An examination of subject variables that influence pressure pain threshold

University of Technology Sydney. Faculty of Science.Background: Pain is a primary clinical concern for most people. Pain is the most common reason for seeking any form of health assistance be it medical, dental, physiotherapeutic or alternative disciplines. Pain threshold is defined as the lowest application of a stimulus that is perceived as pain. Experimental pain studies use a range of pain challenges including electrical, heat or cold, ischaemic and pressure. Some carry a higher potential risk of tissue injury or the sensations experienced are less acceptable to subjects. Pressure pain threshold (PPT), measured by a simple mechanical algometer is an attractive alternative well-suited for non-invasive repeated measurements on multiple sites not limited to limbs over short time intervals in a relaxed setting. Since 2000, the University of Technology Sydney had conducted eight PPT studies and collected over 47,500 baseline PPT measurements on 262 healthy subjects at 24 regional sites with three or four PPT readings for each site at each session of four to eight occasions of at least one week apart. Research Study One included seven studies with over 32,000 pre-intervention PPT measures on 235 healthy subjects at 17 sites with three PPT measures at each occasion for four consecutive occasions. These data were being analysed to develop comprehensive epidemiological profiles that assess relationships between PPT with subject variables (gender, age, BMI) and duration of temporal sessions. Research Study Two assessed the PPT at two affected and two non-affected sites of 20 patients with lateral epicondylitis. Research Study Three examined the inter-device reliability between mechanical and electronic algometers at six sites of 17 subjects. Aims: Research Study One explored the temporal stability of possible relationships between subject variables of gender, age and BMI, the duration of temporal sessions with the regional PPT at each measurement site. Research Study Two assessed the regional PPT measures at LI10 and LI11 of the affected and non-affected elbows for subjects with lateral epicondylitis. Research Study Three examined the inter-device reliability of a mechanical and an electronic algometers of same measurement parameters: circular rubber plunger of 1cm2 and force application rate of 1kg/s. Methods: Research Study One: All studies used the same protocol including the same model algometer, tip dimensions, application rates, rest interval between measurement cycles and at least seven days between each of four data collection visits. Regional PPT measurement sites included sites on head, neck and limbs. Data analyses used GLM and the alternative non-parametric tests wherever applicable. Research Study Two: A double blind randomised controlled trial that involved PPT measurements at two affected and two non-affected acupoints LI10 and LI11. Research Study Three: PPT measurements were taken by trained examiners using electronic and mechanical algometers alternatively at six sites on hands. Subjects were blinded with a curtain drawn across the neck to the type of algometer being applied at each site. Results: Research Study One: For all 17 sites, the regional PPT for males was significantly higher than for females for each visit and each measurement cycle in general and in Intervention and Control groups. No significant differences between mean PPT and median PPT, and between the means of PPTmean and PPTmedian for each gender at all 17 measurement sites. The mean and median PPT among reading cycles within gender were generally stable for both genders independent of temporal visits. Irrespective of gender, most sites showed significant increase in means of PPTmean and PPTmedian over temporal sessions in general and in Intervention but not the case in Control. The Pearson correlation coefficients of PPT with age and BMI for both genders at all measurement sites were generally weak (<0.35 in magnitude). Stepwise multiple regressions models had PPTmean or PPTmedian in Visit 1 related to solely gender in all sites except bilateral LI20 with age and gender and PC6L with BMI only. Research Study Two: Generally significant increase of mean PPT at non-affected and affected sites in Acupuncture than Sham Laser and in males than females. Research Study Three: The mean PPT of mechanical algometer did not differ with that of electronic algometer at all six measurement sites. Conclusions: Research Study One: Data analysis on PPT to be completed separately by gender. Experimental design for PPT between subjects should ensure a matched gender ratio across groups. Washout period to be extended. Research Study Two: The males received higher PPT than females whilst both genders showed higher PPT from acupuncture treatment than the sham laser in lateral epicondylitis. Research Study Three: Both mechanical and electronic algometers provided valid and reliable PPT scores under similar protocols

Modelling the cost of place of birth: a pathway analysis

Background In New South Wales (NSW), Australia there are three settings available for women at low risk of complications to give birth: home, birth centre and hospital. Between 2000 and 2012, 93.6% of babies were planned to be born in hospital, 6.0% in a birth centre and 0.4% at home. Availability of alternative birth settings is limited and the cost of providing birth at home or in a birth centre from the perspective of the health system is unknown. Objectives The objective of this study was to model the cost of the trajectories of women who planned to give birth at home, in a birth centre or in a hospital from the public sector perspective. Methods This was a population-based study using linked datasets from NSW, Australia. Women included met the following selection criteria: 37-41 completed weeks of pregnancy, spontaneous onset of labour, and singleton pregnancy at low risk of complications. We used a decision tree framework to depict the trajectories of these women and Australian Refined-Diagnosis Related Groups (AR-DRGs) were applied to each trajectory to estimate the cost of birth. A scenario analysis was undertaken to model the cost for 30 000 women in one year. Findings 496 387 women were included in the dataset. Twelve potential outcome pathways were identified and each pathway was costed using AR-DRGs. An overall cost was also calculated by place of birth: $AUD4802 for homebirth,$AUD4979 for a birth centre birth and $AUD5463 for a hospital birth. Conclusion The findings from this study provides some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the relatively lower rates of complex intervention and neonatal outcomes associated with women at low risk of complications, we can assume the cost of providing them with homebirth and birth centre options could be cost-effective

Mapping the trajectories for women and their babies from births planned at home, in a birth centre or in a hospital in New South Wales, Australia, between 2000 and 2012

© 2019 The Author(s). Background: In New South Wales (NSW) Australia, women at low risk of complications can choose from three birth settings: home, birth centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give birth in a birth centre (6%) or at home (0.4%) and 93.6% of women planned to birth in a hospital. A proportion of the woman in the home and birth centre groups transferred to hospital. However, their pathways or trajectories are largely unknown. Aim: The aim was to map the trajectories and interventions experienced by women and their babies from births planned at home, in a birth centre or in a hospital over a 13-year period in NSW. Methods: Using population-based linked datasets from NSW, women at low risk of complications, with singleton pregnancies, gestation 37-41 completed weeks and spontaneous onset of labour were included. We used a decision tree framework to depict the trajectories of these women and estimate the probabilities of the following: giving birth in their planned setting; being transferred; requiring interventions and neonatal admission to higher level hospital care. The trajectories were analysed by parity. Results: Over a 13-year period, 23% of nulliparous and 0.8% of multiparous women planning a home birth were transferred to hospital. In the birth centre group, 34% of nulliparae and 12% of multiparas were transferred to a hospital. Normal vaginal birth rates were higher in multiparous women compared to nulliparous women in all settings. Neonatal admission to SCN/NICU was highest in the planned hospital group for nulliparous women (10.1%), 7.1% for nulliparous women planning a birth centre birth and 5.1% of nulliparous women planning a homebirth. Multiparas had lower admissions to SCN/NICU for all thee settings (hospital 6.3%, BC 3.6%, home 1.6%, respectively). Conclusions: Women who plan to give birth at home or in a birth centre have high rates of vaginal birth, even when transferred to hospital. Evidence on the trajectories of women who choose to give birth at home or in birth centres will assist the planning, costing and expansion of models of care in NSW

Maternal and perinatal outcomes by planned place of birth in Australia 2000 - 2012: A linked population data study

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Objective To compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home. Design A population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ 2 tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance. Setting All eight Australian states and territories. Participants Women with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks' gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home. Main outcome measures Mode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death). Results Compared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth. Conclusions This is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths were very small and therefore firm conclusions cannot be drawn about perinatal mortality outcomes

Multicomponent non-pharmacological intervention to prevent delirium for hospitalised people with advanced cancer: Study protocol for a phase II cluster randomised controlled trial

© 2019 Author(s) (or their employer(s)). Introduction Delirium is a significant medical complication for hospitalised patients. Up to one-third of delirium episodes are preventable in older inpatients through non-pharmacological strategies that support essential human needs, such as physical and cognitive activity, sleep, hydration, vision and hearing. We hypothesised that a multicomponent intervention similarly may decrease delirium incidence, and/or its duration and severity, in inpatients with advanced cancer. Prior to a phase III trial, we aimed to determine if a multicomponent non-pharmacological delirium prevention intervention is feasible and acceptable for this specific inpatient group. Methods and analysis The study is a phase II cluster randomised wait-listed controlled trial involving inpatients with advanced cancer at four Australian palliative care inpatient units. Intervention sites will introduce delirium screening, diagnostic assessment and a multicomponent delirium prevention intervention with six domains of care: preserving natural sleep; maintaining optimal vision and hearing; optimising hydration; promoting communication, orientation and cognition; optimising mobility; and promoting family partnership. Interdisciplinary teams will tailor intervention delivery to each site and to patient need. Control sites will first introduce only delirium screening and diagnosis, later implementing the intervention, modified according to initial results. The primary outcome is adherence to the intervention during the first seven days of admission, measured for 40 consecutively admitted eligible patients. Secondary outcomes relate to fidelity and feasibility, acceptability and sustainability of the study intervention, processes and measures in this patient population, using quantitative and qualitative measures. Delirium incidence and severity will be measured to inform power calculations for a future phase III trial. Ethics and dissemination Ethical approval was obtained for all four sites. Trial results, qualitative substudy findings and implementation of the intervention will be submitted for publication in peer-reviewed journals, and reported at conferences, to study sites and key peak bodies

Burden of rare variants in ALS genes influences survival in familial and sporadic ALS

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Point-of-admission hypothermia among high-risk Nigerian newborns

<p>Abstract</p> <p>Background</p> <p>Facilities which manage high-risk babies should frequently assess the burden of hypothermia and strive to reduce the incidence.</p> <p>Objective</p> <p>To determine the incidence and outcome of point-of-admission hypothermia among hospitalized babies.</p> <p>Methods</p> <p>The axillary temperatures of consecutive admissions into a Nigerian Newborn Unit were recorded. Temperature <36.5°C defined hypothermia. The biodata and outcome of these babies were studied.</p> <p>Results</p> <p>Of 150 babies aged 0 to 648 hours, 93 had hypothermia with an incidence of 62%. Mild and moderate hypothermia accounted for 47.3% and 52.7% respectively. The incidence of hypothermia was highest (72.4%) among babies aged less than 24 hours. It was also higher among out-born babies compared to in-born babies (64.4% <it>vs </it>58.3%). Preterm babies had significantly higher incidence of hypothermia (82.5%) compared with 54.5% of term babies (RR = 1.51; CI = 1.21 – 1.89). The incidence of hypothermia was also highest (93.3%) among very-low-birth-weight babies.</p> <p>The Case-Fatality-Rate was significantly higher among hypothermic babies (37.6% vs 16.7%; RR = 2.26, CI = 1.14 – 4.48) and among out-born hypothermic babies (50% vs 17.1%; RR = 0.34, CI = 0.16 – 0.74). CFR was highest among hypothermic babies with severe respiratory distress, sepsis, preterm birth and asphyxia.</p> <p>Conclusion</p> <p>The high incidence and poor outcome of hypothermia among high-risk babies is important. The use of the 'warm chain' and skin-to-skin contact between mother and her infant into routine delivery services in health facilities and at home may be useful.</p

Unusual finding of endocervical-like mucinous epithelium in continuity with urothelium in endocervicosis of the urinary bladder

Endocervicosis in the urinary bladder is a rare benign condition. We present a case in a 37-year-old woman with classical clinical and pathological features of endocervicosis. The unusual observation of endocervical-like mucinous epithelium in continuity with the urothelium in addition to fully developed endocervicosis prompted immunohistochemical profiling of the case using antibodies to cytokeratins (AE1/AE3, CK19, CK7, CK5/6, CK20), HBME-1, estrogen receptor (ER) and progesterone receptor (PR) to assess the relationship of the surface mucinous and endocervicosis glandular epithelia. The surface mucinous epithelium, urothelium and endocervicosis glands were immunopositive for AE1/AE3, CK7 and CK19 while CK20 was only expressed by few urothelial umbrella cells. The surface mucinous epithelium was CK5/6 and HBME-1 immunonegative but showed presence of ER and PR. This was in contrast to the urothelium's expression of CK5/6 but not ER and PR. In comparison, endocervicosis glands expressed HBME-1, unlike the surface mucinous epithelium. The endocervicosis epithelium also demonstrated the expected presence of ER and PR and CK5/6 immunonegativity. The slightly differing immunohistochemical phenotypes of the surface mucinous and morphologically similar endocervicosis glandular epithelium is interesting and requires further clarification to its actual nature. The patient has remained well and without evidence of disease 18-months following transurethral resection of the lesion

Mutation screening of NOS1AP gene in a large sample of psychiatric patients and controls

<p>Abstract</p> <p>Background</p> <p>The gene encoding carboxyl-terminal PDZ ligand of neuronal nitric oxide synthase (<it>NOS1AP</it>) is located on chromosome 1q23.3, a candidate region for schizophrenia, autism spectrum disorders (ASD) and obsessive-compulsive disorder (OCD). Previous genetic and functional studies explored the role of <it>NOS1AP </it>in these psychiatric conditions, but only a limited number explored the sequence variability of <it>NOS1AP</it>.</p> <p>Methods</p> <p>We analyzed the coding sequence of <it>NOS1AP </it>in a large population (n = 280), including patients with schizophrenia (n = 72), ASD (n = 81) or OCD (n = 34), and in healthy volunteers controlled for the absence of personal or familial history of psychiatric disorders (n = 93).</p> <p>Results</p> <p>Two non-synonymous variations, V37I and D423N were identified in two families, one with two siblings with OCD and the other with two brothers with ASD. These rare variations apparently segregate with the presence of psychiatric conditions.</p> <p>Conclusions</p> <p>Coding variations of <it>NOS1AP </it>are relatively rare in patients and controls. Nevertheless, we report the first non-synonymous variations within the human <it>NOS1AP </it>gene that warrant further genetic and functional investigations to ascertain their roles in the susceptibility to psychiatric disorders.</p

Integrating Human-Centred Design Approach into Sustainable-Oriented 3D Printing Systems

Modern 3D printing systems have become pervasive and widely used both in professional and in informal contexts, including sustainable-oriented ones. However, the risk to create very effective but non-sustainable solutions is very high since 3D printing systems could potentially increase the environmental emergencies and the unsustainable growth. In the transition process toward sustainable ways of production and consumption, the so-called human factor still plays an important role in the achievement of sustainable-oriented actions; it drives the adoption of proper lifestyles that directly and indirectly influence the ways through which such technologies are used. Therefore, future Sustainable 3D Printing Systems should integrate the humans in the systems’ development. This study presents two important results: (a) it presents a set of interdisciplinary ‘Sustainable 3D Printing Systems’, which compose a promising sustainable-oriented scenario useful to support the transition processes toward sustainable designs and productions, and (b) it proposes a new strategy for the integration of human-centred aspects into Sustainable 3D Printing Systems, by combining insights from human-centred design approach