Handheld probe for quantitative micro-elastography

Funding: Australian Research Council (ARC); Department of Health, Western Australia; Cancer Council, Western Australia; OncoRes Medical.Optical coherence elastography (OCE) has been proposed for a range of clinical applications. However, the majority of these studies have been performed using bulks, lab based imaging systems. A compact. handheld imaging probe would accelerate clinical translation, however, to date. tins had been inhibited by the slow scan rates of compact devices and the motion artifact induced by the user's hand. In this paper, we present a proof-of-concept. handheld quantitative micro-elastography (QME) probe capable of scanning a 6 x 6 x 1 mm volume of tissue in 3.4 seconds. This handheld probe is enabled by a novel QME acquisition protocol that incorporates a custom bidirectional scan pattern driving a microelectromechanical system (MEMS) scanner, synchronized with the sample deformation induced by an annular PZT actuator. The custom scan pattern reduces the total acquisition time and the time difference between B-scans used to generate displacement maps. minimizing the impact of motion artifact. We test the feasibility of the handheld QME probe on a tissue-mimicking silicone phantom, demonstrating comparable image quality to a bench-mounted setup. In addition, we present the first handheld QME scans performed on human breast tissue specimens. For each specimen, quantitative micro-elastograms are co-registered with, and validated by, histology, demonstrating the ability-to distinguish stiff cancerous tissue from surrounding soft benign tissue.Publisher PDFPeer reviewe

A population-based retrospective cohort study comparing care for Western Australians with and without Alzheimer's disease in the last year of life

Our study investigated health service use for people in the last year of life, comparing those who died with and without Alzheimer’s disease (AD) documented on the death certificate. Using a population-based retrospective cohort design, and utilizing the Western Australian Data Linkage System for the period 2000–2002 (2.5 years), the study found that 992 people died of either AD alone or AD with at least one other condition recorded on the death certificate. Of those with documented AD, 90.4% were aged 75 or more years, two-thirds were female (68.8%), more than one-half were widowed (59.3%) and the majority lived in a major city (77.0%). Most deceased people had comorbidities recorded on death certificates (90.0%); the majority having either two (34.5%) or three (28.8%) comorbid conditions. Over two-thirds of people aged over 75 years with AD died in a residential aged care facility (RACF, 67.4%), while the greatest proportion of people without AD died in hospital (52.9%). When a comparison was made in the use of hospital and community-based services for decedents aged over 75 years with and without AD, dissimilarities were evident. Less than one-half of people with documented AD received hospital care in the last year of life (46.3%) compared to over 80% of people without AD (80.5%). Likewise, fewer people in the Alzheimer’s group received community care when compared to those without documented AD (10.8% vs. 28.5%). Despite a small group of people with AD (5.4%) who were transferred to an RACF shortly before dying, most people in this group lived and died in an RACF and had their care provided in this setting. Adequate nursing, medical and allied health services, and the provision of appropriate social support, including the use of advance care directives in RACFs, are essential for equitable provision of care to people with AD

Severe psychiatric disorders in mid-life and risk of dementia in late-life (age 65-84 years): A population based case-control study

Objective: To examine the association of mid-life exposure to several psychiatric disorders with the development of late-life dementia. Methods: A matched case-control study using Western Australian state-wide hospital inpatient, outpatient mental health and emergency records linked to death records. Incident dementia cases (2000-2009) aged 65 to 84 years were sex- and age-matched to an electoral roll control. Records as far back as 1970 were used to assess exposure to medical risk factors before age 65 years. Candidate psychiatric risk factors were required to be present at least 10 years before dementia onset to ensure direction of potential causality. Odds ratios were estimated using conditional logistic regression. Results: 13, 568 dementia cases (median age 78.7 years, 43.4 % male) were matched to a control. Depression, bipolar disorder, schizophrenia, anxiety disorder and alcohol dependence were found to be significant and independent risk factors for late-life dementia after adjusting for diabetes, heart disease, cerebrovascular disease and smoking risk factors. The effect of a history of depression, schizophrenia and alcohol dependency on dementia risk varied with age, being strongest for earlier onset late-life dementia and waning at older ages. Conclusion: Severe depression, anxiety disorder, bipolar disorder, schizophrenia and alcoholic dependency disorder treated by specialists in psychiatric facilities in mid-life are important risk factors for late-life dementia. These psychiatric conditions need to be considered in future studies of the risk and prevention of late-life dementia

Australian population trends and disparities in cholinesterase inhibitor use, 2003 to 2010

Background: The Australian Pharmaceutical Benefits Scheme (PBS) first subsidized cholinesteraseinhibitors (CEIs) for Alzheimer’s disease in 2001, introducing a novel therapy fora previously untreatable common condition. This study aims to determine Australian rates ofCEI use and to assess equality of access to treatment based on socioeconomic status andgeographic remoteness.Methods: Pharmaceutical claims records were used to identify all Australians prescribed CEIsbetween January 2003 and December 2010. Age-standardized and sex-adjusted index prescriptionrates were derived using the total Australian population as the denominator to examine temporaltrends and the impacts of socioeconomic and geographic disadvantage on CEI index prescriptionrates.Results: Index prescription rates peaked in 2004 at 92.5 per 100,000 person-years, declining tobetween 70.2 and 73.5 for years 2006 to 2010. Rates were highest in the 85- to 89-year age groupand 2.6-fold higher in the least socioeconomic disadvantaged population when compared with themost disadvantaged population. In major cities in Australia, index prescription rates were 1.4 to1.7 times greater compared with remote areas.Conclusions: Increasing geographic remoteness and socioeconomic disadvantage are associatedwith lower CEI index prescription rates, indicating inequities in the management of Alzheimer’sdisease in Australia

The effects of alcohol on ambulatory blood pressure and other cardiovascular risk factors in type 2 diabetes: A randomized intervention

Objective: Although prospective studies suggest light-to-moderate chronic alcohol intake protects against coronary artery disease in type 2 diabetic patients, the balance of effects on individual cardiovascular risk factors needs further assessment. We examined the effects of alcohol consumption on 24-h ambulatory blood pressure (BP) and heart rate (HR), high-density lipoprotein cholesterol, fibrinogen, C-reactive protein, homocysteine, and glycaemic control in well controlled type 2 diabetes. Methods: Twenty-four participants aged 49-66 year were randomized to a three-period crossover study with women drinking red wine 230ml/day (~24g alcohol/day) and men drinking red wine 300ml/day (~31g alcohol/day), or equivalent volumes of dealcoholized red wine (DRW) or water, each for 4 weeks. Ambulatory BP and HR were monitored every 30min for 24h at the end of each period. Home blood glucose monitoring was carried out twice weekly throughout. Results: Red wine increased awake SBP and DBP relative to water by 2.5±1.2/1.9±0.7mmHg (P=0.033, P=0.008, respectively), with a similar nonsignificant trend relative to DRW. Asleep DBP fell with red wine relative to DRW (2.0±0.8mmHg, P=0.016) with a similar nonsignificant trend relative to water. Red wine increased 24-h, awake and asleep HR relative to water and DRW. Relative to DRW, red wine did not affect glycaemic control or any other cardiovascular risk factor.Conclusion: In well controlled type 2 diabetic individuals 24–31 g alcohol/day (∼2–3 standard drinks) raises awake BP and 24-h HR and lowers asleep BP but does not otherwise favourably or adversely modify cardiovascular risk factors