Iron status in patients with burn anaemia.

PURPOSE: The iron status of burn patients is poorly understood, limited by difficulty interpreting conventional iron studies in the context of the acute phase response triggered by critical illness. The aim of this study was to evaluate the iron status of patients with burn anaemia using recent post-operative guidelines. METHODOLOGY: This retrospective cohort study utilised data collected from records for adult patients admitted to the Royal Brisbane and Women's Hospital with burns to at least 15% TBSA. Rates of iron deficiency, defined as ferritin< 100 µg/L or ferritin 100-300 µg/L with transferrin saturation< 20%, and low iron availability, defined as transferrin saturation< 20%, were calculated. RESULTS: Of 60 included patients (90% male), 16 (27%) underwent iron studies. 11 (18%) were treated with intravenous iron. Iron studies showed that five (31%) patients had evidence of iron deficiency, and ten out of 12 (83%) had evidence of reduced iron availability. Two patients (40%) with evidence of iron deficiency were not treated with intravenous iron. CONCLUSION: Application of recent guidelines for interpretation of conventional iron studies in patients with inflammatory states may improve the identification of iron deficiency in burn patients. Iron deficiency may be an under-recognised and under-treated contributor to burn anaemia.

Intravenous iron therapy to treat burn anaemia: A retrospective cohort study.

PURPOSE: Intravenous iron is an effective treatment for anaemia in many populations but has not been evaluated in those with burn anaemia. This study aimed to evaluate the efficacy and safety of intravenous iron to manage burn anaemia. METHODOLOGY: This was a retrospective cohort study of patients admitted to the Royal Brisbane and Women's Hospital with burns to at least 15% total body surface area (TBSA). Data collected from patient records included demographics, treatment details, and outcomes including length of stay, blood transfusions, and serum haemoglobin concentrations. Linear mixed effects regression models were used to assess the effect of treatment with intravenous iron on haemoglobin over time. RESULTS: Sixty patients met inclusion criteria, with 11 (18%) treated using intravenous iron. Those treated with intravenous iron had higher TBSA burns (median 39% vs 18%, P = 0.0005), more operations (3 vs 1, P = 0.0012), and more blood transfusions (median 8 units vs 0 units, P = 0.0002). One patient (9%) experienced a minor adverse drug reaction from intravenous iron. When examining the change in modelled haemoglobin levels over the first 14 days following the last major operation, the change in the intravenous iron group (11.22 g/L) was 14.56 g/L greater than the change in the group not receiving intravenous iron (-3.34 g/L, P = 0.0282). CONCLUSION: This exploratory study provides preliminary evidence of benefit and safety of intravenous iron treatment on burn anaemia recovery.

The mental health impact of perinatal loss: A systematic review and meta-analysis.

Perinatal loss can pose a significant risk to maternal mental health. There is limited data on the strength of association between perinatal loss and subsequent common mental health disorders (CMHD) such as anxiety, depression and post-traumatic symptoms (PTS). A systematic review and meta-analysis identified studies with control groups, published between January 1995 and March 2020 reporting validated mental health outcomes following perinatal loss. We identified 29 studies from 17 countries, representing a perinatal loss sample (n = 31,072) and a control group of women not experiencing loss (n = 1,261,517). We compared the likelihood of increased CMHD in both groups. Random-effects modelling on suggested that compared to controls, perinatal loss was associated with increased risk of depressive (RR = 2.14, 95% CI = 1.73-2.66, p < 0.001, k = 22) and anxiety disorders (RR = 1.75, 95% CI = 1.27-2.42, p < 0.001, k = 9). Compared to controls, Perinatal loss was also associated with increased depression (SMD = 0.34, 95% CI = 0.20-0.48, p < 0.001, k = 12) and anxiety scores (SMD = 0.35, 95% CI = 0.12-0.58, p < 0.003, k = 10). There were no significant effects for post-traumatic stress (PTS) outcomes (k = 3). Our findings confirm that anxiety and depression levels following perinatal loss are significantly elevated compared to "no loss" controls (live-births, non pregnant from community, or difficult live births). Elevated depression and anxiety rates were also reported for those who experienced loss during later stages of pregnancy. Assessing mental health following loss is a maternal health priority.

Differential success in obtaining gametes between male and female Australian temperate frogs by hormonal induction: A review.

Most Australian frogs fall into two deeply split lineages, conveniently referred to as ground frogs (Myobatrachidae and Limnodynastidae) and tree frogs (Pelodryadidae). Species of both lineages are endangered because of the global chytrid pandemic, and there is increasing interest and research on the endocrine manipulation of reproduction to support the use of assisted reproductive technologies in conservation. Hormonal induction of gamete release in males and females is one such manipulation of the reproductive process. This paper reviews progress in temperate ground and tree frogs towards developing simple and efficient hormonal protocols for induction of spermiation and ovulation, and presents some new data, that together build towards an understanding of advances and obstacles towards progress in this area. We report that protocols for the non-invasive induction of sperm release, relying on single doses of gonadotropin-releasing hormone (GnRH) or human chorionic gonadotropin are very effective in both ground and tree frog species investigated to date. However, we find that, while protocols based on GnRH, and GnRH and dopamine antagonists, are moderately efficient in inducing ovulation in ground frogs, the same cannot be said for the use of such protocols in tree frogs. Although induced ovulation in the pelodryadid tree frogs has not been successfully implemented, and is difficult to explain in terms of the underlying endocrinology, we propose future avenues of investigation to address this problem, particularly the need for a source of purified or recombinant follicle-stimulating hormone and luteinising hormone for species from this group.

'Are you siding with a personality or the grant proposal?': observations on how peer review panels function.

BACKGROUND: In Australia, the peer review process for competitive funding is usually conducted by a peer review group in conjunction with prior assessment from external assessors. This process is quite mysterious to those outside it. The purpose of this research was to throw light on grant review panels (sometimes called the 'black box') through an examination of the impact of panel procedures, panel composition and panel dynamics on the decision-making in the grant review process. A further purpose was to compare experience of a simplified review process with more conventional processes used in assessing grant proposals in Australia. METHODS: This project was one aspect of a larger study into the costs and benefits of a simplified peer review process. The Queensland University of Technology (QUT)-simplified process was compared with the National Health and Medical Research Council's (NHMRC) more complex process. Grant review panellists involved in both processes were interviewed about their experience of the decision-making process that assesses the excellence of an application. All interviews were recorded and transcribed. Each transcription was de-identified and returned to the respondent for review. Final transcripts were read repeatedly and coded, and similar codes were amalgamated into categories that were used to build themes. Final themes were shared with the research team for feedback. RESULTS: Two major themes arose from the research: (1) assessing grant proposals and (2) factors influencing the fairness, integrity and objectivity of review. Issues such as the quality of writing in a grant proposal, comparison of the two review methods, the purpose and use of the rebuttal, assessing the financial value of funded projects, the importance of the experience of the panel membership and the role of track record and the impact of group dynamics on the review process were all discussed. The research also examined the influence of research culture on decision-making in grant review panels. One of the aims of this study was to compare a simplified review process with more conventional processes. Generally, participants were supportive of the simplified process. CONCLUSIONS: Transparency in the grant review process will result in better appreciation of the outcome. Despite the provision of clear guidelines for peer review, reviewing processes are likely to be subjective to the extent that different reviewers apply different rules. The peer review process will come under more scrutiny as funding for research becomes even more competitive. There is justification for further research on the process, especially of a kind that taps more deeply into the 'black box' of peer review.

A randomized trial of fellowships for early career researchers finds a high reliability in funding decisions.

OBJECTIVES: Funding for early career researchers in Australia's largest medical research funding scheme is determined by a competitive peer-review process using a panel of four reviewers. The purpose of this experiment was to appraise the reliability of funding by duplicating applications that were considered by separate grant review panels. STUDY DESIGN AND METHODS: Sixty duplicate applications were considered by two independent grant review panels that were awarding funding for Australia's National Health and Medical Research Council. Panel members were blinded to which applications were included in the experiment and to whether it was the original or duplicate application. Scores were compared across panels using Bland-Altman plots to determine measures of agreement, including whether agreement would have impacted on actual funding. RESULTS: Twenty-three percent of the applicants were funded by both panels and 60 percent were not funded by both, giving an overall agreement of 83 percent [95% confidence interval (CI): 73%, 92%]. The chance-adjusted agreement was 0.75 (95% CI: 0.58, 0.92). CONCLUSION: There was a comparatively high level of agreement when compared with other types of funding schemes. Further experimental research could be used to determine if this higher agreement is due to nature of the application, the composition of the assessment panel, or the characteristics of the applicants.

Using simplified peer review processes to fund research: a prospective study.

OBJECTIVE: To prospectively test two simplified peer review processes, estimate the agreement between the simplified and official processes, and compare the costs of peer review. DESIGN, PARTICIPANTS AND SETTING: A prospective parallel study of Project Grant proposals submitted in 2013 to the National Health and Medical Research Council (NHMRC) of Australia. The official funding outcomes were compared with two simplified processes using proposals in Public Health and Basic Science. The two simplified processes were: panels of 7 reviewers who met face-to-face and reviewed only the nine-page research proposal and track record (simplified panel); and 2 reviewers who independently reviewed only the nine-page research proposal (journal panel). The official process used panels of 12 reviewers who met face-to-face and reviewed longer proposals of around 100 pages. We compared the funding outcomes of 72 proposals that were peer reviewed by the simplified and official processes. MAIN OUTCOME MEASURES: Agreement in funding outcomes; costs of peer review based on reviewers' time and travel costs. RESULTS: The agreement between the simplified and official panels (72%, 95% CI 61% to 82%), and the journal and official panels (74%, 62% to 83%), was just below the acceptable threshold of 75%. Using the simplified processes would save $A2.1-$A4.9 million per year in peer review costs. CONCLUSIONS: Using shorter applications and simpler peer review processes gave reasonable agreement with the more complex official process. Simplified processes save time and money that could be reallocated to actual research. Funding agencies should consider streamlining their application processes.

Streamlined research funding using short proposals and accelerated peer review: an observational study.

BACKGROUND: Despite the widely recognised importance of sustainable health care systems, health services research remains generally underfunded in Australia. The Australian Centre for Health Services Innovation (AusHSI) is funding health services research in the state of Queensland. AusHSI has developed a streamlined protocol for applying and awarding funding using a short proposal and accelerated peer review. METHOD: An observational study of proposals for four health services research funding rounds from May 2012 to November 2013. A short proposal of less than 1,200 words was submitted using a secure web-based portal. The primary outcome measures are: time spent preparing proposals; a simplified scoring of grant proposals (reject, revise or accept for interview) by a scientific review committee; and progressing from submission to funding outcomes within eight weeks. Proposals outside of health services research were deemed ineligible. RESULTS: There were 228 eligible proposals across 4 funding rounds: from 29% to 79% were shortlisted and 9% to 32% were accepted for interview. Success rates increased from 6% (in 2012) to 16% (in 2013) of eligible proposals. Applicants were notified of the outcomes within two weeks from the interview; which was a maximum of eight weeks after the submission deadline. Applicants spent 7 days on average preparing their proposal. Applicants with a ranking of reject or revise received written feedback and suggested improvements for their proposals, and resubmissions composed one third of the 2013 rounds. CONCLUSIONS: The AusHSI funding scheme is a streamlined application process that has simplified the process of allocating health services research funding for both applicants and peer reviewers. The AusHSI process has minimised the time from submission to notification of funding outcomes.

The impact of a streamlined funding application process on application time: two cross-sectional surveys of Australian researchers.

OBJECTIVE: To examine if streamlining a medical research funding application process saved time for applicants. DESIGN: Cross-sectional surveys before and after the streamlining. SETTING: The National Health and Medical Research Council (NHMRC) of Australia. PARTICIPANTS: Researchers who submitted one or more NHMRC Project Grant applications in 2012 or 2014. MAIN OUTCOME MEASURES: Average researcher time spent preparing an application and the total time for all applications in working days. RESULTS: The average time per application increased from 34 working days before streamlining (95% CI 33 to 35) to 38 working days after streamlining (95% CI 37 to 39; mean difference 4 days, bootstrap p value <0.001). The estimated total time spent by all researchers on applications after streamlining was 614 working years, a 67-year increase from before streamlining. CONCLUSIONS: Streamlined applications were shorter but took longer to prepare on average. Researchers may be allocating a fixed amount of time to preparing funding applications based on their expected return, or may be increasing their time in response to increased competition. Many potentially productive years of researcher time are still being lost to preparing failed applications.

'As many options as there are, there are just not enough for me': contraceptive use and barriers to access among Australian women.

OBJECTIVE: A comprehensive life course perspective of women's experiences in obtaining and using contraception in Australia is lacking. This paper explores free-text comments about contraception provided by women born between 1973 and 1978 who participated in the Australian Longitudinal Study on Women's Health (ALSWH). METHODS: The ALSWH is a national population-based cohort study involving over 40,000 women from three age groups, who are surveyed every three years. An initial search identified 1600 comments from 690 women across five surveys from 1996 (when they were aged 18-23 years) to 2009 (31-36 years). The analysis included 305 comments from 289 participants. Factors relating to experiences of barriers to access and optimal contraceptive use were identified and explored using thematic analysis. RESULTS: Five themes recurred across the five surveys as women aged: (i) side effects affecting physical and mental health; (ii) lack of information about contraception; (iii) negative experiences with health services; (iv) contraceptive failure; and (v) difficulty with accessing contraception. CONCLUSION: Side effects of hormonal contraception and concerns about contraceptive failure influence women's mental and physical health. Many barriers to effective contraception persist throughout women's reproductive lives. Further research is needed into reducing barriers and minimising negative experiences, to ensure optimal contraceptive access for Australian women.

Higher uptake of long-acting reversible and permanent methods of contraception by Australian women living in rural and remote areas.

OBJECTIVES: To examine factors associated with the uptake of i) long-acting reversible, ii) permanent and iii) traditional contraceptive methods among Australian women. METHODS: Participants in the Australian Longitudinal Study on Women's Health born in 1973-78 reported on their contraceptive use at three surveys: 2003, 2006 and 2009. The participants were 5,849 women aged 25-30 in 2003 randomly sampled from Medicare. The main outcome measure was current contraceptive method at age 28-33 years categorised as long-acting reversible methods (implant, IUD, injection), permanent (tubal ligation, vasectomy), and traditional methods (oral contraceptive pills, condoms, withdrawal, safe period). RESULTS: Compared to women living in major cities, women in inner regional areas were more likely to use long-acting (OR=1.26, 95%CI 1.03-1.55) or permanent methods (OR=1.43, 95%CI 1.17-1.76). Women living in outer regional/remote areas were more likely than women living in cities to use long-acting (OR=1.65, 95%CI 1.31-2.08) or permanent methods (OR=1.69, 95%CI 1.43-2.14). CONCLUSIONS: Location of residence is an important factor in women's choices about long-acting and permanent contraception in addition to the number and age of their children. IMPLICATIONS: Further research is needed to understand the role of geographical location in women's access to contraceptive options in Australia.

The impact of funding deadlines on personal workloads, stress and family relationships: a qualitative study of Australian researchers.

OBJECTIVE: To examine the impact of applying for funding on personal workloads, stress and family relationships. DESIGN: Qualitative study of researchers preparing grant proposals. SETTING: Web-based survey on applying for the annual National Health and Medical Research Council (NHMRC) Project Grant scheme. PARTICIPANTS: Australian researchers (n=215). RESULTS: Almost all agreed that preparing their proposals always took top priority over other work (97%) and personal (87%) commitments. Almost all researchers agreed that they became stressed by the workload (93%) and restricted their holidays during the grant writing season (88%). Most researchers agreed that they submitted proposals because chance is involved in being successful (75%), due to performance requirements at their institution (60%) and pressure from their colleagues to submit proposals (53%). Almost all researchers supported changes to the current processes to submit proposals (95%) and peer review (90%). Most researchers (59%) provided extensive comments on the impact of writing proposals on their work life and home life. Six major work life themes were: (1) top priority; (2) career development; (3) stress at work; (4) benefits at work; (5) time spent at work and (6) pressure from colleagues. Six major home life themes were: (1) restricting family holidays; (2) time spent on work at home; (3) impact on children; (4) stress at home; (5) impact on family and friends and (6) impact on partner. Additional impacts on the mental health and well-being of researchers were identified. CONCLUSIONS: The process of preparing grant proposals for a single annual deadline is stressful, time consuming and conflicts with family responsibilities. The timing of the funding cycle could be shifted to minimise applicant burden, give Australian researchers more time to work on actual research and to be with their families.

On the time spent preparing grant proposals: an observational study of Australian researchers.

OBJECTIVE: To estimate the time spent by the researchers for preparing grant proposals, and to examine whether spending more time increase the chances of success. DESIGN: Observational study. SETTING: The National Health and Medical Research Council (NHMRC) of Australia. PARTICIPANTS: Researchers who submitted one or more NHMRC Project Grant proposals in March 2012. MAIN OUTCOME MEASURES: Total researcher time spent preparing proposals; funding success as predicted by the time spent. RESULTS: The NHMRC received 3727 proposals of which 3570 were reviewed and 731 (21%) were funded. Among our 285 participants who submitted 632 proposals, 21% were successful. Preparing a new proposal took an average of 38 working days of researcher time and a resubmitted proposal took 28 working days, an overall average of 34 days per proposal. An estimated 550 working years of researchers' time (95% CI 513 to 589) was spent preparing the 3727 proposals, which translates into annual salary costs of AU$66 million. More time spent preparing a proposal did not increase the chances of success for the lead researcher (prevalence ratio (PR) of success for 10 day increase=0.91, 95% credible interval 0.78 to 1.04) or other researchers (PR=0.89, 95% CI 0.67 to 1.17). CONCLUSIONS: Considerable time is spent preparing NHMRC Project Grant proposals. As success rates are historically 20-25%, much of this time has no immediate benefit to either the researcher or society, and there are large opportunity costs in lost research output. The application process could be shortened so that only information relevant for peer review, not administration, is collected. This would have little impact on the quality of peer review and the time saved could be reinvested into research.

Challenges for researchers investigating contraceptive use and pregnancy intentions of young women living in urban and rural areas of Australia: face-to-face discussions to increase participation in a web-based survey.

BACKGROUND: It is imperative to understand how to engage young women in research about issues that are important to them. There is limited reliable data on how young women access contraception in Australia especially in rural areas where services may be less available. OBJECTIVE: This paper identifies the challenges involved in engaging young Australian women aged 18-23 years to participate in a web-based survey on contraception and pregnancy and ensure their ongoing commitment to follow-up web-based surveys. METHODS: A group of young women, aged 18-23 years and living in urban and rural New South Wales, Australia, were recruited to participate in face-to-face discussions using several methods of recruitment: direct contact (face-to-face, telephone or email) and snowball sampling by potential participants inviting their friends. All discussions were transcribed verbatim and analyzed using thematic analysis. RESULTS: Twenty young women participated (urban, n=10: mean age 21.6 years; rural, n=10: 20.0 years) and all used computers or smart phones to access the internet on a daily basis. All participants were concerned about the cost of internet access and utilized free access to social media on their mobile phones. Their willingness to participate in a web-based survey was dependent on incentives with a preference for small financial rewards. Most participants were concerned about their personal details and survey responses remaining confidential and secure. The most appropriate survey would take up to 15 minutes to complete, be a mix of short and long questions and eye-catching with bright colours. Questions on the sensitive topics of sexual activity, contraception and pregnancy were acceptable if they could respond with "I prefer not to answer". CONCLUSIONS: There are demographic, participation and survey design challenges in engaging young women in a web-based survey. Based on our findings, future research efforts are needed to understand the full extent of the role social media and incentives play in the decision of young women to participate in web-based research.

Predictors of sexually transmitted infection in Australian women: evidence from the Australian Longitudinal Study on Women's Health.

This longitudinal study examined characteristics of women diagnosed with sexually transmitted infections (STI) for the first time in their later 20s and early 30s. Participants were 6,840 women (born 1973-1978) from the Australian Longitudinal Study on Women's Health. Women aged 18-23 years were surveyed in 1996 (S1), 2000 (S2), 2003 (S3), and 2006 (S4). There were 269 women reporting an STI for the first time at S3 or S4. Using two multivariable logistic regression analyses (examining 18 predictor variables), these 269 women were compared (1) with 306 women who reported an STI at S2 and (2) with 5,214 women who never reported an STI across the four surveys. Women who reported an STI for the first time at S3 or S4 were less likely to have been pregnant or had a recent Pap smear compared to women reporting an STI at S2. Women reporting a first STI at S3 or S4 were less likely to have been pregnant or had a recent Pap smear compared to women reporting an STI at S2. Women were more likely to report an STI for the first time at S3 or S4 compared to women not reporting an STI at any survey if they were younger, unpartnered, had a higher number of sexual partners, had never been pregnant, were recently divorced or separated, and reported poorer access to Women's Health or Family Planning Centres at S2. These findings demonstrate the value of longitudinal studies of sexual health over the life course beyond adolescence.

Agreement between self-reported use of in vitro fertilization or ovulation induction, and medical insurance claims in Australian women aged 28-36 years.

STUDY QUESTION: What is the self-reported use of in vitro fertilization (IVF) and ovulation induction (OI) in comparison with insurance claims by Australian women aged 28-36 years? SUMMARY ANSWER: The self-reported use of IVF is quite likely to be valid; however, the use of OI is less well reported. WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Population-based research often relies on the self-reported use of IVF and OI because access to medical records can be difficult and the data need to include sufficient personal identifying information for linkage to other data sources. There have been few attempts to explore the reliability of the self-reported use of IVF and OI using the linkage to medical insurance claims for either treatment. STUDY DESIGN: This prospective, population-based, longitudinal study included the cohort of women born during 1973-1978 and participating in the Australian Longitudinal Study on Women's Health (ALSWH) (n = 14247). From 1996 to 2009, participants were surveyed up to five times. PARTICIPANTS AND SETTING: Participants self-reported their use of IVF or OI in two mailed surveys when aged 28-33 and 31-36 years (n = 7280), respectively. This study links self-report survey responses and claims for treatment or medication from the universal national health insurance scheme (i.e. Medicare Australia). MAIN RESULTS AND THE ROLE OF CHANCE: Comparisons between self-reports and claims data were undertaken for all women consenting to the linkage (n = 3375). The self-reported use of IVF was compared with claims for OI for IVF (Kappa, K = 0.83), oocyte collection (K = 0.82), sperm preparation (K = 0.83), intracytoplasmic sperm injection (K = 0.40), fresh embryo transfers (K = 0.82), frozen embryo transfers (K = 0.64) and OI for IVF medication (K = 0.17). The self-reported use of OI was compared with ovulation monitoring (K = 0.52) and OI medication (K = 0.71). BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION: There is a possibility of selection bias due to the inclusion criteria for participants in this study: (1) completion of the last two surveys in a series of five and (2) consent to the linkage of their responses with Medicare data. GENERALIZABILITY TO OTHER POPULATIONS: The results are relevant to questionnaire-based research studies with infertile women in developed countries.

Miscarriage, preterm delivery, and stillbirth: large variations in rates within a cohort of Australian women.

OBJECTIVES: We aimed to use simple clinical questions to group women and provide their specific rates of miscarriage, preterm delivery, and stillbirth for reference. Further, our purpose was to describe who has experienced particularly low or high rates of each event. METHODS: Data were collected as part of the Australian Longitudinal Study on Women's Health, a national prospective cohort. Reproductive histories were obtained from 5806 women aged 31-36 years in 2009, who had self-reported an outcome for one or more pregnancy. Age at first birth, number of live births, smoking status, fertility problems, use of in vitro fertilisation (IVF), education and physical activity were the variables that best separated women into groups for calculating the rates of miscarriage, preterm delivery, and stillbirth. RESULTS: Women reported 10,247 live births, 2544 miscarriages, 1113 preterm deliveries, and 113 stillbirths. Miscarriage was correlated with stillbirth (r = 0.09, P<0.001). The calculable rate of miscarriage ranged from 11.3 to 86.5 miscarriages per 100 live births. Women who had high rates of miscarriage typically had fewer live births, were more likely to smoke and were more likely to have tried unsuccessfully to conceive for ≥12 months. The highest proportion of live preterm delivery (32.2%) occurred in women who had one live birth, had tried unsuccessfully to conceive for ≥12 months, had used IVF, and had 12 years education or equivalent. Women aged 14-19.99 years at their first birth and reported low physical activity had 38.9 stillbirths per 1000 live births, compared to the lowest rate at 5.5 per 1000 live births. CONCLUSION: Different groups of women experience vastly different rates of each adverse pregnancy event. We have used simple questions and established reference data that will stratify women into low- and high-rate groups, which may be useful in counselling those who have experienced miscarriage, preterm delivery, or stillbirth, plus women with fertility intent.