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1. Interviewing vulnerable suspects arrested for homicide offences : the working practices of detectives and third parties

Author

Holmes, Jennifer, Pierpoint, Harriet, and Brookman, Fiona

Abstract

The aim of this research is to critically explore the working practices of detectives and third parties involved in the detention and interviewing of vulnerable suspects, who have been arrested on suspicion of committing homicide (and attempted murder) offences in England and Wales. Vulnerable suspects (juveniles under 18 years of age and adults with a mental health condition or mental disorder (Code C PACE)) are over-represented within the criminal justice system (Loucks, 2007; Bradley, 2009) and are at a higher risk of making false confessions or being unable to act in their best interests during a suspect interview (Gudjonsson, 2003). Those who are arrested on suspicion of committing homicide offences can be detained in custody for up to 96 hours and may experience lengthy and complex interviews, potentially exacerbating their vulnerability. Therefore, it is important to explore how these interviews take place and whether the safeguards that vulnerable suspects are entitled to enable fair treatment. This research explores what takes place prior to and during the suspect interview and the working practices of detectives and third parties (e.g., the appropriate adult (AA) and legal advisor). To achieve this aim, a case study design was employed. Fieldwork was undertaken between July 2018 and January 2020. 125 police suspect interviews and 29 custody records were analysed for 27 vulnerable suspects on 26 investigations, across three police forces. This was supplemented with 37 semi-structured interviews with police officers, AAs and legal advisors. This research identified that detectives and third parties do not always adhere to the rules and guidance which govern the detention and interviewing of vulnerable suspects. Theoretical explanations include police culture and pro-social rule-breaking and these highlight the tensions between the crime control objectives of the police, which prioritise obtaining an evidential account from a suspect, and the due process or welfare objectives of third parties. The research concludes that vulnerable suspects are not always treated fairly, and the implications of these findings for policy and practice are explored. This thesis proposes that the rules which govern the practices of detectives and third parties need to be defined clearly, and that when breaches occur those responsible are held accountable. Proposals also include specialist training (similar to a 'Tier' system) for AAs to prepare them for participation in major crime interviews.

Published
2023

2. Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months

Author

Hodgson, Carol, Fulcher, Bentley, Linke, Natalie, Board, Jasmin, Buhr, Heidi, Cooper, Jamie, Fraser, John, Bernard, Stephen, Brodie, Daniel, Pilcher, David, Fan, Eddy, Udy, Andrew, Gattas, David, Pellegrino, Vincent, Hopper, Ingrid, Litton, Ed, Nair, Priya, Orford, Neil, Parke, Rachael, Stub, Dion, Higgins, Alisa M., Burrell, Aidan, McGuiness, Shay, Reddi, Benjamin, Trapani, Tony, Huckson, Sue, Anderson, Shannah, Dicker, Craig, Jones, Annalie, Martin, Emma, McCracken, Phoebe, Sheldrake, Jayne, Vallance, Shirley, Young, Meredith, Bellomo, Rinaldo, Eastwood, Glenn, Hilton, Andrew, Peck, Leah, Dyett, John, Hunter, Stephanie, Liew, Cheelim, Heard, Joshua, Lijo, Sebastian, Nourse, Mary, Rai, Sumeet, Singh, Manoj, Veerendra, Hemanth, Xu, Tina, Barrett, Jonathan, Brooks, Kyle, Hanlon, Gabrielle, Allen, Chris, Bizzell, Samantha, Eroglu, Ege, Palermo, Annamaria, Pellicano, Susan, Bersten, Andrew, Bihari, Shailesh, Brown, Julia, Comerford, Sharon, Grear, Laura, McIntyre, Joanne, Jin, Xia, Wiersema, Ubbo, Figures, Dee, Gough, Maimoonbe, Pitman, Julie, Tallott, Mandy, Winearls, James, Brieva, Jorge, Hopkins, Madeleine, Jayarman, Nanda, Poulter, Amber-Louise, Quarello, Kate, Aneman, Anders, Austin, Danielle, McCanny, Peter, Miller, Jennene, Murfin, Brendan, Cox, Yolanda, Guo, Stephanie, Shehabi, Yayha, Brown, Amanda, Butt, Pamela, Bushell, Rachel, Lavana, Jayshree, Lockwood, Dawn, Pearce, India, Salt, Gavin, Thambiraj, Solomon, Howard, Meg, Joyce, Chris, Meyer, Jason, Walsham, James, Brown, Nerissa, Glasby, Kathleen, O'Connor, Stephanie, Rivett, Justine, Yap, Joannies, Bristow, Debra, Pincus, Jason, Stuart, Janine, Anstey, James, Barge, Deborah, Butler, Menoly, Gebbie, Bradley, Bass, Frances, Janin, Pierre, Hammond, Naomi, Potger, Kieron, Yarad, Elizabeth, Carey, Ruaidhri, Coles, Jennifer, Totaro, Richard, Anstey, Matthew, Endemann, Anthadene, Hardy, Sarah, Popa, Roxana, Richards, Stephen, Rock, Lara, Wibrow, Bradley, Barbazza, Leanne, Dixon, Barry, Holmes, Jennifer, Hurune, Patricia, O'Brien, Yvette, Buscher, Hergen, Newman, Sally, Reynolds, Claire, Henson, Gail, Senthuran, Siva, Win, April, Breguet, Samantha, Horton, Michelle, McCaffrey, Joe, Trickey, Jemma, Bannerjee, Ashoke, Davidson, Benjamin, Joy, Jenyfer, Kong, Jing, Ertugrul, Atacan D., Neto, Ary Serpa, Fulcher, Bentley J., Charles-Nelson, Anaïs, Bailey, Michael, Burrell, Aidan J.C., Board, Jasmin V., Cooper, D. James, Fraser, John F., Gattas, David J., Hopper, Ingrid K., Linke, Natalie J., Litton, Edward, McGuinness, Shay P., Parke, Rachael L., Pellegrino, Vincent A., Pilcher, David V., Udy, Andrew A., Reddi, Benjamin A.J., Trapani, Tony V., and Hodgson, Carol L.

Published
2024
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3. Using hotspot analysis to prioritize security efforts in Colombian critical infrastructure, a focus on the power grid

Author

Mendizabal, Agustin Palao, Holmes, Jennifer S, Callenes, Mercedez, Ortiz, Neil, and Cardenas, Alvaro

Subjects
Peace, Justice and Strong Institutions, Critical infrastructure, Power grid, Colombia, Hotspot, Spatial analysis, Terrorism, Security, Priority action, Criminology
Abstract

To effectively protect critical infrastructure, it is essential to identify vulnerable areas for priority protection. The use of geographic information systems has increased over the last few decades for crime activity and the identification of delinquency hotspots. This study analyzes the areas of a power grid that are exposed to a higher than the average risk of terrorist attacks. One of the concerns for operation managers and policy makers is that subversive groups may have “inside” information to perform the attacks and create a critical failure that puts more pressure on the operational condition of the power grid. We use exploratory spatial data analysis (ESDA) and information from the Colombian power grid to prompt the question: why hotspots emerge in some parts of the power grid, but not in others? The theoretical framework of attacks in the power grid operation exists but need to be corroborated with historical events that reflect such possible way of action. To this end, we perform a Getis-Ord Gi* hotspot analysis to direct attention to areas that are both under attack and critical in terms of operational risks that could affect the reliability and provision of critical services such as power generation and distribution. This subnational case study of Colombia uses data from XM and InterColombia (managers and operators of the Colombian power grid) to identify the areas of electrical infrastructure that have been most attacked and explain the motivations at the local level that the subversive groups have had to attack these areas.

Published
2022

5. How often are infusion sets for central venous catheters changed in Australian and New Zealand Intensive Care Units? A point prevalence survey

Author

Hammond, Naomi, Freeman-Sanderson, Amy, Ganu, Subodh, Howe, Belinda, Litton, Ed, Mackle, Diane, Saxena, Manoj, Seppelt, Ian, Towns, Miriam, Yarad, Elizabeth, Knowles, Serena, Gao, Annie, Li, Yang, Myburgh, John, Nangla, Conrad, Butt, Fatima, Duke, Graeme, Hunter, Stephanie, Evans, Julie, Parker, Dianne, Loughnan, Clare, Thomas, Blessy, Gilder, Eileen, Robertson, Melissa, McMahon, Ellie, Ali, Farisha, Cowdrey, Keri-Anne, McArthur, Colin, Chen, Yan, Simmonds, Catherine, McConnochie, Rachael, O'Connor, Caroline, El-Khawas, Khaled, Hill, Dianne, Cattigan, Claire, Horton, Michelle, Trickey, Jemma, Knott, Cameron, Smith, Julie, Boschert, Catherine, Sara, Treena, Nand, Kiran, Ramanan, Mahesh, Marella, Prashanti, Affleck, Julia, Simpson, Shannon, Ellem, Katrina, McKenna, Toni, Nourse, Mary, Leung, Kristine, Edmunds, Tash, McDonald, Bree, Mehrtens, Jan, Cross, Rosalba, Wong, Helen, Twardowski, Pawel, France, Dawn, Hanlon, Gabrielle, Barrett, Jonathan, Palermo, Annamaria, Pellicano, Susan, Eroglu, Ege, Bihari, Shailesh, Brown, Julia, Grear, Laura, Jin, Xia, French, Craig, Bates, Samantha, Marshall, Fiona, McEldrew, Rebecca, McCullough, James, Tallott, Mandy, Gough, Maimoonbe, Nalos, Marek, Younger, Laura, Krishnamurphy, Ravi, Trent, Louise, How, Janet, Stuart, Anne, Chadwick, Llesley, Bhadange, Neeraj, Tyler, Steven, Sosnowski, Kellie, Morrison, Lynette, Sutton, Joanne, Soar, Natalie, Lee, David, Doyle, Marina, Jongebloed, Katherine, Finnis, Mackenzie, Wilson, Jane, Williams, Tony, Song, Rima, Lai, Vivian, Girijadevi, Dinu, Habraken, Hannah, Browne, Alex, Koelle, Jette, McNab, Charlotte, Masters, Kristy, Gresham, Rebecca, Lowrey, Julie, Whitehead, Christina, Liang, Janet, Harward, Meg, Jones, Cassie, Peake, Sandra, Williams, Tricia, Kurenda, Catherine, Tabah, Alexis, Duroux, Maree, Warhurst, Timothy, Ratcliffe, Megan, Pollock, Hamish, Baker, Stuart, Sonawane, Ravikiran, O'Connor, Stephanie, Brown, Nerissa, Glasby, Kathleen, Rivett, Justine, Campbell, Lewis, Tabuzo, Vera, Smyth, Kirsty, Bass, Frances, O'Connor, Anne, Leonard, Anton, Waterson, Sharon, Coles, Jennifer, Buhr, Heidi, Newman, Duncan, Boorawong, Piyaporn, Bregolin, Vanessa, Yun, Ji-Hyun, Anstey, Matthew, Rock, Lara, Endemann, Anthadene, Lo, Wei, Ferrier, Janet, Reynolds, Claire, Santamaria, John, Holmes, Jennifer, Beca, John, Sherring, Claire, Garrett, Peter, Murray, Lauren, Brailsford, Jane, Browne, Troy, Goodson, Jennifer, Udy, Andrew, Young, Meredith, Board, Jasmin, McCracken, Phoebe, Martin, Emma-Leah, Martynoga, Robert, Butler, Amelia, Trask, Kara, Olatunji, Shaanti, Cruz, Rhoze Sol, Cruz, Raulle Sol, Navarra, Leanlove, Delaney, Kirsha, Lesona, Eden, Young, Chelsea, Spring, Amelia, Aguilar, April, Young, Paul, Law, Erin, Anstey, Matthew H., Maxwell, Nicky, Rickard, Claire M., Hammond, Naomi E., and McGain, Forbes

Published
2024
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6. Utilising routine population healthcare data for epidemiological research and quality improvement in care : application of a national acute kidney alerting system as a proof of concept

Author

Holmes, Jennifer, Higginson, Ray, and Geen, John

Abstract

Acute kidney injury (AKI) is a global health issue known to cause avoidable harm and death. Improvement in its prevention and management is therefore considered an important goal for the healthcare sector. While improvement science states that without measurement, improvement is not possible, at the outset of this research, the epidemiology of AKI was also not fully understood. Whereas numerous studies had described AKI that is developed during hospitalisation, less had focused on that developed in the community. This healthcare informatics thesis centres on the proposed utilisation of routine serum creatinine (SCr) data for informing both the epidemiology of AKI, and improvement in care for patients who develop and/or are at risk of AKI. It follows the recent implementation of an automated laboratory-based electronic alerting system for AKI across the entire Welsh National Health Service which, in addition to its primary purpose of aiding early intervention, also had potential to be applied as a centralised system of data collection. The first of three projects documented in the portfolio style thesis involves development of processes to systematically extract, cleanse and classify data on electronic (e)-alerts transmitted by the algorithm of the aforementioned system. This author's work results in a data set which is suitable for analysis and enables reliable identification of all AKI occurring in the Welsh population, including that which is hospital and community acquired. Following this is project two and presentation of a series of peer-reviewed studies by the author which, by utilising the described novel data set, include some of the first comprehensive, population-based descriptions of AKI and its associated factors known to date. Project three follows with further practical examples of work by the author to demonstrate the potential of the same data set. It begins with studies by the author which, in helping end-users better understand the significance of AKI e-alerts, could allay speculation healthcare providers and professionals may have regarding their clinical utility. It closes by presenting a prototype of a tool which, via application of statistical process control techniques and indicators developed by the author, provides a means to robustly measure, and identify variation in, quality of healthcare provision related to AKI in Wales, a mechanism which did not exist prior. The original contribution to knowledge is the methodological development of a new national data source for AKI, and the demonstration and conclusion that these large validated data provide unique opportunity to reliably inform the epidemiology of, and quality improvement in healthcare provision for, AKI. Work on and of this scale and scope is yet to be achieved elsewhere. This thesis therefore significantly adds to the literature to which it relates. To validate its contribution, and support its overall conclusion, the peer-reviewed status of the author's 14 published works appended and presented throughout are offered. Finally, while the work here concerns SCr and AKI, it is also presented as a wider proof of concept which in theory could be replicated for other routine laboratory-based healthcare data, to improve the epidemiological understanding and management of other health conditions.

Published
2022

7. Neuromuscular blockade and oxygenation changes during prone positioning in COVID-19

Author

Rollinson, Thomas C., McDonald, Luke A., Rose, Joleen, Eastwood, Glenn, Costa-Pinto, Rahul, Modra, Lucy, Maeda, Akinori, Bacolas, Zoe, Anstey, James, Bates, Samantha, Bradley, Scott, Dumbrell, Jodi, French, Craig, Ghosh, Angaj, Haines, Kimberley, Haydon, Tim, Hodgson, Carol L., Holmes, Jennifer, Leggett, Nina, McGain, Forbes, Moore, Cara, Nelson, Kathleen, Presneill, Jeffrey, Rotherham, Hannah, Said, Simone, Young, Meredith, Zhao, Peinan, Udy, Andrew, Neto, Ary Serpa, Chaba, Anis, and Bellomo, Rinaldo

Published
2024
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10. How much do we throw away in the intensive care unit? An observational point prevalence study of Australian and New Zealand ICUs

Author

Hammond, Naomi, Knowles, Serena, Freeman-Sanderson, Amy, Ganu, Subodh, Howe, Belinda, Litton, Ed, Mackle, Diane, Saxena, Manoj, Seppelt, Ian, Towns, Miriam, Yarad, Elizabeth, Hammond, Gao, Annie, Li, Yang, Myburgh, John, Nangla, Conrad, Butt, Fatima, Duke, Graeme, Hunter, Stephanie, Evans, Julie, Parker, Dianne, Loughnan, Clare, Thomas, Blessy, Gilder, Eileen, Robertson, Melissa, McMahon, Ellie, Ali, Farisha, Cowdrey, Keri-Anne, McArthur, Colin, Chen, Yan, Simmonds, Catherine, McConnochie, Rachael, O'Connor, Caroline, El-Khawas, Khaled, Hill, Dianne, Cattigan, Claire, Horton, Michelle, Trickey, Jemma, Knott, Cameron, Smith, Julie, Boschert, Catherine, Sara, Treena, Nand, Kiran, Ramanan, Mahesh, Marella, Prashanti, Affleck, Julia, Simpson, Shannon, Ellem, Katrina, McKenna, Toni, Nourse, Mary, Leung, Kristine, Edmunds, Tash, McDonald, Bree, Mehrtens, Jan, Cross, Rosalba, Wong, Helen, Twardowski, Pawel, France, Dawn, Hanlon, Gabrielle, Barrett, Jonathan, Palermo, Annamaria, Pellicano, Susan, Eroglu, Ege, Bihari, Shailesh, Brown, Julia, Grear, Laura, Jin, Xia, French, Craig, Bates, Samantha, Marshall, Fiona, McEldrew, Rebecca, McCullough, James, Tallott, Mandy, Gough, Maimoonbe, Nalos, Marek, Younger, Laura, Krishnamurphy, Ravi, Trent, Louise, How, Janet, Stuart, Anne, Chadwick, Llesley, Bhadange, Neeraj, Tyler, Steven, Sosnowski, Kellie, Morrison, Lynette, Sutton, Joanne, Soar, Natalie, Lee, David, Doyle, Marina, Jongebloed, Katherine, Finnis, Mackenzie, Wilson, Jane, Williams, Tony, Song, Rima, Lai, Vivian, Girijadevi, Dinu, Habraken, Hannah, Browne, Alex, Koelle, Jette, McNab, Charlotte, Masters, Kristy, Gresham, Rebecca, Lowrey, Julie, Whitehead, Christina, Liang, Janet, Harward, Meg, Jones, Cassie, Peake, Sandra, Williams, Tricia, Kurenda, Catherine, Tabah, Alexis, Duroux, Maree, Warhurst, Timothy, Ratcliffe, Megan, Pollock, Hamish, Baker, Stuart, Sonawane, Ravikiran, O'Connor, Stephanie, Brown, Nerissa, Glasby, Kathleen, Rivett, Justine, Campbell, Lewis, Tabuzo, Vera, Smyth, Kirsty, Bass, Frances, O'Connor, Anne, Leonard, Anton, Waterson, Sharon, Coles, Jennifer, Buhr, Heidi, Newman, Duncan, Boorawong, Piyaporn, Bregolin, Vanessa, Yun, Ji-Hyun, Anstey, Matthew, Rock, Lara, Endemann, Anthadene, Lo, Wei, Ferrier, Janet, Reynolds, Claire, Santamaria, John, Holmes, Jennifer, Beca, John, Sherring, Claire, Garrett, Peter, Murray, Lauren, Brailsford, Jane, Browne, Troy, Goodson, Jennifer, Udy, Andrew, Young, Meredith, Board, Jasmin, McCracken, Phoebe, Martin, Emma-Leah, Martynoga, Robert, Butler, Amelia, Trask, Kara, Olatunji, Shaanti, Cruz, Rhoze Sol, Cruz, Raulle Sol, Navarra, Leanlove, Delaney, Kirsha, Lesona, Eden, Young, Chelsea, Spring, Amelia, Aguilar, April, Young, Paul, Law, Erin, Anstey, Matthew H., Bhonagiri, Deepak, Hammond, Naomi E., and McGain, Forbes

Published
2023
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12. T-cell and antibody responses to first BNT162b2 vaccine dose in previously infected and SARS-CoV-2-naive UK health-care workers: a multicentre prospective cohort study

Author

Harding, Adam, Watson, Adam, Shields, Adrian, Angyal, Adrienn, Alhussni, Ahmed, Richter, Alex, Nicols, Alexander, Deeks, Alexandra, Webb-Bridges, Alice, Cross, Andrew, Ogbe, Ane, Jämsén, Anni, Brown, Anthony, Chawla, Anu, Dold, Christina, Duncan, Christopher, Conlon, Christopher, Skelly, Donal, O'Donnell, Denise, Barnes, Eleanor, Adland, Emily, Weeks, Esme, Sandhar, Gurjinder, Hornsby, Hailey, Brown, Helen, Mehta, Hema, Abuelgasim, Hibatullah, Xiao, Huiyuan, Austin, James, Spegarova, Jarmila, Holmes, Jennifer, Haworth, Jenny, Tyerman, Jessica, Frater, John, Kilby, Jonathan, Cutteridge, Joseph, Jeffery, Katie, Lillie, Katy, Turtle, Lance, Romaniuk, Leigh, Denly, Lucy, Hering, Luisa, Ansari, M. Azim, Pace, Matthew, Chand, Meera, Carroll, Miles, Ali, Mohammad, Kasanyinga, Mwila, Meardon, Naomi, Gillson, Natalie, Rongkard, Patpong, Klenerman, Paul, Goulder, Philip, Matthews, Philippa, Whitham, Rachel, Brown, Rebecca, Payne, Rebecca, Wilson, Robert, Rowland-Jones, Sarah, Thomas, Sarah, Moore, Shona, Gardiner, Siobhan, Longet, Stephanie, Tucker, Stephanie, Dobson, Sue, Hopkins, Susan, Dunachie, Susanna, Adlou, Syed, de Silva, Thushan, Tipton, Tom, Hall, Victoria, James, William, Lawrie, Allan, Smith, Nikki, Turton, Helena, Zawia, Amira, Bayley, Martin, Fairman, Alex, Harrington, Kate, Kirk, Rosemary, Marsh, Louise, Watson, Lisa, Wood, Steven, Diffey, Benjamin, Jones, Chris, Lett, Lauren, Platt, Gareth, Subramaniam, Krishanthi, Wootton, Daniel, Payne, Brendan, Hambleton, Sophie, Kelly, Sinead, Marston, Judith, Poolan, Sonia, Turner, Dianne, Haniffa, Muzlifah, Stephenson, Emily, Adele, Sandra, Akhter, Hossain Delowar, Chinnakannan, Senthil, de Lara, Catherine, Donnison, Timothy, Hackstein, Carl-Philipp, Lee, Lian, Lim, Nicholas, Malone, Tom, Phillips, Eloise, Ramamurthy, Narayan, Robinson, Nichola, Sampson, Oliver, Eyre, David, Simmons, Beatrice, Stafford, Lizzie, Mentzer, Alexander, Amini, Ali, Arancibia-Cárcamo, Carolina, Provine, Nicholas, Travis, Simon, Dimitriadis, Stavros, Johnson, Sile, Foulkes, Sarah, Khawam, Jameel, Wellington, Edgar, Gilbert-Jaramillo, Javier, Knight, Michael, Dupont, Maeva, Horner, Emily, Thaventhiran, James, Chalk, Jeremy, Moore, Shona C, Payne, Rebecca P, Hering, Luisa M, Dobson, Sue L, Kilby, Jonathan A, Tyerman, Jessica K, Nicols, Alexander R, Spegarova, Jarmila S, Conlon, Christopher P, Ansari, M Azim, Matthews, Philippa C, Rowland-Jones, Sarah L, Duncan, Christopher J A, and de Silva, Thushan I

Published
2022
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13. How often are infusion sets for central venous catheters changed in Australian and New Zealand Intensive Care Units? A point prevalence survey

Author

Anstey, Matthew H., primary, Maxwell, Nicky, additional, Rickard, Claire M., additional, Hammond, Naomi E., additional, Knowles, Serena, additional, McGain, Forbes, additional, Hammond, Naomi, additional, Freeman-Sanderson, Amy, additional, Ganu, Subodh, additional, Howe, Belinda, additional, Litton, Ed, additional, Mackle, Diane, additional, Saxena, Manoj, additional, Seppelt, Ian, additional, Towns, Miriam, additional, Yarad, Elizabeth, additional, Gao, Annie, additional, Li, Yang, additional, Myburgh, John, additional, Nangla, Conrad, additional, Butt, Fatima, additional, Duke, Graeme, additional, Hunter, Stephanie, additional, Evans, Julie, additional, Parker, Dianne, additional, Loughnan, Clare, additional, Thomas, Blessy, additional, Gilder, Eileen, additional, Robertson, Melissa, additional, McMahon, Ellie, additional, Ali, Farisha, additional, Cowdrey, Keri-Anne, additional, McArthur, Colin, additional, Chen, Yan, additional, Simmonds, Catherine, additional, McConnochie, Rachael, additional, O'Connor, Caroline, additional, El-Khawas, Khaled, additional, Hill, Dianne, additional, Cattigan, Claire, additional, Horton, Michelle, additional, Trickey, Jemma, additional, Knott, Cameron, additional, Smith, Julie, additional, Boschert, Catherine, additional, Sara, Treena, additional, Nand, Kiran, additional, Ramanan, Mahesh, additional, Marella, Prashanti, additional, Affleck, Julia, additional, Simpson, Shannon, additional, Ellem, Katrina, additional, McKenna, Toni, additional, Nourse, Mary, additional, Leung, Kristine, additional, Edmunds, Tash, additional, McDonald, Bree, additional, Mehrtens, Jan, additional, Cross, Rosalba, additional, Wong, Helen, additional, Twardowski, Pawel, additional, France, Dawn, additional, Hanlon, Gabrielle, additional, Barrett, Jonathan, additional, Palermo, Annamaria, additional, Pellicano, Susan, additional, Eroglu, Ege, additional, Bihari, Shailesh, additional, Brown, Julia, additional, Grear, Laura, additional, Jin, Xia, additional, French, Craig, additional, Bates, Samantha, additional, Marshall, Fiona, additional, McEldrew, Rebecca, additional, McCullough, James, additional, Tallott, Mandy, additional, Gough, Maimoonbe, additional, Nalos, Marek, additional, Younger, Laura, additional, Krishnamurphy, Ravi, additional, Trent, Louise, additional, How, Janet, additional, Stuart, Anne, additional, Chadwick, Llesley, additional, Bhadange, Neeraj, additional, Tyler, Steven, additional, Sosnowski, Kellie, additional, Morrison, Lynette, additional, Sutton, Joanne, additional, Soar, Natalie, additional, Lee, David, additional, Doyle, Marina, additional, Jongebloed, Katherine, additional, Finnis, Mackenzie, additional, Wilson, Jane, additional, Williams, Tony, additional, Song, Rima, additional, Lai, Vivian, additional, Girijadevi, Dinu, additional, Habraken, Hannah, additional, Browne, Alex, additional, Koelle, Jette, additional, McNab, Charlotte, additional, Masters, Kristy, additional, Gresham, Rebecca, additional, Lowrey, Julie, additional, Whitehead, Christina, additional, Liang, Janet, additional, Harward, Meg, additional, Jones, Cassie, additional, Peake, Sandra, additional, Williams, Tricia, additional, Kurenda, Catherine, additional, Tabah, Alexis, additional, Duroux, Maree, additional, Warhurst, Timothy, additional, Ratcliffe, Megan, additional, Pollock, Hamish, additional, Baker, Stuart, additional, Sonawane, Ravikiran, additional, O'Connor, Stephanie, additional, Brown, Nerissa, additional, Glasby, Kathleen, additional, Rivett, Justine, additional, Campbell, Lewis, additional, Tabuzo, Vera, additional, Smyth, Kirsty, additional, Bass, Frances, additional, O'Connor, Anne, additional, Leonard, Anton, additional, Waterson, Sharon, additional, Coles, Jennifer, additional, Buhr, Heidi, additional, Newman, Duncan, additional, Boorawong, Piyaporn, additional, Bregolin, Vanessa, additional, Yun, Ji-Hyun, additional, Anstey, Matthew, additional, Rock, Lara, additional, Endemann, Anthadene, additional, Lo, Wei, additional, Ferrier, Janet, additional, Reynolds, Claire, additional, Santamaria, John, additional, Holmes, Jennifer, additional, Beca, John, additional, Sherring, Claire, additional, Garrett, Peter, additional, Murray, Lauren, additional, Brailsford, Jane, additional, Browne, Troy, additional, Goodson, Jennifer, additional, Udy, Andrew, additional, Young, Meredith, additional, Board, Jasmin, additional, McCracken, Phoebe, additional, Martin, Emma-Leah, additional, Martynoga, Robert, additional, Butler, Amelia, additional, Trask, Kara, additional, Olatunji, Shaanti, additional, Cruz, Rhoze Sol, additional, Cruz, Raulle Sol, additional, Navarra, Leanlove, additional, Delaney, Kirsha, additional, Lesona, Eden, additional, Young, Chelsea, additional, Spring, Amelia, additional, Aguilar, April, additional, Young, Paul, additional, and Law, Erin, additional

Published
2024
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14. Hospital-level volume in extracorporeal membrane oxygenation cases and death or disability at 6 months

Author

Ertugrul, Atacan D., Neto, Ary Serpa, Fulcher, Bentley J., Charles-Nelson, Anaïs, Bailey, Michael, Burrell, Aidan J.C., Anderson, Shannah, Bernard, Stephen, Board, Jasmin V., Brodie, Daniel, Buhr, Heidi, Cooper, D. James, Dicker, Craig, Fan, Eddy, Fraser, John F., Gattas, David J., Hopper, Ingrid K., Huckson, Sue, Linke, Natalie J., Litton, Edward, McGuinness, Shay P., Nair, Priya, Orford, Neil, Parke, Rachael L., Pellegrino, Vincent A., Pilcher, David V., Stub, Dion, Udy, Andrew A., Reddi, Benjamin A.J., Trapani, Tony V., Jones, Annalie, Higgins, Alisa M., Hodgson, Carol L., Hodgson, Carol, Fulcher, Bentley, Linke, Natalie, Board, Jasmin, Buhr, Heidi, Cooper, Jamie, Fraser, John, Bernard, Stephen, Brodie, Daniel, Pilcher, David, Fan, Eddy, Udy, Andrew, Gattas, David, Pellegrino, Vincent, Hopper, Ingrid, Litton, Ed, Nair, Priya, Orford, Neil, Parke, Rachael, Stub, Dion, Higgins, Alisa M., Burrell, Aidan, McGuiness, Shay, Reddi, Benjamin, Trapani, Tony, Huckson, Sue, Anderson, Shannah, Dicker, Craig, Jones, Annalie, Board, Jasmin, Jones, Annalie, Martin, Emma, McCracken, Phoebe, Pellegrino, Vincent, Sheldrake, Jayne, Vallance, Shirley, Young, Meredith, Bellomo, Rinaldo, Eastwood, Glenn, Hilton, Andrew, Peck, Leah, Dyett, John, Hunter, Stephanie, Liew, Cheelim, Heard, Joshua, Lijo, Sebastian, Nourse, Mary, Rai, Sumeet, Singh, Manoj, Veerendra, Hemanth, Xu, Tina, Barrett, Jonathan, Brooks, Kyle, Hanlon, Gabrielle, Allen, Chris, Bizzell, Samantha, Eroglu, Ege, Litton, Ed, Palermo, Annamaria, Pellicano, Susan, Bersten, Andrew, Bihari, Shailesh, Brown, Julia, Comerford, Sharon, Grear, Laura, McIntyre, Joanne, Jin, Xia, Wiersema, Ubbo, Figures, Dee, Gough, Maimoonbe, Pitman, Julie, Tallott, Mandy, Winearls, James, Brieva, Jorge, Hopkins, Madeleine, Jayarman, Nanda, Poulter, Amber-Louise, Quarello, Kate, Aneman, Anders, Austin, Danielle, McCanny, Peter, Miller, Jennene, Murfin, Brendan, Cox, Yolanda, Guo, Stephanie, Shehabi, Yayha, Brown, Amanda, Butt, Pamela, Bushell, Rachel, Fraser, John, Lavana, Jayshree, Lockwood, Dawn, Pearce, India, Salt, Gavin, Thambiraj, Solomon, Howard, Meg, Joyce, Chris, Meyer, Jason, Walsham, James, Brown, Nerissa, Glasby, Kathleen, O'Connor, Stephanie, Reddi, Benjamin, Rivett, Justine, Yap, Joannies, Bristow, Debra, Pincus, Jason, Stuart, Janine, Anstey, James, Barge, Deborah, Butler, Menoly, Gebbie, Bradley, Bass, Frances, Janin, Pierre, Hammond, Naomi, Potger, Kieron, Yarad, Elizabeth, Buhr, Heidi, Carey, Ruaidhri, Coles, Jennifer, Gattas, David, Totaro, Richard, Anstey, Matthew, Endemann, Anthadene, Hardy, Sarah, Popa, Roxana, Richards, Stephen, Rock, Lara, Wibrow, Bradley, Barbazza, Leanne, Dixon, Barry, Holmes, Jennifer, Hurune, Patricia, O'Brien, Yvette, Buscher, Hergen, Nair, Priya, Newman, Sally, Reynolds, Claire, Henson, Gail, Senthuran, Siva, Win, April, Breguet, Samantha, Horton, Michelle, McCaffrey, Joe, Orford, Neil, Trickey, Jemma, Bannerjee, Ashoke, Davidson, Benjamin, Joy, Jenyfer, and Kong, Jing

Abstract

Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.

Published
2024
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15. Utilising routine clinical laboratory data to support quality improvement in health care: Application of a national acute kidney injury alert system as a proof of concept.

Author

Holmes, Jennifer, Higginson, Ray, Geen, John, and Phillips, Aled

Subjects
*MEDICAL quality control, *ACUTE kidney failure, *STATISTICAL process control, *PATHOLOGICAL laboratories, *PROOF of concept, *DATA quality
Abstract

Background: Acute kidney injury (AKI) is a global health issue known to cause avoidable harm and death. Improvement in its prevention and management is therefore considered an important goal for the health-care sector. The work here aimed to develop a tool which could be used to robustly and reliably measure, monitor, and compare the effectiveness of health-care interventions related to AKI across the Welsh NHS, a mechanism which did not exist previously. Methods: Using serum creatinine (SCr) as a biomarker for AKI and a validated national data-set collected from the all Wales Laboratory Information Management System, work involved applying Donabedian's framework to develop indicators with which to measure outcomes related to AKI, and exploring the potential of statistical process control (SPC) techniques for analysing data on these indicators. Results: Rate of AKI incidence and 30-day AKI-associated mortality are proposed as valid, feasible indicators with which to measure the effectiveness of health-care interventions related to AKI. The control chart, funnel plot, and Pareto chart are proposed as appropriate, robust SPC techniques to analyse and visualise variation in AKI-related outcomes. Conclusions: This work demonstrates that routinely collected large SCr data offer a significant opportunity to monitor and therefore inform improvement in patient outcomes related to AKI. Moreover, while this work concerns utilisation of SCr data for improvement in AKI strategies, it is a proof of concept which could be replicated for other routinely collected clinical laboratory data, to improve the prevention and/or management of the conditions to which they relate. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Magnitude and time to peak oxygenation effect of prone positioning in ventilated adults with COVID‐19 related acute hypoxemic respiratory failure

Author

Rollinson, Thomas C., primary, McDonald, Luke A., additional, Rose, Joleen, additional, Eastwood, Glenn, additional, Costa‐Pinto, Rahul, additional, Modra, Lucy, additional, Maeda, Akinori, additional, Bacolas, Zoe, additional, Anstey, James, additional, Bates, Samantha, additional, Bradley, Scott, additional, Dumbrell, Jodi, additional, French, Craig, additional, Ghosh, Angaj, additional, Haines, Kimberley, additional, Haydon, Tim, additional, Hodgson, Carol, additional, Holmes, Jennifer, additional, Leggett, Nina, additional, McGain, Forbes, additional, Moore, Cara, additional, Nelson, Kathleen, additional, Presneill, Jeffrey, additional, Rotherham, Hannah, additional, Said, Simone, additional, Young, Meredith, additional, Zhao, Peinan, additional, Udy, Andrew, additional, Chaba, Anis, additional, Bellomo, Rinaldo, additional, and Neto, Ary Serpa, additional

Published
2023
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18. Immunization of turkeys with Clostridium septicum alpha toxin-based recombinant subunit proteins can confer protection against experimental Clostridial dermatitis.

Author

John, Feba Ann, Criollo, Valeria, Gaghan, Carissa, Armwood, Abigail, Holmes, Jennifer, Thachil, Anil J., Crespo, Rocio, and Kulkarni, Raveendra R.

Subjects
RECOMBINANT proteins, IMMUNOGLOBULINS, NECROTIC enteritis, CLOSTRIDIUM, SKIN inflammation, IMMUNIZATION, GENE expression
Abstract

Clostridial dermatitis (CD), caused by Clostridium septicum, is an emerging disease of increasing economic importance in turkeys. Currently, there are no effective vaccines for CD control. Here, two non-toxic domains of C. septicum alpha toxin, namely ntATX-D1 and ntATX-D2, were identified, cloned, and expressed in Escherichia coli as recombinant subunit proteins to investigate their use as potential vaccine candidates. Experimental groups consisted of a Negative control (NCx) that did not receive C. septicum challenge, while the adjuvant-only Positive control (PCx), ntATX-D1 immunization (D1) and ntATX-D2 immunization (D2) groups received C. septicum challenge. Turkeys were immunized subcutaneously with 100 μg of protein at 7, 8 and 9 weeks of age along with an oil-in-water nano-emulsion adjuvant, followed by C. septicum challenge at 11 weeks of age. Results showed that while 46.2% of birds in the PCx group died post-challenge, the rate of mortality in D1- or D2-immunization groups was 13.3%. The gross and histopathological lesions in the skin, muscle and spleen showed that the disease severity was highest in PCx group, while the D2-immunized birds had significantly lower lesion scores when compared to PCx. Gene expression analysis revealed that PCx birds had significantly higher expression of pro-inflammatory cytokine genes in the skin, muscle and spleen than the NCx group, while the D2 group had significantly lower expression of these genes compared to PCx. Peripheral blood cellular analysis showed increased frequencies of activated CD4+ and/or CD8+ cells in the D1 and D2-immunized groups. Additionally, the immunized turkeys developed antigen-specific serum IgY antibodies. Collectively, these findings indicate that ntATX proteins, specifically the ntATX-D2 can be a promising vaccine candidate for protecting turkeys against CD and that the protection mechanisms may include downregulation of C. septicum-induced inflammation and increased CD4+ and CD8+ cellular activation. [ABSTRACT FROM AUTHOR]

Published
2024
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19. Magnitude and time to peak oxygenation effect of prone positioning in ventilated adults with COVID‐19 related acute hypoxemic respiratory failure.

Author

Rollinson, Thomas C., McDonald, Luke A., Rose, Joleen, Eastwood, Glenn, Costa‐Pinto, Rahul, Modra, Lucy, Maeda, Akinori, Bacolas, Zoe, Anstey, James, Bates, Samantha, Bradley, Scott, Dumbrell, Jodi, French, Craig, Ghosh, Angaj, Haines, Kimberley, Haydon, Tim, Hodgson, Carol, Holmes, Jennifer, Leggett, Nina, and McGain, Forbes

Subjects
PATIENT positioning, ADULT respiratory distress syndrome, OXYGEN in the blood, COVID-19, SUPINE position
Abstract

Background: Prone positioning may improve oxygenation in acute hypoxemic respiratory failure and was widely adopted in COVID‐19 patients. However, the magnitude and timing of its peak oxygenation effect remain uncertain with the optimum dosage unknown. Therefore, we aimed to investigate the magnitude of the peak effect of prone positioning on the PaO2:FiO2 ratio during prone and secondly, the time to peak oxygenation. Methods: Multi‐centre, observational study of invasively ventilated adults with acute hypoxemic respiratory failure secondary to COVID‐19 treated with prone positioning. Baseline characteristics, prone positioning and patient outcome data were collected. All arterial blood gas (ABG) data during supine, prone and after return to supine position were analysed. The magnitude of peak PaO2:FiO2 ratio effect and time to peak PaO2:FIO2 ratio effect was measured. Results: We studied 220 patients (mean age 54 years) and 548 prone episodes. Prone positioning was applied for a mean (±SD) 3 (±2) times and 16 (±3) hours per episode. Pre‐proning PaO2:FIO2 ratio was 137 (±49) for all prone episodes. During the first episode. the mean PaO2:FIO2 ratio increased from 125 to a peak of 196 (p <.001). Peak effect was achieved during the first episode, after 9 (±5) hours in prone position and maintained until return to supine position. Conclusions: In ventilated adults with COVID‐19 acute hypoxemic respiratory failure, peak PaO2:FIO2 ratio effect occurred during the first prone positioning episode and after 9 h. Subsequent episodes also improved oxygenation but with diminished effect on PaO2:FIO2 ratio. This information can help guide the number and duration of prone positioning episodes. [ABSTRACT FROM AUTHOR]

Published
2024
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22. Myeloid cell MHC I expression drives CD8+ T cell activation in nonalcoholic steatohepatitis.

Author

Adams, Victoria R., Collins, Leonard B., Williams, Taufika Islam, Holmes, Jennifer, Hess, Paul, Atkins, Hannah M., Scheidemantle, Grace, Xiaojing Liu, Lodge, Mareca, Johnson, Aaron J., and Kennedy, Arion

Subjects
MYELOID cells, T cells, NON-alcoholic fatty liver disease, GENE expression, NADPH oxidase, T cell receptors
Abstract

Background & aims: Activated CD8+ T cells are elevated in Nonalcoholic steatohepatitis (NASH) and are important for driving fibrosis and inflammation. Despite this, mechanisms of CD8+ T cell activation in NASH are largely limited. Specific CD8+ T cell subsets may become activated through metabolic signals or cytokines. However, studies in NASH have not evaluated the impact of antigen presentation or the involvement of specific antigens. Therefore, we determined if activated CD8+ T cells are dependent on MHC class I expression in NASH to regulate fibrosis and inflammation. Methods: We used H2Kb and H2Db deficient (MHC I KO), Kb transgenic mice, and myeloid cell Kb deficient mice (LysM Kb KO) to investigate how MHC class I impacts CD8+ T cell function and NASH. Flow cytometry, gene expression, and histology were used to examine hepatic inflammation and fibrosis. The hepatic class I immunopeptidome was evaluated by mass spectrometry. Results: In NASH, MHC class I isoform H2Kb was upregulated in myeloid cells. MHC I KO demonstrated protective effects against NASH-induced inflammation and fibrosis. Kb mice exhibited increased fibrosis in the absence of H2Db while LysM Kb KO mice showed protection against fibrosis but not inflammation. H2Kb restricted peptides identified a unique NASH peptide Ncf2 capable of CD8+ T cell activation in vitro. The Ncf2 peptide was not detected during fibrosis resolution. Conclusion: These results suggest that activated hepatic CD8+ T cells are dependent on myeloid cell MHC class I expression in diet induced NASH to promote inflammation and fibrosis. Additionally, our studies suggest a role of NADPH oxidase in the production of Ncf2 peptide generation. [ABSTRACT FROM AUTHOR]

Published
2024
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23. Identifying thresholds for clinically meaningful change among clients of drug and alcohol services using the Australian Treatment Outcomes Profile.

Author

Deacon, Rachel M., Mills, Llewellyn, Bruno, Raimondo, Mammen, Kristie, Dunlop, Adrian, Childs, Steven, Shakeshaft, Anthony, Holmes, Jennifer, and Lintzeris, Nicholas

Subjects
SUBSTANCE abuse treatment, WELL-being, ALCOHOL-induced disorders, HEALTH status indicators, TREATMENT effectiveness, QUALITY of life, QUALITY assurance, RESEARCH funding, DESCRIPTIVE statistics, EVALUATION
Abstract

Aims: The Austraian Treatment Outcomes Profile (ATOP) is a brief clinical outcomes tool used widely in the Australian alcohol and other drugs treatment sector to monitor clients' substance use, health, wellbeing and clinical risk factors. It has demonstrated reliability and validity, and has recommended clinical cut‐offs for assessing single‐occasion client‐rated health scores. This study determined clinically meaningful change thresholds for ATOP substance use and health and wellbeing variables for use by clinicians in monitoring client progress, and for quality improvement and service evaluation. Design, Setting and Participants: A framework for assessing clinically meaningful changes scores was developed by (1) calculating statistically reliable change thresholds using data‐driven techniques with a reference sample of clinical ATOP data and (2) conducting a multi‐disciplinary subject matter expert group to review the utility and validity of data‐derived clinically meaningful change. The study was conducted within Outpatient Alcohol and Other Drug treatment services in New South Wales, Australia. The reference sample comprised 6100 ATOPs from clients at entry to public outpatient Alcohol and Other Drug treatment services; the subject matter expert group comprised 29 key stakeholders from the specialist alcohol and other drug treatment sector. Measurements and Findings: We used the Reliable Change Index method to calculate clinically meaningful change thresholds for ATOP variables. For substance use variables, a change of 30% in days of use in the last 28 (minimum 4 days) was the threshold for clinically meaningful change for substance use; for health and wellbeing variables, a change of 2 or more points in psychological health, physical health or quality of life scores (measured on 0–10 scales) was the minimum clinically meaningful change. Conclusions: Clinically meaningful change thresholds have been proposed for Australian Treatment Outcomes Profile substance use and health and wellbeing items, based on statistical reliability and subject matter expert assessment. These will be used in the development of an outcomes metric for assessing change and assigning meaning in aggregated data for evaluation of services. [ABSTRACT FROM AUTHOR]

Published
2023
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27. Health and social characteristics of clients reporting amphetamine type substance use at entry to public alcohol and other drug services in New South Wales, Australia, 2016–2019

Author

Black, Emma, primary, Mammen, Kristie, additional, Deacon, Rachel M., additional, Ezard, Nadine, additional, Mills, Llewellyn, additional, Dunlop, Adrian J., additional, Montebello, Mark, additional, Reid, David, additional, Childs, Steven, additional, Bruno, Raimondo, additional, Shakeshaft, Anthony, additional, Siefried, Krista J., additional, Farrell, Michael, additional, Holmes, Jennifer, additional, and Lintzeris, Nicholas, additional

Published
2022
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29. Substance use, socio‐demographic characteristics, and self‐rated health of people seeking alcohol and other drug treatment in New South Wales: baseline findings from a cohort study.

Author

Black, Emma, Bruno, Raimondo, Mammen, Kristie, Mills, Llewellyn, Siefried, Krista J, Deacon, Rachel M, Shakeshaft, Anthony, Dunlop, Adrian J, Ezard, Nadine, Montebello, Mark, Childs, Steven, Reid, David, Holmes, Jennifer, and Lintzeris, Nicholas

Abstract

Objective: To investigate the demographic characteristics, substance use, and self‐rated health of people entering treatment in New South Wales public health services for alcohol, amphetamine‐type stimulants, cannabis, cocaine, or opioids use, by principal drug of concern. Design: Baseline findings of a cohort study; analysis of data in patient electronic medical records and NSW minimum data set for drug and alcohol treatment services. Setting, participants: People completing initial Australian Treatment Outcomes Profile (ATOP) assessments on entry to publicly funded alcohol and other drug treatment services in six NSW local health districts/networks, 1 July 2016 – 30 June 2019. Main outcome measures: Socio‐demographic characteristics, and substance use and self‐rated health (psychological, physical, quality of life) during preceding 28 days, by principal drug of concern. Results: Of 14 087 people included in our analysis, the principal drug of concern was alcohol for 6051 people (43%), opioids for 3158 (22%), amphetamine‐type stimulants for 2534 (18%), cannabis for 2098 (15%), and cocaine for 246 (2%). Most people commencing treatment were male (9373, 66.5%), aged 20–39 years (7846, 50.4%), and were born in Australia (10 934, 86.7%). Polysubstance use was frequently reported, particularly by people for whom opioids or amphetamine‐type stimulants were the principal drugs of concern. Large proportions used tobacco daily (53–82%, by principal drug of concern group) and reported poor psychological health (47–59%), poor physical health (32–44%), or poor quality of life (43–52%). Conclusions: The prevalence of social disadvantage and poor health is high among people seeking assistance with alcohol, amphetamine‐type stimulants, cannabis, cocaine, or opioids use problems. Given the differences in these characteristics by principal drug of concern, health services should collect comprehensive patient information during assessment to facilitate more holistic, tailored, and person‐centred care. [ABSTRACT FROM AUTHOR]

Published
2023
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30. Cost-effectiveness of an Emergency Department-Based Intensive Care Unit

Author

Bassin, Benjamin S, Haas, Nathan L, Sefa, Nana, Medlin, Richard, Peterson, Timothy A, Gunnerson, Kyle, Maxwell, Steve, Cranford, James A, Laurinec, Stephanie, Olis, Christine, Havey, Renee, Loof, Robert, Dunn, Patrick, Burrum, Debra, Gegenheimer-Holmes, Jennifer, and Neumar, Robert W

Abstract

Importance: Value in health care is quality per unit cost (V = Q/C), and an emergency department-based intensive care unit (ED-ICU) model has been associated with improved quality. To assess the value of this care delivery model, it is essential to determine the incremental direct cost of care. Objective: To determine the association of an ED-ICU with inflation-adjusted change in mean direct cost of care, net revenue, and direct margin per ED patient encounter. Design, Setting, and Participants: This retrospective economic analysis evaluated the cost of care delivery to patients in the ED before and after deployment of the Joyce and Don Massey Family Foundation Emergency Critical Care Center, an ED-ICU, on February 16, 2015, at a large academic medical center in the US with approximately 75 000 adult ED visits per year. The pre-ED-ICU cohort was defined as all documented ED visits by patients 18 years or older with a complete financial record from September 8, 2012, through June 30, 2014 (660 days); the post-ED-ICU cohort, all visits from July 1, 2015, through April 21, 2017 (660 days). Fiscal year 2015 was excluded from analysis to phase in the new care model. Statistical analysis was performed March 1 through December 30, 2021. Exposures: Implementation of an ED-ICU. Main Outcomes and Measures: Inflation-adjusted direct cost of care, net revenue, and direct margin per patient encounter in the ED. Results: A total of 234 884 ED visits during the study period were analyzed, with 115 052 patients (54.7% women) in the pre-ED-ICU cohort and 119 832 patients (54.5% women) in the post-ED-ICU cohort. The post-ED-ICU cohort was older (mean [SD] age, 49.1 [19.9] vs 47.8 [19.6] years; P < .001), required more intensive respiratory support (2.2% vs 1.1%; P < .001) and more vasopressor use (0.5% vs 0.2%; P < .001), and had a higher overall case mix index (mean [SD], 1.7 [2.0] vs 1.5 [1.7]; P < .001). Implementation of the ED-ICU was associated with similar inflation-adjusted total direct cost per ED encounter (pre-ED-ICU, mean [SD], $4875 [$15 175]; post-ED-ICU, $4877 [$17 400]; P = .98). Inflation-adjusted net revenue per encounter increased by 7.0% (95% CI, 3.4%-10.6%; P < .001), and inflation-adjusted direct margin per encounter increased by 46.6% (95% CI, 32.1%-61.2%; P < .001). Conclusions and Relevance: Implementation of an ED-ICU was associated with no significant change in inflation-adjusted total direct cost per ED encounter. Holding delivery costs constant while improving quality demonstrates improved value via the ED-ICU model of care.

Published
2022
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31. The Effect of a Liberal Approach to Glucose Control in Critically Ill Patients with Type 2 Diabetes: A Multicenter, Parallel-Group, Open-Label Randomized Clinical Trial

Author

Poole, Alexis P., primary, Finnis, Mark E., additional, Anstey, James, additional, Bellomo, Rinaldo, additional, Bihari, Shailesh, additional, Biradar, Vishwanath, additional, Doherty, Sarah, additional, Eastwood, Glenn, additional, Finfer, Simon, additional, French, Craig J., additional, Heller, Simon, additional, Horowitz, Michael, additional, Kar, Palash, additional, Kruger, Peter S., additional, Maiden, Matthew J., additional, Mårtensson, Johan, additional, McArthur, Colin J., additional, McGuinness, Shay P., additional, Secombe, Paul J., additional, Tobin, Antony E., additional, Udy, Andrew A., additional, Young, Paul J., additional, Deane, Adam M., additional, Schultz, Rebecca, additional, Secombe, Paul, additional, Butler, Magdalena, additional, Cowdrey, Keri-Anne, additional, Gilder, Eileen, additional, McGuinness, Shay, additional, O’Connor, Karina, additional, Parke, Rachael, additional, Ryan, Samantha, additional, Woolett, Melissa, additional, Chen, Yan, additional, McArthur, Colin, additional, McConnochie, Rachael, additional, Newby, Lynette, additional, Simmonds, Catherine, additional, Peck, Leah, additional, Young, Helen, additional, Comerford, Sharon, additional, Jin, Xia, additional, Bates, Samantha, additional, French, Craig, additional, Marshall, Fiona, additional, McEldrew, Rebecca, additional, Morgan, Rebecca, additional, Tippett, Anna, additional, Towns, Miriam, additional, Morrison, Lynette, additional, Sutton, Joanne, additional, White, Hayden, additional, Soar, Natalie, additional, Harward, Meg, additional, Kruger, Peter, additional, Mackay, Josephine, additional, Meyer, Jason, additional, Saylor, Emma, additional, Wetzig, Krista, additional, Brown, Nerissa, additional, Finnis, Mark, additional, Glasby, Kathleen, additional, O’Connor, Stephanie, additional, Poole, Alex, additional, Rivett, Justine, additional, Barge, Deborah, additional, Byrne, Kathleen, additional, Clancy, Annabelle, additional, Deane, Adam, additional, Driscoll, Alana, additional, Barbazza, Leanne, additional, Holmes, Jennifer, additional, Smith, Roger, additional, Tobin, Anthony, additional, Board, Jasmin, additional, Martin, Emma, additional, McCracken, Phoebe, additional, Udy, Andrew, additional, Vallance, Shirley, additional, Young, Meredith, additional, Bone, Allison, additional, Horton, Michelle, additional, Maiden, Matthew, additional, Salerno, Tania, additional, Trickey, Jemma, additional, Latimer-Bell, Charlie, additional, Delaney, Kirsha, additional, Hendry, Deborah, additional, Lawrence, Cassie, additional, Lesona, Eden, additional, Milington, Alexandra, additional, Navarra, Leanlove, additional, Olatunji, Shaanti, additional, Cruz, Raulle Sol, additional, Cruz, Rose Sol, additional, Young, Chelsea, additional, and Young, Paul, additional

Published
2022
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32. Cost-effectiveness of an Emergency Department–Based Intensive Care Unit

Author

Bassin, Benjamin S., primary, Haas, Nathan L., additional, Sefa, Nana, additional, Medlin, Richard, additional, Peterson, Timothy A., additional, Gunnerson, Kyle, additional, Maxwell, Steve, additional, Cranford, James A., additional, Laurinec, Stephanie, additional, Olis, Christine, additional, Havey, Renee, additional, Loof, Robert, additional, Dunn, Patrick, additional, Burrum, Debra, additional, Gegenheimer-Holmes, Jennifer, additional, and Neumar, Robert W., additional

Published
2022
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36. Health and social characteristics of clients reporting amphetamine type substance use at entry to public alcohol and other drug services in New South Wales, Australia, 2016–2019.

Author

Black, Emma, Mammen, Kristie, Deacon, Rachel M., Ezard, Nadine, Mills, Llewellyn, Dunlop, Adrian J., Montebello, Mark, Reid, David, Childs, Steven, Bruno, Raimondo, Shakeshaft, Anthony, Siefried, Krista J., Farrell, Michael, Holmes, Jennifer, and Lintzeris, Nicholas

Subjects
SUBSTANCE abuse, AMPHETAMINES, ALCOHOL, DEMOGRAPHIC characteristics, DRUGS, DRUG abuse treatment
Abstract

Introduction: Amphetamine type substances (ATS) are commonly used by Australian alcohol and other drug service entrants. We describe demographic characteristics, patterns of ATS and other substance use, health and social conditions among clients entering New South Wales (NSW) public alcohol and other drug services. Methods: Retrospective cohort of 13,864 records across six health districts (2016–2019) for clients seeking substance use treatment. These districts service approximately 44% of the NSW population aged 15 years and over. Multivariate analysis was conducted on a subsample for whom full data were available (N = 9981). Data included NSW Minimum Data Set for drug and alcohol treatment services and Australian Treatment Outcomes Profile items. Results: Over the preceding 4 weeks, 77% (n = 10,610) of clients (N = 13,864) reported no recent ATS use, 15% (n = 2109) reported 'low frequency' (1–12 days) and 8% (n = 1145) 'high frequency' (13–28 days) use. ATS use was most common among people attending for ATS or opioids as primary drug of concern. A multinomial regression (N = 9981) identified that clients reporting recent arrest (aOR 1.74, 95% CI 1.36, 2.24), higher cannabis use frequency (aOR 1.01, 95% CI 1.00, 1.02), lower opioid use frequency (aOR 0.98, 95% CI 0.97, 0.99) and poorer quality of life (aOR 0.91, 95% CI 0.86, 0.97) were more likely to report 'high frequency' rather than 'low frequency' ATS use. Discussion and Conclusions: People who use ATS experience health and social issues that may require targeted responses. These should be integrated across all services, not only for clients with ATS as principal drug of concern. [ABSTRACT FROM AUTHOR]

Published
2023
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39. T-cell and antibody responses to first BNT162b2 vaccine dose in previously infected and SARS-CoV-2-naive UK health-care workers: a multicentre prospective cohort study

Author

Angyal, Adrienn, primary, Longet, Stephanie, additional, Moore, Shona C, additional, Payne, Rebecca P, additional, Harding, Adam, additional, Tipton, Tom, additional, Rongkard, Patpong, additional, Ali, Mohammad, additional, Hering, Luisa M, additional, Meardon, Naomi, additional, Austin, James, additional, Brown, Rebecca, additional, Skelly, Donal, additional, Gillson, Natalie, additional, Dobson, Sue L, additional, Cross, Andrew, additional, Sandhar, Gurjinder, additional, Kilby, Jonathan A, additional, Tyerman, Jessica K, additional, Nicols, Alexander R, additional, Spegarova, Jarmila S, additional, Mehta, Hema, additional, Hornsby, Hailey, additional, Whitham, Rachel, additional, Conlon, Christopher P, additional, Jeffery, Katie, additional, Goulder, Philip, additional, Frater, John, additional, Dold, Christina, additional, Pace, Matthew, additional, Ogbe, Ane, additional, Brown, Helen, additional, Ansari, M Azim, additional, Adland, Emily, additional, Brown, Anthony, additional, Chand, Meera, additional, Shields, Adrian, additional, Matthews, Philippa C, additional, Hopkins, Susan, additional, Hall, Victoria, additional, James, William, additional, Rowland-Jones, Sarah L, additional, Klenerman, Paul, additional, Dunachie, Susanna, additional, Richter, Alex, additional, Duncan, Christopher J A, additional, Barnes, Eleanor, additional, Carroll, Miles, additional, Turtle, Lance, additional, de Silva, Thushan I, additional, Watson, Adam, additional, Angyal, Adrienn, additional, Alhussni, Ahmed, additional, Nicols, Alexander, additional, Deeks, Alexandra, additional, Webb-Bridges, Alice, additional, Jämsén, Anni, additional, Chawla, Anu, additional, Duncan, Christopher, additional, Conlon, Christopher, additional, O'Donnell, Denise, additional, Weeks, Esme, additional, Abuelgasim, Hibatullah, additional, Xiao, Huiyuan, additional, Spegarova, Jarmila, additional, Holmes, Jennifer, additional, Haworth, Jenny, additional, Tyerman, Jessica, additional, Kilby, Jonathan, additional, Cutteridge, Joseph, additional, Lillie, Katy, additional, Romaniuk, Leigh, additional, Denly, Lucy, additional, Hering, Luisa, additional, Ansari, M. Azim, additional, Kasanyinga, Mwila, additional, Matthews, Philippa, additional, Payne, Rebecca, additional, Wilson, Robert, additional, Rowland-Jones, Sarah, additional, Thomas, Sarah, additional, Moore, Shona, additional, Gardiner, Siobhan, additional, Tucker, Stephanie, additional, Dobson, Sue, additional, Adlou, Syed, additional, de Silva, Thushan, additional, Lawrie, Allan, additional, Smith, Nikki, additional, Turton, Helena, additional, Zawia, Amira, additional, Bayley, Martin, additional, Fairman, Alex, additional, Harrington, Kate, additional, Kirk, Rosemary, additional, Marsh, Louise, additional, Watson, Lisa, additional, Wood, Steven, additional, Diffey, Benjamin, additional, Jones, Chris, additional, Lett, Lauren, additional, Platt, Gareth, additional, Subramaniam, Krishanthi, additional, Wootton, Daniel, additional, Payne, Brendan, additional, Hambleton, Sophie, additional, Kelly, Sinead, additional, Marston, Judith, additional, Poolan, Sonia, additional, Turner, Dianne, additional, Haniffa, Muzlifah, additional, Stephenson, Emily, additional, Adele, Sandra, additional, Akhter, Hossain Delowar, additional, Chinnakannan, Senthil, additional, de Lara, Catherine, additional, Donnison, Timothy, additional, Hackstein, Carl-Philipp, additional, Lee, Lian, additional, Lim, Nicholas, additional, Malone, Tom, additional, Phillips, Eloise, additional, Ramamurthy, Narayan, additional, Robinson, Nichola, additional, Sampson, Oliver, additional, Eyre, David, additional, Simmons, Beatrice, additional, Stafford, Lizzie, additional, Mentzer, Alexander, additional, Amini, Ali, additional, Arancibia-Cárcamo, Carolina, additional, Provine, Nicholas, additional, Travis, Simon, additional, Dimitriadis, Stavros, additional, Johnson, Sile, additional, Foulkes, Sarah, additional, Khawam, Jameel, additional, Wellington, Edgar, additional, Gilbert-Jaramillo, Javier, additional, Knight, Michael, additional, Dupont, Maeva, additional, Horner, Emily, additional, Thaventhiran, James, additional, and Chalk, Jeremy, additional

Published
2022
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40. How much do we throw away in the intensive care unit? An observational point prevalence study of Australian and New Zealand ICUs

Author

Anstey, Matthew H., Trent, Louise, Bhonagiri, Deepak, Hammond, Naomi E., Knowles, Serena, McGain, Forbes, Hammond, Naomi, Knowles, Serena, Freeman-Sanderson, Amy, Ganu, Subodh, Howe, Belinda, Litton, Ed, Mackle, Diane, Saxena, Manoj, Seppelt, Ian, Towns, Miriam, Yarad, Elizabeth, Hammond, Knowles, Serena, Gao, Annie, Li, Yang, Myburgh, John, Seppelt, Ian, Nangla, Conrad, Butt, Fatima, Duke, Graeme, Hunter, Stephanie, Evans, Julie, Parker, Dianne, Loughnan, Clare, Thomas, Blessy, Gilder, Eileen, Robertson, Melissa, McMahon, Ellie, Ali, Farisha, Cowdrey, Keri-Anne, McArthur, Colin, Chen, Yan, Simmonds, Catherine, McConnochie, Rachael, O'Connor, Caroline, El-Khawas, Khaled, Hill, Dianne, Cattigan, Claire, Horton, Michelle, Trickey, Jemma, Knott, Cameron, Smith, Julie, Boschert, Catherine, Sara, Treena, Nand, Kiran, Duke, Graeme, Hunter, Stephanie, Evans, Julie, Parker, Dianne, Loughnan, Clare, Thomas, Blessy, Ramanan, Mahesh, Marella, Prashanti, Affleck, Julia, Simpson, Shannon, Ellem, Katrina, McKenna, Toni, Nourse, Mary, Leung, Kristine, Edmunds, Tash, McDonald, Bree, Mehrtens, Jan, Cross, Rosalba, Wong, Helen, Twardowski, Pawel, France, Dawn, Hanlon, Gabrielle, Barrett, Jonathan, Palermo, Annamaria, Pellicano, Susan, Eroglu, Ege, Bihari, Shailesh, Brown, Julia, Grear, Laura, Jin, Xia, French, Craig, Bates, Samantha, Towns, Miriam, Marshall, Fiona, McEldrew, Rebecca, McCullough, James, Tallott, Mandy, Gough, Maimoonbe, Nalos, Marek, Younger, Laura, Krishnamurphy, Ravi, Trent, Louise, How, Janet, Stuart, Anne, Chadwick, Llesley, Bhadange, Neeraj, Tyler, Steven, Sosnowski, Kellie, Morrison, Lynette, Sutton, Joanne, Soar, Natalie, Lee, David, Duke, Graeme, Hunter, Stephanie, Evans, Julie, Parker, Dianne, Loughnan, Clare, Doyle, Marina, Jongebloed, Katherine, Finnis, Mackenzie, Wilson, Jane, Williams, Tony, Song, Rima, Lai, Vivian, Girijadevi, Dinu, Habraken, Hannah, Browne, Alex, Koelle, Jette, McNab, Charlotte, Masters, Kristy, Gresham, Rebecca, Lowrey, Julie, Whitehead, Christina, Liang, Janet, Harward, Meg, Jones, Cassie, Peake, Sandra, Williams, Tricia, Kurenda, Catherine, Tabah, Alexis, Duroux, Maree, Warhurst, Timothy, Ratcliffe, Megan, Pollock, Hamish, Baker, Stuart, Sonawane, Ravikiran, O'Connor, Stephanie, Brown, Nerissa, Glasby, Kathleen, Rivett, Justine, Campbell, Lewis, Tabuzo, Vera, Smyth, Kirsty, Yarad, Elizabeth, Bass, Frances, Hammond, Naomi, O'Connor, Anne, Leonard, Anton, Waterson, Sharon, Coles, Jennifer, Buhr, Heidi, Newman, Duncan, Boorawong, Piyaporn, Bregolin, Vanessa, Yun, Ji-Hyun, Anstey, Matthew, Rock, Lara, Endemann, Anthadene, Lo, Wei, Ferrier, Janet, Palermo, Annamaria, Reynolds, Claire, Santamaria, John, Holmes, Jennifer, Beca, John, Sherring, Claire, Garrett, Peter, Murray, Lauren, Brailsford, Jane, French, Craig, Bates, Samantha, Towns, Miriam, Marshall, Fiona, McEldrew, Rebecca, Browne, Troy, Goodson, Jennifer, Udy, Andrew, Young, Meredith, Board, Jasmin, McCracken, Phoebe, Martin, Emma-Leah, Martynoga, Robert, Butler, Amelia, Trask, Kara, Olatunji, Shaanti, Cruz, Rhoze Sol, Cruz, Raulle Sol, Navarra, Leanlove, Delaney, Kirsha, Lesona, Eden, Young, Chelsea, Spring, Amelia, Aguilar, April, Young, Paul, and Law, Erin

Abstract

During the current COVID pandemic, waste generation has been more evident with increased use of single use masks, gowns and other personal protective equipment. We aimed to understand the scale of waste generation, recycling rates and participation in Australian and New Zealand (ANZ) ICUs.

Published
2023
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41. Human Rights Violations in Space: Assessing the External Validity of Machine-Geocoded versus Human-Geocoded Data.

Author

Stundal, Logan, Bagozzi, Benjamin E., Freeman, John R., and Holmes, Jennifer S.

Subjects
HUMAN rights violations, GAUSSIAN Markov random fields, STOCHASTIC partial differential equations, POLITICAL violence, FOREIGN news
Abstract

Political event data are widely used in studies of political violence. Recent years have seen notable advances in the automated coding of political event data from international news sources. Yet, the validity of machine-coded event data remains disputed, especially in the context of event geolocation. We analyze the frequencies of human- and machine-geocoded event data agreement in relation to an independent (ground truth) source. The events are human rights violations in Colombia. We perform our evaluation for a key, 8-year period of the Colombian conflict and in three 2-year subperiods as well as for a selected set of (non)journalistically remote municipalities. As a complement to this analysis, we estimate spatial probit models based on the three datasets. These models assume Gaussian Markov Random Field error processes; they are constructed using a stochastic partial differential equation and estimated with integrated nested Laplacian approximation. The estimated models tell us whether the three datasets produce comparable predictions, underreport events in relation to the same covariates, and have similar patterns of prediction error. Together the two analyses show that, for this subnational conflict, the machine- and human-geocoded datasets are comparable in terms of external validity but, according to the geostatistical models, produce prediction errors that differ in important respects. [ABSTRACT FROM AUTHOR]

Published
2023
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42. Protecting the Texas electric grid: A cybersecurity strategy for the Electric Reliability Council of Texas (ERCOT) and the Public Utility Commission of Texas (PUCT).

Author

Stanaland, Les, Baldick, Ross, Cardenas, Alvaro, and Holmes, Jennifer

Subjects
ELECTRIC power distribution grids, PUBLIC service commissions, INTERNET security
Abstract

Copyright of Risk, Hazards & Crisis in Public Policy is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2022
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43. Predicting Direct-Specimen SARS-CoV-2 Assay Performance Using Residual Patient Samples.

Author

Schroeder, Lee F, Bachman, Michael A, Idoni, Allison, Gegenheimer-Holmes, Jennifer, Kronick, Steven L, Valdez, Riccardo, and Lephart, Paul R

Subjects
SARS-CoV-2, VIRAL load, LOGISTIC regression analysis, EMERGENCY medical services, FORECASTING, COVID-19
Abstract

Background: Diagnostic sensitivities of point-of-care SARS-CoV-2 assays depend on specimen type and population-specific viral loads. Evaluation of these assays require "direct" specimens from paired-swab studies rather than more accessible residual specimens in viral transport media (VTM). Methods: Residual VTM and limit-of-detection studies were conducted on Abbott ID NOW™ COVID-19, Quidel Sofia 2™ SARS Antigen FIA, and DiaSorin Simplexa™ COVID-19 Direct assays, with cycle threshold (CT) adjustments to approximate direct-specimen testing based on gene-target doubling each PCR cycle. Logistic regression was used to model assay performance by specimen CT. These models were applied to CT distributions of symptomatic and asymptomatic populations presenting to emergency services to predict the percentage of specimens that would be detected by each assay. A 96-sample paired-swab study was conducted to confirm model results. Results: When using direct nasopharyngeal samples and fit with either VTM or limit-of-detection data, percent positivities for ID NOW (symptomatic 94.9%/97.4%; asymptomatic 88.4.0%/89.6%) and Simplexa (symptomatic 97.8%/97.2%; asymptomatic 91.1%/90.8%) were predicted to be similar. Likewise, percent positivities for ID NOW with direct nasal specimens (symptomatic 77.8%; asymptomatic 64.5%) and, fit with VTM data, Sofia 2 with direct nasopharyngeal specimens (symptomatic 76.6%, asymptomatic 60.3%) were similar. The paired-swab study comparing direct nasopharyngeal specimens on ID NOW and nasopharyngeal VTM specimens on Simplexa showed 99% concordance. Conclusions: Assay performance can be modeled as dependent on viral load, fit using laboratory bench study results, and adjusted to account for direct-specimen testing. When using nasopharyngeal specimens, direct testing on Abbott ID NOW and VTM testing on DiaSorin Simplexa have similar performance. [ABSTRACT FROM AUTHOR]

Published
2022
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45. Determining clinical cutoff scores for the Australian Treatment Outcomes Profile psychological health, physical health and quality of life questions.

Author

Mammen, Kristie, Mills, Llewellyn, Deacon, Rachel M., Bruno, Raimondo, Dunlop, Adrian, Holmes, Jennifer, Luksza, Jennifer, Shakeshaft, Anthony, Farrell, Michael, and Lintzeris, Nicholas

Subjects
TREATMENT effectiveness, QUALITY of life, RECEIVER operating characteristic curves, STATISTICAL reliability, ALCOHOL drinking, DRUG abuse treatment
Abstract

Introduction: The Australian Treatment Outcomes Profile (ATOP) is a brief instrument that measures self‐reported substance use, health, and wellbeing in the previous 28 days for people in alcohol and other drug treatment. Previous studies have established the concurrent validity, inter‐rater, and test–retest reliability of the tool. The current study sought to identify recommended cutoff scores for ATOP items for psychological health, physical health and quality of life that identify clients reporting clinically significant problems warranting further assessment and/or intervention, compared to cutoffs used by 'gold‐standard' measures for these domains. Methods: Clients attending for treatment for problems with opioid (n = 144) or alcohol use (n = 134) completed the ATOP and comparison standardised questionnaires (Kessler‐10, Short Form Survey 12 and the Personal Wellbeing Index) with a researcher. Receiver operating characteristics analysis, along with clinician perspectives, were used to recommend cutoff scores for ATOP items indicative of clinically significant problems. Results: A cutoff score of 5 or less out of 10 was identified as an optimal pragmatic cutoff for ATOP items relating to psychological health, physical health and quality of life items with regards to balancing sensitivity, specificity, and application in a treatment setting. Discussion and Conclusions: The recommended clinical cutoffs will support clinicians and treatment services to identify clients who require further assessment and follow up for their psychological health, physical health and quality of life. The current study provides further evidence for the utility of the ATOP for individual clinical review, service planning and research. [ABSTRACT FROM AUTHOR]

Published
2022
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47. How often are infusion sets for central venous catheters changed in Australian and New Zealand Intensive Care Units? A point prevalence survey

Author

Anstey, Matthew H., Maxwell, Nicky, Rickard, Claire M., Hammond, Naomi E., Knowles, Serena, McGain, Forbes, Hammond, Naomi, Knowles, Serena, Freeman-Sanderson, Amy, Ganu, Subodh, Howe, Belinda, Litton, Ed, Mackle, Diane, Saxena, Manoj, Seppelt, Ian, Towns, Miriam, Yarad, Elizabeth, Hammond, Naomi, Knowles, Serena, Gao, Annie, Li, Yang, Myburgh, John, Seppelt, Ian, Nangla, Conrad, Butt, Fatima, Duke, Graeme, Hunter, Stephanie, Evans, Julie, Parker, Dianne, Loughnan, Clare, Thomas, Blessy, Gilder, Eileen, Robertson, Melissa, McMahon, Ellie, Ali, Farisha, Cowdrey, Keri-Anne, McArthur, Colin, Chen, Yan, Simmonds, Catherine, McConnochie, Rachael, O’Connor, Caroline, El-Khawas, Khaled, Hill, Dianne, Cattigan, Claire, Horton, Michelle, Trickey, Jemma, Knott, Cameron, Smith, Julie, Boschert, Catherine, Sara, Treena, Nand, Kiran, Duke, Graeme, Hunter, Stephanie, Evans, Julie, Parker, Dianne, Loughnan, Clare, Thomas, Blessy, Ramanan, Mahesh, Marella, Prashanti, Affleck, Julia, Simpson, Shannon, Ellem, Katrina, McKenna, Toni, Nourse, Mary, Leung, Kristine, Edmunds, Tash, McDonald, Bree, Mehrtens, Jan, Cross, Rosalba, Wong, Helen, Twardowski, Pawel, France, Dawn, Hanlon, Gabrielle, Barrett, Jonathan, Palermo, Annamaria, Pellicano, Susan, Eroglu, Ege, Bihari, Shailesh, Brown, Julia, Grear, Laura, Jin, Xia, French, Craig, Bates, Samantha, Towns, Miriam, Marshall, Fiona, McEldrew, Rebecca, McCullough, James, Tallott, Mandy, Gough, Maimoonbe, Nalos, Marek, Younger, Laura, Krishnamurphy, Ravi, Trent, Louise, How, Janet, Stuart, Anne, Chadwick, Llesley, Bhadange, Neeraj, Tyler, Steven, Sosnowski, Kellie, Morrison, Lynette, Sutton, Joanne, Soar, Natalie, Lee, David, Duke, Graeme, Hunter, Stephanie, Evans, Julie, Parker, Dianne, Loughnan, Clare, Doyle, Marina, Jongebloed, Katherine, Finnis, Mackenzie, Wilson, Jane, Williams, Tony, Song, Rima, Lai, Vivian, Girijadevi, Dinu, Habraken, Hannah, Browne, Alex, Koelle, Jette, McNab, Charlotte, Masters, Kristy, Gresham, Rebecca, Lowrey, Julie, Whitehead, Christina, Liang, Janet, Harward, Meg, Jones, Cassie, Peake, Sandra, Williams, Tricia, Kurenda, Catherine, Tabah, Alexis, Duroux, Maree, Warhurst, Timothy, Ratcliffe, Megan, Pollock, Hamish, Baker, Stuart, Sonawane, Ravikiran, O'Connor, Stephanie, Brown, Nerissa, Glasby, Kathleen, Rivett, Justine, Campbell, Lewis, Tabuzo, Vera, Smyth, Kirsty, Yarad, Elizabeth, Bass, Frances, Hammond, Naomi, O'Connor, Anne, Leonard, Anton, Waterson, Sharon, Coles, Jennifer, Buhr, Heidi, Newman, Duncan, Boorawong, Piyaporn, Bregolin, Vanessa, Yun, Ji-Hyun, Anstey, Matthew, Rock, Lara, Endemann, Anthadene, Lo, Wei, Ferrier, Janet, Palermo, Annamaria, Reynolds, Claire, Santamaria, John, Holmes, Jennifer, Beca, John, Sherring, Claire, Garrett, Peter, Murray, Lauren, Brailsford, Jane, French, Craig, Bates, Samantha, Towns, Miriam, Marshall, Fiona, McEldrew, Rebecca, Browne, Troy, Goodson, Jennifer, Udy, Andrew, Young, Meredith, Board, Jasmin, McCracken, Phoebe, Martin, Emma-Leah, Martynoga, Robert, Butler, Amelia, Trask, Kara, Olatunji, Shaanti, Cruz, Rhoze Sol, Cruz, Raulle Sol, Navarra, Leanlove, Delaney, Kirsha, Lesona, Eden, Young, Chelsea, Spring, Amelia, Aguilar, April, Young, Paul, and Law, Erin

Abstract

Infusion sets (comprising the tubing, measuring burettes, fluid containers, transducers) that are connected to invasive vascular devices are changed on a regular basis in an effort to reduce bacterial colonisation and bloodstream infection. There is a balance between reducing infection and creating unnecessary waste. Current evidence suggests that for central venous catheters, changing infusion sets at 7 days does not increase infection risks.

Published
2023
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48. Neuromuscular blockade and oxygenation changes during prone positioning in COVID-19

Author

Rollinson, Thomas C., McDonald, Luke A., Rose, Joleen, Eastwood, Glenn, Costa-Pinto, Rahul, Modra, Lucy, Maeda, Akinori, Bacolas, Zoe, Anstey, James, Bates, Samantha, Bradley, Scott, Dumbrell, Jodi, French, Craig, Ghosh, Angaj, Haines, Kimberley, Haydon, Tim, Hodgson, Carol L., Holmes, Jennifer, Leggett, Nina, McGain, Forbes, Moore, Cara, Nelson, Kathleen, Presneill, Jeffrey, Rotherham, Hannah, Said, Simone, Young, Meredith, Zhao, Peinan, Udy, Andrew, Neto, Ary Serpa, Chaba, Anis, and Bellomo, Rinaldo

Abstract

Neuromuscular blockers (NMBs) are often used during prone positioning to facilitate mechanical ventilation in COVID-19 related ARDS. However, their impact on oxygenation is uncertain.

Published
2023
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49. Furosemide with adjunctive acetazolamide vs furosemide only in critically ill patients: A pilot two-center randomized controlled trial.

Author

Maeda A, Brown A, Spano S, Chaba A, Phongphithakchai A, Hikasa Y, Pattamin N, Kitisin N, Nübel J, Nielsen B, Holmes J, Peck L, Young H, Eastwood G, Bellomo R, and Neto AS

Abstract

Purpose: Furosemide is the most commonly used diuretic in intensive care units (ICU). We aimed to evaluate the physiological effects of adjunctive acetazolamide with furosemide on diuresis and the prevention of potential furosemide-induced metabolic alkalosis., Materials and Methods: We performed a two-center, pilot, open-label, randomized trial. Where the treating physicians planned intravenous diuretic therapy, we randomized ICU patients to a bolus of furosemide (40 mg) plus acetazolamide (500 mg) (n = 15) or furosemide alone (40 mg) (n = 15). Urine output, additional furosemide use, acid-base parameters, and electrolytes were compared following a Bayesian framework., Results: Adjunctive acetazolamide didn't increase urine output in the first six hours (mean difference: -112 ml, credible interval: [-742, 514]). However, compared with furosemide alone, it maintained a greater urine output response to furosemide over 24 h, with 100 % probability. Acetazolamide also acidified plasma (pH difference: -0.045, [-0.081, -0.008]) while alkalinizing urine (1.10, [0.04, 2.11]) at six hours, compared to furosemide alone with >95 % probability. Finally, we didn't observe severe acidosis or electrolyte disturbances over 24 h., Conclusions: Adjunctive acetazolamide may increase diuretic efficacy and counterbalance furosemide-induced metabolic alkalosis without safety concerns. Larger trials are warranted to verify these findings and assess their impacts on clinical outcomes., Registration Number: ACTRN12623000624684., Registration Title: A pilot trial of single versus dual diuretic therapy in the intensive care unit., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Published
2024
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50. Complications associated with prone positioning in mechanically ventilated COVID-19 patients: A multicentre, retrospective observational study.

Author

Rollinson TC, McDonald LA, Rose J, Eastwood G, Costa-Pinto R, Modra L, Akinori M, Bacolas Z, Anstey J, Bates S, Bradley S, Dumbrell J, French C, Ghosh A, Haines K, Haydon T, Hodgson CL, Holmes J, Leggett N, McGain F, Moore C, Nelson K, Presneill J, Rotherham H, Said S, Young M, Zhao P, Udy A, Serpa Neto A, Chaba A, and Bellomo R

Abstract

Background and Aims: Prone positioning is commonly applied to improve gas exchange in mechanically ventilated patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). Whilst prone positioning is effective, specific complications may arise. We aimed to assess the prevalence of specific complications related to prone positioning in patients mechanically ventilated for COVID-19-related ARDS., Design: Multicentre, retrospective observational study., Methods: Multi-centre observational study of mechanically ventilated patients with COVID-19-related ARDS admitted to intensive care units in Melbourne, Australia, from August to November 2021. Data on baseline characteristics, prone positioning, complications, and patient outcomes were collected., Results: We assessed 553 prone episodes in 220 patients across seven sites (mean ± standard deviation age: 54 ± 13 years, 61% male). Overall, 58% (127/220) of patients experienced at least one prone-positioning-related complication. Pressure injury was the most prevalent (n = 92/220, 42%) complication reported. Factors associated with increased risk of pressure injury were male sex (adjusted odds ratio = 1.15, 95% confidence interval: [1.02-1.31]) and the total number of prone episodes (adjusted odds ratio = 1.11, 95% confidence interval: [1.07-1.15]). Device dislodgement was the next most common complication, occurring in 28 of 220 (13%) patients. There were no nerve or retinal injuries reported., Conclusions: Pressure injuries and line dislodgement were the most prevalent complications associated with prone positioning of patients mechanically ventilated for COVID-19. The risk of pressure injuries was associated with male sex and the number of prone positioning episodes., Competing Interests: Conflict of interest The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Published
2024
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