Medicine & Health
Medicine & Health
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(2022) Cao, JunThesisThis thesis focuses on the development and applications of magnetic resonance electrical properties tomography (MREPT), which is an emerging imaging modality to noninvasively obtain the electrical properties of tissues, such as conductivity and permittivity. Chapter 2 describes the general information about human research ethics, MRI scanner, MR sequence and the method of phase-based MREPT implemented in this thesis. Chapter 3 examines the repeatability of phase-based MREPT in the brain conductivity measurement using balanced fast field echo (bFFE) and turbo spin echo (TSE) sequences, and investigate the effects of compressed SENSE, whole-head B_1 shimming and video watching during scan on the measurement precision. Chapter 4 investigates the conductivity signal in response to short-duration visual stimulus, compares the signal and functional activation pathway with that of BOLD, and tests the consistency of functional conductivity imaging (funCI) with visual stimulation across participants. Chapter 5 extends the use of functional conductivity imaging to somatosensory stimulation and trigeminal nerve stimulation to evaluate the consistency of functional conductivity activation across different types of stimuli. In addition, visual adaptation experiment is performed to test if the repetition suppression effect can be observed using funCI. Chapter 6 explores if resting state conductivity networks can be reliably constructed using resting state funCI, evaluates the consistency of persistent homology architectures, and compares the links between nodes in the whole brain. Chapter 7 investigates the feasibility of prostate conductivity imaging using MREPT, and distinctive features in the conductivity distribution between healthy participants and participants with suspected abnormalities.
(2022) Indraratna, PraveenThesisCardiovascular disease (CVD) is the leading cause of global mortality. Two forms of CVD are acute coronary syndromes (ACS) and heart failure (HF). Patients with either are prone to repeat hospitalisations, which are detrimental to both patients and the healthcare system. Traditional care models are suboptimal in preventing readmissions. Mobile health interventions (MHIs) are attractive due to the computing power and convenience of the smartphone. Firstly, the literature regarding MHIs in CVD is systematically reviewed and meta-analysed. MHIs improved medication adherence in ACS patients and hospitalisation rates in HF patients. The review noted limitations of published trials and identified features of successful MHIs, which were incorporated into the design of a novel smartphone app-based model of care (TeleClinical Care, TCC). TCC allows home measurement of blood pressure, heart rate and weight by patients. The readings are automatically transmitted to a central server, where clinicians can identify abnormalities and intervene accordingly. A pilot RCT comparing TCC and usual care (UC) to UC alone was performed (n=164). Patients using TCC had fewer readmissions at 6 months (41 vs. 21, hazard ratio 0.51, P= 0.015), and were more likely to be adherent with medications (75% vs. 50%, P= 0.001) and complete cardiac rehabilitation (39% vs. 18%, odds ratio 2.9, P= 0.02) compared to patients in the control arm. A process evaluation of the RCT was subsequently undertaken, which identified several contributory factors to TCC’s success, such as a helpful orientation protocol for team members, and high background rates of HF outreach service and cardiologist follow-up in both trial arms. Via a series of interviews, methods to improve the future delivery of TCC were identified, particularly relating to its integration into mainstream healthcare. Patterns of smartphone ownership among cardiac inpatients were also examined. Age, sex, diagnosis, and private health insurance subscription influenced smartphone ownership. These data will help identify patients who may be excluded from MHIs. The thesis contains a cost-effectiveness model of TCC if applied widely. When enrolment exceeds 237 patients, TCC will reduce healthcare costs relative to UC, resultant to readmission prevention. Enrolment of 500 patients is projected to save $100,000 annually. In conclusion, TCC is demonstrated as a feasible, beneficial, safe, and cost-effective intervention for patients with CVD.
(2023) Chow, BrianThesisLittle is known about human muscle growth in children with and without cerebral palsy (CP). The MUGgLE study aims to investigate growth-related changes in the three-dimensional (3D) architecture of lower leg muscles (muscle volume, physiological cross-sectional area (PCSA), fascicle length, and pennation angle) in 320 infants and children with and without CP aged < 3 months and 5 to 15 years. Infants have one leg scan (anatomical magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) images), while children have three scans over three years. The MUGgLE study is ongoing. This thesis presents data derived from the first scan conducted on each of 208 typically developing (TD) infants and children. Chapter 2 provides muscle volumes of ten muscle groups in infants, and the architecture and moment arms of the medial (MG) and lateral gastrocnemius (LG) muscles. By comparing these data to data obtained from adults, it was shown that MG muscle fascicles grow primarily in cross-section rather than in length from birth to adulthood. Chapter 3 determines if lower leg muscles grow synchronously from birth to 15 years. The data show that muscle volumes, normalised to total lower leg volume, vary with age, indicating asynchronous growth. The soleus and MG muscles grow disproportionately faster. Chapter 4 determines muscle-, age-, and sex-conditional distributions of MG and tibialis anterior (TA) muscle architecture from birth to 15 years. Up to age 15 years, both muscles grow nonlinearly in volume, PCSA, and fascicle length, while the pennation angles remain nearly constant. The MG and TA muscle fascicles grow primarily transversely rather than longitudinally over this period. Chapter 5 explores the development and evaluation of a portable dynamometer used to estimate the passive length-tension curves of the gastrocnemius muscles in children. The evaluation shows that the dynamometer requires further methodological refinements to be reliable enough for clinical and research use. This thesis contributes to the fields of biomechanics, muscle physiology, and human anatomy, providing the largest high-resolution 3D dataset of muscle architecture in children to date. Biomechanists can use the data to build more effective structure-function models of children’s muscles, clinicians can use the data to investigate disordered muscle growth in children and inform early interventions and treatments, and academics can use the data to teach muscle and bone anatomy.
(2023) Bradbury, TomThesisBackground: Chronic Obstructive Pulmonary Disease (COPD) is a minimally reversible, inflammatory condition of the lower airways. Addressing exacerbations – acute episodes of symptom worsening - has emerged as a priority in the development of COPD management strategies and shapes the ethos behind trial design and concepts of efficacy in this field. Currently, there is poor consensus as to how the different aspects of exacerbations should be integrated into clinical trial outcomes. Furthermore, as COPD exacerbations are a relatively newly defined clinical entity there is a need to re-examine previous assumptions regarding the clinical efficacy of established interventions, incorporating updated knowledge and research methods. Aims: The aim of this thesis was to investigate how COPD exacerbations are represented and used as a measured outcome of efficacy and safety in past and current clinical trials of exacerbation prevention and management. The secondary aim was to develop a range of skills needed to conduct original research in this area. Methods: Five studies were conducted. These were a systematic literature review of exacerbation-based outcomes in published clinical trials, qualitative analysis of original interview data to assess COPD patient priorities in exacerbation treatment and future research, and a case series of an app-based exacerbation identification system. Quantitative analyses of the TASCS (Theophylline and Steroids in COPD Study) and PACE (Preventing Adverse Cardiac Events in COPD) trial datasets were performed to advance our understanding of how pharmacological agents modulate exacerbation properties in different COPD patient phenotypes. Results & Conclusions: The heterogeneity and evolving understanding of the pathophysiology of COPD is new knowledge which should be incorporated into clinical trial design and conduct. This was shown in the analyses of the TASCS and PACE trial data, where established understandings of exacerbations and different patient phenotypes were challenged by the findings. The results of the remaining three studies suggest that: (i) trial outcomes pertaining to exacerbations should be standardised and validated, and (ii) how these outcomes are defined, valued by patients, and measured should be clearly communicated and accurately cited. This will improve data quality, enhance representation of patient values in future research and minimise ambiguity in communicating research results.
Chemical incorporation of NAD+ intermediates into an extended-release drug delivery system to provide new avenues in oncofertility(2023) Sehnert, RebeccaThesisCellular deficiencies in nicotinamide dinucleotide (NAD+) have been linked to a wide range of pathophysiologies. Boosting NAD+ levels via supplementation with its metabolic intermediates, such as nicotinamide mononucleotide (NMN), has been shown to be a potential treatment for many diseases. Notably, NMN administration is a promising solution to prevent female fertility damage due to chemotherapeutic insult. However, this strategy is severely limited due to a lack of drug delivery application methods. To address this need, we propose a drug-loaded hydrogel system that can be implanted at the location of interest. By chemically conjugating the NMN drug molecule to a poly (vinyl alcohol) (PVA) polymer via a linker of biodegradable ester bonds, it is hypothesised that we can prevent burst release while providing targeted, prolonged release duration through hydrolytic cleavage. PVA previously conjugated with photo-crosslinkable methacrylate pendants was chosen as the base system, as this allows for easy hydrogel formation. This work’s aim was to achieve conjugation of NMN into this PVA system, characterisation of the synthesis pathways utilised, as well as evaluation of the resultant hydrogel systems. It is proposed that a linear pendant containing multiple ester groups could be grown from the hydroxyl moieties on the PVA backbone via a series of carbodiimide reactions. Conjugation of the NMN to this pendant was investigated via three different synthesis pathways: 1) “Linear” amine building block, 2) “Reverse” amine building blocks and 3) “Fmoc” protecting group method. Each strategy has individual benefits and drawbacks, and each was evaluated for key parameters such as efficiency of reaction, maximum NMN loading achieved, and cytocompatibility. This work demonstrates the first known incorporation of NMN into a hydrogel system for the purpose of sustained drug release. These results demonstrate that NMN has been chemically conjugated into a PVA hydrogel system in a controlled, non-toxic and reproducible manner, allowing for eventual use in drug delivery applications.