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Adolescent depression is both common and harmful, with an estimated 15-20% of adolescents experiencing clinical depression. Depression is strongly associated with disturbed sleep, a relationship that is particularly marked in adolescence. There is accumulating evidence that disturbed sleep can play a precipitating role in the onset of depression, which suggests that treatment of disturbed sleep might improve resilience against the development of depression. However, efforts to clinically target disturbed sleep as a critical mechanism in treatment or prevention are still in their infancy. Improved sleep can also be expected to benefit cardiovascular health. There is a complex relationship between depression, sleep and cardiovascular disease (CVD) across the lifespan, suggesting that early intervention for sleep may impact on a mechanism jointly associated with risk for CVD and depression. Aim: 1. To deliver a brief sleep intervention to adolescents who are experiencing both anxiety symptoms and sleep disturbance with the aim of preventing the onset of depression and improving cardiovascular health. Research Questions: 1. Can a brief sleep intervention: a. Improve both subjective and objective indices of sleep quality in at-risk adolescents, and will this improvement persist at two-year follow-up? b. Decrease reports of anxiety and mood symptoms, and prevent the onset of case level depression over a two year follow-up period in at-risk adolescents? c. Improve indices of adolescent cardiovascular health at two-year follow-up? 2. Are benefits to both mental and cardiovascular health mediated by measured improvements in sleep that result from the sleep intervention?

The primary purpose of this study is to investigate whether early intervention can improve outcomes following acute lower motor neurone facial nerve paralysis. The hypothesis is that by commencing mental imagery training during the time of complete facial nerve paralysis facial movements and quality of life will be improved following movement return.

Catatonia is a neuropsychiatric syndrome that can occur due to medical or psychiatric disorder. It is a behavioral syndrome that can be associated with schizophrenia, shizoaffective disorder, or atypical psychosis. ECT was found to be effective for both catatonic stupor and excitement, where benzodiazepine or neuroleptics may not prove successful, and has proven to increase intracortical inhibition (ICI) which is reduced in patients with schizophrenia. Since TMS has been shown to alter cortical excitability, this provides a rationale for moving from ECT to TMS based treatment. Essentially arguing by analogy with ECT, and its effect in depression, three case reports appear to show an ECT-like effect of rTMS in catatonic schizophrenia. All studies used facilitatory fast rTMS (10Hz and 20Hz) although on opposite sides of the prefrontal cortex. In this study we will replicate the best practice application of rTMS in the treatment of catatonia. Since this paradigm is similar to an existing treatment for depression at our unit, no additional preparation is required. As suitable participants are expected to be uncommon, a case series approach will allow us to recruit opportunistically, over an extended period, as clinically warranted. Findings will be reported as a series of case studies, or accumulated as a case series report, depending on the number of cases. This is a fairly novel application of rTMS, but builds on our unit’s experience with rTMS, and Dr Lee’s previous experience in catatonia research, to contribute to this emerging field. The objective is to answer two questions. Whether rTMS will affect catatonia, and what are the clinical circumstances that indicate rTMS treatment. A series of case findings will give an indication of an answer, and inform local treatment consideration.

Huntington’s disease (HD) is an autosomal dominant neurodegenerative illness characterized by disorders of movement, cognition, behavior, and functional capacity. In Huntington's disease (HD), the cerebral cortex is involved early in the disease process, and this region has been shown to have abnormal excitability characteristics prior to illness onset, as well as different long term potentiation. Repetitive Transcranial Magnetic Stimulation (rTMS) is a potential new treatment for depression, and other psychiatric disorders. Using TMS, circuits of the human motor cortex can be activated non-invasively, and because the excitability of neural circuits in the cerebral cortex is not static, repetitive TMS (rTMS) can produce changes in neurotransmission that outlast the period of stimulation. rTMS has been shown to modify excitability in the motor cortex in general, has been used extensively in the treatment of movements in Parkinson’s and other dyskinesias, and has positive preliminary findings in the treatment of Huntington’s chorea. The purpose of the study is twofold: to investigate the short term effects (up to 24 hours) of inhibitory rTMS on choreic movements as have been reported previously; and to seek to establish a lasting effect of rTMS in a double blind, randomized, sham-controlled study. Firstly, we intend to replicate previous work, using the standard protocol for decreasing excitability in the motor cortex (1Hz). This is also the “best practice” protocol in limited previous studies in this area. The hypothesis, based on previous findings, is that a group receiving rTMS treatment will experience a reduction in choreic movement rating scores when compared with their pre-treatment scores. In addition, the study will extend investigation by applying a complete treatment set of 6 sessions of real treatment, putatively sufficient to induce long term potentiation effects. If such effect is shown, then a sham crossover trial will be continued to compare real and sham effects. The hypothesis is that real rTMS stimulation will be more effective in its long term effect, than the sham form. The Statewide Department of Neurophysiology has experience in using rTMS in the treatment of depression. In addition, Dr Lee with the Huntington’s Study Group (HSG) at the Neurosciences Unit, Graylands Hospital has extensive experience with this patient population. Patients who attended that unit, who have choreic movements, and for whom the movements are especially intrusive or poorly controlled, will be offered the option of the rTMS trial. This is the rationale for an investigation that combines both fields in an assessment of rTMS as a treatment of choreic movements with Huntington’s disease.

The purpose of this study is to prevent the current excess of abdominal obesity from translating into an excess of diabetes in the future. We aim to begin this objective through a workplace health promotion program in the major employer in the city as working age has been shown to be the most cost-effective period of the lifecourse for behavioural interventions in obesity. Through personal and environmentl strategies we aim to promote healthful trajectories in: (a) behaviour (physical activity, sleep, diet and smoking reduction); (b) waist girth and blood sugar; (c) diabetes detection and management; (d) workplace injuries and productivity.

Physical activity levels of Australia’s ageing population are declining, while their rates of overweight and obesity are increasing. Physical activity and a healthy diet are recognised as important in maintaining a healthy weight and preventing chronic disease. The retirement village provides a unique setting to access and engage with this older target group, to test the effectiveness of strategies to increase levels of physical activity, improve nutrition and maintain a healthy weight. This large scale RCT will evaluate a physical activity, nutrition and healthy weight management intervention for adults aged 60-75 years residing in retirement villages that will ultimately reduce chronic disease (e.g. diabetes, cardiovascular disease, and some cancers). By the end of the intervention we anticipate that there will be a significant improvement in physical activity (time/intensity) and dietary behaviours (10% reduction in dietary fat; 10%fibre intake; 10% increase in fruit/vegetables consumption), and body composition of the intervention group participants, compared to the control group participants.

To see if the addition of dry powder mannitol as an extra therapy during hospitalisation for an acute pulmonary exacerbation in young people with Cystic Fibrosis improves outcomes from that admission. Our hypothesis is that it will improve not only clinical status at the time of discharge but also measures of lung function.

This study aims to compare Gallium-68 citrate PET-CT with Gallium-67 citrate SPECT-CT, the current standard of care, for diagnosis in patients with suspected bone/joint infection or with pyrexia of unknown origin (PUO). Image quality and reporter confidence with Ga-68 PET-CT will be assessed and the cost-benefit of routine Ga-68 citrate PET-CT compared to Ga-67 SPECT-CT will be evaluated. On completion of the study an informed recommendation for future infection imaging protocols for bone/joint infections and PUO will be made based on clinical efficacy and cost-benefit analysis.

Dementia is a terminal disease. Care for people with advanced dementia requires a palliative approach that is targeted to the illness trajectory and tailored to the needs of each individual and his/her family. Currently, the quality of care in residential aged care (RAC) is compromised by lack of staff expertise and poor communication between staff, family and health professionals. Residents suffer unnecessary hospitalisations and aggressive treatments, while symptoms often go unmanaged. Facilitated case conferencing (FCC) is an approach that brings together RAC staff, health professionals and families to plan person-centred management based on best practice. FCC has improved outcomes in other palliative settings but evidence is lacking for RAC residents with advanced dementia. This study will compare the efficacy and cost-effectiveness of FCC compared with usual care for improving end of life outcomes and quality of care for people with advanced dementia in residential aged care.

Primary objective: To determine whether four weeks of ES cycling in addition to usual care results in greater improvements in quadriceps strength and walking ability in people with an acquired brain injury compared to usual physiotherapy alone. Secondary objective: To determine whether four weeks of ES cycling in addition to usual care improves global lower limb strength and reduces spasticity in people with an acquired brain injury compared to usual physiotherapy alone. The null hypothesis is that application of ES cycling in addition to usual physiotherapy will not improve people’s lower limb strength and walking ability more than usual physiotherapy alone.