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Evidence suggests that new insights can be gained in efforts to reduce high school dropout rates by applying techniques that have proven effective in reducing small business failures. The process o...

Depression remains under-recognised and under-treated despite it being more disabling than any other medical disorder and the availability of effective protocol-based psychotherapy and pharmacotherapy treatments. Prevailing psychotherapy seldom employs evidence-based treatments, continuing instead the use of idiosyncratic psychotherapies of dubious value. Computer interview programs have been developed and evaluated that have the potential to make protocol-based psychotherapy of proven efficacy available over the Internet. Interactive voice response (IVR) makes these programs even more accessible through any touch-tone telephone. COPE™ is a self-help program for patients with depression that combines a series of booklets, videotapes and IVR telephone calls. One trial reported significant reductions in Hamilton Depression Rating Scale scores in patients with depression who completed a 12-week COPE™ program. Impediments to dissemination of these computer tools that complement, supplement and reinforce best practice values include developer’s limited knowledge of business practices and the slow change of practice paradigms.

Objective: To evaluate the efficacy and acceptability of a self-help program for mild-to-moderate depression that combined treatment booklets and telephone calls to a computer-aided Interactive Voice Response (IVR) system. Method: In an open trial, 41 patients from Boston, Massachusetts; Madison, Wisconsin; and London, England, used COPE, a 12-week self-help system for depression. COPE consisted of an introductory videotape and 9 booklets accompanied by 11 telephone calls to an IVR system that made self-help recommendations to patients based on information they entered. Results: All 41 patients successfully completed the self-assessment in the booklets and telephone calls; 28 (68%) also completed the 12-week self-help program. Hamilton Rating Scale for Depression (HAM-D) and Work and Social Adjustment scores improved significantly (41% and 42% mean reduction in the intent-to-treat sample, respectively, p

Trichotillomania is a disorder of compulsive hair pulling that often results in alopecia. The clinical features include the pulling of hair from the scalp, eyebrows, and eyelashes, sometimes symmetrically; pubic and other bodily hair may also be plucked. The disorder is present in 0.6% of college students. The majority of sufferers who seek treatment are female, with usual age of onset between 11 and 16 years. Trichotillomania can occur in a wide variety of psychiatric disorders, and patients with the condition may be more likely to have a lifetime diagnosis of depression or an anxiety, eating, or substance abuse disorder. Although empirically derived treatment guidelines are still lacking, the current literature suggests that behavior therapy and pharmacotherapy are the most efficacious treatments for adult trichotillomania. Controlled trials with pharmacotherapy (clomipramine) have shown significant reductions in hair pulling over the short term. Controlled investigations of behavior therapy have not been conducted, but several treatment series suggest efficacy. At least three reports also suggest that behavior therapy and pharmacotherapy bring some improvement in childhood trichotillomania, although this has not been empirically studied. A case illustrating the combination of behavior therapy techniques and pharmacotherapy in the treatment of trichotillomania is presented.

The visual acuity of 30 male and female drivers aged 20-25, 40-45, and 60-65 years was examined under conditions of “high” background luminance, “low” background luminance, and “high” background luminance with added glare. Results illustrate the characteristic decline in visual ability associated with increasing age and decreasing background luminance, and in addition show that strong correlations exist between scores achieved in the various background and glare conditions. Based on the data collected, it is estimated that the proportion of drivers who would fail a 20/40 visual acuity test at a “low” but representative background luminance ranges from less than 10% of the 20-25 year age group to more than 90% of the 60-65 year age group. It is recommended that a testing procedure be made available which would permit drivers to learn the extent of their potential nighttime seeing deficits, especially in the case of professional drivers who may be required to operate at night.

The visual acuity and contrast sensitivity of two groups of 30 male and female drivers (aged 20–25, 40–45, and 60–65 years) were measured over a range of background luminances and in the presence of glare. Results showed that (1) visual acuity decreased significantly with both increasing age and decreasing background luminance, (2) threshold target luminance increased significantly with age, (3) glare had a multiplicative effect on threshold target luminance that was independent of age, and (4) there were high correlations between vision measures made at "high" and "low" background luminances and under glare. It is concluded that a "night driving" vision test could be successfully based upon measurement of visual acuity at low luminance. Whereas the rate at which drivers would fail such a test is dependent upon the acuity required and the definition of "low" luminance chosen, the failure rate would increase significantly with age; this would primarily affect the older portion of the driving population.