Current and projected burden of heart failure in the Australian adult population: A substantive but still ill-defined major health issue

Background: Comprehensive epidemiological data to describe the burden of heart failure (HF) in Australia remain lacking despite its importance as a major health issue. Herewith, we estimate the current and future burden of HF in Australia using best available data

Establishing a Pragmatic Framework to Optimise Health Outcomes in Heart Failure and Multimorbidity (ARISE-HF): A Multidisciplinary Position Statement

Background Multimorbidity in heart failure (HF), defined as HF of any aetiology and multiple concurrent conditions that require active management, represents an emerging problem within the ageing HF patient population worldwide. Methods To inform this position paper, we performed: 1) an initial review of the literature identifying the ten most common conditions, other than hypertension and ischaemic heart disease, complicating the management of HF (anaemia, arrhythmias, cognitive dysfunction, depression, diabetes, musculoskeletal disorders, renal dysfunction, respiratory disease, sleep disorders and thyroid disease) and then 2) a review of the published literature describing the association between HF with each of the ten conditions. From these data we describe a clinical framework, comprising five key steps, to potentially improve historically poor health outcomes in this patient population. Results We identified five key steps (ARISE-HF) that could potentially improve clinical outcomes if applied in a systematic manner: 1) Acknowledge multimorbidity as a clinical syndrome that is associated with poor health outcomes, 2) Routinely profile (using a standardised protocol — adapted to the local health care system) all patients hospitalised with HF to determine the extent of concurrent multimorbidity, 3) Identify individualised priorities and person-centred goals based on the extent and nature of multimorbidity, 4) Support individualised, home-based, multidisciplinary, case management to supplement standard HF management, and 5) Evaluate health outcomes well beyond acute hospitalisation and encompass all-cause events and a person-centred perspective in affected individuals. Conclusions We propose ARISE-HF as a framework for improving typically poor health outcomes in those affected by multimorbidity in HF

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Persistence in soccer betting : the effects of secondary knowledge, risks & earnings on youth gamblers decision to continue or quit.

Soccer bettors believe that the information they encompass and their recent winning streak makes them skilled in predicting the outcomes of soccer matches. Thus they often naively choose to continue gambling, even when they are in deficit. This study investigated the effects of (a) the type of soccer knowledge (odds or background information) utilized, (b) amount of stake (high or low), (c) the reinforcement outcome (high profit, high loss, low profit and low loss) and (d) the effect of BIS and BAS personality on soccer bettor’s persistence in a betting scenario. 199 male undergraduates from Nanyang Technological University participated in this experimental study. The findings revealed that the type of soccer knowledge, amount of stake, degree of earnings, and the BAS Drive and Reward Responsiveness variables were not significant predictors of one’s decision to continue or quit gambling. However, the BIS and the BAS Fun Seeking scales proved to be significant predictors.Bachelor of Art

Addressing physical and psychological factors in knee osteoarthritis

© 2014 Dr. Yasmin AhamedKnee osteoarthritis (OA) is a prevalent, chronic musculoskeletal condition. Pain is the most common symptom and is associated with poorer physical function, lower limb muscle weakness, psychological impairments, and reduced quality-of-life. Strong evidence supports the use of strengthening exercises to improve pain and physical function in this patient population. There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training (PCST) on pain and physical and psychological impairments, particularly in conditions such as chronic low back pain and cancer-related pain. Though typically provided separately, there are clinical-, resource- and personnel-advantages of exercise and PCST being delivered together by physiotherapists as they already have expertise in administering exercise for knee OA. Apart from a small pilot study conducted by our research group, no other studies to date have examined the effects of an integrated PCST and strengthening exercise program delivered solely by physiotherapists in those with knee OA. Therefore, this thesis investigated whether an integrated 12-week strengthening exercise and PCST program delivered by physiotherapists is more efficacious than either program alone in treating pain and self-reported physical function in individuals with knee OA. Additionally, the thesis examined the efficacy of these interventions on improving muscle strength, objective measures of physical functioning, psychological functioning, health-related quality-of-life, and physical activity levels. This was a multi-site, assessor-blinded, three-arm randomised controlled trial involving 10 individual physiotherapy visits together with home PCST and/or exercise practice in 222 individuals with symptomatic knee OA. The results demonstrated that a physiotherapist-delivered Integrated PCST and strengthening exercise intervention for knee OA is more effective than either PCST or strengthening exercise alone for improving physical function and for several secondary outcomes including pain on walking, arthritis self-efficacy and pain coping attempts. In addition, all treatment arms were well received by participants as there was good adherence to treatments and all groups reported minimal adverse events. However, it is important to determine whether the Integrated intervention is efficacious in maintaining improvements in symptoms found over the longer-term given the chronic nature of knee OA. The longer-term effects of strengthening exercise interventions and PCST are not well known. Therefore, this thesis also examined whether any of the benefits of the 12-week intervention on the outcomes mentioned above were maintained over a 32 and 52-week longer-term follow-up period. These results showed that the integrated intervention was more efficacious over the individual treatment groups alone for maintaining improvements in physical function, self-efficacy, coping attempts, and global improvements in pain, physical function and overall. This long-term study also highlighted effective strategies for maintaining good adherence to treatment. The studies in this thesis provide scientific evidence for an integrated pain coping skills training and strengthening exercise for the management of knee OA pain, physical dysfunction, psychological impairments, muscle strength, functional performance, and quality of life over both the short and longer-term

Sex-specific changes in bone structure and strength during growth: pQCT analysis of the mid-tibia

Introduction: The process by which children's bones grow has not been fully charcterised. The current dogma is that girls fill in their medullary canal area by forming bone at the endosteum. It has been argued that the sex difference in how bone strength is conferred -- favouring boys -- may contribute to the relative protection that aging men have over aging women with respect to fracture incidence and the prevalence of osteoporosis. Primary Objectives: 1)To compare bone surface changes at the periosteal and endosteal surface of the tibial midshaft in boys and girls. 2)To compare how bone density at the tibial midshaft is accrued in boys and girls. 3) To compare sex differences in bone strength accrual. Methods: Design and Participants: Participants were obtained from a 20-month randomized, controlled school-based physical activity intervention. As we found no difference in the effect of the intervention on pQCT bone outcome variables, both groups were combined for our current study. A total of 183 participants (93 boys, 89 girls) received a pQCT scan at baseline. Results: Sex-specific comparisons of the pQCT bone outcome variables showed significantly greater rates of change (slope) for boys for the total area (ToA), cortical area (CoA), medullary canal area (MedA) and strength-strain index (SSI) measures, p<0.001. No significant differences were observed for CoD, p=0.904. The magnitude of these differences is 60.8% for ToA, 55.7% for CoA, 75.6% for MedA, 1.3% for CoD, and 54.7% for SSI. Examination of differences between the sexes (intercept) revealed significant differences with greater gains observed for boys for all measures p<0.001 except for CoD where girls exhibited greater gains p<0.001. Conclusion: Girls showed a similar pattern of cortical bone growth at the tibial midshaft- periosteal apposition dominated over endosteal resorption. Boys' increased changes and pattern of growth were of a greater magnitude at both surfaces compared to girls. This resulted in a greater increase in strength as measured by SSI in boys which can partly be explained by their larger size. Girls exhibited greater increases in CoD; however, no significant difference in the change in CoD was observed between the two.Medicine, Faculty ofMedicine, Department ofExperimental Medicine, Division ofGraduat

Characterising cortical density in the mid-tibia : Intra-individual variation in adolescent girls and boys

Background: Inter-individual differences in cortical bone volumetric density (CoD), such as those related to sex, are a product of differences in remodelling rates. While cortical bone is often treated as a uniform tissue, remodelling rates also vary within individual bones. This level of adaptation has largely been overlooked in analyses of peripheral quantitative computed tomography (pQCT) images. Further, such variation in CoD has never been assessed in growing bones. We hypothesised that CoD varied significantly within the same cross-section of the mid-tibia of adolescents. We further hypothesised that due to the profound impact of oestrogen on remodelling, this variation would be different between sexes

Persistence in soccer gambling : the effects of secondary knowledge, risks & earnings on youth gamblers decision to continue or quit

Youth gamblers in Singapore are turning to soccer gambling to earn easy money, and there are those who do not know when to quit, despite incurring huge debts. One hundred and ninety nine male undergraduate students played a soccer gambling computer program. By experimentally manipulating the amount of stakes and the source of information, we wanted to investigate if such conditions would predict an individual’s behaviour to continue or quit gambling. By including the BIS BAS scales in our study, we also wanted to investigate if an individual’s personality would affect their decision to continue or quit gambling. Our findings suggest that having both types of information, background information and odds, is crucial in making a decision to continue gambling. The amount of stakes placed and the profit or loss incurred does not play any part in affecting one’s decision to continue or quit gambling.Bachelor of Art

Older fallers with poor working memory overestimate their postural limits

Objective: To compare the accuracy of perceived postural limits between older fallers with good working memory and those with poor working memory. Design: Cross-sectional study. Setting: Research laboratory. Participants: Thirty-three community-dwelling older adults with a history of falls. Interventions: Not applicable. Main Outcome Measures: We measured the accuracy of perceived postural limits by using the perceived reach test in 33 fallers. The difference between the verbal digits forward test score and the verbal digits backward test score was used to provide an index of the central executive component of working memory. Participants were then allocated into 2 groups: (1) good working memory or (2) poor working memory. Comparisons of group characteristics and scores were undertaken by using Student independent-sample t tests for differences in means between those with good working memory and those with poor memory. One hierarchical linear regression model was constructed to determine the independent association of the central executive component of working memory with the accuracy of older fallers' perceived reach capacity. Results: There was a significant difference in the mean percentage error in perceived reach between older fallers with good working memory and those with poor working memory (P=.01). The verbal digit span difference score was independently associated with the percentage error in perceived reach. The verbal digit span difference score resulted in an R2 change of 18.2% and significantly improved the regression model (F1,26 change, 7.45; P=.01). Conclusions: Our novel results suggest that impaired executive functioning may increase falls risk by impairing older adults' judgment in motor planning for daily activities. However, future studies with larger sample sizes are needed to confirm our current results