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Pneumonia in children is a worldwide problem and a leading cause of morbidity and mortality. Rarely pneumonia is complicated by an ‘empyema’ where fluid collects around the lung and requires drainage with a tube. Many different types of bacteria can cause pneumonia and empyema. Streptococcus pneumoniae (SP) is one of the leading causes and has more than 90 different strains. It is unknown why some children are susceptible to pneumonia from SP; some evidence from adult patients suggests that there may be a genetic reason for susceptibility to Pneumococcal infection. Furthermore, viruses are commonly found in the upper airway of children with pneumonia and increase the risk of infection with SP. Vaccination can help prevent infection with many of the strains of pneumococcus. Australia recently introduced a vaccine which covers 13 of these strains. The main aim of this study is to look at the effectiveness of this newly introduced vaccine. The study will also look at the other bacteria and viruses that can cause pneumonia in children in Australia using sensitive molecular tests.

The current study aims to provide nursing staff in aged care residential facilities with a psychologically-based mobile application in conjunction with a web-based system. The Nurses Behavioural Assistant (NBA) will provide evidence based interventions to assist nursing staff to implement effective non pharmacological behavioural intervention strategies in response to behavioural and psychological symptoms of dementia (BPSD) in real time. Through educating nursing staff via the NBA it is anticipated that they will have more management strategies to draw from and feel more competent when responding. As a consequence, the residents may experience an improved quality of life and may show a decrease in the number behavioural and psychological symptoms experienced. The current research will be conducted at an aged care residential facility which houses 30 residents, with approximately 30 personal care attendants and nursing staff. Nursing staff and personal care attendants will be provided with an initial NBA training session, and then asked to use the NBA application over a 4 week period. Data on the BPSD each resident experiences and the interventions used will be inputted via the NBA mobile application and then automatically transferred to a secure server. Data will also be viewable to nurses via the web-dashboard. This data will be used to measure the NBA uptake, as well as the effectiveness of the behavioural management strategies recommended. Residents will be assessed on their level of dementia, anxiety, depression, confusion and agitation. Nursing staff will be assessed on their level of knowledge regarding BPSD, before and after the intervention. Nursing staff will also be interviewed to provide feedback regarding the implementation of the NBA at the end of the research. The results will provide a theoretical and applied basis for future expansion of the NBA system to other aged care facilities

Metabolic syndrome (MetS) is a cluster of metabolic abnormalities characterised by dysglycemia, raised blood pressure, elevated triglyceride concentration, low high density lipoprotein (HDL) cholesterol level and obesity (central adiposity) (Alberti et al., 2009). In Australia, up to approximately one third of the population is diagnosed with metabolic syndrome (Cameron, Magliano, Zimmet, Welborn, & Shaw, 2007). These numbers are only expected to increase in the coming years. The most unifying concept of metabolic syndrome is insulin resistance (Bremer, Mietus-Snyder, & Lustig, 2012). There is ample evidence suggesting altered lipoprotein homeostasis in insulin resistant state (Avramoglu, Basciano, & Adeli, 2006). Chylomicrons are lipoprotein particles that transport dietary fat from the intestine to tissues expressing lipoprotein lipase (LPL) such as skeletal muscle and adipose tissue. In insulin resistance, chylomicron homeostasis is impaired: either due to overproduction and/or delayed removal of chylomicron particles from circulation. The balance between chylomicron production and remnant clearance will determine the exposure of arterial tissues to pro-atherogenic remnants. In the fasting state, the circulating concentration of chylomicron particles is elevated in insulin resistance compared to normal controls (Curtin et al., 1996). Following a lipid-rich meal these defects are further manifested with elevated concentrations of chylomicrons persisting in circulation for a longer time compared to insulin sensitive controls (Avramoglu et al., 2006). As humans spend most of their lives in a postprandial state due to ingestion of several meals eaten in sequence, these insulin resistant subjects would be placed at greater risk of developing atherosclerosis, particularly if remnant (small, lipid-poor) chylomicron particles accumulate. Very little is known about the distribution profile of the chylomicron remnant fractions in the postprandial state, though it has been shown that these smaller particles have greater atherogenicity (Nakajima et al., 2010; Nakajima et al., 2011; Nakajima et al., 2012; Pang, Chan, Barrett, & Watts, 2012). The overarching aims of this project is to determine whether subjects with metabolic syndrome exhibit a more atherogenic size distribution of chylomicron particles than control subjects in the fasting and postprandial states. Furthermore, since dietary modification is an important supportive therapy for diabetes, metabolic syndrome and CVD, one aspect that may be important is the fatty acid composition of a meal. There is some evidence that dietary fatty acid composition may affect chylomicron homeostasis and fat oxidation rate (DeLany, Windhauser, Champagne, & Bray, 2000; Perez-Martinez et al., 2011; Silva et al., 2003). Thus this study will also investigate the effect of meals containing a range of vegetable oils each with differing fatty acids on the postprandial size distribution of chylomicron particles. Of particular interest is the effect of an edible oil, rice bran oil, that has been shown to have beneficial effects on cholesterol and hepatic lipoprotein concentration (Lai, Chen, Chen, Chang, & Cheng, 2012; Most, Tulley, Morales, & Lefevre, 2005).

This study assesses if patients who are suitable for a transplant (and have a suitable bone marrow donor) will have better results if they are treated with a transplant compared to those patients that would have had a transplant but a suitable bone marrow donor was not available and instead received standard chemotherapy. The trial results will show whether future treatment of AML in patients over 50 should always include BMT whenever possible. Who is it for? You may be eligible to join this study if you are aged between 51 and 70 years of age (inclusive), diagnosed with Acute Myeloid Leukaemia (AML) of intermediate or poor prognosis, have achieved first complete remission (CR1) or complete remission with incomplete blood count recovery (CRi), have an indication for reduced intensity conditioning transplantation (RICT) but not myeloablative allogeneic hematopoietic stem cell transplantation (Allo SCT), judged to be able to tolerate further standard consolidation chemotherapy, willing to undergo a RICT if a suitable donor is found, and willing and able to comply with protocol requirements. Trial details Participants in this study will be divided into one of two groups – one group are those who will receive Reduced Intensity Conditioning Transplant (RICT) as an available suitable bone marrow donor (i.e. Matched Sibling Donor (MSD) or Matched Unrelated Donor (MLD)) has been found whilst the other group is comprised of participants will not undergo RICT as a suitable bone marrow donor was not available. Participants in the group that will undergo RICT will proceed as soon as possible to transplant as the next treatment after achieved remission. Due to medical or logistic factors, consolidation course(s) according to institutional practice may be given. Consequently, patients in the RICT group will (before conditioning) receive a total of 1-3 chemotherapy courses. If a patient in the RICT group relapses, or if a contraindication to the assigned treatment occurs, the patient will be treated at the discretion of the clinician. Centres may select any of the following conditioning regimens and are then asked to consistently use the chosen regimen. 1) Intrathecally administered methotrexate will be given to selected patients as per centre routine. As fludarabine is metabolized partly by a renal mechanism (Malspies Sem Oncol 1990), doses of fludarabine need to be modified if the calculated or assessed renal clearance is below the lower limit of the normal range. 2) Busulphan (administered orally or intravenously (IV)) and fludarabine. Fludarabine 30 mg/sqm IV infusion over 30 minutes on day –8 to day – 4 (=five days) for MSDs and on day -9 to day -5 or -4 (= five or six days) for MUDs. Busulphan may be administrated orally or intravenously. Oral busulphan will be administered as a total dose of 8 mg/kg, given as eight doses of 1 mg/kg each on day –4 (two doses), day –3 (four doses) and day –2 (two doses). Intravenous busulphan will be administered with a total dose of 6.4 mg/kg Busulphex (Registered Trademark) given as two doses of 3.2 mg/kg each, administered over 3 hours, on days -3 and -2. In-vivo T depletion with ATG, or alemtuzumab, as per local standards is permitted for MUDs. There shall be an interval of 8 hours between fludarabine and busulphan, and 48 hours between last dose of busulphan and infusion of stem cells. SUPPORTIVE MEASURES POST TRANSPLANT: Supportive measures post-transplant listed below represent basic general recommendations. In principle, centres are free to follow their local standard guidelines including blood transfusion support, antibacterial prophylaxis, herpes simplex virusand varicella zoster prophylaxis, surveillance and pre-emptive treatment of Cytomegalovirus (CMV). , fungal prophylaxis, P. carinii prophylaxis, and the use of Granulocyte colony-stimulating factor (G-CSF) in the post-transplant setting should be individualized. IMMUNOSUPRESSIVE THERAPY: Immunosuppressive therapy in the RICT setting includes the use of eithermethotrexate or mycophenolate mofetil (MMF) in addition to cyclosporine-A (CyA) in this trial. The dose of CyA should be targeted and adjusted to a serum concentration as per center preference. The first doses of CyA are given intravenously to try and ensure adequate levels at the time of transplant. If there is nausea and vomiting anytime during CyA treatment the drug should be given intravenously at the appropriate dose. Blood pressure, renal function tests (creatinine, BUN), electrolytes and magnesium need to be followed closely while receiving CyA at full dose. In principle, cyclosporine should be given IV or orally in full dose from Day –1 until day 60, then be tapered, in the absence of GvHD, and stopped at day +120. However, if Graft versus host Disease (GvHD) occurs, or if justified by chimerism data, CyA dose and duration should be individualized CyA and short course methotrexate. This immunosuppression combination includes full dose CyA and methotrexate. The dose of methotrexate is 15 mg/sqm IV day 1, 10 mg/sqm day 3 and day 6. The use of folinic acid rescue on days 4 and days 7 –10 is optional. A fourth dose (10 mg/sqm) of methotrexate Day +11 with optional use of folinic acid rescue on day +12, should be added after MUD-RICT, or otherwise if the risk of GvHD is considered high. The immunosuppression combination of CyA and MMF includes full dose CyA and MMF. The CyA dosage schedule is described above. The MMF dose, either orally or IV, is 15 mg/kg twice daily. Doses will be rounded to the nearest 250 mg (capsules are 250 mg). Most patients will receive 1000 mg twice daily. After MSD-RICT, and in the absence of GvHD, MMF will be given until day +50 post-treatment and then stopped without tapering. After MUD-RICT, MMF will be given 15mg/kg every 8 hrs to day +40, then tapered to day +96. If there is nausea and vomiting, preventing oral administration, MMF dose should be reduced accordingly, or administered intravenously. GvHD should be treated as per local routines with prednisone/prednisolone. In case of steroid-refractory GvHD, defined as progression after three days or no improvement after 7 days or incomplete response after 14 days of corticosteroid treatment, patients will be managed according to local practice or ongoing studies. Chronic GvHD will be treated according to local practice. Most centers have developed routines for chimerism assessment and immunological intervention. Therefore, only some principles are stated and centers are free to use their own routines as to the rest. For the purpose of this trial, chimerism analysis should be performed at least in PB at +1 month, at D +100 and at 1 year in PB or BM. Extra assessments may be needed in case of remaining MRD or administration of DLI. It is recommended to assess chimerism in T-cells and myeloid cells separately. Remaining or reappearing of host myeloid cells may be used as surrogate marker for MRD. Immunological intervention such as CyA taper or DLI may be considered. SURVEILLANCE AND INTERVENTION: Local or national routines for surveillance and intervention will be applied. Participants in the second study group will not undergo RICT as a suitable bone marrow donor was not available. Instead, they will receive conventional consolidation therapy according to institutional practice or within studies of post consolidation therapy. It is presumed that the participants in this group will receive a total of 3-4 chemotherapy courses. Participants in this group who relapse will be treated at the discretion of the clinician. Relapsed patients may receive any salvage treatment.

The study will assess the feasibility of a specified exercise program in patients with advanced breast cancer and its impact on improving fatigue. Who is it for? You may be eligible to join this study if you are a female with metastatic breast cancer aged between 18-80 years, and are being managed at Breast Cancer Research Centre- WA. Eligible women will also have experienced subjective fatigue in the past several weeks as a persistent symptom. Study details This study will be conducted in two parts. In Part 1, eligible patients will be offered a 6 week exercise program, where the primary endpoint will be to assess feasibility and overall safety. If the program is deemed as being feasible and safe, Part 2 of the study will commence. In Part 2, participants will be randomly (by chance) allocated to one of two groups. Participants in one group will be offered the 6 week exercise program, whilst participants in the other group will not participate in the exercise program. On completion of the program, participants will be asked to complete some questionnaires to assess their levels of fatigue, depression and pain. They will also be asked to conduct a brief walking test to assess any changes in aerobic fitness.

This trial is aimed at determining if Glyceryl Trinitrate given by the surgeon prior to haemorrhoid banding during colonoscopy reduces peri-operative pain and need for analgesia when compared against placebo.

Each year, about 2 in 3 adults living in aged care centres falls at least once. These falls can have serious consequences such as injuries and mobility limitations or fear to fall again. Churches of Christ Queensland have designed an exercise program to prevent falls and improve balance among residents of aged care centres. This study aims to evaluate the feasibility and efficacy of this exercise program. The outcome of this study will help inform and facilitate ongoing improvements in falls prevention and management.

This project aims to assess the safety of Metformin and how well it works in patients with active Ulcerative Colitis. Metformin is approved in Australia to treat Type 2 Diabetes and has been used for over 50 years. In addition its effect on blood glucose metformin has more recently been shown to have anti-inflammatory effects, which are important in the activity and severity of ulcerative colitis. Metformin may have a therapeutic benefit in ulcerative colitis via this anti-inflammatory effect.

BACKGROUND Ultrasound guided regional anaesthesia (UGRA) is a complex component of anaesthesia practice to learn. UGRA has evidence of improved safety, efficacy and is considered standard of care for peripheral nerve blocks. To safely practice UGRA, procedural accuracy is required when introducing the nerve block needle into the patient and guiding that needle to the target nerve structure under real time ultrasound guidance. This procedural task encompasses several domains of knowledge and manual dexterity skills: 1. Ability to manipulate the ultrasound transducer to visualise and optimise the nerve and surrounding tissue sonoanatomy 2. Ability to plan a needle path trajectory that maintains an in-plane visualisation of the needle shaft and tip from skin surface to deeper structures 3. Motor skill ability to guide the needle under real time visualisation to inject local anaesthesia at positions around the nerve to create a circumferential deposition of injectate (local anaesthesia) 4. Ability to recognise an optimal spread of injectate and to correct the needle position appropriately Successful performance of UGRA thus requires hand-eye coordination and needle guidance techniques to maximise efficacy while minimising potential complications. Learning curve patterns of novices performing UGRA in patients has revealed an initial high rate of errors, from a mean of 12.6 errors per block during the first 10 attempts, decreasing to 4.6 errors per block by the end of the 39th attempt. In a study using cadavers, 28 UGRA attempts were required to reach competency as defined by needle visualisation under ultrasound and transducer steadiness. Both studies revealed wide variability in novices' error and success rates. This suggests that UGRA skills are difficult to master and individuals reach proficiency at different times, due to innate psychomotor abilities. For ethical reasons, initial teaching of these procedural skills has thus focused on in vitro models. It allows repeated practice of high stakes procedural skills without risk of patient harm. It concentrates trainees and trainers in a single learning environment. A curriculum can be devised without distractions of clinical duties as occurs in hospital-based teaching. The ideal in vitro model should be inexpensive, has similar properties to human tissue both under ultrasound (echogenicity, fascial planes, muscle texture, hyperechoic peripheral nerves, arterial and venous blood vessels that collapse appropriately under pressure, spread of injectate along fascial planes and around nerves, swelling of the nerve sheath if an intraneural injection was performed), as well as tactile feedback of resistance and fascial plane pops when a facet tipped nerve block needle is used. Commonly used in vitro models include the gelatin model, meat model, and fresh frozen human cadaveric model. None of these satisfy as an ideal model, and all have advantages and disadvantages. Inexpensive and easily procured models such as gelatin and meat based models are commonly used in teaching, but offer a low fidelity experience of what a trainee would expect when performing UGRA in patients. Anatomical relationships, tactile feedback, appearance of human tissues and fascial planes under ultrasound, and nerve block needle echogenicity are not realistic. In our experience, these models are useful in introducing novices to UGRA but create overconfidence in performance as they do not reflect the clinical reality. The meat model, usually constructed out of turkey, beef or pork, is relatively inexpensive, easy to construct, and has more similar properties to human tissue in terms of echogenicity and texture. Hydrodissection by injections of simulated local anaesthetic can also be performed. However, meat models do not have realistic human anatomical relationships. Unlike traditional formalin based cadaveric dissections, fresh frozen human cadavers retain all of the in vivo anatomical relationships and currently represents the highest fidelity model for UGRA training. Nerves, fascial planes, and muscle textures are similar to live patients. Tactile feedback is retained when performing needling manoeuvres. Injection spreads patterns are similar to live patients. Limitation to access include financial cost and scarcity of centres accredited to handle fresh cadavers. This study will compare the effectiveness of two in vitro models commonly used to teach UGRA: pork meat model, and fresh frozen cadavers. Effectiveness is measured using objective assessment of proficiency in procedural skills before and after exposure to different in vitro models. RATIONALE FOR PERFORMING THE STUDY The traditional apprenticeship model of teaching medicine has emphasised clinical exposure and supervised tutelage of procedural skills in our patients. Due to multiple factors including ethical concerns of relatively unskilled trainees performing invasive procedures on patients, reduction in caseload due to safe working hours directives, and reduction of available teaching staff, this apprenticeship model may be inappropriate. In UGRA, poor needle visualisation and suboptimal sonoanatomical imaging have been identified as the two most common mistakes in novices, which may contribute to patient complications during nerve blocks. Educators are still uncertain as to the best methods of teaching UGRA, including what are the best in vitro models. In this study, we will compare the effectiveness of 2 commonly used in vitro models. The models range from low fidelity (but low cost, easily accessible) to high fidelity (but high cost, not easily accessible). Each model has been used and reported in literature, but no previous study has compared each model's effectiveness in teaching procedural skills to trainees. The results of this study will inform us of the value of fresh frozen cadavers in UGRA teaching. We will compare the relative skills of trainees taught with different models using an objective assessment tool. If the hypothesis is confirmed, we would recommend that fresh frozen cadavers be incorporated into regular UGRA teaching. HYPOTHESIS That fresh frozen human cadavers, representing a high fidelity simulator of human anatomy, is the most effective in vitro model to teach UGRA technical skills to doctors training in anaesthesia when measured against time taken, error rates, and success rates. STUDY OBJECTIVES Primary objective is time taken from insertion of the needle using an in-plane technique (maintaining visualisation of needle shaft and tip) to the 6 o’clock and 12 o’clock positions of the target, and injecting 0.5mls of saline at each position. Secondary outcomes were selected based on common problems exhibited by novices in UGRA. 1. Number of needle passes 2. Number of errors during performance of task 3. Image quality score of best sonoanatomical image

The purpose of this study is to define the value of strain in patient management, by identification of subclinical left ventricular (LV) dysfunction, which will be used to guide cardioprotective therapy. Who is it for? You may be eligible to join if you are aged between 18 and 80 years old (inclusive), and actively undergoing chemotherapy at increased risk of cardiotoxicity. Trial details Participants in this study will be randomly (by chance) divided into one of two groups. Participants in one group will undergo screening echocardiography for the development of cardiotoxicity with the inclusion of myocardial mechanics to measure LV strain. The measurement of LV strain will be used to guide the participant's cardioprotection treatment to avoid cardiotoxicity. Serial screening tests are envisaged to take place at 3 monthly intervals for one year with each screening session taking approximately 30 minutes. Participants in the other group will undergo standard echocardiogram and an ultrasound test of the heart where ejection fraction (EF) is measured. The measurement of EF will be used to guide the participant's cardioprotection treatment to avoid cardiotoxicity. This screening test is envisaged to take place at 3 monthly intervals for a year with each session taking approximately 30 minutes.