Research Australia grassROOTS magazine Autumn 2016 by Research Australia

RESEARCH AUSTRALIA MEMBER MAGAZINE

AUTUMN 2016

Contents FEATURED ARTICLE 6 Australian patients inspire change

AUSTRALIAN HEALTH & MEDICAL RESEARCH 4

Editors Corner

Protein ‘handbrake’ halts leukaemia in its tracks

Australian Cancer Research Foundation awards $17m to advance cancer research

6 Australian patients inspire change

14 Researchers exploit natural microbial predators to beat antibiotic resistance

22 Moving with the power of thought

8 New silicon nanotech transistors, a bold new weapon in the hunt for tumour cells

10 Australia’s biggest health study moves towards new frontiers

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The difference between the dementias

Safeguarding the future of medical research: the need for leaders to drive innovation

18 20 year study provides valuable data on Australian women’s health

26 Formula 1 technology used to speed up research and manufacture medicines grassROOTS | AUTUMN 2016

‘Matrix’ model takes research to new heights

Rethink the system to drive new age of effective cancer treatment

Increasing uptake of long acting reversible contraception

Broncos Partnership, Game Changer for Human Movement and Nutrition Research

MS Research Australia’s fundraising campaign goes global

Research provides new understanding of life after cancer treatment for young people

32 Women need to be their own greatest champions

35 Exercise research hits the gym

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40 Milestone progress for milestone australian cancer research project

48 ANZIC-RC wins $4.4 million for ground-breaking pneumonia trial

42 Understanding Chronic Fatigue Syndrome

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Editor’s Corner It is my pleasure to bring you this latest edition of GrassROOTS; the second in our new format and my first as CEO of Research Australia. Activity in our sector has been at fever pitch for a while now and there have been some good outcomes. The National Innovation and Science Agenda (NISA) was announced by the Prime Minister in early December. Research Australia welcomes this clear focus by our Government on science and innovation as essential to Australia’s future and there is no doubt that health and medical research has an important role to play. This agenda reconfirmed the importance of the Medical Research Future Fund, it has enabled the set up of a biomedical translation fund to quickly address the funding gap for mid to later stage clinical research and development, and it is also focused on developing a new plan for research infrastructure and championing the importance of STEM subjects such as maths and science, in our education system. These sorts of initiatives take clear thinking and leadership to deliver and it is worth noting that there is support across the political spectrum about the importance of science and innovation to Australia’s future. And it is not just the Commonwealth that is investing in H&MR. State Governments around Australia are investing in new facilities and programmes to advance research and innovation, and philanthropy continues to make a vital contribution. Innovation takes a collective effort to make it happen and some of the articles in this edition of grassROOTS highlight just how much can be achieved when that effort is made. For example, a research team from the University of South Australia has developed a novel diagnostic technology that could enable surgeons to immediately detect the presence of tumour cells in surrounding healthy tissue potentially sparing further surgery. Researchers at the University of Melbourne and the Florey Institute of Medical Research have developed a device the size of a matchstick, implanted into the brain that could help paralysed people walk and it seems humans and fast cars have quite a lot in common as GSK and Formula 1’s McLaren discover through the sharing of their collective expertise. There is so much more and the Research Australia team looks forward to both finding and sharing with you, evidence of all of our collective efforts. Nadia Levin CEO & Managing Director

Publisher Research Australia Ltd Advertising & Sponsorship Marketing and Communications Coordinator Danijela Krha danijela.krha@researchaustralia.org (02) 9295 8546 Research Australia online www.researchaustralia.org twitter.com/ResAustralia facebook.com/ResearchAustralia linkedin.com/company/research-australia grassROOTS online issuu.com/researchaustralia grassROOTS is a publication of Research Australia Ltd ABN 28 095 324 379 384 Victoria Street Darlinghurst NSW 2010 Who can submit articles? Any current member of Research Australia who would like to share a relevant story that affects their organisation including, philanthropic donations and their outcomes, research findings, and any other related health and medical research topic that affects the Australian population. Submission guidelines & deadlines For information regarding how to submit and publishing deadlines, visit www.researchaustralia.org/advocacypublications/grassroots

Research Australia does not warrant or guarantee the accuracy, quality, completeness, currency, or validity of any information in grassROOTS. All articles are supplied by member organisations and are edited for readability only and are not fact checked. Neither Research Australia nor the contributors to grassROOTS make any representations as to the accuracy or integrity of the information. They disclaim all express, implied, and statutory warranties of any kind, including warranties as to accuracy, timeliness, completeness, merchantability, or fitness for any particular purpose. Neither Research Australia nor its contributors will be liable for any damages of any kind incurred as a result of the information contained within this magazine.

previous page: Digital representation of neurones

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Medical Research Future Fund popular The Medical Research Future Fund (MRFF) legislation passed into law in August 2015. The new Fund is forecast to provide an additional $1 billion p.a. for health and medical research and innovation within seven years. Read and download the full 2015 Research Australia Polling Report

Support for the MRFF

36%

Strongly support

42%

Somewhat support

78%

Somewhat oppose

of Australians support the MRFF

Strongly oppose

I do not know / not sure

12%

Support is strongest among those aged over 65, with 85% in favour of the MRFF.

Perceived benefits of MRFF* Better health for Australians

Development of new drugs & medical devices

Improving our health system

88% 87% 84%

Job creation

70%

Economic growth

56%

*Total of the ‘Very Important’ and ‘Somewhat Important’ ratings WWW.RESEARCHAUSTRALIA.ORG

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Australian patients inspire change Novartis Pharmaceuticals is creating a clinical trial research platform to gain patient insights in relation to their disease management and desired outcomes for clinical research

ovartis Pharmaceuticals is creating a clinical trial research platform to gain patient insights in relation to their disease management and desired outcomes for clinical research.

As the patient’s perspective can sometimes be overlooked, the Novartis Australian Patient Advisory Committee was established to ensure that outcomes that matter most to those actually living with a medical condition, are measured. Novartis Pharmaceuticals Australia Managing Director Brian Gladsden says the idea for the Australian Patient Advisory Committee was born from the Novartis Declaration for Patients. “The declaration motivates us to revolutionise the research, development and manufacturing of innovative, high-quality medicines,“ he said. “We believe it is vital for Australians living with a medical condition to share first-hand what they feel what they want from a treatment, “ he said. Novartis recognises that patient knowledge and experience with their condition is valuable in the design of clinical trial protocols and outcomes. The company is committed to inviting patient input early on regarding clinical protocols design and desired outcomes as well as improving the way information is shared with patients along the clinical trial process so that the patient perspective is

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truly represented in clinical development programs. “Understanding patients and receiving their input makes sense” says Brian. “The voice of patients and patient communities is critical to us understanding how we can partner to improve healthcare.” The first phase of the Australian local research is designed with a primary focus on patient reported outcomes and quality of life in those experiencing chronic plaque psoriasis. Psoriasis is a chronic auto immune disease primarily affecting skin and joints.1 An estimated 125 million people are affected worldwide and approximately 30% have moderate to severe plaque psoriasis.2,3 More than 500,000 Australians are living with psoriasis.4 Psoriasis can have a profound effect on people’s lives. 5-8 A study of Australians with psoriasis found it is not only a physically debilitating condition, it also has a significant impact on quality of life with more that 40% of reporting weight problems, stress and joint pain1; more than 30% reporting fatigue, depression and anxiety1; and more than 75% experiencing some degree of stigmatisation due to psoriasis1. Nearly 73% of Australians reported hiding their condition due to feelings of embarrassment of fear of stigmatisation.1 “Our goal is to provide a forum for people most affected by psoriasis to provide input on the design of the study and the

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measurement of the clinical outcomes,” said Brian. “We also want recommendations from patients to be incorporated in the final protocol. We feel privileged to work closely with those who volunteer to help us expand the scientific knowledge for our products and translate clinical trial results into the real world setting.” The first Novartis Australian Patient Advisory Committee meeting was held in late 2015 and continues in 2016.

About Novartis

References 1.

Baker, C. S. et al. Australasian Journal of Dermatology 2013; 54: 1–6.

The National Psoriasis Foundation website. Accessed 13 June 2013.

Herrier R. Am J Heath Syst Pharm 2011; 68: 795-806

A ustralian Bureau of Statistics, Canberra 2012. Australian Health Survey.cat. no. 4364.0.55.001

Krueger G, Arch Dermatol 2001;137:280-284.

Rapp SR et al. JAAD1999;41 (3 Pt 1):401-7.

Farley E et al. G Ital Dermatol Venereol. 2011 Feb;146(1):9-15.

Abuabara K et al. Br J Dermatol. 2010 Sep;163(3):586-92.

Novartis provides innovative healthcare solutions that address the evolving needs of patients and societies. Headquartered in Basel, Switzerland, Novartis offers a diversified portfolio to best meet these needs: innovative medicines, eye care and cost-saving generic pharmaceuticals. We have more than 60 years’ history in Australia and employ around 800 associates across our three divisions. We believe continued R&D is essential to innovation and in Australia we invest around $20M AUD annually in local clinical trials. Our mission is to discover new ways to improve and extend people’s lives. To find out more about Novartis in Australia visit www.novartis.com.au

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CORP0299. Novartis Pharmaceuticals Pty Limited Australia 54 Waterloo Rd, Macquarie Park NSW 2113

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New silicon nanotech transistors, a bold new weapon in the hunt for tumour cells A research team from the University of South Australia has developed a novel diagnostic technology able to detect, during the time-frame of a surgery and with extreme sensitivity, the presence of tumor cells among healthy tissue. This new nanotech method could enable surgeons to assess on the spot the extent of spreading of the disease, and in turn spare patients subsequent surgery.

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iny new sensing transistors developed at the University of South Australia’s Future Industries Institute with the support of the National Health and Medical Research Council are set to revolutionise surgical treatment for cancer patients.

Detecting the spread of cancer through the lymphatic system is one of the more difficult and critical areas of cancer diagnosis. The presence of tumour cells inside regional lymph nodes is indeed indicative of aggressive diseases and their accurate detection is essential towards selecting the most appropriate treatment. Current practice is that a surgeon operates to remove a primary tumour or search for tumours and lymph nodes and then take samples for pathological examination to see how far a cancer has spread. The resected lymph nodes are analysed by a trained pathologist in search for these tumours cells. In a collaborative project between the University of South Australia and the Forschungszentrum Jülich GmbH in Germany, the research team has developed an ultrasensitive sensing technology for use during surgery, based on state-of-the-art, nanostructured silicon field-effect transistors, that promises to be a boon for doctors and patients. This cutting-edge sensing technology has been at the forefront of the nanotechnology field since pioneering work in the early year 2000s at Harvard University. The presence of biomolecules of interest in a specific sample is detected through their interactions with the surface of these field-effect transistor sensors. These interactions translate into extremely small changes in the electrical conductivity of the sensor, which can be detected using a transducer. The sensitivity of silicon field-effect transistors is extremely dependent on their physical dimensions, and nanoscale devices have, in theory, the capability of detecting single molecules. However, despite their tremendous potential, silicon field-effect transistors are yet to be translated into a mainstream biodiagnostic technology. This is mostly due to the complexity and challenges associated in manufacturing these ultrasensitive sensors. With the support of the National Health and Medical Research Council and facilitated by the state-of-the-art facilities of the Australian National Fabrication Facility (ANFF), the University of South Australia team has developed and optimised a novel fabrication process that yields high quality devices at an affordable cost. Building on this exciting development, they have applied for the first time this technology to address the important challenge of detecting small amounts of malignant cells within tissues. University of South Australia Associate Professor Benjamin Thierry says the new technology provides superior detection of cancer cells hidden among healthy tissues and can be completed during an operation, reducing the need for further surgeries. “Right now, when a cancer patient is undergoing treatment, a surgeon has to wait relatively lengthy lead times, often up to a few days, to get results of lymph node samples from the pathologists to get a measure of the spread of the cancer,” Assoc Prof Thierry says.

thousand times more sensitive than the most advanced technology clinically available to date. Although still controversial, the presence of very small tumour clusters in lymph nodes has been associated to poor prognosis in a number of cancer types, and current pathological examinations often miss these malignant deposits. “Perhaps even more significantly for cancer patients and their doctors, is that the whole analysis could be completed within an hour. “And using a streamlined protocol we can cut that to within 30 minutes and still provide the required sensitivity.” Assoc Prof Thierry says the research, which was published this month in the leading journal ACS Nano, has the potential to revolutionise surgical treatments for breast cancer, head and neck cancer, and gastrointestinal cancer, all of which develop secondary cancers via the spread of tumour cells to the regional lymph nodes. The technology, once validated clinically, could also help to address the shortage of pathologists in Australia by providing semi-automated analyses. The University of South Australia team, in collaboration with its partner in Germany, is currently researching the possibility to develop an even simpler and cheaper manufacturing process, which is an essential step for the technology to become commercially viable. “The support of the Australian Government through the NHMRC and the possibility to readily access cutting edge facilities such as those of the nationally funded ANFF is critical to bridge the gap between early academic research and commercially viable technology” he says. “And we have high hope that the recently announced National Innovation and Science Agenda will help us bring this technology to the clinic”. “In the future, our technology could be used more generally to distinguish malignant from benign tumours, thereby providing important answers to the surgeon during surgery”. “With this technology on board we could greatly reduce the need for secondary surgeries. “We estimate that reliable intraoperative testing during surgery could spare up to 40 per cent of breast cancer patients a secondary surgery. “Not only is the technology extremely reliable and efficient, it will also help to spare some of the trauma associated with cancer treatment, eliminating the need for multiple operations and giving doctors more confidence to make informed decisions during surgery.” Read the full research report Towards Intraoperative Detection of Disseminated Tumour Cells in Lymph Nodes with Silicon Nanowire Field Effect Transistors, by Duy P. Tran, Marnie A. Winter, Bernhard Wolfrum, Regina Stockmann, Chih-Tsung Yang, Mohammad P. Moghaddam, Andreas Offenhäusser, and Benjamin Thierry. For more information about health and medical research at the University of South Australia visit www.unisa.edu.au

“This new technology has the potential to eliminate that lag time and to provide results within the time-frame of the surgery. “Our research shows the accuracy and sensitivity of the silicon transistors is more advanced than anything being used today. “In model studies, the technology proved so refined it could detect even one tumour cell per lymph node, making it as much as a

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Australia’s biggest health study moves towards new frontiers Sax Institute 45 and Up Study to be used in project to sequence genomes of the ‘wellderly’, as data contributes to growing body of research on healthy ageing.

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ustralia’s biggest health study, the Sax Institute’s 45 and Up Study, is moving towards new frontiers, including helping to create the world’s largest public genome database to drive cutting-edge research into the genetic causes of conditions such as heart disease, diabetes, cancer and kidney disease. The Study is the largest ongoing study of healthy ageing in the Southern Hemisphere involving a quarter of a million people – one in every 10 men and women aged 45 and over in NSW. Participants are asked questions about a wide range of factors ranging from their health and lifestyle to income and work status, providing the first large-scale, comprehensive measure of health as people move from mid to later life, and allowing governments and health policy makers to better plan health services and programs for our ageing population. Major enhancements to the Study and some of the latest research findings were outlined at the annual 45 and Up Collaborators’ meeting held in Sydney late last year.

Sequencing the genomes of the ‘wellderly’ A new collaborative project with the Garvan Institute of Medical Research will see the 45 and Up Study used to investigate what the genome of a healthy older Australian looks like – dubbed sequencing the genome of the “wellderly”. Blood samples from about 2000 Study participants will form part of the NSW Government-funded Medical Genome Reference Bank (MRGB), the largest public genome database in the world. It will sequence a total of 4000–4500 genomes of individuals aged over 75 years, who are free of chronic diseases like cancer, cardiac and neurological diseases. Head of the Garvan Institute’s Kinghorn Centre for Clinical Genomics, Associate Professor Marcel Dinger, told the Study meeting that the data would be used as a “filter” to distinguish between normal genetic variation and variation caused by disease, helping to identify genetic variants linked to disease.

Use in predictive modelling In another new collaboration with major Study partner Cancer Council NSW, the Study data will also be used to build predictive models on the risk of disease that will help determine where to intervene for prevention and early detection of diseases such as lung and prostate cancer. Director of the Cancer Council NSW Cancer Research Division Professor Karen Canfell said her team would use information already collected from participants in the Study to create computer simulated ‘virtual populations’. The information from these computer models could then be used to predict outcomes like lung cancer and the health and economic impacts of prevention strategies.

A rich resource of data The Study’s Scientific Director Professor Emily Banks said the Study, which has been running for more than a decade, is now linked to a growing number of datasets including 42 million Medicare (MBS) and Pharmaceutical Benefits Schedule (PBS) records, making it an incredibly rich resource.

Professor Banks said some of the Study’s achievements to date included: • 128 projects involving the Study have or are being conducted • 580 researchers across 75 organisations have used the Study • 27 policy agencies have used the Study • 70 grants have been awarded, worth about $29 million

Retirement a window of opportunity for healthier living Among the wide range of findings presented at the recent meeting was research that suggests retirement is an ideal time to focus on positive lifestyle changes. The researchers looked at lifestyle behaviours such as alcohol use, physical activity, diet, sedentary behaviour and sleep among a cohort of 27,257 working adults from the 45 and Up Study, and followed up 3,016 participants who retired over the next three years. Lead author Dr Melody Ding, Senior Research Fellow at the School of Public Health, University of Sydney, said they found that, compared with people who were still working, retirees were less likely to smoke, they were less likely to be physically inactive, they spent less time sitting during the day, and they had healthier sleep patterns. The differences were significant even after adjusting for factors such as age, sex, urban/rural residence, marital status and education. Sydney retiree Allan Wareham, one of the 267,000 participants of the Study, agrees. Upon his retirement, the 76-year-old decided it was the ideal time to take his fitness seriously and hit the ground running − literally. He joined the Sydney Striders running club and now runs up to five days a week. Last year he completed nine half-marathons, with his hobby taking him to central Australia as well as to New Zealand where he completed the Auckland half-marathon. “I’d been a runner on and off for a number of years, but I became more serious about it and started running longer distances when I retired because I had time to train,” he said. Dr Ding said the findings suggested retirement was an opportunity to engineer new, healthier lifestyles, and both health professionals and policy makers could consider developing special programs for retirees to capitalise on the health transitions through retirement. “A major life change like this creates a great window of opportunity to promote positive lifestyle changes,” she said. 45 and Up Study Director Ms Margo Barr told the meeting other future opportunities for the Study included exploring more linkage possibilities, improving the timeliness of linked data and the facilitation of remote, secure data linkage through the Sax Institute’s SURE (Secured Unified Research Environment) facility. The 45 and Up Study is managed by the Sax Institute in partnership with major partner Cancer Council NSW and partners: the National Heart Foundation of Australia (NSW Division); NSW Ministry of Health; NSW Government Family & Community Services – Carers, Ageing and Disability Inclusion; and the Australian Red Cross Blood Service. For more information about health and medical research at the Sax Institute at www.saxinstitute.org.au

“Researchers already have a huge data resource available to them in the 45 and Up Study and its quarter of a million participants, but these new enrichments mean we now have a research advantage that people in other parts of the world will envy,” she said. An average of one new piece of research made possible by the Study is now published each week in a peer-reviewed journal, she said.

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45 and Up Study participant and avid runner Mr Allan Wareham agrees with new findings that retirement is a window of opportunity for healthier lifestyles.

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Protein ‘handbrake’ halts leukaemia in its tracks Melbourne researchers have found a way to stop leukaemia in its tracks by targeting a protein that puts the handbrake on cancer cell growth. The research team from the Walter and Eliza Hall Institute discovered that targeting the protein Hhex could eliminate acute myeloid leukaemia in preclinical disease models, and become a key target for new therapies for human leukaemia.

Acute Myeloid Leukaemia (AML) is an aggressive blood cell cancer that appears suddenly and grows quickly. The disease is more prevalent in adults than in children and continues to increase with age. In Australia, AML causes the most leukaemia deaths each year, and the incidence of AML is expected to rise as our population ages. Existing treatments for AML are associated with serious side-effects and often fail to keep the cancer at bay after a relatively short period of time. The prognosis for patients diagnosed with AML is poor, with a five-year survival rate of only 24 per cent. Dr Matt McCormack from the Cancer and Haematology Division at the Walter and Eliza Hall Institute said new treatments for AML were urgently required. “AML is such an aggressive blood cancer because the AML cells grow uncontrollably and fail to mature into normal functioning cells. AML cells multiply so rapidly that they crowd out healthy blood cells, leaving the body prone to infection, anaemia and bruising.” Dr McCormack’s colleague, Dr Ben Shields said Hhex was a particularly attractive therapeutic target because it was overproduced in leukaemia and, while essential for growth of AML cells, was not needed by healthy blood cells. “Most existing treatments for AML are not cancer cell-specific, and unfortunately kill off many normal, healthy cells in the process of eliminating the cancer. This is why cancer therapy causes sideeffects such as hair loss, nausea, bleeding and predisposition to infection,” Dr Shields said. “Our preclinical models showed that removing Hhex completely abolishes AML growth but has no significant impact on normal cells. This means we can target and treat leukaemia while avoiding many of the serious side-effects that come with standard cancer treatments.” The team used molecular studies to reveal precisely how Hhex contributes to AML. “We found that Hhex influences gene expression in AML cells, switching off the controls that strictly manage cell growth and division,” said Dr Shields. “These control genes are normally activated when a cell is stressed, such as in the early stages of cancer, to stop the damaged cell from reproducing.” In AML cells, these control genes are switched off through a process called epigenetic modification. Epigenetic modifications are labels on our DNA that act like musical notations, telling the cell whether to play genes ‘loudly’ or ‘softly’.

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“Hhex works by recruiting epigenetic factors to growth control genes, effectively silencing them. This allows the leukaemia cells to reproduce and accumulate more damage, contributing to the speed of AML progression,” Dr Shields said. As well as causing fewer side effects, targeting Hhex could also be more effective than standard therapies for AML, which often only control the disease for a short amount of time. Approximately three out of four patients will relapse after a short period of treatment and their prognosis at that point is dire. Dr McCormack said standard therapies were thought to fail because although they destroyed the bulk of the cancer, they left behind a rare population of cells called cancer ‘stem cells’, so named because they have the ability to self-renew – or propagate indefinitely. “Self-renewal capacity is normally restricted to a small population of blood stem cells,” Dr McCormack said. “These stem cells need to be able to self-renew so that they can generate new blood cells throughout life.” Cancer cells hijack this self-renewal process for their own purpose, to reproduce uncontrollably. “The cancer stem cells left behind after standard cancer therapies are capable of growing and recapitulating the cancer, leading to disease relapse,” Dr McCormack said. There is a huge drive in the research community to find ways of eliminating cancer stem cells by blocking their self-renewal. In order to self-renew, the cancer stem cells must keep the control genes silenced. Dr McCormack said that targeting Hhex could be an effective way of turning the control genes back on and thereby blocking self-renewal. “The fact the control genes are still present in the AML cells, albeit silenced, means we can potentially switch them back on again to block self-renewal and eliminate leukaemia growth. Targeting Hhex kills both the bulk of the cancer and the cancer stem cells, leading to highly effective therapy responses in our preclinical models. This gives us hope that we could cause more durable remission in AML patients.” Drugs that inhibit epigenetic modification had been previously used to treat AML, but caused significant toxicity because their targets were also required for normal blood cell function.

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Dr Ben Shields and Dr Matt McCormack, Walter and Eliza Hall Institute of Medical Research

“Unlike the epigenetic factors targeted previously, Hhex only regulates a small number of genes and is dispensable for normal blood cell production. This gives us a rare opportunity to kill AML cells without causing significant side-effects. We now hope to identify the critical regions of the Hhex protein that enable it to function, which will allow us to design much-needed new drugs to treat AML,” Dr McCormack said. Dr McCormack said the human impact of leukaemia was a huge motivator for their work. “It is exciting to think that our research may one day lead to better treatment outcomes for people suffering from blood cancers,” he said.

Council, the Cancer Council of Victoria, the Leukaemia Foundation of Australia, the Australian Research Council, the Australian Cancer Research Fund and a Victorian State Government Operational Infrastructure Support Program. The work is also supported by a generous donation from the estate of Jakob Frenkiel. For more information about the Walter and Eliza Hall Institute of Medical Research visit www.wehi.edu.au

The research was published in the journal Genes & Development and was supported by the National Health and Medical Research

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Researchers exploit natural microbial predators to beat antibiotic resistance In an effort to address the real and serious public health threat of antibiotic resistance, researchers from The Westmead Institute are taking a second look at an alternative therapy which has the potential to be our best defence against superbugs.

isuse of existing antibiotics has led to rising resistance levels in bacteria causing serious disease. To combat the looming threat, researchers from the Westmead Institute’s Centre for Infectious Disease and Microbiology have been awarded an $867,716 NHMRC grant to investigate the eradication of high-risk bacterial infections using bacteria-killing viruses. The use of bacteriophage, or phage therapy for short, is not new according to the Institute’s Dr Carola Venturini, who specialises in antibiotic resistance in gut bacteria. Discovered in the early 1900s by the English bacteriologist Frederick Twort and French-Canadian microbiologist Felix d’Herelle, phages were used to treat bacterial infections up until the 1920s. “Although phage therapy was proving successful, it largely went out of use in Western countries with the advent of powerful antibiotics” says Dr Venturini. “Antibiotics were very effective, and nobody was thinking about antibiotic resistance back then.” However, Dr Venturini says that while the West had left these bacteriafighting viruses behind, phage therapy was flourishing in Russia. “Behind the Iron Curtain there was a big push for phage therapy and they had a lot of success, particularly in burns patients and with skin infections. But because of the cold war, we didn’t really have access to real, solid research to back up this information.” In the desperate war against antibiotic resistance, phage therapy is making a comeback, and Dr Venturini and her colleagues are at the forefront of this research in Australia.

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“Phage therapy has really come to life in the last 5-10 years. The antibiotic pipeline is drying up – there is no real investment in antibiotics anymore because of the development of resistance,” says Dr Venturini. “It is in the forefront of your mind. While you are investigating all of the molecular mechanisms for resistance you realise that, fundamentally, it is a race between us and the bacteria. And the bacteria are going to win. “So people are turning to alternative ways of treating infection to curb the development of antibiotic resistance. Phage therapy is very appealing because you are exploiting an interaction between the bacteria and their natural predators.” The project at the Westmead Institute examines a potential role for phage therapy in eliminating bacteria responsible for antibioticresistant gut infections. These superbugs pose worldwide public health risks, with periodic outbreaks emerging in all our major cities. “We are looking specifically at bacteria that cause sepsis – E. coli and Klebsiella – directly in intensive care patients. These bacteria can spread easily through travel, are multiply resistant and are becoming a big problem worldwide. We need to be smart and preempt any large outbreak.” This is not the first time researchers from the Westmead Institute have investigated the use of phage therapy. In 2010, Professor Jon Iredell, who heads the Institute’s Critical Infection Group and is the Director of Infectious Diseases at the Westmead Hospital, used adjunctive phage therapy to successfully treat a 67-year-old woman who was suffering from an antibiotic resistant urinary tract infection.

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Bacteriophage viruses infecting bacterial cells Credit: shutterstock.com/ nobeastsofierce

As well as a microbiological cure, the patient experienced no side effects from the treatment, which was found to be self-limiting. The wonder of phage therapy, says Dr Venturini, is that it is target specific, and therefore safe. “Phage is a beautiful thing. They don’t invade mammalian cells, they don’t do anything to your blood cells – they just go and hit the bacteria. And while there is still a risk of developing resistance, it can be circumvented more easily than with antibiotics.” But the targeted nature of bacteriophages is a double-edged sword. “The trick is to be able to isolate the right phage for the right bacterium. Our research is important in terms of developing a protocol for the isolation of specific phages against very specific set of strains. Ultimately, we would like to develop diagnostic methods for quickly and accurately predicting bacteriophage susceptibility, so that we can choose the right phages in the same way we choose the right antibiotics. “Furthermore, if our protocol for putting together the cocktail of phages works, it can be applied to other infections in plants and animals.” Dr Venturini says one of the big hurdles of phage therapy has nothing to do with science. “Regulation is a challenge. Because phages are natural, they are not considered a drug and the regulations should be quite easy. But in actual fact, it makes it more complicated because the regulatory framework isn’t in place yet. Currently phage therapy is only approved for use in extreme cases, for example with immunecompromised patients with chronic infections.”

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“We know it works. It is just a case of how we can effectively use it therapeutically. Our research is about building a framework that can work in therapy.” Investigating bacteriophages is only one arm of the research conducted at the Westmead Institute against antibiotic resistance. The Institute’s Critical Infection Group is involved in a number of research projects including examining the ecological effects of antibiotics, and finding ways of detecting antibiotic resistance in patients suffering from septic shock. A team led by Professor Iredell is also investigating the use of ‘therapeutic plasmids’, which involves replacing genetically resistant bacteria with non-antibiotic resistant bacteria by altering the DNA molecule responsible for replication. According to Professor Iredell, this process can reset the bacteria to a state where it can be treated by antibiotics. While not a complete cure to antibiotic resistance, Professor Iredell said the therapy is capable of dealing directly with the real and emerging threat of antibiotic resistant gene-sharing gut bacteria, which has been identified by World Health Organisation as one of the top heath priorities worldwide. For more information about health and medical research conducted at the Westmead Institute visit www.westmeadinstitute.org.au

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The difference between the dementias The number of Australians with dementia is predicted to grow to over one million people in the next 40 years. However Neuroscience Research Australia believes weâ&#x20AC;&#x2122;re in a better position than ever before to discover how to diagnose the many different dementias and reduce the number of people who will be affected in the future.

NeuRA researcher Professor Glenda Halliday

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ith more than 330,000 Australians currently living with dementia, there continues to be an urgent need to better understand this complex disease. Fortunately, this is an exciting time to be a researcher working on developing innovative ways to diagnose and treat the various dementias. “Right now, as a group, we’re in a good position to make a real difference,” says Neuroscience Research Australia’s Professor Glenda Halliday.

The future of dementia research As part of the Federal Government’s Boosting Dementia Research Initiative, Prof Halliday and the team she leads have been awarded one of six Dementia Research Team Grants. These five-year grants, will provide support for teams of researchers to pursue collaborative research, promote effective translation of research, and develop capacity under a dementia research priority framework. Prof Halliday is looking specifically at the non-Alzheimer’s disease dementias, such as frontotemporal dementia and dementia with Lewy bodies, which are often not correctly diagnosed. “If you have a dementia syndrome, people are more likely to call it Alzheimer’s disease,” says Prof Halliday, who estimates that for every 1,000 patients clinically diagnosed with Alzheimer’s disease, just over half have the tissue pathology of Alzheimer’s disease and about a third have a non-Alzheimer dementia. This is a figure that can only be arrived at via autopsy, so it is critical to find a way to accurately differentiate and diagnose the dementias earlier to ensure that the best treatment is provided. “The interesting thing with Alzheimer’s disease is that its progression is very slow and the majority of people will get it late in life,” she says. “With non-Alzheimer’s dementias, people get it earlier on in life and its progression is fast. So we really do need to develop a way to identify a dementia earlier for those people.” To achieve this goal, Prof Halliday will lead a collaborative group of ten teams from five different organisations as they study families with non-Alzheimer’s disease dementias for the next five years to identify the genes involved, possible biomarkers to aid in diagnosis, and the different pathways each disease takes as it progresses. “We’re looking at families because researchers studying Alzheimer’s disease have been able to identify early indicators so that we can treat people before the disease has an effect on the brain. We’d like to achieve the same outcome for other dementias. Certainly over the next five years we’ll know more about what differentiates nonAlzheimer’s dementias from Alzheimer’s.”

South Wales, with a major reputation in the area of pathology of neurodegenerative diseases. Most recently she was recognised with the award of the Elizabeth Blackburn Research Fellowship by the NHMRC. This annual prize acknowledges the research accomplishments and potential of top female scientists in the clinical, public health and biomedical sciences, while taking into account their international profile and the mentoring they provide to junior researchers. The fellowship, which has been named in honour of Australian Nobel Laureate Professor Elizabeth Blackburn, is the only national research award for women. “NHMRC Research Fellowships provide the career support for our most outstanding researchers and we are delighted to have someone of Glenda’s calibre leading a team that is identifying factors that lead to degeneration of the brain in dementia patients,” says Neuroscience Research Australia’s CEO Prof Peter Schofield. The NHMRC Elizabeth Blackburn Fellowships were first introduced in 2011 to foster the career development of female scientists, a move that Prof Halliday endorses. “In a career, women usually have to take time out for having families and that means their career doesn’t have a normal trajectory. So when they come back in, their compatriots look like they’re streets ahead,” she explains. Prof Halliday’s published works have been cited over 8,500 times and her early work established the more widespread pathology now accepted as integral to Parkinson’s disease. She was among the first to recognise the association between visual hallucinations and cortical Lewy body formation. “My group is also internationally recognised for work on genetic forms of Alzheimer’s disease (I am part of the international consortia for the Dominantly Inherited Alzheimer Network), and my research is integral to the international Frontotemporal Dementia Research Group. This group published the first survival and longitudinal analyses of these disorders and developed the first predictive clinical assessment tools.” By highlighting the career paths of women such as Prof Halliday, it is hoped that younger female scientists will be inspired to remain working in research. “The NHMRC knows that a lot of women are lost to the scientific workforce,” she agrees, “and there are more female PhD students than male, but not as many women use their PhD in the senior workforce for a variety of reasons. Creating this award helps provide role models so that women are reminded to keep pursuing their career path.” To find out more about the health and medical research conducted at Neuroscience Research Australia visit www.neura.edu.au

Celebrating women in research Prof Halliday is the Head of the Ageing and Neurodegeneration Research program at NeuRA where her core area of research is neurodegenerative diseases. She is the Director of the Sydney Brain Bank, which is a national research facility funded by the National Health and Medical Research Council of Australia (NHMRC), and is also the Professor of Neuroscience at the University of New

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20 year study provides valuable data on Australian women’s health Two decades of data collection by the Australian Longitudinal Study on Women’s Health at the Universities of Newcastle and Queensland has created a rich resource for both policy makers and researchers.

his autumn marks 20 years since researchers began surveying tens of thousands of Australian women about their health and well-being.

It has been a phenomenal undertaking by the Australian Longitudinal Study of Women’s Health (ALSWH) team at the Universities of Newcastle and Queensland. They have processed close to 250,000 survey papers, capturing information on 114 million variables—chronicling women’s experiences on everything from weight and exercise to mental health, life stages and how they utilise health services. The study is a long-term investment by the Australian Government Department of Health in gaining a greater understanding of factors which improve or inhibit good health in women of all ages. The 20 years of data collected also represents a rich resource for those researching a broad range of women’s health issues, and has been used in hundreds of peer reviewed papers. Since 1996 more than 58,000 women have completed ALSWH surveys, providing both qualitative and quantitative data on physical and emotional wellbeing. Those who have been with the study since the start were recruited in three cohorts – reflecting young (18-23), mid-aged (45-50) and older women (70-75). Comparisons between the cohorts allows researchers to establish whether the nature and extent of health problems represent generational differences, or the position of women in the life cycle. As the initial cohorts aged, a fourth cohort of young women was recruited in 2013 to ensure ALSWH continues to reflect the adult lifespan. The study is directed by Professor Gita Mishra, Head of the Epidemiology and Biostatistics Division of the University of Queensland’s School of Public Health and Professor Julie Byles, Director of the Research Centre for Generational health and Ageing at the University of Newcastle.

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Professor Mishra said the project studies women’s health and health service use in the context of their personal, family, social employment and economic circumstances. “The longitudinal design provides a unique opportunity to explore causal relationships between those factors and long-term health and well-being.” In recent weeks a number of significant papers on diverse public health topics have been based on ALSWH data. University of Newcastle researcher Jenny Powers was able to show that 16 per cent of young Australian women could be classified as “extremely frequent” binge drinkers and may be increasing their risk of depression. Her University of Newcastle colleague Dr Cath Chojenta found that women with a history of mental health problems are overwhelmingly more likely to suffer postnatal depression (PND) than other women, highlighting the need for early intervention. At the University of Queensland Dr Paul Gardiner identified three distinct patterns of frailty in older Australian women, and determined those who experienced income stress later in life were at greater risk. Professor Byles said ALSWH has provided evidence to support changes to national health guidelines and policies, and public awareness campaigns. “Our primary aim is to ensure that the findings can be translated into policies and practices which are relevant and which reflect the social and cultural diversity of Australian women.” For example, published ALSWH research contributed to recommendations in the Australian Government 2014 Physical Activity Guidelines on prevalence and predictors of weight gain, sedentary behaviour and health.

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Since 1996 data from ALSWH have been provided to collaborators for use in more than 650 research projects. That demand is increasing, with data supplied during 2015 to collaborators for 63 new projects across Australia and overseas. Each survey is carefully formulated to ensure researchers are getting the best possible insight into those factors that are helping women to be healthy, or having an adverse impact on their wellbeing. Women might be asked about their preferences when it comes to health services, about illnesses or life events they’ve experienced and how they spend their time. As well as completing the regular surveys, women are at times invited to participate in sub-studies targeting particular areas of health. These have included topics including domestic violence, diabetes, menopausal problems and caring. In recent years ALSWH has become a key foundation study for three other studies: the Centre for Research Excellence in Women’s Health in the 21st Century (CREWH21), the International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE), and the Mothers and their Children’s Health Study (MatCH).

In their qualitative responses many participants have expressed their pride in being able to make a difference for the generations of women who will follow them. Professor Mishra said ALSWH researchers are incredibly grateful for the generosity of participants. “These women are providing a lasting legacy by sharing information about their health journey.” With two decades of data to draw on, ‘Reaping the Benefits’ will be the theme of ALSWH’s inaugural Scientific Meeting which will be held in Newcastle in May. Those attending will be updated on the latest outcomes of ALSWH as well as current life course research methods. The meeting is aimed at anyone with an interest in women’s health, including researchers, policy makers and clinicians. Sessions will cover topics including sexual and reproductive health, mental health, abuse and trauma, healthy behaviours and health services and systems. More information about ALSWH or accessing study data is available from www.alswh.org.au and for information about health and medical research at the University of Newcastle visit www.newcastle.edu.au

In MatCH, funded by the National Health and Medical Research Council, mothers from the 1973-78 ALSWH cohort have been invited to participate in a survey of every child in their family, providing an unparalleled opportunity for a family-centred approach to child health outcomes. Two decades in, the older cohort now aged 90 to 95 show tremendous loyalty to the study, although many of them now require the help of a family member or carer to continue to provide their data.

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Australian Cancer Research Foundation awards $17m to advance cancer research Thanks to the kindness of their donors, the Australian Cancer Research Foundation awarded one of the largest private grants for cancer research equipment to Children’s Medical Research Institute in Westmead, Sydney. Plus four other grants to ground-breaking cancer research projects across Australia. Children’s Medical Research Institute’s Professors Roger Reddel and Phil Robinson, co-leaders of the Australian Cancer Research Foundation International Centre for the Proteome of Cancer.

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he $10 million Australian Cancer Research Foundation’s 30th anniversary grant will help establish The Australian Cancer Research Foundation International Centre for the Proteome of Cancer (ProCanTM). Cancer proteomics is an important new frontier in cancer research as most of the drugs used to treat diseases such as cancer interact with proteins. Knowing what proteins are present in cancers is essential for developing new cancer treatments, and to use existing treatments as effectively as possible. The researchers at the Children’s Medical Research Institute will analyse the proteomes of tens of thousands of samples of all types of cancers from all over the world. And will develop a library of information to enable rapid and more accurate development and initiation of the most appropriate cancer treatments for each individual patient. “Australian Cancer Research Foundation challenged the Australian cancer research community to propose projects that were bold and that would have a very significant impact on cancer prevention, detection and treatment. The response was tremendous with six very impressive projects submitted,” said Professor Ian Brown, Chief Executive, Australian Cancer Research Foundation. “Our international judges were impressed both by the quality and vision of the applications and the high standard of Australian research. Children’s Medical Research Institute was chosen after lengthy discussion to be the best of the best.” In addition to the grant from Australian Cancer Research Foundation, Cancer Institute NSW will be supporting research at the Australian Cancer Research Foundation ProCan by funding a full time researcher at Children’s Medical Research Institute to operate the new technology.

Enabling technology is key to unlocking cancer’s secrets In 2015, the Australian Cancer Research Foundation also supported four projects that focus on shortening the time between discovery and clinical trials and look for new cancer treatments and innovative early detection methods. The annual Australian Cancer Research Foundation grant recipients were selected by the organisations Medical Research Advisory Committee comprising eminent Australian and international cancer researchers and clinicians. The Australian Synchrotron was awarded $2 million for the establishment of the Australian Cancer Research Foundation Detector. The new technology, which is available at only a handful of other synchrotron facilities around the world, will enable the shape and function of proteins to be analysed ten times faster, and more accurately. This will shorten the timeline from laboratory research to clinical trials of new cancer drugs. Professor Michael Parker, Deputy Director of St Vincent’s Institute of Medical Research in Melbourne and co-Principal Investigator on the successful grant, said that proteins are crucial to understanding disease and treatment targets. “With malfunctioning proteins causing many diseases, including cancer, arming researchers with clear representations of protein structures supports efforts to design drugs that target particular proteins, to boost their anti-cancer properties or suppress their cancer-enabling effects.”

“This project has the potential to give an advantage to Australian cancer research and to develop new treatments that may have worldwide impact,” Professor Brown said. Another $2 million grant will help establish the Australian Cancer Research Foundation Cancer Discovery Accelerator facility in Adelaide. The Accelerator, based at the Centre for Cancer Biology (CCB), aims to significantly enhance our understanding of fundamental cancer biology and translate these findings to improve outcomes for cancer patients. “The CCB is conducting breakthrough research capitalising on genomics and various experimental models, which is fuelling the discovery of genes proteins and regulatory RNAs (ribonucleic acids) which are natural suppressors of cancer,” Prof Brown said. “Converting these discoveries into actionable targets for drugs is the goal of the project. The Australian Cancer Research Foundation Cancer Discovery Accelerator will provide access to new methodologies for uncovering molecular mechanisms relevant to cancer, and it will facilitate the transition of these discoveries into treatments that will benefit patients with all types of cancer. ” The Thoracic Research Centre at the University of Queensland received $1 million for the establishment of the Australian Cancer Research Foundation Centre for Lung Cancer Early Detection. The Centre will conduct research into the discovery and development of innovative methods for detecting lung cancer as early as possible. Lung cancer remains a major worldwide cause of cancer deaths, and early detection will improve treatment outcomes and survival rates. “One of the projects will investigate unique molecules and biomarkers of lung cancer that are likely to be in the exhaled breath of a person with lung cancer from a very early stage. The earlier a cancer is found, it usually improves the success of the treatment. It’s innovative, and has the potential to change the way lung cancer is diagnosed,” said Professor Brown.

Discovery is often preceded by a major technological advance Technology has become one of the most essential elements in making lifesaving discoveries. To date it has underpinned some of the most significant breakthroughs in the treatment and prevention of cancer and is now enabling truly personalised care for patients. A great example of the impact of the Australian Cancer Research Foundation’s innovative funding approach is the success of the cervical cancer vaccine. In 1999, vaccine creators Professor Ian Frazer and Jian Zhou received seed funding from the Australian Cancer Research Foundation to help them purchase equipment which would help them uncover the world’s first cancer vaccine. The vaccine that has now been available for almost a decade has been given safely to over 187 million people in over 130 countries, preventing two thirds of deaths caused by cervical cancer. They were initially turned down by several funding bodies before being awarded an Australian Cancer Research Foundation grant. Through its fundraising activities and grants, the Australian Cancer Research Foundation gives all Australians the chance to invest in research projects that have a real impact and are closing in on the answers that will finally bring an end to cancer. For more information about Australian Cancer Research Foundation visit www.acrf.com.au

The John Curtin School of Medical Research, Australian National University received $2 million for the establishment of the new Australian Cancer Research Foundation Department of Cancer Biology and Therapeutics. The department will help to understand the underlying biology of cancer and to develop new drugs to treat Australian cancer patients. Research will focus on Australia’s chemome (whole sets of small molecule natural products) and explore the existing collections for novel lead compounds that can be developed into drugs for cancer therapy.

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Moving with the power of thought A device the size of a matchstick, implanted next to the brain’s motor cortex, could one day help paralysed people move their limbs

group of paralysed patients will soon undergo a revolutionary procedure that could allow them to walk with the power of thought.

The key to returning mobility is a tiny, matchstick-sized device called a stentrode. It will be implanted into a blood vessel next to the motor cortex, the brain’s control centre, bypassing the need for complex brain surgery. From there it will pick up brain signals and allow patients to move a robotic exoskeleton attached to their limbs simply by thinking about it. This notion of wirelessly thought-controlled limbs is within reach, thanks to a collaboration of 39 brilliant minds from 16 departments across the University of Melbourne’s medicine, science, veterinary science and engineering faculties. The new device is the result of close collaborations between the University of Melbourne, the Royal Melbourne Hospital and the Florey Institute of Neuroscience and Mental Health. A research paper published in Nature Biotechnology hails the preclinical animal trials of the stentrode, which measures only three millimetres wide, a success. In late 2017, a select group of paralysed patients will be chosen for the trial, where they will be implanted with the stentrode. If the trial succeeds, the technology could become commercially available in as little as six years. The stentrode could also benefit people with Parkinson’s disease, motor neurone disease, obsessive compulsive disorder and depression and could even predict and manage seizures in epileptic patients. Neurologist at the University of Melbourne, Florey Institute and the Royal Melbourne Hospital, and current endovascular neurosurgery fellow at Mount Sinai Hospital, New York City, Dr Thomas Oxley, is the founder of this technology. Under the supervision of Professor Terry O’Brien, from the Royal Melbourne Hospital and the University of Melbourne’s Medicine,

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Dentistry and Health Sciences Faculty, Dr Oxley assembled a team of scientists, neuroscientists, surgeons, doctors and engineers, who with $1.3 million initial DARPA funding, leveraged two large grants from the Australian National Health and Medical Research Council for a further $2.2 million. Professor O’Brien, who is Head of the University’s Department of Medicine at the Royal Melbourne Hospital, has dubbed Dr Oxley’s new technology the ‘Holy Grail’ of medicine. “This technology is really exciting. It’s the first time that we’ve been able to demonstrate and develop a device that can be implanted without the need for a big operation, to chronically record brain activity,” Professor O’Brien says. “The most obvious benefit is for people who are paralysed following a stroke or spinal cord injury. It is simple and non-invasive and much safer for patients.” The stentrode, designed in Melbourne and crafted from a spaceage alloy called nitinol, will be inserted into the blood vessel with a catheter fed up through the groin – the same approach that has been used for years for cardiology and removing stroke clots. When the catheter is inserted into the blood vessel in the brain, it leaves a small cigar-shaped ‘basket’, wired with electrodes, which can record the brainwave activity. “There is no craniotomy, no risk of infection, it’s all run through the groin and passed inside the body up into the brain,” Professor O’Brien says. “This has been the Holy Grail for research in bionics – a device that can record brainwave activity over long periods. Inside the blood vessel, it’s protected, it doesn’t damage the brain vessel and can stay there forever.” Professor Clive May, from the Florey Institute of Neuroscience and Mental Health, trialled the technology in the brains of healthy living sheep. He recorded this seamless integration of technology and biology, with the device reading electronic brain signals from the

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motor cortex loud and clear. The sheep were unaffected by the painless, quick and simple operation and were walking and eating within an hour. “As the device absorbed into the vein wall after nine or so days, the electrical signals continued to become clearer and stronger, up to 190 hertz, as strong as signals previously recorded with intricate invasive brain surgery,” Professor May says. Importantly, Professor May showed that the stentrode can be safely left inside the vessel wall long term, and does not cause any bleeding or clotting. “Personally, the fact that our device can record signals up to 190 hertz is the most exciting finding in our ‘Nature Biotechnology’ paper,” Dr Oxley adds. “The data between 70 to 200 hertz is the most useful for brain machine interfacing.” The chief engineer behind the device is the University of Melbourne’s Dr Nick Opie, a Senior Research Fellow and co-head of the Vascular Bionics Laboratory at the Royal Melbourne Hospital. He and Dr Oxley co-founded SmartStent, the company that will translate this research into reality. Dr Opie was recruited from the bionic eye project. His challenge: to engineer a tiny net-like device that could be fitted with electrode receivers. “The first iteration was pretty horrible,” he admits. “I don’t want to count how many we’ve made. It required a lot of microscope work and very steady hands.” Hundreds of iterations later, Dr Opie and his team produced the winning design using a flexible material called nitinol, also used in bra underwires and for modern glasses frames. It is fitted with tiny recording discs, called electrodes, which sit on the wall of the blood vessel, right next to the brain tissue. Each disc records electrical activity fired by some 10,000 neurons, which is delivered via delicate wires that run out of the brain, into the neck and emerge into the chest into a wireless transmission system.

The researchers say this transmission can be coded into signals that control an exoskeleton. The first patient will work hard to ‘code’ each of these unique signals to their exoskeleton. Much like the process of learning to walk or speak again, the process will take many months, until finally, the movement becomes as effortless as driving a car, touch-typing, or writing your name on a form. In 2017, the stent will be implanted into carefully selected paraplegic or quadriplegic patients by surgeons at the Royal Melbourne Hospital. The first patients will most likely be young people who have suffered a traumatic spinal cord injury around six months to a year earlier, who are suitable for exoskeleton legs. But, Dr Oxley says, it will be a matter of years before people with paralysis will be able to ask for this treatment. “The process for getting commercial approval for new medical devices is a long process, so realistically, it could be another five to seven years away,” Dr Oxley says. “And during that five years, we’d have to do a broader clinical trial of closer to 30 to 40 people. So we are hopeful this will be on the market by 2022.” This work was funded by DARPA, the NHMRC, the US Department of Defense, US Office of Naval Research Global, the Australian Defence Health Foundation, the Brain Foundation. For more information regarding health and medical research at the University of Melbourne visit www.unimelb.edu.au, and the Florey Institute of Neuroscience and Mental Health visit www.florey.edu.au

Professor Clive May from the Florey Institute of Neuroscience and Mental Health with the Stentrode device.

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Safeguarding the future of medical research: the need for leaders to drive innovation We must act now to implement strategies which will increase the innovative capacity of future research leaders, ensuring the continued evolution of scientific discovery and the delivery of improved healthcare to patients.

he future leaders of innovative research are today’s early-mid career scientists. Yet we’re rapidly losing these young scientists, either overseas where there are more funding opportunities, or to other professions. Those who do stay in the field are known to increasingly pursue “safe” and conservative research to boost their chances of securing funding, rather than leading more innovative research projects with higher perceived risk. With a “publish or perish” culture driving focus towards research “output”, the development of the broad but less tangible set of skills crucial for effective leadership can also take a backseat. Research leaders of the future are faced with an increasingly complex research and healthcare sector, and will need to be armed with strategies and resources to successfully drive scientific discovery all the way from the laboratory through to market. However the current generation of emerging scientists are being deprived of both funding for leading innovative research, and the opportunity to build skills and experience that they will depend on in the future. So what can we do? How can we equip emerging leaders with the skills that enable them to effectively drive innovation, strategy and progress? Australia excels in innovative capacity, with “research output” as measured by citations ranking sixth in the world, but we rank 81st for translating this innovative capacity into real-life innovation and healthcare advances. Increasing the delivery of innovation is now an urgent priority for governments and the health and medical research sector. The recently released National Innovation and Science Agenda states that the Australian Government will “make innovation central to all our major policies going forward”. Specifically, the Agenda outlines new policies relating to increased university

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funding for collaboration, increased funding for commercialisation of research, and incentives for collaboration between academic research and businesses. What these policies lack is investment in the individuals who will be responsible for delivering innovation. Today’s world-class research leaders will not be around forever, and emerging researchers are not being trained in the broad range of skills and leadership experience that they will depend on when the baton is passed to them. Traditionally, scientific leadership is learned “on the job” as scientists progress from working on their mentor’s project under supervision, to leading small projects and then a research team within a larger laboratory, to leading large collaborative research programs. This approach can no longer be relied upon. Funding scarcity has resulted in a conservative, risk-averse approach to research investment, leading to preferential funding of established scientists with strong track records. Early-mid career researchers simply cannot compete and miss out on the opportunity to lead their own research projects and develop crucial leadership skills in the process. This is creating a void in the future academic workforce at a time when innovative leadership is absolutely crucial.

Recommendations There are three key areas in which a relatively small investment could maximise leadership capacity of early-mid career scientists: 1. Develop core leadership skills of emerging research leaders Major universities and academic institutions are recognising the growing need to support career development of scientists, but

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the generic, and often self-directed, training programs available aren’t always delivering the right information and engagement opportunities, and are also not widely accessible. Leadership training and courses should be tailored to address the specific needs of early-mid career researchers attempting to launch an independent career. These courses should cover technical skills such as project management, budget development, intellectual property management and research communication, as well as training on how to build and manage an effective research team and devise strong and feasible research projects.

In the short-term, increased success in securing research funding.

2. Connect emerging leaders with established research leader mentors

Investing in our future leaders must be a priority if we wish to ensure the sustainability, progress and innovation of health and medical research. And we can act now. We must capitalise on Australia’s strong, collaborative network of senior researchers to provide the ideal environment for supporting our emerging leaders. A concerted effort to enhance the ability of these future research leaders to navigate and lead in the complex research environment will have enormous flow-on effects for type 1 diabetes research, in line with JDRF’s mission to accelerate life-changing breakthroughs to cure, prevent and treat type 1 diabetes and its complications. This will advance innovations that are urgently needed to translate into new therapies, and ultimately result in improved healthcare for the 120,000 Australians currently living with the lifelong autoimmune disease.

Connecting emerging leaders with mentors will complement skills learnt in formal leadership training programs. Mentors can provide direction on putting learnings into practice, provide valuable connections and can help to build and manage large collaborative networks. Mentoring programs should be structured and goal oriented, with regular meetings aimed at addressing specific career objectives. 3. Provide opportunities for external stakeholder engagement Understanding how industry, regulatory affairs and government work is vital for research leaders in ensuring the progress of their innovative idea from the laboratory through to the patient. Engaging with key external parties takes practice, and it can be difficult to achieve without influential connections. Increasing opportunities for early-mid career researchers to engage with these stakeholders will help to initiate these connections for future liaisons.

In the mid-term, improved capacity of early-mid career researchers to successfully develop and deliver innovative research projects, increasing publication output. In the long-term, through building on the foundation of skills and experience gained, these researchers will be well-placed to effectively lead and influence the field of type 1 diabetes research, driving innovation and progress.

To find out more about JDRF visit www.jdrf.org.au

An intensive, multi-faceted strategy such as this would have farreaching outcomes.

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Formula 1 technology used to speed up research and manufacture medicines Formula 1 cars and Grand Prix racing may seem like a world away from the slow process of medicine discovery but McLaren and GSK have used the F1 team’s expertise in engineering, technology, analytics, and strategy modelling to help deliver improvements in clinical research, manufacturing and understanding human performance.

ne of the first areas GSK and McLaren have partnered on is clinical development of new medicines. McLaren pioneered the data-gathering technology used today across Formula 1 by all racing teams, which helps in the analysis of an F1 car’s race performance. Over a race weekend, the McLaren team captures more than one billion data points from 500 sensors located on each car. The sensors record data on, for example, downforce, temperature and airflow, which all help to give an indication on how well the car is performing. These data are processed and transmitted back to engineers and strategists to enable in-race decision making. GSK has used McLaren’s expertise in data capture and analysis to help find better ways to capture, visualise and interpret clinical research information. Wearable or remote biosensors and mobile health platforms provide the opportunity to get highly-detailed and accurate monitoring of a patient’s physiology and behaviour. This information can potentially improve understanding of a disease and a patient’s response to medication. GSK has been conducting clinical studies with biosensors and mobile devices to monitor activity and vital signs in patients, and collect patient feedback in order to improve the quality of data used to help decision making in the development of new medicines. This technology can also be used to send reminders to patients to help them stay on track with a clinical trial protocol. Applying McLaren’s expertise in biotelemetry to clinical studies, allows the collection of continuous patient data in real time and in a real world setting, rather than data from a single test at a single point in time. “Using this type of technology benefits patients in other ways too – it can mean fewer trips to the clinic as biosensor devices can be used for remote monitoring. And because these devices are able to continuously monitor activity, such as the amount of time a person is active or asleep, the end result is a much more robust collection of data with minimal interruption to a patient’s day-to-day life” said Dr Andrew Weekes, Medical Director, GSK Australia.

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GSKs work with biosensors and mobile health platforms is currently helping to better understand: Area of Study Respiratory Neuroscience Immuno-inflammation

Clinical trial targets COPD, Asthma Amyotrophic lateral sclerosis (ALS), Stroke Rheumatoid arthritis

Another area GSK and McLaren collaborate is to strengthen manufacturing processes. Each year GSK’s global manufacturing and supply business produces four billion packs of medicine and consumer healthcare products and 900 million doses of vaccines. McLaren has helped identify where efficiencies can be made in how GSK manufacture products. Many processes in a factory have similar steps to a choreographed pit-stop in Formula 1: the team working on the project needs to be coordinated, with a very clear goal and ensure every action is done appropriately with the right quality to get a good result. Working with McLaren engineers, GSK took a fresh approach to how they run ‘changeovers’ (setting up a production line to change from making one product to another) at some of their factories, allowing the teams to massively improve on efficiency. At one factory making Sensodyne and McLeans, this allowed GSK to cut their changeover time from 39 minutes to just 15, allowing the £15 million production system to fill an additional 6.7 million tubes of toothpaste per year – though in reality it gave GSK the flexibility to change lines twice as often without losing any production time The final area GSK and McLaren are working together is to understand human performance. GSK has built a world-class lab in London that is wholly focused on the science of human performance. Scientists in the GSK Human Performance Lab (GSK HPL) are gathering insights into the human body and brain. GSK’s aim is to use these learnings to improve consumer healthcare products and inform wider research, seeking not just to meet healthcare needs but to also anticipate them. At the start of last year, McLaren Honda mechanics undertook a series of body composition, cognitive, physiological and strength assessments in the lab. The assessments were carried out over a two day period to gain a thorough and detailed analysis of the

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GSK Human Performance Lab

team. Each mechanic was then given a personalised nutrition and fitness plan in order to help them prepare in the best possible way for the long season ahead. The plan helps the team better deal with extremes of climate, travel, time zones and periods away from home that impact on their performance. The tests help identify key areas for individuals and to start to build new strategies in sleep, travel, nutrition and fitness to cope. The team will visit the GSK HPL for follow up assessments throughout the season. McLaren Honda’s drivers use a drink in their McLaren Honda MP4-30 F1 cars during every Grand Prix that has been specifically designed for them by the GSK HPL team. The unique formulation helps ensure they stay at peak condition during the demands of a Grand Prix weekend. The drink, which has been developed by working with the drivers over a period of months, contains a personalised glucose and electrolyte formulation. This provides their replacement of fluid and salts lost when racing and the maintenance of blood glucose to enhance performance. It is

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specifically formulated for the drivers, as sweat rate and fluid loss vary greatly between individuals. GSKs final aim for the HPL is to keep pushing the limits of human performance to help people do more, feel better, live longer. This partnership has been beneficial for both companies with obvious gains in manufacturing and advances in clinical research being of great benefit to GSK, while McLaren are utilising the GSK HPL to ensure that their entire team is performing at their peak through the gruelling F1 season. For more information on GSK visit www.gsk.com

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Carol Bryant, CEO, Macquarie University Hospital & Prof Patrick McNeil, Executive Dean Faculty of Medicine and Health Sciences

‘Matrix’ model takes research to new heights A joint venture between Macquarie University and Macquarie University Hospital and Clinic has established the new Macquarie University Health Sciences Centre – a unique model of health care integrating clinical care, learning and research.

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acquarie University’s bold vision for health care in Australia became a reality last year when it established Australia’s first university-led integrated academic health campus. The new Macquarie University Health Sciences Centre (MUHSC) will see translational research, medical education and training, and patient care brought together in an unprecedented way. At its core, the venture is a carefully planned and implemented partnership between one of Australia’s most established advanced medical training institutions and the nation’s first private hospital on a university campus. Patrick McNeil, Executive Dean of the Faculty of Medicine and Health Sciences, says that when it came to looking at how to blend the two organisations for most effective research, learning and patient outcomes, a ‘matrix’ structure provided the nuanced integration they were after. “If you look at other hospitals with medical schools attached to them, the medical school is generally not integrated very well,” said Professor McNeil. “Academia is not always well understood by hospitals. “Our goal has been to create a single enterprise that breaks that separation between hospital and faculty. No doubt this has been easier to do in the private sector than public. However, we have still needed to be diligent about creating a solid structure. “The matrix structure has allowed the interface between the University’s five academic departments and the Hospital’s seven clinical programs, in ways that are nuanced rather than rigid. The matrix intentionally encourages connections between different academic and clinical areas, a sort of cross-pollination that avoids silos. Neurosciences, for example, might have people from all five academic departments participating in research and clinical trials.” The Faculty is now structured around five academic departments – Biomedical Sciences, Clinical Medicine, Health Professions, Health Systems and Populations, and the research-intensive Australian Institute of Health Innovation. The Faculty replaces the disestablished Australian School of Advanced Medicine, and includes the relocation of the large Australian Institute of Health Innovation from the University of New South Wales to Macquarie University with around 130 leading researchers and research students from three centres. The Institute now has the largest concentration of researchers and grant funding in the field of health services research in the nation. Macquarie University Hospital simultaneously tightened focus around seven core clinical programs with senior clinicians leading the integration of clinical services, teaching and research in a patient-centric manner, within and between their programs and across the Hospital. “The changes enable us to build core hubs of combined research and clinical expertise, such as our world-leading motor neuron disease research group, which works closely with Macquarie University Hospital’s clinical experts in MND and is now the most comprehensive MND research team in Australia,” explained Professor McNeil.

between clinician, scientist and patient that is critical to its vision. For example, the work of the melanoma cell biology team–led by Professor Helen Rizos – absolutely depends on a close and productive relationship between clinicians and researchers.” Innovative research synergies are popping up everywhere, researchers say. Indeed, Professor Rizos’ cell biology team has now collaborated with the MND team to include zebrafish models in their work – something that would never have happened if the zebrafish program did not already exist at the Hospital. But the vision has also embedded change at the most fundamental level – the training of next-generation scientists in the undergraduate degree. And in this regard, it is the Faculty’s new Bachelor of Clinical Science degree that is one of the most exciting sites of change. The degree aims to assist students in learning the fundamentals of biomedical sciences and research, and then applying this knowledge to clinical scenarios with a strong emphasis on evidence-based practice. “The new course aims to strengthen training of the future health workforce at the undergraduate level,” said Professor Rizos, who is also Head of the new Department of Biomedical Sciences. “This program stands out in how it will better prepare students early on in their academic life to pursue careers in clinical practice and research. “Importantly, the Bachelor of Clinical Science will highlight our research strengths, and is taught by leaders in clinical practice and medical research. This degree is, in some ways, the backbone of the integration embedded in the Macquarie University Health Sciences Centre by training clinicians with a research focus and researchers with a clinical focus.” Having these two components of medicine better able to ‘talk to each other’ and to work together in productive ways underpins the careful structure that is present throughout the many facets of MUHSC. It is what provides the foundations for the latest research discoveries to be translated across to patient care, and to improved patient outcomes. To ensure a strong organisational culture is in place to support the health sciences initiative, the University and Hospital have aligned their values to encourage an environment rich in new ideas, teamwork and care that – importantly – always places the patient at the centre. “The three guiding principles that we clearly established for Macquarie University’s bold new health sciences centre are that it should encourage collaboration, be patient-focused where possible and be boldly innovative in its design,” said Professor McNeil. “I’m confident we’ve achieved all three.” For more information about Macquarie University Health Sciences Centre visit www.muh.org.au

“Melanoma research is another of our outstanding research areas and foregrounds the initiative’s commitment to the alliance

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Broncos Partnership, Game Changer for Human Movement and Nutrition Research The Brisbane Broncos are known to have big appetites, but they’ll be paying special attention to what they eat after announcing a University of Queensland scholarship for their own nutritional advisor.

The three-and-a-half-year scholarship worth $112,000 funds a doctoral student from The University of Queensland’s School of Human Movement and Nutrition Sciences to research and improve the team’s diet. It’s one of the latest developments of the landmark partnership announced in April 2015, joining the most successful Australian rugby league club of the past 30 years and one of Australia’s topranked universities. Senior Lecturer in Nutrition and Dietetics Dr Michael Leveritt, who previously worked for the Australian Institute of Sport and Queensland Academy of Sport, said nutrition was vital for athlete development. “Implementing and evaluating nutrition interventions are keys to the discovery of improved practices that can enhance on-field performances,” Dr Leveritt said. “The Brisbane Broncos are leaders when it comes to the science of rugby league and this investment will help keep them at the forefront.” PhD candidate Mr Dean Paningbatan was the first student awarded the scholarship. He is one of many UQ Human Movement and Nutrition Sciences students working side-by-side with Broncos coaching and high-performance staff as they attack the 2016 season.

“Most people are aware that effective sleep helps recovery and tissue repair, so we’re building an education intervention around that, particularly aimed at the Broncos’ younger players. It considers everything from how long they should use their mobile phone through to the environment they sleep in. In the English Premier League they drill down to what specific type of pillow each player should use, but I don’t know if we will go that far just yet.” Another UQ-developed tool which is already being utilised by the NRL powerhouse is the Match Difficulty Index. Proving remarkably accurate, the index predicts the outcome of each game based on a number of factors, including home ground advantage, time between matches, the ranking of both teams and line-up changes. “It actually becomes more interesting when the team performance does not reflect the prediction of the model,” Mr Kelly said. “If the model has said you should lose, but you end up winning, can you track that back to something you did in preparation or was it an extraordinary performance by the players? Likewise, if you should have won, but in reality you lost, what has gone wrong there that you can identify?”

For the Broncos, NRL grand finalists in 2015, it is just as important to develop a reputation for leading the competition off the field as on it.

Mr Kelly said the Match Difficulty Index successfully predicted the Broncos’ round 21 loss to Manly (44-14) in 2015, which took many by surprise at the time.

UQ School of Human Movement and Nutrition Sciences high performance expert Vince Kelly said there were several other research projects underway with potential impact for the Broncos. “One interesting study is centred on what we call ‘sleep hygiene’, basically using sleep as a weapon for better performance,” Mr Kelly said.

Other UQ projects underway with rugby league implications include an analysis of developmental pathways and methods of postmatch recovery. One of those students actively involved is PhD candidate Mr Johnpaul Caia, with his work centred around recovery in particular.

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UQ Bachelor of Exercise and Sports Sciences (Honours) student Carolyn Seng monitors Brisbane Broncos player Keegan Hipgrave.

“It’s been a fantastic opportunity to combine doctoral research with working alongside staff from an elite sporting organisation,” Mr Caia said. “We are learning from some of the best when it comes to sports performance. I’ve been really impressed by the club in terms of their professionalism and focus and it’s a great environment to learn in.” Honours student Ms Marni Simpson also worked with the team. She will graduate from UQ in December after spending eight months of practical placement with the Broncos. “I learnt so many skills, particularly around collaboration and communication,” Ms Simpson said. “Being a Broncos supporter, I had to pinch myself at the chance to benefit from their feedback.” UQ Vice-Chancellor and President Professor Peter Høj said the partnership recognised existing linkages in teaching and research activities and a desire to strengthen those links. “The Broncos are synonymous with success – both on the football field and in the business world,” Professor Høj said. “They have fans right across the state’s regional and rural centres, plus plenty of loyal followers interstate. UQ is proud to be associated with the Broncos and we look forward to building a strong partnership that benefits both organisations.”

“We share many values with UQ and look forward to working with them to tell their wonderful stories across the state through our fans, our match days and our events across Queensland.” The Broncos have remained one of the most successful NRL clubs since their inception in 1988, winning five NRL premierships (1992, 1993, 1998, 2000, 2006) and a Super League premiership (1997). The team has the largest fan base of any football club in Australia, with more than 1.1 million fans nationally, including almost 390,000 females – the largest female fan base in the NRL, and they are regularly the most watched NRL team in the regular season with unparalleled TV viewership and venue attendance figures. Professor Høj noted the Broncos have consistently achieved at the highest level, mostly guided by master coach Wayne Bennett. “This partnership helps UQ and the Broncos to continue to formalise a pre-existing relationship, based on our mutual strengths and areas of interest,” Professor Høj said. “As one of the world’s top universities and one of Australia’s outstanding sports clubs, both organisations aim to achieve at the elite level, without being elitist.” For more information about health and medical research conducted at the University of Queensland visit www.health.uq.edu.au

Broncos CEO Paul White Mr White said UQ and the Broncos shared many values. “The Broncos are delighted to have an educational partnership with an iconic Queensland organisation such as The University of Queensland,” he said.

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Women need to be their own greatest champions The issue of gender inequality in the national science sector is gaining attention as individuals and organisations recognise the importance of action to address this critical issue. Two of Australiaâ&#x20AC;&#x2122;s leading scientists, Associate Professor Rebecca Ritchie and Professor Bronwyn Kingwell discuss how female researchers can put their best foot forward when it comes to striving for gender equity.

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he well-respected journal Cell Metabolism is featuring a ‘Women in Metabolism’ series, asking female scientific leaders to share their stories and words of wisdom for the new generation. Key themes throughout have been to “dare to take yourself seriously” and ensure you have sponsors who can campaign aggressively on your behalf and provide you with perspective. This is sage advice for female scientists, particularly those at postdoctoral level and beyond, in a fiercely competitive, maledominated sector. An issue echoed by many over the years relates to the difficulty that many women have with self promotion and owning their success. It is a common reflection that women tend to underestimate their abilities. A female leader in metabolism, Associate Professor Deborah Muoio, wrote that women tend to ask for more after they deliver and men ask first and promise to deliver. Maybe, she says, we should take some lessons from the guys. In fact, it is something that I employed when trying to enter the senior research fellowship scheme, says Associate Professor Rebecca Ritchie. “The first year I applied, I didn’t even get an interview, I wasn’t even remotely close. The difference between that and securing a National Health and Medical Research Council Fellowship the following year was that I thought of two or three leading male scientists and I considered what they would have written about themselves if they had my CV. Even years later, when I share my application with others, I feel the need to point out that what is written is not how I view myself. But it is clear that if you don’t present yourself in the best possible light, it will still be assumed that you have, and you won’t get anywhere.” Perhaps we do need to get a better grip on personal branding, something that people such as Steve Jobs made an art form. His personal brand was defined by words and actions. He made clear what mattered to him – being passionate about what you do, being innovative and not afraid to break the rules, and looking beyond money to something bigger. Many of us are equally passionate about our work. This is why we stick at it despite the uncertainty and stress that comes with a career in science. But developing our brand and highlighting the unique assets, skills and experience that we bring to the table is something that we also need to hone alongside our ability to do great science and publish in wellregarded journals. Scientist-turned-business-leader Adele Gulfo wrote in the Huffington Post that personal branding is what differentiates you and your unique value proposition from others, it is not about self-promotion, it is a leadership imperative. Formerly president of Pfizer Latin America, Ms Gulfo says your personal brand “is not a list of accomplishments or an exercise in self-promotion. That’s an important distinction.” She says women need to be their own biggest fan. “I encourage my group heads to continually look for opportunities to surface their great work and compliments they’ve received,” Ms Gulfo says.

However much it might go against the grain, women do need to be their own greatest supporters. But equally, having someone to champion you is also critical. To really champion someone you need to be entrenched in the scientific network at both a national and international level, and of course, most of the people in the networks are male. This is not necessarily an issue, just the reality. We both have several mentors and champions, some are female but most are male. A champion or sponsor might suggest you as a speaker for an international conference, to be on an editorial board or to take on a policy role in an advocacy organisation. While such positions are achieved on merit, you do need to be on people’s radars in the first place to be offered such opportunities and a champion can play a pivotal role in this. Professor Sharon Bell and Professor Lyn Yates, who undertook a research project examining Women in the Science Research Workforce, found that “networks, connections and knowing the right people are seen as equally important as being good at your work” and that those whose circumstances did not provide the opportunity or time to develop supportive and influential networks were unlikely to succeed. The corporate sector is no different. The 2011 McKinsey report Unlocking the full potential of women in the US economy found that despite women’s unflagging confidence and desire to advance, the lack of a sponsor in upper management to create opportunities and exclusion from informal networks were key reasons that women choose to remain at their current level or move to another organisation. Being your own greatest champion, owning your success and developing a supportive network of mentors and champions is critical to female scientists achieving even greater success. For many of us, we need to consciously work at incorporating this into how we do business on a daily basis. It is widely agreed that there is a great deal more work to be done to improve the representation of women at senior levels in Australian medical research. The latest edition of Baker IDI’s Perspectives publication, titled Women in Science, focuses on gender inequality in the Australian science sector and explores how individuals and organisations are taking steps to effect change. If, and how, such measures can foster a cultural shift and bring real and sustainable change to the sector remains to be seen, with gender equality in science set to dominate the spotlight during the coming years. For more information about health and medical research conducted at Baker IDI Heart & Diabetes Institute visit www.bakeridi.edu.au

Associate Professor Rebecca Ritchie and Professor Bronwyn Kingwell from Baker IDI Heart and Diabetes Institute

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Trainers taking part in an Osteocise workshop at Fernwood Fitness Centre, Hornsby Sydney

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Exercise research hits the gym Exercise for health isn’t a new idea, but targeted exercise for bones is still gaining traction with doctors and the community. Osteoporosis Australia’s new project is a long-overdue practical step towards the introduction of an evidence-based program to help reduce the burden of osteoporosis in Australia.

staggering 4.7 million Australians over the age of 50 have osteoporosis or low bone density. By 2022, this figure will be closer to 6.2 million, a rise of over 30%. 1 in 3 women and 1 in 5 men will suffer a fracture due to osteoporosis at some point in their life. Osteoporosis can have disabling and even deadly consequences. Over half of those who fracture a hip will never regain their former independence, and women are nearly 5 times more likely to die within a year of experiencing a hip fracture, compared to their fracture-free counterparts. Osteoporosis medications are very effective in reducing fracture risk in those who know they have the disease, but could be thought of as “shutting the stable door after the horse has bolted”. With osteoporosis, early and targeted prevention is key. Osteoporosis Australia CEO Dr Greg Lyubomirsky is committed to osteoporosis prevention. “Our focus remains on prevention strategies, including exercise. Research is vitally important to understand how specific exercises can contribute to bone health and be utilised in a practical way”. It’s been known for some time that a combination of weight bearing, resistance and balance exercise contributes to improvements in bone density and helps to reduce the risk of falls in older people. Specificity is key, however, when it comes to exercise for bone health, and whilst regular exercise for the over 50s is an important preventative measure against the lifestyle-related diseases common to this age group, including hypertension, cardiovascular disease and diabetes, the often generalised approach of community-based exercise programming is unlikely to make a significant dent in the nation’s declining bone health. The Osteo-cise: Strong Bones for Life program, a joint initiative between the University of Melbourne, Western Health, Deakin University and La Trobe University, is a research and evidence based community program designed to improve musculoskeletal health and functional capacity in middle aged and older adults at increased risk of osteoporosis and fractures. The program is multimodal, incorporating traditional slow speed resistance training with high velocity power training, along with a variety of weight-bearing impact exercises designed to target the muscles around the hips and spine, and task-specific functional and balance activities to prevent falls and fractures. Resistance training is a core element of the Osteo-cise program because of its well-defined benefits on muscle strength, muscle mass and bone density. Crucially, the program incorporates the principles of specificity and progressive overload, targeting the muscles attached to or near the hip, spine and wrist, which are the most common fracture sites.

trainers and exercise physiologists took part in a specially developed workshop-based “Train the Trainers” program in Sydney, Melbourne, Canberra and Geelong. Take-up of Osteo-cise amongst fitness centre clients was impressive, with over 300 participating in the pilot. Dr Lisa Croucher, project manager of the Osteo-cise implementation pilot, was struck by the skill and dedication of the trainers taking part, particularly those working with clients with multiple health or mobility issues. “The commitment of the trainers, and their creativity and knowledge of their client’s abilities and limitations, was very important to the successful implementation of the program”. Most trainers chose not to maintain complete fidelity to the program, instead incorporating elements of Osteocise into their client’s individualised training regimes or adding core Osteo-cise exercises to established class-based exercise routines. This unexpected but very positive outcome is an indication of the adaptability of the program and its potential for realising one of the most important goals for the next phase of Osteo-cise – a safe and enjoyable program that can be adapted and expanded from its bone-specific foundation to address the multiple chronic disease priorities of the over 50s population. Trainers were overwhelmingly positive about the program and its potential, revealing opportunities for a high-quality, evidence based program addressing the bone health of older people. Professor Robin Daly, co-founder of Osteo-cise and a key member of the team delivering the pilot implementation, is keen to stress the program’s evidence base credentials. “In the past there have been programs that claim to assist bone health, but this is the first time in Australia we have taken evidence-based research findings into the real world of community based fitness centres as a pilot exercise approach for bone health. It is an important first step.” The importance of developing robust primary health referral mechanisms was also revealed by the pilot – health professional referral is an important pathway to exercise participation in this age-group. Plans are now underway for the next phase of Osteo-cise. A web-based platform will deliver a “Train the Trainer” program that remains true to the core principles of Osteo-cise, but has relevance to the range of the chronic disease priorities of the over 50s. A selfdirected program for consumers will extend the reach of Osteo-cise and introduce the concept of exercise for bone health to a new cohort of older Australians. These new developments will extend the reach of Osteo-cise and ensure its sustainability into the future. For more information about Osteoporosis Australia visit www.osteoporosis.org.au

Osteoporosis Australia has supported the development of Osteocise since its 2008 research beginnings, via a grant from the JO and JR Wicking Trust. In 2012, Osteoporosis Australia was awarded Commonwealth funding to carry out a pilot implementation of the program in community fitness centres. Completed in December 2015, the pilot has delivered encouraging outcomes. 38 fitness

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Rethink the system to drive new age of effective cancer treatment As US Vice President Joe Biden recently discussed his cancer “Moonshot” at the World Economic Forum, Cure Brain Cancer Foundation CEO Catherine Stace heralded that the data-driven scientific race to find new cancer cures is on.

had the pleasure of meeting Vice President Joe Biden last November at the GBM AGILE launch in Washington DC and spoke at the Washington Press Club on behalf of brain cancer patients globally. When he asked what Cure Brain Cancer Foundation does, I said:

“We do what we say and say what we do, which is a lot Mr Vice President.” I then shared our global work on GBM AGILE, led by the inspirational Dr Anna Barker from Arizona State University. Dr Barker, Dr Al Yung, Prof Web Cavenee, Dr Paul Mischel, Dr Sujuan Ba, Dr Mustafa Khasraw and 140 other scientists, clinicians and researchers have dared greatly and led GBM AGILE across USA, China and Australia. It is a giant leap forward to curing brain cancer and cancer overall. VP Biden held my hand and an unspoken connection was made to eradicate brain cancer using a collective and unspoken will, and a new approach to solving cancer. VP Biden has courage and his own grief as motivators. The subject of curing cancer has shaped policy and funding in Western civilisation for decades. Yet, despite our brilliant scientific advances, we have only witnessed incremental outcomes in brain cancer research. What if funding cures was as simple as reorganising ways of working, pruning inefficient and redundant approaches, repurposing treatments, and re-engineering scientific systems, making investing in cancer research attractive to mega-funds? This question has driven much of our strategy, leading to Cure Brain Cancer playing a prominent role in the launching GBM AGILE, a global adaptive clinical trial which is a new way of doing medical research to get results faster and more cheaply. Researchers have answers in the lab, but commercialising breakthroughs and supporting scientists to drive discoveries from bench to bedside has relied on limited pathways. Combine this with stifling controls at every twist and turn, policy, protocol and drip-feeding funding, it begs the question, “have we made it too complicated and controlled?”

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We want to flip cancer research so all roads lead to big data, creating a flow of insights, policymaking and funding, and compress time to breakthroughs. We need an over-the-top play on brain cancer. Big data is the hero of both science and pharma, for the faster we gather information on cancer, the faster we will find cures. Data insights help mitigate failure risk upfront before a patient enters a trial, saving time and money and giving patients hope derived through science and algorithms. The system of data insights for cancer derives from the patient as part of translational research: the patient gives medical information to their clinician and the clinician gives this to the researcher. The combination of collaboration and precision medicine will allow this data to plug into complex algorithms to precisely match treatments to tumours using genomic and other useful information. Exponential and global outcomes will be realised with this approach. The data-driven scientific race is on. Can the Australian Federal Government swiftly join this race and fund translational research and big data platforms? Will they support global collaborations mega-funds for cancer research being established? The historical war on cancer could be summed up as a case of the right intention, wrong execution. The trillions of dollars cancer research investment begs the question “do our cancer research systems have a fatal design flaw?” It is a huge industry but who does it serve? Cure Brain Cancer is a patient-centric organisation which espouses our key value of fierce compassion to ensure patients’ needs are at the forefront of strategic and funding decisions. We apply design thinking to our strategic approach and have worked with Alex Klat Smith and Matt and Gail Taylor, the ‘grandparents’ of design thinking, to help steer our course. We are due for a course correction. Vice President Biden spelt out what others – like Cure Brain Cancer – have known, experienced and championed for years.

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It gets really interesting for brain cancer here; complexity has restrained advances in understanding, things like how to cross the blood-brain barrier and also treat the tumour. It’s a rarer cancer and harder to accumulate patient numbers to reach statistical significance in clinical trials. But when many ask us “why”, we ask “why not?” If we put our minds to it we can achieve great strides forward and it is this attitude that has compelled Cure Brain Cancer Foundation to bust out of a traditional approach, to change conditions to make them optimal instead of dismal for brain cancer by harnessing the power of collaboration and design thinking around a shared problem. What has held brain cancer back over the past 30 years is what now propels us forward. Brain cancer has received little funding over the past 30 years, meaning we haven’t inherited old systems, infrastructure, nor are we tied to long term grants that have become redundant. Our mindset isn’t wedded to politics, silos, power, protectionism and competition, as we are a patient advocate and focused on protecting their needs. We are smaller, freer and more agile.

Forging a global collaboration with the USA, China and Australia, helped make Australia a key player on an adaptive clinical trial and learning system for GBM called GBM AGILE. This platform can be used in most diseases, placing brain cancer at the forefront of a new era of innovative approaches to finding new treatments for cancer and beyond. The new age of effective cancer treatment will come through a change in mindset, systems, behaviours and environments. Big data, algorithms, platforms and global collaboration are the intervention points needed to bring forth the new era and kickstart the big data race. These interventions will also make negative data meaningful, providing the right conditions to overthrow consensus, which holds back advances. Innovators will be the winners as science embraces technological advances and attracts mega-funds, stewarding innovative ways to invest which will have an historic impact on humanity. For more information about Cure Brain Cancer Foundation visit www.curebraincancer.org.au

We wanted to understand the system of science and look at ways to intervene in this system to rise above external factors.

Chanelle Merheb with her mum Kristie, at the launch of Zero Childhood Cancer launch, which Cure Brain Cancer Foundation is helping to fund.

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MS Research Australia’s fundraising campaign goes global Kiss Goodbye to MS, looks set to change the fundraising landscape of multiple sclerosis research around the world.

MS researchers wearing red lab coats to raise awareness for Kiss Goodbye to MS as part of Red Lab Coat Day in 2015.

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S is the most commonly acquired neurological disease in young people and there is currently no cure. While great progress has been made over the past 10 years in better understanding MS, and finding treatments which halt the symptoms in certain types of MS, it is now critical that the momentum reached, does not wane. More funds are needed to support the best quality research into MS not only in Australia, but also globally. ‘Kiss Goodbye to MS’ is an Australian founded DIY style fundraising initiative that has experienced ongoing success over the last 3 years. In 2015, the campaign raised over $1 million and has raised more than $3 million for MS Research Australia since 2011. The campaign has had a huge impact among the MS community largely thanks to an engaging social media approach. With a significant social media presence, and a considered social media strategy, ‘Kiss Goodbye to MS’ is executed on a lean budget, with low administration costs, maximising the net profit for research. Because of this Australian success, and the modest resources required to execute the campaign, ‘Kiss Goodbye to MS’ has been adopted as the global fundraising initiative to raise funds for MS research around the world. The implementation of a global fundraising campaign of this nature is a first in the world of MS. While many campaigns have successfully raised funds and awareness for MS research in their own countries or jurisdictions, ‘Kiss Goodbye to MS’ is pioneering the way for a cohesive, global approach to raising the profile and importance of raising funds directly for MS research around the world. Renee Steenstra, 33 had her MS diagnosis confirmed in 2015 said “The scariest part of MS is the not knowing. My dream is a world where a diagnosis with MS is followed by an explanation of what the cure is. I know that research into MS will not continue simply because it is right or fair or needed, we must demand that the world makes finding a cure a priority. I am hopeful that Kiss Goodbye to MS being implemented globally will make the world take notice, and bring MS research to the forefront.” Luke Thomas, Head of International Fundraising at MS International Federation (MSIF) and based in London, is excited about this opportunity, “From the day I first joined the MS International Federation (MSIF), the Kiss Goodbye to MS campaign stood out as one of the most exciting things happening around the world. “Whenever we have spoken to our member countries and people involved with MS there has been a real excitement about it, and it is now going to be our first major international fundraising campaign,” said Mr Thomas. ‘Kiss Goodbye to MS’ resulted in a direct increase in vital funds available for top quality, competitive, category 1 funding of research via MS Research Australia, the largest national not-for-profit organisation dedicated to funding MS research.

The MSIF was drawn to the positivity of the campaign and the hope that it brings to people living with MS. With continued research, more treatments will be made available, and the world will be one step closer to the ultimate goal, freedom from MS. It hasn’t been just the MS community engaging with the campaign. Corporate support has been excellent and continues to grow with pro bono assistance in 2015 conservatively valued at $250,000, a significant factor in reducing campaign expenditure. Not to be outdone, MS researchers from virtually every university, medical research institute (MRI) or hospital, wore bright red lab coats to launch the campaign in 2015. Standing proudly in an otherwise sea of white coats, and sharing via social media. It is hoped that the Australian ‘Red Lab Coat Day’ will also be a part of every country’s campaign in the future. With the global implementation of ‘Kiss Goodbye to MS’, MS Research Australia is quietly confident that the campaign will be embraced around the world, and experience the success that Australia has enjoyed. In 2016, nine countries launched their own campaigns including the USA, France, Sweden, Mexico, Argentina, Greece, Denmark and New Zealand. The UK, Canada, India and Spain are currently developing their strategic approach and are planning to introduce ‘Kiss Goodbye to MS’ in 2017. In only a few months, the campaign has gained support around the world with hundreds of people raising awareness for the importance of MS research on social media. An excellent roll-out in the US has seen comedian, Amy Schumer, whose father has MS, show her support, as well as actor Shemar Moore, who’s mum is living with MS. “We are really proud to see ‘Kiss Goodbye to MS’ reach new heights. I have always been confident about two things when thinking of funding medical research; the importance of a global outlook and the need to collaborate effectively with like-minded groups,” said Dr Matthew Miles, Chief Executive Officer of MS Research Australia. “MS Research Australia is working closely with the countries who have adopted the campaign to ensure a smooth collaboration, maximising this exciting opportunity,” Dr Miles said. This is a unique opportunity for an Australian-founded campaign to make waves in the world of medical research. With increased funding into MS, better treatments and a cure for all types of MS will not just be a matter of ‘if’ but a matter of ‘when’. To find out more about ‘Kiss Goodbye to MS’ and MS Research Australia visit www.msra.org.au

The campaign has successfully captured the attention of a somewhat previously unreached audience; young women (18-50 years of age) with MS. With an average age of diagnosis of just 30, and 3 out of 4 people diagnosed being female, MS is largely a young woman’s disease. Research into the age and demographics of the K’iss Goodbye to MS’ community indicate that this campaign resonates strongly with younger MS patients, their family and friends, and particularly with people recently diagnosed with MS.

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Milestone progress for milestone Australian cancer research project The Ingham Institute for Applied Medical Research at Liverpool Hospital is pioneering Australian-first cancer research technology called an MRI-Linac which will improve the accuracy and effectiveness of radiotherapy treatment for cancer.

he Ingham Institute for Applied Medical Research recently made great in-roads on its flagship MRI-Linac cancer research project by conducting the first-ever test of the equipment in its home, a high-tech Research Bunker situated at Liverpool Hospital in NSW.

One of only three in the world and a first for Australia at the Ingham Institute, the MRI-Linac combines an Magnetic Resonance Imaging (MRI) scanner with a Linear Accelerator (Linac) to provide a mechanism that will improve the precision of radiotherapy treatment for cancer, the leading cause of death in Australia.

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At present, approximately 50 per cent of cancer patients need radiotherapy at some stage during the course of their illness, which uses X-rays that kill or damage tumours to stop them from growing. Although radiotherapy is commonly used today as a mode of treatment, it presents certain limitations when taking into account the location and shape of tumours which move as a result of breathing, swallowing and other normal body changes. â&#x20AC;&#x153;This is where the strength of our MRI-Linac system comes into play, as it is the only system that will enable us to target the tumour with the radiation beam accurately in real-time and have control

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over the radiation dose,” explained Associate Professor Gary Liney, Senior MRI Physicist at the Ingham Institute. “What gives us this accuracy is the MRI scanner, as it gives us a way to see the tissue inside the body with exceptional clarity. That’s why an MRI is normally used for diagnosing the disease – we are integrating this into treatment so we can see and treat at the same time,” Associate Professor Liney explained. Until now, the MRI and the Linac have worked separately. By joining them together as one the Ingham Institute has a system that enables a real-time view of tumours that stretches way beyond basic anatomy, including the chemical structure of tumours and normal tissues. The unique design of the system gives Ingham Institute scientists and cancer researchers the ability to position the treatment or radiation beam in two different arrangements, a world first and unlike the other two existing MRI-Linac systems which are located in Canada and The Netherlands. To enable this, the Ingham Institute has recruited a specialist team of scientists and cancer researchers from all around the world, including Chief Investigator Professor Paul Keall, who hails from Stanford University in the USA, Senior MR Physicist Associate Professor Gary Liney from the UK, and Professor Stuart Crozier from the University of Queensland, one of the world’s leading innovators in MRI.

causes of death from cancer– lung cancer and pancreatic cancer. Other types that may benefit specifically from the MRI-Linac are liver, oesophageal and kidney cancer, which impact 1,304, 1,200 and 2,712 Australians per year respectively. Through testing and research on the MRI-Linac, Ingham Institute cancer researchers hope that, in time, it may be used as part of a radiotherapy treatment program for these types of cancers. “The Ingham Institute’s flagship MRI-Linac system is one of the most exciting initiatives I have worked on in my research career. In time, it will improve the effectiveness of cancer treatment for patients in our community, Australia and around the world,” added Professor Barton. The Ingham Institute’s MRI-Linac cancer research project is a worldwide research collaboration that involves researchers and scientists spanning from across seven universities including UNSW Australia, the University of Sydney, University of Queensland, University of Wollongong, University of Newcastle, Western Sydney University and Stanford University. Learn more about the Ingham Institute’s MRI-Linac on YouTube.

“The special design will enable us to investigate and determine the best way of using the technology to ensure the effectiveness of treatment, offering greater potential of improving cancer treatment across a broad range of types,” explained Associate Professor Liney.

The Ingham Institute for Applied Medical Research at Liverpool Hospital in NSW conducts world-class medical research tackling a range of diseases including cancer, cardiovascular disease, diabetes, injury, infectious diseases, mental health and community and population health. Founded by the community for the community, the Institute’s team of award-winning medical researchers are dedicated to preventing and finding better ways to treat these health conditions to help improve and save lives in Australia and around the world.

The first ‘beam-on image’ was performed which produced an image with the treatment beam turned on. To conduct this test, the team of researchers and scientists used a kangaroo steak, representing a piece of human anatomy.

All of the Institute’s medical research programs have a translational focus. This means that results from the laboratory are transformed into direct health benefits in the form of new treatments and standards of care for local, national and international communities.

“The first test of the MRI-Linac is a result of many years of hard work from the Ingham Institute’s team of scientists and researchers. It’s incredible to see it all put together and working so well. We are already discovering new effects that will change cancer treatment,” said Professor Michael Barton OAM, Ingham Institute Research Director who is a radiation oncologist and MRI-Linac Chief Investigator.

The Ingham Institute is a charity that relies on the generosity of public donations to carry out its work. 100% of all of funds raised go directly to support research. For further information about health and medical research conducted at The Ingham Institute for Applied Medical Research visit www.inghaminstitute.org.au

Next steps for the project include further testing of the MRI-Linac on a Phase 2 model of the MRI magnet arriving for installation in the Ingham Institute’s Research Bunker in April 2016. The Ingham Institute’s MRI-Linac cancer research technology will enable targeted radiotherapy on a range of cancers that have, to date, been limited as result of the patients breathing, swallowing and other normal body functions. This includes two of the leading

MRI-Linac – The Ingham Institute of Applied Medical Resarch, at Liverpool Hospital

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Understanding Chronic Fatigue Syndrome Trivialised for years due to the lack of scientific evidence supporting its diagnosis, the 180,000 Australian Chronic Fatigue Syndrome sufferers continue to endure the stigma of a condition that is often poorly recognised by the medical community and treated with scepticism by family, friends, and co-workers.

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rofessor Sonya Marshall-Gradisnik and Professor Donald Staines, co-directors of the National Centre for Neuroimmunology and Emerging Diseases at the Menzies Health Institute Queensland, Griffith University share their findings on Chronic Fatigue Syndrome.

The term ‘chronic fatigue syndrome’ (CFS) is a poorly conceived diagnostic term to describe a debilitating and protracted condition of debilitating, profound fatigue, usually worsened by exertion, and an incapacitating type of brain fog associated with greatly impaired memory, concentration and rational and emotional thought processes. It is also known as myalgic encephalomyelitis and the joint term CFS/ME is often used. Many patients are undiagnosed or disbelieved and its severity drives some to suicide. Currently no confirmatory diagnostic test is available, and diagnosis depends on case definitions developed in various international settings and that have evolved over time. These definitions classify the experience of the illness in terms of fatigue, memory and concentration disorder, and a variety of other symptoms pertaining to the cardiovascular, gastrointestinal and immunological systems. Almost all body systems are affected by this illness.

Causes and onset of CFS/ME The illness often follows infection, trauma or another incident and appears to affect the immune system along with major body systems. The immune system comprises an ancient or innate immune system, as well as a more recently evolved acquired immune system. The innate immune system comprises natural killer cells, macrophages, mast cells and even nitric oxide and carbon monoxide produced by the body. The innate immune system is intended to defeat incoming threats such as infection or trauma and its consequences. This part of the immune system has no memory and relies mostly on directing its toxic effects at the threat. The acquired immune system relies on memory and a well organised capacity to respond to a remembered threat. This is a far more adaptable and better targeted part of the immune system than the innate system. Indeed the principle of vaccination depends on this system remembering specific antigens within B cells and plasma cells and producing antibodies to them. T cells also have a vital role to play, and this system relies on intelligent cross activation between B cells and T cells.

Identifying the Pathology Most research in CFS/ME has focused on the immune system, suggesting whether the illness could be the result of a persistent infection. Alternatively altered immune responses to the body’s own systems may result in autoimmunity, so research often pursues an autoimmune process. However whether antibodies occur in CFS/ ME remains contentious. In any event it is clear that perturbations or changes in cellular processes critical to homeostasis do occur. External threats, such as potent chemicals, toxins, tobacco smoke and even some foods, are now known to make the symptoms far

worse. In fact, there are so-called threat receptors located on and in almost every cell of the body. These ion channels are part of the ancient immune system as a first line of defence, and they hold the key to a profound miscalculation of the immune system and cellular pathways. A second receptor type we investigated is the acetylcholine receptor. This is also an ancient signalling mechanism that controls many signalling mechanisms within the cell including entry of ions into the cell. Dysregulation of these receptors causes significant problems in cell communication. Our work has found changes in the genetic make-up of both types of receptors. These changes are known as single nucleotide polymorphisms that involve changes to these receptor genes. These changes may result in changes to the structure and function of the receptors. However it was questioned whether relatively small changes in these single nucleotide polymorphisms could lead to illness. Using highly complex gene informatics software, it was possible to identify whether single nucleotide polymorphisms in both the acetylcholine and threat receptors have an effect on pathology. It was found there was a very high level of probability that these receptors did lead to aberrant functioning. In other words, the homeostasis of the cell would be significantly compromised from having these changed receptors. Work is now focusing on key areas in the cell where these receptors influence cell function. To some extent CFS/ME resembles other debilitating conditions. For example autoimmunity to acetylcholine receptors is associated with a debilitating illness called myasthenia gravis.

Changes to receptor function These changes in both the acetylcholine and threat receptors in CFS/ME patients, suggests that the very complex association between these receptors may develop different patterns or combinations of these anomalies and their effects. This complexity may be reflected in the varied symptoms reported by chronic fatigue syndrome patients. There is the possibility that across different patients in different populations, and even in the same patients over time, clinical variations may occur due to the different threats that patients encounter. While this may seem contradictory, it suggests that different combinations of altered acetylcholine and threat receptors have varying effects. The challenge now is to describe these effects and attempt to unravel the complex pathologies that may cause them through detailed analysis of cellular function and cellular products that are being produced by cells from chronic fatigue syndrome patients and comparing them to healthy people. If true, these relationships make for a highly complex diagnostic challenge, as well as the potential for diverse treatment strategies. For more information on the health and medical research conducted at the Menzies Health Institute Queensland visit www.griffith.edu.au/ health/menzies-health-institute-queensland

Professor Sonya Marshall-Gradisnik, National Centre for Neuroimmunology and Emerging Diseases, Menzies Health Institute Queensland, Griffith University

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Discussing contraceptive options so women can make informed choices that are best for them.

Increasing uptake of long acting reversible contraception Australia is lagging behind many parts of the world when it comes to uptake of long acting reversible contraception, thus it is timely to consider enhancing the scope of practice for nurses in the practical insertion and removal skills that are performed routinely by nurses in many other countries.

ong acting reversible contraceptive methods (LARC), including intrauterine devices (IUDs) and contraceptive implants, have many proven benefits and are suitable for women of all reproductive ages from teenagers to those nearing menopause. LARC methods have few contraindications, risks or side-effects, are well tolerated with high continuation rates, and are highly effective as a result of their â&#x20AC;&#x2DC;set and forgetâ&#x20AC;&#x2122; nature. Economic modelling of the costs associated with the provision of contraception and unintended pregnancy outcomes in the United Kingdom (UK) found that LARC methods were all more effective in preventing unintended pregnancy and less costly than oral contraceptives. Additionally, LARC methods have benefits beyond contraception: the hormonal IUD which releases a small amount of the progestogen hormone called levonorgestrel from its stem over a 5-year period significantly reduces menstrual blood loss

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and is indicated for women with appropriately investigated heavy menstrual bleeding (HMB), while the copper-bearing IUD provides an effective method of post-coital emergency contraception which can be continued long term for up to ten years. The benefits of LARC are increasingly recognised internationally. The US-based CHOICE project involving over 9,000 women found that when women were educated about all contraceptive options and given their preferred option free of cost, the most popular choice was the hormonal-IUD (46%), with only 9% of participants choosing an oral contraceptive pill. This study also provided evidence of significant reductions in teenage birth rates and abortion rates among participants in the St. Louis area. Yet despite these evidence-based benefits, LARC methods and in particular IUDs, are underutilised in Australia with only about 5% of women using an IUD compared to 19% in Sweden and 13% in France.

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So what are the reasons for this low uptake of LARC in Australia? It appears to result from a combination of low awareness of their benefits as well as misinformation amongst women as well as health care practitioners, in particular in relation to their suitability for young women and nulliparous women (women who have not had a child) as well as access issues. Even once a decision has been made to use an IUD or an implant a woman may face challenges in finding a local trained practitioner to insert the device in a timely manner, particularly if she is in a rural or remote area of the country. In many countries around the world, including New Zealand and the UK, insertions by trained registered nurses has helped overcome this barrier and increased access to and uptake of these effective methods of contraception. Following the example set by New Zealand, in 2012 Family Planning NSW initiated an IUD insertion training program for its nurses. The competency-based training was adapted from the training package used for general practitioner inserters and included a theory component and training on a pelvic model, followed by 10-12 supervised insertions with an experienced IUD-inserting doctor to provide support and assistance if requested. A paper published recently in the Australian and New Zealand Journal of Obstetrics and Gynaecology reported on the outcomes of IUD insertions by the first four trained RNs at Family Planning NSW between February 2012 and May 2014 within the context of a multidisciplinary clinical team. During this time frame the newly trained RNs attempted 207 IUD insertions, 185 (89%) involving parous women and 22 (11%) involving nulliparous women with an age range of 16 to 50 years. Overall, 91% of registered nurses insertion attempts were successful without the need for assistance from the doctor and 94% including cases when the doctor was called upon to assist with a very low rate of reported complications. While it is commonly perceived that insertion of an IUD is more difficult in a woman who has either not had children or has only had caesarean section deliveries than in women with one or more vaginal delivery, there was no difference in the likelihood of the registered nurses requiring assistance for this group of women.

Following the success of IUD training for nurses, contraceptive implant insertion and removal training, which includes practical training in the administration of local anaesthetic, is now occurring at Family Planning Organisations around the country. These initiatives will help pave the way for the development of costeffective practice-based models for both IUD and implant insertions and removals by nurses and midwives in the primary care and hospital setting. While a doctor was required to be on site for IUD insertions during the Family Planning NSW study, this requirement will depend on the experience of the inserter as well as the clinical setting. Nurse-alone clinics may be appropriate in rural and remote areas where LARC insertion options are generally scarce and women often have to travel long distances to access these effective contraceptive methods. There certainly seems to be no shortage of nurses outside of the family planning setting wanting to learn these skills, and next steps require consideration of remuneration, including the possibility of Medicare rebates, for the insertion and removal of LARC devices by credentialed nurses. Given that Australia is lagging behind many parts of the world when it comes to LARC uptake, it is timely to consider enhancing the scope of practice for nurses in these practical skills which are performed routinely by nurses in many other countries, including neighbouring New Zealand. LARC procedures by credentialed nurses will benefit Australian women of all reproductive ages who may otherwise miss out on these highly effective and cost-effective methods of contraception. For more information about Family Planning NSW and its services visit www.fpnsw.org.au

The outcomes reported in this article highlight the success of registered nurses IUD insertions in the family planning setting.

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Research provides new understanding of life after cancer treatment for young people A cancer diagnosis among adolescents and young adults can have a significant effect on a young person’s life experiences during and after treatment.

ue to improved diagnosis and treatment, increasing numbers of adolescents and young adults are surviving cancer, yet little is known about the effects of cancer and treatment on their lives beyond the initial treatment phase.

The study’s geographical spread was to capture a wide variety of experiences within different healthcare and cultural settings in comparable western societies that also are world leaders in the development of age-specific models of adolescent and young adult cancer care.

Danielle Tindle, a researcher in the sociology of cancer and a long-term survivor of lymphoma whom herself was diagnosed and treated as an adolescent/young adult, has chosen to “represent young people impacted by cancer”, and address some critical gaps in knowledge about the experiences of this growing population by conducting an international cross-cultural study.

“There is increasing recognition within these countries’ healthcare systems that although adolescents and young adults constitute only a small percentage of cancer patients, the distinct biological, psychosocial and information needs of this group warrant the development of adolescent and young adult cancer care as a subspecialty of oncology,” Danielle said.

Her research project, ‘Creating meaning: the cancer survivorship experiences of young adults in Australia, England and the United States’ was supported by a PhD scholarship ($120,000 from 2012-2014) under the Leukaemia Foundation’s National Research Program.

She found that although there is greater focus on the treatment phase, adolescents and young adult cancer survivorship is poorly understood.

“The aim of the study was to develop a new understanding about how young survivors conceptualise meaning in life,” Danielle said. She examined ‘cancer survivorship’ by analysing the experiences of adolescents and young adults diagnosed with cancer in three countries, exploring issues around creating meaning and negotiating identity in young adulthood, and how these were influenced by cancer experiences, healthcare environments and other social and cultural practices. Over three years, Danielle travelled around the world to conduct in-depth interviews with 45 people who had survived cancer – 15 people in each country. The interviewees, aged 18 to 40 years, were diagnosed with cancer between the ages of 15-29 years and were at least two years post-treatment.

“Current research literature on adolescent and young adult cancer focuses on health or psychological needs in an effort to improve service provision for this group. By contrast, this study provided space for young people’s everyday experiences to be explored beyond medical or healthcare contexts,” she said. “While the origin of cancer survivorship is biomedical, the experiences of cancer survivors are lived in everyday society. An interdisciplinary approach to adolescent and young adult cancer survivorship program development is indicated, that goes beyond the multidisciplinary healthcare model and confines of a hospital setting, and further develops appropriate legal, financial, practical and healthcare resources in the community sector.” Danielle was awarded her PhD from the Queensland University of Technology in March last year. Her thesis is available online through QUT ePrints.

More than half the study participants (51%) had a blood cancer diagnosis (leukaemia or lymphoma).

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Key findings

About Danielle Tindle

The concept of ‘time’ resonated throughout participants’ accounts of ongoing cancer survivorship experiences. Life-challenging illnesses challenged taken-for-granted assumptions about the conventional temporal framing of human life. This affected the organisation of time, the structuring and meaning of life events and the use of time as a resource, thus impacting every aspect of adolescent and young adult survivorship.

Danielle Tindle, 35, describes her various roles as “patient, professional, advocate and academic”. Being diagnosed with lymphoma at the age of 22, while studying a Masters Degree in International Relations, changed the course of her career. After completing her studies, Danielle approached the Leukaemia Foundation as she felt there was a lack of support for people her age affected by cancer. She was appointed Project Officer for the Foundation and from 2006-2009 initiated the development of a national education and support program for young adults affected by blood cancer. She carried out research to identify the supportive care needs of this group, developed online materials, and the information booklet, ‘Young Adults with a Blood Cancer’. Danielle also completed international postgraduate studies in Teenage and Young Adult Cancer Care. As the Senior Project Officer of Adolescent and Young Adult Cancer Services at Queensland Health from 2009-2012, Danielle developed and implemented a statewide model of specialised Adolescent and Young Adult care. She has been an advisory committee member of CanSpeak Queensland since 2007. Since completing her PhD, Danielle has worked at the Institute of Health and Biomedical Innovation at QUT. She is involved with numerous committees to develop innovative approaches and interdisciplinary partnerships to enhance the experiences of people impacted by cancer.

The everyday experiences of young cancer survivors highlighted a state of uncertainty about the future. Participants struggled to adjust to the realisation that their lives would not unfold the way they imagined. Relationships with future time developed in reference to biomedical language, including survival statistics and prognoses. A way of negating the distress that accompanied uncertainty about the future was to focus on present-oriented activities and shortterm goals. Recognition of temporal limitations challenged young survivors to make the most of their time and they engaged in a transitional process of re-creating meanings and identities. Three main factors deemed meaningful after cancer included engaging in new experiences, helping others, and close relationships with family and friends. Meanings, identities and social roles were further shaped by cultural and political factors including healthcare experiences and social depictions of illness and survival. There were variations across the three countries. In Australia, the majority of study participants had never met another young person who’d had cancer, someone who had been through the same thing. This lack of social interaction with peers left them feeling lonely and isolated. The significance of temporality and social interaction in young survivors’ experiences indicates these factors need to be central in survivorship care programs that extend beyond the healthcare context and into the community. It is important that these programs are developed in negotiation with young people and do not prescribe a ‘right’ approach to survivorship.

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For more information about the Leukaemia Foundation visit www.leukaemia.org.au

Danielle Tindle, with Judy Stokker, Deputy-Vice Chancellor, QUT and Tim Fairfax, Chancellor, when she was conferred with her PhD last year in Brisbane.

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ANZIC-RC wins $4.4 million for ground-breaking pneumonia trial Australian investigators at Monash University will be at the forefront of the global development and implementation of a ground-breaking new pneumonia trial.

n real world terms, the mortality burden of severe community acquired pneumonia is as high as the annual road toll in Australia. Yet the existing clinical evidence that guides therapies is in stark contrast to the substantial public health impact of the disease.

Professor Steve Webb from the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) at Monash University is heralding a new era of innovative trial design in intensive care medicine with the OPTIMISE CAP trial (Optimisation by Platform Trial Involving Multiple Interventions with Simultaneous Evaluation in Community Acquired Pneumonia). The trial has secured $4.4 million from the National Health Medical Research Council (NHMRC) and is planned as a perpetual trial to commence in 2016. The trial will also contribute to the pre-prepared global research response to future pandemics of Severe Acute Respiratory Illness (SARI) in the event of a pandemic SARI outbreak. The most recent influenza pandemic, while mild, still resulted in 200,000 deaths world-wide; in Australia, Intensive Care Unit services were stretched almost to breaking point. “One of the ground-breaking aspects of this project is that it puts patients at the centre. It focuses not on a single treatment that may be applicable to only a few, but on a range of treatments, making the study relevant to virtually all of those with the disease,” Dr Litton, Staff Specialist Intensive Care Unit at Fiona Stanley Hospital and Clinical Senior Lecturer at University of Western Australia said. Dr Litton added that OPTIMISE CAP also has the enormous benefit of building the infrastructure and expertise necessary to be able to respond in a pandemic, allowing promising novel treatments to be tested in a scientifically rigorous way within the necessary timeframes. Professor Webb is leading the Australian and New Zealand component of the trial and is enthusiastic about being at the

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cutting edge of trial design, and believes that a platform trial is the best strategy to rapidly improve the strength of available evidence and guideline recommendations for treatment. A platform trial is a novel and innovative trial design that is highly adaptive and utilises frequent Bayesian interim analyses to answer as many questions as possible from the available sample. It simultaneously evaluates the effectiveness of multiple alternative treatment options including identifying any interactions between treatments. It evaluates treatment effects in sub-groups, allows modification of key trial parameters and preferentially randomises participants to treatments that are likely to be more effective, leading to better outcomes for patients within the trial. “Platform trials are ideally suited to diseases where there are many different interventions, as their aim is to find the optimal combination of treatments, rather than testing each intervention separately,” Professor Allen Cheng, Professor of Infectious Diseases Epidemiology, Monash University said. With this ground-breaking new platform trial, researchers from ANZIC-RC in collaboration with the Platform for European Preparedness Against (Re-) emerging Epidemics (PREPARE) hope to rapidly improve the strength of available evidence. “This trial represents a paradigm shift in the way evidence is generated to help clinicians provide optimal treatment to their patients. The trial design is around five times more efficient than conventional trials and it is highly likely that this type of design will become used increasingly across all disciplines of medicine,” Professor Webb said. Severe CAP is a major cause of mortality worldwide and in Australia, it is responsible for more than 7,000 ICU admissions and 1,400 deaths each year. “The existing evidence base is manifestly inadequate and with 1 in 5 patients dying there is major unmet need for improved outcomes,” Professor Webb said.

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The Australian and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS CORE) clinical registry data estimates that the annual direct costs of ICU care of these patients is in excess of $200 million. The trial will compare different types of ventilation, as well as antibiotic and immunomodulation strategies that are currently used as standard care. Patients will be preferentially randomised to treatments that the trial has found to be more effective, leading to better outcomes for patients within the trial. The OPTIMISE CAP trial will recruit 2,000 patients from 40 ICUs in Australia, and a further 4,000 will be recruited in Europe, with additional patients recruited in New Zealand. “Perhaps the most remarkable feature of this trial is that, assuming at least some interventions are more effective than others, it actually saves lives among trial participants compared with conducting a conventional trial,” Dr Colin McArthur, Adjunct Senior Research Fellow at ANZIC-RC and the Immediate Past Chair of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS CTG) said.

The trial will also run in Europe coordinated by the Julius Center for Health Sciences and Primary Care at the University Medical Centre in the Netherlands. Professor Webb said there is a strong case that this trial is one of the most advanced trial designs ever developed. The trial is able to test multiple interventions simultaneously, allowing researchers to move on and test new interventions and the proportion of patients randomised to a particular intervention can be varied according to whichever interventions are showing to be more effective. “This response adaptive randomisation means that mortality for patients within the trial is lower than would have been the case than if the trial had been conducted with 50:50 randomisation. This is a fabulous fusion of continuous quality improvement with generation of new knowledge,” Professor Webb said. This means that, as the trials proceeds the patients are likely to receive the best combination of results. For more information about health and medical research conducted at Monash University visit www.monash.edu.au

A Registry will also be nested within this trial which captures all data for patients with Severe CAP.

Professor Steve Webb from the Australian and New Zealand Intensive Care Research Centre (ANZIC-RC) at Monash University.

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