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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.

The body’s lymphatics vessels have an important function and move fluid outside blood vessels through lymph glands. This role in ‘clean up’ of cell debris after surgery is very important to understand as these lymphatic channels are also mechanisms of spread of cancer cells. Lymph glands are a common site where cancer recurs after surgery. There is evidence to suggest that the movement of lymph through lymphatic channels alters under epidural/spinal anaesthesia. These sorts of anaesthesia techniques are sometimes performed at the time of surgery for pain relief; this study will consider whether they also have a role in the reduction of lymph flow at the time of surgery. Doctors may therefore be able to utilise another technique to reduce the risk of cancer recurrence after surgery. Primary research hypothesis: Lymphatic flow in the lower limb is reduced by sympathetic blockade (spinal anaesthesia).

Behavioural disturbances associated with dementia are common amongst community-residing people with moderate to severe dementia and are associated with reduced quality of life for both the person with dementia and their caregiver. We propose a randomized trial to test the effectiveness and cost effectiveness of the Tailored Activities Program (TAP) to reduce the burden of behavioural and psychological symptoms of dementia. The 8-session intervention involves occupational therapists identifying preserved capabilities, deficit areas, and previous interests of the person from which they prescribe specific activities. Family caregivers are then trained to use activities as part of daily care at home as a management strategy to reduce behavioural symptoms.

There is a great deal of lay information to suggest that people with MS or at risk of MS should take oral Vitamin D supplementation. However, no adequately powered scientific study has examined the role of Vitamin D3 supplementation as prevention or treatment for MS. There is insufficient commercial interest in conducting such a study, but the need for evidence is great. If effective, oral Vitamin D supplementation could provide a low cost MS therapy with virtually no side effects. Sponsored by Multiple Sclerosis Research Australia, we therefore plan to conduct a randomised, placebo controlled, double-blind clinical trial to assess the efficacy of oral Vitamin D3 in preventing the development of Multiple Sclerosis in participants at high risk of MS (participants with a first demyelinating event, FDE). We will compare three doses of oral daily vitamin D3 (1,000IU 5,000IU or 10,000IU/day) to placebo. After agreeing to participate, participants will be randomly and blindly assigned to one of these four study arms and will continue to take study medication for 48 weeks. Scope: We plan to enrol 240 participants with FDE from 21 Australian and New Zealand MS trial centres over the course of three years. We may invite additional centres depending on recruitment and trial progress.