I would like to congratulate iCAHE’s 64 members on the research, education, service provision and partnership activity they have undertaken in 2015 to achieve our mission of contributing to better health and wellbeing for all, through evidence-based allied health care. 2015 reflected the first year of activity from the iCAHE research area teams (affectionately known as the RATs). The RATs, and their leaders, were determined in our 2014 strategic review of iCAHE activities and structure, which examined how iCAHE could better support its members and students, and produce strategic outputs that could support the iCAHE mission. This report summarises the research area teams’ activities in 2015, and their plans for 2016. 2015 saw the revision of an existing RAT (changed from the Clinical Practice Guidelines RAT, to the broader emphasis Methods RAT), the establishment of a new RAT in consumer engagement and research, and the strengthening of an existing RAT, in medical radiation, which followed the appointment of Professor Eva Bezak.
iCAHE is increasingly recognised for its national and international activities in allied health research production and translation. I sincerely thank and congratulate the University, the School of Health Sciences and its Head, Prof Roger Eston, iCAHE staff and members and our local, national and international partners for another successful year of research, teaching, partnership building and evidence translation, and we look forward to continuing and strengthening this work in 2016.
iCAHE members look forward to a stellar 2016 with research activities, publications, teaching and capacity building. iCAHE project staff have hit the ground running with applied research projects for four external agencies, all due for completion towards the end of January. Already two response to tenders have been submitted through the Business Development Unit. Several staff are working on ARC Grant applications, and there have been five publications in print already in 2016. An advertisement has just been released for a leader for the new initiative in iCAHE, that of the iCAHE training arm. The successful applicant will collate and streamline current iCAHE training material, and develop new material to provide courses of various lengths in aspects of evidence-based practice (for instance searching, critical appraisal, research methods) and in outputs from this (eg clinical guideline writing, clinical audits, journal clubs, writing for publication). Participants would be graduates from any health science degree. Course delivery will be by a mixture of online and face-to-face teaching. The plan is that the iCAHE short courses could articulate with School of Health Science programs, if appropriate assessments are completed, so that participants could earn credit points towards an award. The Professional Certificate in Consumer Engagement led the way with this training initiative in 2015. Watch this space as the iCAHE training arm rolls out.
Under Transforming Health, the South Australian Government aims to transform the healthcare system to deliver best care, first time, every time.
The Delivering Transforming Health Summary Paper (2015) outlines that to improve the consistency and quality of care across South Australia’s health system, Transforming Health:
At present, within metropolitan SA Health, there are limited allied health services available on weekends. A Transforming Health Allied Health project is underway, to identify the key priority areas, where allied health services across 7 days is required to support patient recovery, prevent patient deterioration, and facilitate timely discharge.
The UniSA’s International Centre for Allied Health Evidence (iCAHE) through its partnership with the Allied and Scientific Health Office is informing the process to ensure that proposed project recommendations for 7 day allied health services are underpinned by evidence based practice.
Reference: Government of South Australia, Department of Health and Ageing, Delivering Transforming Health - Summary Paper, March 2015. Accessed via www.transforminghealth.sa.gov.au 2/2/16.
During 2015, ADEA and iCAHE have been working together to identify the evidence, and create tools and resources, to better enable Credentialled Diabetes Educators (CDEs) to deliver evidence informed person-centred care. Projects and outputs include:
ADEA and iCAHE have also developed an evaluation tool to assist CDEs to implement person centred health literate practices. The tool has been evaluated and validated with consumers and CDEs. This work was profiled at a shared workshop session on Person Centred Care at the Australian Diabetes Educators Association/Australian Diabetes Society Annual Scientific Meeting in August 2015.
New projects are already underway and include systematic reviews and policy development.
‘Our partnership with iCAHE has enabled us to have quick and easy access to expert knowledge in evidence based practice, to skilled researchers and expert evidence based information on consumer engagement. We have achieved outcomes we could not have achieved alone. We look forward to our next series of collaborative projects’.
ADEA is committed to supporting its members to access, conduct and participate in quality research. They have developed a Research Framework and have partnered with iCAHE to initially develop two tools to support their members: a Research Register and Research Toolkit. The Register enables members to share contemporary research information and the online Toolkit allows members to explore evidence-based practice and develop their knowledge and understanding of evidence translation.
‘The partnership with iCAHE has meant that our members have benefited from the wealth of research expertise and experience of the iCAHE team. Together we have customised the best information about evidence-based practice and sharing our research and practice to benefit members and hence people living with diabetes’
Professor Karen Grimmer had the rare opportunity to participate in the UniSA Professional Experience Program, to work in South Africa for six months in 2015, on the South African Guidelines Excellence (SAGE) Project with Ms Shingai Machingaidze and Dr Tamara Kredo (Cochrane South Africa), and Prof Quinette Louw, Prof Taryn Young and Dr Janine Dizon (Stellenbosch University, South Africa), on primary and secondary research which aimed to improve the quality of South African Primary Health Care clinical practice guidelines (CPG). The project is funded by a Medical Research Council (South Africa) Flagship Grant. Karen and the team built on the work undertaken in the Philippines since 2012 (by Janine and Prof Consuelo Gonzalez-Suarez), on contextualising, updating and adapting CPGs. The SAGE research included the use of the iCAHE Rapid Critical Appraisal Instrument for CPGs (1) (which was also cited for the first time, in a German systematic review of CPG appraisal tools during 2015 (2)). Publications from the SAGE project are starting to flow (3-6), and more are expected in 2016.
- Grimmer K, Dizon J, Milanese S, King E, Beaton K, Thorpe O, Lizarondo L, Luker J, Kumar S, Machokta Z. Efficient clinical evaluation of guideline quality: development and testing of a new tool. BMC Res Notes. 2014; 14: 63.
- Semlitsch T, Blank WA, Kopp IB, Siering U, Siebenhofer A: Evaluating guidelines—a review of key quality criteria. Dtsch Arztebl Int. 2015; 112: 471–8.
- Machingaidze S, Kredo T, Young T, Louw Q, Grimmer K. South African Guidelines Excellence (SAGE): Clinical Practice Guidelines - Quality and Credibility. Editorial Series. SAMJ. 2015; 105(9):743-745.
- Machingaidze S, Zani B, Abrams A, Durao S, Louw Q et al. Quality and Reporting Standards of South African Primary Care Clinical Practice Guidelines. J Clin Epi. 2016; in press.
- Kredo T, Bernhardson S, Young T, Louw Q, Machingaidze S, Grimmer K. Guide to clinical practice guidelines: The current state of play. Int J Qual Health Care 2016; in press.
- Kredo T, Machingaidze S, Young T, Louw Q, Grimmer K. South African Guideline Excellence (SAGE): What’s in a name? Editorial Series. SAMJ 2016; in press.
Resources for You
The iCAHE Outcomes Calculator aims to facilitate the use of standardised outcome measures in clinical practice to monitor changes in patient status over time. Allied health practitioners complete selected outcome measures prior to, or following treatment using the iCAHE Outcomes Calculator which can then automatically compute the score for each outcome measure and use norms for comparison, as appropriate. Summarising outcomes in this way assists not just in communicating patient progress between clinicians, patients and funders but also in evaluating effectiveness of health services.
The iCAHE Outcomes Calculator contains outcome measures for a range of conditions including musculoskeletal, neurological, incontinence and chronic illnesses. These measures have been selected based on their validity, reliability, clinical utility and sensitivity to detect change over time. iCAHE has developed manuals for the calculator to provide access to the actual outcome measure and information on how they are administered, scored and interpreted.
The iCAHE outcomes calculator is available on CD-ROM and a web-based version is currently under development.
Feature Guideline - See the latest featured guideline, the Assessment and Management of Congenital Muscular Dystrophy, by the American Academy of Neurology.
The iCAHE Guidelines clearing house is a collection of clinical guidelines that have been appraised with the iCAHE Clinical Guideline Quality Checklist. This resource provides clinicians with a fast way of accessing relevant clinical guidelines and the knowledge of the methodological quality of the guideline. This page also hosts the iCAHE Clinical Guideline Quality Checklist, which is a clinician friendly, fast, validated critical appraisal tool that assesses the methodological quality of a guideline. The page also defines what a clinical guideline is and what it looks like, this is handy; as the media are often confused between clinical guidelines and policy statements (a policy statement is a suggested course of action for a condition, a guideline is developed based on the best available evidence for the condition, which is systematically searched for, ranked, appraised and synthesised, also in a systematic and rigorous fashion, all of which is updated regularly)
Actions in Allied Health
- 3RD INTERNATIONAL PRIMARY HEALTH CARE REFORM CONFERENCE, “Creating value. But for whom?” will be held on the 14-16 Mar 2016, Stamford Plaza Brisbane QLD. This conference will bring together primary care organisations, policy makers, consumers, researchers and clinicians from Australia, New Zealand, Europe, the Asia Pacific and North America, to continue the reform platform for primary care globally, and to further develop our international network for future growth. For more details got to http://iphcrc.yrd.com.au/
- 12th Asia-Pacific Congress of Cardiovascular and Interventional Radiology (APCCVIR 2016). The Asia-Pacific Society of Cardiovascular and Interventional Radiology (APSCVIR) and Chinese Society of Interventional Radiology (CSIR) will be holding the 12th Asia-Pacific Congress of Cardiovascular and Interventional Radiology (APCCVIR 2016) will be held in Suzhou, China in 21-24 April 2016. APCCVIR 2016 aims to bring together physicians, scientists and allied health professionals dedicated to improving minimally invasive, image-guided therapeutic interventions. The scientific program aims to inspire all participants by exposing them to new perspectives in the Interventional Radiology field. For more details go to http://www.apccvir2016.org/
Civil Society Australia is holding a National Reform Series. Both events will be held at the Angliss Conference Centre in Melbourne. This series is open to users of services, families, friends, support organisations, community groups, services and policy thinkers.
Reforming NDIS: Fulfilling the Promise to Revolutionise Disability Services, Monday 21 March 2016
Reforming Mental Health: Consumer and Carer Co-Design, Tuesday 22 March 2016.
Kumar S, Anuar MS, Abdullah SN, Han BL. 2015. Quality health care in Brunei Darussalam: The growing impact of allied health professions. Brunei International Medical Journal, 11(4):173-181. Article
Hellmanns K, McBean K, Thoirs K 2015. Magnetic Resonance Imaging in the measurement of whole body muscle mass: A comparison of interval gap methods. Radiography, 21(1):e35-39. Abstract
Wolf SL, Kwakkel G, Bayley M, McDonnell MN, Upper Extremity Stroke Algorithm Working Group 2015. Best practice for arm recovery post stroke: an international application. Physiotherapy. http://dx.doi.org/10.1016/j.physio.2015.08.007 Article
McDonnell MN, Koblar S, Ward NS, Rothwell JC, Hordacre B, Ridding MC 2015 . An investigation of cortical neuroplasticity following stroke in adults: is there evidence for a critical window for rehabilitation? BMC neurology, 15(1):109. DOI 10.1186/s12883-015-0356-7 Article
Delany C, Fryer C, van Kessel G 2015. An ethical approach to health promotion in physiotherapy practice. Health Promotion Journal of Australia. (5 year Impact Factor 1.186, 2 year Impact Factor 0.945, Ranking of the Journal 103/147 Public, Environmental and Occupational Health). Abstract
Lewis LK, Wong SC, Wiles LK, McEvoy MP 2015. Diminishing Effect Sizes with Repeated Exposure to Evidence-Based Practice Training in Entry-Level Health Professional Students: A Longitudinal Study. Physiotherapy Canada, 8:1-8. Abstract
Arnold JB, Mackintosh S, Olds TS, Jones S, Thewlis D 2015. Improvements in knee biomechanics during walking are associated with increased physical activity after total knee arthroplasty. Journal of Orthopaedic Research, 33(12):1818-25 Abstract
Williams B, Brown T, McKenna L, Palermo C, Morgan P, Nestel D, Brightwell R, Gilbert-Hunt S, Stagnitti K, Olaussen A, Wright C 2015. Student empathy levels across 12 medical and health professions: an interventional study. Journal of Compassionate Health Care, 2(1). DOI 10.1186/s40639-015-0013-4 Abstract
Hills C, Boshoff K, Gilbert-Hunt S, Ryan S, Smith DR 2015. The Future in Their Hands: The Perceptions of Practice Educators on the Strengths and Challenges of “Generation Y” Occupational Therapy Students. The Open Journal of Occupational Therapy. Sep 22;3(4):6. Abstract
Bennett L, Luker J, English C, Hillier S. Stroke survivors’ perspectives on two novel models of inpatient rehabilitation: seven-day a week individual therapy or five-day a week circuit class therapy. Disability and rehabilitation. 2015 Oct 27:1-0. Abstract
Gonzalez-Suarez CB, Grimmer K, Alipio I, Anota-Canencia EG, Santos-Carpio ML, Dizon JM, Liao L, Cabrera JT, Martinez R, Beredo E, Valdecanas C 2015. Stroke Rehabilitation in the Philippines: An Audit Study. Disability, CBR & Inclusive Development, 26(3):44-67. Abstract
Gambito ED, Gonzalez-Suarez CB, Grimmer KA, Valdecañas CM, Dizon JM, Beredo ME, Zamora MT, 2015. Updating contextualized clinical practice guidelines on stroke rehabilitation and low back pain management using a novel assessment framework that standardizes decisions. BMC Research Notes, 8:643. DOI 10.1186/s13104-015-1588-8. Abstract
Grimmer K, Kay D, Foot J, Pastakia K 2015. Consumer views about aging-in-place. Clinical interventions in aging, 10:1803. Abstract
Odunaiya NA, Louw QA, Grimmer KA 2015. Are lifestyle cardiovascular disease risk factors associated with pre-hypertension in 15–18 years rural Nigerian youth? A cross sectional study. BMC cardiovascular disorders, 15(1):144. doi:10.1186/s12872-015-0134-x Abstract
Brown MP, Bezak E, Allen BJ 2015. The potential complementary role of targeted alpha therapy in the management of metastatic melanoma. Melanoma Management, 2(4):353-66. Abstract
Thomas S, Makcintosh S 2015. Improvement of physiotherapist assessment of falls risk in hospital and discharge handover through an intervention to modify clinical behaviour. Physical Therapy. doi: 10.2522/ptj.20150215 Abstract
Prynor LN, Baldwin CE, Ward EC, Cornwell PL, O’Connor SN, Chapman MJ, Bersten AD (In press). Tracheostomy tube type and inner cannula selection impacts pressure and resistance to airflow. Respiratory Care.
Grimmer K, Milanese S, Morris J, Fletcher W, Kim S (In Press). Physiotherapy practice: opportunities for international collaboration on workforce reforms, policy and research. Physiotherapy Research International.
Mine K, Nakayama T, Milanese S, Grimmer K (In Press). Effects of microwave diathermy on signs and symptoms of delayed onset muscle soreness: A systematic review of Japanese-language primary studies. Physical Therapy Reviews.
Mine K, Nakayama T, Milanese S, Grimmer K (In Press). Acute effects of stretching on maximal muscle strength and functional performance: A systematic review of Japanese-language randomised controlled trials. Manual therapy.
Lynch EA, Luker JA, Cadilhac DA, Hillier SL 2015. Inequities in access to rehabilitation: exploring how acute stroke unit clinicians decide who to refer to rehabilitation. Disability and Rehabilitation. 27:1-0. Abstract
Firfirey N, Grimmer K, van Niekerk S-M , Louw Q (In Press). Measuring distress in South African children during burns dressing changes. Physiotherapy Theory and Practice.
Brink Y, Louw Q, Grimmer K, Jordaan E 2015. The relationship between sitting posture and seated-related upper quadrant musculoskeletal pain in computing South African adolescents: A prospective study. Manual therapy. Abstract
van Kessel, G, Gibbs, L & MacDougall, C 2015 ‘Strategies to enhance resilience post natural disaster: A qualitative study of experiences with Australian floods and fires’ Journal of Public Health, vol 37 (2), pp. 328-336 doi:10.1093/pubmed/fdu051. Abstract
Firfirey N, Grimmer K, van Niekerk S-M , Louw Q (in Press). Measuring distress in South African children during burns dressing changes. Physiotherapy Theory and Practice. accepted Oct 2015
Perraton L, Machotka Z, Gibbs C, Mahar C, Grimmer K (In Press). Embedding evidence-based practice education into a post-graduate physiotherapy program: Reflecting on eight years’ pre-post course evaluations. PRI accepted June 2015
Machingaidze S, Zani B, Grimmer K et al. (In Press). Quality and Reporting Standards of Clinical Practice Guidelines in use in Primary Care in South Africa. Journal Clinical Epidemiology. Accepted March 2015
Perraton L, Machotka Z, Gibbs C, Mahar C, Grimmer K (In Press). Evidence based practice intensions following an intensive education program, and long-term behaviours. PRI. accepted July 2015
Morris LD, Louw QA, Grimmer KA; Spottiswoode B, Meinjies E (In Press). Virtual reality exposure therapy as treatment for pain catastrophizing in fibromyalgia patients: A proof-of-concept study. The Journal of Physical Therapy Science. accepted July 2015
Van Niekerk S-M, Louw Q, Grimmer K (In Press). Does the prototype ‘Dynamic’ chair facilitate more postural changes in computing adolescents compared to a normal school chair? Work. accepted Nov 2015
van Kessel G, MacDougall C, Gibbs L (In Press). The process of rebuilding human resilience in the face of the experience of a natural disaster: a multisystem model. International Journal of Emergency Mental Health.
van Kessel G, MacDougall C, Gibbs L (In Press). Public testimony as a source of naturally occurring data: An ethical and rigorous approach to investigating resilience in the face of a natural disaster. SAGE Research Methods.
Medical Radiations Research Area Team
Staff Highlight: Dr Nayana Parange
Nayana is the program director for the postgraduate medical sonography program and her professional background is medicine, obstetrics and gynaecology and ultrasound. Her vision is to have every mum be able to deliver a healthy child, and to use ultrasound to contribute to positive pregnancy outcomes. She volunteers as an ultrasound outreach trainer with International Society of Ultrasound in Obstetrics and Gynaecology to upskill health professionals in developing countries such as rural India, Ghana, East Indonesia and Papua New Guinea and travels extensively to train health professionals in ultrasound. Nayana led the development of an education and training model in Adelaide to help upskill midwives and GPs caring for Aboriginal women in remote locations. This enables them to provide life-saving ultrasound services to patients who would otherwise not have access, or would have had to travel long distances. Nayana was one of the 8 women statewide in South Australia to receive a Winnovation SA award. She was recognised for her significant contribution to the development of Australian Ultrasound outreach for rural and remote and Indigenous communities and was awarded the Australasian Society of Ultrasound in Medicine 2015 Award of Excellence for her service to rural and remote ultrasound. Nayana loves teaching, particularly with technology enhanced approach, and her work with postgraduate student sonographers led to her being awarded the UniSA 2015 Citation for Outstanding Contribution to Student learning (digital learning).
Grant Highlight: Developing 3D virtual anatomy resources for use across disciplines
The Medical Radiations and the Anatomy groups have recently celebrated an interdisciplinary grant success. The aim of the project is to develop educational resources for understanding anatomical relationships across disciplines. The project will capitalise on the School of Health Sciences Virtual Environment Radiotherapy Training (VERT) facility which provides a 3D visualisation of patient structures and radiation dose in cancer treatments. This facility has capacity for extending its application to anatomy teaching. An example is prostate cancer treatment where the bladder, rectum and hip joints are closely related to the prostate and seminal vesicles. Students’ understanding of the anatomical positon and relationship of these structures is assisted by the 3D appearance of VERT. The patient’s image is made transparent and structures are built one at a time until all are displayed together. Student difficulty in imagining anatomical relationships that cannot be seen without partial destruction of the structure of interest was the driver that brought UniSA medical radiations and anatomy academics together to collaborate. The project scoping has taken an inter-professional approach. The anatomy team members, Nicola Massy-Westropp, Arjun Burlakoti and Harsha Wechalekar, were introduced to VERT by Med Rad member Eileen Giles, and there was immediate awareness of the positive potential to harness this medium for learning. The prospect of making VERT anatomy videos led to consulting experts who educate health professionals of other disciplines. The project will be supported by the employment of a project assistant Rachaelle Dantu who brings expertise in developing VERT resources. Work has begun on developing resources to embed in 2016 anatomy courses across the School of Health Sciences with a view to then developing resources for 2017 courses.
Thesis Highlight: The effectiveness of simulation training in the teaching of skills required for sonographic fetal assessment in mid-trimester pregnancy.
Brooke Osborne was recently awarded first class honours for her thesis on the development and effectiveness testing of a clearly defined training program using a high-fidelity ultrasound simulator to teach point-of-care mid-trimester obstetric ultrasound evaluation to health and medical professionals with no previous experience in ultrasound imaging. Whilst the participants (mainly midwives) did not reach a level of full competency by the end of the simulation-based training, the standard reached transferred well to the clinical environment. In the context of busy ultrasound departments and stretched training resources, it is hoped that the findings of this study encourage further consideration of the benefits of using high-fidelity ultrasound simulators as an important teaching and learning tool in ultrasound skills development.
Student Highlights: Summer Vacation projects
The medical radiations group hosted 2 summer vacation students: Sophie Thorpe from UniSA and Bianca So from University of NSW. Their accounts shown below demonstrate the value that both the research group and the students can gain from summer scholarship projects.
Sophie Thorpe: Radiation therapy image verification practices in Australia and New Zealand: 2011 survey.
I completed a Vacation Research Scholarship over the 2015/16 summer holidays. I honestly cannot speak highly enough of this scholarship program and the value that the experience has given to me. I had the opportunity to conduct extensive background searches for literature relative to my scholarship topic, trial methods of data entry and data presentation, experiment with data analysis techniques and write a report summarising all of the data I had analysed and comparing it with literature I found. The results from my research have led me to question what current practice involves, how it is determined and how it may be improved to give patients and radiation therapists the best outcomes and experience possible.
Bianca So: Treatment modalities on oesophageal cancer.
Despite many advances in chemotherapy, radiotherapy and follow-up treatment, the prognosis for oesophageal cancer remains grim: most carcinomas have metastasised by the time of diagnosis, and 5-year survival rates rarely exceed 40%. As a third-year medical student, I spent 7 weeks gathering data from clinical trials on treatment for oesophageal cancer. My findings were that chemoradiotherapy administered prior to surgery (neoadjuvant treatment) has the best survival outcome. The most widely used therapy is cisplatin and 5-fluorouracil given concurrent to radiotherapy, usually around 50.4G; if the patient has contra-indications such as poor renal function, then carboplatin and paclitaxel will be used. There have also been many other new chemotherapy drugs that show promise, but have not been extensively trialled. However, there have been many issues with clinical trials. Different drugs, doses and schedules have been used; staging has not always been accurate; and most importantly, studies that have found benefits to neoadjuvant treatment did not examine survival benefit by tumour stage. Recent studies have suggested that there is no benefit of neoadjuvant treatment for early stage tumours.
Far more research is needed in this field, and future trials must focus on identifying the optimum therapy for individuals by standardising staging techniques and quality of treatment. Toxicities must be minimised, and quality of life must be maximised. Only then can the appropriate treatment be given, and only then may the prognosis for oesophageal cancer hopefully improve.
2016/2017 Commencing Honours projects within Med Rad iCAHE
- Title: An assessment of the suitability for the deep inspiration breath hold (DIBH) technique of left sided breast patients – a retrospective study; Supervisors: Eva Bezak, Eileen Giles, Amy De Smit; Student: Mikaela Dell’Oro (Radiation Therapy)
- Title: Development of Poster for Radiography of the Carpal Bones; Supervisors: Eva Bezak, Denise Ogilvie, Michael Fuller; Student: Mohsen Jamali (Medical Imaging)
- Title: The knowledge of Lateral Elbow Radiography Repositioning in radiographers in relation to positioning errors; Supervisors: Nayana Parange, Minh Chau (Shayne), Michael Fuller; Student: Isabella Calabrese (Medical Imaging)
- Title: The erect abdominal radiograph. What does it add to the diagnosis of acute bowel obstruction and paralytic ileus?; Supervisors: Kerry Thoirs, Michael Fuller, Brooke Osborne Student: Wendy Geng (Medical Imaging)
2015/2016 Completing Honours projects within Med Rad iCAHE
- Title: The effect of a five minute repeated hand gripping activity upon ultrasound appearances of the median nerve in patients with carpal tunnel syndrome; Supervisors: Nicola Massy-Westropp, Kerry Thoirs; Student: Rhiannon Jaeschke (Medical Imaging)
- Title: The effect of pelvic size in an anthropomorphic phantom on the subjective assessment of radiotherapy image quality by radiation therapists; Supervisors: Michala Short, Eileen Giles, Lyndal Newmarch; Student: Sara Chan (Radiation Therapy)
- Title: Safety of ultrasound exposure: can a poster change knowledge, attitudes and practices of Australian Sonographers; Supervisors: Maureen McEvoy, Jessie Childs, Adrian Esterman; Student: Monique Moderiano (Medical Imaging)