Belmont Hospital

BACKGROUND: Actinic keratosis (AK) is a very common condition, which has the potential of progressing to squamous cell carcinoma. The present study is a prospective, randomized study comparing the lesion response, cosmetic outcome, patient satisfaction and tolerability of a new treatment modality, photodynamic therapy (PDT), using topical methyl aminolevulinate (Metvix), with the most commonly used standard therapy for AK, cryotherapy. METHODS: A total of 204 patients with clinically diagnosed AK were randomized to either cryotherapy or PDT. The PDT patients were further assigned to an active or placebo group in a random, double-blind manner. Cryotherapy was performed using liquid nitrogen spray in a single freeze-thaw cycle. PDT was performed using 160 mg/g methyl aminolevulinate cream or placebo, a 3-hour application time, red light (570-670 nm) and a total light dose of 75 J/cm(2). PDT was repeated after 7 days. Two sessions of PDT were undertaken, as a previous study had shown a single session had similar efficacy to cryotherapy. Lesion response was assessed clinically after 3 months (complete response or non-complete response). RESULTS: The lesion response rate was 91% in the methyl aminolevulinate PDT group, 68% in the cryotherapy group and 30% in the placebo PDT group. Methyl aminolevulinate PDT was statistically significantly better than both cryotherapy and placebo PDT in terms of response rates and cosmetic outcome. Most patients preferred PDT to other treatments. CONCLUSIONS: PDT with methyl aminolevulinate is an excellent treatment option, particularly for patients with widespread damage or AK lesions in cosmetically sensitive areas.

Abstract Given the centrality of argumentation in the Next Generation Science Standards, there is an urgent need for an empirically validated learning progression of this core practice and the development of high‐quality assessment items. Here, we introduce a hypothesized three‐tiered learning progression for scientific argumentation. The learning progression accounts for the intrinsic cognitive load associated with orchestrating arguments of increasingly complex structure. Our proposed learning progression for argumentation in science also makes an important distinction between construction and critique. We present validity evidence for this learning progression based on item response theory, and discuss the development of items used to test this learning progression. By analyzing data from cognitive think‐aloud interviews of students, written responses on pilot test administrations, and large‐scale test administrations using a Rasch analysis, we discuss the refinement both of our items and our learning progression to improve construct validity and scoring reliability. Limitations to this research as well as implications for future work on assessment of scientific argumentation are discussed. © 2016 Wiley Periodicals, Inc. J Res Sci Teach 53: 821–846, 2016

BACKGROUND: The irritable bowel syndrome (IBS) may lead to considerable impairment of health-related quality of life and high health care costs. It is not clear whether these poor outcomes directly result from severe bowel symptoms or reflect a coexisting psychiatric disorder. OBJECTIVE: To determine whether bowel symptom severity and psychological symptoms directly influence health-related quality of life and health care costs. DESIGN: Cross-sectional survey. SETTING: Secondary and tertiary gastroenterology clinics. PATIENTS: 257 patients with severe IBS who did not respond to usual treatments and were recruited for a trial of psychological treatment. MEASUREMENTS: Predictors were abdominal pain, entries in a diary of 10 IBS symptoms, and measures of psychological symptoms. Outcomes were inability to work, health-related quality of life (measured by Medical Outcomes Survey 36-item short-form questionnaire [SF-36] physical component summary scores), and health care and productivity costs. Predictor and outcome measures were compared by using multiple regression and logistic regression analyses. RESULTS: Abdominal pain occurred on average 24 days per month and activities were restricted on 145 days of the previous 12 months. The mean (+/-SD) Hamilton depression score was 11.3 +/- 6.1. The SF-36 physical component summary score was low (37.7 +/- 10.6), and the patients had incurred high health care costs ($1743 +/- $2263) over the previous year. Global severity and somatization scores on the Symptom Checklist 90 Revised, abdominal pain, and Hamilton depression scores independently contributed to the physical component score of the SF-36 (adjusted R(2) = 35.2%), but only psychological scores were associated with disability due to ill health. These variables did not accurately predict health care or other costs (adjusted R(2) = 9.3%). History of sexual abuse was not an independent predictor of outcome. CONCLUSIONS: Both abdominal and psychological symptoms are independently associated with impaired health-related quality of life in patients with severe IBS. Optimal treatment is likely to require a holistic approach. Since health care and loss of productivity costs are not clearly associated with these symptoms, alleviation of them will not necessarily lead to reduced costs.

Two assumptions underlying the Stanford Sleepiness Scale (SSS) were evaluated: that the descriptors defining each level of the scale are equivalent ways of characterizing a particular level of sleepiness; and that sleepiness, thus measured, is an unidimensional construct. Twenty-four True/False items were derived from the descriptors at each level of the SSS. This revised scale was administered to 340 undergraduates in a questionnaire which also included: the SSS; four visual analogue scales; items identifying the subject's age, sex, and circadian type; and the time of administration. Analyses of the responses indicated that endorsement of items on the revised scale was not consistent with the SSS level endorsed, indicating that the descriptors at each scale level are not equivalent. A principal components analysis revealed two components, tentatively identified as activation and sleepiness, accounting, respectively, for 24.2 and 20.6% of the variance. It was concluded that sleepiness is not an unidimensional construct. Further studies are necessary to elucidate the nature of its components.

This study examined the experiences of shame and guilt in adult males sexually abused as children. Seven participants attending a service for male sexual abuse completed measures of shame, guilt, dissociation, and childhood trauma history and subsequently participated in a focus group. All participants experienced childhood sexual abuse in the "severe" range and showed elevated scores for shame, guilt, and dissociation. Four superordinate themes with associated subordinate themes emerged: (a) self-as-shame (foundations of self-as-shame, fear of exposure, temporary antidote: connection), (b) pervasiveness and power of doubt and denial (from others, from self, consequences of incredulity), (c) uncontrollability (of problems after disclosure, of rage, of intrusions and emotional pain), and (d) dissociation. Results are discussed with reference to the existing literature and the emerging "self-as-shame" construct, which appeared to encapsulate participants' view of themselves.

OBJECTIVE: A cavum between the septi pellucidi may reflect neurodevelopmental anomalies in midline structures of the brain. The authors examined cavum septi pellucidi in subjects with schizophrenia, affective disorder, and schizotypal personality disorder and in normal subjects. METHOD: Thirty schizophrenic patients (15 chronic, 15 first-episode), 16 patients with affective disorder (first-episode), 21 patients with schizotypal personality disorder, and 46 normal subjects were evaluated with magnetic resonance imaging. Cavum septi pellucidi was assessed by counting the number of 1.5-mm slices containing cavum septi pellucidi. RESULTS: The presence or absence of cavum septi pellucidi did not differentiate among groups. However, the prevalence of abnormal cavum septi pellucidi (i.e., cavum septi pellucidi contained on four or more slices) was 30.4% for schizophrenic patients (36.4% for chronic, 25.0% for first-episode), 20.0% for patients with affective disorder, 18.8% for patients with schizotypal personality disorder, and 10.3% for normal subjects. When the authors used the Nopoulos et al. criteria for rating cavum septi pellucidi, which omitted borderline cases with cavum septi pellucidi on three slices, the prevalence of abnormal cavum septi pellucidi increased to 35.0% for schizophrenia (40.0% for chronic, 30.0% for first-episode), 25.0% for affective disorder, 27.3% for schizotypal personality disorder, and 13.0% for normal subjects. There was a statistically significant difference in ratings between schizophrenic and normal subjects. CONCLUSIONS: The results suggest that alterations in midline structures during the course of neurodevelopment may play a role in the pathogenesis of schizophrenia.

Little is known about similarities and differences in voice hearing in schizophrenia and dissociative identity disorder (DID) and the role of child maltreatment and dissociation. This study examined various aspects of voice hearing, along with childhood maltreatment and pathological dissociation in 3 samples: schizophrenia without child maltreatment (n = 18), schizophrenia with child maltreatment (n = 16), and DID (n = 29). Compared with the schizophrenia groups, the DID sample was more likely to have voices starting before 18, hear more than 2 voices, have both child and adult voices and experience tactile and visual hallucinations. The 3 groups were similar in that voice content was incongruent with mood and the location was more likely internal than external. Pathological dissociation predicted several aspects of voice hearing and appears an important variable in voice hearing, at least where maltreatment is present.

Informatics paradigms for brain and mental health research have seen significant advances in recent years. These developments can largely be attributed to the emergence of new technologies such as machine learning, deep learning, and artificial intelligence. Data-driven methods have the potential to support mental health care by providing more precise and personalised approaches to detection, diagnosis, and treatment of depression. In particular, precision psychiatry is an emerging field that utilises advanced computational techniques to achieve a more individualised approach to mental health care. This survey provides an overview of the ways in which artificial intelligence is currently being used to support precision psychiatry. Advanced algorithms are being used to support all phases of the treatment cycle. These systems have the potential to identify individuals suffering from mental health conditions, allowing them to receive the care they need and tailor treatments to individual patients who are mostly to benefit. Additionally, unsupervised learning techniques are breaking down existing discrete diagnostic categories and highlighting the vast disease heterogeneity observed within depression diagnoses. Artificial intelligence also provides the opportunity to shift towards evidence-based treatment prescription, moving away from existing methods based on group averages. However, our analysis suggests there are several limitations currently inhibiting the progress of data-driven paradigms in care. Significantly, none of the surveyed articles demonstrate empirically improved patient outcomes over existing methods. Furthermore, greater consideration needs to be given to uncertainty quantification, model validation, constructing interdisciplinary teams of researchers, improved access to diverse data and standardised definitions within the field. Empirical validation of computer algorithms via randomised control trials which demonstrate measurable improvement to patient outcomes are the next step in progressing models to clinical implementation.

PURPOSE: Despite the well-documented advantages of meniscal repair over meniscectomy, horizontal cleavage tears (HCTs) are often not repaired. Reported reasons include difficulty performing the repair, potential suture failure due to mechanical stresses, and poor healing rates. In addition, many surgeons have the perception that debriding the tear until the superior and inferior laminae are stable results in a good clinical outcome. Furthermore, many of the tears occur in patients who are older than the generally accepted indicated age for repair and may also have a degenerative component, making them potentially less likely to benefit from repair. This review was performed to evaluate the published outcomes of HCT repairs and test the hypothesis that surgically repaired HCTs have an unacceptably low rate of success. METHODS: A systematic search of the PubMed and Embase databases was performed in December 2013 to identify studies in which meniscal HCTs were repaired. Inclusion criteria for the analysis were English language, reference to a patient with an HCT repaired by any method, and a report of at least 1 postoperative outcome. For the purposes of this review, a failed outcome was defined as the need for reoperation. RESULTS: More than 16,000 abstracts were returned in the search. From these abstracts, we identified 210 articles for further review, of which 9 met the inclusion criteria. A total of 98 repairs of horizontal tears were evaluated in these studies. By use of reoperation as the criterion for treatment failure, 77 of the repairs were successful, for an overall success rate of 77.8%. CONCLUSIONS: The literature does not support the hypothesis that surgically repaired HCTs have an unacceptably low rate of success. Rather, our results show that existing studies of repaired HCTs show a comparable success rate to repairs of other types of meniscal tears. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.

The issues influencing the construction of Western Australia’s first six-star Green Star energy-rated commercial office building are examined. Green Star is a comprehensive, national, voluntary environmental rating system that evaluates the environmental design and construction of buildings and is undertaken by the Green Building Council of Australia. A six-star rating signifies “world leadership” in environmentally sustainable design and construction. The case study presented in this paper describes how a client acted as a catalyst for driving the sustainability agenda. The client’s key drivers for implementing sustainable technologies were procurement and organizational resources. Existing building regulations and a lack of government incentives were identified as being the main barriers to implementing sustainable technologies. The case findings presented provide an opportunity for clients and practitioners to learn from the experiences of others who have, and continue to address the environmental challenges facing the built environment.

OBJECTIVE: The aim of this paper is to explore the conceptual basis of limiting access to potential methods of suicide as a public health measure. METHOD: A review of the literature was conducted. RESULTS: Both physical availability and sociocultural acceptability are important determinants of choice. There is considerable evidence of an association between method availability and method specific suicide rates. There is also evidence that restriction of method availability is often associated with a reduction in method specific suicide rates. There is some evidence that restrictions on method availability under certain conditions may reduce overall suicide rates. CONCLUSIONS: Suicide methods employed by young Australians are changing, with a disturbing rise in frequency of hanging and car exhaust suicides slightly offset by a decline in firearm suicides. Opportunities exist for further reducing firearm suicides and addressing exhaust suicides by practical measures. There are also obvious options for changing prescribing practices with respect to more lethal medications (e.g. tricyclic antidepressants). However, the rise in hanging seems problematic from this perspective and in need of ecological study.

OBJECTIVE: Series of patients fulfilling diagnostic criteria for Dissociative Identity Disorder (DID), otherwise known as multiple personality disorder, have particularly been reported on in North America and increasingly in other countries. The present study investigated the trauma and past treatment histories, symptom profiles and dissociative phenomenology of 62 patients fulfilling diagnostic criteria for DID seen in Brisbane (Queensland, Australia). METHOD: From 1992, systematic assessments, including the Dissociative Experience Scale and the Dissociative Disorders Interview Schedule, were performed with a personal series of 57 patients with DID seen by one of the authors (WM) and five patients seen by the second author (JB). RESULTS: The histories of childhood trauma, the clinical profiles and dissociative indices of these patients closely approximate those described in series reported in other countries. CONCLUSIONS: Patients fulfilling diagnostic criteria for DID are regularly seen in Australian inpatient and outpatient settings. The dissociative symptomatology of the patients examined in the present study represents a significant component of a complex syndrome associated with a history of severe ongoing developmental trauma dating from early childhood.

Abstract Results from a field trial commissioned for the Australian Department of Defence at the Army Aviation Centre Oakey evaluated the effectiveness of the Surface‐Active Foam Fractionation (SAFF) process at removing per‐ and polyfluoroalkyl substances (PFAS) in groundwater. The study showed that the SAFF process is effective in removing ≥99.5% of the aggregate of perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS), and perfluorooctanoic acid (PFOA) in PFAS‐contaminated groundwater, and consistently achieved the criteria for these PFAS species prescribed in the Australian PFAS National Environmental Management Plan (HEPA, 2020) water quality specification, and exceeded such by a factor of 3.3 over the 12‐month study period. The field trial also demonstrated the sustainability attributes of SAFF since it requires no chemical reagents nor adsorbent media, other than air introduced to the foam fractionation vessels. However, when an anionic exchange (AIX) resin “polisher” was installed downstream of SAFF, all trace detectable PFAS species were removed. In addition, by reducing the PFAS loading, the SAFF process extends the AIX resin lifespan. The field trial demonstrated that the removal (i.e., separation and concentration) extent of PFAS species due to SAFF is closely correlated with the adsorption coefficient of the molecules at the gas–liquid interface. When the reported adsorption coefficient is greater than approximately 1.0 × 10 −6 m, practically all of the PFAS species, including PFOS, PFHxS, and PFOA, were removed by SAFF. Longer‐chain PFAS species that benefit from higher adsorption coefficients are easier to remove than shorter‐chain species that exhibit lower adsorption coefficient values. It is noted that the presence of dissolved electrolytes arising from the site groundwater being classified as hard is believed to enhance the adsorption coefficients, and so SAFF is likely to become still more effective in brackish, saline, and reverse osmosis reject waters.

(U-Th)/He dating of late-stage authigenic goethite, combined with corrections for diffusive loss of He-4 by the He-4/He-3 methodology, reveals strong correlation between a sample's age and its depth in ferruginized channel sediments from the Yandicoogina deposit, Western Australia. Corrected ages, ranging from ca. 18 Ma near the surface to ca. 5 Ma at the bottom of the profile, indicate that ferruginization of the aggraded channels becomes progressively younger with depth. This trend is consistent with goethite precipitation at the groundwater-atmosphere interface during water table drawdown driven by the aridification of Western Australia during the Neogene. The results demonstrate that the (U-Th)/He system is ideal for dating goethite if diffusive loss corrections are applied. The approach is suitable for dating weathering reactions on Earth and should also be suitable for dating Fe oxyhydroxides in the Martian regolith.

Sleep disturbance is commonly found in depression. Plasma cortisol levels in non-hospitalized normal subjects show a rise prior to waking, with peak values at between 5 and 8 a.m. (9, 10). In a group of eight normal subjects, Perkoff (10) changed the sleep rhythm to sleeping during the day, using darkened rooms, and found that the plasma cortisol level followed suit, rising sharply in the two-hour period before waking. He stated: “A fundamental characteristic of the diurnal variation of plasma 17 OHCS concentration is the abrupt rise which occurs during the sleep period.”

Eucalyptus oil is well documented as being extremely toxic if ingested. We report a case of systemic eucalyptus oil toxicity from topical application. A 6-year-old girl presented with slurred speech, ataxia and muscle weakness progressing to unconsciousness following the widespread application of a home remedy for urticaria containing eucalyptus oil. Six hours following removal of the topical preparation her symptoms had resolved, with no long term sequelae.

INTRODUCTION AND AIMS: Despite the availability of effective treatments for substance use disorders, engaging people in treatment remains a challenge. This clinical study describes a 7-week trial of music therapy as an adjunct to group cognitive behaviour therapy with the aim of increasing patient engagement in a private hospital open group programme. DESIGN AND METHODS: Patient attendance rates and perceptions of the music therapy were collected at the end of each music therapy session by means of an anonymous survey, and only data from each patient's first survey were used in the analysis. Twenty-four surveys were analysed, representing feedback from 10 men and 14 women, aged between 17 and 52 years. RESULTS: The average attendance rate over the 7-week trial was 75%. The results indicated that enjoyment and motivation to participate during the sessions was uniformly high (mean ratings of 4.3 and 4.0 out of 5, respectively). The majority (83%) of participants reported that they would attend another music therapy session, and almost half (46%) endorsed that '(music therapy) would help them to feel more a part of the group'. Additional analyses revealed that music therapy was able to engage patients regardless of their age group (25 years and under vs. over-25 years) or substance (alcohol only vs. other drugs). DISCUSSION AND CONCLUSIONS: Music therapy is a promising approach to improving engagement in substance abuse treatment groups.

The aim of this study was to systematically examine the impact of shame, guilt, and dissociation on interpersonal relationships. Study 1 assessed 81 participants attending a trauma-related treatment service with the Structured Interview for Disorders of Extreme Stress and the Community and Interpersonal Connectedness Scale. Study 2 assessed 21 traumatized participants from the same service with the above measures, as well as the Dissociative Experiences Scale. Lifetime shame and current dissociation made significant contributions to relationship disconnectedness, with dissociation having the most significant impact in all analyses. Both dissociation and shame appear to have a severing effect on interpersonal relationships.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, formally recognizes a dissociative subtype of posttraumatic stress disorder (PTSD; PTSD with dissociative symptoms). This nomenclative move will boost empirical and theoretical efforts to further understand the links between dissociation, trauma, and PTSD. This article examines the empirical literature showing that patients with PTSD can be divided into 2 different groups based on their neurobiology, psychological symptom profile, history of exposure to early relational trauma, and depersonalization/derealization symptoms. It then explores the conceptual and empirical challenges of conceiving 1 of these types as reflecting a "dissociative" type of PTSD. First, this classification is based on the presence of a limited subset of dissociative symptoms (i.e., depersonalization, derealization). This sets aside an array of positive and negative psychoform and somatoform dissociative symptoms that may be related to PTSD. Second, empirical evidence suggests heightened dissociation in PTSD compared to many other disorders, indicating that dissociation is relevant to PTSD more broadly rather than simply to the so-called dissociative subtype. This article sets out important issues to be examined in the future study of dissociation in PTSD, which needs to be informed by solid conceptual understandings of dissociation.

Purpose The purpose of this paper is to describe a research method successfully used to study intellectual capital (IC) and IC flows through a highly networked marketplace. Design/methodology/approach The method integrates computer‐assisted content analysis (CA) and multivariate statistics. The CA is performed on a large source of business and analyst reports. The method is successful in enabling the elements of IC to be related to firm performance, using 156 firms in the global information technology market as a testing ground. Findings Computer‐assisted CA techniques could be successfully used to analyse the larger samples of firms for IC attributes like human capital, internal capital and external or relational capital, than have previously been feasible using manual CA methods. Research limitations/implications Several limitations of the method are identified and relate to the computer‐assisted CA method used. First, the method relies on the existence of a large body of content, in this case business reports and articles, to create the indices for the IC attributes. A second limitation is that the IC attributes are constructed from public sources (i.e. they represent the view of external reporters, rather than internal to the organisation reporters). The method presented combines and extends the benefits of both qualitative and quantitative methods. The richer source of IC content for a larger sample of firms is made accessible through computer‐assisted CA. The overall method enables insights to be explored in relating firm IC to firm performance in the market place. Originality/value The integrated research method presented is the result of original research. The value to researchers is the opportunity it provides to study the IC/performance relationship across markets, rather than be limited to small sample or limited attribute studies.