Melanie Brown - Academia.edu (original) (raw)

Papers by Melanie Brown

IN THE CENTURY since women were finally granted the right to vote, the women's liberation mov... more IN THE CENTURY since women were finally granted the right to vote, the women's liberation movement has continued to demand equality between the sexes. The recent “Time's Up” and #MeToo campaigns highlight that these issues are still far from resolved, but it was in the 1960s that the single biggest revolution for women occurred. It transformed women's lives across the globe, and was central to the revolutionary gains that women made throughout the 1960s, 1970s, and 1980s. It was, ofcourse, the development ofthe Pill. The first Version ofthe Pill, Enovid, was licensed as a contraceptive in the United States in 1960. Itcontains artificial versions of estrogen and progesterone, hormones that occur naturally in women. It mimics the effects of pregnancy by preventing ovulation, thickening cervical mucus to create a barrier to prevent sperm from reaching the womb, and by thinning the lining of the womb, which lowers the chance of a fertilized egg implanting itself. These combi...

The gap between funds available to water utilities and the demand for water infrastructure has gr... more The gap between funds available to water utilities and the demand for water infrastructure has grown. There is therefore a need to facilitate the process of mobilizing additional funding for developing the water sector and ensuring that these investments result in sustainable service delivery. One of the key actions taken in this regard has been to conduct credit ratings so as to develop a better understanding of the credit worthiness water utilities in Africa. The findings from a sample study are presented in this regional report. The analysis is based on data sourced from seven participating water utilities across five African countries: Burkina Faso, Kenya, Senegal, Tunisia and Uganda. The bulletin's three main sections are: 1) an economic and regulatory overview of water utilities; 2) a comparative water utility analysis - this compares the relative position of the water utilities included in the analysis in terms of their size, efficiency, debt and liquidity measures, and d...

Internet Journal of Allied Health Sciences and Practice

Purpose: To date, few interprofessional education initiatives have included just medicine and pha... more Purpose: To date, few interprofessional education initiatives have included just medicine and pharmacy learners. This research sought to explore learners’ and facilitators’ views of an interprofessional education medicines pilot study involving medical students and pharmacy interns. Methods: Qualitative feedback was gathered from the participating learners and a facilitator focus group was undertaken. Results: Medical student and pharmacy intern learners reported enjoying taking part and found the simulation and overall initiative to be authentic. They described learning most about each other’s roles and responsibilities and about teamwork, collaborative management, and collaboration. Some logistical improvements were suggested. The facilitators judged that the topic of medicines, with medical and pharmacy learners taking part, to be a match made in heaven. Conclusions: Medical student and pharmacy intern learners found the medicines topic and discipline grouping facilitated their l...

Clinical Journal of the American Society of Nephrology

The COVID-19 pandemic continues to strain health care systems and drive shortages in medical supp... more The COVID-19 pandemic continues to strain health care systems and drive shortages in medical supplies and equipment around the world. Resource allocation in times of scarcity requires transparent, ethical frameworks to optimize decision making and reduce health care worker and patient distress. The complexity of allocating dialysis resources for both patients receiving acute and maintenance dialysis has not previously been addressed. Using a rapid, collaborative, and iterative process, BC Renal, a provincial network in Canada, engaged patients, doctors, ethicists, administrators, and nurses to develop a framework for addressing system capacity, communication challenges, and allocation decisions. The guiding ethical principles that underpin this framework are (1) maximizing benefits, (2) treating people fairly, (3) prioritizing the worst-off individuals, and (4) procedural justice. Algorithms to support resource allocation and triage of patients were tested using simulations, and the...

Pediatric Critical Care Medicine

Supplemental Digital Content is available in the text. Objectives: Communication breakdowns in PI... more Supplemental Digital Content is available in the text. Objectives: Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure. Design: Patient-level, randomized trial. Setting: Two university-based, tertiary-care children’s hospital PICUs. Participants: Parents of patients requiring more than 24 hours in the PICU. Interventions: PICU Supports included adding a trained navigator to the patient’s healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers. Measurements and Main Results: The primary outcome was percentage of “excellent” responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3–5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3–5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; se, 4.53; 95% CI, –5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as “extremely” or “somewhat” helpful. Conclusions: Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.

Journal of Applied Research in Higher Education

Purpose The purpose of this paper is to overview an institution wide accessibility project undert... more Purpose The purpose of this paper is to overview an institution wide accessibility project undertaken at the Vietnam locations of a transnational Australian university, and the significance of this initiative in symbolising the organisation’s commitment to inclusion and diversity. The project implemented universal accessibility standards for learning materials across all courses delivered at the university. This facilitated an easier in-class and online learning experience for students with a broad range of print disabilities, visual or hearing impairments, and a range of other learning differences or disabilities. Design/methodology/approach The implementation of this project entailed three concurrent streams of activity which the authors describe in this paper. These included development of accessibility standards and processes for conversion of the existing learning materials, a sustained awareness raising campaign for staff and students, and integration of the accessibility stan...

Forensic Science International: Genetics Supplement Series

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Cognitive and Behavioral Practice

Abstract Avoidant/restrictive food intake disorder (ARFID), which was introduced in DSM-5, may be... more Abstract Avoidant/restrictive food intake disorder (ARFID), which was introduced in DSM-5, may be one of the most functionally impairing eating disorders, yet little is known regarding risk factors, prevalence, or efficacious treatment models for the disorder. With no empirically supported treatment for ARFID, it is important to investigate the clinical utility of innovative therapeutic approaches. Here we describe a novel parent-facilitated behavioral treatment for youth with ARFID (PBT-ARFID) that is grounded in learning theory, as well as components of well-established family-based treatment (FBT) for eating disorders. We propose a two-factor theory of avoidance learning within a biopsychosocial model to explain behavior in ARFID and utilize counterconditioning as a core intervention to reverse paired, classically conditioned association between food and aversive state (i.e., disgust and/or anxiety). This report details a step-by-step comprehensive treatment approach for ARFID that can be adapted to a broad range of youth and their families, along with a case study illustrating application of the model. This pilot case provides preliminary evidence that the PBT-ARFID model incorporating counterconditioning may be a powerful treatment for youth with ARFID. More case and pilot studies are needed to justify formally investigating its efficacy in a randomized controlled trial.

Nature communications, Jan 25, 2018

Allogeneic transplantation (allo-HCT) has led to the cure of HIV in one individual, raising the q... more Allogeneic transplantation (allo-HCT) has led to the cure of HIV in one individual, raising the question of whether transplantation can eradicate the HIV reservoir. To test this, we here present a model of allo-HCT in SHIV-infected, cART-suppressed nonhuman primates. We infect rhesus macaques with SHIV-1157ipd3N4, suppress them with cART, then transplant them using MHC-haploidentical allogeneic donors during continuous cART. Transplant results in ~100% myeloid donor chimerism, and up to 100% T-cell chimerism. Between 9 and 47 days post-transplant, terminal analysis shows that while cell-associated SHIV DNA levels are reduced in the blood and in lymphoid organs post-transplant, the SHIV reservoir persists in multiple organs, including the brain. Sorting of donor-vs.-recipient cells reveals that this reservoir resides in recipient cells. Moreover, tetramer analysis indicates a lack of virus-specific donor immunity post-transplant during continuous cART. These results suggest that earl...

European eating disorders review : the journal of the Eating Disorders Association, 2018

A neurocognitive profile characterized by problems in set shifting, executive functioning, and ce... more A neurocognitive profile characterized by problems in set shifting, executive functioning, and central coherence may pre-date and maintain anorexia nervosa (AN). To test this pattern as a possible endophenotype for AN, 10 youth with current AN, 14 healthy youth, and their biological parents, participated in a neuropsychological battery. Youth with AN demonstrated significantly weaker central coherence, related to enhanced detail-focused processing. Youth with AN and their parents demonstrated significantly greater psychopathology relative to controls, and youth-parent scores were significantly correlated. The study, limited by a small sample size, found little evidence supporting a neuropsychological endophenotype for AN. Identifying a neurocognitive profile for children and adolescents with AN has important implications for the treatment of young patients.

Children (Basel, Switzerland), Jan 13, 2018

Pediatric palliative care is a field which focuses on caring for and treating the symptoms and di... more Pediatric palliative care is a field which focuses on caring for and treating the symptoms and distress typically associated with life-limiting illness. Integrative medicine is supported by evidence and aims to heal the whole person, including all aspects of one’s lifestyle. Therapies offered by integrative medicine often empower patients and families, allowing for a sense of control. This review addresses the merging of integrative medicine philosophy and modalities with the care given to children with life-limiting illness. We review an introduction to integrative medicine, trends in its incorporation in the healthcare setting, application to patients receiving palliative care and the management of specific symptoms. A case study is offered to illustrate these principles.

Medical acupuncture, 2018

The Journal of clinical investigation, Jan 31, 2018

Controlling graft-versus-host disease (GVHD) remains a major unmet need in stem cell transplantat... more Controlling graft-versus-host disease (GVHD) remains a major unmet need in stem cell transplantation, and new, targeted therapies are being actively developed. CD28-CD80/86 costimulation blockade represents a promising strategy, but targeting CD80/CD86 with CTLA4-Ig may be associated with undesired blockade of coinhibitory pathways. In contrast, targeted blockade of CD28 exclusively inhibits T cell costimulation and may more potently prevent GVHD. Here, we investigated FR104, an antagonistic CD28-specific pegylated-Fab', in the nonhuman primate (NHP) GVHD model and completed a multiparameter interrogation comparing it with CTLA4-Ig, with and without sirolimus, including clinical, histopathologic, flow cytometric, and transcriptomic analyses. We document that FR104 monoprophylaxis and combined prophylaxis with FR104/sirolimus led to enhanced control of effector T cell proliferation and activation compared with the use of CTLA4-Ig or CTLA4-Ig/sirolimus. Importantly, FR104/sirolimu...

Children (Basel, Switzerland), Jan 7, 2018

While pediatric integrative medicine (PIM) emphasizes an "evidence-based practice using mult... more While pediatric integrative medicine (PIM) emphasizes an "evidence-based practice using multiple therapeutic modalities"; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind⁻body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches in children and youth are scarce. Nevertheless, integrative practitioners in clinical practice routinely mix approaches to meet the individual needs of each patient. Best practices are flexible, and include blending and augmenting services within the same session, and/or connecting modalities sequentially for an incremental effect, and/or referring to outside resources for additional interventions. Resonating with integrative medicine's definition, this article's goal is to demonstrate paradigms that "bring together complementary approaches in a coordinated way within clinical practice" by li...

Science Translational Medicine

A critical question facing the field of transplantation is how to control effector T cell (T eff)... more A critical question facing the field of transplantation is how to control effector T cell (T eff) activation while preserving regulatory T cell (T reg) function. Standard calcineurin inhibitor-based strategies can partially control T effs , but breakthrough activation still occurs, and these agents are antagonistic to T reg function. Conversely, mechanistic target of rapamycin (mTOR) inhibition with sirolimus is more T reg-compatible but is inadequate to fully control T eff activation. In contrast, blockade of OX40L signaling has the capacity to partially control T eff activation despite maintaining T reg function. We used the nonhuman primate graft-versus-host disease (GVHD) model to probe the efficacy of combinatorial immunomodulation with sirolimus and the OX40L-blocking antibody KY1005. Our results demonstrate significant biologic activity of KY1005 alone (prolonging median GVHD-free survival from 8 to 19.5 days), as well as marked, synergistic control of GVHD with KY1005 + sirolimus (median survival time, >100 days; P < 0.01 compared to all other regimens), which was associated with potent control of both T H /T C 1 (T helper cell 1/cytotoxic T cell 1) and T H /T C 17 activation. Combined administration also maintained T reg reconstitution [resulting in an enhanced T reg /T eff ratio (40% over baseline) in the KY1005/sirolimus cohort compared to a 2.9-fold decrease in the unprophylaxed GVHD cohort]. This unique immunologic signature resulted in transplant recipients that were able to control GVHD for the length of analysis and to down-regulate donor/ recipient alloreactivity despite maintaining anti-third-party responses. These data indicate that combined OX40L blockade and sirolimus represents a promising strategy to induce immune balance after transplant and is an important candidate regimen for clinical translation.

European eating disorders review : the journal of the Eating Disorders Association, Sep 23, 2017

Intolerance of uncertainty is an empirically supported transdiagnostic construct that may have re... more Intolerance of uncertainty is an empirically supported transdiagnostic construct that may have relevance in understanding eating disorders. We conducted a meta-analysis and systematic review of intolerance of uncertainty in eating disorders using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We calculated random-effects standardised mean differences (SMD) for studies utilising the Intolerance of Uncertainty Scale (IUS) and summarised additional studies descriptively. Women with eating disorders have significantly higher IUS scores compared with healthy controls (SMD = 1.90; 95% C.I. 1.24 to 2.56; p < 0.001). Post hoc meta-analysis revealed significant differences when comparing women with anorexia nervosa with controls (SMD = 2.16; 95% C.I. 1.14 to 3.18; p < 0.001) and women with bulimia nervosa with controls (SMD = 2.03; 95% C.I. 1.30 to 2.75; p < 0.001). Our synthesis of findings suggests that intolerance of uncertainty may repres...

Children (Basel, Switzerland), Jan 20, 2017

Pain is a significant public health problem that affects all populations and has significant fina... more Pain is a significant public health problem that affects all populations and has significant financial, physical and psychological impact. Opioid medications, once the mainstay of pain therapy across the spectrum, can be associated with significant morbidity and mortality. Centers for Disease and Control (CDC) guidelines recommend that non-opioid pain medications are preferred for chronic pain outside of certain indications (cancer, palliative and end of life care). Mindfulness, hypnosis, acupuncture and yoga are four examples of mind-body techniques that are often used in the adult population for pain and symptom management. In addition to providing significant pain relief, several studies have reported reduced use of opioid medications when mind-body therapies are implemented. Mind-body medicine is another approach that can be used in children with both acute and chronic pain to improve pain management and quality of life.

RICERCHE DI PSICOLOGIA, 2016