Medicine (RMH) - Research Publications

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    Genetics in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.
    KDIGO Conference Participants, (Elsevier BV, 2022-06)
    Numerous genes for monogenic kidney diseases with classical patterns of inheritance, as well as genes for complex kidney diseases that manifest in combination with environmental factors, have been discovered. Genetic findings are increasingly used to inform clinical management of nephropathies, and have led to improved diagnostics, disease surveillance, choice of therapy, and family counseling. All of these steps rely on accurate interpretation of genetic data, which can be outpaced by current rates of data collection. In March of 2021, Kidney Diseases: Improving Global Outcomes (KDIGO) held a Controversies Conference on "Genetics in Chronic Kidney Disease (CKD)" to review the current state of understanding of monogenic and complex (polygenic) kidney diseases, processes for applying genetic findings in clinical medicine, and use of genomics for defining and stratifying CKD. Given the important contribution of genetic variants to CKD, practitioners with CKD patients are advised to "think genetic," which specifically involves obtaining a family history, collecting detailed information on age of CKD onset, performing clinical examination for extrarenal symptoms, and considering genetic testing. To improve the use of genetics in nephrology, meeting participants advised developing an advanced training or subspecialty track for nephrologists, crafting guidelines for testing and treatment, and educating patients, students, and practitioners. Key areas of future research, including clinical interpretation of genome variation, electronic phenotyping, global representation, kidney-specific molecular data, polygenic scores, translational epidemiology, and open data resources, were also identified.
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    Designing an App for Pregnancy Care for a Culturally and Linguistically Diverse Community
    Smith, W ; Wadley, G ; Daly, JO ; Webb, M ; Hughson, J ; Hajek, J ; Parker, A ; Woodward-Kron, R ; Story, DA (The Association for Computing Machinery, 2017)
    We report a study to design and evaluate an app to support pregnancy information provided to women through an Australian health service. As part of a larger project to provide prenatal resources for culturally and linguistically diverse groups, this study focused on the design and reception of an app with the local Vietnamese community and health professionals of a particular hospital. Our study had three stages: an initial design workshop with the hospital; prototype design and development; prototype-based interviews with health professionals and focus groups with Vietnamese women. We explore how an app of this sort must be designed for a range of different use scenarios, considering its use by consumers with a multiplicity of differing viewpoints about its nature and purpose in relation to pregnancy care.
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    A Pilot Study on the use of Accelerometer Sensors for Monitoring Post Acute Stroke Patients
    Gubbi, J ; Kumar, D ; Rao, AS ; Yan, B ; Palaniswami, M (IEEE, 2013-01-01)
    The high incidence of stroke has raised a major concern among health professionals in recent years. Concerted efforts from medical and engineering communities are being exercised to tackle the problem at its early stage. In this direction, a pilot study to analyze and detect the affected arm of the stroke patient based on hand movements is presented. The premise is that the correlation of magnitude of the activities of the two arms vary significantly for stroke patients from controls. Further, the cross-correlation of right and left arms for three axes are differentiable for patients and controls. A total of 22 subjects (15 patients and 7 controls) were included in this study. An overall accuracy of 95.45% was obtained with sensitivity of 1 and specificity of 0.86 using correlation based method.
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    Classification of Convulsive Psychogenic Non-epileptic Seizures Using Histogram of Oriented Motion of Accelerometry Signals
    Kusmakar, S ; Gubbi, J ; Rao, AS ; Yan, B ; O'Brien, TJ ; PALANISWAMI, M (IEEE, 2015)
    A seizure is caused due to sudden surge of electrical activity within the brain. There is another class of seizures called psychogenic non-epileptic seizure (PNES) that mimics epilepsy, but is caused due to underlying psychology. The diagnosis of PNES is done using video-electroencephalography monitoring (VEM), which is a resource intensive process. Recently, accelerometers have been shown to be effective in classification of epileptic and non-epileptic seizures. In this work, we propose a novel feature called histogram of oriented motion (HOOM) extracted from accelerometer signals for classification of convulsive PNES. An automated algorithm based on HOOM is proposed. The algorithm showed a high sensitivity of (93.33%) and an overall accuracy of (80%) in classifying convulsive PNES.
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    Industry Viable Electrochemical DNA Detection Sensor Architecture via a Stem-Loop Methylene Blue Redox Reporter and Rapid In Situ Probe Immobilization Method for Pharmacogenetic Biomarker Testing Application
    Jayawardena, A ; Tan, SM ; Richardson, MB ; Chan, J ; Thissen, H ; Voelcker, NH ; Kwan, P (ELECTROCHEMICAL SOC INC, 2022-01-01)
    Identification of biomarkers in clinical applications for diagnostics at the point-of-care (POC) setting requires the development of industry viable biosensing platform. Herein, we report such development of biosensor architecture for the detection of pharmacogenetic biomarker HLA-B*15:02 gene. The biosensor architecture comprises of an oligonucleotide stem-loop probe modified with a methylene blue redox (MB) reporter, immobilized via a rapid “printing” method on the commercially available disposable screen-printed electrodes (SPE). The square wave voltammetric measurements on the DNA sensor showed a clear peak difference of ∼80 nA with a significant difference in peak height values of the faradaic current generated for the MB redox moiety between the positive control (biotin-modified 19 based oligonucleotides with the sequence mimicking the specific region of the HLA-B*15:02 allele and complementary to the probe sequence) and negative control samples (biotin-modified 19 based oligonucleotides with the sequence unrelated to the probe sequence and the HLA-B*15:02 allele). These initial proof of concept results provide support for the possibility of using this signal-off biosensor architecture in the intended pharmacogenetic biomarker testing.
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    Eosinophilic and Noneosinophilic Asthma: An Expert Consensus Framework to Characterize Phenotypes in a Global Real-Life Severe Asthma Cohort.
    Heaney, LG ; Perez de Llano, L ; Al-Ahmad, M ; Backer, V ; Busby, J ; Canonica, GW ; Christoff, GC ; Cosio, BG ; FitzGerald, JM ; Heffler, E ; Iwanaga, T ; Jackson, DJ ; Menzies-Gow, AN ; Papadopoulos, NG ; Papaioannou, AI ; Pfeffer, PE ; Popov, TA ; Porsbjerg, CM ; Rhee, CK ; Sadatsafavi, M ; Tohda, Y ; Wang, E ; Wechsler, ME ; Alacqua, M ; Altraja, A ; Bjermer, L ; Björnsdóttir, US ; Bourdin, A ; Brusselle, GG ; Buhl, R ; Costello, RW ; Hew, M ; Koh, MS ; Lehmann, S ; Lehtimäki, L ; Peters, M ; Taillé, C ; Taube, C ; Tran, TN ; Zangrilli, J ; Bulathsinhala, L ; Carter, VA ; Chaudhry, I ; Eleangovan, N ; Hosseini, N ; Kerkhof, M ; Murray, RB ; Price, CA ; Price, DB (Elsevier BV, 2021-09)
    BACKGROUND: Phenotypic characteristics of patients with eosinophilic and noneosinophilic asthma are not well characterized in global, real-life severe asthma cohorts. RESEARCH QUESTION: What is the prevalence of eosinophilic and noneosinophilic phenotypes in the population with severe asthma, and can these phenotypes be differentiated by clinical and biomarker variables? STUDY DESIGN AND METHODS: This was an historical registry study. Adult patients with severe asthma and available blood eosinophil count (BEC) from 11 countries enrolled in the International Severe Asthma Registry (January 1, 2015-September 30, 2019) were categorized according to likelihood of eosinophilic phenotype using a predefined gradient eosinophilic algorithm based on highest BEC, long-term oral corticosteroid use, elevated fractional exhaled nitric oxide, nasal polyps, and adult-onset asthma. Demographic and clinical characteristics were defined at baseline (ie, 1 year before or closest to date of BEC). RESULTS: One thousand seven hundred sixteen patients with prospective data were included; 83.8% were identified as most likely (grade 3), 8.3% were identified as likely (grade 2), and 6.3% identified as least likely (grade 1) to have an eosinophilic phenotype, and 1.6% of patients showed a noneosinophilic phenotype (grade 0). Eosinophilic phenotype patients (ie, grades 2 or 3) showed later asthma onset (29.1 years vs 6.7 years; P < .001) and worse lung function (postbronchodilator % predicted FEV1, 76.1% vs 89.3%; P = .027) than those with a noneosinophilic phenotype. Patients with noneosinophilic phenotypes were more likely to be women (81.5% vs 62.9%; P = .047), to have eczema (20.8% vs 8.5%; P = .003), and to use anti-IgE (32.1% vs 13.4%; P = .004) and leukotriene receptor antagonists (50.0% vs 28.0%; P = .011) add-on therapy. INTERPRETATION: According to this multicomponent, consensus-driven, and evidence-based eosinophil gradient algorithm (using variables readily accessible in real life), the severe asthma eosinophilic phenotype was more prevalent than previously identified and was phenotypically distinct. This pragmatic gradient algorithm uses variables readily accessible in primary and specialist care, addressing inherent issues of phenotype heterogeneity and phenotype instability. Identification of treatable traits across phenotypes should improve therapeutic precision.
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    1 Carer perspectives of trust and authority during COVID-19
    Aker, N ; West, E ; Davies, N ; Moore, K ; Sampson, L ; Nair, P ; Kupeli, N (British Medical Journal Publishing Group, 2021-03)
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    Allogeneic Stem Cell Transplantation for Diffuse Large B Cell Lymphoma Can Achieve Durable Remissions: An Australasian Bone Marrow Transplant Recipient Registry Study
    Di Ciaccio, PR ; Greenwood, M ; Kennedy, G ; Milliken, S ; Gottlieb, D ; Ritchie, DS ; Purtill, D ; Larsen, SR ; Spencer, A ; Perera, T ; Yeung, DT ; Durrant, S ; Butler, A ; Watson, A-M ; Lai, HC ; Doocey, RT ; Goodman, HJ ; Kerridge, IH ; Arthur, C ; Curley, C ; Stewart, C ; Micklethwaite, K ; Collins, J ; Cooney, JP ; Hamad, N (Elsevier BV, 2021-03)