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Mechanical Mobility Of The Thorax For Continuous Determination Of Lung Gas Volume
Funder
National Health and Medical Research Council
Funding Amount
$165,000.00
Summary
Percussion is a valuable clinical method for physical examination of parts of the body. A sharp tap (impulsive force) is applied to the body wall and the sound radiated in response is observed. This sound may be dull (over liver) or stony dull (pleural effusion), or resonant (over normal lung) or hyper-resonant (over bowel). While the variation in radiated sound is not fully understood, it is apparent that the presence of gas, which is highly compliant, increases mobility of the overlying tissue ....Percussion is a valuable clinical method for physical examination of parts of the body. A sharp tap (impulsive force) is applied to the body wall and the sound radiated in response is observed. This sound may be dull (over liver) or stony dull (pleural effusion), or resonant (over normal lung) or hyper-resonant (over bowel). While the variation in radiated sound is not fully understood, it is apparent that the presence of gas, which is highly compliant, increases mobility of the overlying tissue and allows it to resonate; where the sub-tissue is largely fluid, tissue mobility is low and the percussive sound is dull. Percussion is useful for examining the adult chest and lung, but cannot for example be applied in infant intensive care as only limited impulsive force can be used, and the adult finger, which is both a coupling device and sounding board, is too large. As well, percussion requires skill and quiet conditions. Accordingly, we developed a device to measure mobility of the chest and other tissues in real time. The VibroPulse applies a known low-level force to the body surface and records the resultant velocity induced in the surface. The force is generated by a vibrating mass set in motion by an electromagnetic motor driven by pseudo-random noise. Tissue mobility, defined as velocity-force, is derived simultaneously across the frequency range, providing an easily interpreted quantitative output unaffected by ambient noise. This proposal has two aims we can achieve in 1 year: (1) to continue evaluating VibroPulse sensitivity to tissue composition, using symmetrical percussive sites on the human chest and abdomen that are dull on one side and resonant on the other, and the chest of anaesthetised animals with experimentally induced pneumothorax and lung collapse, two life-threatening conditions for which percussion is a key diagnostic method, and (2) to engineer a small device from our bulky prototype that is suitable for clinical use, in infants and adults.Read moreRead less
Mechanisms Of Apnea And Periodic Breathing In The Newborn.
Funder
National Health and Medical Research Council
Funding Amount
$381,100.00
Summary
Breathing pauses referred to as apnea or periodic breathing occur frequently in the preterm infant, and often require intensive clinical vigilance to ensure survival. And yet the mechanisms that produce and terminate apnea are not understood. This study will investigate the mechanisms underlying infantile apnea and periodic breathing and the effectiveness of drugs and techniques currently used to control apnea by using a combination of infant animal model studies, mathematical modelling studies ....Breathing pauses referred to as apnea or periodic breathing occur frequently in the preterm infant, and often require intensive clinical vigilance to ensure survival. And yet the mechanisms that produce and terminate apnea are not understood. This study will investigate the mechanisms underlying infantile apnea and periodic breathing and the effectiveness of drugs and techniques currently used to control apnea by using a combination of infant animal model studies, mathematical modelling studies and studies in human preterm infants to improve our understanding of breathing control in infancy.Read moreRead less
Pneumovirus Infection In Infancy Affects The Development Of Life-long Adaptive Immunity.
Funder
National Health and Medical Research Council
Funding Amount
$408,469.00
Summary
Respiratory syncytial virus is the most important cause of acute lower respiratory tract infection (RTI) in young children worldwide. Hospital admission rates in Western societies for RTIs are around 3% for children younger than 1 year. A vaccine to RSV is not yet available and repeat infections occur thoughout life, suggesting that the immune response does not develop correctly. In this project we are exploring the mechanisms that underpin disease development and promote incomplete immunity.
Systematic Expansion Of The Clinical Evidence Base In Opioid Prescribing For Refractory Dyspnoea At The End Of Life
Funder
National Health and Medical Research Council
Funding Amount
$414,535.00
Summary
Morphine can relieve breathlessness in the palliative setting. But many important questions remain. What is the best dose, should the dose change over time, do different medications provide the same relief, and how common is dyspnoea in the general population? This three part project will extend our knowledge to answer these questions. Population data will provide critical background to plan best care for future palliative patients distressed by breathlessness.
Extra Corporeal Membrane Oxygenation (ECMO) is a heart/lung machine that replaces blood CO2 with oxygen, giving organs a chance to rest after injury due to infection or trauma. It saved many lives in the swine flu outbreak. Blood moving across foreign surfaces causes inflammation, cell injury and a need for transfusions. This study aims to identify which part of the ECMO causes injury and how. This will to improve survival rates of the most severe forms of cardiac and respiratory disease.
A Comprehensive Self-Management Programme For Chronic Obstructive Pulmonary Disease In The Community
Funder
National Health and Medical Research Council
Funding Amount
$391,610.00
Summary
Chronic obstructive pulmonary disease (COPD) is the third leading cause of burden of disease in Australia. It has a major impact on sufferers, their carers and society. This study introduces a new model of community care, based on case management, mentoring to improve self-efficacy and information systems to deliver information and closely monitor disease status. This will improve the quality of life of sufferers, develop healthcare networks and decrease healthcare utilisation.
Randomised Double-blind Controlled Trial Of Oxygen Versus Air To Palliate Intractable End-of-life Dyspnoea When Pa02 >55
Funder
National Health and Medical Research Council
Funding Amount
$463,318.00
Summary
Shortness of breath at the end-of-life is one of the most feared symptoms. Unlike most other symptoms, it worsens as death approaches. Despite the fact that more than 50,000 Australian will die an expected death in the next year, of whom the majority will have breathlessness toward the end-of-life, we know little about how best to treat this symptom. Oxygen is frequently introduced but we have not identified whether it is more effective than medical air, and, if it is more effective, which patie ....Shortness of breath at the end-of-life is one of the most feared symptoms. Unlike most other symptoms, it worsens as death approaches. Despite the fact that more than 50,000 Australian will die an expected death in the next year, of whom the majority will have breathlessness toward the end-of-life, we know little about how best to treat this symptom. Oxygen is frequently introduced but we have not identified whether it is more effective than medical air, and, if it is more effective, which patients would most benefit from it. Because of this lack of evidence, oxygen is only funded in Australia in community settings for people who have severely low oxygen levels in their blood. Palliative oxygen is provided on a compassionate basis at times but this is on an ad hoc basis and does not ensure equitable access for people at the end of life who experience shortness of breath. This multi-centre study will compare oxygen and air, with neither the participant nor caring clinicians knowing which treatment they will receive. After careful explanation, volunteers who agree to participate will be asked to use the oxygen machine for at least 15 hours each day for 7 days and fill out a diary twice each day. Five centres across Australia are planning to enroll 240 participants in this study. Outcomes will include whether the sensation of breathlessness has improved, the overall quality of life while being treated, the ability to perform activities of daily living and any side effects experienced. This study is eagerly awaited by clinicians and health planners not only in Australia but in North America and Europe. This study will provide data in a long-standing international debate about the role of oxygen in people with relatively normal levels of oxygen in their blood who suffer from shortness of breath at the end-of-life.Read moreRead less
Upper Bedding As A Prevention Measure In Childhood Asthma: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$198,075.00
Summary
Asthma has recently been identified as a National health Priority (1) by the Australian Government in view of the increasing prevalence of asthma and its great importance as a public health problem. The total health system costs of asthma are estimated to be in excess of $600 million (2). Recently, feather pillows have been shown to have more than five times less house dust mite allergen than other pillows. To date, several population-based studies have shown that children using feather upper be ....Asthma has recently been identified as a National health Priority (1) by the Australian Government in view of the increasing prevalence of asthma and its great importance as a public health problem. The total health system costs of asthma are estimated to be in excess of $600 million (2). Recently, feather pillows have been shown to have more than five times less house dust mite allergen than other pillows. To date, several population-based studies have shown that children using feather upper bedding are also reported by their parents to have less severe wheeze. These findings call into question the National Asthma Council recommendation that people with asthma who are allergic to house dust mite should use synthetic quilts rather than feather or down (3). However, concerns remain that these important findings may only have occurred because unmeasured factors, such as the socioeconomic status or child diet may be closely related to feather bedding use, and in themselves, protective against asthma. Alternatively, parents of a child with asthma symptoms may be more likely to have chosen non-feather bedding. The best way to address these concerns is to conduct a randomised controlled trial to evaluate whether the use of new feather upper bedding is associated with reduced asthma severity among house dust mite-sensitised children with severe asthma. This study is underway and has support in 2001-2002 from the Financial Markets Foundation for Children. The research will address the following NHMRC Primary Health Care project grant thematic research areas: Evidence based primary health care practice; Quality of primary care; and Illness prevention and health promotion as a primary health care strategy. (1) National Health Priority Areas: Asthma. http:--www.health.gov.au-hsdd-nhpq-asthma-index.htm (2) NH and MRC Evidence Based Clinical Practice Research Program Workshop - December 16-17, 1999. (3) National Asthma Campaign Asthma Management Handbook 1998Read moreRead less
A Randomised Controlled Trial Of A Simplified Management Strategy Versus Standard Care In Moderate To Severe OSA
Funder
National Health and Medical Research Council
Funding Amount
$561,400.00
Summary
Currently breathing difficulties during sleep known as obstructive sleep apnea (OSA) are undertreated in our community. This reflects an inability of the current diagnostic and treatment strategies to deal with the high clinical burden of OSA. As a result, in particular in rural and remote areas, many have long waits for treatment, or no access to therapy at all. The purpose of this project is to evaluate a simplified protocol for the management of OSA. This will be done using diagnostic devices ....Currently breathing difficulties during sleep known as obstructive sleep apnea (OSA) are undertreated in our community. This reflects an inability of the current diagnostic and treatment strategies to deal with the high clinical burden of OSA. As a result, in particular in rural and remote areas, many have long waits for treatment, or no access to therapy at all. The purpose of this project is to evaluate a simplified protocol for the management of OSA. This will be done using diagnostic devices and treatment strategies that are more widely available than the current approaches to the diagnosis and management of obstructive sleep apnea. This will involve measurement of the numbers of falls in oxygen levels in a patient via a device to measure oxygen levels called an oximeter. These falls in oxygen levels correlate well with breath holding episodes during sleep characteristic of OSA. Treatment can be commenced in the patient's home depending on these results. We intend to compare these new approaches with the current best practice in OSA. If the outcomes are good these stategies could be applied to reduce the waiting times for to diagnose and manage OSA and make therapy more widely available throughout the community.Read moreRead less