Medicine (RMH) - Research Publications
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ItemRe-thinking the brain. new insights into early experience and brain development(Elsevier, 2013-08-18)The brain is a self-organizing system that adapts to its specific environment throughout pre- and postnatal life (Braun and Bock, 2011). Self-organization refers to the spontaneous formation of patterns and pattern change in open nonequilibrium systems. Edelman’s theory of neuronal group selection (Edelman, 1989) highlights this process. Groups of neurons are ‘selected’ or organized into groups or networks that are dynamically organized through epigenetic factors and experience. Developmental selection occurs largely before birth. Processes such as cell division, differentiation and programmed cell death and the mechanisms of neuronal migration are regulated by epigenetic factors. While genetics provides a general blueprint for neural development, the developmental processes are not precisely prespecified by genes, and produce unique patterns of neurons and neuronal groups in every brain. The result is a diverse pattern of connectivity forming primary repertoires of different neuronal groups. Structural diversity occurs through selective mechanical and chemical events regulated by cell and substrate adhesion molecules. A second process called experiential selection occurs postnatally through behavioural experience, resulting in modifications in the strength of synaptic connections, and creating diverse secondary repertoires. Finally, re-entrant signalling leads to the development of dynamic ‘maps’, an interconnected series of neuronal groups that independently receive inputs from the real world and create coherent perceptual constructs.
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ItemClinical data linkages in spinal cord injuries (SCI) in Australia: What are the concerns?(IGI Global, 2014-10-31)Clinical data linkage amongst patients with Spinal Cord Injury (SCI) is a challenge, as the Australian Health System is fragmented and there is lack of coordination between multiple data custodians at the state and federal levels, private and public hospitals, and acute and allied health sectors. This is particularly problematic in chronic conditions such as SCI, where multiple data custodians collect data on patients over long periods of time. The author presents findings based on interviews with a range of data custodians for SCI categorized as clinical, statutory, and financial data custodians. It is found that data are kept in different silos, which are not coordinated, hence duplication exists and patient information that exists on many different databases is inconsistently updated. This chapter describes the importance of Clinical Data Linkage for healthcare in predicting disease trajectories for SCI and discusses how administrative and clinical data are collected and stored and some of the challenges in linking these datasets.
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ItemOverview of clinical decision support systems in healthcare(IGI Global, 2016-07-18)Clinical Decision Support Systems (CDSS) are software designed to help clinicians to make decisions about patient diagnosis using technical devices such as desktops, laptops and iPads, and mobile devices, to obtain medical information and set up alert systems to monitor medication. A Clinical Decision Support System has been suggested by many as a key to a solution for improving patient safety together with Physician Based Computer Order Entry. This technology could prove to be very important in conditions such as chronic diseases where health outlay is high and where self-efficacy can affect health outcomes. However, the success of CDSS relies on technology, training and ongoing support. This chapter includes a historical overview and practical application of CDSS in medicine, and discusses challenges involved with implementation of such systems. It discusses new frontiers of CDSS and implications of self-management using social computing technologies, in particular in the management of chronic disease.
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ItemNo Preview AvailableThe Oversight of Clinical Innovation in a Medical Marketplace(Cambridge University Press, 2021-06-24)
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ItemNo Preview AvailableModelling the Economic Impacts of Epidemics in Developing Countries Under Alternative Intervention Strategies(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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ItemSex steroids and gender differences in muscle, bone, and fat(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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ItemAutomated inter-ctal epileptiform discharge detection from routine EEG(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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ItemMotor neuron disease: Causes, classification and treatments(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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ItemImproving access to and participation in medical research for Culturally and Linguistically Diverse background patients: A bilingual, digital communication approach.(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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ItemNo Preview AvailableManagement of Prosthetic Infection According to Organism(InTech, 2013)