Digital Commons Network^™

Examining The Potential For Coronary Artery Calcium (Cac) Scoring For Individuals At Low Cardiovascular Risk., David Playford, Christian Hamilton-Craig, Girish Dwivedi, Gemma Figtree

Medical Papers and Journal Articles

Atherosclerosis is the commonest cause of death in Australia. Cardiovascular (CV) risk calculators have an important role in preventative cardiology, although they are are strongly age-dependent and designed to identify individuals at high risk of an imminent event. The imprecision around “intermediate” or “low” risk generates therapeutic uncertainty, and a significant proportion of patients presenting with myocardial infarction come from these groups, often with no warning. This highlights a conundrum: “Low” risk does not mean “no” risk.

A fresh approach may be required to address the clinical conundrum around CV preventative approaches in non-high-risk individuals. While probabilistic calculators do not …

Birthing In Regional Australia: Women's Decision Making Surrounding Birthplace, Alexa Seal, Emma Hoban, Annette Panzera, Joseph Mcgirr

Medical Papers and Journal Articles

Objective

Although there is some research on women’s choice of birthplace, most of this research has been conducted overseas. This study explored factors influencing the decision to use public or private maternity services within regional Australia.

Methods

This cross-sectional study consisted of a community-based, anonymous, online questionnaire focused on factors influencing a woman’s choice of birth location and included adult females who had given birth in the past 2 years within two regional areas. Descriptive statistics were used to analyse demographic characteristics and factors influencing decisions regarding birthplace. Pearson’s Chi-squared test was used to compare public and private births for …

Cardiac Damage Staging Classification Predicts Prognosis In All The Major Subtypes Of Severe Aortic Stenosis: Insights From The National Echo Database Australia, Afik Snir, Martin Ng, Geoffrey A. Strange, David Playford, Simon Stewart, David S. Celermajer

Medical Papers and Journal Articles

Background

There are currently no established prognostic models for “low-gradient” severe aortic stenosis (AS), including those with low-flow, low-gradient (LFLG) or normal-flow, low-gradient (NFLG) severe AS. The “cardiac damage staging classification” has been validated as a clinically useful prognostic tool for high-gradient severe AS but not yet for these other common subtypes of severe AS, LFLG and NFLG.

Methods

The authors analyzed data from the National Echo Database of Australia, a large national, multicenter registry with individual data linkage to mortality. Of 192,060 adults (mean age, 62.8 ± 17.8 years) with comprehensive ultrasound profiling of the native aortic valve studied …

Markers Of Elevated Left Ventricular Filling Pressure Are Associated With Increased Mortality In Nonsevere Aortic Stenosis, Lauren C. Giudicatti, Sally Burrows, David Playford, Geoff Strange, Graham Hillis

Medical Papers and Journal Articles

Background: Echocardiographic measures of elevated left ventricular filling pressures are associated with an adverse prognosis. The aim of this study was to determine the relationship between acute (ratio of early transmitral flow to mitral annular velocities; E/e’) and chronic (indexed left atrial volume; LAVI) markers of left ventricular filling pressure (LVFP) and mortality in patients with non-severe aortic stenosis (AS), within the National Echo Database of Australia cohort. We hypothesised that they would reflect the early haemodynamic consequences of AS and be associated with increased mortality in this setting.

Methods: The first record for patients 18 years or over showing …

Machine Learning Applications To Neuroimaging For Glioma Detection And Classification: An Artificial Intelligence Augmented Systematic Review, Quinlan D. Buchlak, Nazanin Esmaili, Jean-Christophe Leveque, Christine Bennett, Farrokh Farrokhi, Massimo Piccardi

Medical Papers and Journal Articles

Glioma is the most common primary intraparenchymal tumor of the brain and the 5-year survival rate of high-grade glioma is poor. Magnetic resonance imaging (MRI) is essential for detecting, characterizing and monitoring brain tumors but definitive diagnosis still relies on surgical pathology. Machine learning has been applied to the analysis of MRI data in glioma research and has the potential to change clinical practice and improve patient outcomes. This systematic review synthesizes and analyzes the current state of machine learning applications to glioma MRI data and explores the use of machine learning for systematic review automation. Various datapoints were extracted …

Clinical Outcomes Associated With Robotic And Computer-Navigated Total Knee Arthroplasty: A Machine Learning-Augmented Systematic Review, Quinlan D. Buchlak, Joe Clair, Nazanin Esmaili, Arshad Barmare, Siva Chandrasekaran

Medical Papers and Journal Articles

Background

Robotic (RTKA) and computer-navigated total knee arthroplasty (CNTKA) are increasingly replacing manual techniques in orthopaedic surgery. This systematic review compared clinical outcomes associated with RTKA and CNTKA and investigated the utility of natural language processing (NLP) for the literature synthesis.

Methods

A comprehensive search strategy was implemented. Results of included studies were combined and analysed. A transfer learning approach was applied to train deep NLP classifiers (BERT, RoBERTa and XLNet), with cross-validation, to partially automate the systematic review process.

Results

52 studies were included, comprising 5,067 RTKA and 2,108 CNTKA. Complication rates were 0–22% and 0–16% and surgical time …

Patients' Attitudes And Intentions Towards Taking Medical Advice For Type 2 Diabetes Mellitus: A Theory Of Planned Behaviour Analysis, Catherine Krejany, Epi Kanjo, Lee Gaedtke, Aron Chakera, Moyez Jiwa

Medical Papers and Journal Articles

Purpose: A key component of effective diabetes care is understanding patients’ perceptions about diabetes management. Patients’ attitudes and intentions towards taking medical advice may predict the outcomes for effective diabetes care. This study aims to measure participants’ attitudes, beliefs and intentions towards following medical advice to manage their diabetes using the Theory of Planned Behaviour (TPB). The domains of the TPB are correlated with clinical measures of diabetes to determine if these attitudes and intentions are predictive of better diabetes control.

Methods: A pilot study was conducted. A 34-item survey was designed using the Theory of Planned Behaviour …

Relative Incidence And Predictors Of Pulmonary Arterial Hypertension Complicating Type 2 Diabetes: The Fremantle Diabetes Study Phase I, Nishant Nundlall, David Playford, Timothy M E Davis, Wendy A. Davis

Medical Papers and Journal Articles

Aims: To determine the relative incidence and predictors of pulmonary arterial hypertension (PAH) in type 2 diabetes.

Methods: Hospitalizations for/with and death from/with PAH, and all-cause mortality, were ascertained from validated databases for participants from the longitudinal, community-based Fremantle Diabetes Study Phase I (FDS1; n = 1287) and age-, sex- and zip code-matched people without diabetes (n = 5153) between entry (1993–1996) and end-2017. Incidence rates (IRs) and IR ratios (IRRs) were calculated. Cox proportional hazards and competing risk models generated cause-specific (cs) and subdistribution (sd) hazard ratios (HRs) for incident PAH.

Results: In the pooled cohort (mean age …

Supporting Families Of Patients With Dementia At End-Of-Life In Hospital, Felicity Moon, Fiona Mcdermott, David Kissane

Medical Papers and Journal Articles

Introduction: There are barriers to implementing person-and family-centred end-of-life care for people with dementia in hospitals. Nursing care for people with dementia is enhanced through family involvement. However, families report unmet needs during admissions contributing to distress and dissatisfaction. Furthermore, little is known about families’ needs during end-of-life care for people with dementia in hospital.

Aim: This study examined perceptions of interpersonal care during end-of-life for patients with dementia.

Methods: This research used a qualitative approach framed through a social constructionist and complex systems theoretical frameworks. Hospital clinicians (n = 20) and bereaved family members (n = 12) of deceased …

The Impact Of Mandatory Mammographic Breast Density Notification On Supplemental Screening Practice In The United States: A Systematic Review, Shuangqin Huang, Nehmat Houssami, Meagan Brennan, Brooke Nickel

Medical Papers and Journal Articles

Purpose: Dense breast tissue is an independent risk factor for breast cancer and lowers the sensitivity of screening mammography. Supplemental screening with ultrasound or MRI improves breast cancer detection rate but has potential harms. Breast density notifcation (BDN) legislation has been introduced in the United States (US) and its impact on supplemental screening practice is unclear. This study systematically reviewed current evidence to explore the impact of BDN on supplemental screening practice in the US.

Methods: Medline, PubMed, Embase, Cochrane and the Cinhal Library databases were searched (2009-August 2020). Studies were assessed for eligibility, data were extracted and …

The Impact Of Device-Assisted Therapies On The Gut Microbiome In Parkinson's Disease, Michal Lubomski, Xiangnan Xu, Andrew J. Holmes, Jean Y.H. Yang, Carolyn M. Sue, Ryan L. Davis

Medical Papers and Journal Articles

Background: Microbiome feedbacks are proposed to influence Parkinson’s disease (PD) pathophysiology. A number of studies have evaluated the impact of oral medication on the gut microbiome (GM) in PD. However, the influence of PD device-assisted therapies (DATs) on the GM remains to be investigated.

Objectives: To profile acute gut microbial community alterations in response to PD DAT initiation.

Methods: Clinical data and stool samples were collected from 21 PD patients initiating either deep brain stimulation (DBS) or levodopa–carbidopa intestinal gel (LCIG) and ten spousal healthy control (HC) subjects. 16S amplicon sequencing of stool DNA enabled comparison of …

Transhumanist Genetic Enhancement: Creation Of A 'New Man' Through Technological Innovation, George Mendz, Michael Cook

Medical Papers and Journal Articles

The transhumanist project of reshaping human beings by promoting their improvement through technological innovations has a broad agenda. This study focuses on the enhancement of the human organism through genetic modification techniques. Transhumanism values and a discussion of their philosophical background provide a framework to understand its ideals. Genetics and ethics are employed to assess the claims of the transhumanist program of human enhancement. A succinct description of central concepts in genetics and an explanation of current techniques to edit the human genome serve to assess the capabilities and limitations of editing techniques. Potential benefits and liabilities of human enhancement …

Posthumanism: Creation Of 'New Men' Through Technological Innovation, George L. Mendz, Michael Cook

Medical Papers and Journal Articles

he posthumanist project proposes directing the evolution of human beings by promoting their improvement through technological means to create a variety of entities that will have few or no common characteristics with current humans. Its agenda is extremely broad and this study mostly addresses enhancement of the human organism through genetic modification techniques. An overview of posthumanist values and a brief discussion of its philosophical background provide a framework to understand its ideals. Genetics and ethics are employed to assess some claims of the posthumanist program of creating evolved humans; in particular, the capabilities and limitations of techniques for somatic …

Behavioural Phenotyping Of Thunder Mice With A Hypomorphic Mutation Of Heterogeneous Nuclear Ribonuclear Protein L-Like (Hnrnpll) And Reduced T Cell Function, Maarten Van Den Buuse, Paul Halley, Gerard Hoyne

Medical Papers and Journal Articles

Heterogeneous nuclear ribonuclear protein l-like (hnRNPLL) is an RNA binding protein that regulates alternative splicing of mRNA and is abundantly expressed in memory T lymphocytes of the immune system and in the brain. A hypomorphic allele of the gene encoding hnRNPLL (Hnrpllthunder) selectively reduces T cell accumulation in lymphoid tissues, but little is known about its effects in the brain. Therefore, we exposed Hnrpllthunder mice to a test battery with relevance for a range of psychiatric illnesses. Thunder mice showed enhanced immobility in the tail-suspension test for depression-related behaviours, impaired short-term spatial memory in the Y-maze and reduced …

Incident Aortic Stenosis In 49 449 Men And 42 229 Women Investigated With Routine Echocardiography, Simon Stewart, Yih-Kai Chan, David Playford, Geoffrey Strange

Medical Papers and Journal Articles

Objective

We addressed the paucity of data describing the characteristics and consequences of incident aortic stenosis (AS).

Methods

Adults undergoing echocardiography with a native aortic valve (AV) and no AS were studied. Subsequent age-specific and sex-specific incidence of AS were derived from echocardiograms conducted a median of 2.8 years apart. Progressive AV dysfunction and individually linked mortality were examined per AS category.

Results

49 449 men (53.9%, 60.9±15.8 years) and 42 229 women (61.6±16.9 years) with no initial evidence of AS were identified. Subsequently, 6293 (6.9%) developed AS—comprising 5170 (5.6%), 636 (0.7%), 339 (0.4%) and 148 (0.2%) cases of mild, …

Mild Pulmonary Hypertension And Premature Mortality Among 154 956 Men And Women Undergoing Routine Echocardiography, Simon Stewart, Yih-Kai Chan, David Playford, Geoffrey A. Strange, On Behalf Of The Neda Investigators

Medical Papers and Journal Articles

Although mild pulmonary hypertension (PHT) is known to be associated with increased mortality, its impact on premature mortality is largely unknown.

We studied the distribution of estimated right ventricular systolic pressures (eRVSP) among 154 956 adults with no evidence of left heart disease investigated with echocardiography. We then examined individually linked mortality, premature mortality and associated life-years lost (LYL) according to eRVSP levels.

The cohort comprised 70 826 men (61.3±17.7 years) and 84 130 women (61.4±18.4 years). Overall, 85 173 (55.0%), 49 276 (31.8%), 13 060 (8.4%) and 7447 (4.8%) cases had an eRVSP level indicative of no (<30.0 mmHg), mild (30.0–39.9 mmHg), moderate (40.0–49.9 mmHg), or severe (≥50.0 mmHg) PHT, respectively. During median 5.7 (interquartile range 3.2–8.9) years follow-up, 38 456/154 986 (24.8%) individuals died. Compared to an eRVSP <30.0 mmHg, age and sex-adjusted hazard ratios for all-cause and cardiovascular-related mortality were 1.90 (95% CI 1.84–1.96) and 1.85 (95% CI 1.74–1.97) respectively, for an eRVSP of 35.0–39.9 mmHg. Overall, 6,256 (54%) men and 7524 (55%) women died prematurely. As a proportion of all deaths, premature mortality rose from 46.7% to 79.2% among those with an eRVSP <30.0 mmHg versus …