Institution
University of Queensland
Education•Brisbane, Queensland, Australia•
About: University of Queensland is a education organization based out in Brisbane, Queensland, Australia. It is known for research contribution in the topics: Population & Poison control. The organization has 51138 authors who have published 155721 publications receiving 5717659 citations. The organization is also known as: UQ & The University of Queensland.
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University of Sydney1, Norwegian University of Science and Technology2, Cerebral Palsy Alliance3, University of Queensland4, Children's Medical Center of Dallas5, University of Pisa6, National Institutes of Health7, University of Alberta8, Karolinska Institutet9, University Medical Center Utrecht10, Medical University of Graz11, Monash University12, Holland Bloorview Kids Rehabilitation Hospital13, University of California, San Francisco14, University of Southern California15, Columbia University16, Royal Children's Hospital17, University Medical Center Groningen18, Duquesne University19, Makerere University20, Boston Children's Hospital21, Nationwide Children's Hospital22, Newcastle University23, Catholic University of the Sacred Heart24, University of Melbourne25, University of Western Australia26
TL;DR: Best available evidence about cerebral palsy–specific early intervention that should follow early diagnosis to optimize neuroplasticity and function is summarized.
Abstract: Importance Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months’ corrected age. Objectives To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy–specific early intervention that should follow early diagnosis to optimize neuroplasticity and function. Evidence Review This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy , diagnosis , detection , prediction , identification , predictive validity , accuracy , sensitivity , and specificity . The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. Findings Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months’ corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months’ corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence. Conclusions and Relevance Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
744 citations
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TL;DR: The motor adaptation to pain from the micro (single motoneuron) to macro (coordination of whole-muscle behaviour) levels is considered and to provide a basis for a new theory to explain the motor changes in pain.
Abstract: People move differently in pain. Although this statement is unquestioned, the underlying mechanisms are surprisingly poorly understood. Existing theories are relatively simplistic, and although their predictions are consistent with a range of experimental and clinical observations, there are many observations that cannot be adequately explained. New theories are required. Here, we seek to consider the motor adaptation to pain from the micro (single motoneuron) to macro (coordination of whole-muscle behaviour) levels and to provide a basis for a new theory to explain the motor changes in pain.
743 citations
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TL;DR: An ecologic model of sedentary behaviors is described, highlighting the behavior settings construct and the multiple levels of determinants of prolonged sitting time, which are likely to operate in distinct ways in these different contexts.
743 citations
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26 Aug 2002TL;DR: In this article, the development of appropriate context modeling concepts for pervasive computing, which can form the basis for such a context management infrastructure is discussed, and the model overcomes problems associated with previous context models, including their lack of formality and generality, and tackles issues such as wide variations in information quality, the existence of complex relationships amongst context information and temporal aspects of context.
Abstract: As computing becomes more pervasive, the nature of applications must change accordingly. In particular, applications must become more flexible in order to respond to highly dynamic computing environments, and more autonomous, to reflect the growing ratio of applications to users and the corresponding decline in the attention a user can devote to each. That is, applications must become more context-aware. To facilitate the programming of such applications, infrastructure is required to gather, manage, and disseminate context information to applications. This paper is concerned with the development of appropriate context modeling concepts for pervasive computing, which can form the basis for such a context management infrastructure. This model overcomes problems associated with previous context models, including their lack of formality and generality, and also tackles issues such as wide variations in information quality, the existence of complex relationships amongst context information and temporal aspects of context.
741 citations
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TL;DR: Critics have started to question current reliance on trough measurement during therapeutic drug monitoring, with instances of toxicity and rejection occurring when trough concentrations are within ‘acceptable’ ranges, and controversy exists as to whether this will provide any great benefit, given the added complexity in monitoring.
Abstract: The aim of this review is to analyse critically the recent literature on the clinical pharmacokinetics and pharmacodynamics of tacrolimus in solid organ transplant recipients. Dosage and target concentration recommendations for tacrolimus vary from centre to centre, and large pharmacokinetic variability makes it difficult to predict what concentration will be achieved with a particular dose or dosage change. Therapeutic ranges have not been based on statistical approaches. The majority of pharmacokinetic studies have involved intense blood sampling in small homogeneous groups in the immediate post-transplant period. Most have used nonspecific immunoassays and provide little information on pharmacokinetic variability. Demographic investigations seeking correlations between pharmacokinetic parameters and patient factors have generally looked at one covariate at a time and have involved small patient numbers. Factors reported to influence the pharmacokinetics of tacrolimus include the patient group studied, hepatic dysfunction, hepatitis C status, time after transplantation, patient age, donor liver characteristics, recipient race, haematocrit and albumin concentrations, diurnal rhythm, food administration, corticosteroid dosage, diarrhoea and cytochrome P450 (CYP) isoenzyme and P-glycoprotein expression. Population analyses are adding to our understanding of the pharmacokinetics of tacrolimus, but such investigations are still in their infancy. A significant proportion of model variability remains unexplained. Population modelling and Bayesian forecasting may be improved if CYP isoenzymes and/or P-glycoprotein expression could be considered as covariates. Reports have been conflicting as to whether low tacrolimus trough concentrations are related to rejection. Several studies have demonstrated a correlation between high trough concentrations and toxicity, particularly nephrotoxicity. The best predictor of pharmacological effect may be drug concentrations in the transplanted organ itself. Researchers have started to question current reliance on trough measurement during therapeutic drug monitoring, with instances of toxicity and rejection occurring when trough concentrations are within 'acceptable' ranges. The correlation between blood concentration and drug exposure can be improved by use of non-trough timepoints. However, controversy exists as to whether this will provide any great benefit, given the added complexity in monitoring. Investigators are now attempting to quantify the pharmacological effects of tacrolimus on immune cells through assays that measure in vivo calcineurin inhibition and markers of immunosuppression such as cytokine concentration. To date, no studies have correlated pharmacodynamic marker assay results with immunosuppressive efficacy, as determined by allograft outcome, or investigated the relationship between calcineurin inhibition and drug adverse effects. Little is known about the magnitude of the pharmacodynamic variability of tacrolimus.
741 citations
Authors
Showing all 52145 results
Name | H-index | Papers | Citations |
---|---|---|---|
Graham A. Colditz | 261 | 1542 | 256034 |
George Davey Smith | 224 | 2540 | 248373 |
David J. Hunter | 213 | 1836 | 207050 |
Daniel Levy | 212 | 933 | 194778 |
Christopher J L Murray | 209 | 754 | 310329 |
Matthew Meyerson | 194 | 553 | 243726 |
Luigi Ferrucci | 193 | 1601 | 181199 |
Nicholas G. Martin | 192 | 1770 | 161952 |
Paul M. Thompson | 183 | 2271 | 146736 |
Jie Zhang | 178 | 4857 | 221720 |
Alan D. Lopez | 172 | 863 | 259291 |
Ian J. Deary | 166 | 1795 | 114161 |
Steven N. Blair | 165 | 879 | 132929 |
Carlos Bustamante | 161 | 770 | 106053 |
David W. Johnson | 160 | 2714 | 140778 |