Novel and effective treatment modality for medically unexplained symptoms

Medically unexplained symptoms (MUS) confound physicians, and the incidence and prevalence of these conditions is poorly documented.  This is not least due to the complex nature of MUS and mimicry of morbidity with conditions that have common clinical assessment and treatment modalities, e.g. migraine headaches which stress headaches commonly are misdiagnosed as.  Effective treatment modalities for MUS have been more or less non-existent.  In the following we present a modality for the assessment, diagnosis and treatment of MUS that in our experience leads to cure, at least in better than half of these cases measured in terms of allowing the individual back to work.  These results are at least twice as high as those described hitherto (see below), and yet, our treatment modality is beset with many obstacles, not the least of which is the intrasigence of a system that will not and/or can not understand why this modality is so much better than what they are able to offer.  The most importance obstacle is financing, as this modality requires long term and committed financing to work.  The economic implications of not dealing with these issues are described.

Early symptomatic presbyopes - what correction modality works best?

Purpose: To compare the performance of a low-addition silicone hydrogel multifocal soft lens with other soft lens correction options in a group of habitual soft lens wearers of distance correction who are symptomatic of early presbyopia.

Method: This clinical study was designed as a prospective, double-masked, randomized, crossover, dispensing trial consisting of four 1-week phases, one for each of the correction modalities: a low-addition silicone hydrogel multifocal soft lens, monovision, habitual correction, and optimized distance visual correction. The prescriptions of all modalities were finalized at a single fitting visit, and the lenses were worn according to a randomized schedule. All lenses were made from lotrafilcon B material. A series of objective vision tests were conducted: high- and low-contrast LogMAR under high- and low-room lighting conditions, stereopsis, and critical print size. A number of other data collection methods used were novel: some data were collected under controlled laboratory-based conditions and others under real-world conditions, some of which were completed on a BlackBerry hand-held communication device.

Results: All participants were able to be fit with all four correction modalities. Objective vision tests showed no statistical difference between the lens modalities except in the case of low-contrast near LogMAR acuity under low-lighting levels where monovision (+0.29 ± 0.10) performed better than the multifocal (+0.33 ± 0.11, P=0.027) and the habitual (+0.37 ± 0.12, P<0.001) modalities. Subjective ratings indicated a statistically better performance provided by the multifocal correction compared with monovision, particularly for the vision associated with driving tasks such as driving during the daytime (93.3 ± 8.8 vs. 84.2 ± 23.7, P=0.05), at nighttime (88.8 ± 11.7 vs. 74.9 ± 23.6, P=0.001), any associated haloes or glare (92.0 ± 10.6 vs. 78.0 ± 22.8, P=0.003), and observing road signs (90.1 ± 11.8 vs. 79.4 ± 20.2, P=0.027). Preference for the multifocal compared with monovision was also reported when watching television (95.0 ± 6.4 vs. 82.6 ± 20.1, P=0.001) and when changing focus from distance to near (87.0 ± 13.4 vs. 66.1 ± 32.2, P<0.001).

Conclusions: For this group of early presbyopes, the AIR OPTIX AQUA MULTIFOCAL-Low Add provided a successful option for visual correction, which was supported by the results of subjective ratings, many of which were made during or immediately after performing such activities as reading, using a computer, watching television, and driving. These results suggest that making a prediction of success or not based on consulting room acuity tests alone is probably unwise.

The influence of demographic, behavioural and treatments characteristics on problem gambling counselling outcomes

The paper considers the influence of client characteristics and gambling behaviour as well as treatment modality on the resolution of gambling behaviour for 591 clients who sought help from the publicly funded BreakEven counselling services in the state of Victoria between 1 July 1996 and 30 June 1997. Statistical data about clients and their consultations was collected in the form of a Minimum Data Set. On their own, client demographics accounting for 12% of the variance were identified as discriminating between problem gamblers who achieved some resolution of their gambling behaviour and those whose behaviour did not change. Variables associated with gambling behaviour accounted for 10% of variance and treatment variables for 12% of variance in treatment outcomes. Collectively, the three types of data could explain 26% of the variance in problem resolution. Importantly, these findings demonstrate that the resolution of problematic gambling behaviour is affected by a complex interplay of client characteristics, their gambling behaviour and the treatment they receive. It is argued that the evaluation of treatment programs for problem gambling, and potentially all counselling programs in the primary health arena, needs to include measures from each of these domains.

Additive effect of interferential therapyover pelvic floor exercise alone in the treatment of female urinary stress and urge incontinence: A randomized controlled trial

This pilot study attempted to examine the additional efficacy of interferential therapy in reducing the symptoms of urinary stress and urge incontinence. Twenty-four subjects were randomly allocated to the experimental group, which received interferential therapy plus pelvic floor exercises, or the control group, which received pelvic floor exercises only. Treatment was given three times a week for 4 weeks. Subjects were given urinary diaries to record urinary symptoms (including frequency of passing urine and number of times woken by desire to pass urine) for 5 days prior to and after treatment. Perineometer readings, pad weighing test and start/stop test were also performed in a physiotherapy clinic before and at completion of treatment regimes. Significant improvements were observed in all the outcome variables in the experimental group, but in only the perineometer readings in controls. When the changes from pre- to post-treatment were compared between the two groups, four of the dependent variables did not reach statistical significance. Power analysis indicated that the sample size for each group needed to be 70 for all results to be statistically significant. This study shows that interferential therapy plus pelvic floor exercise appears to be a more effective treatment modality than pelvic floor muscle strengthening exercise alone for incontinence, but a larger trial with longer followup is needed before definitive conclusions can be reached.

Students perceptions of learning outcomes from group-based, problem-based teaching and learning activities

Objective: A study aimed at exploring the variation in perceptions of learning outcomes reported by undergraduate nursing students enrolled in a problem-based learning subject in a pre-registration Bachelor of Nursing course (BN).
Method: Students were asked to respond to four open-ended questions which focussed on their learning outcomes in the different teaching/learning modalities of the subject. Data were analysed in two phases using a modified phenomenographic analysis. In the first phase a set of categories of description were developed from the student responses to questions related to the learning modalities. In the second phase the individual responses were classified in terms of the categories. Finally, correlations between the learning modalities were identified. In this paper the approach to analysis, the process of category identification and the correlations between the learning modalities will be described and the implications for further research and teaching will be discussed.
Results: The findings indicated that there were two distinct groups of student responses. Inward focussed students who described outcomes in terms of their own learning and students whose focus was outward i.e. describing learning in terms of patient care and how learning relates to that care. Another important result shows the relationship between the learning modalities and outcomes. From the students' perspective, the most sophisticated outcomes of the lectures and laboratories were ideas and skills to be used and applied in clinical settings. Whereas, the group-based activities in which clinical problems were presented to the students in the form of Situation Improvement Packages (SIPS) focussed their attention on the clinical setting which constituted a preparation for the realities of clinical practice.
Conclusion: The findings from this study indicate that students perceive their learning in the group based teaching/learning modality (SIPS) as effective in focussing them on the reality of their role in the clinical practice environment while lectures and laboratories provided the skills and knowledge required for this setting.

A study of face-to-face and online teaching philosophies in Canada and Australia

The perspectives of instructors who teach both online and face-to-face in a higher education context have been compared in this study. The differences and similarities between their approaches, and the influences each modality has on the other have been explored, as well as possible differences in organizational cultures between the groups who were based in Canada and Australia. The trend to blended learning in higher education was an important outcome of the study.

Fuzzy haptic augmentation for telerobotic stair climbing

Teleoperated robotic systems provide a valuable solution for the exploration of hazardous environments. The ability to explore dangerous environments from the safety of a remote location represents an important progression towards the preservation of human safety in the inevitable response to such a threat. While the benefits of removing physical human presence are clear, challenges associated with remote operation of a robotic system need to be addressed. Removing direct human presence from the robot's operating environment introduces telepresence as an important consideration in achieving the desired objective. The introduction of the haptic modality represents one approach towards improving operator performance subject to reduced telepresence. When operating in an urban environment, teleoperative stair climbing is not an uncommon scenario. This work investigates the operation of an articulated track mobile robot designed for ascending stairs under teleoperative control. In order to assist the teleoperator in improved navigational capabilities, a fuzzy expert system is utilised to provide the teleoperator with intelligent haptic augmentation with the aim of improving task performance.

"Where myth becomes history" : the politics of mythical time in Heiner Muller's Medea

Heiner Müller in the 1980s produced a sequence of plays featuring Euripides’ heroine Medea using his distinctive, poetic modality of “the theatre of images”. These ostensibly postmodern narratives take the form of disjointed, visual and textual representations that are also fragmentations of historical and mythical times and spaces. Müller’s Medea plays are thus suggestive of the intersection between the discourses of history and myth — and the blending of historical time with ahistorical, supposedly “timeless” mythical narratives. Further, the postmodern possibility of history’s textuality to liquidate it into a type of (modern) mythology seeks expression in the plays’ representation of a converse equation: the moment signaled in the text as that “where myth becomes history”. This paper examines the problematisation of the myth-history dichotomy in Müller’s Medea plays, outlining the ways in which the “timeless” myth of the classical, infanticidal figure of Medea is strategically deployed to politicise evolutionist teleology, Western colonialism and the technologies of war in twentieth century Europe.

An electromyographic comparison of neck conditioning exercises in healthy controls

The purpose of this study was to compare surface electromyography (EMG) activation levels of selected neck muscles for two common neck-training modalities (Thera-Band and Cybex). Seventeen asymptomatic subjects (eight men and nine women) with a mean age 23.4 years were recruited. EMG activation normalized to maximal voluntary isometric contraction (MVIC) was measured with subjects performing exercises with green, blue, and black Thera-Bands and 50%, 70%, and 90% of 3RM for the Cybex modality. Four variables were used to depict exercise intensity: average and peak EMG activation in the concentric and eccentric phases. Significant differences (P <= 0.05) in EMG activation were evident when comparing intensities of the Cybex modality with each other and when comparing the Cybex intensities with Thera-Band intensities in most cases. Minimal differences were found among differing intensities of Thera-Band. Thera-Band exercise resulted in low-level EMG activation (range, flexion 3.8-15.7% MVIC; range, extension 20.2-34.8% MVIC); therefore, such exercise may be useful in rehabilitation programs. Cybex exercise (range, flexion 20.9-83.5% MVIC; range, extension 40.6-95.8% MVIC) may be useful for occupation-related injury prevention. However, exercise prescription should be undertaken with care as the mechanical loading on passive spinal structures is unknown.

Teaching philosophy : moving from face-to-face to online classrooms

This article explores the similarities and differences between Canadian and Australian university teachers’ face-to-face and online teaching approaches and philosophies. It presents perspectives on teaching face-to-face and online in two comparable Canadian and Australian universities, both of which offer instruction in these two modes. The key research question was to determine if moving from face-to-face instruction to on-line teaching results in new teaching approaches or in a creative blend of those developed within each teaching modality. Qualitative data were collected using an open-ended survey, which asked participants for their thoughts on their face-to-face (f2f) and online teaching experiences. Quantitative data were collected using the “Teaching Perspectives Inventory,” which assessed participants’ teaching approaches and philosophies in terms of their beliefs, intentions, and actions. The authors’ conclusions address the issue of assisting teachers to successfully make the transition from traditional teacher-centred to newly emerging learner-centred teaching approaches in distributed classrooms.

The role of fatty acids in satiation and satiety

Background – Satiation and satiety describe the events which lead to meal termination and the maintenance of hunger induced by physical and metabolic events following food ingestion. Fatty acids, components of dietary fat (triglyceride) may be important, if not essential components of satiation and satiety. Emerging evidence suggests fatty acid now constitutes a sixth taste modality and orally sensed fatty acids mediate unique cephalic and hormonal responses priming the body for fat digestion, and may contribute to sensory specific satiety. Once ingested, fatty acids are sensed in the gastrointestinal tract (GIT) where they cause the release of hormones, stimulate the vagus and enter the blood stream where they act a number of organs (brain, liver) to influence satiety.
Objective – To review the role of fatty acids in sensory and metabolic satiation and satiety.
Design – Literature search and review of papers from the past decade on satiety, satiation, fat taste and fatty acids.
Outcomes – The physiological significance of gustatory fat detection is still unclear, but it may signal the nutritious content of fat similar to the tastes of sweet or umami which signal the presence of carbohydrate or proteins. Like other tastants, fatty acid taste sensitivity is thought to vary in the population and differences in sensitivity may influence dietary choice and fat intake. Fatty acid taste may contribute to sensory specific satiety as foods are eaten. Animal models have observed an inverse relationship between oral fatty acid sensitivity and fat consumption, which leads to obesity. Observations that the obese have heightened preferences for, and consume more fat than lean individuals questions whether such a relationship may also be apparent in humans. At the GIT, fatty acids are sensed by enterocytes and bind to receptors, transporters or ion channels where they initiate gut-brain communication over nutrient status through the vagus and cause the release of satiety hormones which lead to meal termination. Inefficient fatty acid sensing at either or both locations is thought to accompany the aetiology of obesity.
Conclusion – Variations in sensitivity to fatty acids may alter preferences and consumption of fats or hormonal responses to fat ingestion which influence sensory-specific, metabolic and subjective satiety.

3D virtual haptic cone for intuitive vehicle motion control

Haptic technology provides the ability for a system to recreate the sense of touch to a human operator, and as such offers wide reaching advantages. The ability to interact with the human's tactual modality introduces haptic human-machine interaction to replace or augment existing mediums such as visual and audible information. A distinct advantage of haptic human-machine interaction is the intrinsic bilateral nature, where information can be communicated in both directions simultaneously. This paper investigates the bilateral nature of the haptic interface in controlling the motion of a remote (or virtual) vehicle and presents the ability to provide an additional dimension of haptic information to the user over existing approaches [1-4]. The 3D virtual haptic cone offers the ability to not only provide the user with relevant haptic augmentation pertaining to the task at hand, as do existing approaches, however, to also simultaneously provide an intuitive indication of the current velocities being commanded.

Cortical and trabecular bone at the forearm show different adaptation patterns in response to tennis playing

Bone responds to impact-loading activity by increasing its size and/or density. The aim of this study was to compare the magnitude and modality of the bone response between cortical and trabecular bone in the forearms of tennis players. Bone area, bone mineral content (BMC), and bone mineral density (BMD) of the ulna and radius were measured by dual-energy X-ray absorptiometry (DXA) in 57 players (24.5 ± 5.7 yr old), at three sites: the ultradistal region (50% trabecular bone), the mid-distal regions, and third-distal (mainly cortical bone). At the ultradistal radius, the side-to-side difference in BMD was larger than in bone area (8.4 ± 5.2% and 4.9 ± 4.0%, respectively, p < 0.01). In the cortical sites, the asymmetry was lower (p < 0.01) in BMD than in bone area (mid-distal radius: 4.0 ± 4.3% vs 11.7 ± 6.8%; third-distal radius: 5.0 ± 4.8% vs 8.4 ± 6.2%). The asymmetry in bone area explained 33% of the variance of the asymmetry in BMC at the ultradistal radius, 66% at the mid-distal radius, and 53% at the third-distal radius. The ulna displayed similar results. Cortical and trabecular bone seem to respond differently to mechanical loading. The first one mainly increases its size, whereas the second one preferentially increases its density.

The self concepts and possible selves of problem gamblers : a qualitative exploration

The study investigated the self-concepts and possible selves of pathological gamblers. Six female egm users were recruited from a Victorian problem gambling counselling service. Three participants were currently gambling and three were not gambling. They were interviewed in-depth and using thematic analysis four dominant themes were identified. (1) Self-concepts tended to be consistent across all participants, (2) having a past self as being the dominant characteristics of possible selves coincided with greater possible selves clarity, (3) non-gambler’s had more elaborate and specific plans for how to create change than did gambler’s, and (4) non-gambler’s had more plans to become possible selves which address goals of intrinsic meaning, rather then having a general goal to ‘not gamble’. The findings are discussed in terms of implications for the cognitive theory of possible selves and suggestions for further research to investigate the utility of the constructs as a basis for a treatment modality.

Second person : a point of view? The function of the second person pronoun in narrative prose fiction

This thesis looks at the functions and effects of the ‘second-person’ pronoun in narrative prose fiction, with particular focus on the fluidity and ambiguity of the mode that I will call Protean-'you.' It is a mode in which it is unclear whether the ‘you’ is a character, the narrator, a reader/narratee, or no-one in particular—or a combination of these—so that readers find ‘second-person’ utterances at once familiar and deeply strange. I regard the ‘second person’ as a special case of narrative ‘person’ that, at its most fluid, can produce an experience of reading quite unlike that of reading traditional ‘first-‘ and ‘third-person’ narrative. Essentially, this unique experience comes about because Protean-‘you’ neglects to constitute the stable modes of subjectivity that readers expect to find within narrative textuality. These stable modes of subjectivity, modelled on what I will refer to as Cartesianism’s hegemonic notion of the self, have been thoroughly formalised and naturalised within the practices of ‘first-‘ and ‘third-person’ narrative. The Protean-‘you’ form of ‘second-person’ narrative, conversely, is a mode of narrative discourse that puts readers in a place of doubt and uncertainty, its unsettling equivocations forcefully disrupting accustomed, mimetic explanations of narrative and denying us access to the foundational, authorising subject of classical Cartesian thought. Rather than founding a notion of ‘second-person’ narrative and narrative ‘person’ generally on Cartesianism's ‘self-ish’ logic of unified, privatised identity, I turn to C.S, Peirce's notion of the semiotic self and to developments in post-structuralist thought. Essentially, the conception of subjectivity underpinning my arguments is Peirce's proposition that the self is to be conceived of not as a cogito, but as a sign by which the conscious entity knows itself. It is a sign, moreover, that is constantly being re-read, reinterpreted, so that identity is never self-complete. This reconception of subjectivity is necessary because 1 will argue that the effects of Protean-‘you’ arise in some part from a tension between Cartesianism's hegemony and what philosophical pragmatism and post-structuralism glimpse as the actual condition of the human subject—the subject as dispersed and contingent rather than unified and authoritative. Most discussions of ‘second-person’ narrative conceive of the mode in terms of implicit communicative relations, in some measure instituting Cartesianism's notion of the intentionalist self at the centre of literary meaning. I contrast the paradigmatic address model that arises from this conception against a model that approaches the analysis of ‘second-person’ narrative modality in terms of a referential function, that is, in terms of the object or objects referred to deictically by the ‘second-person’ pronoun. Two principal functions of ‘second-person’ textuality are identified and discussed at length. The first is generalisation, which is rarely dissipated altogether, a situation that contributes to the ambiguities of the pronoun's reference in much ‘second-person’ fiction. The second principal function is that of address, that is, the allocutionary function. Clearly, although stories that continually refer to a ‘you’ can seem quite baffling and unnatural, not all ‘second-person’ narratives unsettle the reader. In order to make the ‘second person's’ outlandish narratives knowable and stable, we bring to bear on them in our habits of reading whatever hermeneutic frames, whatever interpretive keys, come to hand, including a large number of unexceptional forms of literary and ‘natural’ discourse that employ the ‘second-person’ pronoun. These forms include letter writing and internal dialogue (i.e., talking to one's self), the language of the courtroom, the travelogue, the maxim, and so on. In looking at the ways in which the radicalising potentials of ‘second-person’ discourse are contained or recuperated, I focus on issues of vraisemblance and mimesis. Vraisemblance can be described as the ‘system of conventions and expectations which rests on/reinforces that more general system of ‘mutual knowledge’ produced within a community for the realisation and maintenance of a whole social world’. All of the forms of the vraisemblable are already instituted within social, cultural relations, so that what vraisemblance describes is the way we fit the inscriptions we read-that is, the way in which we naturalise what we read-into those given cultural and social forms. I also look at the conventionalising and naturalising work done by notions of mimesis in explaining relations between the world, our being in it, and texts, proposing that mimesis provides a principle buttress by which the good standing of the metaphor of ‘person’ is preserved in traditional and pre-critical modes of analysis. Indeed, the critic’s recourse to ‘person’ is in some measure always an engagement with mimesis. Any discussion that maintains that mimesis is in some way productive of meaning-which this thesis in fact does-must identify mimesis as a merely conventional category within practices of reading and semiosis more generally, and at the very least remove that term from its traditional position of transparent primacy and authority. Some of the most interesting and insightful arguments about ‘second-person’ narrative propose that the ‘second person’s’ most striking effects derive from the constitution of an ‘intersubjective’ experience of reading in which the subject positions of the ‘you’-protagonist, reader-narratee and narrator are combined into a fluid and indeterminate multiple subjectivity. Notions of intersubjectivity frequently position themselves as liberating the reader from Cartesianism's fixed, authoritative modes of subjectivity, Frequently, however, they tend implicitly to reinstate Cartesianism's notion of the self at the centre of textual practice and subjectivity. I look at Daniel Gunn's novel ‘Almost You’, at length in this context, illustrating the constant overdetermination of the ‘you’ and the novel's narrating voice, and demonstrating that this overdetermination leaves the origin of the narrative discourse, the identity of the narrator, and the ontological nature of both principal protagonists utterly ambiguous. The fluidity and ambiguity of Protean-‘you’ in ‘Almost You’ is discussed in terms of ‘second-person’ intersubjectivity, but with a view to demonstrating the indebtedness by the notion of intersubjectivity to Cartesianism's hegemony of ‘person’. I then turn to a discussion of what might be a more ‘old fashioned’ if perhaps ultimately more far-reaching approach to the ‘second person’s’ often startling ambiguities. This is Keats's notion of negative capability, a capacity or quality in which a person ‘is capable of being in uncertainties, Mysteries, doubts, without any irritable reaching after fact and reason.’ I suggest that Protean-‘you’ texts will license all of the readings of ambiguity and fluidity proposed in my discussion of ‘Almost You’, but conclude that the instances of indeterminacy illustrate no more than that: the fluidity and deep ambiguity, and thus, finally, the lack of coherence, of Protean-‘you’ discourse. This has particular implications for how we are to consider readers’ experiences of narrative texts. More fundamentally, it has implications for how we are to consider readers as subjects. I suggest that unstable, ambiguous instances of ‘second-person’ narrative can tear the complex and systematic embroidery of ideological suture that unifies Cretinism’s experience or sense of subjectivity, leaving the reader in a condition of epistemological and ontological havoc. I go on to argue that much of the deeply unsettling effect of Protean-‘you’ discourse anises because its utterances explicitly gesture towards Cretinism’s notion of self. Protean-‘you’ involves a sense of address that is much more pronounced than we are accustomed to facing when reading literary narrative, alerting us to the presence of inscribed anthropomorphic subjects. At the very same time, protean-‘you’ leaves its inscribed subjects indeterminate, ambiguous. This conflict generates a tension between the anticipation of the emergence of speaking and listening selves and our inability to find them. I go on to propose that Protean-‘you’ narrative's lack of coherence is also to be understood as the condition of narrative actuality generally, but a condition that is vigorously mediated against by dominant practices of reading and writing, hocusing my discussion in this respect on the issue of narrative ‘person,’ I argue that narrative ‘person’ is constituted within texts as an apparent unity, but that it is in fact, produced as unitary solely within the practice of making sense, that is, Within our habits of reading, and so is never finally unified. I propose that this is the case for ‘first-‘ and ‘third-person’ modes no less than for the ‘second.’ Where ‘second-person’ narrative at its most radical and Protean differs from conventional ‘first-‘ and ‘third-person’ narratives is the degree to which each has been circumscribed by practices of tantalization, containment and limit, and, in particular, Cretinism’s hegemony of ‘person.’ It may be that the most significant insights ‘second-person’ narrative has to offer are to be found within its capacity to reveal to the engaged reader the underlying condition of narrative discourse, and more generally, its capacity to reveal the actual condition of the human subject-a condition in which, exactly like its textual corollary of narrative ‘person,’ the self is glimpsed as thoroughly dispersed and contingent.