ORCID Profile
0000-0002-3036-5540
Current Organisation
Royal Brisbane and Women's Hospital
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Publisher: Elsevier BV
Date: 03-2010
DOI: 10.1016/J.RESP.2010.01.001
Abstract: This study examined the effect of sitting posture on regional chest wall shape in three dimensions, chest wall motion (measured with electromagnetic motion analysis system), and relative contributions of the ribcage and abdomen to tidal volume (%RC/V(t)) (measured with inductance plethysmography) in 7 healthy volunteers. In seven seated postures, increased dead space breathing automatically increased V(t) (to 1.5 V(t)) to match volume between conditions and study the effects of posture independent of volume changes. %RC/V(t) (p<0.05), chest wall shape (p<0.05) and motion during breathing differed between postures. Compared to a reference posture, movement at the 9th rib lateral diameter increased in the thoracolumbar extension posture (p<0.008). In slumped posture movement at the AP diameters at T1 and axilla increased (p<0.00001). Rotation postures decreased movement in the lateral diameter at the axilla (p<0.0007). The data show that single plane changes in sitting posture alter three-dimensional ribcage configuration and chest wall kinematics during breathing, while maintaining constant respiratory function.
Publisher: Elsevier BV
Date: 07-2008
DOI: 10.1016/J.HEALUN.2008.03.017
Abstract: The 6-minute walk distance (6MWD) is a widely used clinical indicator of exercise capacity. Although used as part of the assessment process in determining a candidate's suitability for lung transplantation (LT), the literature describing the impact of the 6MWD in predicting survival on LT waiting lists is limited. This study aimed to determine the hazard function associated with the 6MWD, and its utility relative to other prognostic variables. A retrospective chart review was conducted on 163 patients who were listed for single or double LT, and either survived to transplant or died while on the waiting list. A Cox regression for survival analysis, stratified by diagnostic group, was conducted utilizing the 6MWD, demographic variables and measures of cardiopulmonary function. The 6MWD proved to be the only significant covariate in the Cox regression for survival analysis (p < 0.001), with all other variables eliminated as non-significant. Furthermore, there was a protective effect for each unit increase in the 6MWD [Exp (B) = 0.994, 95% confidence interval 0.990 to 0.997]. This research demonstrates that the 6MWD is useful for stratifying patients on the LT waiting list by identifying those patients with a significantly higher risk of mortality.
Publisher: Springer Science and Business Media LLC
Date: 09-08-2019
Publisher: Elsevier BV
Date: 09-2008
DOI: 10.1016/J.CCT.2008.04.004
Abstract: Pulmonary rehabilitation is only accessible by a small proportion of in iduals with COPD. For the vast majority who are not able to access these programs, self management approaches may be an alternative to improve health care outcomes. The PRSM study is a three group randomised controlled trial with in idual randomisation, blinded outcome assessment, 3 monthly follow-up assessments across a 12-month period and concurrent economic evaluation. The inclusion criteria are adults with COPD. The primary outcome measure is the St George Respiratory Disease Questionnaire. Secondary outcome measures include a series of questionnaires (Frenchay Activities Index, International Physical Activity Questionnaire, the Hospital Anxiety and Depression Scale and the COPD self-efficacy scale) and two physiological measures (Forced Vital Capacity in 1-second and an incremental shuttle walk). Economic outcome measures include assessment of direct and indirect costs. The s le size of 318 patients (106 per group) is required to detect 4 point difference in the SGRQ, power 90% employing a 2 tailed alpha=0.05. Enrollment to start April 2008 and complete December 2010. Intention to treat analyses will be used to compare group effect. The results will provide an evidence base regarding the community management of in iduals with COPD.
Publisher: CSIRO Publishing
Date: 2018
DOI: 10.1071/AH16222
Abstract: Objective The aim of the present study was to determine the rates of re-referral to specialist out-patient clinics for patients previously managed and discharged from an advanced practice physiotherapy-led service in three metropolitan hospitals. Methods A retrospective audit was undertaken of 462 patient cases with non-urgent musculoskeletal conditions discharged between 1 April 2014 and 30 March 2015 from three metropolitan hospitals. These patients had been discharged from the physiotherapy-led service without requiring specialist medical review. Rates and patterns of re-referral to specialist orthopaedic, neurosurgical, chronic pain, or rheumatology services within 12 months of discharge were investigated. Results Forty-six of the 462 patients (10.0%) who were managed by the physiotherapy-led service were re-referred to specialist medical orthopaedic, neurosurgical, chronic pain or rheumatology departments within 12 months of discharge. Only 22 of these patients (4.8%) were re-referred for the same condition as managed previously and discharged. Conclusions Ninety-five per cent of patients with non-urgent musculoskeletal conditions managed by an advanced practice physiotherapy-led service at three metropolitan hospitals did not re-present to access public specialist medical services for the same condition within 12 months of discharge. This is the first time that re-presentation rates have been reported for patients managed in advanced practice physiotherapy services and the findings support the effectiveness of these models of care in managing demand for speciality out-patient services. What is known about the topic? Advanced practice physiotherapy-led services have been implemented to address the needs of patients referred with non-urgent musculoskeletal conditions to hospital specialist out-patient services. Although this model is widely used in Australia, there has been very little information about whether patients managed in these services subsequently re-present for further specialist medical care. What does this paper add? This paper identifies that the majority (95%) of patients managed by an advanced practice physiotherapy-led service did not re-present for further medical care for the same condition within 12 months of discharge. What are the implications for practitioners? This paper supports the use of advanced practice physiotherapy-led services in the management of overburdened neurosurgical and orthopaedic specialist out-patient waiting lists.
Publisher: Springer Science and Business Media LLC
Date: 02-11-2005
DOI: 10.1007/S00421-005-0019-2
Abstract: Passive tilting increases ventilation in healthy subjects however, controversy surrounds the proposed mechanism. This study is aimed to evaluate the possible mechanism for changes to ventilation following passive head-up tilt (HUT) and active standing by comparison of a range of ventilatory, metabolic and mechanical parameters. Ventilatory parameters (V (T), V (E), V (E)/VO(2), V (E)/VCO(2), f and PetCO(2)), functional residual capacity (FRC), respiratory mechanics with impulse oscillometry oxygen consumption (VO(2)) and carbon dioxide production (VCO(2)) were measured in 20 healthy male subjects whilst supine, following HUT to 70 degrees and unsupported standing. Data were analysed using a linear mixed model. HUT to 70 degrees from supine increased minute ventilation (V (E)) (P<0.001), tidal volume (V (T)) (P=0.001), ventilatory equivalent for O(2) (V (E)/VO(2)) (P=0.020) and the ventilatory equivalent for CO(2) (V (E)/VCO(2)) (P<0.001) with no change in f (P=0.488). HUT also increased FRC (P<0.001) and respiratory system reactance (X5Hz) (P<0.001) with reduced respiratory system resistance (R5Hz) (P=0.004) and end-tidal carbon dioxide (PetCO(2)) (P<0.001) compared to supine. Standing increased V (E) (P<0.001), V (T) (P<0.001) and V (E)/VCO(2) (P=0.020) with no change in respiratory rate (f) (P=0.065), V (E)/VO(2) (P=0.543). Similar changes in FRC (P<0.001), R5Hz (P=0.013), X5Hz (P<0.001) and PetCO(2) (P<0.001) compared to HUT were found. In contrast to HUT, standing increased VO(2) (P=0.002) and VCO(2) (P=0.048). The greater increase in V (E) in standing compared to HUT appears to be related to increased VO(2) and VCO(2) associated with increased muscle activity in the unsupported standing position. This has implications for exercise prescription and rehabilitation of critically ill patients who have reduced cardiovascular and respiratory reserve.
Publisher: JMIR Publications Inc.
Date: 18-03-2021
DOI: 10.2196/27196
Abstract: Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI kg/m2 and gaining weight above recommendations at weeks’ gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. DERR1-10.2196/27196
Publisher: SAGE Publications
Date: 03-2017
DOI: 10.1177/0310057X1704500214
Abstract: The reproducibility of the regional distribution of ventilation and the timing of onset of regional filling as measured by electrical impedance tomography lacks evidence. This study investigated whether electrical impedance tomography measurements in healthy males were reproducible when electrodes were replaced between measurements. Part 1: Recordings of five volunteers lying supine were made using electrical impedance tomography and a pneumotachometer. Measurements were repeated at least three hours later. Skin marking ensured accurate replacement of electrodes. No stabilisation period was allowed. Part 2: Electrical impedance tomography recordings of ten volunteers a 15 minute stabilisation period, extra skin markings, and time-averaging were incorporated to improve the reproducibility. Reproducibility was determined using the Bland–Altman method. To judge the transferability of the limits of agreement, a Pearson correlation was used for electrical impedance tomography tidal variation and tidal volume. Tidal variation was judged to be reproducible due to the significant correlation between tidal variation and tidal volume (r 2 = 0.93). The ventilation distribution was not reproducible. A stabilisation period, extra skin markings and time-averaging did not improve the outcome. The timing of regional onset of filling was reproducible and could prove clinically valuable. The reproducibility of the tidal variation indicates that non-reproducibility of the ventilation distribution was probably a biological difference and not measurement error. Other causes of variability such as electrode placement variability or lack of stabilisation when accounted for did not improve the reproducibility of the ventilation distribution.
Publisher: Elsevier BV
Date: 10-2005
Abstract: Respiratory muscle weakness and decreased endurance have been demonstrated following mechanical ventilation. However, its relationship to the duration of mechanical ventilation is not known. The aim of this study was to assess respiratory muscle endurance and its relationship to the duration of mechanical ventilation. Prospective study. Tertiary teaching hospital ICU. Twenty subjects were recruited for the study who had received mechanical ventilation for > or = 48 h and had been discharged from the ICU. FEV1, FVC, and maximal inspiratory pressure (P(I(max)) at functional residual capacity were recorded. The P(I(max)) attained following resisted inspiration at 30% of the initial P(I(max)) for 2 min was recorded, and the fatigue resistance index (FRI) [P(I(max)) final/P(I(max))initial] was calculated. The duration of ICU length of stay (ICULOS), duration of mechanical ventilation (MVD), duration of weaning (WD), and Charlson comorbidities score (CCS) were also recorded. Relationships between fatigue and other parameters were analyzed using the Spearman correlations (rho). Subjects were admitted to the ICU for a mean duration of 7.7 days (SD, 3.7 days) and required mechanical ventilation for a mean duration of 4.6 days (SD, 2.5 days). The mean FRI was 0.88 (SD, 0.13), indicating a 12% fall in P(I(max)), and was negatively correlated with MVD (r = -0.65 p = 0.007). No correlations were found between the FRI and FEV1, FVC, ICULOS, WD, or CCS. Patients who had received mechanical ventilation for > 48 h have reduced inspiratory muscle endurance that worsens with the duration of mechanical ventilation and is present following successful weaning. These data suggest that patients needing prolonged mechanical ventilation are at risk of respiratory muscle fatigue and may benefit from respiratory muscle training.
Publisher: Springer Science and Business Media LLC
Date: 23-05-2014
Publisher: Public Library of Science (PLoS)
Date: 17-12-2021
DOI: 10.1371/JOURNAL.PONE.0261303
Abstract: This study aims to determine whether redeploying junior doctors to assist at triage represents good value for money and a good use of finite staffing resources. We undertook a cost-minimisation analysis to produce new evidence, from an economic perspective, about the costs associated with reallocating junior doctors in the emergency department. We built a decision-analytic model, using a mix of prospectively collected data, routinely collected administrative databases and hospital costings to furnish the model. To measure the impact of uncertainty on the model’s inputs and outputs, probabilistic sensitivity analysis was undertaken, using Monte Carlo simulation. The mean costs for usual care were $27,035 (95% CI $27,016 to $27,054), while the mean costs for the new model of care were $25,474, (95% CI $25,453 to $25,494). As a result, the mean difference was -$1,561 (95% CI -$1,533 to -$1,588), with the new model of care being a less costly approach to managing staffing allocations, in comparison to the usual approach. Our study shows that redeploying a junior doctor from the fast-track area of the department to assist at triage provides a modest reduction in cost. Our findings give decision-makers who seek to maximise benefit from their finite budget, support to reallocate personnel within the ED.
Publisher: Wiley
Date: 12-2005
DOI: 10.1002/PRI.14
Abstract: Inspiratory muscle weakness and fatigue has been documented following prolonged mechanical ventilation despite successful weaning from mechanical ventilation. This report describes the application of inspiratory muscle training in two patients following successful discharge from an intensive care unit (ICU) after prolonged mechanical ventilation. Both patients undertook inspiratory muscle training in conjunction with standard physiotherapy rehabilitation. Improvements in inspiratory muscle strength and endurance, exercise tolerance and functional performance following twice-daily inspiratory muscle training were recorded. In both cases, an improvement in maximal inspiratory pressure (MIP) and maximal tolerated inspiratory load (MIP(load)) was found following training. These positive results indicate further research is needed to investigate the effect of inspiratory muscle training on respiratory function, exercise tolerance and functional performance, for the possible inclusion of inspiratory muscle training into the physiotherapy management of patients following prolonged mechanical ventilation.
Publisher: Elsevier BV
Date: 2004
DOI: 10.1016/S0004-9514(14)60249-X
Abstract: Although tilt tables are used by physiotherapists to reintroduce patients to the vertical position, no quantitative evidence is available regarding their use within intensive care units (ICUs) of Australian hospitals. The purpose of this study was to evaluate the use of tilt tables in physiotherapy management of patients in ICUs across Australia. Ninety-nine physiotherapists working in Australian public ICUs were contacted via mail and asked to complete a questionnaire regarding their use of tilt tables in practice. Reasons for the use of the tilt table, contraindications, commonly used adjuncts, monitoring, and outcome measures were also investigated. Eighty-six questionnaires were returned (87% response). The tilt table was used by 58 physiotherapists (67.4%). The most common reasons for inclusion of tilt table treatment were to: facilitate weight bearing (94.8% of those who tilt) prevent muscle contractures (86%) improve lower limb strength (81%) and increase arousal (70%). The tilt table was most frequently applied to patients with neurological conditions (63.8%) and during long-term ICU stay (43.1%). Techniques often combined with tilt table treatment included upper limb exercises (93.1%) and breathing exercises (86.2%). Standing with assistance of the tilt table is used by the majority of physiotherapists working in Australian ICUs. A moderate level of agreement is demonstrated by physiotherapists regarding indications to commence tilt table treatment and adjunct modalities combined with standing with assistance of the tilt table.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2013
Publisher: Springer Science and Business Media LLC
Date: 12-2014
DOI: 10.7603/S40933-014-0007-Z
Abstract: Ever since Truscott (1996) commented on the use of written corrective feedback (CF), there has been a growing interest in this field of study. Unfortunately, despite the number of researches done in this field, most of them has only focused on the pedagogical and fundamental aspects. Very few researches looked at students’ perception of written CF. This paper investigates the perspectives of Taylor’s University Lakeside C us Intensive English Program (IEN) students on Corrective Feedback in their writing class. This study was conducted using a quantitative approach and used T-test to test the hypotheses. The results of this study shed light on the impact of CF in second language acquisition (SLA).
Publisher: Informa UK Limited
Date: 26-07-2010
DOI: 10.3109/09593980903423210
Abstract: This study investigated the effect of flow rates and spirometer type on chest wall motion in healthy in iduals. Twenty-one healthy volunteers completed breathing trials to either two times tidal volume (2xV(T)) or inspiratory capacity (IC) at high, low, or natural flow rates, using a volume- or flow-oriented spirometer. The proportions of rib cage movement to tidal volume (%RC/V(T)), chest wall diameters, and perceived level of exertion (RPE) were compared. Low and natural flow rates resulted in significantly lower %RC/V(T) compared to high flow rate trials (p=0.001) at 2xV(T). Low flow trials also resulted in significantly less chest wall motion in the upper anteroposterior direction than high and natural flow rates (p<0.001). At IC, significantly greater movement occurred in the abdominal lateral direction during low flow compared to high and natural flow trials (both p<0.003). RPE was lower for the low flow trials compared to high flow trials at IC and 2xV(T) (p<0.01). In healthy in iduals, inspiratory flow (not device type) during incentive spirometry determines the resultant breathing pattern. High flow rates result in greater chest wall motion than low flow rates.
Publisher: JMIR Publications Inc.
Date: 17-01-2021
Abstract: espite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. his study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. etrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI & kg/m sup /sup and gaining weight above recommendations at & weeks’ gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. ata collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. his study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. ERR1-10.2196/27196
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1016/J.APMR.2004.03.024
Abstract: To investigate the effect of standing with assistance of the tilt table on ventilatory parameters and arterial blood gases in intensive care patients. Consecutive s le. Tertiary referral hospital. Fifteen adult patients who had been intubated and mechanically ventilated for more than 5 days (3 subjects successfully weaned, 12 subjects being weaned). Passive tilting to 70 degrees from the horizontal for 5 minutes using a tilt table. Minute ventilation (VE), tidal volume (VT), respiratory rate, and arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2). Standing in the tilted position for 5 minutes produced significant increases in VE (P <.001) and produced both increases in respiratory rate (P <.001) and VT (P =.016) compared with baseline levels. These changes were maintained during the tilt intervention and immediately posttilt. Twenty minutes after the tilt, there were no significant changes in ventilatory measures of VE, VT, or arterial blood gases PaO2 and PaCO2 compared with initial values. Standing for 5 minutes with assistance of a tilt table significantly increased ventilation in critical care patients during and immediately after the intervention. There were no improvements in gas exchange posttilt. Using a tilt table provided an effective method to increase ventilation in the short term.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2008
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1016/J.GAITPOST.2010.01.022
Abstract: It has recently been suggested that people with chronic obstructive pulmonary disease have an increased risk of falls. Although falls risk is multifactorial, impaired balance may contribute. The primary aim of this study was to compare balance between people with and without chronic obstructive pulmonary disease and the secondary aim was to determine if balance deteriorates when respiratory demand is increased by upper limb exercise. Twelve people with chronic obstructive pulmonary disease and 12 healthy control subjects participated in this study. Participants stood on a force plate to record centre of pressure displacement during a range of conditions that challenge balance. Lumbar spine and hip motion were measured with inclinometers. Balance trials were performed before and after participation in upper limb exercise that increased respiratory demand in those with chronic obstructive pulmonary disease. People with chronic obstructive pulmonary disease had increased mediolateral centre of pressure displacement and increased angular motion of the hip compared to healthy controls. Mediolateral centre of pressure displacement was further increased in people with chronic obstructive pulmonary disease following exercise, but unchanged in controls. Anteroposterior centre of pressure displacement did not differ between groups. People with chronic obstructive pulmonary disease have reduced control of balance in the mediolateral direction. This may contribute to an increased risk of falls in this population.
Publisher: SAGE Publications
Date: 07-07-2019
Abstract: Recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities in Queensland, Australia remains a challenge. To overcome this barrier, two different service delivery models (Fly-In, Fly-Out (FIFO), Telehealth) were trialled by one regional facility. This study aims to describe the economic- and service-related outcomes of these two methods of service delivery. A retrospective audit was conducted where two nine-week time periods were selected for each service delivery model. Outcomes of interests include patient demographics and case-mix, service utilisation, clinical actions, adverse events and costs. Net financial position for both models was calculated based upon costs incurred and revenue generated by service activity. A total of 33 appointment slots were recorded for each service delivery model. Patient case-mix was variable, where the Telehealth model predominately involved patients with musculoskeletal spinal conditions managed from a neurosurgical waiting list. Appointment slot utilisation and pattern of referral for further investigations were similar between models. No safety incidents occurred in either service delivery model. An estimated cost-savings of 13% for the Telehealth model could be achieved when compared to the FIFO model. Telehealth is a safe, efficient and viable option when compared to a traditional in-person outreach service, while providing cost-savings. Telehealth should be seen as a service delivery medium in which sustainable recruitment of advanced-practice physiotherapists to regional and rural healthcare facilities can be achieved.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.GAITPOST.2015.09.004
Abstract: Increased respiration in chronic obstructive pulmonary disease (COPD) requires greater abdominal muscle activation, which may impact on contribution of the trunk to postural control. This study aimed to determine whether recovery of balance from postural perturbations and trunk muscle activity differs in people with and without COPD before and/or after exercise. Electromyography (EMG) of the obliquus internus (OI) and externus (OE) abdominis, rectus abdominis (RA), erector spinae (ES) and deltoid muscles was recorded with surface electrodes during rapid shoulder flexion and extension. Time taken to regain baseline centre of pressure velocity (vCOP) and the number of postural adjustments following arm movement was calculated from force plate data. Time to recover balance in the direction of postural disturbance (anteroposterior vCOP) was longer in COPD, particularly more severe COPD, than controls. Mediolateral vCOP (perpendicular to the perturbation) and the number of postural adjustments did not differ between groups, but people with more severe COPD were less successful at returning their mediolateral vCOP to baseline. Abdominal muscle EMG was similar between groups, but controls had greater ES EMG during arm movements. In iduals with more severe COPD had greater OE and RA EMG both before and during arm movement compared to those with less severe COPD and controls. Following exercise, OE and ES EMG increased in people with less severe COPD. This study shows that severe COPD is associated with impaired ability to recover balance and greater trunk muscle activity during postural challenges. Augmented trunk muscle activity may limit the contribution of trunk movements to balance recovery and could contribute to increased falls risk.
No related grants have been discovered for Angela Chang.