Effects of N-acetylcysteine on substance use in bipolar disorder : a randomized placebo controlled clinical trial

Objective: To evaluate the effect of N-acetylcysteine (NAC) on substance use in a double-blind, placebo-controlled trial of NAC in bipolar disorder. It is hypothesised that NAC will be superior to placebo for reducing scores on the Clinical Global Impressions scale for Substance Use (CGI-SU).

Methods: Participants were randomised to 6-months of treatment with 2 g/day NAC (n = 38) or placebo (n = 37). Substance use was assessed at baseline using the Habits instrument. Change in substance use was assessed at regular study visits using the CGI-SU.

Results: Amongst the 75 participants 78.7% drank alcohol (any frequency), 45.3% smoked tobacco and 92% consumer caffeine. Other substances were used by fewer than six participants. Caffeine use was significantly lower for NAC-treated participants compared with placebo at week 2 of treatment but not at other study visits.

Conclusion: NAC appeared to have little effect on substance use in this population. A larger study on a substance using population will be necessary to determine if NAC may be a useful treatment for substance use.

The impact of age at onset of bipolar I disorder on functioning and clinical presentation

Objectives: Recent studies have proposed the existence of three distinct subgroups of bipolar 1 disorder based on age at onset (AAO). The present study aims to investigate potential clinical and functional differences between these subgroups in an Australian sample.

Methods: Participants (n = 239) were enrolled in the Bipolar Comprehensive Outcomes Study (BCOS), a 2-year longitudinal, observational, cross-sectional study. Assessment measures included the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAMD21), Clinical Global Impressions Scale (CGI-BP), SF-36, SLICE/Life Scale, and the EuroQol (EQ-5D). Participants were also asked about their age at the first major affective episode.

Results: Three AAO groups were compared: early (AAO < 20, mean = 15.5 ± 2.72; 44.4% of the participants); intermediate (AAO 20–39, mean = 26.1 ± 4.8; 48.14% of the participants) and late (AAO > 40, mean = 50.6 ± 9.04; 7.4% of the participants). Higher rates of depression, suicidal ideation and binge drinking were reported by the early AAO group. This group also reported poorer quality of life in a number of areas. The early AAO group had a predominant depressive initial polarity and the intermediate group had a manic predominance.

Conclusion: Early AAO is associated with an adverse outcome.

The validity of the 21-item version of the depression anxiety stress scales as a routine outcome measure

Objective: This study aimed to test the validity of the 21-item Depression Anxiety Stress Scales (DASS-21) as a routine clinical outcome measure in the private in-patient setting. We hypothesized that it would be a suitable routine outcome instrument in this setting.

Method: All in-patients treated at a private psychiatric hospital over a period of 24 months were included in the study. Data were collected on demographics, service utilization, diagnosis and a set of four routine measures both at admission and discharge. These measures consisted of the Clinical Global Impressions (CGI) scales, Health of the Nation Outcome Scales (HoNOS), the Mental Health Questionnaire (MHQ-14) and DASS-21. The results of these measures were compared.

Results: Of 786 admissions in total, the number of fully completed (ie paired admission and discharge) data sets for the DASS-21 depression, anxiety and stress subscales were 337, 328 and 347, respectively. All subscales showed statistically significant reductions in mean scores from admission to discharge (P < 0.001) and were significantly correlated with all MHQ-14 subscales and significantly related to CGI scale categories. The total DASS-21 and total HoNOS scores were also significantly correlated.

Conclusions: The findings from the present study support the validity of DASS-21 as a routine clinical outcome measure in the private in-patient setting.

Ground truthing : explorations in a creative region

Australia’s evocative Mallee region is rich with histories, impressions and geographical complexities. It is also a microcosm of a world in turmoil.

Ground Truthing allows the Mallee to speak: to show its nurturing and renewable self. In searching for the creative principles that bring the Mallee into being, Carter digs, plots and weaves a poetic passage. A Wotjobaluk man, 'Jowley', the poet John Shaw Neilson and pastoralist William Stanbridge are among characters that give creative access to the region. Their voices mingle with those of vanished peoples and an ecological future crying out for renegotiation.

Through this spatial history of the Mallee, we see that regions contain 'the region of regions' that is the creative key to the production and sustenance of all places.

Video capture : pre-service teacher reflection, assessment or both

This paper reports on a small trial with 6 pre-service teachers who videoed their own teaching practices. The pre-service teachers used the tool to reflect on practice and to enhance their own understandings of themselves as teachers. The initial footage was used to by the pre-service teachers to gauge quite specific elements of their teaching: for example, were they asking effective questions, or were they responding appropriately to questions children asked and as always, what management strategies seemed to be working? Critical feedback from other students was initially „less than critical‟, but again over time, this also appeared to sharpen as they had more opportunity to use the technology. Initial embarrassment of being on screen was replaced with a professional approach to seeing the video as a tool for providing the opportunity to systematically deconstruct practices and for providing concrete feedback for improvement. Used in conjunction with teaching preparation courses, the videoed segments of teaching practice could be used to highlight exemplars, to show what actually happens in classrooms and to explain certain practices. Cunningham and Benedetto (2002) state “Recent developments in digital video technologies permit teacher candidates to collect, review, and manipulate video to demonstrate their growth as a professional and as a reflective practitioner.” However, in the development of the trial, the issue was raised by the pre-service teachers that they would be interested in keeping the videos as evidence of their teaching competence to be used in applications for teaching positions. In the small trial, ethics permission had not been gained for that to happen, but it is certainly a valid and viable possibility for the future. Currently prospective employers have to rely on paper applications which respond to selection criteria, evidence from pre-service teachers‟ teaching rounds and the subjective impressions of an interview. If students were able to present a 5 minute segment of them teaching, it might count for much more than any other evidence. Video capture of teaching practice would provide potential employers with an indication of a pre-service teacher‟s management strategies, relationships with children and a snapshot of a pre-service teacher‟s instructional practice. The idea of video-capture as a tool for pre-service teachers to illustrate teaching capabilities will be more fully investigated in this paper.

Treatment and outcomes of an Australian cohort of outpatients with bipolar 1 or schizoaffective disorder over twenty-four months : implications for clinical practice

Background The Bipolar Comprehensive Outcomes Study (BCOS) is a 2-year, prospective, non-interventional, observational study designed to explore the clinical and functional outcomes associated with ‘real-world’ treatment of participants with bipolar I or schizoaffective disorder. All participants received treatment as usual. There was no study medication.

Methods Participants prescribed either conventional mood stabilizers (CMS; n = 155) alone, or olanzapine with, or without, CMS (olanzapine ± CMS; n = 84) were assessed every 3 months using several measures, including the Young Mania Rating Scale, 21-item Hamilton Depression Rating Scale, Clinical Global Impressions Scale – Bipolar Version, and the EuroQol Instrument. This paper reports 24-month longitudinal clinical, pharmacological, functional, and socioeconomic data.

Results On average, participants were 42 (range 18 to 79) years of age, 58%; were female, and 73%; had a diagnosis of bipolar I. Polypharmacy was the usual approach to pharmacological treatment; participants took a median of 5 different psychotropic medications over the course of the study, and spent a median proportion of time of 100%; of the study on mood stabilizers, 90%; on antipsychotics, 9%; on antidepressants, and 5%; on benzodiazepines/hypnotics. By 24 months, the majority of participants had achieved both symptomatic and syndromal remission of both mania and depression. Symptomatic relapse rates were similar for both the CMS alone (65%;) and the olanzapine ± CMS (61%;) cohorts.

Conclusions Participants with bipolar I or schizoaffective disorder in this study were receiving complex medication treatments that were often discordant with recommendations made in contemporary major treatment guidelines. The majority of study participants demonstrated some clinical and functional improvements, but not all achieved remission of symptoms or syndrome.

Physical environmental factors that invite older adults to walk for transportation

Knowledge on the physical environmental factors that invite older adults to walk for transportation is limited. The current study aimed to investigate the relationships between environmental factors and invitingness to walk for transportation and the potential moderating effects of gender, functional limitations and current walking for transportation behavior. Sixty older participants evaluated 40 panoramic photographs on their invitingness in two ways: a forced choice (first impressions) and a rating task (more deliberate evaluation). Presence of vegetation, benches, and surveillance significantly positively related to both invitingness-measures. Upkeep and presence of historic elements significantly positively related to the assigned invitingness-ratings. For the forced choice task, significant positive relationships emerged for land use and separation between sidewalk and cycling path, but only in functionally limited participants. Environments offering comfort, safety from crime, and pleasantness may attract older adults to walk for transportation. Experimental and on-site studies are needed to elaborate on current findings.

Exemplification and deconstructive writing: dancing with Massumi, Derrida, and others

I am experimenting with ‘exemplification’ (Massumi, 2002) and ‘deconstrucitve writing’ (Maclure, 2010) by applying them to selected data from research for my doctoral thesis. Central to both is the power of examples to expose detail and divergence that lead to new and different possibilities and connections. I have been inspired by Derrida’s (Maclure, 2003; Spitzer, 2011) notion of the fabric of a text with ‘tears’, ‘cuts’, ‘knots or aporias’. Therefore, I have created a fabric of text with tears and aporias: one that encourages readers to think and read doubly (Derrida, cited in Spitzer, 2011). I write in an ‘inattentive’ way (Massumi, 2002): juxtaposing examples (narratives) with the identities of the narrators, my responses to their narratives, and theoretical and other musings to play with the ambiguity of reality and identity. The interplay of inattention, exemplification, and deconstructive writing allows for interpretation, reinterpretation, affective responses, and new and different impressions and possibilities. My aim in writing this paper is threefold: (1) to explore the application of a Derridean perspective to some of my research, (2) to practise exemplification and deconstructive writing, and (3) to write in an inattentive and creative way.

Protocol and rationale-the efficacy of minocycline as an adjunctive treatment for major depressive disorder: a double blind, randomised, placebo controlled trial

While current pharmacotherapies are efficacious, there remain a clear shortfall between symptom remission and functional recovery. With the explosion in our understanding of the biology of these disorders, the time is ripe for the investigation of novel therapies. Recently depression is conceptualized as an immune-inflammatory and nitro-oxidative stress related disorder. Minocycline is a tetracycline antibiotic that has anti-inflammatory, pro-oxidant, glutamatergic, neurotrophic and neuroprotective properties that make it a viable target to explore as a new therapy. This double blind, randomised, placebo controlled adjunctive trial will investigate the benefits of 200 mg/day of minocycline treatment, in addition to any usual treatment, as an adjunctive treatment for moderate-severe major depressive disorder. Sixty adults are being randomised to 12 weeks of treatment (with a 4 week follow-up post-discontinuation). The primary outcome measure for the study is mean change on the Montgomery-Asberg Depression Rating Scale (MADRS), with secondary outcomes including the Social and Occupational Functioning Assessment Scale (SOFAS), Clinical Global Impressions (CGI), Hamilton Rating Scale for Anxiety (HAM-A), Patient Global Impression (PGI), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) and Range of Impaired Functioning Tool (LIFE-RIFT). Biomarker analyses will also be conducted at baseline and week 12. The study has the potential to provide new treatment targets, both by showing efficacy with a new class of 'antidepressant' but also through the analysis of biomarkers that may further inform our understanding of the pathophysiology of unipolar depression.

Organizational Fit: Key Issues and New Directions

An ambitious survey of the field, by an international group of scholars, that looks toward the future of person-organization fit. Explores how people form their impressions of fit and the impact these have on their behavior, and how companies can maximize fit. Includes multiple perspectives on the topic of how people fit into organizations, discussing issues across the field and incorporating insights from related disciplines. Actively encourages scholars to take part in organizational fit research, drawing on workshops and symposia held specially for this book to explore some of the creative directions that the field is taking into the future. © 2013 John Wiley & Sons, Ltd.

Understanding executive presence : Perspectives of business professionals

Executive presence is an unclear concept but one that reportedly has a substantial influence on successful leadership. The purpose of this study was to understand the meaning of executive presence from the perspectives of business professionals with expertise in the effectiveness of organizational executives. From interviews with 34 professionals, 5 main findings emerged: (a) executive presence is based on audience perceptions of the characteristics of particular people, (b) 10 core characteristics affect executive presence (status and reputation, physical appearance, projected confidence, communication ability, engagement skills, interpersonal integrity, values-in-action, intellect and expertise, outcome delivery ability, and coercive power use), (c) perceptions are based on impressions made during initial contacts (first 5 characteristics) and on evaluations made over time (second 5 characteristics), (d) the characteristics combine in different ways to form 4 presence archetypes (positive presence, unexpected presence, unsustainable presence, and dark presence), and (e) the majority of the executives described as having presence were men. Based on the interview material, we suggest that a person with executive presence is someone who, by virtue of how he or she is perceived by audience members at any given point in time, exerts influence beyond that conferred through formal authority. The findings serve to highlight the complexity of executive presence, particularly in terms of the breadth of characteristics that underpin this construct and the influence of time on people's perceptions.

The effects of a course of intranasal oxytocin on social behaviors in youth diagnosed with autism spectrum disorders: A randomized controlled trial

Background There is increasing interest in oxytocin as a therapeutic to treat social deficits in autism spectrum disorders (ASD). The aim of this study was to investigate the efficacy of a course of oxytocin nasal spray to improve social behavior in youth with ASD. Methods In a double-blind, placebo-controlled trial across two Australian university sites between February 2009 and January 2012, 50 male participants aged between 12 and 18 years, with Autistic or Asperger's Disorder, were randomized to receive either oxytocin (n = 26) or placebo (n = 24) nasal sprays (either 18 or 24 International Units), administered twice-daily for 8 weeks. Participants were assessed at baseline, after 4- and 8-weeks of treatment, and at 3-month follow-up. Primary outcomes were change in total scores on the caregiver-completed Social Responsiveness Scale and clinician-ratings on the Clinical Global Impressions-Improvement scale. Secondary assessments included caregiver reports of repetitive and other developmental behaviors and social cognition. Clinical trial registration: Australian New Zealand Clinical Trials Registry www.anzctr.org.au ACTRN12609000513213. Results Participants who received oxytocin showed no benefit following treatment on primary or secondary outcomes. However, caregivers who believed their children received oxytocin reported greater improvements compared to caregivers who believed their child received placebo. Nasal sprays were well tolerated and there was no evidence of increased side effects resulting from oxytocin administration. Conclusions This is the first evaluation of the efficacy for a course of oxytocin treatment for youth with ASD. Although results did not suggest clinical efficacy, further research is needed to explore alternative delivery methods, earlier age of intervention, and the influence of caregiver expectation on treatment response.

Exploring nurses' reactions to a novel technology to support acute health care delivery

AIMS AND OBJECTIVES: To explore nurses' reactions to new novel technology for acute health care. BACKGROUND: Past failures of technology developers to deliver products that meet nurses' needs have led to resistance and reluctance in the technology adoption process. Thus, involving nurses in a collaborative process from early conceptualisation serves to inform design reflective upon current clinical practice, facilitating the cementing of 'vision' and expectations of the technology. DESIGN: An exploratory descriptive design to capture nurses' immediate impressions. METHODS: Four focus groups (52 nurses from medical and surgical wards at two hospitals in Australia; one private and one public). RESULTS: Nursing reactions towards the new technology illustrated a variance in barrier and enabler comments across multiple domains of the Theoretical Domains Framework. Most challenging for nurses were the perceived threat to their clinical skill, and the potential capability of the novel technology to capture their clinical workflow. Enabling reactions included visions that this could help integrate care between departments; help management and support of nursing processes; and coordinating their patients care between clinicians. Nurses' reactions differed across hospital sites, influenced by their experiences of using technology. For example, Site 1 nurses reported wide variability in their distribution of barrier and enabling comments and nurses at Site 2, where technology was prevalent, reported mostly positive responses. CONCLUSION: This early involvement offered nursing input and facilitated understanding of the potential capabilities of novel technology to support nursing work, particularly the characteristics seen as potentially beneficial (enabling technology) and those conflicting (barrier technology) with the delivery of both safe and effective patient care. RELEVANCE TO CLINICAL PRACTICE: Collaborative involvement of nurses from the early conceptualisation of technology development brings benefits that increase the likelihood of successful use of a tool intended to support the delivery of safe and efficient patient care.

Determinação da glico-hemoglobina : relação com a glicemia e aspectos analíticos

A glico-hemoglobina (HbA1c) é um parâmetro importante no controle glicêmico de pacientes diabéticos. Vários estudos clínicos mostraram claramente que a melhora no controle glicêmico está fortemente associada com a diminuição no desenvolvimento e/ou progressão das complicações microvasculares do diabetes. A medida exata e precisa da HbA1c é uma questão importante para os laboratórios clínicos. Vários fatores afetam os resultados e podem levar a resultados errôneos. Este trabalho analisou o efeito de fatores analíticos, estados patológicos e drogas nos resultados de HbA1c. Em um primeiro estudo, demonstramos que a fração lábil de HbA1c contribui significativamente para o resultado final. Quando está fração é separada inadequadamente, há a necessidade de um pré - tratamento na amostra, para evitarmos valores falsamente elevados. O armazenamento das amostras é um fator pré – analítico importante. Amostras mantidas sob refrigeração são estáveis por 10 dias e o armazenamento a longo prazo deve ser feito a – 80oC. No entanto, amostras congeladas a –20oC apresentam uma diminuição significativa nos valores de HbA1c, já nas primeiras 24h de armazenamento. Em um segundo estudo, relatamos que as hemoglobinas anômalas estão associadas com valores muito baixos de HbA1c. Adicionalmente, também demonstramos que a anemia é uma importante fonte de interferência negativa nos resultados. Sugerimos que, para a correta interpretação dos valores de HbA1c, o estado hematológico do paciente seja sempre considerado. Em um terceiro estudo, analisamos o uso crônico de aspirina, vitamina C e vitamina E nos níveis de HbA1c. Houve inexistência de efeito significativo nos resultados de HbA1c, medidos por 3 métodos rotineiramente utilizados pelos laboratórios clínicos, em indivíduos não - diabéticos. O clínico deve conhecer os fatores que afetam a determinação de HbA1c na população atendida e os resultados discordantes com a história clínica do paciente devem ser sempre investigado.

A customização no atendimento como fator de fidelização do cliente às lojas de decoração de alto estilo

This study investigates how far customization in attendance act as clients faithfulness factor in top style interior design stores in Great Vitoria. After relative economic stability was reached with ¿Plano Real¿, customers could visualize better their money and consequently gave it more value. When clients acquire a product and demand high quality attendance they consider much beyond price. They want something new. Something that surprise. They are not satisfied only with what is best. They want the utmost. Do what is best is no longer a competitive advantage. It is now just a duty. Emphasizes application of custom-made attendance according to client specific needs as a competitive advantage-key to be pursued by companies. Analyses using extensive literature review including the world wide web source, the problem main theoretical fundaments. An intentional sample was used and interviews with closed questions were carried out with 230 clients and 18 store managers, to collect directly involved agents impressions. Conclusions show a mature customer, highly educated with good income and that demand exclusive treatment. In majority the study shows that customized attendance creates client faithfulness to top style interior design stores provided that price and product quality are adequate. Knowledge acquired with this study on attendance customization can give important contributions to top style interior design segment giving stores stimulus in the adoption of this distinctive competence facing growing global competitive market.