RESPOND – A patient-centred program to prevent secondary falls in older people presenting to the emergency department with a fall: Protocol for a multi-centre randomised controlled trial

Introduction: Participation in falls prevention activities by older people following presentation to the Emergency Department (ED) with a fall is suboptimal. This randomised controlled trial (RCT) will test the RESPOND program which is designed to improve older persons’ participation in falls prevention activities through delivery of patient-centred education and behaviour change strategies. Design and setting: An RCT at two tertiary referral EDs in Melbourne and Perth, Australia. Participants: Five-hundred and twenty eight community-dwelling people aged 60-90 years presenting to the ED with a fall and discharged home will be recruited. People who: require an interpreter or hands-on assistance to walk; live in residential aged care or >50 kilometres from the trial hospital; have terminal illness, cognitive impairment, documented aggressive behaviour or history of psychosis; are receiving palliative care; or are unable to use a telephone will be excluded. Methods: Participants will be randomly allocated to the RESPOND intervention or standard care control group. RESPOND incorporates: (1) home-based risk factor assessment; (2) education, coaching, goal setting, and follow-up telephone support for management of one or more of four risk factors with evidence of effective intervention; and (3) healthcare provider communication and community linkage delivered over six months. Primary outcomes are falls and fall injuries per-person-year. Discussion: RESPOND builds on prior falls prevention learnings and aims to help individuals make guided decisions about how they will manage their falls risk. Patient-centred models have been successfully trialled in chronic and cardiovascular disease however evidence to support this approach in falls prevention is limited. Trial registration. The protocol for this study is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614000336684)

First-principles study of orthorhombic CdTiO3 perovskite

In this work we perform an ab-initio study of CdTiO3 perovskite in its orthorhombic phase using FLAPW method. Our calculations help to decide between the different cristallographic structures proposed for this perovskite from X-Ray measurements. We compute the electric field gradient tensor (EFG) at Cd site and obtain excellent agreement with available experimental information from a perturbed angular correlation (PAC) experiment. We study EFG under an isotropic change of volume and show that in this case the widely used "point charge model approximation" to determine EFG works quite well.Comment: 4 pages, 1 figure. Accepted in Physical Review

Composite structural motifs of binding sites for delineating biological functions of proteins

Most biological processes are described as a series of interactions between proteins and other molecules, and interactions are in turn described in terms of atomic structures. To annotate protein functions as sets of interaction states at atomic resolution, and thereby to better understand the relation between protein interactions and biological functions, we conducted exhaustive all-against-all atomic structure comparisons of all known binding sites for ligands including small molecules, proteins and nucleic acids, and identified recurring elementary motifs. By integrating the elementary motifs associated with each subunit, we defined composite motifs which represent context-dependent combinations of elementary motifs. It is demonstrated that function similarity can be better inferred from composite motif similarity compared to the similarity of protein sequences or of individual binding sites. By integrating the composite motifs associated with each protein function, we define meta-composite motifs each of which is regarded as a time-independent diagrammatic representation of a biological process. It is shown that meta-composite motifs provide richer annotations of biological processes than sequence clusters. The present results serve as a basis for bridging atomic structures to higher-order biological phenomena by classification and integration of binding site structures.Comment: 34 pages, 7 figure

Factors Influencing Engagement, Perceived Usefulness and Behavioral Mechanisms Associated with a Text Message Support Program

Introduction Many studies have now demonstrated the efficacy of text messaging in positively changing behaviours. We aimed to identify features and factors that explain the effectiveness of a successful text messaging program in terms of user engagement, perceived usefulness, behavior change and program delivery preferences. Methods Mixed methods qualitative design combining four data sources; (i) analytic data extracted directly from the software system, (ii) participant survey, (iii) focus groups to identify barriers and enablers to implementation and mechanisms of effect and (iv) recruitment screening logs and text message responses to examine engagement. This evaluation was conducted within the TEXT ME trial—a parallel design, single-blind randomized controlled trial (RCT) of 710 patients with coronary heart disease (CHD). Qualitative data were interpreted using inductive thematic analysis. Results 307/352 (87% response rate) of recruited patients with CHD completed the program evaluation survey at six months and 25 participated in a focus group. Factors increasing engagement included (i) ability to save and share messages, (ii) having the support of providers and family, (iii) a feeling of support through participation in the program, (iv) the program being initiated close to the time of a cardiovascular event, (v) personalization of the messages, (vi) opportunity for initial face-to-face contact with a provider and (vii) that program and content was perceived to be from a credible source. Clear themes relating to program delivery were that diet and physical activity messages were most valued, four messages per week was ideal and most participants felt program duration should be provided for at least for six months or longer. Conclusions This study provides context and insight into the factors influencing consumer engagement with a text message program aimed at improving health-related behavior. The study suggests program components that may enhance potential success but will require integration at the development stage to optimize up-scaling

Revisiting diagenesis on the Ontong Java Plateau: Evidence for authigenic crust precipitation in Globorotalia tumida

The calcite tests of foraminifera lie in marine sediments for thousands to millions of years, before being analysed to generate trace element and isotope palaeoproxy records. These sediments constitute a distinct physio-chemical environment from the conditions in which the tests formed. Storage in sediments can modify the trace element and isotopic content of foraminiferal calcite through diagenetic alteration, which has the potential to confound their palaeoceanographic interpretation. A previous study of G. tumida from the Ontong Java Plateau, western equatorial Pacific, found that preferential dissolution of higher-Mg chamber calcite, and the preservation of a low-Mg crust on the tests significantly reduced whole-test Mg/Ca and Sr/Ca [Brown and Elderfield, 1996]. Here, we revisit these specimens with a combination of synchrotron X-ray computed tomography (sXCT) and electron probe micro-analyses (EPMA) to re-evaluate the nature of their diagenetic alteration. The dissolution of higher-Mg calcite with depth was directly observed in the sXCT data, confirming the inference of the previous study. The sXCT data further reveal a thickening of the chemically and structurally distinct calcite crust with depth. We propose that these crusts have a diagenetic origin, driven by the simultaneous dissolution of high-Mg chamber calcite and precipitation of low-Mg crust from the resulting modified pore-water solution. While the breadth of the study is limited by the nature of the techniques, the observation of both dissolution and re-precipitation of foraminiferal calcite serves to demonstrate the action of two simultaneous diagenetic alteration processes, with significant impacts on the resulting palaeoproxy signals.The authors would like to acknowledge Aleksey Sadekov, Gerald Langer, India Weidle, Alberto de Fanis, Andrew Bodey, Joan Vila-Comamala and Ulrich Wagner for their help with the project. The work was funded by the Diamond Light Source and by the ERC (2010-NEWLOG ADG-267931 grant to HE).This is the author accepted manuscript. The final version is available from Wiley via http://dx.doi.org/10.1002/2014PA00275

Hands On Biofilm! A multidisciplinary public engagement event using kombucha tea pellicle as an accessible example of biofilm

Public engagement with science has become increasingly important for the scientific community. There are many documented public engagement events that focus on aspects of microbiology, but relatively few utilise biofilms as a topic, despite their importance. Kombucha tea pellicles are easy to grow biofilms, facilitating their use within the public domain as examples of these complex communities. The aim of this work was to deliver a public engagement event that introduced visitors to general concepts about biofilm, and applications around sustainability, using kombucha. The event encouraged visitors to: build a biofilm using model clay; inoculate kombucha tea cultures using different incubation conditions, as part of a citizen science experiment to assess impact on pellicle biofilm yield; create garments and drapes on mini-mannequins using dried kombucha pellicle fabric, and demonstrate the range and importance of fermented foods (including kombucha tea), and ‘good bacteria’. Quantitative and qualitative indicators of engagement were built into the activities. More than 1200 visitors, mainly in family groups, visited the event over a 4-h period. Knowledge of biofilms was low at the beginning of the event. Participation in all activities was high. Indicators of quantitative engagement were impressive, but it was difficult to obtain qualitative evidence other than observations from the delivery team (nineteen members) because of the intensity of the event and volume of visitors. The event was clearly successful in terms of fulfilment of aims, audience engagement and enthusiasm: the embedded evaluations helped to evidence the impact and reach of the event, enabling confidence in dissemination of good practice in the enhancement of public understanding of the importance of biofilm in general, and kombucha in particular

Grb2 depletion under non-stimulated conditions inhibits PTEN, promotes Akt-induced tumor formation and contributes to poor prognosis in ovarian cancer

In the absence of extracellular stimulation the adaptor protein growth factor receptor-bound protein (Grb2) and the phospholipase Plcγ1 compete for the same binding site on fibroblast growth factor receptor 2 (FGFR2). Reducing cellular Grb2 results in upregulation of Plcγ1 and depletion of the phospholipid PI(4,5)P2. The functional consequences of this event on signaling pathways are unknown. We show that the decrease in PI(4,5)P2 level under non-stimulated conditions inhibits PTEN activity leading to the aberrant activation of the oncoprotein Akt. This results in excessive cell proliferation and tumor progression in a xenograft mouse model. As well as defining a novel mechanism of Akt phosphorylation with important therapeutic consequences, we also demonstrate that differential expression levels of FGFR2, Plcγ1 and Grb2 correlate with patient survival. Oncogenesis through fluctuation in the expression levels of these proteins negates extracellular stimulation or mutation and defines them as novel prognostic markers in ovarian cancer

Quantifying ship strike risk to breeding whales in a multiple-use marine park: The Great Barrier Reef

Spatial risk assessments are an effective management tool used in multiple-use marine parks to balance the needs for conservation of natural properties and to provide for varying socio-economic demands for development. The multiple-use Great Barrier Reef Marine Park (GBRMP) has recently experienced substantial increases in current and proposed port expansions and subsequent shipping. Globally, large whale populations are recovering from commercial whaling and ship strike is a significant threat to some populations and a potential welfare issue for others. Within the GBRMP, there is spatial conflict between the main breeding ground of the east Australian humpback whale population and the main inner shipping route that services several large natural resource export ports. The east coast humpback whale population is one of the largest humpback whale populations globally, exponentially increasing (11% per annum) close to the maximum potential rate and estimated to reach pre-exploitation population numbers in the next 4-5 years. We quantify the relative risk of ship strike to calving and mating humpback whales, with areas of highest relative risk coinciding with areas offshore of two major natural resource export ports. We found females with a dependent calf had a higher risk of ship strike compared to groups without a calf when standardized for group size and their inshore movement and coastal dependence later in the breeding season increases their overlap with shipping, although their lower relative abundance decreases risk. The formalization of a two-way shipping route has provided little change to risk and projected risk estimates indicate a three- to five-fold increase in risk to humpback whales from ship strike over the next 10 years. Currently, the whale Protection Area in the GBRMP does not cover the main mating and calving areas, whereas provisions within the legislation for establishment of a Special Management Area during the peak breeding season in high-risk areas could occur. A common mitigation strategy of re-routing shipping lanes to reduce risk is not a viable option for the GBRMP due to physical spatial limitations imposed by the reef, whereas speed restrictions could be the most feasible based on current ship speeds

Quantitative assessment of the relative risk of ship strike to humpback whales in the Great Barrier Reef

There is global recognition that ship strike represents a significant risk to some populations of whales around the world. Analysis of ship strike records worldwide demonstrates that humpback whales are the second most frequently reported whale species to be struck by a ship. In Australia, both the east and west coast populations of humpback whales are strongly recovering from commercial whaling during the mid-20th century which resulted in populations nearing extinction. On the east coast of Australia the main breeding ground for humpback whales is within the Great Barrier Reef World Heritage Area (GBRWHA). Both the east and west coast of Australia have also in the past decade experienced considerable coastal and port development associated with an increase in natural resource projects. It is due to substantial coastal development and port expansions related to the mining industry that UNESCO were considering listing the GBRWHA on the 'List of World Heritage in Danger' and are currently monitoring Australia's commitment to its sustainability. Along with considerable port expansion along the GBRWHA coastline to meet increasing global demands for coal and liquefied natural gas (LNG), there is projected to be substantial increases in shipping traffic. Conservative estimates are predicting a doubling of shipping traffic by 2025, albeit not for all Queensland ports. Considering the rapid rate of increase of the east Australian population of humpback whales (approximately 10.9% increase per annum), there is potential for increased interaction between humpback whales and shipping traffic and increased risk of ship strikes to the whales on their breeding ground. To understand the risk of ship strike to humpbacks in the GBRWHA, it is necessary to understand the distribution and densities for both whales and shipping. This report uses current knowledge on the distribution of humpback whales within the GBRWHA from aerial survey data from 2012 and 2014 and contemporary (2012-2014) shipping traffic data of ships travelling within the GBR to provide estimates of relative risk of ship strike to humpback whales within the GBR

Visual Dependency and Dizziness after Vestibular Neuritis

Symptomatic recovery after acute vestibular neuritis (VN) is variable, with around 50% of patients reporting long term vestibular symptoms; hence, it is essential to identify factors related to poor clinical outcome. Here we investigated whether excessive reliance on visual input for spatial orientation (visual dependence) was associated with long term vestibular symptoms following acute VN. Twenty-eight patients with VN and 25 normal control subjects were included. Patients were enrolled at least 6 months after acute illness. Recovery status was not a criterion for study entry, allowing recruitment of patients with a full range of persistent symptoms. We measured visual dependence with a laptop-based Rod-and-Disk Test and severity of symptoms with the Dizziness Handicap Inventory (DHI). The third of patients showing the worst clinical outcomes (mean DHI score 36–80) had significantly greater visual dependence than normal subjects (6.35° error vs. 3.39° respectively, p = 0.03). Asymptomatic patients and those with minor residual symptoms did not differ from controls. Visual dependence was associated with high levels of persistent vestibular symptoms after acute VN. Over-reliance on visual information for spatial orientation is one characteristic of poorly recovered vestibular neuritis patients. The finding may be clinically useful given that visual dependence may be modified through rehabilitation desensitization techniques