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Article: Comment to 'A New Intellectual Atmosphere' by President Alexander.

Hart, G C / Avison, M P

1989 Volume 57, Issue 1, Page(s) 206

MeSH term(s)	Dose-Response Relationship, Radiation ; Humans ; Radiation Dosage ; Radiation Effects ; Radiation, Ionizing
Language	English
Publishing date	1989-07
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	2406-5
ISSN	1538-5159 ; 0017-9078
ISSN (online)	1538-5159
ISSN	0017-9078
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Zs.MO 253: Show issues

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Article ; Online: Insights into implementation planning for point-of-care testing to guide treatment of chronic obstructive pulmonary disease exacerbation: a mixed methods feasibility study.

Hart, Julie / Edwards, Alexander Daniel / Stainthorpe, Andrew

Frontiers in health services

2024 Volume 3, Page(s) 1302653

Abstract: The purpose of this mixed methods feasibility study was to gain insights into unmet clinical needs, stakeholder preferences and potential barriers and enablers to adoption for planning the implementation of point-of-care testing for earlier detection and ...

Abstract	The purpose of this mixed methods feasibility study was to gain insights into unmet clinical needs, stakeholder preferences and potential barriers and enablers to adoption for planning the implementation of point-of-care testing for earlier detection and guided treatment of chronic obstructive pulmonary disease (COPD) acute exacerbation in the NHS in England. Exacerbations of COPD cause considerable mortality and morbidity. Earlier identification of exacerbations and guided treatment would lead to reduced exacerbation duration, reduced hospitalizations and mortality, improve health-related quality of life, reduce unnecessary treatments (including inappropriate antibiotic prescribing) which could save the NHS over £400 per patient. During the early stages of product design, we took a multi-disciplinary approach to evidence generation, gaining insights from key stakeholders to test the product concept and inform evidence-based implementation planning. Primary data was collected from 11 health care and service professionals involved in the management of acute COPD exacerbations. Overall, participants agreed that by earlier differentiation of acute exacerbation from stable COPD, patients could be started on appropriate treatment. To implement point-of-care testing into clinical practice, evidence is required to demonstrate the accuracy of differentiating between exacerbation etiologies and to provide information on the beneficial impact to the system in terms of optimized management, reduced long-term side effects, admission avoidance, and cost-effectiveness. This research provides an evidence base for future implementation planning of point-of-care testing for earlier detection and guided treatment of COPD acute exacerbation. Moreover, the technology developers can decide whether to refine the product design and value proposition thereby de-risking product development.
Language	English
Publishing date	2024-01-03
Publishing country	Switzerland
Document type	Journal Article
ISSN	2813-0146
ISSN (online)	2813-0146
DOI	10.3389/frhs.2023.1302653
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Article ; Online: Insights into implementation planning for point-of-care testing to guide treatment of chronic obstructive pulmonary disease exacerbation

Julie Hart / Alexander Daniel Edwards / Andrew Stainthorpe

Frontiers in Health Services, Vol

a mixed methods feasibility study

2024 Volume 3

Abstract	The purpose of this mixed methods feasibility study was to gain insights into unmet clinical needs, stakeholder preferences and potential barriers and enablers to adoption for planning the implementation of point-of-care testing for earlier detection and guided treatment of chronic obstructive pulmonary disease (COPD) acute exacerbation in the NHS in England. Exacerbations of COPD cause considerable mortality and morbidity. Earlier identification of exacerbations and guided treatment would lead to reduced exacerbation duration, reduced hospitalizations and mortality, improve health-related quality of life, reduce unnecessary treatments (including inappropriate antibiotic prescribing) which could save the NHS over £400 per patient. During the early stages of product design, we took a multi-disciplinary approach to evidence generation, gaining insights from key stakeholders to test the product concept and inform evidence-based implementation planning. Primary data was collected from 11 health care and service professionals involved in the management of acute COPD exacerbations. Overall, participants agreed that by earlier differentiation of acute exacerbation from stable COPD, patients could be started on appropriate treatment. To implement point-of-care testing into clinical practice, evidence is required to demonstrate the accuracy of differentiating between exacerbation etiologies and to provide information on the beneficial impact to the system in terms of optimized management, reduced long-term side effects, admission avoidance, and cost-effectiveness. This research provides an evidence base for future implementation planning of point-of-care testing for earlier detection and guided treatment of COPD acute exacerbation. Moreover, the technology developers can decide whether to refine the product design and value proposition thereby de-risking product development.
Keywords	insights ; COPD exacerbation ; implementation science ; point-of-care testing (POCT) ; feasibility study ; mixed methods ; Medicine ; R
Subject code	650
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
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Article ; Online: Rurality modifies the association between symptoms and the diagnosis of amyotrophic lateral sclerosis.

Hart, Alexander A / Swenson, Andrea / Narayanan, Nandakumar S / Simmering, Jacob E

Amyotrophic lateral sclerosis & frontotemporal degeneration

2024 , Page(s) 1–11

Abstract: Objective: We utilized national claims-based data to identify the change in odds of diagnosis of ALS following possible-ALS-symptoms-and whether the change varies in urban/rural areas.: Methods: Insurance claims were obtained from the Merative ... ...

Abstract	Objective: We utilized national claims-based data to identify the change in odds of diagnosis of ALS following possible-ALS-symptoms-and whether the change varies in urban/rural areas. Methods: Insurance claims were obtained from the Merative MarketScan databases, 2001-2021 in the United States. Individuals with incident ALS were identified and matched on age, sex, and enrollment period to individuals without ALS. For all individuals, claims for 8 possible-ALS-symptoms in the time before any ALS diagnosis were identified. We then used conditional logistic regression to estimate the odds of being diagnosed with ALS following these symptoms and whether the association varied by urban/rural location. Results: 19,226 individuals with ALS were matched to 96,126 controls. Patients with ALS were more likely to live in an urban area (87.0% vs 84.5%). Of those with ALS 84% had 1+ of our 8 possible-ALS-symptom compared to 51% of controls. After adjustment for confounders, having possible-ALS-symptoms increased the odds of a future ALS diagnosis by nearly 5-fold. A dose-response pattern was present with increasing odds as the number of symptoms increased. In all models, urban areas were associated with increased odds of diagnosis with ALS while the effect of having a symptom was smaller in urban places. Urban cases of ALS are diagnosed at younger ages. Conclusions: These results suggest symptoms may appear and be noted years before the diagnosis of ALS. Additionally, rural patients are diagnosed at later ages with a greater dependence on symptoms than urban patients. These results highlight potential improvements for screening for ALS.
Language	English
Publishing date	2024-02-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2705049-X
ISSN	2167-9223 ; 2167-8421
ISSN (online)	2167-9223
ISSN	2167-8421
DOI	10.1080/21678421.2024.2315185
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Article ; Online: Recurrence after transanal endoscopic microsurgery for benign and malignant rectal tumours: experience of a single New Zealand centre.

Hart, Alexander / Clifford, Kari / Thompson-Fawcett, Mark

ANZ journal of surgery

2023 Volume 94, Issue 3, Page(s) 412–417

Abstract: Background: Transanal endoscopic microsurgery (TEM) is an established technique for the resection of rectal adenomas and selected malignant tumours. It avoids the morbidity of radical resection for tumours not amenable to endoscopic resection. An ... ...

Abstract	Background: Transanal endoscopic microsurgery (TEM) is an established technique for the resection of rectal adenomas and selected malignant tumours. It avoids the morbidity of radical resection for tumours not amenable to endoscopic resection. An important marker of quality is the local recurrence rate. The primary objective was to determine local recurrence rates for benign and malignant rectal tumours. Methods: We identified index TEM excisions of rectal adenomas and adenocarcinomas in patients age 18 and over at Dunedin Hospital, New Zealand, between 2000 and 2020, from a prospective database. Surveillance data were collected via chart review. The primary outcome was recurrence rate for adenomas and adenocarcinomas. Secondary outcomes included time to recurrence, association of recurrence with recognized risk factors, and adverse event rates. Results: We identified 100 patients for analysis. Of 75 benign cases, 11 (14.7%) developed local recurrence, with 63.6% identified within 1 year. Of the 25 malignant cases (19 T1, 5 T2, 1 T3), 9 (36%) developed recurrence, with 77.8% identified within 2 years. Adverse events occurred in 26% of patients, with no reoperations or deaths. Conclusion: Our adenoma recurrence rate was at the higher end of the reported range of 2.4-16%. Minor complications were common, but not major morbidity. The propensity for rectal tumours to recur commonly and early reinforces the importance of regular standardized endoscopic surveillance.
MeSH term(s)	Humans ; Adolescent ; Transanal Endoscopic Microsurgery/adverse effects ; Transanal Endoscopic Microsurgery/methods ; New Zealand/epidemiology ; Microsurgery/methods ; Rectal Neoplasms/surgery ; Rectal Neoplasms/pathology ; Adenocarcinoma/surgery ; Adenoma/surgery ; Adenoma/pathology ; Precancerous Conditions ; Neoplasm Recurrence, Local/pathology ; Treatment Outcome
Language	English
Publishing date	2023-11-14
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/ans.18780
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Article ; Online: The Use of Physical Characteristics to Explain Variation in Ball-Carrying Capability in Elite Rugby Union: A Narrative Review.

Hart, Alexander S / Erskine, Robert M / Clark, David R

Journal of strength and conditioning research

2023 Volume 37, Issue 8, Page(s) 1718–1727

Abstract: Abstract: Hart, AS, Erskine, RM, and Clark, DR. The use of physical characteristics to explain ...

Abstract	Abstract: Hart, AS, Erskine, RM, and Clark, DR. The use of physical characteristics to explain variation in ball-carrying capability in elite rugby union: a narrative review. J Strength Cond Res 37(8): 1718-1727, 2023-The effectiveness of offensive ball carrying has been identified as a key determinant in elite rugby union try-scoring success and subsequent match outcome. Despite this, there is limited research evaluating the physical qualities believed to underpin the ball-carrying capability among elite rugby union players. The aim of this review was to critically appraise the scientific literature that has investigated the use of physical characteristics to explain ball-carrying capability in elite rugby union. Measures of sprint performance, specifically acceleration, maximum sprinting speed, and sprint momentum have presented weak-to-strong correlations with the number of tries scored, line breaks, tackle breaks, defenders beaten, and dominant collisions recorded among international rugby union players. In addition, unilateral and bilateral vertical countermovement jump height, peak power output, and drop jump reactive strength index have each demonstrated meaningful associations with the number of tries scored, line breaks, tackle breaks, and dominant collisions. However, various measures of maximal lower-body strength have presented only trivial correlations with the game statistics associated with ball-carrying capability. These trivial correlations are likely a result of the inconsistent and inaccurate methods used to assess maximal lower-body strength, with methods ranging from a box squat-predicted 1 repetition maximum to a maximal isometric mid-thigh pull. Further investigation is required to assess the contribution of maximal lower-body strength, agility, repeated sprint ability, and aerobic capacity to ball-carrying capability in elite rugby union. Such robust, objective data could be used to inform the specificity of physical preparation and maximize the transfer of these physical qualities to on-field performance.
MeSH term(s)	Humans ; Athletic Performance ; Muscle Strength ; Rugby ; Running ; Football
Language	English
Publishing date	2023-02-07
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	1156349-7
ISSN	1533-4287 ; 1064-8011
ISSN (online)	1533-4287
ISSN	1064-8011
DOI	10.1519/JSC.0000000000004468
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Zs.A 6263: Show issues

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Article ; Online: Repeatability, reproducibility, and diagnostic accuracy of a commercial large language model (ChatGPT) to perform emergency department triage using the Canadian triage and acuity scale.

Franc, Jeffrey Michael / Cheng, Lenard / Hart, Alexander / Hata, Ryan / Hertelendy, Atilla

CJEM

2024 Volume 26, Issue 1, Page(s) 40–46

Abstract: Purpose: The release of the ChatGPT prototype to the public in November 2022 drastically reduced the barrier to using artificial intelligence by allowing easy access to a large language model with only a simple web interface. One situation where ChatGPT ...

Abstract	Purpose: The release of the ChatGPT prototype to the public in November 2022 drastically reduced the barrier to using artificial intelligence by allowing easy access to a large language model with only a simple web interface. One situation where ChatGPT could be useful is in triaging patients arriving to the emergency department. This study aimed to address the research problem: "can emergency physicians use ChatGPT to accurately triage patients using the Canadian Triage and Acuity Scale (CTAS)?". Methods: Six unique prompts were developed independently by five emergency physicians. An automated script was used to query ChatGPT with each of the 6 prompts combined with 61 validated and previously published patient vignettes. Thirty repetitions of each combination were performed for a total of 10,980 simulated triages. Results: In 99.6% of 10,980 queries, a CTAS score was returned. However, there was considerable variations in results. Repeatability (use of the same prompt repeatedly) was responsible for 21.0% of overall variation. Reproducibility (use of different prompts) was responsible for 4.0% of overall variation. Overall accuracy of ChatGPT to triage simulated patients was 47.5% with a 13.7% under-triage rate and a 38.7% over-triage rate. More extensively detailed text given as a prompt was associated with greater reproducibility, but minimal increase in accuracy. Conclusions: This study suggests that the current ChatGPT large language model is not sufficient for emergency physicians to triage simulated patients using the Canadian Triage and Acuity Scale due to poor repeatability and accuracy. Medical practitioners should be aware that while ChatGPT can be a valuable tool, it may lack consistency and may frequently provide false information.
MeSH term(s)	Humans ; Triage/methods ; Reproducibility of Results ; Artificial Intelligence ; Canada ; Emergency Service, Hospital
Language	English
Publishing date	2024-01-11
Publishing country	England
Document type	Journal Article
ISSN	1481-8043
ISSN (online)	1481-8043
DOI	10.1007/s43678-023-00616-w
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Article ; Online: Mass Gathering Event Medical Preparedness and Response: A Review of Canadian Legislation and Guidelines.

Pigeon, Marc-Antoine / Hertelendy, Attila / Hart, Alexander / Lund, Adam / Ranse, Jamie / Ciottone, Gregory

Disaster medicine and public health preparedness

2024 Volume 18, Page(s) e50

Abstract: Introduction: The mass gathering event (MGE) industry is growing globally, including in countries such as Canada. MGEs have been associated with a greater prevalence of injury and illness when compared with daily life events, despite most participants ... ...

Abstract	Introduction: The mass gathering event (MGE) industry is growing globally, including in countries such as Canada. MGEs have been associated with a greater prevalence of injury and illness when compared with daily life events, despite most participants having few comorbidities. As such, adequate health, safety, and emergency medical planning is required. However, there is no single entity regulating these concerns for MGEs, resulting in the responsibility for health planning lying with event organizers. This study aims to compare the legislative requirements for MGE medical response systems in the 13 provinces and territories of Canada. Methods: This study is a cross-sectional descriptive analysis of Canadian legislation. Lists of publicly available legislative requirements were obtained by means of the emergency medical services directors and Health Ministries. Descriptive statistics were performed to compare legislation. Results: Of the 13 provinces and territories, 10 responded. For the missing 3, a law library review confirmed the absence of specific legislation. Most ( Conclusions: No provinces could list specific legislation guiding safety, health, and medical response for an MGE.
MeSH term(s)	Humans ; Mass Gatherings ; Cross-Sectional Studies ; Canada ; Emergency Medical Services
Language	English
Publishing date	2024-03-11
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2024.38
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Article ; Online: No party no joy?-Changes in university students' extraversion, neuroticism, and subjective well-being during two COVID-19 lockdowns.

Krautter, Kai / Friese, Malte / Hart, Alexander / Reis, Dorota

Applied psychology. Health and well-being

2022 Volume 14, Issue 4, Page(s) 1314–1332

Abstract: The COVID-19 lockdowns represent a major life event with an immense impact on university students' lives. Findings prior to the pandemic suggest that changes in personality and subjective well-being (SWB) can occur after critical life events or ... ...

Abstract	The COVID-19 lockdowns represent a major life event with an immense impact on university students' lives. Findings prior to the pandemic suggest that changes in personality and subjective well-being (SWB) can occur after critical life events or psychological interventions. The present study examined how university students' extraversion, neuroticism, and SWB changed during two COVID-19 lockdowns in Germany. To this end, we conducted a partly preregistered, two-cohort study with four measurement points each from October 2019 to May 2021 (N
MeSH term(s)	Humans ; Extraversion, Psychological ; Neuroticism ; Universities ; Cohort Studies ; COVID-19 ; Communicable Disease Control ; Personality ; Students
Language	English
Publishing date	2022-01-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2483053-7
ISSN	1758-0854 ; 1758-0846
ISSN (online)	1758-0854
ISSN	1758-0846
DOI	10.1111/aphw.12336
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Article ; Online: Mental health-related limitations and political leadership in Germany: A multidisciplinary analysis of legal, psychiatric, and ethical frameworks.

Smith, Alexander / Theil, Stefan / Hart, Stephen D / Liebrenz, Michael

International journal of law and psychiatry

2023 Volume 89, Page(s) 101908

Abstract: In recent years, political events have reignited contentious debates about psychiatry and democratic governance. This discourse has largely centred around the ethics and morality of public commentary, particularly in relation to the American Psychiatric ... ...

Abstract	In recent years, political events have reignited contentious debates about psychiatry and democratic governance. This discourse has largely centred around the ethics and morality of public commentary, particularly in relation to the American Psychiatric Association's Goldwater Rule. Yet, few studies have examined the practical implications of health-related limitations due to mental illness in national leadership and the constitutional and legal provisions that surround these issues, including voluntary or involuntary proceedings. Accordingly, this theoretical paper analyses these topics in a German context using the position at the head of the executive: the chancellorship. Germany was selected as a case example as the biggest democracy in Europe with modern legal frameworks representative of the post-World War Two era in European constitutionalism, and for its economic and political influence within the European Union. Throughout this paper, we do not speculate on the mental health of any individual (past or present), but instead explore jurisdictional mechanisms around health-related limitations in German high office. Consequently, we outline relevant constitutional and legal scenarios, and how short- or long-term medical incapacity may determine requisite responses and contingent complexities. This underpins our discussion, where we consider legal ambiguities, functional capacity, and ethical concerns in psychiatric practice.
MeSH term(s)	Humans ; Mental Health ; Leadership ; Germany ; Mental Disorders ; Europe
Language	English
Publishing date	2023-07-17
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	304429-4
ISSN	1873-6386 ; 0160-2527
ISSN (online)	1873-6386
ISSN	0160-2527
DOI	10.1016/j.ijlp.2023.101908
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