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Williams C.J.,Curtin University Australia | Williams C.J.,Curtin Health Innovation Research Institute | McLeod S.,Charles Sturt University
International Journal of Speech-Language Pathology | Year: 2012

Within predominantly English-speaking countries such as the US, UK, Canada, New Zealand, and Australia, there are a significant number of people who speak languages other than English. This study aimed to examine Australian speech-language pathologists' (SLPs) perspectives and experiences of multilingualism, including their assessment and intervention practices, and service delivery methods when working with children who speak languages other than English. A questionnaire was completed by 128 SLPs who attended an SLP seminar about cultural and linguistic diversity. Approximately one half of the SLPs (48.4%) reported that they had at least minimal competence in a language(s) other than English; but only 12 (9.4%) reported that they were proficient in another language. The SLPs spoke a total of 28 languages other than English, the most common being French, Italian, German, Spanish, Mandarin, and Auslan (Australian sign language). Participants reported that they had, in the past 12 months, worked with a mean of 59.2 (range 1-100) children from multilingual backgrounds. These children were reported to speak between two and five languages each; the most common being: Vietnamese, Arabic, Cantonese, Mandarin, Australian Indigenous languages, Tagalog, Greek, and other Chinese languages. There was limited overlap between the languages spoken by the SLPs and the children on the SLPs' caseloads. Many of the SLPs assessed children's speech (50.5%) and/or language (34.2%) without assistance from others (including interpreters). English was the primary language used during assessments and intervention. The majority of SLPs always used informal speech (76.7%) and language (78.2%) assessments and, if standardized tests were used, typically they were in English. The SLPs sought additional information about the children's languages and cultural backgrounds, but indicated that they had limited resources to discriminate between speech and language difference vs disorder. © 2012 The Speech Pathology Association of Australia Limited.


Jackaman C.,Curtin University Australia | Jackaman C.,Western Research Institute | Jackaman C.,Curtin Health Innovation Research Institute | Nelson D.J.,Curtin University Australia | And 2 more authors.
Cancer Immunology, Immunotherapy | Year: 2012

Targeting interleukin-2 (IL-2) and/or agonist anti-CD40 antibody (Ab) into tumors represents an effective vaccination strategy that avoids systemic toxicity and resolves treated-site tumors. Here, we examined IL-2 and/ or anti-CD40 Ab-driven local versus systemic T cell function and the installation of T cell memory. Single tumor studies showed that IL-2 induced a potent CD4+ and CD8+ T cell response that was limited to the draining lymph node and treated-site tumor, and lymph node tumor-specific CD8+ T cells did not upregulate CD44. A two-tumor model showed that while IL-2-treated-site tumors resolved, distal tumors continued to grow, implying limited systemic immunity. In contrast, anti-CD40 Ab treatment with or without IL-2 expanded the systemic T cell response to non-draining lymph nodes, and distal tumors resolved. Tumor-specific T cells in lymph nodes of anti-CD40 Ab ±IL-2-treated mice upregulated CD44, demonstrating activation and transition to effector/memory migratory cells. While CD40-activated CD4 + T cells were not required for eradicating treated-site tumors, they, plus CD8+ T cells, were crucial for removing distal tumors. Rechallenge/ depletion experiments showed that the effector/memory phase required the presence of previously CD40/IL-2-activated CD4+ and CD8+ T cells to prevent recurrence. These novel findings show that different T cell effector mechanisms can operate for the eradication of local treated- site tumors versus untreated distal tumors and that signaling through CD40 generates a whole of body, effector/memory CD4+ and CD8 + T cell response that is amplified and prolonged via IL-2. Thus, successful immunotherapy needs to generate collaborating CD4+ and CD8+ T cells for a complete long-term protective cure. © Springer-Verlag 2011.


Ahmad N.,National University of Malaysia | Amin M.C.I.M.,National University of Malaysia | Mahali S.M.,University of Malaysia, Terengganu | Ismail I.,National University of Malaysia | Chuang V.T.G.,Curtin Health Innovation Research Institute
Molecular Pharmaceutics | Year: 2014

Stimuli-responsive bacterial cellulose-g-poly-(acrylic acid) hydrogels were investigated for their potential use as an oral delivery system for proteins. These hydrogels were synthesized using electron beam irradiation without any cross-linking agents, thereby eliminating any potential toxic effects associated with cross-linkers. Bovine serum albumin (BSA), a model protein drug, was loaded into the hydrogels, and the release profile in simulated gastrointestinal fluids was investigated. Cumulative release of less than 10% in simulated gastric fluid (SGF) demonstrated the potential of these hydrogels to protect BSA from the acidic environment of the stomach. Subsequent conformational stability analyses of released BSA by SDS-PAGE, circular dichroism, and an esterase activity assay indicated that the structural integrity and bioactivity of BSA was maintained and preserved by the hydrogels. Furthermore, an increase in BSA penetration across intestinal mucosa tissue was observed in an ex vivo penetration experiment. Our fabricated hydrogels exhibited excellent cytocompatibility and showed no sign of toxicity, indicating the safety of these hydrogels for in vivo applications. © 2014 American Chemical Society.


Takechi R.,Curtin Health Innovation Research Institute | Galloway S.,Curtin Health Innovation Research Institute | Pallebage-Gamarallage M.M.S.,Curtin Health Innovation Research Institute | Lam V.,Curtin Health Innovation Research Institute | Mamo J.C.L.,Curtin Health Innovation Research Institute
Progress in Lipid Research | Year: 2010

An emerging body of evidence is consistent with the hypothesis that dietary fats influence Alzheimer's disease (AD) risk, but less clear is the mechanisms by which this occurs. Alzheimer's is an inflammatory disorder, many consider in response to fibrillar formation and extracellular deposition of amyloid-beta (Aβ). Alternatively, amyloidosis could notionally be a secondary phenomenon to inflammation, because some studies suggest that cerebrovascular disturbances precede amyloid plaque formation. Hence, dietary fats may influence AD risk by either modulating Aβ metabolism, or via Aβ independent pathways. This review explores these two possibilities taking into consideration; (i) the substantial affinity of Aβ for lipids and its ordinary metabolism as an apolipoprotein; (ii) evidence that Aβ has potent vasoactive properties and (iii) studies which show that dietary fats modulate Aβ biogenesis and secretion. We discuss accumulating evidence that dietary fats significantly influence cerebrovascular integrity and as a consequence altered Aβ kinetics across the blood-brain barrier (BBB). Specifically, chronic ingestion of saturated fats or cholesterol appears to results in BBB dysfunction and exaggerated delivery from blood-to-brain of peripheral Aβ associated with lipoproteins of intestinal and hepatic origin. Interestingly, the pattern of saturated fat/cholesterol induced cerebrovascular disturbances in otherwise normal wild-type animal strains is analogous to established models of AD genetically modified to overproduce Aβ, consistent with a causal association. Saturated fats and cholesterol may exacerbate Aβ induced cerebrovascular disturbances by enhancing exposure of vessels of circulating Aβ. However, presently there is no evidence to support this contention. Rather, SFA and cholesterol appear to more broadly compromise BBB integrity with the consequence of plasma protein leakage into brain, including lipoprotein associated Aβ. The latter findings are consistent with the concept that AD is a dietary-fat induced phenotype of vascular dementia, reflecting the extraordinary entrapment of peripherally derived lipoproteins endogenously enriched in Aβ. Rather than being the initiating trigger for inflammation in AD, accumulation of extracellular lipoprotein-Aβ may be a secondary amplifier of dietary induced inflammation, or possibly, simply be consequential. Clearly, delineating the mechanisms by which dietary fats increase AD risk may be informative in developing new strategies for prevention and treatment of AD. © 2009 Elsevier Ltd. All rights reserved.


Oddy W.H.,University of Western Australia | Li J.,Curtin Health Innovation Research Institute | Whitehouse A.J.O.,University of Western Australia | Zubrick S.R.,Curtin Health Innovation Research Institute | And 2 more authors.
Pediatrics | Year: 2011

INTRODUCTION: The aim of this study was to examine the relationship between duration of breastfeeding and educational outcomes. We hypothesized that longer periods of breastfeeding would predict better educational outcomes in middle childhood. METHODS: The Western Australian Pregnancy Cohort (Raine) Study used a cohort of 2900 women who were enrolled at 18 weeks' gestation; with 2868 live-born children were followed prospectively. At ∼10 years of age, data from 1038 children were linked to standardized mathematics, reading, writing, and spelling scores. Associations between breastfeeding duration and educational outcomes were estimated by using linear models with adjustment for gender, family income, maternal factors, and early stimulation at home through reading. RESULTS: Ten-year-old children who were predominantly breastfed for 6 months or longer in infancy had higher academic scores than children who were breastfed for less than 6 months. The effect of breastfeeding on educational outcomes differed according to gender; boys were particularly responsive (in mathematics, spelling, reading, and writing) to a longer duration of breastfeeding. CONCLUSIONS: Predominant breastfeeding for 6 months or longer was positively associated with academic achievement in children at 10 years of age. However, the effectiveness of breastfeeding differed according to gender; the benefits were only evident for boys. Copyright © 2011 by the American Academy of Pediatrics.


Bredin A.,Curtin University Australia | Mullins B.J.,Curtin University Australia | Mullins B.J.,Curtin Health Innovation Research Institute
Separation and Purification Technology | Year: 2012

This study investigated the influence of flow interruptions on the filtration performance of two different multi-layered fibrous filters during liquid aerosol filtration. It was found that both types of filters experienced a significant secondary loading stage, though they had reached a steady state for continuous flow. The filters showed distinctive increases in pressure drop and filter saturation until a second equilibrium state was reached. This second equilibrium state was attributed to a rearrangement of liquid in the filter during the breaks, clogging previously free passages. The ratio of shear and capillary forces was found to determine whether these passages were able to be "cleaned" once airflow was recommenced. Based on these findings, the airflow required to clean fully saturated filters was investigated and a phenomenological model developed to describe this behaviour. Furthermore, it was found that filters could be cleaned and reused, whereby they would return to one of the previous steady states (continuous or discontinuous flow). The experiments conducted in this work represent a more realistic test for oil-mist (or coalescing) filters than typical laboratory testing. Furthermore, it is hoped that they will help to bridge the gap between laboratory and field test results. © 2012 Elsevier B.V. All rights reserved.


Ferrari P.,University of Western Australia | Kulkarni H.,University of Western Australia | Dheda S.,University of Western Australia | Betti S.,University of Western Australia | And 5 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2011

Background and objectives: Iron (Fe) overload may complicate parenteral Fe therapy used to enhance the efficacy of erythropoietic-stimulating agents in the treatment of anemia of chronic kidney disease. However, serum Fe markers are influenced by inflammation or malignancy and may not accurately reflect the amount of body Fe. Design, setting, participants, & measurements: We studied the relationship between parenteral Fe therapy, conventional serum Fe markers, and liver iron concentration (LIC) measured using magnetic resonance R2 relaxometry (FerriScan) in 25 Fe-deficient predialysis chronic kidney disease patients before and 2 and 12 weeks after single high-dose intravenous Fe and in 15 chronic hemodialysis patients with elevated serum ferritin (>500 μg/L). Results: In predialysis patients, there was strong dose dependency between the administered Fe dose and changes in LIC at weeks 2 and 12; however, no dose dependency between Fe dose and changes in ferritin or transferrin saturation (TSAT) were observed. In hemodialysis patients, LIC correlated with the cumulative Fe dose and duration of dialysis but not with current ferritin or TSAT. The cumulative Fe dose remained a significant independent predictor of LIC in a multiple regression model. Two dialysis patients who received >6 g parenteral Fe had substantially elevated LIC >130 μmol/g, which is associated with hemochromatosis. Conclusions: In Fe-deficient predialysis patients, intravenous Fe therapy is associated with increases in LIC unrelated to changes in conventional Fe markers. In hemodialysis patients, TSAT and ferritin are poor indicators of body Fe load, and some patients have LICs similar to those found in hemochromatosis. Copyright © 2011 by the American Society of Nephrology.


Pal S.,Curtin Health Innovation Research Institute | Ellis V.,Curtin Health Innovation Research Institute | Dhaliwal S.,Curtin Health Innovation Research Institute
British Journal of Nutrition | Year: 2010

The health benefits currently associated with increased dairy intake may be attributable to the whey component of dairy proteins. The present study evaluated the effects of whey protein supplementation on body composition, lipids, insulin and glucose in comparison to casein and glucose (control) supplementation in overweight/obese individuals for 12 weeks. The subjects were randomised to whey protein, casein or glucose supplementation for 12 weeks according to a parallel design. Fasting blood samples and dual-energy X-ray absorptiometry measurements were taken. Seventy men and women with a mean age of 484 (sem 086)years and a mean BMI of 313 (sem 08)kg/m2 completed the study. Subjects supplemented with whey protein had no significant change in body composition or serum glucose at 12 weeks compared with the control or casein group. Fasting TAG levels were significantly lowered in the whey group compared with the control group at 6 weeks (P=0025) and 12 weeks (P=0035). There was a significant decrease in total cholesterol and LDL cholesterol at week 12 in the whey group compared with the casein (P=0026 and 0045, respectively) and control groups (P<0001 and 0003, respectively). Fasting insulin levels and homeostasis model assessment of insulin resistance scores were also significantly decreased in the whey group compared with the control group (P=0049 and P=0034, respectively). The present study demonstrated that supplementation with whey proteins improves fasting lipids and insulin levels in overweight and obese individuals. Copyright © The Authors 2010.


Jiwa M.,Curtin Health Innovation Research Institute | Jiwa M.,Curtin University Australia | Dhaliwal S.,Curtin University Australia
Quality in Primary Care | Year: 2012

Background We aimed to explore if increasing the amount of relevant information relayed in referral letters between general practitioners (GPs) or family physicians and hospital specialists helps in the scheduling of appointments for patients. We report a before and after study comparing outcomes before and after the introduction of software to assist referral writing. Methods The participants were GPs and hospital specialists based in metropolitan Perth, Western Australia. The amount of relevant information in referral letters from GPs was assessed with reference to a published schedule three months before and four months after deploying interactive computerised Referral Writer software (RW). The longer period after deploying the RW was to allow GPs time to become iamiliar with the RW. The letters were scored by a researcher for the amount of relevant information included and then independently assessed by two specialists in each of six specialties to determine if they were able to decide which patients needed to be seen soonest and what was the most likely outcome of the specialist consultation. The actual diagnosis for each case was recorded later to assess if there was an association between the amount of relevant information relayed and the diagnosis of life limiting or other pathologies. Results Each GP referred 5.6 patients on average, range (1, 14) before the RW and 4.8 patients, range (0, 14) after the RW. The amount of relevant information in the letters improved substantially after the RW, mean difference 37%, 95% Confidence Interval 43-30%, P<0.001. For 91% of letters after the RW, both specialists in each specialty were confident or very confident that they had enough information to decide when the patient should come to their clinic; this had increased from 50% before the RW, P= 0.001. There was no association observed between the amount of relevant information relayed and the final diagnosis. Conclusion Standardising and using electronic communications to refer appears to facilitate rational scheduling of specialist appointments. Comprehensive referral may help to ensure that the right patients are seen by the specialist sooner rather than later. © 2012 Radcliffe Publishing.


Jiwa M.,Curtin University Australia | Spilsbury K.,Curtin University Australia | Duke J.,Curtin Health Innovation Research Institute
Annals of Pharmacotherapy | Year: 2010

BACKGROUND: Pharmacists in Australia are routinely asked to advise people with lower bowel symptoms. Clinical, demographic, and working environment parameters may affect whether appropriate referral for advanced care is advised by pharmacists. OBJECTIVE: To characterize how selected clinical, demographic, and working environment variables affect the likelihood of a pharmacist providing a referral for patients with lower bowel symptoms to consult a general practitioner, and to investigate factors associated with agreement with an expert panel and colorectal cancer guidelines. METHODS: Self-administered questionnaires were distributed to a random sample of 300 pharmacists in Western Australia. Vignettes were constructed around 6 clinical variables and pharmacists were asked to describe a referral pathway. Logistic regression was used to identify factors associated with odds of referral and agreement with an expert panel. RESULTS: One hundred sixty-seven completed surveys were returned, giving a response rate of 56%. The odds of referral to a general practitioner were mostly associated with presenting symptoms, although lower odds of referral were observed with increasing volumes of weekly prescriptions. The odds of pharmacists agreeing with the expert panel for an urgent referral were 70% (95% CI 50 to 80) lower for weight loss as the presenting symptom compared to rectal bleeding. The expert panel considered weight loss or rectal bleeding of 4 weeks' duration as meriting an urgent referral, but 63% and 30% of pharmacists, respectively, disagreed. In contrast to cancer guidelines, over 60% of respondents did not consider persistent diarrhea in a 65-year-old patient as a likely symptom of significant bowel pathology. CONCLUSIONS: In general, pharmacists' patterns of referral were influenced by clinical symptoms and not by demographic or working environment variables. They over-referred patients with diarrhea but under-referred those with weight loss and rectal bleeding, according to the expert panel. This is a cause for concern because any unexplained rectal bleeding should be referred for further investigation.

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