ORCID Profile
0000-0002-4815-5840
Current Organisation
University of New South Wales
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Publisher: S. Karger AG
Date: 2010
DOI: 10.1159/000311080
Abstract: i Background: /i For MR perfusion-diffusion mismatch to be clinically useful as a means of selecting patients for thrombolysis, it needs to occur in real time at the MRI console. Visual mismatch assessment has been used clinically and in trials but has not been systematically validated. We compared the accuracy of visually rating console-generated images with offline volumetric measurements using data from the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). i Methods: /i Perfusion time-to-peak (TTP) and diffusion-weighted images (DWI) (as generated by commercial MRI console software) and T sub max /sub perfusion maps (which required offline calculation) were visually rated. Perfusion-diffusion mismatch, defined as a ratio of perfusion:diffusion lesion volume of .2, was independently scored by 1 expert and 2 inexperienced raters blinded to calculated volumes and clinical information. Visual mismatch was compared with region-of-interest-based volumetric calculation, which was used as the gold standard. i Results: /i Volumetric calculation demonstrated perfusion-diffusion mismatch in 85/99 patients. Visual TTP-DWI mismatch was correctly classified by the experienced rater in 82% of the cases (sensitivity: 0.86 specificity: 0.54) compared to 73% for the inexperienced raters (sensitivity: 0.75 specificity: 0.57). The interrater reliability for TTP-DWI mismatch was moderate (ĸ = 0.50). Visual T sub max /sub -DWI mismatch performed better (agreement – 93 and 87%, sensitivity – 95 and 88%, specificity – 77 and 82% for the experienced and inexperienced raters, respectively). i Conclusions: /i The assessment of visual TTP-DWI mismatch at the MRI console is insufficiently reliable for use in clinical trials. Differences in perfusion analysis technique and visual inaccuracies combine to make visual TTP-DWI mismatch substantially different to volumetric T sub max /sub -DWI mismatch. Automated software that applies perfusion thresholds may improve the reproducibility of real-time mismatch assessment.
Publisher: Elsevier BV
Date: 2020
Publisher: Springer Science and Business Media LLC
Date: 08-06-2013
DOI: 10.1007/S10899-013-9389-2
Abstract: Problem gambling represents a significant public health problem, however, research on effective gambling harm-minimisation measures lags behind other fields, including other addictive disorders. In recognition of the need for consistency between international jurisdictions and the importance of basing policy on empirical evidence, international conventions exist for policy on alcohol, tobacco, and illegal substances. This paper examines the evidence of best practice policies to provide recommendations for international guidelines for harm-minimisation policy for gambling, including specific consideration of the specific requirements for policies on Internet gambling. Evidence indicates that many of the public health policies implemented for addictive substances can be adapted to address gambling-related harms. Specifically, a minimum legal age of at least 18 for gambling participation, licensing of gambling venues and activities with responsible gambling and consumer protection strategies mandated, and brief interventions should be available for those at-risk for and experiencing gambling-related problems. However, there is mixed evidence on the effectiveness of limits on opening hours and gambling venue density and increased taxation to minimise harms. Given increases in trade globalisation and particularly the global nature of Internet gambling, it is recommended that jurisdictions take actions to harmonise gambling public health policies.
Publisher: SAGE Publications
Date: 04-06-2015
DOI: 10.1111/IJS.12537
Abstract: Infarct location has a critical effect on patient outcome after ischemic stroke, but the study of its role independent of overall lesion volume is challenging. We performed a retrospective, hypothesis-generating study of the effect of infarct location on three-month functional outcome in a pooled analysis of the EPITHET and DEFUSE studies. Posttreatment MRI diffusion lesions were manually segmented and transformed into standard-space. A novel composite brain atlas derived from three standard brain atlases and encompassing 132 cortical and sub-cortical structures was used to segment the transformed lesion into different brain regions, and calculate the percentage of each region infarcted. Classification and Regression Tree (CART) analysis was performed to determine the important regions in each hemisphere associated with nonfavorable outcome at day 90 (modified Rankin score [mRS] 1). Overall, 152 patients (82 left hemisphere) were included. Median diffusion lesion volume was 37·0 ml, and median baseline National Institutes of Health Stroke Score was 13. In the left hemisphere, the strongest determinants of nonfavorable outcome were infarction of the uncinate fasciculus, followed by precuneus, angular gyrus and total diffusion lesion volume. In the right hemisphere, the strongest determinants of nonfavorable outcome were infarction of the parietal lobe followed by the putamen. Assessment of infarct location using CART demonstrates regional characteristics associated with poor outcome. Prognostically important locations include limbic, default-mode and language areas in the left hemisphere, and visuospatial and motor regions in the right hemisphere.
Publisher: Frontiers Media SA
Date: 13-01-2021
DOI: 10.3389/FNEUR.2020.590766
Abstract: We aimed to compare Perfusion Imaging Mismatch (PIM) and Clinical Core Mismatch (CCM) criteria in ischemic stroke patients to identify the effect of these criteria on selected patient population characteristics and clinical outcomes. Patients from the INternational Stroke Perfusion Imaging REgistry (INSPIRE) who received reperfusion therapy, had pre-treatment multimodal CT, 24-h imaging, and 3 month outcomes were analyzed. Patients were ided into 3 cohorts: endovascular thrombectomy (EVT), intravenous thrombolysis alone with large vessel occlusion (IVT-LVO), and intravenous thrombolysis alone without LVO (IVT-nonLVO). Patients were classified using 6 separate mismatch criteria: PIM-using 3 different measures to define the perfusion deficit (Delay Time, Tmax, or Mean Transit Time) or CCM-mismatch between age-adjusted National Institutes of Health Stroke Scale and CT Perfusion core, defined as relative cerebral blood flow & % within the perfusion deficit defined in three ways (as above). We assessed the eligibility rate for each mismatch criterion and its ability to identify patients likely to respond to treatment. There were 994 patients eligible for this study. PIM with delay time (PIM-DT) had the highest inclusion rate for both EVT (82.7%) and IVT-LVO (79.5%) cohorts. In PIM positive patients who received EVT, recanalization was strongly associated with achieving an excellent outcome at 90-days (e.g., PIM-DT: mRS 0-1, adjusted OR 4.27, P = 0.005), whereas there was no such association between reperfusion and an excellent outcome with any of the CCM criteria (all p & 0.05). Notably, in IVT-LVO cohort, 58.2% of the PIM-DT positive patients achieved an excellent outcome compared with 31.0% in non-mismatch patients following successful recanalization ( P = 0.006). Conclusion: PIM-DT was the optimal mismatch criterion in large vessel occlusion patients, combining a high eligibility rate with better clinical response to reperfusion. No mismatch criterion was useful to identify patients who are most likely response to reperfusion in non-large vessel occlusion patients.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Wiley
Date: 11-2020
DOI: 10.1111/DAR.13061
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2009
DOI: 10.1161/STROKEAHA.108.532622
Abstract: Background and Purpose— Before Phase III trials of acute stroke therapies, proof-of-concept MRI trials are increasingly used to gauge the likelihood of success. Given that animal models use infarct volume as the end point, Phase II trials have aimed to translate the findings using infarct growth. These trials could be expedited if subacute diffusion-weighted imaging lesion volume replaced late T2-weighted lesion volume as the primary end point. Methods— In the Echoplanar Imaging Thrombolytic Evaluation Trial, patients with acute ischemic stroke presenting within 3 to 6 hours were randomized to tissue plasminogen activator or placebo. We assessed correlations between acute (Day 1), subacute (Day 3 to 5) as well as late (Day 90) lesion volumes and clinical outcome (National Institutes of Health Stroke Scale). We compared lesion growth between placebo- and tissue plasminogen activator-treated patients. Results— All 3 scans were performed in 72 of 101 patients (32 tissue plasminogen activator, 40 placebo). Median time to subacute imaging was 3 days (interquartile range, 2 to 4) and 90 days (interquartile range, 90 to 95) for the late scan. Increase in lesion volume from acute to subacute scans was smaller in the tissue plasminogen activator group compared with the placebo group (6.77 mL interquartile range, 2.30 to 49.10 versus 30.00 mL interquartile range, 7.19 to 85.93 P =0.03). Subsequent shrinkage did not reveal significant treatment effects. Correlation coefficient between acute and late lesion volumes was 0.81 ( P .01). Subacute and late lesion volumes were strongly correlated (rho=0.94, P .01). Correlation coefficient for acute, subacute, and late lesion volume and late National Institutes of Health Stroke Scale score was 0.64 ( P .01), 0.81 ( P .01), and 0.77 ( P .01), respectively. Conclusions— These findings suggest that subacute imaging at Day 3 after thrombolysis is an appropriate imaging end point for proof-of-concept MRI-based stroke treatment trials and can replace later MRI measurements.
Publisher: Alcohol Research Documentation, Inc.
Date: 09-2010
DOI: 10.15288/JSAD.2010.71.778
Abstract: Although there is a well-established quantitative literature examining the impact of alcohol consumption on the drinker, there has been much less examination of how someone's drinking affects other people. This study attempts to assess the degree to which relationships with heavy drinkers affect health and well-being. The study is based on a random telephone survey of 2,649 Australians (2,422 providing sufficient data for analysis) that asked respondents to identify people in their lives who were heavy drinkers or who sometimes drank a lot. In addition, information on respondents' well-being and health was collected using the Personal Wellbeing Index and the EuroQol Group 5-Dimension Self-Report Questionnaire score (EQ-5D) index, along with data on a range of other sociodemographic factors. Multivariate regression models were developed to determine whether living with heavy drinkers or knowing heavy drinkers outside the household were related to health and well-being once socioeconomic and demographic factors and the respondent's own drinking behavior were statistically controlled. The study finds negative effects on both health and well-being related to the number of heavy drinkers identified outside the respondent's household, whereas heavy drinkers within the household were negatively related to health but not well-being. The study suggests that other people's drinking can have substantial effects on health and well-being, providing impetus for policies that reduce heavy drinking in the population.
Publisher: Frontiers Media SA
Date: 08-12-2020
DOI: 10.3389/FNEUR.2020.593238
Abstract: Background and Aims: Disability-adjusted life years (DALYs) are an important measure of the global burden of disease that informs patient outcomes and policy decision-making. Our study aimed to compare the DALYs saved by endovascular thrombectomy (EVT) in the Australasian-based EXTEND-IA trial vs. clinical registry data from EVT in Australian routine clinical practice. Methods: The 3-month modified Rankin scale (mRS) outcome and treatment status of consecutively enrolled Australian patients with large vessel occlusion (LVO) stroke were taken from the International Stroke Perfusion Imaging Registry (INSPIRE). DALYs were calculated as the summation of years of life lost (YLL) due to premature death and years lived with a disability (YLD). A generalized linear model (GLM) with gamma family and log link was used to compare the difference in DALYs for patients receiving/not receiving EVT while controlling for key covariates. Ordered logit regression model was utilized to compare the difference in functional outcome at 3 months between the treatment groups. Cox regression analysis was undertaken to compare the difference in survival over an 18-year time horizon. Estimated long-term DALYs saved based on the EXTEND-IA randomized controlled trial (RCT) results were used as the comparator. Results: INSPIRE patients who received EVT treatment only achieved nominally better functional outcomes than the non-EVT group ( p = 0.181) at 3 months. There was no significant survival gain from EVT over the first 3 months of stroke in both INSPIRE and EXTEND-IA patients. However, measured against no EVT in the long-term, EVT in INSPIRE was associated with no significant survival gain [hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.78–1.08, p = 0.287] compared with the survival benefit extrapolated from the EXTEND-IA trial (HR: 0.42, 95% CI: 0.22–0.82, p = 0.01]. Offering EVT to patients with LVO stroke was also associated with fewer DALYs lost (11.04, 95% CI: 10.45–11.62) than those not receiving EVT in INSPIRE (12.13, 95% CI: 11.75–12.51), a reduction of −1.09 DALY (95% CI: −1.76 to −0.43, p = 0.002). The absolute magnitude of the treatment effect was lower than that seen in EXTEND-IA (−2.72 DALY reduction in EVT vs non-EVT patients). Conclusions: EVT for the treatment of LVO in a registry of routine care was associated with significantly lower DALYs lost than medical care alone, but the saved DALYs are less than those reported in clinical trials, as there were major differences in the baseline characteristics of the patients.
Publisher: Wiley
Date: 30-04-2019
DOI: 10.1111/DAR.12933
Abstract: Public support for restrictions on late night trading of licensed venues increased substantially between 2001 and 2013, a period with very few policy interventions in Australia. In early 2014 a set of high profile restrictions were introduced in Sydney, New South Wales. In this study, we examine whether these 2014 policy interventions affected public support for late trading restrictions. We use data from the National Drug Strategy Household Survey, focussing especially on the 2013 (n = 23 521) and 2016 (n = 23 425) waves. A series of regression models with interaction terms between socio-demographic variable and year were used to examine how trends in support for late trading policies varied between different population groups. Support for late trading restrictions fell substantially between 2013 and 2016-from 2.58 to 2.35 on a 0-4 point scale. In particular, support fell more in New South Wales than in other jurisdictions. Among New South Wales residents, support fell more for middle-aged and older respondents and more for drinkers than non-drinkers. Support for late trading restrictions fell sharply, especially among those affected in New South Wales. Advocates for public health-oriented alcohol policy restrictions need to pay attention to public support in the aftermath of policy 'wins'.
Publisher: Figshare
Date: 2009
Publisher: Wiley
Date: 11-02-2009
DOI: 10.1111/J.1465-3362.2009.00027.X
Abstract: Drawing on 16 items in the 2004 National Drug Strategy Household Survey (NDSHS), the paper explores the degree to which Australian public opinion towards different alcohol policies cohere or erge, and the social location of support for and resistance to more restrictive alcohol controls. Variations in support for particular policies by demographic groups, across states and territories and among those with difference drinking patterns are explored. The extent and direction in which attitudes have changed over time was determined. Sixteen items from the 2004 NDSHS were subjected to factor analysis. Both a single factor and a four-factor solution were derived and became the dependent variables for state/territory comparisons and multiple regression analyses determining the predictive power of respondents demographics and drinking behaviour. Trends over time in alcohol policy attitudes used the 1993, 1995, 1998, 2001 and 2004 NDSHS. More severe penalties against drink driving and stricter laws against serving customers who were drunk had the strongest support while policies that controlled accessibility to alcohol such as reducing trading hours received the least support. For all policies support was greater among females, older respondents and those drinking less. The in idual's drinking pattern was as strong, and in some cases a stronger predictor of support than gender and age. While support for the majority of the alcohol policies decreased over the 11-year period since 1993, attitudes may be influenced and changed over a shorter period of time.
Publisher: American Public Health Association
Date: 2017
Publisher: Wiley
Date: 17-04-2023
DOI: 10.1111/ADD.16192
Abstract: Restrictive late‐night alcohol policies are aimed at reducing alcohol‐related violence but, to date, no evaluations of their impact on family and domestic violence have been conducted. This study aimed to measure whether modifying the drinking environment and restricting on‐site trading hours affected reported rates of family and domestic violence. This study used a non‐equivalent control group design with two treatment sites and two matched control sites with pre‐ and postintervention data on rates of family and domestic violence assaults within local catchment areas of four late‐night entertainment precincts in New South Wales, Australia, covering a population of 27 309 people. Participants comprised monthly counts of police‐recorded incidents of domestic violence assaults from January 2001 to December 2019. Two variations of restrictive late‐night interventions were used: restricted entry to late‐night venues after 1:30 a.m., trading ceasing at 3:30 a.m. and other restrictions on alcohol service (Newcastle) and restricted entry to late‐night venues after 1 a.m. and a range of restrictions on alcohol service (Hamilton). The comparators were no restrictions on late‐night trading or modifications of the drinking environment (Wollongong and Maitland). Measurements involved the rate, type and timing of reported family and domestic violence assaults. Reported rates of domestic violence assaults fell at both intervention sites, while reported domestic violence assaults increased over time in the control sites. The protective effects in Newcastle were robust and statistically significant across three main models. The relative reduction associated with the intervention in Newcastle was 29% (incidence rate ratio = 0.71, 95% confidence interval: 0.60–0.83) and an estimated 204 assaults were prevented across the duration of the study. The protective effects found in Hamilton were not consistently supported across the three main models. Increases to late‐night alcohol restrictions may reduce rates of domestic violence.
Publisher: Wiley
Date: 26-02-2013
DOI: 10.1002/ANA.23837
Publisher: Wiley
Date: 26-02-2009
DOI: 10.1111/J.1465-3362.2009.00055.X
Abstract: In light of possible introduction of alcohol warning labels in Australia and New Zealand, this paper discusses the international experience with and evidence of effects of alcohol warning labels. The report describes international experience with providing information and warnings concerning the promotion or sale of alcoholic beverages, and considers the evidence on the effects of such information and warnings. The experience with and evaluations of the effects of tobacco warning labels are also considered. The most methodologically sound evaluations of alcohol warning labels are based on the US experience. Although these evaluations find little evidence that the introduction of the warning label in the USA had an impact on drinking behaviour, there is evidence that they led to an increase in awareness of the message they contained. In contrast, evaluations of tobacco warning labels find clear evidence of effects on behaviour. There is a need and opportunity for a rigorous evaluation of the impacts of introducing alcohol warning labels to add to the published work on their effectiveness. The experience with tobacco labels might guide the way for more effective alcohol warning labels. Alcohol warning labels are an increasingly popular alcohol policy initiative. It is clear that warning labels can be ineffective, but the tobacco experience suggests that effective warning labels are possible. Any introduction of alcohol warning labels should be evaluated in terms of effects on attitudes and behaviour.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2010
DOI: 10.1161/STROKEAHA.109.563767
Abstract: Background and Purpose— Reliable predictors of hemorrhagic transformation (HT) after stroke thrombolysis have not been identified. We analyzed hemorrhage in a randomized trial of tissue plasminogen activator (t-PA) vs placebo in ischemic stroke patients. We hypothesized that acute diffusion-weighted imaging (DWI) lesion volumes would be larger and blood pressures would be higher in patients with HT. Methods— HT was assessed 2 to 5 days after treatment in 97 patients. Hemorrhage was assessed by using susceptibility-weighted imaging sequences and was classified as petechial hemorrhagic infarction (HI) or parenchymal hematoma (PH). Results— PH was more frequent in t-PA– (11/49) than in placebo- (4/48) treated patients ( P =0.049). Patients with PH had larger DWI lesion volumes (63.1±56.1 mL) than did those without HT (27.6±39.0 mL, P =0.033). There were no differences in baseline systolic blood pressure (SBP) between patients with and without hemorrhage. Weighted average SBP 24 hours after treatment was higher in patients with PH (159.4±18.8 mL, P .011) relative to those without HT (143.1±20.0 mL). Multinomial logistic regression indicated that PH was predicted by DWI lesion volume (odds ratio=1.16 per 10 mL 95% CI, 1.03 to 1.30), atrial fibrillation (odds ratio=9.33 95% CI, 2.30 to 37.94), and 24-hour weighted average SBP (odds ratio=1.59 per 10 mm Hg 95% CI, 1.14 to 2.23). Conclusions— Pretreatment DWI lesion volume and postthrombolysis BP are both predictive of HT. Consideration should be given to excluding patients with very large baseline DWI volumes from t-PA therapy and to more stringent BP control after stroke thrombolysis.
Publisher: Elsevier BV
Date: 03-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2007
DOI: 10.1161/01.STR.0000258099.69995.B6
Abstract: Background and Purpose— The Alberta Stroke Program Early CT Score (ASPECTS) is a validated method of assessing parenchymal ischemic changes, including focal swelling and hypoattenuation. The hypothesis that these signs result from different pathophysiological processes was tested by comparing CT with diffusion and perfusion- weighted MRI. Methods— MRI and CT were performed, within 2 hours of each other, in 30 ischemic stroke patients hours after symptom onset. Relative apparent diffusion coefficient, relative cerebral blood flow, and relative cerebral blood volume were calculated for in idual cortical ASPECTS regions. Regional infarction was assessed on days 3 to 5. Results— Isolated focal swelling was seen in 25 ASPECTS cortical regions from 6 patients. Cortical hypoattenuation was observed in 25 regions from 11 patients. Median relative apparent diffusion coefficient was significantly lower in hypoattenuated regions (0.84 interquartile range, 0.66 to 0.91) relative to those with focal swelling (0.97 interquartile range, 0.91 to 1.01 P .001). Median relative cerebral blood flow in focal swelling regions (81.0% interquartile range, 70.4 to 93.0) was similar to that of tissue that appeared normal on CT (71.8% interquartile range, 47.1 to 94.5). In hypoattenuated regions, relative cerebral blood flow was significantly decreased (37.0% interquartile range, 25.6 to 70.2 P =0.002). Median relative cerebral blood volume was increased (121.1% interquartile range, 112.0 to 130.3) in focal swelling regions, relative to normal-appearing tissue (94.7% interquartile range, 62.0 to 114.6 P .001), but decreased in hypoattenuated regions (58.9% interquartile range, 47.5 to 92.7 P =0.012). Infarction occurred in all hypoattenuated regions, but only in 32% of those with focal swelling. Conclusions— Elevated relative cerebral blood volume and normal relative apparent diffusion coefficient in ASPECTS regions with focal swelling on CT is consistent with penumbral tissue. Isolated focal swelling is not always associated with infarction. These results support removal of focal swelling from the ASPECTS system.
Publisher: Frontiers Media SA
Date: 28-02-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2017
DOI: 10.1161/STROKEAHA.117.018587
Abstract: In alteplase-treated patients with acute ischemic stroke, we investigated the relationship between penumbral reperfusion at 24 hours and clinical outcomes, with and without adjustment for baseline ischemic core volume. Data were collected from consecutive acute ischemic stroke patients with baseline and follow-up perfusion imaging presenting to hospital within 4.5 hours of symptom onset at 7 hospitals. Logistic regression models were used for predicting the effect of the reperfused penumbral volume on the dichotomized modified Rankin Scale (mRS) at 90 days and improvement of National Institutes of Health Stroke Scale at 24 hours, both adjusted for baseline ischemic core volume. This study included 1507 patients. Reperfused penumbral volume had moderate ability to predict 90-day mRS 0 to 1 (area under the curve, 0.77 R 2 , 0.28 P .0001). However, after adjusting for baseline ischemic core volume, the reperfused penumbral volume was a strong predictor of good functional outcome (area under the curve, 0.946 R 2 , 0.55 P .0001). For every 1% increase in penumbral reperfusion, the odds of achieving mRS 0 to 1 at day 90 increased by 7.4%. Improvement in acute 24-hour National Institutes of Health Stroke Scale was also significantly related to the degree of reperfused penumbra ( R 2 , 0.31 P .0001). This association was again stronger after adjustment for baseline ischemic core volume ( R 2 , 0.41 P .0001). For each 1% of penumbra that was reperfused, the 24-hour National Institutes of Health Stroke Scale decreased by 0.069 compared with baseline. In patients treated with alteplase, the extent of the penumbra that is reperfused is a powerful predictor of early and late clinical outcomes, particularly when baseline ischemic core is taken into account.
Publisher: Wiley
Date: 10-08-2020
DOI: 10.1002/ANA.25785
Publisher: Wiley
Date: 29-10-2019
DOI: 10.1111/ADD.14803
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2009
DOI: 10.1161/STROKEAHA.108.543595
Abstract: Background and Purpose— Reperfusion and recanalization have both been used as surrogate markers of clinical outcome in trials of stroke thrombolysis. We aimed to prove that the beneficial impact of recanalization with intravenous tissue plasminogen activator on clinical outcomes is attributable to reperfusion in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). Methods— EPITHET was a prospective, randomized, placebo-controlled trial of intravenous tissue plasminogen activator in the 3- to 6-hour window. Reperfusion was defined as % reduction in magnetic resonance perfusion-weighted imaging lesion volume and recanalization as improvement of MR angiographic Thrombolysis In Myocardial Infarction grading by ≥2 points from baseline to Day 3 to 5. Results— At Day 3 to 5, reperfusion and recanalization with intravenous tissue plasminogen activator were strongly correlated. Reperfusion was associated with improved clinical outcome independent of whether recanalization occurred. In contrast, recanalization was not associated with clinical outcome when reperfusion was included as a covariate in regression analyses. Conclusion— Reperfusion is a surrogate marker of clinical outcomes independent of recanalization based on the criteria applied in EPITHET. The impact of recanalization on clinical outcomes was attributable to reperfusion.
Publisher: Elsevier BV
Date: 07-2019
Publisher: Elsevier BV
Date: 07-2018
DOI: 10.1016/J.CORTEX.2018.03.003
Abstract: Phantom limbs are the phenomenal persistence of postural and sensorimotor features of an utated limb. Although immaterial, their characteristics can be modulated by the presence of physical matter. For instance, the phantom may disappear when its phenomenal space is invaded by objects ("obstacle shunning"). Alternatively, "obstacle tolerance" occurs when the phantom is not limited by the law of impenetrability and co-exists with physical objects. Here we examined the link between this under-investigated aspect of phantom limbs and apparent motion perception. The illusion of apparent motion of human limbs involves the perception that a limb moves through or around an object, depending on the stimulus onset asynchrony (SOA) for the two images. Participants included 12 unilateral lower limb utees matched for obstacle shunning (n = 6) and obstacle tolerance (n = 6) experiences, and 14 non- utees. Using multilevel linear models, we replicated robust biases for short perceived trajectories for short SOA (moving through the object), and long trajectories (circumventing the object) for long SOAs in both groups. Importantly, however, utees with obstacle shunning perceived leg stimuli to predominantly move through the object, whereas utees with obstacle tolerance perceived leg stimuli to predominantly move around the object. That is, in people who experience obstacle shunning, apparent motion perception of lower limbs was not constrained to the laws of impenetrability (as the phantom disappears when invaded by objects), and legs can therefore move through physical objects. Amputees who experience obstacle tolerance, however, had stronger solidity constraints for lower limb apparent motion, perhaps because they must avoid co-location of the phantom with physical objects. Phantom limb experience does, therefore, appear to be modulated by intuitive physics, but not in the same way for everyone. This may have important implications for limb experience post- utation (e.g., improving prosthesis embodiment when limb representation is constrained by the same limits as an intact limb).
Publisher: Wiley
Date: 23-11-2020
DOI: 10.1111/DAR.13219
Publisher: Wiley
Date: 23-12-2016
DOI: 10.1111/DAR.12368
Publisher: Wiley
Date: 03-2022
DOI: 10.1111/DAR.13457
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2019
DOI: 10.1161/STROKEAHA.118.023769
Abstract: Hyperglycemia is a negative prognostic factor after acute ischemic stroke but is not known whether glucose is associated with the effects of endovascular thrombectomy (EVT) in patients with large-vessel stroke. In a pooled-data meta-analysis, we analyzed whether serum glucose is a treatment modifier of the efficacy of EVT in acute stroke. Seven randomized trials compared EVT with standard care between 2010 and 2017 (HERMES Collaboration [highly effective reperfusion using multiple endovascular devices]). One thousand seven hundred and sixty-four patients with large-vessel stroke were allocated to EVT (n=871) or standard care (n=893). Measurements included blood glucose on admission and functional outcome (modified Rankin Scale range, 0–6 lower scores indicating less disability) at 3 months. The primary analysis evaluated whether glucose modified the effect of EVT over standard care on functional outcome, using ordinal logistic regression to test the interaction between treatment and glucose level. Median (interquartile range) serum glucose on admission was 120 (104–140) mg/dL (6.6 mmol/L [5.7–7.7] mmol/L). EVT was better than standard care in the overall pooled-data analysis adjusted common odds ratio (acOR), 2.00 (95% CI, 1.69–2.38) however, lower glucose levels were associated with greater effects of EVT over standard care. The interaction was nonlinear such that significant interactions were found in subgroups of patients split at glucose or mg/dL (5.0 mmol/L P =0.019 for interaction acOR, 3.81 95% CI, 1.73–8.41 for patients 90 mg/dL versus 1.83 95% CI, 1.53–2.19 for patients mg/dL), and glucose or mg/dL (5.5 mmol/L P =0.004 for interaction acOR, 3.17 95% CI, 2.04–4.93 versus acOR, 1.72 95% CI, 1.42–2.08) but not between subgroups above these levels of glucose. EVT improved stroke outcomes compared with standard treatment regardless of glucose levels, but the treatment effects were larger at lower glucose levels, with significant interaction effects persisting up to 90 to 100 mg/dL (5.0–5.5 mmol/L). Whether tight control of glucose improves the efficacy of EVT after large-vessel stroke warrants appropriate testing.
Publisher: Wiley
Date: 02-10-2018
DOI: 10.1111/ADD.14433
Publisher: Elsevier BV
Date: 03-2020
Publisher: MDPI AG
Date: 21-04-2010
Publisher: Wiley
Date: 10-2021
DOI: 10.1111/ADD.15243
Abstract: During the past decade, ‘alcohol's harm to others’ (AHTO) has emerged as an international approach to studying alcohol problems and informing policy. The AHTO approach seeks to increase political will for alcohol policy by mapping, measuring and often costing harms beyond the person who drinks (e.g. family members, co‐workers). In this paper we consider the implications of a ‘harm to others’ approach for illicit drugs. We ask whether it could and should be used as a policy tool, given the high risks of further stigmatizing people who use drugs. We consider the ways in which the concept and measurement of ‘harm to others’ may be either productive or potentially harmful, depending on the extent to which the AHTO is replicated for illicit drugs. Shifting the language may assist: the term ‘harm from others’ appears to carry less risk of stigma. In addition, all harms inclusive of drug supply and drug consumption need to be included if a full picture of harms that accrue to other people from illicit drugs is to be achieved.
Publisher: Wiley
Date: 10-2011
DOI: 10.1002/ANA.22444
Publisher: Wiley
Date: 06-2020
DOI: 10.1111/DAR.13092
Publisher: Wiley
Date: 21-06-2021
DOI: 10.1111/ADD.15605
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2021
DOI: 10.1161/STROKEAHA.121.034205
Abstract: This study aimed to explore whether the therapeutic benefit of endovascular thrombectomy (EVT) was mediated by core growth rate. This retrospective cohort study identified acute ischemic stroke patients with large vessel occlusion and receiving reperfusion treatment, either EVT or intravenous thrombolysis (IVT), within 4.5 hours of stroke onset. Patients were ided into 2 groups: EVT versus IVT only patients (who had no access to EVT). Core growth rate was estimated by the acute core volume on perfusion computed tomography ided by the time from stroke onset to perfusion computed tomography. The primary clinical outcome was good outcome defined by 3-month modified Rankin Scale score of 0–2. Tissue outcome was the final infarction volume. A total of 806 patients were included, 429 in the EVT group (recanalization rate of 61.6%) and 377 in the IVT only group (recanalization rate of 44.7%). The treatment effect of EVT versus IVT only was mediated by core growth rate, showing a significant interaction between EVT treatment and core growth rate in predicting good clinical outcome (interaction odds ratio=1.03 [1.01–1.05], P =0.007) and final infarct volume (interaction odds ratio=−0.44 [−0.87 to −0.01], P =0.047). For patients with fast core growth of mL/h, EVT treatment (compared with IVT only) increased the odds of good clinical outcome (adjusted odds ratio=3.62 [1.21–10.76], P =0.021) and resulted in smaller final infarction volume (37.5 versus 73.9 mL, P =0.012). For patients with slow core growth of mL/h, there were no significant differences between the EVT and the IVT only group in either good clinical outcome (adjusted odds ratio=1.44 [0.97–2.14], P =0.070) or final infarction volume (22.6 versus 21.9 mL, P =0.551). Fast core growth was associated with greater benefit from EVT compared with IVT in the early .5-hour time window.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2012
DOI: 10.1161/STROKEAHA.111.643932
Abstract: The mismatch lesion volumes defined by perfusion-weighted imaging exceeding diffusion-weighted imaging have been used as a marker of ischemic penumbral tissue. Defining the perfusion lesion by thresholding has shown promise as a practical tool several positron emission tomography studies have indicated a more probabilistic relationship between perfusion and infarction. Here, we used a randomized controlled trial dataset of tissue-type plasminogen activator 3 to 6 hours after stroke to: (1) quantify the relationship between severity of hypoperfusion (measured by Tmax) and risk of infarction (2) exploit this relationship to present a novel definition of mismatch based on infarct probabilities rather than dichotomies and (3) examine the treatment response in the subgroup of patients with mismatch by the new definition. Patients from the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) were included. Baseline perfusion-weighted imaging and 90-day T2-weighted imaging were coregistered. Perfusion-weighted imaging lesion volumes were ided into 10 Tmax delay strata, and infarct risk was defined as the fraction of the tissue at a given Tmax strata that progressed to infarction by day 90. Sixty-two patients were studied. Infarct risk was an increasing function of Tmax for all subgroups, including the whole cohort. The probabilistic approach outperformed all Tmax thresholds, with exception of the Tmax ≥10 threshold, for which it was only favored by a trend. Infarct risk and treatment effect increased with severity of perfusion abnormalities. This suggests that a severity-weighted mismatch definition may define penumbral tissue more accurately.
Publisher: BMJ
Date: 02-2022
DOI: 10.1136/BMJOPEN-2021-055461
Abstract: Stroke reperfusion therapies, comprising intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT), are best practice treatments for eligible acute ischemic stroke patients. In Australia, EVT is provided at few, mainly metropolitan, comprehensive stroke centres (CSC). There are significant challenges for Australia’s rural and remote populations in accessing EVT, but improved access can be facilitated by a ‘drip and ship’ approach. TACTICS (Trial of Advanced CT Imaging and Combined Education Support for Drip and Ship) aims to test whether a multicomponent, multidisciplinary implementation intervention can increase the proportion of stroke patients receiving EVT. This is a non-randomised controlled, stepped wedge trial involving six clusters across three Australian states. Each cluster comprises one CSC hub and a minimum of three primary stroke centre (PSC) spokes. Hospitals will work in a hub and spoke model of care with access to a multislice CT scanner and CT perfusion image processing software (MIStar, Apollo Medical Imaging). The intervention, underpinned by behavioural theory and technical assistance, will be allocated sequentially, and clusters will move from the preintervention (control) period to the postintervention period. Proportion of all stroke patients receiving EVT, accounting for clustering. Proportion of patients receiving IVT at PSCs, proportion of treated patients (IVT and/or EVT) with good (modified Rankin Scale (mRS) score 0–2) or poor (mRS score 5–6) functional outcomes and European Quality of Life Scale scores 3 months postintervention, proportion of EVT-treated patients with symptomatic haemorrhage, and proportion of reperfusion therapy-treated patients with good versus poor outcome who presented with large vessel occlusion at spokes. Ethical approval has been obtained from the Hunter New England Human Research Ethics Committee (18/09/19/4.13, HREC/18/HNE/241, 2019/ETH01238). Trial results will be disseminated widely through published manuscripts, conference presentations and at national and international platforms regardless of whether the trial was positive or neutral. ACTRN12619000750189 UTNU1111-1230-4161.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-06-2019
DOI: 10.1212/WNL.0000000000007768
Abstract: To assess whether complete reperfusion after IV thrombolysis (IVT-R) would result in similar clinical outcomes compared to complete reperfusion after endovascular thrombectomy (EVT-R) in patients with a large vessel occlusion (LVO). EVT-R patients were matched by age, clinical severity, occlusion location, and baseline perfusion lesion volume to IVT-R patients from the International Stroke Perfusion Imaging Registry (INSPIRE). Only patients with complete reperfusion on follow-up imaging were included. The excellent clinical outcome rates at day 90 on the modified Rankin Scale (mRS) were compared between EVT-R vs IVT-R patients within quintiles of increasing baseline ischemic core and penumbral volumes. From INSPIRE, there were 141 EVT-R patients and 141 matched controls (IVT-R) who met the eligibility criteria. In patients with a baseline core mL, EVT-R resulted in a lower odds of achieving an excellent outcome at day 90 compared to IVT-R (day 90 mRS 0–1 odds ratio 0.01, p 0.001). The group with a baseline core mL contained mostly patients with distal M1 or M2 occlusions, and good collaterals ( p = 0.01). In patients with a baseline ischemic core volume mL (internal carotid artery and mostly proximal M1 occlusions), EVT-R increased the odds of patients achieving an excellent clinical outcome (day 90 mRS 0–1 odds ratio 1.61, p 0.001) and there was increased symptomatic intracranial hemorrhage in the IVT-R group with core mL (20% vs 3% in EVT-R, p = 0.008). From this observational cohort, LVO patients with larger baseline ischemic cores and proximal LVO, with poorer collaterals, clearly benefited from EVT-R compared to IVT-R alone. However, for distal LVO patients, with smaller ischemic cores and better collaterals, EVT-R was associated with a lower odds of favorable outcome compared to IVT-R alone.
Publisher: Oxford University Press (OUP)
Date: 21-11-2013
Abstract: Given the variety of relationships found between alcohol consumption and health using in idual data (both negative and positive), the likely impact of changes in population-level alcohol consumption on health at the population level is not clear. This paper uses historical data from 1911 to 2006 to assess the relationship between changes in per-capita alcohol consumption on total male mortality in Australia. A longitudinal aggregate study using Australian per-capita alcohol consumption and mortality data from 1911 to 2006. Analysis is undertaken using autoregressive integrated moving average time-series methods. Per-capita pure alcohol consumption has a significant association with male all-cause mortality, with an increase (decrease) of 1 l per-capita per year associated with a 1.5% increase (decrease) in male mortality (controlling for female mortality and smoking rates). The association between per-capita consumption and mortality was significant for all age groups, with a particularly strong effect among 15-29 year olds. These results place Australia in the group of countries for which a positive association between per-capita alcohol consumption and total mortality can be demonstrated. Thus, despite the beneficial effects of alcohol consumption on health found in many studies, increases in consumption at the population level in Australia are associated with declines in population health. Thus, per-capita alcohol consumption in Australia is a significant contributor to rates of male mortality, particularly among young adults, suggesting an interaction between per-capita consumption and risky episodic drinking. The policies aiming to reduce population-level alcohol consumption and episodic risky drinking have the potential to substantially improve population-health outcomes in Australia, particularly among young men.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2022
Publisher: Informa UK Limited
Date: 26-01-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2022
DOI: 10.1161/STROKEAHA.122.038798
Abstract: Definitive diagnosis of acute ischemic stroke is challenging, particularly in telestroke settings. Although the prognostic utility of CT perfusion (CTP) has been questioned, its diagnostic value remains under-appreciated, especially in cases without an easily visible intracranial occlusion. We assessed the diagnostic accuracy of routine CTP in the acute telestroke setting. Acute and follow-up data collected prospectively from consecutive suspected patients with stroke assessed by a state-wide telestroke service between March 2020 and August 2021 at 12 sites in Australia were analyzed. All patients in the final analysis had been assessed with multimodal CT, including CTP, which was post-processed with automated volumetric software. Diagnostic sensitivity and specificity were calculated for multimodal CT and each in idual component (noncontrast CT [NCCT], CT angiogram [CTA], and CTP). Final diagnosis determined by consensus review of follow-up imaging and clinical data was used as the reference standard. During the study period, complete multimodal CT examination was obtained in 831 patients, 457 of whom were diagnosed with stroke. Diagnostic sensitivity for ischemic stroke increased by 19.5 percentage points when CTP was included with NCCT and CTA compared with NCCT and CTA alone (73.1% positive with NCCT+CTA+CTP [95% CI, 68.8–77.1] versus 53.6% positive with NCCT+CTA alone [95% CI, 48.9–58.3], P .001). No difference was observed between specificities of NCCT+CTA and NCCT+CTA+CTP (98.7% [95% CI, 98.5–100] versus 98.7% [95% CI, 96.9–99.6], P =0.13). Multimodal CT, including CTP, demonstrated the highest negative predictive value (75.0% [95% CI, 72.1–77.7]). Patients with stroke not evident on CTP had small volume infarcts on follow-up (1.2 mL, interquartile range 0.5–2.7mL). Acquisition of CTP as part of a telestroke imaging protocol permits definitive diagnosis of cerebral ischemia in 1 in 5 patients with normal NCCT and CTA.
Publisher: Elsevier BV
Date: 08-2020
Publisher: Wiley
Date: 15-09-2012
DOI: 10.1111/J.1465-3362.2011.00346.X
Abstract: There are a number of studies in recent years that have examined the relationship of alcohol outlets to the incidence of alcohol-related problems. Only a small number of these studies examine the types of alcohol-related problems which may be considered amenity problems, such as neighbourhood disturbance, litter and noise. This paper examines the association between the proximity of someone's home to alcohol outlets and their experience of public amenity problems. Data came from an Australian general population survey: the Alcohol's Harm to Others Survey (2008). Two thousand six hundred and forty-nine Australians aged 18 years and over were asked about their experiences of a number of amenity-type problems and the distance they lived to the nearest on- and off-premise alcohol outlet. Bivariate results showed that respondents living closer to on- and off-premise outlets reported more problems, with minor differences by distance to on- and off-premise outlet. In multivariate logistic regression analyses, controlling for possible confounding effects of the respondent and neighbourhood characteristics, living closer to on-premise outlets was independently associated with reporting being kept awake or disturbed at night and living closer to an off-premise outlet was independently associated with reporting property damage. A possible interpretation of the results is that respondents living close to on- and off-premise outlets experience more amenity problems than those living further away, but that these experiences are concentrated among demographic groups who live in these areas. Direction of influence cannot be inferred from these cross-sectional findings.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
DOI: 10.1161/STROKEAHA.110.580464
Abstract: The Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) was a prospective, randomized, double-blinded, placebo-controlled, phase II trial of alteplase between 3 and 6 hours after stroke onset. The primary outcome of infarct growth attenuation on MRI with alteplase in mismatch patients was negative when mismatch volumes were assessed volumetrically, without coregistration, which underestimates mismatch volumes. We hypothesized that assessing the extent of mismatch by coregistration of perfusion and diffusion MRI maps may more accurately allow the effects of alteplase vs placebo to be evaluated. Patients were classified as having mismatch if perfusion-weighted imaging ided by coregistered diffusion-weighted imaging volume ratio was .2 and total coregistered mismatch volume was ≥10 mL. The primary outcome was a comparison of infarct growth in alteplase vs placebo patients with coregistered mismatch. Of 99 patients with baseline diffusion-weighted imaging and perfusion-weighted imaging, coregistration of both images was possible in 95 patients. Coregistered mismatch was present in 93% (88/95) compared to 85% (81/95) with standard volumetric mismatch. In the coregistered mismatch patients, of whom 45 received alteplase and 43 received placebo, the primary outcome measure of geometric mean infarct growth was significantly attenuated by a ratio of 0.58 with alteplase compared to placebo (1.02 vs 1.77 95% CI, 0.33–0.99 P =0.0459). When using coregistration techniques to determine the presence of mismatch at study entry, alteplase significantly attenuated infarct growth. This highlights the necessity for a randomized, placebo-controlled, phase III clinical trial of alteplase using penumbral selection beyond 3 hours.
Publisher: Wiley
Date: 26-11-2018
DOI: 10.1111/ADD.14075
Abstract: Established in 2006, the Centre for Alcohol Policy Research (CAPR) is Australia's only research centre with a primary focus on alcohol policy. CAPR has four main areas of research: alcohol policy impacts alcohol policy formation and regulatory processes involved in implementing alcohol policies patterns and trends in drinking and alcohol problems in the population and the influence of drinking norms, cultural practices and social contexts, particularly in interaction with alcohol policies. In this paper, we give ex les of key publications in each area. During the past decade, the number of staff employed at CAPR has increased steadily and now hovers at approximately 10. CAPR has supported the development of independent researchers who collaborate on a number of international projects, such as the Alcohol's Harm to Others study which is now replicated in approximately 30 countries. CAPR receives core funding from the Foundation for Alcohol Research and Education, and staff have been highly successful in securing additional competitive research funding. In 2016, CAPR moved to a new institutional setting at La Trobe University and celebrated 10 years of operation.
Publisher: Elsevier BV
Date: 04-2008
Publisher: Wiley
Date: 27-03-2023
DOI: 10.1111/DAR.13648
Publisher: SAGE Publications
Date: 06-07-2015
DOI: 10.1111/IJS.12551
Abstract: The 2015 update of the Canadian Stroke Best Practice Recommendations Hyperacute Stroke Care guideline highlights key elements involved in the initial assessment, stabilization, and treatment of patients with transient ischemic attack (TIA), ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and acute venous sinus thrombosis. The most notable change in this 5th edition is the addition of new recommendations for the use of endovascular therapy for patients with acute ischemic stroke and proximal intracranial arterial occlusion. This includes an overview of the infrastructure and resources required for stroke centers that will provide endovascular therapy as well as regional structures needed to ensure that all patients with acute ischemic stroke that are eligible for endovascular therapy will be able to access this newly approved therapy recommendations for hyperacute brain and enhanced vascular imaging using computed tomography angiography and computed tomography perfusion patient selection criteria based on the five trials of endovascular therapy published in early 2015, and performance metric targets for important time-points involved in endovascular therapy, including computed tomography-to-groin puncture and computed tomography-to-reperfusion times. Other updates in this guideline include recommendations for improved time efficiencies for all aspects of hyperacute stroke care with a movement toward a new median target door-to-needle time of 30 min, with the 90th percentile being 60 min. A stronger emphasis is placed on increasing public awareness of stroke with the recent launch of the Heart and Stroke Foundation of Canada FAST signs of stroke c aign reinforcing the public need to seek immediate medical attention by calling 911 further engagement of paramedics in the prehospital phase with prehospital notification to the receiving emergency department, as well as the stroke team, including neuroradiology updates to the triage and same-day assessment of patients with transient ischemic attack updates to blood pressure recommendations for the hyperacute phase of care for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. The goal of these recommendations and supporting materials is to improve efficiencies and minimize the absolute time lapse between stroke symptom onset and reperfusion therapy, which in turn leads to better outcomes and potentially shorter recovery times.
Publisher: Frontiers Media SA
Date: 06-06-2018
Publisher: Wiley
Date: 12-01-2012
DOI: 10.1111/J.1465-3362.2011.00413.X
Abstract: In 2007 the National Health and Medical Research Council issued the draft of the revised Australian alcohol guidelines. The document presented guidelines explicitly in terms of risk. This paper seeks to explore the public response to this document by analysing the submissions received during the 60 day period for public feedback. One-hundred and three submissions were reviewed. Considerations of what interests were reflected in submissions and how interest groups responded to the framing of risk were examined. Submissions were received from in iduals and organisations. Analysis revealed a range of views and rhetoric. Temperance interests wanted the guidelines' thresholds to be lower the industry critiqued the evidence base as flawed and also argued that the public was unlikely to listen to low-risk drinking messages submissions from public health groups and government wanted a greater rationale for the guidelines and were also concerned with the dropping of a second differentiation of a higher-risk level personal testimonies supported the risk assessments based on personal experiences and those working in clinical service provision expressed concern about the reception of the guidelines among client groups. The ersity of views expressed seems to have had little effect in the revision of the guidelines. Disseminating the low-risk drinking guidelines message poses many challenges.
Publisher: The Sax Institute
Date: 2016
DOI: 10.17061/PHRP2641644
Abstract: Legislative limits on trading hours for licensed premises have a long history in Australia as a key policy approach to managing alcohol-related problems. In recent years, following substantial extensions to permitted hours of sale, there has been renewed attention to policies aimed at reducing late-night trading hours. Restrictions on on-premise alcohol sales have been implemented in Australia after 3.30 am in Newcastle, and after 3 am in Kings Cross and the Sydney central business district in New South Wales. In July 2016, similar restrictions were introduced state-wide after 2 am, or 3 am in 'safe night precincts', in Queensland. Similar policy changes have occurred internationally (e.g. in the UK and the Nordic countries) and there is a growing body of research examining the impacts of trading hour policies on alcohol-related harm. Although there has been a series of reviews of the research in this area, the most recent is now 5 years old and limited to studies published before March 2008. Objective and importance of study: To examine recent (2005-2015) research about the impact of changing the hours of sale of alcohol on alcohol-related harms. The ongoing public discussion about trading hours policy in Australia can benefit from an up-to-date and comprehensive review of the research. Systematic review of the literature that considered the impact of policies that extended or restricted trading hours. MEDLINE, Core Collection, PsychINFO and EMBASE databases were searched from January 2005 to December 2015. Articles were summarised descriptively, focusing on studies conducted in Australia and published since the previous reviews. The search identified 21 studies, including seven from Australia. There were 14 studies published since previous reviews. A series of robust, well-designed Australian studies demonstrate that reducing the hours during which on-premise alcohol outlets can sell alcohol late at night can substantially reduce rates of violence. The Australian studies are supported by a growing body of international research. The evidence of effectiveness is strong enough to consider restrictions on late trading hours for bars and hotels as a key approach to reducing late-night violence in Australia.
Publisher: Springer Berlin Heidelberg
Date: 2004
Publisher: SAGE Publications
Date: 30-09-2016
Abstract: Systemic thrombolysis with rt-PA is contraindicated in patients with acute ischemic stroke anticoagulated with dabigatran. This expert opinion provides guidance on the use of the specific reversal agent idarucizumab followed by rt-PA and/or thrombectomy in patients with ischemic stroke pre-treated with dabigatran. The use of idarucizumab followed by rt-PA is covered by the label of both drugs.
Publisher: Wiley
Date: 09-2022
DOI: 10.1111/DAR.13517
Publisher: Wiley
Date: 08-03-2023
DOI: 10.1111/DAR.13639
Publisher: American Society of Neuroradiology (ASNR)
Date: 12-12-2013
DOI: 10.3174/AJNR.A3733
Publisher: Wiley
Date: 17-03-2022
DOI: 10.1002/ANA.26331
Abstract: The objective of this study was to evaluate functional and safety outcomes of endovascular thrombectomy (EVT) versus medical management (MM) in patients with M2 occlusion and examine their association with perfusion imaging mismatch and stroke severity. In a pooled, patient-level analysis of 3 randomized controlled trials (EXTEND-IA, EXTEND-and IA-TNK parts 1 and 2) and 2 prospective nonrandomized studies (INSPIRE and SELECT), we evaluated EVT association with 90-day functional independence (modified Rankin Scale [mRS] = 0-2) in isolated M2 occlusions as compared to medical management overall and in subgroups by mismatch profile status and stroke severity. We included 517 patients (EVT = 195 and MM = 322), baseline median (interquartile range [IQR]) National Institutes of Health Stroke Scale (NIHSS) was 13 (8-19) in EVT versus 10 (6-15) in MM, p < 0.001. Pretreatment ischemic core did not differ (EVT = 10 [0-24] ml vs MM = 9 [3-21] ml, p = 0.59). Compared to MM, EVT was more frequently associated with functional independence (68.3 vs 61.6%, adjusted odds ratio [aOR] = 2.42, 95% confidence interval [CI] = 1.25-4.67, p = 0.008, inverse probability of treatment weights [IPTW]-OR = 1.75, 95% CI = 1.00-3.75, p = 0.05) with a shift toward better mRS outcomes (adjusted cOR = 2.02, 95% CI:1.23-3.29, p = 0.005), and lower mortality (5 vs 10%, aOR = 0.32, 95% CI = 0.12-0.87, p = 0.025). EVT was associated with higher functional independence in patients with a perfusion mismatch profile (EVT = 70.7% vs MM = 61.3%, aOR = 2.29, 95% CI = 1.09-4.79, p = 0.029, IPTW-OR = 2.02, 1.08-3.78, p = 0.029), whereas no difference was found in those without mismatch (EVT = 43.8% vs MM = 62.7%, p = 0.17, IPTW-OR: 0.71, 95% CI = 0.18-2.78, p = 0.62). Functional independence was more frequent with EVT in patients with moderate or severe strokes, as defined by baseline NIHSS above any thresholds from 6 to 10, whereas there was no difference between groups with milder strokes below these thresholds. In patients with M2 occlusion, EVT was associated with improved clinical outcomes when compared to MM. This association was primarily observed in patients with a mismatch profile and those with higher stroke severity. ANN NEUROL 2022 :629-639.
Publisher: Informa UK Limited
Date: 17-09-2020
Publisher: Oxford University Press
Date: 07-03-2013
Publisher: Wiley
Date: 11-2009
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2008
DOI: 10.1161/STROKEAHA.107.490524
Abstract: Background and Purpose— For MR perfusion–diffusion (PWI-DWI) mismatch to become routine in thrombolysis patient selection, rapid and reliable assessment tools are required. We examined interrater variability in PWI/DWI volume measurements and developed a rapid assessment tool based on the Alberta Stroke Program Early CT Scores (ASPECTS) system. Methods— DWI and PWI were performed in 35 patients with stroke hours after symptom onset. DWI lesion and PWI (time to peak) volumes were measured with planimetric techniques by 4 raters and the 95% limits of agreement calculated. ASPECT scores were assessed separately by 4 investigators (2 experienced and 2 inexperienced) for DWI (MR DWI scores) and PWI (MR time to peak scores). MR mismatch scores were calculated as MR DWI-MR time to peak scores. Results— Interobserver variability was much greater for PWI (95% limit of agreement=±72.3 mL) than for DWI (95% limit of agreement=±12.6 mL). A semiautomated PWI volume (time to peak+2 s) was therefore used to calculate mismatch volume. MR mismatch scores ≥2 predicted 20% PWI-DWI mismatch by volume with mean 78% sensitivity (range, 72% to 84%) and 88% specificity (range, 83% to 90%). There was excellent agreement on mismatch classification using MR mismatch scores between experienced raters (weighted kappa scores of 0.94) with agreement in 34 of 35 cases. Agreement was less consistent between inexperienced raters (weighted kappa=0.49, 28 of 35 cases). Conclusions— Variability in planimetric mismatch measurements arises primarily from differences in PWI volume assessment. High specificity and interrater reliability may make MR mismatch scores an ideal rapid screening tool for potential thrombolysis patients.
Publisher: Wiley
Date: 24-04-2020
DOI: 10.1111/DAR.13076
Publisher: Springer International Publishing
Date: 2019
Publisher: Informa UK Limited
Date: 12-07-2018
Publisher: Elsevier BV
Date: 2019
Publisher: Oxford University Press (OUP)
Date: 16-01-2018
Abstract: Like the tobacco industry, the alcohol industry, with the support of governments in alcohol exporting nations, is looking to international trade and investment law as a means to oppose health warning labels on alcohol. The threat of such litigation, let alone its commencement, has the potential to deter all but the most resolute governments from implementing health warning labeling.
Publisher: Elsevier BV
Date: 06-2006
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2010
DOI: 10.1161/STROKEAHA.109.562827
Abstract: Background and Purpose— In ischemic stroke, the site of arterial obstruction has been shown to influence recanalization and clinical outcomes. However, this has not been studied in randomized controlled trials, nor has the impact of arterial obstruction site on reperfusion and infarct growth been assessed. We studied the influence of site and degree of arterial obstruction patients enrolled in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). Methods— EPITHET was a prospective, randomized, placebo-controlled trial of intravenous tissue plasminogen activator (tPA) in the 3- to 6-hour time window. Arterial obstruction site and degree were rated on magnetic resonance angiography blinded to treatment allocation and outcomes. Results— In 101 EPITHET patients, 87 had adequate quality magnetic resonance angiography, of whom 54 had baseline arterial obstruction. Infarct growth attenuation was greater in those with tPA treatment compared to placebo among patients with middle cerebral artery (MCA) obstruction ( P =0.037). The treatment benefit of tPA over placebo in attenuating infarct growth was greater for MCA than internal carotid artery (ICA) obstruction ( P =0.060). With tPA treatment, good clinical outcome was more likely with MCA than with ICA obstruction ( P =0.005). Most patients with ICA obstruction did not achieve good clinical outcome, whether treated with tPA (100%) or placebo (77%). The study was underpowered to prove any treatment benefit of tPA among patients with any or severe degree of arterial obstruction. Conclusions— Arterial obstruction site strongly predicts outcomes. ICA obstruction carries a uniformly poor prognosis, whereas good outcomes with MCA obstruction are associated with tPA therapy.
Publisher: Wiley
Date: 25-01-2023
DOI: 10.1111/DAR.13599
Abstract: Most studies of alcohol policy have focussed on the role of industry. However, little is known about the evidence base used in alcohol policymaking or policymakers' actions in the field. Here, we mapped the different evidence types used in a case study to construct a classification framework of the evidence types used in alcohol policymaking. Using a case study from the state‐level in Australia, we used content analysis to delineate the evidence types cited across six phases of a policymaking process. We then grouped these types into a higher‐level classification framework. We used descriptive statistics to study how the different evidence types were used in the policymaking process. Thirty‐one evidence types were identified in the case study, across four classes of knowledge: person knowledge, shared knowledge, studied knowledge and practice knowledge. The participating public preferenced studied knowledge. Policymakers preferenced practice knowledge over all other types of knowledge. The classification framework expands on models of evidence and knowledge used across public health, by mapping new evidence types and proposing an inductive method of classification. The policymakers' preferences found here are in line with theories regarding the alcohol industry's influence on policymaking. The classification framework piloted here can provide a useful tool to examine the evidence base used in decision‐making. Further study of evidence types used in policymaking processes can help inform research translation and advocacy efforts to produce healthier alcohol policies.
Publisher: Wiley
Date: 02-2021
DOI: 10.1111/DAR.13236
Abstract: Local governments (LG) have a key role in reducing alcohol‐related harm, yet, Australian research investigating this is limited. This study aimed to explore Australian LGs' role in alcohol policy by investigating how LGs respond to alcohol‐related harm and what influences their responses. A collective case study approach guided two‐stage purposive s ling. Victorian metropolitan and regional LGs were invited to participate based on alcohol‐related harm profiles. Officers within LGs with alcohol policy knowledge participated in semi‐structured interviews. Transcripts were analysed deductively using a pre‐existing alcohol policy framework and inductively using thematic analysis. Nine officers from eight LGs participated. LG responses to alcohol‐related harm predominately included bans on alcohol in public spaces, licensed premises planning and alcohol‐free youth events. Half implemented liquor forums/accords and most implemented education programs in sporting clubs, schools or workplaces. In some LGs, the reduction of alcohol‐related harm was not considered a priority. Key influences on alcohol initiatives were legislation, the composition of licensed venues, extent of alcohol‐related harms, resources and priorities, and stakeholder feedback. While particular policies were widespread, participating LGs varied greatly in activity in, and responses to, reducing alcohol‐related harm. LGs reported varied influences on their responses. LGs recognised the long‐term health harms of alcohol in their health planning documents, however, most prioritised interventions targeting short‐term amenity and safety harms. Changes to Victorian planning and liquor licensing legislation to give additional powers to LGs and providing pre‐developed alcohol programs with dedicated funding should be considered.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2003
DOI: 10.1161/01.STR.0000086529.83878.A2
Abstract: Background and Purpose— Perfusion-weighted MRI has been shown to be useful in the early identification of cerebral tissue at risk of infarction during acute ischemia. Identification of threshold perfusion measures that predict infarction may assist in the selection of patients for thrombolysis. Methods— Mean transit time (MTT), regional cerebral blood flow (rCBF), and regional cerebral blood volume (rCBV) maps were generated in 35 acute stroke patients (17 treated with tissue plasminogen activator and 18 control patients) imaged within 6 hours from symptom onset. Day 90 outcome infarcts (T2-weighted MRI) were superimposed on acute MTT, rCBF, and rCBV maps. Perfusion-weighted MRI measures were then calculated for 2 regions: infarcted and salvaged tissue. Results— MTT was prolonged by 22% in infarcted regions relative to salvaged tissue ( P .001). rCBF was 10% lower in infarcted tissue than in salvaged regions ( P .01). rCBV did not differ significantly between infarcted and salvaged regions. When reperfusion occurred, tissue with more severely prolonged MTT was salvaged from infarction relative to patients with persistent hypoperfusion ( P .05). In contrast, rCBF in salvaged regions did not differ between patients with and without reperfusion. In reperfused patients, an inverse correlation ( R =0.93, P .001) was found between time of initial MRI scan and MTT delay in salvaged tissue. Conclusions— Both increases in MTT and decreases in rCBF predict infarction. Differences in MTT also predict salvage in more severely hypoperfused tissue after reperfusion, suggesting that it is the most clinically useful quantitative perfusion measure. Perfusion thresholds for infarction need to be assessed in the context of symptom duration.
Publisher: AMPCo
Date: 08-2011
DOI: 10.5694/J.1326-5377.2011.TB03261.X
Abstract: To analyse the links between other people's drinking and mental health and to explore the effects on mental health of heavy and problematic drinkers both within and outside spousal relationships. A secondary analysis of data obtained as part of the Alcohol's Harm to Others survey from 2622 randomly s led Australian adults interviewed by telephone between October and December 2008. Self-reported anxiety or depression and satisfaction with mental wellbeing the presence of heavy and problematic drinkers in respondents' lives. Identification of at least one heavy drinker in the respondents' social network of friends, family and co-workers was significantly negatively associated with self-reported mental wellbeing and anxiety or depression. If the heavy drinker was identified by the respondent as someone whose drinking had had a negative impact on their life in the past year, the adverse effect on mental wellbeing and anxiety was much greater. Our findings support a causal pathway between alcohol use and mental health problems by way of someone else's drinking. The association with adverse mental health is substantial regardless of the type of relationship an in idual has with the heavy drinker whose drinking has had an adverse effect on them.
Publisher: S. Karger AG
Date: 05-11-2009
DOI: 10.1159/000255969
Abstract: i Background: /i Previous data have suggested that diabetes and hyperglycemia predict poor outcome following stroke. We studied the prognostic impact of diabetes and admission blood glucose in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). i Methods: /i EPITHET was a prospective randomized placebo-controlled trial of intravenous tissue plasminogen activator (tPA) in the 3- to 6-hour time window. A preexisting diagnosis of diabetes was noted and baseline serum glucose was measured. i Results: /i Intravenous tPA attenuated infarct growth in non-diabetics, but not in diabetics (p = 0.029). In the tPA treatment group, admission blood glucose was higher among patients with poor functional outcome (p = 0.002). i Conclusions: /i Diabetes and hyperglycemia attenuate the effects of tPA on infarct evolution. Future thrombolytic trials should consider randomizing patients by subgroups based on diabetic status and serum glucose levels.
Publisher: Wiley
Date: 05-08-2011
DOI: 10.1111/J.1360-0443.2011.03445.X
Abstract: This study aims to document the adverse effects of drinkers in Australia on people other than the drinker. Cross-sectional survey. In a national survey of Australia, respondents described the harmful effects they experienced from drinkers in their households, family and friendship networks, as well as work-place and community settings. A randomly selected s le of 2,649 adult Australians. Problems experienced because of others' drinking were ascertained via computer-assisted telephone interviews. Respondent and drinker socio-demographic and drinking pattern data were recorded. A total of 70% of respondents were affected by strangers' drinking and experienced nuisance, fear or abuse, and 30% reported that the drinking of someone close to them had negative effects, although only 11% were affected by such a person 'a lot'. Women were more affected by someone they knew in the household or family, while men were more affected by strangers, friends and co-workers. Young adults were consistently the most negatively affected across the majority of types of harm. Substantial proportions of Australians are affected by other people's drinking, including that of their families, friends, co-workers and strangers. These harms range in magnitude from noise and fear to physical abuse, sexual coercion and social isolation.
Publisher: SAGE Publications
Date: 20-01-2010
DOI: 10.1038/JCBFM.2010.3
Abstract: We hypothesized that pretreatment magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI) lesion volumes may have influenced clinical response to thrombolysis in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). In 98 patients randomized to intravenous (IV) tissue plasminogen activator (tPA) or placebo 3 to 6 h after stroke onset, we examined increasing acute DWI and PWI lesion volumes (Tmax—with 2-sec delay increments), and increasing PWI/DWI mismatch ratios, on the odds of both excellent (modified Rankin Scale (mRS): 0 to 1) and poor (mRS: 5 to 6) clinical outcome. Patients with very large PWI lesions (most had internal carotid artery occlusion) had increased odds ratio (OR) of poor outcome with IV-tPA (58% versus 25% placebo OR=4.13, P=0.032 for Tmax +2-sec volume mL). Excellent outcome from tPA treatment was substantially increased in patients with DWI lesions mL (77% versus 18% placebo, OR=15.0, P .001). Benefit from tPA was also seen with DWI lesions up to 25 mL (69% versus 29% placebo, OR=5.5, P=0.03), but not for DWI lesions mL. In contrast, increasing mismatch ratios did not influence the odds of excellent outcome with tPA. Clinical responsiveness to IV-tPA, and stroke outcome, depends more on baseline DWI and PWI lesion volumes than the extent of perfusion–diffusion mismatch.
Publisher: Wiley
Date: 28-02-2023
DOI: 10.1111/DAR.13627
Abstract: Online alcohol purchasing and home delivery has increased in recent years, accelerated by the onset of the coronavirus disease 2019 pandemic. This article aims to investigate the purchasing and drinking behaviour of Australians who use online alcohol delivery services. A cross‐sectional self‐report survey with a convenience s le of 1158 Australians ≥18 years (49.3% female) who used an online alcohol delivery service in the past 3 months, recruited through paid social media advertisements from September to November 2021. Quota s ling was used to obtain a s le with age and gender strata proportional to the Australian adult population. Descriptive statistics were generated and logistic regression used to explore variables that predict hazardous/harmful drinking (Alcohol Use Disorders Identification Test score ≥8). One‐in‐five (20.1%, 95% confidence interval [CI] 17.8–22.5) participants had used an alcohol delivery service to extend a home drinking session because they had run out of alcohol and wanted to continue drinking and, of these, one‐third (33.9%, 95% CI 27.9–40.4) indicated that if the service was not available they would have stopped drinking. Using delivery services in this way was associated with six times higher odds of drinking at hazardous/harmful levels (odds ratio 6.26, 95% CI 3.78–10.36). Participants ≤25 years were significantly more likely to report never having their identification verified when receiving their alcohol delivery at the door compared with purchasing takeaway alcohol in‐person at a bottle shop ( p 0.001, McNemar). Given the risks associated with alcohol delivery, regulation of these services should be improved to meet the same standards as bricks‐and‐mortar bottle shops.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2006
DOI: 10.1161/01.STR.0000221212.36860.C9
Abstract: Background and Purpose— The relationship between baseline and recurrent vascular events may be important in the targeting of secondary prevention strategies. We examined the relationship between initial event and various types of further vascular outcomes and associated effects of blood pressure (BP)–lowering. Methods— Subsidiary analyses of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trial, a randomized, placebo-controlled trial that established the benefits of BP–lowering in 6105 patients (mean age 64 years, 30% female) with cerebrovascular disease, randomly assigned to either active treatment (perindopril for all, plus indapamide in those with neither an indication for, nor a contraindication to, a diuretic) or placebo(s). Results— Stroke subtypes and coronary events were associated with 1.5- to 6.6-fold greater risk of recurrence of the same event (hazard ratios, 1.51 to 6.64 P =0.1 for large artery infarction, P .0001 for other events). However, 46% to 92% of further vascular outcomes were not of the same type. Active treatment produced comparable reductions in the risk of vascular outcomes among patients with a broad range of vascular events at entry (relative risk reduction, 25% P .0001 for ischemic stroke 42%, P =0.0006 for hemorrhagic stroke 17%, P =0.3 for coronary events P homogeneity=0.4). Conclusions— Patients with previous vascular events are at high risk of recurrences of the same event. However, because they are also at risk of other vascular outcomes, a broad range of secondary prevention strategies is necessary for their treatment. BP–lowering is likely to be one of the most effective and generalizable strategies across a variety of major vascular events including stroke and myocardial infarction.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2022
DOI: 10.1161/STROKEAHA.122.040480
Abstract: Endovascular thrombectomy (EVT) access in remote areas is limited. Preliminary data suggest that long distance transfers for EVT may be beneficial however, the magnitude and best imaging strategy at the referring center remains uncertain. We hypothesized that patients transferred miles would benefit from EVT, achieving rates of functional independence (modified Rankin Scale [mRS] score of 0–2) at 3 months similar to those patients treated at the comprehensive stroke center in the randomized EVT extended window trials and that the selection of patients with computed tomography perfusion (CTP) at the referring site would be associated with ordinal shift toward better outcomes on the mRS. This is a retrospective analysis of patients transferred from 31 referring hospitals miles (measured by the most direct road distance) to 9 comprehensive stroke centers in Australia and New Zealand for EVT consideration (April 2016 through May 2021). There were 131 patients the median age was 64 [53–74] years and the median baseline National Institutes of Health Stroke Scale score was 16 [12–22]. At baseline, 79 patients (60.3%) had noncontrast CT+CT angiography, 52 (39.7%) also had CTP. At the comprehensive stroke center, 114 (87%) patients underwent cerebral angiography, and 96 (73.3%) proceeded to EVT. At 3 months, 62 patients (48.4%) had an mRS score of 0 to 2 and 81 (63.3%) mRS score of 0 to 3. CTP selection at the referring site was not associated with better ordinal scores on the mRS at 3 months (mRS median of 2 [1–3] versus 3 [1–6] in the patients selected with noncontrast CT+CT angiography, P =0.1). Nevertheless, patients selected with CTP were less likely to have an mRS score of 5 to 6 (odds ratio 0.03 [0.01–0.19] P .01). In selected patients transferred miles, there was a benefit for EVT, with outcomes similar to those treated in the comprehensive stroke center in the EVT extended window trials. Remote hospital CTP selection was not associated with ordinal mRS improvement, but was associated with fewer very poor 3-month outcomes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2005
DOI: 10.1161/01.STR.0000166181.86928.8B
Abstract: Background and Purpose— The Echoplanar Imaging Thrombolysis Evaluation Trial (EPITHET) tests the hypothesis that perfusion-weighted imaging (PWI)–diffusion-weighted imaging (DWI) mismatch predicts the response to thrombolysis. There is no accepted standardized definition of PWI-DWI mismatch. We compared common mismatch definitions in the initial 40 EPITHET patients. Methods— Raw perfusion images were used to generate maps of time to peak (TTP), mean transit time (MTT), time to peak of the impulse response (Tmax) and first moment transit time (FMT). DWI, apparent diffusion coefficient (ADC), and PWI volumes were measured with planimetric and thresholding techniques. Correlations between mismatch volume (PWI vol -DWI vol ) and DWI expansion (T2 Day 90-vol -DWI Acute-vol ) were also assessed. Results— Mean age was 68±11, time to MRI 4.5±0.7 hours, and median National Institutes of Health Stroke Scale (NIHSS) score 11 (range 4 to 23). Tmax and MTT hypoperfusion volumes were significantly lower than those calculated with TTP and FMT maps ( P .001). Mismatch ≥20% was observed in 89% (Tmax) to 92% (TTP/FMT/MTT) of patients. Application of a +4s (relative to the contralateral hemisphere) PWI threshold reduced the frequency of positive mismatch volumes (TTP 73%/FMT 68%/Tmax 54%/MTT 43%). Mismatch was not significantly different when assessed with ADC maps. Mismatch volume, calculated with all parameters and thresholds, was not significantly correlated with DWI expansion. In contrast, reperfusion was correlated inversely with infarct growth ( R =−0.51 P =0.009). Conclusions— Deconvolution and application of PWI thresholds provide more conservative estimates of tissue at risk and decrease the frequency of mismatch accordingly. The precise definition may not be critical however, because reperfusion alters tissue fate irrespective of mismatch.
Publisher: Elsevier BV
Date: 07-2022
DOI: 10.1016/J.DRUGPO.2022.103705
Abstract: Customers of online alcohol retailers are exposed to marketing displayed on alcohol retailers' websites and may also receive direct marketing via email and text message once contact details are provided in an online sale. To date, this direct marketing activity from online alcohol retailers has not been studied. This study aims to document the quantity and content of marketing material received by customers of online alcohol retailers in Australia, and whether the material complies with relevant regulation. A cross-sectional study of direct marketing from the 100 most popular online alcohol retailers in Australia. Marketing material received via email and text message was collected for three-months from March to June 2021. Email and text messages were coded for 17 variables in four categories: primary purpose of the communication compliance with relevant regulations marketing themes and practices used and offers, promotions, and discounts. We received 1496 emails from 85 of the 100 retailers. Of the retailers who sent emails, the number sent varied widely (Mdn=8 IQR=2-21). Seven retailers sent a total of 18 text messages. The primary purpose of most emails (67.4%) was to advertise a special or offer a discount. Almost all emails (98.6%) complied with spam legislation to include an unsubscribe link, but around half (46.5%) of emails from retailers in jurisdictions where the inclusion of a liquor license number is mandatory, failed to include one. The most common marketing theme was to link specific times or events to drinking (18.8%). Almost half (48.5%) of emails advertised free or discounted delivery for purchasing over a specified threshold. Most online alcohol retailers in Australia are engaging in direct marketing to their customers via email. More research is needed to understand how these emails may influence purchasing and consumption.
Publisher: S. Karger AG
Date: 2010
DOI: 10.1159/000316886
Abstract: i Background: /i The reasons for worse outcome following ischemic stroke in patients with atrial fibrillation (AF) remain unclear. We aimed to elucidate the pathophysiological determinants of poorer stroke outcome in patients with AF using systematic MRI data from the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). i Methods: /i Comparisons of infarct size, hypoperfusion volume, infarct growth, arterial occlusion, recanalization, reperfusion, hemorrhagic transformation and stroke severity were made between patients with and without AF enrolled in the EPITHET study. i Results: /i AF was present in 42 of 101 patients. At baseline, AF patients were older (79 vs. 73 years, p = 0.02), had more severe neurological impairment (National Institutes of Health Stroke Scale score 16 vs. 11, p = 0.006), larger infarcts (29 vs. 15 ml, p = 0.04) and greater volumes of more severe hypoperfusion (T sub max /sub ≧8 s, perfusion-weighted imaging volume 70 vs. 43 ml, p = 0.01) compared to patients without AF. There were no significant differences in arterial occlusion site, infarct growth, recanalization or reperfusion. At outcome, AF patients had larger infarcts (52 vs. 16 ml, p = 0.05), more severe hemorrhagic transformation (29 vs. 5%, p = 0.002 for parenchymal hematomas), greater disability (modified Rankin Scale score 4 vs. 3, p = 0.03) and higher mortality rates (31 vs. 12%, p = 0.04). AF was an independent predictor of parenchymal hematoma (OR = 6.90, 95% CI = 1.57–30.25), but not mortality (OR = 2.56, 95% CI = 0.83–7.85). i Conclusions: /i Patients with AF have worse clinical and imaging outcomes following ischemic stroke. This study suggests that the adverse effect of AF is due to greater volumes of more severely hypoperfused tissue, leading to larger infarct size and greater risk of severe hemorrhagic transformation.
Publisher: S. Karger AG
Date: 2011
DOI: 10.1159/000331467
Abstract: i Background: /i Fluid-attenuated inversion recovery (FLAIR) hyperintensity within an acute cerebral infarct may reflect delayed onset time and increased risk of hemorrhage after thrombolysis. Given the important implications for clinical practice, we examined the prevalence of FLAIR hyperintensity in patients 3–6 h from stroke onset and its relationship to parenchymal hematoma (PH). i Methods: /i Baseline DWI and FLAIR imaging with subsequent hemorrhage detection (ECASS criteria) were prospectively obtained in patients 3–6 h after stroke onset from the pooled EPITHET and DEFUSE trials. FLAIR hyperintensity within the region of the acute DWI lesion was rated qualitatively (dichotomized as visually obvious or subtle (i.e. only visible after careful windowing)) and quantitatively (using relative signal intensity (RSI)). The association of FLAIR hyperintensity with hemorrhage was then tested alongside established predictors (very low cerebral blood volume (VLCBV) and diffusion (DWI) lesion volume) in logistic regression analysis. i Results: /i There were 49 patients with pre-treatment FLAIR imaging (38 received tissue plasminogen activator (tPA), 5 developed PH). FLAIR hyperintensity within the region of acute DWI lesion occurred in 48/49 (98%) patients, was obvious in 18/49 (37%) and subtle in 30/49 (61%). Inter-rater agreement was 92% (ĸ = 0.82). The prevalence of obvious FLAIR hyperintensity did not differ between studies obtained in the 3–4.5 h and 4.5–6 h time periods (40% vs. 33%, p = 0.77). PH was poorly predicted by obvious FLAIR hyperintensity (sensitivity 40%, specificity 64%, positive predictive value 11%). In univariate logistic regression, VLCBV (p = 0.02) and DWI lesion volume (p = 0.03) predicted PH but FLAIR lesion volume (p = 0.87) and RSI (p = 0.11) did not. In ordinal logistic regression for hemorrhage grade adjusted for age and baseline stroke severity (NIHSS), increased VLCBV (p = 0.002) and DWI lesion volume (p = 0.003) were associated with hemorrhage but FLAIR lesion volume (p = 0.66) and RSI (p = 0.35) were not. i Conclusions: /i Visible FLAIR hyperintensity is almost universal 3–6 h after stroke onset and did not predict subsequent hemorrhage in this dataset. Our findings question the value of excluding patients with FLAIR hyperintensity from reperfusion therapies. Larger studies are required to clarify what implications FLAIR-positive lesions have for patient selection.
Publisher: Informa UK Limited
Date: 30-04-2013
Publisher: Elsevier BV
Date: 07-2008
Start Date: 2018
End Date: 2022
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2018
End Date: 2022
Funder: VicHealth
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