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1. Harmonising IV Oxycodone with Paediatric Perioperative Medications: A Compatibility Study Through Y-Type Connectors

Author

Youssef SH, Garg A, Song Y, Wylie NE, and Garg S

Subjects
analgesia, physical compatibility, co-administration, intravenous fluid, oxycodone, y-connector, Therapeutics. Pharmacology, RM1-950
Abstract

Souha H Youssef,1 Alka Garg,2 Yunmei Song,1 Nicole E Wylie,3 Sanjay Garg1 1Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia; 2SA Pharmacy, Women’s and Children’s Hospital, Adelaide, SA, Australia; 3Department of Paediatric Anaesthesia, Women’s and Children’s Hospital, Adelaide, SA, AustraliaCorrespondence: Sanjay Garg, University of South Australia, Adelaide, SA, 5000, Australia, Tel +618 8302 1575, Email sanjay.garg@unisa.edu.auPurpose: Co-administering multiple intravenous (IV) agents via Y-connectors is a common practice in hospitalised and fasting surgical patients. However, there is a lack of reliable data confirming the physical compatibility of some combinations including IV oxycodone, a drug that is gaining increasing popularity in the perioperative period. Concern regarding physical drug incompatibilities precludes concurrent coadministration with other common drugs through a single lumen. This can result in the cessation of infusions to allow the administration of other medications, resulting in exacerbation of acute pain. This study aims to evaluate the physical compatibility of IV oxycodone with some commonly co-administered drugs and IV fluids.Methods: Mixtures of oxycodone (1mg.mL− 1) and the tested drugs and IV fluids were prepared in a ratio of 1:1. The mixtures were examined at 0 and 60 minutes from mixing and assessed using the European Conference Consensus Standards. This involved visual inspection (precipitation, turbidity, colour change, gas formation), spectrophotometry, and pH change. The tested drugs included ketamine, tramadol, clonidine, vancomycin, piperacillin/tazobactam, dexmedetomidine, cefotaxime, gentamicin, and paracetamol. In addition, the commonly used IV fluids tested included glucose 5% + sodium chloride 0.9% + 60 mmol potassium chloride, plasmalyte + dextrose 5%;plasmalyte + dextrose 5% + 55 mmol potassium chloride, plasmalyte + dextrose 5% + 55mmol potassium acetate, plasmalyte + dextrose 5% + 55mmol potassium dihydrogen phosphate, Hartmann’s solution, Standard pediatric Total Parenteral Nutrition (TPN) 20/100 and TPN 25/150.Results: IV oxycodone (1 mg.mL− 1) showed no visual changes; no spectrophotometric absorption variability at 350, 410, or 550nm; and no pH changes of > 0.5 at 0 or 60 minutes with any of the tested drugs or fluids in the concentrations tested.Conclusion: According to European Consensus Conference Standards, IV Oxycodone at 1 mg.mL− 1 is physically compatible in a ratio of 1:1 v/v with all investigated drugs and fluids tested for at least 60 minutes. Keywords: analgesia, physical compatibility, co-administration, intravenous fluid, oxycodone, Y-connector

Published
2024

2. The Tristan legend, 1804-1914

Author

Wylie, N. V.

Subjects
820.9008
Abstract

The thesis traces the emergence and development of the Tristan legend during the 19th century as a subject for both scholarly research and creative reinterpretfktion, the latter being ultimately dependent on the former. In addition, a context of 19th century Arthurian literature is included, together with a discussion of the growth of studies in mediaeval literature. As Tristan scholarship declined in England due attention has been paid to its Continental development. After a consideration of the unique qualities of the legend and a summary of current scholarly ideas on its development, the thesis continues with an enquiry into the state of mediaeval studies at the beginning of the 19th century, out of which arose Scott's edition of Sir Tristrem. The genesis of this work is traced as an example of contemporary academic method, and is followed by an overall view of British and French scholarship in the first half of the century, including the work of Southey, Guest and la Villermarqué, who provided source material for Tennyson, Arnold and the Pre-Raphaelites. From the early Continental work with its developing Celtic affiliations came Arnold's Tristram and Iseult. This forme the subject of the third chapter and is set against a background of nascent Arthurian literature in England, which mostly drew on previous English scholarship for material. The poem is seen as an uneasy work originating from unfamiliar subject matter on the one hand, and Arnold's recoil from Marguerite on the other. The artistry of the work, its revisions and contemporary reception are discussed, and it is finally seen as remaining outside the mainstream of Arthurian literature, but having affinities with the later Pre-Raphaelite ethos. The more usual moralistic attitudes adopted towards the Arthurian legend are discussed in Chapter IV, where the antithetical heroes of Lancelot and Galahad are seen as the heroes of the mid-century. Tennyson's Idylls of the King is then considered as a reflection and development of those attitudes, thus illuminating his treatment of the Tristan story in 'The Last Tournament'. After dealing with the genesis of the Idylls and the 1859 aud 1869 publications, the chapter continues with a consideration Of 'The Last Tournament' from its inception in the draft of the Gareth Idyll to its cool reception in 1872. Tennyson's treatment of Malory, the significance of the Idyll in relation to the overall conception and as analysis of its structural and symbolic qualities are included. Swinburne's Tristram of Lyonesse is seen in the following chapter as embodying the Pre-Raphaelite revolt against this interpretation of the Arthurian material. It is prefigured in Queen Yseult and the early fragments, where is also seen Swinburne's concern with an accurate representation of the sources, together with the stylistic influence of Morris. The prolonged composition of Tristram of Lyonesse, contemporary reaction, Swinburne's use of sources and a discussion of the artistic anomaly this creates within the poem, lead up to a comparison with Wagner's Tristan und Isolde. Chapter VI begins with an examination of English scholarship and current attitudes to Malory which anticipated the Wagnerite reaction against Gottfried's Tristan. It then continues with a survey of the academic enthusiasm for Tristan on the Continent, tracing its progress from the work of Bossert to that of Bédier and Schoepperle. As the Tristan legend was thus established academically, so it came to be established on a creative level. The coinciding of Wagner's Tristan and the new cultural mood saw an outcrop of Tristan re-workings which reflect the Aesthetic climate in their Wagner-based projections of transcendental passion. This, together with a discussion of the backward-looking Arthurian dramas, is the subject of chapter VII. Finally, the last chapter summarizes ths emergence of the legend in three forms: the academic form, the popular narrative form and lastly, through the Wagner enthusiasm, as a symbol of rarefied passion. It also considers 19th century attitudes towards the romantic Middle Ages in conjunction with the artistic flaws which occur in mediaevalistic works of the period.

Published
1973

5. The Tristan legend, 1804-1914

Author

Wylie, N

Abstract

The thesis traces the emergence and development of the Tristan legend during the 19th century as a subject for both scholarly research and creative reinterpretfktion, the latter being ultimately dependent on the former. In addition, a context of 19th century Arthurian literature is included, together with a discussion of the growth of studies in mediaeval literature. As Tristan scholarship declined in England due attention has been paid to its Continental development. After a consideration of the unique qualities of the legend and a summary of current scholarly ideas on its development, the thesis continues with an enquiry into the state of mediaeval studies at the beginning of the 19th century, out of which arose Scott's edition of Sir Tristrem. The genesis of this work is traced as an example of contemporary academic method, and is followed by an overall view of British and French scholarship in the first half of the century, including the work of Southey, Guest and la Villermarqué, who provided source material for Tennyson, Arnold and the Pre-Raphaelites. From the early Continental work with its developing Celtic affiliations came Arnold's Tristram and Iseult. This forme the subject of the third chapter and is set against a background of nascent Arthurian literature in England, which mostly drew on previous English scholarship for material. The poem is seen as an uneasy work originating from unfamiliar subject matter on the one hand, and Arnold's recoil from Marguerite on the other. The artistry of the work, its revisions and contemporary reception are discussed, and it is finally seen as remaining outside the mainstream of Arthurian literature, but having affinities with the later Pre-Raphaelite ethos. The more usual moralistic attitudes adopted towards the Arthurian legend are discussed in Chapter IV, where the antithetical heroes of Lancelot and Galahad are seen as the heroes of the mid-century. Tennyson's Idylls of the King is then considered as a reflection and development of those attitudes, thus illuminating his treatment of the Tristan story in 'The Last Tournament'. After dealing with the genesis of the Idylls and the 1859 aud 1869 publications, the chapter continues with a consideration Of 'The Last Tournament' from its inception in the draft of the Gareth Idyll to its cool reception in 1872. Tennyson's treatment of Malory, the significance of the Idyll in relation to the overall conception and as analysis of its structural and symbolic qualities are included. Swinburne's Tristram of Lyonesse is seen in the following chapter as embodying the Pre-Raphaelite revolt against this interpretation of the Arthurian material. It is prefigured in Queen Yseult and the early fragments, where is also seen Swinburne's concern with an accurate representation of the sources, together with the stylistic influence of Morris. The prolonged composition of Tristram of Lyonesse, contemporary reaction, Swinburne's use of sources and a discussion of the artistic anomaly this creates within the poem, lead up to a comparison with Wagner's Tristan und Isolde. Chapter VI begins with an examination of English scholarship and current attitudes to Malory which anticipated the Wagnerite reaction against Gottfried's Tristan. It then continues with a survey of the academic enthusiasm for Tristan on the Continent, tracing its progress from the work of Bossert to that of Bédier and Schoepperle. As the Tristan legend was thus established academically, so it came to be established on a creative level. The coinciding of Wagner's Tristan and the new cultural mood saw an outcrop of Tristan re-workings which reflect the Aesthetic climate in their Wagner-based projections of transcendental passion. This, together with a discussion of the backward-looking Arthurian dramas, is the subject of chapter VII. Finally, the last chapter summarizes ths emergence of the legend in three forms: the academic form, the popular narrative form and lastly, through the Wagner enthusiasm, as a symbol of rarefied passion. It also considers 19th century attitudes towards the romantic Middle Ages in conjunction with the artistic flaws which occur in mediaevalistic works of the period.

Published
2017

6. Plant Community and Soil Microbial Carbon and Nitrogen Responses to Fire and Clipping in a Southern Mixed Grassland

Author

Wylie N. Harris, R.J. Ansley, and Thomas W. Boutton

Subjects
Biomass (ecology), geography, geography.geographical_feature_category, Ecology, food and beverages, Plant community, Management, Monitoring, Policy and Law, complex mixtures, Grassland, Nutrient, Agronomy, Grazing, Litter, Environmental science, Animal Science and Zoology, Ecosystem, Cycling, Nature and Landscape Conservation
Abstract

Disturbances, such as fire and grazing, play important roles in determining grassland plant community composition and soil microbial dynamics, as well as regulating the flows of carbon (C) and nitrogen (N) between the two groups of organisms. In a mixed grassland of the southern Great Plains, we tested the hypotheses that spring-season fire would increase the absolute biomass and relative proportion of C4 grasses in the plant community, and decrease soil microbial biomass N, thereby increasing microbial C∶N ratios. We also tested the hypothesis that clipping (to simulate grazing) would reduce effects of fire, with a greater reduction of fire effect corresponding to an increased frequency of clipping. Contrary to our hypothesis, C4 grasses showed no significant treatment responses. Treatment effects were limited to C3 grasses, and clipping was more important than fire in terms of effects on plant community composition. However, because of its greater capacity to reduce aboveground litter, fire had the greater impact on soil microbial C. Contrary to the hypothesized outcome, no significant effects of disturbance on soil microbial N were observed. This suggests that control of N cycling in this ecosystem is primarily microbial in nature, though dependent on inputs of plant C via litter. Interactions between fire and clipping were observed in litter mass, highlighting the importance of litter inputs for plant–soil nutrient feedbacks.

Published
2008
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9. Surgical Management in Patients With Pancreatic Cancer: a Queensland Perspective

Author

Wylie, N., Adib, R., Barbour, A., Fawcett, J., Hill, A., Lynch, S., Martin, I., O'Rourke, T., Puhalla, H., Rutherford, L., Slater, K., Whiteman, D., Neale, R., Fritschi, Lin, Wylie, N., Adib, R., Barbour, A., Fawcett, J., Hill, A., Lynch, S., Martin, I., O'Rourke, T., Puhalla, H., Rutherford, L., Slater, K., Whiteman, D., Neale, R., and Fritschi, Lin

Abstract

Background: Little has been published regarding presenting symptoms, investigations and outcomes for patients with pancreatic cancer in Australia. Data from a series of patients undergoing attempted resection in Queensland, Australia, are presented with the aim of assisting development of consistent strategies in disease management.Methods: We reviewed the medical records of 121 patients who underwent attempted surgical resection and who took part in a case-control study between 2007 and 2009. Information relating to symptoms, investigations, surgical procedures and outcomes was captured.Results: The mean age was 63 years and 60% were men. The most common presenting symptoms were jaundice (64%) and pain (63%). Over 80% of patients had multiple imaging investigations or laparoscopy prior to surgery. Seventy-eight patients (64%) had a completed resection and 23% of these had involved margins. The presence of metastases and/or involvement of vessels or adjacent structures precluded resection in the remaining patients. The 1-year survival for patients whose resections were completed was 77% compared with 51% for those whose tumours were notresectable (P = 0.004). There was no 30-day mortality and 68% of patients were alive 1 year after diagnosis. Resections were performed in 11 different hospitals but over 90% of patients underwent their surgery in one of five high-volume centres.Conclusion: The Queensland experience is consistent with that reported internationally. A significant proportion of attempted resections was not completed because preoperative staging underestimated disease extent. Most patients with potentially resectable disease are being treated in high-volume centres.

Published
2013

10. Management innovation through standardization: Management consultants as standardizers of organizational practice

Author

Wright, C, Sturdy, A, Wylie, N, Wright, C, Sturdy, A, and Wylie, N

Abstract

Management innovation and the consultants who promote and support it are both typically associated with the ‘new’, with departures from the norm and from standard approaches. Indeed, standardization is often seen as an impediment to innovation, especially in the current ‘post-bureaucratic’ era. This article challenges such a view, arguing that consultant-led management innovation is often highly standardized. Based upon qualitative research into internal consultancy in large business organizations, both standardizing agendas and standardized methods are identified from a range of consultant-led management innovation programs. The analysis then points to some of the structural and cultural features of organizations that lead to managers favouring incremental, standardized approaches to change, even if these are often contested. In conclusion, the article points to the need to consider a range of different dimensions in the relationship between standardization and management innovation.

Published
2012

11. The Hydrogen Economy: The Creation of the Worldwide Energy Web and the Redistribution of Power on Earth, By Jeremy Rifkin. Tarcher/Putnam, 2002, 285 pp., US $24.95. ISBN 1-58542-193-6 (paperback)

Author

Wylie N. Harris

Subjects
Power (social and political), Energy (psychological), Environmental Engineering, business.industry, Hydrogen economy, Economics, Earth (chemistry), Redistribution (cultural anthropology), Management, Monitoring, Policy and Law, Economic system, business, Nature and Landscape Conservation
Published
2003
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16. Humoral Responses After SARS-CoV-2 mRNA Vaccination and Breakthrough Infection in Cancer Patients.

Author

Chumsri S, Advani PP, Pai TS, Li Z, Mummareddy A, Acampora M, Reynolds GA, Wylie N, Boyle AW, Lou Y, Mody K, Moreno-Aspitia A, Swift MD, Virk A, Bharucha AE, Marquez CP, Patel TC, Gores GJ, and Knutson KL

Abstract

Objective: To evaluate the magnitude of humoral response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) messenger RNA (mRNA) vaccines in patients with cancer receiving active therapies., Patients and Methods: Patients 18 years or older in whom SARS-CoV-2 spike antibody (anti-S Ab) levels were measured after 2 doses of SARS-CoV-2 mRNA vaccines were included. Patients with prior coronavirus disease 2019 (COVID-19) infection or receiving other immunosuppressive therapy were excluded., Results: Among 201 patients who met the criteria, 61 were immunocompetent, 91 had a hematologic malignancy, and 49 had a solid malignancy while receiving treatments associated with cytopenia, including chemotherapy or cyclin-dependent kinase 4 and 6 inhibitors. A significantly greater proportion of immunocompetent patients (96.7% [59 of 61]) had anti-S Ab titers of 500 U/mL or greater compared to patients with hematologic (7.7% [7 of 91) and solid (55.1% [27 of 49]) malignancy ( P <.001). Despite 2 doses of SARS-CoV-2 mRNA vaccines, 52.7% of patients with hematologic malignancy (48 of 91) and 8.2% of those with solid malignancy (4 of 49) receiving cytopenic therapy had no seroconversion (spike antibody titers <0.8 U/mL). Two patients subsequently had development of breakthrough COVID-19 infection after full vaccination., Conclusion: A substantial proportion of patients with hematologic and solid malignancies receiving chemotherapies and CDK4/6i had poor humoral responses after SARS-CoV-2 mRNA vaccination. Our study adds to a growing body of literature suggesting that immunosuppressed patients have a suboptimal humoral response to COVID-19 vaccination. Our study also underscores the importance of assessing antibody response after COVID-19 vaccines in these vulnerable patients., (© 2021 The Authors.)

Published
2022
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17. Atypical Lung Carcinoid With EML4/ALK Fusion Detected With Circulating Tumor DNA.

Author

Gococo-Benore DA, Boyle A, Wylie N, Drusbosky L, Khoor A, and Starr JS

Abstract

Atypical carcinoids are a rare subset of neuroendocrine tumors that originate from cells within the bronchopulmonary tree. Compared to typical carcinoids, atypical carcinoids are associated with a worse prognosis. EML4-ALK fusions are reported in 5% of non-small cell lung carcinoma, but are rare in atypical carcinoids with only five previously reported cases. We report a case of a 70-year-old female with atypical carcinoid with metastasis to the liver and axial skeleton. She did not respond to standard of care chemotherapy with carboplatin and etoposide and was elected to enroll in hospice because of worsening clinical status. However, a circulating tumor DNA (ctDNA) sample was obtained the same day which revealed an EML4-ALK fusion gene. She immediately began therapy with the second-generation ALK inhibitor alectinib, with a remarkable symptomatic and radiographic response. Seven months later, the disease progression was demonstrated in the liver and the patient was switched to the third-generation ALK inhibitor lorlatinib. At the time of writing, the patient has continued to demonstrate sustained clinical, radiographic, and biochemical responses while on lorlatnib for two years. The dramatic treatment results highlighted in this case make the argument to consider ctDNA after the diagnosis of locally advanced or metastatic atypical carcinoid., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2022, Gococo-Benore et al.)

Published
2022
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18. Circulating Tumor DNA-Based Testing and Actionable Findings in Patients with Advanced and Metastatic Pancreatic Adenocarcinoma.

Author

Botrus G, Kosirorek H, Sonbol MB, Kusne Y, Uson Junior PLS, Borad MJ, Ahn DH, Kasi PM, Drusbosky LM, Dada H, Surapaneni PK, Starr J, Ritter A, McMillan J, Wylie N, Mody K, and Bekaii-Saab TS

Subjects
Biomarkers, Tumor genetics, High-Throughput Nucleotide Sequencing, Humans, Mutation, Adenocarcinoma diagnosis, Adenocarcinoma genetics, Carcinoma, Pancreatic Ductal diagnosis, Carcinoma, Pancreatic Ductal genetics, Circulating Tumor DNA genetics, Pancreatic Neoplasms diagnosis, Pancreatic Neoplasms genetics
Abstract

Purpose: Recent advances in molecular diagnostic technologies allow for the evaluation of solid tumor malignancies through noninvasive blood sampling, including circulating tumor DNA profiling (ctDNA). Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, often because of late presentation of disease. Diagnosis is often made using endoscopic ultrasound or endoscopic retrograde cholangiopancreatography, which often does not yield enough tissue for next-generation sequencing. With this study, we sought to characterize the ctDNA genomic alteration landscape in patients with advanced PDAC with a focus on actionable findings., Materials and Methods: From December 2014 through October 2019, 357 samples collected from 282 patients with PDAC at Mayo Clinic underwent ctDNA testing using a clinically available assay. The majority of samples were tested using the 73-gene panel which includes somatic genomic targets, including complete or critical exon coverage in 30 and 40 genes, respectively, and in some, amplifications, fusions, and indels. Clinical data and outcome variables were available for 165 patients; with 104 patients at initial presentation., Results: All patients included in this study had locally advanced or metastatic PDAC. Samples having at least one alteration, when variants of unknown significance (VUS) were excluded, numbered 266 (75%). After excluding VUS, therapeutically relevant alterations were observed in 170 (48%) of the total 357 cohort, including KRAS (G12C), EGFR, ATM, MYC, BRCA, PIK3CA, and BRAF mutations. KRAS, SMAD, CCND2, or TP53 alterations were seen in higher frequency in patients with advanced disease., Conclusion: Our study is the largest cohort to date that demonstrates the feasibility of ctDNA testing in PDAC. We provide a benchmark landscape upon which the field can continue to grow. Future applications may include use of ctDNA to guide treatment and serial monitoring of ctDNA during disease course to identify novel therapeutic targets for improved prognosis., Implications for Practice: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis often due to late presentation of disease. Biopsy tissue sampling is invasive and samples are often inadequate, requiring repeated invasive procedures and delays in treatment. Noninvasive methods to identify PDAC early in its course may improve prognosis in PDAC. Using ctDNA, targetable genes can be identified and used for treatment., (© 2021 AlphaMed Press.)

Published
2021
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19. Outcomes of liver resection for hepatocellular carcinoma in octogenarians.

Author

Sanyal S, Kron P, Wylie N, Hildalgo E, Toogood GJ, and Lodge P

Subjects
Aged, 80 and over, Hepatectomy adverse effects, Humans, Retrospective Studies, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery
Abstract

Background: There is a dearth of information about operative outcomes in patients ≥80 years for hepatocellular carcinoma (HCC) from Western institutions. We compare the result of HCC resections in patients <80 years vs. patients ≥80 years from our institution in the UK., Methods: We conducted a retrospective review of all patients undergoing liver resections for HCC between 2005 and 2015. Demographics, comorbidities, morbidity, mortality and survival were compared between the two age groups., Results: 200 patients underwent resection for HCC in this time period. Nineteen patients were ≥80 years and 181 were <80 years. Comorbidities measured by the Charlson Comorbidity Index were significantly higher in the ≥80 group (p < 0.0001). There was no significant difference in the extent of resection in the two groups. Morbidity and mortality between the <80 years and the ≥80 years group were not significantly different (morbidity 27% vs.16%; p = 0.29) (mortality 7% vs. 0%; p = 0.11). The one-year (83.4% vs. 88.2%; p = 0.83), five-year (56.3% vs. 55.8%; p = 0.83) and the overall survival rate rates (887 days vs. 1035 days; p = 0.66) were not significantly different between the groups., Discussion: Liver resection should not be precluded based on age alone; with good outcomes in patients ≥80 years justifying surgery., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

Published
2020
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20. Development and initial outcomes of an upper gastrointestinal multidisciplinary clinic.

Author

Brown A, Wylie N, Rodgers M, Casement J, McIlree N, Gray L, Mulholland G, Volkova V, van der Watt E, Booth M, and Koea J

Subjects
Appointments and Schedules, Humans, New Zealand epidemiology, Patient Satisfaction statistics & numerical data, Referral and Consultation, Gastrointestinal Neoplasms epidemiology, Outpatient Clinics, Hospital, Patient Care Team organization & administration, Patient-Centered Care organization & administration
Abstract

Introduction: Patients with upper gastrointestinal cancer are often comorbid and require complex surgical treatments for their cancers, meaning that their preoperative assessment can be based around numerous outpatient assessments with multiple services. A multidisciplinary clinic (MDC) was developed for the assessment of patients with confirmed or suspected upper gastrointestinal cancers., Methods: Face-to-face meetings were held between stakeholder services at Waitemata District Health Board, and clinic resource allocated. Significant IT modification of existing clinic booking software was required., Results: Between September 2014, and September 2015, there were a total of 165 new patient, and 710 follow-up appointments. All new patients were seen by a surgeon and then other specialties. Of the 165 new patient appointments, 146 (88%) patients had a definitive treatment plan in place and were cleared by anaesthesia and intensive care at the end of the clinic. Staff and patients report high levels of satisfaction for the clinic., Conclusion: A dedicated MDC has provided a single forum where complex patients can be reviewed, and a definitive treatment plan formulated in nearly 90% of patients, even when this involves multiple medical and paramedical specialties with high levels of patient and clinician satisfaction.

Published
2016

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