11C-methionine PET aids localization of microprolactinomas in patients with intolerance or resistance to dopamine agonist therapy.

PURPOSE: To assess the potential for 11C-methionine PET (Met-PET) coregistered with volumetric magnetic resonance imaging (Met-PET/MRCR) to inform clinical decision making in patients with poorly visualized or occult microprolactinomas and dopamine agonist intolerance or resistance. PATIENTS AND METHODS: Thirteen patients with pituitary microprolactinomas, and who were intolerant (n = 11) or resistant (n = 2) to dopamine agonist therapy, were referred to our specialist pituitary centre for Met-PET/MRCR between 2016 and 2020. All patients had persistent hyperprolactinemia and were being considered for surgical intervention, but standard clinical MRI had shown either no visible adenoma or equivocal appearances. RESULTS: In all 13 patients Met-PET/MRCR demonstrated a single focus of avid tracer uptake. This was localized either to the right or left side of the sella in 12 subjects. In one patient, who had previously undergone surgery for a left-sided adenoma, recurrent tumor was unexpectedly identified in the left cavernous sinus. Five patients underwent endoscopic transsphenoidal selective adenomectomy, with subsequent complete remission of hyperprolactinaemia and normalization of other pituitary function; three patients are awaiting surgery. In the patient with inoperable cavernous sinus disease PET-guided stereotactic radiosurgery (SRS) was performed with subsequent near-normalization of serum prolactin. Two patients elected for a further trial of medical therapy, while two declined surgery or radiotherapy and chose to remain off medical treatment. CONCLUSIONS: In patients with dopamine agonist intolerance or resistance, and indeterminate pituitary MRI, molecular (functional) imaging with Met-PET/MRCR can allow precise localization of a microprolactinoma to facilitate selective surgical adenomectomy or SRS.

The Cambridge Otology Quality of Life Questionnaire: an otology-specific patient-recorded outcome measure. A paper describing the instrument design and a report of preliminary reliability and validity.

OBJECTIVE: The Cambridge Otology Quality of Life Questionnaire (COQOL) is a patient-recorded outcome measurement (PROM) designed to quantify the quality of life of patients attending otology clinics. DESIGN: Item-reduction model. A systematically designed long-form version (74 items) was tested with patient focus groups before being presented to adult otology patients (n. 137). Preliminary item analysis tested reliability, reducing the COQOL to 24 questions. This was then presented in conjunction with the SF-36 (V1) questionnaire to a total of 203 patients. Subsequently, these were re-presented at T + 3 months, and patients recorded whether they felt their condition had improved, deteriorated or remained the same. Non-responders were contacted by post. A correlation between COQOL scores and patient perception of change was examined to analyse content validity. SETTING: Teaching hospital and university psychology department. PARTICIPANTS: Adult patients attending otology clinics with a wide range of otological conditions. MAIN OUTCOME MEASUREMENTS: Item reliability measured by item­total correlation, internal consistency and test­ retest reliability. Validity measured by correlation between COQOL scores and patient-reported symptom change. RESULTS: Reliability: the COQOL showed excellent internal consistency at both initial presentation (a = 0.90) and 3 months later (a = 0.93). Validity: One-way analysis of variance showed a significant difference between groups reporting change and those reporting no change in quality of life (F(2, 80) = 5.866, P < 0.01). CONCLUSIONS: The COQOL is the first otology-specific PROM. Initial studies demonstrate excellent reliability and encouraging preliminary criterion validity: further studies will allow a deeper validation of the instrument.

Outcome of translabyrinthine surgery for vestibular schwannoma in neurofibromatosis type 2.

OBJECTIVES: To analyse the long-term outcome of translabyrinthine surgery for vestibular schwannoma (VS) in neurofibromatosis type 2 (NF2). RESEARCH TYPE: Retrospective cohort study. SETTING: Two tertiary referral NF2 units. PATIENTS: One hundred and forty eight translabyrinthine operations for patients with VS were performed. Preoperative stereotactic radiotherapy had been performed on 12(9.4%) patients. RESULTS: Mean tumour size was 3.1 cm. Total tumour excision was achieved in 66% of cases, capsular remnants were left in 24% of cases, and subtotal excision was achieved in 5% and partial removal was achieved in 5%. The radiological residual/recurrence rate was 13.9%. The perioperative mortality was 1.6%. At 2 years postoperatively, facial function was expressed in terms of House-Brackmann score (HB): HB 1 in 53.4%, HB 1/2 in 61.3%, HB 1-3 in 83.2% and HB 4-6 in 16.8%. All nine patients who underwent surgery following failed stereotactic radiotherapy had HB 3 function or better. Among 9.5% of the cases, 14 facial nerves were lost during surgery and repaired using direct anastomosis or grafting. There was no tinnitus present preoperatively in 27% of the cases, and 22% of patients developed tinnitus postoperatively. In patients with preoperative tinnitus, 61% remained the same, 17% got it resolved and only in 21% it worsened. The preoperative hydrocephalus rate was 26%, and among 15% of the cases five ventriculo-peritoneal (VP) shunts were performed. The cerebrospinal fluid leak rate was 2.5%. Fifty-six patients underwent auditory brainstem implantation (ABI) and two patients had cochlear implant (CI) sleepers inserted. CONCLUSIONS: The management of patients with NF2 presents the clinician with a formidable challenge with many patients still presenting themselves late with the neurological compromise and a large tumour load. There is still an argument for the management by observation until the neurological compromise dictates interventional treatment particularly with the option of hearing rehabilitation with ABI or CI. The translabyrinthine approach provides a very satisfactory means of reducing the overall tumour volume.

Smoking in vehicles is lower than mobile telephone use while driving, but is socially patterned.

Legislation is being considered which bans smoking in cars carrying children under the age of 16. This was an observational survey of smoking by drivers and passengers and mobile phone use by drivers in 2,230 cars over three time periods in two Dublin locations. The observed prevalence of mobile telephone use (2.56%) was higher than smoking (1.39%) (p < 0.01), but was low in both. There was no significant variation according to time of day. There was an inverse pattern according to car value for smoking drivers (p = 0.029). Eight adult passengers and just one child were observed as being exposed to a smoking adult driver. In conclusion, the public health importance of regulating passive smoke exposure is clear but the resources required to police such a ban in vehicles may be labour intensive for the yield in detection or prevention.

Childhood immuno-metabolic markers and risk of depression and psychosis in adulthood: A prospective birth cohort study.

BACKGROUND: Metabolic and inflammatory disorders commonly co-occur with depression and psychosis, with emerging evidence implicating immuno-metabolic dysfunction in their aetiology. Previous studies have reported metabolic dysfunction and inflammation in adults with depression and psychosis. However, longitudinal studies testing the direction of association, and the effects of different dimensions of early-life immuno-metabolic dysfunction on adult psychopathology are limited. METHODS: Using data from 3258 birth cohort participants we examined longitudinal associations of three metabolic hormones (leptin, adiponectin, insulin) at age 9 with risks for depression- and psychosis-spectrum outcomes at age 24. In addition, using nine immuno-metabolic biomarkers (leptin, adiponectin, insulin, interleukin-6, C-Reactive protein, low density lipoprotein, high density lipoprotein, triglycerides, and BMI), we constructed an exploratory bifactor model showing a general immuno-metabolic factor and three specific factors (adiposity, inflammation, and insulin resistance), which were also used as exposures. RESULTS: Childhood leptin was associated with adult depressive episode (adjusted odds ratio (aOR)= 1.31; 95% CI, 1.02-1.71) and negative symptoms (aOR=1.15; 95% CI, 1.07-1.24), but not positive psychotic symptoms. The general immuno-metabolic factor was associated with atypical depressive symptoms (aOR=1.07; 95% CI, 1.01-1.14) and psychotic experiences (aOR=1.21; 95% CI, 1.02-1.44). The adiposity factor was associated with negative symptoms (aOR=1.07; 95% CI 1.02-1.12). Point estimates tended to be larger in women, though 95% credible intervals overlapped with those for men. In women, the inflammatory factor was associated with depressive episodes (aOR=1.27; 95% CI, 1.03-1.57). CONCLUSIONS: While general immuno-metabolic dysfunction in childhood may contribute to risks for both psychotic and depressive symptoms in adulthood, childhood adiposity and inflammation appear to be particularly linked to affective (depressive and negative), but not positive psychotic symptoms.

Hearing outcomes of cochlear implant recipients with pre-operatively identified cochlear dead regions.

Objectives: To determine how patients who did not meet UK TA166 NICE criteria for cochlear implantation (CI) but were subsequently found to have cochlear dead regions (DRs) performed with CI.Methods: A retrospective review of medical records was performed on CI recipients: 152 controls and 40 in the DR group. Of these, 34 pairs were matched by pre-operative Bamford-Kowal-Bench (BKB) scores and compared.Results: The forty DR patients had a median age at implantation of 56 years. Their mean pre-operative BKB score of 23% increased to 78% after CI. Thirty-seven experienced improvements in BKB scores. In matched case-control analysis, the improvement in mean BKB score with CI was no different (p = 0.19) between the DR group and control group; a similar proportion of patients benefitted in each group.Discussion: This study is the largestreport to date of performance of patients with DRs, before and after CI. The DR group gain similar benefit as the controls.Conclusion: Patients with DRs, who did not meet TA166 NICE criteria, received the same benefit as those who did. TEN testing to detect DRs should be included in routine CI work-up where standard criteria are not met.

Development and integration of a Surveillance Monitoring solution to provide earlier detection of the deteriorating patient.

This paper presents recent improvement of a Wi-Fi based vital signs monitor used for in-hospital monitoring in medium-risk settings. Valuable insight into design strengths and weaknesses has been gained and device improvements have been confirmed with real-world use. Integration with intuitive central station software is considered with respect to balancing functionality and performance. Practical use of the early warning system in challenging clinical environments has enabled further understanding of the potential impact of the system. A tool to provide a convenient method of tracking patient condition and alerting on deterioration is offered.

Expression is computed separately from facial identity, and it is computed separately for moving and static faces: neuropsychological evidence.

We report data contrasting the processing of facial identity from static photographs, and facial expression from static and moving images, in two patients with face processing impairments. One patient is markedly impaired at perceiving facial identity and he is poor at discriminating facial expression and gender from static photographs of faces. In contrast, he performs normally when required to make judgements of facial expression and gender to faces depicted by sets of moving light dots. The second patient is relatively good at perceiving facial identity, but poor at judging emotional expression from both static and moving faces. The data are consistent with the existence of separate processes for encoding face identity and facial expression, and, furthermore, indicate the separate encoding of expression from moving and static images.

A study of depression in nursing homes.

The Geriatric Depression Scale (GDS) was used to screen for depression among residents of six nursing homes in Sydney. Of the 61% who could answer the questionnaire, more than one third were depressed. Those who were physically disabled, and those admitted in the previous 3 months scored higher on the GDS. Many of the severely demented patients could be tested with the GDS.

Parallel computation of primitive shape descriptions.

This article reports evidence that parallel search functions can occur when heterogeneous conjunction elements configure into a single object description. Experiment 1 demonstrates parallel search for form conjunctions presented in displays of heterogeneous nontargets when closure and good continuation between display elements are exhibited. When closure and good continuation are absent, reaction times increase linearly with set size (Experiment 2). Experiment 3 demonstrates a halfway stage between these two extremes, in which displays have closure but not good continuation. Finally, selection of object descriptions is shown to be temporally limited to one object at a time (Experiment 4). The data are incompatible with both local feature-based and distractor similarity-based accounts of visual search; however, they are compatible with there being an important role for preattentive feature combinations forming primitive object descriptions. Parallel search functions can occur when heterogeneous conjunctions configure into a single object description.

Search via recursive rejection (SERR): visual search for single and dual form-conjunction targets.

Models of visual search that assume spatially serial processing of conjunction stimuli break down when displays contain 2 identical conjunction targets: (a) They fail to account for the slopes of the target-absent reaction time (RT)/display size functions, both when the target-present response requires the detection of only 1 of the 2 targets and when it requires the detection of both targets and (b) under redundant target conditions, the probability of "fast" present RTs is greater than that expected from the independent (serial) processing of the target stimuli. This article shows that G. W. Humphreys and H.J. Müller's (1993) parallel search via recursive rejection (SERR) model can account for human search performance under dual-target conditions. In SERR, simple form conjunctions are coded and grouped (on the basis of their similarity) in a spatially parallel manner, and targets are detected through the activation of a temporary "template" or through the recursive rejection of grouped distractors.

Health behaviour and the school environment in New South Wales, Australia.

The relationship between the school environment and health has infrequently been examined. This study sought to examine the association between school students' perceptions of their school environment, teachers' and peers' support and their health behaviours. A cross sectional descriptive survey by supervised self-administration was conducted in 1996 based on the international WHO collaborative survey of school children's health and lifestyle (the HBSC Study) and extended in an Australian setting. Randomly sampled primary and secondary schools from Catholic, Independent and Government education sectors throughout New South Wales (NSW), Australia, were invited to participate. The final sample included 3918 school students attending Year 6 (primary school), Year 8 and Year 10 (high school) from 115 schools. The main outcome measures were self-reported health status and 7 health behaviours (tobacco use, alcohol use, physical activity, dental hygiene, nutritional intake, seat belt and bicycle helmet use). Independent variables included student perceptions of the school environment, perceptions of teachers' and peers' support. Girls, Year 6 students and students who have less than $19 a week to spend were significantly more likely to have positive perceptions towards their school environment, teacher(s) and peers. Students who had positive perceptions regarding their school environment and perceived their teachers as supportive were significantly more likely to engage in health promoting behaviours adjusting for age, sex and average weekly pocket money. A supportive peer environment was not associated with positive health behaviour. Health promotion practitioners need to consider the impact of the school environment on health behaviours of school students. In particular, practitioners should consider intervention models that improve the school environment as a key strategy within a health promoting school.

The psychosocial impact of implementing a mammography screening campaign in an Australian community.

We examined the psychosocial impact of implementing a generalised campaign to promote mammography screening in an Australian inner city community. Prior to the campaign, telephone interviews were conducted with 628 randomly selected women aged 45-70, 285 in central Sydney (where the screening programme operated) and 343 from the rest of Sydney. A second cross-sectional survey was conducted two years after the campaign commenced. The campaign achieved an estimated 21% attendance rate in an eligible population of 43,000 women over a period of 22 months. Overall the campaign reached a large section of the eligible community, with 70% of women being aware of the van's existence. In addition, the proportion of women who reported being exposed to 'a moderate amount' or 'quite a lot' of information about screening increased by almost 20%. However, two thirds of women still reported being exposed to 'only a little' or no information at all. Attendance was achieved largely in the absence of improvements in knowledge and attitudes. Where change did happen, it occurred in the community overall, rather than being confined to the campaign's target area. Changes were most likely due to general electronic and print media messages, which were largely positive in their tone of reporting on screening. The campaign in one area of central Sydney, Drummoyne, which was much more intense, was successful in encouraging greater awareness of the van and mammography screening, plus greater attendance than in the rest of central Sydney, but had no impact on knowledge or attitudes. There was no demonstrable impact on psychological morbidity.

Object superiority: a comparison of complete and part probes.

Previous research on object superiority effects has shown that certain contexts enhance the recognition of an object part. However, those contexts would not normally be called objects. The present study discusses object superiority within more general issues of object recognition. By using what we call 'complete' probes, superiority effects were extended to exposure durations much longer than those used in previous research. Experiments 1 and 2 found that complete probes gave stable superiorities at 250 msec and even 2-sec stimulus exposures. These object superiority effects were found for both objects (faces and chairs) investigated. Experiment 3 showed that object superiorities established with complete probes were not necessarily greater than those for part probes. The experiments stress the role of spatial arrangement of object parts in accessing stored information. It is argued that a successful match of a structural description to a representation in long-term memory influences stimulus processing by allowing the formation of higher level features.

Impact in general practice of the policies of the organised approach to preventing cancer of the cervix.

This cross-sectional survey of cancer screening in May 1996 used a national random sample of a specified group of general practitioners (GPs). The survey included items to assess the impact of the Organised Approach to the Prevention of Cervical Cancer (OAPCC). Of the 1,271 GPs who satisfied the eligibility criteria, 855 (67%) returned a completed questionnaire. Fifty-two per cent indicated they would be 'highly' likely to introduce a discussion about cervical smears to a 58-year-old woman who was in good health and had come for a non-gynaecological consultation. Female sex, RACGP affiliation, practising in a metropolitan area and awareness of the OAPCC booklet were independent predictors of an opportunistic orientation. By contrast, 91% indicated that they would be 'highly' likely to include a Pap smear in a general health checkup. Thirty-eight per cent reported that they had found the booklet about the 1991 screening policy 'very' useful, while 38% found the NHMRC guidelines for the management of women with screen detected abnormalities 'very' useful. Around one-fifth of the GPs were not aware of these documents. Overall, 19% still recommended annual or more frequent screening. GPs from NSW and Queensland were less likely to support biennial screening than GPs from other states. Overall, 26% of GPs did not indicate that they would refer a woman who had tested positive for any grade of CIN for colposcopic assessment. Female GPs were more likely to refer women with CIN for colposcopic assessment while older doctors were less likely to do so.

Impact of increasing the re-supply interval on the seasonality of subsidised prescription use in Australia.

OBJECTIVE: To evaluate the impact of increasing the minimum re-supply period for prescriptions on the Pharmaceutical Benefits Scheme (PBS) in November 1994. The intervention was designed to reduce the stockpiling of medicines used for chronic medical conditions under the PBS safety net. METHODS: Interrupted times series regression analyses were performed on 114 months of PBS drug utilisation data from January 1991 to June 2000. These analyses assessed whether there had been a significant interaction between the onset of the intervention in November 1994 and the extreme levels of drug utilisation in the months of December (peak utilisation) and January (lowest utilisation) respectively. Both serial and 12-month lag autocorrelations were controlled for. RESULTS: The onset of the intervention was associated with a significant reduction in the December peak in drug utilisation; after the introduction of the policy there were 1,150,196 fewer prescriptions on average for that month (95% CI 708,333-1,592,059). There was, however, no significant change in the low level of utilisation in January. The effect of the policy appears to be decreasing across successive post-intervention years, though the odds of a prescription being dispensed in December remained significantly lower in 1999 compared to each of the pre-intervention years (11% vs. 14%). CONCLUSION: Analysis of the impact of increasing the re-supply period for PBS prescriptions showed that the magnitude of peak utilisation in December had been markedly reduced by the policy, though this effect appears to be decreasing over time. Continued monitoring and policy review is warranted in order to ensure that the initial effect of the intervention be maintained.

Stimulus factors affecting the categorisation of faces and scrambled faces.

Three experiments are reported which investigate the categorisation of faces and scrambled faces in a face/scrambled face decision task. Three kinds of stimuli were presented in upright and inverted orientations; faces, highly scrambled faces (all features out of position) and moderately scrambled faces (two features out of position). Experiment 1 demonstrated that faces and highly scrambled faces are categorised equally quickly and both types of stimulus were categorised faster than moderately scrambled faces. These results held for both upright and inverted presentations. It is argued that for both upright and inverted presentations, faces are categorised by being matched in parallel to a stored mental representation of a face. In contrast scrambled faces are categorised following a serial search of facial features which is probably self-terminating. Experiment 2 demonstrates that the results of Experiment 1 hold when facial features are replaced by other objects which retain the same global shape as facial features and suggest that faces are categorised using a coarsely coded visual description. Experiment 3 demonstrates the importance of stimulus outline on the categorisation of both moderately and highly scrambled faces but not real faces. The results are discussed in terms of the stimulus information used, and the effect of inversion, on face categorisation.

Preventive dentistry: what do Australian patients endorse and recall of smoking cessation advice by their dentists?

OBJECTIVE: To investigate patients' views regarding dentists' smoking cessation advice. DESIGN: Survey questionnaire. SETTING: One hundred and thirty five dental practices in Sydney Australia. Subjects Two thousand, four hundred and fifty one dental patients. RESULTS: One thousand, one hundred and sixty pre-consultation questionnaires were obtained (RR=80%), 302 (26%) were self-reported smokers. From these, 623 post-consultation questionnaires were returned (RR = 54%). Most patients expected dentists to be interested in their smoking status (n = 847/1160, 73%, 95% CI: 70% to 76%) and to discuss smoking with them (n = 713/1160, 61%, 95% CI: 59% to 64%), however, smokers were significantly less likely to respond as such compared with non-smokers (P < 0.001). Smokers and non-smokers equally would not change dentist even if asked about their smoking status opportunistically (59% versus 62%) (OR = 0.91, 95% CI: 0.67 to 1.22). Less than one third of all smokers would try to quit if their dentist suggested they do so (n = 90/302, 30%, 95% CI: 25% to 35%). Smokers' recall of quit advice from their recent consultation was low (n = 22/124, 18%). CONCLUSIONS: Smoking cessation advice by dentists is not self-evidently effective. These findings behove interventional research to ascertain efficacy of smoking cessation advice delivered by dentists before admonishing changes in routine clinical practice.

The clinical experience of citalopram in the treatment of post-traumatic stress disorder: a report of two Persian Gulf War veterans.

OBJECTIVE: To determine the efficacy of the antidepressant citalopram in the treatment of post-traumatic stress disorder (PTSD). METHOD: The cases of two Persian Gulf War veterans are described to illustrate the effects of citalopram in treating their PTSD symptoms. RESULTS: In these two clinical case studies, citalopram led to remission of some of the PTSD symptoms. CONCLUSION: More controlled studies are warranted to further prove the efficacy of citalopram as an agent of choice for the treatment of PTSD.