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Reddan T, Corness J, Harden F, Hu W, Mengersen K. Bayesian Approach to Predicting Acute Appendicitis Using Ultrasonographic and Clinical Variables in Children. Healthc Inform Res 2019; 25:212-220. [PMID: 31406613 PMCID: PMC6689514 DOI: 10.4258/hir.2019.25.3.212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/07/2019] [Accepted: 05/26/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives Ultrasound has an established role in the diagnostic pathway for children with suspected appendicitis. Relevant clinical information can influence the diagnostic probability and reporting of ultrasound findings. A Bayesian network (BN) is a directed acyclic graph (DAG) representing variables as nodes connected by directional arrows permitting visualisation of their relationships. This research developed a BN model with ultrasonographic and clinical variables to predict acute appendicitis in children. Methods A DAG was designed through a hybrid method based on expert opinion and a review of literature to define the model structure; and the discretisation and weighting of identified variables were calculated using principal components analysis, which also informed the conditional probability table of nodes. Results The acute appendicitis target node was designated as an outcome of interest influenced by four sub-models, including Ultrasound Index, Clinical History, Physical Assessment, and Diagnostic Tests. These sub-models included four sonographic, three blood-test, and six clinical variables. The BN was scenario tested and evaluated for face, predictive, and content validity. A lack of similar networks complicated concurrent and convergent validity evaluation. Conclusions To our knowledge, this is the first BN model developed for the identification of acute appendicitis incorporating imaging variables. It has particular benefit for cases in which variables are missing because prior probabilities are built into corresponding nodes. It will be of use to clinicians involved in ultrasound examination of children with suspected appendicitis, as well as their treating clinicians. Prospective evaluation and development of an online tool will permit validation and refinement of the BN.
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Affiliation(s)
- Tristan Reddan
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Australia.,Faculty of Science and Engineering, Queensland University of Technology, Brisbane, Australia
| | - Jonathan Corness
- Medical Imaging and Nuclear Medicine, Queensland Children's Hospital, South Brisbane, Australia
| | | | - Wenbiao Hu
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Kerrie Mengersen
- Faculty of Science and Engineering, Queensland University of Technology, Brisbane, Australia
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Reddan T, Corness J, Harden F, Mengersen K. Paediatric appendiceal ultrasound: a survey of Australasian sonographers' opinions on examination performance and sonographic criteria. J Med Radiat Sci 2018; 65:267-274. [PMID: 30370623 PMCID: PMC6275268 DOI: 10.1002/jmrs.310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The objectives of this study were to identify knowledge gaps and/or perceived limitations in the performance of paediatric appendiceal ultrasound by Australasian sonographers. We hypothesised that: sonographers' confidence in visualising the appendix in children was poor, particularly outside predominantly paediatric practice; workplace support for prolonging examinations to improve visualisation was limited; and the sonographic criteria applied in diagnosis did not reflect contemporary literature. METHODS A cross-sectional survey of Australasian sonographers regarding paediatric appendicitis was conducted using a mixed methods approach (quantitative and qualitative data). Text responses were analysed for key themes, and quantitative data analysed using chi-square, Mann-Whitney U and Wilcoxon signed-rank tests. RESULTS Of the 124 respondents, 27 (21.8%) reported a visualisation rate of less than 10%. Workplace support for extending examination time was significantly related to a higher appendix visualisation rate (χ2 (2) = 16.839, P < 0.001). Text responses reported frustration locating the appendix and a desire for more time and practice to improve visualisation. Sonographers suggested a significantly lower maximum diameter cut-off in a 5-year-old compared to a 13-year-old (Z = -6.07, P < 0.001), and considered the presence of inflamed peri-appendiceal mesentery as the most useful sonographic criterion in diagnosing acute appendicitis. CONCLUSIONS Respondents had a low opinion of their ability to confidently identify the appendix. Confidence was greater in those centres where extending scanning time was encouraged. Application of echogenic mesentery as the most significant secondary sonographic criterion is supported by recent studies. Opinions of diameter cut-offs varied, indicating potential for improved awareness of recent research.
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Affiliation(s)
- Tristan Reddan
- Medical Imaging and Nuclear MedicineLady Cilento Children's HospitalChildren's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
- Science and Engineering FacultyQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Jonathan Corness
- Medical Imaging and Nuclear MedicineLady Cilento Children's HospitalChildren's Health Queensland Hospital and Health ServiceSouth BrisbaneQueenslandAustralia
| | - Fiona Harden
- Hunter Industrial MedicineMaitlandNew South WalesAustralia
| | - Kerrie Mengersen
- Science and Engineering FacultyQueensland University of TechnologyBrisbaneQueenslandAustralia
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Reddan T, Corness J, Harden F, Mengersen K. Analysis of the predictive value of clinical and sonographic variables in children with suspected acute appendicitis using decision tree algorithms. Sonography 2018. [DOI: 10.1002/sono.12156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tristan Reddan
- Medical Imaging and Nuclear Medicine; Lady Cilento Children's Hospital, Children's Health Queensland Hospital and Health Service; South Brisbane QLD Australia
- Science and Engineering Faculty; Queensland University of Technology; Brisbane QLD Australia
| | - Jonathan Corness
- Medical Imaging and Nuclear Medicine; Lady Cilento Children's Hospital, Children's Health Queensland Hospital and Health Service; South Brisbane QLD Australia
| | - Fiona Harden
- Hunter Industrial Medicine; Maitland NSW Australia
| | - Kerrie Mengersen
- Science and Engineering Faculty; Queensland University of Technology; Brisbane QLD Australia
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Hargrave C, Deegan T, Bednarz T, Poulsen M, Harden F, Mengersen K. An image‐guided radiotherapy decision support framework incorporating a Bayesian network and visualization tool. Med Phys 2018; 45:2884-2897. [DOI: 10.1002/mp.12979] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/01/2018] [Accepted: 04/14/2018] [Indexed: 11/10/2022] Open
Affiliation(s)
- Catriona Hargrave
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane 4000 Australia
| | - Timothy Deegan
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
| | - Tomasz Bednarz
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- Data 61 Commonwealth Scientific and Industrial Research Organisation Brisbane 4102 Australia
- Expanded Perception and Interaction Centre University of New South Wales Paddington 2021 Australia
| | - Michael Poulsen
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- Faculty of Medicine University of Queensland Brisbane 4072 Australia
| | - Fiona Harden
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- Hunter Industrial Medicine Maitland 2320 Australia
| | - Kerrie Mengersen
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
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Hargrave C, Deegan T, Poulsen M, Bednarz T, Harden F, Mengersen K. A feature alignment score for online cone‐beam
CT
‐based image‐guided radiotherapy for prostate cancer. Med Phys 2018; 45:2898-2911. [DOI: 10.1002/mp.12980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/22/2018] [Accepted: 04/14/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Catriona Hargrave
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane 4000 Australia
| | - Timothy Deegan
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
| | - Michael Poulsen
- Radiation Oncology Princess Alexandra Hospital – Raymond Terrace Queensland Health Brisbane 4101 Australia
- Faculty of Medicine University of Queensland Brisbane 4072 Australia
| | - Tomasz Bednarz
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
- Data 61 Commonwealth Scientific and Industrial Research Organisation Brisbane 4102 Australia
- Expanded Perception and Interaction Centre University of New South Wales Paddington 2021 Australia
| | - Fiona Harden
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
| | - Kerrie Mengersen
- School of Mathematical Sciences Science and Engineering Faculty Queensland University of Technology Brisbane 4000 Australia
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Reddan T, Corness J, Harden F, Mengersen K. Improving the value of ultrasound in children with suspected appendicitis: a prospective study integrating secondary sonographic signs. Ultrasonography 2018; 38:67-75. [PMID: 30016853 PMCID: PMC6323308 DOI: 10.14366/usg.17062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 05/07/2018] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The purpose of this study was to determine whether the awareness and inclusion of secondary sonographic signs of appendicitis, in combination with a structured evaluation as part of engagement and training for sonographers, improved appendix visualization rates and reduced equivocal findings in children with suspected acute appendicitis. METHODS This was a prospective study of 230 children at a tertiary children's hospital in Australia referred for an ultrasound examination of suspected appendicitis. The ultrasound findings, radiology reports, histology, clinical results, and follow-up were collated. Secondary signs were used as an additional assessment of the likelihood of disease where possible, even in the absence of an identified appendix. RESULTS The implementation of a structured evaluation as part of sonographer engagement and training resulted in a 28% improvement in appendix visualization (68.7%) compared with a prior retrospective study in a similar population (40.7%). The diagnostic accuracy was 91.7%, with likelihood ratios suggesting a meaningful influence of the pre-test probability of appendicitis in children studied (positive likelihood ratio, 11.22; negative likelihood ratio, 0.09.). Only 7.8% of the findings were equivocal. A binary 6-mm diameter cut-off did not account for equivocal cases, particularly lymphoid hyperplasia. CONCLUSION Engagement of sonographers performing pediatric appendiceal ultrasound through training in the scanning technique and awareness of secondary signs significantly improved the visualization rate and provided more meaningful findings to referrers.
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Affiliation(s)
- Tristan Reddan
- Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, South Brisbane, Australia.,Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
| | - Jonathan Corness
- Medical Imaging and Nuclear Medicine, Lady Cilento Children's Hospital, South Brisbane, Australia
| | | | - Kerrie Mengersen
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Australia
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7
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Tuyet-Hanh TT, Minh NH, Vu-Anh L, Dunne M, Toms LM, Tenkate T, Thi MHN, Harden F. Corrigendum to "Environmental health risk assessment of dioxin in foods at the two most severe dioxin hot spots in Vietnam" [Int. J. Hyg. Environ. Health 218 (2015) 471-478]. Int J Hyg Environ Health 2018; 221:364. [PMID: 29290573 DOI: 10.1016/j.ijheh.2017.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tran Thi Tuyet-Hanh
- Hanoi School of Public Health, 138 Giang Vo Street, Hanoi, Viet Nam; School of Clinical Sciences and Institute of Health and Biomedical Innovation - The Queensland University of Technology, Brisbane, Australia.
| | - Nguyen Hung Minh
- Dioxin Laboratory, Centre for Environment Monitoring, Vietnam Environment Administration, Nr. 556 Nguyen Van Cu, Long Bien, Hanoi, Viet Nam.
| | - Le Vu-Anh
- Vietnam Public Health Association, 138 Giang Vo Street, Hanoi, Viet Nam.
| | - Michael Dunne
- School of Public Health and Social Work - The Queensland University of Technology, Brisbane, Australia.
| | - Leisa-Maree Toms
- School of Clinical Sciences and Institute of Health and Biomedical Innovation - The Queensland University of Technology, Brisbane, Australia.
| | | | - Minh-Hue Nguyen Thi
- Dioxin Laboratory, Centre for Environment Monitoring, Vietnam Environment Administration, Nr. 556 Nguyen Van Cu, Long Bien, Hanoi, Viet Nam
| | - Fiona Harden
- School of Clinical Sciences and Institute of Health and Biomedical Innovation - The Queensland University of Technology, Brisbane, Australia.
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8
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Shorter P, Harden F, Owen R, Panizza B, Burmeister B, Sommerville J, Mengersen K, Foote M. Risk Profiles for Sensorineural Hearing Loss in Patients with Head and Neck Cancer Receiving Cisplatin-based Chemoradiation. J Med Imaging Radiat Sci 2017; 48:61-67. [DOI: 10.1016/j.jmir.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 08/23/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022]
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9
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Affiliation(s)
- Tristan Reddan
- Medical Imaging and Nuclear Medicine; Lady Cilento Children's Hospital; Australia
- Science and Engineering Faculty; Queensland University of Technology; Australia
| | - Jonathan Corness
- Medical Imaging and Nuclear Medicine; Lady Cilento Children's Hospital; Australia
| | - Jennifer Powell
- Medical Imaging and Nuclear Medicine; Lady Cilento Children's Hospital; Australia
| | - Fiona Harden
- Science and Engineering Faculty; Queensland University of Technology; Australia
- Hunter Industrial Medicine; Maitland NSW Australia
| | - Kerrie Mengersen
- Science and Engineering Faculty; Queensland University of Technology; Australia
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10
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Brown E, Owen R, Harden F, Mengersen K, Oestreich K, Houghton W, Poulsen M, Harris S, Lin C, Porceddu S. Head and neck adaptive radiotherapy: Predicting the time to replan. Asia Pac J Clin Oncol 2016; 12:460-467. [PMID: 27435432 DOI: 10.1111/ajco.12516] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 02/10/2016] [Accepted: 04/11/2016] [Indexed: 11/27/2022]
Abstract
AIM Head and neck (H&N) cancer patients can undergo anatomical change throughout radiotherapy treatment. Adaptive radiotherapy (ART) is effective in addressing the impact of this change on the planned dose distribution. The aim of this study was to identify pretreatment factors that influence the need for and timing of replanning for patients receiving chemoradiotherapy for node-positive nasopharyngeal (NPC) and oropharyngeal carcinoma (OPC). METHODS Of 110 patients enrolled in a prospective H&N ART study, 21 (19%) underwent a second planning scan (re-CT) and were included in this review. Univariate and multivariate analysis was used to compare those patients who were replanned with those that were not. Factors influencing the timing of replanning were assessed including patient and tumor characteristics and structure volume details. RESULTS Of the five replanned patients, three were diagnosed with NPC (P = 0.06) and had significantly larger initial nodal volumes (median volume 140.3 cc vs. 39.1 cc, P = 0.019). Overall the median time of re-CT was significantly different between replanned and non-replanned patients, with replanned patients having an earlier re-CT: median fraction 18 versus fraction 23 (P = 0.01). Specifically, NPC patients who were replanned had a re-CT performed earlier than OPC patients (median fraction 11 vs. 20). CONCLUSION For H&N patients with large nodes receiving definitive chemoradiotherapy, replanning may be considered at the commencement of week 3 for NPC patients and in week 4 of treatment for OPC patients. This information may facilitate a forward planning approach to H&N ART that enables allocation of departmental resources prior to treatment commencement.
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Affiliation(s)
- Elizabeth Brown
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rebecca Owen
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fiona Harden
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kerrie Mengersen
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kimberley Oestreich
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Whitney Houghton
- Radiation Oncology Department, Radiation Oncology Mater Centre, Brisbane, Queensland, Australia
| | - Michael Poulsen
- Radiation Oncology Department, Radiation Oncology Mater Centre, Brisbane, Queensland, Australia
| | - Selina Harris
- Radiation Oncology Department, Royal Brisbane and Women's, Brisbane, Queensland, Australia
| | - Charles Lin
- Radiation Oncology Department, Royal Brisbane and Women's, Brisbane, Queensland, Australia
| | - Sandro Porceddu
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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11
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Affiliation(s)
- Tristan Reddan
- Medical Imaging and Nuclear Medicine; Lady Cilento Children's Hospital; South Brisbane Queensland Australia
- Science and Engineering Faculty; Queensland University of Technology; Brisbane Queensland Australia
| | - Jonathan Corness
- Medical Imaging and Nuclear Medicine; Lady Cilento Children's Hospital; South Brisbane Queensland Australia
| | - Kerrie Mengersen
- Science and Engineering Faculty; Queensland University of Technology; Brisbane Queensland Australia
| | - Fiona Harden
- Science and Engineering Faculty; Queensland University of Technology; Brisbane Queensland Australia
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12
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Hargrave C, Mason N, Guidi R, Miller JA, Becker J, Moores M, Mengersen K, Poulsen M, Harden F. Automated replication of cone beam CT-guided treatments in the Pinnacle(3) treatment planning system for adaptive radiotherapy. J Med Radiat Sci 2016; 63:48-58. [PMID: 27087975 PMCID: PMC4775828 DOI: 10.1002/jmrs.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/01/2015] [Accepted: 08/08/2015] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Time-consuming manual methods have been required to register cone-beam computed tomography (CBCT) images with plans in the Pinnacle(3) treatment planning system in order to replicate delivered treatments for adaptive radiotherapy. These methods rely on fiducial marker (FM) placement during CBCT acquisition or the image mid-point to localise the image isocentre. A quality assurance study was conducted to validate an automated CBCT-plan registration method utilising the Digital Imaging and Communications in Medicine (DICOM) Structure Set (RS) and Spatial Registration (RE) files created during online image-guided radiotherapy (IGRT). METHODS CBCTs of a phantom were acquired with FMs and predetermined setup errors using various online IGRT workflows. The CBCTs, DICOM RS and RE files were imported into Pinnacle(3) plans of the phantom and the resulting automated CBCT-plan registrations were compared to existing manual methods. A clinical protocol for the automated method was subsequently developed and tested retrospectively using CBCTs and plans for six bladder patients. RESULTS The automated CBCT-plan registration method was successfully applied to thirty-four phantom CBCT images acquired with an online 0 mm action level workflow. Ten CBCTs acquired with other IGRT workflows required manual workarounds. This was addressed during the development and testing of the clinical protocol using twenty-eight patient CBCTs. The automated CBCT-plan registrations were instantaneous, replicating delivered treatments in Pinnacle(3) with errors of ±0.5 mm. These errors were comparable to mid-point-dependant manual registrations but superior to FM-dependant manual registrations. CONCLUSION The automated CBCT-plan registration method quickly and reliably replicates delivered treatments in Pinnacle(3) for adaptive radiotherapy.
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Affiliation(s)
- Catriona Hargrave
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia; Faculty of Health School of Clinical Sciences Queensland University of Technology Brisbane Queensland Australia; Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia
| | - Nicole Mason
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia
| | - Robyn Guidi
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia
| | - Julie-Anne Miller
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia
| | - Jillian Becker
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia
| | - Matthew Moores
- Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia; School of Mathematics, Science and Engineering Queensland University of Technology Brisbane Queensland Australia
| | - Kerrie Mengersen
- Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia; School of Mathematics, Science and Engineering Queensland University of Technology Brisbane Queensland Australia
| | - Michael Poulsen
- Radiation Oncology Mater Centre Cancer Services, Metro South Health Service District South Brisbane Queensland Australia
| | - Fiona Harden
- Faculty of Health School of Clinical Sciences Queensland University of Technology Brisbane Queensland Australia; Institute for Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Queensland Australia
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Brown E, Owen R, Harden F, Mengersen K, Oestreich K, Houghton W, Poulsen M, Harris S, Lin C, Porceddu S. The Use of Predictive Modeling in Adaptive Radiation Therapy for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Victor K, Harden F, Mengersen K, Howard J, Chambers JB. Echocardiographic measures of pulmonary hypertension and the prediction of end-points in sickle cell disease. Sonography 2016. [DOI: 10.1002/sono.12050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- K. Victor
- Department of Cardiology; Guy's and St Thomas' Foundation Trust; London UK
- Faculty of Science and Engineering; Queensland University of Technology; Brisbane Australia
| | - F. Harden
- Faculty of Science and Engineering; Queensland University of Technology; Brisbane Australia
| | - K. Mengersen
- Faculty of Science and Engineering; Queensland University of Technology; Brisbane Australia
| | - J. Howard
- Department of Haematology; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - J. B. Chambers
- Department of Cardiology; Guy's and St Thomas' Foundation Trust; London UK
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15
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Reddan T, Corness J, Mengersen K, Harden F. Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding. J Med Radiat Sci 2016; 63:59-66. [PMID: 27087976 PMCID: PMC4775827 DOI: 10.1002/jmrs.154] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 11/10/2015] [Accepted: 11/14/2015] [Indexed: 01/03/2023] Open
Abstract
Sonography is an important clinical tool in diagnosing appendicitis in children as it can obviate both exposure to potentially harmful ionising radiation from computed tomography scans and the need for unnecessary appendicectomies. This review examines the diagnostic accuracy of ultrasound in the identification of acute appendicitis, with a particular focus on the the utility of secondary sonographic signs as an adjunct or corollary to traditionally examined criteria. These secondary signs can be important in cases where the appendix cannot be identified with ultrasound and a more meaningful finding may be made by incorporating the presence or absence of secondary sonographic signs. There is evidence that integrating these secondary signs into the final ultrasound diagnosis can improve the utility of ultrasound in cases where appendicitis is expected, though there remains some conjecture about whether they play a more important role in negative or positive prediction in the absence of an identifiable appendix.
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Affiliation(s)
- Tristan Reddan
- Lady Cilento Children's Hospital Children's Health Queensland South Brisbane Qld Australia; School of Mathematics Science and Engineering Faculty Queensland University of Technology Brisbane Qld Australia; Institute of Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Qld Australia
| | - Jonathan Corness
- Lady Cilento Children's Hospital Children's Health Queensland South Brisbane Qld Australia
| | - Kerrie Mengersen
- School of Mathematics Science and Engineering Faculty Queensland University of Technology Brisbane Qld Australia; Institute of Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Qld Australia
| | - Fiona Harden
- Institute of Health and Biomedical Innovation Queensland University of Technology Kelvin Grove Qld Australia; School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane Qld Australia
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16
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Beaudequin D, Harden F, Roiko A, Mengersen K. Utility of Bayesian networks in QMRA-based evaluation of risk reduction options for recycled water. Sci Total Environ 2016; 541:1393-1409. [PMID: 26479913 DOI: 10.1016/j.scitotenv.2015.10.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/07/2015] [Accepted: 10/07/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Quantitative microbial risk assessment (QMRA), the current method of choice for evaluating human health risks associated with disease-causing microorganisms, is often constrained by issues such as availability of required data, and inability to incorporate the multitude of factors influencing risk. Bayesian networks (BNs), with their ability to handle data paucity, combine quantitative and qualitative information including expert opinions, and ability to offer a systems approach to characterisation of complexity, are increasingly recognised as a powerful, flexible tool that overcomes these limitations. OBJECTIVES We present a QMRA expressed as a Bayesian network (BN) in a wastewater reuse context, with the objective of demonstrating the utility of the BN method in health risk assessments, particularly for evaluating a range of exposure and risk mitigation scenarios. As a case study, we examine the risk of norovirus infection associated with wastewater-irrigated lettuce. METHODS A Bayesian network was developed following a QMRA approach, using published data, and reviewed by domain experts using a participatory process. DISCUSSION Employment of a BN facilitated rapid scenario evaluations, risk minimisation, and predictive comparisons. The BN supported exploration of conditions required for optimal outcomes, as well as investigation of the effect on the reporting nodes of changes in 'upstream' conditions. A significant finding was the indication that if maximum post-treatment risk mitigation measures were implemented, there was a high probability (0.84) of a low risk of infection regardless of fluctuations in other variables, including norovirus concentration in treated wastewater. CONCLUSION BNs are useful in situations where insufficient empirical data exist to satisfy QMRA requirements and they are exceptionally suited to the integration of risk assessment and risk management in the QMRA context. They allow a comprehensive visual appraisal of major influences in exposure pathways, and rapid interactive risk assessment in multifaceted water reuse scenarios.
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Affiliation(s)
- Denise Beaudequin
- Faculty of Health, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
| | - Fiona Harden
- Faculty of Health, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
| | - Anne Roiko
- School of Medicine, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland 4222, Australia; Smartwater Research Centre, Griffith University, Gold Coast Campus, Edmund Rice Dr, Southport, Queensland 4215, Australia.
| | - Kerrie Mengersen
- Science and Engineering Faculty, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia; Institute for Future Environments (IFE), Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia.
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Beaudequin D, Harden F, Roiko A, Stratton H, Lemckert C, Mengersen K. Modelling microbial health risk of wastewater reuse: A systems perspective. Environ Int 2015; 84:131-141. [PMID: 26277638 DOI: 10.1016/j.envint.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/15/2015] [Accepted: 08/01/2015] [Indexed: 06/04/2023]
Abstract
There is a widespread need for the use of quantitative microbial risk assessment (QMRA) to determine reclaimed water quality for specific uses, however neither faecal indicator levels nor pathogen concentrations alone are adequate for assessing exposure health risk. The aim of this study was to build a conceptual model representing factors contributing to the microbiological health risks of reusing water treated in maturation ponds. This paper describes the development of an unparameterised model that provides a visual representation of theoretical constructs and variables of interest. Information was collected from the peer-reviewed literature and through consultation with experts from regulatory authorities and academic disciplines. In this paper we explore how, considering microbial risk as a modular system, following the QMRA framework enables incorporation of the many factors influencing human exposure and dose response, to better characterise likely human health impacts. By using and expanding upon the QMRA framework we deliver new insights into this important field of environmental exposures. We present a conceptual model of health risk of microbial exposure which can be used for maturation ponds and, more importantly, as a generic tool to assess health risk in diverse wastewater reuse scenarios.
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Affiliation(s)
- Denise Beaudequin
- Faculty of Health, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
| | - Fiona Harden
- Faculty of Health, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
| | - Anne Roiko
- School of Medicine, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland 4222, Australia; Smartwater Research Centre, Griffith University, Gold Coast Campus, Edmund Rice Dr, Southport, Queensland 4215, Australia.
| | - Helen Stratton
- School of Natural Sciences, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia; Smartwater Research Centre, Griffith University, Gold Coast Campus, Edmund Rice Dr, Southport, Queensland 4215, Australia.
| | - Charles Lemckert
- Griffith School of Engineering, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland 4222, Australia; Smartwater Research Centre, Griffith University, Gold Coast Campus, Edmund Rice Dr, Southport, Queensland 4215, Australia.
| | - Kerrie Mengersen
- Science and Engineering Faculty, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia; Institute for Future Environments (IFE), Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia.
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Tuyet-Hanh TT, Vu-Anh L, Dunne M, Toms LM, Tenkate T, Harden F. Dioxin risk reduction programme at the most severe dioxin hot spot in Vietnam: Residual knowledge, attitude and practices five years post intervention. Glob Public Health 2015; 11:463-74. [PMID: 26234818 DOI: 10.1080/17441692.2015.1062904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Bien Hoa Airbase was one of the bulk storage and supply facilities for defoliants during the Vietnam War. Environmental and biological samples taken around the airbase have elevated levels of dioxin. In 2007, a pre-intervention knowledge, attitude and practice (KAP) survey of local residents living in Trung Dung and Tan Phong wards was undertaken regarding appropriate strategies to reduce dioxin exposure. A risk reduction programme was implemented in 2008 and post-intervention KAP surveys were undertaken in 2009 and 2013 to evaluate the longer term impacts. Quantitative assessment was undertaken via a KAP survey in 2013 among 600 local residents randomly selected from the two intervention wards and one control ward (Buu Long). Eight in-depth interviews and two focus group discussions were also undertaken for qualitative assessment. Most programme activities had ceased and dioxin risk communication activities had not been integrated into local routine health education programmes; however, main results generally remained and were better than that in Buu Long. In total, 48.2% of households undertook measures to prevent exposure, higher than those in pre- and post-intervention surveys (25.8% and 39.7%) and the control ward (7.7%). Migration and the sensitive nature of dioxin issues were the main challenges for the programme's sustainability.
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Affiliation(s)
- Tran Thi Tuyet-Hanh
- a Hanoi School of Public Health , Hanoi , Vietnam.,b School of Clinical Sciences and Institute of Biomedical Innovation , The Queensland University of Technology , Brisbane , Australia
| | - Le Vu-Anh
- c Vietnam Public Health Association , Hanoi , Vietnam
| | - Michael Dunne
- d School of Public Health and Social Work , The Queensland University of Technology , Brisbane , Australia
| | - Leisa-Maree Toms
- d School of Public Health and Social Work , The Queensland University of Technology , Brisbane , Australia
| | - Thomas Tenkate
- e School of Occupational and Public Health, Ryerson University , Ontario , Canada
| | - Fiona Harden
- b School of Clinical Sciences and Institute of Biomedical Innovation , The Queensland University of Technology , Brisbane , Australia
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Beaudequin D, Harden F, Roiko A, Stratton H, Lemckert C, Mengersen K. Beyond QMRA: Modelling microbial health risk as a complex system using Bayesian networks. Environ Int 2015; 80:8-18. [PMID: 25827265 DOI: 10.1016/j.envint.2015.03.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/17/2015] [Accepted: 03/19/2015] [Indexed: 05/24/2023]
Abstract
BACKGROUND Quantitative microbial risk assessment (QMRA) is the current method of choice for determining the risk to human health from exposure to microorganisms of concern. However, current approaches are often constrained by the availability of required data, and may not be able to incorporate the many varied factors that influence this risk. Systems models, based on Bayesian networks (BNs), are emerging as an effective complementary approach that overcomes these limitations. OBJECTIVES This article aims to provide a comparative evaluation of the capabilities and challenges of current QMRA methods and BN models, and a scoping review of recent published articles that adopt the latter for microbial risk assessment. Pros and cons of systems approaches in this context are distilled and discussed. METHODS A search of the peer-reviewed literature revealed 15 articles describing BNs used in the context of QMRAs for foodborne and waterborne pathogens. These studies were analysed in terms of their application, uses and benefits in QMRA. DISCUSSION The applications were notable in their diversity. BNs were used to make predictions, for scenario assessment, risk minimisation, to reduce uncertainty and to separate uncertainty and variability. Most studies focused on a segment of the exposure pathway, indicating the broad potential for the method in other QMRA steps. BNs offer a number of useful features to enhance QMRA, including transparency, and the ability to deal with poor quality data and support causal reasoning. CONCLUSION The method has significant untapped potential to describe the complex relationships between microbial environmental exposures and health.
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Affiliation(s)
- Denise Beaudequin
- Faculty of Health, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
| | - Fiona Harden
- Faculty of Health, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059, Australia.
| | - Anne Roiko
- School of Medicine, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland 4222, Australia; Smartwater Research Centre, Griffith University, Gold Coast Campus, Edmund Rice Drive, Southport, Queensland 4215, Australia.
| | - Helen Stratton
- School of Natural Sciences, Griffith University, Nathan Campus, 170 Kessels Road, Nathan, Queensland 4111, Australia; Smartwater Research Centre, Griffith University, Gold Coast Campus, Edmund Rice Drive, Southport, Queensland 4215, Australia.
| | - Charles Lemckert
- Griffith School of Engineering, Griffith University, Gold Coast Campus, Parklands Drive, Southport, Queensland 4222, Australia; Smartwater Research Centre, Griffith University, Gold Coast Campus, Edmund Rice Drive, Southport, Queensland 4215, Australia.
| | - Kerrie Mengersen
- Science and Engineering Faculty, Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia; Institute for Future Environments (IFE), Queensland University of Technology, Gardens Point Campus, 2 George Street, Brisbane, Queensland 4000, Australia.
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Brown E, Owen R, Harden F, Mengersen K, Oestreich K, Houghton W, Poulsen M, Harris S, Lin C, Porceddu S. Predicting the need for adaptive radiotherapy in head and neck cancer. Radiother Oncol 2015; 116:57-63. [PMID: 26142268 DOI: 10.1016/j.radonc.2015.06.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/12/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Adaptive radiotherapy (ART) can account for the dosimetric impact of anatomical change in head and neck cancer patients; however it can be resource intensive. Consequently, it is imperative that patients likely to require ART are identified. The purpose of this study was to find predictive factors that identify oropharyngeal squamous cell carcinoma (OPC) and nasopharyngeal carcinoma (NPC) patients more likely to need ART. MATERIALS AND METHODS One hundred and ten patients with OPC or NPC were analysed. Patient demographics and tumour characteristics were compared between patients who were replanned and those that were not. Factors found to be significant were included in logistic regression models. Risk profiles were developed from these models. A dosimetric analysis was performed. RESULTS Nodal disease stage, pre-treatment largest involved node size, diagnosis and initial weight (categorised in 2 groups) were identified as significant for inclusion in the model. Two models were found to be significant (p=0.001), correctly classifying 98.2% and 96.1% of patients respectively. Three ART risk profiles were developed. CONCLUSION Predictive factors identifying OPC or NPC patients more likely to require ART were reported. A risk profile approach could facilitate the effective implementation of ART into radiotherapy departments through forward planning and appropriate resource allocation.
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Affiliation(s)
- Elizabeth Brown
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Australia; Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia.
| | - Rebecca Owen
- Radiation Oncology Department, Radiation Oncology Mater Centre, Brisbane, Australia
| | - Fiona Harden
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia
| | - Kerrie Mengersen
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia
| | - Kimberley Oestreich
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Whitney Houghton
- Radiation Oncology Department, Radiation Oncology Mater Centre, Brisbane, Australia
| | - Michael Poulsen
- Radiation Oncology Department, Radiation Oncology Mater Centre, Brisbane, Australia
| | - Selina Harris
- Radiation Oncology Department, Royal Brisbane and Women's Hospital, Australia
| | - Charles Lin
- Radiation Oncology Department, Royal Brisbane and Women's Hospital, Australia
| | - Sandro Porceddu
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
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Moores MT, Hargrave CE, Deegan T, Poulsen M, Harden F, Mengersen K. An external field prior for the hidden Potts model with application to cone-beam computed tomography. Comput Stat Data Anal 2015. [DOI: 10.1016/j.csda.2014.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Tuyet-Hanh TT, Vu-Anh L, Dunne M, Toms LM, Tenkate T, Harden F. Sustainability of Public Health Interventions to Reduce the Risk of Dioxin Exposure at Severe Dioxin Hot Spots in Vietnam. J Community Health 2014; 40:652-9. [PMID: 25524211 DOI: 10.1007/s10900-014-9980-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Severe dioxin contamination at Bien Hoa and Da Nang airbases, Vietnam is of international concern. Public Health risk reduction programs were implemented in Bien Hoa in 2007-2009 and in Da Nang in 2009-2011. In 2009 and 2011 we reported the encouraging results of these interventions in improving the knowledge, attitude and practices (KAP) of local residents in reducing the dioxin exposure risk through foods. In 2013 we revisited these dioxin hot spots, aimed to evaluate whether the results of the intervention were maintained and to identify factors affecting the sustainability of the programs. To assess this, 16 in-depth interviews, six focus group discussions, and pre and post intervention KAP surveys were undertaken. 800 respondents from six intervention wards and 200 respondents from Buu Long Ward (the control site) were randomly selected to participate in the surveys. The results showed that as of 2013, the programs were rated as "moderately sustained" with a score of 3.3 out of 5.0 (cut off points 2.5 to <3.5) for Bien Hoa, and "well sustained" with a score of 3.8 out of 5.0 (cut off points 3.5 to <4.5) for Da Nang. Most formal intervention program activities had ceased and dioxin risk communication activities were no longer integrated into local routine health education programs. However, the main outcomes were maintained and were better than that in the control ward. Migration, lack of official guidance from City People's Committees and local authorities as well as the politically sensitive nature of dioxin issues were the main challenges for the sustainability of the programs.
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Affiliation(s)
- Tran Thi Tuyet-Hanh
- Hanoi School of Public Health, 138 Giang Vo Street, Ba Dinh District, Hanoi, 10000, Vietnam,
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Toms LML, Thompson J, Rotander A, Hobson P, Calafat AM, Kato K, Ye X, Broomhall S, Harden F, Mueller JF. Decline in perfluorooctane sulfonate and perfluorooctanoate serum concentrations in an Australian population from 2002 to 2011. Environ Int 2014; 71:74-80. [PMID: 24980755 PMCID: PMC4724209 DOI: 10.1016/j.envint.2014.05.019] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 05/19/2023]
Abstract
Some perfluoroalkyl and polyfluoroalkyl substances (PFASs) have become widespread pollutants detected in human and wildlife samples worldwide. The main objective of this study was to assess temporal trends of PFAS concentrations in human blood in Australia over the last decade (2002-2011), taking into consideration age and sex trends. Pooled human sera from 2002/03 (n=26); 2008/09 (n=24) and 2010/11 (n=24) from South East Queensland, Australia were obtained from de-identified surplus pathology samples and compared with samples collected previously from 2006/07 (n=84). A total of 9775 samples in 158 pools were available for an assessment of PFASs. Stratification criteria included sex and age: <16 years (2002/03 only); 0-4 (2006/07, 2008/09, 2010/11); 5-15 (2006/07, 2008/09, 2010/11); 16-30; 31-45; 46-60; and >60 years (all collection periods). Sera were analyzed using on-line solid-phase extraction coupled to high-performance liquid chromatography-isotope dilution-tandem mass spectrometry. Perfluorooctane sulfonate (PFOS) was detected in the highest concentrations ranging from 5.3-19.2 ng/ml (2008/09) to 4.4-17.4 ng/ml (2010/11). Perfluorooctanoate (PFOA) was detected in the next highest concentration ranging from 2.8-7.3 ng/ml (2008/09) to 3.1-6.5 ng/ml (2010/11). All other measured PFASs were detected at concentrations <1 ng/ml with the exception of perfluorohexane sulfonate which ranged from 1.2-5.7 ng/ml (08/09) and 1.4-5.4 ng/ml (10/11). The mean concentrations of both PFOS and PFOA in the 2010/11 period compared to 2002/03 were lower for all adult age groups by 56%. For 5-15 year olds, the decrease was 66% (PFOS) and 63% (PFOA) from 2002/03 to 2010/11. For 0-4 year olds the decrease from 2006/07 (when data were first available for this age group) was 50% (PFOS) and 22% (PFOA). This study provides strong evidence for decreasing serum PFOS and PFOA concentrations in an Australian population from 2002 through 2011. Age trends were variable and concentrations were higher in males than in females. Global use has been in decline since around 2002 and hence primary exposure levels are expected to be decreasing. Further biomonitoring will allow assessment of PFAS exposures to confirm trends in exposure as primary and eventually secondary sources are depleted.
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Affiliation(s)
- L-M L Toms
- School of Clinical Sciences and Institute for Health and Biomedical Innovation, Queensland University of Technology, Gardens Point, Brisbane 4001, Australia.
| | - J Thompson
- Queensland Health Scientific Services, 39 Kessels Rd, Coopers Plains, QLD 4108, Australia
| | - A Rotander
- The University of Queensland, National Research Centre for Environmental Toxicology, 39 Kessels Rd, Coopers Plains, QLD 4108, Australia
| | - P Hobson
- Sullivan Nicolaides Pathology, 125 Whitmore St, Taringa, QLD 4068, Australia
| | - A M Calafat
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - K Kato
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - X Ye
- Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - S Broomhall
- Department of the Environment, GPO Box 787, Canberra, ACT 2601, Australia
| | - F Harden
- School of Clinical Sciences and Institute for Health and Biomedical Innovation, Queensland University of Technology, Gardens Point, Brisbane 4001, Australia
| | - J F Mueller
- The University of Queensland, National Research Centre for Environmental Toxicology, 39 Kessels Rd, Coopers Plains, QLD 4108, Australia
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Shorter P, Harden F, Owen R, Burmeister B, Foote M. Sensorineural Hearing Loss after Treatment for Head and Neck Cancer: A Review of the Literature. J Med Imaging Radiat Sci 2014; 45:316-322. [PMID: 31051984 DOI: 10.1016/j.jmir.2013.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 11/24/2013] [Accepted: 11/25/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Definitive cisplatin-based chemoradiation is increasingly delivered as the treatment of choice for patients with head and neck cancer. Sensorineural hearing loss is a significant long-term side effect of cisplatin-based chemoradiation and is associated with potential major quality of life issues for patients. The purpose of this article was to review the mechanism behind sensorineural hearing loss in patients treated with cisplatin-based chemoradiation, including incidence, the contributions of radiotherapy and cisplatin to sensorineural hearing loss, and the impact of the toxicity on patient quality of life. METHODS Database searches were conducted through PubMed (National Centre for Biotechnology Information) and OvidSP Medline via the Queensland University of Technology Library website. General article searches were conducted through the online search engine Google Scholar. Articles were excluded if the full text was unavailable, they were not in English, or if they were published before 1990. Key words included hearing loss, ototoxicity, cancer, quality of life, cisplatin, and radiotherapy. RESULTS/DISCUSSION The total number of journal articles accessed was 290. Because of exclusion criteria, 129 articles were deemed appropriate for review. Findings indicated that sensorineural hearing loss is a significant, long-term complication for patients treated with cisplatin-based chemoradiation. Current literature recognizes the ototoxic effects of cisplatin and cranial irradiation as separate entities; however, the impact of combined modality therapy on sensorineural hearing loss is seldom reported. Multiple risk factors for hearing loss are described; however, there are contradictory opinions on incidence and severity and the exact radiation dose threshold responsible for inducing hearing loss in patients receiving combined modality therapy. Sensorineural hearing loss creates a subset of complexities for patients with head and neck cancer and these patients face significant quality of life impairment. CONCLUSIONS The literature review identified that sensorineural hearing loss is a major quality of life issue for patients treated with cisplatin-based chemoradiation for head and neck cancer. Further investigation evaluating the contribution of cisplatin-based chemoradiation to sensorineural hearing loss and the subsequent effect on patient quality of life is warranted.
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Affiliation(s)
- Phoebe Shorter
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane, Queensland, Australia.
| | - Fiona Harden
- Queensland University of Technology, Brisbane, Queensland, Australia
| | - Rebecca Owen
- Department of Radiation Oncology, Radiation Oncology Mater Centre, Brisbane, Queensland, Australia
| | - Bryan Burmeister
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Brown E, Owen R, Mengersen K, Harden F, Porceddu S. Evaluating the dosimetric effect of treatment‐induced changes in virally mediated head and neck cancer patients. J Med Radiat Sci 2013; 60:139-44. [PMID: 26229622 PMCID: PMC4175821 DOI: 10.1002/jmrs.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/24/2013] [Accepted: 10/15/2013] [Indexed: 11/11/2022] Open
Abstract
Introduction Patients with virally mediated head and neck cancer (VMHNC) often present with advanced nodal disease that is highly radioresponsive as demonstrated by tumour and nodal regression during treatment. The resultant changes may impact on the planned dose distribution and so adversely affect the therapeutic ratio. The aim of this study was to evaluate the dosimetric effect of treatment-induced anatomical changes in VMHNC patients who had undergone a replan. Methods Thirteen patients with virally mediated oropharyngeal or nasopharyngeal cancer who presented for definitive radiotherapy between 2005 and 2010 and who had a replan generated were investigated. The dosimetric effect of anatomical changes was quantified by comparing dose–volume histograms (DVH) of primary and nodal gross target volumes and organs at risk (OAR), including spinal cord and parotid glands, from the original plan and a comparison plan. Results Eleven three-dimensional conformal radiation therapy (3DCRT) and two intensity modulated radiation therapy (IMRT) plans were evaluated. Dose to the spinal cord and brainstem increased by 4.1% and 2.6%, respectively. Mean dose to the parotid glands also increased by 3.5%. In contrast, the dose received by 98% of the primary and nodal gross tumour volumes decreased by 0.15% and 0.3%, respectively, when comparing the initial treatment plan to the comparison plan. Conclusion In this study, treatment-induced anatomical changes had the greatest impact on OAR dose with negligible effect on the dose to nodal gross tumour volumes. In the era of IMRT, accounting for treatment-induced anatomical changes is important as focus is placed on minimizing the acute and long-term side effects of treatment.
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Affiliation(s)
- Elizabeth Brown
- Radiation Oncology Department Princess Alexandra Hospital Brisbane Queensland Australia
- Queensland University of Technology Brisbane Queensland Australia
| | - Rebecca Owen
- Radiation Oncology Department Radiation Oncology Mater Centre Brisbane Queensland Australia
| | - Kerrie Mengersen
- Queensland University of Technology Brisbane Queensland Australia
| | - Fiona Harden
- Queensland University of Technology Brisbane Queensland Australia
| | - Sandro Porceddu
- Radiation Oncology Department Princess Alexandra Hospital Brisbane Queensland Australia
- School of Medicine University of Queensland Brisbane Queensland Australia
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Mannetje A', Coakley J, Mueller JF, Harden F, Toms LM, Douwes J. Partitioning of persistent organic pollutants (POPs) between human serum and breast milk: a literature review. Chemosphere 2012; 89:911-8. [PMID: 22868196 DOI: 10.1016/j.chemosphere.2012.06.049] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 05/24/2012] [Accepted: 06/30/2012] [Indexed: 05/09/2023]
Abstract
The literature was reviewed to assess the relationship between the lipid adjusted concentration in human serum and breast milk (expressed as the serum/milk ratio) of a broad range of POPs in paired samples. Thirteen studies were identified, including seven studies that reported serum/milk ratios for polychlorinated dibenzo-dioxins and -furans (PCDD/Fs), ten for polychlorinated biphenyls (PCBs), five for polybrominated diphenyl ethers (PBDEs), and five for organochlorine pesticides (OCPs). Mean serum/milk ratios ranged between 0.7 and 25 depending on the compound and congener. For PCDD/Fs, PCBs and PBDEs, a clear trend of increasing mean serum/milk ratio by increasing molar volume, hydrophobicity and number of halogen substitutes was observed. The mean serum/milk ratios reported by the 13 studies summarized here will aid comparison between human POPs exposure studies using either serum or milk samples. More studies are needed to allow a valid comparison between data obtained from analysis of breast milk and serum samples for a broader range of POPs. Furthermore such studies may shed light on compound specific factors as well as other determinants that may affect the partitioning and partition kinetics of POPs between serum and breast milk.
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Affiliation(s)
- Andrea 't Mannetje
- Centre for Public Health Research, Massey University, Wellington, New Zealand.
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Toms LML, Sjödin A, Harden F, Hobson P, Jones R, Edenfield E, Mueller JF. Serum polybrominated diphenyl ether (PBDE) levels are higher in children (2-5 years of age) than in infants and adults. Environ Health Perspect 2009; 117:1461-5. [PMID: 19750114 PMCID: PMC2737026 DOI: 10.1289/ehp.0900596] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 05/06/2009] [Indexed: 05/02/2023]
Abstract
BACKGROUND Polybrominated diphenyl ethers (PBDEs) are used as flame retardants in many products and have been detected in human samples worldwide. Limited data show that concentrations are elevated in young children. OBJECTIVES We investigated the association between PBDEs and age with an emphasis on young children from Australia in 2006-2007. METHODS We collected human blood serum samples (n = 2,420), which we stratified by age and sex and pooled for analysis of PBDEs. RESULTS The sum of BDE-47, -99, -100, and -153 concentrations ( summation operator(4)PBDE) increased from 0-0.5 years (mean +/- SD, 14 +/- 3.4 ng/g lipid) to peak at 2.6-3 years (51 +/- 36 ng/g lipid; p < 0.001) and then decreased until 31-45 years (9.9 +/- 1.6 ng/g lipid). We observed no further significant decrease among ages 31-45, 45-60 (p = 0.964), or > 60 years (p = 0.894). The mean summation operator(4)PBDE concentration in cord blood (24 +/- 14 ng/g lipid) did not differ significantly from that in adult serum at ages 15-30 (p = 0.198) or 31-45 years (p = 0.140). We found no temporal trend when we compared the present results with Australian PBDE data from 2002-2005. PBDE concentrations were higher in males than in females; however, this difference reached statistical significance only for BDE-153 (p = 0.05). CONCLUSIONS The observed peak concentration at 2.6-3 years of age is later than the period when breast-feeding is typically ceased. This suggests that in addition to the exposure via human milk, young children have higher exposure to these chemicals and/or a lower capacity to eliminate them.
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Affiliation(s)
- Leisa-Maree L Toms
- University of Queensland, National Research Centre for Environmental Toxicology, 39 Kessels Road, Coopers Plains, Queensland 4108, Australia.
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Toms LML, Hearn L, Kennedy K, Harden F, Bartkow M, Temme C, Mueller JF. Concentrations of polybrominated diphenyl ethers (PBDEs) in matched samples of human milk, dust and indoor air. Environ Int 2009; 35:864-869. [PMID: 19351571 DOI: 10.1016/j.envint.2009.03.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 03/04/2009] [Accepted: 03/04/2009] [Indexed: 05/27/2023]
Abstract
Polybrominated diphenyl ethers (PBDEs) are lipophilic, persistent pollutants found worldwide in environmental and human samples. Exposure pathways for PBDEs remain unclear but may include food, air and dust. The aim of this study was to conduct an integrated assessment of PBDE exposure and human body burden using 10 matched samples of human milk, indoor air and dust collected in 2007-2008 in Brisbane, Australia. In addition, temporal analysis was investigated comparing the results of the current study with PBDE concentrations in human milk collected in 2002-2003 from the same region. PBDEs were detected in all matrices and the median concentrations of BDEs -47 and -209 in human milk, air and dust were: 4.2 and 0.3 ng/g lipid; 25 and 7.8 pg/m(3); and 56 and 291 ng/g dust, respectively. Significant correlations were observed between the concentrations of BDE-99 in air and human milk (r=0.661, p=0.038) and BDE-153 in dust and BDE-183 in human milk (r=0.697, p=0.025). These correlations do not suggest causal relationships - there is no hypothesis that can be offered to explain why BDE-153 in dust and BDE-183 in milk are correlated. The fact that so few correlations were found in the data could be a function of the small sample size, or because additional factors, such as sources of exposure not considered or measured in the study, might be important in explaining exposure to PBDEs. There was a slight decrease in PBDE concentrations from 2002-2003 to 2007-2008 but this may be due to sampling and analytical differences. Overall, average PBDE concentrations from these individual samples were similar to results from pooled human milk collected in Brisbane in 2002-2003 indicating that pooling may be an efficient, cost-effective strategy of assessing PBDE concentrations on a population basis. The results of this study were used to estimate an infant's daily PBDE intake via inhalation, dust ingestion and human milk consumption. Differences in PBDE intake of individual congeners from the different matrices were observed. Specifically, as the level of bromination increased, the contribution of PBDE intake decreased via human milk and increased via dust. As the impacts of the ban of the lower brominated (penta- and octa-BDE) products become evident, an increased use of the higher brominated deca-BDE product may result in dust making a greater contribution to infant exposure than it does currently. To better understand human body burden, further research is required into the sources and exposure pathways of PBDEs and metabolic differences influencing an individual's response to exposure. In addition, temporal trend analysis is necessary with continued monitoring of PBDEs in the human population as well as in the suggested exposure matrices of food, dust and air.
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Affiliation(s)
- Leisa-Maree L Toms
- The University of Queensland, National Research Centre for Environmental Toxicology, 39 Kessels Road, Coopers Plains, QLD, 4108, Australia.
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Toms LML, Calafat AM, Kato K, Thompson J, Harden F, Hobson P, Sjödin A, Mueller JF. Polyfluoroalkyl chemicals in pooled blood serum from infants, children, and adults in Australia. Environ Sci Technol 2009; 43:4194-4199. [PMID: 19569351 DOI: 10.1021/es900272u] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Polyfluoroalkyl chemicals (PFCs) have been used worldwide for more than 50 years in a wide variety of industrial and consumer products. Limited data exist on human exposure to PFCs in the Southern Hemisphere. Human blood serum collected in southeast Queensland, Australia, in 2006-2007 from 2420 donors was pooled according to age (cord blood, 0-0.5, 0.6-1, 1.1-1.5, 1.6-2, 2.1-2.5, 2.6-3, 3.1-3.5, 3.6-4, 4.1-6, 6.1-9, 9.1-12, 12.1-15, 16-30, 31-45, 46-60, and > 60 years) and gender and was analyzed for eight PFCs. Across all pools, perfluorooctane sulfonate (PFOS) was detected at the highest mean concentration (15.2 ng/mL) followed by perfluorooctanoate (PFOA, 6.4 ng/mL), perfluorohexane sulfonate (PFHxS, 3.1 ng/mL), perfluorononanoate (PFNA, 0.8 ng/mL), 2-(N-methylperfluorooctance sulfonamide) acetate (Me-PFOSA-AcOH, 0.66 ng/mL), and perfluorodecanoate (PFDeA, 0.29 ng/mL). Perfluorooctane sulfonamide was detected in only 24% of the pools, and 2-(N-ethylperfluorooctane sulfonamide) acetate was detected in only one. PFOS concentrations were significantly higher in pools from adult males than from adult females (p = 0.002); no gender differences were apparent in the pools from children (< 12 years old). The highest mean concentrations of PFOA, PFHxS, PFNA, PFDeA, and Me-PFOSA-AcOH were found in children < 15 years, while PFOS was highest in adults > 60 years. Investigation into the sources and exposure pathways in Australia, in particular for children, is necessary as well as continued biomonitoring to determine the potential effects on human concentrations as a result of changes in the PFC manufacturing practices, including the cessation of production of several PFCs.
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Affiliation(s)
- Leisa-Maree L Toms
- The University of Queensland, National Research Centre for Environmental Toxicology, 39 Kessels Road, Coopers Plains, Queensland 4108, Australia.
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Toms LML, Harden F, Paepke O, Hobson P, Ryan JJ, Mueller JF. Higher accumulation of polybrominated diphenyl ethers in infants than in adults. Environ Sci Technol 2008; 42:7510-7515. [PMID: 18939594 DOI: 10.1021/es800719v] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Pooled serum samples collected from 8132 residents in 2002/ 03 and 2004/05 were analyzed to assess human polybrominated diphenyl ether (PBDE) concentrations from specified strata of the Australian population. The strata were defined by age (0-4 years, 5-15 years, < 16 years, 16-30 years, 31-45 years, 46-60 years, and > 60 years); region; and gender. For both time periods, infants and older children had substantially higher PBDE concentrations than adults. For samples collected in 2004/ 05, the mean +/- standard deviation sigmaPBDE (sum of the homologue groups for the mono-, di-, tri-, tetra-, penta-, hexa-, hepta-, octa-, nona-, and deca-BDEs) concentrations for 0-4 and 5-15 years were 73 +/- 7 and 29 +/- 7 ng g(-1) lipid, respectively, while for all adults > 16 years, the mean concentration was lower at 18 +/- 5 ng g(-1) lipid. A similar trend was observed for the samples collected in 2002/03, with the mean sigmaPBDE concentration for children < 16 years being 28 +/- 8 ng g(-1) lipid and for the adults >16 years, 15 +/- 5 ng g(-1) lipid. No regional or gender specific differences were observed. Measured data were compared with a model that we developed to incorporate the primary known exposure pathways (food, air, dust, breast milk) and clearance (half-life) data. The model was used to predict PBDE concentration trends and indicated that the elevated concentrations in infants were primarily due to maternal transfer and breast milk consumption with inhalation and ingestion of dust making a comparatively lower contribution.
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Affiliation(s)
- Leisa-Maree L Toms
- The University of Queensland, National Research Centre for Environmental Toxicology, 39 Kessels Road, Coopers Plains 4108, Australia.
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Allmyr M, Harden F, Toms LML, Mueller JF, McLachlan MS, Adolfsson-Erici M, Sandborgh-Englund G. The influence of age and gender on triclosan concentrations in Australian human blood serum. Sci Total Environ 2008; 393:162-7. [PMID: 18207219 DOI: 10.1016/j.scitotenv.2007.12.006] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Revised: 11/22/2007] [Accepted: 12/05/2007] [Indexed: 05/22/2023]
Abstract
The bactericide triclosan has found wide-spread use in e.g. soaps, deodorants and toothpastes. Recent in vitro and in vivo studies indicate that triclosan might exert adverse effects in humans. Triclosan has previously been shown to be present in human plasma and milk at concentrations that are well correlated to the use of personal care products containing triclosan. In this study we investigated the influence of age, gender, and the region of residence on triclosan concentrations in pooled samples of Australian human blood serum. The results showed no influence of region of residence on the concentrations of triclosan. There was a small but significant influence of age and gender on the serum triclosan concentrations, which were higher in males than in females, and highest in the group of 31-45 year old males and females. However, overall there was a lack of pronounced differences in the triclosan concentrations within the dataset, which suggests that the exposure to triclosan among different groups of the Australian population is relatively homogenous. A selection of the dataset was compared with previous measurements of triclosan concentrations in human plasma from Sweden, where the use of triclosan is expected to be low due to consumer advisories. The triclosan concentrations were a factor of 2 higher in Australian serum than in Swedish plasma.
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Affiliation(s)
- Mats Allmyr
- Institute of Odontology, Karolinska Institutet, PO Box 4064, SE-141 04 Huddinge, Sweden.
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Mueller JF, Harden F, Toms LM, Symons R, Fürst P. Persistent organochlorine pesticides in human milk samples from Australia. Chemosphere 2008; 70:712-20. [PMID: 17675211 DOI: 10.1016/j.chemosphere.2007.06.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 06/18/2007] [Accepted: 06/18/2007] [Indexed: 05/16/2023]
Abstract
Human milk has been used as a surrogate for the assessment of body burden and exposure to persistent lipophilic organochlorine pesticides (OCPs). With the exception of restricted use of mirex, the use of persistent, lipophilic OCPs has been banned in Australia since the 1980s. The decline of human body burden of OCPs following their ban in many industrialised countries is well recorded worldwide from the 1970s until the 1990s though little is known on whether these trends are continuing. In this study, 157 human milk samples collected during 2002 and 2003 as well as 24 samples collected in 1993 were analysed as 20 regional pools for 17 OCPs. OCPs were detected in all pooled human milk samples from 2002/03 typically with highest concentrations of p,p'-dichlorodiphenyldichloroethylene (p,p'-DDE) (mean+/-standard deviation; median concentration 311+/-174; 279 ng g(-1) lipid) followed by beta-hexachlorocyclohexane (beta-HCH) (80+/-173; 21 ng g(-1) lipid). Other OCPs consistently detected included dieldrin (16+/-6; 17 ng g(-1) lipid), hexachlorobenzene (HCB) (18+/-16; 14 ng g(-1) lipid), transnonachlor (11+/-5; 9 ng g(-1) lipid) and p,p'-dichlorodiphenyltrichloroethane (p,p'-DDT) (9+/-6; 7 ng g(-1) lipid). The results from this study indicated that following a substantial decline of OCP concentrations from the early 1980s to the 1990s, little decline could be observed since then. Furthermore the use of multivariate statistics indicated some regional trends with slightly higher levels of the broadly used insecticides DDT and HCH in both historic and recent samples from Melbourne, whereas, sample pools collected from mothers that lived in rural Queensland and New South Wales as well as Adelaide and Sydney showed comparatively higher levels of heptachlor and dieldrin - both of which have been used for termite treatment. These results indicate that even 20 years after the discontinuation of usage, historical use of OCPs rather than exposure via global transport of OCPs is responsible for continuous low exposure in Australia.
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Affiliation(s)
- Jochen F Mueller
- National Research Centre for Environmental Toxicology, The University of Queensland, 39 Kessels Road, Coopers Plains, Brisbane 4108, Queensland, Australia.
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Kärrman A, Mueller JF, van Bavel B, Harden F, Toms LML, Lindström G. Levels of 12 perfluorinated chemicals in pooled australian serum, collected 2002-2003, in relation to age, gender, and region. Environ Sci Technol 2006; 40:3742-8. [PMID: 16830536 DOI: 10.1021/es060301u] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Pooled serum samples from 3802 Australian residents were analyzed for four perfluoroalkylsulfonates, seven perfluoroalkylcarboxylates, and perfluorooctanesulfonamide (PFOSA). Serum was collected from men and women of five different age groups and from rural and urban regions in Australia. The highest mean concentration was obtained for perfluorooctane sulfonate (PFOS, 20.8 ng/mL) followed by perfluorooctanoic acid (PFOA, 7.6 ng/mL), perfluorohexane sulfonate (PFHxS, 6.2 ng/mL), perfluorononanoic acid (PFNA, 1.1 ng/mL), and PFOSA (0.71 ng/mL). Additional four PFCs were detected in 5-18% of the samples at concentrations near the detection limits (0.1-0.5 ng/mL). An increase in PFOS concentration with increasing age in both regions and genders was observed. The male pool levels of some of the age groups compared to females were higherfor PFOS, PFOA, and PFHxS. In contrast, PFNA concentrations were higher in the female pools. No substantial difference was found in levels of PFCs between the urban and rural regions. The levels are equal or higher than previously reported serum levels in Europe and Asia but lower compared to the U.S.A. These results suggest that emissions from production in the Northern Hemisphere are of less importance for human exposure.
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Affiliation(s)
- Anna Kärrman
- Man-Technology-Environment (MTM) Research Centre, brebro University, SE-701 82 Orebro, Sweden.
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Harden F. [Federico Harden: "The federation endeavors to be heard by the nursing personnel". Interview by Harald Verworner]. Osterr Krankenpflegez 1994; 47:13-4. [PMID: 7854783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Harden F. Some Contributions of Veterinary Medicine to Public Health. Bull Med Libr Assoc 1945; 33:482-90. [PMID: 16016707 PMCID: PMC194527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- F Harden
- Army Medical Library, Washington, D.C
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Harden F. The Guides to the Literature of Veterinary Medicine. Bull Med Libr Assoc 1944; 32:230-3. [PMID: 16016645 PMCID: PMC194349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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