Guideline-based programs in the treatment of complex PTSD

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

A simple two-axiom characterization of the Nash solution

The oldest and best-known cooperative bargaining solution concept is the Nash solution. Nash [2] characterized his seminal solution concept by using the axioms of ‘Independence of Irrelevant Alternatives’ (IIA), ‘Weak Pareto Optimality’ (WPO), ‘Symmetry’ (SYM), and ‘Scale Invariance’ (SI). Except for WPO, these axioms have been at the center of controversy (especially the most crucial axiom, IIA). This paper considers a new and simple axiom ‘Focal Relevance of a Pareto-optimal Midpoint’ (FRPM). It turns out that the Nash solution can be characterized by WPO and FRPM only.

Simple characterizations of the Nash and Kalai/Smorodinsky solutions

In this study we introduce two new properties, the Midpoint Outcome on a Linear Frontier (MOLF) and Balanced Focal Point (BFP) properties, to replace the Weak Pareto Optimality (WPO), Symmetry (SYM) and Independence of Equivalent Utility Representations (IEUR) properties in the axiomatic characterizations of the two most prominent solution concepts, namely the Nash and Kalai/Smorodinsky solutions, respectively.

Golden grove

Golden Grove was designed as an integral part of the redevelopment of the public space area at the university of Sydney's Darlington Campus. It uses a combination of ground patterning, dispersed and embedded lighting and stenciled poetic inscriptions to animation, of rhythmic interconnectivity across place and time. The ground pattern of the work follows that of the constellation Pleiades, to the arrangement of nine focal points across the campus.

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers

• There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers.

• This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work.

• Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate.

• Three major themes emerged from interview data: planning for ward allocation, communication and professionalism.

• In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff.

• Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses.

• For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration.

• A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles.

• The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled – with the aim of providing quality patient care.

Praxis modelling : an evaluation of and extension to feature based modelling

This thesis presents Relation Based Modelling as an extension to the Feature Based Modelling approach to student modelling. Relation Based Modelling dynamically creates new terms allowing the instructional designer to specify a set of primitives and operators from which the modelling system will create the necessary elements. Focal modelling is a new technique devised to manipulate and coordinate the addition of new terms. The thesis presents an evaluation of student modelling systems based on predictive accuracy.

The case | Allograft dysfunction in a patient with sickle cell disease

The article focuses on the study concerning the diagnosis of acute renal allograft in patient with sickle cell disease. The 33 year old underwent several surgeries with immediate graft function. The percutaneous renal biopsy of the patient shows focal cortical necrosis and acute tubular damage coherent with ischemia. It concludes that the allograft sickling is the primary cause of the acute renal dysfunction in patients with sickle cell disease.

Depression in temporal lobe epilepsy surgery patients : an FDG-PET study

Summary: Purpose: Depression is common in temporal lobe epilepsy (TLE) and after temporal lobectomy, and its etiology is obscure. In nonepileptic depression (including depression associated with other neurologic disorders), a consistent PET imaging finding is frontal lobe hypometabolism. Many TLE patients have hypometabolism involving frontal regions. Thus in data available from routine clinical assessments in an epilepsy surgery unit, we tested the hypothesis that the pattern of hypometabolism, particularly in the frontal lobe, may be associated with the depression seen in patients with TLE and TLE surgery.

Methods: We studied 23 medically refractory TLE patients who underwent anterior temporal lobectomy and who had preoperative FDG-PET scanning. All patients had pre- and postoperative psychiatric assessment. By using statistical parametric mapping (SPM-99), patterns of hypometabolism were compared between patients who had a preoperative history of depression (n = 9) versus those who did not (n = 14) and between those in whom postoperative depression developed (n = 13) versus those in whom it did not (n = 10). A significant region of hypometabolism was set at p < 0.001 for a cluster of ≥20 contiguous voxels.

Results: Patients with a history of depression at any time preoperatively showed focal hypometabolism in ipsilateral orbitofrontal cortex compared with those who did not (t= 4.64; p < 0.001). Patients in whom depression developed postoperatively also showed hypometabolism in the ipsilateral orbitofrontal region (t= 5.10; p < 0.001).

Conclusions: Although this study is methodologically limited, and other explanations merit consideration, orbitofrontal cortex dysfunction, already implicated in the pathophysiology of nonepileptic depression, may also be relevant to the depression of TLE and temporal lobectomy.

Evaluation of three remote camera systems for detecting mammals and birds

Automated camera systems have widespread application in wildlife studies and their use is increasing (Kucera & Barrett 1993; Cutler & Swann 1999; Swann et al. 2004; Parker et al. 2008). Among other applications, they have been used to produce species inventories, estimate population sizes, study behaviour and examine the impact and activity of predators (Cutler & Swann 1999; Swann et al. 2004). Modern camera systems can operate for extended durations, are relatively non-invasive, easy to operate, portable, durable and can take good-quality images by day and night (Kucera & Barrett 1993; Peterson & Thomas 1998; Allison & Destefano 2006; Parker et al. 2008). Beyond their scientific applications, the generation of high-quality images can be useful for educational and conservation purposes (Cutler & Swann 1999). The two most common types of systems currently used in ecological research are passive and active infrared (IR) systems (Cutler & Swann 1999; Parker et al. 2008). An older form of remote photography is video which captures a continuous record of activity at a focal site (Stewart et al.1997; King et al. 2001). Camera systems have certain limitations and biases (Swann et al. 2004), yet these have not been well studied. Refinement of the use of camera systems is required to fully realize their value (Towerton et al. 2008). Here, we describe a comparison of detection rates of mammals and birds by passive and active IR camera systems, using a video system to benchmark detection rates.

How to find natural reservoir hosts from endemic prevalence in a multi-host population : a case study of influenza in waterfowl

The transmission dynamics of infectious diseases critically depend on reservoir hosts, which can sustain the pathogen (or maintain the transmission) in the population even in the absence of other hosts. Although a theoretical foundation of the transmission dynamics in a multi-host population has been established, no quantitative methods exist for the identification of natural reservoir hosts. For a host to maintain the transmission alone, the host-specific reproduction number (U), interpreted as the average number of secondary transmissions caused by a single primary case in the host(s) of interest in the absence of all other hosts, must be greater than unity. If the host-excluded reproduction number (Q), representing the average number of secondary transmissions per single primary case in other hosts in the absence of the host(s) of interest, is below unity, transmission cannot be maintained in the multi-host population in the absence of the focal host(s).

The present study proposes a simple method for the identification of reservoir host(s) from observed endemic prevalence data across a range of host species. As an example, we analyze an aggregated surveillance dataset of influenza A virus in wild birds among which dabbling ducks exhibit higher prevalence compared to other bird species. Since the heterogeneous contact patterns between different host species are not directly observable, we test four different contact structures to account for the uncertainty. Meeting the requirements of U > 1 and Q < 1 for all four different contact structures, mallards and other dabbling ducks most likely constitute the reservoir community which plays a predominant role in maintaining the transmission of influenza A virus in the water bird population. We further discuss epidemiological issues which are concerned with the interpretation of influenza prevalence data, identifying key features to be fully clarified in the future.

Enhanced photothermal therapy assisted with gold nanorods using a radially polarized beam

We report on the use of a radially polarized beam for photothermal therapy of cancer cells labeled with gold nanorods. Due to a three-dimensionally distributed electromagnetic field in the focal volume, the radially polarized beam is proven to be a highly efficient laser mode to excite gold nanorods randomly oriented in cancer cells. As a result, the energy fluence for effective cancer cell damage is reduced to one fifth of that required for a linearly polarized beam, which is only 9.3% of the medical safety level.

Catholic intermarriages in Australia : attitudes to children, identity and sharing household responsibilities

A cursory glance of the human history shows a changing view about marriage on various aspects and levels. One of which is the level of people’s exploration leading to marriage with a spouse that may have different articles of faith.

This study’s focal concern is on Australia’s Catholics’ and Christians’ interfaith marriages, and its level of influence on attitudes to children, identity, and sharing household responsibilities. Expectations are predetermined from both parties but it can be discerned that with sound values, relationships can be rockbed strong.

Raising a family for two individuals with distinct spiritual formation can bring multidisciplinary results. It may be a source of inspiration not only for children seeing their parents respecting each other’s belief— for the love of fellow, own children, and especially the love that has flourished through the union of faith.

Gaze behavior among experts and trainees during optic disc examination : does how we look affect what we see?

Purpose. The authors compared the visual gaze behaviors of glaucoma subspecialists with those of ophthalmology trainees during optic disc and retinal nerve fiber layer (RNFL) examination.

Methods. Seven glaucoma subspecialists and 23 ophthalmology trainees participated in the project. Participants were shown eight glaucomatous optic disc images with varied morphology. Eye movements during examination of the optic disc photographs were tracked. For each disc image, graders were asked to assign a presumptive diagnosis for probability of glaucoma. There was no time restriction.

Results. Overall, trainees spent more time looking at disc images than glaucoma subspecialists (21.3 [13.9–37.7] vs. 16.6 [12.7–19.7]) seconds; median [interquartile range (IQR)], respectively; P < 0.01) and had no systematic patterns of gaze behavior, and gaze behavior was unaltered by disc morphology or topographic cues of pathology. Experienced viewers demonstrated more systematic and ordered gaze behavior patterns and spent longer times observing areas with the greatest likelihood of pathology (superior and inferior poles of the optic nerve head and adjacent RNFL) compared with the trainees. For discs with focal pathology, the proportion of total time spent examining definite areas of pathology was 28.9% (22.4%–33.6%) for glaucoma subspecialists and 13.5% (12.2%–19.2%) for trainees (median [IQR]; P < 0.05). Furthermore, experts adapted their viewing habits according to disc morphology.

Conclusions. Glaucoma subspecialists adopt systematic gaze behavior when examining the optic nerve and RNFL, whereas trainees do not. It remains to be elucidated whether incorporating systematic viewing behavior of the optic disc and RNFL into teaching programs for trainees may expedite their acquisition of accurate and efficient glaucoma diagnosis skills.

Conserving the heritage spaces of Kuala Lumpur : a case study of the old Market Square (Medan Pasar)

Being one of the new Asian mega-cities today, the origins of Kuala Lumpur started as early as 1850s at the confluence between two rivers; Gombak and Klang. The history of Kuala Lumpur changed when tin was discovered in Ampang in I 857. To cater for the need of residents and miners, a small trading post was constructed at the confluence between these two rivers. This business activity expanded eastwards to the Klang River resulting in one of the busiest business centres in Kuala Lumpur. Shophouses were erected and streets formed. These rows of shophouses and streets, with the river located to the west, created a rectangular space, known as the Old Market Square (Medan Pasar) which later became the main focal point of Kuala Lumpur. Today, even though the native senlements, chaotic sheds and huts have totally disappeared, some of the original shophouses, streets and even spaces still exist. However, they are struggling to survive and to maintain their authenticity due to pressures of nearby developments. This article considers the status of the Old Market Square in regard to its historical evolution and its position in contemporary heritage legislation and policy.

Life during wartime : sexuality, recruitment and reality television

In 2010, Defence Force Recruiting (DFR) Navy Marketing entered into a media sponsorship package with the Australian version of the reality TV show So You Think You Can Dance (SYTYCD): Footage of the day aired on national television on SYTYCD and weekly ‘dancer bootcamp’ sessions training the dancers in Navy values featured on a dedicated and branded Navy section of the official SYTYCD website. This article analyses the Navy’s SYTYCD ‘integration opportunities’ to consider the role of reality television in the redefinition of the defence forces as a training and vocational pathway for young people. Underpinning such considerations is the conceptualization of the work of reality television through the prism of public and popular pedagogies. Taking sexuality as a focal point, the article will reflect on efforts to lift recruitment through an emphasis on the incorporation of diversity. Reading the work of Jasbir Puar against the Australian ‘archive’ of integration opportunities, this article contributes to queer critiques of homonormative and homonationalist tendencies in contemporary politics.