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Search Results: 1 - 10 of 228372 matches for " Elizabeth C. Ward "
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Managing Patient Factors in the Assessment of Swallowing via Telerehabilitation
Elizabeth C. Ward,Shobha Sharma,Clare Burns,Deborah Theodoros,Trevor Russell
International Journal of Telemedicine and Applications , 2012, DOI: 10.1155/2012/132719
Abstract: Undoubtedly, the identification of patient suitability for a telerehabilitation assessment should be carried out on a case-by-case basis. However, at present there is minimal discussion of how telerehabilitation systems can accommodate and adapt to various patient factors, which may pose challenges to successful service delivery. The current study examines a subgroup of 10 patients who underwent an online assessment of their swallowing difficulties. Although all assessments were completed successfully; there were certain patient factors, which complicated the delivery of the online assessment session. The paper presents a discussion of the main patient factors observed in this cohort including the presence of speech and/or voice disorders, hearing impairment, dyskinesia, and behavioural and/or emotional issues and examines how the assessment session, the telerehabilitation system, and the staff involved were manipulated to accommodate these patient factors. In order for telerehabilitation systems to be more widely incorporated into routine clinical care, systems need to have the flexibility and design capabilities to adjust and accommodate for patients with varying levels of function and physical and psychological comorbidities. 1. Introduction Telerehabilitation services often involve intensive, detail-oriented, and interactive assessments. Hence it is accepted that patients are ideally served by systems and technology designed to optimise high quality visual and audio during a real-time interaction [1]. It is, however, equally important that any telerehabilitation system or service is designed to be sensitive to and accommodate the needs of the end user [2, 3]. Optimising both the equipment technology and the adaptability/usability of the system helps to ensure the development of systems and services that function well and are sufficiently flexible to adapt to patients with various levels of capability. The use of telerehabilitation to conduct clinical assessments of dysphagia is an area of practice which is currently still in its infancy. Hence the system requirements necessary to optimise capabilities for both the user and the patient during online assessments of swallowing are still being established. Initial work by Lalor et al. [4] described the use of a videoconferencing system with fixed cameras to conduct an assessment of swallowing and language for a remote patient with global aphasia and severe dysphagia. Although session objectives were able to be met, the researchers reported facing multiple difficulties during the assessment, which were
The role of menopause and reproductive senescence in a long-lived social mammal
Eric J Ward, Kim Parsons, Elizabeth E Holmes, Ken C Balcomb, John KB Ford
Frontiers in Zoology , 2009, DOI: 10.1186/1742-9994-6-4
Abstract: We examined a unique 30-year time series of killer whales, tracking the reproductive performance of individuals through time. Killer whales are extremely long-lived, and may have the longest documented post-reproductive lifespan of any mammal, including humans. We found no strong support for either of the adaptive hypotheses of menopause; there was little support for the presence of post-reproductive females benefitting their daughter's reproductive performance (interbirth interval and reproductive lifespan of daughters), or the number of mature recruits to the population. Oldest mothers (> 35) did appear to have a small positive impact on calf survival, suggesting that females may gain experience with age. There was mixed support for the grandmother hypothesis – grandoffspring survival probabilities were not influenced by living grandmothers, but grandmothers may positively influence survival of juveniles at a critical life stage.Although existing data do not allow us to examine evolutionary tradeoffs between survival and reproduction for this species, we were able to examine the effect of maternal age on offspring survival. Our results are consistent with similar studies of other mammals – oldest mothers appear to be better mothers, producing calves with higher survival rates. Studies of juvenile survival in humans have reported positive benefits of grandmothers on newly weaned infants; our results indicate that 3-year old killer whales may experience a positive benefit from helpful grandmothers. While our research provides little support for menopause evolving to provide fitness benefits to mothers or grandmothers, our work supports previous research showing that menopause and long post-reproductive lifespans are not a human phenomenon.Individuals in many mammalian species devote a fraction of their lives to reproduction. Females in these species experience a gradual midlife decline in reproductive performance with age, and eventually menopause, the abrupt termin
Comparative analysis of the kinomes of three pathogenic trypanosomatids: Leishmania major, Trypanosoma brucei and Trypanosoma cruzi
Marilyn Parsons, Elizabeth A Worthey, Pauline N Ward, Jeremy C Mottram
BMC Genomics , 2005, DOI: 10.1186/1471-2164-6-127
Abstract: Bioinformatic searches of the trypanosomatid genomes for eukaryotic PKs (ePKs) and atypical PKs (aPKs) revealed a total of 176 PKs in T. brucei, 190 in T. cruzi and 199 in L. major, most of which are orthologous across the three species. This is approximately 30% of the number in the human host and double that of the malaria parasite, Plasmodium falciparum. The representation of various groups of ePKs differs significantly as compared to humans: trypanosomatids lack receptor-linked tyrosine and tyrosine kinase-like kinases, although they do possess dual-specificity kinases. A relative expansion of the CMGC, STE and NEK groups has occurred. A large number of unique ePKs show no strong affinity to any known group. The trypanosomatids possess few ePKs with predicted transmembrane domains, suggesting that receptor ePKs are rare. Accessory Pfam domains, which are frequently present in human ePKs, are uncommon in trypanosomatid ePKs.Trypanosomatids possess a large set of PKs, comprising approximately 2% of each genome, suggesting a key role for phosphorylation in parasite biology. Whilst it was possible to place most of the trypanosomatid ePKs into the seven established groups using bioinformatic analyses, it has not been possible to ascribe function based solely on sequence similarity. Hence the connection of stimuli to protein phosphorylation networks remains enigmatic. The presence of numerous PKs with significant sequence similarity to known drug targets, as well as a large number of unusual kinases that might represent novel targets, strongly argue for functional analysis of these molecules.Trypanosomatid pathogens of humans include Trypanosoma brucei, Trypanosoma cruzi and Leishmania major, causative agents of African sleeping sickness, Chagas disease, and cutaneous leishmaniasis respectively [1]. Trypanosoma brucei lives extracellularly in the human host, primarily in the bloodstream and cerebrospinal fluid. African sleeping sickness, which is estimated to afflict
Evaluation of a Clinical Service Model for Dysphagia Assessment via Telerehabilitation
Elizabeth C. Ward,Clare L. Burns,Deborah G. Theodoros,Trevor G. Russell
International Journal of Telemedicine and Applications , 2013, DOI: 10.1155/2013/918526
Abstract: Emerging research supports the feasibility and viability of conducting clinical swallow examinations (CSE) for patients with dysphagia via telerehabilitation. However, minimal data has been reported to date regarding the implementation of such services within the clinical setting or the user perceptions of this type of clinical service. A mixed methods study design was employed to examine the outcomes of a weekly dysphagia assessment clinic conducted via telerehabilitation and examine issues relating to service delivery and user perceptions. Data was collected across a total of 100 patient assessments. Information relating to primary patient outcomes, session statistics, patient perceptions, and clinician perceptions was examined. Results revealed that session durations averaged 45 minutes, there was minimal technical difficulty experienced, and clinical decisions made regarding primary patient outcomes were comparable between the online and face to face clinicians. Patient satisfaction was high and clinicians felt that they developed good rapport, found the system easy to use, and were satisfied with the service in over 90% of the assessments conducted. Key factors relating to screening patient suitability, having good general organization, and skilled staff were identified as facilitators for the service. This trial has highlighted important issues for consideration when planning or implementing a telerehabilitation service for dysphagia management. 1. Introduction There is a small but emerging evidence base supporting the use of telerehabilitation to improve access to both clinical and instrumental dysphagia assessment services [1–8]. However, while the research conducted to date has focused on the evaluation of different types of system architecture [1, 4, 6], early feasibility data [1, 4, 7, 8], and the validity and reliability of online clinical decisions [2, 3, 5, 7, 8], no studies have examined the service characteristics (session durations, session complication rates, and equipment issues) associated with implementing a telerehabilitation clinical service. There is also limited information regarding potential facilitators and barriers to implementing a successful and time efficient telerehabilitation dysphagia service. Only one paper to date has discussed issues noted during the assessment of a small set of patients where certain patient factors (e.g., hearing impairment, movement disorders) made the assessment process less efficient [9]. That paper highlighted important service considerations including the need for careful patient and
Peroxisome Proliferator Activated Receptor Ligands as Regulators of Airway Inflammation and Remodelling in Chronic Lung Disease
Jane Elizabeth Ward,Xiahui Tan
PPAR Research , 2007, DOI: 10.1155/2007/14983
Abstract: Inflammation is a major component in the pathology of chronic lung diseases, including asthma. Anti-inflammatory treatment with corticosteroids is not effective in all patients. Thus, new therapeutic options are required to control diverse cellular functions that are currently not optimally targeted by these drugs in order to inhibit inflammation and its sequelae in lung disease. Peroxisome proliferator activated receptors (PPARs), originally characterised as regulators of lipid and glucose metabolism, offer marked potential in this respect. PPARs are expressed in both lung infiltrating and resident immune and inflammatory cells, as well as in resident and structural cells in the lungs, and play critical roles in the regulation of airway inflammation. In vitro, endogenous and synthetic ligands for PPARs regulate expression and release of proinflammatory cytokines and chemoattractants, and cell proliferation and survival. In murine models of allergen-induced inflammation, PPARα and PPARγ ligands reduce the influx of inflammatory cells, cytokine and mucus production, collagen deposition, and airways hyperresponsiveness. The activity profiles of PPAR ligands differ to corticosteroids, supporting the hypothesis that PPARs comprise additional therapeutic targets to mimimise the contribution of inflammation to airway remodelling and dysfunction.
Declining Death Rates Reflect Progress against Cancer
Ahmedin Jemal,Elizabeth Ward,Michael Thun
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0009584
Abstract: The success of the “war on cancer” initiated in 1971 continues to be debated, with trends in cancer mortality variably presented as evidence of progress or failure. We examined temporal trends in death rates from all-cancer and the 19 most common cancers in the United States from 1970–2006.
Recent trends in breast cancer incidence rates by age and tumor characteristics among U.S. women
Ahmedin Jemal, Elizabeth Ward, Michael J Thun
Breast Cancer Research , 2007, DOI: 10.1186/bcr1672
Abstract: We performed a joinpoint regression analysis to fit a series of joined straight lines to the trends in age-adjusted rates and described the resultant trends (slope) by annual percentage change (two-sided, P < 0.05).A plot of the age-specific rates of invasive breast cancer shows a decrease in all 5-year age groups from 45 years and above between 1999 and 2003 and sharp decreases largely confined to ER+ tumors in age groups from 50 to 69 years between 2002 and 2003. In joinpoint analyses by tumor size and stage, incidence rates decreased for small tumors (less than or equal to 2 cm) by 4.1% (95% confidence interval [CI], 0.2% to 7.8%) per year from 2000 through 2003 and for localized disease by 3.1% (95% CI, 1.2% to 5.0%) per year from 1999 through 2003. No decrease in incidence was observed for larger tumors or advanced-stage disease during the corresponding periods. Rates for in situ disease were stable from 2000 through 2003 after increasing rapidly since 1981.Two distinct patterns are observed in breast cancer trends. The downturn in incidence rates in all age groups above 45 years suggests a period effect that is consistent with saturation in screening mammography. The sharp decrease in incidence from 2002 to 2003 that occurred in women 50 to 69 years old who predominantly, but not exclusively, had ER+ tumors may reflect the early benefit of the reduced use of hormone replacement therapy.A recent abstract presented in a breast cancer symposium suggested that the sharp decrease in female breast cancer incidence rates from 2002 to 2003 in the Surveillance, Epidemiology, and End Results (SEER) cancer registries of the United States may have resulted from the reduced use of hormone replacement therapy (HRT) following a July 2002 publication from the Women's Health Initiative [1]. However, the age-standardized delay-adjusted incidence rate of invasive breast cancer in the nine oldest SEER cancer registry areas began to decrease in 1999, although the trend through 200
Inter-Instrument Comparison of Bioimpedance Spectroscopic Analysers
L.C. Ward
The Open Medical Devices Journal , 2009, DOI: 10.2174/1875181400901010003]
Abstract: Three commercially available bioimpedance spectroscopy analysers were compared for technical performance and for their design purpose of prediction of body composition. All three analysers were electronically stable, remaining in calibration over a year, and provided highly reproducible (coefficients of variation < 0.5%) and accurate (within 0.5% of component values) measurements of impedances of a test circuit. Whole body impedances in humans were highly correlated between all three instruments although significant biases between instruments were observed, particularly for the measurement of intracellular resistance. However, when the measured impedances, and using instrument-specific resistivity coefficients, were used to predict fat-free mass of the subjects, the difference between instruments was approximately 1.7 kg fat-free mass, a value comparable with that observed for the error associated with reference methods such as multi-compartment models of body composition. It is concluded that, with appropriate regard to standardisation of measurement protocol, all three analysers are suitable for their design purpose of estimating body composition in humans.
The role of causal criteria in causal inferences: Bradford Hill's "aspects of association"
Ward Andrew C
Epidemiologic Perspectives and Innovations , 2009, DOI: 10.1186/1742-5573-6-2
Abstract: As noted by Wesley Salmon and many others, causal concepts are ubiquitous in every branch of theoretical science, in the practical disciplines and in everyday life. In the theoretical and practical sciences especially, people often base claims about causal relations on applications of statistical methods to data. However, the source and type of data place important constraints on the choice of statistical methods as well as on the warrant attributed to the causal claims based on the use of such methods. For example, much of the data used by people interested in making causal claims come from non-experimental, observational studies in which random allocations to treatment and control groups are not present. Thus, one of the most important problems in the social and health sciences concerns making justified causal inferences using non-experimental, observational data. In this paper, I examine one method of justifying such inferences that is especially widespread in epidemiology and the health sciences generally – the use of causal criteria. I argue that while the use of causal criteria is not appropriate for either deductive or inductive inferences, they do have an important role to play in inferences to the best explanation. As such, causal criteria, exemplified by what Bradford Hill referred to as "aspects of [statistical] associations", have an indispensible part to play in the goal of making justified causal claims.
Screening for alcohol use disorders in HIV patients
C Ward,S Ahmad
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18160
Abstract: Many chronic health conditions have been linked to alcohol consumption, as well as excess morbidity, mortality and an increased financial burden on the National Health Service (NHS). The British HIV Association (BHIVA) recommends that HIV patients be asked about alcohol due to its effect on adherence to antiretroviral therapy. National Institute of Health and Clinical Excellence (NICE) guidelines recommend screening for alcohol use disorders in patients attending genitourinary medicine (GUM) clinics. In this study we looked at the use of a screening tool for alcohol use disorders in HIV patients in a metropolitan city. We assessed HIV patients over a 6-month period for alcohol use disorders using the AUDIT-C questionnaire. Patients with a score >4 were identified as higher risk and provided with brief advice about alcohol and offered written information and support. Demographic data was collected along with hepatitis B and C status, information on sexually transmitted infection (STI) testing and diagnosis. 352 patients were reviewed with a mean age of 41. 297 (84.4%) patients were male, 235 (66.8%) were white British and 251 (71.3%) were men who have sex with men (MSM). 277 (78.7%) patients were on antiretroviral therapy with 254 (91.7%) of these having an undetectable viral load. Alcohol use disorders were assessed using the AUDIT-C score in 332 (94.3%) patients with no patient declining assessment. 166 (50%) patients had an AUDIT-C score >4 signifying higher risk. Alcohol advice was provided to 161 (97%) of these patients and a Drink Smart guide offering advice on alcohol self help offered to 103 (64%) patients and accepted by 45 (43.7%). An opportunistic STI screen was offered to 258 (73.3%) patients on that visit in line with best practice guidelines and was accepted by 83 (32.2%). 25 infections were found in 20 patients, of which 13 (65%) had AUDIT-C scores >4. There were 8 active hepatitis C co-infected patients of which 3 had an AUDIT-C score >4 and 12 chronic hepatitis B co-infected patients with 3 having an AUDIT-C score >4. Our results show that screening for alcohol use disorders using the AUDIT-C questionnaire has high acceptability among HIV patients; however the data is biased to Caucasian MSM. Alcohol use has been shown to exacerbate liver damage in patients with chronic hepatitis, increase the likelihood of STI acquisition and compromise immunity. It is therefore important to screen for and quantify alcohol use as part of routine HIV clinical practice.
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