Michael Williams - Academia.edu (original) (raw)

Papers by Michael Williams

Research paper thumbnail of Simulated eye clinic and virtual eye case: alternative worlds for medical students

BMJ Simulation and Technology Enhanced Learning, 2016

Research paper thumbnail of Having Your Cake - How to Preserve Universal-Service Cross Subsidies While Facilitating Competitive Entry: A Response

SSRN Electronic Journal, 2003

Differential pricing for access to bottleneck inputs such as local telephone facilities or electr... more Differential pricing for access to bottleneck inputs such as local telephone facilities or electricity transmission facilities is shown to solve the old dilemma of deregulation. facilitating competitive entry without destroying cross subsidies indispensable for "universal service" programs. If bottleneck facilities are inputs to two services, one of which subsidizes the other, entrants that provide the subsidized service must receive the same subsidy in the access price as consumers receive when they purchase those services. Rivals in the supply of the other service must contribute an equivalent subsidy through paying a higher access price. Differential access pricing allows efficient competitors to find it equally profitable to supply either service because any motive for "cream skimming" disappears. Such differential pricing, coupled with access pricing consistent with the Efficient Component Pricing Rule, is shown to be necessary for economic efficiency.

Research paper thumbnail of N budgets and aquatic uptake in the Ipswich River basin, northeastern Massachusetts

Water Resources Research, 2004

We calculated N budgets and conducted nutrient uptake experiments to evaluate the fate of N in th... more We calculated N budgets and conducted nutrient uptake experiments to evaluate the fate of N in the aquatic environment of the Ipswich River basin, northeastern Massachusetts. A mass balance indicates that the basin retains about 50% of gross N inputs, mostly in terrestrial components of the landscape, and the loss and retention of total nitrogen (TN) in the aquatic environment was about 9% of stream loading. Uptake lengths of PO 4 and NH 4 were measurable in headwater streams, but NO 3 uptake was below detection (minimum detection limit = 0.05 mM). Retention or loss of NO 3 was observed in a main stem reach bordered by wetland habitat. Nitrate removal in urban headwater tributaries was because of water withdrawals and denitrification during hypoxic events and in ponded wetlands with long water residence times. A mass balance using an entire river network indicates that basin-wide losses due to aquatic denitrification are considerably lower than estimates from several recent studies and range from 4 to 16% of TDN in stream loading. Withdrawals for domestic use restrict the runoff of headwater catchments from reaching the main stem during low base flow periods, thereby contributing to the spatial and temporal regulation of N export from headwater tributaries.

Research paper thumbnail of The point-of-referral barrier—a factor in the success of telehealth

Journal of Telemedicine and Telecare, 2001

A feasibility study was carried out to test the hypothesis that, for an effective telehealth serv... more A feasibility study was carried out to test the hypothesis that, for an effective telehealth service, a full-time coordinator is required to act as a single point of contact for consultation requests. By shifting the responsibility for telepaediatrics from the referrer to the provider, the telehealth process becomes equally (or more) attractive as the conventional alternative. Preliminary results showed that, within six months, telepaediatric activity increased to an average of 8 h per month. Not only did certain health services become more accessible to children and their families in remote areas of Queensland, but significant savings were also made. At least 12 patient transfers were avoided to and from the tertiary facility, with an estimated minimum saving of $18,000 to the health-care provider.

Research paper thumbnail of Observations on the Migration of Insects in the Pyrenees in the Autumn of 1953

Transactions of the Royal Entomological Society of London, 2009

Research paper thumbnail of Role of wetlands and developed land use on dissolved organic nitrogen concentrations and DON/TDN in northeastern U.S. rivers and streams

Limnology and Oceanography, 2004

Previous studies have shown that watersheds with significant human development (i.e., urban and a... more Previous studies have shown that watersheds with significant human development (i.e., urban and agricultural land use) generally have higher concentrations and fluxes of dissolved inorganic nitrogen (DIN) in comparison to less-developed or forested watersheds. However, the impact of watershed development on dissolved organic nitrogen (DON) concentrations in drainage waters has received little attention. We present data from 39 watersheds in Massachusetts (Ipswich River watershed) encompassing a gradient of developed land use (0%-92% urban plus agriculture) and wetland abundance (0%-32%) to assess controls on mean annual DON concentrations and DON/ total dissolved nitrogen (TDN) in drainage waters. In addition, we compiled published data from 119 northeastern U.S. watersheds to evaluate broader-scale relationships between DON, developed land use, and wetlands. The percentage of developed land is a poor predictor of DON concentrations in the Ipswich watersheds (r 2 ϭ 0.09) and the compiled dataset (r 2 ϭ 0.27). In contrast, wetland percentage explains 56% of the variability in DON concentrations in the Ipswich watersheds, and 60% when all literature data are included. Excluding watersheds with direct wastewater inputs to surface waters improves the regional relationship significantly (r 2 ϭ 0.79). The DON : TDN ratio is best explained by a multiple regression of wetland percentage and developed land use percentage for both the Ipswich watersheds (r 2 ϭ 0.73) and the compiled dataset (r 2 ϭ 0.50). Watersheds with abundant wetlands may therefore have high DON concentrations and DON : TDN ratios despite elevated anthropogenic nitrogen inputs associated with human development.

Research paper thumbnail of Elevations in plasmatic titers of corticosterone and aldosterone, in the absence of changes in ACTH, testosterone, or glial fibrillary acidic protein, 72 h following d,l-fenfluramine or d-fenfluramine administration to rats

Neurotoxicology and Teratology, 2001

Studies in both humans and animals demonstrate that D,L-and D-fenfluramine (D,L-FEN and D-FEN, re... more Studies in both humans and animals demonstrate that D,L-and D-fenfluramine (D,L-FEN and D-FEN, respectively) can activate the hypothalamic-pituitary-adrenal axis following an acute dose. No data exist showing a prolonged effect of either drug, although two studies have hinted at increased adrenal activity. There are also considerable differences in the literature pertaining to the neurotoxic effects of D,Land D-FEN. Some possible explanations for these differences include: activation of different neurotransmitter systems, the temperature at which the animals were maintained during exposure, or the substance sampled in each study. We investigated the effects of either D,L-FEN or D-FEN on pituitary, adrenal, and gonadal hormones 72 h after drug exposure. Furthermore, using a dosing regimen adapted from studies on methamphetamine (e.g., four times every 2 h in a single day) known to produce elevations in glial fibrillary acidic protein (GFAP) under hyperthermic conditions, we examined the effects of D-and D,L-FEN (15 mg/kg, four times) on GFAP content when the animals were dosed at ambient temperatures of 21 or 32°C. Approximately fivefold increases of corticosterone and threefold increases of aldosterone were found 72 h later under resting conditions following both D-and D,L-FEN. Nonetheless, when animals were dosed with D-FEN at 32°C, no significant elevation in corticosterone was detected. No effect was observed for ACTH, testosterone, or GFAP following D-or D,L-FEN treatment. These data suggest that: (1) FEN treatment causes prolonged elevations in adrenal cortical hormones; (2) FEN-treated animals displayed hormonal characteristics similar to animals undergoing a chronic stressor as suggested by no difference in ACTH titers; (3) D,L-FEN treatment or D-FEN treatment (as reported previously) is not similar to other substituted amphetamines in that it does not increase GFAP, even under hyperthermic conditions.

Research paper thumbnail of MicroRNAs in Bladder Cancer

MicroRNAs in Cancer Translational Research, 2010

Bladder cancer is the fourth most common solid malignancy in men and fifth most common overall wi... more Bladder cancer is the fourth most common solid malignancy in men and fifth most common overall with an estimated 70,000 new cases of urothelial carcinoma (UC) and over 14,000 deaths from the disease expected in 2010 in the United States. Although the majority of patients with invasive bladder cancer present without radiographic or clinical evidence of disease beyond the bladder, up to 56% of patients die from the result of occult metastasis not detected by current staging modalities. The potential of microRNAs (miRNAs) as novel tumor markers has been the focus of recent scrutiny because of their tissue specificity, stability, and association with clinical-pathological parameters. Prognostic tools based on conventional clinical and pathologic staging can quantify the risk of death from UC, but their accuracy is imperfect due to the heterogeneous biologic behavior of tumors. Use of biomarkers specific to the tumor and/or patient can provide prognostic utility over that available from routine clinical features. Data have emerged documenting altered systemic miRNAs expression across a spectrum of cancers including urothelial carcinoma of the bladder. Examples include miR-21 (up-regulated), miR-200 family (associated with epithelial-mesenchymal transition and Zeb1/2), and miR-145 (apoptosis). Assessing the expression of all known and predicted non-coding RNAs species and contrasting the miRNAs in the circulation of patients with superficial or invasive disease has great potential in determining whether we can identify systemic miRNAs as screening tools for bladder cancer.

Research paper thumbnail of The multidisciplinary management of a paediatric cardiac emergency

Journal of telemedicine and telecare, 2002

Queensland is a state with a population of 3.4 million people and a land area seven times greater... more Queensland is a state with a population of 3.4 million people and a land area seven times greater than that of Great Britain. The uneven distribution of specialist health services presents difficulties for patients in rural and remote areas. Paediatric cardiology is a case in point, since the only subspecialists are located in the state capital, Brisbane, in the south-east corner of Queensland. Some 300–350 operations on children under 14 years with serious congenital heart disease are performed annually in Queensland. Infants with suspected congenital heart disease are referred to the tertiary centre in Brisbane for assessment and diagnosis, although some of these infants turn out not to have significant disease. The cost and use of resources involved in transporting these infants for assessment are substantial. We describe the management of a 12-day-old infant with a suspected cardiac abnormality.

Research paper thumbnail of A comparison of telepaediatric activity at two regional hospitals in Queensland

Journal of telemedicine and telecare, 2002

We conducted a 15-month feasibility study of telepaediatrics. A novel service was offered to two ... more We conducted a 15-month feasibility study of telepaediatrics. A novel service was offered to two hospitals in Queensland (Mackay and Hervey Bay). We used data from all other hospitals throughout the state as the control group. Although both intervention hospitals were provided with the same service, the telepaediatric activity generated and the effect on admissions and outpatient activity were markedly different. There was a significant decrease in the number of patient admissions to Brisbane from the Mackay region. In addition, there was an increase in the number of Mackay patients treated locally (as outpatients). In contrast, little change was observed in Hervey Bay. We assessed whether the observed differences between the two hospitals were due to various factors which influenced the use of the telepaediatric service. These factors included the method of screening patients before transfer to the tertiary centre and the physical distance between each facility and the tertiary cen...

Research paper thumbnail of The family costs of attending hospital outpatient appointments via videoconference and in person

Journal of telemedicine and telecare, 2003

We compared the costs incurred by families attending outpatient appointments at the Royal Childre... more We compared the costs incurred by families attending outpatient appointments at the Royal Children's Hospital (RCH) in Brisbane with those incurred by families who had a consultation via videoconference in their regional area. In each category 200 families were interviewed. The median time spent travelling for videoconferences was 30 min compared with 80 min for face-to-face appointments. Families interviewed in the outpatient department had travelled a median distance of 70 km, while those who had a videoconference at the local hospital had travelled only 20 km. It cost these families much more to attend an appointment at the RCH than to attend a videoconference. Ninety-six per cent of families (193) reported at least one of the following types of expense: 150 families had expenses related to parking (median A 10 dollars), 156 had fuel expenses (median A 10 dollars) and 122 reported costs related to meals purchased at the RCH (median A 10 dollars). Only 21 families who had thei...

Research paper thumbnail of Paediatric telecardiology services in Queensland: a review of three years' experience

Journal of telemedicine and telecare, 2004

Videoconferencing at 384 kbit/s for the transmission of echocardiograms has proved useful for the... more Videoconferencing at 384 kbit/s for the transmission of echocardiograms has proved useful for the assessment of children with suspected cardiac disease, in regional areas of Queensland. A retrospective review of patient and management outcomes was conducted on cardiac teleconsultations performed at two regional hospitals during the period November 2000 to February 2004, inclusive. There were 106 echo studies. A subset of 72 cardiac teleconsultations performed between May 2001 and February 2004 was reviewed in detail. The median age of patients at the time of consultation was 3 months (range 1 day-17 years). Sixteen per cent of teleconsultations were classified as urgent and were conducted on the same day as referral. Following the videoconference, 90% of patients could be managed locally and reviewed by the paediatrician or visiting paediatric cardiologist during an outreach clinic. Six children (8%) had significant cardiac lesions that were initially managed locally, with subsequen...

Research paper thumbnail of Age and Body Mass Index Are Independent Risk Factors for the Development of Postoperative Paralytic Ileus After Radical Cystectomy

Urology, 2010

OBJECTIVES To identify the risk factors that would aid in the identification of patients at the g... more OBJECTIVES To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus (POI). POI is a common complication after radical cystectomy and can result in a prolonged hospital stay and delayed recovery. METHODS A retrospective cohort study design was used to analyze data from consecutive patients presenting to our institution for radical cystectomy with pelvic nodal dissection. POI was declared if patients were without evidence of bowel function beyond the anticipated discharge goal of 6 days. The association between several clinical features and the occurrence of POI was examined. RESULTS Of 283 patients, 43 (15.2%) developed POI. Of the 43 patients, 38 (88.4%) were given total parenteral nutrition for nutritional supplementation. No difference in the incidence of POI was observed between the sexes, previous abdominal operations, estimated blood loss, transfusion requirement, operative time, neoadjuvant chemotherapy, or previous radiotherapy. POI was observed in 11.3% of normal and overweight patients (body mass index [BMI] Ͻ30.0 kg/m 2) compared with 25.6% of obese patients (BMI Ն30.0 kg/m 2 ; P ϭ .005). On multivariate analysis adjusted for the influence of competing variables, increasing age (hazard ratio 1.09, 95% confidence interval 1.02-1.16, P ϭ .008) and BMI (hazard ratio 1.09, 95% confidence interval 1.03-1.17, P ϭ .007) were significantly associated with the presence of POI. CONCLUSIONS Our results showed that increasing age and BMI were significantly associated with the presence of POI in patients undergoing radical cystectomy for bladder cancer.

Research paper thumbnail of Prenatal immune challenge in rats: Altered responses to dopaminergic and glutamatergic agents, prepulse inhibition of acoustic startle, and reduced route-based learning as a function of maternal body weight gain after prenatal exposure to poly IC

Research paper thumbnail of Unreason and alienation: A review of History of Madness

Research paper thumbnail of Ethical Issues in Critical Care and Cardiac Arrest: Clinical Research, Brain Death, and Organ Donation

Seminars in Neurology, 2006

Cardiac arrest results in global hypoxic-ischemic brain injury from which there is a range of pos... more Cardiac arrest results in global hypoxic-ischemic brain injury from which there is a range of possible neurological outcomes. In most cases, patients may require a surrogate to make decisions regarding end-of-life care, including the withdrawal of life-sustaining therapies. This article reviews ethical considerations that arise in the clinical care of patients following cardiac arrest, including decisions to continue or withdraw life-sustaining therapies; brain death determination; and organ donation in the context of brain death and cardiac death (so-called non-heart-beating donation). This article also discusses ethical concerns pertaining to the design and conduct of resuscitation research that is necessary for the development of effective therapies to prevent anoxic brain injury or promote neurological recovery.

Research paper thumbnail of Effects of overlapping ages of exposure to (+)-methamphetamine (MA) in rats on later allocentric and egocentric learning

Neurotoxicology and Teratology, 2010

Research paper thumbnail of The long-term behavioral effects of exposure to metals and chronic stress during development

Neurotoxicology and Teratology, 2010

Research paper thumbnail of 975 Recovery of Circulating Tumor Cells in Urothelial Carcinoma Cell Lines Utilizing a Novel Antibody Based Microfluidic Cell Capture Technique

The Journal of Urology, 2010

Research paper thumbnail of Psychosocial Assessment of Functional Gastrointestinal Disorders in Clinical Practice

Journal of Clinical Gastroenterology, 2005

Functional gastrointestinal disorders are the most common conditions encountered in gastroenterol... more Functional gastrointestinal disorders are the most common conditions encountered in gastroenterology practice and are also commonly encountered in primary care. Psychosocial factors play an important role in these disorders (along with any chronic digestive disorder) by influencing healthcare seeking, illness behavior, symptom severity, quality of life, and digestive motility and sensation. Identification of relevant psychosocial factors in patients with chronic digestive disorders influences care and is a critical determinant of outcomes. This article provides a review of relevant psychosocial variables, assessment techniques, and therapeutic suggestions that can be of value in assessing patients with functional gastrointestinal disorders.

Research paper thumbnail of Simulated eye clinic and virtual eye case: alternative worlds for medical students

BMJ Simulation and Technology Enhanced Learning, 2016

Research paper thumbnail of Having Your Cake - How to Preserve Universal-Service Cross Subsidies While Facilitating Competitive Entry: A Response

SSRN Electronic Journal, 2003

Differential pricing for access to bottleneck inputs such as local telephone facilities or electr... more Differential pricing for access to bottleneck inputs such as local telephone facilities or electricity transmission facilities is shown to solve the old dilemma of deregulation. facilitating competitive entry without destroying cross subsidies indispensable for "universal service" programs. If bottleneck facilities are inputs to two services, one of which subsidizes the other, entrants that provide the subsidized service must receive the same subsidy in the access price as consumers receive when they purchase those services. Rivals in the supply of the other service must contribute an equivalent subsidy through paying a higher access price. Differential access pricing allows efficient competitors to find it equally profitable to supply either service because any motive for "cream skimming" disappears. Such differential pricing, coupled with access pricing consistent with the Efficient Component Pricing Rule, is shown to be necessary for economic efficiency.

Research paper thumbnail of N budgets and aquatic uptake in the Ipswich River basin, northeastern Massachusetts

Water Resources Research, 2004

We calculated N budgets and conducted nutrient uptake experiments to evaluate the fate of N in th... more We calculated N budgets and conducted nutrient uptake experiments to evaluate the fate of N in the aquatic environment of the Ipswich River basin, northeastern Massachusetts. A mass balance indicates that the basin retains about 50% of gross N inputs, mostly in terrestrial components of the landscape, and the loss and retention of total nitrogen (TN) in the aquatic environment was about 9% of stream loading. Uptake lengths of PO 4 and NH 4 were measurable in headwater streams, but NO 3 uptake was below detection (minimum detection limit = 0.05 mM). Retention or loss of NO 3 was observed in a main stem reach bordered by wetland habitat. Nitrate removal in urban headwater tributaries was because of water withdrawals and denitrification during hypoxic events and in ponded wetlands with long water residence times. A mass balance using an entire river network indicates that basin-wide losses due to aquatic denitrification are considerably lower than estimates from several recent studies and range from 4 to 16% of TDN in stream loading. Withdrawals for domestic use restrict the runoff of headwater catchments from reaching the main stem during low base flow periods, thereby contributing to the spatial and temporal regulation of N export from headwater tributaries.

Research paper thumbnail of The point-of-referral barrier—a factor in the success of telehealth

Journal of Telemedicine and Telecare, 2001

A feasibility study was carried out to test the hypothesis that, for an effective telehealth serv... more A feasibility study was carried out to test the hypothesis that, for an effective telehealth service, a full-time coordinator is required to act as a single point of contact for consultation requests. By shifting the responsibility for telepaediatrics from the referrer to the provider, the telehealth process becomes equally (or more) attractive as the conventional alternative. Preliminary results showed that, within six months, telepaediatric activity increased to an average of 8 h per month. Not only did certain health services become more accessible to children and their families in remote areas of Queensland, but significant savings were also made. At least 12 patient transfers were avoided to and from the tertiary facility, with an estimated minimum saving of $18,000 to the health-care provider.

Research paper thumbnail of Observations on the Migration of Insects in the Pyrenees in the Autumn of 1953

Transactions of the Royal Entomological Society of London, 2009

Research paper thumbnail of Role of wetlands and developed land use on dissolved organic nitrogen concentrations and DON/TDN in northeastern U.S. rivers and streams

Limnology and Oceanography, 2004

Previous studies have shown that watersheds with significant human development (i.e., urban and a... more Previous studies have shown that watersheds with significant human development (i.e., urban and agricultural land use) generally have higher concentrations and fluxes of dissolved inorganic nitrogen (DIN) in comparison to less-developed or forested watersheds. However, the impact of watershed development on dissolved organic nitrogen (DON) concentrations in drainage waters has received little attention. We present data from 39 watersheds in Massachusetts (Ipswich River watershed) encompassing a gradient of developed land use (0%-92% urban plus agriculture) and wetland abundance (0%-32%) to assess controls on mean annual DON concentrations and DON/ total dissolved nitrogen (TDN) in drainage waters. In addition, we compiled published data from 119 northeastern U.S. watersheds to evaluate broader-scale relationships between DON, developed land use, and wetlands. The percentage of developed land is a poor predictor of DON concentrations in the Ipswich watersheds (r 2 ϭ 0.09) and the compiled dataset (r 2 ϭ 0.27). In contrast, wetland percentage explains 56% of the variability in DON concentrations in the Ipswich watersheds, and 60% when all literature data are included. Excluding watersheds with direct wastewater inputs to surface waters improves the regional relationship significantly (r 2 ϭ 0.79). The DON : TDN ratio is best explained by a multiple regression of wetland percentage and developed land use percentage for both the Ipswich watersheds (r 2 ϭ 0.73) and the compiled dataset (r 2 ϭ 0.50). Watersheds with abundant wetlands may therefore have high DON concentrations and DON : TDN ratios despite elevated anthropogenic nitrogen inputs associated with human development.

Research paper thumbnail of Elevations in plasmatic titers of corticosterone and aldosterone, in the absence of changes in ACTH, testosterone, or glial fibrillary acidic protein, 72 h following d,l-fenfluramine or d-fenfluramine administration to rats

Neurotoxicology and Teratology, 2001

Studies in both humans and animals demonstrate that D,L-and D-fenfluramine (D,L-FEN and D-FEN, re... more Studies in both humans and animals demonstrate that D,L-and D-fenfluramine (D,L-FEN and D-FEN, respectively) can activate the hypothalamic-pituitary-adrenal axis following an acute dose. No data exist showing a prolonged effect of either drug, although two studies have hinted at increased adrenal activity. There are also considerable differences in the literature pertaining to the neurotoxic effects of D,Land D-FEN. Some possible explanations for these differences include: activation of different neurotransmitter systems, the temperature at which the animals were maintained during exposure, or the substance sampled in each study. We investigated the effects of either D,L-FEN or D-FEN on pituitary, adrenal, and gonadal hormones 72 h after drug exposure. Furthermore, using a dosing regimen adapted from studies on methamphetamine (e.g., four times every 2 h in a single day) known to produce elevations in glial fibrillary acidic protein (GFAP) under hyperthermic conditions, we examined the effects of D-and D,L-FEN (15 mg/kg, four times) on GFAP content when the animals were dosed at ambient temperatures of 21 or 32°C. Approximately fivefold increases of corticosterone and threefold increases of aldosterone were found 72 h later under resting conditions following both D-and D,L-FEN. Nonetheless, when animals were dosed with D-FEN at 32°C, no significant elevation in corticosterone was detected. No effect was observed for ACTH, testosterone, or GFAP following D-or D,L-FEN treatment. These data suggest that: (1) FEN treatment causes prolonged elevations in adrenal cortical hormones; (2) FEN-treated animals displayed hormonal characteristics similar to animals undergoing a chronic stressor as suggested by no difference in ACTH titers; (3) D,L-FEN treatment or D-FEN treatment (as reported previously) is not similar to other substituted amphetamines in that it does not increase GFAP, even under hyperthermic conditions.

Research paper thumbnail of MicroRNAs in Bladder Cancer

MicroRNAs in Cancer Translational Research, 2010

Bladder cancer is the fourth most common solid malignancy in men and fifth most common overall wi... more Bladder cancer is the fourth most common solid malignancy in men and fifth most common overall with an estimated 70,000 new cases of urothelial carcinoma (UC) and over 14,000 deaths from the disease expected in 2010 in the United States. Although the majority of patients with invasive bladder cancer present without radiographic or clinical evidence of disease beyond the bladder, up to 56% of patients die from the result of occult metastasis not detected by current staging modalities. The potential of microRNAs (miRNAs) as novel tumor markers has been the focus of recent scrutiny because of their tissue specificity, stability, and association with clinical-pathological parameters. Prognostic tools based on conventional clinical and pathologic staging can quantify the risk of death from UC, but their accuracy is imperfect due to the heterogeneous biologic behavior of tumors. Use of biomarkers specific to the tumor and/or patient can provide prognostic utility over that available from routine clinical features. Data have emerged documenting altered systemic miRNAs expression across a spectrum of cancers including urothelial carcinoma of the bladder. Examples include miR-21 (up-regulated), miR-200 family (associated with epithelial-mesenchymal transition and Zeb1/2), and miR-145 (apoptosis). Assessing the expression of all known and predicted non-coding RNAs species and contrasting the miRNAs in the circulation of patients with superficial or invasive disease has great potential in determining whether we can identify systemic miRNAs as screening tools for bladder cancer.

Research paper thumbnail of The multidisciplinary management of a paediatric cardiac emergency

Journal of telemedicine and telecare, 2002

Queensland is a state with a population of 3.4 million people and a land area seven times greater... more Queensland is a state with a population of 3.4 million people and a land area seven times greater than that of Great Britain. The uneven distribution of specialist health services presents difficulties for patients in rural and remote areas. Paediatric cardiology is a case in point, since the only subspecialists are located in the state capital, Brisbane, in the south-east corner of Queensland. Some 300–350 operations on children under 14 years with serious congenital heart disease are performed annually in Queensland. Infants with suspected congenital heart disease are referred to the tertiary centre in Brisbane for assessment and diagnosis, although some of these infants turn out not to have significant disease. The cost and use of resources involved in transporting these infants for assessment are substantial. We describe the management of a 12-day-old infant with a suspected cardiac abnormality.

Research paper thumbnail of A comparison of telepaediatric activity at two regional hospitals in Queensland

Journal of telemedicine and telecare, 2002

We conducted a 15-month feasibility study of telepaediatrics. A novel service was offered to two ... more We conducted a 15-month feasibility study of telepaediatrics. A novel service was offered to two hospitals in Queensland (Mackay and Hervey Bay). We used data from all other hospitals throughout the state as the control group. Although both intervention hospitals were provided with the same service, the telepaediatric activity generated and the effect on admissions and outpatient activity were markedly different. There was a significant decrease in the number of patient admissions to Brisbane from the Mackay region. In addition, there was an increase in the number of Mackay patients treated locally (as outpatients). In contrast, little change was observed in Hervey Bay. We assessed whether the observed differences between the two hospitals were due to various factors which influenced the use of the telepaediatric service. These factors included the method of screening patients before transfer to the tertiary centre and the physical distance between each facility and the tertiary cen...

Research paper thumbnail of The family costs of attending hospital outpatient appointments via videoconference and in person

Journal of telemedicine and telecare, 2003

We compared the costs incurred by families attending outpatient appointments at the Royal Childre... more We compared the costs incurred by families attending outpatient appointments at the Royal Children's Hospital (RCH) in Brisbane with those incurred by families who had a consultation via videoconference in their regional area. In each category 200 families were interviewed. The median time spent travelling for videoconferences was 30 min compared with 80 min for face-to-face appointments. Families interviewed in the outpatient department had travelled a median distance of 70 km, while those who had a videoconference at the local hospital had travelled only 20 km. It cost these families much more to attend an appointment at the RCH than to attend a videoconference. Ninety-six per cent of families (193) reported at least one of the following types of expense: 150 families had expenses related to parking (median A 10 dollars), 156 had fuel expenses (median A 10 dollars) and 122 reported costs related to meals purchased at the RCH (median A 10 dollars). Only 21 families who had thei...

Research paper thumbnail of Paediatric telecardiology services in Queensland: a review of three years' experience

Journal of telemedicine and telecare, 2004

Videoconferencing at 384 kbit/s for the transmission of echocardiograms has proved useful for the... more Videoconferencing at 384 kbit/s for the transmission of echocardiograms has proved useful for the assessment of children with suspected cardiac disease, in regional areas of Queensland. A retrospective review of patient and management outcomes was conducted on cardiac teleconsultations performed at two regional hospitals during the period November 2000 to February 2004, inclusive. There were 106 echo studies. A subset of 72 cardiac teleconsultations performed between May 2001 and February 2004 was reviewed in detail. The median age of patients at the time of consultation was 3 months (range 1 day-17 years). Sixteen per cent of teleconsultations were classified as urgent and were conducted on the same day as referral. Following the videoconference, 90% of patients could be managed locally and reviewed by the paediatrician or visiting paediatric cardiologist during an outreach clinic. Six children (8%) had significant cardiac lesions that were initially managed locally, with subsequen...

Research paper thumbnail of Age and Body Mass Index Are Independent Risk Factors for the Development of Postoperative Paralytic Ileus After Radical Cystectomy

Urology, 2010

OBJECTIVES To identify the risk factors that would aid in the identification of patients at the g... more OBJECTIVES To identify the risk factors that would aid in the identification of patients at the greatest risk of developing postoperative paralytic ileus (POI). POI is a common complication after radical cystectomy and can result in a prolonged hospital stay and delayed recovery. METHODS A retrospective cohort study design was used to analyze data from consecutive patients presenting to our institution for radical cystectomy with pelvic nodal dissection. POI was declared if patients were without evidence of bowel function beyond the anticipated discharge goal of 6 days. The association between several clinical features and the occurrence of POI was examined. RESULTS Of 283 patients, 43 (15.2%) developed POI. Of the 43 patients, 38 (88.4%) were given total parenteral nutrition for nutritional supplementation. No difference in the incidence of POI was observed between the sexes, previous abdominal operations, estimated blood loss, transfusion requirement, operative time, neoadjuvant chemotherapy, or previous radiotherapy. POI was observed in 11.3% of normal and overweight patients (body mass index [BMI] Ͻ30.0 kg/m 2) compared with 25.6% of obese patients (BMI Ն30.0 kg/m 2 ; P ϭ .005). On multivariate analysis adjusted for the influence of competing variables, increasing age (hazard ratio 1.09, 95% confidence interval 1.02-1.16, P ϭ .008) and BMI (hazard ratio 1.09, 95% confidence interval 1.03-1.17, P ϭ .007) were significantly associated with the presence of POI. CONCLUSIONS Our results showed that increasing age and BMI were significantly associated with the presence of POI in patients undergoing radical cystectomy for bladder cancer.

Research paper thumbnail of Prenatal immune challenge in rats: Altered responses to dopaminergic and glutamatergic agents, prepulse inhibition of acoustic startle, and reduced route-based learning as a function of maternal body weight gain after prenatal exposure to poly IC

Research paper thumbnail of Unreason and alienation: A review of History of Madness

Research paper thumbnail of Ethical Issues in Critical Care and Cardiac Arrest: Clinical Research, Brain Death, and Organ Donation

Seminars in Neurology, 2006

Cardiac arrest results in global hypoxic-ischemic brain injury from which there is a range of pos... more Cardiac arrest results in global hypoxic-ischemic brain injury from which there is a range of possible neurological outcomes. In most cases, patients may require a surrogate to make decisions regarding end-of-life care, including the withdrawal of life-sustaining therapies. This article reviews ethical considerations that arise in the clinical care of patients following cardiac arrest, including decisions to continue or withdraw life-sustaining therapies; brain death determination; and organ donation in the context of brain death and cardiac death (so-called non-heart-beating donation). This article also discusses ethical concerns pertaining to the design and conduct of resuscitation research that is necessary for the development of effective therapies to prevent anoxic brain injury or promote neurological recovery.

Research paper thumbnail of Effects of overlapping ages of exposure to (+)-methamphetamine (MA) in rats on later allocentric and egocentric learning

Neurotoxicology and Teratology, 2010

Research paper thumbnail of The long-term behavioral effects of exposure to metals and chronic stress during development

Neurotoxicology and Teratology, 2010

Research paper thumbnail of 975 Recovery of Circulating Tumor Cells in Urothelial Carcinoma Cell Lines Utilizing a Novel Antibody Based Microfluidic Cell Capture Technique

The Journal of Urology, 2010

Research paper thumbnail of Psychosocial Assessment of Functional Gastrointestinal Disorders in Clinical Practice

Journal of Clinical Gastroenterology, 2005

Functional gastrointestinal disorders are the most common conditions encountered in gastroenterol... more Functional gastrointestinal disorders are the most common conditions encountered in gastroenterology practice and are also commonly encountered in primary care. Psychosocial factors play an important role in these disorders (along with any chronic digestive disorder) by influencing healthcare seeking, illness behavior, symptom severity, quality of life, and digestive motility and sensation. Identification of relevant psychosocial factors in patients with chronic digestive disorders influences care and is a critical determinant of outcomes. This article provides a review of relevant psychosocial variables, assessment techniques, and therapeutic suggestions that can be of value in assessing patients with functional gastrointestinal disorders.