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Reducing maternal mortality rates has been a worldwide goal for many years. Post partum haemorrhage is the main cause of obstetric haemorrhage accounting for 14 million cases worldwide. It is the leading cause of maternal death throughout the world. In Victoria, Australia, in 2002 the post partum haemorrhage rate was 9.2%. Post partum haemorrhage is associated with ICU admission, the need for blood transfusion and a longer hospital stay, which is at considerable cost. The majority of post partum haemorrhage is caused by uterine atony, so finding an effective agent to prevent uterine atony is paramount in reducing maternal morbidity and mortality. Operative delivery is a known risk factor for PPH therefore improving uterine tone at caesarean section is an important parameter if rates are to be reduced. Carbetocin is a synthetic long-acting analogue of oxytocin used to improve uterine tone. Studies have shown that a single intra-muscular injection of carbetocin is more effective than syntocinon infusion for preventing uterine atony at elective caesarean section, and this is the current practice at Frankston Hospital. Carbetocin is currently licensed in Australia to reduce uterine atony at elective caesarean section, however the efficacy at emergency caesarean section is unclear. In this prospective randomised trial we aim to discover if carbetocin 100 micrograms iv or Syntocinon 5 unit iv bolus, is more effective at improving post partum haemorrhage rates in emergency caesarean sections, by measures of need for further uterotonics, need for >5 minutes uterine massage and haemoglobin drop.

There are a number of studies that show that wearing an orthosis within a shoe helps resolution of heel pain. These orthoses often are prescribed to control excessive pronation, which is thought to be a mechanical factor contributing to overload and eventual pain of the tissues in the plantar heel region (also known as the planta fascia). Recently flip-flops have been designed with features similar to that of the orthoses, but without the need to be fitted within a shoe. A potential benefit of a flip-flop is that the high pain levels felt on first step in in the morning might be prevented if a flip-flop in the shape of an orthosis is worn. Wearing the flip-flop continually then might help relieve tissue stress of the plantar fascia and aid resolution of the problem. Interestingly, the material that flip-flops are made of might also be responsible for any pain relieving effect, hence the inclusion of a flat flip-flop as a comparator in this study. The aim of this study is to test if there are any differences between an in-shoe foot orthosis, a shaped flip-flop and a flat flip-flop over 12 weeks wear.

Autism Spectrum Disorders (ASDs) are defined in terms of social and communicative impairment co-occurring with repetitive behaviours and restricted interests. The most severely affected individuals fail to develop functional language and show little ability or desire for social interaction. The causes of Autism are not known, although the high concordance rate found in twin studies suggests a strong genetic component. Studies of head circumference and imaging studies of brain morphometry have found evidence of increased brain growth beginning within the first year of life, while functional brain imaging in older children and adults has shown abnormal patterns of interactions between brain regions, possibly related to aberrant connections being laid down during earlier stages of development. One model relating these early abnormalities in brain development to the characteristic socio-communicative impairments has hypothesised that early low-level deficits in recognition and orientation towards social stimuli leads to lack of social engagement with primary caregivers during infancy, resulting in decreased exposure to the reciprocal social interactions critical for healthy development of brain circuits responsible for normal social behaviour (Dawson 2008). This model implies that intervention should occur as early as possible to normalize the developmental trajectory and avoid downstream effects, and that a key component of intervention may be to compensate for early deficits in social attention by providing interventions with emphasis on social interaction. Early intervention may also be important in order to take advantage of the increased plasticity present in the first few years of life (Dawson 2008). One such early intervention program consistent with these aims is the Early Start Denver Model (ESDM), a comprehensive early behavioural intervention for infants to preschool-aged children with Autism that integrates applied behaviour analysis with developmental and relationship-based approaches (Rogers et al 2009). A recent randomised control trial in the United States demonstrated significant improvements in clinical outcomes for children receiving ESDM (Dawson et al 2010). After the first 12 months, 18- to 30-month-olds with Autism who received the program showed significant gains in visual processing and improvements in language abilities with subsequent gains in IQ and adaptive behaviour as well as being more likely to receive a less severe diagnosis upon re-assessment. This study seeks to replicate and extend upon the recent positive international findings regarding the benefits of the ESDM model to children with ASD in an Australian context. References: Dawson, G. (2008). Early behavioural intervention, brain plasticity, and the prevention of autism spectrum disorder. Development and Psychopathology, 20, 775-803. Dawson, G., Rogers, S., Munson, J., Smith, M., Winter, J., Greenson, J., Donaldson, A., & Varley, J. (2010). Randomized, Controlled Trial of an Intervention for Toddlers with Autism: The Early Start Denver Model. Pediatrics, 125(1), e17-e23. Rogers, S.J., Dawson, G., Smith, C.M., Winter, J.M. & Donaldson, A.L. (2009). Early Start Denver Model Intervention for Young Children with Autism Manual. Seattle: University of Washington.

The aim of this project is to assess the effectiveness of a web-based personal health management system, called healthy.me, to support healthcare management. healthy.me provides consumers condition specific information, as well as online tools to manage their care including a personal health record. We hypothesise that use of healthy.me will improve the uptake of preventative screening activities and this randomized controlled trial will specifically test whether system use is associated with an increased rate of STI screening among young people aged 18-29 years.

This research will define the mechanisms underlying the presence of gastroesophageal reflux (GOR) in individuals with obstructive sleep apnoea (OSA). Both are common conditions with OSA affecting 1 in 20 individuals and GOR affecting approximately 1 in 12 individuals in the community. Continuous positive airways pressure (CPAP), the most common and effective treatment for OSA has also been found to treat GOR. GOR symptoms are more common in OSA than the general population (14% vs 5%) and increase with increasing OSA severity. Nighttime GOR is a particular worry in individuals with OSA with 1 in 3 OSA patients reporting overnight symptoms. GOR has significant negative health effects in individuals with OSA including painful symptoms and an increase in cancer risk. Identification of the reasons for the increased incidence of reflux in OSA may assist in improving prevention and/or treatment of GOR in individuals with OSA as well as increasing quality of life in these patients. Aims The overall aim of the proposed research is to determine the underlying reason for the presence of gastroesophageal reflux (GOR) in individuals with obstructive sleep apnoea (OSA), including the roles of obesity and arousal from sleep. Furthermore, we aim to determine the effect of OSA treatment with CPAP therapy on nighttime GOR in individuals with and without OSA. . Methods We aim to recruit a total of 80 individuals of mixed gender between the ages of 18 and 70 years of age. Each participant will undergo a 24 hour pH-impedance study for assessment of reflux severity, an overnight sleep study and a DXA scan to assess obesity and fat distribution; or a 48hour recording of oesophageal pH with two consecutive overnight sleep studies, of with CPAP therapy and one without, in a randomised fashion.

The primary purpose of this study is to assess the effectiveness of a flurbiprofen spray formulation, over a period of three days, in relieving the symptoms of sore throat due to an upper respiratory tract infection. Flurbiprofen lozenges are approved by the Australian government’s health authority, the Therapeutic Goods Administration (TGA) for the relief of pain, swelling and inflammation due to severe sore throat. In this study, a spray formulation of flurbiprofen will be tested to determine if it too is effective in the relief of sore throat.

This is a physiological study to assess potential brain waves change during the ventilatory response to hypercapnia and hypoxia tests. We hypothesize that there is an intrinsic link between the change of blood CO2 level and the spectral power of brain waves.

Red blood cell (RBC) transfusion is a very common and potentially life-saving treatment in intensive care units (ICUs). However, RBC transfusion has also been associated with an increased risk of morbidity and/or mortality in critically ill, surgical and trauma patients. Although this association is multifactorial, attention has increasingly focused on the possible adverse impact of transfusing RBC which have been stored for a prolonged time.The primary aim of the trial is to determine if transfusion of the freshest available RBC in critically ill patients compared to standard care decreases patient mortality.

In order to cope with population ageing it is vital that safe, affordable and effective strategies, to arrest or delay cognitive decline, are developed. Research over 30 years has indicated that physical exercise produces small to moderate effects on cognition. Recent studies indicate motor fitness, compared to physical fitness, has different effects on cognition. This randomised controlled trial will test the efficacy of a novel, complex, community-based exercise program, in healthy women aged 65-75 years. The outcomes measured will include cognitive and physical functioning and serum levels of biomarkers related to cognitive functioning.

The purpose of this study is to implement and evaluate an internet-based program designed to increase levels of physical activity (and reduce sedentary behaviours) in middle-aged male university employees aged between 35 and 64 years.