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Kinds of Melbourne Selected AbstractsGEOGRAPHICAL DISTRIBUTION OF CHRONIC RENAL FAILURE IN SYDNEY, MELBOURNE AND BRISBANENEPHROLOGY, Issue 3 2000Elliott Savdie [source] GEOGRAPHICAL DISTRIBUTION OF CHRONIC RENAL FAILURE IN SYDNEY, MELBOURNE AND BRISBANENEPHROLOGY, Issue 3 2000Elliott Savdie [source] Short Report: Psychological adjustment of well siblings of children with Type 1 diabetesDIABETIC MEDICINE, Issue 9 2010F. Sleeman Diabet. Med. 27, 1084,1087 (2010) Abstract Aims, Studies of siblings of children with Type 1 diabetes (Type 1 DM) have shown either increased levels of maladjustment or, alternatively, increased levels of pro-social behaviour according to whether the sibling or parent was interviewed. The purpose of this study was to examine the psychological adjustment of Type 1 DM siblings using both parent and sibling report and to assess the concordance between child and parent reports. Methods, Ninety-nine siblings aged 11,17 years and parents of children with Type 1 DM treated at the Royal Children's Hospital, Melbourne were recruited sequentially. The Strengths and Difficulties Questionnaire (SDQ) was used to assess well siblings' emotional and behavioural functioning using data collected within a semi-structured interview. SDQ data between the sibling cohort and normative data sample were compared using independent-samples t -tests. Sibling reports and parent reports were compared using a series of paired-sample t -tests and correlation analyses. Results, Type 1 DM siblings did not report greater emotional or behavioural maladjustment or more pro-social behaviour than norms. Parents rated siblings' pro-social behaviour as being comparable with that of youth from the general community; however, parents rated healthy siblings as having lower levels of maladjustment; specifically, significantly fewer conduct problems, hyperactive behaviour and peer-related problems (all P < 0.01). There were no significant differences between parent ratings and sibling ratings on peer-related problems or pro-social behaviour. Conclusions, Type 1 DM siblings did not report increased behavioural or emotional dysfunction relative to children in the general population and, according to their parents, were even better adjusted than their peers. [source] Assessing prolonged recovery in first-episode psychosisACTA PSYCHIATRICA SCANDINAVICA, Issue 2002L. Wong The Early Psychosis Prevention and Intervention Centre (EPPIC) is a comprehensive, specialized treatment service for individuals residing in the western metropolitan region of Melbourne who are experiencing their first psychotic episode. A subprogramme of EPPIC, the Treatment Resistance Early Assessment Team (TREAT), has been developing a framework for the management of individuals experiencing ,prolonged recovery' in early psychosis. TREAT is a consultation team that provides technical assistance to clinicians within EPPIC, comprising senior clinicians with expertise in the biopsychosocial treatment of early psychosis and persisting positive and negative symptoms. A system has recently been set up within the TREAT framework to routinely assess clinical and functional outcomes of these clients using standardized instruments. Case managers are trained to conduct assessments at multiple timepoints over the duration of their clients' treatment at EPPIC. A summary will be presented on the current sample (n=15) and examples of clinician and client feedback reports will be illustrated. Discussion is also provided on the development of training, procedures and materials to enhance integration of clinician and client outcome measures into routine clinical practice. [source] Overdose deaths following previous non-fatal heroin overdose: Record linkage of ambulance attendance and death registry dataDRUG AND ALCOHOL REVIEW, Issue 4 2009MARK A. STOOVÉ Abstract Introduction and Aims. Experiencing previous non-fatal overdoses have been identified as a predictor of subsequent non-fatal overdoses; however, few studies have investigated the association between previous non-fatal overdose experiences and overdose mortality. We examined overdose mortality among injecting drug users who had previously been attended by an ambulance for a non-fatal heroin overdose. Design and Methods. Using a retrospective cohort design, we linked data on non-fatal heroin overdose cases obtained from ambulance attendance records in Melbourne, Australia over a 5-year period (2000,2005) with a national death register. Results. 4884 people who were attended by ambulance for a non-fatal heroin overdose were identified. One hundred and sixty-four overdose deaths occurred among this cohort, with an average overdose mortality rate of 1.20 per 100 person-years (95% CI, 1.03,1.40). Mortality rate decreased 10-fold after 2000 coinciding with widely reported declines in heroin availability. Being male, of older age (>35 years) and having been attended multiple times for previous non-fatal overdoses were associated with increased mortality risk. Discussion and Conclusions. As the first to show a direct association between non-fatal overdose and subsequent overdose mortality, this study has important implications for the prevention of overdose mortality. This study also shows the profound effect of macro-level heroin market dynamics on overdose mortality.[Stoové MA, Dietze PM, Jolley D. Overdose deaths following previous non-fatal heroin overdose: Record linkage of ambulance attendance and death registry data. Drug Alcohol Rev 2009;28:347,352] [source] A community development approach to deal with public drug use in Box HillDRUG AND ALCOHOL REVIEW, Issue 1 2007NEIL ROGERS Abstract The use of alcohol and other drugs in public space is one that generates much heat in the public discourse and in the media. Too often the responses called for to reduce the problems of public amenity involve punitive policing and other responses that aim to engineer (mostly) young people out of these public spaces. Often local retailers are a key stakeholder group calling loudest for punitive action. In this Harm Reduction Digest Rogers and Anderson describe a community development approach taken to address these problems in Box Hill in the City of Whitehorse, near Melbourne. This approach which aimed to develop ,bridging social capital' between community retailers and other stakeholders in the area appears to have been effective in reducing harm associated with public drug use. Moreover these changes have become institutionalised and the approach has been expanded to address other public amenity problems in the area. It is a very nice example of how drug related harm can be reduced by grass roots networks of local councils, business people, law enforcement and health and welfare service providers to address these issues. [source] The characteristics of heroin users entering treatment: findings from the Australian Treatment Outcome Study (ATOS)DRUG AND ALCOHOL REVIEW, Issue 5 2005JOANNE ROSS Abstract The current study aimed to describe the characteristics (demographics, drug use, mental and physical health) of entrants to treatment for heroin dependence in three treatment modalities; and to compare these characteristics with heroin users not in or seeking treatment. Participants were 825 current heroin users recruited from Sydney, Adelaide and Melbourne: 277 entering methadone/buprenorphine maintenance treatment (MT), 288 entering detoxification (DTX), 180 entering drug-free residential rehabilitation (RR) and 80 not in treatment (NT). Treatment entrants were generally long-term heroin users with previous treatment experience. The majority of the sample (55%) were criminally active in the month preceding interview. Injection-related health problems (74%) and a history of heroin overdose (58%) were commonly reported. There were high degrees of psychiatric co-morbidity, with 49% reporting severe psychological distress, 28% having current major depression, 37% having attempted suicide and 42% having a lifetime history of post-traumatic stress disorder. Personality disorders were also prevalent, with 72% meeting criteria for antisocial personality disorder and 47% screening positive for borderline personality disorder. Striking similarities were noted between the non-treatment and treatment groups in length of heroin use career, drug use and treatment histories. [source] The development of the Recovery and Prevention of Psychosis Service in Melbourne, AustraliaEARLY INTERVENTION IN PSYCHIATRY, Issue 2 2009Brendan P. Murphy Abstract Aim: To describe the establishment of a multicomponent, phase-specific, early intervention service for young people experiencing psychosis. Methods: The Recovery and Prevention of Psychosis Service commenced streamed clinical service delivery in November 2004, providing comprehensive case management for up to 3 years within Victoria's largest metropolitan health service. It delivers phase-oriented treatment focusing on early detection, recovery and relapse prevention, and minimizing disability and secondary comorbidity. The combined programme covers training and professional development, data collection and evaluation, specialist intervention services, group programme work and community development. Results: Of the first 151 clients, 70.2% were male, the average age at first presentation was 20.9 years, 15% were under 18 at first contact and 67% required inpatient admission at least once. Mean age at first contact was 20.84 years for those requiring inpatient services and 70% admitted were male. The average length of stay was 25.69 days and 23% were secluded, with an average of 2.1 seclusions. A large percentage of Recovery and Prevention of Psychosis Service clients (81%) required involuntary treatment, a significantly greater proportion of admitted patients were on Community Treatment Orders compared to those never admitted (22.5% cf. 4.1%; P = 0.04) and 92% of those admitted subsequently relapsed compared to 8% of those not admitted (P = 0.02). Conclusions: Recovery and Prevention of Psychosis Service is successfully developing a fully integrated first episode service. Recent developments include expanding the period of care up to 5 years for selected patients, the recruitment of a health promotions officer and planning for the development of a youth inpatient unit. [source] Early intervention with difficult to engage, ,high-risk' youth: evaluating an intensive outreach approach in youth mental healthEARLY INTERVENTION IN PSYCHIATRY, Issue 3 2008Carsten Schley Abstract Background: Although intensive outreach (IO) models such as assertive community treatment and intensive case management have a strong evidence base in adult psychiatry, their effectiveness in the early intervention sector is unknown. Aim: To explore client characteristics and treatment effects in a group of difficult to engage, ,high-risk' young people, seen by the Intensive Mobile Youth Outreach Service (IMYOS, ORYGEN Youth Heath) in Western Metropolitan Melbourne. Methods: The clinical files of 47 clients were audited, targeting demographic and treatment outcome data prior to and during IMYOS involvement. Results: Clients typically presented with traumatic childhoods, disrupted education, repeated treatment dropout, poor mental health and ,high-risk' behaviours. Results showed a significant reduction in risk to self and others between referral and discharge, and significantly lower admissions rates and inpatient days compared with the 9 months prior to referral. Conclusions: IO might be an effective early intervention strategy to minimize risk of harm and decrease hospitalization in young people. However, conclusions are provisional as there was no control group included in this study. Further study is required, perhaps with a waiting list control. [source] Extending drug ethno-epidemiology using agent-based modellingADDICTION, Issue 12 2009David Moore ABSTRACT Aims To show how the inclusion of agent-based modelling improved the integration of ethno-epidemiological data in a study of psychostimulant use and related harms among young Australians. Methods Agent-based modelling, ethnographic fieldwork, in-depth interviews and epidemiological surveys. Setting Melbourne, Perth and Sydney, Australia. Participants Club drug users in Melbourne, recreational drug users in Perth and street-based injecting drug users in Sydney. Participants were aged 18,30 years and reported monthly or more frequent psychostimulant use. Findings Agent-based modelling provided a specific focus for structured discussion about integrating ethnographic and epidemiological methods and data. The modelling process was underpinned by collective and incremental design principles, and produced ,SimAmph', a data-driven model of social and environmental agents and the relationships between them. Using SimAmph, we were able to test the probable impact of ecstasy pill-testing on the prevalence of harms,a potentially important tool for policy development. The study also navigated a range of challenges, including the need to manage epistemological differences, changes in the collective design process and modelling focus, the differences between injecting and non-injecting samples and concerns over the dissemination of modelling outcomes. Conclusions Agent-based modelling was used to integrate ethno-epidemiological data on psychostimulant use, and to test the probable impact of a specific intervention on the prevalence of drug-related harms. It also established a framework for collaboration between research disciplines that emphasizes the synthesis of diverse data types in order to generate new knowledge relevant to the reduction of drug-related harms. [source] Peer Review Emergency Medicine AustralasiaEMERGENCY MEDICINE AUSTRALASIA, Issue 4 2005Article first published online: 2 AUG 200 Fellows of the Australasian College for Emergency Medicine and members of the Australasian Society for Emergency Medicine are invited to forward to the journal, details of their publications which have appeared in journals other than Emergency Medicine Australasia during the period September-October 2005. Commentary on these papers will appear in the April 2006 issue of the journal. Copies of the papers are to be forwarded by mail or fax to journal headquarters (34 Jeffcott Street, West Melbourne, Victoria 3003, Australia; fax: +61 3 9320 0400) by 15 November 2005. Alternatively, an electronic copy in PDF format may be e-mailed to journal@acem.org.au. The next call will be for papers published in the period November-December 2005. [source] Sustained-release bupropion overdose: A new entity for Australian emergency departmentsEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2002Richard Paoloni Abstract Bupropion hydrochloride (Zyban, Glaxo Wellcome Australia, Melbourne, Vic., Australia) was released in Australia in November 2000 as adjunctive therapy to assist with smoking cessation, having previously been used as an antidepressant in the US since 1989. The toxicity profile of bupropion hydrochloride in overdose differs considerably from other antidepressants, with prominent neurological manifestations and little cardiovascular toxicity. A case of bupropion overdose demonstrating the typical toxic syndrome is presented, together with a review of the literature and a discussion of the magnitude of the demand for bupropion and of the potential differences in presentation of overdoses in Australia. [source] The oral health of street-recruited injecting drug users: prevalence and correlates of problemsADDICTION, Issue 11 2008Anne-Marie Laslett ABSTRACT Aims To examine the effects of a series of injecting drug users' (IDU) characteristics and drug use behaviours upon the self-reported oral health of a sample of IDU. Design Cross-sectional survey. Setting Melbourne, Australia. Participants A total of 285 IDU recruited through needle and syringe programmes, snowballing and outreach across six sites. Measurements Structured survey that collected information on current drug use patterns, self-reported blood-borne virus status and general health factors, including open-ended questions on past-year dental health problems. Findings Sixty-eight per cent of the sample reported dental problems that were commonly severe and caused dental pain. Despite these reported problems, almost half the sample had not visited the dentist in the 12 months prior to the survey. Participants who were older, and reported homelessness, not eating every day and more common injection of amphetamines rather than heroin in the previous month, were more likely to report having a past-year dental problem. Conclusions Dental problems in IDUs are common but few receive treatment. Further, those using amphetamines, with poor housing, hygiene and poor nutrition, are most at risk. Programmes designed to improve the oral health of IDU need to be developed and implemented in a manner amenable to the varying social circumstances of this marginalized group in the community. [source] Effects of long-chain hydrocarbon-polluted sediment on freshwater macroinvertebratesENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 10 2005Vincent Pettigrove Abstract High-molecular weight (>C16) hydrocarbons (HMWHs) are common pollutants in sediments of freshwater systems, particularly urban water bodies. No sediment quality guidelines exist for total hydrocarbons; more emphasis is placed on polyaromatic hydrocarbons, the most toxic component of hydrocarbons. A field-based microcosm experiment was conducted to determine whether unpolluted sediments spiked with synthetic motor oil impair freshwater macroinvertebrate assemblages. Total petroleum hydrocarbon (TPH) concentrations of 860 mg/kg dry weight significantly increased the abundance of Polypedilum vespertinus and Cricotopus albitarsis and decreased the abundance of Paratanytarsus grimmii adults (all Chironomidae), whereas TPH concentrations ranging from 1,858 to 14,266 mg/kg produced a significant reduction in the total numbers of taxa and abundance, with significant declines in the abundance of nine chironomid taxa. About 28% of water bodies surveyed in urban Melbourne, Australia, had TPH concentrations in sediments likely to cause ecological impairment, and about 14% of the water bodies surveyed are likely to have reduced species richness and abundance. Therefore, HMWHs can be a significant pollutant in urban water bodies. Freshwater sediment quality guidelines should be developed for this ubiquitous urban pollutant. [source] A field-based microcosm method to assess the effects of polluted urban stream sediments on aquatic macroinvertebratesENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 1 2005Vincent Pettigrove Abstract A method using field-based microcosms was developed to determine the effects of contaminated sediments on aquatic macroinvertebrates. Fine sediments from nonpolluted, moderately polluted, and severely polluted bodies of water were placed in microcosms positioned within the littoral zone of a nonpolluted wetland near Melbourne (Victoria, Australia). In three experiments, 47 taxa, including 18 Chironomidae, 6 taxa from other Diptera families, and 7 Hemiptera taxa, colonized the microcosms, mostly via eggs deposited by flying adults. The effects of sediment type on the presence and abundance of common taxa were considered statistically. Pollution levels in sediments (indexed either by a principal components analysis or by the concentration of zinc, the predominant metal) resulted in reduced occurrence and abundance of eight taxa but had no effect on another five taxa. These findings were validated with an extensive field database for the distribution of macroinvertebrates and associated concentrations of zinc in sediments from streams and wetlands in the Melbourne region. The occurrence of eight taxa and the abundance of two taxa varied at similar zinc concentrations in sediments from both the microcosms and the field. Patterns for another two species did not match the microcosm results, but these groups contained multiple species with potentially diverse responses. The present results suggest that contaminant levels in sediments probably have a direct effect on the occurrence and abundance of macroinvertebrates in bodies of water in urban areas. The microcosm method can be used to gather information regarding the effects of sediment quality on macroinvertebrates in lentic habitats, particularly for indigenous species that cannot be easily reared or tested in laboratory conditions. Because almost all macroinvertebrates in microcosms develop from eggs, the most sensitive life stages (i.e., first and second instars) are exposed to polluted sediments. [source] A longitudinal study of the effects of adolescent cannabis use on high school completionADDICTION, Issue 5 2003Michael T. Lynskey ABSTRACT Objective ,To examine the extent to which weekly cannabis use during mid-adolescence may increase the risk of early school-leaving. Setting ,A prospective study of a general population sample of adolescents studied from ages 15,21 years in Melbourne, Australia. Method ,Computer-assisted self-completion questionnaires and telephone interviews conducted in six waves at ages 15,18 and again at age 21 in a sample of 1601 male and female school students. Results ,Weekly cannabis use, assessed prospectively, was associated with significantly increased risk of early school-leaving. This effect remained after adjustment for a range of prospectively assessed covariates including demographic characteristics, other substance use, psychiatric morbidity and antisocial behavior. There was suggestive evidence of an interaction between weekly cannabis use and age with the effects of weekly cannabis use on early school-leaving being strongest at the youngest ages and diminishing progressively with age. Conclusions ,Early regular cannabis use (weekly use at age 15) is associated with increased risk of early school-leaving. These effects of regular cannabis use may diminish with increasing age and are likely to operate through the social context within which cannabis is used and obtained. [source] Budgeting in Catholic Parishes: An Exploratory StudyFINANCIAL ACCOUNTABILITY & MANAGEMENT, Issue 1 2001Ron Kluvers In this paper an aspect of accounting, namely budgeting, has been studied in an organizational context. According to Booth (1993) churches represent ,extreme cases' in which to study the impact of accounting. Following on from Laughlin (1988) Booth considered the sacred and secular divide to be a significant element in the use of accounting by church organizations. The parishes of the Catholic Archdiocese of Melbourne form the context of this study in which evidence is sought for the sacred and secular divide by studying the role of budgeting in the parish. Questions were asked regarding participation in the budgetary process and the development and use of the budget. It was found that there was little consultation or participation in the budgetary process and that the use of the budget was restricted. These findings suggest that the sacred and secular divide operates at the parish level. [source] Catchment urbanisation and increased benthic algal biomass in streams: linking mechanisms to managementFRESHWATER BIOLOGY, Issue 6 2004Sally L. Taylor Summary 1. Urbanisation is an important cause of eutrophication in waters draining urban areas. We determined whether benthic algal biomass in small streams draining urban areas was explained primarily by small-scale factors (benthic light, substratum type and nutrient concentrations) within a stream, or by catchment-scale variables that incorporate the interacting multiple impacts of urbanisation (i.e. variables that describe urban density and the intensity of drainage or septic tank systems). 2. Benthic algal biomass was assessed as chlorophyll a density (chl a) in 16 streams spanning a rural,urban gradient, with both a wide range of urban density and of piped stormwater infrastructure intensity on the eastern fringe of metropolitan Melbourne, Australia. The gradient of urban density among streams was broadly correlated with catchment imperviousness, drainage connection (proportion of impervious areas connected to streams by stormwater pipes), altitude, longitude and median phosphorus concentration. Catchment area, septic tank density, median nitrogen concentration, benthic light (photosynthetically active radiation) and substratum type were not strongly correlated with the urban gradient. 3. Variation in benthic light and substratum type within streams explained a relatively small amount of variation in log chl a (3,11 and 1,13%, respectively) compared with between-site variation (39,54%). 4. Median chl a was positively correlated with catchment urbanisation, with a large proportion of variance explained jointly (as determined by hierarchical partitioning) by those variables correlated with urban density. Independent of this correlation, the contributions of drainage connection and altitude to the explained variance in chl a were significant. 5. The direct connection of impervious surfaces to streams by stormwater pipes is hypothesised as the main determinant of algal biomass in these streams through its effect on the supply of phosphorus, possibly in interaction with stormwater-related impacts on grazing fauna. Management of benthic algal biomass in streams of urbanised catchments is likely to be most effective through the application of stormwater management approaches that reduce drainage connection. [source] Clubs, Spades, Diamonds and Disadvantage: the Geography of Electronic Gaming Machines in MelbourneGEOGRAPHICAL RESEARCH, Issue 1 2001D.C. Marshall Opportunities to gamble, particularly on electronic gaming machines (EGMs) have been rapidly increasing in Australia during the 1990s. The increase in expenditure on gambling and the related problems have subsequently become a growing concern, particularly in relation to disadvantaged sectors of the population. Given this, the development of a geography of gambling is an important step in understanding the implications of this rapidly expanding industry. This paper addresses this issue at two distinct geographical scales in metropolitan Melbourne and considers the distribution of EGMs in relation to levels of economic well-being. Findings suggest that patterns evident at the wider Melbourne scale of greater concentration of EGMs in less advantaged regions are also reflected at a local level. These findings are related to the wider issues of accessibility to gambling facilities and problem gambling. [source] Regional teleseismic tomography of the western Lachlan Orogen and the Newer Volcanic Province, southeast AustraliaGEOPHYSICAL JOURNAL INTERNATIONAL, Issue 2 2002Frank M. Graeber Summary From 1998 May to September a portable array of 40 short-period digital seismograph stations was operated in western Victoria, southeast Australia, across the western end of the mid-Paleozoic Lachlan Foldbelt and the Newer Volcanic Province. Consisting of four parallel, almost W,E-oriented receiver lines, the array covered an area of about 270 × 150 km2. The major aim of the LF98 (Lachlan Foldbelt survey 1998) project is to map lateral variations in P -wave speeds (Vp) in the crust and upper mantle using teleseismic arrival time tomography, primarily in order to investigate whether the major surface structural zones are associated with seismic velocity signatures at depth. Little a priori information from seismic profiling is available. We invert 4067 relative arrival time residuals for a minimum structure Vp model in the upper few hundred km using non-linear iteration and 3-D ray tracing. The most prominent negative anomaly (,3.8 per cent) in Vp is found at a depth of about 45 km underneath the eastern part of the Newer Volcanic Province. It correlates spatially with the highest density of Pliocene and Pleistocene eruption centres northwest of Melbourne, and is therefore interpreted as a hotspot-related high-temperature anomaly causing reduced mantle velocities. The related coherent volume of significantly lower than average velocities extends down to depths greater than 100 km in the east, and extends west underneath the Newer Volcanic Province. A strong velocity contrast, with average velocities ,2 per cent greater in the west, is found down to about 100 km across the Moyston Fault Zone, which forms the major structural boundary between the early-Paleozoic Delamerian Orogen in the west and the Lachlan Orogen in the east. This result suggests that the Moyston Fault Zone should be seen as a major lithospheric boundary. In the south this boundary is also expressed by a distinct discontinuity in Sr-isotopic ratios of xenoliths (the so-called Mortlake discontinuity) and a change in the geochemistry of plutons of similar age. However, if the east to west velocity contrast originally existed in this southern zone, it is now overprinted by the thermally reduced mantle velocities beneath the Newer Volcanic Province. [source] The prevalence of lipodystrophy in an ambulant HIV-infected population: it all depends on the definitionHIV MEDICINE, Issue 3 2001VM Carter Objectives This study's objective was to determine the prevalence of body shape changes and metabolic abnormalities in an ambulant population with HIV infection. Three different definitions of lipodystrophy were used to assess these changes. Patients' anthropometric measures and dual-energy X-ray absorptiometry (DEXA) scans were compared in order to estimate fat distribution in this population. We sought to evaluate potential predictors for lipodystrophy according to each of the three definitions. Methods We performed a cross-sectional study in the outpatient clinic of a tertiary referral hospital in Melbourne, Australia. We enrolled a total of 167 HIV-infected ambulatory patients over 3 months in mid-1998. Data on 159 males, 149 of whom were receiving triple combination antiretroviral therapy, were evaluated. Anthropometric measures, clinical examination, self-report of body shape changes, biochemical measures and DEXA scan were used to assess lipodystrophy and risk factors for cardiovascular disease. Patients described body shape changes in the face, trunk, arms and legs. Laboratory parameters measured included fasting triglyceride (TG), cholesterol, high-density lipoproteins (HDL), glucose, insulin, CD4 cell count and plasma HIV RNA. Current and past antiretroviral therapies were ascertained. Results According to one proposed Australian national definition of lipodystrophy (LDNC), the prevalence of lipodystrophy in this population was 65%. This definition included an objective assessment with major and minor criteria. Patient-defined lipodystrophy (LDP), which involved a subjective assessment of thinning arms and legs and central adiposity, occurred in 19%. Patient-defined lipoatrophy (LAP), which involved a subjective assessment of thinning arms and legs without central adiposity, occurred in 21.3%. No change in body habitus was noted by 37% of the cohort. Hypercholesterolaemia was recorded in 44%, hypertriglyceridaemia in 52% and elevated insulin levels in 23%. Anthropometry was predictive of the per cent total body fat recorded by DEXA scan, but produced consistently lower values. In multivariate analysis, LDP and LAP were significantly associated with stavudine (d4T) use, while LAP was also associated with zidovudine (ZDV) treatment. There were no treatment associations with LDNC. Protease inhibitor (PI) exposure was associated with metabolic changes but not patient perceived body shape changes, while d4T and ZDV exposure was associated with increased triglycerides and reduced peripheral fat stores. Conclusions The prevalence of body shape changes in a single population varied depending on the definition applied. The LDNC definition overestimated body shape abnormalities in comparison with patient perception. LAP was associated with significantly lower fat stores measured by anthropometry and DEXA scan than those identified under the LDNC definition. In contrast to LDNC, LAP was associated with d4T exposure, nucleoside reverse transcriptase inhibitor (NRTI) and ZDV duration of use, but not PI use. Until a consensus definition for lipodystrophy is developed, including agreement on objective measurement and thresholds for abnormality, careful description of the individual components of the syndrome is required to enable cohort comparisons so that predictors of the syndrome can be assessed more accurately and outcome studies made feasible. [source] The barnacle and the building: a modern morality taleINTEGRATIVE ZOOLOGY (ELECTRONIC), Issue 2 2008John S. BUCKERIDGE Abstract A rare and almost complete barnacle fossil, previously described on the basis of two isolated shell fragments, was recently exposed in a limestone block on the outer wall of Melbourne's Old Magistrates' Courts in Victoria, Australia. These courts comprise one of the oldest and grandest buildings in Melbourne and because of this they have a heritage listing. As heritage-listed buildings are protected from alteration by law, and as removal of the fossil would be deemed "alteration", official permission had to be obtained to extract the specimen. This paper discusses the processes involved with extraction of a unique specimen from a protected building and provides an overview of the palaeontological significance of the fossil. Consideration is given to the likely fate of a fossil of this nature, situated a little below eye level on a busy city street, if it was left in situ; finally, the implications of designating a holotype from material removed from a building are assessed. [source] Studies of scleroderma at The Alfred Hospital, MelbourneINTERNAL MEDICINE JOURNAL, Issue 8 2006A. J. Barnett Abstract Scleroderma had been virtually unrecognized in this country before this study. Our interest in this condition was raised by the discovery that certain patients being investigated for ischaemic disease of the hand had scleroderma. Although uncommon, it is not excessively rare and we have been able to study an increasingly large number of patients, eventually resulting in 177 patients over a period of 35 years. The clinical features in these patients have been delineated. At first, the patients were subdivided into types: type 1, skin changes obvious only in the hands; type 2, skin changes extending beyond the hands but excluding the trunk; type 3, skin changes diffuse and involving the trunk. All types have similar visceral changes, but these are more severe and there is a worse prognosis in type 3 patients. Types 1 and 2 can conveniently be combined as acrosclerosis. Types 1 and 2 have a similar and good prognosis with survival at 30 years of 40%. Type 3 patients have a much worse prognosis, with no type 3 patients living more than 20 years. All types have a high incidence of autoantibodies, but these are generally not related to the severity of the disease and do not occur in relatives or spouses, this being the evidence of the absence of hereditary and environmental factors in their presence. Although patients may receive much relief from symptomatic measures, no treatment had lessened the skin stiffness and there is no specific treatment for the visceral lesions. The cause of the condition remains unknown. [source] Vitamin D deficiency is common and unrecognized among recently arrived adult immigrants from The Horn of AfricaINTERNAL MEDICINE JOURNAL, Issue 1-2 2003S. A. Skull Abstract The prevalence of and risk factors for vitamin D deficiency were examined for recent adult immigrants from East Africa living in Melbourne. Demographic data were collected via a face-to-face questionnaire and risk factors predicting deficiency were examined. Suboptimal levels <25 nmol/L were found in 61 patients (53%; 74% of women; 20% of men). Lower levels were more likely in: (i) patients with a longer duration of residence in Australia, (ii) patients who were mostly covered when outdoors and (iii) women. Routine assessment for vitamin D deficiency should be considered for male and female immigrants from East Africa. (Intern Med J 2003; 33: 47,51) [source] The technical quality of nonsurgical root canal treatment performed by a selected cohort of Australian endodontistsINTERNATIONAL ENDODONTIC JOURNAL, Issue 7 2008D. E. Bierenkrant Abstract Aim, To investigate the technical quality of nonsurgical root canal treatment performed by endodontists in Melbourne, Australia. Methodology, Clinical and radiographic records of 100 sequential nonsurgical patients were obtained from each of six endodontists working in private practice. The following variables were analysed: proximity of root filling to radiographic apex; homogeneity and radiodensity of root filling; lateral adaptation of the root filling to the canal walls; taper; extrusion of material; small, appropriate or excessive apical enlargement; presence of lateral canals; transportation; procedural errors. The radiographs were assessed by three independent evaluators. Exploratory data analysis was undertaken using simple frequencies and cross-tabulations. A generalised linear mixed model (GLMM) was used for the formal statistical modelling. Results, Of the 1351 canals that were examined, 91.7% were filled within 2 mm of the radiographic apex and 74% were within 1 mm. Homogeneity and adequate density were found along the entire length of the canal in 86.1% and 88.6% of cases respectively. Lateral adaptation was adequate in 95.6% of cases and the taper was ,smooth and continuous' in 83.8% of roots. No and/or small extrusion of sealer was noted in 98.3% of cases. Apical enlargement was ,appropriate' in 85% of roots. Both transportation (1.1%) and procedural errors (1.3%) were rare occurrences. Conclusions, The technical quality of root fillings performed by endodontists in Melbourne, Australia complied with current guidelines in 77.4%,91.0% of roots. All variables examined confirmed high levels of technical proficiency. There were very few instances of canal transportation and/or procedural errors. [source] The relationship of intracanal medicaments to postoperative pain in endodonticsINTERNATIONAL ENDODONTIC JOURNAL, Issue 12 2003E. H. Ehrmann Abstract Aim, To investigate the relationship of postoperative pain to three different medicaments placed in the root canal after a complete biomechanical debridement of the root canal system in patients presenting for emergency relief of pain. Methodology, Two hundred and twenty-three teeth belonging to 221 patients presenting as emergencies to the Royal Dental Hospital of Melbourne were included in the study. Inclusion was limited to patients with a diagnosis of pulp necrosis and acute apical periodontitis. All teeth underwent conventional root canal treatment, which involved the instrumentation to the apices of each canal at the first visit. Canals were instrumented using a stepback technique and hand-files along with irrigants using Milton's (1% sodium hypochlorite) solution followed by 15% EDTAC. The canals were dried and one of the following three medicaments was inserted into the canal in random sequence: Group 1: Ledermix paste (Lederle Pharmaceuticals, Division of Cyanamid, Wolfratshausen, Germany); Group 2: calcium hydroxide paste (Calcipulpe, Septodont, France); and Group 3: no dressing. Before dismissal, the preoperative pain experienced on the previous night was recorded using a visual analogue pain scale. Patients were then instructed to record the degree of pain experienced 4 h after treatment and daily for a further 4 days. Results, The mean score pain for all three groups was between 42 and 48 prior to treatment being commenced. After 4 days, the pain score for Group 2 was 10, for Group 3 was 7 and for Group 1 was 4. Mean preoperative pain level was 44.4 (of a maximum 100) for all groups, and declined by 50% (to 22.1) after 24 h. Patients in Group 1 (Ledermix) experienced significantly less (P = 0.04) postoperative pain than those in the other two groups. There was no significant difference between Group 2 (calcium hydroxide) and Group 3 (no dressing). Conclusion, Under the conditions of this study, painful teeth with acute apical periodontitis that had been dressed with Ledermix paste gave rise to less pain than that experienced by patients who had a dressing of calcium hydroxide or no dressing at all. Ledermix is an effective intracanal medicament for the control of postoperative pain associated with acute apical periodontitis, with a rapid onset of pain reduction. [source] Health-related quality of life of children with acute lymphoblastic leukaemia: Comparisons and correlations between parent and clinician reportsINTERNATIONAL JOURNAL OF CANCER, Issue 4 2003Elizabeth B. Waters Abstract The improving prognosis for children with cancer refocusses attention to long-term outcomes with an emphasis on quality of life. Few studies have examined relationships and differences in reported results between the parent, child and clinician. We examined parent-proxy and clinician-reported functional status and health-related quality of life for children and adolescents with acute lymphoblastic leukemia (ALL). Children and adolescents, 5,18 years, in the maintenance phase of treatment for ALL attending the Haematology/Oncology outpatient clinic at the Royal Children's Hospital, Melbourne, were eligible. Measures included: 1) parent-reported functional health and well-being (Child Health Questionnaire [CHQ]); 2) parent-reported condition specific quality of life (Pediatric Cancer Quality of Life inventory [PCQL]); 3) clinician ratings of physical and psychosocial health; and 4) clinical indicators. Insufficient numbers of older patients prohibited collection of adolescent self-reports. We had a 94% response and 31 participants. Mean time since diagnosis: 1.5 (SD 0.4) years. Parents reported significantly lower functioning and well-being than population norms for all CHQ scales, whereas cancer-specific quality of life was comparable to PCQL norms. Clinician reports of the child's global physical and psychosocial health were moderately associated with each other (rs = 0.56, p < 0.001), and with the parent-reported physical (rs = 0.47, p < 0.01) and psychosocial (rs = 0.56, p < 0.001) CHQ summary scores. Clinician reports of the child's psychosocial health were not associated with any clinical indicators reported regularly. The results demonstrate that the social, physical and emotional health and well-being of children with ALL is significantly poorer than the health of their community-based peers. Routinely collected indicators of clinical progress conceal the psychosocial burden of ALL. Data on health, well-being and quality of life can easily be incorporated into clinical care. © 2002 Wiley-Liss, Inc. [source] Split agent-based routing in interconnected networksINTERNATIONAL JOURNAL OF COMMUNICATION SYSTEMS, Issue 4 2004Constandinos X. Mavromoustakis Abstract Adaptive behaviour of swarm-based agents (BT Technol. J. 1994; 12:104,113; AAMAS Conference '02, Melbourne, Australia, Month 1,2, 2002; Softcomput. J. 2001; 5(4):313,317.) is being studied in this paper with respect to network throughput for a certain amount of data traffic. Algorithmically complex problems like routing data packets in a network need to be faced with a dynamically adaptive approach such as agent-based scheme. Particularly in interconnected networks where multiple networks are participating in order to figure a large-scale network with different QoS levels and heterogeneity in the service of delay sensitive packets, routing algorithm must adopt in frequent network changes to anticipate such situations. Split agent-based routing technique (SART) is a variant of swarm-based routing (Adapt. Behav. 1997; 5:169,207; Proceedings of 2003 International Symposium on Performance Evaluation of Computer and Telecommunication Systems,SPECTS, Montreal, Canada, July 20,24, 2003; 240,247.) where agents are split after their departure to the next node on a hop-by-hop basis. Packets that are delay sensitive are marked as prioritized which agents recognize-as being a part of a packet- and try to influence the two-way routing tables. Thorough examination is made, for the performance of the proposed algorithm in the network and the QoS offered, taking into account a number of metrics. It is shown that the split agent routing scheme applied to interconnected networks offers a decentralized control in the network and an efficient way to increase overall performance and packet control reducing at the same time the packet loss concept. Copyright © 2004 John Wiley & Sons, Ltd. [source] Completed suicide among psychiatric in-patients with depression in an Australian mental hospitalINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2000Ajit Shah Abstract Up to 45% of completed psychiatric in-patient suicides have a diagnosis of depression. Twenty-two completed psychiatric in-patient suicides with depression, over a 21-year period, in a large psychiatric hospital in Melbourne, Australia, were examined. The characteristics, including demographic and clinical data, for the completed suicides with depression were compared with a comparison group of ,alive' in-patients with depression. Completed suicide among psychiatric in-patients with depression was associated with male sex, suicidal thoughts during admission, and fluctuating suicidal ideation or continuous absence of suicidal ideation. Over 40% of completed suicides occurred whilst on approved leave and over 20% after absconding from the hospital. Violent methods (including jumping in front of trains, trams and road traffic, jumping of buildings, hanging and drowning) were used in over 65% of completed suicides. Psychiatric units should be developed away from readily available methods of suicide. In-patients with suicidal thoughts during the admission and unstable suicidal ideation should be carefully observed to avoid absconding and suicide, and should be carefully assessed prior to granting of leave. Copyright © 2000 Whurr Publishers Ltd. [source] A survey of patient satisfaction in a metropolitan Emergency Department: Comparing nurse practitioners and emergency physiciansINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2009Natasha Jennings RN BN CCC(Emerg) GradDipAdvClinNurs MN(Melb) The Emergency Nurse Practitioner role was introduced to an Emergency Department, Melbourne in 2004 as an alternative health-care model to provide accessible and efficient patient care. The aim of the study was to explore patient satisfaction using a questionnaire from their emergency department experience comparing Emergency Nurse Practitioners and emergency department doctors. Patients who received care from either Emergency Nurse Practitioners or emergency department doctors were given a self-administered questionnaire to complete. Descriptive statistics and non-parametric tests were used for data analysis. A total of 202 patients completed the survey with 103 seen by the Emergency Nurse Practitioners and 99 seen by emergency department doctors. Significant differences were reported in 12 of the 16 questions comparing patient satisfaction with either Emergency Nurse Practitioners or emergency department doctors with greater patient satisfaction demonstrated with the Emergency Nurse Practitioners. The Emergency Nurse Practitioner model demonstrates consistent levels of patient satisfaction with patients reporting more favourable satisfaction with the Emergency Nurse Practitioners compared with emergency department doctors. [source] | ||||||||||||||||||||||||||||||||||||||||||||||