Medicine (RMH) - Research Publications

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    The Oversight of Clinical Innovation in a Medical Marketplace
    Lipworth, W ; Wiersma, M ; Ghinea, N ; Hendl, T ; Kerridge, I ; Lysaght, T ; Munsie, M ; Rudge, C ; Stewart, C ; Waldby, C ; Sorbie, A ; SethI, N ; Postan, E ; McMillan, C ; Ganguli-Mitra, A ; Dove, E ; Laurie, G (Cambridge University Press, 2021-06-24)
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    Modelling the Economic Impacts of Epidemics in Developing Countries Under Alternative Intervention Strategies
    Geard, N ; Giesecke, JA ; Madden, JR ; McBryde, ES ; Moss, R ; Tran, NH ; Madden, JR ; Shibusawa, H ; Higano, Y (Springer, 2020)
    Modern levels of global travel have intensified the risk of new infectious diseases becoming pandemics. Particularly at risk are developing countries whose health systems may be less well equipped to detect quickly and respond effectively to the importation of new infectious diseases. This chapter examines what might have been the economic consequences if the 2014 West African Ebola epidemic had been imported to a small Asia-Pacific country. Hypothetical outbreaks in two countries were modelled. The post-importation estimations were carried out with two linked models: a stochastic disease transmission (SEIR) model and a quarterly version of the multi-country GTAP model, GTAP-Q. The SEIR model provided daily estimates of the number of persons in various disease states. For each intervention strategy the stochastic disease model was run 500 times to obtain the probability distribution of disease outcomes. Typical daily country outcomes for both controlled and uncontrolled outbreaks under five alternative intervention strategies were converted to quarterly disease-state results, which in turn were used in the estimation of GTAP-Q shocks to country-specific health costs and labour productivity during the outbreak, and permanent reductions in each country’s population and labour force due to mortality. Estimated behavioural consequences (severe reductions in international tourism and crowd avoidance) formed further shocks. The GTAP-Q simulations revealed very large economic costs for each country if they experienced an uncontrolled Ebola outbreak, and considerable economic costs for controlled outbreaks in Fiji due to the importance of the tourism sector to its economy. A major finding was that purely reactive strategies had virtually no effect on preventing uncontrolled outbreaks, but pre-emptive strategies substantially reduced the proportion of uncontrolled outbreaks, and in turn the economic and social costs.
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    Sex steroids and gender differences in muscle, bone, and fat
    Barmanray, RD ; Yates, CJ ; Duque, G ; Troen, BR (Elsevier, 2022)
    Sex steroids, comprising of the androgens, estrogens, and progestogens, are fundamentally important to the development of muscle, bone, and fat across the life course. Each has roles that differ between these tissues, the male and female sexes, and developmental stage. It is the differential production of sex steroids and expression of their receptors that mediates much of the pubertal development in muscle, bone, and fat, which in turn determines the typical dimorphic sexual phenotypes. It is similar to how this differential production changes over time that is responsible for much of the typical sex-specific changes seen with normal aging. This chapter considers the sex-specific production of sex steroids and their effects upon each muscle, bone, and fat. It additionally covers the developmental changes in sex steroid production, and how this contributes to age-related changes in these three tissues.
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    Automated inter-ctal epileptiform discharge detection from routine EEG
    Nhu, D ; Janmohamed, M ; Shakhatreh, L ; Gonen, O ; Kwan, P ; Gilligan, A ; Wei Tan, C ; Kuhlmann, L (IOS Press, 2021-04-19)
    Epilepsy is the most common neurological disorder. The diagnosis commonly requires manual visual electroencephalogram (EEG) analysis which is time-consuming. Deep learning has shown promising performance in detecting interictal epileptiform discharges (IED) and may improve the quality of epilepsy monitoring. However, most of the datasets in the literature are small (n≤100) and collected from single clinical centre, limiting the generalization across different devices and settings. To better automate IED detection, we cross-evaluated a Resnet architecture on 2 sets of routine EEG recordings from patients with idiopathic generalized epilepsy collected at the Alfred Health Hospital and Royal Melbourne Hospital (RMH). We split these EEG recordings into 2s windows with or without IED and evaluated different model variants in terms of how well they classified these windows. The results from our experiment showed that the architecture generalized well across different datasets with an AUC score of 0.894 (95% CI, 0.881–0.907) when trained on Alfred’s dataset and tested on RMH’s dataset, and 0.857 (95% CI, 0.847–0.867) vice versa. In addition, we compared our best model variant with Persyst and observed that the model was comparable.
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    Motor neuron disease: Causes, classification and treatments
    Ng, L ; Khan, F ; Turner, BJ ; Atkin, JB (Nova Science Publishers, 2014-04-01)
    Motor Neuron Disease (MND) is the most common chronic neurodegenerative disorder of the motor system in adults. It is a relatively rare disease with a reported population incidence of between 1.5 and 2.5 per 100,000 per year worldwide. The only established risk factors are age and family history, with age being the most important factor. The disease occurs throughout adult life, with the peak incidence between 50 to 75 years of age. MND occurs more commonly in men than in women in a ratio of 3:2. MND is characterized by the loss of motor neurons in the cortex, brain stem, and spinal cord, manifested by upper and lower motor neuron signs and symptoms affecting bulbar, limb, and respiratory muscles. Death usually results from respiratory failure and follows on average two to four years after onset, but some may survive for a decade or more. Whilst the aetiology of MND is unknown, current evidence suggests that multiple interacting factors contribute to motor neuron injury in MND. The working hypothesis is that MND, like many other chronic diseases, is a complex genetic condition and the relative contribution of individual environmental and genetic factors is likely to be small. The three key pathogenetic hypotheses are genetic factors, oxidative stress and glutamatergic toxicity, which result in damage to critical target proteins such as neurofilaments and organelles such as mitochondria. The symptoms in MND are diverse and challenging and include weakness, spasticity, limitations in mobility and activities of daily living, communication deficits and dysphagia, and in those with bulbar involvement, respiratory compromise, fatigue and sleep disorders, pain and psychosocial distress. Hence, the burden of disease and economic impact of MND upon patients, their caregivers (often family members) and on society is substantial, often beginning long before the actual diagnosis is made, and increasing with increasing disability and the need for medical equipment and assisted care. At present, the only approved drug treatment for MND in the USA, Australia and in many European countries is riluzole, which is thought to prolong median survival by about two to three months. In the absence of a cure or indeed any medical intervention, which might stop the progression of MND, the management relies mostly on symptomatic, rehabilitative and palliative therapy, which is the focus of this chapter. An update in the symptomatic and disability management of MND is provided, covering the interface between neurology, rehabilitation and palliative care and incorporates issues encountered over the spectrum of disease, including activity and pain related issues, respiratory and dysphagia issues and psychosocial changes. Recent trends, developments and future research in rehabilitation approaches that maintain and restore functional independence and quality of life will be presented.
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    Improving access to and participation in medical research for Culturally and Linguistically Diverse background patients: A bilingual, digital communication approach.
    Hajek, J ; Woodward-Kron, R ; Parker, A ; Bresin, A ; Hughson, J-A ; Dien Phan, T ; Story, D ; Ji, M (Routledge Studies in Empirical Translation and Multilingual Communication, 2019)
    Chapters in this book aim to fill in a persistent knowledge gap in current multicultural health research, that is, culturally effective and user-oriented healthcare translation.
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    Management of Prosthetic Infection According to Organism
    Peel, T ; Buising, K ; Dowsey, M ; Choong, P (InTech, 2013)
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    International Immigrant and Refugee Health Issues
    BIGGS, B ; Levers, LL ; Strickler, A (Springer Publishing Co Inc, 2014-12-30)