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Falls among older adults cause serious challenges for the individual and health care systems, including bone fractures. Our recent systematic review and meta-analysis has shown that reactive step training (repeated exposure to balance perturbations) can reduce falls by approximately 50% (Okubo et al., 2016). However, the methods to generate perturbations (e.g. slips) in previous studies have been considerably heterogeneous and have limitations to training reactive balance control. We have developed a novel overground perturbation system which can generate both slips and trips in random locations. Since this system can provide unpredictable slips and trips, it is theoretically possible to train specifically reactive balance control (as opposed to proactive balance control or prediction). This randomized controlled trial will examine the effectiveness of the reactive step training using this perturbation system in older adults.

This project aims to improve the quality of care for older people with dementia when admitted to hospital by targeting delirium - a common condition in this population associated with serious adverse consequences. Experienced nurses at the Princess Alexandra Hospital will be provided with comprehensive education regarding the identification, prevention and management of delirium. They will subsequently pass this education onto other nurses on their wards. Expected project outcomes include improvements in nursing practices for patients with cognitive impairment (dementia and delirium).

Patients having sleep/CPAP/ventilation (SCV) studies for chronic respiratory failure often require arterial blood to be taken for measurement of blood oxygen, pH and carbon dioxide measurement - so called arterial blood gases (ABGs). These measurements are used to assist in 1. identifying inadequate breathing 2. determining need for assisted ventilation in patients with known or possible ventilatory disorders (eg chronic respiratory or neuromuscular disease or reduced ventilatory capacity associated with obesity ( “obesity hypoventilation syndrome”) . 3. providing information to assist in modification of ventilator settings in such patients. An arterial blood sample is somewhat more difficult to obtain and generally believed to be more painful than a venous sample (venous blood gases (VBGs)), but there is currently no evidence that VBGs can adequately replace the role of ABGs in this setting. The project will involve taking a venous blood sample for VBGs at the same time as the standard arterial blood sample (for ABGs) from patients already having SCV studies already including ABGs. The results from the arterial and venous samples will be compared. The study will involve an additional paired blood test for each ABG (estimated two per patient), during the same visit and should take minimal extra time (estimated 10 minutes total). At the end of the study we will compare the ABG and VBG measurements to see if we can use venous gases as a reliable alternative to ABGs in future. The data may also be used to see if we can use an equation to better approximate the arterial values from VBGs and if there is a consistent relationship between VBGs and transcutaneous measurements (across skin) of carbon dioxide, which are already being measured.

The emergence of bacteria or germs that have become resistant to most antibiotic treatments is an urgent public health problem. Often called “superbugs”, these germs have the ability to resist treatment with almost all antibiotics and can infect hospitalized as well as healthy people in the community. Superbugs transform previously easily treated minor infections into life-threatening conditions with very few treatment options. So far efforts to reduce superbug spread in our hospitals have failed to halt the global spread of these organisms. Nor are there new antibiotics in production to deal with this problem. New innovative approaches are needed to deal with this emerging threat. The faecal microbiota transplant, also called FMT, is a procedure where stool is collected from healthy donors and delivered to the gut of the recipient. This is done with the goal of the healthy bacteria from the donor replacing the harmful bacteria in the recipient. The FMT procedure is already proven safe and effective in treating patients with another type of bacterial gut infection called Clostridium difficile. FMT has also been shown in animal studies and human cases to eliminate gut carriage of certain superbugs called multi-resistant gram negative bacteria. The elimination of gut carriage would both prevent superbug infections developing in the individual and also prevent the spread of these organisms to other persons. In order to address this growing problem we have designed a study to test the effectiveness of FMT in people who have suffered from recurrent infections with a type of superbug. The goals of this study are to determine if FMT can result in clearance of superbug bacteria from the stool and to observe the effect of FMT on rates of recurrent infections in study participants. In collaboration with South Australian experts in this field the stool will be analysed to determine how FMT affects the range of germs in the gut and their ability to become resistant to antibiotics. If successful this study will represent a major scientific advance in our ability to prevent superbug infection and spread. It will open up new treatment possibilities for patients who suffer from superbug infections and benefit the community at large by giving us a new tool to stop the spread of superbugs to others.

The aim of this study is to investigate the impact of discharge education and the use of patient resources in patients that have had a heart attack or unstable angina when they return home. We will explore if patients actually follow the recommended activity guidelines and use of healthcare services such as cardiac rehabilitation, pharmacy, general practice, pathology and emergency department in the first 30 up to 90 days after discharge from hospital. Patients who live in areas with high and low levels of access to cardiac services will be compared with each other. Outcomes will be assessed with the use of Global Positioning Systems (GPS) and Geographic Information Systems (GIS). Participants who agree to participate will be educated on the use of a phone which they will be asked to carry for at least 30 days. Participants will receive weekly phone calls for the duration of the study during which the nurse will ask a series of questions about their experiences with the phone and will ask about the health service locations that have been visited.

The purpose of the study is to investigate whether using a smart phone application can assist in the reduction of intake of foods which contain phosphate and sodium by helping people to adhere to a diet. We believe that using this app will help people adhere to a diet over a 2 week period. We will measure whether this has happened by collecting a sample of all the urine passed over 24 hours at both the beginning and end of the 2 week period and compare the result from that to others in the study who receive routine dietetic advice. Once all of the data has been collected, the researchers will aim to see whether the app has been helpful or not and to see if it can be used as a valid research tool in future experiments. Participants will then be asked for some information about themselves including: 1. Age, weight, gender, height, blood pressure, body mass index. 2. A food questionnaire and 3 day food record. Participation in the trial will require the following procedures: 1. A urine analysis 2. A 24 hour urinary collection for phosphate, sodium, creatinine and urine volume Participating in the trial will require some restrictions upon lifestyle during the study. These include changing ones diet to one which contains low levels of phosphate and sodium. Participants will be allocated in a group: 1.Diet sheets outlining dietary measures, including foods to avoid, to achieve the required dietary sodium and phosphate reduction (given out and explained by the student investigator), plus a telephone interview with a trained dietician in which the dietary intervention will be further explained and reinforced. 2.Instructions on the use of the dietary app, which participants will be able to use to monitor their sodium and phosphate targets. The app will be supplied on an iPad and taught how to use the app. Use of the app will be explained by the student investigator. This app has many functions including allowing users to input their dietary intake on a daily basis. It then keeps a running tally of nutrient intake and allows users to identify the nutrient content of individual foods, bar scans foods and indicates how well users are meeting or exceeding nutrient targets. All trial participants will be asked to keep a 3 day food diary (either via the app or via usual paper food diary) prior to the final repeat urine collection.

Point-of-care HbA1c testing in the intensive care setting may be advantageous for patients with diabetes who are admitted to ICU because including rapid availability of the result may guide insulin therapy. This may be of particular benefit for patients with poor glycemic control that are at a greater risk of hypoglycemic complications. However the accuracy of the HbA1c point of care testing has not been validated in the critically ill.

Excess weight is a major risk factor for chronic diseases, such as heart disease, diabetes and some cancers. In Australia over 60% of adults are overweight or obese. Lack of exercise, overconsuming foods high in fat and sugars and not enough fruits and vegetables are recognised as key lifestyle factors leading to obesity in the population. Therefore new cost-effective approaches to improving the diet and physical activity of the population are needed. Self-monitoring is recognised as effective strategy in helping people improve their diet and physical activity. As people may not always know what changes to make, the addition of personalised feedback which provides specific recommendations may assist in weight maintenance. LiveLighter, is a public health education program to encourage people to eat well, be physically active and maintain a healthy weight. The aim of this study is to investigate in an overweight population whether diet and physical activity can be improved with personalised feedback. Volunteers will be invited from those who enrol in the LiveLighter Campaign. There will be three groups of 200 people (total 600 people). To record their diet, people will use an app designed by the investigators, known as a mobile Food Record for four days. They will also wear an activity monitor for 7 days. After recording details of their diet and physical activity, one group will receive frequent personalised feedback on their diet and physical activity for six months and provided with fitness tracker. Another group will record details of their diet and physical activity. A third group will only fill out only on-line surveys with questions about their diet and physical activity. All groups will be followed up again at one year. This will make it possible to determine if the addition of personalised feedback has any added benefit and if it helps people improve their diet and physical activity, as well as being able to achieve a healthy weight. Details of all costings will be collected making it possible to work out how cost effective the program is. If successful and cost-effective, expansion for use in large scale state-wide and national interventions will be highly feasible.

The project aims to establish the reliability and face validity characteristics of the ASQ-TRAK, a culturally adapted version of a developmental screening tool, for use with Australian Aboriginal children. The project also aims to explore the characteristics of developmental difficulty or delay in South Australian Aboriginal children. The project will contribute to an existing study about the validation of the ASQ-TRAK. Aboriginal children and their caregivers who attend the Child and Family Health Services (CaFHS) in four South Australian locations will be invited to participate in the project. THe proposed sites are Port Adelaide (urban), Morphett Vale (urban), Port Augusta (regional), and Anangu Pitjantjatjara Yankunytjatjara - the APY lands (remote), Child health staff will be trained to use the ASQ-TRAK. The project will employ a cross-sectional design and the methods will be as follows: 1. Reliability: for test-retest reliability, the same practitioner will re-administer the ASQ-TRAK within a two week period. For inter-observer reliability, a different practitioner will re-administer the ASQ-TRAK within a two week period. To calculate internal consistency, the ASQ-TRAK only needs to be administered once. In the urban and regional sites, the ASQ-TRAK will be conducted twice and this data will establish test-retest and inter-observer reliability. In the remote site, the ASQ-TRAK will be conducted once. For children who have the ASQ-TRAK, this data will contribute to establishing internal consistency. 2. Face validity: practitioners and caregivers will be surveyed about their experiences with the ASQ-TRAK. 3. Prevalence: rates of developmental difficulties or delay will be estimated for the four locations, using hte cut-off rates determined by the ASQ-3. The project will provide information about the accuracy and acceptability of the culturally adapted ASQ-3. This will help to fill a gap in providing developmental services to Australian Aboriginal children.

This study aims to: 1. compare baseline phenotypes amongst those with recently identified prediabetes and type 2 diabetes, in Sydney, Australia and in Shanghai, China. 2. examine the effect of an exercise program on changes in metabolic end-points, complications, surrogate biomarkers, gut microbial profile and cognitive measures. 3. examine the effectiveness of an intervention to improve exercise maintenance. Study Hypotheses: 1. The phenotypes amongst those with recently identified prediabetes and type 2 diabetes, in Sydney, Australia and in Shanghai, China, differ in their body composition and adiposity (by DXA scan and abdominal MRI), and degree of insulin deficiency (by insulin, glucose and C-peptide measures). 2. A structured exercise program involving high intensity interval training (HIIT) and resistance exercise will lead to improved percentage of liver steatosis (1H-MRS), non-alcoholic fatty liver disease (steatosis greater than or equal to 5.5% and insulin-fibrosis measures), body composition, metabolic end-points (including HbA1c, fructosamine), lesser organ complications (including albuminuria, cardiac diastolic dysfunction, cardiac autonomic neuropathy, peripheral neuropathy), improved surrogate blood biomarkers of complications (including CD monocyte markers, CTGF and FAP), and more normal gut microbial profile, mood state and cognition. 3. An intervention aiming to improve exercise maintenance will result in improved exercise adherence, sustained outcomes in exercise parameters (adherence to exercise amount, greater intensity) and cardiovascular fitness, NAFLD, body composition, improved metabolic end-points, lesser organ complications, improved surrogate biomarkers of complications, and more normal gut microbial profile, mood state and cognitive function.