Cognitive behaviour therapy (CBT) for the treatment of co-occurring depression and substance use : current evidence and directions for future research

Issues and Approach: The high rates of co-occurring depression and substance use, and the negative impact of this on illness course and outcomes have been well established. Despite this, few clinical trials have examined the efficacy of cognitive behaviour therapy (CBT). This paper systematically reviews these clinical trials, with an aim of providing recommendations for how future research can develop a more robust evidence base for the treatment of these common comorbidities. Leading electronic databases, including PubMed (ISI) and PsychINFO (CSA), were searched for peer-reviewed journal articles using CBT for the treatment of co-occurring depression and substance use. Of the 55 articles identified, 12 met inclusion criteria and were included in the review. ---------- Key Findings: There is only a limited evidence for the effectiveness of CBT either alone or in combination with antidepressant medication for the treatment of co-occurring depression and substance use. While there is support for the efficacy of CBT over no treatment control conditions, there is little evidence that CBT is more efficacious than other psychotherapies. There is, however, consistent evidence of improvements in both depression and substance use outcomes, regardless of the type of treatment provided and there is growing evidence that that the effects of CBT are durable and increase over time during follow up. ---------- Conclusions. Rather than declaring the ‘dodo bird verdict’ that CBT and all other psychotherapies are equally efficacious, it would be more beneficial to develop more potent forms of CBT by identifying variables that mediate treatment outcomes.

Human atrial beta1L-adrenoceptor but not beta3-adrenoceptor activation increases force and Ca2+ current at physiological temperature

BACKGROUND AND PURPOSE It has been proposed that BRL37344, SR58611 and CGP12177 activate b3-adrenoceptors in human atrium to increase contractility and L-type Ca2+ current (ICa-L). b3-adrenoceptor agonists are potentially beneficial for the treatment of a variety of diseases but concomitant cardiostimulation would be potentially harmful. It has also been proposed that (-)-CGP12177 activates the low affinity binding site of the b1-adrenoceptor in human atrium. We therefore used BRL37344, SR58611 and (-)-CGP12177 with selective b-adrenoceptor subtype antagonists to clarify cardiostimulant b-adrenoceptor subtypes in human atrium. EXPERIMENTAL APPROACH Human right atrium was obtained from patients without heart failure undergoing coronary artery bypass or valve surgery. Cardiomyocytes were prepared to test BRL37344, SR58611 and CGP12177 effects on ICa-L. Contractile effects were determined on right atrial trabeculae. KEY RESULTS BRL37344 increased force which was antagonized by blockade of b1- and b2-adrenoceptors but not by blockade of b3-adrenoceptors with b3-adrenoceptor-selective L-748,337 (1 mM). The b3-adrenoceptor agonist SR58611 (1 nM–10 mM) did not affect atrial force. BRL37344 and SR58611 did not increase ICa-L at 37°C, but did at 24°C which was prevented by L-748,337. (-)-CGP12177 increased force and ICa-L at both 24°C and 37°C which was prevented by (-)-bupranolol (1–10 mM), but not L-748,337. CONCLUSIONS AND IMPLICATIONS We conclude that the inotropic responses to BRL37344 are mediated through b1- and b2-adrenoceptors. The inotropic and ICa-L responses to (-)-CGP12177 are mediated through the low affinity site b1L-adrenoceptor of the b1-adrenoceptor. b3-adrenoceptor-mediated increases in ICa-L are restricted to low temperatures. Human atrial b3-adrenoceptors do not change contractility and ICa-L at physiological temperature.

Perspectives on the recruitment and retention of culturally and linguistically diverse police

Purpose: The aims of this paper are: to investigate the perceptions held by police (insiders) and community member (outsiders) of the recruitment and retention of culturally and linguistically diverse employees of Victoria Police; and, to develop a model that can assist in future recruitment and retention policy development.---------- Design/methodology/approach: Structured focus group interviews were conducted based on an instrument deduced from existing literature. Police and community members were interviewed separate cohorts. The discussions were thematically coded to themes and sub-themes.---------- Findings: Specific differences were identified in perceptions of the importance of recruiting culturally and linguistically diverse groups, barriers to recruitment, recruitment methods, and retention methods.---------- Research limitations/implications: Based on these perceptions, a propose a model addresses the importance of cultural diversity in policing and barriers to recruitment and retention of culturally and linguistically diverse employees. Further research is necessary to assess the broader applicability of this model.---------- Practical implications: The proposed model is may be used as the basis for future recruitment and retention activities, and human resource management policy development.---------- Originality/value: This is the first study in the Australian context of recruitment and retention of culturally and linguistically diverse police that addresses both community and police perspectives. Aligning the demographic profile of the police service with that of the community is beneficial to effective policing.

Young drivers’ optimism bias for accident risk and driving skill : accountability and insight experience manipulations

This study aimed to determine whether two brief, low cost interventions would reduce young drivers’ optimism bias for their driving skills and accident risk perceptions. This tendency for such drivers to perceive themselves as more skilful and less prone to driving accidents than their peers may lead to less engagement in precautionary driving behaviours and a greater engagement in more dangerous driving behaviour. 243 young drivers (aged 17 - 25 years) were randomly allocated to one of three groups: accountability, insight or control. All participants provided both overall and specific situation ratings of their driving skills and accident risk relative to a typical young driver. Prior to completing the questionnaire, those in the accountability condition were first advised that their driving skills and accident risk would be later assessed via a driving simulator. Those in the insight condition first underwent a difficult computer-based hazard perception task designed to provide participants with insight into their potential limitations when responding to hazards in difficult and unpredictable driving situations. Participants in the control condition completed only the questionnaire. Results showed that the accountability manipulation was effective in reducing optimism bias in terms of participants’ comparative ratings of their accident risk in specific situations, though only for less experienced drivers. In contrast, among more experienced males, participants in the insight condition showed greater optimism bias for overall accident risk than their counterparts in the accountability or control groups. There were no effects of the manipulations on drivers’ skills ratings. The differential effects of the two types of manipulations on optimism bias relating to one’s accident risk in different subgroups of the young driver sample highlight the importance of targeting interventions for different levels of experience. Accountability interventions may be beneficial for less experienced young drivers but the results suggest exercising caution with the use of insight type interventions, particularly hazard perception style tasks, for more experienced young drivers typically still in the provisional stage of graduated licensing systems.

The low-affinity site of the β1-adrenoceptor and its relevance to cardiovascular pharmacology

β-Adrenoceptor blocking agents (β-blockers) that at low concentrations antagonize cardiostimulant effects of catecholamines, but at high concentrations also cause cardiostimulation, have been appearing since the late 1960s. These cardiostimulant β-blockers, coined non-conventional partial agonists, antagonize the effects of catecholamines through a high-affinity site (β1HAR), but cause cardiostimulation mainly through a low-affinity site (β1LAR) of the myocardial β1-adrenoceptor. The experimental non-conventional partial agonist (−)-CGP12177 increases cardiac L-type Ca2+ current density and Ca2+ transients, shortens action potential duration but augments action potential plateau, increases heart rate and force, as well as causes arrhythmic Ca2+ transients and arrhythmic cardiocyte contractions. Other β-blockers, which do not cause cardiostimulation, consistently have lower affinity for β1LAR than β1HAR. These sites were verified and the cardiac pharmacology of non-conventional partial agonists confirmed on recombinant β1-adrenoceptors and on β1-adrenoceptors overexpressed into the heart. A targeted mutation of Asp138 to Glu138 virtually abolished the pharmacology of β1HAR but left intact the pharmacology of β1LAR. Non-conventional partial agonists may be beneficial for the treatment of peripheral autonomic neuropathy but probably due to their arrhythmic propensities, may be harmful for the treatment of chronic heart failure.

Assessment of critical constructability activities among Malaysian building contractors

After the primary researches on constructability issue which were implemented in United States, United Kingdom and Australia, more explorations were applied on that in order to assess this unique scientific fact in East Asian country of Malaysia. Based on the latest researches done on constructability concept in Malaysia, the most Critical Constructability Activities (CCAs) are defined according to amount of contractors’ participation in each activity and amount of gap between actual and potential effects of each of them on achieving the overall objectives of the construction projects with more cost and time savings and better quality which is the whole aim of a beneficial constructability activity. The present research aims to assess the current findings on CCAs in order to identify the types of contractors and projects which these CCAs are getting performed in and also the types of contracts is used in these CCAs. Finally it was found that there are some significant differences in amount of contractors’ involvement in CCAs among various considered independent variables. This study uses the former researches to help Malaysian construction stakeholders to find out the barriers of constructability implementation in building projects via giving more details on application of CCAs among different IVs.

AITPM national newsletter October 2008 president's report

It’s a pleasure for me to be penning my first President’s Message for the AITPM Newsletter. I am eagerly looking forward to serving the Institute and members over the coming couple of years. First though, I’d like to congratulate Andrew Hulse for steering the good ship AITPM over the past two years, bringing so many initiatives to the fore, including the Certified Transport Planner (CTP), stronger ties with other organisations and agencies such as IPENZ and Austroads, mutually beneficial sponsorship arrangements, and sharing his enthusiasm towards the Thunderbirds. Personally and largely thanks to my kids’ domination of the TV I’m a bit keener on the other great British sixties sci-fi classic, Doctor Who. Maybe we can generate a “favourite Doctor” dialogue in the Newsletter.

Teachers’ and parents’ perspectives of digital technology in the lives of young children

The pervasiveness of technology in the 21st Century has meant that adults and children live in a society where digital devices are integral to their everyday lives and participation in society. How we communicate, learn, work, entertain ourselves, and even shop is influenced by technology. Therefore, before children begin school they are potentially exposed to a range of learning opportunities mediated by digital devices. These devices include microwaves, mobile phones, computers, and console games such as Playstations® and iPods®. In Queensland preparatory classrooms and in the homes of these children, teachers and parents support and scaffold young children’s experiences, providing them with access to a range of tools that promote learning and provide entertainment. This paper examines teachers’ and parents’ perspectives and considers whether they are techno-optimists who advocate for and promote the inclusion of digital technology, or whether they are they techno-pessimists, who prefer to exclude digital devices from young children’s everyday experiences. An exploratory, single case study design was utilised to gather data from three teachers and ten parents of children in the preparatory year. Teacher data was collected through interviews and email correspondence. Parent data was collected from questionnaires and focus groups. All parents who responded to the research invitation were mothers. The results of data analysis identified a misalignment among adults’ perspectives. Teachers were identified as techno-optimists and parents were identified as techno-pessimists with further emergent themes particular to each category being established. This is concerning because both teachers and mothers influence young children’s experiences and numeracy knowledge, thus, a shared understanding and a common commitment to supporting young children’s use of technology would be beneficial. Further research must investigate fathers’ perspectives of digital devices and the beneficial and detrimental roles that a range of digital devices, tools, and entertainment gadgets play in 21st Century children’s lives.

Shear tests of Litesteel beams with web openings

This paper presents the details of experimental studies on the shear strength of a recently developed, cold-formed steel beam known as LiteSteel Beam (LSB) with web openings. The innovative LSB sections have the beneficial characteristics of torsionally rigid closed rectangular flanges combined with economical fabrication processes from a single strip of high strength steel. They combine the stability of hot-rolled steel sections with the high strength to weight ratio of conventional cold-formed steel sections. The LSB sections are commonly used as flexural members in the building industry. Current practice in flooring systems is to include openings in the web element of floor joists or bearers so that building services can be located within them. Shear behaviour of LSBs with web openings is more complicated while their shear strengths are considerably reduced by the presence of web openings. However, limited research has been undertaken on the shear behaviour and strength of LSBs with web openings. Therefore a detailed experimental study involving 26 shear tests was undertaken to investigate the shear behaviour and strength of different LSB sections. Simply supported test specimens of LSBs with an aspect ratio of 1.5 were loaded at midspan until failure. This paper presents the details of this experimental study and the results. Experimental results showed that the current design rules in cold-formed steel structures design codes (AS/NZS 4600) [1] are very conservative for the shear design of LSBs with web openings. Improved design equations have been proposed for the shear strength of LSBs with web openings based on experimental results from this study.

Addressing sustainable living using a collaborative approach and multi-disciplinary techniques

In order to achieve meaningful reductions in individual ecological footprints, individuals must dramatically alter their day to day behaviours. Effective interventions will need to be evidence based and there is a necessity for the rapid transfer or communication of information from the point of research, into policy and practice. A number of health disciplines, including psychology and public health, share a common mission to promote health and well-being and it is becoming clear that the most practical pathway to achieving this mission is through interdisciplinary collaboration. This paper argues that an interdisciplinary collaborative approach will facilitate research that results in the rapid transfer of findings into policy and practice. The application of this approach is described in relation to the Green Living project which explored the psycho-social predictors of environmentally friendly behaviour. Following a qualitative pilot study, and in consultation with an expert panel comprising academics, industry professionals and government representatives, a self-administered mail survey was distributed to a random sample of 3000 residents of Brisbane and Moreton Bay (Queensland, Australia). The Green Living survey explored specific beliefs which included attitudes, norms, perceived control, intention and behaviour, as well as a number of other constructs such as environmental concern and altruism. This research has two beneficial outcomes. First, it will inform a practical model for predicting sustainable living behaviours and a number of local councils have already expressed an interest in making use of the results as part of their ongoing community engagement programs. Second, it provides an example of how a collaborative interdisciplinary project can provide a more comprehensive approach to research than can be accomplished by a single disciplinary project.

Business service management : understanding business models

One of the prominent topics in Business Service Management is business models for (new) services. Business models are useful for service management and engineering as they provide a broader and more holistic perspective on services. Business models are particularly relevant for service innovation as this requires paying attention to the business models that make new services viable and business model innovation can drive the innovation of new and established services. Before we can have a look at business models for services, we first need to understand what business models are. This is not straight-forward as business models are still not well comprehended and the knowledge about business models is fragmented over different disciplines, such as information systems, strategy, innovation, and entrepreneurship. This whitepaper, ‘Understanding business models,’ introduces readers to business models. This whitepaper contributes to enhancing the understanding of business models, in particular the conceptualisation of business models by discussing and integrating business model definitions, frameworks and archetypes from different disciplines. After reading this whitepaper, the reader will have a well-developed understanding about what business models are and how the concept is sometimes interpreted and used in different ways. It will help the reader in assessing their own understanding of business models and that and of others. This will contribute to a better and more beneficial use of business models, an increase in shared understanding, and making it easier to work with business model techniques and tools.

Being Grateful : Does it Bring Us Closer? Gratitude, Attachment and Intimacy in Romantic Relationships

To date, little is known about the function of gratitude in romantic relationships. Being grateful has been demonstrated to provide a number of positive benefits for individuals; however, few studies have explored how grateful experiences may be beneficial in enhancing romantic relationships. This study explored the extent to which adult attachment moderates the relationship between dispositional gratitude and the experience of intimacy within romantic relationships. A greater disposition toward gratitude was expected to result in more frequent experiences of gratitude. It was also anticipated that experiences of gratitude would be associated with feelings of closeness. Participants (n = 156) were required to be currently in a relationship of at least six months duration and completed a series of questionnaires assessing dispositional gratitude, attachment and emotional intimacy. Moderation analysis revealed that although a positive, weak correlation existed between dispositional gratitude and intimacy, attachment did not moderate this association. It was concluded that further investigation of the experience of gratitude is necessary to understand the function of gratitude in romantic relationships. Methods focusing on specific experiences of gratitude in romantic relationships, and the associated feelings of closeness experienced by each partner, may yield more conclusive findings and may provide support for therapeutic approaches focused on enhancing closeness between couples by increasing experiences of gratitude.

Being grateful : does it bring us closer? Gratitude, attachment and intimacy in romantic relationships

This study proposed that levels of dispositional gratitude influence experiences of intimacy within romantic relationships and that this influence is moderated by relationship attachment. Gratitude, in this study, was described as feelings of appreciation associated with the perception that one had been the focus of another’s intentionally beneficial actions. A greater disposition toward gratitude was expected to result in more frequent experiences of gratitude. It was also anticipated that experiences of gratitude would be associated with feelings of closeness toward the one responsible for the beneficial act. Participants (n=156) ranged in age from 18 – 70 and, although required to be currently in a relationship of at least six months’ duration, each was studied as an individual. Participants included both males and females, in same-sex or other-sex relationships, and completed a series of questionnaires assessing dispositional gratitude, attachment and emotional intimacy. Moderation analysis was conducted using hierarchical regression and revealed that although a positive, weak correlation exists between gratitude and intimacy, attachment did not moderate that association. However, the measures used did not elicit sufficiently divergent responses. Thus neither complete exploration of the proposed association between gratitude and intimacy, nor of the moderation of that association by attachment were possible. In conclusion, further investigation of experiences of gratitude, particularly in relation to enhancing feelings of closeness, is necessary to understand the function of gratitude in romantic relationships. Methods focusing on specific experiences of gratitude in romantic relationships and the associated feelings of closeness experienced by each partner may yield more conclusive findings. In addition, such findings may provide support for therapeutic approaches focused on enhancing closeness between couples by increasing experiences of gratitude.

Business Process Management (BPM) education in Australia : a critical review based on content analysis

Business Process Management (BPM) is a top priority in organisations and is rapidly proliferating as an emerging discipline in practice. However, the current studies show lack of appropriate BPM skilled professionals in the field and a dearth of opportunities to develop BPM expertise. This paper analyses the gap between available BPM-related education in Australia and required BPM capabilities. BPM courses offered by Australian universities and training institutions have been critically analysed and mapped against leading BPM capability frameworks to determine how well current BPM education and training offerings in Australia actually address the core capabilities required for BPM professionals. The outcomes reported here can be used by Australian universities and training institutions to better align and position their training materials to the BPM required capabilities. It could also be beneficial to individuals looking for a systematic and in-depth understanding of BPM capabilities and trainings.

Maximum recovery after knee replacement - the MARKER study rationale and protocol

Background There is little scientific evidence to support the usual practice of providing outpatient rehabilitation to patients undergoing total knee replacement surgery (TKR) immediately after discharge from the orthopaedic ward. It is hypothesised that the lack of clinical benefit is due to the low exercise intensity tolerated at this time, with patients still recovering from the effects of major orthopaedic surgery. The aim of the proposed clinical trial is to investigate the clinical and cost effectiveness of a novel rehabilitation strategy, consisting of an initial home exercise programme followed, approximately six weeks later, by higher intensity outpatient exercise classes. Methods/Design In this multicentre randomised controlled trial, 600 patients undergoing primary TKR will be recruited at the orthopaedic pre-admission clinic of 10 large public and private hospitals in Australia. There will be no change to the medical or rehabilitative care usually provided while the participant is admitted to the orthopaedic ward. After TKR, but prior to discharge from the orthopaedic ward, participants will be randomised to either the novel rehabilitation strategy or usual rehabilitative care as provided by the hospital or recommended by the orthopaedic surgeon. Outcomes assessments will be conducted at baseline (pre-admission clinic) and at 6 weeks, 6 months and 12 months following randomisation. The primary outcomes will be self-reported knee pain and physical function. Secondary outcomes include quality of life and objective measures of physical performance. Health economic data (health sector and community service utilisation, loss of productivity) will be recorded prospectively by participants in a patient diary. This patient cohort will also be followed-up annually for five years for knee pain, physical function and the need or actual incidence of further joint replacement surgery. Discussion The results of this pragmatic clinical trial can be directly implemented into clinical practice. If beneficial, the novel rehabilitation strategy of utilising outpatient exercise classes during a later rehabilitation phase would provide a feasible and potentially cost-effective intervention to optimise the physical well-being of the large number of people undergoing TKR.