The value of Landcare to the Australian community

Landcare is a unique community-based approach to managing and restoring Australia’s natural environment and improving the sustainability of agricultural activities. Established in the late 1980s, Landcare and its associated networks of community-based action have constantly evolved, responding to the opportunities and challenges posed by successive Governments’ approaches to managing Australia’s challenging natural environment. Consistent throughout these past three decades has been the critical role that Landcare has played in leading Australia’s approach to agricultural practices, natural resource management, environmental protection and biodiversity conservation. While these positive environmental and agricultural impacts of Landcare have been well recognised, the multiple benefits derived from the economic, social and cultural contributions of this volunteer and not-for-profit movement have not been as widely appreciated. This Landcare NSW Position Statement outlines the extent of these economic, social and cultural benefits, highlighting the enormous role Landcare has played in building and maintaining the capacity and social cohesion of many communities, particularly in rural and regional Australia. As this statement demonstrates, Landcare has provided a framework for land owners and managers to formally and informally recognise existing expertise and knowledge, to share information and experiences and to support further learning and communities of practice. Landcare groups and networks have also provided a foundation for intergenerational learning, particularly through its school-based activities. Founded on the understanding that community action is required to collectively address environmental and sustainability challenges, Landcare has brought together people of different ages, cultures and socioeconomic groups, positively impacting on the health and wellbeing of both communities and individuals. The volunteering aspect of Landcare has further supported individual wellbeing and mental health by helping people feel valued and part of their community. Individuals and communities involved in Landcare have developed extensive experience and skills in working with governments, non-government organisations and businesses, in grant management, project management, financial, communication and governance systems – all transferrable experience, skills and systems which are utilised in a broad range of other social, economic and community activities. Landcare groups, networks and programs have also provided a forum for engagement between Aboriginal and Torres Strait Islander Peoples and other Australians, and a platform for increasing the recognition of women in regional and rural communities. On the economic front, the Landcare model has matched vast volunteer time and effort with major in- kind and financial investment in communities, resulting in significant multiplier effects for Government investment. For a relatively small investment there have been significant returns for Government and the community at large. The benefits of investment in Landcare – for instance clean water, improved health and community relations – extend well beyond the (private) individual landholder or a Landcare group, to the community at large. In summary, Landcare has brought enormous value to Australia over the past three decades, extending well beyond its positive environmental and agricultural impacts

Beat-to-beat variability of fetal myocardial performance index

Objectives: To determine whether there is beat-to-beat (BTB) variability in the fetal left myocardial performance index (MPI), as evaluated by an automated system, and whether there is a correlation between MPI and fetal heart rate (FHR). Methods: This was a prospective cross-sectional study of uncomplicated, morphologically normal, singleton pregnancies at 20–38 weeks' gestation. Multiple cineloops for left MPI measurement were acquired during a single examination of each fetus. Raw cineloop data were analyzed by our automated MPI system (intraclass correlation coefficient of 1.0 for any given waveform) to produce a set of MPIs. The corresponding instantaneous FHR was measured for each individual cardiac cycle for which MPI was calculated. Results: Data from 29 fetuses were analyzed; mean MPI was 0.52, mean FHR was 150 beats per min and the median number of cardiac cycles examined per fetus was 70 (interquartile range, 31–115). Marked BTB variability was noted; median coefficient of variation was 10% (range, 5.5–13.9%). FHR was weakly correlated with absolute MPI (r = 0.22; P < 0.05). BTB variation in MPI as a percentage of the mean MPI was not significantly correlated with FHR (r = 0.031; P = 0.146). When standard error of the mean of all MPI values was divided by the mean for each case, it showed that at least four cardiac cycles should be averaged to reduce MPI variability to approximately ± 5%. Conclusion: There is significant BTB variability in fetal left MPI, which has an overall weak correlation with FHR. This could be a factor affecting the consistency of MPI values reported by different research groups. Variability would be reduced by averaging 4–5 cardiac cycles per fetus. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd

Repeatability of an automated fetal modified myocardial performance index

Introduction: The fetal modified myocardial performance index (Mod-MPI) is a non-invasive, pulsed-wave Doppler-derived measure of global myocardial function. The potential for the left ventricular Mod-MPI to clinically assess fetal cardiac function is well established. However, there are wide variations in published reference ranges, as (i) a standardised method of selecting cardiactime intervals used in Mod-MPI calculation has not been established and (ii) cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms. We have developed a novel automated Mod-MPI system in a collaboration between fetal medicine practitioners and biomedical engineers. This study compares the repeatability of the fetal left Mod-MPI when obtained using this automated system with that of its manual measurement. Methods: A multi centre international (USA, Saudi Arabia, Spain, Israel and Australia) evaluation was undertaken using online technology to compare automation with human evaluation for determination of the fetal Mod-MPI. Fetal ultrasound scans were performed of women with uncomplicated, singleton pregnancies at 16–38 weeks of gestation with normal morphology scans in a separate study, after local ethics committee approval. Individual Doppler ultrasound waveform images from the left ventricle of 25 cases from that dataset were chosen for this study. Each individual waveform was used in triplicate and placed into an arbitrary order (n = 75). One senior observer at each of the six centres involved in this study manually calculated the Mod-MPI for the75 waveforms through online means. Our automated system was used to also measure the Mod-MPI for those waveforms. Repeatability of automated and manual Mod-MPI measurements and the inter-operator reproducibility of the latter were assessed using intraclass correlation coefficients (ICC) and 95% confidence intervals (95% CI). Bland–Altmanplots, ICC and 95% CI were used to evaluate the agreement between each observer’s manual Mod-MPI measurements and the corresponding automated measurements. Results: Preliminary data analysed show that automated measurements have a superior intra-operator repeatability (ICC = 1.00) compared to the intra-operator repeatability (ICCranging from 0.572–0.945) and inter-operator reproducibility (ICC = 0.649) of manual measurements. There was good agreement between automated and manual measurements. Conclusion: The use of automated fetal Mod-MPI provides superior repeatability to the currently used subjective, manual methodology. Combined with the fact that automation will simplify Mod-MPI measurement amongst researchers with limited Mod-MPI experience, automation may facilitate the incorporation of the Mod-MPI into routine fetal cardiac functional assessment

Repeatability of an automated fetal modified myocardial performance index

Introduction: The fetal modified myocardial performance index (Mod-MPI) is a non-invasive, pulsed-wave Doppler-derived measure of global myocardial function. The potential for the left ventricular Mod-MPI to clinically assess fetal cardiac function is well established. However, there are wide variations in published reference ranges, as (i) a standardised method of selecting cardiactime intervals used in Mod-MPI calculation has not been established and (ii) cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms. We have developed a novel automated Mod-MPI system in a collaboration between fetal medicine practitioners and biomedical engineers. This study compares the repeatability of the fetal left Mod-MPI when obtained using this automated system with that of its manual measurement. Methods: A multi centre international (USA, Saudi Arabia, Spain, Israel and Australia) evaluation was undertaken using online technology to compare automation with human evaluation for determination of the fetal Mod-MPI. Fetal ultrasound scans were performed of women with uncomplicated, singleton pregnancies at 16–38 weeks of gestation with normal morphology scans in a separate study, after local ethics committee approval. Individual Doppler ultrasound waveform images from the left ventricle of 25 cases from that dataset were chosen for this study. Each individual waveform was used in triplicate and placed into an arbitrary order (n = 75). One senior observer at each of the six centres involved in this study manually calculated the Mod-MPI for the75 waveforms through online means. Our automated system was used to also measure the Mod-MPI for those waveforms. Repeatability of automated and manual Mod-MPI measurements and the inter-operator reproducibility of the latter were assessed using intraclass correlation coefficients (ICC) and 95% confidence intervals (95% CI). Bland–Altmanplots, ICC and 95% CI were used to evaluate the agreement between each observer’s manual Mod-MPI measurements and the corresponding automated measurements. Results: Preliminary data analysed show that automated measurements have a superior intra-operator repeatability (ICC = 1.00) compared to the intra-operator repeatability (ICCranging from 0.572–0.945) and inter-operator reproducibility (ICC = 0.649) of manual measurements. There was good agreement between automated and manual measurements. Conclusion: The use of automated fetal Mod-MPI provides superior repeatability to the currently used subjective, manual methodology. Combined with the fact that automation will simplify Mod-MPI measurement amongst researchers with limited Mod-MPI experience, automation may facilitate the incorporation of the Mod-MPI into routine fetal cardiac functional assessment

A co-designed mHealth programme to support healthy lifestyles in Māori and Pasifika peoples in New Zealand (OL@-OR@): a cluster-randomised controlled trial

© 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Background: The OL@-OR@ mobile health programme was co-designed with Māori and Pasifika communities in New Zealand, to support healthy lifestyle behaviours. We aimed to determine whether use of the programme improved adherence to health-related guidelines among Māori and Pasifika communities in New Zealand compared with a control group on a waiting list for the programme. Methods: The OL@-OR@ trial was a 12-week, two-arm, cluster-randomised controlled trial. A cluster was defined as any distinct location or setting in New Zealand where people with shared interests or contexts congregated, such as churches, sports clubs, and community groups. Members of a cluster were eligible to participate if they were aged 18 years or older, had regular access to a mobile device or computer, and had regular internet access. Clusters of Māori and of Pasifika (separately) were randomly assigned (1:1) to either the intervention or control condition. The intervention group received the OL@-OR@ mHealth programme (smartphone app and website). The control group received a control version of the app that only collected baseline and outcome data. The primary outcome was self-reported adherence to health-related guidelines, which were measured with a composite health behaviour score (of physical activity, smoking, alcohol intake, and fruit and vegetable intake) at 12 weeks. The secondary outcomes were self-reported adherence to health-related behaviour guidelines at 4 weeks; self-reported bodyweight at 12 weeks; and holistic health and wellbeing status at 12 weeks, in all enrolled individuals in eligible clusters; and user engagement with the app, in individuals allocated to the intervention. Adverse events were not collected. This study is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12617001484336. Findings: Between Jan 24 and Aug 14, 2018, we enrolled 337 Māori participants from 19 clusters and 389 Pasifika participants from 18 clusters (n=726 participants) in the intervention group and 320 Māori participants from 15 clusters and 405 Pasifika participants from 17 clusters (n=725 participants) in the control group. Of these participants, 227 (67%) Māori participants and 347 (89%) Pasifika participants (n=574 participants) in the intervention group and 281 (88%) Māori participants and 369 (91%) Pasifika participants (n=650 participants) in the control group completed the 12-week follow-up and were included in the final analysis. Relative to baseline, adherence to health-related behaviour guidelines increased at 12 weeks in both groups (315 [43%] of 726 participants at baseline to 329 [57%] of 574 participants in the intervention group; 331 [46%] of 725 participants to 369 [57%] of 650 participants in the control group); however, there was no significant difference between intervention and control groups in adherence at 12 weeks (odds ratio [OR] 1·13; 95% CI 0·84–1·52; p=0·42). Furthermore, the proportion of participants adhering to guidelines on physical activity (351 [61%] of 574 intervention group participants vs 407 [63%] of 650 control group participants; OR 1·03, 95% CI 0·73–1·45; p=0·88), smoking (434 [76%] participants vs 501 [77%] participants; 1·12, 0·67–1·87; p=0·66), alcohol consumption (518 [90%] participants vs 596 [92%] participants; 0·73, 0·37–1·44; p=0·36), and fruit and vegetable intake (194 [34%] participants vs 196 [30%] participants; 1·08, 0·79–1·49; p=0·64) did not differ between groups. We found no significant differences between the intervention and control groups in any secondary outcome. 147 (26%) intervention group participants engaged with the OL@-OR@ programme (ie, set at least one behaviour change goal online). Interpretation: The OL@-OR@ mobile health programme did not improve adherence to health-related behaviour guidelines amongst Māori and Pasifika individuals. Funding: Healthier Lives He Oranga Hauora National Science Challenge

Genome-wide association and Mendelian randomisation analysis provide insights into the pathogenesis of heart failure

Heart failure (HF) is a leading cause of morbidity and mortality worldwide. A small proportion of HF cases are attributable to monogenic cardiomyopathies and existing genome-wide association studies (GWAS) have yielded only limited insights, leaving the observed heritability of HF largely unexplained. We report results from a GWAS meta-analysis of HF comprising 47,309 cases and 930,014 controls. Twelve independent variants at 11 genomic loci are associated with HF, all of which demonstrate one or more associations with coronary artery disease (CAD), atrial fibrillation, or reduced left ventricular function, suggesting shared genetic aetiology. Functional analysis of non-CAD-associated loci implicate genes involved in cardiac development (MYOZ1, SYNPO2L), protein homoeostasis (BAG3), and cellular senescence (CDKN1A). Mendelian randomisation analysis supports causal roles for several HF risk factors, and demonstrates CAD-independent effects for atrial fibrillation, body mass index, and hypertension. These findings extend our knowledge of the pathways underlying HF and may inform new therapeutic strategies