Developing an Intranet-Based Lymphedema Dashboard for Breast Cancer Multidisciplinary Teams: Design Research Study.

BACKGROUND: A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner. OBJECTIVE: This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema. METHODS: The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5). RESULTS: Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness. CONCLUSIONS: Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge.

Rationale and protocol paper for the Healthy Active Peaceful Playgrounds for Youth (HAPPY) study.

BACKGROUND: A growing body of evidence suggest an association between physical activity levels and students psychological well-being. A number of research studies have evaluated playground interventions that aim to increase physical activity levels, decrease conflict and bullying, and improve students behaviour. The HAPPY Study will evaluate the success of an intervention combining environmental modifications, teacher development, and peer support that can culminate in an easy to implement, low cost and effective model for increasing physical activity, and improving psychological well-being for children. METHODS/DESIGN: Data will be collected at six New South Wales (NSW) primary schools, on physical activity levels, on-task time during classes, and social support for physical activity during a 12 month Cluster Controlled Trial (CT). Three quantitative data collection tools will be used to capture student's physical activity levels during lunch and recess breaks (the SOPARC tool), student's on-task behaviour during classes following recess and lunch breaks (the BOSS tool) and where students receive the most encouragement to be physically active from (the Physical Activity Social Support Scale survey). Baseline data will be analysed against follow-up data, collected after an intervention that is rolled out in all schools as part of a stepped wedge CT design. DISCUSSION: A review of relevant Australian and New Zealand literature suggests that playground interventions can be successful at increasing physical activity levels, increasing social and conflict resolution skills in students, and decreasing incidences of bullying. This study will investigate any correlation between physical activity levels, and student behaviour during classes following breaks. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Register ACTRN12616000575437 , registered May 2016.

An objective and cross-sectional examination of sun-safe behaviours in New South Wales primary schools.

BACKGROUND: Previous evaluations have supported the link between sun protection policies and improved sun protection behaviours. However these evaluations have relied on self-reported data. METHODS: A cross-sectional design as part of an ongoing 18-month cluster-controlled trial in primary schools (n = 20) was used. Researchers conducted direct observations to record students' hat use and teachers' use of sun protective measures during recess and lunch. Researchers also recorded the volume of sunscreen consumed in each school. RESULTS: Only 60% of primary school children wear a sun-safe hat during their breaks when observed using objective measures. Weak correlations were observed between the wearing of a sun-safe hat and a school's socio-economic status (r = 0.26). All other independent variables measured had only very weak correlations (r < 0.19) with sun-safe hat wearing behaviour of students. Sunscreen consumption by school students during the school day is negligible. CONCLUSIONS: A large percentage of NSW primary schools in this study wear sun-safe hats during the school day but this is well below what has been reported in previous national surveys. Given the finite resources of schools and the correlation, though small, with SES status for these behaviours, it behoves researchers to investigate low-cost solutions to these problems. Further qualitative data will also be needed to inform the enablers and barriers for sun-safe behaviour interventions to be adopted in NSW primary schools.

A Retrospective Study of the Effectiveness of Four Different Treatments of Periodontal Disease in Equine Cheek Teeth.

Periodontal disease of equine cheek teeth is common and may lead to tooth loss if left untreated. Limited information is available comparing the effectiveness of treatment methods. The objective of this study was to retrospectively compare the effectiveness of 4 commonly used treatments in reducing periodontal pocket depth (in addition to routine dental treatment and occlusal equilibration). The 4 treatments compared were (1) removal of feed material, lavaging the pocket with dilute chlorhexidine, and then rinsing the mouth with chlorhexidine-containing mouthwash (CL); (2) CL plus placement of metronidazole into the pocket (M); (3) M plus the addition of polyvinyl siloxane temporary filling over the diastema (PVS); and (4) diastema widening to increase the interdental space, then PVS (DW). Pocket measurements were compared before and 2 to 6 months after treatment. Treatment groups CL, M, and PVS showed statistically significant reductions in pocket depth following treatment. The mean pocket depth reduction was the greatest in the DW group (and this was the only group with no cases having an increase in pocket depth), but this was not significant due to the small sample size. Additional analysis to compare effectiveness revealed a confounding effect of initial pocket depth. After accounting for this, DW was associated with smaller improvements than the other treatments, however, this was also based on a small sample size. After accounting for confounders, differences between treatments CL, M and PVS were not found to be significant, although all were associated with statistically significant reductions in pocket depth.

Optimization of a miniaturized fluid array device for cell-free protein synthesis.

Cell-free protein synthesis (CFPS), which entails synthesizing proteins outside of intact cells, is conducted in several formats with the continuous-exchange cell-free (CECF) format generally having the greatest protein expression yields. With this format, continuous chemical exchange occurs through a dialysis membrane separating a reaction solution from a feeding solution containing supplemental nutrient/energy molecules. Here, we describe the optimization of the miniaturized fluid array device (µFAD) by studying the effects of structural and experimental parameters responsible for the heightened chemical exchange across the dialysis membranes and enhanced protein expression capabilities of the high-throughput device. The interface area and number between the reaction and feeding solutions have a direct impact on protein expression, with a 1.6% enhancement in protein expression yield with each square millimeter increase in area and a 20% decrease with each additional interface. For nutrient/energy availability, an increasing solution volume ratio and height difference increase protein expression yield until the expression yield plateaus at a volume ratio of 20 to 1 (feeding to reaction solution) and a solution height difference of 2 mm. This yield can be further increased by 7% every 30 min with feeding solution replacement. Of the studied experimental factors (feeding solution stirring, device shaking, and temperature increase), feeding solution stirring has a significant effect on protein expression in this device. In the optimized system, green fluorescent protein (GFP), ß-glucuronidase (GUS), ß-galactosidase (LacZ), luciferase, and tissue plasminogen activator (tPA) expression increased 77.8-, 212-, 3.66-, 463-, and 5.43-fold, respectively, compared to the conventional batch format in a standard microplate. These results highlight the significance of structural/experimental conditions on the productive expression of proteins in the CECF format.

Rationale and study protocol to evaluate the SunSmart policy intervention: a cluster randomised controlled trial of a primary school-based health promotion program.

BACKGROUND: Previous evaluations of the SunSmart Program have supported the link between a written sun protection policy and improved sun protection behaviours in New South Wales (NSW) primary schools. However these evaluations have relied on self-reported data and research suggests that direct observations are required to better represent schools' usual sun protective practices. METHODS/DESIGN: Data will be collected in the summer months of 2014, 2015, and 2016 as part of an 18-month cluster-controlled trial in NSW primary schools (n = 20). Researchers will conduct three direct observations to record students' hat use and teachers' use of sun protective measures during recess and lunch periods in each school. Researchers will also record the volume of sunscreen that the Year 6 classes in each school utilise over the term. At the conclusion of baseline data collection, five schools will be randomised into an intervention group that will work with researchers to develop a policy-driven intervention to improve sun safety behaviour in NSW primary schools. DISCUSSION: An initial review of relevant Australian and New Zealand literature suggests that provision of policy support is likely to improve school sun protection practices; however there is no suggested model for this support. This will be the first objective analysis of sun safe behaviours leading to a policy-driven intervention conducted in Australian primary schools since the 1990s, and will inform the future direction of sun safety in our schools. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Register ACTRN12614000926639 Registered 28(th) August 2014.

Recent advances in the treatment and prevention of equine peripheral caries.

Equine peripheral caries is a common condition characterized by demineralization and degradation of the clinical crown of equine cheek teeth. The condition can cause significant pain and morbidity, particularly in severe cases. Recent studies indicate that the condition is driven by environmental conditions within the mouth, as only the clinical crown of the tooth is affected (the reserve crown below the gingival margin remains unaffected). It is hypothesized that peripheral caries is driven by changes in oral pH, with risk factors for the condition including the intake of high-sugar feeds (oaten hay and feeding moderate levels of concentrate feed) and access to drinking water with an acidic pH. However, other identified risk factors include breed (Thoroughbred), limited pasture access, and concurrent dental or periodontal disease. Further studies have been able to show that affected teeth can recover from the condition if the inciting cause is removed and the unaffected reserve crown is allowed to replace the damaged clinical crown. Improvements in the condition can be observed within a few months. Signs of inactive (recovering) caries include a darker color and a smooth, hard, and reflective surface, and there is a new layer of unaffected cementum at the gingival margin, indicating that the newly erupted tooth is unaffected. Peripheral caries is a common and often overlooked condition in horses, which can often be treated with simple changes to equine management.

Retrospective case review investigating the effect of replacing oaten hay with a non-cereal hay on equine peripheral caries in 42 cases.

BACKGROUND: Equine peripheral caries can cause significant morbidity and can have considerable welfare implications. Recent research suggests that diets with high water soluble carbohydrate (WSC) content are associated with high risk of peripheral caries. Previous work has indicated that the condition may be treatable if the inciting cause is removed and the damaged tooth allowed to erupt out, being replaced by the unaffected tooth previously under the gingival margin. OBJECTIVES: To see whether the peripheral caries process can be ceased if oaten hay (typically high WSC) is removed from the diet and replaced with a non-cereal hay (typically lower WSC). STUDY DESIGN: Retrospective blinded longitudinal study. METHODS: Forty-two cases with peripheral caries that were on oaten hay were asked if they would change the hay type from oaten hay to a non-cereal hay or straw (meadow, Rhodes hay, lucerne hay or barley straw). Photographs were taken at the time and then again at subsequent visits. The photographs were anonymised, randomised and scored by six equine veterinary dentists using the Jackson et al. 'Peripheral Caries Grading System' grading scale. RESULTS: At follow-up, 69.0% of cases were marked as inactive, compared with 47.6% of cases at baseline (OR: 2.45, 95%CI: 1.12-5.36, P = .02). Significantly lower grades of peripheral caries were observed in the gingival, middle and occlusive third of the molars (triadan 9-11's) at follow-up compared with baseline. However, significant improvements were not observed in the premolars (triadan 6-8's). MAIN LIMITATIONS: This is a review of clinical records, not a prospective study. As such, other changes in the diet and management were not recorded, and there was no control group. CONCLUSIONS: Recommending clients change their horse's diet from oaten hay (high WSC) to a typically lower WSC hay was associated with significant improvements in equine peripheral caries located in the molars.

A Randomized Controlled Trial Assessing the Effects of Feeding High Water Soluble Carbohydrate (WSC) Oaten Hay Versus Low WSC Oaten Hay on Equine Peripheral Dental Caries.

Equine peripheral caries (PC) can cause significant dental pathology and appears to be increasing in prevalence and recognition in many areas [1, 2]. Previous studies have identified risk factors for the condition including the feeding of oaten hay [3]. It was hypothesized that this may be due to the higher water soluble carbohydrate (WSC) or "sugar" content of the hay. A randomized control trial involving 30 horses on three properties was completed. The horses were randomly assigned to two groups: high WSC (H-WSC) or low WSC (L-WSC) oaten hay and were then sedated and intraoral photographs and endoscopy were performed for baseline levels. They were maintained on this assigned hay source for three months when they were again sedated, examined, and photographs and endoscopic videos recorded. Horses with significant PC were then changed to meadow hay (previously shown to be lower risk for PC [3]) for seven months and re-examined to assess for recovery. Images and videos were anonymized and graded for PC, and the PC grades of the teeth before and after intervention were compared using a Fisher exact test. Thirteen horses fed L-WSC hay and 15 fed H-WSC hay completed the study. Of horses fed the H-WSC oaten hay, 60% deteriorated and of horses on L-WSC oaten hay, 53.8% improved in PC grade over the trial, however, the difference was not statistically significant (P = .274). All three horses available for recheck after changing to meadow hay improved.

A new equine peripheral caries grading system: Are the caries likely active or inactive?

BACKGROUND: Equine peripheral caries can be a significant welfare issue in affected horses. Recent work has shown that complete reversal of the condition may be possible if the primary risk factor can be identified and corrected. Determining whether caries are active (deteriorating) or inactive (improving) is of vital importance when formulating a management and treatment plan. A new grading system is proposed that looks at whether caries are likely active or inactive to assist clinicians deciding whether intervention is required. OBJECTIVES: To examine the reliability of an alternative grading method for equine peripheral caries. STUDY DESIGN: Online survey of veterinary surgeons. METHODS: Reviewers (n = 22) graded images of peripheral caries using three methods: the traditional grading system, a new research grading system and a new clinical grading system. Percentage agreement and Fleiss' kappa were used to examine the participant's agreement of the severity of caries. RESULTS: All percentage agreements and Fleiss' kappa values were significantly greater than zero (P < .001). The Fleiss' kappa for the new methods were higher (ranging from 0.48 to 0.58), but not significantly different from the traditional method (0.40). There was a high level of consistency in the assessment of caries as either active or inactive with both grading systems reporting over 80% agreement. Feedback on the grading systems was positive with over 90% of reviewers saying they were likely to use the system. MAIN LIMITATIONS: The use of photographs provided some difficulties with image quality and judging whether the dentin was affected without an occlusal image. CONCLUSIONS: The new grading system produced a consistent estimate of caries severity and provided high levels of agreement on whether the caries were likely 'active' or 'inactive'. This is likely to be very useful clinically to assist practitioners to determine whether intervention is required.

Cogenerating Synthetic Parts toward a Self-Replicating System.

To build replicating systems with new functions, the engineering of existing biological machineries requires a sensible strategy. Protein synthesis Using Recombinant Elements (PURE) system consists of the desired components for transcription, translation, aminoacylation and energy regeneration. PURE might be the basis for a radically alterable, lifelike system after optimization. Here, we regenerated 54 E. coli ribosomal (r-) proteins individually from DNA templates in the PURE system. We show that using stable isotope labeling with amino acids, mass spectrometry based quantitative proteomics could detect 26 of the 33 50S and 20 of the 21 30S subunit r-proteins when coexpressed in batch format PURE system. By optimizing DNA template concentrations and adapting a miniaturized Fluid Array Device with optimized feeding solution, we were able to cogenerate and detect at least 29 of the 33 50S and all of the 21 30S subunit r-proteins in one pot. The boost on yield of a single r-protein in coexpression pool varied from ∼1.5 to 5-fold compared to the batch mode, with up to ∼2.4 µM yield for a single r-protein. Reconstituted ribosomes under physiological condition from PURE system synthesized 30S r-proteins and native 16S rRNA showed ∼13% activity of native 70S ribosomes, which increased to 21% when supplemented with GroEL/ES. This work also points to what is still needed to obtain self-replicating synthetic ribosomes in situ in the PURE system.

Cell-Free Protein Synthesis in Miniaturized Array Devices and Effects of Device Orientation.

Cell-free protein synthesis (CFPS) has been used as an alternative to cell-based recombinant technology for protein production in academic and industrial labs. The continuous-exchange format generally has higher expression yield by constantly supplying a nutrient solution and removing inhibitory by-products through a porous membrane. Because of the concern of possible membrane clogging by large molecules in the CFPS solution, we investigated the effects of membrane orientation on protein synthesis. We fabricated a miniaturized array device called Vertical-I with its membrane oriented vertically in reference to the table surface and found that the protein synthesis yield in the Vertical-I device was 144% higher than the Horizontal Device reported previously. The reaction time was also faster; ß-glucuronidase reached the synthesis yield plateau after 2 h in the Vertical-I device versus 4 h in the Horizontal Device. Possible clogging of membrane pores was confirmed by fluorescein diffusion measurement. Using these results, we designed a device called Vertical-II that would fit into a 96 well plate holder for compatibility with commercial reagent dispensers and microplate readers. The experimentally optimized device increased protein expression 406% over the Horizontal Device and consumes 5 times fewer reagents than a commercial device, showing the potential for high-throughput protein synthesis.

Cell-free protein synthesis in microfluidic 96-well plates.

Cell-free protein synthesis (CFPS) enables rapid protein expression for the structural and functional characterization of proteins. Implementation of CFPS in a microfluidic platform has additional benefits such as reduced reaction volumes and simultaneous expression of multiple proteins. Here, we describe a microfluidic device that is composed of 96 continuous-exchange cell-free protein expression units and produces a protein synthesis yield up to 87 times higher than a conventional batch system.

Protein synthesis yield increased 72 times in the cell-free PURE system.

Compared to cell-based protein expression, cell-free protein synthesis (CFPS) offers several advantages including a greater control over system additives. This control is further enhanced with a CFPS system called the Protein synthesis Using Recombinant Elements (PURE) system, which consists of 108 purified transcriptional and translational elements. With the PURE system, all elements are known, nuclease and protease activities are reduced, and the concentration of each element can be optimized for maximal protein expression. However, protein expression yield with this system is relatively low due to the consumption of nutrients and energy molecules as well as the accumulation of inhibitory byproducts in the batch format. To enhance protein expression with the PURE system, we developed a feeding solution that was optimized using a miniaturized fluid array device (µFAD) in a continuous-exchange cell-free (CECF) format. The device enabled (1) continuous supply of energy/nutrient molecules from the feeding solution to the reaction solution where protein synthesis occurred, and (2) simultaneous removal of inhibitory expression byproducts from the reaction solution to the feeding solution. Consequently, the synthesis yield of green fluorescent protein (GFP) increased 72.5-fold in comparison with the same reaction in the conventional batch format.

Shade in urban playgrounds in Sydney and inequities in availability for those living in lower socioeconomic areas.

OBJECTIVE: This study investigated the differences between the amount of shade covering typical activity areas in playgrounds of higher and lower socioeconomic status (SES) areas within metropolitan Sydney, Australia. METHODS: Using an established audit tool, surveyors visited 139 urban playgrounds and made 1,033 shade observations recording the estimated percentage of an activity area that was covered by shade and the type of shade available. RESULTS: Shade coverage was significantly associated with SES of an area and with type of activity area (p<0.001 for both), but not with time since last upgrade of playground (p=0.116). Activity areas in playgrounds in the lowest SES areas had 34% lower mean shade coverage (95%CI 18-50) than activity areas in playgrounds in the highest SES regions. The mean shade coverage for eating areas was found to be 35% higher (95%CI 27-43) than the main play areas for children. CONCLUSIONS: This study highlights inequities in available shade for those living in lower SES urban areas. Furthermore, the results of this study are concerning from a skin cancer prevention perspective as the playground areas where children spend the majority of their time (the main play equipment and stand-alone equipment) were considerably less shaded than the eating areas. IMPLICATIONS: Local government should ensure that the issue of playground shade is comprehensively addressed in all relevant planning and policy documents so that it becomes an increased priority when developing and upgrading parks and playgrounds.

Microflow Cytometer for optical analysis of phytoplankton.

Analysis of the intrinsic fluorescence profiles of individual marine algae can be used in general classification of organisms based on cell size and fluorescence properties. We describe the design and fabrication of a Microflow Cytometer on a chip for characterization of phytoplankton. The Microflow Cytometer measured distinct side scatter and fluorescence properties of Synechococcus sp., Nitzschia d., and Thalassiosira p.; measurements were confirmed using the benchtop Accuri C6 flow cytometer. The Microflow Cytometer proved sensitive enough to detect and characterize picoplankton with diameter approximately 1 µm and larger phytoplankton of up to 80 µm in length. The wide range in size discrimination coupled with detection of intrinsic fluorescent pigments suggests that this Microflow Cytometer will be able to distinguish different populations of phytoplankton on unmanned underwater vehicles.