ORCID Profile
0000-0001-9201-8678
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University of Otago
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Murdoch University
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Publisher: Springer Science and Business Media LLC
Date: 05-2005
Publisher: Public Library of Science (PLoS)
Date: 09-07-2014
Publisher: Springer Science and Business Media LLC
Date: 16-05-2015
Publisher: CSIRO Publishing
Date: 20-08-2021
DOI: 10.1071/WR20073
Abstract: Abstract Context Carnaby’s (Calyptorhychus latirostris), Baudin’s (Calyptorhynchus baudinii) and forest red-tailed black cockatoos (Calyptorhynchus banksii naso) are threatened parrot species endemic to south-western Australia. Behavioural monitoring has previously involved direct observation, which has proven challenging because of their cryptic nature, the type of habitat they move through and their speed of movement. The development of a model to accurately classify behaviour from tri-axial accelerometer data will provide greater insight into black cockatoo behaviour and ecology. Aims To develop an automated classifier model to classify accelerometer data from released black cockatoos to determine behaviour and activity budgets for three species of black cockatoo. Methods In the present study, we attached tri-axial accelerometers, housed in GPS tags, to four Carnaby’s cockatoos, three forest red-tailed black cockatoos and two Baudin’s cockatoos in captive care, undergoing rehabilitation for release back to the wild. Accelerometer data from these birds was coupled with 19 video files of the birds’ behaviour when flying, feeding and resting, to develop an automated behaviour classifier. The classifier was then used to annotate accelerometer data from 15 birds released after successful rehabilitation and to calculate activity budgets for these birds post-release. Key results We developed a classifier able to identify resting, flying and foraging behaviours from accelerometer data with 86% accuracy, as determined by the percentage of observed behaviours correctly identified by the classifier. The application of the classifier to accelerometer data from 15 released cockatoos enabled us to determine behaviours and activity budgets for all three species of black cockatoo. Black cockatoos spent most of their time at rest, followed by foraging with a short period of time flying. Conclusions Application of the classifier to data from released birds gives researchers the ability to remotely identify patterns of behaviour and calculate activity budgets. Implications Combining behaviour and activity budgets with location data provides useful insight into cockatoo movement, distribution, and habitat use. Such information is important for informing conservation efforts and addressing outstanding research objectives. Further studies including larger s le sizes of Baudin’s and forest red-tailed black cockatoos and comparing behaviour and activity between birds in breeding and non-breeding areas are warranted.
Publisher: BMJ
Date: 09-09-2019
DOI: 10.1136/ANNRHEUMDIS-2019-215933
Abstract: There is a lack of standardisation in the terminology used to describe gout. The aim of this project was to develop a consensus statement describing the recommended nomenclature for disease states of gout. A content analysis of gout-related articles from rheumatology and general internal medicine journals published over a 5-year period identified potential disease states and the labels commonly assigned to them. Based on these findings, experts in gout were invited to participate in a Delphi exercise and face-to-face consensus meeting to reach agreement on disease state labels and definitions. The content analysis identified 13 unique disease states and a total of 63 unique labels. The Delphi exercise (n=76 respondents) and face-to-face meeting (n=35 attendees) established consensus agreement for eight disease state labels and definitions. The agreed labels were as follows: ‘asymptomatic hyperuricaemia’, ‘asymptomatic monosodium urate crystal deposition’, ‘asymptomatic hyperuricaemia with monosodium urate crystal deposition’, ‘gout’, ‘tophaceous gout’, ‘erosive gout’, ‘first gout flare’ and ‘recurrent gout flares’. There was consensus agreement that the label ‘gout’ should be restricted to current or prior clinically evident disease caused by monosodium urate crystal deposition (gout flare, chronic gouty arthritis or subcutaneous tophus). Consensus agreement has been established for the labels and definitions of eight gout disease states, including ‘gout’ itself. The Gout, Hyperuricaemia and Crystal-Associated Disease Network recommends the use of these labels when describing disease states of gout in research and clinical practice.
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.SEMARTHRIT.2015.09.008
Abstract: Despite major progress in the imaging of gout, it is unclear which domains these techniques can evaluate and whether imaging modalities have the potential to provide valid outcome measures. The aim of this study was to assess the use of imaging instruments in gout according to the Outcomes in Rheumatology Clinical Trials (OMERACT) filter to inform the development of imaging as an outcome measure. A systematic literature search of imaging modalities for gout was undertaken. Articles were assessed by two reviewers to identify imaging domains and summarize information according to the OMERACT filter. The search identified 78 articles (one abstract). Modalities included were conventional radiography (CR) (16 articles), ultrasound (US) (29), conventional computed tomography (CT) (11), dual energy computed tomography (DECT) (20), and magnetic resonance imaging (MRI) (16). Three domains were identified as follows: urate deposition, joint damage, and inflammation. Although sufficient data were available to assess feasibility, validity, and reliability, comprehensive assessment of discrimination was not possible due to the paucity of prospective imaging studies. CR is widely accessible, inexpensive with a validated damage scoring system. US and MRI offer radiation-free methods of evaluating urate deposition, damage and inflammation, but may be limited by accessibility. DECT provides excellent definition of urate deposition and bone damage, but has restricted availability and requires radiation. Imaging methods can detect urate deposition, damage, and inflammation in gout. More than one modality may be required depending on the domains and therapeutic agent of interest. No single imaging method currently fulfils all aspects of the OMERACT filter for any domain.
Publisher: The Journal of Rheumatology
Date: 02-2015
Abstract: The gout working group at the Outcome Measures in Rheumatology (OMERACT) 12 meeting in 2014 aimed to determine which imaging modalities show the most promise for use as measurement instruments for outcomes in studies of people with chronic gout and to identify the key foci for future research about the performance of these imaging techniques with respect to the OMERACT filter 2.0. During the gout session, a systematic literature review of the data addressing imaging modalities including plain radiography (XR), conventional computed tomography (CT), dual-energy computed tomography (DECT), magnetic resonance imaging (MRI), and ultrasound (US) and the fulfillment of the OMERACT filter 2.0 was presented. The working group identified 3 relevant domains for imaging in gout studies: urate deposition (tophus burden), joint inflammation, and structural joint damage. The working group prioritized gaps in the data and identified a research agenda.
Publisher: CSIRO Publishing
Date: 2023
DOI: 10.1071/PC23015
Publisher: Oxford University Press (OUP)
Date: 20-04-2002
Publisher: Wiley
Date: 10-2023
DOI: 10.1002/ECE3.10598
Publisher: Wiley
Date: 02-02-2022
DOI: 10.1002/ART.41983
Abstract: To develop and validate classification criteria for microscopic polyangiitis (MPA). Patients with vasculitis or comparator diseases were recruited into an international cohort. The study proceeded in 5 phases: 1) identification of candidate items using consensus methodology, 2) prospective collection of candidate items present at the time of diagnosis, 3) data‐driven reduction of the number of candidate items, 4) expert panel review of cases to define the reference diagnosis, and 5) derivation of a points‐based risk score for disease classification in a development set using least absolute shrinkage and selection operator logistic regression, with subsequent validation of performance characteristics in an independent set of cases and comparators. The development set for MPA consisted of 149 cases of MPA and 408 comparators. The validation set consisted of an additional 142 cases of MPA and 414 comparators. From 91 candidate items, regression analysis identified 10 items for MPA, 6 of which were retained. The final criteria and their weights were as follows: perinuclear antineutrophil cytoplasmic antibody (ANCA) or anti–myeloperoxidase‐ANCA positivity (+6), pauci‐immune glomerulonephritis (+3), lung fibrosis or interstitial lung disease (+3), sino‐nasal symptoms or signs (−3), cytoplasmic ANCA or anti–proteinase 3 ANCA positivity (−1), and eosinophil count ≥1 × 10 9 /liter (−4). After excluding mimics of vasculitis, a patient with a diagnosis of small‐ or medium‐vessel vasculitis could be classified as having MPA with a cumulative score of ≥5 points. When these criteria were tested in the validation data set, the sensitivity was 91% (95% confidence interval [95% CI] 85–95%) and the specificity was 94% (95% CI 92–96%). The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology classification criteria for MPA are now validated for use in clinical research.
Publisher: JMIR Publications Inc.
Date: 02-09-2023
Publisher: Elsevier BV
Date: 10-2021
Publisher: Elsevier BV
Date: 12-2012
Publisher: Oxford University Press (OUP)
Date: 2022
DOI: 10.1093/RAP/RKAC001
Abstract: The aim was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the clinical experiences, research opportunities and well-being of rheumatology trainees. A voluntary, anonymous, Web-based survey was administered in English, Spanish or French from 19 August 2020 to 5 October 2020. Adult and paediatric rheumatology trainees were invited to participate via social media and email. Using multiple-choice questions and Likert scales, the perceptions of trainees regarding the impact of the COVID-19 pandemic on patient care and redeployment, learning and supervision, research and well-being were assessed. There were 302 respondents from 33 countries, with 83% in adult rheumatology training. An increase in non-rheumatology clinical work was reported by 45%, with 68% of these having been redeployed to COVID-19. Overall, trainees reported a negative impact on their learning opportunities during rheumatology training, including outpatient clinics (79%), inpatient consultations (59%), didactic teaching (55%), procedures (53%), teaching opportunities (52%) and ultrasonography (36%). Impacts on research experiences were reported by 46% of respondents, with 39% of these reporting that COVID-19 negatively affected their ability to continue their pre-pandemic research. Burnout and increases in stress were reported by 50% and 68%, respectively. Physical health was negatively impacted by training programme changes in 25% of respondents. The COVID-19 pandemic has had a substantial impact on rheumatology training and trainee well-being. Our study highlights the extent of this impact on research opportunities and clinical care, which are highly relevant to future curriculum planning and the clinical learning environment.
Publisher: Oxford University Press (OUP)
Date: 19-09-2022
DOI: 10.1093/RHEUMATOLOGY/KEAC534
Abstract: To describe obstetric outcomes based on COVID-19 vaccination status, in women with rheumatic and musculoskeletal diseases (RMDs) who developed COVID-19 during pregnancy. Data regarding pregnant women entered into the COVID-19 Global Rheumatology Alliance registry from 24 March 2020–25 February 2022 were analysed. Obstetric outcomes were stratified by number of COVID-19 vaccine doses received prior to COVID-19 infection in pregnancy. Descriptive differences between groups were tested using the chi-squared or Fisher’s exact test. There were 73 pregnancies in 73 women with RMD and COVID-19. Overall, 24.7% (18) of pregnancies were ongoing, while of the 55 completed pregnancies, 90.9% (50) of pregnancies resulted in livebirths. At the time of COVID-19 diagnosis, 60.3% (n = 44) of women were unvaccinated, 4.1% (n = 3) had received one vaccine dose while 35.6% (n = 26) had two or more doses. Although 83.6% (n = 61) of women required no treatment for COVID-19, 20.5% (n = 15) required hospital admission. COVID-19 resulted in delivery in 6.8% (n = 3) of unvaccinated women and 3.8% (n = 1) of fully vaccinated women. There was a greater number of preterm births (PTB) in unvaccinated women compared with fully vaccinated 29.5% (n = 13) vs 18.2% (n = 2). In this descriptive study, unvaccinated pregnant women with RMD and COVID-19 had a greater number of PTB compared with those fully vaccinated against COVID-19. Additionally, the need for COVID-19 pharmacological treatment was uncommon in pregnant women with RMD regardless of vaccination status. These results support active promotion of COVID-19 vaccination in women with RMD who are pregnant or planning a pregnancy.
Publisher: Wiley
Date: 04-2005
Publisher: BMJ
Date: 15-04-2020
Publisher: CSIRO Publishing
Date: 31-07-2023
DOI: 10.1071/WF22196
Publisher: Oxford University Press (OUP)
Date: 06-05-2020
Publisher: Springer Science and Business Media LLC
Date: 25-02-2022
Publisher: American College of Physicians
Date: 16-06-2020
DOI: 10.7326/M20-1223
Publisher: Springer Science and Business Media LLC
Date: 22-03-2015
Publisher: Wiley
Date: 22-07-2022
DOI: 10.1002/ACR2.11481
Abstract: Some patients with rheumatic diseases might be at higher risk for coronavirus disease 2019 (COVID‐19) acute respiratory distress syndrome (ARDS). We aimed to develop a prediction model for COVID‐19 ARDS in this population and to create a simple risk score calculator for use in clinical settings. Data were derived from the COVID‐19 Global Rheumatology Alliance Registry from March 24, 2020, to May 12, 2021. Seven machine learning classifiers were trained on ARDS outcomes using 83 variables obtained at COVID‐19 diagnosis. Predictive performance was assessed in a US test set and was validated in patients from four countries with independent registries using area under the curve (AUC), accuracy, sensitivity, and specificity. A simple risk score calculator was developed using a regression model incorporating the most influential predictors from the best performing classifier. The study included 8633 patients from 74 countries, of whom 523 (6%) had ARDS. Gradient boosting had the highest mean AUC (0.78 95% confidence interval [CI]: 0.67‐0.88) and was considered the top performing classifier. Ten predictors were identified as key risk factors and were included in a regression model. The regression model that predicted ARDS with 71% (95% CI: 61%‐83%) sensitivity in the test set, and with sensitivities ranging from 61% to 80% in countries with independent registries, was used to develop the risk score calculator. We were able to predict ARDS with good sensitivity using information readily available at COVID‐19 diagnosis. The proposed risk score calculator has the potential to guide risk stratification for treatments, such as monoclonal antibodies, that have potential to reduce COVID‐19 disease progression.
Publisher: CSIRO Publishing
Date: 2019
DOI: 10.1071/PC18033
Abstract: Increasingly, space use by foraging seabirds is being used as an indicator of ocean condition to inform projected planning for climate change, fisheries management and marine protected areas. We tracked foraging common noddies (Anous stolidus) from a colony in the East Indian Ocean using back-mounted solar GPS trackers during incubation and chick rearing to evaluate their suitability as biomonitors of ocean condition, and the overlap of flight tracks with marine protected area boundaries. This is the first study to track this species in its eastern distribution and across different stages of the breeding cycle. Six birds were tracked for 89 days in total, describing 10089km of flight. Birds made significantly longer trips during chick rearing, which may reflect reduced availability of prey. The tracking period coincided with a particularly strong ENSO event, which may have impacted foraging behaviour, but the foraging area was found to be at least 10000km2. Foraging was associated with the end points of outward trips that were generally at the edge of the continental shelf, or within proximity of canyon-like bathymetric features or current structures on the shelf. Birds foraged over the shelf during incubation, suggesting a greater reliance on food web structures associated with Leeuwin Current structures. Home ranges and movement tracks showed limited overlap with proposed marine park boundaries, but are promising as indicators of ocean productivity, suggesting that their role in the design of marine reserve networks in the future should be maximised.
Publisher: JMIR Publications Inc.
Date: 19-07-2019
Abstract: n emerging literature describes systematic reviews of the app stores to identify mobile applications (apps) to support diagnosis, assessment or management of health conditions. There are currently no guidelines for the conduct and reporting of methods of these studies. The first step in developing guidelines is to evaluate current reporting of methods of systematic reviews of health apps. he aims of this scoping review were: 1. To identify what parts of the ‘usual’ methods of systematic review are used and adapted in app-focused systematic reviews 2. To describe how methods of critical appraisal are adapted and done and 3. To assess what clinical recommendations are made and the ‘strength’ of those recommendations. systematic search of seven databases was undertaken to identify app-focused systematic reviews meeting the inclusion criteria: (1) the article was “systematic” defined by “systematic review” in the title OR an a priori systematic search procedure described in the article methods OR the app search process described based on PRISMA standard flow diagram (2) the article described a systematic search for apps in at least one app store (3) the article focused on a named health condition and (4) the focus of the article was apps for people with any diagnosed acute or chronic health condition or for clinicians in direct clinical care. Articles were excluded if not in English, focused on general or psychological health or nutrition. A data extraction template was created based on standard data elements in PRISMA guidelines. The extracted data from the included articles were summarised by frequencies. rom 2798 records, 26 of the 177 potentially eligible full text articles were included. In the 26 included app-focused systematic reviews, many of the typical procedures of a systematic review as operationalized for app-focused reviews were not reported at all, or not clearly reported. Absences, lack of clarity or completeness of reporting occured in: a priori review protocol registration or following a reporting guideline the processes of screening apps in the app stores the data extracted from app store description or the device the app was downloaded to for data extraction and appraisal tools for assessing the app quality, usability or clinical content. Further, there was no explicit reporting of clinical efficacy of apps or recommendations for use in the majority of reviews. he reporting of methods used in app-focused systematic reviews is variable and could be substantially improved. Development and publication of consensus reporting guidelines would increase transparency and quality of published studies. A repository for registration of reviews would ensure reviews are easy to find and not duplicated. These steps would also enable clinicians and people with health conditions to more easily find high quality apps.
Publisher: The Journal of Rheumatology
Date: 09-2021
Abstract: To describe coronavirus disease 2019 (COVID-19) and pregnancy outcomes in patients with rheumatic disease who were pregnant at the time of infection. Since March 2020, the COVID-19 Global Rheumatology Alliance has collected cases of patients with rheumatic disease with COVID-19. We report details of pregnant women at the time of COVID-19 infection, including obstetric details separately ascertained from providers. We report on 39 patients, including 22 with obstetric detail available. The mean and median age was 33 years, range 24–45 years. Rheumatic disease diagnoses included rheumatoid arthritis (n = 9), systemic lupus erythematosus (n = 9), psoriatic arthritis/other inflammatory arthritides (n = 8), and antiphospholipid syndrome (n = 6). Most had a term birth (16/22), with 3 preterm births, 1 termination, and 1 miscarriage 1 woman had yet to deliver at the time of report. One-quarter (n = 10/39) of pregnant women were hospitalized following COVID-19 diagnosis. Two of 39 (5%) required supplemental oxygen (both hospitalized) no patients died. The majority did not receive specific medication treatment for their COVID-19 (n = 32/39, 82%), and 7 patients received some combination of antimalarials, colchicine, anti–interleukin 1β, azithromycin, glucocorticoids, and lopinavir/ritonavir. Women with rheumatic diseases who were pregnant at the time of COVID-19 had favorable outcomes. These data have limitations due to the small size and methodology however, they provide cautious optimism for pregnancy outcomes for women with rheumatic disease particularly in comparison to the increased risk of poor outcomes that have been reported in other series of pregnant women with COVID-19.
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.1186/AR2371
Publisher: Oxford University Press (OUP)
Date: 2021
DOI: 10.1093/RAP/RKAB031
Abstract: Given the limited data regarding the risk of hospitalization in patients with rheumatic disease and coronavirus disease 2019 (COVID-19) in Ireland, we used the COVID-19 Global Rheumatology Alliance (GRA) registry data to study outcomes and their predictors. The primary objective was to explore potential predictors of hospitalization. We examined data on patients and their disease-related characteristics entered in the COVID-19 GRA provider registry from Ireland (from 24 March 2020 to 31 August 2020). Multivariable logistic regression was used to assess the association of demographic and clinical characteristics with hospitalization. Of 105 patients, 47 (45.6%) were hospitalized and 10 (9.5%) died. Multivariable logistic regression analysis showed that age [odds ratio (OR) = 1.06, 95% CI 1.01, 1.10], number of co-morbidities (OR = 1.93, 95% CI 1.11, 3.35) and glucocorticoid use (OR = 15.01, 95% CI 1.77, 127.16) were significantly associated with hospitalization. A diagnosis of inflammatory arthritis was associated with lower odds of hospitalization (OR = 0.09, 95% CI 0.02, 0.32). Increasing age, co-morbidity burden and glucocorticoid use were associated with hospitalization, whereas a diagnosis of inflammatory arthritis was associated with lower odds of hospitalization.
Publisher: Elsevier BV
Date: 05-2020
Publisher: Informa UK Limited
Date: 06-12-2018
Publisher: Georg Thieme Verlag KG
Date: 25-04-2019
Abstract: Objective: Artificial intelligence (AI) provides people and professionals working in the field of participatory health informatics an opportunity to derive robust insights from a variety of online sources. The objective of this paper is to identify current state of the art and application areas of AI in the context of participatory health. Methods: A search was conducted across seven databases (PubMed, Embase, CINAHL, PsychInfo, ACM Digital Library, IEEExplore, and SCOPUS), covering articles published since 2013. Additionally, clinical trials involving AI in participatory health contexts registered at clinicaltrials.gov were collected and analyzed. Results: Twenty-two articles and 12 trials were selected for review. The most common application of AI in participatory health was the secondary analysis of social media data: self-reported data including patient experiences with healthcare facilities, reports of adverse drug reactions, safety and efficacy concerns about over-the-counter medications, and other perspectives on medications. Other application areas included determining which online forum threads required moderator assistance, identifying users who were likely to drop out from a forum, extracting terms used in an online forum to learn its vocabulary, highlighting contextual information that is missing from online questions and answers, and paraphrasing technical medical terms for consumers. Conclusions: While AI for supporting participatory health is still in its infancy, there are a number of important research priorities that should be considered for the advancement of the field. Further research evaluating the impact of AI in participatory health informatics on the psychosocial wellbeing of in iduals would help in facilitating the wider acceptance of AI into the healthcare ecosystem.
Publisher: BMJ
Date: 09-2021
DOI: 10.1136/RMDOPEN-2021-001814
Abstract: We describe the early experiences of adults with systemic rheumatic disease who received the COVID-19 vaccine. From 2 April to 30 April 2021, we conducted an online, international survey of adults with systemic rheumatic disease who received COVID-19 vaccination. We collected patient-reported data on clinician communication, beliefs and intent about discontinuing disease-modifying antirheumatic drugs (DMARDs) around the time of vaccination, and patient-reported adverse events after vaccination. We analysed 2860 adults with systemic rheumatic diseases who received COVID-19 vaccination (mean age 55.3 years, 86.7% female, 86.3% white). Types of COVID-19 vaccines were Pfizer-BioNTech (53.2%), Oxford/AstraZeneca (22.6%), Moderna (21.3%), Janssen/Johnson & Johnson (1.7%) and others (1.2%). The most common rheumatic disease was rheumatoid arthritis (42.3%), and 81.2% of respondents were on a DMARD. The majority (81.9%) reported communicating with clinicians about vaccination. Most (66.9%) were willing to temporarily discontinue DMARDs to improve vaccine efficacy, although many (44.3%) were concerned about rheumatic disease flares. After vaccination, the most reported patient-reported adverse events were fatigue/somnolence (33.4%), headache (27.7%), muscle/joint pains (22.8%) and fever/chills (19.9%). Rheumatic disease flares that required medication changes occurred in 4.6%. Among adults with systemic rheumatic disease who received COVID-19 vaccination, patient-reported adverse events were typical of those reported in the general population. Most patients were willing to temporarily discontinue DMARDs to improve vaccine efficacy. The relatively low frequency of rheumatic disease flare requiring medications was reassuring.
Publisher: BMJ
Date: 27-01-2021
DOI: 10.1136/ANNRHEUMDIS-2020-219498
Abstract: To determine factors associated with COVID-19-related death in people with rheumatic diseases. Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66–75 years: OR 3.00, 95% CI 2.13 to 4.22 years: 6.18, 4.47 to 8.53 both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage mg/day (1.69, 1.18 to 2.41 vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.
Publisher: BMJ
Date: 29-05-2020
DOI: 10.1136/ANNRHEUMDIS-2020-217871
Abstract: COVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease. Case series of in iduals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed. A total of 600 cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% CI 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively). Non-steroidal anti-inflammatory drug (NSAID) use was not associated with hospitalisation status (OR 0.64, 95% CI 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed. We found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalisation.
Publisher: Elsevier BV
Date: 03-2021
Publisher: SAGE Publications
Date: 11-09-2020
Abstract: No guidelines exist for the conduct and reporting of manuscripts with systematic searches of app stores for, and then appraisal of, mobile health apps (‘health app-focused reviews’). We undertook a scoping review including a systematic literature search for health app-focused reviews describing systematic app store searches and app appraisal, for apps designed for patients or clinicians. We created a data extraction template which adapted data elements from the PRISMA guidelines for systematic literature reviews to data elements operationalised for health app-focused reviews. We extracted the data from included health app-focused reviews to describe: (1) which elements of the adapted ‘usual’ methods of systematic review are used (2) methods of app appraisal and (3) reporting of clinical efficacy and recommendations for app use. From 2798 records, the 26 included health app-focused reviews showed incomplete or unclear reporting of review protocol registration use of reporting guidelines processes of screening apps data extraction and appraisal tools. Reporting of clinical efficacy of apps or recommendations for app use were infrequent. The reporting of methods in health app-focused reviews is variable and could be improved by developing a consensus reporting standard for health app-focused reviews.
Publisher: Wiley
Date: 02-12-2022
DOI: 10.1002/ACR.25039
Abstract: To determine the association between race/ethnicity and COVID-19 outcomes in in iduals with systemic lupus erythematosus (SLE). In iduals with SLE from the US with data entered into the COVID-19 Global Rheumatology Alliance registry between March 24, 2020 and August 27, 2021 were included. Variables included age, sex, race, and ethnicity (White, Black, Hispanic, other), comorbidities, disease activity, pandemic time period, glucocorticoid dose, antimalarials, and immunosuppressive drug use. The ordinal outcome categories were: not hospitalized, hospitalized with no oxygenation, hospitalized with any ventilation or oxygenation, and death. We constructed ordinal logistic regression models evaluating the relationship between race/ethnicity and COVID-19 severity, adjusting for possible confounders. We included 523 patients 473 (90.4%) were female and the mean ± SD age was 46.6 ± 14.0 years. A total of 358 patients (74.6%) were not hospitalized 40 patients (8.3%) were hospitalized without oxygen, 64 patients (13.3%) were hospitalized with any oxygenation, and 18 (3.8%) died. In a multivariable model, Black (odds ratio [OR] 2.73 [95% confidence interval (95% CI) 1.36-5.53]) and Hispanic (OR 2.76 [95% CI 1.34-5.69]) in iduals had higher odds of more severe outcomes than White in iduals. Black and Hispanic in iduals with SLE experienced more severe COVID-19 outcomes, which is consistent with findings in the US general population. These results likely reflect socioeconomic and health disparities and suggest that more aggressive efforts are needed to prevent and treat infection in this population.
Publisher: Oxford University Press (OUP)
Date: 13-08-2020
DOI: 10.1093/RHEUMATOLOGY/KEAA483
Abstract: As the coronavirus disease 2019 pandemic developed there was a paucity of data relevant to people living with rheumatic disease. This led to the development of a global, online registry to meet these information needs. This manuscript provides a detailed description of the coronavirus disease 2019 Global Rheumatology Alliance registry development, governance structure, and data collection, and insights into new ways of rapidly establishing global research collaborations to meet urgent research needs. We use previously published recommendations for best practices for registry implementation and describe the development of the Global Rheumatology Alliance registry in terms of these steps. We identify how and why these steps were adapted or modified. In Phase 1 of registry development, the purpose of the registry and key stakeholders were identified on online platforms, Twitter and Slack. Phase 2 consisted of protocol and data collection form development, team building and the implementation of governance and policies. All key steps of the registry development best practices framework were met, though with the need for adaptation in some areas. Outputs of the registry, two months after initial conception, are also described. The Global Rheumatology Alliance registry will provide highly useful, timely data to inform clinical care and identify further research priorities for people with rheumatic disease with coronavirus disease 2019. The formation of an international team, easily able to function in online environments and resulting in rapid deployment of a registry is a model that can be adapted for other disease states and future global collaborations.
Publisher: Oxford University Press (OUP)
Date: 25-09-0003
DOI: 10.1093/RHEUMATOLOGY/KEAC142
Abstract: Although evidence is accumulating globally, data on outcomes in rheumatic disease and COVID-19 in Ireland are limited. We used data from the COVID-19 Global Rheumatology Alliance (C19-GRA) to describe time-varying COVID-19 outcomes for people with rheumatic disease in Ireland. Data entered into the C19-GRA provider registry from Ireland between 24 March 2020 and 9 July 2021 were analysed. Differences in the likelihood of hospitalization and mortality according to demographic and clinical variables were investigated using Chi-squared test or Fisher’s exact test, as appropriate. Trends in odds of hospitalization and mortality over time were investigated using logistic regression with the time period as a categorical variable. Of 212 cases included, 59.4% were female and median age was 58.0 years (range 13–96). Of the 212 cases, 92 (43%) were hospitalized and 22 (10.4%) died. Increasing age, a diagnosis of gout, ever smoking, glucocorticoid use, having comorbidities and specific comorbidities of cancer, cardiovascular and pulmonary disease were more common in those hospitalized. A diagnosis of inflammatory arthritis, csDMARD and/or b/tsDMARD use were less frequent in those hospitalized. Increasing age, a diagnosis of gout, ever smoking, having comorbidities and specific comorbidities of obesity, cardiovascular and pulmonary disease were more common in those who died. Odds of hospitalization or mortality did not change over time. No temporal trend was observed in either COVID-19-related hospitalization or mortality outcomes for people with rheumatic disease in Ireland.
Publisher: American Geophysical Union (AGU)
Date: 12-2005
DOI: 10.1029/2005GB002546
Publisher: BMJ
Date: 28-05-2021
DOI: 10.1136/ANNRHEUMDIS-2021-220418
Abstract: To investigate baseline use of biologic or targeted synthetic (b/ts) disease-modifying antirheumatic drugs (DMARDs) and COVID-19 outcomes in rheumatoid arthritis (RA). We analysed the COVID-19 Global Rheumatology Alliance physician registry (from 24 March 2020 to 12 April 2021). We investigated b/tsDMARD use for RA at the clinical onset of COVID-19 (baseline): abatacept (ABA), rituximab (RTX), Janus kinase inhibitors (JAKi), interleukin 6 inhibitors (IL-6i) or tumour necrosis factor inhibitors (TNFi, reference group). The ordinal COVID-19 severity outcome was (1) no hospitalisation, (2) hospitalisation without oxygen, (3) hospitalisation with oxygen/ventilation or (4) death. We used ordinal logistic regression to estimate the OR (odds of being one level higher on the ordinal outcome) for each drug class compared with TNFi, adjusting for potential baseline confounders. Of 2869 people with RA (mean age 56.7 years, 80.8% female) on b/tsDMARD at the onset of COVID-19, there were 237 on ABA, 364 on RTX, 317 on IL-6i, 563 on JAKi and 1388 on TNFi. Overall, 613 (21%) were hospitalised and 157 (5.5%) died. RTX (OR 4.15, 95% CI 3.16 to 5.44) and JAKi (OR 2.06, 95% CI 1.60 to 2.65) were each associated with worse COVID-19 severity compared with TNFi. There were no associations between ABA or IL6i and COVID-19 severity. People with RA treated with RTX or JAKi had worse COVID-19 severity than those on TNFi. The strong association of RTX and JAKi use with poor COVID-19 outcomes highlights prioritisation of risk mitigation strategies for these people.
Publisher: Informa UK Limited
Date: 04-08-2023
Publisher: BMJ
Date: 04-2022
DOI: 10.1136/RMDOPEN-2021-002187
Abstract: While COVID-19 vaccination prevents severe infections, poor immunogenicity in immunocompromised people threatens vaccine effectiveness. We analysed the clinical characteristics of patients with rheumatic disease who developed breakthrough COVID-19 after vaccination against SARS-CoV-2. We included people partially or fully vaccinated against SARS-CoV-2 who developed COVID-19 between 5 January and 30 September 2021 and were reported to the Global Rheumatology Alliance registry. Breakthrough infections were defined as occurring ≥14 days after completion of the vaccination series, specifically 14 days after the second dose in a two-dose series or 14 days after a single-dose vaccine. We analysed patients’ demographic and clinical characteristics and COVID-19 symptoms and outcomes. SARS-CoV-2 infection was reported in 197 partially or fully vaccinated people with rheumatic disease (mean age 54 years, 77% female, 56% white). The majority (n=140/197, 71%) received messenger RNA vaccines. Among the fully vaccinated (n=87), infection occurred a mean of 112 (±60) days after the second vaccine dose. Among those fully vaccinated and hospitalised (n=22, age range 36–83 years), nine had used B cell-depleting therapy (BCDT), with six as monotherapy, at the time of vaccination. Three were on mycophenolate. The majority (n=14/22, 64%) were not taking systemic glucocorticoids. Eight patients had pre-existing lung disease and five patients died. More than half of fully vaccinated in iduals with breakthrough infections requiring hospitalisation were on BCDT or mycophenolate. Further risk mitigation strategies are likely needed to protect this selected high-risk population.
Publisher: Elsevier BV
Date: 12-2021
Publisher: Wiley
Date: 24-08-2022
DOI: 10.1002/ACR2.11495
Abstract: To describe people with gout who were diagnosed with coronavirus disease 2019 (COVID‐19) and hospitalized and to characterize their outcomes. Data on patients with gout hospitalized for COVID‐19 between March 12, 2020, and October 25, 2021, were extracted from the COVID‐19 Global Rheumatology Alliance registry. Descriptive statistics were used to describe the demographics, comorbidities, medication exposures, and COVID‐19 outcomes including oxygenation or ventilation support and death. One hundred sixty‐three patients with gout who developed COVID‐19 and were hospitalized were included. The mean age was 63 years, and 85% were male. The majority of the group lived in the Western Pacific Region (35%) and North America (18%). Nearly half (46%) had two or more comorbidities, with hypertension (56%), cardiovascular disease (28%), diabetes mellitus (26%), chronic kidney disease (25%), and obesity (23%) being the most common. Glucocorticoids and colchicine were used pre‐COVID‐19 in 11% and 12% of the cohort, respectively. Over two thirds (68%) of the cohort required supplemental oxygen or ventilatory support during hospitalization. COVID‐19‐related death was reported in 16% of the overall cohort, with 73% of deaths documented in people with two or more comorbidities. This cohort of people with gout and COVID‐19 who were hospitalized had high frequencies of ventilatory support and death. This suggests that patients with gout who were hospitalized for COVID‐19 may be at risk of poor outcomes, perhaps related to known risk factors for poor outcomes, such as age and presence of comorbidity.
Publisher: The Journal of Rheumatology
Date: 15-12-2013
Abstract: To determine the extent to which participants at the Outcome Measures in Rheumatology (OMERACT) 11 meeting agree that instruments used in clinical trials to measure OMERACT core outcome domains in acute gout fulfill OMERACT filter requirements of truth, discrimination, and feasibility and where future research efforts need to be directed. Results of a systematic literature review and analysis of in idual-level data from recent clinical studies of acute gout were presented to OMERACT participants. The information was discussed in breakout groups, and opinion was defined by subsequent voting in a plenary session. Endorsement was defined as at least 70% of participants voting in agreement with the proposition (where the denominator excluded those participants who did not vote or who voted “don’t know”). The following measures were endorsed for use in clinical trials of acute gout: (1) 5-point Likert scale and/or visual analog scale (0 to 100 mm) to measure pain (2) 4-point Likert scale for joint swelling (3) 4-point Likert scale for joint tenderness and (4) 5-point Likert scale for patient global assessment of response to treatment. Measures for the activity limitations domain were not endorsed. Measures of pain, joint swelling, joint tenderness, and patient global assessment in acute gout were endorsed at OMERACT 11. These measures should now be used in clinical trials of acute gout.
Publisher: Elsevier BV
Date: 04-2022
Publisher: Wiley
Date: 30-08-2017
DOI: 10.1111/COBI.12955
Abstract: Glyphosate has become the most commonly used herbicide worldwide and is reputedly environmentally benign, nontoxic, and safe for use near wildlife and humans. However, studies indicate its toxicity is underestimated and its persistence in the environment is greater than once thought. Its actions as a neurotoxin and endocrine disruptor indicate its potential to act in similar ways to persistent organic pollutants such as the organochlorines dichlorodiphenyltrichloroethane (DDT) and dioxin. Exposure to glyphosate and glyphosate-based herbicides for both wildlife and people is likely to be chronic and at sublethal levels, with multiple and ongoing exposure events occurring in urban and agricultural landscapes. Despite this, there has been little research on the impact of glyphosate on wildlife populations, and existing studies appear in the agricultural, toxicology, and water-chemistry literature that may have limited visibility among wildlife biologists. These studies clearly demonstrate a link between chronic exposure and neurotoxicity, endocrine disruption, cell damage, and immune suppression. There is a strong case for the recognition of glyphosate as an emerging organic contaminant and substantial potential exists for collaborative research among ecologists, toxicologists, and chemists to quantify the impact of glyphosate on wildlife and to evaluate the role of biosentinel species in a preemptive move to mitigate downstream impacts on people. There is scope to develop a decision framework to aid the choice of species to biomonitor and analysis methods based on the target contaminant, spatial and temporal extent of contamination, and perceived risk. Birds in particular offer considerable potential in this role because they span agricultural and urban environments, coastal, inland, and wetland ecosystems where glyphosate residues are known to be present.
Publisher: Wiley
Date: 02-02-2021
DOI: 10.1002/ART.41567
Publisher: CSIRO Publishing
Date: 2015
DOI: 10.1071/PC14917
Abstract: Baudin’s cockatoo, Calyptorhynchus baudinii, is a threatened forest black cockatoo species, endemic to the south-west of Western Australia. In this study we fitted tail-mounted satellite transmitters to two female Baudin’s cockatoos that had undergone treatment and rehabilitation at Perth Zoo and Kaarakin Black Cockatoo Conservation Centre to investigate the feasibility of satellite tracking this species. Both birds were released in Kelmscott, Perth, into an area frequently visited by a flock of wild Baudin’s cockatoos. Both telemetry units provided reliable datasets, with one bird moving ~250 km south from the release site. The success of this trial opens the way to address key objectives in the Forest Black Cockatoo Recovery Plan, including: postrelease survival of rehabilitated birds, flock movement, habitat use, and the identification of critical feeding and breeding habitat. Most importantly, it demonstrates that satellite transmitters can be successfully used to locate and track forest black cockatoo species, which are otherwise difficult to monitor.
Publisher: Georg Thieme Verlag KG
Date: 22-04-2018
Abstract: Objectives: With the increased use of participatory health enabling technologies, such as social media, balancing the need for health information with patient privacy and confidentiality has become a more complex and immediate concern. The purpose of this paper produced by the members of the IMIA Participatory Health and Social Media (PHSM) working group is to investigate patient needs for health information using participatory health enabling technologies, while balancing their needs for privacy and confidentiality. Methods: Six domain areas including media sharing platforms, patient portals, web-based platforms, crowdsourcing websites, medical avatars, and other mobile health technologies were identified by five members of the IMIA PHSM working group as relevant to participatory health and the balance between data sharing and patient needs for privacy and confidentiality. After identifying the relevant domain areas, our scoping review began by searching several databases such as PubMed, MEDLINE, Scopus, and Google Scholar using a variety of key search terms. Results: A total of 1,973 studies were identified, of which 68 studies met our inclusion criteria and were included in the analysis. Results showed that challenges for balancing patient needs for information and privacy and confidentiality concerns included: cross-cultural understanding, clinician and patient awareness, de-identification of data, and commercialization of patient data. Some opportunities identified were patient empowerment, connecting participatory health enabling technologies with clinical records, open data sharing agreement, and e-consent. Conclusion: Balancing between privacy and patient needs for health information in the age of participatory health and social media offers several opportunities and challenges. More people are engaging in actively managing health through participatory health enabling technologies. Such activity often includes sharing health information and with this comes a perennial tension between balancing in idual needs and the desire to uphold privacy and confidentiality. We recommend that guidelines for both patients and clinicians, in terms of their use of participatory health-enabling technologies, are developed to ensure that patient privacy and confidentiality are protected, and a maximum benefit can be realized.
Publisher: Oxford University Press (OUP)
Date: 23-05-2020
DOI: 10.1093/RHEUMATOLOGY/KEAA215
Abstract: ANCA-associated vasculitis (AAV) can affect all age groups. We aimed to show that differences in disease presentation and 6 month outcome between younger- and older-onset patients are still incompletely understood. We included patients enrolled in the Diagnostic and Classification Criteria for Primary Systemic Vasculitis (DCVAS) study between October 2010 and January 2017 with a diagnosis of AAV. We ided the population according to age at diagnosis: & years or ≥65 years. We adjusted associations for the type of AAV and the type of ANCA (anti-MPO, anti-PR3 or negative). A total of 1338 patients with AAV were included: 66% had disease onset at & years of age [female 50% mean age 48.4 years (s.d. 12.6)] and 34% had disease onset at ≥65 years [female 54% mean age 73.6 years (s.d. 6)]. ANCA (MPO) positivity was more frequent in the older group (48% vs 27% P = 0.001). Younger patients had higher rates of musculoskeletal, cutaneous and ENT manifestations compared with older patients. Systemic, neurologic,cardiovascular involvement and worsening renal function were more frequent in the older-onset group. Damage accrual, measured with the Vasculitis Damage Index (VDI), was significantly higher in older patients, 12% of whom had a 6 month VDI ≥5, compared with 7% of younger patients (P = 0.01). Older age was an independent risk factor for early death within 6 months from diagnosis [hazard ratio 2.06 (95% CI 1.07, 3.97) P = 0.03]. Within 6 months of diagnosis of AAV, patients & years of age display a different pattern of organ involvement and an increased risk of significant damage and mortality compared with younger patients.
Publisher: Oxford University Press (OUP)
Date: 13-01-2023
DOI: 10.1093/RHEUMATOLOGY/KEAC713
Abstract: To explore current management practices for PMR by general practitioners (GPs) and rheumatologists including implications for clinical trial recruitment. An English language questionnaire was constructed by a working group of rheumatologists and GPs from six countries. The questionnaire focused on: 1: Respondent characteristics 2: Referral practices 3: Treatment with glucocorticoids 4: Diagnostics 5: Comorbidities and 6: Barriers to research. The questionnaire was distributed to rheumatologists and GPs worldwide via members of the International PMR/Giant Cell Arteritis Study Group. In total, 394 GPs and 937 rheumatologists responded to the survey. GPs referred a median of 25% of their suspected PMR patients for diagnosis and 50% of these were returned to their GP for management. In general, 39% of rheumatologists evaluated patients with suspected PMR & weeks after referral, and a median of 50% of patients had started prednisolone before rheumatologist evaluation. Direct comparison of initial treatment showed that the percentage prescribing & mg prednisolone daily for patients was 30% for GPs and 12% for rheumatologists. Diagnostic imaging was rarely used. More than half (56%) of rheumatologists experienced difficulties recruiting people with PMR to clinical trials. This large international survey indicates that a large proportion of people with PMR are not referred for diagnosis, and that the proportion of treatment-naive patients declined with increasing time from referral to assessment. Strategies are needed to change referral and management of people with PMR, to improve clinical practice and facilitate recruitment to clinical trials.
Publisher: Wiley
Date: 28-02-2019
DOI: 10.1002/ACR.23607
Publisher: Wiley
Date: 07-11-2013
DOI: 10.1002/ECE3.845
Publisher: The Journal of Rheumatology
Date: 15-11-2022
Abstract: The study aimed to describe the prevalence and outcomes of gout flare in patients with comorbid gout hospitalized for coronavirus disease 2019 (COVID-19). Factors associated with gout flare and hospital length of stay were explored. This retrospective cohort study included adults with comorbid gout who were hospitalized for PCR-confirmed COVID-19 between March 2020 and December 2021 in 3 hospitals in Thailand. Prevalence, characteristics, and outcomes of gout flare were described. Factors associated with gout flare were explored using least absolute shrinkage and selection operator selection and multivariate logistic regression. The association between gout flare and hospital length of stay was explored using multivariate linear regression. Among 8697 patients hospitalized for COVID-19, 146 patients with comorbid gout were identified and gout flare occurred in 26 (18%). Compared to those without flare, patients with gout flare had higher baseline serum urate and lower prevalence of use of urate-lowering therapy (ULT) and gout flare prophylaxis medications. One-third of gout flare episodes were treated with ≥ 2 antiinflammatory medications. Logistic regression identified GOUT-36 rule ≥ 2, a predictive index for inpatient gout flare, as the only factor associated with gout flare (odds ratio 5.46, 95% CI 1.18-25.37). Gout flare was found to be independently associated with hospital length of stay and added 3 days to hospital course. Gout flare occurred in 18% of patients with comorbid gout hospitalized for COVID-19 and added up to 3 days to hospital length of stay. Patients with suboptimal ULT appeared to be at high risk for gout flare during COVID-19 hospitalization.
Publisher: Informa UK Limited
Date: 03-2004
DOI: 10.1071/MU03043
Publisher: Springer Science and Business Media LLC
Date: 09-01-2009
Publisher: Wiley
Date: 29-06-2020
DOI: 10.1002/ACR.24257
No related grants have been discovered for Rebecca Grainger.