Addiction research centres and the nurturing of creativity: The Centre for Alcohol Policy Research (CAPR), Melbourne: a decade on.

Established in 2006, the Centre for Alcohol Policy Research (CAPR) is Australia's only research centre with a primary focus on alcohol policy. CAPR has four main areas of research: alcohol policy impacts; alcohol policy formation and regulatory processes involved in implementing alcohol policies; patterns and trends in drinking and alcohol problems in the population; and the influence of drinking norms, cultural practices and social contexts, particularly in interaction with alcohol policies. In this paper, we give examples of key publications in each area. During the past decade, the number of staff employed at CAPR has increased steadily and now hovers at approximately 10. CAPR has supported the development of independent researchers who collaborate on a number of international projects, such as the Alcohol's Harm to Others study which is now replicated in approximately 30 countries. CAPR receives core funding from the Foundation for Alcohol Research and Education, and staff have been highly successful in securing additional competitive research funding. In 2016, CAPR moved to a new institutional setting at La Trobe University and celebrated 10 years of operation.

Overcoming barriers to tobacco cessation counselling in dental students.

PURPOSE: Tobacco use screening and brief intervention is recognised as an effective available preventive health service; yet, this service is still not routinely offered to dental patients by clinicians, despite dental schools generally providing some form of tobacco cessation counselling (TCC) by including it in their dental curriculum. A pilot study was therefore carried out to more clearly identify barriers that prevented the delivery of this service to tobacco-using patients at the University of Pittsburgh School of Dental Medicine and educational initiatives that might overcome these barriers. MATERIALS AND METHODS: A survey of faculty and students asked participants to rank their knowledge, preparation and comfort levels in performing TCC as well as their belief as to the importance of such training in the dental curriculum. Six months following training and practice opportunities, surveys were again administered to participants. Each individual's pre- and post-TCC training surveys were reviewed and difference in response to each item was calculated. RESULTS: The results of the present study show that students feel more prepared, that the time required to provide TCC was less than anticipated and that training in TCC is an important part of dental education to a greater extent after the pilot study than before. CONCLUSIONS: TCC training and practice opportunities for clinical application were effective in this pilot study in improving students' attitudes towards cited barriers.

Dropout rate of training cases: who and when.

Training cases define clinical immersion for candidates and are essential to their education, progression, and graduation. While dropouts from treatment are expected, repeated dropouts can be detrimental to a candidate's education and progression. In a study of the rate and timing of dropout in 145 cases at the Columbia University Center for Psychoanalytic Training and Research, 40 percent of patients were found to have dropped out within the first twelve months of treatment, though converted cases were less likely to drop out than were new patients evaluated at intake. This high dropout rate raises many questions about the reasons for it and suggests that there are critical educational issues regarding supervision and/or regarding candidates' technique during the induction phase.

Why we recommend analytic treatment for some patients and not for others.

One hundred consecutive patients applying for analysis completed a comprehensive battery of structured interviews and self-report questionnaires assessing dimensions of psychopathology and psychological functions that analysts consider important when evaluating patients for analysis. Patients were evaluated for analysis by a candidate supervised by a training analyst. Fifty patients were accepted for analysis and fifty rejected. In both groups, psychiatric morbidity and psychosocial impairment were high, with a 50% current and 74% lifetime diagnosis of mood disorder, 56% current and 61% lifetime history of anxiety disorder. The mean Beck Depression Inventory score fell in the moderate range, 19.1 (SD = 11.0), mean Hamilton Depression score in the mild range, 14.1 (SD = 7.8), and the mean Hamilton Anxiety score in the moderate range, 14.6 ( SD = 8.1), with 57% meeting criteria for an Axis II diagnosis, and mean social adjustment in the moderate to high pathology range. Patients accepted and rejected for analysis did not differ with regard to any of these dimensions. Accepted patients scored lower on measures of impulsivity, aggression, and sociopathy, and on scores of personality rigidity, primitive defenses, and outward aggression. The major finding was the striking similarity between patients accepted and rejected for psychoanalytic treatment.

An innovative model improving success at university for regional Australians suffering educational and social disadvantage.

CONTEXT: Regional Australia is critically short of registered nurses (RNs) due to an ageing nursing workforce and difficulty in attracting new staff. It is recognised that rural background is the most influential factor shaping a health professional's decision to practise in regional areas. Because of this, Charles Sturt University (CSU), with campuses throughout regional New South Wales (NSW), Australia, offered a bachelor of nursing by distance education (DE), enabling rural and remote enrolled nurses (ENs) trained by the Department of Technical and Further Education (TAFE) to upgrade their qualifications to RN. However, despite the flexible study mode offered, many rural and remote ENs were reluctant to progress to university study. This article describes an outreach model developed in recognition of the importance of supporting ENs to undertake RNs studies. ISSUE: Theories of social capital informed the model, which assisted understanding of the reluctance of rural and remote ENs to undertake university studies to become RNs. Most of the ENs lived and worked in communities where this was not an expectation; in addition, they were not members of social networks that knew about university study. The model assisted the development of participants by recognising and respecting barriers to their university participation. These barriers included their: self-perception as learners; concept of a university and themselves as university students; understanding of enrolment processes and course progression; understanding of what university study entails and the supports available in both community and university. Central to the model was the provision of face-to-face academic workshops for the ENs in the communities where they lived and worked. This allowed direct contact with university lecturers and support staff, enabling the rural ENs to establish the trustworthiness of 'the messengers'. Once this was achieved they were able to build a personal connection with the university and potential support providers, and to develop their own support networks. The workshops occurred at least 6 months before an intake of bachelor of nursing by DE. LESSONS LEARNED: Eight academic preparation workshops were conducted between 2003 and 2008 throughout rural and remote NSW with a total of 168 participants. Currently 89 participants (63%) have enrolled in the CSU Bachelor of Nursing course by DE. Successive workshops have built on knowledge acquired in this process. The model was supported by CSU and industry partnerships; since 2005 the academic preparation workshops have been supported by area health services' (AHSs) promotion, participation and funding. The workshops now form part of the AHSs' nursing recruitment strategy and have been endorsed by the Nursing and Midwifery Office, Aboriginal Nursing and Midwifery, NSW Health. The CSU believes the model has potential application beyond prospective nursing.

SENORITAS: an HIV/sexually transmitted infection prevention project for Latina college students at a Hispanic-serving university.

Few HIV prevention projects have specifically targeted Latina college students. These young women may be at risk for HIV infection because of developmental issues, normative behaviors, gender roles, and cultural beliefs that affect their sexual practices. The SENORITAS project (an acronym for Student Education Needed in Order to Reduce Infection and Transmission of AIDS/HIV and STIs [sexually transmitted infections]) is an innovative program designed for Latina college students at an urban Hispanic-serving institution in South Florida. The project has two major aims: (a) to provide age-appropriate, gender-specific, and culturally tailored HIV/STI prevention education for Latina college students through the use of a theoretically based, single-session peer education program: and (b) to improve the competence, comfort level, and skills of multiethnic nursing students as HIV prevention educators. This article discusses project development and design using the information-motivation-behavioral skill model for HIV prevention, describes implementation with peer educators, and concludes with progress to date and future directions.

Women with high-risk pregnancies, problems, and APN interventions.

PURPOSE: To (a) describe women's prenatal and postpartum problems and advanced practice nurses (APN) interventions; and (b) determine if problems and APN interventions differed by women's medical diagnosis (diabetes, hypertension, preterm labor). DESIGN AND METHODS: Content analysis of 85 interaction logs created by APNs during a randomized clinical trial in which half of physician-provided prenatal care was substituted with APN-provided prenatal care in the women's homes. Patients' problems and APN interventions were classified with the Omaha Classification System. FINDINGS: A total of 212,835 health problems and 212,835 APN interventions were identified. The dominant antenatal problems were physiologic (59.2%) and health-related behaviors (33.3%); postpartum were physiologic (44.0%) and psychosocial problems (31.6%). Antenatally, women with diabetes had significantly more health-related behavior problems; women with preterm labor had more physiologic problems. APN surveillance interventions predominated antenatally (65.6%) and postpartum (66.0%), followed by health teaching, guidance, and counseling both antenatally (25.4%) and postpartum (28.1%). Women with chronic hypertension required significantly more case-management interventions. CONCLUSIONS: The categories of women's problems were largely similar across medical diagnostic groups. Interventions to address women's problems ranged from assessing maternal and fetal physiologic states to teaching interpersonal relationships and self-care management to assisting with transportation and housing. Data show the range of APN knowledge and skills needed to improve maternal and infant outcomes and ultimately reduce healthcare costs in women with high-risk pregnancies.

Effective drug policy: a new approach demonstrated in the Drug Policy Modelling Program.

The aim of this paper is to describe a new comprehensive approach to studying illicit drug policy - one that integrates evidence, disciplinary approaches, drug use behaviours and policy making processes. The methods described here include systematic reviews of the evidence, studies of the ways in which policy decision-making actually occurs, and the use of modelling approaches that can explicate the multi-dimensional nature of drug policy responses and their dynamic interactions. The approach described has the potential to facilitate new drug policy that would not have been possible or apparent through the sole study of one aspect of drug policy, such as the evidence-base or the political context or the economics of drug markets. We believe this approach may be more likely to produce strategic drug policy because it reflects the richness and complexity of the real world of drug use, and drug policy. The purpose of employing an integrative methodology is to create the potential for new drug policy insights, ideas and interventions - not restricted to one body of evidence, nor to accidental or fortuitous policy-making processes.

Utility of Ictal SPECT in the presurgical evaluation of Rasmussen's encephalitis.

BACKGROUND: Rasmussen's encephalitis is a progressive disease characterized by severe progressive neurological and cognitive deficits. It is a difficult condition to treat with conventional medical treatment and requires, in most of the cases, surgical intervention. METHODS: We present the case of a patient with Rasmussen's encephalitis who presented with epilepsia partialis continua, who did not respond to antiepileptic treatment and was evaluated for possible surgical intervention. RESULTS: The electroencephalographic studies revealed bihemispheric involvement during seizures, although magnetic resonance imaging (MRI) showed a marked right hemispheric atrophy. Hyperperfusion over the right hemisphere was seen with the performance of ictal single photon emission computed tomography (SPECT), which finally guided a right functional hemispherectomy and subsequent seizure control. CONCLUSION: Ictal SPECT could be a useful tool in the armamentarium of tools used for the localization of the epileptogenic focus in patients with Rasmussen's encephalitis and other localization-related epilepsies.

Diet and chronic haloperidol effects on rat midbrain dopamine neurons.

The effects of dietary glucose (chow containing 0%, 10%, 20%, or 40% glucose, w/w) on chronic haloperidol-induced changes in dopamine (DA) neuronal activity were tested. Rats were treated daily by oral gavage for 21 days with either water or 0.5 mg/kg haloperidol, then anesthetized for in vivo electrophysiological recording. The numbers of spontaneously active DA neurons in the substantia nigra (A9) and ventral tegmental area (A10) regions of the midbrain were estimated with the cells-per-track sampling method. In rats fed standard chow, haloperidol significantly reduced the number of active neurons in both regions compared to water controls. In water controls there were no differences in DA cells per track between rats fed standard chow or chow containing 10% or 20% glucose, whereas these glucose diets significantly attenuated the effects of chronic haloperidol on DA cells per track. The 40% glucose diet itself nonsignificantly reduced cells per track and, in turn, nonsignificantly attenuated the effects of haloperidol. The results demonstrate that dietary glucose content can alter haloperidol-induced changes in the activity of midbrain DA neurons.

Converted patients and clinic patients as control cases: a comparison with implications for psychoanalytic training.

All twenty-eight respondents to a recent poll of the thirty institutes affiliated with the American Psychoanalytic Association reported that they now accept cases converted from psychotherapy to psychoanalysis as control cases. This study was designed to compare converted cases to clinic cases systematically with respect to patient characteristics, treatment, and the educational experience of the treating candidate. The study followed twenty-four candidates entering analytic training between 1992 and 1995, who treated thirty-four clinic cases and forty-three converted cases between February 1993 and July 2000. Clinic and converted patients were comparable with regard to demographics, prior treatment histories, structural diagnoses, and Axis I diagnoses. In addition, the two groups of cases were indistinguishable with respect to the rate at which candidates received credit toward graduation requirements. Candidates treating converted cases earned approximately dollars 7,600 per patient per year, compared to candidates treating clinic cases, who earned nothing. Eighty-four percent of converted patients diagnosed with a mood disorder by the treating candidate were on medication, in contrast to only 20% of clinic patients with the same diagnosis. Similar differences were seen in the case of anxiety disorders. Given the prevalence of affective and anxiety disorders in control cases and the availability of a variety of medications and psychotherapies with documented efficacy in treating these disorders, candidates should be trained to discuss treatment options with patients who present with Axis I disorders.

A mutation in transmembrane domain II of the 5-hydroxytryptamine(3A) receptor stabilizes channel opening and alters alcohol modulatory actions.

Mutant 5-hydroxytryptamine (5-HT)3A receptors, in which changes were made at Ile294, position 16', of the second transmembrane domain, were assessed for alterations in macroscopic response kinetics and modulation by alcohols. Function of heterologously expressed receptors was measured in Xenopus oocytes in the two-electrode voltage clamp configuration and in human embryonic kidney 293 cells using whole cell patch-clamp electrophysiological recordings with rapid drug application. Compared with the wild-type receptor, a decrease in the 5-HT EC50 value in the Ile294Thr mutant was observed, whereas an increase in the 5-HT EC50 value in the Ile294Leu mutant was measured. Ile294Thr receptors showed a marked reduction in the extent of desensitization. Ethanol and 2,2,2-trichloroethanol (TCEt) enhanced 5-HT-mediated currents in wild-type and Ile294Leu receptors, but inhibited or had little stimulatory effect in the Ile294Thr mutant. Kinetic analysis revealed that in the presence of TCEt, the slope of activation was unchanged in the Ile294Thr mutant and increased in the wild-type receptor. Alcohol cutoff was altered with wild-type = heptanol and Ile294Leu = hexanol. Kinetic changes in the Ile294Thr mutant that favor the open channel state, as well as reduction in the rate of channel activation in the presence of TCEt, likely underlie this mutant's altered response to n-chain alcohols.