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Cameron F.J.,Royal Childrens Hospital | Donath S.M.,University of Melbourne | Baghurst P.A.,Public Health Research Unit | Baghurst P.A.,University of Adelaide
Current Diabetes Reviews | Year: 2010

The measurement of glycaemic variation (GV) is conceived to be of clinical significance in determining diabetes outcomes. The debate as to the importance of GV has been complicated by studies using various meetrics of GV in qualitatively different datasets. The purpose of this review is to discuss the properties of 8 of the more commonly used metrics (M-value, MAGE, "J"-index, CONGA, BG rate of change, ADRR, Lability/HYPO score and GRADE). Comparable metrics that can be used to measure continuous glycaemic measurements (CGM) (SDBGL, "J"-index, MAGE, CONGA, GRADE) were then compared in assessing diabetic and non-diabetic datasets. In non-diabetic conditions there was very close correlation (correlation coefficients >0.92) between SDBGL, MAGE and CONGA, however under diabetic conditions the correlation coefficients of the GV metrics diminished significantly. The varying GV metrics have varying inherent properties depending upon the purpose for which they were designed and should not be seen as being interchangeable. Investigators therefore need to be clear about the nature of their enquiry of GV and choose an appropriate metric. © 2010 Bentham Science Publishers Ltd. Source

Baghurst P.A.,Public Health Research Unit | Baghurst P.A.,University of Adelaide
Diabetes Technology and Therapeutics | Year: 2011

Background: Glycemic variability is currently under scrutiny as a possible predictor of the complications of diabetes. The manual process for estimating a now classical measure of glycemic variability, the mean amplitude of glycemic excursion (MAGE), is both tedious and prone to error, and there is a special need for an automated method to calculate the MAGE from continuous glucose monitoring (CGM) data. Methods: An automated algorithm for identifying the peaks and nadirs corresponding to the glycemic excursions required for the MAGE calculation has been developed. The algorithm takes a column of timed glucose measurements and generates a plot joining the peaks and nadirs required for estimating the MAGE. It returns estimates of the MAGE for both upward and downward excursions, together with several other indices of glycemic variability. Results: Details of the application of the algorithm to CGM data collected over a 48-h period are provided, together with graphical illustrations of the intermediate stages in identifying the peaks and nadirs required for the MAGE. Application of the algorithm to 104CGM datasets (92 from children with diabetes and 12 from controls) generated plots that, on visual inspection, were all found to have identified the peaks, nadirs, and excursions correctly. Conclusions: The proposed algorithm eliminates the tedium and/or errors of manually identifying and measuring countable excursions in CGM data in order to estimate the MAGE. It can also be used to calculate the MAGE from "sparse" blood glucose measurements, such as those collected in home blood glucose monitoring. © Copyright 2011, Mary Ann Liebert, Inc. 2011. Source

Gillman M.W.,Harvard University | Oakey H.,University of Adelaide | Baghurst P.A.,University of Adelaide | Volkmer R.E.,Public Health Research Unit | And 2 more authors.
Diabetes Care | Year: 2010

OBJECTIVE - Gestational diabetes mellitus (GDM) may cause obesity in the offspring. The objective was to assess the effect of treatment for mild GDM on the BMI of 4- to 5-year-old children. RESEARCH DESIGN AND METHODS - Participants were 199 mothers who participated in a randomized controlled trial of the treatment of mild GDM during pregnancy and their children. Trained nurses measured the height and weight of the children at preschool visits in a state-wide surveillance program in the state of South Australia. The main outcome measure was age- and sex-specific BMI Z score based on standards of the International Obesity Task Force. RESULTS - At birth, prevalence of macrosomia (birth weight ≥4,000 g) was 5.3% among the 94 children whose mothers were in the intervention group, and 21.9% among the 105 children in the routine care control group. At 4- to 5-years-old, mean (SD) BMI Z score was 0.49 (1.20) in intervention children and 0.41 (1.40) among controls. The difference between treatment groups was 0.08 (95% CI -0.29 to 0.44), an estimate minimally changed by adjustment for maternal race, parity, age, and socio-economic index (0.08 [-0.29 to 0.45]). Evaluating BMI ≥85th percentile rather than continuous BMI Z score gave similarly null results. CONCLUSIONS - Although treatment of GDM substantially reduced macrosomia at birth, it did not result in a change in BMI at age 4- to 5-years-old. © 2010 by the American Diabetes Association. Source

Baghurst P.A.,Public Health Research Unit | Baghurst P.A.,University of Adelaide
Australian and New Zealand Journal of Obstetrics and Gynaecology | Year: 2013

Background The incidence of severe perineal tears acquired during vaginal childbirth varies considerably across hospitals but its use as a safety and quality indicator is in jeopardy because of problems associated with accurate detection and recording. Aim To understand and interpret time trends in the incidence of third- and fourth-degree perineal tears among women giving birth vaginally in 18 public maternity hospitals in South Australia, taking into account individualised risk factors for each birth. Methods The risk-adjusted probability of a third- and fourth-degree tear was estimated for each of 65,598 singleton vaginal births (2002-2008), using a previously published regression model. The risk factors for each birth included maternal age; parity and ethnicity; assistance with instruments and episiotomy; shoulder dystocia; and infant birthweight. Plots of 'excess' tears were generated to help identify maternity services where the observed incidence of severe trauma differed from the expectation estimated from the risk profiles. Results Three hospitals were identified at which there were systematically more tears than expected (given their risk profiles), and five hospitals were identified at which there were fewer tears. However, increased tearing at two hospitals coincided closely with improved advocacy for better detection and treatment of perineal tears (especially partial third-degree tears). Conclusion Statistical process control methods provide a powerful means of investigating temporal variations in the incidence of outcomes like severe perineal tears. Third- or fourth- degree tears should be retained as a quality indicator of maternity services, but it is likely that many third-degree tears currently go undetected. © 2012 The Author ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Source

Antoniou G.,Public Health Research Unit | Freeman B.J.C.,Womens and Childrens Hospital | Freeman B.J.C.,University of Adelaide
Spine | Year: 2013

STUDY DESIGN.: A prospective cohort study. OBJECTIVE.: To determine serum titanium, niobium, and aluminum levels in pediatric patients within the first postoperative year after instrumented spinal arthrodesis. SUMMARY OF BACKGROUND DATA.: Instrumented spinal arthrodesis is a common procedure to correct scoliosis and kyphosis. Titanium-based instrumentation is increasingly favored due to enhanced biomechanical properties, but concerns have arisen regarding metal debris release and the potential for local and systemic complications. METHODS.: The pattern of systemic metal release over time was evaluated by measuring serum titanium, niobium, and aluminum levels preoperatively and 1 week, 1 month, 6 months, and 12 months after instrumented spinal arthrodesis using a titanium alloy. Serum metal levels were measured using high-resolution inductively coupled plasma mass spectrometry. RESULTS.: Thirty-two patients were included in the study group. Mean age at surgery was 14.7 years. Preoperative and postoperative concentrations of serum titanium and niobium were significantly different (P = 0.0001). Median postoperative serum concentrations of titanium and niobium were elevated 2.4- and 5.9-fold above the normal range respectively with 95% and 99% of samples elevated postoperatively. A significant and rapid rise in serum titanium and niobium levels was observed within the first postoperative week, after which elevated serum levels persisted up to 12 months. CONCLUSION.: We report abnormally elevated serum titanium and niobium levels in patients with titanium-based spinal instrumentation up to 12 months. The long-term systemic consequences of debris generated by wear and corrosion of spinal instrumentation is unclear but concerning, particularly as these implants inserted into the pediatric population may remain in situ for beyond 6 decades. © 2013, Lippincott Williams & Wilkins. Source

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