The letter contrast sensitivity test : clinical evaluation of a new design

PURPOSE. To compare the reliability, validity, and responsiveness of the Mars Letter Contrast Sensitivity (CS) Test to the Pelli-Robson CS Chart.

METHODS. One eye of 47 normal control subjects, 27 patients with open-angle glaucoma, and 17 with age-related macular degeneration (AMD) was tested twice with the Mars test and twice with the Pelli-Robson test, in random order on separate days. In addition, 17 patients undergoing cataract surgery were tested, once before and once after surgery.

RESULTS. The mean Mars CS was 1.62 log CS (0.06 SD) for normal subjects aged 22 to 77 years, with significantly lower values in patients with glaucoma or AMD (P < 0.001). Mars test-retest 95% limits of agreement (LOA) were ±0.13, ±0.19, and ±0.24 log CS for normal, glaucoma, and AMD, respectively. In comparison, Pelli-Robson test-retest 95% LOA were ±0.18, ±0.19, and ±0.33 log CS. The Spearman correlation between the Mars and Pelli-Robson tests was 0.83 (P < 0.001). However, systematic differences were observed, particularly at the upper-normal end of the range, where Mars CS was lower than Pelli-Robson CS. After cataract surgery, Mars and Pelli-Robson effect size statistics were 0.92 and 0.88, respectively.

CONCLUSIONS. The results indicate the Mars test has test-retest reliability equal to or better than the Pelli-Robson test and comparable responsiveness. The strong correlation between the tests provides evidence the Mars test is valid. However, systematic differences indicate normative values are likely to be different for each test. The Mars Letter CS Test is a useful and practical alternative to the Pelli-Robson CS Chart.

Underlying neurobiology and clinical correlates of mania status after subthalamic nucleus deep brain stimulation in Parkinson's Disease : a review of the literature

Deep brain stimulation (DBS) is a novel and effective surgical intervention for refractory Parkinson's disease (PD). The authors review the current literature to identify the clinical correlates associated with subthalamic nucleus (STN) DBS-induced hypomania/mania in PD patients. Ventromedial electrode placement has been most consistently implicated in the induction of STN DBS-induced mania. There is some evidence of symptom amelioration when electrode placement is switched to a more dorsolateral contact. Additional clinical correlates may include unipolar stimulation, higher voltage (>3 V), male sex, and/or early-onset PD. STN DBS-induced psychiatric adverse events emphasize the need for comprehensive psychiatric presurgical evaluation and follow-up in PD patients. Animal studies and prospective clinical research, combined with advanced neuroimaging techniques, are needed to identify clinical correlates and underlying neurobiological mechanisms of STN DBS-induced mania. Such working models would serve to further our understanding of the neurobiological underpinnings of mania and contribute valuable new insight toward development of future DBS mood-stabilization therapies.

Evaluation of the giant reed (Arundo donax) in horizontal subsurface flow wetlands for the treatment of dairy processing factory wastewater

Two emergent macrophytes, Arundo donax and Phragmites australis, were established in experimental horizontal subsurface flow (HSSF), gravel-based constructed wetlands (CWs) and challenged by treated dairy processing factory wastewater with a median electrical conductivity of 8.9 mS cm−1. The hydraulic loading rate was tested at 3.75 cm day−1. In general, the plants grew well during the 7-month study period, with no obvious signs of salt stress. The major water quality parameters monitored (biological oxygen demand (BOD), suspended solids (SS) and total nitrogen (TN) but not total phosphorus) were generally improved after the effluent had passed through the CWs. There was no significance different in removal efficiencies between the planted beds and unplanted gravel beds (p > 0.007), nor was there any significant difference in removal efficiencies between the A. donax and P. australis beds for most parameters. BOD, SS and TN removal in the A. donax and P. australis CWs was 69, 95 and 26 % and 62, 97 and 26 %, respectively. Bacterial removal was observed but only to levels that would allow reuse of the effluent for use on non-food crops under Victorian state regulations. As expected, the A. donax CWs produced considerably more biomass (37 ± 7.2 kg wet weight) than the P. australis CWs (11 ± 1.4 kg wet weight). This standing crop equates to approximately 179 and 68 tonnes ha−1 year−1 biomass (dry weight) for A. donax and P. australis, respectively (assuming a 250-day growing season and single-cut harvest). The performance similarity of the A. donax and P. australis planted CWs indicates that either may be used in HSSF wetlands treating dairy factory wastewater, although the planting of A. donax provides additional opportunities for secondary income streams through utilisation of the biomass produced.

Assessment of proximal outcomes of self-management programs : translation and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQtm)

Purpose This paper describes the translation, cultural adaption, and psychometric evaluation of a German version of the Health Education Impact Questionnaire (heiQ™), a widely used generic instrument assessing a wide range of proximal outcomes of self-management programs.

Methods The translation was carried out according to international standards and included forward and backward translations. Comprehensibility and content validity were tested using cognitive interviews with 10 rehabilitation inpatients. Psychometric properties were examined in rehabilitation inpatients (n = 1,202) with a range of chronic conditions. Factorial validity was assessed using confirmatory factor analysis; concurrent validity was explored by correlations with comparator scales.

Results The items of the German heiQ™ were well understood by rehabilitation inpatients. The structure of the eight heiQ™ scales was replicated after minor adjustment. heiQ™ scales had higher correlations with comparator scales with similar constructs, particularly mental health concepts than with physical health. Moreover, all heiQ™ scales differentiated between individuals across different levels of depression.

Conclusion The German heiQ™ is comprehensible for German-speaking patients suffering from different types of chronic conditions; it assesses relevant outcomes of self-management programs in a reliable and valid manner. Further studies involving its practical application are warranted.

Prospective evaluation of respiratory exacerbations in children with cystic fibrosis from newborn screening to 5 years of age

Background Newborn screening allows novel treatments for cystic fibrosis (CF) to be trialled in early childhood before irreversible lung injury occurs. As respiratory exacerbations are a potential trial outcome variable, we determined their rate, duration and clinical features in preschool children with CF; and whether they were associated with growth, lung structure and function at age 5 years. Methods: Respiratory exacerbations were recorded prospectively in Australasian CF Bronchoalveolar Lavage trial subjects from enrolment after newborn screening to age 5 years, when all participants underwent clinical assessment, chest CT scans and spirometry. Results 168 children (88 boys) experienced 2080 exacerbations, at an average rate of 3.66 exacerbations per person-year; 80.1% were community managed and 19.9% required hospital admission. There was an average increase in exacerbation rate of 9% (95% CI 4% to 14%; p<0.001) per year of age. Exacerbation rate differed by site (p<0.001) and was 26% lower (95% CI 12% to 38%) in children receiving 12 months of prophylactic antibiotics. The rate of exacerbations in the first 2 years was associated with reduced forced expiratory volume in 1 s z scores. Ever having a hospitalmanaged exacerbation was associated with bronchiectasis (OR 2.67, 95% CI 1.13 to 6.31) in chest CT scans, and lower weight z scores at 5 years of age (coefficient -0.39, 95% CI -0.74 to -0.05). Conclusions Respiratory exacerbations in young children are markers for progressive CF lung disease and are potential trial outcome measures for novel treatments in this age group.

Evaluation of management scenarios for controlling eutrophication in a shallow tropical urban lake

Urban lakes are typically smaller, shallower, and more exposed to human activities than natural lakes. Although the effects of harmful algal blooms (HABs) associated with eutrophication in urban lakes has become a growing concern for water resources management and environmental protection, studies focussing on this topic in relation to urban lakes are rare and knowledge of the ecological dynamics and effective management strategies for controlling eutrophication in urban lakes is lacking. This study applied an integrated three-dimensional hydrodynamics-ecological model for a small shallow tropical urban lake in Singapore and evaluated various management scenarios to control eutrophication in the lake. It is found that in-lake treatment techniques including artificial destratification, sediment manipulation and algaecide addition are either ineffective or possess environmental concerns; while watershed management strategies including hydraulic flushing and inflow nutrients reduction are more effective and have posed less environmental concerns. In this study, inflow phosphorus reduction was found to be the best strategy after evaluating the advantages and drawbacks of the management strategies studied. Runoff from the watershed exerts significant influence on urban lakes and thus an integrated water resources management at the watershed level is critical for the control of eutrophication

Recombinant human growth hormone for the treatment of growth disorders in children: a systematic review and economic evaluation

Recombinant human growth hormone (rhGH) is licensed for short stature associated with growth hormone deficiency (GHD), Turner syndrome (TS), Prader-Willi syndrome (PWS), chronic renal insufficiency (CRI), short stature homeobox-containing gene deficiency (SHOX-D) and being born small for gestational age (SGA). To assess the clinical effectiveness and cost-effectiveness of rhGH compared with treatment strategies without rhGH for children with GHD, TS, PWS, CRI, SHOX-D and those born SGA. The systematic review used a priori methods. Key databases were searched (e.g. MEDLINE, EMBASE, NHS Economic Evaluation Database and eight others) for relevant studies from their inception to June 2009. A decision-analytical model was developed to determine cost-effectiveness in the UK. Two reviewers assessed titles and abstracts of studies identified by the search strategy, obtained the full text of relevant papers, and screened them against inclusion criteria. Data from included studies were extracted by one reviewer and checked by a second. Quality of included studies was assessed using standard criteria, applied by one reviewer and checked by a second. Clinical effectiveness studies were synthesised through a narrative review. Twenty-eight randomised controlled trials (RCTs) in 34 publications were included in the systematic review. GHD: Children in the rhGH group grew 2.7 cm/year faster than untreated children and had a statistically significantly higher height standard deviation score (HtSDS) after 1 year: -2.3 ± 0.45 versus -2.8 ± 0.45. TS: In one study, treated girls grew 9.3 cm more than untreated girls. In a study of younger children, the difference was 7.6 cm after 2 years. HtSDS values were statistically significantly higher in treated girls. PWS: Infants receiving rhGH for 1 year grew significantly taller (6.2 cm more) than those untreated. Two studies reported a statistically significant difference in HtSDS in favour of rhGH. CRI: rhGH-treated children in a 1-year study grew an average of 3.6 cm more than untreated children. HtSDS was statistically significantly higher in treated children in two studies. SGA: Criteria were amended to include children of 3+ years with no catch-up growth, with no reference to mid-parental height. Only one of the RCTs used the licensed dose; the others used higher doses. Adult height (AH) was approximately 4 cm higher in rhGH-treated patients in the one study to report this outcome, and AH-gain SDS was also statistically significantly higher in this group. Mean HtSDS was higher in treated than untreated patients in four other studies (significant in two). SHOX-D: After 2 years' treatment, children were approximately 6 cm taller than the control group and HtSDS was statistically significantly higher in treated children. The incremental cost per quality adjusted life-year (QALY) estimates of rhGH compared with no treatment were: 23,196 pounds for GHD, 39,460 pounds for TS, 135,311 pounds for PWS, 39,273 pounds for CRI, 33,079 pounds for SGA and 40,531 pounds for SHOX-D. The probability of treatment of each of the conditions being cost-effective at 30,000 pounds was: 95% for GHD, 19% for TS, 1% for PWS, 16% for CRI, 38% for SGA and 15% for SHOX-D.

The clinical effectiveness and cost-effectiveness of bariatric (weight loss) surgery for obesity: a systematic review and economic evaluation

To assess the clinical effectiveness and cost-effectiveness of bariatric surgery for obesity. Seventeen electronic databases were searched [MEDLINE; EMBASE; PreMedline In-Process & Other Non-Indexed Citations; The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, DARE, NHS EED and HTA databases; Web of Knowledge Science Citation Index (SCI); Web of Knowledge ISI Proceedings; PsycInfo; CRD databases; BIOSIS; and databases listing ongoing clinical trials] from inception to August 2008. Bibliographies of related papers were assessed and experts were contacted to identify additional published and unpublished references. Two reviewers independently screened titles and abstracts for eligibility. Inclusion criteria were applied to the full text using a standard form. Interventions investigated were open and laparoscopic bariatric surgical procedures in widespread current use compared with one another and with non-surgical interventions. Population comprised adult patients with body mass index (BMI) > or = 30 and young obese people. Main outcomes were at least one of the following after at least 12 months follow-up: measures of weight change; quality of life (QoL); perioperative and postoperative mortality and morbidity; change in obesity-related comorbidities; cost-effectiveness. Studies eligible for inclusion in the systematic review for comparisons of Surgery versus Surgery were RCTs. For comparisons of Surgery versus Non-surgical procedures eligible studies were RCTs, controlled clinical trials and prospective cohort studies (with a control cohort). Studies eligible for inclusion in the systematic review of cost-effectiveness were full cost-effectiveness analyses, cost-utility analyses, cost-benefit analyses and cost-consequence analyses. One reviewer performed data extraction, which was checked by two reviewers independently. Two reviewers independently applied quality assessment criteria and differences in opinion were resolved at each stage. Studies were synthesised through a narrative review with full tabulation of the results of all included studies. In the economic model the analysis was developed for three patient populations, those with BMI > or = 40; BMI > or = 30 and < 40 with Type 2 diabetes at baseline; and BMI > or = 30 and < 35. Models were applied with assumptions on costs and comorbidity.

Critical evaluation of a program to foster reflexive antiracism

This paper documents the evaluation of a three-day program entitled “Race, Culture, Indigeneity and the Politics of Disadvantage,” which was delivered in 2010 in Melbourne, Australia with the aim of promoting Reflexive Antiracism (RA), a novel diversity training approach. To assess the impact of the program on its participants, the Reflexive Antiracism Scale- Indigenous (RAS-I) was devised and administered before and after the program both to participants and a matched control group. The program increased Reflexive Antiracism among participants through an enhanced understanding of whiteness, racialisation and White Racial Identity. Future studies are required to advance both the concept of Reflexive Antiracism and its measurement.

Process evaluation design and tools used in a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The ToyBox-study

Process evaluation (PE) is used for the in-depth evaluation of the implementation process of health promotion programmes. The aim of the current paper was to present the PE design and tools used in the ToyBox-intervention. The PE design was based on a three-step approach, including the identification of ToyBox-specific PE elements (step 1), the development of PE tools and harmonization of procedures (step 2), and the implementation of PE using standardized protocol and tools across the intervention countries (step 3). Specifically, to evaluate the implementation of the intervention, teachers' monthly logbooks were recorded (dose delivered, fidelity, dose received); post-intervention questionnaires were completed by parents/caregivers and teachers (dose received); participation and attrition rates were recorded (recruitment, reach); and audit questionnaires and retrospective information on weather conditions were collected (physical and social environment within which the intervention was implemented). Regarding the teachers' training sessions, the researchers who performed the trainings completed evaluation forms and documented teachers' attendance after each training (dose delivered, fidelity, dose received) and teachers completed evaluation forms after each training (dose received). The PE performed in the ToyBox-intervention may contribute in the evaluation of its effectiveness, guide the revision of the intervention material and provide insights for future health promotion programmes and public health policy.

Process evaluation of an integrated health promotion/occupational health model in WellWorks-2

Disparities in chronic disease risk by occupation call for newapproaches to health promotion. Well Works-2 was a randomized, controlled study comparing the effectiveness of a health promotion/occupational health program (HP/OHS) with a standard intervention (HP). Interventions in both studies were based on the same theoretical foundations. Results from process evaluation revealed that a similar number of activities were offered in both conditions and that in the HP/OHS condition there were higher levels of worker participation using three measures: mean participation per activity (HP: 14.2% vs. HP/OHS: 21.2%), mean minutes of worker exposure to the intervention/site (HP: 14.9 vs. HP/OHS: 33.3), and overall mean participation per site (HP: 34.4% vs. HP/ OHS: 45.8%). There were a greater number of contacts with management (HP: 8.8 vs. HP/OHS: 24.9) in the HP/ OHS condition. Addressing occupational health may have contributed to higher levels of worker and management participation and smoking cessation among blue-collar workers.

Evaluation of Victoria Police SOCIT-MDC reforms for sexual assault investigation

 This thesis evaluated the impact of sexual offence reforms implemented by Victoria Police. The findings of this thesis demonstrated that the reforms reduced victim-blaming attitudes of police, improved investigators’ understanding of sexual offending, increased perceptions of case authorisation, and demonstrated faster police investigation times after the reform.

Evaluation of bread crumbs as a potential carbon source for the growth of Thraustochytrid species for oil and omega-3 production

The utilization of food waste by microorganisms to produce omega-3 fatty acids or biofuel is a potentially low cost method with positive environmental benefits. In the present study, the marine microorganisms Thraustochytrium sp. AH-2 and Schizochytrium sp. SR21 were used to evaluate the potential of breadcrumbs as an alternate carbon source for the production of lipids under static fermentation conditions. For the Thraustochytrium sp. AH-2, submerged liquid fermentation with 3% glucose produced 4.3 g/L of biomass and 44.16 mg/g of saturated fatty acids after seven days. Static fermentation with 0.5% and 1% breadcrumbs resulted in 2.5 and 4.7 g/L of biomass, and 42.4 and 33.6 mg/g of saturated fatty acids, respectively. Scanning electron microscopic (SEM) studies confirmed the growth of both strains on breadcrumbs. Attenuated total reflection Fourier transform infrared (ATR-FTIR) spectroscopy for both strains were consistent with the utilization of breadcrumbs for the production of unsaturated lipids, albeit at relatively low levels. The total lipid yield for static fermentation with bread crumbs was marginally lower than that of fermentation with glucose media, while the yield of unsaturated fatty acids was considerably lower, indicating that static fermentation may be more appropriate for the production of biodiesel than for the production of omega-3 rich oils in these strains.

A qualitative evaluation of an intervention for parents of adolescents with mental disorders: the parenting challenging adolescents seminar

This qualitative study describes parents’ responses to a targeted and brief educational seminar (known as ‘Parenting Challenging Adolescents’), and provides recommendations for brief parenting interventions designed to engage adolescents in mental health treatment. The 2-h intervention was designed to assist parents who were concerned about their adolescents and in the identification of mental disorders. Participants were invited to attend the seminars conducted in a community setting on the basis of local advertising and promotion of the event with community health services and schools. Any parent of a young person aged 12–25 interested in the seminar material was eligible to attend. Sixteen parents completed measures of parent and youth mental health and family satisfaction and were also interviewed using semi-structured telephone interviews 4 weeks after the seminar. Interpretational phenomenological analysis of interviews suggested that most parents valued the chance to connect with others in similar situations and appreciated knowing about local services available for mental health disorders. Many parents also reported positive changes to communication and family dynamics following the seminar. Another common theme was an increased knowledge of mental disorders and appropriate treatments, along with the desire to receive more specific, targeted information. Overall the findings suggest that even a single session of educational material designed for parents may be useful, engaging and potentially encourage improved service usage for adolescents with mental disorders.

Knowledge-based automatic performance evaluation for medical training debriefing

 Manikin-based medical simulation has been shown to benefit the knowledge, skills and attitudes of the learner, and to impart favourable patient effects. A vital component of any training simulation is the after-session discussion with trainees to debrief their performance. In this study we develop a rule-based debriefing tool for improving the efficacy of medical training sessions. Unlike most existing de-briefing tools, the tool presented here has been designed to reduce medical trainer assessment time and to improve evaluation accuracy through a largely automated evaluation of trainee performance. The developed tool is acknowledged by the School of Medicine of Deakin University as an important advancement in assisting medical trainers carry out the debriefing process effectively and efficiently.