http://hdl.handle.net/11343/159 Sat, 22 Jan 2022 11:53:35 GMT 2022-01-22T11:53:35Z http://hdl.handle.net/11343/297104 Jongenelis, M; Jackson, B; Newton, RU; Pettigrew, S 2021-02-04 Longitudinal associations between formal volunteering and well-being among retired older people: follow-up results from a randomized controlled trial Volunteering has been identified as a potential mechanism for improving the psychosocial health of older adults. Utilizing a randomized controlled trial approach, the present study assessed the extent to which commencing volunteering can improve psychosocial health outcomes for older people. Fully retired Australian adults aged 60+ years (N= 445) were assessed at baseline and allocated to either the intervention or control arms of the trial. Those in the intervention condition were asked to participate in at least 60 min of formal volunteering per week for 6 months. Per-protocol analyses were conducted comparing psychosocial outcomes for those who complied with the intervention condition (n= 73) to outcomes for those who complied with the control condition (n= 112). Those who complied with the intervention condition demonstrated significant improvements in life satisfaction, purpose in life, and personal growth scores over a 12-month period relative to those in the control condition who did no volunteering. Findings provide evidence of a causal relationship between commencing volunteering and improvements in psychosocial health among older adults and indicate that encouraging participation in this activity could constitute an effective healthy aging intervention. Journal Article Thu, 04 Feb 2021 00:00:00 GMT http://hdl.handle.net/11343/297104 2021-02-04T00:00:00Z http://hdl.handle.net/11343/297103 Gans, J 2021 Mutilating words In late 2019, a majority of Australia’s High Court ruled that the term ‘otherwise mutilates’ in New South Wales’ female genital mutilation offence extends to nicks or cuts that heal quickly. Earlier that year, Professor Michael Plaxton published a book arguing that courts interpreting Canada’s substantive criminal law follow three theses: Parliament makes the criminal law, it usually does not mean to transform society, but it does mean to guide lay people. Tis combined case note and book review concludes that the Australian decision largely reflects those theses and vice versa, but identifies some problems about how to read the words of criminal offences which require further attention from both the High Court and Professor Plaxton Journal Article Fri, 01 Jan 2021 00:00:00 GMT http://hdl.handle.net/11343/297103 2021-01-01T00:00:00Z http://hdl.handle.net/11343/297102 Webber, S; Hirskyj-Douglas, I 2021 Reflecting on Methods in Animal Computer Interaction: Novelty Effect and Habituation Conference Paper Fri, 01 Jan 2021 00:00:00 GMT http://hdl.handle.net/11343/297102 2021-01-01T00:00:00Z http://hdl.handle.net/11343/297101 Pillai, P 2020 The Role of Data in a Rapid and Coordinated Response to Infectious Disease Outbreaks Conference Paper Wed, 01 Jan 2020 00:00:00 GMT http://hdl.handle.net/11343/297101 2020-01-01T00:00:00Z http://hdl.handle.net/11343/297100 Pillai, P 2022-01-21 Minimum information model for APPRISE Virtual Biobank Preprint Fri, 21 Jan 2022 00:00:00 GMT http://hdl.handle.net/11343/297100 2022-01-21T00:00:00Z http://hdl.handle.net/11343/297099 Wilson-O'Brien, AL; Patron, N; Rogers, S 2010-05-21 Evolutionary ancestry and novel functions of the mammalian glucose transporter (GLUT) family BACKGROUND: In general, sugar porters function by proton-coupled symport or facilitative transport modes. Symporters, coupled to electrochemical energy, transport nutrients against a substrate gradient. Facilitative carriers transport sugars along a concentration gradient, thus transport is dependent upon extracellular nutrient levels. Across bacteria, fungi, unicellular non-vertebrates and plants, proton-coupled hexose symport is a crucial process supplying energy under conditions of nutrient flux. In mammals it has been assumed that evolution of whole body regulatory mechanisms would eliminate this need. To determine whether any isoforms bearing this function might be conserved in mammals, we investigated the relationship between the transporters of animals and the proton-coupled hexose symporters found in other species. RESULTS: We took a comparative genomic approach and have performed the first comprehensive and statistically supported phylogenetic analysis of all mammalian glucose transporter (GLUT) isoforms. Our data reveals the mammalian GLUT proteins segregate into five distinct classes. This evolutionary ancestry gives insight to structure, function and transport mechanisms within the groups. Combined with biological assays, we present novel evidence that, in response to changing nutrient availability and environmental pH, proton-coupled, active glucose symport function is maintained in mammalian cells. CONCLUSIONS: The analyses show the ancestry, evolutionary conservation and biological importance of the GLUT classes. These findings significantly extend our understanding of the evolution of mammalian glucose transport systems. They also reveal that mammals may have conserved an adaptive response to nutrient demand that would have important physiological implications to cell survival and growth. Journal Article Fri, 21 May 2010 00:00:00 GMT http://hdl.handle.net/11343/297099 2010-05-21T00:00:00Z http://hdl.handle.net/11343/297098 Haralambous, B; Haines, TP; Hill, K; Moore, K; Nitz, J; Robinson, A 2010-01-01 A protocol for an individualised, facilitated and sustainable approach to implementing current evidence in preventing falls in residential aged care facilities BACKGROUND: Falls are common adverse events in residential care facilities. Commonly reported figures indicate that at least 50% of residents fall in a 12 month period, and that this figure is substantially higher for residents with dementia. This paper reports the protocol of a project which aims to implement evidence based falls prevention strategies in nine residential aged care facilities (RACFs) in Australia. The facilities in the study include high and low care, small and large facilities, metropolitan and regional, facilities with a specific cultural focus, and target groups recognised as being more challenging to successful implementation of falls prevention practice (e.g. residents with dementia). METHODS: The project will be conducted from November 2007-November 2009. The project will involve baseline scoping of existing falls rates and falls prevention activities in each facility, an action research process, interactive falls prevention training, individual falls risk assessments, provision of equipment and modifications, organisation based steering committees, and an economic evaluation. In each RACF, staff will be invited to join an action research group that will lead the process of developing and implementing interventions designed to facilitate an evidence based approach to falls management in their facility. In all RACFs a pre/post design will be adopted with a range of standardised measures utilised to determine the impact of the interventions. DISCUSSION: The care gap in residential aged care that will be addressed through this project relates to the challenges in implementing best practice falls prevention actions despite the availability of best practice guidelines. There are numerous factors that may limit the uptake of best practice falls prevention guidelines in residential aged care facilities. A multi-factorial individualised (to the specific requirements of each facility) approach will be used to develop and implement an action plan in each participating facility based on the best available evidence. Journal Article Fri, 01 Jan 2010 00:00:00 GMT http://hdl.handle.net/11343/297098 2010-01-01T00:00:00Z http://hdl.handle.net/11343/297097 Fritschi, L; Erren, TC; Glass, DC; Girschik, J; Thomson, AK; Saunders, C; Boyle, T; El-Zaemey, S; Rogers, P; Peters, S; Slevin, T; D'Orsogna, A; de Vocht, F; Vermeulen, R; Heyworth, JS 2013-10-29 The association between different night shiftwork factors and breast cancer: a case-control study BACKGROUND: Research on the possible association between shiftwork and breast cancer is complicated because there are many different shiftwork factors, which might be involved including: light at night, phase shift, sleep disruption and changes in lifestyle factors while on shiftwork (diet, physical activity, alcohol intake and low sun exposure). METHODS: We conducted a population-based case-control study in Western Australia from 2009 to 2011 with 1205 incident breast cancer cases and 1789 frequency age-matched controls. A self-administered questionnaire was used to collect demographic, reproductive, and lifestyle factors and lifetime occupational history and a telephone interview was used to obtain further details about the shiftwork factors listed above. RESULTS: A small increase in risk was suggested for those ever doing the graveyard shift (work between midnight and 0500 hours) and breast cancer (odds ratio (OR)=1.16, 95% confidence interval (CI)=0.97-1.39). For phase shift, we found a 22% increase in breast cancer risk (OR=1.22, 95% CI=1.01-1.47) with a statistically significant dose-response relationship (P=0.04). For the other shiftwork factors, risks were marginally elevated and not statistically significant. CONCLUSION: We found some evidence that some of the factors involved in shiftwork may be associated with breast cancer but the ORs were low and there were inconsistencies in duration and dose-response relationships. Journal Article Tue, 29 Oct 2013 00:00:00 GMT http://hdl.handle.net/11343/297097 2013-10-29T00:00:00Z http://hdl.handle.net/11343/297096 Laver, K; Lannin, NA; Bragge, P; Hunter, P; Holland, AE; Tavender, E; O'Connor, D; Khan, F; Teasell, R; Gruen, R 2014-09-17 Organising health care services for people with an acquired brain injury: an overview of systematic reviews and randomised controlled trials BACKGROUND: Acquired brain injury (ABI) is the leading cause of disability worldwide yet there is little information regarding the most effective way to organise ABI health care services. The aim of this review was to identify the most up-to-date high quality evidence to answer specific questions regarding the organisation of health care services for people with an ABI. METHODS: We conducted a systematic review of English papers using MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library. We included the most recently published high quality systematic reviews and any randomised controlled trials, non-randomised controlled trials, controlled before after studies or interrupted time series studies published subsequent to the systematic review. We searched for papers that evaluated pre-defined organisational interventions for adults with an ABI. Organisational interventions of interest included fee-for-service care, integrated care, integrated care pathways, continuity of care, consumer engagement in governance and quality monitoring interventions. Data extraction and appraisal of included reviews and studies was completed independently by two reviewers. RESULTS: A total of five systematic reviews and 21 studies were included in the review; eight of the papers (31%) included people with a traumatic brain injury (TBI) or ABI and the remaining papers (69%) included only participants with a diagnosis of stroke. We found evidence supporting the use of integrated care to improve functional outcome and reduce length of stay and evidence supporting early supported discharge teams for reducing morbidity and mortality and reducing length of stay for stroke survivors. There was little evidence to support case management or the use of integrated care pathways for people with ABI. We found evidence that a quality monitoring intervention can lead to improvements in process outcomes in acute and rehabilitation settings. We were unable to find any studies meeting our inclusion criteria regarding fee-for-service care or engaging consumers in the governance of the health care organisation. CONCLUSIONS: The review found evidence to support integrated care, early supported discharge and quality monitoring interventions however, this evidence was based on studies conducted with people following stroke and may not be appropriate for all people with an ABI. Journal Article Wed, 17 Sep 2014 00:00:00 GMT http://hdl.handle.net/11343/297096 2014-09-17T00:00:00Z http://hdl.handle.net/11343/297095 Marshall, SD; Kitto, S; Shearer, W; Wilson, SJ; Finnigan, MA; Sturgess, T; Hore, T; Buist, MD 2011-04-16 Why don't hospital staff activate the rapid response system (RRS)? How frequently is it needed and can the process be improved? BACKGROUND: The rapid response system (RRS) is a process of accessing help for health professionals when a patient under their care becomes severely ill. Recent studies and meta-analyses show a reduction in cardiac arrests by a one-third in hospitals that have introduced a rapid response team, although the effect on overall hospital mortality is less clear. It has been suggested that the difficulty in establishing the benefit of the RRS has been due to implementation difficulties and a reluctance of clinical staff to call for additional help. This assertion is supported by the observation that patients continue to have poor outcomes in our institution despite an established RRS being available. In many of these cases, the patient is often unstable for many hours or days without help being sought. These poor outcomes are often discovered in an ad hoc fashion, and the real numbers of patients who may benefit from the RRS is currently unknown. This study has been designed to answer three key questions to improve the RRS: estimate the scope of the problem in terms of numbers of patients requiring activation of the RRS; determine cognitive and socio-cultural barriers to calling the Rapid Response Team; and design and implement solutions to address the effectiveness of the RRS. METHODS: The extent of the problem will be addressed by establishing the incidence of patients who meet abnormal physiological criteria, as determined from a point prevalence investigation conducted across four hospitals. Follow-up review will determine if these patients subsequently require intensive care unit or critical care intervention. This study will be grounded in both cognitive and socio-cultural theoretical frameworks. The cognitive model of situation awareness will be used to determine psychological barriers to RRS activation, and socio-cultural models of interprofessional practice will be triangulated to inform further investigation. A multi-modal approach will be taken using reviews of clinical notes, structured interviews, and focus groups. Interventions will be designed using a human factors analysis approach. Ongoing surveillance of adverse outcomes and surveys of the safety climate in the clinical areas piloting the interventions will occur before and after implementation. Journal Article Sat, 16 Apr 2011 00:00:00 GMT http://hdl.handle.net/11343/297095 2011-04-16T00:00:00Z http://hdl.handle.net/11343/297094 Wang, Yiwen 2021 Statistical and Computational Methods for Microbiome Data Analysis Microorganisms are ubiquitous on earth, but our understanding of how microorganisms' function and composition relate to the environment remains limited. In this thesis, we refer to the microbiome as the collection of microorganisms and their genomes within a specific environment. In particular, we have focused on the analysis of microbiome profiled using 16S rRNA gene sequencing. Microbiome data have their inherent characteristics, which limit statistical analysis. These characteristics include a large number of zeroes, uneven library sizes, compositional and multivariate structures. Furthermore, as the microbial communities are very sensitive to their surrounding environment, microbiome data are prone to batch effects, i.e. any unwanted sources of variation that are unrelated to and obscure the biological factors of interest. Therefore, computational methods for batch effect management that take into account the data characteristics are needed. In the first part of this thesis, we reviewed existing methods to manage batch effects. These can be distinguished between correcting or accounting for batch effects. The former generates batch effect corrected data for any downstream analysis, while the latter includes batch effects as covariates in statistical models. However, methods correcting for batch effects do not consider the non-Gaussian distribution and multivariate structure of the data, while methods accounting for batch effects are limited to differential abundance analysis. We proposed a new method for batch effect correction based on Partial Least Squares Discriminant Analysis. "PLSDA-batch" is non-parametric and multivariate. It estimates latent components related to treatment and batch effects to remove batch variation whilst preserving treatment variation. Two variants were also developed to handle unbalanced batch x treatment designs and to select microbial variables that discriminate sample groups (such as treatments). We also implemented "PLSDA-batch" into an R package. In the second part of this thesis, we developed two frameworks for batch effect management including our proposed methods or variable selection in microbiome data analysis, which are available on GitHub (https://github.com/EvaYiwenWang). In the third part of this thesis, we presented the collaborative work on oral microbiome to identify microbial signatures discriminating between Rheumatoid Arthritis (RA) and healthy control subjects, thus uncovering new knowledge on the relationship between oral microbiome and RA disease. © 2021 Yiwen Wang PhD thesis Fri, 01 Jan 2021 00:00:00 GMT http://hdl.handle.net/11343/297094 2021-01-01T00:00:00Z http://hdl.handle.net/11343/297093 Wijeysundera, DN; Pearse, RM; Shulman, MA; Abbott, TEF; Torres, E; Croal, BL; Granton, JT; Thorpe, KE; Grocott, MPW; Farrington, C; Myles, PS; Cuthbertson, BH 2016-01-01 Measurement of Exercise Tolerance before Surgery (METS) study: a protocol for an international multicentre prospective cohort study of cardiopulmonary exercise testing prior to major non-cardiac surgery INTRODUCTION: Preoperative functional capacity is considered an important risk factor for cardiovascular and other complications of major non-cardiac surgery. Nonetheless, the usual approach for estimating preoperative functional capacity, namely doctors' subjective assessment, may not accurately predict postoperative morbidity or mortality. 3 possible alternatives are cardiopulmonary exercise testing; the Duke Activity Status Index, a standardised questionnaire for estimating functional capacity; and the serum concentration of N-terminal pro-B-type natriuretic peptide (NT pro-BNP), a biomarker for heart failure and cardiac ischaemia. METHODS AND ANALYSIS: The Measurement of Exercise Tolerance before Surgery (METS) Study is a multicentre prospective cohort study of patients undergoing major elective non-cardiac surgery at 25 participating study sites in Australia, Canada, New Zealand and the UK. We aim to recruit 1723 participants. Prior to surgery, participants undergo symptom-limited cardiopulmonary exercise testing on a cycle ergometer, complete the Duke Activity Status Index questionnaire, undergo blood sampling to measure serum NT pro-BNP concentration and have their functional capacity subjectively assessed by their responsible doctors. Participants are followed for 1 year after surgery to assess vital status, postoperative complications and general health utilities. The primary outcome is all-cause death or non-fatal myocardial infarction within 30 days after surgery, and the secondary outcome is all-cause death within 1 year after surgery. Both receiver-operating-characteristic curve methods and risk reclassification table methods will be used to compare the prognostic accuracy of preoperative subjective assessment, peak oxygen consumption during cardiopulmonary exercise testing, Duke Activity Status Index scores and serum NT pro-BNP concentration. ETHICS AND DISSEMINATION: The METS Study has received research ethics board approval at all sites. Participant recruitment began in March 2013, and 1-year follow-up is expected to finish in 2016. Publication of the results of the METS Study is anticipated to occur in 2017. Journal Article Fri, 01 Jan 2016 00:00:00 GMT http://hdl.handle.net/11343/297093 2016-01-01T00:00:00Z http://hdl.handle.net/11343/297092 Cnossen, MC; Scholten, AC; Lingsma, HF; Synnot, A; Tavender, E; Gantner, D; Lecky, F; Steyerberg, EW; Polinder, S 2021-04-15 Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review Guidelines aim to improve the quality of medical care and reduce treatment variation. The extent to which guidelines are adhered to in the field of traumatic brain injury (TBI) is unknown. The objectives of this systematic review were to (1) quantify adherence to guidelines in adult patients with TBI, (2) examine factors influencing adherence, and (3) study associations of adherence to clinical guidelines and outcome. We searched EMBASE, MEDLINE, Cochrane Central, PubMed, Web of Science, PsycINFO, SCOPUS, CINAHL, and grey literature in October 2014. We included studies of evidence-based (inter)national guidelines that examined the acute treatment of adult patients with TBI. Methodological quality was assessed using the Research Triangle Institute item bank and Quality in Prognostic Studies Risk of Bias Assessment Instrument. Twenty-two retrospective and prospective observational cohort studies, reported in 25 publications, were included, describing adherence to 13 guideline recommendations. Guideline adherence varied considerably between studies (range 18-100%) and was higher in guideline recommendations based on strong evidence compared with those based on lower evidence, and lower in recommendations of relatively more invasive procedures such as craniotomy. A number of patient-related factors, including age, Glasgow Coma Scale, and intracranial pathology, were associated with greater guideline adherence. Guideline adherence to Brain Trauma Foundation guidelines seemed to be associated with lower mortality. Guideline adherence in TBI is suboptimal, and wide variation exists between studies. Guideline adherence may be improved through the development of strong evidence for guidelines. Further research specifying hospital and management characteristics that explain variation in guideline adherence is warranted. Journal Article Thu, 15 Apr 2021 00:00:00 GMT http://hdl.handle.net/11343/297092 2021-04-15T00:00:00Z http://hdl.handle.net/11343/297091 Bragge, P; Clavisi, O; Turner, T; Tavender, E; Collie, A; Gruen, RL 2011-06-17 The Global Evidence Mapping Initiative: Scoping research in broad topic areas BACKGROUND: Evidence mapping describes the quantity, design and characteristics of research in broad topic areas, in contrast to systematic reviews, which usually address narrowly-focused research questions. The breadth of evidence mapping helps to identify evidence gaps, and may guide future research efforts. The Global Evidence Mapping (GEM) Initiative was established in 2007 to create evidence maps providing an overview of existing research in Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI). METHODS: The GEM evidence mapping method involved three core tasks:1. Setting the boundaries and context of the map: Definitions for the fields of TBI and SCI were clarified, the prehospital, acute inhospital and rehabilitation phases of care were delineated and relevant stakeholders (patients, carers, clinicians, researchers and policymakers) who could contribute to the mapping were identified. Researchable clinical questions were developed through consultation with key stakeholders and a broad literature search. 2. Searching for and selection of relevant studies: Evidence search and selection involved development of specific search strategies, development of inclusion and exclusion criteria, searching of relevant databases and independent screening and selection by two researchers. 3. Reporting on yield and study characteristics: Data extraction was performed at two levels - 'interventions and study design' and 'detailed study characteristics'. The evidence map and commentary reflected the depth of data extraction. RESULTS: One hundred and twenty-nine researchable clinical questions in TBI and SCI were identified. These questions were then prioritised into high (n = 60) and low (n = 69) importance by the stakeholders involved in question development. Since 2007, 58 263 abstracts have been screened, 3 731 full text articles have been reviewed and 1 644 relevant neurotrauma publications have been mapped, covering fifty-three high priority questions. CONCLUSIONS: GEM Initiative evidence maps have a broad range of potential end-users including funding agencies, researchers and clinicians. Evidence mapping is at least as resource-intensive as systematic reviewing. The GEM Initiative has made advancements in evidence mapping, most notably in the area of question development and prioritisation. Evidence mapping complements other review methods for describing existing research, informing future research efforts, and addressing evidence gaps. Journal Article Fri, 17 Jun 2011 00:00:00 GMT http://hdl.handle.net/11343/297091 2011-06-17T00:00:00Z http://hdl.handle.net/11343/297090 Green, SE; Bosch, M; McKenzie, JE; O'Connor, DA; Tavender, EJ; Bragge, P; Chau, M; Pitt, V; Rosenfeld, JV; Gruen, RL 2012-08-07 Improving the care of people with traumatic brain injury through the Neurotrauma Evidence Translation (NET) program: protocol for a program of research The Neurotrauma Evidence Translation (NET) program was funded in 2009 to increase the uptake of research evidence in the clinical care of patients who have sustained traumatic brain injury. This paper reports the rationale and plan for this five-year knowledge translation research program. The overarching aims of the program are threefold: to improve outcomes for people with traumatic brain injury; to create a network of neurotrauma clinicians and researchers with expertise in knowledge translation and evidence-based practice; and to contribute knowledge to the field of knowledge translation research. The program comprises a series of interlinked projects spanning varying clinical environments and disciplines relevant to neurotrauma, anchored within four themes representing core knowledge translation activities: reviewing research evidence; understanding practice; developing and testing interventions for practice change; and building capacity for knowledge translation in neurotrauma. The program uses a range of different methods and study designs, including: an evidence fellowship program; conduct of and training in systematic reviews; mixed method study designs to describe and understand factors that influence current practices (e.g., semi-structured interviews and surveys); theory-based methods to develop targeted interventions aiming to change practice; a cluster randomised trial to test the effectiveness of a targeted theory-informed intervention; stakeholder involvement activities; and knowledge translation events such as consensus conferences. Journal Article Tue, 07 Aug 2012 00:00:00 GMT http://hdl.handle.net/11343/297090 2012-08-07T00:00:00Z http://hdl.handle.net/11343/297089 Glas, GJ; Muller, J; Binnekade, JM; Cleffken, B; Colpaert, K; Dixon, B; Juffermans, NP; Knape, P; Levi, MM; Loef, BG; Mackie, DP; Malbrain, M; Schultz, MJ; van der Sluijs, KF 2014-03-25 HEPBURN - investigating the efficacy and safety of nebulized heparin versus placebo in burn patients with inhalation trauma: study protocol for a multi-center randomized controlled trial BACKGROUND: Pulmonary coagulopathy is a hallmark of lung injury following inhalation trauma. Locally applied heparin attenuates lung injury in animal models of smoke inhalation. Whether local treatment with heparin benefits patients with inhalation trauma is uncertain. The present trial aims at comparing a strategy using frequent nebulizations of heparin with standard care in intubated and ventilated burn patients with bronchoscopically confirmed inhalation trauma. METHODS: The Randomized Controlled Trial Investigating the Efficacy and Safety of Nebulized HEParin versus Placebo in BURN Patients with Inhalation Trauma (HEPBURN) is an international multi-center, double-blind, placebo-controlled, two-arm study. One hundred and sixteen intubated and ventilated burn patients with confirmed inhalation trauma are randomized to nebulizations of heparin (the nebulized heparin strategy) or nebulizations of normal saline (the control strategy) every four hours for 14 days or until extubation, whichever comes first. The primary endpoint is the number of ventilator-free days, defined as days alive and breathing without assistance during the first 28 days, if the period of unassisted breathing lasts for at least 24 consecutive hours. DISCUSSION: As far as the authors know, HEPBURN is the first randomized, placebo-controlled trial, powered to investigate whether local treatment with heparin shortens duration of ventilation of intubated and ventilated burn patients with inhalation trauma. TRIAL REGISTRATION: NCT01773083 (http://www.clinicaltrials.gov), registered on 16 January 2013.Recruiting. Randomisation commenced on 1 January 2014. Journal Article Tue, 25 Mar 2014 00:00:00 GMT http://hdl.handle.net/11343/297089 2014-03-25T00:00:00Z http://hdl.handle.net/11343/297088 Kemp, A; Preen, DB; Saunders, C; Boyle, F; Bulsara, M; Malacova, E; Roughead, EE 2014-06-04 Early discontinuation of endocrine therapy for breast cancer: who is at risk in clinical practice? PURPOSE: Despite evidence supporting at least five years of endocrine therapy for early breast cancer, many women discontinue therapy early. We investigated the impact of initial therapy type and specific comorbidities on discontinuation of endocrine therapy in clinical practice. METHODS: We identified women in a population-based cohort with a diagnosis of early breast cancer and an incident dispensing of anastrozole, letrozole or tamoxifen from 2003-2008 (N = 1531). Pharmacy and health service data were used to determine therapy duration, treatment for pre-existing and post-initiation comorbidities (anxiety, depression, hot flashes, musculoskeletal pain, osteoporosis, vaginal atrophy), demographic and other clinical characteristics. Time to discontinuation of initial, and any, endocrine therapy was calculated. Cox regression determined the association of different characteristics on early discontinuation. RESULTS: Initial endocrine therapy continued for a median of 2.2 years and any endocrine therapy for 4.8 years. Cumulative probability of discontinuing any therapy was 17% after one year and 58% by five years. Initial tamoxifen, pre-existing musculoskeletal pain and newly-treated anxiety predicted shorter initial therapy but not discontinuation of any therapy. Early discontinuation of any therapy was associated with newly-treated hot flashes (HR = 2.1, 95% CI = 1.3-3.3), not undergoing chemotherapy (HR = 1.4, 95% CI = 1.1-1.8) and not undergoing mastectomy (HR = 1.5, 95% CI = 1.2-1.8). CONCLUSIONS: Less than half of women completed five years of endocrine therapy. Women at greatest risk of stopping any therapy early were those with newly-treated hot flashes, no initial chemotherapy, or no initial mastectomy. This suboptimal use means that the reductions in recurrence demonstrated in clinical trials may not be realised in practice. Journal Article Wed, 04 Jun 2014 00:00:00 GMT http://hdl.handle.net/11343/297088 2014-06-04T00:00:00Z http://hdl.handle.net/11343/297087 Kemp, A; Preen, DB; Saunders, C; Boyle, F; Bulsara, M; Holman, CDJ; Malacova, E; Roughead, EE 2014-01-02 Women Commencing Anastrozole, Letrozole or Tamoxifen for Early Breast Cancer: The Impact of Comorbidity and Demographics on Initial Choice BACKGROUND: Australian clinical guidelines recommend endocrine therapy for all women with hormone-dependent early breast cancer. Guidelines specify tamoxifen as first-line therapy for pre-menopausal women, and tamoxifen or an aromatase inhibitor (AI) for post-menopausal women depending on the risk of recurrence based on tumour characteristics including size. Therapies have different side effect profiles; therefore comorbidity may also influence choice. We examined comorbidity, and the clinical and demographic characteristics of women commencing different therapies. PATIENTS AND METHODS: We identified the first dispensing of tamoxifen, anastrozole or letrozole for women diagnosed with invasive breast cancer in the 45 and Up Study from 2004-2009 (N = 1266). Unit-level pharmacy and medical service claims, hospital, Cancer Registry, and self-reported data were linked to determine menopause status at diagnosis, tumour size, age, comorbidities, and change in subsidy restrictions. Chi-square tests and generalised regression models were used to compare the characteristics of women commencing different therapies. RESULTS: Most pre-menopausal women commenced therapy with tamoxifen (91%). Anastrozole was the predominant therapy for post-menopausal women (57%), followed by tamoxifen (28%). Women with osteoporosis were less likely to commence anastrozole compared with tamoxifen (anastrozole RR = 0.7, 95% CI = 0.5-0.9). Women with arthritis were 1.6-times more likely to commence letrozole than anastrozole (95% CI = 1.1-2.1). Tamoxifen was more often initiated in women with tumours >1 cm, who were also ≥75 years. Subsidy restriction changes were associated with substantial increases in the proportion of women commencing AIs (anastrozole RR = 4.3, letrozole RR = 8.3). CONCLUSIONS: The findings indicate interplay of comorbidity and therapy choice for women with invasive breast cancer. Most post-menopausal women commenced therapy with anastrozole; however, letrozole and tamoxifen were more often initiated for women with comorbid arthritis and osteoporosis, respectively. Tamoxifen was also more common for women with tumours >1 cm and aged ≥75 years. Subsidy restrictions appear to have strongly influenced therapy choice. Journal Article Thu, 02 Jan 2014 00:00:00 GMT http://hdl.handle.net/11343/297087 2014-01-02T00:00:00Z http://hdl.handle.net/11343/297086 Kemp, A; Preen, DB; Saunders, C; Holman, CDJ; Bulsara, M; Rogers, K; Roughead, EE 2013-02-11 Ascertaining invasive breast cancer cases; the validity of administrative and self-reported data sources in Australia BACKGROUND: Statutory State-based cancer registries are considered the 'gold standard' for researchers identifying cancer cases in Australia, but research using self-report or administrative health datasets (e.g. hospital records) may not have linkage to a Cancer Registry and need to identify cases. This study investigated the validity of administrative and self-reported data compared with records in a State-wide Cancer Registry in identifying invasive breast cancer cases. METHODS: Cases of invasive breast cancer recorded on the New South Wales (NSW) Cancer Registry between July 2004 and December 2008 (the study period) were identified for women in the 45 and Up Study. Registry cases were separately compared with suspected cases ascertained from: i) administrative hospital separations records; ii) outpatient medical service claims; iii) prescription medicines claims; and iv) the 45 and Up Study baseline survey. Ascertainment flags included diagnosis codes, surgeries (e.g. lumpectomy), services (e.g. radiotherapy), and medicines used for breast cancer, as well as self-reported diagnosis. Positive predictive value (PPV), sensitivity and specificity were calculated for flags within individual datasets, and for combinations of flags across multiple datasets. RESULTS: Of 143,010 women in the 45 and Up Study, 2039 (1.4%) had an invasive breast tumour recorded on the NSW Cancer Registry during the study period. All of the breast cancer flags examined had high specificity (>97.5%). Of the flags from individual datasets, hospital-derived 'lumpectomy and diagnosis of invasive breast cancer' and '(lumpectomy or mastectomy) and diagnosis of invasive breast cancer' had the greatest PPV (89% and 88%, respectively); the later having greater sensitivity (59% and 82%, respectively). The flag with the highest sensitivity and PPV ≥ 85% was 'diagnosis of invasive breast cancer' (both 86%). Self-reported breast cancer diagnosis had a PPV of 50% and sensitivity of 85%, and breast radiotherapy had a PPV of 73% and a sensitivity of 58% compared with Cancer Registry records. The combination of flags with the greatest PPV and sensitivity was '(lumpectomy or mastectomy) and (diagnosis of invasive breast cancer or breast radiotherapy)' (PPV and sensitivity 83%). CONCLUSIONS: In the absence of Cancer Registry data, administrative and self-reported data can be used to accurately identify cases of invasive breast cancer for sample identification, removing cases from a sample, or risk adjustment. Invasive breast cancer can be accurately identified using hospital-derived diagnosis alone or in combination with surgeries and breast radiotherapy. Journal Article Mon, 11 Feb 2013 00:00:00 GMT http://hdl.handle.net/11343/297086 2013-02-11T00:00:00Z http://hdl.handle.net/11343/297085 Legge, S; Garnett, S; Maute, K; Heathcote, J; Murphy, S; Woinarski, JCZ; Astheimer, L 2015-10-07 A Landscape-Scale, Applied Fire Management Experiment Promotes Recovery of a Population of the Threatened Gouldian Finch, Erythrura gouldiae, in Australia's Tropical Savannas Fire is an integral part of savanna ecology and changes in fire patterns are linked to biodiversity loss in savannas worldwide. In Australia, changed fire regimes are implicated in the contemporary declines of small mammals, riparian species, obligate-seeding plants and grass seed-eating birds. Translating this knowledge into management to recover threatened species has proved elusive. We report here on a landscape-scale experiment carried out by the Australian Wildlife Conservancy (AWC) on Mornington Wildlife Sanctuary in northwest Australia. The experiment was designed to understand the response of a key savanna bird guild to fire, and to use that information to manage fire with the aim of recovering a threatened species population. We compared condition indices among three seed-eating bird species--one endangered (Gouldian finch) and two non-threatened (long-tailed finch and double-barred finch)--from two large areas (> 2,830 km2) with initial contrasting fire regimes ('extreme': frequent, extensive, intense fire; versus 'benign': less frequent, smaller, lower intensity fires). Populations of all three species living with the extreme fire regime had condition indices that differed from their counterparts living with the benign fire regime, including higher haematocrit levels in some seasons (suggesting higher levels of activity required to find food), different seasonal haematocrit profiles, higher fat scores in the early wet season (suggesting greater food uncertainty), and then lower muscle scores later in the wet season (suggesting prolonged food deprivation). Gouldian finches also showed seasonally increasing stress hormone concentrations with the extreme fire regime. Cumulatively, these patterns indicated greater nutritional stress over many months for seed-eating birds exposed to extreme fire regimes. We tested these relationships by monitoring finch condition over the following years, as AWC implemented fire management to produce the 'benign' fire regime throughout the property. The condition indices of finch populations originally living with the extreme fire regime shifted to resemble those of their counterparts living with the benign fire regime. This research supports the hypothesis that fire regimes affect food resources for savanna seed-eating birds, with this impact mediated through a range of grass species utilised by the birds over different seasons, and that fire management can effectively moderate that impact. This work provides a rare example of applied research supporting the recovery of a population of a threatened species. Journal Article Wed, 07 Oct 2015 00:00:00 GMT http://hdl.handle.net/11343/297085 2015-10-07T00:00:00Z http://hdl.handle.net/11343/297084 Dar, ME; Kanaan, RAA 2016-01-01 Positron emission tomography in patients with psychogenic non-epileptic seizures response Journal Article Fri, 01 Jan 2016 00:00:00 GMT http://hdl.handle.net/11343/297084 2016-01-01T00:00:00Z http://hdl.handle.net/11343/297083 Marshall, SD; Chrimes, N 2016-11-01 Time for a breath of fresh air: Rethinking training in airway management Journal Article Tue, 01 Nov 2016 00:00:00 GMT http://hdl.handle.net/11343/297083 2016-11-01T00:00:00Z http://hdl.handle.net/11343/297082 Marshall, SD 2017-03-01 Helping experts and expert teams perform under duress: an agenda for cognitive aid research Journal Article Wed, 01 Mar 2017 00:00:00 GMT http://hdl.handle.net/11343/297082 2017-03-01T00:00:00Z http://hdl.handle.net/11343/297081 Mehta, S; Granton, J; Gordon, AC; Cook, DJ; Lapinsky, S; Newton, G; Bandayrel, K; Little, A; Siau, C; Ayers, D; Singer, J; Lee, TCK; Walley, KR; Storms, M; Cooper, DJ; Holmes, CL; Hebert, P; Presneill, J; Russell, JA; Vasopressin and Septic Shock Trial (VASST) Investigators, 2017-05-04 Erratum to: Cardiac ischemia in patients with septic shock randomized to vasopressin or norepinephrine. Journal Article Thu, 04 May 2017 00:00:00 GMT http://hdl.handle.net/11343/297081 2017-05-04T00:00:00Z http://hdl.handle.net/11343/297080 Xiang, Y; Wang, X; He, L; Wang, W; Moran, W 2016 Spatial-Temporal Analysis of Environmental Data of North Beijing District Using Hilbert-Huang Transform. Temperature, solar radiation and water are major important variables in ecosystem models which are measurable via wireless sensor networks (WSN). Effective data analysis is necessary to extract significant spatial and temporal information. In this work, information regarding the long term variation of seasonal field environment conditions is explored using Hilbert-Huang transform (HHT) based analysis on the wireless sensor network data collection. The data collection network, consisting of 36 wireless nodes, covers an area of 100 square kilometres in Yanqing, the northwest of Beijing CBD, in China and data collection involves environmental parameter observations taken over a period of three months in 2011. The analysis used the empirical mode decomposition (EMD/EEMD) to break a time sequence of data down to a finite set of intrinsic mode functions (IMFs). Both spatial and temporal properties of data explored by HHT analysis are demonstrated. Our research shows potential for better understanding the spatial-temporal relationships among environmental parameters using WSN and HHT. Journal Article Fri, 01 Jan 2016 00:00:00 GMT http://hdl.handle.net/11343/297080 2016-01-01T00:00:00Z http://hdl.handle.net/11343/297079 Burvenich, IJG; Parakh, S; Lee, F-T; Guo, N; Liu, Z; Gan, HK; Rigopoulos, A; O'Keefe, GJ; Gong, SJ; Goh, YW; Tochon-Danguy, H; Scott, FE; Kotsuma, M; Hirotani, K; Senaldi, G; Scott, AM 2018-01-01 Molecular imaging of T cell co-regulator factor B7-H3 with Zr-89-DS-5573a B7-H3 is a transmembrane protein widely expressed in a variety of cancers and has been shown to play a role in anti-tumor immunity. This study aims to develop a molecular imaging probe to identify B7-H3 expression in tumors and to develop 89Zr-DS-5573a as a theranostic that could aid patient selection in clinical Phase I studies. Methods: The anti-B7-H3 humanised monoclonal antibody DS-5573a was labeled with zirconium-89 (89Zr-), and assessed for radiochemical purity, immunoreactivity (Lindmo analysis), antigen binding affinity (Scatchard analysis), and serum stability in vitro. In vivo biodistribution and imaging studies were performed with positron emission tomography and magnetic resonance imaging (PET/MRI) studies to identify and quantitate 89Zr-DS-5573a tumor uptake in a B7-H3-positive breast cancer model (MDA-MB-231) and a B7-H3-negative murine colon cancer model (CT26). Imaging and biodistribution studies were also performed in MDA-MB-231 tumor-bearing SCID mice in the absence and presence of therapeutic DS-5573a antibody dose (3 mg/kg DS-5573a). Results:89Zr-DS-5573a showed high and specific binding to B7-H3-expressing MDA-MB-231 cells (immunoreactivity on day 0, 75.0 ± 2.9%), and low binding to B7-H3-negative CT26 cells (immunoreactivity on day 0, 10.85 ± 0.11%) in vitro. 89Zr-DS-5573a demonstrated good serum stability in vitro with 57.2 ± 2.0% of immunoreactivity remaining on day 7. In vivo biodistribution studies showed high uptake of 89Zr-DS-5573a in B7-H3-expressing MDA-MB-231 tumor-bearing mice, achieving 32.32 ± 6.55 %ID/g on day 7 post injection in BALB/c nu/nu mice and 25.76 ± 1.79 %ID/g in SCID mice, with minimal evidence of non-specific uptake in normal tissues, and excellent tumor localization on PET/MRI. In a combined imaging/therapy study, receptor saturation was demonstrated in tumors responding to therapy. Conclusion:89Zr-DS-5573a demonstrates specific and prolonged targeting of B7-H3-expressing tumors in vivo. Saturation of binding sites was demonstrated in tumors responding to DS-5573a therapy. These results indicate that 89Zr-DS-5573a has potential to target B7-H3-expressing tumors in cancer patients. Furthermore 89Zr-DS-5573a has the potential to provide important insights into T cell biology through its specific binding to B7-H3. Journal Article Mon, 01 Jan 2018 00:00:00 GMT http://hdl.handle.net/11343/297079 2018-01-01T00:00:00Z http://hdl.handle.net/11343/297078 Wu, T; Luo, J; Xu, B 2015-11 In vitro antidiabetic effects of selected fruits and vegetables against glycosidase and aldose reductase. In vitro antidiabetic effect of fruits and vegetables with reports as folk remedies were investigated. The antidiabetic effects were evaluated by comparing the inhibitory properties of α-glycosidase, aldose reductase, and antioxidant activity. The results indicated that lychee extract exhibited the best dose-dependent inhibitory activity against α-glycosidase with IC 50 of 10.4 mg/mL, and lemon peel extract exhibited aldose reductase inhibitory potential with IC 50 value at 3.63 mg/mL. Besides, the result also showed that the inhibitory effects of blueberry and plum against α-glycosidase were strong among the fruits samples. Bitter gourd and eggplant demonstrated significant inhibitory potential against aldose reductase, with IC 50 values at 8.55 mg/mL and 8.06 mg/mL, respectively. The result from correlation analysis part showed that the antioxidant activities of selected fruits and vegetables were found related to their health beneficial effects, as there was positive correlations between total flavonoids content (TFC) and aldose reductase inhibitory activity (r (2) = 0.556). Journal Article Sun, 01 Nov 2015 00:00:00 GMT http://hdl.handle.net/11343/297078 2015-11-01T00:00:00Z http://hdl.handle.net/11343/297077 Flannick, J; Fuchsberger, C; Mahajan, A; Teslovich, TM; Agarwala, V; Gaulton, KJ; Caulkins, L; Koesterer, R; Ma, C; Moutsianas, L; McCarthy, DJ; Rivas, MA; Perry, JRB; Sim, X; Blackwell, TW; Robertson, NR; Rayner, NW; Cingolani, P; Locke, AE; Tajes, JF; Highland, HM; Dupuis, J; Chines, PS; Lindgren, CM; Hartl, C; Jackson, AU; Chen, H; Huyghe, JR; van de Bunt, M; Pearson, RD; Kumar, A; Mueller-Nurasyid, M; Grarup, N; Stringham, HM; Gamazon, ER; Lee, J; Chen, Y; Scott, RA; Below, JE; Chen, P; Huang, J; Go, MJ; Stitzel, ML; Pasko, D; Parker, SCJ; Varga, TV; Green, T; Beer, NL; Day-Williams, AG; Ferreira, T; Fingerlin, T; Horikoshi, M; Hu, C; Huh, I; Ikram, MK; Kim, B-J; Kim, Y; Kim, YJ; Kwon, M-S; Lee, J; Lee, S; Lin, K-H; Maxwell, TJ; Nagai, Y; Wang, X; Welch, RP; Yoon, J; Zhang, W; Barzilai, N; Voight, BF; Han, B-G; Jenkinson, CP; Kuulasmaa, T; Kuusisto, J; Manning, A; Ng, MCY; Palmer, ND; Balkau, B; Stancakova, A; Abboud, HE; Boeing, H; Giedraitis, V; Prabhakaran, D; Gottesman, O; Scott, J; Carey, J; Kwan, P; Grant, G; Smith, JD; Neale, BM; Purcell, S; Butterworth, AS; Howson, JMM; Lee, HM; Lu, Y; Kwak, S-H; Zhao, W; Danesh, J; Lam, VKL; Park, KS; Saleheen, D; So, WY; Tam, CHT; Afzal, U; Aguilar, D; Arya, R; Aung, T; Chan, E; Navarro, C; Cheng, C-Y; Palli, D; Correa, A; Curran, JE; Rybin, D; Farook, VS; Fowler, SP; Freedman, BI; Griswold, M; Hale, DE; Hicks, PJ; Khor, C-C; Kumar, S; Lehne, B; Thuillier, D; Lim, WY; Liu, J; Loh, M; Musani, SK; Puppala, S; Scott, WR; Yengo, L; Tan, S-T; Taylor, HA; Thameem, F; Wilson, G; Wong, TY; Njolstad, PR; Levy, JC; Mangino, M; Bonnycastle, LL; Schwarzmayr, T; Fadista, J; Surdulescu, GL; Herder, C; Groves, CJ; Wieland, T; Bork-Jensen, J; Brandslund, I; Christensen, C; Koistinen, HA; Doney, ASF; Kinnunen, L; Esko, T; Farmer, AJ; Hakaste, L; Hodgkiss, D; Kravic, J; Lyssenko, V; Hollensted, M; Jorgensen, ME; Jorgensen, T; Ladenvall, C; Justesen, JM; Karajamaki, A; Kriebel, J; Rathmann, W; Lannfelt, L; Lauritzen, T; Narisu, N; Linneberg, A; Melander, O; Milani, L; Neville, M; Orho-Melander, M; Qi, L; Qi, Q; Roden, M; Rolandsson, O; Swift, A; Rosengren, AH; Stirrups, K; Wood, AR; Mihailov, E; Blancher, C; Carneiro, MO; Maguire, J; Poplin, R; Shakir, K; Fennell, T; DePristo, M; de Angelis, MH; Deloukas, P; Gjesing, AP; Jun, G; Nilsson, PM; Murphy, J; Onofrio, R; Thorand, B; Hansen, T; Meisinger, C; Hu, FB; Isomaa, B; Karpe, F; Liang, L; Peters, A; Huth, C; O'Rahilly, SP; Palmer, CNA; Pedersen, O; Rauramaa, R; Tuomilehto, J; Salomaa, V; Watanabe, RM; Syvanen, A-C; Bergman, RN; Bharadwaj, D; Bottinger, EP; Cho, YS; Chandak, GR; Chan, JC; Chia, KS; Daly, MJ; Ebrahim, SB; Langenberg, C; Elliott, P; Jablonski, KA; Lehman, DM; Jia, W; Ma, RCW; Pollin, TI; Sandhu, M; Tandon, N; Froguel, P; Barroso, I; Teo, YY; Zeggini, E; Loos, RJF; Small, KS; Ried, JS; DeFronzo, RA; Grallert, H; Glaser, B; Metspalu, A; Wareham, NJ; Walker, M; Banks, E; Gieger, C; Ingelsson, E; Im, HK; Illig, T; Franks, PW; Buck, G; Trakalo, J; Buck, D; Prokopenko, I; Magi, R; Lind, L; Farjoun, Y; Owen, KR; Gloyn, AL; Strauch, K; Tuomi, T; Kooner, JS; Lee, J-Y; Park, T; Donnelly, P; Morris, AD; Hattersley, AT; Bowden, DW; Collins, FS; Atzmon, G; Chambers, JC; Spector, TD; Laakso, M; Strom, TM; Bell, GI; Blangero, J; Duggirala, R; Tai, E; McVean, G; Hanis, CL; Wilson, JG; Seielstad, M; Frayling, TM; Meigs, JB; Cox, NJ; Sladek, R; Lander, ES; Gabriel, S; Mohlke, KL; Meitinger, T; Groop, L; Abecasis, G; Scott, LJ; Morris, AP; Kang, HM; Altshuler, D; Burtt, NP; Florez, JC; Boehnke, M; McCarthy, MI 2018-01-23 Erratum: Sequence data and association statistics from 12,940 type 2 diabetes cases and controls. This corrects the article DOI: 10.1038/sdata.2017.179. Journal Article Tue, 23 Jan 2018 00:00:00 GMT http://hdl.handle.net/11343/297077 2018-01-23T00:00:00Z http://hdl.handle.net/11343/297076 Peyton, PJ; Wallin, M; Hallback, M 2019-02-26 New generation continuous cardiac output monitoring from carbon dioxide elimination BACKGROUND: There is continuing interest among clinicians in the potential for advanced hemodynamic monitoring and "goal directed" intravenous fluid administration guided by minimally-invasive cardiac output measurement to reduce complication rates in high risk patients undergoing major surgery. However, the adoption of the available technologies has been limited, due to cost, complexity and reliability of measurements provided. We review progress in the development of new generation methods for continuous non-invasive monitoring of cardiac output from measurement of carbon dioxide elimination in ventilated patients using the Differential Fick method. MAIN TEXT: The history and underlying theoretical basis are described, and its recent further development and implementation using modern generation anesthesia monitoring and delivery systems by two separate but parallel methods, termed "Capnotracking" and "Capnodynamics". Both methods generate breath-by-breath hands-free cardiac output monitoring from changes in carbon dioxide elimination produced by automatic computerized modulation of respiratory rate delivered by an electronic ventilator. Extensive preclinical validation in animal models of hemodynamic instability, with implanted ultrasonic flow probes for gold standard reference measurements, shows this approach delivers reliable, continuous cardiac output measurement in real time. The accuracy and precision of measurement by the Capnodynamic method were maintained under a wide range of both hemodynamic and respiratory conditions, including inotropic stimulation, vasodilatation, hemorrhage, caval compression, alveolar lavage, changes in tidal volume and positive end-expiratory pressure, and hypercapnia, with only brief derangement observed in a model of lower body ischemia involving release of prolonged aortic occlusion by an intra-aortic balloon. Phase 2 testing of a Capnotracking system in patients undergoing cardiac surgery and liver transplantation has achieved a percentage error of agreement with thermodilution of +/- 38.7% across a wide range of hemodynamic states. CONCLUSIONS: Progress in development of these technologies suggest that a robust, automated and reliable method of non-invasive cardiac output monitoring from capnography is close at hand for use in major surgery and critical care. The great advantage of this approach is that it can be fully integrated into the anesthesia machine and ventilator, using components that are already standard in modern anesthesia and intensive care workstations, and should be virtually hands-free and automatic. Journal Article Tue, 26 Feb 2019 00:00:00 GMT http://hdl.handle.net/11343/297076 2019-02-26T00:00:00Z http://hdl.handle.net/11343/297075 Shepherd, SM; Willis-Esqueda, C; Newton, D; Sivasubramaniam, D; Paradies, Y 2019-02-26 The challenge of cultural competence in the workplace: perspectives of healthcare providers BACKGROUND: Cross-cultural educational initiatives for professionals are now commonplace across a variety of sectors including health care. A growing number of studies have attempted to explore the utility of such initiatives on workplace behaviors and client outcomes. Yet few studies have explored how professionals perceive cross-cultural educational models (e.g., cultural awareness, cultural competence) and the extent to which they (and their organizations) execute the principles in practice. In response, this study aimed to explore the general perspectives of health care professionals on culturally competent care, their experiences working with multi-cultural patients, their own levels of cultural competence and the extent to which they believe their workplaces address cross-cultural challenges. METHODS: The perspectives and experiences of a sample of 56 health care professionals across several health care systems from a Mid-Western state in the United States were sourced via a 19-item questionnaire. The questionnaire comprised both open-ended questions and multiple choice items. Percentages across participant responses were calculated for multiple choice items. A thematic analysis of open-ended responses was undertaken to identify dominant themes. RESULTS: Participants largely expressed confidence in their ability to meet the needs of multi-cultural clientele despite almost half the sample not having undergone formal cross-cultural training. The majority of the sample appeared to view cross-cultural education from a 'cultural awareness' perspective - effective cross-cultural care was often defined in terms of possessing useful cultural knowledge (e.g., norms and customs) and facilitating communication (the use of interpreters); in other words, from an immediate practical standpoint. The principles of systemic cross-cultural approaches (e.g., cultural competence, cultural safety) such as a recognition of racism, power imbalances, entrenched majority culture biases and the need for self-reflexivity (awareness of one's own prejudices) were scarcely acknowledged by study participants. CONCLUSIONS: Findings indicate a need for interventions that acknowledge the value of cultural awareness-based approaches, while also exploring the utility of more comprehensive cultural competence and safety approaches. Journal Article Tue, 26 Feb 2019 00:00:00 GMT http://hdl.handle.net/11343/297075 2019-02-26T00:00:00Z