Additive BIO Fabrication: Impact, Opportunities and Challenges

Written by:

Prof. Gordon Wallace and Dr Stephen Beirne
Follow Gordon on Twitter: @gordongwallace

ARC Centre of Excellence for Electromaterials Science (ACES)
Intelligent Polymer Research Institute, AIIM Facility, Innovation Campus
University of Wollongong, Wollongong, NSW 2522, Australia

First published in ATSE magazine (Academy of  Technological Science & Engineering)

In recent years we have outrun our ability to fabricate structures from the amazing materials that we can now create. While this can be said of many areas of materials research it is particularly so in the area of biomaterials. Here, we are often confronted with delicate compositions with nano- to microscopic features that will not survive the traditional (hammer and chisel) approach to fabrication. There is good reason why nature “grows” complex, highly functional structures. Such structures with functionality determined by the spatial distribution of composition with nanodimensional resolution can not be chiselled from a slab of material.

Additive fabrication (AdFab), often referred to as 3D Printing, involves layer-by-layer deposition and fusion of materials to create customised structures. The structure to be produced can be conceptualised, manipulated and defined within a growing array of modelling environments; from conventional parametric Computer-Aided Design (CAD) solutions such as Solidworks™ or ProE™, through to free-form animation toolsets such as Autodesk 3ds Max™, and even free web-based applications like Tinkercad™ (www.tinkercad.com). Once a design is completed, a file that describes the structures’ surface geometry is generated and a set of digitised instructions then drives the printer to create the required structure layer by layer.

The fabrication process can involve several deposition modes. In fused deposition modelling / extrusion printing, a molten build material is deposited and solidified on cooling.  For higher resolution structures (layer thicknesses as low as 16 µm), a fluid material precursor is ink-jetted onto a substrate and simultaneously transformed into a solid structure via a chemical reaction (UV induced polymerisation). Metal structures can be fabricated through a physical micron-scale welding process known as selective laser melting.

The Impact

The recent race to embrace AdFab has had significant wide-ranging impact on those of us involved in biomaterials and biodevices research. For example:-

In Wollongong, we have established Additive Biofabrication capabilities within a dedicated Processing and Devices Facility (Figure 1). Equipment housed here includes commercial additive fabrication systems like the Objet Connex 350™ and Relaizer SLM50™, commercial bio-fabrication systems such as the EnvisonTec Bioplotter™, and customised printing systems such as the KIMM SPS1000, a Reactive Ink-jet Printer and an Extrusion Printer. A more detailed description can be found at http://www.electromaterials.edu.au/equipment/index.html

Figure 1: AdBioFab at Innovation Campus – UOW

The ability to create customised 3D polymeric or metallic structures in the laboratory accelerates experimental design by enhancing the realisation of material components that facilitate experimentation. Additive fabrication provides an in-house capability to design and realise unique set ups in a minimal period of time.

One case in point was the development of an experimental procedure to electrically stimulate cells in vitro on organic conducting polymer surfaces (a study in the field of “Organic Bionics”[1]). Off-the-shelf chamber wells were removed from their original substrate and bonded to a conducting polymer coated gold Mylar substrate to act as a media reservoir. A custom platinum counter electrode mount was produced by additive fabrication (see Figure 2). The mount allows accurate placement of the platinum mesh electrodes in the media reservoir and ensures a repeatable electrode orientation. A proprietary bio-compatible material, Objet MED610™, was chosen as the build material. Production of these components by conventional machining would have been relatively expensive and would not have easily facilitated the small dimensional features of the component.

Batch production of biocompatible components using Objet MED610™ for use in biological experiments (Fig. 2.A)

Platinum mesh electrode mount as used to provide repeatable spacing between electrode surfaces during cell stimulation trials
(Fig. 2.B).

Another example of experimental tool production involved the development of a device to enable studies related to the alleviation of eye pressure arising from glaucoma; a study led by Prof. Michael Coote at the Centre for Eye Research Australia. Concept outline sketches were provided and translated into 3D CAD models. Graphical representations of the implant design allowed for revisions and modifications to be easily communicated and implemented before fabrication (Figure 3).

Batch production of an array of design permutations was achieved in a single build tray printing cycle. Design iterations were simply undertaken without any concern for re-tooling of the hardware.

Figure 3: Illustration depicting concept glaucoma implant as developed within Solidworks™ 2012 and highlighting external dimensions. Completed device as produced using Objet MED610™, after addition of 700 μm OD silicone tubing.

These examples illustrate what can be achieved with commercially available machinery and materials. In other aspects of our work within the ARC Centre of Excellence for Electromaterials Science (ACES), we are concerned with the fabrication of structures containing biopolymers, organic conductors and even living cells within new structures for bionics[1].

Existing commercially available equipment can not handle such materials. Consequently we have been involved with the Korean Institute of Machinery and Materials (KIMM) and the company M4T, who have supplied a customised Scaffold Plotting System (SPS1000™) that is capable of extrusion printing biopolymers; including synthetic biodegradables such as polycaprolactone, or naturally occurring biopolymers such as chitosan. Using this system, we have printed 3D scaffolds (Figure 4(a)). The lower feature size is limited to about 200 µm and is determined by the rheological properties of the bio-ink. Such structures have previously proven useful as scaffolds for tissue regeneration. More recently we have modified this extrusion printer to enable co-axial printing. This required the design and fabrication of a dual reservoir system and a co-axial print head (Figure 4(b)). These components were designed and fabricated in-house – the printhead itself was produced using a 3D metal printer – the era of printing printers is upon us!  Co-axial structures with an inner core diameter range of 200 to 500 µm and an outer core of 600 to 1200 µm diameter were produced. This customised co-axial printing system has already proven useful for the creation of alginate / polycaprolactone co-axial 3D structures and even the creation of structures containing living cells[2].

4a: Porous polycaprolactone (PCL) structures produced through hot-melt extrusion printing in an array of structure geometries based on geometric .stl data and user defined grid spacing parameters.

4b: A batch of co-axial extrusion tips, before final finishing and polishing, produced in Stainless Steel 316L with a Realizer SLM50™ operating with layer slice thickness of 25μm

Using a commercially available ink-jet printer from Dimatix™ and a customised ink using organic conducting polymer nano-particles, we have printed features as small as 20 µm that have been used as bionic guidance tracks to control the direction of nerve growth[3]. Another addition to our printing armoury is a custom built multi-head ink-jet printer that allows printing of multiple components to create new material structures during fabrication, so called reactive printing, wherein the individual components react to form a more mechanically robust structure. For example, this has been used to form biopolymer hydrogel structures that are ionically cross-linked during printing.

With minimal modification, we have also found these print heads to be useful in allowing for the effective delivery of living cells during the printing process; delivering both nerve and muscle cells to create unique biofunctional structures. The cells are maintained using a biopolymer suspension with optimised rheological properties that enable effective delivery through the ink-jet head. The formulation used is multi-purpose and multi-functional, in that it maintains the cells in a healthy state in suspension for many hours, protects cells during delivery and sustains cell viability after printing [4].

AdBioFab – Changing the way we teach, commercialise and do research

After a number of decades wherein advances in materials science have often been limited by our inability to fabricate effectively, we have now entered a new era. Biomaterials researchers have been empowered with the ability to fabricate customised structures using hardware that can be accommodated in most research laboratories at reasonable cost.

The convergence of advances in biomaterials, AdBioFab, Information technology, Nano technology and Bio technology is set to move us forward in biomedical science at an unprecedented rate. Our ability to convert data into knowledge and to effectively disseminate that knowledge has been outrun by our ability to create the primary data!

The knowledge dissemination gap continues to grow wider and this has implications for:

•  Schools and Universities: those responsible for skilling the next generation of researchers.
•  Regulatory authorities: who require information and an understanding of the implications of advances occurring on a number of technological fronts simultaneously.
•  The commercialisation sector: these advances are challenging traditional commercialisation models that are based on mass-manufacturing / cost reduction / sales targets. With additive biofabrication, localised manufacture using exotic materials will deliver the most effective solutions.
•  The community: social acceptance of advances in the medical sector is obviously critical to success. We must develop innovative approaches to present understandable chunks of knowledge.

Now we in materials science can be bold, even audacious. We can develop materials not amenable to current processing and fabrication approaches with the knowledge that we can print-printers; creating the fabrication machinery of the future in tandem with breakthroughs in materials science!

Advances in AdBioFab will have a staggering impact because it not only accelerates the thought-to-thing process, delivering practical solutions sooner, but it also empowers us to make unprecedented fundamental advances. For example, the ability to arrange living cells in 3D within naturally occurring or synthetic biomaterial structures will give insights into environmental effects on cell behaviour – insights hitherto unavailable.

Acknowledgements

The establishment of Additive Biofabrication capabilities in Wollongong has been made possible through the support of the Australian Federal Governments EIF program in providing a processing and devices fabrication facility. Equipment has been made available through EIF as well as the Australian National Fabrication Facility (ANFF) via the Australian Federal Governments NCRIS program. Personnel and personnel support has been provided through the NSW State Government Science Leveraging Fund and the ANFF.

References

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[1] Wallace, G.G., Moulton, S.E., Higgins, M.J., Kapsa, R.M.I. “Organic Bionics” Wiley-VCH Verlag & Co. KGaA, Boschstr. 12, 69469 Weinheim, Germany 2012.

[2] Cornock, R., Honours thesis, University of Wollongong 2012.

[3] Weng, B., Liu, X., Higgins, M.J., Shepherd, R., Wallace, G. “Fabrication and Characterization of Cytocompatible Polypyrrole Films Inkjet Printed from Nanoformulations Cytocompatible, Inkjet-Printed Polypyrrole Films” Small 2011, 7 (24), 3434-3438.

[4] Ferris, C.J., Gilmore, K.J., Beirne, S., McCallum, D., Wallace, G.G., in het Panhuis, M. “Bio-ink for on-demand printing of living cells” Biomaterials Science, 2013, 1, 224-230.

The focus on obesity is not so healthy

By Professor Jan Wright and Associate Professor Valerie Harwood of UOW’s Faculty of Education & Interdisciplinary Educational Research Institute.

 

The Australia government has made and is continuing to make substantial investments in policies, strategies and research to address the perceived risk of obesity and related health issues. We argue that obesity is a complex issue and there are very real disconcerting effects of the widespread preoccupation with obesity as a major public health issue. Obesity is not a neutral concept. It is tied to moral and ideological beliefs about fatness. These beliefs are evident both in depictions of obesity in the media and in the ready subscription to moralistic ways of recognizing and dealing with obesity as a public concern. Our research in schools points to the way obesity has become the emblem of ill-health; children believe they can evaluate health simply by looking to see who is fat.

The preoccupation with childhood obesity drives major policy initiatives on health, and schools in particular have been targeted for the implementation of a plethora of initiatives geared towards helping children and young people lose weight, become more active, and change their eating patterns in and outside school. Young people (and their guardians, including schools) are implicitly held personally responsible and accountable for the prevention of obesity and related health problems, by knowing and avoiding relevant ‘risk’ factors. This emphasis on individual responsibility ignores the complexities and different opportunities that people have to make ‘healthy’ choices’. Much of the epidemiological research on overweight and obesity points to its greater prevalence of overweight and obesity amongst populations that are socially and economically disadvantaged. Research by Pickett and colleagues, for example, suggest that countries with the greatest gap between the rich and the poor have the highest level of obesity.

These inequalities point to the importance of structural changes to improve the health of all. For example, we would argue that in relation to physical activity government should be promoting a social justice approach rather than an approach that blames the individual for not being healthy (for not being the right weight), particularly when those individuals are the most vulnerable in society. An intensified focus on obesity can create further social divisions as body size becomes a source of stigma, discrimination and shame. Our research reveals stark contrasts between the facilities and resources for physical activity and physical education in government schools, particularly those in poorer areas, compared to private schools.  For the young people in these government schools, school is often the main and often the only opportunity they have for physical activity. In their communities, access in terms of places to play, transport, and costs as well as their other commitments to family preclude participation in physical activity outside of school.  

We suggest that government funds need to directed toward changing the substantive causes of health inequalities, rather than a one dimensional focus that situates obesity front and centre and holds individuals solely responsible for their health and lifestyle ‘choices’.

Professor Jan Wright and Associate Professor Valerie Harwood have recently had their highly successful book “Biopolitics and the ‘Obesity Epidemic’: Governing Bodies” republished in paperback.

Photo: Goran Kuzmanovski | Dreamstime.com

Clinical research a no-brainer

By Dr Heath Ecroyd

Dr Heath Ecroyd – Illawarra Health and Medical Research Institute, UOW.

Dr Ecroyd is an Australian Research Council Future Fellow in the School of Biological Sciences at the University of Wollongong and a group leader at the Illawarra Health and Medical Research Institute.

Let’s start with the good news. The census data released on 21 June 2012 shows that Australians are living longer than ever and that death rates from heart attacks and some kinds of cancer are falling.

However, our increasing life span comes at a cost. Indeed, if you live long enough, it is very likely that you will experience some kind of neurodegenerative disorder which may be a form of mild dementia or something more serious like Alzheimer’s disease.

Current figures suggest that over 260,000 Australians already suffer dementia, with some predicting that this figure will grow to one million by 2050.

Unfortunately, the Illawarra is likely to become a hotspot for these kinds of diseases as we already have a higher proportion of people aged 85 years and over (16 per cent) than the NSW average (14 per cent) and, by 2021, it is predicted that the population aged 70-84 years will increase by 45 per cent, while the 85 years and over group will more than double.

It doesn’t take a mathematical genius to see that we are likely to be in for a bit of a rough ride when it comes to neurodegenerative disorders; especially when you consider that current treatments for these diseases are based on alleviating the symptoms, rather than treating the cause.

As health “consumers”, Illawarra residents probably imagine that scientists around the world are working hard on understanding these diseases and seeking cures – and they are.

What many may not realise, however, is that right here in the Illawarra, there is a growing group of researchers who are also trying to piece together the puzzle about the causes of neurodegeneration – a term we use to describe the progressive loss of function and eventual death of neurons.

Based at the Illawarra Health and Medical Research Institute (IHMRI) and the University of Wollongong, we all have slightly different views on how to piece the puzzle together, but what we all share is a focus on the fundamental science behind these diseases. What that means is that we are focused on understanding the cause. By doing so, we hope that we can one day discover a cure.

My area of interest is the role that proteins play in diseases such as Parkinson’s disease.

As we get older, the proteins in our body can start to lose their shape and, because of this, they start to malfunction and form clumps that sit in the brain and cause disease. These clumps are the telltale signs of many neurodegenerative diseases, including Parkinson’s.

Our current thinking is that, if you can stop the clumping, you can stop the onset of the disease. A number of clinical trials are now being conducted internationally on drugs that do exactly this – which means we are on the right track.

Normally, our body has systems in place to prevent this clumping but, as we age, these too do not work like they used to, making us more vulnerable to disease. The focus of my work is discovering how we can boost the activity of these systems in order to stop those clumps forming in the first place.

While a cure may still be a way off, the fact that we have people working in this area and access to state-of-the-art facilities in the Illawarra means that we have just as much of a chance to finding a solution than any other lab or scientist.

In fact, we are attracting more funding and more talented researchers to Wollongong. In November this year we will host a major conference focused on these diseases and what causes them. It has attracted some of the best national and international researchers, giving us the opportunity to hear the latest results from leading labs around the world as well as highlighting the great work we are doing here at IHMRI.

I feel it is important to promote what we do as it is the Australian tax payer who ultimately funds our work and we want to show that that money is being put to good use.

UOW ’s Research into Schizophrenia and Better Treatments

Written by Dr Elisabeth Frank
Schizophrenia Research Institute (SRI)
School of Health Sciences, University of Wollongong

 

“Schizophrenia is a devastating brain disorder that affects up to 1 per cent of the population worldwide…” is a frequently used statistic in publications on schizophrenia research. Whereas worldwide seems far away, it is a fact for our community; over 2,000 people in Wollongong alone have schizophrenia.

Schizophrenia is a chronic psychiatric disease, which has its onset mostly in the late teens or early twenties. It significantly impairs normal brain function; the neurodevelopmental hypothesis of schizophrenia assumes that it is a consequence of disrupted brain development in early-life.

Clinically, schizophrenia is divided into positive, negative and cognitive symptoms. What this means for patients is paranoia, hallucinations, a retreat from reality; total social isolation is often the result. The emotional burden on sufferers, families and friends is considerable, and the disease is estimated to cost the Australian community $2 billion every year.

There is currently no cure for schizophrenia; and though there are antipsychotic drugs, they are insufficient. Patients are medicated at high doses over their entire lifetime and the drugs cause serious immediate and long term side effects.

For these reasons and more, research into schizophrenia and better treatments is critical.

At UOW, several centres and researchers from various scientific fields are engaged in cooperative research on schizophrenia. Many of the basic and clinical researchers are found under the roof of the Illawarra Health and Medical Research Institute (IHMRI) and are associated with the Schizophrenia Research Institute (SRI).

The Centre for Translational Neuroscience (CTN) has a special focus on schizophrenia. Under the lead of Professor Xu-Feng Huang and based at IHMRI, the majority of the 30 research fellows and research students are working to uncover the neurochemical and genetic underpinnings of schizophrenia as well as neurophysiological consequences of antipsychotic drug treatment.

Studying samples from patients in Australia and China, human post-mortem brain tissue and rodent models, we use sophisticated state-of-the-art biochemical, genetic and intracranial techniques to explore neurochemical mechanisms of the disease in vitro and in vivo.

For example, the NHMRC-funded research team of Professor Xu-Feng Huang, Dr Kelly Newell and Dr Teresa Du Bois examines the glutamatergic NMDA receptor, since it is highly relevant for adequate neurodevelopment. Our second neurodevelopmental target and studied in its interaction with the NMDA receptor is the neuronal growth factor Neuregulin-1, which was identified in human genetic population studies as a major candidate for schizophrenia risk.

In a NHMRC-funded linkage project, Dr Mei Han and Dr Francesca Fernandez are screening schizophrenia patients in Beijing for mutations in this gene in correlation with symptomatology and neurochemistry. By comparing this to a Neuregulin-1 model at UOW, my SRI-funded research team is making discoveries in the novel field of neuroimmunology, which has only recently been unravelled for its aetiological relevance for schizophrenia.

 The severe side effects of antipsychotic drugs are also being investigated at the CTN. Currently available drugs have limited efficacy and are associated with a range of side effects. The NHMRC-funded research team of Professor Xu-Feng Huang investigates antipsychotic action on neurochemistry in relation to side effects like weight gain and metabolic disorders. The NHMRC-funded research team led by Dr Chao Deng is studying the functional selectivity of antipsychotics in treating schizophrenia.  These projects are expected to lead to better treatments for schizophrenia patients with reduced side effects.

 The schizophrenia research projects underway at our centre complement and collaborate with many others at the University. Working with researchers from IHMRI, the School’s of Health Sciences, Psychology and Nursing, the Graduate School of Medicine, the Illawarra Institute for Mental Health (iiMH) and the Brain and Behaviour Research Institute (BBRI), we further our understanding of disease development and treatment through combined approaches.

 We have close collaborations with the School of Psychology, where Dr Nadja Solowij, Dr Emma Barkus and several collaborators have attracted major funding for their research on the role of cannabis in the risk for schizophrenia. In a new collaborative project, an Illawarra schizophrenia patient cohort has been established. Patients will be studied by clinical and basic researchers from several schools and centres from a psychiatric, psychological, drug-compliance, dietetic, genetic, lipidomic, neurochemical and neuroimmune perspective. This will not only be a unique project due to its inter-disciplinary approach, but has the potential to directly feedback to patients and carers in the Illawarra community. Determining factors that predict a good treatment response as well as indicators for side effects of drug treatment will allow us to improve the choice of drugs used as well as to better monitor indicators for, and therefore potentially prevent, deleterious side effects in our patients.

 Linking as well with researchers from the School of Chemistry and Intelligent Polymer Research Institute (IPRI), and having access to their highly developed tools, gives us the opportunity to explore novel ways to target discovery, drug development and drug application. This is additionally supported by our cooperations with pharmaceutical companies.

 Our investment into schizophrenia does not end at the lab bench. In addition to our scientific investigations, our researchers also engage in community awareness and education around schizophrenia. With the support of IHRMI and SRI, our researchers and students have organised and contributed to a Schizophrenia Awareness Event and Mental Health Expo; and the Illawarra Mental Health Round Table which brings together major stakeholders of schizophrenia research and care in the Illawarra.

Schizophrenia is a devastating disease, but many researchers at UOW are working actively together to improve prevention, diagnosis and treatment of schizophrenia, and finally help patients and carers lead a better life. 

More information:
www.uow.edu.au/health/healthsciences/ctn/
http://ihmri.uow.edu.au/nmh/schizophrenia/index.html
www.schizophreniaresearch.org.au

Cancer. A simple cure is complex

A/Prof. Marie Ranson

As a society we enjoy better health than previous generations and we are living longer as a result. Yet paradoxically cancer incidence is on the rise. Is this because of our polluted environment, increased obesity and stress levels? To some extent it is, but the main risk factor for cancer is our increasing lifespan. Fortunately, survival rates are also increasing due to earlier detection and more effective, less toxic treatments.

Healthy cells in adults only divide to replace themselves with new cells when there is a need to do so or when they have reached the end of their pre-programmed life span. They are good citizens, responding appropriately to their neighbouring cells and their environment. They are also self-sacrificing. If for example a small piece of their DNA becomes damaged beyond the point of repair, say after nasty sunburn, those cells will self-destruct rather than reproduce damaged copies of themselves. The result is that the top layer of your skin peels  and the underlying skin cells receive a signal to replace this lost layer of skin. But as we age, the ability of our cells to fight continual damage to our DNA (caused by environmental factors such as sun, pollutants, and even by what we eat), decreases. This increases the chance that cells will not die when they should. They may also divide uncontrollably to form an abnormal mass of cells, known as a tumour, which can often be removed surgically. Unfortunately, sometimes cells within the tumour invade nearby tissues and spread to other parts of the body forming secondary tumours. This potentially lethal process is called metastasis and is the subject of intensive research to find effective treatments.

Why is cancer so difficult to cure? While we understand the basic hallmarks of cancer, we also know that there are numerous permutations giving rise to more than 100 different types of cancer. There are also differences in the same cancer type between patients, and the patient’s own immune system can help or hinder the progression of a cancer. Finding a simple cure, akin to using antibiotics to treat infections, requires a deeper understanding of genetics, how the immune system works and how we age. Here at the University of Wollongong the Illawarra Health & Medical Research Institute (IHMRI) brings together a network of biologists, chemists, physicists, clinicians and radiologists dedicated to improving our understanding of cancer so that we can develop improved methods of prevention, detection and treatment.

Traditional treatments such as chemotherapy rely on balancing the attack on cancer while minimising damage to healthy tissues and organs, but this can still cause unpleasant side-effects. One outcome of our research in the Illawarra aims to improve patient comfort by reducing the debilitating side-effects of drugs used in chemotherapy.

Future treatments will be more individualised. By screening each patient’s cancer for characteristics that will allow therapy to be customised to that patient, new generation drugs designed to target only cancer cells will be used. 

In the meantime, combination chemotherapy strategies have improved outcomes for several types of cancer. According to the National Cancer Institutes, USA, “ Treatment for this disease has become so effective that 80% of patients with metastatic testicular cancer can now be cured. Thirty-five years ago, 95% of these patients died, usually within 1 year of diagnosis”. So in fact, for at least a few types of cancer, there are cures.

Our work continues and this has been facilitated by the generosity of local organisations and donors.

Associate Professor Marie Ranson is the Foundation Scientific Director for the Cancer Research Program at the Illawarra Health and Medical Research Institute and teaches in the School of Biological Sciences at the University of Wollongong.

New Approach to Dementia Care

Dr Nancy Humpel

Dementia is one of the fastest growing sources of major disease burden in Australia and will overtake coronary heart disease in its total wellbeing cost by 2023. Without a significant medical breakthrough, the prevalence of dementia is estimated to increase from around 257,000 people in 2010 to about one million in 2050.

Dementia is a term that encompasses a range of conditions characterised by impairment of brain functions including language, memory, perception, personality and cognitive skills. Dementia is a fatal condition and there is currently no cure.

This distressing disease is presenting a significant challenge to the nation’s health system, and needs to be tackled on many research and clinical fronts. One of these is the support and training provided to residential aged care facility (RACF) staff.

In 2010 it is estimated there are approximately 82,000 residents in these facilities across the country who suffer from dementia. Due to the characteristics of the disease, caring for people with dementia is particularly demanding. To better cope with future demands, there is a clear need to support care providers and staff in RACFs through the development of sustainable models of care.

One area that clinicians and the research literature suggest needs addressing in dementia is the recognition of, and approach towards, end-of-life care. In many cases, staff in aged care facilities do not feel empowered or confident to initiate a change in the direction of care towards a palliative approach.

From research to date, it is evident that funding additional staff members for each of the many facilities may help provide the human resources needed to tackle the issue, but that is neither sustainable financially nor in terms of staff recruitment.

Rather, the ability of existing staff within aged care facilities to recognise the end-of-life stage, and to make appropriate, shared decisions about taking a palliative care approach, needs to be enhanced. This has been recognised via a $600,000 grant to the Illawarra Health and Medical Research Institute to deliver the REACH Out In Dementia Project.

The purpose of this project is to implement, and assess the impact of, an evidence-based best practice palliative approach in providing care to late stage dementia residents in aged care facilities. It will educate care providers, staff and families of residents about the clinical features which might predict an opportunity to move in the direction of palliative care.

There is already an abundance of evidence of the quality of life benefits that taking a ‘comfort’ palliative care approach can bring at end of life stage. On the other hand, there is also evidence of many barriers to providing this approach.

A major factor leading to avoidance of the necessary end-of-life conversations with residents and families in aged care facilities may be that health care providers feel unskilled at this task. They are unlikely to initiate end-of-life discussions when they believe they lack the needed interpersonal skills.

Although this type of conversation would help identify the resident’s wishes about their ongoing care, education alone may be insufficient to fully empower doctors and care providers to initiate the needed changes.

Addressing the barriers to initiating end of life conversations is where the REACH project stands out from previous work, and is leading in this area of research.

While the project aims to ensure a more appropriate approach for residents with late stage dementia, what are the implications for reducing the burden on an already overstretched health care system?

Currently, many residents with end stage dementia frequently end up in the Emergency Department. This could be a result of staffing shortages within these facilities or other reasons, none the less the ‘casualty ward’ is clearly not the ideal place for end-of-life symptom management.

With an improved model for end of life care delivered in the residential aged care facility by professional care staff and GPs, the number of dementia patients presenting at emergency could be reduced significantly and residents can spend their final days in their own home.

For these reasons, the experience of professional care staff and GPs will be pivotal to the program that is implemented and the collaboration between researchers and clinicians in the REACH Out In Dementia project. This focus on end stage dementia is what sets the project apart from others underway in the delivery of dementia care.

There has been plenty of enthusiasm from both RACFs and GPs in the local area to participate in the project and to embrace new models of care. This will include psychological education and workshops to improve their interpersonal and confidence skills when communicating with residents who have dementia and their families.

The project will take a collaborative approach involving REACH nurses working with RACF staff, visiting clinicians, and residents and families at 12 aged care facilities in the Illawarra and Shoalhaven over the next nine months. It will also trial the provision of a local guideline called the REACH Toolkit to empower them to care holistically within the facility.

Designed with a range of features and training resources to ensure acceptable and sustainable change within the participating aged care facilities, it is also critical that the program developed is transferable to other facilities in the region and across the country.

With so many people and their families living with dementia now and into the future, we hope this project will make a positive and significant impact on their lives. This will come through a more consistent and open approach to discussing and recording the person’s, and their family’s, desires for ongoing care as the person approaches the end of life.

Making a difference will require the experience and willingness of RACF staff and GPs to recognise the need for a new model, and to participate and support its implementation. Already, the collaboration has been fruitful.

Finally, the literature on geriatric care will be enhanced with the reporting of results from the project implementation and evaluation. We hope the REACH Out In Dementia project will impact and improve the care of our elderly across the nation for many years into the future.

*Dr Nancy Humpel is the Project Manager of the REACH Out In Dementia Project (Recognise End-of-life And Care Holistically in Dementia) based at the Illawarra Health and Medical Research Institute. Her PhD was in health behaviour change and she has extensive experience in the management of clinical trials and other cancer and health related projects. The REACH Out In Dementia Project is funded by a grant from the Commonwealth Department of Health and Ageing.

Everything I need to know about my health is on TV – but most of it is wrong

Professor Sandra Jones, Director of the Centre for Health Initiatives, UOW

The average Australian home has 2.6 people & 2.8 televisions. We watch TV for more than 2 hours a day, and between 7.00pm and 8.00pm, 44% of us are watching TV. We spend 16 hours each week on the Internet, 9 hours listening to the radio, 5 hours watching DVDs, 3 hours reading the newspaper and 2 hours reading magazines. There is now so much media in our lives that we often use them at the same time, with almost two-thirds of Australians watching TV while they use the Internet.

Much of what we know – or think we know – about our health comes from watching television, reading newspapers and magazines, and surfing the Internet. However, decades of research into health information in entertainment programs, news coverage, and advertising shows that most of this information is confusing, misleading or just plain wrong.

If you talk to many people about autism they will tell you that it is caused by vaccination. This is not correct. There have been lots of well-designed and carefully controlled studies that have proven for certain that the MMR vaccine does not cause autism. So, why do so many people believe that vaccination ‘makes children autistic’? Most of them saw it on TV or read it in a book.

Those scientific studies were published in leading academic journals, so they were probably read by a few thousand academics. When television stations around the world broadcast an episode of Eli Stone in which the fictional lawyer represented a mother suing a pharmaceutical company for ‘causing’ her child’s autism more than 5 million Americans and more than 1 million Australians were watching. When Jodi Picoult wrote in ‘House Rules’ that vaccination caused the young Jacob to develop autism almost overnight, millions of people around the world were reading (and even more will watch if they make it into a movie). In America, an actress named Jenny McCarthy is attracting a huge amount of media coverage, even appearing on the Oprah show. Ms McCarthy is not a doctor or a scientist – she is Jim Carrey’s girlfriend – but when she claims that vaccination causes autism, millions of women around the world will be convinced not to vaccinate their children.

So why does this matter? It matters because high rates of vaccination had virtually eliminated diseases like mumps, measles and whooping cough in countries like Australia. Each time stories like this appear in the media, parents stop getting their children vaccinated. Some of these children will develop preventable diseases and become extremely ill. Others will spread the infection to babies who are too young to be immunized and some of these babies will die.

Cancer is another popular topic for news and entertainment media. Women’s magazines frequently provide in-depth coverage of celebrities’ battles with cancer. Soap operas kill off characters by having them develop fatal cancers, or show their strength by having them survive cancer (often so they can be struck down with another fatal disease in the next season). Newspapers and magazines tell us every month of another ‘cause’ of cancer, and at the same time report another ‘scientific breakthrough’ that will eliminate cancer.

Unfortunately, much of what the media tells us about cancer is misleading or just plain wrong. The biggest risk factor for breast cancer is increasing age – the older you are the greater the risk – but readers of women’s magazines are regularly presented with stories of very young women with breast cancer and, as a result, many women believe that risk is highest when they are young.

Why does the media get it wrong? Sometimes its because journalists, editors or authors sensationalise stories to get our attention. Sometimes its because scientists and researchers provide the media with confusing or misleading information. Sometimes its because there is conflicting evidence, with ‘experts’ arguing for different points of view.

 So what can we do to sort the good information from the misinformation? Professor Jones will be speaking at the Uni in Brewery on 25^th August from 5:30 at the Five Islands Brewery. In her presentation she will discuss some of the misinformation in the media, reasons why the media gets it wrong, and how we can more critically interpret the information we receive. For more information visit http://www.uow.edu.au/research/unibrewery/UOW075583.html

PhD student Kate Williams – Values as predictors of well-being in emerging adulthood

PhD student Kate Williams

Values are stable, general beliefs about what is desirable; goals are the specific objectives towards which our values guide us. Asking people to clarify and act upon their values can improve outcomes in public health, education and clinical psychology.  But are all values equally beneficial?  One view is that success at any personally important goal will improve well-being.  Others argue that it doesn’t matter what one aims for, as long as one does it for the ‘right’ reasons.