCs (58% male) were included.

Primary Outcome Measure: PCCRC rates.

Results: There were 15 PCCRCs in our cohort. The PCCRC incidence rate was 0.384/1000 person-years and the 5-year PCCRC risk was estimated as 0.192% (95% CI 0.095 to 0.289). The index colonoscopy prior to PCCRC was more likely to show diverticulosis (p=0.017 for association, OR 3.56, p=0.014) and have poor bowel preparation (p=0.017 for association, OR 4.19, p=0.009).

Conclusion: In this population-based cohort study, the PCCRC incidence rate was 0.384/1000 person-years and the 5-year PCCRC risk was 0.192%. These data show the 'real world' accuracy of colonoscopy for CRC exclusion.
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http://dx.doi.org/10.1136/bmjopen-2018-026138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6596957PMC
June 2019

Long-term follow-up for Psychological stRess in Intensive CarE (PRICE) survivors: study protocol for a multicentre, prospective observational cohort study in Australian intensive care units.

BMJ Open 2019 01 25;9(1):e023310. Epub 2019 Jan 25.

Intensive Care Unit, Canberra Hospital, Canberra, Australian Capital Territory, Australia.

Introduction: There are little published data on the long-term psychological outcomes in intensive care unit (ICU) survivors and their family members in Australian ICUs. In addition, there is scant literature evaluating the effects of psychological morbidity in intensive care survivors on their family members. The aims of this study are to describe and compare the long-term psychological outcomes of intubated and non-intubated ICU survivors and their family members in an Australian ICU setting.

Methods And Analysis: This will be a prospective observational cohort study across four ICUs in Australia. The study aims to recruit 150 (75 intubated and 75 non-intubated) adult ICU survivors and 150 family members of the survivors from 2015 to 2018. Long-term psychological outcomes and effects on health-related quality of life (HRQoL) will be evaluated at 3 and 12 months follow-up using validated and published screening tools. The primary objective is to compare the prevalence of affective symptoms in intubated and non-intubated survivors of intensive care and their families and its effects on HRQoL. The secondary objective is to explore dyadic relations of psychological outcomes in patients and their family members.

Ethics And Dissemination: The study has been approved by the relevant human research ethics committees (HREC) of Australian Capital Territory (ACT) Health (ETH.11.14.315), New South Wales (HREC/16/HNE/64), South Australia (HREC/15/RAH/346). The results of this study will be published in a peer-reviewed medical journal and presented to the local intensive care community and other stakeholders.

Trial Registration Number: ACTRN12615000880549; Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2018-023310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352815PMC
January 2019

Which ICU patients benefit most from inspiratory muscle training? Retrospective analysis of a randomized trial.

Physiother Theory Pract 2020 Dec 9;36(12):1316-1321. Epub 2019 Feb 9.

Intensive Care Unit, Royal Brisbane and Women's Hospital , Brisbane, Australia.

: Inspiratory muscle training (IMT) increases inspiratory muscle strength and improves quality of life in intensive care unit (ICU) patients who have been invasively mechanically ventilated for ≥7 days. The purpose of this study was to identify which patients benefit most from IMT following weaning from mechanical ventilation. : Secondary analysis of a randomized trial of supervised daily IMT in 70 patients (mean age 59 years) in a 31-bed ICU was carried out. Changes in inspiratory muscle strength (maximum inspiratory pressure, MIP) between enrolment and 2 weeks (ΔMIP) were analyzed to compare the IMT group (71% male) and the control group (58% male). Linear regression models explored which factors at baseline were associated with ΔMIP. : Thirty-four participants were allocated to the IMT group where baseline MIP was associated with an increase in ΔMIP, significantly different from the control group ( = 0.025). The highest ΔMIP was associated with baseline MIP ≥ 28 cmHO. In the IMT group, higher baseline quality of life (EQ5D) scores were associated with positive ΔMIP, significantly different from the control group ( = 0.029), with largest ΔMIP for those with EQ5D ≥ 40. : Physiotherapists should target ICU patients with moderate inspiratory muscle weakness (MIP ≥28 cmHO) and moderate to high quality of life (EQ5D>40) within 48 h of ventilatory weaning as ideal candidates for IMT following prolonged mechanical ventilation.
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http://dx.doi.org/10.1080/09593985.2019.1571144DOI Listing
December 2020

Total volume of cam deformity alone predicts outcome in arthroscopy for femoroacetabular impingement.

Knee Surg Sports Traumatol Arthrosc 2020 Apr 7;28(4):1283-1289. Epub 2019 Feb 7.

Australian National University Medical School, College of Health and Medicine, Australian National University, Acton, ACT, 2601, Australia.

Purpose: Rates for arthroscopic surgery for femoroacetabular impingement (FAI) are rising and there is growing concern related to the effectiveness and costs associated with this treatment. There is a general lack of consensus as to the criteria for surgical selection of patients. The purpose of this study was to determine whether patient outcome following arthroscopic surgery for FAI could be predicted based on the size and location of deformity. The specific questions were: (1) what is the morphology of FAI in terms of size and location of deformity in a cohort of patients selected for surgery? (2) Do morphological factors predict postoperative improvement in hip scores? (3) Do morphological factors predict preoperative hip scores? (4) Are there clusters of morphological factors which explain postsurgical improvement in hip scores?

Materials And Methods: Computer tomography (CT) surgical plans of 90 hips in 79 patients who had undergone primary hip arthroscopy for FAI were retrospectively reviewed. Four parameters for the femur and acetabulum were created: total depth of deformity, maximal depth, extent and the position of maximal deformity. This data were compared with prospectively acquired preoperative and postoperative patient outcome data using generalised linear models.

Results: The cohort comprised 33 males and 46 females aged 37.9 (18-61). The majority (74%) had mixed morphology, 23% isolated cam, and 3% isolated pincer. Overall, the bone depth was greatest and more extensive on the femur. Increased total additional cam deformity alone predicted poorer postoperative outcome (p = 0.045). None of the morphological factors were related to preoperative scores and there was no association between the meta-variables and postoperative outcome.

Conclusions: The results of this study indicate that a greater total volume of cam deformity led to poorer postoperative patient outcome scores at 1 year. This information provides the surgeon with more accurate patient-specific data for prediction of expected outcomes.

Level Of Evidence: Level III diagnostic.
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http://dx.doi.org/10.1007/s00167-019-05383-9DOI Listing
April 2020

Minimally invasive McKeown's vs open oesophagectomy for cancer: A meta-analysis.

Eur J Surg Oncol 2019 06 24;45(6):941-949. Epub 2018 Nov 24.

Division of Surgery, The Canberra Hospital, Garran, ACT, Australia. Electronic address:

Background: The effectiveness of minimally invasive oesophagectomy (MIO) compared to open oesophagectomy (OO) remains controversial. Various techniques for performing MIO are currently used, but the evidence for them is lacking. The objective of this meta-analysis was to compare the safety, efficacy and oncological outcomes of McKeown's minimally invasive oesophagectomy (McKeown's-MIO) to OO.

Methods: PubMed, Embase and Cochrane Library databases were searched up to December 2016 for relevant articles comparing McKeown's-MIO to OO. As no randomised control trials (RCTs) currently exist, only cohort and case control studies were included. Fixed or random-effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for binary outcomes, and hazard ratios (HRs) for time-to-event outcomes. Heterogeneity among studies were evaluated using I statistics.

Results: Four studies, which consisted a total of 573 patients, were included in the meta-analysis. In comparison to patients undergoing OO, those who were treated with McKeown's-MIO had a reduced incidence of pneumonia and total respiratory complications, however, there were no statistically significant differences for other measures of safety such as RLN palsy and anastomotic leak. In terms of efficacy data, MIO had significantly less blood loss and a shorter duration of hospital stay but a longer operating time. Lymph node retrieval trended towards favouring McKeown's-MIO, but was not statistically significant. There was insufficient data to report on other oncological outcomes.

Conclusions: McKeown's-MIO is a safe and effective procedure that has comparable outcomes to OO. However, RCTs with large sample sizes are needed to confirm these results.
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http://dx.doi.org/10.1016/j.ejso.2018.11.017DOI Listing
June 2019

Musculoskeletal Injury in Paddle Sport Athletes.

Clin J Sport Med 2020 01;30(1):67-75

Trauma and Orthopaedic Research Unit, College of Health and Medicine, Australian National University, Canberra, Australia; and.

Introduction: Kayak racing has been an Olympic sport since 1936. The sport is evolving with the introduction of ocean skis and stand-up-paddle boards (SUP). Musculoskeletal injury incidence surveys have been conducted for ultra-marathon events, but no data have been published for other racing formats.

Objective: To identify and compare the rates and types of injuries sustained by paddling athletes as a function of discipline and training parameters in Sprint, Marathon, Ultra-Marathon, and Ocean events.

Methods: Competitors from 6 kayak and/or ocean surf-ski races in Australia were surveyed. Before each race, competitors were asked to complete a questionnaire. The questionnaire investigated paddling-related injuries over the previous 5 years, athlete morphology, flexibility, equipment and its setup, training volume, and environment.

Results: Five hundred eighty-three competitors were surveyed. Disciplines included 173 racing-kayak (K1), 202 touring-kayak, 146 ocean-skis, 42 SUP, and 20 other. The top 5 paddling-related injuries were shoulder (31%), low back (23.5%), wrist (16.5%), neck (13.7%), and elbow (11.0%). The highest percentage of injury was found in K1 paddlers for shoulder (40.5%), SUP for low back (33.3%), and ocean-ski for wrist (22.6%). After controlling for on-water training hours, the relative risk (RR) of wrist injury was significantly increased in ocean-ski paddlers (1.86) and in paddlers with decreased flexibility (1.53-1.83). Relative risk of shoulder and low-back injury was significantly increased in athletes with lower training volumes (1.82-2.07). Younger athletes had lower RR of wrist and shoulder injury (0.58-0.62).
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http://dx.doi.org/10.1097/JSM.0000000000000565DOI Listing
January 2020

Defining new barriers to mobilisation in a highly active intensive care unit - have we found the ceiling? An observational study.

Heart Lung 2018 Jul - Aug;47(4):380-385. Epub 2018 May 7.

The Canberra Hospital, Intensive Care Unit, Garran, ACT, Australia; Discipline of Physiotherapy, University of Canberra, Faculty of Health, Bruce, ACT, Australia. Electronic address:

Background: Mobilisation of intensive care (ICU) patients attenuates ICU-acquired weakness, but the prevalence is low (12-54%). Better understanding of barriers and enablers may inform practice.

Objectives: To identify barriers to mobilisation and factors associated with successful mobilisation in our medical /surgical /trauma ICU where mobilisation is well-established.

Methods: 4-week prospective study of frequency and intensity of mobilisation, clinical factors and barriers (extracted from electronic database). Generalized linear mixed models were used to describe associations between demographics, clinical factors and successful mobilisation.

Results: 202 patients accounted for 742 patient days. Patients mobilised on 51% of patient days. Most frequent barriers were drowsiness (18%), haemodynamic/respiratory contraindications (17%), and medical orders (14%). Predictors of successful mobilisation included high Glasgow Coma Score (OR = 1.44, 95%CI=[1.29-1.60]), and male sex (OR = 2.29, 95%CI=[1.40-3.75]) but not age (OR = 1.05, 95%CI=[1.01-1.08]).

Conclusions: Our major barriers (drowsiness, haemodynamic/respiratory contraindications) may be unavoidable, indicating an upper limit of feasible mobilisation therapy in ICU.
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http://dx.doi.org/10.1016/j.hrtlng.2018.04.004DOI Listing
February 2019

Mobilisation is feasible in intensive care patients receiving vasoactive therapy: An observational study.

Aust Crit Care 2019 03 25;32(2):139-146. Epub 2018 Apr 25.

Discipline of Physiotherapy, University of Canberra, Australia; Canberra Hospital, ACT Health, Canberra, Australia. Electronic address:

Background: Mobilisation of intensive care unit (ICU) patients reduces ICU-acquired weakness and is associated with better functional outcomes. However, the prevalence of mobilisation of ICU patients remains low. A known barrier to mobilisation is haemodynamic instability, frequently with patients requiring vasoactive therapy. There is a lack of published data to guide clinicians about the safety and feasibility of mobilising patients receiving vasoactive therapy.

Objectives: To describe our mobilisation practice in ICU patients receiving vasoactive therapy and identify factors associated with mobilisation and adverse events.

Methods: Retrospective cohort study of patients undergoing vasoactive therapy in a 31-bed tertiary ICU (October-December, 2016). Details of vasoactive drug dosage, mobilisation, and adverse events were extracted from databases, including mobilisation intensity (ICU Mobility Scale [IMS]). Two generalised linear mixed models were used: first, to describe factors associated with mobilisation and second, to describe factors associated with adverse events during mobilisation, adjusting for age, gender, and acute physiology and chronic health evaluation II score as co-variates.

Results: In 119 patients undergoing vasoactive therapy on 371 cumulative vasoactive days, 195 mobilisation episodes occurred (37.5% of vasoactive days). Low (76.8%) and moderate (13.7%) dose vasoactive therapies were associated with a higher probability of mobilisation relative to high (9.4%) dose therapy (odds ratio = 5.50, 95% confidence interval = 2.23-13.59 and odds ratio = 2.50, 95% confidence interval = 0.95-6.59, respectively). For patients who mobilised on vasoactive therapy (n = 72), maximum mobilisation intensity was low (IMS = 1-2) in 31%, moderate (IMS = 3-5) in 51%, and high (IMS = 6-10) in 18% of vasoactive days. While no serious adverse events occurred, there were 14 occurrences of reversible hypotension requiring transient escalation of vasoactive therapy (7.3%), associated with lower mean arterial pressure (p = 0.001).

Conclusion: In our ICU, patients mobilised on approximately one-third of vasoactive days. Clinicians should anticipate a higher risk of hypotension during mobilisation in patients receiving vasoactive therapy, which may require transient escalation of vasoactive therapy.
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http://dx.doi.org/10.1016/j.aucc.2018.03.004DOI Listing
March 2019

Breast surgery for metastatic breast cancer.

Cochrane Database Syst Rev 2018 Mar 15;3:CD011276. Epub 2018 Mar 15.

Iamada Hospital, Cassemiro Boscoli 236, Jd Icaray, Presidente Prudente, Sao Paulo, Brazil, 19060-530.

Background: Metastatic breast cancer is not a curable disease, but women with metastatic disease are living longer. Surgery to remove the primary tumour is associated with an increased survival in other types of metastatic cancer. Breast surgery is not standard treatment for metastatic disease, however several recent retrospective studies have suggested that breast surgery could increase the women's survival. These studies have methodological limitations including selection bias. A systematic review mapping all randomised controlled trials addressing the benefits and potential harms of breast surgery is ideal to answer this question.

Objectives: To assess the effects of breast surgery in women with metastatic breast cancer.

Search Methods: We conducted searches using the MeSH terms 'breast neoplasms', 'mastectomy', and 'analysis, survival' in the following databases: the Cochrane Breast Cancer Specialised Register, CENTRAL, MEDLINE (by PubMed) and Embase (by OvidSP) on 22 February 2016. We also searched ClinicalTrials.gov (22 February 2016) and the WHO International Clinical Trials Registry Platform (24 February 2016). We conducted an additional search in the American Society of Clinical Oncology (ASCO) conference proceedings in July 2016 that included reference checking, citation searching, and contacting study authors to identify additional studies.

Selection Criteria: The inclusion criteria were randomised controlled trials of women with metastatic breast cancer at initial diagnosis comparing breast surgery plus systemic therapy versus systemic therapy alone. The primary outcomes were overall survival and quality of life. Secondary outcomes were progression-free survival (local and distant control), breast cancer-specific survival, and toxicity from local therapy.

Data Collection And Analysis: Two review authors independently conducted trial selection, data extraction, and 'Risk of bias' assessment (using Cochrane's 'Risk of bias' tool), which a third review author checked. We used the GRADE tool to assess the quality of the body of evidence. We used the risk ratio (RR) to measure the effect of treatment for dichotomous outcomes and the hazard ratio (HR) for time-to-event outcomes. We calculated 95% confidence intervals (CI) for these measures. We used the random-effects model, as we expected clinical or methodological heterogeneity, or both, among the included studies.

Main Results: We included two trials enrolling 624 women in the review. It is uncertain whether breast surgery improves overall survival as the quality of the evidence has been assessed as very low (HR 0.83, 95% CI 0.53 to 1.31; 2 studies; 624 women). The two studies did not report quality of life. Breast surgery may improve local progression-free survival (HR 0.22, 95% CI 0.08 to 0.57; 2 studies; 607 women; low-quality evidence), while it probably worsened distant progression-free survival (HR 1.42, 95% CI 1.08 to 1.86; 1 study; 350 women; moderate-quality evidence). The two included studies did not measure breast cancer-specific survival. Toxicity from local therapy was reported by 30-day mortality and did not appear to differ between the two groups (RR 0.99, 95% CI 0.14 to 6.90; 1 study; 274 women; low-quality evidence).

Authors' Conclusions: Based on existing evidence from two randomised clinical trials, it is not possible to make definitive conclusions on the benefits and risks of breast surgery associated with systemic treatment for women diagnosed with metastatic breast cancer. Until the ongoing clinical trials are finalised, the decision to perform breast surgery in these women should be individualised and shared between the physician and the patient considering the potential risks, benefits, and costs of each intervention.
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http://dx.doi.org/10.1002/14651858.CD011276.pub2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494198PMC
March 2018

Evidence for cervical muscle morphometric changes on magnetic resonance images after whiplash: A systematic review and meta-analysis.

Injury 2018 Feb 6;49(2):165-176. Epub 2017 Dec 6.

Medical School, College of Health and Medicine, Australian National University, Canberra, ACT, 2601, Australia. Electronic address:

Introduction: Morphometric changes to cervical musculature in whiplash associated disorder have been reported in several studies with varying results. However, the evidence is not clear because only a limited number of cohorts have been studied and one cohort has been reported in multiple publications. The aim of this study was to assess the evidence for cervical muscle morphometric changes on magnetic resonance (MR) images after whiplash using a systematic review with meta-analysis.

Materials And Methods: PubMed, MEDLINE and Cochrane Library were searched without language restriction using combinations of the MeSH terms "muscles", "whiplash injuries", and "magnetic resonance imaging". Studies of acute and chronic whiplash were included if they compared whiplash and control cervical spine muscle morphometry measurements from MR images. The search identified 380 studies. After screening, eight studies describing five cohorts (one acute, three chronic, one both acute and chronic) met the inclusion criteria. Participant characteristics and outcome measures were extracted using a standard extraction format. Quality of eligible studies was assessed using the Newcastle-Ottawa Scale. Muscle cross-sectional area (CSA) and fat infiltrate (MFI) for acute and chronic whiplash cohorts were compared using mean difference and 95% confidence intervals. Meta-analysis models were created when data from more than two eligible cohorts was available, using inverse-variance random-effects models (RevMan5 version 5.3.5).

Results: Quality assessment was uniformly good but only two studies blinded the assessor. Analysis of the acute cohorts revealed no consensus with respect to CSA. MFI was not measured in the acute cohorts. Analysis of the chronic cohorts revealed CSA is probably increased in some muscles after whiplash but there is insufficient evidence to confirm whether MFI is also increased. Because the available data were limited, meta-analyses of only multifidus were performed. In chronic whiplash multifidus CSA was significantly increased at C5 (Z = 3.51, p < 0.01) and C6 (Z = 2.66, p < 0.01); and MFI was significantly increased at C7 only (Z = 2.52, p < 0.01) but the heterogeneity was unacceptably high (I = 83%).

Conclusions: The strength of the evidence for cervical muscle morphometric changes on MR images after whiplash is inconsistent for CSA and MFI. Future study designs should be standardised with quantification of three-dimensional muscle morphometry.
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http://dx.doi.org/10.1016/j.injury.2017.12.001DOI Listing
February 2018

Place of death in the Snowy Monaro region of New South Wales: A study of residents who died of a condition amenable to palliative care.

Aust J Rural Health 2018 Apr 11;26(2):126-133. Epub 2017 Dec 11.

Rural Clinical School, Australian National University, Cooma, New South Wales, Australia.

Objective: To describe the place of death of residents in a rural region of New South Wales.

Design: Cross-sectional quantitative study using death data collected from local funeral directors (in person and websites), residential aged-care facilities, one multipurpose heath service and obituary notices in the local media (newspapers/radio).

Setting: Snowy Monaro region (New South Wales Australia).

Participants: Residents, with advanced frailty or one of 10 conditions amenable to palliative care, who died between 1 February 2015 and 31 May 2016.

Main Outcome Measure: Place of death.

Results: Of 224 deaths in this period, 138 were considered amenable to palliative care. Twelve per cent of these deaths occurred in a private residence, 38% in the usual place of residence and 91% within the region.

Conclusion: Most rural residents with conditions amenable to palliative care died in the region. Most did not die in their usual place of residence. Further qualitative work is needed to determine palliative care patients' and family caregivers' preferences for, and the importance placed on, place of death. While there may be a need to support an increase in home deaths, local rural hospitals and residential aged-care facilities must not be overlooked as a substitute for inpatient hospices.
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http://dx.doi.org/10.1111/ajr.12393DOI Listing
April 2018

Presence of atopy increases the risk of asthma relapse.

Arch Dis Child 2018 04 11;103(4):346-351. Epub 2017 Oct 11.

Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.

Objectives: To describe the point prevalence of respiratory viruses/atypical bacteria using PCR and evaluate the impact of respiratory viruses/atypical bacteria and atopy on acute severity and clinical recovery in children with hospitalised and non-hospitalised asthma exacerbations.

Design: This was a prospective study performed during 2009-2011.

Setting: The study was performed in the emergency departments of two hospitals.

Patients: 244 children aged 2-16 years presenting with acute asthma to the emergency departments were recruited. A nasopharyngeal aspirate and allergen skin prick test were performed.

Main Outcome Measures: The outcomes were divided into (1) acute severity outcomes (Australian National Asthma Council assessment, hospitalisation, Functional Severity Scale, Acute Asthma Score, asthma quality of life questionnaires for parents (PACQLQ) on presentation, asthma diary scores (ADS) on presentation and length of hospitalisation) and (2) recovery outcomes (PACQLQ for 21 days, ADS for 14 days and representation for asthma for 21 days).

Results: PCR for viruses/atypical bacteria was positive in 81.7% of children (75.1% human rhinovirus, codetection in 14.2%). and were rarely detected. The presence of micro-organisms had little impact on acute asthma or recovery outcomes. Children with atopy were significantly more likely to relapse and represent for medical care by day 14 (OR 1.11, 95% CI 1.00 to 1.23).

Conclusions: The presence of any viruses is associated with asthma exacerbations but does not appear to influence asthma recovery. In contrast, atopy is associated with asthma relapse. and are rare triggers of acute asthma in young children.
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http://dx.doi.org/10.1136/archdischild-2017-312982DOI Listing
April 2018

Asking the difficult questions: Building the capacity of community paediatricians to routinely enquire and respond to family violence.

J Paediatr Child Health 2018 Mar 26;54(3):234-237. Epub 2017 Sep 26.

Community Paediatric and Child Health Service, Canberra, Australian Capital Territory, Australia.

Aim: To enhance the confidence and capacity of community paediatricians and paediatric trainees to identify and respond to family violence, through a series of education sessions and evidence-based recommendations.

Methods: The action research methodology included a literature search to review the data on family violence education programmes and evidence-based family violence screening tools. Six education sessions were then developed and held for physicians at the Community Paediatric and Child Health Service (CPCHS). An audit was performed on the charts of all new referrals to the CPCHS for a period of 18 months prior to the education sessions and 5 months following the education sessions. A questionnaire was distributed at the first and final education sessions to gauge physician comfort with enquiry into family violence.

Results: The documented rate of enquiry into family violence at CPCHS was 24% in the retrospective chart audit. Following the series of education sessions, the documented rate of enquiry increased to 60% (P < 0.05, odds ratio 4.7, confidence interval 2.7-8.4). The documented rate of disclosure of family violence also increased from 13% of all new patients in the retrospective chart audit to 24% in the prospective arm of the study (P < 0.05, odds ratio 2.1, confidence interval 1.0-4.0). Following the education sessions, all participants agreed that they routinely enquired about family violence and were comfortable enquiring about family violence.

Conclusion: This study demonstrates that clinician education about family violence supports routine enquiry about family violence in community paediatric consultations.
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http://dx.doi.org/10.1111/jpc.13704DOI Listing
March 2018

Statistical response to issues with the determination of the troponin 99th percentile.

Clin Biochem 2017 12 14;50(18):1332-1333. Epub 2017 Aug 14.

Statistical Consulting Unit, Australian National University, Canberra, Australia; Centre for Public Health Research, Massey University, Wellington, New Zealand.

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http://dx.doi.org/10.1016/j.clinbiochem.2017.08.007DOI Listing
December 2017

The Cost-Effectiveness of a Stroke Unit in Providing Enhanced Patient Outcomes in an Australian Teaching Hospital.

J Stroke Cerebrovasc Dis 2017 Oct 13;26(10):2362-2368. Epub 2017 Jun 13.

Calvary Hospital, Bruce, Canberra, Australia; Australian National University, Canberra, Australia.

Background: Stroke is one of the leading causes of disability and mortality. Patients who receive organized inpatient care in a stroke unit (SU) have better clinical outcomes. However, evidence on the cost analysis of an SU is lacking. The objective of this study was to assess the performance and analyze the cost-effectiveness of an SU.

Methods: A retrospective observational study was conducted comparing the acute stroke patient care in a 6-month period before and after the establishment of an acute SU at Calvary Hospital in 2013-2014.

Results: There were 103 patients included in the pre-SU period, as compared to 186 patients in the post-SU period. In the pre- and post-SU groups, 54 and 87 patients, respectively, had ischemic stroke, with significant trends in improved morbidity and mortality in the post-SU group (P = .01). The average length of stay (LOS) for patients was reduced from 9.7 days to 4.6 days in the post-SU group (P = .001). There was a reduction of cost per admission from $6382 Australian dollars (AUD) with conventional ward care as compared to $6061 (AUD) with SU care.

Conclusion: This study confirmed that the establishment of an SU not only improves treatment outcomes but also shortens LOS, thereby achieving cost-effectiveness.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.05.025DOI Listing
October 2017

Supervised or Unsupervised Rehabilitation After Total Hip Replacement Provides Similar Improvements for Patients: A Randomized Controlled Trial.

Arch Phys Med Rehabil 2017 11 12;98(11):2253-2264. Epub 2017 May 12.

Faculty of Health (Physiotherapy), University of Canberra, Canberra, Australia.

Objective: To determine whether patients do better with unsupervised (home-based) physiotherapy or in an outpatient setting.

Setting: Acute care public hospital in the region, supporting a population of ∼540,000.

Design: Single-blind randomized controlled trial.

Participants: Adult patients (N=98) after unilateral elective total hip replacement (THR) were randomly assigned to a supervised (center-based) exercise (n=56) or a unsupervised (home-based) exercise (n=42) program and followed for 6 months postsurgery.

Interventions: The supervised group attended a 4-week outpatient rehabilitation program supervised by a physiotherapist. The unsupervised group was given written and pictorial instructions to perform rehabilitation independently at home.

Main Outcome Measures: Western Ontario and McMaster Universities Osteoarthritis Index; Short-Form 36-item Health Questionnaire (SF-36) mental and physical component summary measures; University of California, Los Angeles activity scale; and timed Up and Go test.

Results: There were no differences between the groups for any measure. The overall differences between the adjusted means were as follows: Western Ontario and McMaster Universities Osteoarthritis Index, 0.50 (95% confidence interval [CI], -6.8 to 5.7); SF-36 physical component summary, 0.8 (95% CI, -6.5 to 8.1); SF-36 mental component summary, 1.7 (95% CI, -4.1 to 7.4); University of California, Los Angeles activity scale, 0.3 (95% CI, 5.2 to 6.1); and timed Up and Go test, 0 seconds (95% CI, -1.4 to 1.3s).

Conclusions: The results demonstrated that outcomes in response to rehabilitation after THR are clinically and statistically similar whether the program was supervised or not. The results suggest that early rehabilitation programs can be effectively delivered unsupervised in the home to low-risk patients discharged home after THR. However, the relative effect of late-stage rehabilitation was not tested.
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http://dx.doi.org/10.1016/j.apmr.2017.03.032DOI Listing
November 2017

Body mass index trajectories of Indigenous Australian children and relation to screen time, diet, and demographic factors.

Obesity (Silver Spring) 2017 04;25(4):747-756

National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Acton, Australian Capital Territory, Australia.

Objective: Limited cross-sectional data indicate elevated overweight/obesity prevalence among Indigenous versus non-Indigenous Australian children. This study aims to quantify body mass index (BMI) trajectories among Indigenous Australian children aged 3-6 and 6-9 years and to identify factors associated with the development of overweight/obesity.

Methods: Three-year BMI change was examined in up to 1,157 children in the national Longitudinal Study of Indigenous Children. BMI trajectories among children with normal baseline BMI (n = 907/1,157) were quantified using growth curve models.

Results: Baseline prevalences of overweight/obesity were 12.1% and 25.4% among children of mean age 3 and 6 years, respectively. Of children with normal baseline BMI, 31.9% had overweight/obesity 3 years later; BMI increased more rapidly for younger versus older (difference: 0.59 kg/m /year; 95% CI: 0.50-0.69), female versus male (difference: 0.15 kg/m /year; 95% CI: 0.07-0.23), and Torres Strait Islander versus Aboriginal (difference: 0.36 kg/m /year; 95% CI: 0.17-0.55) children. Results were consistent with less rapid rates of BMI increase for children with lower sugar-sweetened beverage (including fruit juice) and high-fat food consumption. Children's BMI was lower in more disadvantaged areas.

Conclusions: Overweight/obesity is common, and increases rapidly, in early childhood. Interventions are required to reduce the overweight/obesity prevalence among Indigenous Australian children in the first 3 years of life and to slow the rapid overweight/obesity onset from age 3 to 9 years.
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http://dx.doi.org/10.1002/oby.21783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5396259PMC
April 2017

Statistical Methods for Identifying Sequence Motifs Affecting Point Mutations.

Genetics 2017 02 14;205(2):843-856. Epub 2016 Dec 14.

Research School of Biology, The Australian National University, Canberra, Australian Capital Territory 2601, Australia

Mutation processes differ between types of point mutation, genomic locations, cells, and biological species. For some point mutations, specific neighboring bases are known to be mechanistically influential. Beyond these cases, numerous questions remain unresolved, including: what are the sequence motifs that affect point mutations? How large are the motifs? Are they strand symmetric? And, do they vary between samples? We present new log-linear models that allow explicit examination of these questions, along with sequence logo style visualization to enable identifying specific motifs. We demonstrate the performance of these methods by analyzing mutation processes in human germline and malignant melanoma. We recapitulate the known CpG effect, and identify novel motifs, including a highly significant motif associated with A[Formula: see text]G mutations. We show that major effects of neighbors on germline mutation lie within [Formula: see text] of the mutating base. Models are also presented for contrasting the entire mutation spectra (the distribution of the different point mutations). We show the spectra vary significantly between autosomes and X-chromosome, with a difference in T[Formula: see text]C transition dominating. Analyses of malignant melanoma confirmed reported characteristic features of this cancer, including statistically significant strand asymmetry, and markedly different neighboring influences. The methods we present are made freely available as a Python library https://bitbucket.org/pycogent3/mutationmotif.
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http://dx.doi.org/10.1534/genetics.116.195677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5289855PMC
February 2017

Pain, not structural impairments may explain activity limitations in people with gluteal tendinopathy or hip osteoarthritis: A cross sectional study.

Gait Posture 2017 02 5;52:237-243. Epub 2016 Dec 5.

Latrobe University, La Trobe Sport and Exercise Medicine Research Centre, Bundoora, Vic, Australia. Electronic address:

Question: What are the functional differences between people with greater trochanteric pain syndrome (GT), hip osteoarthritis (OA) or an asymptomatic population as measured by walking, Time Up and Go, single leg standing and strength?

Design: Cross sectional study with blinded measurers.

Participants: 38 participants with GT, 20 with end stage hip OA and 21 asymptomatic healthy control (AS) participants. All participants were women.

Outcome Measures: Pain (numeric rating scale), Walking speed (m/s), cadence (steps/min) and step length (m) measured via the 10m walk test and the Timed Up and Go; balance via single leg stance (s) duration; and hip abduction, adduction, medial and lateral rotation strength, standardized to body mass (BM) via the body mass average index (BMavg), measured via a wall mounted dynamometer.

Results: The two symptomatic groups reported similar pain levels (p=0.226), more pain then the AS group (p<0.000). Compared to the AS participants, participants with GT or hip OA demonstrated lower walking speed (10mwt and TUG, p<0.001), lower cadence and shorter duration single leg stance on the affected leg (p<0.05). Participants with GT or hip OA also demonstrated bilaterally weaker hip abduction than the AS group (p≤0.005). Compared to AS and GT participants, participants with hip OA demonstrated adduction weakness on the affected side (p=0.008 and p=0.002 respectively).

Conclusion: There is a significant level of dysfunction and impairments associated with GT and hip OA. As activity limitations do not appear to be differentiated by structural impairments, we suggest that pain, rather than the underlying pathology may be the driving impairment that leads to walking and single leg standing dysfunction.
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http://dx.doi.org/10.1016/j.gaitpost.2016.12.005DOI Listing
February 2017