2016 AMREP EMCR Best Paper Awards

Public Health

Dr Eric Chow (Monash CCS/Alfred)
Paper: Human papillomavirus in young women with Chlamydia trachomatis infection 7 years after the Australian human papillomavirus vaccination programme: a cross-sectional study

Journal: The Lancet Infectious Diseases [IF: 22.433]

Summary: Australia is the first country to implement the national human papillomavirus (HPV) vaccination programme (covers types 6/11/16/18) for females and we have previously described dramatic falls in genital warts (types 6/11). But until I published this paper, there was no data on what was happening to the other two HPV types (16/18) covered in the vaccine. HPV 16/18 are very important because they are types that cause most cases of cervical cancer. The study looked over 10 years; 3 years before and 7 years after the HPV vaccination programme. For the first time we showed a near elimination of all vaccine preventable types (6/11/16/18) in young Australian women aged ≤25. This means that at current levels of vaccination (~73%) are sufficient for the almost complete eradication of the four vaccine-preventable types from the Australian population which means the HPV vaccine will result in dramatic falls in genital cancer in women.

Biomedical Research
Dr Michelle Boyle (Burnet Institute)
Paper: Human Antibodies Fix Complement to Inhibit Plasmodium falciparum Invasion of Erythrocytes and Are Associated with Protection against Malaria

Journal: Immunity [IF: 21.561]

Summary: Malaria that is caused by a parasite that infects red blood cells, kills about half a million people each year, the majority of them children. There are no good vaccines to protect from malaria. Part of the difficulty in developing vaccines is limited knowledge of how the body fights malaria. This publication is focused on understanding how a specific part of the immune system, called antibodies, attacks the parasite. We showed that antibodies need to team-up with another part of the immune system called ‘complement’ to block infection. Without complement, many antibodies don't function. We showed that in Papua New Guinea, children who had high levels of antibodies that could team-up with complement, were protected from malaria disease, while children with low levels of these antibodies became sick. This finding is important for vaccine development as it identifies the right sort of antibodies that stop the parasite and prevent disease.

Clinical Research
Dr Dion Stub (Monash SPHPM)
Paper: Air Versus Oxygen in ST-segment Myocardial Infarction

Journal: Circulation [IF: 14.43]

Summary: Heart attack is one of the leading causes of death in Australia. For over one hundred years supplemental oxygen has been administered to patients with suspected heart attack as a first aid measure by paramedics, doctors and nurses, in the thought that oxygen may provide benefit. The Air Versus Oxygen in Myocardial Infarction (AVOID) study was a randomised trial designed to investigate the effect on oxygen on patient with heart attack. The study was conducted by Ambulance Victoria and nine metropolitan hospitals that provide 24 hour percutaneous coronary intervention (PCI) services in Melbourne, Australia, with collaborations from Monash University and Baker IDI Heart and Diabetes institute, between October 2011 and July 2014. The AVOID study found that supplemental oxygen in patients experiencing heart attack with initial normal oxygen levels, did not relive their pain or minimise heart damage. Instead supplemental oxygen was found to increase heart injury and dangerous rhythms both in hospital and at 6 months on testing with heart MRI. The findings of the AVOID study has led to dramatic change in practice for all care providers of patients with heart attack both in Australia and around the world.

2016 Mid-Career Researcher Best Paper Award Winners

Public Health
Dr Jessica Kasza (Monash SPHPM)
Paper: Clustering and residual confounding in the application of marginal structural models: dialysis modality, vascular access, and mortality

Journal: American Journal of Epidemiology [IF: 5.230]

Summary: This paper extends statistical methods known as marginal structural models to allow for the clustering of patients within healthcare providers, and for the impact of unmeasured confounding on estimates to be assessed. Marginal structural models are becoming increasingly popular statistical tools for the estimation of treatment effects in situations where treatments may change over time: an example being dialysis patients who may switch between haemodialysis and peritoneal dialysis during the course of their treatment. These methodological extensions are demonstrated with a major application to data from the Australia and New Zealand Dialysis and Transplant Registry, investigating the impact of dialysis modality and vascular access type on mortality. These methods allow the clustering of patients treated in the same dialysis centre to be accounted for, and the impact of unmeasured confounding to be assessed: necessary in this application since the amount of data collected from each patient is limited.

Biomedical Research
Dr Smitha Georgy (Monash CCS)
Paper: Identification of a novel proto-oncogenic network in head and neck squamous cell carcinoma in mice and humans

Journal: JNCI-Journal of the National Cancer Institute [IF: 12.58]

Summary: The article provides the first real insight in more than 50 years as to how head and neck cancers – one of the more deadly forms of cancer – develop. The discovery opens the way to identifying patients with particular types of head and neck cancer that may be candidates for more targeted therapies. Each year more than 3100 Australians are diagnosed with squamous cell cancers (SCC) of the head and neck, with almost 1000 dying from the disease – which predominantly affects the tongue, mouth, pharynx, and larynx, usually in patients who smoke. The discovery is the first step in being able to select patients for specific therapies that are likely to target their disease – so called personalized medicine. Disruption of this key gene (GRHL3) sets up a pathway of changes in cells in the mouth and oral cavity that induces rapid cell growth, the hallmark of cancer.

Clinical Research
Dr Carol Hodgson (Monash SPHPM/Alfred)
Paper: Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study

Journal: Critical Care Medicine [IF: 7.442]

Summary: Critically ill patients who require extracorporeal membrane oxygenation (ECMO) are the sickest in the hospital and the use of ECMO has doubled in Australia in the past five years and in the USA has increased by 433%. ECMO patients are one of the most expensive diagnosis-related groups in Australia, costing on average AUD $177,158 per admission or AUD $28 million annually. This international study evaluated the effects of mechanical ventilation on patients receiving this lifesaving therapy, ECMO. In 168 patients we found that the level of pressure applied by the ventilator during ECMO was associated with improved outcomes, including survival. This study informed a large international prospective trial that will evaluate the use of mechanical ventilation during ECMO to reduce time in intensive care and to improve patient outcomes.