School of Mathematics and Statistics - Research Publications
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ItemImplementing a choice of pulmonary rehabilitation models in chronic obstructive pulmonary disease (HomeBase2 trial): protocol for a cluster randomised controlled trial(BMJ PUBLISHING GROUP, 2022-04-01)INTRODUCTION: There is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent potentially eligible patients from accessing the benefits of pulmonary rehabilitation. The aim of this hybrid effectiveness-implementation trial is to examine the effects of offering patients a choice of pulmonary rehabilitation locations (home or centre) compared with offering only the traditional centre-based model. METHOD AND ANALYSIS: This is a two-arm cluster randomised, controlled, assessor-blinded trial of 14 centre-based pulmonary rehabilitation services allocated to intervention (offering choice of home-based or centre-based pulmonary rehabilitation) or control (continuing to offer centre-based pulmonary rehabilitation only), stratified by centre-based programme setting (hospital vs non-hospital). 490 participants with COPD will be recruited. Centre-based pulmonary rehabilitation will be delivered according to best practice guidelines including supervised exercise training for 8 weeks. At intervention sites, the home-based pulmonary rehabilitation will be delivered according to an established 8-week model, comprising of one home visit, unsupervised exercise training and telephone calls that build motivation for exercise participation and facilitate self-management. The primary outcome is all-cause, unplanned hospitalisations in the 12 months following rehabilitation. Secondary outcomes include programme completion rates and measurements of 6-minute walk distance, chronic respiratory questionnaire, EQ-5D-5L, dyspnoea-12, physical activity and sedentary time at the end of rehabilitation and 12 months following rehabilitation.Direct healthcare costs, indirect costs and changes in EQ-5D-5L will be used to evaluate cost-effectiveness. A process evaluation will be undertaken to understand how the choice model is implemented and explore sustainability beyond the clinical trial. ETHICS AND DISSEMINATION: Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients across Australia with support from national lung charities and societies. TRIAL REGISTRATION NUMBER: NCT04217330.
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ItemEvaluation of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) a staff simulation training intervention to improve palliative care of people with advanced dementia living in nursing homes: a cluster randomised controlled trial(BMC, 2022-02-14)BACKGROUND: People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care. OBJECTIVE: The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia. DESIGN: Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside. SUBJECTS & SETTING: One thousand three hundred four people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff. METHODS: Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence. Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes. RESULTS: At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified. CONCLUSION: This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618002012257 . Registered 14 December 2018.
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ItemTeaching Radial Endobronchial Ultrasound with a Three-Dimensional-printed Radial Ultrasound Model(AMER THORACIC SOC, 2021-12-01)BACKGROUND: Peripheral pulmonary lesion (PPL) incidence is rising because of increased chest imaging sensitivity and frequency. For PPLs suspicious for lung cancer, current clinical guidelines recommend tissue diagnosis. Radial endobronchial ultrasound (R-EBUS) is a bronchoscopic technique used for this purpose. It has been observed that diagnostic yield is impacted by the ability to accurately manipulate the radial probe. However, such skills can be acquired, in part, from simulation training. Three-dimensional (3D) printing has been used to produce training simulators for standard bronchoscopy but has not been specifically used to develop similar tools for R-EBUS. OBJECTIVE: We report the development of a novel ultrasound-compatible, anatomically accurate 3D-printed R-EBUS simulator and evaluation of its utility as a training tool. METHODS: Computed tomography images were used to develop 3D-printed airway models with ultrasound-compatible PPLs of "low" and "high" technical difficulty. Twenty-one participants were allocated to two groups matched for prior R-EBUS experience. The intervention group received 15 minutes to pretrain R-EBUS using a 3D-printed model, whereas the nonintervention group did not. Both groups then performed R-EBUS on 3D-printed models and were evaluated using a specifically developed assessment tool. RESULTS: For the "low-difficulty" model, the intervention group achieved a higher score (21.5 ± 2.02) than the nonintervention group (17.1 ± 5.7), reflecting 26% improvement in performance (P = 0.03). For the "high-difficulty" model, the intervention group scored 20.2 ± 4.21 versus 13.3 ± 7.36, corresponding to 52% improvement in performance (P = 0.02). Participants derived benefit from pretraining with the 3D-printed model, regardless of prior experience level. CONCLUSION: 3D-printing can be used to develop simulators for R-EBUS education. Training using these models significantly improves procedural performance and is effective in both novice and experienced trainees.
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ItemHome-based pulmonary rehabilitation early after hospitalisation in COPD (early HomeBase): protocol for a randomised controlled trial(BMJ PUBLISHING GROUP, 2021-11-01)INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is characterised by exacerbations of respiratory disease, frequently requiring hospital admission. Pulmonary rehabilitation can reduce the likelihood of future hospitalisation, but programme uptake is poor. This study aims to compare hospital readmission rates, clinical outcomes and costs between people with COPD who undertake a home-based programme of pulmonary rehabilitation commenced early (within 2 weeks) of hospital discharge with usual care. METHODS: A multisite randomised controlled trial, powered for superiority, will be conducted in Australia. Eligible patients admitted to one of the participating sites for an exacerbation of COPD will be invited to participate. Participants will be randomised 1:1. Intervention group participants will undertake an 8-week programme of home-based pulmonary rehabilitation commencing within 2 weeks of hospital discharge. Control group participants will receive usual care and a weekly phone call for attention control. Outcomes will be measured by a blinded assessor at baseline, after the intervention (week 9-10 posthospital discharge), and at 12 months follow-up. The primary outcome is hospital readmission at 12 months follow-up. ETHICS AND DISSEMINATION: Human Research Ethics approval for all sites provided by Alfred Health (Project 51216). Findings will be published in peer-reviewed journals, conferences and lay publications. TRIAL REGISTRATION NUMBER: ACTRN12619001122145.
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ItemNo Preview AvailableBlood parameters of young calves at abattoirs are related to distance transported and farm of origin(ELSEVIER SCIENCE INC, 2021-07-08)Nonreplacement dairy calves, or bobby calves, are fasted and transported to abattoirs from as young as 5 d of age in Australia. The aims of this cross-sectional observational study were (1) to assess the welfare status, as measured by blood parameters, of bobby calves in the commercial supply chain after transport and lairage, and (2) to assess whether distance and duration of transport are risk factors for poor bobby calf welfare, as measured by blood parameters. We hypothesized that bobby calves transported greater distances would be more likely to show evidence of compromised welfare, as measured by blood indicators of hydration, energy status, and muscle fatigue or damage. We also hypothesized that there would be a large amount of variability in indicators of energy status between calves from different farms. We analyzed blood samples collected at slaughter over a spring and an autumn calving period from 4,484 Australian bobby calves aged approximately 5 to 14 d old from 3 different states, after transport, fasting, and lairage. Packed cell volume (PCV), plasma glucose, and serum urea, total protein, β-hydroxybutyrate (BHB), and creatine kinase (CK) were measured. Radio frequency identification ear tag data were used to estimate the distance that the calves were transported and to identify the farm of origin. Data were analyzed using linear mixed models, except for BHB, which was analyzed using a Goodman-Kruskal gamma test due to left censoring of the data. Twelve percent of calves showed evidence of anemia (PCV less than 0.23 L/L), and 11% had urea concentrations consistent with dehydration (urea more than 7.7 mmol/L). Thirty-six percent of calves had CK activity above normal resting values, and 1% of calves had CK >2,000 U/L, indicating muscle fatigue or damage. Distance transported had significant effects on all blood variables except urea and BHB. With increasing distance transported, calves were more likely to show evidence of a negative energy balance (low plasma glucose) or dehydration (high PCV or total protein). The estimated effect of distance overall was small, but for calves transported more than 500 km, plasma glucose concentration declined more per kilometer. The calves' farm of origin accounted for a reasonable amount of the random variation between calves for plasma glucose (20%). Our results suggest that longer transport distances may increase the risk of poor calf welfare (dehydration, negative energy balance) after transport, and on-farm calf management (e.g., nutrition, timing of feeding before transport) may affect transported calves' energy status; improving this area could result in better energy availability during fasting.
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ItemNo Preview AvailableEstimating proportions by group retesting with unequal group sizes at each stage(TAYLOR & FRANCIS INC, 2021-03-10)
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ItemDifferences in Hedonic Responses, Facial Expressions and Self-Reported Emotions of Consumers Using Commercial Yogurts: A Cross-Cultural Study(MDPI, 2021-06-01)Hedonic scale testing is a well-accepted methodology for assessing consumer perceptions but is compromised by variation in voluntary responses between cultures. Check-all-that-apply (CATA) methods using emotion terms or emojis and facial expression recognition (FER) are emerging as more powerful tools for consumer sensory testing as they may offer improved assessment of voluntary and involuntary responses, respectively. Therefore, this experiment compared traditional hedonic scale responses for overall liking to (1) CATA emotions, (2) CATA emojis and (3) FER. The experiment measured voluntary and involuntary responses from 62 participants of Asian (53%) versus Western (47%) origin, who consumed six divergent yogurt formulations (Greek, drinkable, soy, coconut, berry, cookies). The hedonic scales could discriminate between yogurt formulations but could not distinguish between responses across the cultural groups. Aversive responses to formulations were the easiest to characterize for all methods; the hedonic scale was the only method that could not characterize differences in cultural preferences, with CATA emojis displaying the highest level of discrimination. In conclusion, CATA methods, particularly the use of emojis, showed improved characterization of cross-cultural preferences of yogurt formulations compared to hedonic scales and FER.
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ItemEffect of seaweed extract application on wine grape yield in Australia(SPRINGER, 2021-03-08)Abstract Seaweed extracts are agricultural biostimulants that have been shown to increase the productivity of many crops. The aim of this study was to determine the effect of a seaweed extract from the brown algae Durvillaea potatorum and Ascophyllum nodosum as a soil treatment on the yield of wine grapes grown in Australian production and climate conditions. This study used a series of seven field experiments (2012–2017), across five locations, in three Australian states and four cultivars, and analysed data using a linear mixed model approach. The analysis revealed that recurring soil applications of the seaweed extract significantly increased wine grape yield by an average of 14.7% across multiple growing years that experienced climate extremes. Partial budget analysis showed that the use of the seaweed extract increased profits depending on the grape cultivar. This study is the most extensive investigation of its type in Australian viticulture to understand the effect of a soil-applied seaweed extract on wine grape production.
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ItemNo Preview AvailableAssociation Between Cognitive Function and Clustered Cardiovascular Risk of Metabolic Syndrome in Older Adults at Risk of Cognitive Decline(SPRINGER FRANCE, 2020-02-11)OBJECTIVES: Metabolic syndrome (MetS) represents a cluster of obesity and insulin resistance-related comorbidities. Abdominal obesity, hypertension, elevated triglyceride and glucose levels are components of MetS and may have a negative effect on cognitive function, but few cognitive studies have examined the combined risk severity. We sought to determine which specific cognitive abilities were associated with MetS in older adults at risk of cognitive decline. DESIGN: Cross-sectional study. PARTICIPANTS: 108 AIBL Active participants with memory complaints and at least one cardiovascular risk factor. MEASUREMENTS: Cardiovascular parameters and blood tests were obtained to assess metabolic syndrome criteria. The factors of MetS were standardized to obtain continuous z-scores. A battery of neuropsychological tests was used to evaluate cognitive function. RESULTS: Higher MetS z-scores were associated with poorer global cognition using ADAS-cog (adjusted standardized beta=0.26, SE 0.11, p<0.05) and higher Trail Making B scores (adjusted beta=0.23, SE 0.11, p<0.05). Higher MetS risk was related to lower cognitive performance. CONCLUSION: Combined risk due to multiple risk factors in MetS was related to lower global cognitive performance and executive function. A higher MetS risk burden may point to opportunities for cognitive testing in older adults as individuals may experience cognitive changes.