bluuebunny/crossref_metadata_2025 huggingface dataset:
Limited cone-beam computed tomography imaging of the middle ear: a comparison with multislice helical computed tomography
Authors: Peltonen L. I. , Aarnisalo A. A. , Kortesniemi M. K. , Suomalainen A. , Jero J. , Robinson S.
Published: March 2007

Purpose: To determine the applicability of cone-beam computed tomography (CBCT) in otological imaging, and to compare its accuracy with the routinely used multislice helical CT (MSCT) for imaging of the middle- and inner-ear areas.

Material and Methods: Thirteen unoperated human cadaver temporal bones were imaged with CBCT and MSCT. Sixteen landmarks of the middle and adjacent inner ear were evaluated and compared for their conspicuity according to a modified Likert scale. Total scores and scores for subgroups including landmarks of specific clinical interest were also compared.

Results: No significant differences were found between the imaging techniques or subgroups when scores of individual structures were compared. While the middle ear itself was visible in all cases with CBCT, parts of the inner ear were “cut off” in four cases due to the limited field of view. For the same reason, the evaluation of the whole mastoid was not possible with CBCT. The cochlear and vestibular aqueducts were not visualized in either CT techniques. The contrast-to-noise ratio was more than 50% lower in CBCT than in MSCT, but still adequate for diagnostic task.

Conclusion: CBCT proved to be at least as accurate as routinely used MSCT in revealing the clinically and surgically important middle-ear structures. The results show that high-quality imaging of the middle ear is possible with the current CBCT device.
Brain magnetic resonance imaging of infants exposed prenatally to buprenorphine
Authors: Kahila H. , Kivitie-Kallio S. , Halmesmäki E. , Valanne L. , Autti T.
Published: March 2007

Purpose: To evaluate the brains of newborns exposed to buprenorphine prenatally.

Material and Methods: Seven neonates followed up antenatally in connection with their mothers' buprenorphine replacement therapy underwent 1.5T magnetic resonance imaging (MRI) of the brain before the age of 2 months. The infants were born to heavy drug abusers. Four mothers were hepatitis C positive, and all were HIV negative. All mothers smoked tobacco and used benzodiazepines. All pregnancies were full term, and no perinatal asphyxia occurred. All but one neonate had abstinence syndrome and needed morphine replacement therapy.

Results: Neither structural abnormalities nor abnormalities in signal intensity were recorded.

Conclusion: Buprenorphine replacement therapy does not seem to cause any major structural abnormalities of the brain, and it may prevent known hypoxic-ischemic brain changes resulting from uncontrolled drug abuse. Longitudinal studies are needed to assess possible abnormalities in the brain maturation process.
Diffusion tensor imaging in patients with acute onset of neuropsychiatric systemic lupus erythematosus: a prospective study of apparent diffusion coefficient, fractional anisotropy values, and eigenvalues in different regions of the brain
Authors: Hughes M. , Sundgren P. C. , Fan X. , Foerster B. , Nan B. , Welsh R. C. , Williamson J. A. , Attwood J. , Maly P. V. , Chenevert T. L. , McCune W. , Gebarski S.
Published: March 2007

Purpose: To investigate whether apparent diffusion coefficient (ADC), fractional anisotropy (FA), and eigenvalues in neuropsychiatric systemic lupus erythematosus (NPSLE) patients differ from those of healthy controls.

Material and Methods: Eight NPSLE patients (aged 23–55 years, mean 42.9 years) and 20 healthy age-matched controls (aged 22–59 years, mean 44.4 years) underwent conventional brain magnetic resonance (MR) and diffusion tensor imaging (DTI). The ADC, FA, principal eigenvalue (λ∥), and the corresponding average perpendicular eigenvalue (λ⊥) ( = (λ2+λ3)/2) were measured in selected regions of normal appearing gray and white matter brain parenchyma. For statistical evaluation of differences between the two groups, a Student's t-test was used. The P value for statistical significance was set to P = 0.0025 after Bonferroni correction for multiple measurements.

Results: Significantly increased ADC values were demonstrated in normal-appearing areas in the insular cortex ( P<0.001), thalamus ( P<0.001), and the parietal and frontal white matter ( P<0.001 and P<0.001, respectively) in NPSLE patients. Significantly decreased FA values were demonstrated in normal-appearing thalamus ( P<0.001), corpus callosum ( P = 0.002), and in the parietal and frontal white matter ( P<0.001 and P<0.001, respectively) in NPSLE patients compared to healthy controls. The λ⊥ was significantly higher in several of these regions in NPSLE patients compared to healthy controls.

Conclusion: Our study demonstrates alterations in normal-appearing gray and white matter brain parenchyma of patients with NPSLE by means of abnormal ADC, FA, and eigenvalues. These alterations may be based on loss of tissue integrity in part due to demyelination. It is possible that DTI in the future could assist in the diagnosis of NPSLE and possibly help to further elucidate the pathogenesis of NPSLE.
Chronic hepatosplenic schistosomiasis mansoni: magnetic resonance imaging and magnetic resonance angiography findings
Authors: Bezerra A. S. A. , D'Ippolito G. , Caldana R. P. , Cecin A. O. , Ahmed M. , Szejnfeld J.
Published: March 2007

Purpose: To evaluate the hepatosplenic manifestations and the portal venous system in patients with chronic infection by Schistosoma mansoni.

Material and Methods: A cross-sectional observational study was performed in 28 patients with chronic hepatosplenic schistosomiasis submitted to magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the abdomen. Images were interpreted independently by two radiologists to determine the reproducibility of image interpretation and who evaluated the presence of morphological alterations in the liver and spleen, such as hepatosplenomegaly, hepatic fissure widening, periportal fibrosis, and the presence of siderotic nodules. Interobserver and intra-observer agreement were measured with the kappa and intraclass correlation tests. Evaluation of venous collateral pathways and portal and splenic veins was done in consensus by both examiners.

Results: Observers identified enlargement of the left lobe (78.5–92.8%) and caudate-to-right-lobe ratio (78.5–92.8%), irregularity of hepatic contours (89.2–96.4%), fissure widening (89.2–100%), and splenic siderotic nodules (84.2%). Splenomegaly, heterogeneity of hepatic parenchyma, peripheral hepatic vessels, and periportal fibrosis were observed in 100% of patients. MRI findings presented almost perfect interobserver (κ = 0.65–1) and intra-observer (κ = 0.73–1 for observer 1, and κ = 0.65–1 for observer 2) agreement for the variables analyzed. MRA showed the presence of collateral pathways in the majority of patients (71.4%) along with widening of portal and splenic veins.

Conclusion: Using MRI, hepatosplenic alterations in schistosomiasis are characterized by heterogeneity of hepatic parenchyma, presence of peripheral perihepatic vessels, periportal fibrosis, splenomegaly, siderotic nodules, and the presence of venous collateral pathways.
Thyroid arterial embolization to treat graves' disease
Authors: Zhao W. , Gao B. -L. , Yang H. -Y. , Li H. , Song D. -P. , Xiang S. -T. , Shen J.
Published: March 2007

Purpose: To prospectively investigate the effect of thyroid arterial embolization on hyperthyroid Graves' disease in selected patients.

Material and Methods: Twenty-eight patients with hyperthyroidism caused by Graves' disease were enrolled to undergo thyroid arterial embolization and followed up for 12–22 months. Twenty-two patients had three thyroid arteries embolized and six patients two arteries. Serum thyroid hormone, thyroid-stimulating hormone (TSH), and autoimmune function were tested before and after embolization in all patients.

Results: Of 28 patients, 22 (78.6%) became euthyroid, five improved (17.8%), and one had temporary improvement followed by recurrence (3.6%). No serious complications occurred. Compared with the pre-embolization values, serum concentrations of thyroid hormone increased temporarily on day 3 post-embolization, dropped substantially after 1 and 2 months, and returned to nearly normal at 6 and 12 months post-embolization. TSH dropped on day 3, increased after 1 and 2 months, and returned to normal after 6 and 12 months. Thyroid antibodies TGAb and TMAb declined on day 3 to normal range, rose after 1 month, dropped to normal again after 2 months, and were slightly increased at 6 and 12 months follow-up.

Conclusion: Thyroid arterial embolization may be an effective approach for patients with hyperthyroidism caused by Graves' disease.
Granulomatous mastitis: radiological findings
Authors: Ozturk M. , Mavili E. , Kahriman G. , Akcan A. C. , Ozturk F.
Published: March 2007

Purpose: To evaluate the radiological, ultrasonographic, and magnetic resonance imaging (MRI) findings of idiopathic granulomatous mastitis.

Material and Methods: Between April 2002 and June 2005, the mammography, ultrasound, color Doppler ultrasound, nonenhanced MR, and dynamic MR findings of nine patients with the preliminary clinical diagnosis of malignancy and the final diagnosis of granulomatous mastitis were evaluated.

Results: On mammography, asymmetrical focal densities with no distinct margins, ill-defined masses with spiculated contours, and bilateral multiple ill-defined nodules were seen. On ultrasound, in four patients a discrete, heterogenous hypoechoic mass, in two patients multiple abscesses, in one patient bilateral multiple central hypo peripheral hyperechoic lesions, in two patients heterogeneous hypo- and hyperechoic areas together with parenchymal distortion, and in one patient irregular hypoechoic masses with tubular extensions and abscess cavities were seen. Five of the lesions were vascular on color Doppler ultrasound. On MR mammography, the most frequent finding was focal or diffuse asymmetrical signal intensity changes that were hypointense on T1W images and hyperintense on T2W images, without significant mass effect. Nodular lesions were also seen. On dynamic contrast-enhanced mammography, mass-like enhancement, ring-like enhancement, and nodular enhancement were seen. The time–intensity curves differed from patient to patient and from lesion to lesion.

Conclusion: The imaging findings of idiopathic granulomatous mastitis have a wide spectrum, and they are inconclusive for differentiating malignant and benign lesions.
The influence of magnetic resonance imaging findings of degenerative disease on dual-energy X-ray absorptiometry measurements in middle-aged men
Authors: Donescu O. S. , Battié M. C. , Videman T.
Published: March 2007

Purpose: To examine degenerative features based on magnetic resonance imaging (MRI) measurements at the lumbar spine in relation to dual-energy X-ray absorptiometry (DXA), and to investigate whether bone mineral density (BMD) is reflected in the substitution of bone trabecular structure by fat at the vertebral body level indicated by MRI T1 relaxation time, endplate concavity, and hypertrophic (osteophytes and endplate sclerosis) MRI findings.

Material and Methods: The sample for this cross-sectional study was composed of 102 subjects, 35–70 years old, from a population-based cohort. Data collection included DXA in the anterior–posterior projection at the L1–L4 vertebrae and right femoral neck, and MRI of the lumbar spine in the midsagittal plane.

Results: Age, vertebral signal intensity, osteophytes, and endplate concavity collectively explained 20% of the variance in spine BMD.

Conclusion: The study findings suggest that degenerative findings based on MRI measurements at the lumbar spine have an influence on bone assessment using DXA. Therefore, an overall bone assessment such as DXA might not offer an accurate measure of BMD.
Nuclear Power and Antiterrorism: Obscuring the Policy Contradictions
1
Authors: Martin Brian
Published: March 2007

Some governments are promoting both nuclear power and antiterrorism, but without much attention to connections between the two issues. Nuclear power increases the risk of nuclear terrorism directly and via nuclear proliferation, but this is seldom mentioned by policy‐makers. Governments use a set of rhetorical moves to hide the tensions in their policies concerning nuclear power and terrorism.
Knowledge and Cooperation for Regional Development: The Effect of Provincial and Federal Policy Initiatives in Canada and Australia
1
Authors: Garrett‐Jones Sam
Published: March 2007

This paper examines how federal systems of government in Canada and Australia deal with the challenges of promoting regional innovation and knowledge‐based industries. It focuses on selected cases of federal and regional (provincial or municipally based) policy initiatives and structures that support cross‐sector collaboration between ‘knowledge institutions’ (such as universities) and locally based industries. The study reveals both anticipated commonalities in and unexpected differences between the Canadian and Australian innovation environments and policy approaches. Federalism, resource‐based economies and sparse population have led to similar concerns and solutions. However, building local innovation systems and networks is a question of building on social capital and Canada seems rather more inventive and effective than Australia in turning social capital into sustainable organisations. Several regions of Canada have developed very strong community involvement in networks and institutions for improving technological skills, awareness and programmes—examples which provide valuable lessons for Australia.
Fault Lines: Emerging Domains of Inertia within the Australian Wine Industry
Authors: Aylward David
Published: March 2007

It is common knowledge that the Australian wine industry has enjoyed remarkable success over the past three decades in terms of production and export growth, innovation and reputation for consistent quality. The centralisation of resources and infrastructure, as well as the nationally‐oriented funding and R&D agendas, are usually cited as providing the foundation for this success. Yet in more recent years it is this same nationally‐focused centralisation that is increasingly at odds with a rapidly changing international wine landscape and therefore, the organisational and innovation requirements of the firms that must respond to these changes.

This paper explores these issues within the theoretical context of what it has termed domain inertia—an industry‐level dislocation between organisation and firm imperatives. Arguing that neither traditional organisational nor innovation‐based change theories deal with the complexities of industry‐level inertia, the paper attempts to move beyond orthodox theoretical parameters. In so doing, it adopts a somewhat unique theory that places organisational and innovation inertia within a widening domain of discordant industry‐level imperatives.
MDMA, methamphetamine and their combination: possible lessons for party drug users from recent preclinical research
Authors: CLEMENS KELLY J. , McGREGOR IAIN S. , HUNT GLENN E. , CORNISH JENNIFER L.
Published: March 2007

The substituted amphetamines 3,4‐methylenedioxymethamphetamine (MDMA, ‘Ecstasy’) and methamphetamine (METH, ‘ice’, ‘speed’) are increasingly popular drugs amongst party‐drug users. Studies with humans have investigated the acute and possible long‐term adverse effects of these drugs, yet outcomes of such studies are often ambiguous due to a variety of confounding factors. Studies employing animal models have value in determining the acute and long‐term effects of MDMA and METH on brain and behaviour. Self‐administration studies show that intravenous METH is a particularly potent reinforcer in rats and other species. In contrast, MDMA appears to have powerful effects in enhancing social behaviour in laboratory animals. Brief exposure to MDMA or METH may produce long‐term reductions in dopamine, serotonin and noradrenaline in the brain and alterations in the density of various receptor and transporter proteins. However it is still unclear, particularly in the case of MDMA, whether this reflects a ‘neurotoxic’ effect of the drug. Lasting alterations in social behaviour, anxiety, depressive symptoms and memory have been demonstrated in laboratory rats given MDMA or METH and this matches long‐term changes reported in some human studies. Recent laboratory studies suggest that MDMA/METH combinations may produce greater adverse neurochemical and behavioural effects than either drug alone. This is of some concern given recent evidence that party drug users may be frequently exposed to this combination of drugs.
Should personality traits be considered when refining substance misuse treatment programs?
Authors: STAIGER PETRA K. , KAMBOUROPOULOS NICOLAS , DAWE SHARON
Published: March 2007

The interplay between stable personality characteristics and environmental factors is emphasised in most contemporary approaches to individual differences. This interaction appears to be important in understanding the development of substance use and misuse. Impulsivity related personality traits such as sensation‐seeking, novelty seeking, reward‐sensitivity and behavioural disinhibition, are strongly linked to adolescent and adult substance use and misuse. The role of anxiety‐related traits, in the development of substance misuse is less clear. Nonetheless, anxiety disorders are very common amongst adult substance misusers and almost certainly play a critical role in the maintenance of a substance use disorder and influence treatment effectiveness. The data suggest that personality influences treatment outcomes and yet these individual differences are generally not addressed in treatment. We argue in this review that interventions which are matched to these relevant personality traits may improve treatment outcomes for substance misusers.
The Australian Treatment Outcome Study (ATOS): what have we learnt about treatment for heroin dependence?
Authors: DARKE SHANE , ROSS JOANNE , TEESSON MAREE
Published: March 2007

Opioids make the single largest contribution to illicit drug‐related mortality and morbidity worldwide In this paper we reflect upon what has been learnt regarding treatment outcome and the natural history of heroin use from the Australian Treatment Outcome Study (ATOS). We focus on what we knew prior to ATOS, what ATOS revealed that is novel, and the implications for research, practice and policy. ATOS provided strong evidence for sustained improvement attributable to treatment across the three years of the study. It is argued that treatment for heroin dependence is money well spent, and leads to clear and sustained benefits to both heroin users and society.
Dual diagnosis in Spain
Authors: GUAL ANTONI
Published: March 2007

Our aim is to describe the current situation regarding the diagnosis and treatment of addiction in a variety of settings in Spain. Four‐hundred and twenty‐seven physicians known to treat addicted patients in non‐private settings were recruited and agreed to participate. Each physician provided clinical and anonymous information on the first 6 consecutive patients who attended on a scheduled day. A total of 2361 patients were interviewed (92.1%) and data were obtained concerning gender, age, work, educational level, civil status, addiction diagnosis, type of treatment and psychiatric comorbidity. Seven‐hundred and ninety‐eight out of 2361 addicts (33.8%) presented with a dual diagnosis. Depression was the most prevalent disorder (21.6%), followed by anxiety disorders (11.7%). Comorbidity was found to be related to age, female gender, divorce and widowhood, and higher educational levels. Alcoholics who abused other drugs showed the highest rates of comorbidity (48.5%), while opiate addicts were at the lower end of the spectrum (27.4%). No differences were found related to the treatment setting, the doctor's medical specialty, or the geographical area. Finally, doctors tended to perceive that dual diagnosis was related to a worse psychiatric prognosis but not to higher relapse rates. Antidepressants were the most commonly prescribed drugs (62.4% of co‐morbid patients) and anticraving agents were prescribed equally to comorbid and non‐comorbid patients. Within the limitations of a descriptive study, our data show that comorbidity is a common clinical problem in patients who access addiction treatment. Affective and anxiety disorders are the most common comorbid diseases, and comorbidity rates seem to be unrelated to regional differences, medical settings or doctor's professional background. Dual diagnosis patients thus account for one third of the clinical workload of addiction specialists in Spain.
Magazine alcohol advertising compliance with the Australian Alcoholic Beverages Advertising Code
Authors: DONOVAN KATI , DONOVAN ROB , HOWAT PETER , WELLER NARELLE
Published: March 2007

The purpose of this study was to assess the frequency and content of alcoholic beverage advertisements and sales promotions in magazines popular with adolescents and young people in Australia, and assess the extent to which the ads complied with Australia's self‐regulatory Alcoholic Beverages Advertising Code (ABAC). Alcohol advertisements and promotions were identified in a sample of 93 magazines popular with young people. The identified items were coded against 28 measures constructed to assess the content of the items against the five sections of the ABAC. Two thirds of the magazines contained at least one alcohol advertisement or promotion with a total of 142 unique items identified: 80 were brand advertisements and 62 were other types of promotional items (i.e. sales promotions, event sponsorships, cross promotions with other marketers and advertorials). It was found that 52% of items appeared to contravene at least one section of the ABAC. The two major apparent breaches related to section B‐the items having a strong appeal to adolescents (34%) and to section C‐promoting positive social, sexual and psychological expectancies of consumption (28%). It was also found that promotional items appeared to breach the ABAC as often as did advertisements. It is concluded that the self‐regulating system appears not to be working for the alcoholic beverages industry in Australia and that increased government surveillance and regulation should be considered, giving particular emphasis to the inclusion of promotional items other than brand advertising.
A community development approach to deal with public drug use in Box Hill
Authors: ROGERS NEIL , ANDERSON WARREN
Published: March 2007

The use of alcohol and other drugs in public space is one that generates much heat in the public discourse and in the media. Too often the responses called for to reduce the problems of public amenity involve punitive policing and other responses that aim to engineer (mostly) young people out of these public spaces. Often local retailers are a key stakeholder group calling loudest for punitive action. In this Harm Reduction Digest Rogers and Anderson describe a community development approach taken to address these problems in Box Hill in the City of Whitehorse, near Melbourne. This approach which aimed to develop ‘bridging social capital’ between community retailers and other stakeholders in the area appears to have been effective in reducing harm associated with public drug use. Moreover these changes have become institutionalised and the approach has been expanded to address other public amenity problems in the area. It is a very nice example of how drug related harm can be reduced by grass roots networks of local councils, business people, law enforcement and health and welfare service providers to address these issues.
Alcohol and injuries: a review of international emergency room studies since 1995
Authors: CHERPITEL CHERYL J.
Published: March 2007

This paper provides a review of emergency room (ER) studies on alcohol and injury, using representative probability samples of adult injury patients, and focuses on the scope and burden of the problem as measured by estimated blood alcohol concentration (BAC) at the time of the ER visit, self‐report drinking prior to injury, violence‐related injury and alcohol use disorders. A computerized search of the English‐language literature on MEDLINE, PsychINFO and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) Alcohol and Alcohol Problems Science Database (ETOH) was conducted for articles published between 1995 and 2005, using the following key descriptors: (1) emergency room/emergency department/accident and emergency, (2) alcohol/drinking and (3) injuries (intentional and unintentional). Findings support prior reviews, with injured patients more likely to be positive for BAC and report drinking prior to injury than non‐injured, and with the magnitude of the association substantially increased for violence‐related injuries compared to non‐violence‐related injuries. Indicators of alcohol use disorders did not show a strong association with injury. Findings were not homogeneous across studies, however, and contextual variables, including study‐level detrimental drinking pattern, explained some of the variation. This review represents a broader range of ER studies than that reported previously, across both developed and developing countries, and has added to our knowledge base in relation to the influence of contextual variables on the alcohol‐injury relationship. Future research on alcohol and injury should focus on obtaining representative samples of ER patients, with special attention to both acute and chronic alcohol use, and to organisational and socio‐cultural variables that may influence findings across studies. In‐depth patient interviews may also be useful for a better understanding of drinking in the injury event and associated circumstances.
The Limitations of Advance Directives and Statements in Mental Health
Authors: Hobbs Paul
Published: March 2007

Objective: Advance directives and statements in mental health are defined and the necessary conditions for making them explained. The practical limitations on their usefulness are discussed.

Conclusion: Legal recognition of advance directives and statements is limited. There has been little research into their use and impact on care and what little exists, is equivocal in results.
Consultant Caseload Management
Authors: Mathai John
Published: March 2007

Objective: This study was designed to survey a different model of working as a consultant in a child and adolescent mental health service to address the problem of a long waiting list.

Methods: A log of referrals was kept from date of entry and when patient were seen

Results: The main outcome was in reducing the waiting time from 22 weeks to 8.4 weeks.

Conclusions: The clinical implication is for consultants to consider using a consultation model in child and adolescent mental health services.
A Survey of Combination Antidepressant Use in Australia
Authors: Horgan David , Dodd Seetal , Berk Michael
Published: March 2007

Objective: The aim of this study was to survey doctors working in psychiatry in Australia about the practice of using two antidepressants simultaneously.

Method: A postal survey was sent to all doctors in psychiatry in Australia enquiring about their prescribing history and their attitudes to combination antidepressants and related issues.

Results: Seventy-nine percent of respondents had used combination antidepressants. The most frequently reported combination was a selective serotonin reuptake inhibitor combined with a tricyclic antidepressant. Combinations of mirtazepine with venlafaxine and other antidepressants were the next most frequently used. Seventeen percent of respondents reported having seen a complication from combination antidepressants, 75% believed that Australian GPs should be given information on the use of combination antidepressants, 89% wished for more information on this topic, and 88% believed patients had a right to be informed of this option in their treatment. Use of combination antidepressants was more frequent than exceeding the recommended maximum dose of an individual antidepressant.

Conclusion: Combination antidepressants are used far more frequently in Australia than suspected previously. Research into safe and evidence-based practice is strongly indicated.
Perceptions of Mental Health Service Delivery among Staff and Indigenous Consumers: It's Still about Communication
Authors: Eley Diann , Young Louise , Hunter Keith , Baker Peter , Hunter Ernest , Hannah Dominique
Published: March 2007

Objective: A needs analysis was undertaken to determine the quality and effectiveness of mental health services to Indigenous consumers within a health district of Southern Queensland. The study focussed on identifying gaps in the service provision for Indigenous consumers. Tools and methodologies were developed to achieve this.

Method: Data were collected through the distribution of questionnaires to the target populations: district health service staff and Indigenous consumers. Questionnaires were developed through consultation with the community and the Steering Committee in order to achieve culturally appropriate wording. Of prime importance was the adaptation of questionnaire language so it would be fully understood by Indigenous consumers. Both questionnaires were designed to provide a balanced perspective of current mental health service needs for Indigenous people within the mental health service.

Results: Results suggest that existing mental health services do not adequately meet the needs of Indigenous people.

Conclusions: Recommendations arising from this study indicate a need for better communication and genuine partnerships between the mental health service and Indigenous people that reflect respect of cultural heritage and recognises the importance of including Indigenous people in the design and management of mental health services. Attention to the recommendations from this study will help ensure a culturally appropriate and effective mental health service for Indigenous consumers.
The Democratisation of Psychiatry
Authors: Little John , Lobb David , Atkins Martin
Published: March 2007

Objective: To explore the decline in expertise of the consultant psychiatrist and its replacement by a range of professional colleagues.

Conclusion: Averting a devaluing of expertise in Australasia requires thoughtfulness, willingness to quietly and confidently contribute, and professional behaviour. There are early promising developments.
Contemporary Management of Aggression in an Inner City Mental Health Service
Authors: Emmerson Brett , Fawcett Lisa , Ward Warren , Catts Stanley , Ng Agnes , Frost Aaron
Published: March 2007

Objectives: From 2002 to mid 2003, Royal Brisbane and Women's Hospital Mental Health experienced increased patient – staff aggression and staff injury which resulted in staff conflict and recruitment difficulties. Strategies introduced to reduce the frequency and impact of aggression in the mental health service were evaluated.

Method: By mid 2003, incident data indicated increasing aggressive incidents. Based on this, an aggression management strategy was developed which included improved staff communication, new acute pharmacological treatment protocols, mandatory staff aggression management training, personal alarms and aggression risk assessment tools.

Results: Following the introduction of the strategy in early 2004, there was a reduction of 40% in aggressive incidents and a 56% reduction in staff injuries in 2005 compared to 2003 levels. A more assertive approach to tranquillisation was not associated with an increased adverse event rate for patients.

Conclusions: A co-ordinated strategy can contain and reduce aggressive incidents in acute inpatient mental health settings. These strategies are transferable to other health settings including Emergency Departments.
Is Deep Brain Stimulation a Form of Psychosurgery?
Authors: Sachdev Perminder
Published: March 2007

Objective: To examine the potential for the experimental treatment of deep brain stimulation for neuropsychiatric disorders, and to debate the argument that it should be considered another form of psychosurgery.

Conclusions: Psychosurgery is an old term with considerable pejorative connotations. It should be replaced with the more descriptive and accurate ‘neurosurgery for psychiatric disorders’. Moreover, neurosurgery should reflect ablative neurosurgery, and surgery for brain stimulation should be categorised as brain stimulation rather than neurosurgery, or indeed psychosurgery. This will prevent legislative restrictions on the development of brain stimulation techniques and not tar them with the lobotomy brush.
We can't find the Solution until We Know the Problem: Understanding the Mental Health Nursing Labour Force
Authors: Gough Karla , Happell Brenda
Published: March 2007

Objective: Difficulties recruiting and retaining adequate numbers of mental health nurses have been extensively documented in the Australian literature. The continued increase in the average age of practicing mental health nurses has intensified concerns that a workforce crisis is rapidly approaching. Despite the urgency of this situation, there has been no comprehensive, co-ordinated collection of labour force data. The aim of this paper is to synthesise and present labour force data gathered from various official sources to more clearly identify and articulate the nature and extent of the problem.

Method: Relevant labour force data was obtained from reports produced by the Australian Institute of Health and Welfare and the Victorian Department of Human Services. Information was collated, synthesised and, in some cases, re-analysed to provide a clearer picture of the current national and Victorian mental health nursing labour force, as well as requirement and supply projections.

Results: Findings are consistent with conclusions in the available literature but suggest that the magnitude of the problem is likely to be greater than previously anticipated.

Conclusions: The systematic and coordinated collection of mental health nursing labour force data is crucial in order that appropriate interventions can be implemented and evaluated.
A Cognitive Behavioral Therapy for Alcohol‐Dependent Domestic Violence Offenders: An Integrated Substance Abuse–Domestic Violence Treatment Approach (SADV)
Authors: Easton Caroline J. , Mandel Dolores L. , Hunkele Karen A. , Nich Charla , Rounsaville Bruce J. , Carroll Kathleen M.
Published: March 2007

This pilot study evaluated the efficacy of a twelve‐session cognitive behavioral group therapy for alcohol‐dependent males with co‐occurring interpersonal violence (IPV). Participants were 85 alcohol‐dependent males who were arrested for domestic violence within the past year. Seventy‐eight male adults were randomized to either a cognitive behavioral Substance Abuse Domestic Violence (SADV) group (N = 40) or a Twelve‐Step Facilitation (TSF) Group (N = 38). There was no significant difference between SADV versus TSF in the number of sessions attended. Regarding substance use, the group assigned to SADV reported using alcohol significantly fewer days (eg, 90 days of abstinence across the 12 weeks of treatment) as compared to the TSF group. Regarding physical violence, there was a trend for participants in the SADV condition to achieve a greater reduction in the frequency of violent episodes across time compared to individuals in the TSF group. These data suggest the promise of the SADV group therapy approach for alcohol‐dependent males with a history of IPV who present for substance abuse treatment.
Cigarette Smoking and Long‐Term Alcohol and Drug Treatment Outcomes: A Telephone Follow‐Up at Five Years
Authors: Satre Derek D. , Kohn Carolynn S. , Weisner Constance
Published: March 2007

This prospective study examined the relationship between cigarette smoking and five‐year substance abuse treatment outcomes. Of 749 individuals who began private outpatient treatment, 598 (80%) were re‐interviewed by telephone at five years. At five‐year follow‐up, 53% reported smoking cigarettes in the prior 30 days. Smokers were less likely to be abstinent from alcohol and drugs in the prior 30 days (48.3% vs. 64.0%), and had higher Addiction Severity Index (ASI) scores in employment, alcohol, drug, psychiatric, and family/social problems; worse self‐reported health; and greater self‐reported depression. Findings inform understanding of long‐term substance abuse treatment outcomes and potential service needs of smokers.
Adolescents with Conduct Disorder: Early Smoking and Treatment Requests
Authors: Bagot Kara S. , Berarducci Jennifer M. , Franken Frederick H. , Frazier Matthew J. , Ernst Monique , Moolchan Eric T.
Published: March 2007

This study explored the relationship of a diagnosis of conduct disorder (CD) with the developmental smoking trajectory among 117 adolescent volunteers. Logistic regression analyses revealed that adolescents with CD smoked their first whole cigarette earlier (p = 0.03) and sought cessation treatment earlier (p = .01) compared to non‐CD adolescents. Additionally, adolescents who smoked their first whole cigarette before the age of nine were eight times more likely to have CD. These findings suggest that in addition to addressing disruptive behaviors, early prevention and access to interventions for tobacco use are needed for youths with CD.
Arteriolar Involvement in the Microvascular Lesions of Diabetic Retinopathy: Implications for Pathogenesis
Authors: GARDINER TOM A. , ARCHER DESMOND B. , CURTIS TIM M. , STITT ALAN W.
Published: March 2007

Diabetic retinopathy (DR) is the most widespread complication of diabetes mellitus and a major cause of blindness in the working population of developed countries. The clinicopathology of the diabetic retina has been extensively studied, although the relative contribution of the various biochemical and molecular sequelae of hyperglycemia remains ill defined. Many neural and microvascular abnormalities occur in the retina of short‐term diabetic animals but it remains uncertain how closely these acute changes relate to chronic human disease. It is important to determine the relationship between alterations observed within the first weeks or months in short‐term animal models, and human disease, where clinically manifest retinopathy occurs only after durations of diabetes measured in years. This review is focused on the retinal microvasculature, although it should be appreciated that pathological changes in this system often occur in parallel with abnormalities in the neural parenchyma that may be derivative or even causal. Nevertheless, it is useful to reevaluate the microvascular lesions that are manifest in the retina during diabetes in humans and long‐term animal models, since in addition to providing useful clues to the pathogenic basis of DR as a disease entity, it is in the deterrence of such changes that the efficacy of any novel treatment regimes will be measured. In particular, an emphasis will be placed on the relatively unappreciated role of arteriolar dysfunction in the clinical manifestations and pathology of this disease.
Control of Retinal Arterial Tone by a Paracrine Retinal Relaxing Factor
Authors: MAENHAUT NELE , BOUSSERY KOEN , DELAEY CHRISTOPHE , VAN DE VOORDE JOHAN
Published: March 2007

Retinal blood flow is regulated by local factors. In vitro bioassay experiments give evidence that retinal tissue from different species (dogs, pigs, sheep, cows, rats, and mice) continuously releases a factor lowering tone of isolated retinal arteries. This factor is a general relaxant as it was effective in relaxing different types of vascular as well as nonvascular smooth muscle preparations. This factor is called the retinal relaxing factor (RRF) and its characteristics do not correspond with those of the many well‐known vasorelaxants found in retina (i.e., NO, prostanoids, adenosine, ADP, ATP, lactate, glutamate, GABA, taurine, adrenomedullin, CGRP, ANP, BNP, and CNP). This unknown RRF is transferable, hydrophilic, and heat‐stable. Its relaxing effect is independent of the presence of the vascular endothelium and of NO‐synthase, adenylyl cyclase, guanylyl cyclase, and cyclooxygenase activity. RRF might have a role in hypoxic vasodilation in retinal arteries since hypoxia induces relaxation only when retinal tissue is present. Thus, the RRF pathway is sensitive to changes in oxygen tension and might be a sensitive mechanism for adjusting vascular diameter to retinal oxygen levels. Diminished RRF release might explain the decreased retinal circulation observed in disease with atrophic retina.
Retinal Blood Flow in Diabetes
Authors: CLERMONT ALLEN C. , BURSELL SVEN‐ERIK
Published: March 2007

Objective: This is a review of work focused on characterizing retinal blood flow in diabetes. The review describes results on validation of the methodology for retinal blood flow measurements, the mechanisms of action of various factors that contribute to abnormalities in retinal blood flow in diabetic rodent models, and the translation of these results to clinical studies demonstrating the effectiveness of different therapeutic agents in normalizing retinal blood flow abnormalities in patients with diabetes.

Methods: Retinal blood flow measurements were performed using video fluorescein angiography, a methodology that is based on the measurement of fluorescein dye circulation times through the retinal circulation

Results: The results of a number of experiments are summarized, detailing the effects of hyperglycemia and the roles of factors such as protein kinase C activation, endothelin‐1 and endothelin‐3, angiotensin‐II, and nitric oxide in the development of retinal blood flow abnormalities in diabetes.

Conclusion: The measurement of retinal blood flow both in animals and in clinical trials using the same retinal blood flow measurement methodology can provide a valuable method of quantitation allowing characterization of physiological effects and their association with metabolic alterations in diabetes and their effects on the development and incidence of microvascular complications.
Inflammation and Breakdown of the Blood–Retinal Barrier During “Physiological Aging” in the Rat Retina: A Model for CNS Aging
Authors: CHAN‐LING TAILOI , HUGHES SUZANNE , BAXTER LOUISE , ROSINOVA EMELIA , McGREGOR IAIN , MORCOS YVETTE , VAN NIEUWENHUYZEN PETRA , HU PING
Published: March 2007

Objective:To examine the possible contribution of inflammation and breakdown of the blood–brain barrier in the central nervous system (CNS) of physiologically aged rats showing cognitive decline.

Methods:Young (3‐ to 6‐month‐old) and aged (24‐ to 30‐month‐old) Wistar rats were assessed by the novel object recognition test. Vascular and inflammatory changes in the CNS were investigated in whole‐mount preparations or sections of retinas from young adult or aged male Wistar rats.

Results:Aged rats showed a significant impairment in short‐term memory compared with young adults. Deterioration of blood–retinal barrier function in aged rats was evidenced by leakage of intravascular tracer into the retinal parenchyma and reduced immunoreactivity for the tight junctional protein, occludin. Immunohistochemistry revealed the presence of major histocompatibility complex (MHC) class II‐positive resident microglia, activated T cells, and monocyte‐like cells in the retinal parenchyma of aged rats only. Microglia positive for the ED1 antigen, indicative of phagocytic activity, were also observed in these retinas.

Conclusion:Breakdown of the blood–retinal barrier, MHC class II expression, microglial activation, and trafficking of activated T cells are associated with physiological aging. Such changes in the CNS may contribute to the pathogenesis of age‐related cognitive decline.
Host Immune Competence and Local Ischemia Affects the Functionality of Engineered Vasculature
Authors: CHEN RUTH R. , SNOW JONATHAN K. , PALMER JACK P. , LIN ANGELA S. , DUVALL CRAIG L. , GULDBERG ROBERT E. , MOONEY DAVID J.
Published: March 2007

Objective: Localized and sustained delivery of vascular endothelial growth factor (VEGF) is a promising approach to overcome the limited efficacy of bolus delivery. The authors examined the effects of host immune competence and local ischemia on the functionality of new vessel networks formed with this approach.

Methods: Vessel structure and perfusion resulting from implantation of porous 85:15 poly(lactide‐co‐glycolide) scaffolds releasing VEGF165 were measured in both subcutaneous tissue and ischemic hindlimbs of immune competent C57BL/6 and immune deficient SCID mice.

Results: Sustained VEGF delivery resulted in a similar ∼100% increase in vessel density within scaffolds in both implant sites, and both animal models. However, the resulting perfusion within scaffolds implanted in subcutaneous tissue increased modestly versus control (18–35%), while perfusion increased 52–110% above control when VEGF‐releasing scaffolds were placed in ischemic hindlimbs of C57BL/6 or SCID mice. VEGF delivery improved perfusion in the entire ischemic limb (55 ± 18% of the normal value by week 6; 138% increase over control) in SCID mice. Although C57BL/6 mice demonstrated spontaneous recovery from ischemia, VEGF delivery accelerated recovery as compared to control.

Conclusions: Localized and sustained VEGF delivery can create functional vasculature that amplifies recovery of tissue ischemia. However, increases in local and regional perfusion were highly dependent on the implantation site and the animal model.
Proapoptotic Nitric Oxide Production in Amyloid β Protein‐Treated Cerebral Microvascular Endothelial Cells
Authors: KIMURA CHIWAKA , OIKE MASAHIRO , WATANABE MICHI , ITO YUSHI
Published: March 2007

Objective: The objective of this study was to investigate the effects of amyloid β protein (Aβ) on cerebral microvascular endothelium, and their possible involvement in Aβ‐induced apoptosis in the neighboring cells.

Methods: Cultured bovine brain microvascular endothelial cells (BBECs) were incubated with Aβ for 24 h. Production of nitric oxide (NO) was assessed by nitric oxide‐sensitive fluorescent dye, DAF‐2, and the expression of NO synthase (NOS) proteins was examined by Western blotting. Effects of Aβ‐treated microvascular endothelium on the DNA damage of the neighboring cells were assessed by single‐cell gel electrophoresis.

Results: Aβ increased the expression of iNOS protein, but did not affect eNOS and nNOS expressions in BBECs. Aβ‐treated BBECs showed spontaneous NO production in the presence of L‐arginine. The neural cell line PC12 showed marked apoptosis after being co‐cultured with Aβ‐treated BBECs for 48 h, and the apoptosis was as potent as that induced by the inflammatory stimuli lipopolysaccharide and interferon‐γ. The DNA damage of PC12 cells evoked by co‐culture with Aβ‐treated BBECs was prevented by L‐NG‐nitroarginine methyl ester, an inhibitor of NOS.

Conclusions: These results indicate that Aβ induces the expression of iNOS in BBECs, and that microvascular endothelium‐derived NO may induce apoptosis in neighboring neural cells.