Impact of cognitive behaviour therapy via mail for cessation of benzodiazepine use : a series of case reports

Benzodiazepines are widely prescribed to manage sleep disorders, anxiety and muscular tension. While providing short-term relief, continued use induces tolerance and withdrawal, and in older users, increases the risk of falls. However, long-term prescription remains common, and effective interventions are not widely available. This study developed a self-managed cognitive behaviour therapy package for cessation of benzodiazepine use delivered to participants via mail (M-CBT) and trialled its effectiveness as an adjunct to a general practitioner (GP)-managed dose reduction schedule. In the pilot trial, participants were randomly assigned to GP management with immediate or delayed M-CBT. Significant recruitment and engagement problems were experienced, and only three participants were allocated to each condition. After immediate M-CBT, two participants ceased use, while none receiving delayed treatment reduced daily intake by more than 50%. Across the sample, doses at 12 months remained significantly lower than baseline, and qualitative feedback from participants was positive. While M-CBT may have promise, improved engagement of GPs and participants is needed for this approach to substantially impact on community-wide benzodiazepine use.

The impact of tobacco smoking on treatment for comorbid depression and alcohol misuse

Tobacco use is a major public health concern, and is associated with a number of mental illnesses as well as increased alcohol/other drug (AOD). Research into treatment for individuals experiencing such comorbidities is limited. Participants (n = 447) were those enrolled in the Depression and Alcohol Integrated and Single-focused Interventions project (Baker et al. 2010), and the Self Help for Alcohol/other drugs and DEpression project (Kay-Lambkin et al. Medical Journal of Australia 195:S44-S50, 2011a, Journal of Medical Internet Research 13(1):e11p11, b), who reported current depression and hazardous alcohol use at entry to the study. Smoking cessation was not targeted in, nor a goal of, treatment. After controlling for socioeconomic variables, tobacco use was not associated with higher levels of depressive symptoms at baseline; however heavy smokers (30+ cigarettes per day) consumed significantly more alcohol at baseline than did non-smokers (13 vs. 9 standard drinks per day). Baseline smoking severity did not impact on depression or alcohol use outcomes over a 12-month period. Reductions in tobacco use between baseline and 3-month follow-up were significantly associated with reductions in depression and alcohol consumption over the same time period. The study results suggest that tobacco use does not interfere with treatment for depression and alcohol use problems, and adds weight to the idea of considering specific treatment for tobacco use in the context of treatment for alcohol/other drug use.

The impact of temperature variability on years of life lost

The relationship between temperature and mortality is generally found to be bathtub shaped (rising at both extremes). However, there are limited data on the potential health effects of temperature variability and on temperature itself...

The impact of personal identity and intimacy on the use of social media

Personal identity and intimacy levels change over time and this can influence the way consumers buy and use goods and services. This thesis examined how levels of personal identity and intimacy influence the use of social media by consumers of different ages. A survey of 208 users of facebook demonstrated that consumers with weak levels of personal identity use social media to increase their identity and popularity, while consumers with strong levels of personal identity use social media for self-expression. Consumers with high intimacy levels use social media for socian connection and social investigation.

The impact on clinical practice of a postgraduate clinical pharmacy programme, incorporating competency-based performance evaluation

Background A goal of the postgraduate clinical pharmacy programme (PGCPP) at the University of Queensland is to enhance clinical practice. Aims To evaluate student perceptions of the impact of the PGCPP on practice and the inclusion of a competency-based performance evaluation as a formative component of the curriculum. Method In 2010, students completed a questionnaire to evaluate the impact of the PGCPP. In 2011, formative competency-based performance evaluations were conducted as a component of the course and the questionnaire was repeated. Responses, competency ratings and evaluation feedback were collated. Data were analysed using descriptive statistics. Results 51/57 (89%) of students completed the questionnaire in 2010 and 2011. Over 90% of students agreed or strongly agreed that the PGCPP enhanced practice, knowledge, confidence and contribution to patient care. Responses were similarly positive after the inclusion of the performance evaluation. Conclusion This study demonstrated that the PGCPP is achieving the goal of enhancing the practice of pharmacists.

Biocompatibility, SiH lenses and the impact of hydration on comfort

Silicone hydrogel (SiH) contact lenses have been available for over a decade. During that time, these highly innovative materials and designs have continually improved and now represent a major percentage of fits within the global contact lens market.1 Their high oxygen transmissibility has drastically reduced the incidence of hypoxia-related conditions such as corneal edema, limbal hyperaemia, and corneal vascularisation.2,3 However, there remain significant challenges in the quest for the ideal contact lens. The silicone material used in SiH contact lenses is inherently more hydrophobic than the non-silicone hydrogel materials. SiH lens manufacturers must find ways to overcome lens surface hydrophobicity since it can create issues in terms of lens wettability and surface deposition. Achieving ideal lens water content presents yet another challenge since increasing water content in a silicone hydrogel lens can reduce oxygen transmissibility. This is because increasing water content results in decreased silicone content in the lens and silicone is a better transmitter of oxygen than water.

Prognostic impact of vascular and lymphovascular invasion in early lung cancer

Background The prognostic significance of vascular and lymphatic invasion in non-small-cell lung cancer is under continuous debate. We analyzed the effect of tumor aggressiveness (lymphatic and/or vessel invasion) on survival and relapse in stage I and II non-small-cell lung cancer. Methods We retrospectively analyzed prospectively collected data of 457 patients with stage I and II non-small-cell lung cancer from 1998 to 2008. Specimens were analyzed for intratumoral vascular invasion and lymphovascular space invasion. Overall survival and disease-free survival were estimated using the Kaplan-Meier method, and differences were determined by the logrank test. Cox regression analysis was performed to identify independent risk factors. Results: The incidence of intratumoral vascular invasion was 23.4%, and this correlated significantly with grade of differentiation, visceral pleural involvement, lymphovascular space invasion, and N status. The incidence of lymphovascular space invasion was 5.5%, and this correlated significantly with grade of differentiation, lymph nodes involved, and intratumoral vascular invasion. On multivariate analyses, intratumoral vascular invasion proved to be an significant independent risk factor for overall survival but not for disease-free survival. Lymphovascular space invasion was associated significantly with early tumor recurrence but not with overall survival. Conclusions: Vascular and lymphatic invasion can serve as independent prognostic factors in completely resected nonsmall- cell lung cancer. Intratumoral vascular invasion and lymphovascular space invasion in early stage non-small-cell lung cancer are important factors in overall survival and early tumor recurrence. Further large scale studies with more recent patient cohorts and refined histological techniques are warranted.

The impact of social media features on print media firms’ online business models

Many newspapers and magazines have added “social media features” to their web-based information services in order to allow users to participate in the production of content. This study examines the specific impact of the firm’s investment in social media features on their online business models. We make a comparative case study of four Scandinavian print media firms that have added social media features to their online services. We show how social media features lead to online business model innovation, particularly linked to the firms’ value propositions. The paper discusses the repercussions of this transformation on firms’ relationship with consumers and with traditional content contributors. The modified value proposition also requires firms to acquire new competences in order to reap full benefit of their social media investments. We show that the firms have been unable to do so since they have not allowed the social media features to affect their online revenue models.

The importance of importance : its impact on decision-making in mall retail categories during an economic downturn

The study examines how, during an economic downturn, the perceived importance of the value offering of retail store categories, as identified by a major international mall operator based in Australia, influences the relationship between consumers’ shopping attitudes and likelihood of purchasing in those categories. The findings show variance in the importance pertaining to retail store categories between those that have and those that have not altered their shopping behaviour. Different mediating effects were found in the major, mini-major, leisure, apparel, and mobile phone categories, suggestive of each group having differing levels of self-interest in the value offerings of each category, thus, symptomatic of dissimilar decision-making strategies for each group. Contributions to theory and practice are discussed.

Cultural forces in journalism : the impact of cultural values on Māori journalists’ professional views

Social system-level analyses of journalism have tended to focus on political and economic influences, at the expense of other factors, such as the role that culture and cultural values play in shaping journalists' professional views and practices. This paper identifies cultural values as a particularly fruitful area for providing a more nuanced analysis of journalism culture. It examines this issue in the context of in-depth interviews with 20 M?ori journalists from Aotearoa New Zealand. The study finds that Indigenous journalism in that country is strongly influenced by M?ori cultural values, such as showing respect to others, following cultural protocols, and making use of culturally-specific language. Cultural limitations are also identified in the form of the social structures of M?ori society, and journalists' strategies in working around these are discussed. The paper highlights the implications a renewed focus on cultural values can have for the study of journalism culture more broadly.

Arts practice and disconnected youth in Australia : impact and domains of change

Background: This paper describes research conducted with Big hART, Australia's most awarded participatory arts company. It considers three projects, LUCKY, GOLD and NGAPARTJI NGAPARTJI across separate sites in Tasmania, Western NSW and Northern Territory, respectively, in order to understand project impact from the perspective of project participants, Arts workers, community members and funders. Methods: Semi-structured interviews were conducted with 29 respondents. The data were coded thematically and analysed using the constant comparative method of qualitative data analysis. Results: Seven broad domains of change were identified: psychosocial health; community; agency and behavioural change; the Art; economic effect; learning and identity. Conclusions: Experiences of participatory arts are interrelated in an ecology of practice that is iterative, relational, developmental, temporal and contextually bound. This means that questions of impact are contingent, and there is no one path that participants travel or single measure that can adequately capture the richness and diversity of experience. Consequently, it is the productive tensions between the domains of change that are important and the way they are animated through Arts practice that provides sign posts towards the impact of Big hART projects.

Moulding them in the industry's image : journalism education's impact on students' professional views

Long-running debates over the value of university-based journalism education have suffered from a lack of empirical foundation, leading to a wide range of assertions both from those who see journalism education playing a crucial role in moulding future journalists and those who do not. Based on a survey of 320 Australian journalism students from six universities across the country, this study provides an account of the professional views these future journalists hold. Findings show that students hold broadly similar priorities in their role perceptions, albeit to different intensities from working journalists. The results point to a relationship between journalism education and the way in which students' views of journalism's watchdog role and its market orientation change over the course of their degree – to the extent that, once they are near completion of their degree, students have been moulded in the image of industry professionals.

Projecting the impact of climate change on the transmission of Ross River virus : methodological challenges and research needs

Ross River virus (RRV) is the most common vector-borne disease in Australia. It is vitally important to make appropriate projections on the future spread of RRV under various climate change scenarios because such information is essential for policy-makers to identify vulnerable communities and to better manage RRV epidemics. However, there are many methodological challenges in projecting the impact of climate change on the transmission of RRV disease. This study critically examined the methodological issues and proposed possible solutions. A literature search was conducted between January and October 2012, using the electronic databases Medline, Web of Science and PubMed. Nineteen relevant papers were identified. These studies demonstrate that key challenges for projecting future climate change on RRV disease include: (1) a complex ecology (e.g. many mosquito vectors, immunity, heterogeneous in both time and space); (2) unclear interactions between social and environmental factors; and (3) uncertainty in climate change modelling and socioeconomic development scenarios. Future risk assessments of climate change will ultimately need to better understand the ecology of RRV disease and to integrate climate change scenarios with local socioeconomic and environmental factors, in order to develop effective adaptation strategies to prevent or reduce RRV transmission.

The impact of heat waves on children's health : a systematic review

Young children are thought to be particularly sensitive to heatwaves, but relatively less research attention has been paid to this field to date. A systematic review was conducted to elucidate the relationship between heat waves and children’s health. Literature published up to August 2012 were identified using the following MeSH terms and keywords: “heatwave”, “heat wave”, “child health”, “morbidity”, “hospital admission”, “emergency department visit”, “family practice”, “primary health care”, “death” and “mortality”. Of the 628 publications identified, 12 met the selection criteria. The existing literature does not consistently suggest that mortality among children increases significantly during heat waves, even though infants were associated with more heat-related deaths. Exposure to heat waves in the perinatal period may pose a threat to children’s health. Pediatric diseases or conditions associated with heat waves include renal disease, respiratory disease, electrolyte imbalance and fever. Future research should focus on how to develop a consistent definition of a heat wave from a children’s health perspective, identifying the best measure of children’s exposure to heat waves, exploring sensitive outcome measures to quantify the impact of heat waves on children, evaluating the possible impacts of heat waves on children’s birth outcomes, and understanding the differences in vulnerability to heat waves among children of different ages and from different income countries. Projection of the children’s disease burden caused by heat waves under climate change scenarios, and development of effective heat wave mitigation and adaptation strategies that incorporate other child protective health measures, are also strongly recommended.

Violence in and around entertainment districts : a longitudinal analysis of the impact of late-night lockout legislation

Violence in entertainment districts is a major problem across urban landscapes throughout the world. Research shows that licensed premises are the third most common location for homicides and serious assaults, accounting for one in ten fatal and nonfatal assaults. One class of interventions that aims to reduce violence in entertainment districts involves the use of civil remedies: a group of strategies that use civil or regulatory measures as legal “levers” to reduce problem behavior. One specific civil remedy used to reduce problematic behavior in entertainment districts involves manipulation of licensed premise trading hours. This article uses generalized linear models to analyze the impact of lockout legislation on recorded violent offences in two entertainment districts in the Australian state of Queensland. Our research shows that 3 a.m. lockout legislation led to a direct and significant reduction in the number of violent incidents inside licensed premises. Indeed, the lockouts cut the level of violent crime inside licensed premises by half. Despite these impressive results for the control of violence inside licensed premises, we found no evidence that the lockout had any impact on violence on streets and footpaths outside licensed premises that were the site for more than 80 percent of entertainment district violence. Overall, however, our analysis suggests that lockouts are an important mechanism that helps to control the level of violence inside licensed premises but that finely grained contextual responses to alcohol-related problems are needed rather than one-size-fits-all solutions.