ORCID Profile
0000-0002-0171-3972
Current Organisation
University of South Australia
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Publisher: Frontiers Media SA
Date: 20-02-2023
DOI: 10.3389/FNEUR.2023.1071794
Abstract: Assessment of functional impairment following ischaemic stroke is essential to determine outcome and efficacy of intervention in both clinical patients and pre-clinical models. Although paradigms are well described for rodents, comparable methods for large animals, such as sheep, remain limited. This study aimed to develop methods to assess function in an ovine model of ischaemic stroke using composite neurological scoring and gait kinematics from motion capture. Merino sheep ( n = 26) were anaesthetised and subjected to 2 hours middle cerebral artery occlusion. Animals underwent functional assessment at baseline (8-, 5-, and 1-day pre-stroke), and 3 days post-stroke. Neurological scoring was carried out to determine changes in neurological status. Ten infrared cameras measured the trajectories of 42 retro-reflective markers for calculation of gait kinematics. Magnetic resonance imaging (MRI) was performed at 3 days post-stroke to determine infarct volume. Intraclass Correlation Coefficients (ICC's) were used to assess the repeatability of neurological scoring and gait kinematics across baseline trials. The average of all baselines was used to compare changes in neurological scoring and kinematics at 3 days post-stroke. A principal component analysis (PCA) was performed to determine the relationship between neurological score, gait kinematics, and infarct volume post-stroke. Neurological scoring was moderately repeatable across baseline trials (ICC & 0.50) and detected marked impairment post-stroke ( p & 0.05). Baseline gait measures showed moderate to good repeatability for the majority of assessed variables (ICC & 0.50). Following stroke, kinematic measures indicative of stroke deficit were detected including an increase in stance and stride duration ( p & 0.05). MRI demonstrated infarction involving the cortex and/or thalamus (median 2.7 cm 3 , IQR 1.4 to 11.9). PCA produced two components, although association between variables was inconclusive. This study developed repeatable methods to assess function in sheep using composite scoring and gait kinematics, allowing for the evaluation of deficit 3 days post-stroke. Despite utility of each method independently, there was poor association observed between gait kinematics, composite scoring, and infarct volume on PCA. This suggests that each of these measures has discreet utility for the assessment of stroke deficit, and that multimodal approaches are necessary to comprehensively characterise functional impairment.
Publisher: American Academy of Sleep Medicine (AASM)
Date: 15-07-2020
DOI: 10.5664/JCSM.8456
Publisher: Wiley
Date: 09-02-2023
DOI: 10.1002/OA.3204
Abstract: Archaeological investigation of the dentoalveolar complex in situ within a human skull requires detailed measurements using non‐invasive techniques. Standard macroscopic and radiographic methods have limitations but large volume micro‐computed tomography (LV micro‐CT) scanning has the potential to acquire data at high resolution in microns. In this study, archaeological specimens are analyzed using three‐dimensional data visualization software from LV micro‐CT scans with the aims of (1) determining whether LV micro‐CT can act as a single technique to provide detailed analysis of the dentoalveolar complex and (2) how findings from the LV micro‐CT technique compare with standard methods. These aims are explored by measuring a range of human skull specimens from a rare archaeological s le requiring non‐invasive methods, for multiple dental and alveolar bone health categories. The LV micro‐CT technique was the only method to provide a full range of detailed measurements across all categories studied. A combination of macroscopic and radiographic techniques covered a number of categories, but the use of multiple methods was more time consuming, did not provide the same level of accuracy, and did not include all measurements. There were high levels of reproducibility for intra‐operator scoring and good inter‐operator agreement from four operators with one operator whose results were outliers. As a further investigation of the potential of the LV micro‐CT technique, an additional in idual, a fragile, fragmented skull of an infant was studied. This investigation confirms the value of LV micro‐CT scanning as a non‐invasive, accurate, single technique for the extensive analysis of the dentoalveolar complex within archaeological skulls, which also allows the relationship of different tissues to be studied in situ.
Publisher: Springer Science and Business Media LLC
Date: 26-05-2022
DOI: 10.1186/S40814-022-01057-5
Abstract: Anterior knee pain is often reported following intramedullary nailing of tibial shaft fractures. The aetiology remains unclear, but the surgical approach may play an important role. To date, no biomechanically validated method exists to assess patient outcomes specific to anterior knee pain in this cohort. The central aims of this study are to (1) evaluate the feasibility of a full-scale randomised controlled trial (RCT) investigating the influence of surgical approach on intramedullary nailing of tibial shaft fractures (suprapatellar versus infrapatellar nailing), (2) explore differences in clinical outcomes between the approaches, and (3) explore the development of a biomechanically validated methodology for assessing post-operative anterior knee pain and knee function specific to intramedullary nailing of tibial shaft fractures. This pilot study will follow a prospective randomised controlled design at the Royal Adelaide Hospital and The Queen Elizabeth Hospital (South Australia). This study aims to recruit 60 patients between 18 and 60 years old who will be randomly assigned to either the suprapatellar or infrapatellar approach following a decision for intramedullary surgical fixation by the treating surgeon. All nails in this study will be Stryker T2 Alpha nails. Patients will undergo standard radiograph, magnetic resonance imaging, and clinical assessments in-line with their standard operative care, and complete a number of patient-reported and performance-based outcome measures. Performance-based outcome measures will be assessed utilising three-dimensional motion capture techniques. Follow-up time points are 3, 6, 12, and 18 months. Feasibility outcomes include ability to meet enrolment and retention metrics, compliance with all questionnaires and assessment procedures, and the occurrence of any adverse events. The primary clinical outcome is the incidence of anterior knee pain at 12 months after surgery. This study will establish the feasibility and inform the design of a large-scale RCT. Evaluation of all clinical data and patient outcomes will lead to the development of a new tool for assessing patient outcomes in this cohort. Limitations of the study include an unpredictable enrolment rate and loss to follow-up, small s le size, and the unknown ability of three-dimensional motion analysis to pick up the effects of anterior knee pain after tibial nailing. This trial was prospectively registered on the 7 February 2020 on ANZCTR, ACTRN12620000109909 .
Publisher: Springer Science and Business Media LLC
Date: 15-04-2021
Publisher: Informa UK Limited
Date: 04-2020
DOI: 10.2147/NSS.S226834
Publisher: Elsevier BV
Date: 05-2021
DOI: 10.1016/J.AUCC.2021.04.006
Abstract: The aim of the study was to determine the response rate to a mixed-mode survey using email compared with that to a paper survey in survivors of critical illness. This is a prospective randomised controlled trial. The study was conducted at a single-centre quaternary intensive care unit (ICU) in Adelaide, Australia. Study participants were patients admitted to the ICU for ≥48 h and discharged from the hospital. The participants were randomised to receive a survey by paper (via mail) or via online (via email, or if a non-email user, via a letter with a website address). Patients who did not respond to the initial survey received a reminder paper survey after 14 days. The survey included quality of life (EuroQol-5D-5L), anxiety and depression (Hospital Anxiety and Depression Scale), and post-traumatic symptom (Impact of Event Scale-Revised) assessment. Survey response rate, extent of survey completion, clinical outcomes at different time points after discharge, and survey cost analysis were the main outcome measures. Outcomes were stratified based on follow-up time after ICU discharge (3, 6, and 12 months). A total of 239 patients were randomised. The response rate was similar between the groups (mixed-mode: 78% [92/118 patients] vs. paper: 80% [97/121 patients], p = 0.751) and did not differ between time points of follow-up. Incomplete surveys were more prevalent in the paper group (10% vs 18%). The median EuroQol-5D-5L index value was 0.83 [0.71-0.92]. Depressive symptoms were reported by 25% of patients (46/187), anxiety symptoms were reported by 27% (50/187), and probable post-traumatic stress disorder was reported by 14% (25/184). Patient outcomes did not differ between the groups or time points of follow-up. The cost per reply was AU$ 16.60 (mixed-mode) vs AU$ 19.78 (paper). The response rate of a mixed-mode survey is similar to that of a paper survey and may provide modest cost savings.
Publisher: BMJ
Date: 09-2022
DOI: 10.1136/BMJOPEN-2022-062586
Abstract: Proximal humerus fractures (PHFs) comprise % of all fractures in children and adolescents. While it is accepted that minimally displaced PHFs can be treated conservatively, the management of severely displaced PHFs remains controversial, especially in older children. This study will aim to analyse the functional and quality-of-life outcomes of children with PHFs, in order to inform their optimal management. We will conduct a retrospective cohort study to evaluate the outcomes of patients who were diagnosed with a paediatric PHF at the Women’s and Children’s Hospital (WCH) in South Australia. The primary outcome will be each participant’s pain and quality-of-life outcome, determined by use of the Quick Disabilities of the Arm, Shoulder and Hand, Shoulder Pain and Disability Index and Paediatric Outcomes Data Collection Instrument. Secondary outcomes will include rates of non-union, persistent deformity and complications. The information for these variables will be acquired during a brief clinic appointment, and from the medical records and WCH radiology database. Multivariable logistic regression will be performed to determine the clinical variables associated with a worse clinical outcome. The study has been approved by the Women’s and Children’s Health Network Human Research Ethics Committee (protocol number: 2021/HRE00250). The study findings will be submitted to peer-reviewed scientific journals for publication and disseminated at conference presentations. Australian New Zealand Clinical Trials Registry (ACTRN12622000176763).
Publisher: Wiley
Date: 10-08-2021
DOI: 10.1111/ANS.17118
Abstract: Breast reconstruction (BR) often forms part of a patient's breast cancer journey. Revision surgery may be required to maintain the integrity of a BR, although this is not commonly reported in the literature. Different reconstructive methods may have differing requirements for revision. It is important for patients and surgeons to understand the factors leading to the need for revision surgery. This retrospective cohort study analyses BRs performed by oncoplastic breast surgeons in public and private settings between 2005 and 2014, with follow‐up until December 2018. Surgical and patient factors were examined, including types of BR, complications and reasons for revision surgery. A total of 390 women with 540 reconstructions were included, with a median follow‐up of 61 months. Twenty‐eight percent (151/540) of reconstructions required at least one revision operation. Overall, implant‐based reconstructions (direct‐to‐implant [DTI] and two‐stage expander‐implant) had a higher revision rate compared to pedicled flap reconstructions (odds ratio 1.91, 95% confidence interval 1.08, 3.38). DTI reconstructions had the highest odds, and pedicled flap without implants the lowest odds of requiring revision. Post‐reconstruction radiotherapy increased the chance of revision surgery, while pre‐reconstruction radiotherapy did not. Odds of revision were higher in implant‐based reconstructions compared to pedicled flap reconstructions that had radiotherapy. Other factors increasing the rates of revision surgery were being a current smoker and post‐operative infection. Almost one‐third of reconstructive patients require revision surgery. Autologous pedicled flap reconstructions have lower rates of revision compared to implant‐based reconstructions. Radiotherapy increases the need for revision surgery, particularly in implant‐based reconstructions.
Publisher: Cold Spring Harbor Laboratory
Date: 06-2021
DOI: 10.1101/2021.05.28.21257892
Abstract: To assess the generalisability of a deep learning (DL) system for screening mammography developed at New York University (NYU), USA (1, 2) in a South Australian (SA) dataset. Clients with pathology-proven lesions (n=3,160) and age-matched controls (n=3,240) were selected from women screened at BreastScreen SA from January 2010 to December 2016 (n clients=207,691) and split into training, validation and test subsets (70%, 15%, 15% respectively). The primary outcome was area under the curve (AUC), in the SA Test Set 1 (SATS1), differentiating invasive breast cancer or ductal carcinoma in situ (n=469) from age-matched controls (n=490) and benign lesions (n=44). The NYU system was tested statically, after training without transfer learning (TL), after retraining with TL and without (NYU1) and with (NYU2) heatmaps. The static NYU1 model AUCs in the NYU test set (NYTS) and SATS1 were 83.0%(95%CI=82.4%-83.6%)(2) and 75.8%(95%CI=72.6%-78.8%), respectively. Static NYU2 AUCs in the NYTS and SATS1 were 88.6%(95%CI=88.3%-88.9%)(2) and 84.5%(95%CI=81.9%-86.8%), respectively. Training of NYU1 and NYU2 without TL achieved AUCs in the SATS1 of 65.8% (95%CI=62.2%-69.1%) and 85.9%(95%CI=83.5%-88.2%), respectively. Retraining of NYU1 and NYU2 with TL resulted in AUCs of 82.4%(95%CI=79.7-84.9%) and 86.3%(95%CI=84.0-88.5%) respectively. We did not fully reproduce the reported performance of NYU on a local dataset local retraining with TL approximated this level of performance. Optimising models for local clinical environments may improve performance. The generalisation of DL systems to new environments may be challenging. In this study, the original performance of deep learning models for screening mammography was reduced in an independent clinical population. Deep learning (DL) systems for mammography require local testing and may benefit from local retraining. An openly available DL system approximates human performance in an independent dataset. There are multiple potential sources of reduced deep learning system performance when deployed to a new dataset and population.
Publisher: Elsevier BV
Date: 2023
DOI: 10.1016/J.IJOM.2022.04.008
Abstract: The purpose of this study was to assess the impact of a change in macroscopic/surgical margin width upon histological margins and loco-regional failure in early oral tongue squamous cell carcinoma (OTSCC). In 2009, the surgical margin protocol was increased from 10 mm to 15 mm. A retrospective review was performed of all patients who underwent treatment for early OTSCC between 2009 and 2016 with a 15-mm surgical margin (n = 142), and these patients were compared to those treated between 1999 and 2008 with a 10-mm surgical margin (n = 78). There was a significant increase in the rate of clear histological margins (P < 0.001). The rates of close (P = 0.002) and involved (P < 0.001) histological margins decreased significantly. There were significant reductions in local (P < 0.001) and regional (P < 0.001) recurrence rates. This study demonstrated that a surgical margin of 15 mm delivered significantly lower rates of close/involved histological margins and improved local and regional disease recurrence in early OTSCC when compared with a surgical margin of 10 mm.
Publisher: MDPI AG
Date: 18-10-2022
DOI: 10.3390/NU14204355
Abstract: Background: Increasing age is a strong risk factor for infertility, and there is accumulating evidence of the importance of a healthier diet for fertility. Whether a healthier diet modifies the association between increasing age and infertility has not been investigated. This study aimed to (i) examine if better diet quality could help reduce age-related infertility and (ii) assess whether changes in diet quality over time are associated with fertility problems. Methods: Data were from Surveys 3 and 5 of the 1973–1978 birth cohort of the Australian Longitudinal Study on Women’s Health. Cross-sectional analysis with multivariable generalized linear models were used to examine the association between age and fertility status, adjusted for various confounders. Multiplicative and additive effect modification by diet quality was assessed, with additive effect modification evaluated with the relative risk for interaction (RERI). Results: In total, 3387 women were included from Survey 3 (age range 24–31 years) and 5614 women from Survey 5 (age range 30–38 years) 588 (17.4%) and 1321 (23.4%) self-reported to have fertility problems in the respective surveys. In Survey 3, compared to younger women with a good-quality diet, older women with a poor-quality diet had a 43% increased risk for fertility problems, with risk increasing after further adjustment for BMI (RR: 1.59 95% CI: 1.07, 2.37) and PCOS (RR: 1.74 95% CI: 1.15, 2.62). In Survey 5 in younger women ( .9 years), there was no association between diet quality and risk for infertility problems. The RERI (across different adjusted models) was between −0.08 (−0.70, 0.55) to −0.39 (−1.40, 0.62) in survey 3 and 0.07 (−0.17, 0.31) to 0.08 (−0.17, 0.32) in Survey 5. Conclusions: There is little evidence to suggest effect modification on the effect of age and fertility problems with diet quality.
Location: Australia
No related grants have been discovered for Kelly Hall.