Dr Martin Turner

Dr Martin Turner Brief bio BSc (Eng) (Witwatersrand), MSc (Eng) (Witwatersrand) PhD (Witwatersrand)

Honorary Fellow
The Australian School of Advanced Medicine, Macquarie University

Contact Details
The Australian School of Advanced Medicine
2 Technology Place, Macquarie University NSW 2109, Australia
Tel: +61 (0)2 9812 3606
Fax: +61 (0)2 9812 3560

Email: martin.turner@mq.edu.au

 

Professional Overview

Dr Martin Turner, an electrical engineer, lectured measurement and instrumentation to undergraduate and postgraduate electrical engineers and anaesthetists for 11 years. During that time he completed his PhD on measurement and mathematical modelling of respiratory function in mechanically ventilated infants.  He has also made measurements on and modelled the human thermoregulatory and cardiovascular systems.   More recently he has been active in measurement and mathematical modelling of the adult respiratory system. He has consulted to accredited calibration laboratories and is a volunteer Technical Assessor for the National Association of Testing Authorities, Australia (NATA).  His dual experience in physical medical measurements and industrial and scientific metrology made him acutely aware of major discrepancies between the quality of industrial and medical measurements, and stimulated his interest in Medical Metrology.

His current research at Macquarie University has the objective of improving the quality control of physical medical measurements.

Areas of Research Interest

  • Metrology. Metrology is the science of measurement. Metrologists take care of the world-wide measurement system that ensures that measurements such as length, mass, pressure and time are comparable, within well-defined limits, in every country.  The world-wide metrology framework ensures that a wheel bearing made in Germany fits precisely in the hub of a wheel made in Australia, and that a kg of tomatoes that we buy at the greengrocer is within 5 grams of the mass of the International Prototype kg kept at the International Bureau of Weights and Measures (BIPM) in Paris.  At present, many physical medical measurements do not take advantage of the international metrology system.  The quality control of many medical measurements such as blood pressure, eye pressure, respiratory measurements and even simple variables such as body weight, is not of the same standard as measurements for industry and trade.  For reasons that are not clear, society is willing to put resources into ensuring that petrol and tomatoes are measured correctly at the point of sale, but at present appears to be unwilling to put similar resources into assuring the quality of physical medical measurements.  This research aims to provide evidence to motivate for substantial improvements in quality control of physical medical measurements.  It will include investigation of the cost effectiveness of quality control, in both Dollars and Quality of Life. 
  • Non-invasive blood pressure measurement. High blood pressure (hypertension) is the leading risk factor for mortality worldwide, responsible for 13% of all deaths. Approximately 30% of Australians adults have hypertension.  Anti-hypertensive treatment can be given to the right people only if blood pressure is measured correctly.This research aims to find out what steps clinicians take to minimise errors in blood pressure (BP) measurements caused by the BP monitor.  Further studies will test BP monitors used in the community to assess the distribution of errors and the effects those preventable errors have on detection and treatment of hypertension and cardiovascular risk.
  • Automatic blood pressure monitors use computer algorithms to estimate BP from pressure oscillations in the cuff as it deflates.  These algorithms are not disclosed by manufacturers.  The British Hypertension Society, the European Society for Hypertension and the Association for the Advancement of Medical Instrumentation publish protocols for validating automatic monitors against manual BP measured by experts.  Even validated monitors, however, give substantial errors in some people, particularly people with stiff arteries.  This research will use mathematical modelling to investigate the stiffening of arteries with age and the effects of stiffening and of the mechanics of tissues in the arm on the transmission of arterial pressure pulsations to the cuff of the BP monitor.
  • Intraocular pressure measurement. Intraocular pressure (IOP) is measured by optometrists and ophthalmologists to screen for, diagnose, treat and monitor ocular hypertension and glaucoma.  Glaucoma is a neurodegenerative disease of the retina and is the second leading cause of blindness worldwide.  Reduction and control of IOP are the only effective treatments for glaucoma.  The Goldmann applanation tonometer is the gold standard for measuring IOP, but it is known to produce significant errors if inadequately calibrated.  This research aims to find out what the effects of IOP errors are and the steps optometrists and ophthalmologists take to minimise errors in IOP caused by their tonometers.  We will also work towards developing new, simpler techniques for calibrating tonometers.
  • Other physical clinical measurements that we will study include body weight, respiratory function, and many other medical measurements that are becoming increasingly important in an ageing society.

Grants (last 10 years)

2012 Macquarie University Partnership Seeding Grant. $9,820.

2012 - 2013. Macquarie University Vice-Chancellor's Innovation Fellowship. Blood pressure - understanding its regulation and improving its measurement. $248,496

2007 Australian and New Zealand College of Anaesthetists. Clinical and mathematical modelling studies of the cerebral haemodynamic effects of drugs used during anaesthesia. $45,000.

2006. NHMRC Research Infrastructure Block Grant  $3,062

2005. NHMRC Research Infrastructure Block Grant  $5,050

2002 - 2004. NHMRC development grant. Development of novel methods for non-invasive measurement of cardiac output and lung volume during anaesthesia $255,000.

Selected Publications

Peer-review publications

  1. Robinson P, Turner MJ, Brown N, Salome C, Berend N, Marks, GB, King GG.  Procedures to improve the repeatability of forced oscillation measurements in school-aged childrenRespir Physiol & Neurobiol. 2011 117(2):199-206..
  2. Turner M.J. Can we trust automatic sphygmomanometer validations? J Hypertens 2010, 28(12):2353-2356. 
    Accompanying editorial: O'Brien E, Stergiou G. Who will bell the cat? A call for a new approach for validating blood pressure measuring devices. J Hyperten 2010, 28(12):2378-2381.
  3. McCulloch TJ, Turner MJ. The effects of hypocapnia and the cerebral autoregulatory response on cerebrovascular resistance and apparent zero flow pressure during isoflurane anesthesia. Anesth Analg. 2009 Apr;108(4):1284-90.
  4. Turner MJ, van Schalkwyk JM. Blood pressure variability causes spurious identification of hypertension in clinical studies: a computer simulation study. Am J Hypertens. 2008 Jan;21(1):85-91.
    Accompanying editorial:
    Marshall TP. Blood pressure variability: the challenge of variation. Am J Hypertens. 2008 Jan;21(1):3-4.
  5. Turner M.J., van Schalkwyk J.M., Irwig L. Lax sphygmomanometer standard causes over- and under-detection of hypertension - a computer simulation study. Blood Press Monit. 2008 Apr;13(2):91-9.
  6. McCulloch T.J, Thompson C.L., Turner M.J.  A Randomized Crossover Comparison of the Effects of Propofol and Sevoflurane on Cerebral Hemodynamics during Carotid Endarterectomy. Anesthesiology 106(1):56-64 2007.
  7. Tang Y., Turner M.J., Baker A.B. Systematic errors and susceptibility to noise of four methods for calculating anatomical dead space from the CO2 expirogram. Br J Anaesth. 98(6):828-834 2007.
  8. Turner M.J., Speechly C., Bignell N. Sphygmomanometer calibration - why, how and how often? Aust Fam Physician 2007 36(10):834-838
  9. Tang YQ, Turner MJ, Baker AB. A New Equal Area Method to Calculate and Represent Physiological, Anatomic and Alveolar Dead Spaces. Anesthesiol 104(4):696-700 2006.
  10. Tang YQ, Turner MJ, Baker AB. A new calibration method that compensates for the effects of O2 and N2 on infrared CO2 analysers. J Clin Monit Comput 20(2):75-79 2006.
  11. Turner M.J., Irwig L., Bune A.J., Kam P.C., Baker A.B. Lack of sphygmomanometer calibration causes over- and under-detection of hypertension - a computer simulation studyJ Hypertens 24(10):1931-1938 2006.
    Accompanying editorial: Parati G, Fainia A, Castiglionic P. Accuracy of blood pressure measurement: sphygmomanometer calibration and beyond. J Hypertens 24(10):1915-1918 2006.
    This article featured in:
    • Nature Clinical Practice Nephrology: Sphygmomanometer calibration could increase the accuracy of hypertension detection December 2006 2:665.
    • Nature Clinical Practice Cardiology: Sphygmomanometer calibration could increase the accuracy of hypertension detection January 2007 4(1):11.
    • dabl Educational Trust website (www.dableducational.org), an evidence-based website providing up-to-date-information on sphygmomanometers and BP measurement.
  12. Yem J.S., Turner M.J., Baker A.B., Young I.H., Crawford A.B. A tidally breathing model of ventilation, perfusion and volume in normal and diseased lungs. Br J Anaesthesia 97(5):718-731 2006.
  13. Yem, J.S., M.J. Turner, A.B. Baker. Sources of error in partial rebreathing pulmonary blood flow measurements in lungs with emphysema and pulmonary embolism. Br J Anaesthesia 97(5):73-741 2006.
  14. Tang YQ, Turner MJ, Baker AB. Effects of alveolar dead space, shunt and  distribution on respiratory dead-space measurements. Br J Anaesth 95(4):538-548 2005.
  15. Tang YQ, Turner MJ, Baker AB. Effects of lung time constant and gas analyser delay and rise time on measurements of respiratory dead space. Physiol Measurement 26(6):1103-1114 2005.
  16. Turner M.J., Baker A.B. Kam PC. Effects of systematic errors in blood pressure measurements on the diagnosis of hypertension. Blood Press Monit.2004; 9(5):249-253.
  17. Turner M.J., McCulloch T.J., Kennedy R.R., Baker A.B. Pharmacokinetics of sevoflurane uptake into the brain. Anaesthesia 59(12):1201:1206 2004.
  18. Baker AB, Tang YQ, Turner MJ. Percentage decline in masters superathlete track and field performance with ageing. Experimental Aging Research 29(1):47-65. 2003.
  19. Yem JS, Tang YQ, Turner M.J, Baker AB. Sources of error in non-invasive cardiac output measurements by partial re-breathing: a computer model study. Anaesthesiol 98(4):881-887 2003.
  20. Tang YQ, Turner MJ, Yem JS, Baker AB. Calibration of pneumotachographs using a calibrated syringe. J Appl Physiology 95:571-576. 2003
  21. Whiteley JP, Turner MJ, Baker AB Gavaghan DJ, Hahn CEW. The effects of ventilation pattern on carbon dioxide transfer in three computer models of the airways. Respir Physiol Neurobiol 131:269-284. 2002.
  22. Hartford CG. van Schalkwyk JM. Rogers GG. Turner MJ. Primate pleuroesophageal tissue barrier frequency response and esophageal pressure waveform bandwidth in health and acute lung injury. Anesthesiol. 92(2):550-8, 2000.
  23. Turner MJ, Weismann D, Járos GG, Baker AB. Estimation of pulmonary blood flow from sinusoidal gas exchange during anaesthesia: a theoretical study. Br J Anaesthesia. 85(3):371-378 2000.

 

Letters to the editor

  1. Turner MJ. Blood pressure variation with cuff height: effect of time. J Hypertens. 30(4):828 2012.
  2. Turner MJ. Is pressure decrease at peak hyperemia due to Poiseuille or Bernouli or both? Hypertension. 2011 Oct 58(4):e21.
  3. Turner MJ, van Schalkwyk JM. Is it ethical to perform irreversible renal denervation before a trial of low sodium intake for treatment-resistant hypertension?  Hypertension. 2011. Aug 58(2):e9.
  4. van Schalkwyk JM, Turner MJ. Diagnosing hypertension in children and adolescents. JAMA. 9;299(2):168 2008.
  5. Turner MJ, van Schalkwyk JM. Automated sphygmomanometers should not replace manual ones, based on current evidence. Am J Hypertens. 2008 Aug;21(8):845.
  6. Yem, J.S., Y.Q. Tang, M.J. Turner, A.B. Baker. Noninvasive cardiac output monitor algorithms are more sophisticated and perform better than indicated in modeling paper - Reply. Anesthesiol, 2003. 99(6): p. 1462-1462.

Chapters in books

Bates JHT, Turner MJ, Lanteri CJ, Jonson B, Sly PD. Measurement of flow and volume. In: Infant Respiratory Function Testing. Edited by J Stocks, PD Sly, RS Tepper, WJ Morgan. Wiley-Liss 1996. New York.

Invited presentations

  1. Turner M.J. Can we trust automatic sphygmomanometer validations? School of Public Health, University of Sydney. October 2010.
  2. Turner M.J. Measurements of mass loss from Greenland and Antarctica by Grace satellites. Invited presentation at Metrology Society of Australia Annual General Meeting October 2010.
  3. Turner M.J., Irwig L., Bune A.J., Baker A.B, Kam P.C. Effects of systematic and random errors in non-invasive blood pressure measurements. School of Public Health Seminar. Screening & Test Evaluation Program (STEP). University of Sydney. February 2005.
  4. Turner MJ. Metrology in Medicine. Dept of Physiology. University of the Witwatersrand. Johannesburg. April 2004.
  5. Turner M.J., Kam P. Govender G. and Thyssen T. Metrology in medicine. National Metrology Laboratory, West Lindfield, NSW, Australia. By invitation of the Director and Chief Metrologist of Australia. April 2003.
  6. Turner M.J., Kam P. and Baker A.B. Calibration of medical equipment. Dept of Anaesthetics, University of Sydney. Australia, October 2003.

Published International conference proceedings

  1. Tang Y.Q., Yem J.S., Turner M.J. and Baker A.B. The comparison of different calibration methods for pneumotachograph. Anesthes Analg 96(2S):S149 2003.
  2. Yem J.S., Tang Y., Turner M. and Baker A.B. Sources of error in non-invasive pulmonary blood flow measurements by partial re-breathing: a computer model study. Anesthes Analg 96(2S):S141 2003.

Refereed conference presentations

  1. Turner MJ, van Schalkwyk JM. Inadequate quality control of physical clinical measurements is an unrecognised cause of harm. Metrology Society of Australia Conference. Geelong Australia. 19-21 October 2011.
  2. Turner M.J., Irwig L, Bune A.J., Baker A.B., Kam P.C. Lack of sphygmomanometer calibration causes over- and under-detection of hypertension. 6th Biennial Conference of The Metrology Society of Australia. Canberra 19-21 October 2005.
  3. Turner M.J., Kam P.C., Baker A.B. Metrology in Medicine. 5th Biennial Conference of The Metrology Society of Australia. Melbourne 15-16 March 2004.

External Appointments

Honorary Principal Research Fellow, Sydney School of Public Health, The University of Sydney
Technical Assessor, National Association of Testing Authorities, Australia (NATA).

Memberships and Committees

High Blood Pressure Research Council of Australia
Metrology Society of Australia
National Committee of the Metrology Society of Australia. 2011-present