Search

Understanding rapid solidification behavior at velocities relevant to additive manufacturing (AM) is critical to controlling microstructure selection. Although in-situ visualization of solidification dynamics is now possible, systematic studies under AM conditions with microstructural outcomes compared to solidification theory remain lacking. Here we measure solid-liquid interface velocities of Ni-Mo-Al alloy single crystals under AM conditions with synchrotron X-ray imaging, characterize the microstructures, and show discrepancies with classical theories regarding the onset velocity for absolute stability of a planar solid-liquid interface. Experimental observations reveal cellular/dendritic microstructures can persist at velocities larger than the expected absolute stability limit, where banded structure formation should theoretically appear. We show that theory and experimental observations can be reconciled by properly accounting for the effect of solute trapping and kinetic undercooling on the velocity-dependent solidus and liquidus temperatures of the alloy. Further theoretical developments and accurate assessments of key thermophysical parameters - like liquid diffusivities, solid-liquid interface excess free energies, and kinetic coefficients - remain needed to quantitatively investigate such discrepancies and pave the way for the prediction and control of microstructure selection under rapid solidification conditions.

High-energy, microfocus x-ray imaging, or x-radiography, is a useful tool for in situ analysis and monitoring of materials processing. Large fields-of-view, spatial and temporal resolutions sufficient for mesoscopic imaging, and high-energy x-rays capable of probing metallic alloy samples make the technique attractive for in situ solidification studies in the laboratory. Here, we demonstrate the usefulness of high-energy, microfocus x-radiography in the laboratory, particularly when paired with complementary techniques. Multimodal, multiscale characterization was performed, including x-radiographic analysis of solidifying Al-Ag and compositional analysis of the same sample after solidification with scanning electron microscopy (SEM) and energy dispersive x-ray spectroscopy (EDS). The dynamics observed through x-radiography during solidification are compared to the compositional results obtained by EDS. The fraction solid measured in radiographs is also used in combination with a calculation of phase diagrams (CalPhaD) Scheil solidification simulation to reconstruct a spatiotemporal microsegregation map. The multimodal, multiscale characterization techniques presented here illustrate a promising pathway toward improved analyses and monitoring of materials processing within a laboratory setting.

Working therapeutically online can offer a number of challenges, not least to therapists' ideas about ways of engaging and working with clients, and views of reality, as well as to familiar theories about therapy, including the therapeutic relationship or ways of therapeutic relating Taking Rogers' theory of certain necessary and sufficient conditions - of psychotherapeutic change and of constructive personality change - this article considers each condition with regard to different experiences and aspects of online video conferencing therapy In doing so, the article tests not only the necessity and sufficiency of these six conditions but also, and in keeping with Rogers' methodology, of the theory itself As the article was written in a time of a global pandemic, it also offers reflections on the experiences of the authors working therapeutically online in this context (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (French) Le travail therapeutique en ligne peut presenter un certain nombre de defis, non seulement concernant les conceptions des therapeutes quant aux modalites de travail et d'engagement avec les clients et a la perception de la realite, mais aussi concernant les theories usuelles de la therapie, y compris ce qui concerne la relation therapeutique ou la maniere d'etre en relation therapeutique Sur base de la theorie de Rogers des conditions necessaires et suffisantes - de la psychotherapie et du changement constructif de la personnalite - cet article examine chaque condition en ce qui concerne les differentes experiences et differents aspects de la therapie en ligne par visoconference Ce faisant, cet article evalue non seulement le caractere necessaire et suffisant de ces six conditions, mais aussi, en phase avec la methodologie de Rogers, la theorie elle-meme Etant donne que cet article a ete ecrit dans une periode de pandemie planetaire, il propose aussi une reflexion sur l'experience des auteurs dans le travail therapeutique en ligne dans ce contexte (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (German) Zusammenfassung: Therapeutisches Arbeiten online kann uns vor einige Herausforderungen stellen, nicht zuletzt, was die Vorstellungen der therapeutischen Fachperson angeht, wie man sich einbringt und mit den Klienten arbeitet sowie auch die Sichtweisen auf Realitat, aber auch, was die gangigen Theorien zu Therapie angeht, inklusive die therapeutische Beziehung oder die Art und Weise, sich therapeutisch in Beziehung zu setzen Wenn man Rogers' Theorie von gewissen notwendigen und hinreichenden Bedingungen nimmt - von therapeutischer Veranderung und von konstruktiver Personlichkeitsveranderung - dann untersucht dieser Artikel jede dieser Bedingungen im Hinblick auf verschiedene Erfahrungen und Aspekte von Online-Video-Therapie Damit uberpruft dieser Artikel nicht nur die Notwendigkeit und das Hinreichende dieser sechs Bedingungen, sondern auch der Theorie an sich, dies unter Beibehaltung von Rogers' Methodologie Da der Artikel in einer Zeit globaler Pandemie geschrieben wurde, bietet er auch Reflexionen zu den Erfahrungen der Autoren, als sie unter solchen Bedingungen therapeutisch online arbeiteten (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (Portuguese) Trabalhar em terapia online pode apresentar diversos desafios, dos quais nao e de desconsiderar a perspetiva do terapeuta acerca de: como envolver os clientes e trabalhar com eles;perspetivas em relacao a realidade e teorias conhecidas sobre terapia, incluindo a relacao terapeutica ou formas de estabelecer uma relacao terapeutica Partindo da teoria de Rogers de que ha determinadas condicoes necessarias e suficientes - de mudanca terapeutica e de uma mudanca construtiva da personalidade, este artigo considera cada condicao em relacao a diferentes experiencias e aspetos da terapia por videochamada Ao faze-lo, o artigo testa nao so a necessidade e suficiencia das seis condicoes, mas tambem, e mantendo a metodologia de Rogers, da teoria propriamente dita Uma vez que o artigo foi escrito numa epoca de pandemia global, ele oferece ainda reflexoes acerca das experiencias dos autores no seu trabalho via internet neste contexto (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (Spanish) Resumen: Trabajar terapeuticamente en linea puede ofrecer una serie de desafios, entre ellos las ideas de los terapeutas sobre las formas de interactuar y trabajar con los clientes, y las visiones de la realidad, asi como las teorias familiares sobre la terapia, incluida la relacion terapeutica o las formas de relacion terapeutica Tomando la teoria de Rogers de ciertas condiciones necesarias y suficientes - del cambio psicoterapeutico y del cambio de personalidad constructivo - este articulo considera cada condicion con respecto a diferentes experiencias y aspectos de la terapia de videoconferencia en linea Al hacerlo, el articulo prueba no solo la necesidad y suficiencia de estas seis condiciones, sino tambien, y de acuerdo con la metodologia de Rogers, de la teoria misma Dado que el articulo fue escrito en un momento de una pandemia mundial, tambien ofrece reflexiones sobre las experiencias de los autores que trabajan terapeuticamente en linea en este context (PsycInfo Database Record (c) 2021 APA, all rights reserved)

This article examines how the person-centered approach (PCA) became established in Aotearoa New Zealand, and draws parallels between how a Western psychology lands and settles and the process of co...

Background Tumor molecular profiling from patients experiencing exceptional responses to systemic therapy may provide insights into cancer biology and improve treatment tailoring. This pilot study evaluates the feasibility of identifying exceptional responders retrospectively, obtaining pre-exceptional response treatment tumor tissues, and analyzing them with state-of-the-art molecular analysis tools to identify potential molecular explanations for responses. Methods Exceptional response was defined as partial (PR) or complete (CR) response to a systemic treatment with population PR or CR rate less than 10% or an unusually long response (eg, duration >3 times published median). Cases proposed by patients’ clinicians were reviewed by clinical and translational experts. Tumor and normal tissue (if possible) were profiled with whole exome sequencing and, if possible, targeted deep sequencing, RNA sequencing, methylation arrays, and immunohistochemistry. Potential germline mutations were tracked for relevance to disease. Results Cases reflected a variety of tumors and standard and investigational treatments. Of 520 cases, 476 (91.5%) were accepted for further review, and 222 of 476 (46.6%) proposed cases met requirements as exceptional responders. Clinical data were obtained from 168 of 222 cases (75.7%). Tumor was provided from 130 of 168 cases (77.4%). Of 117 of the 130 (90.0%) cases with sufficient nucleic acids, 109 (93.2%) were successfully analyzed; 6 patients had potentially actionable germline mutations. Conclusion Exceptional responses occur with standard and investigational treatment. Retrospective identification of exceptional responders, accessioning, and sequencing of pretreatment archived tissue is feasible. Data from molecular analyses of tumors, particularly when combining results from patients who received similar treatments, may elucidate molecular bases for exceptional responses.

An integrative literature review was undertaken as a means of drawing together contemporary perspectives on the outcomes and affordances of videoconference-based therapy. This review was conducted in a way which placed emphasis on the need for mental healthcare strategies which are mindful of the cultural and social needs of indigenous and ethnic minority populations, particularly those situated in the Global South. The review was undertaken using an inverse funnelling approach which sought to prioritise literature on videoconference-based therapy literature which specifically focused on indigenous and ethnic minority populations. A series of general and population specific searches across relevant health databases were supplemented by a simultaneous search of Google Scholar. The PICOS search tool was used in developing the search terms, and data was processed using an inductive approach to thematic analysis. A final dataset of 43 articles were included in the review. This body of literature encompassed an international range of studies and included perspectives informed by quantitative, qualitative and mixed methods research. Four key themes were identified across the reviewed literature: indigenous and ethnic minority populations, therapeutic relationships, clinical outcomes and technical and logistical considerations. Based on our findings, there is reason to believe that videoconference-based therapy can be made to be just as effective as offline, face-to-face modes of delivery. However, research into the efficacy, impact and cultural implications of this technology in relation to indigenous and ethnic minority populations represents a significant gap within contemporary literature.

Background Racism and dishonouring of te Tiriti o Waitangi are significant contributors to ethnic health inequities in Aotearoa. It is unclear how health professionals can contribute to the disruption of racism. Methods This multi-disciplinary study draws on systems change tools, evidence from the health kaupapa Waitangi Tribunal claim (WAI 2575), a review of professional competencies documents, and focus groups with Māori and non-Māori health practitioners to identify how to strengthen anti-racism praxis in health services. The preliminary data collected in 2019 has undergone a thematic analysis and is being synthesised collaboratively with stakeholders to generate a complex continuum of anti-racism praxis. This will be applied via two site-specific action research projects. Results The pilot study has been completed but data collection is still underway on the main study. The initial cut of a continuum of practice grouped behaviours into i) problematic, ii) variable to iii) proactive. Problematic behaviors included examples of cultural and institutional racism, Variable behavior included engagement with Te Reo me ona tikanga (Māori language and protocols), and professional development and compliance. The proactive grouping included Māori leadership and workforce, responding to Māori realities, reflective practice and critical consciousness. Conclusions Initial findings suggest anti-racism continuum of practice may be useful to strengthen competency documents, curricula, policy and discipline-specific professional development planning. Key messages With the persistence of institutional racism in colonial settings like Aotearoa we need to imagine new ways to pursue anti-racism. Mapping anti-racism praxis is a useful way to identify variations in practice with a view to strengthening curriculum, competencies and ultimately practice.

Author(s): Schander, Artur; Glickman, Andrew A.; Weber, Nancy; Rodgers, Brian; Carney, Michael B. | Abstract: Introduction: Emergency physicians are trained to treat a variety of ailments in the emergency department (ED), some of which are emergent, while others are not. A common complaint seen in the ED is a sore throat. While most sore throats are easily diagnosed and treated, less common causes are often not considered in the differential diagnoses. Therefore, the purpose of this case study was to present an atypical case of sore throat and discuss differential diagnoses.Case Presentation: The patient was a 45-year-old female who presented to the ED with a three-day history of sore throat that was exacerbated by eating and drinking. The patient was not on any prescription medications, but tried over-the-counter medications for the sore throat without any improvement in symptoms. Review of systems was positive for sore throat, fevers, and chills. Physical examination of her oropharynx revealed mildly dry mucous membranes with confluent plaques and white patchy ulcerative appearance involving the tongue, tonsils, hard palate, and soft palate. Rapid streptococcal antigen, mononucleosis spot test, and KOH test were performed and found to be negative.Discussion: After initial testing was negative, a follow-up complete blood count with differential and complete metabolic profile were ordered. The patient was found to have decreased lymphocytes and platelets. Based upon those results, a diagnosis was made in the ED, the patient was started on medication, and further laboratory workup was ordered to confirm the diagnosis. ED providers should consider non-infectious as well as infectious causes for a sore throat, as this might lead to a diagnosis of an underlying condition.

The Strathclyde Inventory (SI) was created as an outcome measure to go beyond symptom intensity. It is designed to assess personality development such as congruent and flexible functioning from a person-centered perspective. The present study validated the data obtained from the 22-item French version of the SI collected in eight samples, including student groups and patients from four different hospital settings. This study describes the psychometric properties of the Strathclyde Inventory-French version. Results indicated high internal consistency and test-retest reliability. A single general Congruence vs. Incongruence factor structure with two sub-factors was found. The scale scores indicate sensitivity to the effects of two types of experiential trainings among university students and in an alcohol withdrawal program for hospitalized patients but did not show change in the absence of experiential training and in treatment as usual conditions among cancer and psychiatric patients. Construct validity was confirmed using correlations with data from trait, behavioral, and symptom measures. The results indicated that the scale is well designed to assess the process of personality development in training helping professionals and therapy process-outcome studies.

Many person-centered therapists provide their services on a voluntary basis wishing to enrich and expand their experiences as individuals and counselors. However, while rewarding, volunteers may also be affected by the difficulties of long-term unemployment. In this study, nine volunteer person-centered counselors in Greece aged 22–65, holding a Diploma in person-centered counseling, were interviewed. Participants were asked about how their experiences of not finding paid work might be affecting both themselves and their client work. The results indicated that long-term unemployment substantially reduces the counselors’ belief in their knowledge, skills, and counseling abilities while at the same time introducing doubts about their choice of profession, and even the very nature of the person-centered counseling process.

A small fraction of cancer patients with advanced disease survive significantly longer than patients with clinically comparable tumors. Molecular mechanisms for exceptional responses to therapy have been identified by genomic analysis of tumor biopsies from individual patients. Here, we analyzed tumor biopsies from an unbiased cohort of 111 exceptional responder patients using multiple platforms to profile genetic and epigenetic aberrations as well as the tumor microenvironment. Integrative analysis uncovered plausible mechanisms for the therapeutic response in nearly a quarter of the patients. The mechanisms were assigned to four broad categories���DNA damage response, intracellular signaling, immune engagement, and genetic alterations characteristic of favorable prognosis���with many tumors falling into multiple categories. These analyses revealed synthetic lethal relationships that may be exploited therapeutically and rare genetic lesions that favor therapeutic success, while also providing a wealth of testable hypotheses regarding oncogenic mechanisms that may influence the response to cancer therapy. Profiling multi-platform genomics of 110 cancer patients with an exceptional therapeutic response, Wheeler et al. identify putative molecular mechanisms explaining this survival phenotype in ���23% of cases. Therapeutic success is related to rare molecular features of responding tumors, exploiting synthetic lethality and oncogene addiction.

Objective: To compare and contrast our experience with middle cranial fossa approach (MFR) and transmastoid approach with capping of the dehiscence (TMR) of superior semicircular canal dehiscence and to determine guidelines to help guide management of these patients. Methods: All patients from 2005 to 2014 with symptomatic superior semicircular canal dehiscence syndrome with dehiscence demonstrated on CT scan of the temporal bone who underwent surgical repair and had a minimum 3 months of follow up. Surgical repair via the MFR or TMR, preoperative CT temporal bone, preoperative, and postoperative cervical vestibular evoked myogenic potential (cVEMP) testing and anterior canal video head thrust testing (vHIT). Success of repair was stratified as complete success, moderate success, mild success, or failure based on resolution of all symptoms, the chief complaint, some symptoms, or no improvement, respectively. Results: A total of 29 ears in 27 patients underwent surgical repair of canal dehiscence. Complete or moderate success was seen in 71% of the MFR group compared to 80% of the TMR group. There were zero failures with the MFR group and no major intracranial complications. There were 2 failures out of 15 ears that underwent the TMR. Residual symptoms were most commonly vertigo or disequilibrium in the MFR and aural fullness or autophony in the TMR groups, respectively. MFR hospital stay was approximately 2 days longer. Average cVEMP threshold shifted 18 dB with surgical correction in the MFR group. A 29 dB average shift was seen in the TMR group. The MFR group had a significant reduction in their anterior canal gain compared to the TMR group. Conclusions: TMR is a less invasive alternative to MFR. However, in our series, we have not seen any intracranial complications (aphasia, stroke, seizures, etc.) in our MFR patients. Interestingly, vestibular symptoms were better addressed than audiological symptoms by the TMR suggesting its usefulness as a less invasive option for patients with primarily vestibular complaints. Residual auditory symptoms in TMR patients may be due to the flow of acoustic energy from the superior canal to the mastoid cavity through an incompletely sealed third window. Keywords: Superior canal dehiscence, Plugging, Middle fossa, Transmastoid, Cartilage graft

Background Inflammatory myoblastic tumors (IMTs) are rare, mesenchymal neoplasms most commonly located in areas of previous inflammation. In the temporal bone, these tumors typically present as solitary, space-occupying lesions that clinically resemble chronic otitis media. Methods We present a case of bilateral IMTs with facial nerve involvement, sigmoid sinus thrombosis, leptomeningeal enhancement, and seizures. Results/Conclusion This case demonstrates the need for a high index of suspicion of IMT when imaging reveals bilateral mastoid opacification. These tumors are more aggressive than their orbital counterparts and require multimodality therapy to prevent recurrence and alleviate severe neurotologic symptoms. © 2015 Wiley Periodicals, Inc. Head Neck, 2015

The hallmarks of symptomatic human monocytic ehrlichiosis (HME) include fever, headache, myalgia, nausea, malaise, transaminitis, and blood cell abnormalities. Previous case reports have described isolated cranial nerve palsies in infected patients but not hearing loss. We describe the onset of sudden sensorineural hearing loss in 2 patients with HME—a 31-year-old woman and an 82-year-old woman. The older patient experienced objective and subjective improvement in her hearing after treatment with an antibiotic and steroid taper; the younger patient was lost to audiologic follow-up. Additionally, we discuss the possible mechanisms of the hearing loss in these patients.

We present a range of evidence for the reliability and validity of data generated by the Personal Questionnaire (PQ), a client-generated individualized outcome measure, using 5 data sets from 3 countries. Overall pretherapy mean internal consistency (alpha) across clients was .80, and within-client alphas averaged .77; clients typically had 1 or 2 items that did not vary with the other items. Analyses of temporal structure indicated high levels of between-clients variance (58%), moderate pretherapy test-retest correlation (r = .57), and high session-to-session Lag-1 autocorrelation (. 82). Scores on the PQ provided clear evidence of convergence with a range of outcome measures (within-client r = .41). Mean pre-post effects were large (d = 1.25). The results support a revised caseness cutoff of 3.25 and a reliable change index interval of 1.67. We conclude that PQ data meet criteria for evidence-based, norm-referenced measurement of client psychological distress for supporting psychotherapy practice and research. info:eu-repo/semantics/acceptedVersion

Social Anxiety (SA) is a common and debilitating problem. Although a range of therapies have been applied to treat SA, only a narrow range of these has been researched to date. In this study, Hermeneutic Single Case Efficacy Design (HSCED) was used to investigate Process-Experiential/Emotion-Focused Therapy (PE-EFT) with a socially isolated client with Social Anxiety. Using a combination of qualitative and quantitative data, we constructed a rich case record and a set of documents arguing for and against client change; these were judged by three graduate student peer judges. The judges found the client to have changed substantially over the first 16 sessions of therapy, and PE-EFT was found to have contributed substantially to this change.

Primary hyperparathyroidism may cause fetal demise in pregnant patients if prompt diagnosis and treatment is not initiated. The paper describes a novel guide wire technique for a targeted parathyroidectomy, which may reduce the risk to mother and fetus and be useful in other related circumstances.

Counselling outcomes are often measured in terms of standardised questionnaires. Though efficient for large numbers of participants, this method cannot capture the unique and subtle ‘shifts’ that clients often report when qualitative methods are utilised. Further, such questionnaires usually focus on the individual, missing the wider social implications of therapy. This paper presents the preliminary findings from a study that utilises the client's own perceptions of changes in their “Life Space” to establish the significance of their change process. These results are compared and contrasted with a standard outcome questionnaire and the participant's experiences of using the two methods are explored.

Over 50 years ago Eysenck challenged the existing base of research into psychotherapy. Since that time, a large number of investigations have been conducted to verify the efficacy of therapy. Recently however, an increasing number of studies have cast new doubts on this research base. Instead of therapy being a function of the therapist, it is now becoming ever more apparent that the client plays a prime role in the therapeutic process. The qualitative studies presented in this paper provide some examples of research that demonstrates that clients are actively involved in their therapy, even making counselling work despite their counsellor. These studies suggest that clients may not experience therapy as beneficially as traditional outcome studies indicate. This raises a new challenge to researchers to more fully explore the client's experience of therapy, a challenge to which qualitative methods of inquiry would appear well suited.

This paper reports on an exploration of the experience of the client at the heart of therapy. A grounded theory analysis of clients' experiences of therapy provided through a voluntary sector counselling service was undertaken, and generated four main categories: permission, engagement, transparency and restructuring. The results of the study are presented in a way that hopefully retains much of the richness of what people have reported about their experience of counselling. The findings of the study are discussed in terms of the idea that counselling can provide a setting where people can have common therapeutic requirements met.

The modern paradigm of evidence-based practice dominates the therapeutic world and influences all aspects of the profession. Yet this pervasive concept is based on surprisingly shaky ground. When looked at in detail, the source of the raw data used as the basis of much of this evidence, standardized outcome measures, can be seen to be fundamentally flawed. This article sets out the many methodological, sociopolitical, and technical flaws in standardized outcome measures, and asks what this means for the field of psychotherapy.

Inflammatory myoblastic tumors (IMTs) are rare, mesenchymal neoplasms most commonly located in areas of previous inflammation. In the temporal bone, these tumors typically present as solitary, space-occupying lesions that clinically resemble chronic otitis media.We present a case of bilateral IMTs with facial nerve involvement, sigmoid sinus thrombosis, leptomeningeal enhancement, and seizures.This case demonstrates the need for a high index of suspicion of IMT when imaging reveals bilateral mastoid opacification. These tumors are more aggressive than their orbital counterparts and require multimodality therapy to prevent recurrence and alleviate severe neurotologic symptoms.

This chapter highlights the potential and variety of qualitative methods that can be applied to counselling and psychotherapy outcome research. The chapter’s main focus is on outlining the various forms of qualitative data collection methods that are available to researchers. This is followed by an overview of the various qualitative analysis methods that can be utilised for interpreting the data. Finally, the limitations of qualitative outcome research are discussed, including a number of approaches to evaluating the credibility of such research.

The biology of persistent virus infections presents many intriguing questions, which extend well beyond classical virology into molecular and cell biology and immunology. Here, Patrick Sissons and his colleagues review the current state of knowledge of the biology and immunology of one particular medically important persistent human virus — human cytomegalovirus (HCMV) and they discuss insights into the normal and pathological virus-host relationship provided by recent work both on HCMV itself, and on its murine counterpart mouse cytomegalovirus (MCMV).

Hearing loss, tinnitus and balance disturbance represent common diseases that have tremendous impact on quality of life. Despite the high incidence of inner ear disease in the general population, there are currently no dedicated pharmacologic interventions available to treat these problems.This review will focus on how treatment of inner ear disease is moving toward local delivery at the end organ level. The authors will discuss current practice, ongoing clinical trials and potential areas of development such as hair cell regeneration and neurotrophin therapy.The inner ear is accessible through the middle ear via the oval and round windows allowing diffusion of drugs into the perilymph. With a better understanding of the physiology of the inner ear and the underlying molecular causes of inner ear disease there is great potential for the development of novel therapeutics that can be locally administered. At present, there is a rapid development of drugs to target diverse inner ear diseases that cause sensorineural hearing loss and balance dysfunction.

Papillary angioendothelioma is a rare, low-grade neoplasm of lymphatic channels that usually presents intradermally. We report the case of a 6-year-old girl with isolated splenomegaly and symptoms of early satiety and weight loss, whom was found to have a splenic papillary angioendothelioma. Preoperative abdominal computed tomography scan showed an irregular, heterogeneous mass; a tagged red cell scan ruled out a hemangioma, whereas a positron emission tomography scan showed mildly increased uptake. Subsequent surgery and pathologic assessment revealed a papillary angioendothelioma (Dabska tumor) within lymphatic spaces. The child has no evidence of recurrence or metastases 1 year postoperatively.

Objective: International research has failed to demonstrate area effects in the distribution of common mental disorders. In contrast, strong and robust household effects are evident, though relatively rarely examined. This study investigated household and area effects in the distribution of mental health scores using Australian data. Method: Analysis of data from the first wave of the Household, Income and Labour Dynamics in Australia Survey: a large representative survey of 13 969 Australian adults. Multilevel regression methods were used to model variance in the mental health scale and mental component summary scale of the Short-Form 36 at the individual, household and area (Census Collection District) levels. A number of risk factors at various levels of the model were also examined. Results: Very little variance in mental health scores occurred at the area level (1.5%), whereas significant and substantial variance occurred at the household level (23.0%). The variance at the household level remained highly significant following the inclusion of a range of risk factors at the individual, household and area levels. Conclusions: The results confirm the absence of substantial area-level variation in mental health using Australian data. The findings highlight the importance of focusing on household-level characteristics in future research.

A 15-year-old girl reports a 1-year history of a mass on the lower portion of her left leg associated with occasional pain. Antero-posterior and lateral radiography, T1 and T2 magnetic resonance imaging (MRI), and bone/joint whole body scan were performed.

We present a case of well-differentiated liposarcoma of the hypopharynx in a 51-year-old male, with a review of the literature of this very rare condition.

The lungs from three cases of pulmonary emphysema obtained at heart-lung transplantation were examined by electron microscopy to determine the origin of intimal longitudinal muscle and the formation of muscular tubes in small pulmonary arteries and arterioles. The earliest change consisted of migration of mature smooth muscle cells from the media of small pulmonary arteries, through gaps in the internal elastic lamina, into the subendothelial space. Most of these cells then adopted a longitudinal orientation, maintained a muscular phenotype, and became enmeshed in a web of elastic fibres. A small minority, immediately subjacent to the endothelium, were orientated circularly and, in some vessels, were enclosed by rudimentary internal and external elastic laminae to form early muscular tubes. Pulmonary arterioles, which are normally devoid of a media, contained several layers of circularly orientated smooth muscle cells, some of which also formed muscular tubes. It is postulated that the limited migration of mature smooth muscle cells seen in states of chronic hypoxia is mediated by a different stimulus from that causing the florid invasion of the intima by immature smooth muscle, with subsequent transformation into myofibroblasts, which characterize plexogenic pulmonary arteriopathy.