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Search Results: 1 - 10 of 168123 matches for " Gillian E Caughey "
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Guideline Compliance in Chronic Heart Failure Patients with Multiple Comorbid Diseases: Evaluation of an Individualised Multidisciplinary Model of Care
Tam H. Ho, Gillian E. Caughey, Sepehr Shakib
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0093129
Abstract: Objective To assess the impact of individualised, reconciled evidence-based recommendations (IRERs) and multidisciplinary care in patients with chronic heart failure (CHF) on clinical guideline compliance for CHF and common comorbid conditions. Design and setting A retrospective hospital clinical audit conducted between 1st July 2006 and February 2011. Participants A total of 255 patients with a diagnosis of CHF who attended the Multidisciplinary Ambulatory Consulting Services (MACS) clinics, at the Royal Adelaide Hospital, were included. Main outcome measures Compliance with Australian clinical guideline recommendations for CHF, atrial fibrillation, diabetes mellitus and ischaemic heart disease. Results Study participants had a median of eight medical conditions (IQR 6–10) and were on an average of 10 (±4) unique medications. Compliance with clinical guideline recommendations for pharmacological therapy for CHF, comorbid atrial fibrillation, diabetes or ischaemic heart disease was high, ranging from 86% for lipid lowering therapy to 98% anti-platelet agents. For all conditions, compliance with lifestyle recommendations was lower than pharmacological therapy, ranging from no podiatry reviews for CHF patients with comorbid diabetes to 75% for heart failure education. Concordance with many guideline recommendations was significantly associated if the patient had IRERs determined, a greater number of recommendations, more clinic visits or if patients participated in a heart failure program. Conclusions Despite the high number of comorbid conditions and resulting complexity of the management, high compliance to clinical guideline recommendations was associated with IRER determination in older patients with CHF. Importantly these recommendations need to be communicated to the patient’s general practitioner, regularly monitored and adjusted at clinic visits.
Prevalence of comorbidity of chronic diseases in Australia
Gillian E Caughey, Agnes I Vitry, Andrew L Gilbert, Elizabeth E Roughead
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-221
Abstract: A systematic review of Australian studies (1996 – May 2007) was conducted. The review focused specifically on the chronic diseases included as national health priorities; arthritis, asthma, cancer, cardiovascular disease (CVD), diabetes mellitus and mental health problems.A total of twenty five studies met our inclusion criteria. Over half of the elderly patients with arthritis also had hypertension, 20% had CVD, 14% diabetes and 12% mental health problem. Over 60% of patients with asthma reported arthritis as a comorbidity, 20% also had CVD and 16% diabetes. Of those with CVD, 60% also had arthritis, 20% diabetes and 10% had asthma or mental health problems.There are comparatively few Australian studies that focused on comorbidity associated with chronic disease. However, they do show high prevalence of comorbidity across national health priority areas. This suggests integration and co-ordination of the national health priority areas is critical. A greater awareness of the importance of managing a patients' overall health status within the context of comorbidity is needed together with, increased research on comorbidity to provide an appropriate scientific basis on which to build evidence based care guidelines for these multimorbid patients.The proportion of Australians aged 65 years and over is projected to increase from 2.6 million in 2004, to over 6.5 million by 2051, with the highest projected growth rate for those aged 80 years or older [1]. This ageing Australian population, with a concomitant rise in the number of people living with chronic diseases, has major implications for both health care services and their associated costs. Chronic diseases are the leading cause of illness and disability in those aged 65 years and over [2] and in 2000–01 accounted for nearly 70% of all health system expenditure in Australia (over $AU 35 billion) [3-5]. The World Health Organisation estimates that chronic disease accounts for 60% of deaths worldwide and has given preced
Influence of Comorbidities on Therapeutic Progression of Diabetes Treatment in Australian Veterans: A Cohort Study
Agnes I. Vitry,Elizabeth E. Roughead,Adrian K. Preiss,Philip Ryan,Emmae N. Ramsay,Andrew L. Gilbert,Gillian E. Caughey,Sepehr Shakib,Adrian Esterman,Ying Zhang,Robyn A. McDermott
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0014024
Abstract: This study assessed whether the number of comorbid conditions unrelated to diabetes was associated with a delay in therapeutic progression of diabetes treatment in Australian veterans.
On the validity of area-based income measures to proxy household income
Gillian E Hanley, Steve Morgan
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-79
Abstract: Using administrative data files for the population of BC, Canada, we calculate income deciles from both area-based census data and Canada Revenue Agency validated household-level data. These deciles are then compared for misclassification. Spearman's correlation, kappa coefficients and weighted kappa coefficients are all calculated. We then assess the validity of using the area-based income measure as a proxy for household income in regression equations explaining socio-economic inequalities in total prescription drug expenditures.The variability between household-level income and area-based income is large. Only 37% of households are classified by area-based measures to be within one decile of the classification based on household-level incomes. Statistical evidence of the disagreement between income measures also indicates substantial misclassification, with Spearman's correlations, kappa coefficients and weighted kappa coefficients all indicating little agreement. The regression results show that the size of the coefficients changes considerably when area-based measures are used instead of household-level measures, and that use of area-based measures smooths out important variation across the income distribution.These results suggest that, in some contexts, the choice of area-based versus household-level income can drive conclusions in an important way. Access to reliable household-level income/socio-economic data such as the tax-validated data used in this study would unambiguously improve health research and therefore the evidence on which health and social policy would ideally rest.Measures of income are often central to health and health policy research. Among many potential implications, income can be a non-medical determinant of health [1-3] an enabling factor for access to care[4], or a consideration when judging equity of policies and programs[5]. As important as this variable may be, it is often difficult for health and health policy researchers to obtai
Land of a Couple of Dances: Global and Local Influences on Freestyle Play in Dance Dance Revolution
Fibreculture Journal , 2006,
Abstract: This paper traces successful and unsuccessful attempts to shape the meanings of the video game Dance Dance Revolution, specifically with reference to what "dancing" means in this context, as the game moves between various interested parties - game developers, players, Internet forum participants, and other media producers. Drawing on Actor-Network Theory and the network analyses of Manuel Castells, the paper reconstructs the forces shaping players' stylistic decisions through an analysis of dance game machines and software, and of a single forum thread on DDRFreak.com, a major website in the dance game community. The paper asks who decides how DDR players dance and at what times? Are the decisions about play made in the development meeting, the arcade, competitions, online or around the home console? Globally, how do some regions or groups emerge as experts or leaders in play style? Analysis indicates that within the United States, Californian players from major cities dominate discussion, supported by the global flows of people, resources, and capital through the state. The dominant players support their stated norms for play through recourse to mainstream conceptions of masculinity, rap music and associated styles of dance.
Measuring perinatal complications: methodologic issues related to gestational age
Aaron B Caughey
BMC Pregnancy and Childbirth , 2007, DOI: 10.1186/1471-2393-7-18
Abstract: One issue that can clearly affect absolute rates and trends is how groups of women are categorized by their gestational age. Since most perinatal outcomes can only occur in women and neonates who have delivered, using the number of pregnancies delivered (PD) as the denominator of outcomes is appropriate. However, for an outcome such as antepartum stillbirth, all women who are pregnant at a particular gestational age are at risk. Thus, the denominator should include all ongoing pregnancies (OP). When gestational age is used by week this means using both deliveries during a particular week plus those women who deliver beyond the particular week of gestation in the denominator. Researchers should be careful to make sure they are utilizing the appropriate measure of perinatal complications so they do not report findings that would be misleading to clinicians, patients, and policy makers.Traditional perinatal epidemiology utilized metrics such as the neonatal mortality rate (number of neonatal deaths per 1,000 live births) and the perinatal mortality rate (number of neonatal deaths plus stillbirths per 1,000 total births) [1]. Prior to the current age of birth certificate and other large electronic databases, expanding computational power, and statistical software packages, it was recognized that these simple metrics had some small problems, but gave reasonable estimates to compare risk factors. While much of the technological advances have led to better statistical techniques for controlling potential confounders and quicker analysis of large data files, there has been little attempt to develop appropriate metrics to examine rates of perinatal morbidity and mortality and to further improve the accuracy of these measures. This is unfortunate, as the thoughtful approach to measuring complications of pregnancy is paramount and different methods can lead to entirely different outcomes and conclusions.For example, when examining the complications among all patients with term
Parasitic Infection Improves Survival from Septic Peritonitis by Enhancing Mast Cell Responses to Bacteria in Mice
Rachel E. Sutherland,Xiang Xu,Sophia S. Kim,Eric J. Seeley,George H. Caughey,Paul J. Wolters
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0027564
Abstract: Mammals are serially infected with a variety of microorganisms, including bacteria and parasites. Each infection reprograms the immune system's responses to re-exposure and potentially alters responses to first-time infection by different microorganisms. To examine whether infection with a metazoan parasite modulates host responses to subsequent bacterial infection, mice were infected with the hookworm-like intestinal nematode Nippostrongylus brasiliensis, followed in 2–4 weeks by peritoneal injection of the pathogenic bacterium Klebsiella pneumoniae. Survival from Klebsiella peritonitis two weeks after parasite infection was better in Nippostrongylus-infected animals than in unparasitized mice, with Nippostrongylus-infected mice having fewer peritoneal bacteria, more neutrophils, and higher levels of protective interleukin 6. The improved survival of Nippostrongylus-infected mice depends on IL-4 because the survival benefit is lost in mice lacking IL-4. Because mast cells protect mice from Klebsiella peritonitis, we examined responses in mast cell-deficient KitW-sh/KitW-sh mice, in which parasitosis failed to improve survival from Klebsiella peritonitis. However, adoptive transfer of cultured mast cells to KitW-sh/KitW-sh mice restored survival benefits of parasitosis. These results show that recent infection with Nippostrongylus brasiliensis protects mice from Klebsiella peritonitis by modulating mast cell contributions to host defense, and suggest more generally that parasitosis can yield survival advantages to a bacterially infected host.
Phylogenomics reveals subfamilies of fungal nonribosomal peptide synthetases and their evolutionary relationships
Kathryn E Bushley, B Gillian Turgeon
BMC Evolutionary Biology , 2010, DOI: 10.1186/1471-2148-10-26
Abstract: Phylogenomic analysis identified nine major subfamilies of fungal NRPSs which fell into two main groups: one corresponds to NPS genes encoding primarily mono/bi-modular enzymes which grouped with bacterial NRPSs and the other includes genes encoding primarily multimodular and exclusively fungal NRPSs. AARs shared a closer phylogenetic relationship to NRPSs than to other acyl-adenylating enzymes. Phylogenetic analyses and taxonomic distribution suggest that several mono/bi-modular subfamilies arose either prior to, or early in, the evolution of fungi, while two multimodular groups appear restricted to and expanded in fungi. The older mono/bi-modular subfamilies show conserved domain architectures suggestive of functional conservation, while multimodular NRPSs, particularly those unique to euascomycetes, show a diversity of architectures and of genetic mechanisms generating this diversity.This work is the first to characterize subfamilies of fungal NRPSs. Our analyses suggest that mono/bi-modular NRPSs have more ancient origins and more conserved domain architectures than most multimodular NRPSs. It also demonstrates that the α-aminoadipate reductases involved in lysine biosynthesis in fungi are closely related to mono/bi-modular NRPSs. Several groups of mono/bi-modular NRPS metabolites are predicted to play more pivotal roles in cellular metabolism than products of multimodular NRPSs. In contrast, multimodular subfamilies of NRPSs are of more recent origin, are restricted to fungi, show less stable domain architectures, and biosynthesize metabolites which perform more niche-specific functions than mono/bi-modular NRPS products. The euascomycete-only NRPS subfamily, in particular, shows evidence for extensive gain and loss of domains suggestive of the contribution of domain duplication and loss in responding to niche-specific pressures.Nonribosomal peptide synthetases (NRPSs) are multimodular megasynthases which catalyze biosynthesis of small bioactive peptides (NRPs)
Toys, Décor, and More: Evidence of Hazardous Electronic Waste Recycled into New Consumer Products  [PDF]
Gillian Z. Miller, Meghanne E. Tighe, Graham F. Peaslee, Karla Pe?a, Jeff Gearhart
Journal of Environmental Protection (JEP) , 2016, DOI: 10.4236/jep.2016.73030

Hazardous chemicals used in electronic and electrical consumer products can re-enter commerce when these products are recycled. The objectives of this study were to 1) identify the possible sources of unexpected chemicals and elements in consumer products, including the use of recycled E-waste plastics and 2) demonstrate bromine detection with nondestructive spectroscopy as an indicator of brominated flame retardants contaminating new products via recycled waste streams. More than 1500 consumer products of diverse types purchased in 2012-2014 were examined using X-ray fluorescence spectroscopy for correlations between bromine and other elements. New electronic products were much more likely than new non-electronics to contain greater than 1000 ppm bromine, consistent with intentionally added flame retardants, while non- electronic products were more likely to contain between 5 and 100 ppm bromine, suggesting unintentional contamination. A typical suite of elements present in E-waste was found in a majority of plastic products. Two product categories, vinyl floor tiles and beaded necklaces/garlands, were explored in more detail. Specific flame retardant chemicals in bead samples were identified by mass spectrometry and their distribution in beads was studied using scanning electron microscopy and energy dispersive spectroscopy. Five brominated chemicals typically used as flame retardants, including BDE-209, were identified in 50 of 50 Mardi Gras beads analyzed.

In Vitro Detection of prionemia in TSE-Infected Cervids and Hamsters
Alan M. Elder, Davin M. Henderson, Amy V. Nalls, Jason M. Wilham, Byron W. Caughey, Edward A. Hoover, Anthony E. Kincaid, Jason C. Bartz, Candace K. Mathiason
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0080203
Abstract: Blood-borne transmission of infectious prions during the symptomatic and asymptomatic stages of disease occurs for both human and animal transmissible spongiform encephalopathies (TSEs). The geographical distribution of the cervid TSE, chronic wasting disease (CWD), continues to spread across North America and the prospective number of individuals harboring an asymptomatic infection of human variant Creutzfeldt-Jakob Disease (vCJD) in the United Kingdom has been projected to be ~1 in 3000 residents. Thus, it is important to monitor cervid and human blood products to ensure herd health and human safety. Current methods for detecting blood-associated prions rely primarily upon bioassay in laboratory animals. While bioassay provides high sensitivity and specificity, it requires many months, animals, and it is costly. Here we report modification of the real time quaking-induced conversion (RT-QuIC) assay to detect blood-borne prions in whole blood from prion-infected preclinical white-tailed deer, muntjac deer, and Syrian hamsters, attaining sensitivity of >90% while maintaining 100% specificity. Our results indicate that RT-QuIC methodology as modified can provide consistent and reliable detection of blood-borne prions in preclinical and symptomatic stages of two animal TSEs, offering promise for prionemia detection in other species, including humans.
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