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1. FUSE Measurements of Far Ultraviolet Extinction. I. Galactic Sight Lines

Author: Sofia, U. J., Wolff, M. J., Rachford, B., Gordon, K. D., Clayton, G. C., Cartledge, S. I. B., Martin, P. G., Draine, B. T., Mathis, J. S., Snow, T. P., and Whittet, D. C. B.
Subjects: Astrophysics
Abstract: We present extinction curves that include data down to far ultraviolet wavelengths (FUV; 1050 - 1200 A) for nine Galactic sight lines. The FUV extinction was measured using data from the Far Ultraviolet Spectroscopic Explorer. The sight lines were chosen for their unusual extinction properties in the infrared through the ultraviolet; that they probe a wide range of dust environments is evidenced by the large spread in their measured ratios of total-to-selective extinction, R_V = 2.43 - 3.81. We find that extrapolation of the Fitzpatrick & Massa relationship from the ultraviolet appears to be a good predictor of the FUV extinction behavior. We find that predictions of the FUV extinction based upon the Cardelli, Clayton & Mathis (CCM) dependence on R_V give mixed results. For the seven extinction curves well represented by CCM in the infrared through ultraviolet, the FUV extinction is well predicted in three sight lines, over-predicted in two sight lines, and under-predicted in 2 sight lines. A Maximum Entropy Method analysis using a simple three component grain model shows that seven of the nine sight lines in the study require a larger fraction of grain materials to be in dust when FUV extinction is included in the models. Most of the added grain material is in the form of small (radii < 200 A) grains., Comment: Accepted for publication in the Astrophysical Journal. 31 pages with 7 figures
Published: 2005
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2. Interstellar Carbon in Translucent Sightlines

Author: Sofia, U. J., Lauroesch, J. T., Meyer, D. M., and Cartledge, S. I. B.
Subjects: Astrophysics
Abstract: We report interstellar C II column densities or upper limits determined from weak absorption of the 2325.4029 A intersystem transition observed in six translucent sightlines with STIS. The sightlines sample a wide range of interstellar characteristics including total-to-selective extinction, R_{V} = 2.6 - 5.1; average hydrogen density along the sightline, = 3 - 14 cm^{-3}; and fraction of H in molecular form, 0 - 40%. Four of the sightlines, those toward HD 37021, HD 37061, HD 147888 and HD 207198, have interstellar gas-phase abundances that are consistent with the diffuse sightline ratio of 161 +/- 17 carbon atoms in the gas per million hydrogen nuclei. We note that while it has a gas-phase carbon abundance that is consistent with the other sightlines, a large fraction of the C II toward HD 37061 is in an excited state. The sightline toward HD 152590 has a measured interstellar gas-phase carbon abundance that is well above the diffuse sightline average; the column density of C in this sightline may be overestimated due to noise structure in the data. Toward HD 27778 we find a 3 sigma abundance upper limit of <108 C atoms in the gas per million H, a substantially enhanced depletion of C as compared to the diffuse sightline value. The interstellar characteristics toward HD 27778 are otherwise not extreme among the sample except for an unusually large abundance of CO molecules in the gas., Comment: Accepted for publication in the Astrophysical Journal
Published: 2004
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3. Declining Public Awareness of Heart Attack Warning Symptoms in the Years Following an Australian Public Awareness Campaign: A Cross-Sectional Study

Author: Bray, Janet, Howell, S., Nehme, Z., Buttery, A., Stub, D., Cartledge, S., Finn, Judith, Bray, Janet, Howell, S., Nehme, Z., Buttery, A., Stub, D., Cartledge, S., and Finn, Judith
Abstract: Background: The National Heart Foundation of Australia's (NHFA) Warning Signs campaign ran between 2010 and 2013. This study examines trends in Australian adults’ ability to name heart attack symptoms during the campaign and in the years following. Methods: Using the NHFA's HeartWatch data (quarterly online surveys) for adults aged 30–59 years, we conducted an adjusted piecewise regression analysis comparing trends in the ability to name symptoms during the campaign period plus one year lag (2010–2014) to the post-campaign period (2015–2020) Results: Over the study period, there were 101,936 Australian adults surveyed. Symptom awareness was high or increased during the campaign period. However, there was a significant downward trend in each year following the campaign period for most symptoms (e.g., chest pain: adjusted odds ratio [AOR] =0.91, 95%CI: 0.56–0.80; arm pain: AOR=0.92, 95%CI: 0.90–0.94). Conversely, the inability to name any heart attack symptom increased in each year following the campaign (3.7% in 2010 to 19.9% in 2020; AOR=1.13, 95%CI: 1.10–1.15); these respondents were more likely to be younger, male, have less than 12 years of education, identify as Aboriginal and/or Torres Strait Islander Peoples, speak a language other than English at home and have no cardiovascular risk factors. Conclusion: Awareness of heart attack symptoms has decreased in the years since the Warning Signs campaign in Australia, with 1 in 5 adults currently unable to name a single heart attack symptom. New approaches are needed to promote and sustain this knowledge, and to ensure people act appropriately and promptly if symptoms occur.
Published: 2023

4. 2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations: Summary from the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; And First Aid Task Forces

Author: Wyckoff, M. H., Greif, R., Morley, P. T., Ng, K. -C., Olasveengen, T. M., Singletary, E. M., Soar, J., Cheng, A., Drennan, I. R., Liley, H. G., Scholefield, B. R., Smyth, M. A., Welsford, M., Zideman, D. A., Acworth, J., Aickin, R., Andersen, L. W., Atkins, D., Berry, D. C., Bhanji, F., Bierens, J., Borra, V., Bottiger, B. W., Bradley, R. N., Bray, J. E., Breckwoldt, J., Callaway, C. W., Carlson, J. N., Cassan, P., Castren, M., Chang, W. -T., Charlton, N. P., Chung, S. P., Considine, J., Costa-Nobre, D. T., Couper, K., Couto, T. B., Dainty, K. N., Davis, P. G., De Almeida, M. F., De Caen, A. R., Deakin, C. D., Djarv, T., Donnino, M. W., Douma, M. J., Duff, J. P., Dunne, C. L., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Finn, J., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A. -M., Guinsburg, R., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M. -J., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M. D., Kim, H. -S., Kleinman, M., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y. (., Lockey, A. S., Maconochie, I. K., Madar, R. J., Malta Hansen, C., Masterson, S., Matsuyama, T., Mckinlay, C. J. D., Meyran, D., Morgan, P., Morrison, L. J., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., O'Neill, B. J., Ong, Y. -K. G., Orkin, A. M., Paiva, E. F., Parr, M. J., Patocka, C., Pellegrino, J. L., Perkins, G. D., Perlman, J. M., Rabi, Y., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Rudiger, M., Sakamoto, T., Sandroni, Claudio, Sawyer, T. L., Schexnayder, S. M., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Sugiura, T., Tijssen, J. A., Trevisanuto, D., Van De Voorde, P., Wang, T. -L., Weiner, G. M., Wyllie, J. P., Yang, C. -W., Yeung, J., Nolan, J. P., Berg, K. M., Burdick, M. C., Cartledge, S., Dawson, J. A., Elgohary, M. M., Ersdal, H. L., Finan, E., Flaatten, H. I., Flores, G. E., Fuerch, J., Garg, R., Gately, C., Goh, M., Halamek, L. P., Handley, A. J., Hatanaka, T., Hoover, A., Issa, M., Johnson, S., Kamlin, C. O., Ko, Y. -C., Kule, A., Leone, T. A., Mackenzie, E., Macneil, F., Montgomery, W., O'Dochartaigh, D., Ohshimo, S., Palazzo, F. S., Picard, C., Quek, B. H., Raitt, J., Ramaswamy, V. V., Scapigliati, Andrea, Shah, B. A., Stewart, C., Strand, M. L., Szyld, E., Thio, M., Topjian, A. A., Udaeta, E., Vaillancourt, C., Wetsch, W. A., Wigginton, J., Yamada, N. K., Yao, S., Zace, D., Zelop, C. M., Sandroni C. (ORCID:0000-0002-8878-2611), Scapigliati A. (ORCID:0000-0002-4044-2343), Wyckoff, M. H., Greif, R., Morley, P. T., Ng, K. -C., Olasveengen, T. M., Singletary, E. M., Soar, J., Cheng, A., Drennan, I. R., Liley, H. G., Scholefield, B. R., Smyth, M. A., Welsford, M., Zideman, D. A., Acworth, J., Aickin, R., Andersen, L. W., Atkins, D., Berry, D. C., Bhanji, F., Bierens, J., Borra, V., Bottiger, B. W., Bradley, R. N., Bray, J. E., Breckwoldt, J., Callaway, C. W., Carlson, J. N., Cassan, P., Castren, M., Chang, W. -T., Charlton, N. P., Chung, S. P., Considine, J., Costa-Nobre, D. T., Couper, K., Couto, T. B., Dainty, K. N., Davis, P. G., De Almeida, M. F., De Caen, A. R., Deakin, C. D., Djarv, T., Donnino, M. W., Douma, M. J., Duff, J. P., Dunne, C. L., Eastwood, K., El-Naggar, W., Fabres, J. G., Fawke, J., Finn, J., Foglia, E. E., Folke, F., Gilfoyle, E., Goolsby, C. A., Granfeldt, A., Guerguerian, A. -M., Guinsburg, R., Hirsch, K. G., Holmberg, M. J., Hosono, S., Hsieh, M. -J., Hsu, C. H., Ikeyama, T., Isayama, T., Johnson, N. J., Kapadia, V. S., Kawakami, M. D., Kim, H. -S., Kleinman, M., Kloeck, D. A., Kudenchuk, P. J., Lagina, A. T., Lauridsen, K. G., Lavonas, E. J., Lee, H. C., Lin, Y. (., Lockey, A. S., Maconochie, I. K., Madar, R. J., Malta Hansen, C., Masterson, S., Matsuyama, T., Mckinlay, C. J. D., Meyran, D., Morgan, P., Morrison, L. J., Nadkarni, V., Nakwa, F. L., Nation, K. J., Nehme, Z., Nemeth, M., Neumar, R. W., Nicholson, T., Nikolaou, N., Nishiyama, C., Norii, T., Nuthall, G. A., O'Neill, B. J., Ong, Y. -K. G., Orkin, A. M., Paiva, E. F., Parr, M. J., Patocka, C., Pellegrino, J. L., Perkins, G. D., Perlman, J. M., Rabi, Y., Reis, A. G., Reynolds, J. C., Ristagno, G., Rodriguez-Nunez, A., Roehr, C. C., Rudiger, M., Sakamoto, T., Sandroni, Claudio, Sawyer, T. L., Schexnayder, S. M., Schmolzer, G. M., Schnaubelt, S., Semeraro, F., Skrifvars, M. B., Smith, C. M., Sugiura, T., Tijssen, J. A., Trevisanuto, D., Van De Voorde, P., Wang, T. -L., Weiner, G. M., Wyllie, J. P., Yang, C. -W., Yeung, J., Nolan, J. P., Berg, K. M., Burdick, M. C., Cartledge, S., Dawson, J. A., Elgohary, M. M., Ersdal, H. L., Finan, E., Flaatten, H. I., Flores, G. E., Fuerch, J., Garg, R., Gately, C., Goh, M., Halamek, L. P., Handley, A. J., Hatanaka, T., Hoover, A., Issa, M., Johnson, S., Kamlin, C. O., Ko, Y. -C., Kule, A., Leone, T. A., Mackenzie, E., Macneil, F., Montgomery, W., O'Dochartaigh, D., Ohshimo, S., Palazzo, F. S., Picard, C., Quek, B. H., Raitt, J., Ramaswamy, V. V., Scapigliati, Andrea, Shah, B. A., Stewart, C., Strand, M. L., Szyld, E., Thio, M., Topjian, A. A., Udaeta, E., Vaillancourt, C., Wetsch, W. A., Wigginton, J., Yamada, N. K., Yao, S., Zace, D., Zelop, C. M., Sandroni C. (ORCID:0000-0002-8878-2611), and Scapigliati A. (ORCID:0000-0002-4044-2343)
Abstract: This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for futu
Published: 2022

5. Telehealth is here to stay but not without challenges: a consultation of cardiac rehabilitation clinicians during COVID-19 in Victoria, Australia

Author: Cartledge, S, Rawstorn, Jonathan, Tran, M, Ryan, P, Howden, EJ, Jackson, A, Cartledge, S, Rawstorn, Jonathan, Tran, M, Ryan, P, Howden, EJ, and Jackson, A
Abstract: Abstract Aims Delivery of cardiac rehabilitation (CR) was challenged during the pandemic caused by the Coronavirus disease (COVID-19), due to government stay-at-home directives which restricted in-person programmes. The Australian state of Victoria experienced the longest and most severe COVID-19 restrictions and was in lockdown for ∼6 months of 2020. We aimed to explore (i) clinicians’ experiences and perceptions and (ii) identify barriers and enablers, for delivering CR during the COVID-19 pandemic. Methods and results Victorian members of the Australian Cardiovascular Health and Rehabilitation Association (ACRA) were invited to attend an exploratory qualitative online consultation in November 2020. An inductive thematic analysis was undertaken, before deductively applying the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework to identify barriers and enablers for technology adoption in CR. Thirty members participated in a 106-min consultation. Seventeen members who provided demographics represented multiple disciplines (nursing n = 13, exercise physiology n = 3, and physiotherapy n = 1) and geographical settings (metropolitan n = 10, regional n = 4, and rural n = 3). Four main themes were inductively identified: consequences of change; use of technology; capacity; and the way forward. The deductive NASSS analysis demonstrated the main challenges of continuing remotely delivered CR lie with adopters (staff, patients, and carers) and with organizations. Conclusion The COVID-19 pandemic expedited significant changes to CR delivery models. While clinicians are eager to retain technology-enabled delivery in addition to resuming in-person CR, it is now timely to review remote models of care, tools used and plan how they will be integrated with
Published: 2021

6. Cardiac Rehabilitation During COVID-19 in Victoria, Australia: Telehealth is Here to Stay but it is Not Without Challenges. A Focus Group Study

Author: Cartledge, S, Rawstorn, J, Ryan, P, Tran, M, Howden, E, Jackson, A, Cartledge, S, Rawstorn, J, Ryan, P, Tran, M, Howden, E, and Jackson, A
Published: 2021

7. Australia's awareness of cardiac arrest and rates of CPR training: Results from the Heart Foundation's HeartWatch survey

Author: Cartledge, S, Saxton, D, Finn, J, Bray, JE, Cartledge, S, Saxton, D, Finn, J, and Bray, JE
Abstract: Objective: We aimed to provide the first national estimates of cardiopulmonary resuscitation (CPR) training and awareness of cardiac arrest. Design: A retrospective analysis of a national cross-sectional survey was undertaken. Data were collected online from adults in July 2017 as part of the Heart Foundation of Australia’s HeartWatch survey. We used logistic regression to examine demographic factors associated with CPR training. Participants: A national cohort was invited to participate in the survey using purposive, non-probability sampling methods with quotas for age, gender and area of residence, in order to reflect the wider Australian population. The final sample consisted of 1076 respondents. Main outcome measure: To determine an estimation of the prevalence of cardiac arrest awareness and CPR training at a national level and the relationship of training to demographic factors. Results: The majority (76%) of respondents were born in Australia with 51% female and 66% aged between 35 and 64 years. Only 16% of respondents could identify the difference between a cardiac arrest and a heart attack. While 56% reported previous CPR training, only 22% were currently trained (within 1 year). CPR training was associated with younger age (35 to 54 years) (OR 1.45, 95% CI 1.06 to 2.0), being born in Australia (OR 1.59, 95% CI 1.17 to 2.17) and higher levels of education (university, OR 1.86, 95% CI 1.35 to 2.57). CPR training increased confidence in respondents ability to perform effective CPR and use a defibrillator. Lack of CPR training was the most common reason why respondents would not provide CPR to a stranger. Conclusions: There is a need to improve the community’s understanding of cardiac arrest, and to increase awareness and training in CPR. CPR training rates have not changed over the past decades—new initiatives are needed.
Published: 2020

8. The current temperature: A survey of post-resuscitation care across Australian and New Zealand intensive care units.

Author: Bray, JE, Cartledge, S, Finn, J, Eastwood, GM, McKenzie, N, Stub, D, Straney, L, Bernard, S, Bray, JE, Cartledge, S, Finn, J, Eastwood, GM, McKenzie, N, Stub, D, Straney, L, and Bernard, S
Abstract: AIM: Targeted temperature management (TTM) in post-resuscitation care has changed dramatically over the last two decades. However, uptake across Australian and New Zealand (NZ) intensive care units (ICUs) is unclear. We aimed to describe post-resuscitation care in our region, with a focus on TTM, and to gain insights into clinician's opinions about the level of evidence supporting TTM. METHODS: In December 2017, we sent an online survey to 163 ICU medical directors in Australia (n = 141) and NZ (n = 22). RESULTS: Sixty-one ICU medical directors responded (50 from Australia and 11 from NZ). Two respondents were excluded from analysis as their Private ICUs did not admit post-arrest patients. The majority of remaining respondents stated their ICU followed a post-resuscitation care clinical guideline (n = 41/59, 70%). TTM was used in 57 (of 59, 97%) ICUs, of these only 64% had a specific TTM clinical guideline/policy and there was variation in the types of patients treated, temperatures targeted (range = 33-37.5 °C), methods for cooling and duration of cooling (range = 12-72 h). The majority of respondents stated that their ICU (n = 45/57, 88%) changed TTM practice following the TTM trial: with 28% targeting temperatures >36 °C, and 23 (of 46, 50%) respondents expressed concerns with current level of evidence for TTM. Only 38% of post-resuscitation guidelines included prognostication procedures, few ICUs reported the use of electrophysiological tests. CONCLUSIONS: In Australian and New Zealand ICUs there is widespread variation in post-resuscitation care, including TTM practice and prognostication. There also seems to be concerns with current TTM evidence and recommendations.
Published: 2020

9. The Utility of Predicting Hospitalizations Among Patients With Heart Failure Using mHealth: Observational Study.

Author: Cartledge, S, Maddison, R, Vogrin, S, Falls, R, Tumur, O, Hopper, I, Neil, C, Cartledge, S, Maddison, R, Vogrin, S, Falls, R, Tumur, O, Hopper, I, and Neil, C
Abstract: BACKGROUND: Heart failure decompensation is a major driver of hospitalizations and represents a significant burden to the health care system. Identifying those at greatest risk of admission can allow for targeted interventions to reduce this risk. OBJECTIVE: This paper aims to compare the predictive value of objective and subjective heart failure respiratory symptoms on imminent heart failure decompensation and subsequent hospitalization within a 30-day period. METHODS: A prospective observational pilot study was conducted. People living at home with heart failure were recruited from a single-center heart failure outpatient clinic. Objective (blood pressure, heart rate, weight, B-type natriuretic peptide) and subjective (4 heart failure respiratory symptoms scored for severity on a 5-point Likert scale) data were collected twice weekly for a 30-day period. RESULTS: A total of 29 participants (median age 79 years; 18/29, 62% men) completed the study. During the study period, 10 of the 29 participants (34%) were hospitalized as a result of heart failure. For objective data, only heart rate exhibited a between-group difference. However, it was nonsignificant for variability (P=.71). Subjective symptom scores provided better prediction. Specifically, the highest precision of heart failure hospitalization was observed when patients with heart failure experienced severe dyspnea, orthopnea, and bendopnea on any given day (area under the curve of 0.77; sensitivity of 83%; specificity of 73%). CONCLUSIONS: The use of subjective respiratory symptom reporting on a 5-point Likert scale may facilitate a simple and low-cost method of predicting heart failure decompensation and imminent hospitalization. Serial collection of symptom data could be augmented using ecological momentary assessment of self-reported symptoms within a mobile health monitoring strategy for patients at high risk for heart failure decompensation.
Published: 2020

10. CSANZ COVID-19 Cardiovascular Nursing Care Consensus Statement: Executive Summary.

Author: Inglis, SC, Naismith, C, White, K, Hendriks, JM, Bray, J, Hickman, LD, Aldridge, C, Bardsley, K, Cameron, J, Candelaria, D, Cartledge, S, Du, H, Ferguson, C, Martin, L, Selkow, T, Xu, X, Wynne, R, Driscoll, A, Gallagher, R, Clark, R, Davidson, PM, Inglis, SC, Naismith, C, White, K, Hendriks, JM, Bray, J, Hickman, LD, Aldridge, C, Bardsley, K, Cameron, J, Candelaria, D, Cartledge, S, Du, H, Ferguson, C, Martin, L, Selkow, T, Xu, X, Wynne, R, Driscoll, A, Gallagher, R, Clark, R, and Davidson, PM
Published: 2020

11. Australia's awareness of cardiac arrest and rates of CPR training: Results from the Heart Foundation's HeartWatch survey

Author: Cartledge, S., Saxton, D., Finn, Judith, Bray, Janet, Cartledge, S., Saxton, D., Finn, Judith, and Bray, Janet
Abstract: Objective: We aimed to provide the first national estimates of cardiopulmonary resuscitation (CPR) training and awareness of cardiac arrest. Design: A retrospective analysis of a national cross-sectional survey was undertaken. Data were collected online from adults in July 2017 as part of the Heart Foundation of Australia's HeartWatch survey. We used logistic regression to examine demographic factors associated with CPR training. Participants: A national cohort was invited to participate in the survey using purposive, non-probability sampling methods with quotas for age, gender and area of residence, in order to reflect the wider Australian population. The final sample consisted of 1076 respondents. Main outcome measure: To determine an estimation of the prevalence of cardiac arrest awareness and CPR training at a national level and the relationship of training to demographic factors. Results: The majority (76%) of respondents were born in Australia with 51% female and 66% aged between 35 and 64 years. Only 16% of respondents could identify the difference between a cardiac arrest and a heart attack. While 56% reported previous CPR training, only 22% were currently trained (within 1 year). CPR training was associated with younger age (35 to 54 years) (OR 1.45, 95% CI 1.06 to 2.0), being born in Australia (OR 1.59, 95% CI 1.17 to 2.17) and higher levels of education (university, OR 1.86, 95% CI 1.35 to 2.57). CPR training increased confidence in respondents ability to perform effective CPR and use a defibrillator. Lack of CPR training was the most common reason why respondents would not provide CPR to a stranger. Conclusions: There is a need to improve the community's understanding of cardiac arrest, and to increase awareness and training in CPR. CPR training rates have not changed over the past decades - new initiatives are needed.
Published: 2020

12. THE SOUTHERN AUSTRALIAN SPECIES OF SPYRIDIA CERAMIACEAE RHODOPHYTA

Author: Womersley, H B S, Cartledge, S A, and BioStor
Published: 1975

13. Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process

Author: Cartledge, S, Thomas, E, Hollier, K, Maddison, R, Cartledge, S, Thomas, E, Hollier, K, and Maddison, R
Abstract: OBJECTIVE: To develop standardised programme content for Australian phase II cardiac rehabilitation (CR) programme. DESIGN: Using the RAND/UCLA appropriateness method (RAM), a two-phase process including a comprehensive literature review and a two round modified Delphi process was undertaken to develop and validate content of a standardised CR programmes. PARTICIPANTS: An invited multidisciplinary expert advisory group (EAG; n=16), including CR health professionals (nurses, allied health professionals, cardiologist), academics, policy makers, representation from the Australian Cardiovascular Health and Rehabilitation Association and consumers, provided oversight of the literature review and assisted with development of best practice statements. Twelve members of the EAG went onto participate in the modified Delphi process rating the necessity of statements in two rounds on a scale of 1 (not necessary) to 9 (essential). MAIN OUTCOME MEASURE: Best practice statements that achieved a median score of ≥8 on a nine-point scale were categorised as 'essential'; statements that achieved a median score of ≥6 were categorised as 'desirable' and statements with a median score of <6 were omitted. RESULTS: 49 best practice statements were developed from the literature across ten areas of care within four module domains (CR foundations, developing heart health knowledge, psychosocial health and life beyond CR). At the end of a two-round validation process a total of 47 best practice statements were finalised; 29 statements were rated as essential, 18 as desirable and 2 statements were omitted. CONCLUSIONS: For the first time in Australia, an evidence-based and consensus-led standardised programme content for phase II CR has been developed that can be provided to CR coordinators.
Published: 2019

14. A cross-sectional survey examining cardiopulmonary resuscitation training in households with heart disease

Author: Cartledge, S., Finn, Judith, Smith, K., Straney, L., Stub, D., Bray, Janet, Cartledge, S., Finn, Judith, Smith, K., Straney, L., Stub, D., and Bray, Janet
Abstract: Background: Heart disease significantly increases the risk of further cardiac events including out-of-hospital cardiac arrest (OHCA). Given the majority of OHCAs occur in the home, family members of those with heart disease should be trained in cardiopulmonary resuscitation (CPR). Aim: To describe CPR training rates in households with heart disease, and examine if training increases knowledge, confidence and willingness to perform CPR in this population. Methods: A cross-sectional, telephone survey was conducted with adults residing in Victoria, Australia. Findings: Of 404 respondents, 78 (19.3%) reported the presence of heart disease in their household. Prevalence of CPR training was the same among households with (67.9%) and without (67.8%) heart disease, with the majority (51.5%) receiving training more than five years ago. There were no significant differences in barriers to training- the most prevalent barrier was lack of awareness to seek training. Among households with heart disease, physical ability was the most common concern relating to the provision of CPR, while households without heart disease described decreased confidence. Those with heart disease in their household who were CPR trained, had higher self-ratings of CPR knowledge and confidence, and were more willing to perform CPR (all p < 0.05). Conclusions: A large proportion of Victorians with heart disease in their household did not have recent CPR training. CPR training should be targeted to high-risk households containing a member with heart disease, as knowledge and confidence in skills are increased. Cardiac health professionals are well placed to provide CPR training information during patient contacts.
Published: 2019

15. 297Seeing is believing: the feasibility and acceptability of using wearable cameras to enhance self-management of heart failure

Author: Cartledge, S, primary, Rogerson, M, additional, Singh, T K R, additional, Huynh Huu, V, additional, Phung, D, additional, Gurrin, C, additional, Neil, C, additional, Ball, K, additional, and Maddison, R, additional
Published: 2019
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16. Temporal Trends in Emergency Medical Services and General Practitioner Use for Acute Stroke After Australian Public Education Campaigns

Author: Bray, Janet, Finn, Judith, Cameron, P., Smith, K., Straney, L., Cartledge, S., Nehme, Z., Lim, M., Bladin, C., Bray, Janet, Finn, Judith, Cameron, P., Smith, K., Straney, L., Cartledge, S., Nehme, Z., Lim, M., and Bladin, C.
Abstract: Background and Purpose- The Australian Stroke Foundation ran annual paid advertising between 2004 and 2014, using the FAST (Face, Arm, Speech, Time) campaign from 2006 and adding the message to call emergency medical services in 2007. In this study, we examined temporal trends in emergency medical services use and referrals from general practitioners in the Australian state of Victoria to evaluate the impact of these campaigns. Methods- Using data from 33 public emergency departments, contributing to the Victorian Emergency Minimum Dataset, we examined trends in emergency department presentations for 118?000 adults with an emergency diagnosis of stroke or transient ischemic attack between 2003 and 2015. Annual trends were examined using logistic regression using a precampaign period (January 2003 to August 2004) as reference and adjusting for demographic variables. Results- Compared with the precampaign period, significant increases in emergency medical services use were seen annually between 2008 and 2015 (all P<0.001, eg, 2015; adjusted odds ratio, 1.16; 95% CI, 1.10-1.23). In contrast, a decrease was seen in patients presenting via general practitioners across all campaign years (all P<0.001, eg, 2015; adjusted odds ratio, 0.48; 95% CI, 0.44-0.53). Conclusions- Since the Stroke Foundation campaigns began, a greater proportion of stroke and transient ischemic attack patients are presenting to hospital by emergency medical services and appear to be bypassing their general practitioners.
Published: 2018

17. Identifying barriers to the provision of bystander cardiopulmonary resuscitation (CPR) in high-risk regions: A qualitative review of emergency calls

Author: Case, R., Cartledge, S., Siedenburg, J., Smith, K., Straney, L., Barger, B., Finn, J., Bray, Janet, Case, R., Cartledge, S., Siedenburg, J., Smith, K., Straney, L., Barger, B., Finn, J., and Bray, Janet
Abstract: © 2018 Elsevier B.V. Introduction: Understanding regional variation in bystander cardiopulmonary resuscitation (CPR) is important to improving out-of-hospital cardiac arrest (OHCA) survival. In this study we aimed to identify barriers to providing bystander CPR in regions with low rates of bystander CPR and where OHCA was recognised in the emergency call. Methods: We retrospectively reviewed emergency calls for adults in regions of low bystander CPR in the Australian state of Victoria. Included calls were those where OHCA was identified during the call but no bystander CPR was given. A thematic content analysis was independently conducted by two investigators. Results: Saturation of themes was reached after listening to 139 calls. Calls progressed to the point of compression instructions before EMS arrival in only 26 (18.7%) of cases. Three types of barriers were identified: procedural barriers (time lost due to language barriers and communication issues; telephone problems), CPR knowledge (skill deficits; perceived benefit) and personal factors (physical frailty or disability; patient position; emotional factors). Conclusion: A range of factors are associated with barriers to delivering bystander CPR even in the presence of dispatcher instructions – some of which are modifiable. To overcome these barriers in high-risk regions, targeted public education needs to provide information about what occurs in an emergency call, how to recognise an OHCA and to improve CPR knowledge and skills.
Published: 2018

18. Incorporating cardiopulmonary resuscitation training into a cardiac rehabilitation programme: A feasibility study

Author: Cartledge, S., Finn, J., Bray, Janet, Case, R., Barker, L., Missen, D., Shaw, J., Stub, D., Cartledge, S., Finn, J., Bray, Janet, Case, R., Barker, L., Missen, D., Shaw, J., and Stub, D.
Abstract: The European Society of Cardiology 2017. Background: Patients with a cardiac history are at future risk of cardiac events, including out-of-hospital cardiac arrest. Targeting cardiopulmonary resuscitation (CPR) training to family members of cardiac patients has long been advocated, but is an area in need of contemporary research evidence. An environment yet to be investigated for targeted training is cardiac rehabilitation. Aim: To evaluate the feasibility of providing CPR training in a cardiac rehabilitation programme among patients, their family members and staff. Methods: A prospective before and after study design was used. CPR training was delivered using video self-instruction CPR training kits, facilitated by a cardiac nurse. Data was collected pre-training, post-training and at one month. Results: Cardiac patient participation rates in CPR classes were high (n = 56, 72.7% of eligible patients) with a further 27 family members attending training. Patients were predominantly male (60.2%), family members were predominantly female (81.5%), both with a mean age of 65 years. Confidence to perform CPR and willingness to use skills significantly increased post-training (both p < 0.001). Post training participants demonstrated a mean compression rate of 112 beats/min and a mean depth of 48 mm. Training reach was doubled as participants shared the video self-instruction kit with a further 87 people. Patients, family members and cardiac rehabilitation staff had positive feedback about the training. Conclusions: We demonstrated that cardiac rehabilitation is an effective and feasible environment to provide CPR training. Using video self-instruction CPR training kits enabled further training reach to the target population.
Published: 2018

19. Understanding patients and spouses experiences of patient education following a cardiac event and eliciting attitudes and preferences towards incorporating cardiopulmonary resuscitation training: A qualitative study

Author: Cartledge, S., Feldman, S., Bray, Janet, Stub, D., Finn, J., Cartledge, S., Feldman, S., Bray, Janet, Stub, D., and Finn, J.
Abstract: Aim: The aim of this study was to gain a comprehensive perspective about the experience of patient and spousal education following an acute cardiac event. The second objective was to elicit an understanding of patient and spousal attitudes, preferences and intentions towards future cardiopulmonary resuscitation training. Background: Patients with cardiovascular disease require comprehensive patient and family education to ensure adequate long-term disease management. As cardiac patients are at risk of future cardiac events, including out-of-hospital cardiac arrest, providing cardiopulmonary resuscitation training to patients and family members has long been advocated. Design: We conducted a qualitative study underpinned by phenomenology and the Theory of Planned Behaviour. Methods: Semi-structured interviews were conducted with cardiac patients and their spouses (NÂ =Â 12 patient-spouse pairs) between March 2015â€“April 2016 purposively sampled from a cardiology ward. Interviews were transcribed verbatim and thematic analysis undertaken. Findings: Nine male and three female patients and their spouses were recruited. Ages ranged from 47-75Â years. Four strongly interrelated themes emerged: the emotional response to the event, information, control and responsibility. There was evidence of positive attitudes and intentions from the TPB towards undertaking cardiopulmonary resuscitation training in the future. Only the eldest patient spouse pair were not interested in undertaking training. Conclusions: Findings suggest cardiac patients and spouses have unmet education needs following an acute cardiac event. Information increased control and decreased negative emotions associated with diagnosis. Participantsâ€™ preferences were for inclusion of cardiopulmonary resuscitation training in cardiac rehabilitation programs.
Published: 2018

20. Is there an app for that? Mobile phones and secondary prevention of cardiovascular disease

Author: Neubeck, L, Cartledge, S, Dawkes, S, and Gallagher, R
Subjects: Text Messaging, Cardiovascular System & Hematology, 616 Diseases, Cardiovascular Diseases, Risk Factors, Health, Secondary Prevention, RC Internal medicine, Humans, eHealth, Cardiology and Cardiovascular Medicine, Mobile Applications, Cell Phone
Abstract: © 2017 Wolters Kluwer Health, Inc. All rights reserved. Purpose of review Advances in technology coupled with increased penetration of mobile phones and smart devices are rapidly changing healthcare delivery. Mobile phone applications ('apps'), text messages, and Internet platforms used alone or in combination are now providing interventions targeting people with multiple cardiovascular risk factors. The present article will review the emerging evidence regarding apps and discuss their potential role in providing secondary prevention interventions via mobile phones. Recent findings Seven recent randomized controlled trials used text messages or apps for six to 12 months, with or without differing combinations of other technology platforms. All studies, involved cardiac and diabetes populations, and demonstrated at least one positive improvement to cardiovascular risk factor profiles. When measured, acceptability of the intervention was high. Summary Mobile apps and technology can deliver positive outcomes in the management of cardiovascular risk factors. However, because of the complexity of combination interventions, it is difficult to determine the 'active' ingredient. A future challenge for researchers and clinicians will be to respond quickly to these rapidly evolving interventions in order to ensure the delivery of effective, evidence-based outcomes.
Published: 2017

21. Views on cardiopulmonary resuscitation among older Australians in care: A cross-sectional survey

Author: Cartledge, S., Straney, L., Bray, Janet, Mountjoy, R., Finn, Judith, Cartledge, S., Straney, L., Bray, Janet, Mountjoy, R., and Finn, Judith
Abstract: Background: Residential aged care facilities are common locations for out-of-hospital cardiac arrests to occur, yet survival to hospital discharge is poor. Aim: This study aims to examine preferences and perceived outcomes of cardiopulmonary resuscitation among Australians receiving aged care. Methods: A brief survey was provided to 187 residential aged care facilities and 34 home care providers throughout Australia for completion by aged care residents. Respondents were asked to answer three questions about understanding and desire for cardiopulmonary resuscitation on a five-point scale (from strongly agreed to strongly disagreed). Findings: A total of 1985 residents in 163 residential aged care facilities across Australia, and 277 older Australians receiving care in the home from 24 providers responded. The majority of respondents were female (67.4%), and respondents in residential aged care facilities were significantly older (82.6%. > . 75. years) than those receiving care in the home (70.4%. > . 75. years) (p. < . 0.001). Among 2262 respondents over 80% expressed a good understanding of cardiopulmonary resuscitation and its implications. Over half of respondents desired cardiopulmonary resuscitation if they were to experience an out-of-hospital cardiac arrest, and the desire for cardiopulmonary resuscitation was strongly associated and correlated (Pearson's R test = 0.759) with a view that they would likely fully recover. Conclusion: These findings highlight the need for older people to be better informed about cardiopulmonary resuscitation, including a clear understanding of what is involved in cardiopulmonary resuscitation and a realistic perception of outcomes.
Published: 2017

22. Regions with low rates of bystander cardiopulmonary resuscitation (CPR) have lower rates of CPR training in Victoria, Australia

Author: Bray, Janet, Straney, L., Smith, K., Cartledge, S., Case, R., Bernard, S., Finn, Judith, Bray, Janet, Straney, L., Smith, K., Cartledge, S., Case, R., Bernard, S., and Finn, Judith
Abstract: © 2017 The Authors. Background-Bystander cardiopulmonary resuscitation (CPR) more than doubles the chance of surviving an out-of-hospital cardiac arrest. Recent data have shown considerable regional variation in bystander CPR rates across the Australian state of Victoria. This study aims to determine whether there is associated regional variation in rates of CPR training and willingness to perform CPR in these communities. Methods and Results-We categorized each Victorian po stcode as either a low or high bystander CPR region using data on adult, bystander-witnessed, out-of-hospital cardiac arrests of presumed cardiac etiology (n=7175) from the Victorian Ambulance Cardiac Arrest Registry. We then surveyed adult Victorians (n=404) and compared CPR training data of the respondents from low and high bystander CPR regions. Of the 404 adults surveyed, 223 (55%) resided in regions with low bystander CPR. Compared with respondents from high bystander CPR regions, respondents residing in regions with low bystander CPR had lower rates of CPR training (62% versus 75%, P=0.009) and lower self-ratings for their overall knowledge of CPR (76% versus 84%, P=0.04). There were no differences between the regions in their reasons for not having undergone CPR training or in their willingness to perform CPR. Rates of survival for bystander-witnessed, out-of-hospital cardiac arrests were significantly lower in low bystander CPR regions (15.7% versus 17.0%, P < 0.001). Conclusions-This study found lower rates of CPR training and lower survival in regions with lower rates of bystander CPR in Victoria, Australia. Targeting these regions with CPR training programs may improve bystander CPR rates and out-of-hospital cardiac arrest outcomes.
Published: 2017

23. The barriers associated with emergency medical service use for acute coronary syndrome: the awareness and influence of an Australian public mass media campaign.

Author: Cartledge, S., Finn, Judith, Straney, L., Ngu, P., Stub, D., Patsamanis, H., Shaw, J., Bray, Janet, Cartledge, S., Finn, Judith, Straney, L., Ngu, P., Stub, D., Patsamanis, H., Shaw, J., and Bray, Janet
Abstract: BACKGROUND: Emergency medical services (EMS) transport to hospital is recommended in acute coronary syndrome (ACS) guidelines, but only half of patients with ACS currently use EMS. The recent Australian Warning Signs campaign conducted by the Heart Foundation addressed some of the known barriers against using EMS. Our aim was to examine the influence of awareness of the campaign on these barriers in patients with ACS. METHODS: Interviews were conducted with patients admitted to an Australian tertiary hospital between July 2013 and April 2014 with a diagnosis of ACS. Patient selection criteria included: aged 35-75 years, competent to provide consent, English speaking, not in residential care and medically stable. Multivariable logistic regression was used to examine factors associated with EMS use. RESULTS: Only 54% of the 199 patients with ACS interviewed used EMS for transport to hospital. Overall 64% of patients recalled seeing the campaign advertising, but this was not associated with increased EMS use (52.0%vs56.9%, p=0.49) or in the barriers against using EMS. A large proportion of patients (43%) using other transport thought it would be faster. Factors associated with EMS use for ACS were: age >65 years, ST-elevation myocardial infarction, a sudden onset of pain and experiencing vomiting. CONCLUSION: In medically stable patients with ACS, awareness of the Australian Warning Signs campaign was not associated with increased use of EMS or a change in the barriers for EMS use. Future education strategies could emphasise the clinical role that EMS provide in ACS.
Published: 2017

24. Public cardiopulmonary resuscitation training rates and awareness of hands-only cardiopulmonary resuscitation: A cross-sectional survey of Victorians

Author: Bray, Janet, Smith, K., Case, R., Cartledge, S., Straney, L., Finn, J., Bray, Janet, Smith, K., Case, R., Cartledge, S., Straney, L., and Finn, J.
Abstract: © 2017 Australasian College for Emergency Medicine & Australasian Society for Emergency Medicine.Objectives: To provide contemporary Australian data on the public's training in cardiopulmonary resuscitation (CPR) and awareness of hands-only CPR. Methods: A cross-sectional telephone survey in April 2016 of adult residents of the Australian state of Victoria was conducted. Primary outcomes were rates of CPR training and awareness of hands-only CPR. Results: Of the 404 adults surveyed (mean age 55 ± 17 years, 59% female, 73% metropolitan residents), 274 (68%) had undergone CPR training. Only 50% (n = 201) had heard of hands-only CPR, with most citing first-aid courses (41%) and media (36%) as sources of information. Of those who had undergone training, the majority had received training more than 5 years previously (52%) and only 28% had received training or refreshed training in the past 12 months. Most received training in a formal first-aid class (43%), and received training as a requirement for work (67%). The most common reasons for not having training were: they had never thought about it (59%), did not have time (25%) and did not know where to learn (15%). Compared to standard CPR, a greater proportion of respondents were willing to provide hands-only CPR for strangers (67% vs 86%, P < 0.001). Conclusion: From an Australian perspective, there is still room for improvement in CPR training rates and awareness of hands-only CPR. Further promotion of hands-only CPR and self-instruction (e.g. DVD kits or online) may see further improvements in CPR training and bystander CPR rates.
Published: 2017

25. Do Cardiac Rehabilitation Programs Offer Cardiopulmonary Resuscitation Training in Australia and New Zealand?

Author: Cartledge, S., Bray, Janet, Stub, D., Krum, H., Finn, J., Cartledge, S., Bray, Janet, Stub, D., Krum, H., and Finn, J.
Abstract: © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Background: Cardiac rehabilitation may provide an ideal environment to train high-risk cardiac patients and their families in cardiopulmonary resuscitation (CPR). However, whether this training is currently offered is unknown. The aims of this study were to: 1) describe the prevalence of CPR training in cardiac rehabilitation programs in Australia and New Zealand (NZ); and 2) examine perceived barriers and attitudes of cardiac rehabilitation coordinators towards providing CPR training. Methods: We conducted a cross-sectional online survey of Australian and NZ cardiac rehabilitation coordinators. Results: We received 253 completed surveys (46.7% response rate) (Australia n=208, NZ n=45). Cardiopulmonary resuscitation training was included in 23.9% of Australian programs and 56.6% in NZ. Common barriers to CPR training included lack of resources (49.7%) and a lack of awareness to provide CPR training for this high-risk group (33.7%). The majority of coordinators believed that lay people should be trained in CPR (96.3%) and were comfortable with recommending CPR training to this high-risk group (89.4%). Conclusions: While cardiac rehabilitation coordinators have positive attitudes towards CPR training, it is not currently part of most programs - particularly in Australia. Organisations formulating cardiac rehabilitation recommendations and guidelines should give consideration to include the provision of CPR training.
Published: 2015

26. Mass Media Campaigns' Influence on Prehospital Behavior for Acute Coronary Syndromes: An Evaluation of the Australian Heart Foundation's Warning Signs Campaign

Author: Bray, Janet, Stub, D., Ngu, P., Cartledge, S., Straney, L., Stewart, M., Keech, W., Patsamanis, H., Shaw, J., Finn, Judith, Bray, Janet, Stub, D., Ngu, P., Cartledge, S., Straney, L., Stewart, M., Keech, W., Patsamanis, H., Shaw, J., and Finn, Judith
Published: 2015

27. Alpha-melanocyte-stimulating hormone reduces impact of proinflammatory cytokine and peroxide-generated oxidative stress on keratinocyte and melanoma cell lines.

Author: Haycock, John W., Rowe, S J, Cartledge, S, Wyatt, A, Ghanem, Ghanem Elias, Morandini, R, Rennie, I G, MacNeil, S, Haycock, John W., Rowe, S J, Cartledge, S, Wyatt, A, Ghanem, Ghanem Elias, Morandini, R, Rennie, I G, and MacNeil, S
Abstract: We have previously shown that alpha-melanocyte-stimulating hormone (alpha-MSH) can oppose tumor necrosis factor alpha activation of NF-kappaB (1-2 h) and intercellular adhesion molecule 1 up-regulation (mRNA by 3 h and protein by 24 h) in melanocytes and melanoma cells. The present study reports on the ability of four MSH peptides to control intracellular peroxide levels and glutathione peroxidase (GPx) activity in pigmentary and nonpigmentary cells. In human HBL melanoma and HaCaT keratinocytes tumor necrosis factor alpha and H(2)O(2) both activated GPx in a time- and concentration-dependent manner (by 30-45 min). alpha-MSH peptides were found to inhibit the stimulated GPx activity and had biphasic dose-response curves. MSH 1-13 and MSH [Nle(4)-d-Phe(7)] achieved maximum inhibition at 10(-10) and 10(-12) m, respectively. Higher concentrations (10-100 fold) of MSH 4-10 and MSH 11-13 were required to produce equivalent levels of inhibition. alpha-MSH was also capable of reducing peroxide accumulation within 15 min, and again this inhibition was biphasic. The data support a role of alpha-MSH in acute protection of cells to oxidative/cytokine action that precedes NF-kappaB and GPx activation. The rapidity and potency of the response to alpha-MSH in pigmentary and nonpigmentary cells suggest this to be a central role of this peptide in cutaneous cells., Journal Article, Research Support, Non-U.S. Gov't, SCOPUS: ar.j, info:eu-repo/semantics/published
Published: 2000

28. Alpha-melanocyte-stimulating hormone reduces impact of proinflammatory cytokine and peroxide-generated oxidative stress on keratinocyte and melanoma cell lines.

Author: Haycock, J W, Rowe, S J, Cartledge, S, Wyatt, A, Ghanem, G, Morandini, R, Rennie, I G, and MacNeil, S
Abstract: We have previously shown that alpha-melanocyte-stimulating hormone (alpha-MSH) can oppose tumor necrosis factor alpha activation of NF-kappaB (1-2 h) and intercellular adhesion molecule 1 up-regulation (mRNA by 3 h and protein by 24 h) in melanocytes and melanoma cells. The present study reports on the ability of four MSH peptides to control intracellular peroxide levels and glutathione peroxidase (GPx) activity in pigmentary and nonpigmentary cells. In human HBL melanoma and HaCaT keratinocytes tumor necrosis factor alpha and H(2)O(2) both activated GPx in a time- and concentration-dependent manner (by 30-45 min). alpha-MSH peptides were found to inhibit the stimulated GPx activity and had biphasic dose-response curves. MSH 1-13 and MSH [Nle(4)-d-Phe(7)] achieved maximum inhibition at 10(-10) and 10(-12) m, respectively. Higher concentrations (10-100 fold) of MSH 4-10 and MSH 11-13 were required to produce equivalent levels of inhibition. alpha-MSH was also capable of reducing peroxide accumulation within 15 min, and again this inhibition was biphasic. The data support a role of alpha-MSH in acute protection of cells to oxidative/cytokine action that precedes NF-kappaB and GPx activation. The rapidity and potency of the response to alpha-MSH in pigmentary and nonpigmentary cells suggest this to be a central role of this peptide in cutaneous cells.
Published: 2000

29. The Mechanisms of Moral Disengagement in George W. Bush’s ‘War on Terrorism’ Rhetoric

Author: Cartledge, S, Bowman-Grieve, L, and Palasinski, M
Subjects: GN
Abstract: Despite considerable literature on the Bush administration’s war on terrorism rhetoric, little attention has been paid to its discourse of moral disengagement, leaving an important and still relevant gap that this paper aims to address. Rather than approaching this gap in terms of an archival historical analysis that is disconnected from the present, it proposes an exploratory revisit of the rhetoric that the benefits of hindsight might enrich and, we argue, aid in understanding connections to the current post-invasion turmoil and the gradual ISIS takeover. Having subjected nineteen presidential speeches to qualitative content analysis, we identified a number of moral disengagement mechanisms: moral justification, advantageous comparisons, and attribution of blame, dehumanisation of the enemy, the use of sanitizing language, diffusion of responsibility and minimization of harm. We also identified novel themes relating to American excellence/patriotism, religious ideals and fear- arousing appeals, offering original contributions to the existing literature and advancing our understanding of dynamic, real-world, and highest stakes moral disengagement whose parallels can be identified in today’s political discourses. The detailed analysis unveils the apparent paradox of propagating moral disengagement through a thread of arguments that interweave diversity with uniformity, complexity with simplicity, in effect alerting the reader to the processes of moral desensitisation that the past, current and future “warmongering” political discourses may often rely upon.

30. Current Emergency Medical Service Vasoactive Use for the Management of Shock.

Author: Bloom JE, Goel V, Anderson D, Cartledge S, Nehme Z, Ball J, Eliakundu A, Chan W, Chew DP, Kaye DM, and Stub D
Subjects: Humans, Surveys and Questionnaires, Australia, Epinephrine therapeutic use, Epinephrine administration & dosage, North America, Emergency Medical Services, Vasoconstrictor Agents therapeutic use, Shock drug therapy
Abstract: Objectives: We sought to describe the indications for vasoactive medication administration, hemodynamic treatment targets, and specific agents used by various international emergency medical service (EMS) providers., Design and Setting: In March 2022, we sent an online survey comprising of 20 questions to Medical Directors of EMSs across Australia, the Asia Pacific region, and North America., Patients: A total of 108 EMS directors were emailed an invitation to participate., Interventions: None., Measurements and Main Results: Twenty-five EMS medical directors responded. Local site guidelines for vasoactive agent administration were available to 77.3% of providers. Epinephrine was commonly used as first-line vasoactive agent in 52% of questionnaire respondents, followed by norepinephrine (22%), dopamine (18%), and metaraminol (4%). Epinephrine was the most commonly used vasoactive agent across all forms of shock, with a higher proportion of utilization in cases of cardiogenic shock (58%) and patients suffering shock following cardiac arrest (56%)., Conclusions: International EMS vasoactive use in the management of shock is heterogeneous. Future randomized controlled trials should aim to elucidate optimal prehospital treatment strategies for shock, including the initiation, choice of agent, and monitoring of vasoactive medication., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Published: 2024
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31. Data-driven collaborative QUality improvement in Cardiac Rehabilitation (QUICR) to increase program completion: protocol for a cluster randomized controlled trial.

Author: Candelaria D, Redfern J, O'Neil A, Brieger D, Clark RA, Briffa T, Bauman A, Hyun K, Cunich M, Figtree GA, Cartledge S, and Gallagher R
Subjects: Humans, Treatment Outcome, Time Factors, New South Wales, Cooperative Behavior, Victoria, Coronary Disease rehabilitation, Coronary Disease diagnosis, Guideline Adherence standards, Health Care Costs, Quality Improvement standards, Cardiac Rehabilitation standards, Multicenter Studies as Topic, Quality Indicators, Health Care standards, Randomized Controlled Trials as Topic
Abstract: Background: Coronary heart disease (CHD) is the leading cause of deaths and disability worldwide. Cardiac rehabilitation (CR) effectively reduces the risk of future cardiac events and is strongly recommended in international clinical guidelines. However, CR program quality is highly variable with divergent data systems, which, when combined, potentially contribute to persistently low completion rates. The QUality Improvement in Cardiac Rehabilitation (QUICR) trial aims to determine whether a data-driven collaborative quality improvement intervention delivered at the program level over 12 months: (1) increases CR program completion in eligible patients with CHD (primary outcome), (2) reduces hospital admissions, emergency department presentations and deaths, and costs, (3) improves the proportion of patients receiving guideline-indicated CR according to national and international benchmarks, and (4) is feasible and sustainable for CR staff to implement routinely., Methods: QUICR is a multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT) with 12-month follow-up. Eligible CR programs (n = 40) and the individual patient data within them (n ~ 2,000) recruited from two Australian states (New South Wales and Victoria) are randomized 1:1 to the intervention (collaborative quality improvement intervention that uses data to identify and manage gaps in care) or control (usual care with data collection only). This sample size is required to achieve 80% power to detect a difference in completion rate of 22%. Outcomes will be assessed using intention-to-treat principles. Mixed-effects linear and logistic regression models accounting for clusters within allocated groupings will be applied to analyse primary and secondary outcomes., Discussion: Addressing poor participation in CR by patients with CHD has been a longstanding challenge that needs innovative strategies to change the status-quo. This trial will harness the collaborative power of CR programs working simultaneously on common problem areas and using local data to drive performance. The use of data linkage for collection of outcomes offers an efficient way to evaluate this intervention and support the improvement of health service delivery., Ethics: Primary ethical approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH01093), along with site-specific governance approvals., Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001239651 (30/11/2023) ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386540&isReview=true )., (© 2024. The Author(s).)
Published: 2024
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32. Expanding access to telehealth in Australian cardiac rehabilitation services: a national survey of barriers, enablers, and uptake.

Author: Thomas EE, Cartledge S, Murphy B, Abell B, Gallagher R, and Astley C
Abstract: Aims: Cardiac rehabilitation (CR) is traditionally delivered in-person; however, the COVID-19 pandemic provided impetus for alternative offerings such as telehealth. We investigated uptake, barriers, and enablers in a national survey during the pandemic in Australia., Methods and Results: We surveyed CR programmes between April and June 2021 using professional association networks. The anonymous online questionnaire addressed programme characteristics, COVID-19 impacts, and barriers to and enablers of telehealth use. Open-text responses were coded and presented as themes. In total, there were responses from 105 programmes (33% response rate). All states and geographical areas were represented. The use of every modality of telehealth care (telephone, video conferencing, text messaging, and web-based) increased significantly during and after COVID with a strong preference for telephone (85% of services). Respondents perceived video (53%) and telephone (47%) formats as safe and effective for delivering CR. The most common barriers to telehealth were difficulties conducting assessments and reduced engagement with patients. Prominent enablers were increased reach and reduced patient barriers to CR access., Conclusion: Telehealth use by CR programmes increased during the peak pandemic period. However, additional support is required to ensure that telehealth services can be maintained. There is considerable potential to increase the reach of CR by embedding telehealth into existing models of care., Competing Interests: Conflict of interest: We acknowledge that the authors were members of either state or national ACRA committees when this research was conducted., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Published: 2023
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33. A protocol for the Heart Matters stepped wedge cluster randomised trial: The effectiveness of heart attack education in regions at highest-risk.

Author: Bray JE, Nehme Z, Finn JC, Kasza J, Clark RA, Stub D, Cadilhac DA, Buttery AK, Woods J, Kim J, Smith BJ, Smith K, Cartledge S, Beauchamp A, Dodge N, Walker T, Flemming-Judge E, Chow C, Stewart M, Cox N, van Gaal W, Nadurata V, and Cameron P
Abstract: Aim: To describe the Heart Matters (HM) trial which aims to evaluate the effectiveness of a community heart attack education intervention in high-risk areas in Victoria, Australia. These local government areas (LGAs) have high rates of acute coronary syndrome (ACS), out-of-hospital cardiac arrest (OHCA), cardiovascular risk factors, and low rates of emergency medical service (EMS) use for ACS., Methods: The trial follows a stepped-wedge cluster randomised design, with eight clusters (high-risk LGAs) randomly assigned to transition from control to intervention every four months. Two pairs of LGAs will transition simultaneously due to their proximity. The intervention consists of a heart attack education program delivered by trained HM Coordinators, with additional support from opportunistic media and a geo-targeted social media campaign. The primary outcome measure is the proportion of residents from the eight LGAs who present to emergency departments by EMS during an ACS event. Secondary outcomes include prehospital delay time, rates of OHCA and heart attack awareness. The primary and secondary outcomes will be analysed at the patient/participant level using mixed-effects logistic regression models. A detailed program evaluation is also being conducted. The trial was registered on August 9, 2021 (NCT04995900)., Results: The intervention was implemented between February 2022 and March 2023, and outcome data will be collected from administrative databases, registries, and surveys. Primary trial data is expected to be locked for analysis by October 31st 2023, with a follow-up planned until March 31st 2024., Conclusion: The results from this trial will provide high-level evidence the effectiveness of a community education intervention targeting regions at highest-risk of ACS and low EMS use., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Author(s).)
Published: 2023
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34. Long COVID and Hybrid Immunity among Children and Adolescents Post-Delta Variant Infection in Thailand.

Author: Jarupan M, Jantarabenjakul W, Jaruampornpan P, Subchartanan J, Phasomsap C, Sritammasiri T, Cartledge S, Suchartlikitwong P, Anugulruengkitt S, Kawichai S, and Puthanakit T
Abstract: This study aimed to assess long COVID, and describe immunogenicity against Omicron variants following BNT162b2 vaccination. A prospective cohort study was conducted among children (aged 5-11) and adolescents (aged 12-17) who had SARS-CoV-2 infection from July to December 2021 (Delta predominant period). Long COVID symptoms were assessed by questionnaires at 3 months after infection. Immunogenicity was evaluated by using a surrogate virus-neutralizing antibody test (sVNT) against the Omicron variant. We enrolled 97 children and 57 adolescents. At 3 months, 30 children (31%) and 34 adolescents (60%) reported at least one long COVID symptom, with respiratory symptoms prevailing (25% children and 32% adolescents). The median time from infection to vaccination was 3 months in adolescents and 7 months in children. At 1 month following vaccination, in children who received one-dose and two-dose BNT162b2 vaccines, the median (IQR) sVNT against Omicron was 86.2% inhibition (71.1-91.8) and 79.2% inhibition (61.5-88.9), respectively ( p = 0.26). Among adolescents who received one-dose and two-dose BNT162b2 vaccines, the median (IQR) sVNT against Omicron was 64.4% inhibition (46.8-88.8) and 68.8% inhibition (65.0-91.2) ( p = 0.64). Adolescents had a higher prevalence of long COVID than children. Immunogenicity against the Omicron variant after vaccination was high and did not vary between one or two doses of the vaccine in either children or adolescents.
Published: 2023
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35. Factors associated with COVID-19 vaccine intentions during the COVID-19 pandemic; a systematic review and meta-analysis of cross-sectional studies.

Author: Terry E, Cartledge S, Damery S, and Greenfield S
Subjects: Cross-Sectional Studies, Humans, Intention, Male, Pandemics prevention & control, United States epidemiology, Vaccination, COVID-19 epidemiology, COVID-19 prevention & control, COVID-19 Vaccines therapeutic use
Abstract: Background: A high COVID-19 vaccine uptake is essential to achieve herd immunity to combat the current strain of COVID-19 and potential future variants. This review aimed to identify factors associated with public intention to receive COVID-19 vaccines until February 2021 to provide accessible data to policymakers to inform framing and targeting of messages designed to optimise vaccine uptake., Methods: Medline, Embase, CINAHL, PsycINFO, PsycARTICLES, Sociological Abstracts and Applied Social Sciences Index and Abstracts were searched for cross-sectional studies reporting data regarding COVID-19 vaccine intentions, published between 01/01/2020 and 12/02/2021. Title/abstract and full-text screening were performed independently by two authors. The Appraisal Tool for Cross-sectional Studies (AXIS) was used to assess bias and quality. Both random-effects meta-analysis and narrative synthesis were used to describe vaccine intentions and associated factors. A subgroup analysis assessing the impact of sex, sampling method and time of survey on COVID-19 vaccine intention was performed., Results: Searches identified 4739 studies, and 23 cross-sectional studies were deemed eligible for the review; 22 used online surveys and one used a mixed-methods study design. Eighteen surveys were conducted in the first half of 2020 and five were conducted in the latter half of 2020. Fifteen countries were represented, with the most common being the United States (n = 4) and the United Kingdom (n = 4) sampling 41,403 participants across all surveys. Most studies employed convenience sampling and 11 non-responder rates raised concerns over non-response bias. From the 18 studies included in the meta-analysis, the pooled proportion of survey participants willing to receive the COVID-19 vaccine was 73.3% (n = 18, 95% Confidence Interval 64.2 to 81.5%, I 2 = 99.7%). Factors associated with a higher COVID-19 vaccine acceptance included greater perceived risk of COVID-19, lower level of perceived vaccine harm, higher educational attainment and household income, older age, being of White ethnicity and male sex., Conclusions: There was a high willingness to receive the COVID-19 vaccine which was influenced by sociodemographic factors and risk perceptions. The findings suggest future research should explore reasoning behind vaccine intentions for different sociodemographic groups to allow targeted communication strategies to be formulated by public health agencies., Registration: PROSPERO Registration Number: CRD42021239134., (© 2022. The Author(s).)
Published: 2022
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36. Adaptations in clinical examinations of medical students in response to the COVID-19 pandemic: a systematic review.

Author: Cartledge S, Ward D, Stack R, and Terry E
Subjects: Education, Medical trends, Humans, Reproducibility of Results, COVID-19 epidemiology, COVID-19 prevention & control, Education, Medical methods, Pandemics, Students, Medical
Abstract: Introduction: Clinical examinations (assessments) are integral to ensuring that medical students can treat patients safely and effectively. The COVID-19 pandemic disrupted traditional formats of clinical examinations. This prompted Medical Schools to adapt their approaches to conducting these examinations to make them suitable for delivery in the pandemic. This systematic review aims to identify the approaches that Medical Schools, internationally, adopted in adapting their clinical examinations of medical students in response to the COVID-19 pandemic., Methods: Three databases and four key medical education journals were systematically searched up to 22 October 2021; a grey literature search was also undertaken. Two reviewers independently screened at title, abstract stage and full text stage against predefined eligibility criteria. Discrepancies were resolved by discussion and involvement of senior authors. Risk of bias assessment was performed using an adapted version of a pre-existing risk of bias assessment tool for medical education developments. Results were summarised in a narrative synthesis., Results: A total of 36 studies were included, which documented the approaches of 48 Medical Schools in 17 countries. Approaches were categorised into in-person clinical examinations (22 studies) or online clinical examinations (14 studies). Authors of studies reporting in-person clinical examinations described deploying enhanced infection control measures along with modified patient participation. Authors of studies reporting online clinical examinations described using online software to create online examination circuits. All authors reported that adapted examinations were feasible, scores were comparable to previous years' student cohorts, and participant feedback was positive. Risk of bias assessment highlighted heterogeneity in reporting of the clinical examinations., Conclusions: This review identified two broad approaches to adapting clinical examinations in the pandemic: in-person and online. Authors reported it was feasible to conduct clinical examinations in the pandemic where medical educators are given sufficient time and resources to carefully plan and introduce suitable adaptations. However, the risk of bias assessment identified few studies with high reporting quality, which highlights the need for a common framework for reporting of medical education developments to enhance reproducibility across wider contexts. Our review provides medical educators with the opportunity to reflect on past practises and facilitate the design and planning of future examinations., (© 2022. The Author(s).)
Published: 2022
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37. Immunogenicity of BNT162b2 Vaccination against SARS-CoV-2 Omicron Variant and Attitudes toward a COVID-19 Booster Dose among Healthy Thai Adolescents.

Author: Assavavongwaikit P, Chantasrisawad N, Himananto O, Phasomsap C, Klawaja P, Cartledge S, Nadsasarn R, Jupimai T, Kawichai S, Anugulruengkitt S, Puthanakit T, and On Behalf Of The Study Team
Abstract: Despite the BNT162b2 vaccination coverage, rapid transmission of Omicron SARS-CoV-2 has occurred, which is suspected to be due to the immune escape of the variant or waning vaccine efficacy of multiple BNT162b2 vaccination doses. Our study aims to compare immunogenicity against Omicron prior to and post a booster dose of BNT162b2 in healthy adolescents, and to evaluate their attitudes toward booster dose vaccination. A cross sectional study was conducted among healthy adolescents aged 12-17 who received two doses of BNT162b2 more than 5 months ago. Participants and their guardians performed self-reported questionnaires regarding reasons for receiving the booster. A 30 ug booster dose of BNT162b2 was offered. Immunogenicity was evaluated by a surrogate virus neutralization test (sVNT) against the Omicron variant, and anti-spike-receptor-binding-domain IgG (anti-S-RBD IgG) taken pre-booster and 14-days post-booster. From March to April 2022, 120 healthy Thai adolescents with a median age of 15 years (IQR 14-16) were enrolled. sVNT against Omicron pre- and post-booster had 11.9 (95%CI 0-23.9) and 94.3 (90.6-97.4) % inhibition. Geometric means (GMs) of anti-S-RBD IgG increased from 837 (728, 953) to 3041 (2893, 3229) BAU/mL. Major reasons to receive the booster vaccination were perceived as vaccine efficacy, reduced risk of spreading infection to family, and safe resumption of social activities. A booster dose of BNT162b2 elicits high immunogenicity against the Omicron variant. Motivation for receiving booster doses is to reduce risk of infection.
Published: 2022
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38. The Utility of Predicting Hospitalizations Among Patients With Heart Failure Using mHealth: Observational Study.

Author: Cartledge S, Maddison R, Vogrin S, Falls R, Tumur O, Hopper I, and Neil C
Subjects: Aged, Female, Heart Rate, Hospitalization, Humans, Male, Prospective Studies, Heart Failure diagnosis, Heart Failure epidemiology, Heart Failure therapy, Telemedicine
Abstract: Background: Heart failure decompensation is a major driver of hospitalizations and represents a significant burden to the health care system. Identifying those at greatest risk of admission can allow for targeted interventions to reduce this risk., Objective: This paper aims to compare the predictive value of objective and subjective heart failure respiratory symptoms on imminent heart failure decompensation and subsequent hospitalization within a 30-day period., Methods: A prospective observational pilot study was conducted. People living at home with heart failure were recruited from a single-center heart failure outpatient clinic. Objective (blood pressure, heart rate, weight, B-type natriuretic peptide) and subjective (4 heart failure respiratory symptoms scored for severity on a 5-point Likert scale) data were collected twice weekly for a 30-day period., Results: A total of 29 participants (median age 79 years; 18/29, 62% men) completed the study. During the study period, 10 of the 29 participants (34%) were hospitalized as a result of heart failure. For objective data, only heart rate exhibited a between-group difference. However, it was nonsignificant for variability (P=.71). Subjective symptom scores provided better prediction. Specifically, the highest precision of heart failure hospitalization was observed when patients with heart failure experienced severe dyspnea, orthopnea, and bendopnea on any given day (area under the curve of 0.77; sensitivity of 83%; specificity of 73%)., Conclusions: The use of subjective respiratory symptom reporting on a 5-point Likert scale may facilitate a simple and low-cost method of predicting heart failure decompensation and imminent hospitalization. Serial collection of symptom data could be augmented using ecological momentary assessment of self-reported symptoms within a mobile health monitoring strategy for patients at high risk for heart failure decompensation., (©Susie Cartledge, Ralph Maddison, Sara Vogrin, Roman Falls, Odgerel Tumur, Ingrid Hopper, Christopher Neil. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 22.12.2020.)
Published: 2020
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39. Bystander CPR in the COVID-19 pandemic.

Author: Bray J, Cartledge S, and Scapigliati A
Published: 2020
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40. The current temperature: A survey of post-resuscitation care across Australian and New Zealand intensive care units.

Author: Bray JE, Cartledge S, Finn J, Eastwood GM, McKenzie N, Stub D, Straney L, and Bernard S
Abstract: Aim: Targeted temperature management (TTM) in post-resuscitation care has changed dramatically over the last two decades. However, uptake across Australian and New Zealand (NZ) intensive care units (ICUs) is unclear. We aimed to describe post-resuscitation care in our region, with a focus on TTM, and to gain insights into clinician's opinions about the level of evidence supporting TTM., Methods: In December 2017, we sent an online survey to 163 ICU medical directors in Australia (n = 141) and NZ (n = 22)., Results: Sixty-one ICU medical directors responded (50 from Australia and 11 from NZ). Two respondents were excluded from analysis as their Private ICUs did not admit post-arrest patients. The majority of remaining respondents stated their ICU followed a post-resuscitation care clinical guideline (n = 41/59, 70%). TTM was used in 57 (of 59, 97%) ICUs, of these only 64% had a specific TTM clinical guideline/policy and there was variation in the types of patients treated, temperatures targeted (range = 33-37.5 °C), methods for cooling and duration of cooling (range = 12-72 h). The majority of respondents stated that their ICU (n = 45/57, 88%) changed TTM practice following the TTM trial: with 28% targeting temperatures >36 °C, and 23 (of 46, 50%) respondents expressed concerns with current level of evidence for TTM. Only 38% of post-resuscitation guidelines included prognostication procedures, few ICUs reported the use of electrophysiological tests., Conclusions: In Australian and New Zealand ICUs there is widespread variation in post-resuscitation care, including TTM practice and prognostication. There also seems to be concerns with current TTM evidence and recommendations., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Author(s).)
Published: 2020
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41. Australia's awareness of cardiac arrest and rates of CPR training: results from the Heart Foundation's HeartWatch survey.

Author: Cartledge S, Saxton D, Finn J, and Bray JE
Subjects: Adolescent, Adult, Aged, Australia, Cross-Sectional Studies, Educational Status, Female, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Cardiology, Cardiopulmonary Resuscitation education, Health Education methods, Health Knowledge, Attitudes, Practice, Out-of-Hospital Cardiac Arrest therapy, Societies, Medical
Abstract: Objective: We aimed to provide the first national estimates of cardiopulmonary resuscitation (CPR) training and awareness of cardiac arrest., Design: A retrospective analysis of a national cross-sectional survey was undertaken. Data were collected online from adults in July 2017 as part of the Heart Foundation of Australia's HeartWatch survey. We used logistic regression to examine demographic factors associated with CPR training., Participants: A national cohort was invited to participate in the survey using purposive, non-probability sampling methods with quotas for age, gender and area of residence, in order to reflect the wider Australian population. The final sample consisted of 1076 respondents., Main Outcome Measure: To determine an estimation of the prevalence of cardiac arrest awareness and CPR training at a national level and the relationship of training to demographic factors., Results: The majority (76%) of respondents were born in Australia with 51% female and 66% aged between 35 and 64 years. Only 16% of respondents could identify the difference between a cardiac arrest and a heart attack. While 56% reported previous CPR training, only 22% were currently trained (within 1 year). CPR training was associated with younger age (35 to 54 years) (OR 1.45, 95% CI 1.06 to 2.0), being born in Australia (OR 1.59, 95% CI 1.17 to 2.17) and higher levels of education (university, OR 1.86, 95% CI 1.35 to 2.57). CPR training increased confidence in respondents ability to perform effective CPR and use a defibrillator. Lack of CPR training was the most common reason why respondents would not provide CPR to a stranger., Conclusions: There is a need to improve the community's understanding of cardiac arrest, and to increase awareness and training in CPR. CPR training rates have not changed over the past decades-new initiatives are needed., Competing Interests: Competing interests: JF and JB hold appointments with the International Liaison Committee on Resuscitation (ILCOR). JF holds an Adjunct Research Professor appointment with St John Western Australia., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2020
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42. Development of standardised programme content for phase II cardiac rehabilitation programmes in Australia using a modified Delphi process.

Author: Cartledge S, Thomas E, Hollier K, and Maddison R
Subjects: Australia, Consensus, Delphi Technique, Evidence-Based Practice, Female, Humans, Male, Cardiac Rehabilitation standards, Practice Guidelines as Topic standards
Abstract: Objective: To develop standardised programme content for Australian phase II cardiac rehabilitation (CR) programme., Design: Using the RAND/UCLA appropriateness method (RAM), a two-phase process including a comprehensive literature review and a two round modified Delphi process was undertaken to develop and validate content of a standardised CR programmes., Participants: An invited multidisciplinary expert advisory group (EAG; n=16), including CR health professionals (nurses, allied health professionals, cardiologist), academics, policy makers, representation from the Australian Cardiovascular Health and Rehabilitation Association and consumers, provided oversight of the literature review and assisted with development of best practice statements. Twelve members of the EAG went onto participate in the modified Delphi process rating the necessity of statements in two rounds on a scale of 1 (not necessary) to 9 (essential)., Main Outcome Measure: Best practice statements that achieved a median score of ≥8 on a nine-point scale were categorised as 'essential'; statements that achieved a median score of ≥6 were categorised as 'desirable' and statements with a median score of <6 were omitted., Results: 49 best practice statements were developed from the literature across ten areas of care within four module domains (CR foundations, developing heart health knowledge, psychosocial health and life beyond CR). At the end of a two-round validation process a total of 47 best practice statements were finalised; 29 statements were rated as essential, 18 as desirable and 2 statements were omitted., Conclusions: For the first time in Australia, an evidence-based and consensus-led standardised programme content for phase II CR has been developed that can be provided to CR coordinators., Competing Interests: Competing interests: SC received financial support from a Deakin University Dean’s Postdoctoral Research Fellowship. SC has also undertaken short-term consultancy for Medibank Private, not directly related to this work. ET received financial support from a National Health and Medical Research Council postgraduate scholarship (1113920)., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Published: 2019
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43. Validation and Acceptability of a Cuffless Wrist-Worn Wearable Blood Pressure Monitoring Device Among Users and Health Care Professionals: Mixed Methods Study.

Author: Islam SMS, Cartledge S, Karmakar C, Rawstorn JC, Fraser SF, Chow C, and Maddison R
Subjects: Adolescent, Adult, Blood Pressure physiology, Blood Pressure Determination standards, Blood Pressure Determination statistics & numerical data, Female, Health Personnel statistics & numerical data, Humans, Male, Patients statistics & numerical data, Wearable Electronic Devices statistics & numerical data, Blood Pressure Determination instrumentation, Health Personnel psychology, Patients psychology, Wearable Electronic Devices standards
Abstract: Background: Blood pressure (BP) is an important modifiable cardiovascular risk factor, yet its long-term monitoring remains problematic. Wearable cuffless devices enable the capture of multiple BP measures during everyday activities and could improve BP monitoring, but little is known about their validity or acceptability., Objective: This study aimed to validate a wrist-worn cuffless wearable BP device (Model T2; TMART Technologies Limited) and assess its acceptability among users and health care professionals., Methods: A mixed methods study was conducted to examine the validity and comparability of a wearable cuffless BP device against ambulatory and home devices. BP was measured simultaneously over 24 hours using wearable and ambulatory devices and over 7 days using wearable and home devices. Pearson correlation coefficients compared the degree of association between the measures, and limits of agreement (LOA; Bland-Altman plots) were generated to assess measurement bias. Semistructured interviews were conducted with users and 10 health care professionals to assess acceptability, facilitators, and barriers to using the wearable device. Interviews were audio recorded, transcribed, and analyzed., Results: A total of 9090 BP measurements were collected from 20 healthy volunteers (mean 20.3 years, SD 5.4; N=10 females). Mean (SD) systolic BP (SBP)/diastolic BP (DBP) measured using the ambulatory (24 hours), home (7 days), and wearable (7 days) devices were 126 (SD 10)/75 (SD 6) mm Hg, 112 (SD 10)/71 (SD 9) mm Hg and 125 (SD 4)/77 (SD 3) mm Hg, respectively. Mean (LOA) biases and precision between the wearable and ambulatory devices over 24 hours were 0.5 (-10.1 to 11.1) mm Hg for SBP and 2.24 (-17.6 to 13.1) mm Hg for DBP. The mean biases (LOA) and precision between the wearable and home device over 7 days were -12.7 (-28.7 to 3.4) mm Hg for SBP and -5.6 (-20.5 to 9.2) mm Hg for DBP. The wearable BP device was well accepted by participants who found the device easy to wear and use. Both participants and health care providers agreed that the wearable cuffless devices were easy to use and that they could be used to improve BP monitoring., Conclusions: Wearable BP measures compared well against a gold-standard ambulatory device, indicating potential for this user-friendly method to augment BP management, particularly by enabling long-term monitoring that could improve treatment titration and increase understanding of users' BP response during daily activity and stressors., (©Sheikh Mohammed Shariful Islam, Susie Cartledge, Chandan Karmakar, Jonathan Charles Rawstorn, Steve F Fraser, Clara Chow, Ralph Maddison. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 04.10.2019.)
Published: 2019
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44. Usefulness of Wearable Cameras as a Tool to Enhance Chronic Disease Self-Management: Scoping Review.

Author: Maddison R, Cartledge S, Rogerson M, Goedhart NS, Ragbir Singh T, Neil C, Phung D, and Ball K
Subjects: Adult, Chronic Disease psychology, Female, Humans, Male, Self-Management methods, Video Recording methods, Wearable Electronic Devices statistics & numerical data, Chronic Disease therapy, Self-Management psychology, Video Recording instrumentation, Wearable Electronic Devices standards
Abstract: Background: Self-management is a critical component of chronic disease management and can include a host of activities, such as adhering to prescribed medications, undertaking daily care activities, managing dietary intake and body weight, and proactively contacting medical practitioners. The rise of technologies (mobile phones, wearable cameras) for health care use offers potential support for people to better manage their disease in collaboration with their treating health professionals. Wearable cameras can be used to provide rich contextual data and insight into everyday activities and aid in recall. This information can then be used to prompt memory recall or guide the development of interventions to support self-management. Application of wearable cameras to better understand and augment self-management by people with chronic disease has yet to be investigated., Objective: The objective of our review was to ascertain the scope of the literature on the use of wearable cameras for self-management by people with chronic disease and to determine the potential of wearable cameras to assist people to better manage their disease., Methods: We conducted a scoping review, which involved a comprehensive electronic literature search of 9 databases in July 2017. The search strategy focused on studies that used wearable cameras to capture one or more modifiable lifestyle risk factors associated with chronic disease or to capture typical self-management behaviors, or studies that involved a chronic disease population. We then categorized and described included studies according to their characteristics (eg, behaviors measured, study design or type, characteristics of the sample)., Results: We identified 31 studies: 25 studies involved primary or secondary data analysis, and 6 were review, discussion, or descriptive articles. Wearable cameras were predominantly used to capture dietary intake, physical activity, activities of daily living, and sedentary behavior. Populations studied were predominantly healthy volunteers, school students, and sports people, with only 1 study examining an intervention using wearable cameras for people with an acquired brain injury. Most studies highlighted technical or ethical issues associated with using wearable cameras, many of which were overcome., Conclusions: This scoping review highlighted the potential of wearable cameras to capture health-related behaviors and risk factors of chronic disease, such as diet, exercise, and sedentary behaviors. Data collected from wearable cameras can be used as an adjunct to traditional data collection methods such as self-reported diaries in addition to providing valuable contextual information. While most studies to date have focused on healthy populations, wearable cameras offer promise to better understand self-management of chronic disease and its context., (©Ralph Maddison, Susie Cartledge, Michelle Rogerson, Nicole Sylvia Goedhart, Tarveen Ragbir Singh, Christopher Neil, Dinh Phung, Kylie Ball. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 03.01.2019.)
Published: 2019
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45. Temporal Trends in Emergency Medical Services and General Practitioner Use for Acute Stroke After Australian Public Education Campaigns.

Author: Bray JE, Finn J, Cameron P, Smith K, Straney L, Cartledge S, Nehme Z, Lim M, and Bladin C
Subjects: Adolescent, Adult, Aged, Australia, Female, Humans, Male, Middle Aged, Odds Ratio, Retrospective Studies, Young Adult, Emergency Medical Services trends, Emergency Service, Hospital trends, General Practitioners, Health Education, Health Promotion, Ischemic Attack, Transient therapy, Referral and Consultation trends, Stroke therapy
Abstract: Background and Purpose- The Australian Stroke Foundation ran annual paid advertising between 2004 and 2014, using the FAST (Face, Arm, Speech, Time) campaign from 2006 and adding the message to call emergency medical services in 2007. In this study, we examined temporal trends in emergency medical services use and referrals from general practitioners in the Australian state of Victoria to evaluate the impact of these campaigns. Methods- Using data from 33 public emergency departments, contributing to the Victorian Emergency Minimum Dataset, we examined trends in emergency department presentations for 118 000 adults with an emergency diagnosis of stroke or transient ischemic attack between 2003 and 2015. Annual trends were examined using logistic regression using a precampaign period (January 2003 to August 2004) as reference and adjusting for demographic variables. Results- Compared with the precampaign period, significant increases in emergency medical services use were seen annually between 2008 and 2015 (all P<0.001, eg, 2015; adjusted odds ratio, 1.16; 95% CI, 1.10-1.23). In contrast, a decrease was seen in patients presenting via general practitioners across all campaign years (all P<0.001, eg, 2015; adjusted odds ratio, 0.48; 95% CI, 0.44-0.53). Conclusions- Since the Stroke Foundation campaigns began, a greater proportion of stroke and transient ischemic attack patients are presenting to hospital by emergency medical services and appear to be bypassing their general practitioners.
Published: 2018
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46. Regions With Low Rates of Bystander Cardiopulmonary Resuscitation (CPR) Have Lower Rates of CPR Training in Victoria, Australia.

Author: Bray JE, Straney L, Smith K, Cartledge S, Case R, Bernard S, and Finn J
Subjects: Adolescent, Adult, Aged, Cross-Sectional Studies, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Out-of-Hospital Cardiac Arrest diagnosis, Out-of-Hospital Cardiac Arrest epidemiology, Out-of-Hospital Cardiac Arrest physiopathology, Registries, Victoria epidemiology, Young Adult, Cardiopulmonary Resuscitation education, Health Behavior, Health Education, Health Services Accessibility, Healthcare Disparities, Out-of-Hospital Cardiac Arrest therapy
Abstract: Background: Bystander cardiopulmonary resuscitation (CPR) more than doubles the chance of surviving an out-of-hospital cardiac arrest. Recent data have shown considerable regional variation in bystander CPR rates across the Australian state of Victoria. This study aims to determine whether there is associated regional variation in rates of CPR training and willingness to perform CPR in these communities., Methods and Results: We categorized each Victorian postcode as either a low or high bystander CPR region using data on adult, bystander-witnessed, out-of-hospital cardiac arrests of presumed cardiac etiology (n=7175) from the Victorian Ambulance Cardiac Arrest Registry. We then surveyed adult Victorians (n=404) and compared CPR training data of the respondents from low and high bystander CPR regions. Of the 404 adults surveyed, 223 (55%) resided in regions with low bystander CPR. Compared with respondents from high bystander CPR regions, respondents residing in regions with low bystander CPR had lower rates of CPR training (62% versus 75%, P =0.009) and lower self-ratings for their overall knowledge of CPR (76% versus 84%, P =0.04). There were no differences between the regions in their reasons for not having undergone CPR training or in their willingness to perform CPR. Rates of survival for bystander-witnessed, out-of-hospital cardiac arrests were significantly lower in low bystander CPR regions (15.7% versus 17.0%, P <0.001)., Conclusions: This study found lower rates of CPR training and lower survival in regions with lower rates of bystander CPR in Victoria, Australia. Targeting these regions with CPR training programs may improve bystander CPR rates and out-of-hospital cardiac arrest outcomes., (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
Published: 2017
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47. Mass Media Campaigns' Influence on Prehospital Behavior for Acute Coronary Syndromes: An Evaluation of the Australian Heart Foundation's Warning Signs Campaign.

Author: Bray JE, Stub D, Ngu P, Cartledge S, Straney L, Stewart M, Keech W, Patsamanis H, Shaw J, and Finn J
Subjects: Acute Coronary Syndrome complications, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome psychology, Adult, Aged, Awareness, Chi-Square Distribution, Female, Humans, Interviews as Topic, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Patient Education as Topic, Program Evaluation, Propensity Score, Prospective Studies, Recognition, Psychology, Risk Assessment, Risk Factors, Time Factors, Victoria, Acute Coronary Syndrome therapy, Consumer Health Information, Health Knowledge, Attitudes, Practice, Health Promotion, Mass Media, Patient Acceptance of Health Care, Time-to-Treatment, Voluntary Health Agencies
Abstract: Background: The aim of this study was to examine the awareness of a recent mass media campaign, and its influence on knowledge and prehospital times, in a cohort of acute coronary syndrome (ACS) patients admitted to an Australian hospital., Methods and Results: We conducted 199 semistructured interviews with consecutive ACS patients who were aged 35 to 75 years, competent to provide consent, and English speaking. Questions addressed the factors known to predict prehospital delay, awareness of the campaign, and whether it increased knowledge and influenced actions. Multivariable logistic regression was used to examine the association between campaign awareness and a 1-hour delay in deciding to seek medical attention (patient delay) and a 2-hour delay in presenting to hospital (prehospital delay). The median age was 62 years (IQR=53 to 68 years), and 68% (n=136) were male. Awareness of the campaign was reported by 127 (64%) patients, with most of these patients stating the campaign (1) increased their understanding of what is a heart attack (63%), (2) increased their awareness of the signs and symptoms of heart attack (68%), and (3) influenced their actions in response to symptoms (43%). After adjustment for other predictors, awareness of the campaign was significantly associated with patient delay time of ≤1 hour (adjusted odds ratio [AOR]=2.25, 95% CI: 1.03 to 4.91, P=0.04) and prehospital delay time ≤2 hours (AOR=3.11, 95% CI: 1.36 to 7.08, P=0.007)., Conclusions: Our study showed reasonably high awareness of the warning signs campaign, which was significantly associated with shorter prehospital decision-making and faster presentation to hospital., (© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)
Published: 2015
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