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5. The acceptability of, and informational needs related to, self-collection cervical screening among women of Indian descent living in Victoria, Australia: A qualitative study

Author

Machado Colling, A, Creagh, NS, Gogia, N, Wyatt, K, Zammit, C, Brotherton, JML, Nightingale, CE, Machado Colling, A, Creagh, NS, Gogia, N, Wyatt, K, Zammit, C, Brotherton, JML, and Nightingale, CE

Abstract

BACKGROUND: In July 2022, self-collection became universally available as part of Australia's National Cervical Screening Program. This change aims to address screening inequities experienced among underscreened populations, including women of Indian descent. This study explored experiences of cervical screening, alongside the acceptability of self-collection, among women of Indian descent living in Victoria, Australia. We also aimed to articulate the informational needs to promote self-collection among this population. METHODS: Five focus group discussions with 39 women living in Victoria were conducted in English (n = 3) and Punjabi (n = 2). Transcripts were thematically analysed, as informed by the Theoretical Framework of Acceptability. RESULTS: Women were motivated by the choice to self-collect, perceiving the ability to maintain modesty and greater autonomy as key enablers. Healthcare practitioners were seen as central in supporting patient-centred models of care. Perceived barriers to self-collection included concerns around its accuracy and women's confidence in collecting their own sample. Widespread dissemination of culturally tailored promotion strategies communicating concepts such as 'privacy' and 'accuracy' were suggested by women to promote self-collection. CONCLUSION: Self-collection was highly acceptable among women of Indian descent, particularly when assured of its accuracy, and sociocultural norms and previous screening experiences are considered. This study highlights the huge potential that self-collection can play in increasing equity in Australia's cervical screening programme. PATIENT OR PUBLIC CONTRIBUTION: Members of the public were involved in focus group discussions. Findings were summarised and disseminated via a poster. A bicultural worker was involved in all stages of the research.

Published
2024

6. A 10-week intergenerational program bringing together community-living older adults and preschool children (INTERACTION): a pilot feasibility non-randomised clinical trial.

Author

Lim, ML, Zammit, C, Lewis, E, Ee, N, Maiden, G, Goldwater, M, Kimonis, E, Kenning, G, Rockwood, K, Fitzgerald, A, Radford, K, Dodge, H, Ward, SA, Delbaere, K, Peters, R, Lim, ML, Zammit, C, Lewis, E, Ee, N, Maiden, G, Goldwater, M, Kimonis, E, Kenning, G, Rockwood, K, Fitzgerald, A, Radford, K, Dodge, H, Ward, SA, Delbaere, K, and Peters, R

Abstract

BACKGROUND: Social isolation and low levels of physical activity are strong drivers for frailty, which is linked to poor health outcomes and transition to long-term care. Frailty is multifactorial, and thus an integrated approach is needed to maintain older adults' health and well-being. Intergenerational programs represent a novel multifactorial approach to target frailty, social isolation and physical decline but these have not yet been rigorously tested in Australia. Here, we present the results of our pilot study which aimed to test the feasibility of a 10-week intergenerational program between older adults and preschool children. METHODS: A non-randomised wait-listed controlled trial was conducted. Participants were allocated to either the intervention or wait-list control group. The intervention group received 10 weekly 2-h intergenerational sessions led by trained child educators; the control group continued with their usual routine and received their intergenerational program after the 10-week control period. All participants were assessed at baseline and 10 weeks. The primary outcome was the feasibility and acceptability of the program including measures of recruitment eligibility, adherence and effective data collection across the multiple domains important for frailty, including functional mobility and balance, grip strength, cognitive function, mood, social engagement, quality of life and concerns about falling. RESULTS: Nineteen adults were included, with nine in the intervention and ten in the control group. A total of 42% of older adults screened were eligible, 75% of participants were present at each intervention session and the overall attrition rate was 21% (n = 4). The reasons for participant absence were primarily health-related. Missing data was minimal for the majority of assessments but more apparent for the cognitive testing where completion rates ranged from 53 to 79% for baseline tests and 73 to 100% for those who received follow-up testing

Published
2024

7. Research considerations for prospective studies of patients with coma and disorders of consciousness

Author

Tinti, L, Lawson, T, Molteni, E, Kondziella, D, Rass, V, Sharshar, T, Bodien, Y, Giacino, J, Mayer, S, Amiri, M, Muehlschlegel, S, Venkatasubba Rao, C, Vespa, P, Menon, D, Citerio, G, Helbok, R, Mcnett, M, Agarwal, S, Aiyagari, V, Akbari, Y, Albertson, A, Alexander, S, Alexandrov, A, Alkhachroum, A, Al-Mufti, F, Appavu, B, Gebrewold, M, Ayounb, M, Badenes, R, Bader, M, Badjiata, N, Balu, R, Barlow, B, Barra, M, Beekman, R, Beghi, E, Beqiri, E, Berlin, T, Bilotta, F, Bleck, T, Boerwinkle, V, Boly, M, Bonnel, A, Brazzi, L, Brown, E, Bulic, S, Caceres, E, Caceres, A, Cafiero, T, Carroll, E, Cediel, E, Chou, S, Claassen, J, Condie, C, Conti, A, Cosmas, K, Costa, P, Creutzfeldt, C, Dangayach, N, Dauri, M, Debicki, D, Degeorgia, M, Der-Nigoghossian, C, Desai, M, Dhar, R, Diringer, M, Durr, E, Edlow, B, Ercole, A, Estraneo, A, Falcone, G, Farrokh, S, Ferguson, A, Fernandez-Espejo, D, Fink, E, Fins, J, Foreman, B, Franchi, F, Frontera, J, Ganesan, R, Gaspard, N, Ghavam, A, Gibbons, C, Gilmore, E, Glustein, C, Gosseries, O, Green, T, Greer, D, Guanci, M, Gupta, D, Hahn, C, Hakimi, R, Hammond, F, Hanley, D, Hartings, J, Hassan, A, Hemphill, C, Da Cunha, A, Hinson, H, Hirsch, K, Hocker, S, Hu, P, Hu, X, Human, T, Hwang, D, Illes, J, Jaffa, M, James, M, Janas, A, Johnson, S, Jones, M, Jox, R, Kalanuria, A, Keller, E, Kennedy, L, Kennelly, M, Keogh, M, Kim, J, Kim, K, Kirsch, H, Kirschen, M, Ko, N, Kreitzer, N, Kromm, J, Kumar, A, Kurtz, P, Laureys, S, Lejeune, N, Lewis, A, Liang, J, Ling, G, Livesay, S, Luppi, A, Macdonald, J, Maddux, C, Mahanes, D, Mainali, S, Maldonado, N, Ribeiro, R, Mascia, L, Massimini, M, Mathur, R, Mccredie, V, Mejia-Mantilla, J, Mendoza, M, Meyfroidt, G, Mijangos, J, Moberg, D, Moheet, A, Montalenti, E, Monti, M, Morrison, C, Munar, M, Murtaugh, B, Naccache, L, Nagayama, M, Nairon, E, Nakagawa, T, Naldi, A, Narenthiran, G, Natarajan, G, Nemetsky, E, Newcombe, V, Nielsen, N, Niznick, N, Noronha-Falcão, F, Nyquist, P, Olson, D, Othman, M, Owen, A, Padayachy, L, Pajoumand, M, Park, S, Pergakis, M, Perry, H, Polizzotto, L, Pouratian, N, Spivack, M, Prisco, L, Provencio, J, Puglises, F, Puybasset, L, Rao, C, Rasmussen, L, Rasulo, F, Ray, B, Ricci, Z, Richardson, R, Shinotsuka, C, Robba, C, Robertson, C, Rohaut, B, Rolston, J, Romagnoli, S, Rosanova, M, Rosenthal, E, Rowe, S, Rubin, M, Russell, M, Silva, G, Sanz, L, Sarasso, S, Sarwal, A, Schiff, N, Schnakers, C, Seder, D, Shah, V, Shapiro-Rosenbaubm, A, Shapshak, A, Sharma, K, Shutter, L, Sitt, J, Slomine, B, Smetana, K, Smielewski, P, Smith, W, Stamatakis, E, Steinberg, A, Stevens, R, Suarez, J, Sung, G, Sussman, B, Taran, S, Mazzeo, A, Thibaut, A, Thompson, D, Threlkeld, Z, Toker, D, Torbey, M, Tosto, J, Trevick, S, Tsaousi, G, Turgeon, A, Udy, A, Varelas, P, Videtta, W, Voss, H, Vox, F, Wagner, A, Wahlster, S, Wainwright, M, Whyte, J, Witherspoon, B, Yakhkind, A, Yeager, S, Young, M, Zafar, S, Zafonte, R, Zahuranec, D, Zammit, C, Zhang, B, Ziai, W, Zimmerman, L, Zink, E, Tinti, Lorenzo, Lawson, Thomas, Molteni, Erika, Kondziella, Daniel, Rass, Verena, Sharshar, Tarek, Bodien, Yelena G, Giacino, Joseph T, Mayer, Stephan A, Amiri, Moshgan, Muehlschlegel, Susanne, Venkatasubba Rao, Chethan P, Vespa, Paul M, Menon, David K, Citerio, Giuseppe, Helbok, Raimund, McNett, Molly, Agarwal, Sachin, Aiyagari, Venkatesh, Akbari, Yama, Albertson, Asher, Alexander, Sheila, Alexandrov, Anne, Alkhachroum, Ayham, Al-Mufti, Fawaz, Amiri, Moshagan, Appavu, Brian, Gebrewold, Meron Awraris, Ayounb, Marc, Badenes, Rafael, Bader, Mary Kay, Badjiata, Neeraj, Balu, Ram, Barlow, Brooke, Barra, Megan, Beekman, Rachel, Beghi, Ettore, Beqiri, Erta, Berlin, Tracey, Bilotta, Federico, Bleck, Thomas, Bodien, Yelena, Boerwinkle, Varina, Boly, Melanie, Bonnel, Alexandra, Brazzi, Luca, Brown, Emery, Bulic, Sebina, Caceres, Eder, Caceres, Adrian, Cafiero, Tullio, Carroll, Elizabeth, Cediel, Emilio G, Chou, Sherry, Claassen, Jan, Condie, Chad, Conti, Alfredo, Cosmas, Katie, Costa, Paolo, Creutzfeldt, Claire, Dangayach, Neha, Dauri, Mario, Debicki, Derek, DeGeorgia, Michael, Der-Nigoghossian, Caroline, Desai, Masoom, Dhar, Rajat, Diringer, Michael, Durr, Emily, Edlow, Brian, Ercole, Ari, Estraneo, Anna, Falcone, Guido, Farrokh, Salia, Ferguson, Adam, Fernandez-Espejo, Davinia, Fink, Ericka, Fins, Joseph, Foreman, Brandon, Franchi, Federico, Frontera, Jennifer, Ganesan, Rishi, Gaspard, Nicolas, Ghavam, Ahmeneh, Giacino, Joseph, Gibbons, Christie, Gilmore, Emily, Glustein, Chavie, Gosseries, Olivia, Green, Theresa, Greer, David, Guanci, Mary, Gupta, Deepak, Hahn, Cecil, Hakimi, Ryan, Hammond, Flora, Hanley, Daniel F, Hartings, Jed, Hassan, Ahmed, Hemphill, Claude, Da Cunha, Arthur Henrique Galvão Bruno, Hinson, Holly, Hirsch, Karen, Hocker, Sarah, Hu, Peter, Hu, Xiao, Human, Theresa, Hwang, David, Illes, Judy, Jaffa, Matthew, James, Michael L, Janas, Anna, Johnson, Susan, Jones, Morgan, Jox, Ralf J, Kalanuria, Atul, Keller, Emanuela, Kennedy, Lori, Kennelly, Megan, Keogh, Maggie, Kim, Jenn, Kim, Keri, Kirsch, Hannah, Kirschen, Matthew, Ko, Nerissa, Kreitzer, Natalie, Kromm, Julie, Kumar, Abhay, Kurtz, Pedro, Laureys, Steven, Lejeune, Nicolas, Lewis, Ariane, Liang, John, Ling, Geoffrey, Livesay, Sarah, Luppi, Andrea, MacDonald, Jennifer, Maddux, Craig, Mahanes, Dea, Mainali, Shraddha, Maldonado, Nelson, Ribeiro, Rennan Martins, Mascia, Luciana, Massimini, Marcello, Mathur, Rohan, Mayer, Stephan, McCredie, Victoria, Mejia-Mantilla, Jorge, Mendoza, Michael, Menon, David, Meyfroidt, Geert, Mijangos, Julio, Moberg, Dick, Moheet, Asma, Montalenti, Elisa, Monti, Martin, Morrison, Chris, Munar, Marina, Murtaugh, Brooke, Naccache, Lionel, Nagayama, Masao, Nairon, Emerson, Nakagawa, Thomas, Naldi, Andrea, Narenthiran, Ganesalingam, Natarajan, Girija, Nemetsky, Esther, Newcombe, Virginia, Nielsen, Niklas, Niznick, Naomi, Noronha-Falcão, Filipa, Nyquist, Paul, Olson, DaiWai, Othman, Marwan, Owen, Adrian, Padayachy, Llewellyn, Pajoumand, Mehrnaz, Park, Soojin, Pergakis, Melissa, Perry, Heidi, Polizzotto, Len, Pouratian, Nader, Spivack, Marilyn Price, Prisco, Lara, Provencio, Javier, Puglises, Francesco, Puybasset, Louis, Rao, Chethan, Rasmussen, Lindsay, Rasulo, Frank, Ray, Bappaditya, Ricci, Zaccaria, Richardson, Risa, Shinotsuka, Cassia Righy, Robba, Chiara, Robertson, Courtney, Rohaut, Benjamin, Rolston, John, Romagnoli, Stefano, Rosanova, Mario, Rosenthal, Eric, Rowe, Shaun, Rubin, Michael, Russell, Mary Beth, Silva, Gisele Sampaio, Sanz, Leandro, Sarasso, Simone, Sarwal, Aarti, Schiff, Nicolas, Schnakers, Caroline, Seder, David, Shah, Vishank Arun, Shapiro-Rosenbaubm, Amy, Shapshak, Angela, Sharma, Kartavya, Sharma, Kumar Ajay, Shutter, Lori, Sitt, Jacobo, Slomine, Beth, Smetana, Keaton, Smielewski, Peter, Smith, Wade, Stamatakis, Emmanuel, Steinberg, Alexis, Stevens, Robert, Suarez, Jose, Sung, Gene, Sussman, Bethany, Taran, Shaurya, Mazzeo, Anna Teresa, Thibaut, Aurore, Thompson, David, Threlkeld, Zachary, Toker, Daniel, Torbey, Michel, Tosto, Jenna, Trevick, Stephen, Tsaousi, Georgia, Turgeon, Alexis, Udy, Andrew, Varelas, Panos, Vespa, Paul, Videtta, Walter, Voss, Henning, Vox, Ford, Wagner, Amy, Wahlster, Sarah, Wainwright, Mark, Whyte, John, Witherspoon, Briana, Yakhkind, Aleksandra (Sasha), Yeager, Susan, Young, Michael, Zafar, Sahar, Zafonte, Ross, Zahuranec, Darin, Zammit, Chris, Zhang, Bei, Ziai, Wendy, Zimmerman, Lara, Zink, Elizabeth, Tinti, L, Lawson, T, Molteni, E, Kondziella, D, Rass, V, Sharshar, T, Bodien, Y, Giacino, J, Mayer, S, Amiri, M, Muehlschlegel, S, Venkatasubba Rao, C, Vespa, P, Menon, D, Citerio, G, Helbok, R, Mcnett, M, Agarwal, S, Aiyagari, V, Akbari, Y, Albertson, A, Alexander, S, Alexandrov, A, Alkhachroum, A, Al-Mufti, F, Appavu, B, Gebrewold, M, Ayounb, M, Badenes, R, Bader, M, Badjiata, N, Balu, R, Barlow, B, Barra, M, Beekman, R, Beghi, E, Beqiri, E, Berlin, T, Bilotta, F, Bleck, T, Boerwinkle, V, Boly, M, Bonnel, A, Brazzi, L, Brown, E, Bulic, S, Caceres, E, Caceres, A, Cafiero, T, Carroll, E, Cediel, E, Chou, S, Claassen, J, Condie, C, Conti, A, Cosmas, K, Costa, P, Creutzfeldt, C, Dangayach, N, Dauri, M, Debicki, D, Degeorgia, M, Der-Nigoghossian, C, Desai, M, Dhar, R, Diringer, M, Durr, E, Edlow, B, Ercole, A, Estraneo, A, Falcone, G, Farrokh, S, Ferguson, A, Fernandez-Espejo, D, Fink, E, Fins, J, Foreman, B, Franchi, F, Frontera, J, Ganesan, R, Gaspard, N, Ghavam, A, Gibbons, C, Gilmore, E, Glustein, C, Gosseries, O, Green, T, Greer, D, Guanci, M, Gupta, D, Hahn, C, Hakimi, R, Hammond, F, Hanley, D, Hartings, J, Hassan, A, Hemphill, C, Da Cunha, A, Hinson, H, Hirsch, K, Hocker, S, Hu, P, Hu, X, Human, T, Hwang, D, Illes, J, Jaffa, M, James, M, Janas, A, Johnson, S, Jones, M, Jox, R, Kalanuria, A, Keller, E, Kennedy, L, Kennelly, M, Keogh, M, Kim, J, Kim, K, Kirsch, H, Kirschen, M, Ko, N, Kreitzer, N, Kromm, J, Kumar, A, Kurtz, P, Laureys, S, Lejeune, N, Lewis, A, Liang, J, Ling, G, Livesay, S, Luppi, A, Macdonald, J, Maddux, C, Mahanes, D, Mainali, S, Maldonado, N, Ribeiro, R, Mascia, L, Massimini, M, Mathur, R, Mccredie, V, Mejia-Mantilla, J, Mendoza, M, Meyfroidt, G, Mijangos, J, Moberg, D, Moheet, A, Montalenti, E, Monti, M, Morrison, C, Munar, M, Murtaugh, B, Naccache, L, Nagayama, M, Nairon, E, Nakagawa, T, Naldi, A, Narenthiran, G, Natarajan, G, Nemetsky, E, Newcombe, V, Nielsen, N, Niznick, N, Noronha-Falcão, F, Nyquist, P, Olson, D, Othman, M, Owen, A, Padayachy, L, Pajoumand, M, Park, S, Pergakis, M, Perry, H, Polizzotto, L, Pouratian, N, Spivack, M, Prisco, L, Provencio, J, Puglises, F, Puybasset, L, Rao, C, Rasmussen, L, Rasulo, F, Ray, B, Ricci, Z, Richardson, R, Shinotsuka, C, Robba, C, Robertson, C, Rohaut, B, Rolston, J, Romagnoli, S, Rosanova, M, Rosenthal, E, Rowe, S, Rubin, M, Russell, M, Silva, G, Sanz, L, Sarasso, S, Sarwal, A, Schiff, N, Schnakers, C, Seder, D, Shah, V, Shapiro-Rosenbaubm, A, Shapshak, A, Sharma, K, Shutter, L, Sitt, J, Slomine, B, Smetana, K, Smielewski, P, Smith, W, Stamatakis, E, Steinberg, A, Stevens, R, Suarez, J, Sung, G, Sussman, B, Taran, S, Mazzeo, A, Thibaut, A, Thompson, D, Threlkeld, Z, Toker, D, Torbey, M, Tosto, J, Trevick, S, Tsaousi, G, Turgeon, A, Udy, A, Varelas, P, Videtta, W, Voss, H, Vox, F, Wagner, A, Wahlster, S, Wainwright, M, Whyte, J, Witherspoon, B, Yakhkind, A, Yeager, S, Young, M, Zafar, S, Zafonte, R, Zahuranec, D, Zammit, C, Zhang, B, Ziai, W, Zimmerman, L, Zink, E, Tinti, Lorenzo, Lawson, Thomas, Molteni, Erika, Kondziella, Daniel, Rass, Verena, Sharshar, Tarek, Bodien, Yelena G, Giacino, Joseph T, Mayer, Stephan A, Amiri, Moshgan, Muehlschlegel, Susanne, Venkatasubba Rao, Chethan P, Vespa, Paul M, Menon, David K, Citerio, Giuseppe, Helbok, Raimund, McNett, Molly, Agarwal, Sachin, Aiyagari, Venkatesh, Akbari, Yama, Albertson, Asher, Alexander, Sheila, Alexandrov, Anne, Alkhachroum, Ayham, Al-Mufti, Fawaz, Amiri, Moshagan, Appavu, Brian, Gebrewold, Meron Awraris, Ayounb, Marc, Badenes, Rafael, Bader, Mary Kay, Badjiata, Neeraj, Balu, Ram, Barlow, Brooke, Barra, Megan, Beekman, Rachel, Beghi, Ettore, Beqiri, Erta, Berlin, Tracey, Bilotta, Federico, Bleck, Thomas, Bodien, Yelena, Boerwinkle, Varina, Boly, Melanie, Bonnel, Alexandra, Brazzi, Luca, Brown, Emery, Bulic, Sebina, Caceres, Eder, Caceres, Adrian, Cafiero, Tullio, Carroll, Elizabeth, Cediel, Emilio G, Chou, Sherry, Claassen, Jan, Condie, Chad, Conti, Alfredo, Cosmas, Katie, Costa, Paolo, Creutzfeldt, Claire, Dangayach, Neha, Dauri, Mario, Debicki, Derek, DeGeorgia, Michael, Der-Nigoghossian, Caroline, Desai, Masoom, Dhar, Rajat, Diringer, Michael, Durr, Emily, Edlow, Brian, Ercole, Ari, Estraneo, Anna, Falcone, Guido, Farrokh, Salia, Ferguson, Adam, Fernandez-Espejo, Davinia, Fink, Ericka, Fins, Joseph, Foreman, Brandon, Franchi, Federico, Frontera, Jennifer, Ganesan, Rishi, Gaspard, Nicolas, Ghavam, Ahmeneh, Giacino, Joseph, Gibbons, Christie, Gilmore, Emily, Glustein, Chavie, Gosseries, Olivia, Green, Theresa, Greer, David, Guanci, Mary, Gupta, Deepak, Hahn, Cecil, Hakimi, Ryan, Hammond, Flora, Hanley, Daniel F, Hartings, Jed, Hassan, Ahmed, Hemphill, Claude, Da Cunha, Arthur Henrique Galvão Bruno, Hinson, Holly, Hirsch, Karen, Hocker, Sarah, Hu, Peter, Hu, Xiao, Human, Theresa, Hwang, David, Illes, Judy, Jaffa, Matthew, James, Michael L, Janas, Anna, Johnson, Susan, Jones, Morgan, Jox, Ralf J, Kalanuria, Atul, Keller, Emanuela, Kennedy, Lori, Kennelly, Megan, Keogh, Maggie, Kim, Jenn, Kim, Keri, Kirsch, Hannah, Kirschen, Matthew, Ko, Nerissa, Kreitzer, Natalie, Kromm, Julie, Kumar, Abhay, Kurtz, Pedro, Laureys, Steven, Lejeune, Nicolas, Lewis, Ariane, Liang, John, Ling, Geoffrey, Livesay, Sarah, Luppi, Andrea, MacDonald, Jennifer, Maddux, Craig, Mahanes, Dea, Mainali, Shraddha, Maldonado, Nelson, Ribeiro, Rennan Martins, Mascia, Luciana, Massimini, Marcello, Mathur, Rohan, Mayer, Stephan, McCredie, Victoria, Mejia-Mantilla, Jorge, Mendoza, Michael, Menon, David, Meyfroidt, Geert, Mijangos, Julio, Moberg, Dick, Moheet, Asma, Montalenti, Elisa, Monti, Martin, Morrison, Chris, Munar, Marina, Murtaugh, Brooke, Naccache, Lionel, Nagayama, Masao, Nairon, Emerson, Nakagawa, Thomas, Naldi, Andrea, Narenthiran, Ganesalingam, Natarajan, Girija, Nemetsky, Esther, Newcombe, Virginia, Nielsen, Niklas, Niznick, Naomi, Noronha-Falcão, Filipa, Nyquist, Paul, Olson, DaiWai, Othman, Marwan, Owen, Adrian, Padayachy, Llewellyn, Pajoumand, Mehrnaz, Park, Soojin, Pergakis, Melissa, Perry, Heidi, Polizzotto, Len, Pouratian, Nader, Spivack, Marilyn Price, Prisco, Lara, Provencio, Javier, Puglises, Francesco, Puybasset, Louis, Rao, Chethan, Rasmussen, Lindsay, Rasulo, Frank, Ray, Bappaditya, Ricci, Zaccaria, Richardson, Risa, Shinotsuka, Cassia Righy, Robba, Chiara, Robertson, Courtney, Rohaut, Benjamin, Rolston, John, Romagnoli, Stefano, Rosanova, Mario, Rosenthal, Eric, Rowe, Shaun, Rubin, Michael, Russell, Mary Beth, Silva, Gisele Sampaio, Sanz, Leandro, Sarasso, Simone, Sarwal, Aarti, Schiff, Nicolas, Schnakers, Caroline, Seder, David, Shah, Vishank Arun, Shapiro-Rosenbaubm, Amy, Shapshak, Angela, Sharma, Kartavya, Sharma, Kumar Ajay, Shutter, Lori, Sitt, Jacobo, Slomine, Beth, Smetana, Keaton, Smielewski, Peter, Smith, Wade, Stamatakis, Emmanuel, Steinberg, Alexis, Stevens, Robert, Suarez, Jose, Sung, Gene, Sussman, Bethany, Taran, Shaurya, Mazzeo, Anna Teresa, Thibaut, Aurore, Thompson, David, Threlkeld, Zachary, Toker, Daniel, Torbey, Michel, Tosto, Jenna, Trevick, Stephen, Tsaousi, Georgia, Turgeon, Alexis, Udy, Andrew, Varelas, Panos, Vespa, Paul, Videtta, Walter, Voss, Henning, Vox, Ford, Wagner, Amy, Wahlster, Sarah, Wainwright, Mark, Whyte, John, Witherspoon, Briana, Yakhkind, Aleksandra (Sasha), Yeager, Susan, Young, Michael, Zafar, Sahar, Zafonte, Ross, Zahuranec, Darin, Zammit, Chris, Zhang, Bei, Ziai, Wendy, Zimmerman, Lara, and Zink, Elizabeth

Abstract

Disorders of consciousness are neurological conditions characterized by impaired arousal and awareness of self and environment. Behavioural responses are absent or are present but fluctuate. Disorders of consciousness are commonly encountered as a consequence of both acute and chronic brain injuries, yet reliable epidemiological estimates would require inclusive, operational definitions of the concept, as well as wider knowledge dissemination among involved professionals. Whereas several manifestations have been described, including coma, vegetative state/unresponsive wakefulness syndrome and minimally conscious state, a comprehensive neurobiological definition for disorders of consciousness is still lacking. The scientific literature is primarily observational, and studies-specific aetiologies lead to disorders of consciousness. Despite advances in these disease-related forms, there remains uncertainty about whether disorders of consciousness are a disease-agnostic unitary entity with a common mechanism, prognosis or treatment response paradigm. Our knowledge of disorders of consciousness has also been hampered by heterogeneity of study designs, variables, and outcomes, leading to results that are not comparable for evidence synthesis. The different backgrounds of professionals caring for patients with disorders of consciousness and the different goals at different stages of care could partly explain this variability. The Prospective Studies working group of the Neurocritical Care Society Curing Coma Campaign was established to create a platform for observational studies and future clinical trials on disorders of consciousness and coma across the continuum of care. In this narrative review, the author panel presents limitations of prior observational clinical research and outlines practical considerations for future investigations. A narrative review format was selected to ensure that the full breadth of study design considerations could be addressed and to facilit

Published
2024

8. Common Data Elements for Disorders of Consciousness: Recommendations from the Working Group on Hospital Course, Confounders, and Medications

Author

Barra, M, Zink, E, Bleck, T, Caceres, E, Farrokh, S, Foreman, B, Cediel, E, Hemphill, J, Nagayama, M, Olson, D, Suarez, J, Aiyagari, V, Akbari, Y, Al-Mufti, F, Alexander, S, Alexandrov, A, Alkhachroum, A, Amiri, M, Appavu, B, Gebre, M, Bader, M, Badjiata, N, Balu, R, Beekman, R, Beghi, E, Bell, K, Beqiri, E, Berlin, T, Bodien, Y, Boerwinkle, V, Boly, M, Bonnel, A, Brown, E, Carroll, E, Chou, S, Citerio, G, Classen, J, Condie, C, Cosmas, K, Creutzfeldt, C, Dangayach, N, Degeorgia, M, Der-Nigoghoss, C, Desai, M, Diringer, M, Dullaway, J, Edlow, B, Ercole, A, Estraneo, A, Falcone, G, Padayachy, L, Park, S, Pergakis, M, Polizzotto, L, Pouratian, N, Spivack, M, Prisco, L, Provencio, J, Puybasset, L, Rasmussen, L, Rass, V, Richardson, R, Shinots, C, Robba, C, Robertson, C, Rohaut, B, Rolston, J, Rosanova, M, Rosenthal, E, Russell, M, Silva, G, Sanz, L, Sarasso, S, Sarwal, A, Schiff, N, Schnakers, C, Seder, D, Shah, V, Shapiro-Rosen, A, Shapshak, A, Sharma, K, Sharshar, T, Shutter, L, Sitt, J, Slomine, B, Smielewski, P, Smith, W, Stamatakis, E, Steinberg, A, Ferioli, S, Fernandez-Esp, D, Fink, E, Fins, J, Frontera, J, Ganesan, R, Ghavam, A, Giacino, J, Gibbons, C, Gilmore, E, Gosseries, O, Green, T, Greer, D, Guanci, M, Hahn, C, Hakimi, R, Hanley, D, Hartings, J, Hassan, A, Hinson, H, Hirsch, K, Hocker, S, Hu, P, Hu, X, Human, T, Hwang, D, Illes, J, Jaffa, M, James, M, Janas, A, Jones, M, Keller, E, Keogh, M, Kim, J, Kim, K, Kirsch, H, Kirschen, M, Ko, N, Kondziella, D, Kreitzer, N, Stevens, R, Sussman, B, Taran, S, Thibaut, A, Threlkeld, Z, Tinti, L, Toker, D, Torbey, M, Trevick, S, Turgeon, A, Udy, A, Varelas, P, Venkatasubba, C, Vespa, P, Videtta, W, Voss, H, Vox, F, Wagner, A, Wainwright, M, Whyte, J, Witherspoon, B, Yakhind, A, Zafonte, R, Zahuranec, D, Zammit, C, Zhang, B, Ziai, W, Zimmerman, L, Kromm, J, Kumar, A, Kurtz, P, Laureys, S, Lawson, T, Lejeune, N, Lewis, A, Liang, J, Ling, G, Livesay, S, Luppi, A, Madden, L, Maddux, C, Mahanes, D, Mainali, S, Maldonado, N, Ribeiro, R, Massimini, M, Mayer, S, Mccredie, V, Mcnett, M, Mejia-Mantill, J, Menon, D, Meyfroidt, G, Mijangos, J, Moberg, D, Moheet, A, Molteni, E, Monti, M, Morrison, C, Muehlschlegel, S, Murtaugh, B, Naccache, L, Nairon, E, Natarajan, G, Newcombe, V, Nielsen, N, Noronha-Falc‹, F, Nyquist, P, Othman, M, Owen, A, Barra M. E., Zink E. K., Bleck T. P., Caceres E., Farrokh S., Foreman B., Cediel E. G., Hemphill J. C., Nagayama M., Olson D. W. M., Suarez J. I., Aiyagari V., Akbari Y., Al-Mufti F., Alexander S., Alexandrov A., Alkhachroum A., Amiri M., Appavu B., Gebre M. A., Bader M. K., Badjiata N., Balu R., Beekman R., Beghi E., Bell K., Beqiri E., Berlin T., Bodien Y., Boerwinkle V., Boly M., Bonnel A., Brown E., Carroll E., Chou S., Citerio G., Classen J., Condie C., Cosmas K., Creutzfeldt C., Dangayach N., DeGeorgia M., Der-Nigoghoss C., Desai M., Diringer M., Dullaway J., Edlow B., Ercole A., Estraneo A., Falcone G., Padayachy L., Park S., Pergakis M., Polizzotto L., Pouratian N., Spivack M. P., Prisco L., Provencio J., Puybasset L., Rasmussen L., Rass V., Richardson R., Shinots C. R., Robba C., Robertson C., Rohaut B., Rolston J., Rosanova M., Rosenthal E., Russell M. B., Silva G. S., Sanz L., Sarasso S., Sarwal A., Schiff N., Schnakers C., Seder D., Shah V. A., Shapiro-Rosen A., Shapshak A., Sharma K., Sharshar T., Shutter L., Sitt J., Slomine B., Smielewski P., Smith W., Stamatakis E., Steinberg A., Ferioli S., Fernandez-Esp D., Fink E., Fins J., Frontera J., Ganesan R., Ghavam A., Giacino J., Gibbons C., Gilmore E., Gosseries O., Green T., Greer D., Guanci M., Hahn C., Hakimi R., Hanley D. F., Hartings J., Hassan A., Hinson H., Hirsch K., Hocker S., Hu P., Hu X., Human T., Hwang D., Illes J., Jaffa M., James M. L., Janas A., Jones M., Keller E., Keogh M., Kim J., Kim K., Kirsch H., Kirschen M., Ko N., Kondziella D., Kreitzer N., Stevens R., Sussman B., Taran S., Thibaut A., Threlkeld Z., Tinti L., Toker D., Torbey M., Trevick S., Turgeon A., Udy A., Varelas P., Venkatasubba C., Vespa P., Videtta W., Voss H., Vox F., Wagner A., Wainwright M., Whyte J., Witherspoon B., Yakhind A., Zafonte R., Zahuranec D., Zammit C., Zhang B., Ziai W., Zimmerman L., Kromm J., Kumar A., Kurtz P., Laureys S., Lawson T., Lejeune N., Lewis A., Liang J., Ling G., Livesay S., Luppi A., Madden L., Maddux C., Mahanes D., Mainali S., Maldonado N., Ribeiro R. M., Massimini M., Mayer S., McCredie V., McNett M., Mejia-Mantill J., Menon D., Meyfroidt G., Mijangos J., Moberg D., Moheet A., Molteni E., Monti M., Morrison C., Muehlschlegel S., Murtaugh B., Naccache L., Nairon E., Natarajan G., Newcombe V., Nielsen N., Noronha-Falc‹ F., Nyquist P., Othman M., Owen A., Barra, M, Zink, E, Bleck, T, Caceres, E, Farrokh, S, Foreman, B, Cediel, E, Hemphill, J, Nagayama, M, Olson, D, Suarez, J, Aiyagari, V, Akbari, Y, Al-Mufti, F, Alexander, S, Alexandrov, A, Alkhachroum, A, Amiri, M, Appavu, B, Gebre, M, Bader, M, Badjiata, N, Balu, R, Beekman, R, Beghi, E, Bell, K, Beqiri, E, Berlin, T, Bodien, Y, Boerwinkle, V, Boly, M, Bonnel, A, Brown, E, Carroll, E, Chou, S, Citerio, G, Classen, J, Condie, C, Cosmas, K, Creutzfeldt, C, Dangayach, N, Degeorgia, M, Der-Nigoghoss, C, Desai, M, Diringer, M, Dullaway, J, Edlow, B, Ercole, A, Estraneo, A, Falcone, G, Padayachy, L, Park, S, Pergakis, M, Polizzotto, L, Pouratian, N, Spivack, M, Prisco, L, Provencio, J, Puybasset, L, Rasmussen, L, Rass, V, Richardson, R, Shinots, C, Robba, C, Robertson, C, Rohaut, B, Rolston, J, Rosanova, M, Rosenthal, E, Russell, M, Silva, G, Sanz, L, Sarasso, S, Sarwal, A, Schiff, N, Schnakers, C, Seder, D, Shah, V, Shapiro-Rosen, A, Shapshak, A, Sharma, K, Sharshar, T, Shutter, L, Sitt, J, Slomine, B, Smielewski, P, Smith, W, Stamatakis, E, Steinberg, A, Ferioli, S, Fernandez-Esp, D, Fink, E, Fins, J, Frontera, J, Ganesan, R, Ghavam, A, Giacino, J, Gibbons, C, Gilmore, E, Gosseries, O, Green, T, Greer, D, Guanci, M, Hahn, C, Hakimi, R, Hanley, D, Hartings, J, Hassan, A, Hinson, H, Hirsch, K, Hocker, S, Hu, P, Hu, X, Human, T, Hwang, D, Illes, J, Jaffa, M, James, M, Janas, A, Jones, M, Keller, E, Keogh, M, Kim, J, Kim, K, Kirsch, H, Kirschen, M, Ko, N, Kondziella, D, Kreitzer, N, Stevens, R, Sussman, B, Taran, S, Thibaut, A, Threlkeld, Z, Tinti, L, Toker, D, Torbey, M, Trevick, S, Turgeon, A, Udy, A, Varelas, P, Venkatasubba, C, Vespa, P, Videtta, W, Voss, H, Vox, F, Wagner, A, Wainwright, M, Whyte, J, Witherspoon, B, Yakhind, A, Zafonte, R, Zahuranec, D, Zammit, C, Zhang, B, Ziai, W, Zimmerman, L, Kromm, J, Kumar, A, Kurtz, P, Laureys, S, Lawson, T, Lejeune, N, Lewis, A, Liang, J, Ling, G, Livesay, S, Luppi, A, Madden, L, Maddux, C, Mahanes, D, Mainali, S, Maldonado, N, Ribeiro, R, Massimini, M, Mayer, S, Mccredie, V, Mcnett, M, Mejia-Mantill, J, Menon, D, Meyfroidt, G, Mijangos, J, Moberg, D, Moheet, A, Molteni, E, Monti, M, Morrison, C, Muehlschlegel, S, Murtaugh, B, Naccache, L, Nairon, E, Natarajan, G, Newcombe, V, Nielsen, N, Noronha-Falc‹, F, Nyquist, P, Othman, M, Owen, A, Barra M. E., Zink E. K., Bleck T. P., Caceres E., Farrokh S., Foreman B., Cediel E. G., Hemphill J. C., Nagayama M., Olson D. W. M., Suarez J. I., Aiyagari V., Akbari Y., Al-Mufti F., Alexander S., Alexandrov A., Alkhachroum A., Amiri M., Appavu B., Gebre M. A., Bader M. K., Badjiata N., Balu R., Beekman R., Beghi E., Bell K., Beqiri E., Berlin T., Bodien Y., Boerwinkle V., Boly M., Bonnel A., Brown E., Carroll E., Chou S., Citerio G., Classen J., Condie C., Cosmas K., Creutzfeldt C., Dangayach N., DeGeorgia M., Der-Nigoghoss C., Desai M., Diringer M., Dullaway J., Edlow B., Ercole A., Estraneo A., Falcone G., Padayachy L., Park S., Pergakis M., Polizzotto L., Pouratian N., Spivack M. P., Prisco L., Provencio J., Puybasset L., Rasmussen L., Rass V., Richardson R., Shinots C. R., Robba C., Robertson C., Rohaut B., Rolston J., Rosanova M., Rosenthal E., Russell M. B., Silva G. S., Sanz L., Sarasso S., Sarwal A., Schiff N., Schnakers C., Seder D., Shah V. A., Shapiro-Rosen A., Shapshak A., Sharma K., Sharshar T., Shutter L., Sitt J., Slomine B., Smielewski P., Smith W., Stamatakis E., Steinberg A., Ferioli S., Fernandez-Esp D., Fink E., Fins J., Frontera J., Ganesan R., Ghavam A., Giacino J., Gibbons C., Gilmore E., Gosseries O., Green T., Greer D., Guanci M., Hahn C., Hakimi R., Hanley D. F., Hartings J., Hassan A., Hinson H., Hirsch K., Hocker S., Hu P., Hu X., Human T., Hwang D., Illes J., Jaffa M., James M. L., Janas A., Jones M., Keller E., Keogh M., Kim J., Kim K., Kirsch H., Kirschen M., Ko N., Kondziella D., Kreitzer N., Stevens R., Sussman B., Taran S., Thibaut A., Threlkeld Z., Tinti L., Toker D., Torbey M., Trevick S., Turgeon A., Udy A., Varelas P., Venkatasubba C., Vespa P., Videtta W., Voss H., Vox F., Wagner A., Wainwright M., Whyte J., Witherspoon B., Yakhind A., Zafonte R., Zahuranec D., Zammit C., Zhang B., Ziai W., Zimmerman L., Kromm J., Kumar A., Kurtz P., Laureys S., Lawson T., Lejeune N., Lewis A., Liang J., Ling G., Livesay S., Luppi A., Madden L., Maddux C., Mahanes D., Mainali S., Maldonado N., Ribeiro R. M., Massimini M., Mayer S., McCredie V., McNett M., Mejia-Mantill J., Menon D., Meyfroidt G., Mijangos J., Moberg D., Moheet A., Molteni E., Monti M., Morrison C., Muehlschlegel S., Murtaugh B., Naccache L., Nairon E., Natarajan G., Newcombe V., Nielsen N., Noronha-Falc‹ F., Nyquist P., Othman M., and Owen A.

Abstract

The convergence of an interdisciplinary team of neurocritical care specialists to organize the Curing Coma Campaign is the first effort of its kind to coordinate national and international research efforts aimed at a deeper understanding of disorders of consciousness (DoC). This process of understanding includes translational research from bench to bedside, descriptions of systems of care delivery, diagnosis, treatment, rehabilitation, and ethical frameworks. The description and measurement of varying confounding factors related to hospital care was thought to be critical in furthering meaningful research in patients with DoC. Interdisciplinary hospital care is inherently varied across geographical areas as well as community and academic medical centers. Access to monitoring technologies, specialist consultation (medical, nursing, pharmacy, respiratory, and rehabilitation), staffing resources, specialty intensive and acute care units, specialty medications and specific surgical, diagnostic and interventional procedures, and imaging is variable, and the impact on patient outcome in terms of DoC is largely unknown. The heterogeneity of causes in DoC is the source of some expected variability in care and treatment of patients, which necessitated the development of a common nomenclature and set of data elements for meaningful measurement across studies. Guideline adherence in hemorrhagic stroke and severe traumatic brain injury may also be variable due to moderate or low levels of evidence for many recommendations. This article outlines the process of the development of common data elements for hospital course, confounders, and medications to streamline definitions and variables to collect for clinical studies of DoC.

Published
2023

10. Self-Collection Cervical Screening in the Asia-Pacific Region: A Scoping Review of Implementation Evidence

Author

Creagh, NS, Boyd, LAP, Bavor, C, Zammit, C, Saunders, T, Oommen, AM, Rankin, NM, Brotherton, JML, Nightingale, CE, Creagh, NS, Boyd, LAP, Bavor, C, Zammit, C, Saunders, T, Oommen, AM, Rankin, NM, Brotherton, JML, and Nightingale, CE

Abstract

PURPOSE: Although cervical cancer is a disease of inequity, it can be eliminated as a public health problem through vaccination, screening, and treatment. Human papillomavirus vaginal self-collection cervical screening is a high-performance test that can increase reach of screening. This review describes the different contexts and models of care used to pilot or implement self-collection within the Asia-Pacific, measures the extent that implementation outcome measures are reported and, where available, summarizes key implementation findings. METHODS: A scoping review was conducted by searching five databases of the peer-reviewed literature on June 20, 2022. Two researchers assessed eligibility and extracted data independently to the model of care used and the Conceptual Framework for Implementation Outcomes. A mixed-method consolidation of findings (quantitative: count and frequencies; qualitative: content analysis) was undertaken to narratively report findings. RESULTS: Fifty-seven articles, comprising 50 unique studies from 11 countries and two special autonomous regions, were included; 82% were conducted in trials. The implementation of self-collection was conducted in low- (2%), lower-middle- (32%), upper-middle- (32%), and high-income (35%) settings, with 10 different delivery models used; 80% delivered through practitioner-supported models with diversity in how samples were processed, and treatment was offered. Acceptability (73%) and appropriateness (64%) measures were most reported, followed by adoption (57%), feasibility (48%), and fidelity (38%). Only 7% of articles reported implementation cost or penetration measures. No articles reported sustainability measures. CONCLUSION: The literature confirms that self-collection cervical screening has been implemented within the Asia-Pacific region, with evidence demonstrating that it is acceptable and appropriate from the user's perspective. Well-designed, high-quality implementation trials and real-world evaluati

Published
2023

11. Perceived Utility of Intracranial Pressure Monitoring in Traumatic Brain Injury: A Seattle International Brain Injury Consensus Conference Consensus-Based Analysis and Recommendations

Author

Chesnut, R, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hawryluk, G, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Videtta, W, Wright, D, Zammit, C, Chesnut, Randall M, Aguilera, Sergio, Buki, Andras, Bulger, Eileen M, Citerio, Giuseppe, Cooper, D Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko G, Ghajar, Jamshid, Harris, Odette, Hawryluk, Gregory W J, Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K, Meyfroidt, Geert, Michael, Daniel B, Oddo, Mauro, Okonkwo, David O, Patel, Mayur B, Robertson, Claudia, Rosenfeld, Jeffrey V, Rubiano, Andres M, Sahuquillo, Juain, Servadei, Franco, Shutter, Lori, Stein, Deborah M, Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly D, Tsai, Eve C, Ullman, Jamie S, Videtta, Walter, Wright, David W, Zammit, Christopher, Chesnut, R, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hawryluk, G, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Videtta, W, Wright, D, Zammit, C, Chesnut, Randall M, Aguilera, Sergio, Buki, Andras, Bulger, Eileen M, Citerio, Giuseppe, Cooper, D Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko G, Ghajar, Jamshid, Harris, Odette, Hawryluk, Gregory W J, Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K, Meyfroidt, Geert, Michael, Daniel B, Oddo, Mauro, Okonkwo, David O, Patel, Mayur B, Robertson, Claudia, Rosenfeld, Jeffrey V, Rubiano, Andres M, Sahuquillo, Juain, Servadei, Franco, Shutter, Lori, Stein, Deborah M, Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly D, Tsai, Eve C, Ullman, Jamie S, Videtta, Walter, Wright, David W, and Zammit, Christopher

Abstract

BACKGROUND: Intracranial pressure (ICP) monitoring is widely practiced, but the indications are incompletely developed, and guidelines are poorly followed. OBJECTIVE: To study the monitoring practices of an established expert panel (the clinical working group from the Seattle International Brain Injury Consensus Conference effort) to examine the match between monitoring guidelines and their clinical decision-making and offer guidance for clinicians considering monitor insertion. METHODS: We polled the 42 Seattle International Brain Injury Consensus Conference panel members' ICP monitoring decisions for virtual patients, using matrices of presenting signs (Glasgow Coma Scale [GCS] total or GCS motor, pupillary examination, and computed tomography diagnosis). Monitor insertion decisions were yes, no, or unsure (traffic light approach). We analyzed their responses for weighting of the presenting signs in decision-making using univariate regression. RESULTS: Heatmaps constructed from the choices of 41 panel members revealed wider ICP monitor use than predicted by guidelines. Clinical examination (GCS) was by far the most important characteristic and differed from guidelines in being nonlinear. The modified Marshall computed tomography classification was second and pupils third. We constructed a heatmap and listed the main clinical determinants representing 80% ICP monitor insertion consensus for our recommendations. CONCLUSION: Candidacy for ICP monitoring exceeds published indicators for monitor insertion, suggesting the clinical perception that the value of ICP data is greater than simply detecting and monitoring severe intracranial hypertension. Monitor insertion heatmaps are offered as potential guidance for ICP monitor insertion and to stimulate research into what actually drives monitor insertion in unconstrained, real-world conditions.

Published
2023

12. Prognostication and Withdrawal of Care Decisions in Severe Traumatic Brain Injury: A Survey of The Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC) Working Group

Author

Sarigul, B, Bell, R, Chesnut, R, Aguilera, S, Buki, A, Citerio, G, Cooper, D, Diaz-Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Hawryluk, G, Sarigul, Buse, Bell, Randy S, Chesnut, Randall M, Aguilera, Sergio, Buki, Andras, Citerio, Giuseppe, Cooper, D James, Diaz-Arrastia, Ramon R, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romer, Ghajar, Jamshid, Harris, Odette A, Hoffer, Alan, Hutchinson, Peter John, Joseph, Matthew, Kitagawa, Ryan Seiji, Manley, Geoffrey T, Mayer, Stephan, Menon, David, Meyfroidt, Geert, Michael, Daniel, Oddo, Mauro, Okonkwo, David O, Patel, Mayur B, Robertson, Claudia S, Rosenfeld, Jeffrey V, Rubiano, Andres M, Sahuquillo, Juan, Servadei, Franco, Shutter, Lori, Stein, Deborah, Stocchetti, Nino, Taccone, Fabio, Timmons, Shelly, Tsai, Eve, Ullman, Jamie S, Vespa, Paul M, Videtta, Walter, Wright, David, Zammit, Christopher, Hawryluk, Gregory, Sarigul, B, Bell, R, Chesnut, R, Aguilera, S, Buki, A, Citerio, G, Cooper, D, Diaz-Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Hawryluk, G, Sarigul, Buse, Bell, Randy S, Chesnut, Randall M, Aguilera, Sergio, Buki, Andras, Citerio, Giuseppe, Cooper, D James, Diaz-Arrastia, Ramon R, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romer, Ghajar, Jamshid, Harris, Odette A, Hoffer, Alan, Hutchinson, Peter John, Joseph, Matthew, Kitagawa, Ryan Seiji, Manley, Geoffrey T, Mayer, Stephan, Menon, David, Meyfroidt, Geert, Michael, Daniel, Oddo, Mauro, Okonkwo, David O, Patel, Mayur B, Robertson, Claudia S, Rosenfeld, Jeffrey V, Rubiano, Andres M, Sahuquillo, Juan, Servadei, Franco, Shutter, Lori, Stein, Deborah, Stocchetti, Nino, Taccone, Fabio, Timmons, Shelly, Tsai, Eve, Ullman, Jamie S, Vespa, Paul M, Videtta, Walter, Wright, David, Zammit, Christopher, and Hawryluk, Gregory

Abstract

Best practice guidelines have advanced severe traumatic brain injury (TBI) care; however, there is little that currently informs goals of care decisions and processes despite their importance and frequency. Panelists from the Seattle International severe traumatic Brain Injury Consensus Conference (SIBICC) participated in a survey consisting of 24 questions. Questions queried use of prognostic calculators, variability in and responsibility for goals of care decisions, and acceptability of neurological outcomes, as well as putative means of improving decisions that might limit care. A total of 97.6% of the 42 SIBICC panelists completed the survey. Responses to most questions were highly variable. Overall, panelists reported infrequent use of prognostic calculators, and observed variability in patient prognostication and goals of care decisions. They felt that it would be beneficial for physicians to improve consensus on what constitutes an acceptable neurological outcome as well as what chance of achieving that outcome is acceptable. Panelists felt that the public should help to define what constitutes a good outcome and expressed some support for a “nihilism guard.” More than 50% of panelists felt that if it was certain to be permanent, a vegetative state or lower severe disability would justify a withdrawal of care decision, whereas 15% felt that upper severe disability justified such a decision. Whether conceptualizing an ideal or existing prognostic calculator to predict death or an unacceptable outcome, on average a 64-69% chance of a poor outcome was felt to justify treatment withdrawal. These results demonstrate important variability in goals of care decision making and a desire to reduce this variability. Our panel of recognized TBI experts opined on the neurological outcomes and chances of those outcomes that might prompt consideration of care withdrawal; however, imprecision of prognostication and existing prognostication tools is a significant impediment t

Published
2023

14. CN61 Patients’ experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): Interview results

Author

Matthews, L., primary, Teoh, M., additional, May, S., additional, Zammit, C., additional, Bloomfield, D., additional, Kothari, M., additional, Betal, D., additional, Santos, R., additional, Stewart, E., additional, Finlay, J., additional, Nicholson, K., additional, Elwell-Sutton, D., additional, McKinna, F., additional, Gage, H., additional, Bell, S., additional, and Jenkins, V.A., additional

Published
2022
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16. The experience of under-screened and never-screened participants using clinician-supported self-collection cervical screening within the Australian National Cervical Screening Program

Author

Creagh, NS, Zammit, C, Brotherton, JM, Saville, M, McDermott, T, Nightingale, C, Kelaher, M, Creagh, NS, Zammit, C, Brotherton, JM, Saville, M, McDermott, T, Nightingale, C, and Kelaher, M

Abstract

BACKGROUND: Australia has had significant successes in the prevention of cervical cancer. However, there is considerable scope for improving screening participation. In December 2017, Australia shifted from cytology to a human papillomavirus-based screening program as part of the renewed National Cervical Screening Program. This provided the opportunity to introduce a clinician-supported self-collection cervical screening pathway, which allows screening participants aged 30 years or more and who are under-screened or never-screened to screen via a self-collected human papillomavirus test. OBJECTIVE: This study aimed to explore screening participant experiences of a clinician-supported self-collection cervical screening pathway. METHODS: Interviews (n = 45) were conducted with participants who had used the clinician-supported self-collection cervical screening pathway in the Australian National Cervical Screening Program between December 2017 and April 2019. Interviews were analyzed using template analysis. RESULTS: Under-screened and never-screened participants reported a variety of interrelated barriers to cervical screening due to the nature of the test. For these participants, self-collection was a preferable way to perform screening as it overcame various barriers, was easy to use and promoted a sense of empowerment. Participants reported that the role of their practitioner was influential in their decision to undertake cervical screening, and that the support and information provided was a key factor in their experiences of the self-collection pathway. CONCLUSION: Findings support the use of a clinician-supported model of care, as an alternative screening modality in Australia's National Cervical Screening Program. As more countries consider the move from a cytology to human papillomavirus-based cervical screening program, this model may assist in greater engagement of under-screened participants.

Published
2022

21. 3D Path Planning for UAVs in Dynamic Environments in the Presence of Uncertainties

Author

Zammit, C., Mulder, Max, van Kampen, E., and Delft University of Technology

Subjects
Artificial intelligence, Path Planning, UAV, Uncertainty, Dynamic Environments, Real-time, 3-Dimension, Obstacle Avoidance
Abstract

Unmanned Aerial Vehicles (UAVs) are being integrated into all spheres of life, for a wide range of application in civil, commercial and military applications in both indoor and outdoor environments. UAV onboard intelligence is a paramount requirement in the realisation of UAV Traffic Management System (UTM) and Air Traffic Management (ATM) integration. The UAV onboard intelligence requirement is more envisaged in indoor applications where the use of Global Positioning Systems (GPS) is severely restricted and more complex localisation technology is required and traffic management systems are less supportive.For UAVs to be considered for specific tasks, their use must positively outweigh the use of other established, conventional systems. A key feature for UAVs would be a capability to perform autonomous, onboard real–time path planning. Path planning is defined as the process of automatically generating feasible and optimal paths to a predefined goal point in view of static and dynamic environmental and model constraints and uncertainties. This functionality allows UAVs to require minimal human intervention once its working environment and goals are defined. Therefore, autonomous and robust path planning is fundamental for UAVs to be considered for indoor applications in industrial, commercial, military and home applications.The need for autonomous path planning initiated with the introduction of robotics in industrial repetitive applications several decades ago. Since then, path planning extended outside factory floors evolving from 2D to 3D, operating in both static and dynamic environments with a wide spectrum of constraints and uncertainties. Path planning algorithms for autonomous vehicles can be broadly categorised into three main categories: Graph–based or Grid–based algorithms; Sampling–based algorithms and Interpolation algorithms.Although the use of UAVs has increased, the UAVs’ potential is far from reached. This can be mainly attributed to a number of challenges that have not been fully tackled and are hindering the use of small UAVs in indoor environments. This research will focus on path planning challenges in indoor, obstacle–rich environments with no UTM availability except for goal point definitions. In such scenario’s, the UAV is expected to operate using only onboard facilities. In this regard, three challenges are identified, which can be summarised as follows:Construct in real-time, non-colliding paths from the current UAV position to agoal position using only onboard UAV resources in the presence of both staticand dynamic obstacles and in the presence of uncertainties.The following research goal is formulated to address these three challenges for the realisation of path planning algorithm of UAVs in indoor environments.Assess the performance of state-of-the-art path planning rationales in the context of UAVs operating in 3D real–time, dynamic indoor environments in thepresence of uncertainty and identify a customised configuration based on theapplication.To tackle this research goal, five research questions are formulated:Research Question 1: What is the state-of-the-art in the field of path planning for UAVs in 3D and how do these algorithms compare?To investigate the potential of different path planning algorithms, the current state of-the-art in all fields of engineering are considered. The literature review shows that graph–based and sampling–based methods are potential candidates for 3D UAV path planning. The most often utilised algorithms from each category, that is the A* and Rapidly– Exploring Random Tree (RRT), and their variants, namely RRT without step size constraints and the Multiple RRT (MRRT) are tested in 3D scenarios of different complexity. A path smoothing interpolation algorithm is also developed to attenuate non–optimal paths, especially for the sampling-based methods.The same path smoothing algorithm is implemented on each path planning variant with the same parameters to offer a fair comparison. These algorithms are tested on the same set of different complexity 3D scenarios using the same computer. For comparison, the path length and the computational time are the considered performance measures.The A* with a spectrum of resolutions, the standard RRTwith different step–size constraints, RRT without step size constraints and the Multiple RRT (MRRT) with various seeds are implemented and their performance measures compared. For A*, tests show an inherent ripple in path length with change in resolution for all scenarios. This results due to the grid-based nature of the A* algorithm that creates situations in which a small increase in resolution, which theoretically shall slightly decrease the path length, effectively generates longer or shorter paths. This ripple is mitigated by randomly shifting the environment in all three dimensions by a distance varying between zero and half the distance between adjacent graph points.Results confirm that all algorithms are able to generate a path in all scenarios for all resolutions, step sizes and seeds considered. In comparison, the A* algorithm generates shorter paths in less time with respect to RRT algorithms, although the A* algorithm only explores areas necessary for path construction while RRT algorithms explore the environment evenly. Results show that A* outperformed the RRT, both in terms of path length and path generation time in offline situations with static obstacles, with 100% success rate for both in all scenarios considered.A* allows the environment to be discretised differently according to different exigencies of different parts of the scenario, making optimal use of resources. Oppositely, RRT and its variants are suited to generate paths efficiently in evenly distributed and focused 3D area exploration applications. Based on the results obtained, and their implication to UAV path planning, the second research question is tackled.Research Question 2: Can the selected path planning algorithms be applied inreal-time static environments using the computational resources onboard smallUAVs?This research question assumes that all path planning computation, sensing and environmental modelling and actuator controls must be computed onboard and in real–time. Another implication is that the path planner can only visualise the environment within the sensing distance determined by the on-board sensing systems and therefore can only construct, if possible, a path to an intermediate goal point.For the scope of this research question, a sphere equal to the sensing range of the UAV is considered, assuming that the sensing system has a 360 degrees field-of-view (FOV) in all three dimensions. It is further assumed that static obstacles within the sensing range are known with certainty, while other obstacles are unknown and become visible only if the UAV moves in their direction. To simulate real-time path planning, the computational time must be less than or equal to the time needed by the UAV tomove from the currentposition to a new position. The same test environment used to tackle Research Question 1 is used, using the same performance measures.Results show that the A* algorithm again outperforms the RRT algorithm in both path length and computational time for all scenarios considered, with the difference increasing with scenario complexity. A* is successful 90% or more of all tests for all scenarios considered provided the look-ahead distance is at least double the distance moved per iterate. In general, the RRT algorithmresults in a lower success rate than A* owing to the longer computational time required to construct intermediate paths with respect to A*.The UAV speed, sensor range and computational power are defined based on different studies that analyse these parameters onboard a range of UAVs [1–3]. The path planning results, based on these UAV parameters, show that 3D real-time path planning can be realised using only UAV onboard systems. The results outline the best empirical values for the different parameters. The setting of these parameters will configure the 3D real-time path planning platform, optimising its performance to each particular indoor application.Research Question 2 considered only static obstacles but in real UAV application obstacles can move and rotate, hence a dynamic environment needs to be considered to assess the usability of the developed 3D real-time UAV path planning algorithm. This requirement is investigated in the following research question:Research Question 3: What is the effect on path planning performance if staticobstacles are replaced with dynamic obstacles?The inclusion of dynamic environments is external to the path planning algorithmbut it can affect the path that the UAV will traverse. Dynamic obstacles within an indoor environment can be represented by symmetrical shapes. For the scope of this work, four different scenarios with different complexity are constructed. These incorporate rotating and non-rotating cubes, rotating V-shaped obstacles and static 2D planes with windows.Both obstacle movement and orientation are considered in the dynamic environment modelling. The random obstacle movement speed is assumed to be smaller than or equal to the speed of the UAV, as otherwise obstacle avoidance is not possible.A real-time environment with a limited range creates situations where an intermediate goal point is not available. In this regard, two different rationales are developed to mitigate this situation. In the waiting rationale, the UAV waits in its current position until the defined intermediate goal position becomes available. In the moving rationale, the intermediate goal position is moved closed to the current UAV position, consequently increasing the chances of the UAV moving closer to the final goal position. Both rationales are integrated within the A* and RRT path planning algorithms and tested in all scenarios with dynamic obstacles.Results show that the moving option yields better overall results in terms of pathlength, computational time and success rate for A* and RRT with respect to the waiting option. Both A* and RRT produce similar results in relatively simple scenarios with RRT recording better results in path length, computational time and success rate. For complex scenarios, the RRT is better if time is not limited while the A* algorithm is less susceptible to time constraints. Also, as speed increases in complex scenarios the success rate drops due to lack of path planning time in both A* and RRT.The results show that the developed 3D real-time path planning platform with both A* and RRT algorithms has potential to be used in low obstacle density dynamic obstacle scenarios. The waiting variant is suited in situations where safety is paramount. In home environments, this is usually the case as the UAV cannot collide with obstacles, especially if these are humans. The moving variant would be ideal in situations where goal achievement is more important than safety. Such situations include search and rescue.Until now it is assumed that no uncertainties are present within the UAV systems. In real scenarios a range of uncertainties are present. In the next research question, uncertainty in a UAV operating in an indoor environment is investigated.Research Question 4: Do uncertainties affect 3D path planning of UAVs? If yes,how can these uncertainties be modelled?This research question queries whether uncertainties affect path planning of UAVs in indoor environments. This requires a thorough literature survey and consequently the identification and modelling of uncertainty sources that might affect path planning performance.For the scope of this work, only uncertainties within the UAV model and theenvironment (perceived through UAV onboard sensing systems), are considered. Other uncertainties, such as communication with user/s, are not considered as they are out of scope for this analysis.Literature identifies the need for uncertainty consideration in real-time 3D UAV path planning, due to the possible negative implications on path planning performance if uncertainties are neglected. The fidelity with which uncertainties can be predicted is essential in determining the usability of the proposed path planning algorithms. Furthermore, literature portrays the bounding shapes and probabilistic distributions methods as key candidates for uncertainty modelling in UAV applications. After considering the characteristics of both methods, uncertainty is modelled using bounded shapes around the current UAV position and obstacle volume.Once uncertainty sources are identified, estimated and modelled, the developed 3D real-time path planning algorithms are assessed in the presence of dynamic obstacles and uncertainties.Research Question 5: Can uncertainties be mitigated to ensure collision-free 3Dpath planning of UAVs in real-time in the presence of dynamic obstacles?The same test environment constructed to assess Research Question 3 is considered using the same real-time 3D UAV path planning platform. Tests are performed using both A* and RRT path planning algorithms with the moving method. Uncertainty bounds are quantified based on literature and varied between 2% and 20% for both UAV position and obstacles. Uncertainty is included by adding an offset to the actual respective parameter. The effect of each uncertainty source will be analysed independently and collectively with dynamic obstacles to identify how real-time path planning algorithms can safely operate.Results show that both sources of uncertainty (UAV position and obstacles), deteriorate path planning performance of both A* and RRT algorithms, for all scenarios considered, with RRT exhibiting the larger effect. The concurrent inclusion of both uncertainty sources further deteriorates path planning performance. RRT results in the fastest and shortest paths, with approximately the same success rate as A*, for relatively simpler scenarios, while A* performs better in the relatively complex case. Furthermore, RRT has a higher risk of collision than A* as RRT nears obstacles more often than A*.From the results it is confirmed that uncertainty must be considered as it has aneffect on path planning performance. The accuracy with which uncertainty is modelled affects path planning performance for both path planning rationales considered.In this thesis, each research question built on the previous one, in such a way toreach the final research goal and tackling the research challenges. In the process of assessing the path planning performance (first part of research goal) of each algorithm, the response of each method with respect to each additional complication, can be independently analysed. This knowledge can be used to guide future UAV designers in selecting the best configuration, based on their application, hence reaching the second part of the research goal.The implementation of the developed 3D real-time path planning algorithms to configure a real UAV for autonomous 3D UAV navigation in an indoor, obstacle-rich environment is the ultimate future goal that can lead into the commercialisation of this system for use in domestic applications. Moreover, this real-time 3D UAV path planning system can be proposed for integration in outdoor UAVs. Finally, this dissertation’s ultimate aim is to contribute in reducing the gap that still exists to integrate UAVs into domestic environments with the aim of improving current and future services that rely on UAVs with the ultimate aim of enhancing people in their daily lives.REFERENCES[1] Hrabar, S., “3D Path Planning and Stereo-based Obstacle Avoidance for Rotorcraft UAVs”, IEEE/RSJ International Conference on Intelligent Robots and Systems, Nice, France, 22-26 Sep. 2008, pp. 807-814.[2] Yao, P.,Wang, H. and Su, Z., “Real-time path planning of unmanned aerial vehicle for target tracking and obstacle avoidance in complex dynamic environment,” Aerospace Science and Technology, Vol. 47, pp. 269-279, 2015.[3] Ferguson, D. and Stentz, A. “Using interpolation to improve path planning: The field D* algorithm”, Journal of Field Robotics, Vol. 23, No. 2, pp. 79-101, 2006.

Published
2021

25. 3D Real–time Path Planning of UAVs in dynamic environments in the presence of uncertainty

Author

Zammit, C. and Erik-Jan van Kampen

Abstract

Unmanned Aerial Vehicles (UAVs) are being integrated into all spheres of life varying in a wide range of applications from military to civil applications. In such applications, UAVs are expected to operate safely in the presence of uncertainties present in the dynamic environment and the UAV itself. Based on literature different uncertainty sources are identified, quantified and modelled using bounding shapes. The UAV model, path planner parameters and four different complexity scenarios with different moving shapes are defined in view of real UAVs. For analysis uncertainty is varied between 2% and 20% for UAV position and obstacle position and orientation. Results show that both types of uncertainty deteriorate path planning performance of both A* and RRT algorithms for all scenarios considered especially for RRT. RRT results in faster and shorter paths with approximately the same success rate (>95%) as A* for simple scenarios. For complex scenarios A* performs better. This work shows that 3D real—time path planning in different obstacle density, moving obstacle environments in the presence of uncertainty is possible.

Published
2021

26. 3D Real–time Path Planning of UAVs in dynamic environments in the presence of uncertainty

Author

Zammit, C. (author), van Kampen, E. (author), Zammit, C. (author), and van Kampen, E. (author)

Abstract

Unmanned Aerial Vehicles (UAVs) are being integrated into all spheres of life varying in a wide range of applications from military to civil applications. In such applications, UAVs are expected to operate safely in the presence of uncertainties present in the dynamic environment and the UAV itself. Based on literature different uncertainty sources are identified, quantified and modelled using bounding shapes. The UAV model, path planner parameters and four different complexity scenarios with different moving shapes are defined in view of real UAVs. For analysis uncertainty is varied between 2% and 20% for UAV position and obstacle position and orientation. Results show that both types of uncertainty deteriorate path planning performance of both A* and RRT algorithms for all scenarios considered especially for RRT. RRT results in faster and shorter paths with approximately the same success rate (>95%) as A* for simple scenarios. For complex scenarios A* performs better. This work shows that 3D real—time path planning in different obstacle density, moving obstacle environments in the presence of uncertainty is possible., Control & Simulation

Published
2021

27. 3D Path Planning for UAVs in Dynamic Environments in the Presence of Uncertainties

Author

Zammit, C. (author) and Zammit, C. (author)

Abstract

Unmanned Aerial Vehicles (UAVs) are being integrated into all spheres of life, for a wide range of application in civil, commercial and military applications in both indoor and outdoor environments. UAV onboard intelligence is a paramount requirement in the realisation of UAV Traffic Management System (UTM) and Air Traffic Management (ATM) integration. The UAV onboard intelligence requirement is more envisaged in indoor applications where the use of Global Positioning Systems (GPS) is severely restricted and more complex localisation technology is required and traffic management systems are less supportive. For UAVs to be considered for specific tasks, their use must positively outweigh the use of other established, conventional systems. A key feature for UAVs would be a capability to perform autonomous, onboard real–time path planning. Path planning is defined as the process of automatically generating feasible and optimal paths to a predefined goal point in view of static and dynamic environmental and model constraints and uncertainties. This functionality allows UAVs to require minimal human intervention once its working environment and goals are defined. Therefore, autonomous and robust path planning is fundamental for UAVs to be considered for indoor applications in industrial, commercial, military and home applications. The need for autonomous path planning initiated with the introduction of robotics in industrial repetitive applications several decades ago. Since then, path planning extended outside factory floors evolving from 2D to 3D, operating in both static and dynamic environments with a wide spectrum of constraints and uncertainties. Path planning algorithms for autonomous vehicles can be broadly categorised into three main categories: Graph–based or Grid–based algorithms; Sampling–based algorithms and Interpolation algorithms. Although the use of UAVs has increased, the UAVs’ potential is far from reached. This can be mainly, Control & Simulation

Published
2021

28. Self-collection cervical screening in the renewed National Cervical Screening Program: a qualitative study

Author

Creagh, NS, Zammit, C, Brotherton, JML, Saville, M, McDermott, T, Nightingale, C, Kelaher, M, Creagh, NS, Zammit, C, Brotherton, JML, Saville, M, McDermott, T, Nightingale, C, and Kelaher, M

Abstract

OBJECTIVES: To evaluate the implementation and acceptability of the self-collection cervical screening pathway since commencement of the renewed National Cervical Screening Program (rNCSP), from the perspectives of screening participants and primary care practitioners. DESIGN, SETTING, PARTICIPANTS: Qualitative study; individual semi-structured interviews with 45 screening participants and 18 primary care practitioners in Victoria who had engaged with the self-collection pathway during the first 17 months of the rNCSP (1 December 2017 - 30 April 2019). RESULTS: The self-collection pathway was highly acceptable as an alternative cervical screening pathway for most participating screening participants and practitioners. Some screening participants indicated that they would not have been screened had the pathway not been available. Acceptability was lower among those who had tested positive for HPV types not 16/18, a result that requires additional testing of a clinician-collected cervical sample. Use of the self-collection pathway is driven more by practitioners than their patients. Interpretations of the self-collection guidelines varied between practices. Barriers to expanding promotion of the pathway by practitioners included difficulties with identifying eligible participants. CONCLUSIONS: Increasing the accessibility of the self-collection pathway to under- and never screened women could reduce inequities in cervical cancer outcomes for those not participating in the main screening pathway. Practitioners should be provided resources to integrate self-collection into routine practice and to efficiently implement the entire self-collection pathway, in order to maximise its use and to optimise the experience for screening participants.

Published
2021

29. 3D real-time path planning of UAVs in dynamic environments

Author

Zammit, C. (author), van Kampen, E. (author), Zammit, C. (author), and van Kampen, E. (author)

Abstract

Unmanned Aerial Vehicles (UAVs) are taking active roles in personal, commercial, industrial and military applications due to their efficiency, availability and low-cost. UAVs must operate safely and in real-time in both static and dynamic environments. An extensive literature review, defines the dynamic environment term, the need for dynamic path planning and reviews different solutions. This paper presents a 3D real-time path planning platform to assess the performance of the A* and RRT algorithms. Four test scenarios with varying difficulty are constructed consisting of V-obstacles, cubes and 2D planes moving at time-varying speed, direction and orientation. Two rationales to either wait or move further in the direction of the goal when an intermediate goal point is not available are considered. Results show that for both A* and RRT the moving variant case performs better especially in complex scenarios. RRT performs better in simple scenarios and complex scenarios at low speed while A* performs better at high speeds in complex scenarios. A success rate of over 95% is recorded for three scenarios for all considered speeds and for both algorithm., Virtual/online event due to COVID-19, Control & Simulation

Published
2021
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30. Electron-Phonon Interaction in NTD Ge Irradiated in 1980

Author

Stefanyi, P., Rentzsch, R., Fozooni, P., Zammit, C. C., Lea, M. J., Saunders, J., Cardona, Manuel, editor, Fulde, Peter, editor, von Klitzing, Klaus, editor, Queisser, Hans-Joachim, editor, Lotsch, Helmut K. V., editor, Meissner, Michael, editor, and Pohl, Robert O., editor

Published
1993
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32. A BRIEF DISSECTION'S GUIDE TO NORMAL MEDIASTINAL ANATOMY

Author

CIPOLLA, Filippo, Fazio,B, Polisano,V, Sole,F, Spataro,B, Venezia,A, Marino Gammazza,A, Saguto,D, Pitruzzella,A, Mazzola,M, Guarrera,A, Nobile,S, Gagliardo,C, Lo Piccolo,C, Zammit,C, Porrello,C, Tomasello,G, Carini,F, Cipolla,F, Fazio,B, Polisano,V, Sole,F, Spataro,B, Venezia,A, Marino Gammazza,A, Saguto,D, Pitruzzella,A, Mazzola,M, Guarrera,A, Nobile,S, Gagliardo,C, Lo Piccolo,C, Zammit,C, Porrello,C, Tomasello,G, and Carini,F

Subjects
Settore MED/18 - Chirurgia Generale, Settore BIO/16 - Anatomia Umana, DISSECTION COURSE, CADAVERIC STUDTY, MEDIASTINUM
Abstract

The purpose of this article is to show the mediastinal dissection method used during the stage performed by a group of students from the Univrersity of palermo that, during the sumer of 2017, had the opportunity to spend a period of 4 weeks at the Department of Anatomy of The University of malta. The students were guided to practice dissection of some corpes to study various mediastinal organs. This experience permitted to the students to verify practically what they lernt in the books, and reperesented a unique opportunity for them to perform practice with cadavers, that is actually very difficult to do in italian universities.

Published
2019

33. 17. A quality improvement project evaluating the application of a primary care referral screening tool for patients presenting to their GP with breast pain

Author

Halliday, Suzanne, primary, Zammit, C., additional, Preston, K., additional, Tse, U., additional, Sewers, L., additional, Bell, S., additional, Heyre, Z., additional, Groves, N., additional, O'Brien, S., additional, Green, H., additional, Bloomfield, D., additional, and Mancey-Barratt, A., additional

Published
2021
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34. A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)

Author

Chesnut, R, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Hawryluk, G, Chesnut, Randall, Aguilera, Sergio, Buki, Andras, Bulger, Eileen, Citerio, Giuseppe, Cooper, D Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romer, Ghajar, Jamshid, Harris, Odette, Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K, Meyfroidt, Geert, Michael, Daniel B, Oddo, Mauro, Okonkwo, David, Patel, Mayur, Robertson, Claudia, Rosenfeld, Jeffrey V, Rubiano, Andres M, Sahuquillo, Juan, Servadei, Franco, Shutter, Lori, Stein, Deborah, Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly, Tsai, Eve, Ullman, Jamie S, Vespa, Paul, Videtta, Walter, Wright, David W, Zammit, Christopher, Hawryluk, Gregory W J, Chesnut, R, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Hawryluk, G, Chesnut, Randall, Aguilera, Sergio, Buki, Andras, Bulger, Eileen, Citerio, Giuseppe, Cooper, D Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romer, Ghajar, Jamshid, Harris, Odette, Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K, Meyfroidt, Geert, Michael, Daniel B, Oddo, Mauro, Okonkwo, David, Patel, Mayur, Robertson, Claudia, Rosenfeld, Jeffrey V, Rubiano, Andres M, Sahuquillo, Juan, Servadei, Franco, Shutter, Lori, Stein, Deborah, Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly, Tsai, Eve, Ullman, Jamie S, Vespa, Paul, Videtta, Walter, Wright, David W, Zammit, Christopher, and Hawryluk, Gregory W J

Abstract

Background: Current guidelines for the treatment of adult severe traumatic brain injury (sTBI) consist of high-quality evidence reports, but they are no longer accompanied by management protocols, as these require expert opinion to bridge the gap between published evidence and patient care. We aimed to establish a modern sTBI protocol for adult patients with both intracranial pressure (ICP) and brain oxygen monitors in place. Methods: Our consensus working group consisted of 42 experienced and actively practicing sTBI opinion leaders from six continents. Having previously established a protocol for the treatment of patients with ICP monitoring alone, we addressed patients who have a brain oxygen monitor in addition to an ICP monitor. The management protocols were developed through a Delphi-method-based consensus approach and were finalized at an in-person meeting. Results: We established three distinct treatment protocols, each with three tiers whereby higher tiers involve therapies with higher risk. One protocol addresses the management of ICP elevation when brain oxygenation is normal. A second addresses management of brain hypoxia with normal ICP. The third protocol addresses the situation when both intracranial hypertension and brain hypoxia are present. The panel considered issues pertaining to blood transfusion and ventilator management when designing the different algorithms. Conclusions: These protocols are intended to assist clinicians in the management of patients with both ICP and brain oxygen monitors but they do not reflect either a standard-of-care or a substitute for thoughtful individualized management. These protocols should be used in conjunction with recommendations for basic care, management of critical neuroworsening and weaning treatment recently published in conjunction with the Seattle International Brain Injury Consensus Conference.

Published
2020

35. Comparison of A* and RRT in real–time 3D path planning of UAVs

Author

Zammit, C. (author), van Kampen, E. (author), Zammit, C. (author), and van Kampen, E. (author)

Abstract

Unmanned Aerial Vehicles (UAVs) are being integrated into a wide range of military, industrial and commercial applications. Such applications require faultless autonomous systems to coordinate, guide, navigate and control different UAVs of different sizes, designed for different purposes with different capabilities. In this regard, different path planning algorithms were developed to ensure that UAVs are supplied with collision-free path paramount to which are the A* and the RRT algorithms, a graph-based and a sampling-based algorithm respectively. Such algorithms shall ideally operate in real-time to furnish the UAV navigation system with real-time, valid, obstacle-free paths in view of changes in the environment or other external or user-defined restrictions. Owing this need, in this paper a real-time platform to assess the performance of the A* and RRT algorithm with an associated smoothing algorithm was developed and tested using 3, 3D obstacle environment with different complexities. The salient user-defined, system-defined and internal constants were independently considered and their effect on performance assessed. Results showed that the A* outperformed the RRT algorithm in both path length and computational time for all scenarios considered with difference increasing with scenario complexity. But, both algorithms can be utilised if the associated parameters are attentively chosen based on the scenario the UAV will operate as both algorithm reached a 100% success rate for all scenario at specific parameter assignments., Control & Simulation

Published
2020
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39. A BRIEF ANATOMO-SURGICAL DISSECTION GUIDE TO HUMAN NECK: RESULTS OF THE COLLABORATION BETWEEN THE UNIVERSITY OF PALERMO AND THE UNIVERSITY OF MALTA

Author

Carini,F, Salerno,M, Mazzola M, Lo Piccolo, C, Cavallo,G, MUSSO, Serafina, Gentile,S, D'Accardo,S, La Mantia, A, Accardo,A, Baldari,B, Besi,L, scopetti,M, Faleo,M, Zammit,C, Tomasello,G, Carini,F, Salerno,M, Mazzola,M, Lo Piccolo,C, Cavallo,G, Musso,S, Gentile,S, D'Accardo,S, La Mantia, A, Accardo,A, Baldari,B, Besi,L, scopetti,M, Faleo,M, Zammit,C, and Tomasello,G

Subjects
Settore MED/18 - Chirurgia Generale, Settore BIO/06 - Anatomia Comparata E Citologia, surgical dissection cadaveric study, surgical dissection course, topographical anatomy
Abstract

The aim of this article is to show methods for dissection of the neck. In the summer of 2017 a group of students of the University of Palermo that have already passed the exam of Human Anatomy took a 4 weeks dissection course at the University of Malta. The students were provided with a dissection kit, video recording equipment and cameras for taking pictures. They dissected the skin, the subcutaneous tissue, the muscular bundles, the muscles, the vascular and nervous bundles, the nerves, the larynx, the trachea and the esophagus. This paper presents the results of the dissection course and a small and simple guide to young students and medical doctors who want to learn the bases of neck dissection.

Published
2018

45. Advancements for A* and RRT in 3D path planning of UAVs

Author

Zammit, C. (author), van Kampen, E. (author), Zammit, C. (author), and van Kampen, E. (author)

Abstract

Advancements in Unmanned Aerial Vehicles (UAVs) design, actuator and sensory systems and control are making such devices financially available to a wide spectrum of users with various demands and expectations. To mitigate with this ever increasing demand robust, efficient and application–specific path planning is important. This paper presents advancements over the A* and the smoothing algorithms presented in, 1 utilising the same test scenarios. Analysis of results in 1 showed a ripple in path length as the resolution changes for all scenarios considered and less than 0.1% path length improvements after certain amount of smoothing iterates. To attenuate the path length ripple, the A* ripple reduction algorithm was developed. Results show a reduction of more than 46% in terms of standard deviation with respect to the original A* algorithm without any increase in the mean path length for all scenarios. Secondly, the smoothing algorithm developed in 1 was improved to stop smoothing based on the rate of smoothing of previous iterates. Results show more than 10 multiple less path smoothing time maintaining a path length reduction especially for simple scenarios. These advancements further portray the discussed path planning algorithms as candidates to the realisation of online 3D UAV path planning., Control & Simulation

Published
2019
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46. A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC)

Author

Hawryluk, G, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Chesnut, R, Hawryluk, Gregory W. J., Aguilera, Sergio, Buki, Andras, Bulger, Eileen, Citerio, Giuseppe, Cooper, D. Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko, Ghajar, Jamshid, Harris, Odette, Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K., Meyfroidt, Geert, Michael, Daniel B., Oddo, Mauro, Okonkwo, David, Patel, Mayur, Robertson, Claudia, Rosenfeld, Jeffrey V., Rubiano, Andres M., Sahuquillo, Juan, Servadei, Franco, Shutter, Lori, Stein, Deborah, Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly, Tsai, Eve, Ullman, Jamie S., Vespa, Paul, Videtta, Walter, Wright, David W., Zammit, Christopher, Chesnut, Randall M., Hawryluk, G, Aguilera, S, Buki, A, Bulger, E, Citerio, G, Cooper, D, Arrastia, R, Diringer, M, Figaji, A, Gao, G, Geocadin, R, Ghajar, J, Harris, O, Hoffer, A, Hutchinson, P, Joseph, M, Kitagawa, R, Manley, G, Mayer, S, Menon, D, Meyfroidt, G, Michael, D, Oddo, M, Okonkwo, D, Patel, M, Robertson, C, Rosenfeld, J, Rubiano, A, Sahuquillo, J, Servadei, F, Shutter, L, Stein, D, Stocchetti, N, Taccone, F, Timmons, S, Tsai, E, Ullman, J, Vespa, P, Videtta, W, Wright, D, Zammit, C, Chesnut, R, Hawryluk, Gregory W. J., Aguilera, Sergio, Buki, Andras, Bulger, Eileen, Citerio, Giuseppe, Cooper, D. Jamie, Arrastia, Ramon Diaz, Diringer, Michael, Figaji, Anthony, Gao, Guoyi, Geocadin, Romergryko, Ghajar, Jamshid, Harris, Odette, Hoffer, Alan, Hutchinson, Peter, Joseph, Mathew, Kitagawa, Ryan, Manley, Geoffrey, Mayer, Stephan, Menon, David K., Meyfroidt, Geert, Michael, Daniel B., Oddo, Mauro, Okonkwo, David, Patel, Mayur, Robertson, Claudia, Rosenfeld, Jeffrey V., Rubiano, Andres M., Sahuquillo, Juan, Servadei, Franco, Shutter, Lori, Stein, Deborah, Stocchetti, Nino, Taccone, Fabio Silvio, Timmons, Shelly, Tsai, Eve, Ullman, Jamie S., Vespa, Paul, Videtta, Walter, Wright, David W., Zammit, Christopher, and Chesnut, Randall M.

Abstract

Background: Management algorithms for adult severe traumatic brain injury (sTBI) were omitted in later editions of the Brain Trauma Foundation’s sTBI Management Guidelines, as they were not evidence-based. Methods: We used a Delphi-method-based consensus approach to address management of sTBI patients undergoing intracranial pressure (ICP) monitoring. Forty-two experienced, clinically active sTBI specialists from six continents comprised the panel. Eight surveys iterated queries and comments. An in-person meeting included whole- and small-group discussions and blinded voting. Consensus required 80% agreement. We developed heatmaps based on a traffic-light model where panelists’ decision tendencies were the focus of recommendations. Results: We provide comprehensive algorithms for ICP-monitor-based adult sTBI management. Consensus established 18 interventions as fundamental and ten treatments not to be used. We provide a three-tier algorithm for treating elevated ICP. Treatments within a tier are considered empirically equivalent. Higher tiers involve higher risk therapies. Tiers 1, 2, and 3 include 10, 4, and 3 interventions, respectively. We include inter-tier considerations, and recommendations for critical neuroworsening to assist the recognition and treatment of declining patients. Novel elements include guidance for autoregulation-based ICP treatment based on MAP Challenge results, and two heatmaps to guide (1) ICP-monitor removal and (2) consideration of sedation holidays for neurological examination. Conclusions: Our modern and comprehensive sTBI-management protocol is designed to assist clinicians managing sTBI patients monitored with ICP-monitors alone. Consensus-based (class III evidence), it provides management recommendations based on combined expert opinion. It reflects neither a standard-of-care nor a substitute for thoughtful individualized management.

Published
2019

49. Sensitization to dust mite defines different phenotypes of asthma: A multicenter study

Author

Ruggieri, S., Drago, G., Longo, V., Colombo, P., Balzan, M., Bilocca, D., Zammit, C., Montefort, S., Scaccianoce, G., Cuttitta, G., Viegi, G., Cibella, F., Rizzo, G, Ferrante, Giuliana, Ruggieri, S., Drago, G., Longo, V., Colombo, P., Balzan, M., Bilocca, D., Zammit, C., Montefort, S., Scaccianoce, G., Cuttitta, G., Viegi, G., Cibella, F., and Rizzo, G

Subjects
Male, Immunoglobulin E, medicine.disease_cause, Pulmonary function testing, Exhaled nitric oxide, 0302 clinical medicine, Allergen, Risk Factors, Surveys and Questionnaires, Cluster Analysis, Medicine, Immunology and Allergy, 030212 general & internal medicine, Cluster analysi, Child, Sensitization, Settore ING-IND/11 - Fisica Tecnica Ambientale, biology, medicine.diagnostic_test, Mediterranean Region, Pyroglyphidae, respiratory system, Phenotype, medicine.anatomical_structure, Air Pollution, Indoor, Female, medicine.symptom, Spirometry, Adolescent, Asthma risk factor, Immunology, Nitric Oxide, 03 medical and health sciences, Indoor allergen, Wheeze, Animals, Humans, Asthma risk factors, Indoor allergens, Skin Tests, Asthma, business.industry, Environmental Exposure, Allergens, medicine.disease, respiratory tract diseases, Cross-Sectional Studies, 030228 respiratory system, Pediatrics, Perinatology and Child Health, biology.protein, business
Abstract

Background Indoor allergens are risk factors for asthma: Thus, the characterization of indoor air quality is important for studying environment–health relationships in children. In particular, Dermatophagoides pteronyssinus is the dominant allergen for asthma. We cross-sectionally investigated the relationships among respiratory symptoms and function, airway inflammation, allergen sensitization, and indoor allergen concentration. Methods One hundred and thirty-two children aging 10-14 years and living in a Southern Mediterranean area were evaluated by parental questionnaires. Spirometry, exhaled nitric oxide (FeNO), skin prick tests, total, and specific serum IgE analyses were performed along with the evaluation of home dust samples for the content in Der p 1 allergen. Three clusters were created on the basis of the presence/absence of wheeze in the last 12 months (Wh12m) and Der p 1-specific IgE level. Results Cluster 1 (Wh12m+/high Der p 1 IgE) presented higher FeNO and poorer pulmonary function (lower FEV1 and FEF25%-75%), while its symptom score was not different from Cluster 2 (Wh12m+/low Der p 1 IgE). Cluster 3 (Wh12m−/low IgE) showed the lowest FeNO values and pulmonary function similar to Cluster 2. Within Cluster 1, both Der p 1-specific IgE and FeNO were positively correlated with dust Der p 1. Conclusions Similar asthma phenotypes may occur in children despite differences in their atopic state. In atopic children, sensitizing allergens in the indoor environment may increase airway inflammation worsening pulmonary function. Moreover, environmental exposures may contribute to the development of asthma-like symptoms also in the absence of atopic sensitization, thus contributing to asthma overdiagnosis.

Published
2017

50. Nurture groups e resilienza

Author

Cavioni, V, Cefai, C, Duca, M, Zammit, C, Galea, N, Cavioni, V, Cefai, C, Duca, M, Zammit, C, and Galea, N

Subjects
Nurture Group, Resilienza, RESCUR
Published
2017

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