ORCID Profile
0000-0002-9976-0258
Current Organisations
Monash Health
,
Holmesglen Emergency Department P/L
,
BMJ Publishing Group
,
Canadian Institutes of Health Research
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Publisher: Wiley
Date: 11-04-2020
Publisher: Zenodo
Date: 2020
Publisher: Copernicus GmbH
Date: 16-08-2010
Abstract: Abstract. The emission of dimethyl-sulphide (DMS) gas by phytoplankton and the subsequent formation of aerosol has long been suggested as an important climate regulation mechanism. The key aerosol quantity is the number concentration of cloud condensation nuclei (CCN), but until recently global models did not include the necessary aerosol physics to quantify CCN. Here we use a global aerosol microphysics model to calculate the sensitivity of CCN to changes in DMS emission using multiple present-day and future sea-surface DMS climatologies. Calculated annual fluxes of DMS to the atmosphere for the five model-derived and one observations based present day climatologies are in the range 15.1 to 32.3 Tg a−1 sulphur. The impact of DMS climatology on surface level CCN concentrations was calculated in terms of summer and winter hemispheric mean values of ΔCCN/ΔFluxDMS, which varied between −43 and +166 cm−3/(mg m−2 day−1 sulphur), with a mean of 63 cm−3/(mg m−2 day−1 sulphur). The range is due to CCN production in the atmosphere being strongly dependent on the spatial distribution of the emitted DMS. The relative sensitivity of CCN to DMS (i.e. fractional change in CCN ided by fractional change in DMS flux) depends on the abundance of non-DMS derived aerosol in each hemisphere. The relative sensitivity averaged over the five present day DMS climatologies is estimated to be 0.02 in the northern hemisphere (i.e. a 0.02% change in CCN for a 1% change in DMS) and 0.07 in the southern hemisphere where aerosol abundance is lower. In a globally warmed scenario in which the DMS flux increases by ~1% relative to present day we estimate a ~0.1% increase in global mean CCN at the surface. The largest CCN response occurs in the Southern Ocean, contributing to a Southern Hemisphere mean annual increase of less than 0.2%. We show that the changes in DMS flux and CCN concentration between the present day and global warming scenario are similar to interannual differences due to variability in windspeed. In summary, although DMS makes a significant contribution to global marine CCN concentrations, the sensitivity of CCN to potential future changes in DMS flux is very low. This finding, together with the predicted small changes in future seawater DMS concentrations, suggests that the role of DMS in climate regulation is very weak.
Publisher: BMJ
Date: 24-12-2020
Publisher: BMJ
Date: 15-11-2022
DOI: 10.1136/BJSPORTS-2022-106299
Abstract: The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries risk factors for post-traumatic knee OA rehabilitation to prevent post-traumatic knee OA and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7-9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5-5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.
Publisher: BMJ
Date: 19-07-2021
DOI: 10.1136/BJSPORTS-2020-103308
Abstract: Cam morphology, a distinct bony morphology of the hip, is prevalent in many athletes, and a risk factor for hip-related pain and osteoarthritis. Secondary cam morphology, due to existing or previous hip disease (eg, Legg-Calve-Perthes disease), is well-described. Cam morphology not clearly associated with a disease is a challenging concept for clinicians, scientists and patients. We propose this morphology, which likely develops during skeletal maturation as a physiological response to load, should be referred to as primary cam morphology. The aim of this study was to introduce and clarify the concept of primary cam morphology. We conducted a concept analysis of primary cam morphology using articles that reported risk factors associated with primary cam morphology we excluded articles on secondary cam morphology. The concept analysis method is a rigorous eight-step process designed to clarify complex ‘concepts’ the end product is a precise definition that supports the theoretical basis of the chosen concept. We propose five defining attributes of primary cam morphology—tissue type, size, site, shape and ownership—in a new conceptual and operational definition. Primary cam morphology is a cartilage or bony prominence (bump) of varying size at the femoral head-neck junction, which changes the shape of the femoral head from spherical to aspherical. It often occurs in asymptomatic male athletes in both hips. The cartilage or bone alpha angle (calculated from radiographs, CT or MRI) is the most common method to measure cam morphology. We found inconsistent reporting of primary cam morphology taxonomy, terminology, and how the morphology is operationalised. We introduce and clarify primary cam morphology, and propose a new conceptual and operational definition. Several elements of the concept of primary cam morphology remain unclear and contested. Experts need to agree on the new taxonomy, terminology and definition that better reflect the primary cam morphology landscape—a bog-standard bump in most athletic hips, and a possible hip disease burden in a selected few.
Publisher: BMJ
Date: 31-08-2020
Publisher: BMJ
Date: 08-10-2021
DOI: 10.1136/BJSPORTS-2021-103987
Abstract: Poor reporting of medical and healthcare systematic reviews is a problem from which the sports and exercise medicine, musculoskeletal rehabilitation, and sports science fields are not immune. Transparent, accurate and comprehensive systematic review reporting helps researchers replicate methods, readers understand what was done and why, and clinicians and policy-makers implement results in practice. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement and its accompanying Explanation and Elaboration document provide general reporting ex les for systematic reviews of healthcare interventions. However, implementation guidance for sport and exercise medicine, musculoskeletal rehabilitation, and sports science does not exist. The Prisma in Exercise, Rehabilitation, Sport medicine and SporTs science (PERSiST) guidance attempts to address this problem. Nineteen content experts collaborated with three methods experts to identify ex les of exemplary reporting in systematic reviews in sport and exercise medicine (including physical activity), musculoskeletal rehabilitation (including physiotherapy), and sports science, for each of the PRISMA 2020 Statement items. PERSiST aims to help: (1) systematic reviewers improve the transparency and reporting of systematic reviews and (2) journal editors and peer reviewers make informed decisions about systematic review reporting quality.
Publisher: Unpublished
Date: 2011
Publisher: American Geophysical Union (AGU)
Date: 16-12-2014
DOI: 10.1002/2014GL062029
Publisher: Wiley
Date: 25-07-2019
Publisher: SAGE Publications
Date: 10-2022
Publisher: Wiley
Date: 12-06-2020
Publisher: Monash University
Date: 2020
Publisher: Copernicus GmbH
Date: 13-05-2014
Abstract: Abstract. Many of the next generation of global climate models will include aerosol schemes which explicitly simulate the microphysical processes that determine the particle size distribution. These models enable aerosol optical properties and cloud condensation nuclei (CCN) concentrations to be determined by fundamental aerosol processes, which should lead to a more physically based simulation of aerosol direct and indirect radiative forcings. This study examines the global variation in particle size distribution simulated by 12 global aerosol microphysics models to quantify model ersity and to identify any common biases against observations. Evaluation against size distribution measurements from a new European network of aerosol supersites shows that the mean model agrees quite well with the observations at many sites on the annual mean, but there are some seasonal biases common to many sites. In particular, at many of these European sites, the accumulation mode number concentration is biased low during winter and Aitken mode concentrations tend to be overestimated in winter and underestimated in summer. At high northern latitudes, the models strongly underpredict Aitken and accumulation particle concentrations compared to the measurements, consistent with previous studies that have highlighted the poor performance of global aerosol models in the Arctic. In the marine boundary layer, the models capture the observed meridional variation in the size distribution, which is dominated by the Aitken mode at high latitudes, with an increasing concentration of accumulation particles with decreasing latitude. Considering vertical profiles, the models reproduce the observed peak in total particle concentrations in the upper troposphere due to new particle formation, although modelled peak concentrations tend to be biased high over Europe. Overall, the multi-model-mean data set simulates the global variation of the particle size distribution with a good degree of skill, suggesting that most of the in idual global aerosol microphysics models are performing well, although the large model ersity indicates that some models are in poor agreement with the observations. Further work is required to better constrain size-resolved primary and secondary particle number sources, and an improved understanding of nucleation and growth (e.g. the role of nitrate and secondary organics) will improve the fidelity of simulated particle size distributions.
Publisher: BMJ
Date: 17-01-2023
Publisher: Elsevier BV
Date: 11-2020
Publisher: BMJ
Date: 06-12-2022
DOI: 10.1136/BJSPORTS-2022-106092
Abstract: Primary cam morphology is highly prevalent in many athlete populations, causing debilitating hip osteoarthritis in some. Existing research is mired in confusion partly because stakeholders have not agreed on key primary cam morphology elements or a prioritised research agenda. We aimed to inform a more rigorous, inclusive and evidence-based approach to research on primary cam morphology and its natural history by working towards agreement on a set of research priorities for conditions affecting the young person’s hip. An international expert panel—the Young Athlete’s Hip Research (YAHiR) Collaborative—rated research priority statements through an online two-round Delphi exercise and met online to explore areas of tension and dissent. Panellists ranked the prioritised research statements according to the Essential National Health Research (ENHR) ranking strategy. Reporting of results followed REPRISE (REporting guideline for PRIority SEtting of health). A erse Delphi panel (n=65, Delphi rounds 1 and 2 three ENHR strategy surveys: n=49 n=44 n=42) from 18 countries representing six stakeholder groups, prioritised and ranked 18 of 38 research priority statements. The prioritised statements outlined seven research domains: (1) best practice physiotherapy, (2) rehabilitation progression and return to sport, (3) exercise intervention and load management, (4) primary cam morphology prognosis and aetiology, (5) femoroacetabular impingement syndrome prognosis and aetiology, (6) diagnostic criteria, and (7) screening. The panel recommended areas of tension and dissent for the research community to focus on immediately. While informing more rigorous, inclusive and evidence-based research, this consensus is a roadmap for researchers, policy-makers and funders to implement research dedicated to reducing the cost and burden of hip disease related to primary cam morphology.
Publisher: Wiley
Date: 03-2020
Publisher: OAE Publishing Inc.
Date: 2021
DOI: 10.20517/2574-1209.2021.44
Abstract: Evaluation and treatment of acute ischemic stroke has undergone significant advancement since the 1990s, when acute systemic reperfusion with intravenous alteplase became the first approved method for achieving reperfusion. Until recently, 4.5 h after stroke onset appeared to be the maximum time window in which positive results from thrombolysis can be achieved. However, the advent of advanced imaging modalities, including multimodal magnetic resonance imaging and computed tomography perfusion has allowed clinicians to refine the evaluation of these patients by delineating areas of infarcted tissue, areas of potentially salvageable tissue given timely reperfusion, and areas of benign oligemia. Early work in extending the time window beyond this historical limit of 4.5 h has culminated in four positive trials that demonstrate the benefit of acute mechanical or systemic reperfusion therapy in an extended time window of up to 24 h, using advanced imaging criteria for patient selection. The implications of the success of advanced imaging suggest use of these modalities for disposition decisions and selection of greater numbers of patients for reperfusion but add complexity to in idual patient evaluation. Despite this, many questions remain unanswered, including the best choice of thrombolysis agent, whether we can extend the time window further to 24 h, and the optimal combination of mechanical thrombectomy and bridging therapy in the late time window in patients with or without large vessel occlusion.
Publisher: Elsevier BV
Date: 2020
DOI: 10.2139/SSRN.3576522
Publisher: BMJ
Date: 23-12-2020
Publisher: Monash University
Date: 2020
Publisher: American Geophysical Union (AGU)
Date: 07-08-2008
DOI: 10.1029/2007JD009718
Publisher: Monash University
Date: 2020
Publisher: Unpublished
Date: 2011
Publisher: Copernicus GmbH
Date: 15-03-2013
Abstract: Abstract. The Hadley Centre Global Environmental Model (HadGEM) includes two aerosol schemes: the Coupled Large-scale Aerosol Simulator for Studies in Climate (CLASSIC), and the new Global Model of Aerosol Processes (GLOMAP-mode). GLOMAP-mode is a modal aerosol microphysics scheme that simulates not only aerosol mass but also aerosol number, represents internally-mixed particles, and includes aerosol microphysical processes such as nucleation. In this study, both schemes provide hindcast simulations of natural and anthropogenic aerosol species for the period 2000–2006. HadGEM simulations of the aerosol optical depth using GLOMAP-mode compare better than CLASSIC against a data-assimilated aerosol re-analysis and aerosol ground-based observations. Because of differences in wet deposition rates, GLOMAP-mode sulphate aerosol residence time is two days longer than CLASSIC sulphate aerosols, whereas black carbon residence time is much shorter. As a result, CLASSIC underestimates aerosol optical depths in continental regions of the Northern Hemisphere and likely overestimates absorption in remote regions. Aerosol direct and first indirect radiative forcings are computed from simulations of aerosols with emissions for the year 1850 and 2000. In 1850, GLOMAP-mode predicts lower aerosol optical depths and higher cloud droplet number concentrations than CLASSIC. Consequently, simulated clouds are much less susceptible to natural and anthropogenic aerosol changes when the microphysical scheme is used. In particular, the response of cloud condensation nuclei to an increase in dimethyl sulphide emissions becomes a factor of four smaller. The combined effect of different 1850 baselines, residence times, and abilities to affect cloud droplet number, leads to substantial differences in the aerosol forcings simulated by the two schemes. GLOMAP-mode finds a present-day direct aerosol forcing of −0.49 W m−2 on a global average, 72% stronger than the corresponding forcing from CLASSIC. This difference is compensated by changes in first indirect aerosol forcing: the forcing of −1.17 W m−2 obtained with GLOMAP-mode is 20% weaker than with CLASSIC. Results suggest that mass-based schemes such as CLASSIC lack the necessary sophistication to provide realistic input to aerosol-cloud interaction schemes. Furthermore, the importance of the 1850 baseline highlights how model skill in predicting present-day aerosol does not guarantee reliable forcing estimates. Those findings suggest that the more complex representation of aerosol processes in microphysical schemes improves the fidelity of simulated aerosol forcings.
Publisher: BMJ
Date: 07-2220
DOI: 10.1136/BJSPORTS-2019-101453
Abstract: There is no agreement on how to classify, define or diagnose hip-related pain-a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility a comprehensive approach is therefore essential. A negative flexion-adduction-internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head-neck radiographs are the initial diagnostic imaging of choice-advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.
Publisher: Canadian Science Publishing
Date: 2023
Abstract: The Canadian Institutes of Health Research (CIHR) commenced a Quality Assurance Program in 2019 to monitor the quality of peer review in its Project Grant Competition Peer Review Committees. Our primary aim was to describe the performance of CIHR grant peer reviewers, based on the assessments made by CIHR peer review leaders during the first 3 years of the Research Quality Assurance Program. All Peer Review Committee Chairs and (or) Scientific Officers who led peer review for CIHR in 2019, 2020, and 2021 completed Reviewer Quality Feedback forms immediately following Peer Review Committee meetings. The form assessed Performance, Future potential, Review quality, Participation, and Responsiveness. We summarised and descriptively synthesised data from assessments conducted after each of the four grant competitions. The performance of peer reviewers on 4438 occasions was rated by Chairs and Scientific Officers. Approximately one in three peer reviewers submitted outstanding reviews or discussed additional applications and one in 10 demonstrated potential as a future Peer Review Committee leader. At most, one in 20 peer reviewers was considered to have not performed adequately with respect to review quality, participation, or responsiveness. There is a need for more research on the processes involved in allocating research grant funding.
Publisher: Frontiers Media SA
Date: 07-06-2021
DOI: 10.3389/FNEUR.2021.651869
Abstract: Background: There is emphasis on timely administration of thrombolysis and clot retrieval but not antithrombotic therapy within 48 h for ischemic stroke (frequency of 64% in Australia and 97% in North America). We planned to assess the time metrics and variables associated with delaying antithrombotics (antiplatelet and anticoagulant therapy) administration. Methods: This was a retrospective study at Monash Health over 12 months in 2015. We plotted the cumulative event and mapped the key drivers (dimensionless variable Shapley value/SV) of antithrombotics. Results: There were 42 patients with transient ischemic attack/TIA and 483 with ischemic stroke [mean age was 71.8 ± 15.4 56.0% male nil by mouth (NBM) 74.5 and 49.3% of patients received “stat” (immediate and one off) dose antithrombotics]. The median time to imaging for the patients who did not have stroke code activated was 2.3 h (IQR 1.4–3.7), from imaging to dysphagia screen was 14.6 h (IQR 6.2–20.3), and from stopping NBM to antithrombotics was 1.7 h (IQR 0–16.5). TIA patients received antithrombotics earlier than those with ischemic stroke (90.5 vs. 86.5%, p = 0.01). Significant variables in regression analysis for time to antithrombotics were time to dysphagia screen (β 0.20 ± 0.03, SV = 3.2), nasogastric tube (β 19.8 ± 5.9, SV = −0.20), Alteplase (β 8.6 ± 3.6, SV = −1.9), stat dose antithrombotic (β −18.9 ± 2.9, SV = −10.8) and stroke code (β −5.9 ± 2.5, SV = 2.8). The partial correlation network showed that the time to antithrombotics increased with delay in dysphagia screen (coefficient = 0.33) and decreased if “stat” dose of antithrombotics was given (coefficient = −0.32). Conclusion: The proportion of patients receiving antithrombotics within 48 h was higher than previously reported in Australia but remained lower than the standard achieved in North American hospitals. Our process map and network analysis show avenues to shorten the time to antithrombotic.
Publisher: SAGE Publications
Date: 05-2022
Publisher: BMJ
Date: 06-12-2022
DOI: 10.1136/BJSPORTS-2022-106085
Abstract: Primary cam morphology is a mostly benign bony prominence that develops at the femoral head-neck junction of the hip, but it is highly prevalent in many athlete populations. In the small proportion of athletes for whom it is not benign, the resulting hip osteoarthritis can be debilitating. Clinicians, athletes, patients and researchers do not yet agree on important primary cam morphology elements. We aimed to ascertain and improve the level of agreement on primary cam morphology definitions, terminology, taxonomy and imaging outcome measures. To collect and aggregate informed opinions, an expert panel—the Young Athlete’s Hip Research Collaborative—rated primary cam morphology definition, terminology, taxonomy and imaging outcome statements through an online Delphi exercise followed by an online meeting to explore areas of tension and dissent. Reporting followed Conducting and REporting DElphi Studies. A erse and inclusive Delphi panel (n=65 for rounds 1 and 2, representing 18 countries 6 stakeholder groups 40% women) agreed on 35 of 47 statements in 4 domains, while surfacing areas of tension and dissent. This Delphi panel agreed on four key issues essential to moving research and clinical care forward around primary cam morphology. They agreed on: (1) definition, confirming its conceptual attributes (tissue type, size, location, shape and ownership) (2) terminology—use ‘morphology’ and not terms with a negative connotation like ‘lesion’, ‘abnormality’ or ‘deformity’ (3) taxonomy, distinguishing between primary and secondary cam morphology, and (4) imaging outcomes, a continuous bone/cartilage alpha angle on radial femoral head-neck MRI for primary cam morphology aetiology research. This consensus provides athletes, patients, clinicians and researchers with a strong foundation to guide more precise communication, better clinical decision-making and higher value research about primary cam morphology and its natural history.
Publisher: Elsevier BV
Date: 07-2008
Publisher: Cold Spring Harbor Laboratory
Date: 02-09-2022
DOI: 10.1101/2022.09.01.22279512
Abstract: Adherence to study registration and reporting best practices are vital to foster evidence-based medicine. Poor adherence to these standards in clinical trials conducted in Canada would be detrimental to patients, researchers, and the public alike. All registered clinical trials on ClinicalTrials.gov conducted in Canada as of 2009 and completed by 2019 were identified. A cross-sectional analysis of those trials assessed prospective registration, subsequent result reporting in the registry, and subsequent publication of study findings. The lead sponsor, phase of study, clinical trial site location, total patient enrollment, number of arms, type of masking, type of allocation, year of completion, and patient demographics were examined as potential effect modifiers to these best practices. A total of 6,720 trials met the inclusion criteria. From 2009-2019, 59% (n=3,967) of them were registered prospectively and 39% (n=2,642) reported their results in the registry. Of the trials registered between 2009-2014, 55% (n=1,482) were subsequently published in an academic journal. Of the 3,763 trials conducted exclusively in Canada, 3% (n=123) met all 3 criteria of: prospective registration, reporting in the registry, and publishing findings. In contrast, of the remaining 2,957 trials with both Canadian and international sites, 41% (n=1,238) had an overall compliance to these three criteria. Overall, the odds of having adherence to all three practices concurrently in Canadian trials decreases by 95% when compared to international trials (OR = 0.05 95CI: 0.04 – 0.06). Canadian clinical trials substantially lacked adherence to study registration and reporting best practices. Knowledge of this widespread non-compliance should motivate stakeholders in the Canadian clinical trials ecosystem to address and continue to monitor this problem. The data presented provides a baseline against which to compare any improvement in the registration and reporting of clinical trials in Canada.
Publisher: BMJ
Date: 18-02-2020
DOI: 10.1136/BJSPORTS-2019-101969
Abstract: Injury and illness surveillance, and epidemiological studies, are fundamental elements of concerted efforts to protect the health of the athlete. To encourage consistency in the definitions and methodology used, and to enable data across studies to be compared, research groups have published 11 sport-specific or setting-specific consensus statements on sports injury (and, eventually, illness) epidemiology to date. Our objective was to further strengthen consistency in data collection, injury definitions and research reporting through an updated set of recommendations for sports injury and illness studies, including a new Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist extension. The IOC invited a working group of international experts to review relevant literature and provide recommendations. The procedure included an open online survey, several stages of text drafting and consultation by working groups and a 3-day consensus meeting in October 2019. This statement includes recommendations for data collection and research reporting covering key components: defining and classifying health problems severity of health problems capturing and reporting athlete exposure expressing risk burden of health problems study population characteristics and data collection methods. Based on these, we also developed a new reporting guideline as a STROBE Extension—the STROBE Sports Injury and Illness Surveillance (STROBE-SIIS). The IOC encourages ongoing in- and out-of-competition surveillance programmes and studies to describe injury and illness trends and patterns, understand their causes and develop measures to protect the health of the athlete. Implementation of the methods outlined in this statement will advance consistency in data collection and research reporting.
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.JOCN.2010.07.112
Abstract: We report a patient with an unusual presentation of a temporal low-grade glioma with visual symptoms of formed, coloured meaningful images without coexistent psychiatric symptoms or epileptiform activity consistent with a diagnosis of visual hallucinosis. The location and extent of the lesion on the MRI differs from the lesions commonly associated with this diagnosis.
Publisher: Wiley
Date: 18-05-2022
Abstract: To evaluate the effect of a simplified billing form on billings recovery. An interrupted time series analysis of weekly presentations and billings between 1 April 2019 and 14 June 2020. Notably, 3228 patients were included (2030 Overseas Visitor Agreement, 359 Transport Accident Commission and 839 Work Cover). There was a $208.34 (95% CI 155.44–261.23, P 0.0001) increase in billings per episode, that is, 59% (95% CI 44–74, P 0.0001), from a baseline of $351.75/episode. There was no significant change in the actual billing rate during the pandemic. Total billings did not change. Less patients were identified, but each generated 59% more billings.
Publisher: Monash University
Date: 2018
Publisher: Unpublished
Date: 2019
Publisher: BMJ
Date: 04-05-2020
DOI: 10.1136/BJSPORTS-2019-101323
Abstract: High quality sports injury research can facilitate sports injury prevention and treatment. There is scope to improve how our field applies best practice methods—methods matter (greatly!). The 1st METHODS MATTER Meeting, held in January 2019 in Copenhagen, Denmark, was the forum for an international group of researchers with expertise in research methods to discuss sports injury methods. We discussed important epidemiological and statistical topics within the field of sports injury research. With this opinion document, we provide the main take-home messages that emerged from the meeting.
Publisher: BMJ
Date: 23-09-2021
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH20180
Abstract: ObjectiveA pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance and (2) to identify the effect of system and process factors on productivity. MethodsA retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. ResultsA total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56–4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P& .0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in in idual patient load. There was a 2.2% (95% CI: 1.1–3.4, P& .001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4–15.6, P& .001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. ConclusionsEmergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic?An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician’s ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add?This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician’s ability to complete primary consults. What are the implications for practitioners?When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.
Publisher: Monash University
Date: 2006
Publisher: Copernicus GmbH
Date: 22-05-2012
Abstract: Abstract. In the most advanced aerosol-climate models it is common to represent the aerosol particle size distribution in terms of several log-normal modes. This approach, motivated by computational efficiency, makes assumptions about the shape of the particle distribution that may not always capture the properties of global aerosol. Here, a global modal aerosol microphysics module (GLOMAP-mode) is evaluated and improved by comparing against a sectional version (GLOMAP-bin) and observations in the same 3-D global offline chemistry transport model. With both schemes, the model captures the main features of the global particle size distribution, with sub-micron aerosol approximately unimodal in continental regions and bi-modal in marine regions. Initial bin-mode comparisons showed that the current values for two size distribution parameter settings in the modal scheme (mode widths and inter-modal separation sizes) resulted in clear biases compared to the sectional scheme. By adjusting these parameters in the modal scheme, much better agreement is achieved against the bin scheme and observations. Annual mean surface-level mass of sulphate, sea-salt, black carbon (BC) and organic carbon (OC) are within 25% in the two schemes in nearly all regions. Surface level concentrations of condensation nuclei (CN), cloud condensation nuclei (CCN), surface area density and condensation sink also compare within 25% in most regions. However, marine CCN concentrations between 30° N and 30° S are systematically 25–60% higher in the modal model, which we attribute to differences in size-resolved particle growth or cloud-processing. Larger differences also exist in regions or seasons dominated by biomass burning and in free-troposphere and high-latitude regions. Indeed, in the free-troposphere, GLOMAP-mode BC is a factor 2–4 higher than GLOMAP-bin, likely due to differences in size-resolved scavenging. Nevertheless, in most parts of the atmosphere, we conclude that bin-mode differences are much less than model-observation differences, although some processes are missing in these runs which may pose a bigger challenge to modal schemes (e.g., boundary layer nucleation and ultra-fine sea-spray). The findings here underline the need for a spectrum of complexity in global models, with size-resolved aerosol properties predicted by modal schemes needing to be continually benchmarked and improved against freely evolving sectional schemes and observations.
Publisher: Elsevier BV
Date: 10-2009
DOI: 10.1016/J.JOCN.2008.10.023
Abstract: Thoracic canal stenosis caused by hypertrophy of the posterior spinal elements is rare. We report an unusual case of bilateral zygapophyseal joint hypertrophy occurring solely at thoracic levels T10-11, producing bilateral leg weakness and numbness. The diagnosis was established using CT scans and MRI. A wide decompressive laminectomy and posterolateral bone fusion was performed. Postoperatively there was a marked improvement in symptoms and signs. We present a literature review on bilateral single-level facet joint hypertrophy producing canal stenosis and report our experience.
Publisher: BMJ
Date: 23-12-2020
Publisher: BMJ
Date: 16-08-2022
DOI: 10.1136/BJSPORTS-2022-105497
Abstract: We synthesised and assessed credibility (ie, trustworthiness) of thresholds that define meaningful scores for patient-reported outcome measures (PROMs) following interventions for anterior cruciate ligament (ACL) tear or traumatic meniscus injury. Systematic review, narrative synthesis. We searched five databases, handsearched references of included studies and tracked citations. Included studies investigated: in iduals with ACL tear or meniscus injury mean age years and PROM thresholds calculated using any method to define a minimal important change (MIC) or a meaningful post-treatment score (Patient Acceptable Symptom State (PASS) or Treatment Failure). We included 18 studies (15 ACL, 3 meniscus). Three different methods were used to calculate anchor-based MICs across 9 PROMs, PASS thresholds across 4 PROMs and treatment failure for 1 PROM. Credibility was rated ‘high’ for only one study—an MIC of 18 for the Knee injury and Osteoarthritis Outcome Score Quality-of-life (KOOS-QOL) subscale (using the MID Credibility Assessment Tool). Where multiple thresholds were calculated among ‘low’ credibility thresholds in ACL studies, MICs converged to within a 10-point range for KOOS-Symptoms (−1.2 to 5.4) and function in daily living (activities of daily living, ADL 0.5–8.1) subscales, and the International Knee Documentation Committee Subjective Knee Form (7.1–16.2). Other PROM thresholds differed up to 30 points. PASS thresholds converged to within a 10-point range in KOOS-ADL for ACL tears (92.3–100), and KOOS-Symptoms (73-78) and KOOS-QOL (53-57) in meniscus injuries. Meaningful PROM thresholds were highly susceptible to study heterogeneity. While PROM thresholds can aid interpretability in research and clinical practice, they should be cautiously interpreted.
Publisher: Copernicus GmbH
Date: 08-03-2013
Abstract: Abstract. The atmospheric oxidation of dimethyl-sulphide (DMS) derived from marine phytoplankton is a significant source of marine sulphate aerosol. DMS has been proposed to regulate climate via changes in cloud properties, though recent studies have shown that present-day global cloud condensation nuclei (CCN) concentrations have only a weak dependence on the total emission flux of DMS. Here, we use a global aerosol microphysics model to examine how efficiently CCN are produced when DMS emissions are changed in different marine regions. We find that global CCN production per unit mass of sulphur emitted varies by more than a factor of 20 depending on where the change in oceanic DMS emission flux is applied. The variation in CCN production efficiency depends upon where CCN production processes (DMS oxidation, SO2 oxidation, nucleation and growth) are most efficient and removal processes (deposition) least efficient. The analysis shows that the production of aerosol sulphate through aqueous-phase oxidation of SO2 limits the amount of H2SO4 available for nucleation and condensational growth and therefore suppresses CCN formation, leading to the weak response of CCN to changes in DMS emission. Our results show that past and future changes in the spatial distribution of DMS emissions (through changes in the phytoplankton population or wind speed patterns) could exert a stronger control on climate than net increases in biological productivity.
Publisher: Springer Science and Business Media LLC
Date: 11-2013
DOI: 10.1038/NATURE12674
Abstract: The effect of anthropogenic aerosols on cloud droplet concentrations and radiative properties is the source of one of the largest uncertainties in the radiative forcing of climate over the industrial period. This uncertainty affects our ability to estimate how sensitive the climate is to greenhouse gas emissions. Here we perform a sensitivity analysis on a global model to quantify the uncertainty in cloud radiative forcing over the industrial period caused by uncertainties in aerosol emissions and processes. Our results show that 45 per cent of the variance of aerosol forcing since about 1750 arises from uncertainties in natural emissions of volcanic sulphur dioxide, marine dimethylsulphide, biogenic volatile organic carbon, biomass burning and sea spray. Only 34 per cent of the variance is associated with anthropogenic emissions. The results point to the importance of understanding pristine pre-industrial-like environments, with natural aerosols only, and suggest that improved measurements and evaluation of simulated aerosols in polluted present-day conditions will not necessarily result in commensurate reductions in the uncertainty of forcing estimates.
Publisher: Springer Science and Business Media LLC
Date: 12-06-2013
DOI: 10.1038/NATURE12278
Abstract: The amount of ice present in mixed-phase clouds, which contain both supercooled liquid water droplets and ice particles, affects cloud extent, lifetime, particle size and radiative properties. The freezing of cloud droplets can be catalysed by the presence of aerosol particles known as ice nuclei. One of the most important ice nuclei is thought to be mineral dust aerosol from arid regions. It is generally assumed that clay minerals, which contribute approximately two-thirds of the dust mass, dominate ice nucleation by mineral dust, and many experimental studies have therefore focused on these materials. Here we use an established droplet-freezing technique to show that feldspar minerals dominate ice nucleation by mineral dusts under mixed-phase cloud conditions, despite feldspar being a minor component of dust emitted from arid regions. We also find that clay minerals are relatively unimportant ice nuclei. Our results from a global aerosol model study suggest that feldspar ice nuclei are globally distributed and that feldspar particles may account for a large proportion of the ice nuclei in Earth's atmosphere that contribute to freezing at temperatures below about -15 °C.
Publisher: BMJ
Date: 14-02-2020
DOI: 10.1136/BJSPORTS-2019-101337
Abstract: In 2013, the Oslo Sports Trauma Research Center Overuse Injury Questionnaire (OSTRC-O) was developed to record the magnitude, symptoms and consequences of overuse injuries in sport. Shortly afterwards, a modified version of the OSTRC-O was developed to capture all types of injuries and illnesses—The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H). Since then, users from a range of research and clinical environments have identified areas in which these questionnaires may be improved. Therefore, the structure and content of the questionnaires was reviewed by an international panel consisting of the original developers, other user groups and experts in sports epidemiology and applied statistical methodology. Following a review panel meeting in October 2017, several changes were made to the questionnaires, including minor wording alterations, changes to the content of one question and the addition of questionnaire logic. In this paper, we present the updated versions of the questionnaires (OSTRC-O2 and OSTRC-H2), assess the likely impact of the updates on future data collection and discuss practical issues related to application of the questionnaires. We believe this update will improve respondent adherence and improve the quality of collected data.
Publisher: BMJ
Date: 15-11-2020
DOI: 10.1136/BJSPORTS-2019-101458
Abstract: The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain (2) patient-reported outcome measures for hip-related pain (3) measurement of physical capacity for hip-related pain (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for ex le: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement in idualised, evidence-based physiotherapist-led rehabilitation programmes.
Publisher: BMJ
Date: 19-12-2020
DOI: 10.1136/BJSPORTS-2019-101457
Abstract: Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport erformance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management.
Publisher: Center for Open Science
Date: 24-05-2022
Abstract: Consensus is an often neglected but important part of the scientific process. Consensus agreement allows researchers to agree on fundamentals such as terminology and taxonomy, to establish core outcome sets for reporting on medical conditions, and to set research priorities. Consensus methods are invoked by the scientific community to provide answers on topics with little to no previous research, or to provide further guidance when the available evidence is unclear. In the medical literature the most common methods for assessing consensus are the Delphi, RAND-UCLA and Nominal Group Technique. However, consensus methods and their subsequent published 'consensus statements' often: exclude relevant stakeholders or fail to justify their expert panel selection neglect to use systematic/scoping reviews to inform what questions or recommendations their consensus panel will rank or vote upon and often omit the levels of agreement amongst panel members, or worse suppress the existance of important minority views. Given their importance in providing direction to the scientific community, methods of consensus development and their subsequent reporting require further scrutiny. We propose to use the methods of consensus development within the patellofemoral pain field to review: how consensus has been generated who has been invited/involved whether formal literature reviews have supported statements and recommendations and how subsequent agreements/dissent has been reported. By studying the subset of statements on patellofemoral pain we hope to inform future recommendations on the production of rigorous consensus development and reporting.
Location: United Kingdom of Great Britain and Northern Ireland
Start Date: 2001
End Date: 2001
Funder: State Government of Victoria
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