ORCID Profile
0000-0002-6914-4884
Current Organisations
HR Wallingford Ltd
,
University of Western Australia
,
University of Plymouth
,
Perth Children's Hospital
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Publisher: IEEE
Date: 2018
Publisher: Springer Berlin Heidelberg
Date: 2021
Publisher: Wiley
Date: 04-10-2014
DOI: 10.1111/PETR.12369
Abstract: Predose monitoring of tacrolimus levels is standard practice in the care of pediatric renal transplant patients. This is despite a paucity of data investigating the ideal target range in children, and controversy as to whether tacrolimus levels correlate with renal transplant outcomes. We performed a retrospective cohort analysis of 48 renal transplant patients at a single Canadian pediatric transplant center following the initiation of a tacrolimus-mycophenolate-prednisone-based IS protocol. We analyzed the relationship of graft function, as defined by GFR up to five yr post-transplant, to the preceding mean tacrolimus level. There was no significant correlation between absolute GFR and mean tacrolimus levels (r = 0.206, p = 0.38). However, a higher mean tacrolimus level, particularly ≥10 ng/mL in the first three months after transplantation, was associated with a slower rate of decline in GFR with time (r = 0.608, p = 0.004) and with a less likelihood of developing CKD five yr after transplant. We suggest that the optimal target range for tacrolimus levels may be at the upper end of what is currently practiced and that further research to validate these findings would be useful.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-07-2019
Publisher: Springer International Publishing
Date: 2022
Publisher: Springer International Publishing
Date: 2016
Publisher: SAGE Publications
Date: 16-01-2022
DOI: 10.1177/09612033211069765
Abstract: Systemic Lupus Erythematosus (SLE) is a serious autoimmune disease often resulting in major end-organ damage and increased mortality. Currently, no data exists focussing on the presentation, long-term management and progression of SLE in the Australian paediatric population. We conducted the first Australian longitudinal review of childhood SLE, focussing on response to treatment and outcomes. Detailed clinical and laboratory data of 42 children diagnosed with SLE before 16 years from 1998 to 2018 resident in Western Australia was collected. Data was collected at diagnosis and key clinical review time points and compared using the Systemic Lupus Collaborating Clinics (SLICC) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) criteria. End organ damage was assessed against Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI). Incidence rates of disease complications and end organ damage were determined. Of the 42 children, 88% were female with average age at diagnosis of 12.5 years. Indigenous Australians were over represented with an incidence rate 18-fold higher than non-Indigenous, although most children were Caucasian, reflecting the demographics of the Australian population. Median duration of follow-up was 4.25 years. On final review, 28.6% had developed cumulative organ damage as described by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (incidence rate: 0.08/PY (95% CI 0.04–0.14)), and one child died. Twenty-nine children had renal involvement (incidence rate: 0.38/PY (95% CI 0.26–0.56)). Of the 27 patients with biopsy proven lupus nephritis, 70% had Class III or IV disease. Average length of prednisolone use from diagnosis was 32.5 months. Hydroxychloroquine ( n = 36) and mycophenolate mofetil ( n =21) were the most widely used steroid sparing agents. 61.9% received rituximab and/or cyclophosphamide. This is the first longitudinal retrospective review of Australian children with SLE, with a markedly higher incidence in Indigenous children. Although improving, rates of end organ complications remain high, similar to international cohort outcomes. Longitudinal multi-centre research is crucial to elucidate risk factors for poor outcomes, and identifying those warranting early more aggressive therapy.
Publisher: IEEE
Date: 04-2018
Publisher: IEEE
Date: 04-2018
Publisher: Wiley
Date: 31-05-2020
DOI: 10.1111/NEP.13722
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2018
Publisher: Wiley
Date: 14-03-2022
DOI: 10.1111/NEP.14036
Publisher: IEEE
Date: 12-2017
Publisher: Elsevier BV
Date: 03-2019
Publisher: American Geophysical Union (AGU)
Date: 08-2020
DOI: 10.1029/2019JC016022
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 07-2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2019
Publisher: Elsevier BV
Date: 05-2020
Publisher: Elsevier BV
Date: 2019
Publisher: Springer International Publishing
Date: 21-08-2018
Publisher: Informa UK Limited
Date: 22-09-2018
DOI: 10.1080/08037051.2017.1380502
Abstract: To determine the prevalence of hypertension and predictors of blood pressure (BP) in a population based survey of Australian children. We analysed cross-sectional data for 2071 children, aged 5-17 years, from the Australian Health Survey 2011-13. Hypertension and high-normal BP were defined by a systolic or diastolic BP greater than the 95th and 90th centiles respectively, using the National High Blood Pressure Education Program fourth report reference data. We also examined the association of several predictor variables (age, sex, remoteness, socioeconomic status, body mass index) with BP as a continuous variable. A total of 5.8% (95%CI 4.4-7.2) of children had hypertension, and a further 6.8% (95%CI 5.4-8.3) had high-normal BP. The strongest predictor of BP was body mass index. After adjustment, children in the overweight and obese categories had a BP that was on average 4 (95%CI 2-6) and 8 mmHg (95%CI 6-11) higher than those of normal weight. Socio-economic status was a statistically significant predictor of BP, but the effect size was more modest (2 mmHg [95%CI 0-4] between the highest and lowest tertile). Hypertension or high-normal BP is present in 12.6% of Australian children. Body mass index is the most important predictor of BP, followed by low socioeconomic status. These at-risk children may be suitable for screening and intervention studies.
Publisher: Springer Science and Business Media LLC
Date: 19-12-2021
DOI: 10.1186/S12882-021-02619-0
Abstract: Parental donor kidney transplantation is the most common treatment option for children and adolescents with kidney failure. Emerging data from observational studies have reported improved short- and medium-term allograft outcomes in recipients of paternal compared to maternal donors. The INCEPTION study aims to identify potential differences in immunological compatibility between maternal and paternal donor kidneys and ascertain how this affects kidney allograft outcomes in children and adolescents with kidney failure. This longitudinal observational study will recruit kidney transplant recipients aged ≤18 years who have received a parental donor kidney transplant across 4 countries (Australia, New Zealand, United Kingdom and the Netherlands) between 1990 and 2020. High resolution human leukocyte antigen (HLA) typing of both recipients and corresponding parental donors will be undertaken, to provide an in-depth assessment of immunological compatibility. The primary outcome is a composite of de novo donor-specific anti-HLA antibody (DSA), biopsy-proven acute rejection or allograft loss up to 60-months post-transplantation. Secondary outcomes are de novo DSA, biopsy-proven acute rejection, acute or chronic antibody mediated rejection or Chronic Allograft Damage Index (CADI) score of 1 on allograft biopsy post-transplant, allograft function, proteinuria and allograft loss. Using principal component analysis and Cox proportional hazards regression modelling, we will determine the associations between defined sets of immunological and clinical parameters that may identify risk stratification for the primary and secondary outcome measures among young people accepting a parental donor kidney for transplantation. This study design will allow us to specifically investigate the relative importance of accepting a maternal compared to paternal donor, for families deciding on the best option for donation. The INCEPTION study findings will explore potentially differential immunological risks of maternal and paternal donor kidneys for transplantation among children and adolescents. Our study will provide the evidence base underpinning the selection of parental donor in order to achieve the best projected long-term kidney transplant and overall health outcomes for children and adolescents, a recognized vulnerable population. The INCEPTION study has been registered with the Australian New Zealand Clinical Trials Registry, with the trial registration number of ACTRN12620000911998 (14th September 2020).
Publisher: Springer Science and Business Media LLC
Date: 08-08-2022
DOI: 10.1186/S12874-022-01695-6
Abstract: Diagnosing urinary tract infections (UTIs) in children in the emergency department (ED) is challenging due to the variable clinical presentations and difficulties in obtaining a urine s le free from contamination. Clinicians need to weigh a range of observations to make timely diagnostic and management decisions, a difficult task to achieve without support due to the complex interactions among relevant factors. Directed acyclic graphs (DAG) and causal Bayesian networks (BN) offer a way to explicitly outline the underlying disease, contamination and diagnostic processes, and to further make quantitative inference on the event of interest thus serving as a tool for decision support. We prospectively collected data on children present to ED with suspected UTIs. Through knowledge elicitation workshops and one-on-one meetings, a DAG was co-developed with clinical domain experts (the Expert DAG) to describe the causal relationships among variables relevant to paediatric UTIs. The Expert DAG was combined with prospective data and further domain knowledge to inform the development of an application-oriented BN (the Applied BN), designed to support the diagnosis of UTI. We assessed the performance of the Applied BN using quantitative and qualitative methods. We summarised patient background, clinical and laboratory characteristics of 431 episodes of suspected UTIs enrolled from May 2019 to November 2020. The Expert DAG was presented with a narrative description, elucidating how infection, specimen contamination and management pathways causally interact to form the complex picture of paediatric UTIs. Parameterised using prospective data and expert-elicited parameters, the Applied BN achieved an excellent and stable performance in predicting Escherichia coli culture results, with a mean area under the receiver operating characteristic curve of 0.86 and a mean log loss of 0.48 based on 10-fold cross-validation. The BN predictions were reviewed via a validation workshop, and we illustrate how they can be presented for decision support using three hypothetical clinical scenarios. Causal BNs created from both expert knowledge and data can integrate case-specific information to provide in idual decision support during the diagnosis of paediatric UTIs in ED. The model aids the interpretation of culture results and the diagnosis of UTIs, promising the prospect of improved patient care and judicious use of antibiotics.
Publisher: Wiley
Date: 15-12-2021
Publisher: IEEE
Date: 2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-08-2022
Publisher: Elsevier BV
Date: 2017
Publisher: Frontiers Media SA
Date: 22-08-2014
DOI: 10.1111/TRI.12384
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2018
Publisher: Elsevier BV
Date: 09-2023
Publisher: Baskent University
Date: 02-2021
Publisher: Springer International Publishing
Date: 06-12-2016
Publisher: American Geophysical Union (AGU)
Date: 06-2022
DOI: 10.1029/2021JC018343
Abstract: We conducted field work in South San Francisco Bay to examine cohesive sediment flocculation dynamics in a shallow, wave‐ and current‐driven estuarine environment. Drawing on data collected using a suite of acoustic and optical instrumentation over three distinct seasons, we found that the factors driving floc size variability differed substantially when comparing locally sourced sediment (i.e., through wave‐driven resuspension) to suspended sediment advected from upstream. Statistical analysis of our extensive field data revealed additional seasonal variability in these trends, with wave stress promoting floc breakup during the summer and winter months, and biological processes encouraging floc growth during the spring productive period. Combining these data with fractal dimension estimates, we found that seasonally varying floc composition can lead to differences in floc settling velocity by a factor of approximately two to five for a given floc size. Finally, by analyzing co‐located turbulence and sediment flux measurements from the bottom boundary layer, we present evidence that the relationship between floc size and the inverse turbulent Schmidt number varies with floc structure. These results can be used to inform sediment transport modeling parameterizations in estuarine environments.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2018
Publisher: Springer Science and Business Media LLC
Date: 20-10-2022
Publisher: IEEE
Date: 12-2017
Publisher: Springer Science and Business Media LLC
Date: 13-03-2019
DOI: 10.1007/S00467-018-3932-4
Abstract: Missing data is an important and common source of bias in clinical research. Readers should be alert to and consider the impact of missing data when reading studies. Beyond preventing missing data in the first place, through good study design and conduct, there are different strategies available to handle data containing missing observations. Complete case analysis is often biased unless data are missing completely at random. Better methods of handling missing data include multiple imputation and models using likelihood-based estimation. With advancing computing power and modern statistical software, these methods are within the reach of clinician-researchers under guidance of a biostatistician. As clinicians reading papers, we need to continue to update our understanding of statistical methods, so that we understand the limitations of these techniques and can critically interpret literature.
Publisher: Wiley
Date: 09-11-2019
DOI: 10.1111/JPC.14293
Abstract: Proteinuria is an important biomarker commonly used to detect and manage kidney disease in children. There are now a variety of methods available to measure urinary protein loss, and physicians are faced with several contrasting strategies: 24-h or timed collection versus spot s les (first-morning or random), measurement of total urinary protein versus selective measurement of urinary albumin, unadjusted urine protein concentration versus protein-to-creatinine ratio and the use of dipstick versus laboratory-based methods. In this review, we will discuss the advantages and disadvantages of these different approaches. We will then summarise the evidence base for proteinuria as a clinical biomarker in different settings, including discussion of the current and potential role of measuring low-level albuminuria. Finally, we will highlight gaps in the literature and opportunities for further research into proteinuria among children.
Publisher: Wiley
Date: 24-02-2017
DOI: 10.1111/JPC.13481
Abstract: Hyponatraemia with hyperkalaemia in infancy is a typical presentation of congenital adrenal hyperplasia. In the presence of pyelonephritis, the same biochemical picture can occur with transient type 1 pseudohypoaldosteronism (PHA-1) also termed type 4 renal tubular acidosis. Recognition of PHA-1 enables appropriate management thus avoiding unnecessary investigations and treatment. To improve awareness of this condition, we present a case series to highlight the clinical and biochemical features of PHA-1. A retrospective chart review of patients diagnosed with transient PHA-1 at a tertiary children's hospital in Western Australia was conducted. Five male infants (32 days to 6 months) with transient PHA-1 were identified. Failure to thrive was the most common symptom with hyponatraemia on presentation. Two infants had antenatally diagnosed bilateral hydronephrosis and urinary tract infection (UTI) on admission. Two infants were treated for congenital adrenal hyperplasia and received hydrocortisone. All infants had UTI and required parenteral antibiotics. The condition was transient and hyponatraemia corrected by day 4 in all infants. There was no correlation between plasma sodium and aldosterone levels. The severity of PHA-1 was independent of the underlying renal anomaly. Four infants had hydronephrosis and vesicoureteric reflux. Surgical intervention was required in two infants. PHA-1 may be precipitated by UTI or urinary tract anomalies in early infancy. Urine analysis should be performed in infants with hyponatraemia. Diagnosis of PHA-1 facilitates appropriate renal investigations to reduce long-term morbidity.
Publisher: Elsevier BV
Date: 09-2018
Publisher: Wiley
Date: 20-05-2014
DOI: 10.1111/NEP.12262
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2018
Publisher: Wiley
Date: 12-2018
DOI: 10.1111/JPC.14259
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-06-2023
DOI: 10.2215/CJN.0000000000000204
Abstract: No randomized trials exist to guide timing the initiation of KRT in children. We sought to define trends and predictors of the eGFR at initiation of KRT, center-related clinical practice variation, and any association with patient survival. Children and young adults (1–25 years) commencing KRT (dialysis or kidney transplantation) between 1995 and 2018 were included using data from the Australia and New Zealand Dialysis and Transplant Registry. The associations between eGFR on commencing KRT and covariates were estimated using quantile regression. Cox regression was used to estimate the association between eGFR and patient survival. Logistic regression, categorizing eGFR about a value of 10 ml/min per 1.73 m 2 , was used in conjunction with a random effect by center to quantify clinical practice variation. Overall, 2274 participants were included. The median eGFR at KRT initiation increased from 7 to 9 ml/min per 1.73 m 2 over the study period and the 90th centile from 11 to 17 ml/min per 1.73m 2 . The effect of era on median eGFR was modified by modality, with a greater increase among those receiving a preemptive kidney transplant (1.0 ml/min per 1.73 m 2 per 5 years 95% confidence interval [CI], 0.6 to 1.5) or peritoneal dialysis (0.7 ml/min per 1.73 m 2 per 5 years 95% CI, 0.4 to 0.9), compared with hemodialysis (0.1 ml/min per 1.73 m 2 per 5 years 95% CI −0.1 to 0.3). There were 252 deaths (median follow-up 8.5 years, interquartile range 3.7–14.2) and no association between eGFR and survival (hazard ratio 1.01 per ml/min per 1.73 m 2 95% CI, 0.98 to 1.04). Center variation explained 6% of the total variance in the odds of initiating KRT earlier. This rose to over 10% when comparing pediatric centers alone. Children and young adults progressively commenced KRT earlier. This change was more pronounced for children starting peritoneal dialysis or receiving a preemptive kidney transplant. Earlier initiation of KRT was not associated with any difference in patient survival. A substantial proportion of clinical practice variation was due to center variation alone.
Publisher: Springer International Publishing
Date: 2023
Publisher: Association for Computing Machinery (ACM)
Date: 10-05-2017
DOI: 10.1145/3057268
Abstract: In this survey, we review the existing game-theoretic approaches for cyber security and privacy issues, categorizing their application into two classes, security and privacy. To show how game theory is utilized in cyberspace security and privacy, we select research regarding three main applications: cyber-physical security, communication security, and privacy. We present game models, features, and solutions of the selected works and describe their advantages and limitations from design to implementation of the defense mechanisms. We also identify some emerging trends and topics for future research. This survey not only demonstrates how to employ game-theoretic approaches to security and privacy but also encourages researchers to employ game theory to establish a comprehensive understanding of emerging security and privacy problems in cyberspace and potential solutions.
Publisher: Oxford University Press (OUP)
Date: 04-04-2014
DOI: 10.1093/CKJ/SFU029
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2017
Publisher: Springer Science and Business Media LLC
Date: 18-02-2019
DOI: 10.1007/S00467-019-04206-W
Abstract: Hypertension is increasingly recognized as a disease spanning the entire life course. Continued efforts to refine the diagnosis and management of hypertension in children are highlighted by the recent American Academy of Pediatrics (AAP) guidelines, which include lower threshold values than the previous reference standard (Fourth Report). We aimed to determine the population-based prevalence of children exceeding thresholds for hypertension using these two guidelines. We also sought to identify the correlates of blood pressure (BP) among Australian children. Cross-sectional data from the Growing Up in Australia: Longitudinal Survey of Australian Children were analyzed. Blood pressure was measured in 7139 Australian children aged 10-12 years and s led using population-based methodology. The association between BP and explanatory variables linked to BP in other populations was examined using multiple linear regression with fractional polynomial terms for continuous, non-linear relationships. The threshold for hypertension was exceeded in 3.1% and 5.4%, and prehypertension in 3.0% and 3.7% of children, using the Fourth Report and AAP guidelines respectively. Children at the threshold for obesity had a 9.1 mmHg higher adjusted BP than those on the 50th centile for body mass index (BMI) (95% CI 8.4 to 9.9). BMI had a non-linear relationship with BP, and the magnitude of association between BMI and BP increased with BMI. Socioeconomic status, hypertension during pregnancy, birth weight, and sports participation were also independently associated with BP. Using the AAP guidelines is likely to substantially increase the population prevalence of hypertension. The association between BMI and BP was strongest and non-linear for obese children, who should be the focus of interventional trials.
Publisher: Springer International Publishing
Date: 2022
Publisher: Wiley
Date: 16-04-2020
Publisher: Springer Science and Business Media LLC
Date: 28-10-2021
DOI: 10.1007/S00467-021-05270-X
Abstract: Limited data suggest children with secondary steroid-resistant nephrotic syndrome (secondary SRNS) have increased risk of recurrence post transplantation. There are no data on the association between secondary steroid resistance and risk of transplant loss. Children who received kidney transplantation between 2000 and 2019 for either primary or secondary SRNS in Australia and New Zealand were included. Children presenting with nephrotic syndrome before 12 months were excluded. Data were gathered from chart reviews and ANZDATA. Transplant survival was estimated using the Kaplan-Meier estimator with Cox modelling used to explore predictors of survival. There were seventy children, 38 (55%) male, median age at presentation 4 years (IQR 2-7) and 46 (66%) Caucasian. Median age at transplant was 11 years (IQR 7-15) and 39 (55%) received living donor transplant. Secondary SRNS occurred in 20/70 (29%). For those with secondary SRNS, 18/20 (90%) had recurrence post-transplant, compared to 18/50 (36%) with primary SRNS (p = 0.001). Every child with history of atopy (n = 11) or with hypoalbuminaemia at time of transplant (n = 13) experienced immediate recurrence. For children with secondary SRNS, 8/18 (44%) with post-transplant recurrence had no response to therapy. For children with primary SRNS, 4/18 (22%) with recurrence had no response to therapy (p = 0.3). Overall, 10-year transplant survival was 47% (95%CI 29-77%) for those with secondary SRNS, compared to 71 (95%CI 57-88%) for those with primary SRNS (p = 0.05). Secondary steroid resistance is strongly associated with SRNS recurrence. Atopy and hypoalbuminaemia at transplant may be novel risk factors for recurrence. Further research is needed to assess if secondary steroid resistance is associated with poorer transplant outcomes. "A higher resolution version of the Graphical abstract is available as Supplementary information".
Publisher: IEEE
Date: 04-2018
Publisher: MDPI AG
Date: 02-2020
DOI: 10.3390/JCM9020394
Abstract: Patients with chronic kidney disease (CKD) have altered physiologic processes, which result in different treatment outcomes compared with the general population. We aimed to systematically evaluate the efficacy of clinical interventions in reducing mortality of patients with CKD. We searched PubMed, MEDLINE, Embase, and Cochrane Database of Systematic Reviews for meta-analyses of randomized controlled trials (RCT) or observational studies (OS) studying the effect of treatment on all-cause mortality of patients with CKD. The credibility assessment was based on the random-effects summary estimate, heterogeneity, 95% prediction intervals, small study effects, excess significance, and credibility ceilings. Ninety-two articles yielded 130 unique meta-analyses. Convincing evidence from OSs supported mortality reduction with three treatments: angiotensin-converting-enzyme inhibitors or angiotensin II receptor blockers for patients not undergoing dialysis, warfarin for patients with atrial fibrillation not undergoing dialysis, and (at short-term) percutaneous coronary intervention compared to coronary artery bypass grafting for dialysis patients. Two treatment comparisons were supported by highly credible evidence from RCTs in terms of all-cause mortality. These were high-flux hemodialysis (HD) versus low-flux HD as a maintenance HD method and statin versus less statin or placebo for patients not undergoing dialysis. Most significant associations identified in OSs failed to be replicated in RCTs. Associations of high credibility from RCTs were in line with current guidelines. Given the heterogeneity of CKD, it seems hard to assume mortality reductions based on findings from OSs.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2018
Publisher: IEEE
Date: 04-2018
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 07-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2022
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2019
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2018
Publisher: Springer Science and Business Media LLC
Date: 10-11-2018
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 04-2017
Publisher: Springer Science and Business Media LLC
Date: 27-07-2017
DOI: 10.1007/S00467-017-3764-7
Abstract: To determine the population-based prevalence of albuminuria in Australian children and validate any negative correlation with body mass index (BMI). Data from the Australian Health Survey 2011-2013 were used. This is a large-scale survey of the health of the Australian population, conducted by the Australian Bureau of Statistics, and uses a stratified, multistage area design with replicate weights attached to observations to allow for the derivation of accurate population estimates. We considered children aged 5-18 years, and defined albuminuria as an albumin-to-creatinine ratio (ACR) >30 mg/g (3.4 mg/mmol). A total of 975 children provided urine s les for determination of ACR. The prevalence of albuminuria was 10.2% for males (95% confidence interval [CI] 6.1-14.2) and 15.5% for females (95% CI 10.7-20.3). After adjusting for age and gender, the odds ratio for albuminuria associated with being overweight or obese was 0.34 (95% CI 0.15-0.75). This relationship also held for waist-to-height ratio, where the adjusted odds ratio for each 0.1 increase was 0.46 (95% CI 0.26-0.82). Albuminuria, using a measurement suitable for population-based and clinical screening, occurs in 12.8% of school-aged Australian children, and is less common in overweight and obese children.
Publisher: Oxford University Press (OUP)
Date: 31-10-2023
DOI: 10.1093/CKJ/SFAC243
Abstract: The Kidney Donor Profile Index (KDPI) is routinely reported by the donation agencies in Australia. We determined the association between KDPI and short-term allograft loss and assessed if this association was modified by the estimated post-transplant survival (EPTS) score and total ischaemic time. Using data from the Australia and New Zealand Dialysis and Transplant Registry, the association between KDPI (in quartiles) and 3-year overall allograft loss was examined using adjusted Cox regression analysis. The interactive effects between KDPI, EPTS score and total ischaemic time on allograft loss were assessed. Of 4006 deceased donor kidney transplant recipients transplanted between 2010 and 2015, 451 (11%) recipients experienced allograft loss within 3 years post-transplant. Compared with recipients of kidneys with a KDPI of 0–25%, recipients who received donor kidneys with a KDPI & % experienced a 2-fold increased risk of 3-year allograft loss {adjusted hazard ratio [HR] 2.04 [95% confidence interval (CI) 1.53–2.71]}. The adjusted HRs for kidneys with a KDPI of 26–50% and 51–75% were 1.27 (95% CI 0.94–1.71) and 1.31 (95% CI 0.96–1.77), respectively. There were significant interactions between KDPI and EPTS scores (P-value for interaction & .01) and total ischaemic time (P-value for interaction & .01) such that the associations between higher KDPI quartiles and 3-year allograft loss were strongest in recipients with the lowest EPTS scores and longest total ischaemic time. Recipients with higher post-transplant expected survival and transplants with longer total ischaemia who received donor allografts with higher KDPI scores experienced a greater risk of short-term allograft loss compared with those recipients with reduced post-transplant expected survival and with shorter total ischemia.
Publisher: IEEE
Date: 09-2017
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 09-2017
Publisher: Wiley
Date: 04-05-2021
DOI: 10.1111/PETR.14019
Abstract: In this 30‐year national review, we describe trends in DD transplantation for paediatric recipients, assess the impact of paediatric allocation bonuses and identify outstanding areas of need for this population. A retrospective review of all DD kidney only transplants to paediatric recipients ( years old) in Australia between 1989 and 2018 was conducted using deidentified extracts from the ANZDATA. Of the 1011 kidney only transplants performed in paediatric recipients during the study period, 426 (42%) were from deceased donors. Paediatric candidates on the DD waiting list had consistently higher rates of transplantation and shorter time from dialysis initiation to transplantation compared with adult candidates (median 372 vs 832 days in 2018, for ex le). Donor characteristics remained more favourable for paediatric recipients, despite a decline in the overall quality of the donor pool. The mean number of HLA antigen mismatches for paediatric recipients of DD transplants increased each decade (2.86 [1989–1998], 3.85 [1999–2008], 4.01 [2009–2018]). Both patient and graft survival have improved for paediatric DD transplant recipients in the most recent era (5‐year graft and patient survival 85% vs 65% and 99% vs 94%, respectively, for 2009–2018 vs 1999–2008). The current DD kidney allocation system in Australia provides rapid access to high‐quality organs for paediatric recipients, and early graft loss has decreased significantly in recent years however, additional targeted interventions to address HLA matching may improve long‐term outcomes in this population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2017
Publisher: BMJ
Date: 19-08-2016
DOI: 10.1136/ARCHDISCHILD-2015-308924
Abstract: Nephrotic syndrome is one of the most common paediatric glomerular diseases, with an incidence of around two per 100 000 children per year. Corticosteroids are the mainstay of treatment, with 85%–90% of children going into remission with an 8-week course of treatment. Unfortunately, nephrotic syndrome follows a relapsing and remitting course in the majority, with 90% relapsing at least once. About half will progress to frequently relapsing nephrotic syndrome (FRNS) or steroid-dependent nephrotic syndrome (SDNS). Different initial steroid regimens have been evaluated since the first trials in Europe and America in the 1960s. Most trials have been designed to evaluate the optimal duration of the initial therapy, rather than different cumulative doses of corticosteroid, or the management of relapses. Until recently, these data suggested that an initial treatment duration of up to 6 months reduced the number of children developing a relapse, without evidence of increased steroid toxicity. Recently, three large, well-designed randomised control trials were published, which demonstrated no significant reduction in risk of relapse or of developing FRNS by extended treatment compared with 2 or 3 months. While there are few trial data to guide the treatment of in idual relapses in steroid-sensitive nephrotic syndrome (SSNS), there is some evidence that a short course of corticosteroid therapy during upper respiratory tract infection may prevent relapse. In patients with FRNS or SDNS who continue to relapse despite low-dose alternate-day steroids a number of non-corticosteroid, steroid-sparing immunosuppressive agents (cyclophosphamide, ciclosporin, tacrolimus, mycophenolate mofetil, levamisole, rituximab) have been shown to reduce the risk of relapse and of FRNS. However, there are limited head-to-head data to inform which agent should be preferred. In this article, we review recent data from randomised trials to update paediatricians on the current evidence supporting interventions in SSNS.
Publisher: BMJ
Date: 07-2019
DOI: 10.1136/BMJOPEN-2017-020262
Abstract: To describe the distribution of albuminuria among Australian children aged 11–12 years and their parents, and assess its intergenerational concordance within parent–child dyads. Population-based cross-sectional study (the Child Health CheckPoint), nested within the Longitudinal Study of Australian Children. Assessment centres (seven Australian cities and eight regional towns) and home visits across Australia, February 2015 to March 2016. Of all participating CheckPoint families (n=1874), 1557 children (46.2% girls) and 1454 parents (85.5% mothers) provided random urine s les at the visit s les from menstruating females were excluded. Urine albumin-to-creatinine ratio (ACR) and its components (urine albumin and creatinine concentration) albuminuria was defined as an ACR ≥3.4 mg/mmol. Pearson’s correlation coefficients and multivariable linear regression models assessed parent–child concordance, using log-transformed data due to skewing. Survey weights and methods were applied to account for the complex s le design. The median ACR for children was 1.03 mg/mmol (IQR 0.65–1.97) and 1.01 mg/mmol (IQR 0.60–2.09) for adults. The median ACR was higher in girls (1.20, IQR 0.71–2.65) than boys (0.90, IQR 0.61–1.65) and in mothers (1.13, IQR 0.63–2.33) than fathers (0.66, IQR 0.41–1.05). Albuminuria was detected in 15.1% of children (girls 20.8%, boys 10.1%) and 13.5% of adults (15.1% mothers, 4.0% fathers) had albuminuria. There was a small correlation between parent and child ACR (Pearson correlation coefficient 0.06, 95% CI 0.01 to 0.12). Albuminuria is common among Australian children and adults, which is of concern because it predicts risk for kidney and cardiovascular disease, and mortality. The weak concordance among intergenerational pairs for urine ACR suggests either that genetic heritability is low or that it becomes evident only at later offspring life stages.
Publisher: Frontiers Media SA
Date: 10-2019
DOI: 10.1111/TRI.13492
Abstract: Nonadherence is an important risk factor for premature allograft failure after kidney transplantation, but outcomes after re-transplantation remain uncertain. Using data from the Australian and New Zealand Dialysis and Transplant registry, the associations between causes of first allograft failure and acute rejection-related and non-adherence-related allograft failure following re-transplantation were examined using competing risk analyses, treating the respective alternative causes of allograft failure and death with functioning graft as competing events. Fifty-nine of 2450 patients (2%) lost their first allografts from nonadherence. Patients who lost their first kidney allograft from nonadherence were younger at the time of first kidney allograft failure but waited longer for a second allograft (>5 years: 54% vs. 20%, P < 0.001) compared with other causes. Compared with patients who lost their first allograft from causes other than nonadherence, the adjusted subdistribution hazard ratio (HR and 95% CI) for acute rejection-related second allograft failure was 0.58 (0.08, 4.07 P = 0.582) for patients with allograft failure attributed to nonadherence and was 6.30 (1.34, 29.67 P = 0.020) for non-adherence-related second allograft failure. In this cohort of transplant recipients who have received second allografts, first allograft failure secondary to nonadherence was associated with a marginally greater risk of allograft failure attributed to nonadherence in subsequent transplantation.
Publisher: Frontiers Media SA
Date: 20-06-2022
DOI: 10.3389/FIMMU.2022.844438
Abstract: High resolution human leukocyte antigen (HLA) typing is important in establishing eplet compatibility and the specificity of donor-specific anti-HLA antibodies (DSA). In deceased donor kidney transplantation, high resolution donor HLA typing may not be immediately available, leading to inaccuracies during the organ allocation process. We aimed to determine the concordance and agreement of HLA-Class I and II eplet mismatches calculated using population frequency based allelic haplotype association (linkage disequilibrium, LD) from sequence-specific oligonucleotide (SSO) and real-time polymerase chain reaction (rtPCR) donor HLA typing (available at time of donor kidney allocation) compared to high-resolution Next Generation Sequencing (NGS) donor typing. NGS high resolution HLA typing were available for all recipients prior to donor kidney allocation. A cohort of 94 deceased donor-recipient pairs from a single Western Australian center were included (77 in idual donors typed, 55 local and 22 interstate). The number of class I (HLA-A+B+C) and class II (HLA-DRB1+DRB3/4/5+DQB1+DQA1+DPB1+DPA1) eplet mismatches were calculated using HLAMatchmaker, comparing LD- and NGS-HLA typing. The accuracy in assigning pre-transplant DSA was compared between methods. The concordance correlation coefficient (95%CI) for HLA-class I and II eplet mismatches were 0.994 (0.992 to 0.996) and 0.991 (0.986 to 0.993), respectively. The 95% limits of agreement for class I were -1.3 (-1.6 to -1.1) to 1.4 (1.2 to 1.7) and -4.8 (-5.7 to -3.9) to 5.0 (4.1 to 5.9) for Class II. Disagreement between the two methods were present for 11 and 37 of the Class I and II donor/recipient pairs. Of which, 5 had a difference of ≥5 class II eplet mismatches. There were 34 (36%) recipients with potential pre-transplant DSA, of which 8 (24% of recipients with DSA) had indeterminate and ultimately false positive DSA assigned by donor LD-typing. While the concordance between NGS- and LD-typing was high, the limits of agreement suggest meaningful differences between these two techniques. The inaccurate assignment of DSA from donor LD-typing may result in associated HLA being considered unacceptable mismatches, inappropriately precluding candidates’ access to transplantation. Accurate imputation of two-field HLA alleles based on LD from SSO and rtPCR HLA typing remains a substantial challenge in clinical practice in-lieu of widely available, rapid, high-resolution methods.
Publisher: Springer Science and Business Media LLC
Date: 07-01-2002
Publisher: MDPI AG
Date: 10-09-2018
DOI: 10.3390/S18093028
Abstract: In vehicular ad hoc networks (VANETs), many schemes for a multi-channel media access control (MAC) protocol have been proposed to adapt to dynamically changing vehicle traffic conditions and deliver both safety and non-safety packets. One such scheme is to employ both time- ision multiple access (TDMA) and carrier-sense multiple access (CSMA) schemes (called a hybrid TDMA/CSMA scheme) in the control channel (CCH) interval. The scheme can adjust the length of the TDMA period depending on traffic conditions. In this paper, we propose a modified packet transmitted in the TDMA period to reduce transmission overhead under a hybrid TDMA/CSMA multi-channel MAC protocol. Simulation results show that a MAC protocol with a modified packet supports an efficient packet delivery ratio of control packets in the CCH. In addition, we analyze the hybrid TDMA/CSMA multi-channel MAC protocol with the modified packet under saturated throughput conditions on the service channels (SCHs). The analysis results show that the number of neighbors has little effect on the establishment of the number of time slots in TDMA periods and on SCHs under saturated throughput conditions.
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 09-2018
Publisher: IEEE
Date: 04-2019
Publisher: Frontiers Media SA
Date: 07-02-2022
Abstract: Reduced estimated glomerular filtration rate (eGFR) at 12-months after kidney transplantation is associated with increased risk of allograft loss, but it is uncertain whether donor age and types modify this relationship. Using Australia and New Zealand registry data, multivariable Cox proportional modelling was used to examine the interactive effects between donor age, types and 12-month eGFR on overall allograft loss. We included 11,095 recipients (4,423 received live-donors). Recipients with lowest 12-month eGFR (& ml/min/1.73 m 2 ) experienced the greatest risk of allograft loss, with adjusted HR [95% CI) of 2.65 [2.38–2.95] compared to eGFR of 30–60 ml/min/1.73 m 2 whereas the adjusted HR for highest eGFR (& ml/min/1.73 m 2 ) was 0.67 [0.62–0.74]. The association of 12-month eGFR and allograft loss was modified by donor age (but not donor types) where a higher risk of allograft loss in recipients with lower compared with higher 12-month eGFR being most pronounced in the younger donor age groups ( p & 0.01). Recipients with eGFR & ml/min/1.73 m 2 12-months after transplantation experienced ≥2.5-fold increased risk of overall allograft loss compared to those with eGFR of & ml/min/1.73 m 2 , and the magnitude of the increased risk is most marked among recipients with younger donors. Careful deliberation of other factors including donor age when considering eGFR as a surrogate for clinical endpoints is warranted.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Wiley
Date: 28-01-2013
DOI: 10.1111/JPC.12094
Abstract: Primary chilblains are an idiopathic cold-induced vasculopathy affecting the soft tissues of the hands and feet. Secondary chilblains occur in different forms of vasculitis and chronic autoimmune connective tissue disorders. Idiopathic chilblains are rarely reported in children and may generate significant anxiety to doctors and patients. We describe a cluster of idiopathic chilblains encountered over the winter of 2010 in Perth, Western Australia. This is a retrospective review of patients identified from a prospectively compiled database of all new cases seen in our department. Data on history, examination, investigations, prescribed treatments and outcomes were collected. Thirty-two patients with isolated idiopathic chilblains were included, including 20 females and 12 males with a median age at onset of 13.5 years. Lesions were papular with signs of peripheral vasoconstriction causing acrocyanosis, and uncomfortable due to pain and/or pruritis in most. Thickening of the small joints was common where lesions involved these areas. Ulceration of lesions also occurred in some. One patient required hospitalisation for secondary bacterial infection. Most received some form of treatment including non-steroidal anti-inflammatory drugs, prednisolone or nifedipine. Most patients improved spontaneously with warmer weather or responded to cold protection advice. All had resolved completely by late spring (November). Our cluster of chilblains was associated with an unusually cold winter in Perth 2010. It is the largest series reported in the literature, suggesting that chilblains may be more common than previously thought. Chilblains are almost always benign in nature and patients are systemically well and usually need no further investigation and only symptomatic treatment. Prompt recognition can avoid excessive investigation and anxiety, allowing appropriate simple advice and treatment.
Publisher: Wiley
Date: 21-09-2022
DOI: 10.1111/JPC.16210
Abstract: Acute hypertension is common among children admitted to hospital, and large or rapid increases in blood pressure place children at risk of complications such as posterior reversible encephalopathy syndrome. Guidelines in the United States and Europe now include definitions guiding the identification of acute severe hypertension (otherwise known as hypertensive crisis) and its management. This review discusses these recommendations and the appropriate use of oral antihypertensive agents for children with minimal or no symptoms. We focus on the role of oral calcium channel blockers, including isradipine (a second‐generation dihydropyridine), given recent changes to regulatory approvals in Australia. The differing pharmacokinetic and pharmacodynamic properties of agents are compared, with the aim of facilitating directed drug selection and dosing.
Publisher: Elsevier BV
Date: 11-2022
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2018
Publisher: Institute of Electrical and Electronics Engineers (IEEE)
Date: 2018
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2017
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Nicholas Larkins.